14th
FADAS
The 14th Annual Meeting of the Federation of Asian Dental Anesthesiology
Societies

Conference Chair：Takao Ayuse
Professor, Dental Anesthesiology, Course of Medical and Dental Sciences,
Nagasaki University

Program and Abstracts

Date：

October 6（Fri）‑ 8（Sun）,2023

Venue：Nagasaki International Exhibition Hall

（Dejima Messe Nagasaki）

JDSA & FADAS Joint Symposium 1
October 7, Sat, 13：00‑14：30, in Room 102

Analgo-sedation

How Can We Manage Analgesia during Procedural Sedation?

Chair：Makoto Terumitsu（Professor, Division of Dental Anesthesiology, Health Sciences University of
Hokkaido）
Hiroshi Hanamoto（Lecturer, Osaka University Dental Hospital）「Pain management in dental analgosedation」
Xudong Yang（Professor, Peking University School and Hospital of Stomatology, Beijing, China）「Current perspectives on analgesia during procedural sedation」
Kentaro Mizuta（Professor, Tohoku University Graduate School of Dentistry, Sendai, Japan）「The use of remifentanil and ketofol in dental analgo-sedation」
Eun-Ji Choi（Assistant Professor, Department of Dental Anesthesia and Pain Medicine, Pusan National
University, School of Dentistry, Yangsan, Republic of Korea）

JDSA & FADAS Joint Symposium 2
October 9, Sat, 14：40‑16：10, in Room 102

New Possibilities of Dental Anesthesia Opened Up by AI, Metaverse, and VR- To the Next 50 Years
Chair：Hikaru Kohase（Professor, Division of Dental Anesthesiology, Meikai University School of Dentistry）
Ryo Wakita（Associate Professor, Tokyo Medical and Dental University, Dental Anesthesiology
and Orofacial Pain Management, Graduate School of Medical and Dental Sciences）「Development of respiratory monitoring device using piezoelectric vibration sensor
specialized for low frequency」
Hikaru Kohase（Professor, Division of Dental Anesthesiology, Meikai University School of Dentistry,
Saitama, Japan）「Application of virtual reality in children dental procedure」
Cong Yu（Professor, Stomatological Hospital Affiliated to Chongqing Medical University, Chongqing,
China）「AI and patient controlled sedation」
Kwang-Suk Seo（Professor, Seoul National University School of Dentistry, Seoul, Republic of Korea）― 210 ―JDSA & FADAS Joint Symposium 1“Analgo-sedation”
How Can We Manage Analgesia during Procedural Sedation?
Pain management in dental analgosedation
Peking University School and Hospital of Stomatology, Beijing, China

Xudong Yang

Analgosedation reduces pain and anxiety of patients during dental treatment, thus make the dental experience more pleasant. During sedation, pain control should be the top priority. The commonly used analgesics for dental sedation include Opioids, NSADs and et al. Some new medicine such as Esketamine are
immerging. In order to minimize adverse effect, Opioids should be used less and multimodal analgesia is
recommended.
EDUCATION：
1992-1997 Peking Medical University, Medical School
EMPLOYMENT：
2004-present Attending, Peking University School and Hospital of Stomatology
1997-2004 Resident, Peking University School and Hospital of Stomatology― 211 ―JDSA & FADAS Joint Symposium 1“Analgo-sedation”
How Can We Manage Analgesia during Procedural Sedation?
Current perspectives on analgesia during procedural sedation
Tohoku University Graduate School of Dentistry, Sendai, Japan

Kentaro Mizuta

Procedural sedation in dentistry is a widely practiced technique to alleviate patient discomfort and anxiety during dental procedures. Effective pain management is essential during procedural sedation to ensure
patient comfort and the successful completion of the procedure. Multimodal analgesia, combining different
classes of analgesics, has gained popularity due to its ability to improve pain control. While opioids like fentanyl have been commonly used for analgesia during procedural sedation, caution must be exercised to
avoid interactions with sedative medications and the risk of respiratory depression. Incorporating local anesthetics and IV acetaminophen offers advantages, including minimizing opioid-related side effects andimproving recovery profiles. Personalized approaches to analgesia are crucial to optimize pain relief andminimize adverse effects. Tailoring analgesic strategies to each patientʼs specific needs and characteristics
can lead to improved pain control and increased patient satisfaction. Emerging trends and innovations in
analgesia during procedural sedation include the integration of non-pharmacological interventions, such as
virtual reality, which have shown promise in reducing pain and anxiety levels during dental procedures.
These novel approaches provide additional means to enhance patient comfort and satisfaction. Safety during
analgesic administration is paramount, with close monitoring of vital signs necessary to promptly identify
and manage potential adverse events. Dental anesthesiologists should possess a comprehensive understanding of appropriate analgesic dosages, potential drug interactions, and side effect profiles. Implementation ofstandardized protocols and regular training programs is crucial to maintaining consistent and safe practices
in analgesic administration.
This presentation aims to provide an overview of current perspectives on analgesia during procedural
sedation in dentistry, encompassing multimodal approaches, emerging trends, and safety considerations.
EDUCATION：
1993-1999：Tohoku University School of Dentistry（DDS）
1999-2003：Tohoku University Graduate School of Dentistry（PhD）
EMPLOYMENT：
2004-2007：Postdoctoral Research Fellow, JSPS
2005-2007：Postdoctoral Research Fellow, Department of Anesthesiology, Columbia University, USA
2007-2018：Assistant Professor, Associate Professor, Department of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry
2018-Present：Professor― 212 ―JDSA & FADAS Joint Symposium 1“Analgo-sedation”
How Can We Manage Analgesia during Procedural Sedation?
The use of remifentanil and ketofol in dental analgo-sedation
Department of Dental Anesthesia and Pain Medicine, Pusan National University,
School of Dentistry, Yangsan, Republic of Korea

Eun-Ji Choi

The use of propofol alone and propofol in combination with remifentanil for sedation during dental surgeries has been studied, and both methods have been found to be safe and effective when administeredthrough a Target Controlled Infusion（TCI）pump. However, there are some interesting findings related tothe combination of propofol and remifentanil.
One notable finding is that the combination of propofol and remifentanil allows for a lower propofol dosecompared to propofol alone. Remifentanil is an opioid analgesic that provides potent pain relief, and whenused in combination with propofol, it can enhance the sedative effects of propofol. This synergy allows for a
reduction in the required dose of propofol, which can be beneficial in terms of minimizing potential side
effects and promoting patient safety.
Additionally, the combination of propofol and remifentanil has been shown to result in less pain forpatients during dental surgeries. Remifentanil provides effective analgesia, reducing pain sensitivity and discomfort experienced by patients.
Propofol is the most commonly used intravenous anesthetic that is currently used in various procedural
sedations, including dental sedation. Its use is preferred owing to advantages of rapid onset of action, shortduration of action, and easy titration. However, despite these advantages, it carries risks of respiratory
depression and hemodynamic instability；therefore, dentists are not skilled in airway management or
response to emergency situations.
Ketamine is an anesthetic preferred owing to its analgesic effect and the maintenance effect on airwayreflex. Nevertheless, its clinical use is controversial because of disadvantages of dissociative anesthesia, postoperative hallucinations, sympathomimetic effects, and stimulations of saliva and secretions.
A comprehensive review of various studies found that administration of ketofol, a combination of ketamine and propofol, provided effective sedation in various clinical sedation procedures, improved hemodynamic stability, did not increase the risk of respiratory depression, and resulted in rapid onset and recovery
and reduced pain after the procedure.

