三尖弁閉鎖症を合併した歯科治療患者の鎮静管理経験 : 近赤外線酸素モニターの応用  [in Japanese] A Case of Intravenous Sedation Management for a Patient with Tricuspid Atresia in Dental Treatment  [in Japanese]

We experienced intravenous sedation management of a patient who had the tricuspid atresia (TA, 1b) and also investigated the change in intracerebral oxygen environment during intravenous sedation using a near-infrared oxygen monitor (NIRO). A 21-year-old male (height 160cm, weight 61kg) patient, diagnosed with horizontal eruption of wisdom teeth in lower jaw left-hand side, was scheduled for extraction under intravenous sedation. He was diagnosed with tricuspid atresia just after birth. Balloon atrioseptostomy (BAS) was done at 24 days, Blalock-Taussing shunt operation at 4 years old, and Gleen operation at 2 years old. He had cyanosis and clubbed fingers, SPO_2 by pulse oximetry showed 82 to 85% oxygen saturation with room air in everyday life. The ampicillin natrium (2g) was administered 60 minutes before the start of anesthesia intravenously. Intravenous sedation was maintained with 41/min oxygen, midazolam (2.0mg) and propofol (0.6〜1.2μg/ml) to relieve anxiety and procedural stress leading to possible changes in his hemodynamic state. His hemodynamics were almost stable. The oxygenation index (TOI) by NIRO was changed 68.8 to 76.2% within normal range and may not have been a clinical problem. Tricuspid atresia is a disease with a poor prognosis. So we have needed a grasp of sick reserve force and careful caution for the complications in anesthetization management. Moreover, it was suggested that NIRO is effective for safe perioperative management in intravenous sedation management.