Transient asystole associated with vasovagal reflex in an oral surgery patient: A case report

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.

Torsade de pointes during an oral surgery caused by a combination of herbal medicine-induced pseudoaldosteronism and trigeminocardiac reflex

“…Although its incidence rate is low, paroxysmal bradycardia caused by trigeminal nerve stimulation during oral and facial surgery has been reported [ 2 ]. Stimulation of any of the sensory divisions of the trigeminal nerve, including setting up the mouth prop [ 6 ], is thought to provide a stimulus for the initiation of a sudden cardiac response called TGR, trigeminovagal reflex or oculocardiac reflex.…”

“…Stimulation of any of the sensory divisions of the trigeminal nerve, including setting up the mouth prop [ 6 ], is thought to provide a stimulus for the initiation of a sudden cardiac response called TGR, trigeminovagal reflex or oculocardiac reflex. Typically, TGR causes transient bradycardia and hypotension [ 2 ]. However, although rare, there are reports of disastrous ventricular arrhythmia being caused by TGR [ 7 ].…”

“…Using licorice has been reported to cause pseudoaldosteronism, which manifests as hypokalemia and leads to QT prolongation [ 1 ]. Furthermore, manipulations during oral surgeries can cause transient bradycardia via the trigeminocardiac reflex (TGR), posing a risk to patients with transient bradycardia and hypotension [ 2 ].…”

Clinical Efficacy and Safety of Lidocaine Tape for Topical Anesthesia of the Oral Mucosa: A Preliminary Controlled Trial

“…Since older people with cardiovascular disease have a lower tolerance for stress, pain stimuli during dental treatment may cause changes in the circulatory dynamics, leading to various complications such as arrhythmias and angina pectoris. Therefore, we aimed to develop a painless dental treatment that can minimize stress and significant blood pressure fluctuations in dental patients [1,2].…”