Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지

New Mechanism of Vasovagal Syncope -Trigeminocardiac Reflex-

혈관미주신경실신의 새로운 기전 -삼차신경-심장반사-

  • Yoon, Ji Young (Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University) ;
  • Kim, Cheul Hong (Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University)
  • 윤지영 (부산대학교 치의학전문대학원 치과마취통증학교실) ;
  • 김철홍 (부산대학교 치의학전문대학원 치과마취통증학교실)
  • Received : 2012.09.25
  • Accepted : 2012.09.28
  • Published : 2012.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

A vasovagal reaction is defined as the 'development of hypotension and bradycardia associated with the typical clinical manifestations of pallor, sweating and weakness'. The most profound degree of vasovagal reaction results in fainting or syncope. Incidence of vasovagal reactions in the local anesthetic department of a dental hospital is around 2%. The pathophysiology of the hypotension/bradycardia reflex responsible for vasovagal syncope is not completely understood. Central as well as peripheral mechanisms have been implicated in its pathogenesis: however their relative contribution is not fully elucidated. Recently, trigeminocardiac reflex, previously known as oculocardiac reflex, may serve as syncope. The management of vasovagal syncope is evolving. Non-pharmacological treatment options are a fundamental first step of all treatment pathways. In this article, we would like to review new mechanism of vasovagal syncope and hope to be of help to manage the syncopal patients.

Keywords

References

  1. The Korean Dental Society of Anesthesiology: Dental Anesthesiology. 2nd ed. Seoul, Koonja. 2010, pp 679-87.
  2. Fast TB, Martin MD, Ellis TM: Emergency preparedness: a survey of dental paractitioners. J Am Dent Assoc 1986; 112: 499-501.
  3. The Korean Dental Society of Anesthesiology: Dental Anesthesiology. 2nd ed. Seoul, Koonja. 2010, pp 689-693.
  4. Benditt GD, Nguyen TJ: Syncope therapeutic approaches. J Am Coll Cardiol 2009; 53: 1741-51. https://doi.org/10.1016/j.jacc.2008.12.065
  5. Zurak N, Bilic E: Syncope: facts and fiction. Med Hypotheses 2004; 63: 394-401. https://doi.org/10.1016/j.mehy.2004.02.045
  6. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al: Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur Heart J 2009; 30: 2631-2671. https://doi.org/10.1093/eurheartj/ehp298
  7. Kapoor WN: Syncope. N Engl J Med 2000; 343(25): 1856-62. https://doi.org/10.1056/NEJM200012213432507
  8. Edmondson DH, Gordon PH, Lloyd JM, Meeson EJ, Whitehead FIH: Vasovagal episodes in the dental surgery. J Dent 1978; 6(3): 189-95. https://doi.org/10.1016/0300-5712(78)90240-3
  9. Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W: Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91: 1006-8, A8. https://doi.org/10.1016/S0002-9149(03)00127-9
  10. Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al: Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001; 22: 1256-1306. https://doi.org/10.1053/euhj.2001.2739
  11. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al: Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878-85. https://doi.org/10.1056/NEJMoa012407
  12. Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M, et al: Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001; 37: 1921-28. https://doi.org/10.1016/S0735-1097(01)01241-4
  13. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al: Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 2004; 6: 467-537. https://doi.org/10.1016/j.eupc.2004.08.008
  14. Mark AL: The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol 1983; 1(1): 90-102. https://doi.org/10.1016/S0735-1097(83)80014-X
  15. Fenton AM, Hammill SC, Rea RF, Low PA, Shen WK: Vasovagal syncope. Ann Intern Med 2000; 133(9): 714-25. https://doi.org/10.7326/0003-4819-133-9-200011070-00014
  16. Arakeri G, Arali V: A new hypothesis of cause of syncope: trigeminocardiac reflex during extraction of teeth. Med Hypotheses 2010; 74(2): 248-51. https://doi.org/10.1016/j.mehy.2009.09.027
  17. Campbell R, Rodrigo D, Cheung L: Asystole and bradycardia during maxillofacial surgery. Anesth Prog 1994; 41(1): 13-6.
  18. Morillo CA: Evidence-based common sense: the role of clinical history for the diagnosis of vasovagal syncope. Eur Heart J 2006; 27: 253-4.
  19. Sheldon R, Rose S, Connolly S, Ritchie D, Koshman ML, Frenneaux M. Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J 2006; 27: 344-350. https://doi.org/10.1093/eurheartj/ehi584
  20. Grubb BP: Clinical practice. Neurocardiogenic syncope. N Engl J Med 2005; 352: 1004-10. https://doi.org/10.1056/NEJMcp042601
  21. Simon RP: Syncope, In Goldman L: Cecil textbook of medicine. 22 ed. Philadelphia, WB Saunders. 2004, pp 2020-9.