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Carino Mason MR, Vu L, Horn D, Tiu T. Convulsive Syncope as a Complication of Outpatient Procedures: A Case Series and Review of the Literature. Clin J Sport Med 2024; 34:144-148. [PMID: 37257203 PMCID: PMC10883356 DOI: 10.1097/jsm.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/11/2023] [Indexed: 06/02/2023]
Abstract
ABSTRACT Sports medicine providers often perform various outpatient procedures to manage musculoskeletal and neuropathic conditions. Vasovagal syncope is a rare but a possible complication. Convulsive syncope is one subtype that involves brief extensor stiffening and nonsustained myoclonus and can be easily mistaken for seizures. We present a case series of convulsive syncope as a complication of common sports medicine outpatient procedures. We aim to describe how to identify this condition, and offer risk stratification and management strategies to mitigate the risks of this complication. Sports medicine providers who routinely practice outpatient procedures should be aware of this complication. Simple changes in approaching the procedure may mitigate these risks. High- and intermediate-risk features of the syncopal episode should prompt physicians to seek further evaluation by a specialist to rule out more serious conditions. In all instances, appropriate on-site support and equipment for emergent resuscitation and management should be prepared.
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Affiliation(s)
| | - Ly Vu
- University of Miami Miller School of Medicine, Miami
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami & Jackson Memorial Hospital, Miami; and
| | - Danielle Horn
- University of Miami Miller School of Medicine, Miami
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami & Jackson Memorial Hospital, Miami; and
| | - Timothy Tiu
- University of Miami Miller School of Medicine, Miami
- Department of Physical Medicine and Rehabilitation, University of Miami, Miami
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Martone AM, Parrini I, Ciciarello F, Galluzzo V, Cacciatore S, Massaro C, Giordano R, Giani T, Landi G, Gulizia MM, Colivicchi F, Gabrielli D, Oliva F, Zuccalà G. Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review. J Clin Med 2024; 13:727. [PMID: 38337421 PMCID: PMC10856004 DOI: 10.3390/jcm13030727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Syncope is a highly prevalent clinical condition characterized by a rapid, complete, and brief loss of consciousness, followed by full recovery caused by cerebral hypoperfusion. This symptom carries significance, as its potential underlying causes may involve the heart, blood pressure, or brain, leading to a spectrum of consequences, from sudden death to compromised quality of life. Various factors contribute to syncope, and adhering to a precise diagnostic pathway can enhance diagnostic accuracy and treatment effectiveness. A standardized initial assessment, risk stratification, and appropriate test identification facilitate determining the underlying cause in the majority of cases. New technologies, including artificial intelligence and smart devices, may have the potential to reshape syncope management into a proactive, personalized, and data-centric model, ultimately enhancing patient outcomes and quality of life. This review addresses key aspects of syncope management, including pathogenesis, current diagnostic testing options, treatments, and considerations in the geriatric population.
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Affiliation(s)
- Anna Maria Martone
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.M.M.); (F.C.); (V.G.); (G.L.); (G.Z.)
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (C.M.); (R.G.); (T.G.)
| | - Iris Parrini
- Department of Cardiology, Mauriziano Hospital, Largo Filippo Turati, 62, 10128 Turin, Italy
| | - Francesca Ciciarello
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.M.M.); (F.C.); (V.G.); (G.L.); (G.Z.)
| | - Vincenzo Galluzzo
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.M.M.); (F.C.); (V.G.); (G.L.); (G.Z.)
| | - Stefano Cacciatore
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (C.M.); (R.G.); (T.G.)
| | - Claudia Massaro
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (C.M.); (R.G.); (T.G.)
| | - Rossella Giordano
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (C.M.); (R.G.); (T.G.)
| | - Tommaso Giani
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (C.M.); (R.G.); (T.G.)
| | - Giovanni Landi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.M.M.); (F.C.); (V.G.); (G.L.); (G.Z.)
| | | | - Furio Colivicchi
- Division of Cardiology, San Filippo Neri Hospital-ASL Roma 1, Via Giovanni Martinotti, 20, 00135 Rome, Italy;
| | - Domenico Gabrielli
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy;
| | - Fabrizio Oliva
- “A. De Gasperis” Cardiovascular Department, Division of Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milan, Italy;
| | - Giuseppe Zuccalà
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.M.M.); (F.C.); (V.G.); (G.L.); (G.Z.)
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (C.M.); (R.G.); (T.G.)
