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Dexmedetomidine attenuates H₂O₂-induced cell death in human osteoblasts.

Ji Young YOON ; Jeong Hoon PARK ; Eun Jung KIM ; Bong Soo PARK ; Ji Uk YOON ; Sang Wook SHIN ; Do Wan KIM

Journal of Dental Anesthesia and Pain Medicine.2016;16(4):295-302. doi:10.17245/jdapm.2016.16.4.295

BACKGROUND: Reactive oxygen species play critical roles in homeostasis and cell signaling. Dexmedetomidine, a specific agonist of the α₂-adrenoceptor, has been commonly used for sedation, and it has been reported to have a protective effect against oxidative stress. In this study, we investigated whether dexmedetomidine has a protective effect against H₂O₂-induced oxidative stress and the mechanism of H₂O₂-induced cell death in normal human fetal osteoblast (hFOB) cells. METHODS: Cells were divided into three groups: control group—cells were incubated in normoxia without dexmedetomidine, hydrogen peroxide (H2O2) group—cells were exposed to H₂O₂ (200 µM) for 2 h, and Dex/H₂O₂ group—cells were pretreated with dexmedetomidine (5 µM) for 2 h then exposed to H₂O₂ (200 µM) for 2 h. Cell viability and apoptosis were evaluated. Osteoblast maturation was determined by assaying bone nodular mineralization. Expression levels of bone-related proteins were determined by western blot. RESULTS: Cell viability was significantly decreased in the H₂O₂ group compared with the control group, and this effect was improved by dexmedetomidine. The Hoechst 33342 and Annexin-V FITC/PI staining revealed that dexmedetomidine effectively decreased H₂O₂-induced hFOB cell apoptosis. Dexmedetomidine enhanced the mineralization of hFOB cells when compared to the H₂O₂ group. In western blot analysis, bone-related protein was increased in the Dex/H₂O₂ group. CONCLUSIONS: We demonstrated the potential therapeutic value of dexmedetomidine in H₂O₂-induced oxidative stress by inhibiting apoptosis and enhancing osteoblast activity. Additionally, the current investigation could be evidence to support the antioxidant potential of dexmedetomidine in vitro.
Apoptosis ; Blotting, Western ; Cell Death* ; Cell Survival ; Dexmedetomidine* ; Homeostasis ; Humans* ; Hydrogen Peroxide ; In Vitro Techniques ; Miners ; Osteoblasts* ; Oxidative Stress ; Reactive Oxygen Species

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Protective effects of remifentanil against H₂O₂-induced oxidative stress in human osteoblasts.

Ji Young YOON ; Do Wan KIM ; Eun Jung KIM ; Bong Soo PARK ; Ji Uk YOON ; Hyung Joon KIM ; Jeong Hoon PARK

Journal of Dental Anesthesia and Pain Medicine.2016;16(4):263-271. doi:10.17245/jdapm.2016.16.4.263

BACKGROUND: Bone injury is common in many clinical situations, such as surgery or trauma. During surgery, excessive reactive oxygen species (ROS) production decreases the quality and quantity of osteoblasts. Remifentanil decreases ROS production, reducing oxidative stress and the inflammatory response. We investigated remifentanil's protective effects against H₂O₂-induced oxidative stress in osteoblasts. METHODS: To investigate the effect of remifentanil on human fetal osteoblast (hFOB) cells, the cells were incubated with 1 ng/ml of remifentanil for 2 h before exposure to H2O2. For induction of oxidative stress, hFOB cells were then treated with 200 µM H₂O₂ for 2 h. To evaluate the effect on autophagy, a separate group of cells were incubated with 1 mM 3-methyladenine (3-MA) before treatment with remifentanil and H₂O₂. Cell viability and apoptotic cell death were determined via MTT assay and Hoechst staining, respectively. Mineralized matrix formation was visualized using alizarin red S staining. Western blot analysis was used to determine the expression levels of bone-related genes. RESULTS: Cell viability and mineralized matrix formation increased on remifentanil pretreatment before exposure to H₂O₂-induced oxidative stress. As determined via western blot analysis, remifentanil pretreatment increased the expression of bone-related genes (Col I, BMP-2, osterix, and TGF-β). However , pretreatment with 3-MA before exposure to remifentanil and H₂O₂ inhibited remifentanil's protective effects on hFOB cells during oxidative stress. CONCLUSIONS: We showed that remifentanil prevents oxidative damage in hFOB cells via a mechanism that may be highly related to autophagy. Further clinical studies are required to investigate its potential as a therapeutic agent.
Autophagy ; Blotting, Western ; Cell Death ; Cell Survival ; Humans* ; Miners ; Osteoblasts* ; Oxidative Stress* ; Reactive Oxygen Species

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Letter to the Editor: Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients.