― 213 ―EDUCATION：
2006 Yeungnam University, College of Medicine
2022 Doctor Degree, Pusan National University
2007-2011 Anesthesiology Resident ship Training, Yeungnam University Hospital
EMPLOYMENT：
2021-Present Assistant Professor, Pusan National University School of Dentistry, Dept. Dental Anesthesia
and Pain Medicine
2015-2020 Clinical Professor, Pusan National University Yangsan Hospital, Dept. Anesthesia and Pain Medicine― 214 ―JDSA & FADAS Joint Symposium 2“New Possibilities of Dental Anesthesia Opened Up by AI,
Metaverse, and VR”- To the Next 50 Years
Development of respiratory monitoring device using piezoelectric
vibration sensor specialized for low frequency
Division of Dental Anesthesiology, Meikai University School of Dentistry, Saitama, Japan

Hikaru Kohase

The compact low-frequency piezoelectric vibration sensor AYA-P（AYA-P sensor）has high sensitivity in
low-frequency range and low power consumption. We are developing a respiratory monitor that detects
upper airway obstruction. In this session, we will introduce the overview of development.
For patients undergoing dental treatment under intravenous sedation, AYA-P sensors were attached to
the neck and abdomen, and AYA-P waveforms and capnograms were recorded at a sampling rate of 200 Hz（a）. Simultaneously, the movements of the patientʼs neck and abdomen were recorded on video. Based on
the video recordings, including audio, the anesthesiologist determined the patientʼs respiratory status ateach time point for the data in（a）. The patientʼs respiratory status was classified into four categories：noairflow, hypoventilation, normal breathing, and artifact, by the anesthesiologist after the measurements.
We computed the power spectrum of the waveforms obtained from AYA-P every second, for a forward
duration of 10 seconds. After taking the logarithm of the computed spectra, we obtained a total of 98 spectra, consisting of 49 spectra each for the neck and abdomen, with frequencies below 5 Hz. We inputted thisdata into the input layer of a neural network, passed it through two intermediate layers, and obtained theclassification result at the output layer, categorizing it as either no airflow, hypoventilation, normal respiration, or artifact. Next, we evaluated the classification accuracy of unknown data in the neural network. We
performed the analysis using two methods；the Hold-Out method, where the data of one subject was split
into training and testing datasets, and the Cross-Validation method, where all data except for the subjectʼs
data was used as the training dataset, and the subjectʼs data was used as the testing dataset. Additionally,
we conducted the analysis using two different approaches depend on the number of training iterations：one
with a fixed number of 1000 iterations for each method, and another that terminated the training when thehighest accuracy on the testing data was achieved to prevent overfitting. In total, we examined the classification accuracy using four different training methods.
When testing with data that included oneself, the Hold-Out method without preventing overfitting
achieved the highest accuracy（95％ accuracy）. When testing with data that did not include oneself, theCross-Validation method with preventing overfitting achieved the highest accuracy（52％ accuracy）.
To improve the classification accuracy, it is necessary to investigate the correlation between the characteristics of the information obtained from the AYA-P sensors and the morphological features of patientswith upper airway obstruction.

― 215 ―EDUCATION：
1987 D. D. S. Faculty of Dentistry, Tokyo Medical and Dental Univ.
1991 Ph. D. Tokyo Medical and Dental Univ.
EMPLOYMENTS：
1993 Assist. Prof. Sec. of Anesthesiology and Clinical Physiology, Dep. of Oral restitution, Div. of Oral
Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental Univ.
2014-present, Professor. Div. of Dental Anesthesiology, Dep. of Diagnostic and Therapeutic Sciences,
Meikai University School of Dentistry― 216 ―JDSA & FADAS Joint Symposium 2“New Possibilities of Dental Anesthesia Opened Up by AI,
Metaverse, and VR”- To the Next 50 Years
Application of virtual reality in children dental procedure
Stomatological Hospital Affiliated to Chongqing Medical University, Chongqing, China

Cong Yu

Background：Due to the inherent characteristics of immersion, imagination, and interactivity in virtual
reality（VR）, it might be suitable for non-drug behavior management of children in dental clinics. The purpose of this trial was to measure the role of VR distraction on behavior management in short-term dental
procedures in children.
Methods：A randomized clinical trial design was carried out on 120 children aged between 4 and 8 years
to identify the comparative efficacy of VR and tell-show-do（TSD）to improve behavioral management during dental procedures. The primary outcomes were evaluated anxiety, pain, and compliance scores in perioperative children.
Results：The average anxiety and behavioral scores of the VR group significantly reduced compared withthe control. The decreased anxiety score for the VR group and control group were 8（7, 11）and 5（5, 7）,p＜0.05. The compliance scores of the control group during treatment were 3（2, 3）,and the same in the VRintervention were 3（3, 4）,p＝0.02. A significant reduction in pain was observed when using VR distraction（p＜0.05）. Comparing the length of the dental procedure, the VR group（19.02±5.32 min）had a shorter
treatment time than the control group（27.80±10.40 min）.
Conclusion：The use of VR significantly reduced the anxiety and pain of children and the length of thedental procedure and improved the compliance of children that underwent short-term dental procedures
without an adverse reaction.
ACADEMIC APPOINTMENT：
2020. 11 Professor, Chongqing Medical University
EDUCATION：
1995.9-2000.7 Chongqing Medical University, Bachelor
2006.9-2009.7 Chongqing Medical University, Master2011.9-2014.7 Chongqing Medical University, PhD Visiting Scholar at the Affiliated Hospital of Munster University in Germany, Director of Department of Anesthesiology/Comfort Dentistry of Stomatological Hospital Affiliated to Chongqing Medical University― 217 ―JDSA & FADAS Joint Symposium 2“New Possibilities of Dental Anesthesia Opened Up by AI,
Metaverse, and VR”- To the Next 50 Years
AI and patient controlled sedation
Seoul National University School of Dentistry, Seoul Repblic of Korea

Kwang-Suk Seo

Patient-controlled sedation（PCS）, is a method of anxiety and pain control that the patient would have a
way to control the administration of their sedative or anesthetic. This could be beneficial in cases where thepatient has a high level of anxiety or fear about dental procedures, as it would give them some control overtheir own comfort level. However, this method would need to be carefully monitored to ensure that thepatient does not administer too much of the sedative and to assess whether the patient is actually reducing
their own anxiety or just sedating themselves to a higher degree than necessary. Artificial Intelligence（AI）
can be potentially integrated into patient-controlled sedation to improve safety and efficacy. AI algorithms
can use data from a patientʼs medical history, body weight, age, and other factors to recommend personalized sedative doses. This can minimize the risk of over-sedation while ensuring the patient is comfortable.
AI systems can continuously monitor a patientʼs vital signs（like heart rate, oxygen saturation, respiratory
rate, etc.）during sedation. Advanced algorithms can predict deteriorations and complications before they
become critical, allowing for early interventions. AI can be used to create a feedback system that takes into
account a patientʼs reactions to sedation, adjusting doses as needed. For instance, if the patient shows signsof distress, the system could automatically provide additional sedation within safe limits. By analyzing thedata from numerous cases, AI can help in identifying patterns and correlations that can be used to improve
protocols and guidelines for patient-controlled sedation. Implementing AI in patient-controlled sedation
requires careful consideration of the technical, ethical, and legal aspects. The system should have safeguards
to prevent excessive sedation, and the AI algorithms should be thoroughly tested to ensure they are reliable. Also, the clinical team should always be able to override the AI system in case of an emergency or
unforeseen complication. The integration of AI in this area should be seen as a tool to support, not replace,clinical judgment and expertise.
EDUCATION：
1996 Pusan National University, College of Medicine
2006 Dr. Degree, Seoul National University
1997-2001 Anesthesiology Resident ship Training, Seoul National University Hospital
EMPLOYMENT：
2023-Present, Director, Seoul National University Dental Hospital For Persons with Special Needs
2022-Present, Professor, Seoul National University School of Dentistry, Dept. Dental Anesthesiology
2022-Present, EIC, Journal of Dental Anesthesia and Pain Medicine― 218 ―

FADAS General Session：ePoster 1（Basic/Clinical Research, Clinical Statistics）
October 7, Sat, 11：00‑11：54, in Room 107‑1
Chair：Nobuyuki Matsuura（Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College,
Tokyo, Japan）

F1 01

Deep learning-based prediction of difficult laryngoscopy using 3D facial scans in oral andmaxillofacial surgery
1）
Department of Anesthesiology, Shanghai Ninth Peopleʼs Hospital, Shanghai, China
2）
School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University,
Shanghai, China○Ming Xia1）, Bei Pei1）, Yaokun Zheng2）, Chenyu Jin1）, Shuang Cao1）, Mingxu Zhao2）,
Ningning Ji1）, Zhiliang Lin2）, Hong Jiang1）

F1 02

Hormonal mechanisms of the paraventricular nuclei in the hyperalgesia in the Parkinsonʼsdisease model rats
Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka,Japan○Shengsen Yang, Nayuka Usami, Hiroharu Maegawa, Midori Toyama, Hiroaki Shigemasa,
Mayuka Ueda, Chiho Kudo, Hitoshi Niwa

F1 03

Comparative study of the effects of TND1128 and β-NMN on spontaneous locomotor activity, reactive oxygen metabolites-derived compounds（d-ROMs）and biological antioxidant
potential（BAP）in mice under hypoxic conditions
Tokyo Medical University Hachioji Medical Center, Tokyo, Japan○Nanae Takahashi

F1 04

The effect of lidocaine on cell proliferation of myofibroblastsTokyo Medical and Dental University, Tokyo, Japan○Tomoka Matsumura, Sayaka Asano, Shigeru Maeda

F1 05

mRNA expression level of IL-1β in labial mucosal tissues with surgical injury after dexmedetomidine administration
The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan○Yukako Tsutsui, Katsuhisa Sunada― 219 ―

