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Management of post-hyperventilation apnea during dental treatment under monitored anesthesia care with propofol.

Kobayashi M, Kurata S, Sanuki T, Okayasu I, Ayuse T - Biopsychosoc Med (2014)

Bottom Line: A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure.We subsequently successfully provided her with monitored anesthesia care with propofol.This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness.

View Article: PubMed Central - PubMed

Affiliation: Department of Dental Anesthesiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, 852-8588 Japan.

ABSTRACT
Although hyperventilation syndrome generally carries a good prognosis, it is associated with the risk of developing severe symptoms, such as post-hyperventilation apnea with hypoxemia and loss of consciousness. We experienced a patient who suffered from post-hyperventilation apnea. A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure. We subsequently successfully provided her with monitored anesthesia care with propofol. Monitored anesthesia care with propofol may be effective for the general management of patients who have severe hyperventilation attacks and post-hyperventilation apnea. This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness.

No MeSH data available.


Related in: MedlinePlus

Time course of the first episode. Midazolam was used for the treatment of hyperventilation syndrome.
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Fig1: Time course of the first episode. Midazolam was used for the treatment of hyperventilation syndrome.

Mentions: Hyperventilation syndrome in patients with no underlying organic abnormality is frequently observed during medical and dental practice. Although the pathophysiological mechanisms of hyperventilation syndrome are still not fully understood, the relative roles of peripheral and central chemoreceptors in causing hyperventilation attacks have been suggested. Although it is believed that episodes of hyperventilation attacks resolve spontaneously and that the paper-bag rebreathing method or administration of anxiolytic agents may help mitigate an attack, sustained symptoms associated with hypocapnia have been reported to initiate complex clinical complications, such as the delayed occurrence of hypoxemia. Furthermore, several case reports have described the occurrence of post-hyperventilation apnea in association with sustained cyanosis, hypoxemia and loss of consciousness [1-4]. The pathogenesis of post-hyperventilation apnea has been linked to the activity of peripheral chemoreceptors, which may contribute to the susceptibility to apnea during hypoxia or hyperoxia [5]. We provided monitored anesthesia care thrice to a patient who had a history of hyperventilation attacks and post-hyperventilation apnea during dental treatment under sedation with regional anesthesia. The aim of this report is to describe the management of hyperventilation attacks and post-hyperventilation apnea during dental treatment.


Management of post-hyperventilation apnea during dental treatment under monitored anesthesia care with propofol.

Kobayashi M, Kurata S, Sanuki T, Okayasu I, Ayuse T - Biopsychosoc Med (2014)

Time course of the first episode. Midazolam was used for the treatment of hyperventilation syndrome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260203&req=5

Fig1: Time course of the first episode. Midazolam was used for the treatment of hyperventilation syndrome.
Mentions: Hyperventilation syndrome in patients with no underlying organic abnormality is frequently observed during medical and dental practice. Although the pathophysiological mechanisms of hyperventilation syndrome are still not fully understood, the relative roles of peripheral and central chemoreceptors in causing hyperventilation attacks have been suggested. Although it is believed that episodes of hyperventilation attacks resolve spontaneously and that the paper-bag rebreathing method or administration of anxiolytic agents may help mitigate an attack, sustained symptoms associated with hypocapnia have been reported to initiate complex clinical complications, such as the delayed occurrence of hypoxemia. Furthermore, several case reports have described the occurrence of post-hyperventilation apnea in association with sustained cyanosis, hypoxemia and loss of consciousness [1-4]. The pathogenesis of post-hyperventilation apnea has been linked to the activity of peripheral chemoreceptors, which may contribute to the susceptibility to apnea during hypoxia or hyperoxia [5]. We provided monitored anesthesia care thrice to a patient who had a history of hyperventilation attacks and post-hyperventilation apnea during dental treatment under sedation with regional anesthesia. The aim of this report is to describe the management of hyperventilation attacks and post-hyperventilation apnea during dental treatment.

Bottom Line: A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure.We subsequently successfully provided her with monitored anesthesia care with propofol.This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness.

View Article: PubMed Central - PubMed

Affiliation: Department of Dental Anesthesiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, 852-8588 Japan.

ABSTRACT
Although hyperventilation syndrome generally carries a good prognosis, it is associated with the risk of developing severe symptoms, such as post-hyperventilation apnea with hypoxemia and loss of consciousness. We experienced a patient who suffered from post-hyperventilation apnea. A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure. We subsequently successfully provided her with monitored anesthesia care with propofol. Monitored anesthesia care with propofol may be effective for the general management of patients who have severe hyperventilation attacks and post-hyperventilation apnea. This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness.

No MeSH data available.


Related in: MedlinePlus