Jaegyok SONG

Journal of Dental Anesthesia and Pain Medicine.2017;17(1):77-78. doi:10.17245/jdapm.2017.17.1.77

No abstract available.
Humans ; Prognathism* ; Retrognathia*

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Pulseless electrical activity during general anesthesia induction in patients with amyotrophic lateral sclerosis.

Tae Min YOU ; Seungoh KIM

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):235-240. doi:10.17245/jdapm.2017.17.3.235

Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.
Acidosis ; Amyotrophic Lateral Sclerosis* ; Anesthesia, General* ; Anoxia ; Emergencies ; Humans ; Hypovolemia ; Muscles ; Nervous System ; Peas ; Respiratory System

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Anesthetic considerations for a pediatric patient with Wolf-Hirschhorn syndrome: a case report.

Masanori TSUKAMOTO ; Hitoshi YAMANAKA ; Takeshi YOKOYAMA

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):231-233. doi:10.17245/jdapm.2017.17.3.231

Wolf-Hirschhorn syndrome is a rare hereditary disease that results from a 4p chromosome deletion. Patients with this syndrome are characterized by craniofacial dysgenesis, seizures, growth delay, intellectual disability, and congenital heart disease. Although several cases have been reported, very little information is available on anesthetic management for patients with Wolf-Hirschhorn syndrome. We encountered a case requiring anesthetic management for a 2-year-old girl with Wolf-Hirschhorn syndrome. The selection of an appropriately sized tracheal tube and maintaining intraoperatively stable hemodynamics might be critical problems for anesthetic management. In patients with short stature, the tracheal tube size may differ from what may be predicted based on age. The appropriate size ( internal diameter ) of tracheal tubes for children has been investigated. Congenital heart disease is frequently associated with Wolf-Hirschhorn syndrome. Depending on the degree and type of heart disease, careful monitoring of hemodynamics is important.
Anesthesia, General ; Child ; Child, Preschool ; Chromosome Deletion ; Female ; Genetic Diseases, Inborn ; Heart Defects, Congenital ; Heart Diseases ; Hemodynamics ; Humans ; Intellectual Disability ; Intubation, Intratracheal ; Seizures ; Wolf-Hirschhorn Syndrome*

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Removal of a fractured needle during inferior alveolar nerve block: two case reports.

Jae Seek YOU ; Su Gwan KIM ; Ji Su OH ; Hae In CHOI ; Myeong Kwan JIH

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):225-229. doi:10.17245/jdapm.2017.17.3.225

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.
Anesthesia ; Anesthesia, Local ; Mandibular Nerve* ; Methods ; Needles* ; Nerve Block

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Fiberoptic bronchoscope and C-MAC video laryngoscope assisted nasal-oral tube exchange: two case reports.

Sungmi JI ; Jaegyok SONG ; Seok Kon KIM ; Moon Young KIM ; Sangyun KIM

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):219-223. doi:10.17245/jdapm.2017.17.3.219

In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device. We report a successful airway conversion under the aid of both, a fiberoptic bronchoscope and a C-MAC video laryngoscope.
Airway Management ; Bronchoscopes* ; Bronchoscopy ; Hemorrhage ; Humans ; Intubation, Intratracheal ; Laryngoscopes* ; Methods

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Anesthetic management of a patient with branchio-oto-renal syndrome.

Masanori TSUKAMOTO ; Takeshi YOKOYAMA

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):215-217. doi:10.17245/jdapm.2017.17.3.215

Branchio-oto-renal syndrome (BOR) is a rare autosomal dominant disorder. The features include branchial cysts, hearing loss, ear malformation, preauricular pits, retrognathia, congenital heart disease, and renal abnormalities. However, anesthetic management of these patients has seldom been reported. We report a case in which general anesthesia was performed for dental treatment in a patient with BOR. Airway management, renal function, and hemodynamic changes can be of critical concern during anesthetic management. A 13-year-old girl diagnosed with BOR had severe right hearing loss, right external ear malformation, renal abnormalities, and postoperative patent ductus arteriosus (PDA). Dental extraction under general anesthesia was scheduled for a supernumerary tooth. The procedure was completed with sufficient urine volume, adequate airway management, and stable hemodynamics.
Adolescent ; Airway Management ; Anesthesia, General ; Branchio-Oto-Renal Syndrome ; Branchioma ; Ductus Arteriosus, Patent ; Ear ; Ear, External ; Female ; Hearing Loss ; Heart Defects, Congenital ; Hemodynamics ; Humans ; Renal Insufficiency ; Retrognathia ; Tooth, Supernumerary

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Prognosis following dental implant treatment under general anesthesia in patients with special needs.

