Negative pressure pulmonary edema ( NPPE ) following upper airway obstruction (UAO) has been reported in several clinical situations. The main cause of NPPE is reported to be increased negative intrathoracic pressure. We present a case of NPPE that occurred after general anesthesia for plate removal after jaw deformity surgery. After completion of the surgery, administration of inhaled anesthetics was stopped and the patient opened his eyes on verbal command. Immediately after extubation, the patient stopped breathing and became cyanotic. Acute UAO following laryngospasm was suspected. Soon after reintubation, pink, frothy fluid came out of the endotracheal tube, and a tentative diagnosis of NPPE was made. Continuous positive airway pressure was applied. In addition, furosemide and dexamethasone were administered. By the next day, the symptoms had almost disappeared.

Remifentanil had a rapid onset and short duration of action, and probably showed signs of tolerance development, whereas the antinocieptive effect of adenosine was slow in onset and long-lasting, despite its ultrashort plasma half-life and the immediate on-off profiles of its vasodilating effect.

This study was intended to determine the tissue distribution of lidocaine in mandibular mucosa and alveolar bone marrow after local infiltration. Tissue distribution of local anesthetics shortly after regional injection has been unclear. We used macro autoradiography to visually examine the tissue distribution of lidocaine shortly after local anesthetic infiltration. Male Japan White rabbits received an injection of 14 C-labeled 2% lidocaine with or without 1:80,000 epinephrine. The areas of infiltration and proportion of distribution 1, 5 and 10 minutes after administration were measured. After the administration of 2% lidocaine with 1:80,000 epinephrine, infiltration area increased over time. Ratios of distribution in alveolar bone marrow at the level equivalent to the root apex increased in 1 to 5 minutes after administration, and then decreased. In contrast, after the administration of plain lidocaine, infiltration was hardly detected. These results suggest that infiltration of lidocaine with epinephrine diffused to a wider area over time after administration and then gradually absorbed into the capillaries.

The aim of this study was to investigate cases of accidental ingestion or aspiration occurring at Tokyo Dental College Chiba Hospital over the last 4 years in order to determine how the incidence of such events could be reduced. Forty cases of accidents occurring at our hospital over a 4-year period commencing in 2008 (representing 27% of the total number of accidents) included accidental ingestion in 39 patients and aspiration in one. Most of these accidents occurred during the removal or placement of restorations or prosthetics, and the ingested objects were mostly crowns and inlays. Accidental ingestion or aspiration occurred more frequently in the right molar region and when procedures were conducted by practitioners with less than 1 to 7 years of experience, and especially 1 to 3 years only. A higher rate of such accidents was observed in male patients in their 50s to 70s. The conventional safety procedures developed by the Medical Risk Management Team should be adhered to wherever possible. Furthermore, we propose the following measures based on the present results: accident prevention training for students and clinical trainees; improvement of the in-hospital manual; Clinical Report 55Bull Tokyo Dent Coll (2014) 55(1): 55-62 56

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