F1 06

Analysis of the impact on dental sedation trends from fatal accidents during sedation, basedon Koreaʼs health and medical big data
Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul,
Republic of Korea○Eunhye Choi, Seung-Hwa Ryoo, Hyuk Kim, Myong-Hwan Karm, Hyun Jeong Kim,
Kwang-Suk Seo

FADAS General Session：ePoster 2（Clinical Research 1）
October 7, Sat, 11：00‑11：45, in Room 107‑2
Chair：Yoshinari Morimoto（Kanagawa Dental College Graduate School, Department of Systemic Dentistry,
Kanagawa, Japan）

F2 01

Would you choose general anesthesia or physical restraint to perform dental treatment forpatients with special needs?
1）
Department of Dentistry, Morinomiya Hospital, Osaka, Japan2）
Department of Dentistry, Bobath Memorial Hospital, Osaka, Japan3）
Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka,
Japan○Yoshinao Asahi1）, Shiro Omichi2）, Izuka Hayashi2）, Yoshino Mori2）, Yukimi Miyamoto2）,
Chiaki Kato1）, Yuka Sugimoto2）, Miho Hyodo1）, Yoshito Takasaki1）, Hitoshi Niwa3）

F2 02

Autonomic nervous system activity during perioperative period of pediatric patients
1）
Department of Dental Anesthesiology, Kagoshima University Hospital, Kagoshima, Japan2）
Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital○Akari Uto1）, Kaoru Yamashita1）, Shusei Yoshimine1）, Minako Uchino1）, Toshiro Kibe2）,
Mitsutaka Sugimura1）

F2 03

Comparison of the effective length in various preformed nasotracheal intubation tubes
1）
Japan Ground Self-Defense Force2）
Japan Maritime Self-Defense Force○Natsuki Kobayashi1）, Naotaro Nakamura1）, Ryohei Okazawa2）, Manabu Miki2）,
Takeshi Ohno1）, Mutsumi Nonaka1）, Kentaro Ouchi1）― 220 ―

F2 04The effects of Pressure-controlled Volume-guaranteed Ventilation（PCV-VG）on postoperative pulmonary complications（PPCs）of oral and maxillofacial patients undergoing freeflap reconstruction
Peking University School of Stomatology, Beijing, China○Yun Liu, Xudong Yang, Xin Peng, Yue Yang, Guoyong Yang, Dan Zhou, Fang Han

F2 05

Hormonal study of psychological stress for general anesthesia in patients with autism spectrum disorder, including the relationship with physical restraint
Dental Anesthesiology, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan○Makiko Shibuya, Yukifumi Kimura, Takayuki Hojo, Toshiaki Fujisawa, Kanta Kido

FADAS General Session：ePoster 3（Clinical Research 2）
October 7, Sat, 11：00‑11：54, in Room 108‑1
Chair：Takuro Sanuki（Kanagawa Dental University, Department of Dental Anesthesiology, Kanagawa, Japan）

F3 01

Development of predicting system for success or failure of inferior alveolar nerve blockanesthesia using artificial intelligence
Yonsei University College of Dentistry, Seoul, Republic pf Korea○Chanjae Lee, Eun Jeong Choi, Soo-bin Kim, Wonse Park, Seong Eun SongF3 02

Effect of local anesthesia at the bone collection site of iliac bone grafting on autonomic nervous system activity and circulatory dynamics in the treatment of patients with alveolar
cleft
1）
Department of Dental Anesthesiology, Kagoshima University Hospital, Kagoshima, Japan2）
Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima,
Japan○Kaoru Yamashita1）, Shusei Yoshimine1）, Akari Uto1）, Minako Uchino1）, Toshiro Kibe2）,
Mitsutaka Sugimura1）

F3 03

Trial of sensory evoked potential measurement in the trigeminal nerve for diagnosing
nerve injury
1）
Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital,
Niigata, Japan
2）
Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental
Sciences, Niigata, Japan○Yutaka Tanaka1）, Toru Yamamoto1）, Shigenobu Kurata2）, Naotaka Kishimoto2）, Kenji Seo2）― 221 ―

F3 04（Withdraw）

F3 05

Facial images based-deep learning analysis in predicting laryngeal view under video laryngoscope：A novel approach for difficult airway assessment
1）
Department of Anaesthesiology, Shanghai Ninth Peopleʼs Hospital, Shanghai, China
2）
Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China○Ming Xia1）, Chenyu Jin1）, Yaokun Zheng2）, Jie Wang1）, Mingxu Zhao2）, Shuang Cao1）,
Bei Pei1）, Ningning Ji1）, Zhiliang Lin2）, Hong Jiang1）

F3 06

Predicting difficult mask ventilation using speech technology
1）
Department of Anesthesiology, Shanghai Ninth Peopleʼs Hospital, Shanghai, China
2）
X-LANCE Lab, Department of Computer Science and Engineering, Shanghai Jiao Tong
University, Shanghai, China○Ming Xia1）, Shuang Cao1）, Zhikai Zhou2）, Zhengyang Chen2）, Yanmin Qian2）, Tianyi Xu1）,
Chenyu Jin1）, Bei Pei1）, Ningning Ji1）, Hong Jiang1）

FADAS General Session：ePoster 4（Case Report, Clinical Statistics）
October 7, Sat, 11：00‑11：54, in Room 108‑2
Chair：Shinya Yamazaki（Department of Dental Anesthesiology, Ohu University Hospital, Fukushima, Japan）

F4 01

The influence of dilution of oral midazolam as a premedication in a patient with a historyof delayed emergence after intravenous sedation
1）
Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan2）
Department of Dental Anesthesiology and Special Care Dentistry, Okayama University
Graduate School○Yukiko Nishioka1）, Jotaro Tanaka2）, Maki Fujimoto1）, Saki Miyake2）, Hitoshi Higuchi1）,
Takuya Miyawaki2）

F4 02

Tracheal bronchus detected during general anesthesia：A case report
1）
Department of Dental Anesthesia, Niigata University Medical & Dental Hospital, Niigata,Japan
2）
Division of Dental Anesthesiology, Niigata University, Niigata, Japan○Toru Yamamoto1）, Naotaka Kishimoto2）, Yutaka Tanaka1）, Shigenobu Kurata2）,
Hiroko Kanemaru1）, Yumiko Sato1）, Yuhei Koyama1）, Yuzo Imai1）, Tomoaki Ujita1）,
Emi Sawada2）, Kenji Seo2）― 222 ―

F4 03

A case report of heart rate variability record during the onset of vasovagal reflex
1）
Department of Dental Anesthesiology, Kagoshima University Hospital, Kagoshima, Japan2）
Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima,
Japan○Shusei Yoshimine1）, Kaoru Yasmashita1）, Akari Uto1）, Minako Uchino1）, Toshiro Kibe2）,
Mitsutaka Sugimura1）

F4 04

Clinical study on effectiveness of intravenous patient-controlled analgesia（IV-PCA）for
postoperative pain in patients undergoing oral and maxillofacial surgery
1）
Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan2）
Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School, Okayama, Japan○Maki Fujimoto1）, Saki Miyake2）, Ayako Jinzenji1）, Kota Miyake2）, Yuka Honda-Wakasugi2）,
Akiko Yabuki-Kawase2）, Mai Nakano1）, Midori Inoue1）, Hitoshi Higuchi1）, Takuya Miyawaki2）

F4 05

Clinical statistics on anesthetic management for dental outpatients at Okayama University
Hospital for the past five years
1）
Department of Dental Anesthesiology and Spacial Care Dentistry, Okayama University
Graduate School, Okayama, Japan2）
Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan○Saki Miyake1）, Yukiko Nishioka2）, Maki Fujimoto2）, Fumika Hashimoto1）,
Minako Ishii-Maruhama1）, Ikue Hanazawa2）, Kumiko Takaya-Ishida2）, Takuya Saida1）,
Ayaka Yamane-Hirano2）, Hitoshi Higuchi2）, Takuya Miyawaki1）

F4 06

Establishing oral care for a blindness patient with intellectual disability using behavior
modification techniques with professional oral care under intravenous sedation
1）
Yokohama City Center for Oral Health of Persons with Disabilities, Yokohama, Japan2）
Department of Dental Anesthesiology, The Nippon Dental University, School of Life Dentistryat Tokyo, Tokyo, Japan
3）
Yokohama Dental Association, Yokohama, Japan○Mayumi Takei1）, Ayumi Konno1）, Masayuki Suzuki1）, Katsuhisa Sunada2）, Takami Kimura3）,
Naoto Yoshida3）― 223 ―

F1 01

Deep learning-based prediction of difficult laryngoscopy using 3D facial scans in oral and maxillofacial
surgery
1）