Il Hyung KIM ; Tae Seong KUK ; Sang Yoon PARK ; Yong Suk CHOI ; Hyun Jeong KIM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):205-213. doi:10.17245/jdapm.2017.17.3.205

BACKGROUND: This study retrospectively investigated outcomes following dental implantation in patients with special needs who required general anesthesia to enable treatment. METHODS: Patients underwent implant treatment under general anesthesia at the Clinic for the Disabled in Seoul National University Dental Hospital between January 2004 and June 2017. The study analyzed medical records and radiographs. Implant survival rates were calculated by applying criteria for success or failure. RESULTS: Of 19 patients in the study, 8 were males and 11 were females, with a mean age of 32.9 years. The patients included 11 with mental retardation, 3 with autism, 2 with cerebral palsy, 2 with schizophrenia, and 1 with a brain disorder; 2 patients also had seizure disorders. All were incapable of oral self-care due to serious cognitive impairment and could not cooperate with normal dental treatment. A total of 27 rounds of general anesthesia and 1 round of intravenous sedation were performed for implant surgery. Implant placement was performed in 3 patients whose prosthesis records could not be found, while 3 other patients had less than 1 year of follow-up after prosthetic treatment. When the criteria for implant success or failure were applied in 13 remaining patients, 3 implant failures occurred in 59 total treatments. The cumulative survival rate of implants over an average of 43.3 months (15-116 months) was 94.9%. CONCLUSIONS: For patients with severe cognitive impairment who are incapable of oral self-care, implant treatment under general anesthesia showed a favorable prognosis.
Anesthesia, General* ; Autistic Disorder ; Brain Diseases ; Cerebral Palsy ; Cognition Disorders ; Dental Implantation ; Dental Implants* ; Disabled Persons ; Epilepsy ; Female ; Follow-Up Studies ; Humans ; Intellectual Disability ; Male ; Medical Records ; Prognosis* ; Prostheses and Implants ; Retrospective Studies ; Schizophrenia ; Self Care ; Seoul ; Survival Rate

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Complications associated with intravenous midazolam and fentanyl sedation in patients undergoing minor oral surgery.

Krittika SAISO ; Pornnarin ADNONLA ; Jitpisut MUNSIL ; Benjamas APIPAN ; Duangdee RUMMASAK ; Natthamet WONGSIRICHAT

Journal of Dental Anesthesia and Pain Medicine.2017;17(3):199-204. doi:10.17245/jdapm.2017.17.3.199

BACKGROUND: Anxiety control remains an important concern in dental practice. We evaluated the incidence, nature, and sequelae of complications during and after minor oral surgeries performed under intravenous midazolam and fentanyl sedation using the titration technique. METHODS: The medical records of patients who had undergone minor oral surgeries under moderate intravenous midazolam and fentanyl sedation at our institution between January 1, 2015 and December 31, 2015 were retrospectively evaluated. Age, sex, body mass index, medical history, American Society of Anesthesiologists (ASA) classification, indications for sedation, amount of sedative used, surgical duration, and recovery time were evaluated for all patients. RESULTS: In total, 107 patients aged 9–84 years were included. ASA class I and class II were observed for 56.1% and 43.9% patients, respectively. Complications associated with sedation occurred in 11 (10.2%) patients. There were no serious adverse events. Oxygen saturation reached 95% during the procedure in six patients; this was successfully managed by stimulating the patients to take a deep breath. Two patients exhibited deep sedation and one exhibited paradoxical excitement. After the procedure, one patient experienced nausea without vomiting and one exhibited a prolonged recovery time. The surgical procedures were completed in all patients. Obesity was found to be significantly associated with sedation-related complications. CONCLUSIONS: Our results suggest that complications associated with intravenous midazolam and fentanyl sedation using the titration technique for minor oral surgeries are mostly minor and can be successfully managed with no prolonged sequelae.
Anxiety ; Body Mass Index ; Classification ; Deep Sedation ; Fentanyl* ; Humans ; Incidence ; Medical Records ; Midazolam* ; Minor Surgical Procedures ; Nausea ; Obesity ; Oxygen ; Retrospective Studies ; Surgery, Oral* ; Vomiting

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