Kagoshima University · Medical Care Center

Research keywordsheart rate variability・dental anxiety・tooth extraction・autonomic nervous system・alveolar bone grafting・resuscitation skills training

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• Yamashita K., Kibe T., Yoshimine S., Uto A., Uchino M., Sugimura M. . Case Report: A case series: heart rate variability during dental treatment with vasovagal reflex . Frontiers in Ph2025 · 記述言語： 日本語 出版者・発行元： Frontiers in Physiology Introduction: The vasovagal reflex is the most frequent emergency that occurs during dental procedures, but its underlying mechanism is not understood. In this study, we conducted autonomic monitoring of patients with a history of vasovagal reflexes. Case description: We focused on the high-frequency component, an indicator of parasympathetic activity, and interrupted the treatment when the high-frequency component increased. Treatment was then resumed after confirming that there was no mood disturbance and no increase in the high-frequency component. In another patient with a history of dental treatment-induced vasovagal reflex, autonomic activity during treatment was measured under atropine sulfate hydrate administration. Discussion: Analysis of heart rate variability during the vasovagal reflex showed that parasympathetic hyperactivity was followed by sympathetic hyperactivity, indicating real-time changes in autonomic nervous system activity. In addition, the high-frequency component, which decreased after atropine sulfate hydrate administration, did not increase during treatment, along with the low-frequency to high-frequency ratio, a measure of sympathetic nervous system activity, and the vasovagal reflex did not occur. We believe that the visualization of a patient’s autonomic nervous system activity during dental treatment will improve the quality of systemic management and lead to the realization of a safe and comfortable treatment environment. DOI： 10.3389/fphys.2025.1607816 Scopus PubMed
• Kaoru Yamashita, Shusei Yoshimine, Akari Uto, Minako Uchino, Toshiro Kibe, Mitsutaka Sugimura2024 · 記述言語： 英語 掲載種別： 研究論文（学術雑誌）
• 山下 薫, 吉嶺 秀星, 宇都 明莉, 比嘉 憂理奈, 四道 瑠美, 橋口 浩平, 白川 由紀恵, 杉村 光隆 . 定量的な検査と検査結果のフィードバックが治療方針決定の一助となった症例 . 日本口腔顔面痛学会雑誌15 ( 1 ) 27 - 302023 · 記述言語： 日本語 出版者・発行元： 日本口腔顔面痛学会 <b>症例の概要</b>：38歳女性．下顎管に近接している38抜歯後に左側オトガイ部の知覚異常を認めた．ビタミンB12製剤内服で経過観察されていたが，内服開始後1か月経過しても症状に変化がなく，ペインクリニックでの加療を希望されたため，当院へ紹介となった．左側第3枝三叉神経ニューロパチーの診断のもと，星状神経節ブロックと鍼治療を行なった．星状神経節ブロックによる治療が20回終了したところで症状はDysesthesiaからParesthesiaへ変化していたが，著明な改善が認められないため，患者は治療継続を迷っていた．精密触覚機能検査，電流知覚閾値検査を行ったところ数値上改善を認め，その結果をフィードバックしたところ患者は治療継続を希望した．10回の鍼治療終了後，再度検査を行い，精密触覚機能検査，電流知覚閾値検査においてさらに改善を認め，その結果を患者にフィードバックしたところ，これまでの治療内容と現在の症状に納得し，治療終了を希望したため，終診となった． <br><b>考察</b>：本症例のように患者の訴えに著明な改善が認められなくても，検査値が改善しているケースがある．検査結果に基づいた適切な病態説明は，患者の治療継続と良好な経過へつながる可能性があると考えられた． <br><b>結論</b>：自覚症状の著明な改善が認められず，治療継続を迷っている口腔顔面痛患者において，定量的な検査と改善した検査結果のフィードバックは，患者の治療に対するモチベーションを維持し，その意思決定に有用である． DOI： 10.11264/jjop.15.27 CiNii Research
• 山下 薫, 四道 瑠美, 祐德 美耀子, 宇都 明莉, 吉嶺 秀星, 杉村 光隆 . 歯科治療恐怖症を有する化学物質過敏症患者における静脈内鎮静法による全身管理経験 . 日本歯科麻酔学会雑誌51 ( 1 ) 4 - 6 2023年1月 詳細を2023 · 記述言語： 日本語 掲載種別： 研究論文（学術雑誌） 出版者・発行元： 一般社団法人 日本歯科麻酔学会 Multiple chemical sensitivity is a disease in which autonomic and neuropsychiatric symptoms, such as fatigue, headache, joint pain, insomnia, and dermatitis, occur in response to exposure to a trace amount of a chemical substance. Here, we report the management of intravenous sedation for tooth extraction and caries treatment in a patient with multiple chemical sensitivities. A 57-year-old woman visited a nearby dental clinic complaining of dentin hypersensitivity and requiring tooth extraction and treatment for a root fracture in the mandibular right second molar and caries in the mandibular right first premolar. However, she had a history of chemical hypersensitivity and dentophobia. She was referred to our hospital and was scheduled to undergo intravenous sedation in an environment with minimal exposure to inducers. We monitored her blood pressure, percutaneous arterial oxygen saturation（SpO<inf>2</inf>）, and pulse, and a single dose of midazolam（2 mg）and propofol（10 mg）was administered after securing an intravenous route. The continuous administration of propofol was started at 3 mg/kg/h under 3 L/min of oxygen after the patient fell asleep. No symptoms or risks associated with multiple chemical sensitivity were observed during the tooth extraction or caries treatment. The patient was successfully treated in an environment that eliminated the triggers for the onset of symptoms of multiple chemical sensitivity after meticulous interviews with specialists in collaboration with each clinical department. Intravenous sedation using midazolam and propofol under 3 L/min oxygen was a successful approach for minimizing the psychosomatic mechanisms of multiple chemical sensitivity in a patient with dentophobia. DOI： 10.24569/jjdsa.51.1_4 Scopus CiNii Research

• 全身麻酔導入時のアニメーションビデオ視聴による周術期ストレス軽減効果の検討研究課題/領域番号： 25K20482

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