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Ventricular Tachycardia Following Ephedrine During Dexmedetomidine Dental Procedural Sedation
Shota Abe DDS,
 Kanami Suzuki DDS,
 Maki Hamamura DDS,
 Takashi Tamanoi DDS,
 Koji Takahashi DDS,
 Keiichiro Wakamatsu DDS,
 Kenji Yoshida DDS, PhD,
 Hiroyoshi Kawaai DDS, PhD, and
 Shinya Yamazaki DDS, 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 Kishimoto DDS, PhD,
 Munenori Kato DDS,
 Yasunori Nakanishi DDS,
 Akari Hasegawa DDS, and
 Yoshihiro Momota DDS, 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 1 ; Preoperative 12-lead electrocardiography. An incomplete right bundle branch block and sinus bradycardia (heart rate, 56 bpm) were present.
Naotaka Kishimoto,
 Munenori Kato,
 Yasunori Nakanishi,
 Akari Hasegawa, and
 Yoshihiro Momota
<bold>Figure 1</bold>
Figure 1

Preoperative 12-lead electrocardiography. An incomplete right bundle branch block and sinus bradycardia (heart rate, 56 bpm) were present.

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.