PDF(Pubmed)
Abstract：
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.
摘要：
围手术期心脏事件可能是由于过度的心理和身体压力导致的自主神经活动相对失衡引起的。本案例研究的重点是心搏停止，这种心搏停止可能是与血管迷走神经反射相关的严重心脏不良事件，可能是在牙科护理期间通过静脉穿刺来确保静脉内管线的安全而触发的。此外,我们在此描述并讨论了一名牙科恐惧症患者的静脉镇静管理，该患者经历了血管迷走神经反射，并参与了意外的短暂心搏停止。患者在日常生活中有血管迷走反射发作,没有与心血管疾病相关的既往病史，计划在静脉镇静下拔牙。外周静脉导管插入后立即，她抱怨不适和恶心，和II导联心电图显示心搏停止后与血管迷走反射相关的心动过缓。下肢抬高的仰卧位氧合和静脉液体负荷可恢复窦性心律和正常的血流动力学，而无需心肺复苏。静脉注射阿托品和倍他米松作为术前用药，在无压力的心身疾病中,她接受了咪达唑仑最佳镇静治疗,没有任何心血管疾病的迹象.服用氟马西尼后，患者在没有再次镇静的情况下从镇静中令人满意地康复。本病例表明，在牙科焦虑症期间，静脉穿刺进行静脉内导管插入可触发与血管迷走反射相关的心搏停止，这可能会影响交感神经和副交感神经活动之间的失衡。