Department of Anesthesiology, Shanghai Ninth Peopleʼs Hospital, Shanghai, China

2）

School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China

Ming Xia1）, Bei Pei1）, Yaokun Zheng2）, Chenyu Jin1）, Shuang Cao1）, Mingxu Zhao2）, Ningning Ji1）, Zhiliang Lin2）,
Hong Jiang1）【Background】Failure to predict difficult airway is associated with morbidity and mortality. Three-dimensional（3D）scans have emerged as a tool to describe maxillofacial structure. This study aimed to present a deep learning modelfor difficult laryngoscopy prediction using 3D facial scans.
【Methods】After obtaining consent, 3D scans were acquired using FaceGo pro from patients undergoing oral andmaxillofacial surgery and require general anesthesia preoperatively. Patients were asked to open their mouths
widely and protrude their tongues, without vocalizing during the scan. Experienced anesthesiologists performed
direct laryngoscopy and graded the laryngeal view using the Cormack and Lehane（C-L）scale. Grades 3 and 4 wereconsidered as difficult laryngoscopy（DL）. The model was simplified to a 1,024 vertex mesh using furthest point
sampling. PointNet＋＋, a classical neural network for 3D point cloud, was employed for the classification task. The
dataset was split into training and test sets in an 8：2 ratio. The model performance was evaluated by calculating thearea under the curve（AUC）, sensitivity, specificity, and accuracy with 95％ confidence interval（CI）.
【Results】Among 647 patients, 108（16.7％）had difficulty in laryngoscopic exposure. The AUC of the prediction
model was 0.782（95％ CI：0.677 0.888）with a sensitivity of 0.773（95％ CI：0.500 0.909）and a specificity of
0.676（95％ CI：0.324 0.800）in the test set.
【Conclusion】The proposed deep learning model using 3D facial scans can serve as an alternative tool for predicting
difficult laryngoscopy.

― 224 ―

F1 02

Hormonal mechanisms of the paraventricular nuclei in the hyperalgesia in the Parkinsonʼs disease model
rats
Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan

Shengsen Yang, Nayuka Usami, Hiroharu Maegawa, Midori Toyama, Hiroaki Shigemasa, Mayuka Ueda,
Chiho Kudo, Hitoshi Niwa
【Objective】Hyperalgesia in Parkinsonʼs disease（PD）model rats has been reported in prior studies, but the mechanism remains unclear. We have suggested that hyperalgesia in PD model rats may be related to changes in neuronal
activity of oxytocin（OXT）-producing cells in the paraventricular nucleus（PVN）. In the present study, we investigated the relationship between the arginine vasopressin（AVP）and corticotropin releasing hormone（CRH）, which
are regulated by the PVN in addition to OXT, and hyperalgesia in PD.
【Methods & Results】PD model rats were made by injecting 6 hydroxydopamine into the left medial forebrain bundle of male Wistar rats, and the rotation test was performed two weeks later. The subcutaneous injection of 5％ formalin solution was injected into the left upper lip of the PD model and Sham rats under anesthesia, and blood was
drawn from the heart 5 or 15 minutes later, followed by perfusion fixation. PD model and Sham rats with no injection were used as control groups. Immunostaining with antibody against tyrosine hydroxylase was performed, andimmunoreactivity in the left substantia nigra and striatum was found to be decreased in PD model rats. Immunostaining of the trigeminal spinal subnucleus caudalis with antibody against p-ERK revealed increased number of
p-ERK-immunoreactive cells in PD model rats, indicating hyperalgesia. Double staining with each antibody against
OXT, AVP and CRH in combination with antibody against p-ERK in the PVN was also performed. The OXT, AVP
and CRH levels in serum without and after formalin injection were measured with ELISA kits, and the levels of
OXT and CRH were significantly decreased in PD model rats than Sham rats after formalin injection.
【Conclusion】In PD model rats, the functions related to OXT and CRH in the PVN were altered, suggesting that thismay have affected the hyperalgesia to injection of formalin.

― 225 ―

F1 03Comparative study of the effects of TND1128 and β-NMN on spontaneous locomotor activity, reactive oxygen metabolites-derived compounds（d-ROMs）and biological antioxidant potential（BAP）in mice underhypoxic conditions
Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

Nanae Takahashi【Objective】We previously reported that NAD＋（nicotinamide adenine dinucleotide phosphate）enhancer TND1128（a 5-deazaflavin derivative）has much stronger mitochondrial activity compared to β-NMN（β-nicotinamide mononucleotide）. The present study aimed to compare blood-brain barrier permeability between the two drugs underhypoxic conditions.
【Methods】TND1128 and β-NMN were administered intraperitoneally to mice, and the following 4 items were measured： 1） spontaneous locomotor activity under exposure to hypoxia for 10 minutes, 2） amount of peroxide（d-ROMs）in hydroperoxide（ROOH）, which is a metabolite of reactive oxygen species and free radicals, 3）biological antioxidant potential（BAP）of endogenous antioxidants including albumin, bilirubin, reduced glutathione, anduric acid, and exogenous antioxidants such as vitamins C and E and polyphenol, and 4）measurement of potential
antioxidant activity based on the BAP/d-ROMs ratio. We compared the efficacy of the two drugs based on thesefindings.
【Results】Both TND1128 and β-NMN increased locomotor activity under hypoxic conditions. β-NMN tended toincrease d-ROMs in a dose-dependent manner and significantly decreased BAP when administered at 1 mg/kg. However, 100 mg/kg β-NMN showed only a tendency to decrease d-ROMs, and no increasing tendency as seen with
TND1128 was observed. As a result, the potential antioxidant activity of β-NMN （BAP/d-ROMs ratio） was
decreased, and the difference between the two drugs was significant.
【Conclusions】These study findings indicated that TND1128 and β-NMN can enter the brain after systemic administration and protect brain function under adverse conditions, but they have different mechanisms of action in mitochondria.

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F1 04The effect of lidocaine on cell proliferation of myofibroblastsTokyo Medical and Dental University, Tokyo, Japan

Tomoka Matsumura, Sayaka Asano, Shigeru Maeda【Objective】Lidocaine inhibits nerve conduction, as well as suppressing proliferation and inducing apoptosis in fibroblasts mediated by G-protein-linked receptors, and involves the activity of cAMP and PKC. Myofibroblasts（MF）,adifferentiated form of fibroblasts, produce extracellular matrix（ECM）molecules that regulate tissue strength andresilience. However, an imbalance in ECM secretion can lead to tissue fibrosis. Although MF plays an important role
in wound healing and nerve regeneration after surgical procedures, the effects of lidocaine on MF are unknown. In
the present study, we investigated the effects of lidocaine on cell proliferation and apoptosis induction in MF. In
addition, the cell signaling pathways involved in the inhibition of MF proliferation by lidocaine were examined.
【Methods】Normal human dermal fibroblasts were grown in culture and stimulated with TGF-β, which induced thedifferentiation of dermal fibroblasts into MF. cell counting kit-8（CCK-8）was used to investigate the viability offibroblasts and myofibroblasts after the addition of lidocaine（0.1 and 1 mg/m ）. For detection of apoptosis, 24 hafter seeding, cells were treated with lidocaine（at 0.001, 0.01 and 0.1 mg/m ）and, at three days post treatment,
tested with the Apoptotic/Necrotic/Healthy Cells Detection Kit. HA 1004 was used to inhibit cAMP activity and GO
6976 was used to inhibit PKC activity.
【Results】A significant reduction in the proliferation of fibroblasts and MF was observed with 1 mg/m lidocaine
compared to untreated controls on day 3. Apoptosis was detected in MF and fibroblasts 3 days after administering
0.1 mg/m lidocaine. We showed that lidocaine suppressed cell proliferation and induced apoptosis in MF.
【Conclusion】Lidocaine may be a therapeutic agent for wound repair and reinnervation after surgery through theutilization of physiochemically tuned MF.

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F1 05mRNA expression level of IL-1β in labial mucosal tissues with surgical injury after dexmedetomidine
administration
The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan

Yukako Tsutsui, Katsuhisa Sunada【Objective】Dexmedetomidine（DEX）, a selective α2-adrenoreceptor agonist, has the ability to prolong local anesthesia duration without adverse side effects such as hypertension and tachycardia. However, the mechanism of prolongation of local anesthesia duration has not been clarified. In contrast, DEX can inhibit expression levels of proinflammatory cytokines such as IL-1β. IL-1β can cause hyperalgesia and pain. Therefore, we hypothesized that DEX prolongs local anesthesia duration due to its ability to inhibit proinflammatory cytokine levels in the oral mucosa. The
purpose of this study was to assess whether DEX inhibits IL-1β mRNA expression levels in oral mucosa with surgical injury.
【Methods】All experimental procedures and protocols used in the present study were approved by the Animal Careand Use Committee of the Nippon Dental University（Approval number：18-28）.Wistar rats（N＝15）were assigned
to control, normal saline（NS）or DEX administration groups. Samples were obtained from lower right labial mucosa
of rats, which were assigned to NS or DEX administration group. The labial mucosa was incised by a scalpel blade,and NS or DEX solution was administered for 30 min. In the control group, no surgical injury was induced and nosolution was administered. After administration, the mucosa in the experimental and control groups was analyzed
using real time RT-PCR.
【Results】The IL-1β mRNA expression level of samples in the NS group was significantly higher than in the othergroups. However, the IL-1β mRNA expression level was not significantly different between the DEX administrationand control groups.
【Conclusion】These results suggest that prolongation of local anesthesia duration by DEX could be due to its ability
to not increase IL-1β level. This finding might be the mechanism of prolongation of local anesthesia duration.

