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Purpose: Intravenous sedation (IVS) with propofol (PPF) is commonly performed in dental treatment, particular in patients with dentophobia, with gag reflex, or undergoing implant surgeries, as PPF has the advantages of rapid induction and recovery. However, PPF and other intravenous sedatives may cause respiratory depression. Thus, IVS with PPF requires oxygen administration. But airway burn may occur when high-concentration oxygen is stored in the oral cavity and catches fire. For these reasons, the present study aimed to elucidate the changes in oxygen concentration (OC) under IVS with PPF and oxygen administration. Patients and methods: Nineteen healthy male volunteers participated in the study. None of them had missing teeth, nasal congestion, or temporomandibular joint dysfunction. They were sedated with a continuous PPF infusion dose of 6 mg/kg/hr for 25 min, followed by administration of 3 L/min oxygen via a nasal cannula. The OC was measured at two sites, namely, the median maxillary anterior teeth (MMAT) and median maxillary soft palate (MMSP), before PPF infusion (baseline) and 14, 15-18 (Term 1), 19, and 20-23 (Term 2) min after the start of infusion. Results: Compared with the values at baseline, the OC in the MMSP significantly increased at each time point, whereas the OC in the MMAT significantly increased at Term 2. Furthermore, in the comparison of the OC before and after the use of a mouth prop, the OC exhibited an upward trend, but no statistically significant differences were observed between the two time points in the MMAT and MMSP. In IVS with PPF and oxygen administration, the OC in the pharynx increases as the sedative level deepens. Conclusion: Oxygen administration should be temporarily discontinued, and suction should be performed to decrease the OC in the oral cavity when sparking procedures during IVS with PPF and oxygen administration are performed.
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Zero-dimensional kinetic modeling of atmospheric pressure Ar-N2-H2 nonthermal plasma was carried out to gain mechanistic insights into plasma-assisted catalytic synthesis of ammonia. Ar dilution is a common technique for tailoring plasma discharge properties and has been shown to enhance NH3 formation when added to N2-H2 plasma. The kinetic model was developed for a coaxial dielectric barrier discharge quartz wool-packed bed reactor operating at near room temperature using a kHz-frequency plasma source. With 30% Ar mixed in a 1:1 N2-H2 plasma at 760 Torr, we find that NH3 production is dominated by Eley-Rideal (E-R) surface reactions, which heavily involve surface NHx species derived from N and H radicals in the gas phase, while the influence of excited N2 molecules is negligible. This is contrary to the commonly proposed mechanism that excited N2 molecules created by Penning excitation of N2 by Ar(4s) and Ar(4p) play a significant role in assisting NH3 formation. Our model shows that the enhanced NH3 formation upon Ar dilution is unlikely due to the interactions between Ar and H species, as excited Ar atoms have a weak effect on H radical formation through H2 dissociation compared to electrons. We find that excited Ar atoms contribute to 28% of the N radical production in the gas phase via N2 dissociation, while the rest are dominated by electron-impact dissociation. Furthermore, Ar species play a negligible role in the product NH3 dissociation. N2 conversion sensitivity analyses were carried out for electron number density (ne) and reduced electric field (E/N), and contributions from Ar to gas-phase N radical production were quantified. The model can provide guidance on potential reasons for observing enhanced NH3 formation upon Ar dilution in N2-H2 plasma beyond changes in the discharge characteristics.
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A commercially available electron cyclotron resonance (ECR) plasma source (GenII Plasma Source, tectra GmbH) is widely used for surface processing. This plasma source is compatible with ultrahigh vacuum systems, and its working pressure is relatively low, around 10-6-10-4 Torr even without differential pumping. Here, we report ion flux concentration ratios for each ion species in an ion beam from this source, as measured by a mass/energy analyzer that is a combination of a quadrupole mass spectrometer, an electrostatic energy analyzer, and focusing ion optics. The examined beams were those arising from plasmas produced from feed gases of H2, D2, N2, O2, Ar, and dry air over a range of input power and working pressures. H2(D2) plasmas are widely used for nuclear fusion applications and, hence, the ion concentration ratios of H+, H2+, and H3+ reported here will be useful information for research that applies this plasma source to well-controlled plasma-material interaction studies. Ion energy distributions, stability of operation, and impurity concentrations were also assessed for each of the plasma species investigated.
