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Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia
Caroline McCarthyBDS, MFDS,
Paul BradyBDS, MFDS, MSc, ConSed,
Ken D. O'HalloranBSc, PhD, and
Christine McCrearyMA, MD, FDS(OM), RCPS, FFD, RCSI
Article Category: Case Report
Volume/Issue: Volume 63: Issue 1
Online Publication Date: Jan 01, 2016
DOI: 10.2344/15-00005R1.1
Page Range: 25 – 30

This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous (IV) conscious sedation. Hyperventilation can be a manifestation of anxiety and involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. 1 This can lead to hypocapnia, a state of abnormally low levels of carbon dioxide in the blood that results from excessive amounts of carbon dioxide being exhaled. Hyperventilation

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Figure 2. ; Capnography monitor demonstrating respiratory waveform (upper panel) and rate (89 breaths/min), oxygen saturation (SpO2; 98%), end-tidal carbon dioxide (ETCO2; 11), and pulse rate (129 beats/min). This illustrates hyperventilation with resultant low ETCO2; SpO2 is normal and alone would not serve as an index of respiratory disturbance.
Caroline McCarthy,
Paul Brady,
Ken D. O'Halloran, and
Christine McCreary
Figure 2. 
Figure 2. 

Capnography monitor demonstrating respiratory waveform (upper panel) and rate (89 breaths/min), oxygen saturation (SpO2; 98%), end-tidal carbon dioxide (ETCO2; 11), and pulse rate (129 beats/min). This illustrates hyperventilation with resultant low ETCO2; SpO2 is normal and alone would not serve as an index of respiratory disturbance.

Figure 3. ; A trend graph based on mean values for end-tidal carbon dioxide (ETCO2) and respiratory rate calculated every 5 seconds after the first infusion. The graph shows the progressive fall in ETCO2 from baseline, following induction of sedation, as a result of hyperventilation. Note the gradual recovery of ETCO2 as respiratory rate returns towards normal.
Caroline McCarthy,
Paul Brady,
Ken D. O'Halloran, and
Christine McCreary
Figure 3. 
Figure 3. 

A trend graph based on mean values for end-tidal carbon dioxide (ETCO2) and respiratory rate calculated every 5 seconds after the first infusion. The graph shows the progressive fall in ETCO2 from baseline, following induction of sedation, as a result of hyperventilation. Note the gradual recovery of ETCO2 as respiratory rate returns towards normal.

Figure 5. ; Diagnosis of complications (n = 36) Most of the medical emergency cases were hyperventilation syndrome. The second-most common was blood pressure elevation.
<bold>Figure 5.</bold>
Figure 5.

Diagnosis of complications (n = 36)

Most of the medical emergency cases were hyperventilation syndrome. The second-most common was blood pressure elevation.

Figure 1. ; Trousseau sign demonstrating flexure of the fingers and thumb.
Caroline McCarthy,
Paul Brady,
Ken D. O'Halloran, and
Christine McCreary
Figure 1. 
Figure 1. 

Trousseau sign demonstrating flexure of the fingers and thumb.

Figure 4. ; Nasal cannula and oral extension to capture expired CO2.
Caroline McCarthy,
Paul Brady,
Ken D. O'Halloran, and
Christine McCreary
Figure 4. 
Figure 4. 

Nasal cannula and oral extension to capture expired CO2.

Figure 5. ; Method used to have patient rebreathe expired air in an effort to increase arterial CO2.
Caroline McCarthy,
Paul Brady,
Ken D. O'Halloran, and
Christine McCreary
Figure 5. 
Figure 5. 

Method used to have patient rebreathe expired air in an effort to increase arterial CO2.

Subject Index
Article Category: Other
Volume/Issue: Volume 63: Issue 4
Online Publication Date: Jan 01, 2016
DOI: 10.2344/0003-3006-63.4.218
Page Range: 218 – 218

Hypersensitive gag reflex, 181 Hyperventilation, 25 Hypocapnia, 25 Hypoglycemia, 208 ICD, 95 Implant, 67 Inferior alveolar nerve, 84 Inferior alveolar nerve block, 3 Infiltration anesthesia, 17, 71, 131 Inhalational anesthesia, 42 Injection pain, 3 Injection pressure, 131 Intellectual disability, 185 Intranasal sedation, 122 Intravenous sedation, 80 Isoflurane, 42 Jawbone, 17, 131 Joint hypermobility and dislocation, 204 Kuwait, 8

Anesthetic Management of a Patient With Emanuel Syndrome
Masanori TsukamotoDDS, PhD,
Takashi HitosugiDDS, PhD,
Kanako EsakiDDS, and
Takeshi YokoyamaDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 63: Issue 4
Online Publication Date: Jan 01, 2016
DOI: 10.2344/16-00028.1
Page Range: 201 – 203

changes were observed in cardiac function. Sevoflurane is a widely used volatile anesthetic, especially for inhalation induction. However, it may induce seizure-like activity, particularly in combination with hyperventilation, which may decrease cerebral blood flow. We therefore maintained EtCO 2 within the normal level. Since patients with Emanuel syndrome potentially have seizure disorders, 1 , 4 we utilized the BIS monitor. The BIS monitor was used to assess seizure activity, as has been reported, and none was observed in this case. 9 It was useful to

The Anesthetic Management for a Patient With Trisomy 13
Masanori TsukamotoDDS, PhD,
Takashi HitosugiDDS, PhD,
Kanako EsakiDDS, and
Takeshi YokoyamaDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 64: Issue 3
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-64-02-09
Page Range: 162 – 164

activity by using BIS as has been reported. 2 , 3 As hyperventilation may decrease cerebral blood flow leading to seizure, we maintained EtCO 2 within normal levels. No seizure activity was observed via the BIS or postoperatively. Congenital heart disease is frequently associated with trisomy 13, but usually this is noncyanotic with VSD and PDA most common. 2 , 3 In this case, we used the Aesculon ® to follow trends in hemodynamic parameters, although preoperative assessment including echocardiography, electrocardiogram, and chest radiograph were within