― 228 ―

F1 06

Analysis of the impact on dental sedation trends from fatal accidents during sedation, based on Koreaʼshealth and medical big data
Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea

Eunhye Choi, Seung-Hwa Ryoo, Hyuk Kim, Myong-Hwan Karm, Hyun Jeong Kim, Kwang-Suk Seo【Objective】We analyzed how fatal accidents during dental sedation impacted sedation drug use in Korea, including
timing of accidents, significance of drug use decreases, and normalization duration.
【Methods】We used Korea Health Insurance Review and Assessment Service data, collecting monthly claim data foreight sedatives from 2007 to 2019. We examined online death incidents related to dental sedation in Korea, plottedmonthly sedation cases on a time series chart, and applied regression and ARIMA model analysis.
【Results】Our analysis showed significant trends following two fatalities in 2012 and 2017. Usage of the nitrous oxidechloral hydrate-hydroxyzine complex didnʼt change after 2012 but reduced over 30％ after 2017 without full recovery. The nitrous oxide-midazolam combination decreased in 2017, but usage rebounded. Since 2012, chloral hydrate
use declined steadily. Midazolam usage wasnʼt affected by fatalities. Nitrous oxide use decreased significantly in
2017, recovering after two months.
【Conclusion】Fatal accidents during dental sedation affect sedative choice. Decreases were noted in the use of chloral
hydrate and nitrous oxide-chloral hydrate-hydroxyzine complex post-accidents in 2012 and 2017.

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F2 01

Would you choose general anesthesia or physical restraint to perform dental treatment for patients withspecial needs?
1）

Department of Dentistry, Morinomiya Hospital, Osaka Japan2）

Department of Dentistry, Bobath Memorial Hospital, Osaka Japan3）

Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka Japan

Yoshinao Asahi1）, Shiro Omichi2）, Izuka Hayashi2）, Yoshino Mori2）, Yukimi Miyamoto2）, Chiaki Kato1）,
Yuka Sugimoto2）, Miho Hyodo1）, Yoshito Takasaki1）, Hitoshi Niwa3）【Objective】More than 170 years have passed since Wells and Mortonʼs great achievement. However, in Japan, many
patients with special needs receive dental treatment while fully conscious using physical restraint（PR）devices,
despite the fact that dental treatment performed under general anesthesia（GA）by dentists is covered by public
insurance. One reason for this is that ordinary people are unfamiliar with dental treatment under GA. We conducted
this study to better understand how people perceive dental treatment under GA and PR for patients with special
needs.
【Methods】Following an explanation of dental treatment under PR and GA, questionnaires were distributed to 81
new employees joining our medical corporation on the web in March 2023. We polled 53 employees for theirthoughts. The questionnaires asked about the degrees of recognition, appropriateness, necessity, and problems withboth methods.
【Results】The number of participants who answered each way unfamiliar was dental treatment under PR：48；GA：
43 respectively. The number of people who chose each way better was PR：seven；GA：32. The minimum numbersof cavity teeth that needed to be treated were 3.0±2.9 for PR and 5.0±2.9 for GA. More participants responded to
PR with psychological trauma and GA being expensive and requiring specialized equipment and personnel. Treatment precision and safety were considered on comparable levels.
【Conclusion】Dentist anesthesiologists must appeal to the general public about the precision and safety of dental
treatment under GA for patients with special needs when compared to PR.

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F2 02Autonomic nervous system activity during perioperative period of pediatric patients
1）

Department of Dental Anesthesiology, Kagoshima University Hospital, Kagoshima, Japan2）

Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan

Akari Uto1）, Kaoru Yamashita1）, Shusei Yoshimine1）, Minako Uchino1）, Toshiro Kibe2）, Mitsutaka Sugimura1）【Objective】In pediatric patients, perioperative stress is often difficult to understand；hence, it is desirable to establish objective indices. Previously, the relationship between autonomic nervous system（ANS）activity and stress has
been reported. Therefore, we investigated ANS activity during the perioperative period of pediatric patients undergoing alveolar bone graft surgery under general anesthesia.
【Methods】We included 40 patients scheduled for alveolar bone graft surgery under general anesthesia. Sympathetic
activity index（LF/HF）, parasympathetic activity index（HF）,and heart rate were recorded during general anesthesia, 2 hours and 24 hours post-surgery, and before discharge. Correlations were determined between these parameters and the preoperative values recorded before surgery. In addition, the assessment of pain at 2 hours, 24 hours,
and before discharge from the hospital was recorded.
【Results】Preoperative LF/HF positively correlated with LF/HF 2 hours post-surgery and the day before discharge（p＜0.05）, but not intraoperatively and 24 hours post-surgery；Preoperative HF positively correlated with HF 2
hours, 24 hours post-surgery, and the day before discharge（p＜0.05）, but not the intraoperative values. Heart rate
was correlated with the preoperative values at all time points. In addition, 8 patients had pain at 2 hours, 21 patientsat 24 hours, and 4 patients the day before discharge.
【Conclusion】It is possible that intraoperative ANS index did not correlate with preoperative values because generalanesthesia and surgical invasion cause significant fluctuations in ANS activity. Twenty-four hours after surgery,when LF/HF did not correlate with preoperative values, was when most patients complained of pain. This suggests
the association between ANS activity and postoperative pain as one of perioperative stress.

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F2 03Comparison of the effective length in various preformed nasotracheal intubation tubes
1）

Japan Ground Self-Defense Force2）

Japan Maritime Self-Defense ForceNatsuki Kobayashi1）, Naotaro Nakamura1）, Ryohei Okazawa2）, Manabu Miki2）, Takeshi Ohno1）, Mutsumi Nonaka1）,
Kentaro Ouchi1）【Introduction】Preformed nasotracheal intubation tube is often used in general anesthesia for dental procedure andoral surgery to securing the surgical field. Effective length of preformed nasotracheal intubation tube is from tip to
flexion point. It is reported that the distance between tube tip and flexion point have different among manufacturers.
Manufacturers are also making improvements, and there is a possibility that the effective length has been changed.
In this study, therefore, we compared preformed nasotracheal tubes currently available.
【Methods】We measured effective length（the distance between tube tip and flexion point）of inner diameters（ID）
of 6.5 mm, 7.0 mm and 7.5 mm for the Parker preformed Cuffed Endotracheal Tube（Parker）,the Medtronic Taper
Guard RAE（Medtronic）and the Rusch AGT Nasal Preformed Cuffed Endotracheal Tube（Rusch）.
【Results】The effective lengths were 295, 305 and 315 mm（Parker, ID 6.5, 7.0 and 7.5）, 270, 280 and 290 mm（Medtronic）and 270, 280 and 290 mm（Rusch）, respectively.
【Discussion】 Incorrect placement of the tracheal tube can lead to serious complications such as glottis edema
because of compression on the vocal cord. We reported that the appropriate tube length varies among patients of thesame height（Ouchi et al., 2016）. For safe and secure airway management, we should understand the specifications ofeach tube and select tube. In compared to the past report（Soya et al., 2002）, the effective length of the Parker wasincreased 34, 25 and 35 mm（ID 6.5, 7.0 and 7.5 respectively）, whereas the Medtronic and the Rusch had nochange. It is indicated that we anesthesiologist have to get up-to-date in the product specifications, to avoid serious
complications.