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Tumino MA, Royo MB, Adhikary SD. Vasovagal Pre-Syncope Induced by Epidural Electrical Stimulation Test: A Rare Case Report in a 61-Year-Old Woman Undergoing Ventral Hernia Repair. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941004. [PMID: 37740480 PMCID: PMC10534176 DOI: 10.12659/ajcr.941004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/07/2023] [Accepted: 07/27/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Thoracic epidural analgesia is a commonly applied technique for perioperative pain management in major thoraco-abdominal surgery, but is complicated by high failure rates. The epidural electrical stimulation test (EEST) or "Tsui test" is a safe and effective method whereby low electrical current is used to confirm correct epidural catheter position and decrease the variability in analgesic effectiveness of the neuraxial technique. CASE REPORT We present the case of a 61-year-old woman with no prior cardiac or pulmonary comorbidities who was scheduled to undergo a ventral and parastomal hernia repair with component separation. The patient was offered a low thoracic epidural for perioperative analgesia. Technical aspects of the siting of the epidural catheter were uneventful and a confirmatory Tsui test was planned. At the initiation of electrical stimulation via the epidural catheter to confirm optimal catheter positioning, the patient experienced symptomatic bradycardia and hemodynamic instability that persisted despite terminating the electrical stimulation, and required pharmacologic intervention. CONCLUSIONS This report describes a rare case of vasovagal pre-syncope associated with the EEST or Tsui test. Although vasovagal reactions can be commonly associated with neuraxial procedures due to augmented venous return or severe emotional stress, we raise the possibility that through direct electrical stimulation in the epidural space, the EEST may have the potential to trigger such a physiologic response.
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Immediate Adverse Events Following COVID-19 Vaccination in Australian Pharmacies: A Retrospective Review. Vaccines (Basel) 2022; 10:vaccines10122041. [PMID: 36560451 PMCID: PMC9787804 DOI: 10.3390/vaccines10122041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax), and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine the type and management of immediate adverse events following immunisation (I-AEFI) after COVID-19 vaccination. METHODS Retrospective review of I-AEFI recorded between July 2021 and June 2022 in 314 community pharmacies in Australia. RESULTS I-AEFI were recorded in 0.05% (n = 526/977,559) of all COVID-19 vaccinations (highest: AstraZeneca (n = 173/161,857; 0.11%); lowest: Pfizer (n = 50/258,606; 0.02%)). The most common reactions were: (1) syncope, after the first dose of AstraZeneca (n = 105/67,907; 0.15%), Moderna (n = 156/108,339; 0.14%), and Pfizer (n = 22/16,287; 0.14%); and (2) Nausea/vomiting after the first dose of Pfizer (n = 9/16,287; 0.06%), Moderna (n = 55/108,339; 0.05%), and AstraZeneca (n = 31/67,907; 0.05%) vaccines. A total of 23 anaphylactic reactions were recorded (n = 23/977,559; 0.002%), and 59 additional I-AEFI were identified using MedDRA® terminology. Pharmacists primarily managed syncope by laying the patient down (n = 227/342; 66.4%); nausea/vomiting was managed primarily by laying the patient down (n = 62/126; 49.2%), giving water (n = 38/126; 30.2%), or monitoring in the pharmacy (n = 29/126; 23.0%); anaphylactic reaction was treated with adrenaline (n = 18/23; 78.3%) and n = 13/23 (56.5%) anaphylactic reactions were treated with the combination of: administered adrenaline, called ambulance, and laid patient down. CONCLUSION The most commonly recorded I-AEFI was syncope after COVID-19 vaccination in pharmacy; I-AEFI are similar to those previously reported. Pharmacists identified and managed serious and non-serious I-AEFI appropriately and comprehensively.
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Rodriguez S, Haimovich S, Vitale SG, Alonso L, Carugno J. Vasovagal Syncope during Office Hysteroscopy—A Frequently Overlooked Unpleasant Complication. Medicina (B Aires) 2022; 58:medicina58111626. [PMID: 36422165 PMCID: PMC9693602 DOI: 10.3390/medicina58111626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Due to technological advancements in miniaturization of instruments and improved optics, the number of office hysteroscopic procedures has increased over time. Office hysteroscopy is preferred due to avoidance of general anesthesia and decreased overall cost. Vasovagal syncope has been implied as the most common complication. Vasovagal syncope is associated with inappropriate reflex vasodilation and bradycardia in the setting of an acute malfunction between the autonomic nervous system and the cardiovascular system; however, there is no mortality associated with vasovagal syncope. A management strategy for acute vasovagal reflex during office hysteroscopy is proposed in order to manage this common complication.
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Affiliation(s)
- Suset Rodriguez
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
| | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera 32000, Israel
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95121 Catania, Italy
| | - Luis Alonso
- Centro Gutenberg, Endoscopy Unit, 29012 Malaga, Spain
| | - Jose Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Fudim M, Sobotka PA, Dunlap ME. Extracardiac Abnormalities of Preload Reserve: Mechanisms Underlying Exercise Limitation in Heart Failure with Preserved Ejection Fraction, Autonomic Dysfunction, and Liver Disease. Circ Heart Fail 2021; 14:e007308. [PMID: 33464948 DOI: 10.1161/circheartfailure.120.007308] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While many of the cardiac limitations to exercise performance are now well-characterized, extracardiac limitations to exercise performance have been less well recognized but are nevertheless important. We propose that abnormalities of cardiac preload reserve represents an under-recognized but common cause of exercise limitations. We further propose that mechanistic links exist between conditions as seemingly disparate as heart failure with preserved ejection fraction, nonalcoholic fatty liver disease, and pelvic venous compression/obstruction syndromes (eg, May-Thurner). We conclude that extracardiac abnormalities of preload reserve serve as a major pathophysiologic mechanism underlying these and other disease states.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (M.F.). Duke Clinical Research Institute, Durham, NC (M.F.)
| | - Paul A Sobotka
- Affiliated Faculty, Department of Medicine, Division of Cardiology, The Ohio State University, Columbus (P.A.S.)
| | - Mark E Dunlap
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.)
