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Abstract：
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.
摘要：
由于过度的精神和身体压力，交感神经和副交感神经活动之间的不平衡可能会引起围手术期心律失常。迄今为止,尚未对患有房室交界性心律(AVJR)的严重牙科焦虑症患者进行牙科手术期间的静脉镇静(IVS)进行研究.我们在此描述了患有牙科恐惧症的门诊病人的IVS管理，该病人在牙科护理期间经历了AVJR，然后是血管迷走神经反射（VVR）。一名患有严重牙科焦虑症的26岁妇女被安排在静脉内清醒镇静下进行拔牙。II导联心电图显示窦性心律后AVJR。紧接着,她经历了视觉暗淡的VVR，冷汗,低血压,和心动过缓.她被迫以仰卧姿势放松，使血流动力学恢复正常,随后是窦性心律。她用咪达唑仑4毫克最佳镇静剂，并在静脉注射阿托品制剂下顺利治疗，密切监测血流动力学和呼吸状态,以确保自主呼吸无任何AVJR或心肺功能紊乱的体征.最后,给予氟马西尼0.5mg，她恢复了，没有再次镇静或长时间镇静。自主神经系统和内分泌系统密切相关，以控制应激反应。目前的情况表明，由于过度的心身压力，自主神经活动的不平衡会引起诸如AVJR之类的心电图变化，并且被认为是VVR的可能前驱体征，因为牙科手术可能会给某些患者带来压力。
