Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Sci Prog. 2021 Jul-Sep;104(3):368504211033708. doi: 10.1177/00368504211033708.
Perioperative arrhythmias may be induced by an imbalance between sympathetic and parasympathetic activities owing to excessive mental and physical stress. To date, no studies have been conducted on intravenous sedation (IVS) during dental procedures in a serious dental anxiety patient with atrioventricular junctional rhythm (AVJR). We describe herein the management of IVS in an outpatient with dental phobia who experienced the AVJR followed by vasovagal reflex (VVR) during dental care. A 26-year-old woman with serious dental anxiety was scheduled for dental extraction under intravenous conscious sedation. A II-lead electrocardiogram revealed AVJR following sinus rhythm. Immediately afterwards, she experienced VVR with dimmed vision, cold sweat, hypotension, and bradycardia. She was made to relax in the supine position, which restored hemodynamics to normal, and sinus rhythm followed. She was optimally sedated with midazolam 4 mg and uneventfully treated under a preparation of intravenous atropine, and hemodynamic and respiratory statuses were closely monitored to ensure spontaneous breathing without any signs of AVJR or cardiorespiratory disorders. Finally, flumazenil 0.5 mg was administered, and she recovered without re-sedation or prolonged sedation. The autonomic nervous system and endocrine system are closely related in order to control the stress responses. The present case suggests that an electrocardiographic change such as AVJR is induced by an imbalance of autonomic activity owing to excessive psychosomatic stress and is considered as a possible prodromal sign of VVR as the dental procedures are likely to be stressful for some patients.
围手术期心律失常可能是由于精神和身体压力过大导致交感和副交感活动失衡引起的。迄今为止，尚无研究报道在严重牙科焦虑症伴房室结节律（AVJR）患者的牙科手术中进行静脉镇静（IVS）。我们在此描述了对一名牙科恐惧症门诊患者进行 IVS 管理的情况，该患者在牙科护理期间经历了 AVJR 继而出现血管迷走性反射（VVR）。一名 26 岁女性，严重牙科焦虑症，计划在静脉清醒镇静下进行拔牙。II 导联心电图显示窦性心律后出现 AVJR。随后，她立即出现 VVR，表现为视力模糊、冷汗、低血压和心动过缓。她被置于仰卧位放松，使血流动力学恢复正常，并恢复窦性心律。她接受了 4mg 咪达唑仑的最佳镇静，并在静脉阿托品准备下进行了无痛治疗，密切监测血流动力学和呼吸状况，以确保自主呼吸，没有出现 AVJR 或心肺功能障碍的迹象。最后，给予氟马西尼 0.5mg，她无需再次镇静或延长镇静即可恢复。自主神经系统和内分泌系统密切相关，以控制应激反应。本病例提示，由于身心压力过大导致自主活动失衡，可能会引起心电图改变，如 AVJR，并被认为是 VVR 的可能前驱征象，因为牙科手术对某些患者来说可能是有压力的。