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Kaplan DJ, Haskel JD, Dweck EE, Collins M, Mefta M, Long WJ, Schwarzkopf R. The Association between Reasons for a Rapid Response Team Alert and Immediate Patient Management in Total Hip Arthroplasty Patients. J Arthroplasty 2020; 35:3214-3222. [PMID: 32703711 DOI: 10.1016/j.arth.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the value and efficacy of rapid response teams (RRTs) for different triggering events in total hip arthroplasty (THA) patients. METHODS A retrospective review of all RRT events at a single, tertiary referral center from 2014 to 2016 was performed. Inclusion criteria were defined as patients >18 years old that underwent primary or revision THA. Information queried included demographics, primary reason for RRT, Charlson Comorbidity Index (CCI), underlying etiology, whether any changes in management occurred, and whether the patient was uptriaged. RESULTS In total, 168 RRTs were called on 153 hip arthroplasty patients (mean age 65.2 ± 14.1 years; mean body mass index 32.3 ± 4.8, 66% female). Length of stay in RRT for primary and revision THA was 3.4 and 6.2 days, respectively. This was significantly longer than the length of stay for primary THA patients (2.4 days, P < .001) and revision THA patients (4.6 days, P = .005) that did not require an RRT. There were no mortalities. RRTs for hypotension/presyncope (11%) and for syncope (11%) resulted in significantly fewer changes in management (P < .01) than tachycardia (77%), hypoxia (57%), AMS (79%), and other (47%). RRTs for hypotension/presyncope (28%), syncope (15%), and hypoxia (30%) resulted in significantly fewer patients being uptriaged (P < .001) than tachycardia (81%). Hypotension/presyncope was found to be significantly more commonly due to volume depletion (67%) (P < .001) than other etiologies. Hypoxia was significantly more commonly due to atelectasis (57%) and opioids/oversedation (30.4%) (P = .037). AMS/delirium was also significantly more commonly caused by opioids/over-sedation (71%) (P < .001). CONCLUSION In patients undergoing THA, RRTs for hypotension/presyncopal symptoms and syncope were significantly less likely to result in changes in management or uptriaging compared to tachycardia. The most common etiologies were potentially preventable, including volume depletion and opioid use.
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Affiliation(s)
- Daniel J Kaplan
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | | | - Ezra E Dweck
- Department of Internal Medicine, NYU Langone Health, New York, NY
| | - Michael Collins
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | - Morteza Mefta
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | - William J Long
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
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8
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Way KL, Vidal-Almela S, Keast ML, Hans H, Pipe AL, Reed JL. The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis. BMC Sports Sci Med Rehabil 2020; 12:38. [PMID: 32612840 PMCID: PMC7325048 DOI: 10.1186/s13102-020-00186-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022]
Abstract
Background Cardiovascular disease is the leading cause of death worldwide. Notwithstanding the well-known benefits of cardiac rehabilitation (CR), adherence to CR remains low, particularly in women. High-intensity interval training (HIIT) has received specific attention as an emerging exercise-training paradigm that addresses frequently cited barriers to CR (i.e. lack of motivation/enjoyment and time, perceiving exercise regime as tiring/boring) and improves cardiovascular risk factors. Previous studies have examined the safety of HIIT in CR; there is little evidence on the feasibility of HIIT in CR. The aims of this study were to evaluate the feasibility of HIIT within a CR setting and examine the sex differences regarding the feasibility of such programming. Methods Patients attended an on-site HIIT CR program (10-min warm-up, 25 min of interspersed high-intensity [HI - 4 min at 85–95% HRpeak] and lower intensity [LO - 3 min at 60–70% HRpeak] intervals, 10-min cool-down) twice weekly for 10 weeks. Heart rate (HR) and the Borg rating of perceived exertion (RPE) scale (6–20 points) were recorded at each session. Feasibility was assessed by: [1] attendance and compliance: the number of sessions attended and the compliance to the prescribed HI and LO HR ranges; [2] the patient experience: patients’ perceived effort, program difficulty, if the program was challenging and satisfying; and, [3] safety. Descriptive statistics were used to report the means and their variations. Mann-Whitney U tests and Chi-square analyses were performed to examine sex-differences. Results A total of 151 patients (33% women, 57.5 ± 9.1 years) attended the HIIT program and completed 16 ± 5 classes with a low attrition rate (11.3%). Most patients met or exceeded the prescribed target HR for the HI (80%) and LO (84%) intervals, respectively. Patients reported a “somewhat hard” RPE for HI (14 ± 2 points) and “very light” for LO (10 ± 2 points) intervals. All patients were satisfied with the program and found it challenging. Most patients found HIIT to be difficult (7 ± 2 points, scale range 0–10 points), yet safe (97%). Three vasovagal episodes occurred and more women dropped-out of the program than men (p < 0.01). Conclusions HIIT is a feasible, safe and well-received exercise paradigm in a CR setting.
