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1.  Management of post-hyperventilation apnea during dental treatment under monitored anesthesia care with propofol 
Biopsychosocial Medicine  2014;8(1):26.
Although hyperventilation syndrome generally carries a good prognosis, it is associated with the risk of developing severe symptoms, such as post-hyperventilation apnea with hypoxemia and loss of consciousness. We experienced a patient who suffered from post-hyperventilation apnea. A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure. We subsequently successfully provided her with monitored anesthesia care with propofol. Monitored anesthesia care with propofol may be effective for the general management of patients who have severe hyperventilation attacks and post-hyperventilation apnea. This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness.
doi:10.1186/s13030-014-0026-9
PMCID: PMC4260203  PMID: 25493097
Post-hyperventilation apnea; Propofol; Dental treatment
2.  Significance of debriefing methods in simulation-based sedation training courses for medical safety improvement in Japan 
SpringerPlus  2014;3:637.
Based on the American Society of Anesthesiologists’ Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists (ASA-SED), a sedation training course aimed at improving medical safety was developed by the Japanese Association for Medical Simulation in 2011. This study evaluated the effect of debriefing on participants’ perceptions of the essential points of the ASA-SED.
A total of 38 novice doctors participated in the sedation training course during the research period. Of these doctors, 18 participated in the debriefing group, and 20 participated in non-debriefing group. Scoring of participants’ guideline perceptions was conducted using an evaluation sheet (nine items, 16 points) created based on the ASA-SED.
The debriefing group showed a greater perception of the ASA-SED, as reflected in the significantly higher scores on the evaluation sheet (median, 16 points) than the control group (median, 13 points; p < 0.05). No significant differences were identified before or during sedation, but the difference after sedation was significant (p < 0.05).
Debriefing after sedation training courses may contribute to better perception of the ASA-SED, and may lead to enhanced attitudes toward medical safety during sedation and analgesia.
doi:10.1186/2193-1801-3-637
PMCID: PMC4218926  PMID: 25392805
Sedation and analgesia; Simulation training; Debriefing; Medical safety
3.  Thermosoftening of the Parker Flex-TipTM Tracheal Tube in Preparation for Nasotracheal Intubation 
Anesthesia Progress  2013;60(3):109-110.
The Parker Flex-Tip tracheal tube (PFTT, Parker Medical, Highlands Ranch, Colo) has a soft, flexible, curved tip with double Murphy eyes. Previous studies have shown that the PFTT reduces the incidence of epistaxis during nasotracheal intubation and the incidence of postintubation nasal pain, as compared to conventional tracheal tubes. Although thermosoftening is a well-known and effective technique for reducing epistaxis during nasotracheal intubation with conventional tracheal tubes, we occasionally encounter difficulties with advancing the tube through the nasal passage when the PFTT is thermosoftened prior to nasotracheal intubation. Consequently, when using the PFTT for nasotracheal intubation, the procedure of thermosoftening should be avoided.
doi:10.2344/0003-3006-60.3.109
PMCID: PMC3771198  PMID: 24010988
Thermosoftening; Tracheal tubes
4.  Modified i-gel Airway for Oral Surgery 
Anesthesia Progress  2011;58(3):124-125.
doi:10.2344/11-00018.1
PMCID: PMC3167156  PMID: 21882988

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