Jiang Shixie, Nolasco Diego, Czuma Richard, Janssen Brandon, Gunther Matthew
Psychiatry, University of Florida College of Medicine, Gainesville, USA.
Psychiatry, Edward Hines Jr. Veterans Administration Medical Center, Hines, USA.
Cureus. 2025 Jun 15;17(6):e86075. doi: 10.7759/cureus.86075. eCollection 2025 Jun.
This case report describes the successful use of oral guanfacine, a centrally acting alpha-2 agonist, for treating panic-induced vasovagal syncope in a 68-year-old intensive care unit (ICU) patient recovering from lung transplant and cardiac complications. The patient experienced recurrent episodes of severe anxiety and syncope triggered by physical therapy, unresponsive to standard anxiolytics. Guanfacine was chosen given its less pronounced cardiovascular effects and modulation of norepinephrine, and titrated over 10 days, leading to complete resolution of symptoms without adverse effects or recurrence. The patient resumed rehabilitation and guanfacine was successfully tapered prior to discharge. This case highlights guanfacine as a potentially useful anxiolytic option for ICU patients even with cardiovascular vulnerability as it exhibits less pronounced cardiovascular effects and may therefore be considered safer than other alpha-2 agonists.
本病例报告描述了口服胍法辛（一种中枢作用的α-2激动剂）成功用于治疗一名68岁重症监护病房（ICU）患者的惊恐诱发血管迷走性晕厥，该患者正从肺移植和心脏并发症中康复。患者因物理治疗引发严重焦虑和晕厥反复发作，对标准抗焦虑药无反应。选择胍法辛是因其心血管作用不那么明显且能调节去甲肾上腺素，并在10天内滴定给药，症状完全缓解，无不良反应或复发。患者恢复康复治疗，出院前胍法辛成功减量。本病例突出了胍法辛作为ICU患者潜在有用的抗焦虑选择，即使对于有心血管易损性的患者也是如此，因为它表现出不那么明显的心 血管作用，因此可能比其他α-2激动剂更安全。