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Affiliation(s)
- Kimberley L Way
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Canada
| | - Marja-Leena Keast
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Harleen Hans
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Video education to improve clinical skills in the prevention of and response to vasovagal syncopal episodes. Int J Womens Dermatol 2020; 6:186-190. [PMID: 32637542 PMCID: PMC7330430 DOI: 10.1016/j.ijwd.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/19/2020] [Accepted: 02/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background Objective Methods Results Conclusion
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10
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Cho KJ, Hwang DY, Lee HJ, Hyun KH, Kim TJ, Park DH. Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial. Ann Coloproctol 2020; 36:344-348. [PMID: 32178498 PMCID: PMC7714374 DOI: 10.3393/ac.2020.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/12/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention. Methods One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention). Results Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374). Conclusion Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.
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Affiliation(s)
- Kyung Jin Cho
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Do Yeon Hwang
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Hyun Joo Lee
- Department of Anesthesiology, Seoul Song Do Hospital, Seoul, Korea
| | - Ki Hoon Hyun
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Tae Jung Kim
- Department of Surgery, Gangseo Song Do Hospital, Seoul, Korea
| | - Duk Hoon Park
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
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11
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Hillard PJA. Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update. J Pediatr Adolesc Gynecol 2019; 32:S14-S22. [PMID: 30802602 DOI: 10.1016/j.jpag.2019.02.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to "practical tips" for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.
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Affiliation(s)
- Paula J Adams Hillard
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
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12
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He L, Wang L, Li L, Liu X, Yu Y, Zeng X, Li H, Gu Y. A single-center randomized controlled trial observing the safety and efficacy of modified step-up graded Valsalva manoeuver in patients with vasovagal syncope. PLoS One 2018; 13:e0191880. [PMID: 29381726 PMCID: PMC5790265 DOI: 10.1371/journal.pone.0191880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/07/2018] [Indexed: 11/19/2022] Open
Abstract
Non-pharmacological therapies, especially the physical maneuvers, are viewed as important and promising strategies for reducing syncope recurrences in vasovagal syncope (VVS) patients. We observed the efficacy of a modified Valsalva maneuver (MVM) in VVS patients. 72 VVS patients with syncope history and positive head-up tilt table testing (HUTT) results were randomly divided into conventional treatment group (NVM group, n = 36) and conventional treatment plus standard MVM for 30 days group (MVM group, n = 36). Incidence of recurrent syncope after 12 months (6.5% vs. 41.2%, P<0.01) and rate of positive HUTT after 30 days (9.7% vs.79.4%, P<0.01) were significantly lower in MVM group than in NVM group. HRV results showed that low frequency (LF), LF/ high frequency (HF), standard deviation of NN intervals (SDNN) and standard deviation of all 5-min average NN intervals (SDANN) values were significantly lower in the NVM and MVM groups than in the control group at baseline. After 30 days treatment, LF, LF/HF, SDNN, SDANN values were significantly higher compared to baseline in MVM group. Results of Cox proportional hazard model showed that higher SDNN and SDANN values at 30 days after intervention were protective factors, while positive HUTT at 30 days after intervention was risk factor for recurrent syncope. Our results indicate that 30 days MVM intervention could effectively reduce the incidence of recurrent syncope up to 12 months in VVS patients, possibly through improving sympathetic function of VVS patients.
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Affiliation(s)
- Li He
- Department of Cardiology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Lan Wang
- Department of Neurology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Lun Li
- Department of Cardiology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Xiaoyan Liu
- Department of Cardiology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Yijun Yu
- Department of Cardiology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Xiaoyun Zeng
- Department of Neurology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Huanhuan Li
- Department of Cardiology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
| | - Ye Gu
- Department of Cardiology, Puai Hospital, Huazhong University of Science and Technology, Wuhan, Hubei province, China
- * E-mail:
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Orenius T, LicPsych, Säilä H, Mikola K, Ristolainen L. Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors. SAGE Open Nurs 2018; 4:2377960818759442. [PMID: 33415191 PMCID: PMC7774419 DOI: 10.1177/2377960818759442] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/28/2017] [Accepted: 01/15/2018] [Indexed: 11/28/2022] Open
Abstract
The purpose of this clinical update is to provide an overview of the fear of needles and needle phobia in children and adolescents including characteristics and diagnosis, prevalence and epidemiology, etiological factors, and treatment options. Needle-related fear and needle phobia present as significant needle-related distress and avoidance behavior. The etiology is biopsychosocial. These challenging conditions are more common in children and adolescents than in adults. The nurse-patient relationship enables the provision of suitable preparation before injection procedures. Nurses can use exposure-based interventions and incorporate coping strategies and teaching of parents and children. Nurses play a pivotal role in noticing the need for further treatment. Procedural needle-related distress is a complex phenomenon representing a continuum ranging from needle fear to more severe needle phobia. For patients with needle fear management and training methods used by nurses can possibly prevent a progression of the condition into needle phobia. In cases of needle phobia, a correct diagnosis made by a psychiatrist is necessary and enables referral to a psychotherapist with experience in treating children and adolescents with needle phobia.