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Background: We assessed the relationship between patient age and remifentanil dosing rate in patients managed under general anesthesia with spontaneous breathing using low-dose remifentanil in sevoflurane. Methods: The participants were patients with an American Society of Anesthesiologists Physical Status of 1 or 2 maintained under general anesthesia with low-dose remifentanil in 1.5-2.0% sevoflurane. The infusion rate of remifentanil was adjusted so that the spontaneous respiratory rate was half the rate prior to the induction of anesthesia, and γH (µg/kg/min) was defined as the infusion rate of remifentanil under stable conditions where the respiratory rate was half the rate prior to the induction of anesthesia for ≥ 15 minutes. The relationship between γH and patient age was analyzed statistically by Spearman's correlation analysis. Results: During dental treatment under general anesthesia using low-dose remifentanil in sevoflurane, a significant correlation was detected between γH and patient age. The regression line of y = -0.00079 x + 0.066 (y-axis; γH, x-axis; patient's age) was provided. The values of γH provide 0.064 µg/kg/min at 2 years and 0.0186 µg/kg/min at 60 years. Therefore, as age increases, the dosing rate exhibits a declining trend. Furthermore, in the dosing rate of remifentanil when the patient's respiratory rate was reduced by half from the preanesthetic respiratory rate, the dosing rate provided was around 0.88 mL/h in all ages if the remifentanil was diluted as 0.1 mg/mL. EtCO2 showed 51.0 ± 5.7 mmHg, and SpO2 was controlled within the normal range by this method. In addition, all dental treatments were performed without major problems, such as awakening and body movement during general anesthesia, and the post-anesthetic recovery process was stable. Conclusion: General anesthesia with spontaneous breathing provides various advantages, and the present method is appropriate for minimally invasive procedures.
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Background: Recent animal studies have suggested the role of GABA type A (GABA-A) receptors in salivation, showing that GABA-A receptor agonists inhibit salivary secretion. This study aimed to evaluate the effects of propofol (a GABA-A agonist) on salivary secretions from the submandibular, sublingual, and labial glands during intravenous sedation in healthy volunteers. Methods: Twenty healthy male volunteers participated in the study. They received a loading dose of propofol 6 mg/kg/h for 10 min, followed by 3 mg/kg/h for 15 min. Salivary flow rates in the submandibular, sublingual, and labial glands were measured before, during, and after propofol infusion, and amylase activity was measured in the saliva from the submandibular and sublingual glands. Results: We found that the salivary flow rates in the submandibular, sublingual, and labial glands significantly decreased during intravenous sedation with propofol (P < 0.01). Similarly, amylase activity in the saliva from the submandibular and sublingual glands was significantly decreased (P < 0.01). Conclusion: It can be concluded that intravenous sedation with propofol decreases salivary secretion in the submandibular, sublingual, and labial glands via the GABA-A receptor. These results may be useful for dental treatment when desalivation is necessary.
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We present the case of a 46-year-old man who received ephedrine for hypotension after surgery for a mandibular lesion under intravenous (IV) moderate sedation with dexmedetomidine (DEX) and experienced transient ventricular tachycardia (VT). The patient was scheduled to have cystectomy and multiple apicoectomies for the mandibular periapical infection and the simple bone cyst. Other than obesity, snoring, and a nonalcoholic fatty liver, he denied any other significant medical history, medications, or allergies. The surgery was successful; however, his blood pressure dropped after stopping the DEX infusion. Ephedrine was administered IV several times, which resulted in the onset of VT on the electrocardiogram (ECG). His blood pressure could not be measured at the time, but he was able to respond and breathe independently. A defibrillator was immediately made available. The ECG revealed a spontaneous transition from VT to atrial fibrillation with ST depression. Because he was unable to revert to a normal sinus rhythm, the patient was transferred to a general hospital, where he underwent additional testing. No abnormalities were observed in his heart or brain. After DEX administration, its long-lasting alpha-2 adrenoceptor agonist effects can cause vasodilation and inhibition of sympathetic activity, leading to hypotension in some patients. Should that occur, ephedrine can be used to increase blood pressure, but it may also provoke transient coronary artery spasms and lead to VT. Consequently, extreme caution should be exercised in patients who develop hypotension following DEX administration. We also recognize the significance of regular training sessions, such as advanced cardiac life support programs.
