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Effects of Stellate Ganglion Blockade on Muscle Blood Flow During Hypercapnia
Tatsuya IchinoheDDS, PhD,
Yui AkiikeDDS, PhD,
Natsuki SaitoDDS,
Masato KoikeDDS,
Kyotaro KoshikaDDS, PhD, and
Nobuyuki MatsuuraDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-67-01-04
Page Range: 135 – 139

Myofascial pain is a common underlying cause of nonodontogenic pain in clinical practice. 1 Referred pain from the masseter muscle can manifest as a toothache involving the maxillary or mandibular molars. 1 , 2 Muscular deoxygenation due to reduced muscle blood flow (MBF) has been associated with myofascial pain. 3 – 6 Additionally, masseter MBF has been demonstrated to decrease during hypercapnia. 7 This is likely due to the effects of hypercapnia on enhancing sympathetic activity and producing vasoconstriction through α1 and α2

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Figure 1.; Mean changes in muscle blood flow during hypercapnia and after phentolamine or metaproterenol administration. MBF and QBF decreased during hypercapnia, while the decrease in MBF was smaller than that in QBF. Both MBF and QBF recovered to their baseline levels after phentolamine administration. In contrast, although MBF became greater than its baseline level, QBF did not fully recover to its baseline level after phentolamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; b P < .05 versus hypercapnia; c P < .05 between the 2 groups.
Kyotaro Koshika,
Rumi Kaneko,
Mai Shionoya,
Kotaro Shimizu,
Yuka Sendai,
Nobutaka Matsuura,
Yui Akiike, and
Tatsuya Ichinohe
Figure 1.
Figure 1.

Mean changes in muscle blood flow during hypercapnia and after phentolamine or metaproterenol administration.

MBF and QBF decreased during hypercapnia, while the decrease in MBF was smaller than that in QBF. Both MBF and QBF recovered to their baseline levels after phentolamine administration. In contrast, although MBF became greater than its baseline level, QBF did not fully recover to its baseline level after phentolamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; b P < .05 versus hypercapnia; c P < .05 between the 2 groups.

; Muscle blood flow during hypercapnia and post-stellate ganglion block (SGB) compared with baseline. Left and right masseter muscle tissue blood flow (LMBF and RMBF) decreased to ∼75% and left femoral quadriceps muscle tissue blood flow (LQBF) decreased to ∼60% of the respective baseline values at hypercapnia. Although LMBF recovered to its baseline value, RMBF and LQBF further decreased and reached ∼55 and 45% of their respective baseline values at post-SGB. Mean ± SD (n = 8). & p < 0.05 compared with LMBF; $ p < 0.05 compared with RMBF.
Tatsuya Ichinohe,
Yui Akiike,
Natsuki Saito,
Masato Koike,
Kyotaro Koshika, and
Nobuyuki Matsuura

Muscle blood flow during hypercapnia and post-stellate ganglion block (SGB) compared with baseline. Left and right masseter muscle tissue blood flow (LMBF and RMBF) decreased to ∼75% and left femoral quadriceps muscle tissue blood flow (LQBF) decreased to ∼60% of the respective baseline values at hypercapnia. Although LMBF recovered to its baseline value, RMBF and LQBF further decreased and reached ∼55 and 45% of their respective baseline values at post-SGB. Mean ± SD (n = 8). & p < 0.05 compared with LMBF; $ p < 0.05 compared with RMBF.

Involvement of α- and β-Adrenergic Receptors in Skeletal Muscle Blood Flow Changes During Hyper-/Hypocapnia in Anesthetized Rabbits
Kyotaro KoshikaDDS, PhD,
Rumi KanekoDDS,
Mai ShionoyaDDS,
Kotaro ShimizuDDS,
Yuka SendaiDDS,
Nobutaka MatsuuraDDS,
Yui AkiikeDDS, PhD, and
Tatsuya IchinoheDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-70-02-02
Page Range: 58 – 64

(T108, Transonic). A flow probe (type 3SB) was applied to the isolated left common carotid artery. HR, systolic blood pressure (SBP), and CCBF were continuously recorded using a tachometer (HRM-100, Unique Medical). MBF and QBF were analyzed using a data collection analysis system (UCO, Unique Medical). Measurements were performed at 3 periods: (1) baseline, (2) hypercapnia/hypocapnia, and (3) during or after receiving vasoactive agents. After baseline, ETCO 2 was changed to 30 or 60 mm Hg and maintained at this level for 15 minutes, and measurements