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Affiliation(s)
- Tage Orenius
- Tage Orenius, Vattuniemenkatu 18 D 44, 00210, Helsinki, Finland.
| | - LicPsych
- Orton Orthopaedic Hospital, Orton, Helsinki, Finland
| | - Hanna Säilä
- Orton Research Institute, Orton, Helsinki, Finland
| | - Katriina Mikola
- Helsinki University Central Hospital, Children’s Hospital, Helsinki, Finland
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Sachdev S, Singh L, Sharma RR, Marwaha N. A Study on the Effect of Pre-donation Salt Loading on Vasovagal Reactions in Young College Going Whole Blood Donors. Indian J Hematol Blood Transfus 2017; 33:592-597. [PMID: 29075075 DOI: 10.1007/s12288-017-0787-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/25/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The pathophysiology of vasovagal reactions (VVRs) involves both psychological and physiological components. Strategies which could allay physiological changes include interventions like pre-donation water intake and applied muscle tension have been published, however salt loading has not been tested. MATERIALS AND METHODS Cross sectional study enrolling 1000 young college going whole blood donors with intervention 250 ml of salted loaded water or plain water as placebo. The immediate VVRs were recorded with respect to age, gender, donation status, blood volume, blood volume drawn and BMI. RESULTS VVRs occurred in 25 out of 1000 (2.5%) young college going whole blood donors. Overall there were 18 VVRs in 526 (3.4%) donors in the placebo arm compared to 7 in 474 (1.5%) in salt loaded arm with odds of 2.36 (p = 0.049), however the difference in means of VVRs between the study arms could not achieve statistical significance on binary logistic regression. The independent risk factors including age, gender, blood volume, blood volume withdrawn and BMI or the donation status were not found to be effect modifiers on the occurrence of VVRs. CONCLUSION Salt loading before blood donation in young college going whole blood donors does decrease the VVRs in the immediate post donation period; however the decrease was limited to a trend and could not attain statistical significance.
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Affiliation(s)
- Suchet Sachdev
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakhvinder Singh
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Harrison JM, Gilchrist PT, Corovic TS, Bogetti C, Song Y, Bacon SL, Ditto B. Respiratory and hemodynamic contributions to emotion-related pre-syncopal vasovagal symptoms. Biol Psychol 2017; 127:46-52. [PMID: 28456564 DOI: 10.1016/j.biopsycho.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 02/05/2023]
Abstract
Vasovagal reactions are conventionally understood as resulting from systemic changes in cardiovascular activity; however, there exists a complementary perspective focused on specific changes in cerebral vasoconstriction associated with hyperventilation-induced hypocapnia. The present study investigated the role of cardiovascular and respiratory activity in self-reported pre-syncopal vasovagal reactions to a surgery video in a sample of 49 healthy women. Participants who indicated more previous real-life episodes of dizziness reported experiencing significantly more symptoms in the laboratory consistent with a vasovagal response. They also showed lower total peripheral resistance and higher pre-ejection period in general, suggesting lower sympathetic nervous system activity. Significant decreases in end-tidal carbon dioxide (PETCO2) occurred during the surgery video among susceptible participants, without significant increases in respiration rate. Further, participants who experienced reductions from the neutral video in PETCO2, systolic blood pressure, or both, reported vasovagal symptoms during the surgery video. The results suggest that patterns of respiration associated with decreases in PETCO2 may contribute to vasovagal symptoms reported in non-clinical groups as well as those with blood-injection-injury phobia and are associated with susceptibility to dizziness.
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Affiliation(s)
- Johanna M Harrison
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada.
| | - Philippe T Gilchrist
- Wolfson College, University of Cambridge, Cambridge CB3 9BB, United Kingdom; MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge, CB1 8RN, United Kingdom
| | - Tiana S Corovic
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
| | - Curtis Bogetti
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
| | - Yuqing Song
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4 B 1R6, Canada
| | - Blaine Ditto
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
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Predictors of vasovagal reactions during preoperative autologous blood donation: a single-institution analysis. Int J Hematol 2017; 105:812-818. [PMID: 28271415 DOI: 10.1007/s12185-017-2204-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 12/16/2022]
Abstract
Studies examining risk factors associated with vasovagal reactions (VVRs) during autologous blood donations, especially in younger subjects, have been limited. The aim of the present study was to define risk factors for VVRs during preoperative autologous blood donation in patients, including those younger than 18 years old. We retrospectively analyzed 4192 autologous, preoperative blood donations between 2007 and 2015 at Okayama University Hospital. Eighty-seven (2.08%) of the patients experienced VVRs. VVRs occurred approximately three times as often in patients 0-17 years old (16/320, 5.0%) than in patients 18 years and older (71/3872, 1.8%). In particular, VVRs occurred more frequently in those 10-13 years old, and decreased with older age (P = 0.006). In a univariate analysis, younger age, lower body mass index, lower systolic blood pressure, lower body weight, lower total blood volume, female gender, first-time collection, and higher heart rate were associated with a higher incidence of VVRs. In a multivariate analysis, lower systolic blood pressure (P < 0.001), higher heart rate (P = 0.007), and first-time collection (P = 0.015), remained independent predictors of VVRs. These results emphasize the need for careful attention during blood collection.
