vasovagal episode during procedure

[ziggyziggy]

I want to get ur views/input on this trivial issue:

I have a patient who has cervical spondylosis with assoc. headaches. I want to do RF on him but whenever I have tried doing that he has a vasovagal (3 times) reaction with blood pressure and pulse dropping to 30's.
I thought of doing light sedation but have never done it before particularly for RF. Any suggestions/experiences.

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[pastafan]

Not trivial. A partner of mine did an ESI years ago on one of the surgeons that we worked with and the surgeon had asystole for what seemed like more than a few seconds. Do the procedure in a center with an anesthesiologist to take care of the patient. Pre-treat with glycopyrrolate IV and light is the word with any sedation. Asystole can ruin your whole day...

 

[emd123]

Hr is 30's could be much more than vasovagal. Could be sick sinus syndrome, or another significant bradyarhythmia. I wouldn't touch that until cards works that up. I don't care if they're young with no history. HR in 50-60'? I'm cool with being vagal. 30's? Hell no. I've seen too many "HR in 30's" decelerate down to zero. So, you may be able to prevent with atropine or glycopyrolate...or you might not. Don't blow off a HR in the 30's as definitely vagal until it's looked into.

 

[clubdeac]

I'd trust the ER doc. I've pretreated several vasovagalers with atropine and/or versed. Seemed to work ok at the time. However I was in a hospital setting with a super nurse who might as well have been a CRNA.... awww how I miss her