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Dexmedetomidina , Hipotensión , Taquicardia Ventricular , Masculino , Humanos , Persona de Mediana Edad , Dexmedetomidina/efectos adversos , Efedrina/efectos adversos , Arritmias Cardíacas , Agonistas de Receptores Adrenérgicos alfa 2 , Hipotensión/inducido químicamente , Hipotensión/tratamiento farmacológico , Taquicardia Ventricular/inducido químicamente , Taquicardia Ventricular/diagnósticoRESUMEN
Zero-mass metamaterials comprise an orifice and a thin film. The resonance between the film and the air mass of the orifice hole is caused by sound waves, which significantly decreases the transmission loss at a specific frequency. The study novelly incorporates acoustic metamaterials in the delay tube of an interference silencer. In this case, it is determined that an interference silencer and a "side-branch silencer with two different branch pipe lengths" can be realized in a single silencer. At certain frequencies, the acoustic mass of the acoustic metamaterial approaches zero, which results in an interference silencer with the full length of the delay tube applied. At other frequencies, the acoustic metamaterial acts as a rigid wall with high transmission loss, thereby reflecting sound waves at the zero-mass metamaterial location. In this case, it is a side-branch silencer with two different tube lengths, corresponding to the tube lengths from the entrance and exit of the delay tube to the zero-mass metamaterial, respectively. The incorporation of zero-mass metamaterial into an interference-type silencer can introduce the silencing effect of a side-branch silencer with two different branch tube lengths without increasing the volume of the interference-type silencer. Theoretical values were obtained using the transfer matrix. Consequently, the theoretical and experimental values were close, enabling us to predict the transmission loss of the proposed silencer.
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In general dental conditions such as dental caries and periodontal disease, a combination of adverse conditions can cause potentially life-threatening periodontal abscess. We treated a patient in whom an oral infection developed into septic shock, resulting in patient death. A 78-year-old woman experienced spontaneous pain around a moving tooth. Pus discharge was observed, the area was sterilized, and an analgesic was prescribed. A few days later, the swelling spread to the buccal region leading to difficulty while eating. Upon systemic status and blood examination at our dental hospital, depressed consciousness due to dehydration and septic shock were suspected. Oxygenation and infusion of acetate linger with antibiotics were immediately performed. Furthermore, a blood examination revealed malnutrition and a severe infection; therefore, the patient was transferred to a nearby general hospital. However, the patient died the next day because of advanced disseminated intravascular coagulation and multiple organ failure. When an oral infection is suspected in an elderly patient, antibiotics should be quickly administered, the patient's local and systemic state should be confirmed, and sterilization should be performed daily. If no improvement is observed, medical attention should be quickly sought.