Tissue Blood Flow During Remifentanil Infusion With Carbon Dioxide Loading
Hiroaki KanbeDDS, PhD,
Nobuyuki MatsuuraDDS, PhD,
Masataka KasaharaDDS, PhD, and
Tatsuya IchinoheDDS, PhD
Article Category: Other
Volume/Issue: Volume 62: Issue 2
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.2.51
Page Range: 51 – 56

another approach to control tissue blood flow in the oral region during general anesthesia. Handa et al 7 reported that hypercapnia increases common carotid artery blood flow (CCBF) and mandibular bone marrow tissue blood flow (BBF), while it decreases masseter muscle tissue blood flow (MBF). Kemmochi et al 8 reported that remifentanil (Remi) decreases CCBF and BBF without a substantial reduction of blood pressure. Koshika et al 9 reported that Remi decreases tongue mucosal blood flow (TBF), BBF, MBF, upper alveolar tissue blood flow (UBF), and lower alveolar tissue

Figure 1. ; Effect of minute ventilation during oxygen-induced hypercapnia. During 15 minutes of high oxygen administration, which recovers substantially, is seen in patients with acute exacerbation of chronic obstructive pulmonary disease. However, the oxygen-induced hypercapnia does not recover. CO2, carbon dioxide; VE, minute ventilation.
Kristin Chino,
Steven Ganzberg, and
Kristopher Mendoza
<bold>Figure 1.</bold>
Figure 1.

Effect of minute ventilation during oxygen-induced hypercapnia. During 15 minutes of high oxygen administration, which recovers substantially, is seen in patients with acute exacerbation of chronic obstructive pulmonary disease. However, the oxygen-induced hypercapnia does not recover. CO2, carbon dioxide; VE, minute ventilation.

Figure 2.; Mean changes in muscle blood flow during hypocapnia and after phenylephrine or butoxamine administration. MBF and QBF increased during hypocapnia, while the increase in MBF was larger than that in QBF. Both MBF and QBF decreased to about 90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; d P < .05 versus hypocapnia; c P < .05 between the 2 groups.
Kyotaro Koshika,
Rumi Kaneko,
Mai Shionoya,
Kotaro Shimizu,
Yuka Sendai,
Nobutaka Matsuura,
Yui Akiike, and
Tatsuya Ichinohe
Figure 2.
Figure 2.

Mean changes in muscle blood flow during hypocapnia and after phenylephrine or butoxamine administration.

MBF and QBF increased during hypocapnia, while the increase in MBF was larger than that in QBF. Both MBF and QBF decreased to about 90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; d P < .05 versus hypocapnia; c P < .05 between the 2 groups.

Figure 1.; Comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The DBP level was increased and HR was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between two values at the same ETCO2 level.
Hiroaki Kanbe,
Nobuyuki Matsuura,
Masataka Kasahara, and
Tatsuya Ichinohe
Figure 1.
Figure 1.

Comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The DBP level was increased and HR was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between two values at the same ETCO2 level.

Figure 2.; Comparisons of common carotid artery blood flow (CCBF), tongue mucosal blood flow (TBF), mandibular bone marrow tissue blood flow (BBF), upper alveolar tissue blood flow (UBF), lower alveolar tissue blood flow (LBF), and masseter muscle tissue blood flow (MBF) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The BBF, UBF, and LBF values were increased and MBF was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between 2 values at the same ETCO2 level.
Hiroaki Kanbe,
Nobuyuki Matsuura,
Masataka Kasahara, and
Tatsuya Ichinohe
Figure 2.
Figure 2.

Comparisons of common carotid artery blood flow (CCBF), tongue mucosal blood flow (TBF), mandibular bone marrow tissue blood flow (BBF), upper alveolar tissue blood flow (UBF), lower alveolar tissue blood flow (LBF), and masseter muscle tissue blood flow (MBF) during remifentanil (Remi) infusion with those during no Remi infusion. All variables were decreased during Remi infusion when compared under identical end-tidal carbon dioxide tension (ETCO2) level. The BBF, UBF, and LBF values were increased and MBF was decreased along with ETCO2 elevation during Remi infusion. Data are shown as mean ± SD (n = 8). *P < .05 versus respective values at ETCO2 30 mm Hg. #P < .05 between 2 values at the same ETCO2 level.

A Case of General Anesthesia for a Young Infant in Whom Intubation Was Suspected to Be Difficult Because of a Thyrolingual Cyst
Tomoyasu Noguchi,
Noriko Miyazawa,
Nami Ooyama, and
Tatsuya Ichinohe
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-02-04
Page Range: 127 – 128

prolonged apnea during the intubation process, an inner diameter of 3.5-mm uncuffed endotracheal tube was inserted through the right nasal cavity into the oropharynx and connected to the anesthetic circuit. After confirming the tracheal branch, the tracheal tube in the left nasal cavity was advanced to complete the tracheal intubation. Oxygen saturation was kept within the normal range during the process. Using this method, nasal intubation was successfully performed without hypoxia or hypercapnia in this 3-month-old infant. Figure 1