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F2 04The effects of Pressure-controlled Volume-guaranteed Ventilation（PCV-VG）on postoperative pulmonary
complications（PPCs）of oral and maxillofacial patients undergoing free flap reconstruction
Peking University School of Stomatology, Beijing, China

Yun Liu, Xudong Yang, Xin Peng, Yue Yang, Guoyong Yang, Dan Zhou, Fang Han
The effects of Pressure-controlled Volume-guaranteed Ventilation（PCV-VG）on postoperative pulmonary complications（PPCs）of oral and maxillofacial patients undergoing free flap reconstruction. The effect of intra-operative
mechanical ventilation modes on postoperative pulmonary complications（PPCs）after oral and maxillofacial surgery
with free flap reconstruction has not been well established. We evaluated the impact of two ventilation modes on
postoperative pulmonary complications in oral and maxillofacial patients undergoing free flap reconstruction. In thisrandomized controlled trial, 240 adults scheduled for oral and maxillofacial surgery were randomized to one of thetwo groups：volume-controlled ventilation and pressure-control with volume guaranteed ventilation（PCV-VG）.
Enhanced recovery after surgery pathways and lung protective ventilation protocols were implemented in bothgroups. The primary outcome was a composite of postoperative pulmonary complications within the first seven postoperative days. The outcome occurred in 53（22％）, with 25（21％）in the volume control group, and 28（23％）in thepressure-control with volume guaranteed group（p＝0.831）. The secondary outcomes also did not differ acrossstudy groups. in oral and maxillofacial patients undergoing free flap reconstruction, the new ventilation mode did not
influence the risk of developing postoperative pulmonary complications. This is the first randomized controlled trial
examining the effect of PCV-VG ventilation modes on pulmonary outcomes in oral and maxillofacial patients undergoing free flap reconstruction.

― 233 ―

F2 05

Hormonal study of psychological stress for general anesthesia in patients with autism spectrum disorder,
including the relationship with physical restraint
Dental Anesthesiology, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan

Makiko Shibuya, Yukifumi Kimura, Takayuki Hojo, Toshiaki Fujisawa, Kanta Kido
【Objective】Patients with autism spectrum disorder（ASD）are assumed to be under psychological stress during
preoperative examination, including blood collection, and general anesthesia. However, information on the degrees ofstress and relationship between need for physical restraint during anesthesia induction and psychological stress
immediately before anesthesia is lacking. By comparing stress hormone levels, this study aimed to 1）assess thedegree of psychological stress prior to blood collection on the preoperative examination day and anesthesia induction
in patients with ASD and 2）determine whether patients who require physical restraint have higher levels of psychological stress than those who do not.
【Methods】Blood was collected on the preoperative examination day and at the time of establishing an intravenous
line immediately after anesthesia induction, and stress hormone levels were measured and compared.
【Results】Fifty-eight patients participated in this study. The percentage of patients requiring physical restraint during the induction of anesthesia was 22.4％（13/58）. The concentrations of cortisol and adrenocorticotropic hormone
were significantly higher on the treatment day than on the preoperative day. In subgroup analysis, patients who
required physical restraint and those who did not have similar results. There were no significant differences instress hormone levels, except adrenaline, immediately after anesthesia induction between patients who required
physical restraint and those who did not.
【Conclusions】Psychological stress prior to anesthesia induction was greater than that prior to blood collection on
the preoperative consultation day. Moreover, ASD patients who do not require physical restraints may feel as much
psychological stress as those who do.

― 234 ―

F3 01Development of predicting system for success or failure of inferior alveolar nerve block anesthesia using
artificial intelligence
Yonsei University College of Dentistry, Seoul, Republic of Korea

Chanjae Lee, Eun Jeong Choi, Soo-bin Kim, Wonse Park, Seong Eun SongInferior alveolar nerve block anesthesia（IANB）is the most commonly used local anesthetic for mandibular posterior treatment. However, it does not always lead to successful anesthesia. Failure rates of 10-39％ have beenreported in previous studies. Current methods for judging anesthesia success generally consider that success isbased on the degree of pain of the patient by using a dental probe or decreased sensibility or numbness of the lower
lip, but these diagnostic methods are difficult to express objectively. Therefore, this study aims to develop an artificial intelligence system that predicts the success or failure of anesthesia on panorama radiographs using data on the
success of IANB using a pulp tester. The success of IANB was evaluated using the Pulp Vitality Tester for 250
patients who had extracted mandibular third molars at the Department of Advanced General Dentistry at Yonsei
University Dental Hospital. To evaluate the success of IANB, a pulp test was performed on the canine and firstmolar in the same area as the mandibular third molar to be extracted before anesthetic injection. Inject anesthesia
with 1.8 m 2％ lidocaine（2EA）containing 1：100,000 epinephrine using a 27 G needle（0.4×30 mm）.After 10 minutes of IANB, apply toothpaste to the probe tip, place the tip between the gingival margin and occlusion of the toothin the same area, and it is considered successful when 10 is read twice in a row up to the maximum output of thepulp tester（reading value 10）. A deep learning model is developed through panoramic radiographs, pulp tester
results, other personal information data of 250 patients. Train and verify artificial intelligence algorithms using training data with optimal hyperparameter values using a convolutional neural network（CNN）. The performance of the
deep learning model that predicts IANB success/failure is evaluated by Accuracy, Precision, and F1 score. The deeplearning model for predicting IANB success achieved more than 90％ in sensitivity, precision, and F1 score. This
deep learning algorithm showed excellent performance in predicting the success of IANB anesthesia on a panoramic
radiograph. It is expected to help provide useful information for cliniciansʼ judgment.

― 235 ―

F3 02

Effect of local anesthesia at the bone collection site of iliac bone grafting on autonomic nervous system
activity and circulatory dynamics in the treatment of patients with alveolar cleft
1）

Department of Dental Anesthesiology, Kagoshima University Hospital, Kagoshima, Japan2）

Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan

Kaoru Yamashita1）, Shusei Yoshimine1）, Akari Uto1）, Minako Uchino1）, Toshiro Kibe2）, Mitsutaka Sugimura1）【Objective】In the treatment of patients with alveolar cleft, pain management at the site of bone collection in iliacbone grafting is more difficult compared to surgery site of alveolar cleft. Local anesthesia with ropivacaine, which
has a long half-life in the iliac region may have analgesic effects. However, its effects on autonomic nervous activity
and circulatory dynamics are unknown. This study investigated the effects of local iliac ropivacaine anesthesia undergeneral anesthesia on the human body by analyzing changes in autonomic nervous system activity and circulatory
dynamics.
【Methods】 Medical records of patients who underwent iliac bone grafting surgery under general anesthesia
between May 2021 and December 2022 were retrospectively analyzed. Patients with incomplete descriptions of survey items or data records were excluded. The local anesthesia administered was 0.75％ ropivacaine in the iliac
region at the end of surgery. Sympathetic and parasympathetic activity indices（LF/HF and HF respectively）,heartrate, and systolic blood pressure were recorded 5 min before local anesthesia as controls. Data collected 5 min after
local anesthesia administration were analyzed as data during administration. As comparative data, we used the analysis of 2％ lidocaine with 1：200,000 diluted epinephrine administered intraorally and in the iliac region at the beginning of operation. Data on intraoperative and postoperative complications and presence or absence of pain at 2 and24 h after surgery were retrospectively extracted from anesthesia and medical records.
【Results】The study included 17 patients（mean age：9.89±0.19 years；height：135.01±1.92 cm；mean weight：
29.79±1.46 kg）, including 8 males and 9 females. LF/HF was significantly higher during ropivacaine administration
than before regional anesthesia（P＜0.05）. HF, heart rate, and systolic blood pressure did not change significantly
during ropivacaine administration compared with before（P＜0.05）. Analgesic effect was observed at 2 h postoperatively（P＜0.05）but not at 24 h postoperatively. No intra- or postoperative complications were observed in any
patients. Administration of 2％ lidocaine with 1：200,000 diluted epinephrine at the beginning of operation undergeneral anesthesia in the oral cavity and iliac crest increased systolic blood pressure（P＜0.05）.
【Conclusion】2％ lidocaine with 1：200,000 diluted epinephrine had an effect on circulatory. Conversely, 0.75％ ropivacaine did not alter circulatory dynamics, but it increased the sympathetic nervous system activity. Thus, complications associated with sympathetic hyperactivity should be noted.

― 236 ―

F3 03

Trial of sensory evoked potential measurement in the trigeminal nerve for diagnosing nerve injury
1）

Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan

2）

Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Yutaka Tanaka1）, Toru Yamamoto1）, Shigenobu Kurata2）, Naotaka Kishimoto2）, Kenji Seo2）【Introduction】Somatosensory evoked potentials（SEP）was established as a method for diagnosing sensory disorders in the field of spinal nerves. However, it has been believed that precise SEP recording of the trigeminal nerve
was difficult because of short distance from the stimulating electrode to the recording site. Therefore, we tried tomeasure SEP evoked by the electrical facial stimulation and to analyze the recording pulse waves.
【Subjects and Methods】This research was approved by Niigata University clinical ethics community（2021-0284）.
The subjects were normal healthy adult volunteers and patients with trigeminal neuropathy who received a sensory
impairment in the facial region in the dental anesthesia clinics of Niigata University Medical and Dental Hospital.
MEB-2300 NeuropackX1（NIHON KOHDEN Co., Ltd.）was used for recording SEP and the stimulating electrodeplaced near the miotic foramen and the recording electrode measured SEP from the T3（or T4）and C3（or C4）electrodes opposite the stimulating electrode using the international 10-20 method. Stimulation was 5 to 30μV andthe waveform was analyzed after 200 additive averages were performed.
【Results and Discussion】In this study, we could detect a somatosensory evoked potentials with a latency of around10-20 msec. And the latency received the latency by changing stimulus intensity. This analyze could be applied tothe diagnose of trigeminal nerve injury.