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Robinson JA, Shivapour JK, Snyder CS. Tilt table testing to diagnose pseudosyncope in the pediatric population. CONGENIT HEART DIS 2017; 12:411-416. [PMID: 28240408 DOI: 10.1111/chd.12458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pseudosyncope can be difficult to distinguish from true syncope. Often, pediatric patients with pseudosyncope undergo multiple tests and referrals before the appropriate diagnosis is reached. The purpose is to describe the utility of the head-up tilt table test to elicit the diagnosis of pseudosyncope in the pediatric population. DESIGN Retrospective chart review from November 2012 to December 2015 of patients age ≤23 years referred for 30-minute, 80-degree tilt table test. Pretest probability for pseudosyncope was high if there was no response to traditional management, atypical episodes, occurrence during undesirable exercise, or prolonged episode duration. Inductive techniques were utilized to persuade patients of the likelihood of experiencing an episode during the procedure. Pseudosyncope was confirmed when a patient had normal vital signs during their event and had reflex responses to disruptive maneuvers. RESULTS Tilt table testing was performed on 89 patients [median age 16 years (5-23); 26% male] with the majority (60%) being negative for pseudosyncope, including 51 true negatives and 2 false-negatives. Of the 36 patients with syncope during tilt table testing, 28 were diagnosed with vasovagal syncope and 8 with pseudosyncope [median age 16 years (15-21); 38% male]. Pseudosyncope episodes were observed immediately in 2 patients. All patients with late-onset pseudosyncope required inductive techniques prior to the recorded episode. CONCLUSIONS Pseudosyncope can be identified during tilt table testing if inductive techniques are utilized in patients with a high index of suspicion. Disruptive maneuvers are excellent adjunctive methods to confirm the diagnosis. Tilt table testing is an effective means to identify pseudosyncope and allow appropriate diagnosis and treatment.
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Affiliation(s)
- Jeffrey A Robinson
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jill K Shivapour
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher S Snyder
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Vasovagal reflex emergency caused by Riedel's thyroiditis: A case report and review of the literature. Asian J Surg 2016; 39:41-4. [DOI: 10.1016/j.asjsur.2013.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/21/2012] [Accepted: 01/09/2013] [Indexed: 11/18/2022] Open
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Huang YJ, Zhou ZW, Xu M, Ma QW, Yan JB, Wang JY, Zhang QQ, Huang M, Bao L. Alteration of gene expression profiling including GPR174 and GNG2 is associated with vasovagal syncope. Pediatr Cardiol 2015; 36:475-80. [PMID: 25367286 DOI: 10.1007/s00246-014-1036-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/27/2014] [Indexed: 11/24/2022]
Abstract
Vasovagal syncope (VVS) causes accidental harm for susceptible patients. However, pathophysiology of this disorder remains largely unknown. In an effort to understanding of molecular mechanism for VVS, genome-wide gene expression profiling analyses were performed on VVS patients at syncope state. A total of 66 Type 1 VVS child patients and the same number healthy controls were enrolled in this study. Peripheral blood RNAs were isolated from all subjects, of which 10 RNA samples were randomly selected from each groups for gene expression profile analysis using Gene ST 1.0 arrays (Affymetrix). The results revealed that 103 genes were differently expressed between the patients and controls. Significantly, two G-proteins related genes, GPR174 and GNG2 that have not been related to VVS were among the differently expressed genes. The microarray results were confirmed by qRT-PCR in all the tested individuals. Ingenuity pathway analysis and gene ontology annotation study showed that the differently expressed genes are associated with stress response and apoptosis, suggesting that the alteration of some gene expression including G-proteins related genes is associated with VVS. This study provides new insight into the molecular mechanism of VVS and would be helpful to further identify new molecular biomarkers for the disease.
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Affiliation(s)
- Yu-Juan Huang
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
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Abstract
INTRODUCTION We aimed to evaluate changes in the cerebral blood supply in children during vasovagal syncope and to clarify the diagnostic value of transcranial Doppler for vasovagal syncope. MATERIALS AND METHODS Patients were divided into three groups. Group 1 consisted of 31 patients who were symptomatic and whose head-up tilt test was positive. Group 2 comprised 21 patients who were symptomatic but whose tilt test was negative. Group 3 included 22 healthy children. For the diagnosis of vasovagal syncope, the tilt test was applied. For the subjects of the patient and control groups, the tilt test was repeated. The flow rates of bilateral middle cerebral arteries were continuously and simultaneously recorded with temporal window transcranial Doppler. RESULTS There were no statistically significant differences between the three groups with respect to age and gender distribution (p>0.05). When the bed was at an upright position, the maximum blood flow rate of the right middle cerebral artery was lower in Group 1 than in Group 2, although the decrease was more significant in comparison to the healthy control group (p<0.05). The minimum blood flow rate of the right middle cerebral artery was lower in Group 1 than the Group 2, although the decrease was more significant in comparison with the healthy control group (p<0.05). The maximum blood flow rate of the left middle cerebral artery was significantly lower in Group 1 than in the control group (p<0.05). CONCLUSION Minimum and maximum blood flow rates are significantly decreased in patients tilt test (+) patients with vasovagal syncope during orthostatic stress.
