Review of the Evaluation and Treatment of Vasovagal Reactions in Outpatient Procedures

Abstract

Vasovagal reactions should be carefully evaluated. Additional studies may provide greater data in understanding and managing vasovagal reactions.

Characterization of an Artificial Liver Support System-Related Vasovagal Reaction

“…Hypermetabolism in the adrenal gland responsible for synthesizing and secreting catecholamines is indicated by increased adrenal fluorodeoxyglucose accumulation on positron emission tomography/computed tomography [ 20 ]. Elements such as fear, pain, and a bad mood can be triggers, leading to a strong autonomic response [ 12 ]. Internal factors such as hyperventilation, hypotension, and stress may also precipitate a VVR in some cases [ 21 ].…”

“…First, operation of the ALSS device should be stopped to reduce stimulation and prevent a further reduction of the circulating blood volume. The patient's anxiety should be assuaged by reassurance and “talk-esthesia.” [ 12 ] Second, reclining the patient rapidly into the Trendelenburg position helps facilitate perfusion to the brain [ 25 ]. Hand holding will help increase peripheral resistance and venous return [ 26 ].…”

“…A VVR was defined as the presence of at least one of the following criteria with associated symptoms: (1) bradycardic episode (heart rate (HR) < 60 beats/min (bpm)) and hypotension (systolic blood pressure (SBP) < 100 mmHg) in the supine position or (2) development of syncope [ 6 , 11 ]. Common symptoms include pallor, faintness, dizziness, sweating, nausea, shivering, vomiting, heat intolerance, cold intolerance, and loss of consciousness [ 12 ]. Exclusion criteria were heart failure, myocardial infarction, or other severe liver diseases.…”

“…The patient's anxiety should be assuaged by reassurance and "talk-esthesia." [12] Second, reclining the patient rapidly into the Trendelenburg position helps facilitate perfusion to the brain [25]. Hand holding will help increase peripheral resistance and venous return [26].…”

“…Before treatment, clinicians should explain the entire ALSS procedure and related complications to the patient in detail to eliminate their fear and anxiety. The support of a family member or trusted friend is integral [12]. Patients should be encouraged to eat regularly and drink adequate fluids while avoiding alcohol before treatment [12].…”