Shimoda Hajime, Yamauchi Kensuke, Takahashi Tetsu
Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan.
SAGE Open Med Case Rep. 2023 Jan 3;11:2050313X221146019. doi: 10.1177/2050313X221146019. eCollection 2023.
The perioperative cardiac events may be brought about by a relative imbalance of autonomic activities due to excessive psychological and physical stress. The present case study focuses on the asystole that can occur as a serious cardiac adverse event associated with vasovagal reflex likely to be triggered by venipuncture for securing an intravenous line during dental care. In addition, we describe and discuss herein the management of intravenous sedation for a dental phobic patient who experienced the vasovagal reflex involved in an unexpected transient asystole. The patient with vasovagal reflex episodes in daily life, who had no past medical history relevant to cardiovascular disorders, was scheduled for dental extraction under intravenous sedation. Immediately after peripheral intravenous catheterization, she complained of discomfort and nausea, and a II-lead electrocardiogram revealed asystole following bradycardia associated with vasovagal reflex. Oxygenation and intravenous fluid loading in the supine position with elevation of the lower extremities restored sinus rhythm and normal hemodynamics without the intervention of cardiopulmonary resuscitation. With administration of intravenous atropine and betamethasone as premedication, she was uneventfully treated in stress-free psychosomatic conditions under optimal sedation with midazolam without any signs of cardiovascular disorders. After administration of flumazenil, the patient satisfactorily recovered from sedation without re-sedation. The present case suggests that an asystole associated with vasovagal reflex can be triggered by venipuncture for intravenous catheterization during dental anxiety likely to affect the imbalance between sympathetic and parasympathetic activities.
围手术期心脏事件可能是由于过度的心理和身体应激导致自主神经活动相对失衡所致。本病例研究聚焦于心脏停搏，这是一种严重的心脏不良事件，可能与血管迷走反射有关，在牙科治疗中为建立静脉通路进行静脉穿刺时可能会触发该反射。此外，我们在此描述并讨论了对一名牙科恐惧症患者进行静脉镇静的管理，该患者经历了与意外短暂心脏停搏相关的血管迷走反射。该患者在日常生活中有血管迷走反射发作史，无心血管疾病相关既往病史，计划在静脉镇静下进行拔牙。外周静脉置管后立即，她主诉不适和恶心，II导联心电图显示与血管迷走反射相关的心动过缓后出现心脏停搏。在下肢抬高的仰卧位进行氧疗和静脉补液，在未进行心肺复苏干预的情况下恢复了窦性心律和正常血流动力学。通过静脉注射阿托品和倍他米松作为术前用药，她在无压力的身心状态下，在咪达唑仑的最佳镇静下顺利接受治疗，未出现任何心血管疾病迹象。注射氟马西尼后，患者从镇静中顺利恢复，无需再次镇静。本病例表明，在牙科焦虑期间，静脉穿刺置管可能会触发与血管迷走反射相关的心脏停搏，这可能会影响交感神经和副交感神经活动之间的平衡。