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L’emergenza medica nello studio odontoiatrico: riconoscimento e primo intervento. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)70258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sudhakaran S, Surani SS, Surani SR. Prolonged ventricular asystole: a rare adverse effect of hydrocodone use. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:450-3. [PMID: 25330933 PMCID: PMC4210357 DOI: 10.12659/ajcr.891214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patient: Female, 56 Final Diagnosis: Ventricular asystole Symptoms: Dizziness, headache, near-syncope, weakness Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Sivakumar Sudhakaran
- Department of Medicine, Texas A&M University Health Science Center, College Station, USA
| | - Saherish S Surani
- Research Assistant, Pulmonary Associates of Corpus Christi, Aransas Pass, USA
| | - Salim R Surani
- Department of Medicine, Texas A&M University Health Science Center, College Station, USA
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23
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Mowatt-Larssen E. Syncope for phlebologists. Phlebology 2014; 29:517-21. [DOI: 10.1177/0268355513492315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emergencies during phlebology procedures are rare. Nonetheless, a phlebologist needs to be prepared to manage such a situation (like syncope due to anaphylaxis) if it occurs, to distinguish a true emergency from a more benign scenario (like vasovagal syncope), and even to manage an emergency unrelated causally to the procedure itself (like a heart dysrhythmia which happens to occur during sclerotherapy). The focus of such preparations should be actions and information which affect patient outcomes. Physician mental and even medical team rehearsal of such scenarios can improve phlebologist and team responses. This article discusses the differential diagnosis and management of the patient with syncope in a phlebology practice, with emphasis on anaphylaxis.
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Synkope aus der Sicht des Neurologen. Herz 2014; 39:443-8. [DOI: 10.1007/s00059-014-4095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Abstract
Reflex anoxic seizures (RAS) are important in the differential diagnosis of non-epileptic paroxysmal events in infants and preschool-aged children. They are classically provoked by a sudden distressing stimulus, which causes loss of consciousness followed by stiffening and brief clonic movements affecting some or all limbs, often misinterpreted as an epileptic seizure. The underlying pathophysiology is a vagal-induced brief cardiac asystole with resultant transient cerebral hypoperfusion. Parents and carers who witness the event are understandably anxious, and the mainstay of management are ensuring the appropriate timely diagnosis of RAS and excluding cardiac arrhythmia. A detailed history from a witness is all that is needed to diagnose this condition and investigations like EEG or neuroimaging should be avoided. Education and reassurance remain the mainstay in the management. Some children benefit from medical treatment with atropine or fluoxetine; however, there is a lack of evidence for pharmacological treatment. Cardiac pacing is the only definitive treatment, and is reserved for frequent, severe cases in joint consultation with the cardiologist.
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Affiliation(s)
- Anand Iyer
- The Roald Dahl EEG Unit, Paediatric Neurosciences Foundation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Practical tips for intrauterine devices use in adolescents. J Adolesc Health 2013; 52:S40-6. [PMID: 23535056 DOI: 10.1016/j.jadohealth.2012.09.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/16/2012] [Accepted: 09/19/2012] [Indexed: 11/22/2022]
Abstract
The American Congress of Obstetricians and Gynecologists (ACOG) has endorsed intrauterine devices (IUDs) as first-line contraceptive choices for both nulliparous and parous adolescents. The committee opinion did address some of the practical elements of IUD use in adolescents, but because these practical concerns may be barriers to use for both teens and clinicians, this review is devoted to "practical tips," based on the available literature as well as the author's clinical experience. Counseling, informed consent, techniques of pain management, and preventive guidance about possible side effects are addressed in an effort to promote successful use of this long-acting reversible contraception (LARC) option.
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Successful implanted pacemaker for an extreme inhibitory reflex syncope evoked by post herpetic trigeminal neuralgia. J Cardiol Cases 2013; 7:e173-e175. [PMID: 30533156 DOI: 10.1016/j.jccase.2013.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/17/2013] [Accepted: 02/20/2013] [Indexed: 11/22/2022] Open
Abstract
Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Numerous causes of syncope have been described. Vasovagal syncope is the most common with a number of precipitants. We report a case of post herpetic trigeminal neuralgia leading to neurocardiogenic syncope. These episodes were preceded by severe stabbing left frontal headaches followed by significant sinus bradycardia, asystole, and syncope requiring pacemaker implantation. To our knowledge only one previous case of post herpetic trigeminal neuralgia leading to syncope has been reported. <Learning objective: Neuralgia-associated syncope is a rare phenomenon. Failing to recognize and treat appropriately may be associated with recurring episodes of syncope with significant lifestyle limitations. Although post herpetic neuralgia is treatable, one should be prepared to insert a pacemaker if treatment fails to control symptoms that progress to cardioinhibitory syncope.>.
