Vasovagal syncope (VVS) or reflex is usually caused by physical and mental stress-related factors, like pain, anxiety, and fear, and it is one of the most frequent complications during dental treatment. Two patients, both with histories of dental phobia and of VVS during vaccination, venipuncture, and dental treatment with local anesthetics, were scheduled for dental treatment under intravenous (IV) sedation. However, both experienced episodes of VVS that occurred during venipuncture using a 24-gauge indwelling needle. We determined that pain was the main trigger of VVS for these patients and attempted to reduce venipuncture-associated pain using 60% lidocaine tape applied 3 hours before venipuncture at their next dental visits, respectively. Use of the lidocaine tape was successful and permitted comfortable placement of the IV catheter without any onset of VVS.
ECG Tracings Captured During VVS
ECG recorded (a) before IV start, (b) during VVS episode, and (c) after recovery. In Case 1, sinus arrest was observed for ∼12.7 seconds before the occurrence of escape rhythms (arrows). In Case 2, sinus arrest was observed for ∼3.4 seconds. ECG, electrocardiogram; VVS, vasovagal syncope.
60% Lidocaine Tape on Venipuncture Site
Patients were directed to self-apply lidocaine tape containing 18 mg of lidocaine at the previously identified venipuncture site 3 hours prior to venipuncture.
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