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In the present study, the abundance of Prorocentrum and the molecular phylogeny, distribution, and DST production of P. lima complex and P. caipirignum in Japan were investigated. First, the cell densities of Prorocentrum were assessed from the temperate to subtropical zones in Japan between 2014 and 2018. The cell density in the subtropical zone [19.0 ± 40.2 cells/g wet weight (ww) algae] was significantly higher than that in the temperate zone (1.4 ± 3.4 cells/g ww algae). A total of 244 clonal strains were established from the temperate and subtropical zones. Phylogenetic analyses based on the large-subunit ribosomal DNA D1/D2 revealed that the strains were separated into four species/species complex/phylotypes (P. lima complex, P. caipirignum, and new phylotypes Prorocentrum spp. types 1 and 2). The strains of P. lima complex could be separated into two clades (1 and 3). Furthermore, the strains of clades 1 and 3 could be separated into nine subclades (1a, 1c, 1d, 1e, 1f, 1g, 1h, 1i, and 1j) and three subclades (3a, 3b, and 3c), respectively. The strains of P. caipirignum were separated into two subclades (b and e). Each phylotype/subclade showed a unique distribution pattern in Japan: P. lima complex subclades 1a, 1c, and 3a and P. caipirignum subclades b and e were widespread from the temperate to subtropical zones. On the other hand, P. lima complex subclades 1e and 1i were restricted to the temperate zone, and P. lima complex subclades 1d, 1f, 1g, 1h, 1j, 3b, and 3c and Prorocentrum spp. types 1 and 2 were restricted to the subtropical zone. Furthermore, the DST production of the 243 clonal strains was assessed by LC/MS/MS analysis. The results revealed that all strains produced okadaic acid (OA) and that the OA contents of P. lima complex subclades 1d and 1f, P. caipirignum subclades b and e, and Prorocentrum sp. type 2 tended to be higher than those of the other subclades. While P. lima complex subclades 1a, 1e, 1f, and 1i produced DTX1, the other phylotype/subclades produced either no or low quantities of DTX1. A strain of P. lima complex subclade 1e showed the highest OA and DTX1 contents (55.27 and 70.73 pg/cell, respectively) in the world. These results suggest that there are potential risks for DST accumulation in benthic animals in Japan.
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Dinoflagelados , Animales , Dinoflagelados/genética , Japón , Filogenia , Mariscos , Espectrometría de Masas en TándemRESUMEN
Patients with dental phobia frequently require intravenous sedation to complete dental treatment. We encountered a case of a patient who received frequent sedation by propofol, which required escalation in the dosage of propofol required. The patient was a healthy young female with severe dental phobia, and the dental procedures were initiated under intravenous sedation. Intravenous sedation was administered to the patient more than 100 times over 9 years, and the dosages were analyzed. The mean dosage of propofol administered per hour was 6.9 ± 2.4 mg/kg/h, and the dosage tended to increase with frequency (0.06-0.1 mg/kg/h in each administration). Increased dosage was needed with a shorter interval between sedations after 30 episodes of sedation. Regarding the mean dosage of propofol per hour, the step-down method exhibited the highest increase in dosage rate of 0.18 mg/kg/h per administration followed by target-controlled infusion at 0.07 mg/kg/h per administration and combination sedation at 0.06 mg/kg/h per administration. We discuss factors that may be associated with acute tolerance to propofol when frequent propofol sedations are provided.
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Anestesia Dental , Ansiedad al Tratamiento Odontológico , Hipnóticos y Sedantes , Propofol , Sedación Consciente , Femenino , Humanos , Hipnóticos y Sedantes/administración & dosificación , Propofol/administración & dosificaciónRESUMEN
The present study focuses on a silencer built within the thick portion of a door edge and reports on the results of evaluating silencers by determining sound transmission loss via theoretical analysis and experiments on three types of silencers. The theoretical analysis involved determining the calculated values of sound transmission loss obtained using the transfer matrix method. The change in cross-sectional shape was analyzed by elemental division of the transfer matrix. Using the above, simulations were performed with respect to the optimum shape of the silencer. These theoretical analyses were then compared with the measurement results. Furthermore, the study includes the results of an experiment that attempted to restrain the dip in sound transmission loss by adding a non-woven fabric to the opening of the silencer. In a side branch silencer with an increasing shape wherein the longitudinal cross-section is a linear or an exponential function, the peak of the transmission loss was shifted to the lower frequency side when compared with that in the case of a rectangular side branch silencer. Furthermore, in comparisons between the two, the sound attenuation peak frequency was lower in the case of the exponential shape. The resonance of the side branch was suppressed by adding a non-woven fabric to the opening of the side branch silencer. As a result, the peak and dip of sound attenuation were alleviated, and the sound attenuation characteristics could be adjusted.