• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.2
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• pp.119-123
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• 2019

Foreign body aspiration in dental clinics is the most common cause of respiratory emergencies. There are no reports on foreign body aspiration during dental treatment under stable general anesthesia because the patient neither has voluntary movements nor reflex actions. This is a case report on the fall of a prosthesis in the larynx, which occurs rarely under general anesthesia. During the try-in procedure, the prosthesis slid from the surgeon's hand and entered the retromylohyoid space, and while searching for it, it passed down the larynx to the endotracheal tube balloon, leading to a dangerous situation. The prosthesis was promptly removed using video-assisted laryngoscope and forceps, and the patient was discharged without any complications.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.213-217
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• 2024

Numerous neoplastic lesions can arise in the orofacial region in the pediatric populations. Odontogenic tumors typically affect the mandible more than the maxilla. Airway management can be challenging in pediatric oral tumors because of the distorted anatomy and physiological variations. Conventional awake fiberoptic intubation is not always possible owing to limited cooperation from the pediatric populations. Herein, we report the case of a 1-year-old child with odontogenic myxoma of the mandible and an anticipated difficult airway. Given the expected difficulties in the airway, video laryngoscope-assisted orotracheal intubation under general anesthesia with maintenance of spontaneous breathing was scheduled. Proper planning and thorough examinations are vital for successful airway management in pediatric patients.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.135-138
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• 2017

Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl ($100{\mu}g$), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to $38cmH_2O$ and plateau pressure increased from 20 to $28cmH_2O$. We maintained anesthesia because we were unable to access the airway, which was covered with surgical drapes, and tidal volume was delivered. At the end of surgery, we found a longitudinal fold inside the tube with a fiberoptic bronchoscope. The patient was reintubated with another tube and ventilation immediately improved. We recognized that the tube was obstructed due to dissection of the inner layer.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.2
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• pp.111-116
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• 2023

We provided general anesthesia management to a patient with advanced atrioventricular block, which was discovered in the remote period after open-heart surgery. A 21-year-old man with Noonan syndrome was scheduled to undergo excision of a median intramandibular tumor. At 2 months of age, the patient underwent endocardial repair for congenital heart disease. During our preoperative examination, an atrioventricular block was detected, which had not been previously noted. Emergency drugs were administered, and a transcutaneous pacemaker was placed. During anesthesia induction, mask ventilation was easy, and intubation was performed smoothly using a video laryngoscope. The transcutaneous pacemaker was activated in demand mode at a pacing rate of 50 cycles/min approximately throughout the anesthesia time, and the hemodynamic status remained stable. The effect of intraoperatively administered atropine was brief, lasting only a few seconds. Although body movements due to thoracoabdominal muscle spasm were observed during pacemaker activation, they did not interfere with surgery. In postoperative patients with congenital heart disease, an atrioventricular block may be identified in the remote period, and preoperative evaluation should be based on this possibility. In addition, during anesthesia management, it is important to prepare multiple measures to maintain hemodynamic status.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.155-159
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• 2022

Cohen syndrome is a rare genetic disorder associated with mutations in the VPS13B gene. Individuals with this disorder present with diverse clinical manifestations, including muscle hypotonia, intellectual disabilities, and typical facial characteristics, such as prominent upper central incisors and micrognathia. General anesthesia was administered to a 23-year-old man with Cohen syndrome. Although we observed prominent upper central incisors, an overjet of 10 mm, micrognathia, and thyromental distance of 4 cm, hypotonia was not observed in the patient. Intubation was rendered difficult when performing a direct laryngoscopy. However, smooth intubation was achieved using a video laryngoscope. The patient's train of four (TOF) count remained zero close to 60 min after rocuronium administration, suggesting that the drug's muscle-relaxant effect may have been prolonged. A TOF ratio of 0.79 was confirmed 130 min after rocuronium administration, and a TOF ratio of 1.0 was confirmed after administration of 150 mg of sugammadex. The patient's respiration remained stable after extubation, and no recurarization of muscle relaxation was observed. As demonstrated in this case report, it is important to closely monitor recovery from muscle relaxation and prepare multiple techniques for airway management in general anesthesia management of patients with Cohen syndrome.