Abstract
Although hyperventilation syndrome generally carries a good prognosis, it is associated with the risk of developing severe symptoms, such as post-hyperventilation apnea with hypoxemia and loss of consciousness. We experienced a patient who suffered from post-hyperventilation apnea. A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure. We subsequently successfully provided her with monitored anesthesia care with propofol. Monitored anesthesia care with propofol may be effective for the general management of patients who have severe hyperventilation attacks and post-hyperventilation apnea. This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness.
Highlights
Hyperventilation syndrome in patients with no underlying organic abnormality is frequently observed during medical and dental practice
We provided monitored anesthesia care thrice to a patient who had a history of hyperventilation attacks and post-hyperventilation apnea during dental treatment under sedation with regional anesthesia
The pathogenesis of post-hyperventilation apnea has only been partly understood as being due to the activity of peripheral chemoreceptors that may contribute to the susceptibility to apnea during both hypoxia and hyperoxia [2,5,9]
Summary
Hyperventilation syndrome in patients with no underlying organic abnormality is frequently observed during medical and dental practice. After confirming sustained hyperventilation of respiratory rate 50 ~ 60 breaths/minute with desaturation to 92% associated with blood pressure 130/83 mmHg and pulse rate 115 beats/ minute, we decided to provide low dose 2 l/min of oxygen supplementation using a bag-valve-mask instead of using the paper bag. Her oxygen saturation improved to 100%, hyperventilation continued for 20 minutes. Two minutes after continuous mask ventilation of 8 ~ 10 counts/min to treat the complete apnea associated with unconsciousness and cyanosis, she regained consciousness and began to breathe at a respiratory rate of 15 breaths/minute
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