Hyperventilation

Hyperventilation (Table 7) is characterized by anxiety-related dyspnea and tachypnea. Cerebral hypoxia leads to prolonged inspiration (i.e., deep sighs), which result in low CO₂ concentration and elevated arterial pH (respiratory alkalosis). Hyperventilation syndrome is common in young women. Predisposing factors include pain, and personal and environmental stress. Other causes include cardiopulmonary disease (e.g., cardiogenic shock, COPD, pulmonary edema), and central nervous system stimulants (e.g., drugs, cola, coffee, tea).

Table 7. Hyperventilation.

Prevention:

Identify at-risk patient

Reduce anxiety
Ensure profound local anesthesia

Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity

Signs and symptoms:

Frequent (>20 breaths/min), prolonged sighing inspiration
Dyspnea

Sometimes so severe that the patient feels like suffocating

Light-headedness and dizziness
Paresthesia

Burning or prickling feeling of the face and extremities

Tonic muscle spasm
Tetani can occur because with severe respiratory alkalosis
Tightness, pain in the chest
Syncope

Emergency response:

Place patient in an upright or semi-reclining position

Instruct the patient to take in a shallow breath and hold it as long as possible

Repeat this sequence 6 to 10 times

Alternatively, have patient rebreed expired air from a paper bag – DO NOT ADMINISTER OXYGEN

If patient is not responding

Activate EMS

Monitor vital signs

If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest

Immediate CPR and defibrillation congruent with current recommendations

Nota bene:

Signs of recovering: breathing returns to normal
Signs of deterioration: vital signs unstable
Anxiety, often precipitated by personal or environmental stress, is the most common predisposing factor associated with hyperventilation, these patients respond well to pre-operative sedation
Hypoxia, associated with cardiopulmonary disease, may also cause hyperventilation. Patients who relate a history of hyperventilation secondary to a medical condition (other than anxiety) should not receive pre-operative sedation

Managing Adult Medical Emergencies in the Dental Office
Hyperventilation