F3 04（Withdraw）― 237 ―

F3 05

Facial images based-deep learning analysis in predicting laryngeal view under video laryngoscope：
A novel approach for difficult airway assessment
1）

Department of Anaesthesiology, Shanghai Ninth Peopleʼs Hospital, Shanghai, China

2）

Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China

Ming Xia1）, Chenyu Jin1）, Yaokun Zheng2）, Jie Wang1）, Mingxu Zhao2）, Shuang Cao1）, Bei Pei1）, Ningning Ji1）,
Zhiliang Lin2）, Hong Jiang1）【Background】Difficult airway for intubation is a challenge during airway management. This study aimed to investigate the value of facial images based deep learning in predicting the laryngeal view under the video laryngoscope.
【Methods】Patients, who were scheduled for tracheal intubation under general anaesthesia, were enrolled in thisstudy at Shanghai Ninth Peopleʼs Hospital, Shanghai, China from February to October 2021. A binary deep learningclassification model was proposed and constructed with 9 facial images（taken from right front, side with open
mouth and/or stick out tongue）as inputs to predict airway exposure difficulty. The ground-truth labels based on theCormack?Lehane classification under a video laryngoscopy were obtained. Varies combinations of the nine images
were used to obtain the best number of facial images for the deep learning model. The performance of the proposed
deep learning model was compared to those values achieved from traditional methods.
【Results】Of 4,316 recruited patients, the data from 2,785 patients, including 294（11％）who had difficult airway
exposure, were analysed. The seven-images-ensembled model（composed of left-side and right-side head position,
frontal mouth opening with tongue extending position, head-up position, lower teeth biting the upper lip position,
frontal neutral position, and frontal mouth opening without tongue extending position）has the receiver operating
characteristic（ROC）area under the curve（AUC）of 0.751（95％ confidence interval［CI］, 0.687-0.815）, the sensitivity of 0.746（95％ CI, 0.627-0.847）and specificity of 0.600（95％ CI, 0.560-0.643）. The prediction performance of
this model was higher than any single-image based models, other ensembled images derived models, or the traditional methods（modified Mallampati classification（MMT）, thyromental distance（TMD）, inter-incisor gap（IIG）,
upper lip bite test（ULBT）, sternomental distance（SMD）and horizontal length of the mandible（HLM））, in which
their AUC ranges from 0.524（95％ CI, 0.488-0.560）to 0.631（95％ CI, 0.600-0.662）.
【Conclusions】Facial images based deep learning analysis is feasible in predicting laryngeal exposure which may be
used for difficult airway assessment but subjected to further study.

― 238 ―

F3 06Predicting difficult mask ventilation using speech technology
1）

Department of Anesthesiology, Shanghai Ninth Peopleʼs Hospital, Shanghai, China

2）

X-LANCE Lab, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, China

Ming Xia1）, Shuang Cao1）, Zhikai Zhou2）, Zhengyang Chen2）, Yanmin Qian2）, Tianyi Xu1）, Chenyu Jin1）, Bei Pei1）,
Ningning Ji1）, Hong Jiang1）【Objective】Difficult mask ventilation（DMV）is a major cause for perioperative hypoxic brain injury. However, predicting DMV remains a challenge. This study aimed to provide a novel approach for DMV assessment based on
speech technology.
【Methods】Traditional clinical airway examination were conducted, and speech data（10 sentences）were collectedfrom patients undergoing elective surgery under general anesthesia preoperatively. The definition of DMV was theinability of an unassisted anesthesiologist to ensure adequate ventilation during induction of anesthesia. We apply the
deep speaker recognition technology（ECAPA-TDNN）to the prediction of DMV, and the speaker embedding istaken as the input of the support vector machine to make the final decision. We conduct ten-fold cross-validation on
1068 speakers of the training set, and 180 speakers including 24 positive samples and 156 negative samples are left
out for the test set. The model performance was evaluated by calculating the area under the curve（AUC）,sensitivity, specificity, and accuracy with 95％ confidence interval（CI）.
【Results】The prevalence of DMV was 434/1248（24.2％）. The ECAPA-TDNN based model identified the DMVwith an AUC of 0.698（95％ CI, 0.579-0.817）, sensitivity of 0.583（95％ CI, 0.416-0.917）, specificity of 0.846（95％CI, 0.417-0.917）, and an overall accuracy of 0.806（95％ CI, 0.478-0.872）. Among traditional assessment methods,
neck circumference achieved the best performance for DMV prediction, with an AUC of 0.766（95％ CI, 0.7340.799）, sensitivity of 0.724（95％ CI, 0.617-0.840）,specificity of 0.702（95％ CI, 0.562-0.785）,and overall accuracy of
0.705（95％ CI, 0.615-0.759）.
【Conclusions】The proposed model based on speech technology has shown potential value in difficult mask ventilation assessment, but additional studies are needed to confirm the initial findings.

― 239 ―

F4 01

The influence of dilution of oral midazolam as a premedication in a patient with a history of delayed
emergence after intravenous sedation
1）

Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan2）

Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School, Okayama, Japan

Yukiko Nishioka1）, Jotaro Tanaka2）, Maki Fujimoto1）, Saki Miyake2）, Hitoshi Higuchi1）, Takuya Miyawaki2）【Introduction】Oral midazolam is often used as a premedication in dental treatments for patients with disability, butdelayed emergence with midazolam is a problem. We hypothesized that increasing the water dilution of midazolam
would decrease its absorption from the oral mucosa and reduce its pharmacological effects. In this case report, we
describe a patient with a history of delayed emergence after intravenous sedation who received oral midazolam as apremedication in modified diluted water to prevent delayed emergence.
【Case presentation】The patient was an 18-year-old male, 165 cm and 54 kg. Because of his intellectual disability andautism spectrum disorder, he was unable to cooperate with dental treatments, so the treatments under intravenous
sedation was planned. At initial sedation, the dose of midazolam 10 mg diluted in 5 mL of drinking water was administered orally. Thirty minutes after the administration, a continuous intravenous infusion of propofol was started. It
took 2 hours for him to emerge from the anesthesia. At the second sedation, the dose of midazolam 10 mg diluted in
20 mL of drinking water was administered orally. Propofol was administered in the same manner as the initial sedation. It took 3 hours to emerge from the anesthesia. At the third sedation, the dose of midazolam 10 mg diluted in 30
mL of drinking water was administered orally. Propofol was administered in the same manner. As before, it took 3
hours to emerge from the anesthesia.
【Discussion】For oral premedication at our facility manual, midazolam is usually administrated diluted with 5 mL ofdrinking water. However, dilution of midazolam to 4 and 6 times with the drinking water did not reduce emergencetime in the present case. Thus, increasing the water dilution of oral midazolam may not influence the pharmacological effect of midazolam.

― 240 ―

F4 02

Tracheal bronchus detected during general anesthesia：A case report
1）

Department of Dental Anesthesia, Niigata University Medical & Dental Hospital, Niigata, Japan

2）

Division of Dental Anesthesiology, Niigata University, Niigata, Japan

Toru Yamamoto1）, Naotaka Kishimoto2）, Yutaka Tanaka1）, Shigenobu Kurata2）, Hiroko Kanemaru1）, Yumiko Sato1）,
Yuhei Koyama1）, Yuzo Imai1）, Tomoaki Ujita1）, Emi Sawada2）, Kenji Seo2）
A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory
bronchus arises from the trachea superior to its bifurcation. We herein report a case in which a tracheal bronchus
was incidentally found after induction of general anesthesia, and we discuss the potential airway management problems that may have ensued. An 80-year-old man was scheduled for buccal mucosa resection and abdominal skingrafting for treatment of squamous cell carcinoma of the left buccal mucosa. Because of trismus and anticipated airway difficulty, an awake intubation was performed under sedation. A 3-branched structure was incidentallyobserved at the first branching site that was supposed to be the carina. The tip of the endotracheal tube was repositioned 3 cm above the tracheal trifurcation, and the rest of the procedure proceeded uneventfully. A flexible fiberoptic scope is not usually used in most of anesthesia cases, making the identification of such tracheal or bronchialabnormalities more difficult. Therefore, it is important to carefully check the bronchial morphology on any available
chest radiographs before surgery, listen to lung sounds after intubation, and assess thoracic lung compliance without
neglecting routine safety checks.