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Radvansky BM, Husain Q, Cherla DV, Choudhry OJ, Eloy JA. In-office vasovagal response after rhinologic manipulation. Int Forum Allergy Rhinol 2012. [PMID: 23193039 DOI: 10.1002/alr.21121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Advances in endoscopic sinus surgery have led to a greater number of in-office procedures away from the traditional operating room setting. Rhinologists acting independently of anesthesiologists must be prepared for potential complications, such as vasovagal response (VVR), that may arise during in-office rhinologic manipulations. In this study, we review our experience with this condition and discuss risk factors and a management algorithm for in-office VVR. METHODS A retrospective analysis at a large tertiary referral center was performed on all patients undergoing in-office endoscopic procedures with rhinologic manipulation between July 2008 and June 2012. A total of 4973 patients underwent in-office endoscopic procedures and 8 patients with VVR were identified. Demographic data, diagnosis, procedure performed, and outcomes were reviewed. RESULTS Eight patients out of 4973 (0.16%) experienced VVR during in-office endoscopic procedures. Seven (87.5%) of these 8 patients recovered from the VVR within 30 minutes and subsequently completed their scheduled procedure. One (12.5%) of the 8 patients did not fully recover after 30 minutes and was sent to the Emergency Department, where he was stabilized and subsequently discharged. The most common comorbidities in these 8 patients with VVR were hypercholesterolemia in 3 patients (37.5%), and hypertension and benign prostatic hyperplasia, each found in 2 patients (25.0%). CONCLUSION Although the incidence of VVR during rhinologic procedures is low, rhinologists should be familiar with this condition and be prepared for its management.
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Affiliation(s)
- Brian M Radvansky
- Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA
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Seidl K, von Scheidt W, Pfafferott C. [Reflex syncope : diagnosis and therapy]. Herzschrittmacherther Elektrophysiol 2011; 22:93-98. [PMID: 21491128 DOI: 10.1007/s00399-011-0130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 05/30/2023]
Abstract
Reflex-mediated syncope is a common cause for syncope. The first step in evaluating the cause of syncope is to assess the risk of a life-threatening cause for syncope, e.g., ventricular arrhythmias. Reflex-mediated syncope has to be differentiated from orthostatic syncope. In orthostatic syncope, there is an insufficient autonomic response. In contrast to a reflex-mediated syncope, in which the autonomic nervous system acts inappropriately, reflex-mediated syncope is classified into the classical vasovagal form, the situational form, or due to carotid sinus hypersensitivity. In the elderly, often a mixed form is present. Treatment is difficult. Most important is educating the patient and avoiding precipitating factors. Physical maneuvers, e.g., counter pressure maneuvers, are more effective than drug treatment. Permanent pacing is rarely needed. However, before indicating a pacemaker, a correlation between bradycardia and syncope should be documented. This is often only possible by implanting a monitoring device at an early stage.
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Affiliation(s)
- K Seidl
- Medizinische Klinik IV, Kardiologie mit Schwerpunkt Elektrophysiologie, Ingolstadt, Deutschland.
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Devinsky O, Gazzola D, LaFrance WC. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 2011; 7:210-20. [PMID: 21386814 DOI: 10.1038/nrneurol.2011.24] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sinusoidal galvanic vestibular stimulation (sGVS) induces a vasovagal response in the rat. Exp Brain Res 2011; 210:45-55. [PMID: 21374078 DOI: 10.1007/s00221-011-2604-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/11/2011] [Indexed: 12/15/2022]
Abstract
Blood pressure (BP) and heart rate (HR) were studied in isoflurane-anesthetized Long-Evans rats during sinusoidal galvanic vestibular stimulation (sGVS) and sinusoidal oscillation in pitch to characterize vestibular influences on autonomic control of BP and HR. sGVS was delivered binaurally via Ag/AgCl needle electrodes inserted over the mastoids at stimulus frequencies 0.008-0.4 Hz. Two processes affecting BP and HR were induced by sGVS: 1) a transient drop in BP (≈15-20 mmHg) and HR (≈3 beat*s(-1)), followed by a slow recovery over 1-6 min; and 2) inhibitory modulations in BP (≈4.5 mmHg/g) and HR (≈0.15 beats*s(-1)/g) twice in each stimulus cycle. The BP and HR modulations were approximately in-phase with each other and were best evoked by low stimulus frequencies. A wavelet analysis indicated significant energies in BP and HR at scales related to twice and four times the stimulus frequency bands. BP and HR were also modulated by oscillation in pitch at frequencies 0.025-0.5 Hz. Sensitivities at 0.025 Hz were ≈4.5 mmHg/g (BP) and ≈0.17 beat*s(-1)/g (HR) for pitches of 20-90°. The tilt-induced BP and HR modulations were out-of-phase, but the frequencies at which responses were elicited by tilt and sGVS were the same. The results show that the sGVS-induced responses, which likely originate in the otolith organs, can exert a powerful inhibitory effect on both BP and HR at low frequencies. These responses have a striking resemblance to human vasovagal responses. Thus, sGVS-activated rats can potentially serve as a useful experimental model of the vasovagal response in humans.
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