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Vasovagal syncope (VVS) can be triggered by emotional stress or pain even from relatively innocuous procedures like venipuncture and often occurs perioperatively. Not only can it be extremely uncomfortable or embarrassing for the patient, but it can also lead to postponement or case cancellation as well as more serious medical issues, especially in medically compromised patients. Thus, it is important to recognize and prevent VVS whenever possible. This case series presents the successful preoperative application of lidocaine tape to prevent

The induction of intravenous conscious sedation in pediatric patients undergoing extensive dental treatment may be a challenge, particularly during parental separation and venipuncture. The use of sedative premedication may help reduce the anxiety and minimize psychological trauma in these patients. Midazolam (Versed, Hoffman-La Roche Inc, Nutley, NJ) is an example of such a preoperative sedative agent. As a water-soluble benzodiazepine, midazolam is nonirritating and has anxiolytic, sedative, hypnotic, and amnesic properties. Midazolam has been used as a

restroom facilities prior to sedation sessions because clonidine can exert a mild diuretic effect. 21 Patients breathed 4 L/min of 100% O 2 via nasal cannula during venipuncture. Recall and recognition were tested following at least 2 hours of intravenous conscious sedation and approximately 20 minutes of recovery (time = 200) via a post-session follow-up questionnaire and all original baseline measurements repeated. The sedationist and surgeon also completed postsession questionnaires. All subjects also completed a poststudy questionnaire immediately following

sedation. She was lying on a dental chair in a supine position. Routine monitoring, including blood pressure (BP), arterial oxygen saturation (SpO 2 ), and an electrocardiogram (ECG), was conducted. Preoperative vital signs revealed a heart rate of 72 beats/min (bpm), BP of 126/74 mm Hg, and SpO 2 of 100% ( Figure 1 ). The first attempt at venipuncture was not successful. Immediately after the second venipuncture, the patient's heart rate was 68 bpm, BP was 124/84 mm Hg, and SpO 2 was 100%. We started propofol sedation (target concentration in blood 2.0 μg/mL) using a

venipuncture site. Sedation was started by inhalation of 50% N 2 O and 50% O 2 via a nasal cannula. A venous cannula was inserted in the right radial cutaneous vein and an infusion of acetate–Ringer's solution was started. Propofol 35 mg IV was administered as an induction dose followed by an infusion of 3 to 4 mg/kg/h for maintenance of sedation. We monitored blood pressure, pulse rate, SpO 2 , and ETCO 2 . After the patient's vital signs became stable, periodontal ligament injection with 2% lidocaine containing 1 : 80,000 epinephrine was administered to the maxillary left

. Textbook of Medical Physiology . 11th ed . Philadelphia, Pa : Elsevier : 2006 : 151 – 154 . 7 Alijanian A , Bedrossian E , Feeney C , Devlin D. Asystole secondary to venipuncture: report of case . J Oral Maxillofac Surg . 2001 ; 59 : 461 – 462 . 8

prevent venipuncture stress-induced arrhythmia, a lidocaine patch (Penles Tape 18 mg, Nitto Denko Corporation) was applied to the IV site 30 minutes before she entered the operating room appearing anxious. American Society of Anesthesiologists monitors were placed, consisting of a pulse oximeter, 3-lead ECG, and a noninvasive BP cuff. Her initial vital signs were as follows: BP 105/61 mm Hg; HR 55 bpm; and SpO 2 98% on room air. Oxygen 3 L/min was administered via nasal cannula. IV access was secured using a 22-gauge catheter placed in her left hand, and

effectiveness elsewhere in the oral cavity. 24 In a 2000 literature review of intraoral topical anesthetics, Meechan 25 discussed both positive and negative study results for a variety of application sites including the palate. There are more negative than positive studies cited for the palate, most having used placebos in addition to anesthetic agents for penetrations as well as injections of anesthetics. Refrigerants, or vapocoolants, have been used extensively in medicine for providing comfort prior to procedures that involve needles, such as venipunctures