Abrupt changes in body position should be avoided during recovery from intravenous sedation in patients with a history of neurally-mediated syncope to prevent severe syncopal episodes and cardiac arrest.
Supports safe IV sedation for dental procedures in stable neurally-mediated syncope; hypothesis-generating and requires prospective validation.
A 26-year-old woman with a history of feeling nauseated during dental local anesthesia presented to our clinic for tooth extraction under intravenous sedation. Although she had experienced episodes of neurally-mediated syncope, her symptoms were controlled well with drug therapy, stopped 3 years earlier. No syncope episodes developed over the previous 2 years. Tooth extraction was performed under intravenous sedation without incident. When she was returned to a sitting position after being roused, convulsion, loss of consciousness, and cardiac arrest developed. One week later, similar symptoms occurred immediately after suture removal. We suspect that the change in body position triggered these episodes. It is important to avoid abrupt changes in body position and any other triggers and to administer preventive drugs in patients at high risk of syncope.
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Hamazaki et al. (2019) studied this question.
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