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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 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.

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

alveolar nerve block, 3 Prediabetes, 208 Preinjection, 55 Propofol, 67, 80, 116, 147, 175, 185 Rabbit, 17 Radiographs, 95 Recovery profile, 175 Refrigerant, 55 Remifentanil, 116 Ropivacaine, 71 Salivary secretion, 185 Sedation, 67 Sensing, 95 Sevoflurane, 42, 175 Sex, 67 Solubility, 42 Tachyarrhythmias, 95 Takayasu arteritis, 31 Tetany, 25 Tooth extraction, 156 Topical agents, 55 Type 2 diabetes, 208

Author Index
Article Category: Other
Volume/Issue: Volume 63: Issue 4
Online Publication Date: Jan 01, 2016
DOI: 10.2344/0003-3006-63.4.216
Page Range: 216 – 217

report), 67 Maeno M, Remifentanil in Combination With Propofol Is Suitable for Use in the Dental Outpatient Setting (scientific report), 116 Makkad B, see Redmann AJ, 197 McCarthy C, Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia (case report), 25 McCreary C, see McCarthy C, 25 Mickel A, see De Veaux CKE, 181 Miura M, see Sasaki Y, 185 Miyawaki T, see Maeda S, 67 Momota Y, see Ohshita N, 204 Momota Y, see Ohshita N, 80