静脈穿刺時の血管迷走神経反射の予防に貼付用局所麻酔剤の3時間貼付が有用であった2症例

抄録

  A 26-year-old woman (case 1) and a 21-year-old man (case 2) were scheduled to undergo dental treatment ; the administration of intravenous sedatives was planned because both patients had histories of vasovagal reflex (VVR). However, during venipuncture, the patients complained of dysphoria, became pale, temporarily lost consciousness, and experienced convulsions. Furthermore, their blood pressure and heart rates dropped, and sinus arrest was observed on electrocardiography. We diagnosed both patients as having experienced VVR episodes. We proceeded to raise their legs and to administer 0.5 mg of atropine or 3 mg of midazolam intravenously, and their symptoms subsequently improved. VVR is usually caused by mental and physical stress-related factors, such as pain, anxiety, fear, tension, hunger, fatigue, and insomnia. We concluded that our patients’ VVR episodes were triggered by pain, and we decided to take preventive measures to reduce pain during venipuncture. We did this by instructing the patients to self-apply a 60% lidocaine tape at the venipuncture site and to leave the tape in place for 3 h prior to the next attempt at venipuncture. This measure successfully prevented VVR episodes from recurring in both cases, with the patients commenting that they felt no pain or discomfort and that the entire procedure was very comfortable. Both patients also requested the application of 60% lidocaine tape before any further venipuncture procedures. In conclusion, we suggest that clinicians assist patients with histories of VVR by applying 60% lidocaine tape over the planned venipuncture site for 3 h prior to needle insertion. This step can prevent pain and pain-induced VVR and thus promote patient satisfaction with their treatments.