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Ventricular Tachycardia Following Ephedrine During Dexmedetomidine Dental Procedural Sedation
Shota AbeDDS,
Kanami SuzukiDDS,
Maki HamamuraDDS,
Takashi TamanoiDDS,
Koji TakahashiDDS,
Keiichiro WakamatsuDDS,
Kenji YoshidaDDS, PhD,
Hiroyoshi KawaaiDDS, PhD, and
Shinya YamazakiDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
DOI: 10.2344/anpr-70-03-04
Page Range: 184 – 190

Administration of dexmedetomidine (DEX) is associated with the onset of bradycardia, biphasic blood pressure responses (brief hypertension followed by hypotension), and other cardiovascular complications. 1 – 4 Cardiovascular agonists must be appropriately used for treatment in the event of such issues. However, literature regarding ventricular tachycardia (VT) caused by cardiovascular agonists in patients under DEX-induced sedation is scarce. We present the case of a patient who received intravenous (IV) ephedrine to treat low

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Figure 2 ; Intraoperative electrocardiography during the first operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.
Naotaka Kishimoto,
Munenori Kato,
Yasunori Nakanishi,
Akari Hasegawa, and
Yoshihiro Momota
<bold>Figure 2</bold>
Figure 2

Intraoperative electrocardiography during the first operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.

Figure 3 ; Intraoperative electrocardiography during the second operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.
Naotaka Kishimoto,
Munenori Kato,
Yasunori Nakanishi,
Akari Hasegawa, and
Yoshihiro Momota
<bold>Figure 3</bold>
Figure 3

Intraoperative electrocardiography during the second operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.

Recurrent Coronary Artery Spasm Induced by Vasopressors During Two Operations in the Same Patient Under General Anesthesia
Naotaka KishimotoDDS, PhD,
Munenori KatoDDS,
Yasunori NakanishiDDS,
Akari HasegawaDDS, and
Yoshihiro MomotaDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 65: Issue 1
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-64-04-04
Page Range: 44 – 49

. The patient's BP and HR changed from 126/60 mm Hg and 68 bpm before induction of general anesthesia to 96/48 mm Hg and 72 bpm after induction, respectively. We administered ephedrine (4 mg); the BP then increased to 201/166 mm Hg, and marked ST-segment elevation was noted on the monitor ( Figure 2 B). The ST-segment elevation returned to baseline about 5 minutes later. The patient's BP and HR were 90/44 mm Hg and 72 bpm, respectively, 30 minutes after induction of anesthesia. We administered phenylephrine (0.1 mg); the patient's BP then rose to 196/110 mm Hg, and

Images 3 and 4. ; Ephedrine and epinephrine drug labels illustrating “tall man” lettering.
Daniel S. Sarasin,
Jason W. Brady, and
Roy L. Stevens
<bold>Images 3 and 4.</bold>
Images 3 and 4.

Ephedrine and epinephrine drug labels illustrating “tall man” lettering.

; Arrows indicate the timing each medication was administered. Ephedrine was given at 8 mg/bolus, phenylephrine at 0.05 mg/bolus, and dopamine at 2 μg/kg/min.
Naohiro Ohshita,
Shoko Gamoh,
Masahiko Kanazumi,
Masahiro Nakajima,
Yoshihiro Momota, and
Yasuo M. Tsutsumi

Arrows indicate the timing each medication was administered. Ephedrine was given at 8 mg/bolus, phenylephrine at 0.05 mg/bolus, and dopamine at 2 μg/kg/min.

Figure 3.  ; (A) Naïve nerve terminal. (B) Nerve terminal plus a monoamine oxidase inhibitor. (C) Nerve terminal with epinephrine. (D) Nerve terminal with ephedrine.
Mana Saraghi,
Leonard R. Golden, and
Elliot V. Hersh
<bold>Figure 3. </bold>
Figure 3. 

(A) Naïve nerve terminal. (B) Nerve terminal plus a monoamine oxidase inhibitor. (C) Nerve terminal with epinephrine. (D) Nerve terminal with ephedrine.

Figure 2.; Sedation Record Sedation record detailing the patient's vital signs and treatment specifics.
Shota Abe,
Kanami Suzuki,
Maki Hamamura,
Takashi Tamanoi,
Koji Takahashi,
Keiichiro Wakamatsu,
Kenji Yoshida,
Hiroyoshi Kawaai, and
Shinya Yamazaki
Figure 2.
Figure 2.

Sedation Record

Sedation record detailing the patient's vital signs and treatment specifics.

Figure 3.; Changes in Electrocardiographic (ECG) Waveform Over Time The waveform changed from ventricular tachycardia (VT) to atrial fibrillation with ST depression over time. No ECG record was available before the onset of VT.
Shota Abe,
Kanami Suzuki,
Maki Hamamura,
Takashi Tamanoi,
Koji Takahashi,
Keiichiro Wakamatsu,
Kenji Yoshida,
Hiroyoshi Kawaai, and
Shinya Yamazaki
Figure 3.
Figure 3.

Changes in Electrocardiographic (ECG) Waveform Over Time

The waveform changed from ventricular tachycardia (VT) to atrial fibrillation with ST depression over time. No ECG record was available before the onset of VT.

Figure 1.; Preoperative Panoramic Radiograph Unilocular radiolucency approximately 1.3 by 3.8 cm noted in right mandible.
Shota Abe,
Kanami Suzuki,
Maki Hamamura,
Takashi Tamanoi,
Koji Takahashi,
Keiichiro Wakamatsu,
Kenji Yoshida,
Hiroyoshi Kawaai, and
Shinya Yamazaki
Figure 1.
Figure 1.

Preoperative Panoramic Radiograph

Unilocular radiolucency approximately 1.3 by 3.8 cm noted in right mandible.