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F4 03

A case report of heart rate variability record during the onset of vasovagal reflex
1）

Department of Dental Anesthesiology, Kagoshima University Hospital, Kagoshima, Japan2）

Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan

Shusei Yoshimine1）, Kaoru Yasmashita1）, Akari Uto1）, Minako Uchino1）, Toshiro Kibe2）, Mitsutaka Sugimura1）【Objective】Vasovagal reflex is a common medical emergency during dental treatment, with unclear pathogenesis.
Autonomic nervous system（ANS）activity can be quantified through heart rate variability（HRV）analysis, which
examines the RR interval on an electrocardiogram（ECG）. Monitoring of ANS activity during dental treatment has
been attempted previously. However, there are only a few reports on the analysis of HRV during dental treatmentassociated vasovagal reflex. Here, we present a record of HRV analysis during the onset of vasovagal reflex.
【Case Report】A 23-year-old male（height：181 cm, weight：68 kg）was scheduled for maxillary second molar extraction. The patient had experienced vasovagal reflex twice in the past during dental treatment. The patient declined
extraction under intravenous sedation out of fear and requested vital sign monitoring, providing consent for intravenous access in case of vasovagal reflex.
【Results】During the administration of 2％ lidocaine with 1/80,000 epinephrine（1.3 mL）, the patient did not complain of discomfort, and vital signs were normal. However, soon we detected an increase in the high frequency（HF）
component on the ECG, indicating increased parasympathetic activity associated with breathing. The patientreported discomfort, and his heart rate decreased. Therefore, leg raising was performed, and 0.05％ atropine（0.5mg）was administered intravenously. This led to a decrease in parasympathetic activity and recovery of heart rate.
【Conclusion】In this case, real-time changes in autonomic nervous system activity during vasovagal reflex weredetected by HRV analysis. We suggest that monitoring HRV with a focus on increased HF could prevent vasovagal
reflexes, especially during dental treatment.

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F4 04

Clinical study on effectiveness of intravenous patient-controlled analgesia（IV-PCA）for postoperative painin patients undergoing oral and maxillofacial surgery
1）

Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan2）

Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School, Okayama, Japan

Maki Fujimoto1）, Saki Miyake2）, Ayako Jinzenji1）, Kota Miyake2）, Yuka Honda-Wakasugi2）, Akiko Yabuki-Kawase2）,
Mai Nakano1）, Midori Inoue1）, Hitoshi Higuchi1）, Takuya Miyawaki2）【Objective】To evaluate the usefulness of intravenous patient-controlled analgesia（IV-PCA）for postoperative painin patients undergoing oral and maxillofacial surgery.
【Methods】This study was conducted as a retrospective observational study, approved by the Ethical Committee of
Okayama University. The study population was composed of all patients who used IV-PCA with fentanyl for postoperative pain control after oral and maxillofacial surgery under general anesthesia in Okayama University Hospitalfrom April 2021 to March 2023. IV-PCA was performed according to the standardized protocol at our hospital：abackground infusion rate of 10 microgram/h, bolus volume of 20 microgram, and a lockout interval of 10 min. The
numeric rating scale of pain（NRS）was used as a pain score and we determined that mild pain is reflected by NRSscores 0 to 4, moderate pain by NRS scores 5 to 7, and severe pain by NRS scores 8 to 10. We searched for a maximum NRS until 24 hours after surgery and evaluated the usefulness of IV-PCA until 24 hours after surgery for eachtype of surgery.
【Results】Sixty-one patients used IV-PCA with fentanyl for postoperative pain control. The type of surgery was categorized as follows：group 1；removal of oral and maxillofacial tumors and reconstruction with pedicled flap（major
surgery）, group 2；removal of oral and maxillofacial tumors and/or reconstruction（moderate surgery）, group 3；
others. Group 1, 2, and 3 were with 32, 20, and 9 patients, respectively. In group 1（major surgery）,the percentage ofpatients with moderate or severe pain（NRS of 5 or higher）was 56％. In group 2（moderate surgery）, on the otherhands, that was 20％.
【Conclusion】IV-PCA with fentanyl was a useful method for postoperative pain control in patients undergoing moderate surgery. On the other hands, more fentanyl should be needed for postoperative pain control with IV-PCA for
major surgery.

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F4 05

Clinical statistics on anesthetic management for dental outpatients at Okayama University Hospital for the
past five years
1）

Department of Dental Anesthesiology and Spacial Care Dentistry, Okayama University Graduate School, Okayama, Japan2）

Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan

Saki Miyake1）, Yukiko Nishioka2）, Maki Fujimoto2）, Fumika Hashimoto1）, Minako Ishii-Maruhama1）,
Ikue Hanazawa2）, Kumiko Takaya-Ishida2）, Takuya Saida1）, Ayaka Yamane-Hirano2）, Hitoshi Higuchi2）,
Takuya Miyawaki1）【Objective】One of the characteristics of dental anesthesia is that anesthetic management is often performed in an
outpatient setting. Therefore, we searched for dental outpatients undergoing anesthetic management at our hospitalin the past five years.
【Methods】We investigated cases of general anesthesia（GA）and intravenous sedation（IVS）for dental outpatients
performed at our hospital from January 2018 to December 2022.
【Results】The total number of cases of dental treatments or oral surgery under GA or IVS during the five years
was 4,053（male, 2,185；female, 1,868）, of which 585（14.4％）were under GA and 3,468（85.6％）were under IVS.
The cases of IVS for outpatients with special needs, such as intellectual disability and autism spectrum disorder（IVS for special needs）and IVS for outpatients with dental fear or gagging reflex（IVS for dental fear）were 1,660
and 1,808, respectively. The male to female ratio for special needs was approximately 65％ male and 35％ female
and IVS for dental fear was approximately 39％ male and 61％ female. The mean ages of GA for special needs, IVS
for special needs, and IVS for dental fear were 21.3, 35.9, and 44.5 years, respectively. By treatment, under GA for
special needs, 68％ were dental treatments and 32％ were oral surgery, under IVS for special needs, 95％ were dental treatments and 5％ were oral surgery, under IVS for dental fear, 58％ were dental treatments and 42％ were oral
surgery.
【Conclusion】At Okayama University Hospital, anesthetic management was annually performed for about 1,000 dental outpatients. Patients with special needs were more in males, while those with dental fear were more in females.
The age of patients undergoing GA was lower than that of IVS. The reason for this was thought to be that GA wasapplied to children, as it is difficult to maintain optimal sedation levels for IVS in children.

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F4 06

Establishing oral care for a blindness patient with intellectual disability using behavior modification techniques with professional oral care under intravenous sedation
1）

Yokohama City Center for Oral Health of Persons with Disabilities, Yokohama, Japan2）

Department of Dental Anesthesiology, The Nippon Dental University, School of Life Dentistry at Tokyo, Tokyo, Japan

3）

Yokohama Dental Association, Yokohama, Japan

Mayumi Takei1）, Ayumi Konno1）, Masayuki Suzuki1）, Katsuhisa Sunada2）, Takami Kimura3）, Naoto Yoshida3）【Objective】Some patients with visual impairment with intellectual disability may cause emotional instability due tointellectual impairment of comprehension and judgment, resulting in adjustment disorder. We report a case of establishing home oral care in combination with temporal professional oral care with intravenous sedation for a suchpatient, who showed a marked rejection of oral care both at home and clinic.
【Methods】The patient is a 39-year-old woman with blindness and severe intellectual disability. She can understandsimple daily conversation and communicate verbally. Daily life assistance is provided by facility staff. At our oral
health center, oral care of the patient was provided with restraint, but the patient gradually began to refuse oralcare. After review of training in behavior modification techniques, we are currently training for practice to accept
dental instruments and providing professional oral care under intravenous sedation.
【Results】The patient did not understand the need for oral care and refused to accept oral care. There for oral care
under intravenous sedation was performed to improve periodontal condition every 4-6 months, but no improvement
was observed due to lack of home care. As the training for the acceptance of oral care at our oral health center,
tooth brushing instructions using the sense of smell and touch is provided monthly to familiarize with cleaning
equipment and how to recognize plaque in the teeth. The patients tend to reject dental instruments that they cannot
imagine and require much time to accept. However, we consider that once recognition of the exhilaration after toothbrushing is established, the patient can receive oral care at home.
In patients with blindness and intellectual disability, the earlier the onset of disability, the less visual informationnecessary for growth and development is available, and the less experiences the patients have in various situationsof daily life. Although the patient could receive oral care under intravenous sedation, the treatment cannot be considered complete, we have to train the patient to acquire habit of oral care resulting change of the patientʼs consciousness. Thus, for blind patients, behavior modification must be implemented more based on Tell-Feel-Do method
instead of Tell-Show-Do.
【Conclusion】For oral management of the blind with intellectual disability requires an understanding of disease characteristics and implementation of appropriate behavior modification techniques to achieve acquisition of oral care
habit.

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