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Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia
Caroline McCarthy BDS, MFDS,
 Paul Brady BDS, MFDS, MSc, ConSed,
 Ken D. O'Halloran BSc, PhD, and
 Christine McCreary MA, 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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Involvement of α- and β-Adrenergic Receptors in Skeletal Muscle Blood Flow Changes During Hyper-/Hypocapnia in Anesthetized Rabbits
Kyotaro Koshika DDS, PhD,
 Rumi Kaneko DDS,
 Mai Shionoya DDS,
 Kotaro Shimizu DDS,
 Yuka Sendai DDS,
 Nobutaka Matsuura DDS,
 Yui Akiike DDS, PhD, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-70-02-02
Page Range: 58 – 64

(T108, Transonic). A flow probe (type 3SB) was applied to the isolated left common carotid artery. HR, systolic blood pressure (SBP), and CCBF were continuously recorded using a tachometer (HRM-100, Unique Medical). MBF and QBF were analyzed using a data collection analysis system (UCO, Unique Medical). Measurements were performed at 3 periods: (1) baseline, (2) hypercapnia/hypocapnia, and (3) during or after receiving vasoactive agents. After baseline, ETCO 2 was changed to 30 or 60 mm Hg and maintained at this level for 15 minutes, and measurements

Figure 2.; Mean changes in muscle blood flow during hypocapnia and after phenylephrine or butoxamine administration. MBF and QBF increased during hypocapnia, while the increase in MBF was larger than that in QBF. Both MBF and QBF decreased to about 90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; d P < .05 versus hypocapnia; c P < .05 between the 2 groups.
Kyotaro Koshika,
 Rumi Kaneko,
 Mai Shionoya,
 Kotaro Shimizu,
 Yuka Sendai,
 Nobutaka Matsuura,
 Yui Akiike, and
 Tatsuya Ichinohe
Figure 2.
Figure 2.

Mean changes in muscle blood flow during hypocapnia and after phenylephrine or butoxamine administration.

MBF and QBF increased during hypocapnia, while the increase in MBF was larger than that in QBF. Both MBF and QBF decreased to about 90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; d P < .05 versus hypocapnia; c P < .05 between the 2 groups.

Tissue Blood Flow During Remifentanil Infusion With Carbon Dioxide Loading
Hiroaki Kanbe DDS, PhD,
 Nobuyuki Matsuura DDS, PhD,
 Masataka Kasahara DDS, PhD, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Other
Volume/Issue: Volume 62: Issue 2
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.2.51
Page Range: 51 – 56

. Effects of carbon dioxide (hypocapnia and hypercapnia) on tissue blood flow and oxygenation of liver, kidney and skeletal muscle in the dog [in Japanese] . Masui . 1989 ; 38 : 457 – 464 . 17 Oikawa S , Hirakawa H , Kusakabe T , Nakashima Y , Hayashida Y

Figure 1.; Mean changes in muscle blood flow during hypercapnia and after phentolamine or metaproterenol administration. MBF and QBF decreased during hypercapnia, while the decrease in MBF was smaller than that in QBF. Both MBF and QBF recovered to their baseline levels after phentolamine administration. In contrast, although MBF became greater than its baseline level, QBF did not fully recover to its baseline level after phentolamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; b P < .05 versus hypercapnia; c P < .05 between the 2 groups.
Kyotaro Koshika,
 Rumi Kaneko,
 Mai Shionoya,
 Kotaro Shimizu,
 Yuka Sendai,
 Nobutaka Matsuura,
 Yui Akiike, and
 Tatsuya Ichinohe
Figure 1.
Figure 1.

Mean changes in muscle blood flow during hypercapnia and after phentolamine or metaproterenol administration.

MBF and QBF decreased during hypercapnia, while the decrease in MBF was smaller than that in QBF. Both MBF and QBF recovered to their baseline levels after phentolamine administration. In contrast, although MBF became greater than its baseline level, QBF did not fully recover to its baseline level after phentolamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; b P < .05 versus hypercapnia; c P < .05 between the 2 groups.

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 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 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.