vasovagal anyone?

[monkey7247]

Hi all, I need some assistance. I'm a PGY-1 going into ophtho, currently on an ophtho elective month. I had a vasovagal episode in the OR about 6m ago that I blew off as due to food poisoning. However, the other day when I was having no other health issues, it happened again. Both times I was on the scope. Initially I just noticed I was feeling hot and blew it off. I then popped a full-body sweat and it felt like my BP bottomed out (not checked).

I had to leave the room (carefully, I was very lightheaded) and the symptoms did not resolve until I placed my head around knee level while in a seated position. While it was not a big deal to this case, I can't have this happening when I'm the one operating. Any suggestions/tips/similar experiences?


My plan so far:
-taper down caffeine use
-wear shoes that allow my feet to breathe
-continue to go in the OR

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[OMD]

Eat.

I had a few vagal episodes my first few times in the OR (general surgery cases - well before ophtho was even on the radar). I was told to eat a decent breakfast and never had another problem. It isn't necessary now but it helped at the time. Anecdotal for sure, but worked for me.

 

[diosa428]

Drink lots of water before you go into the OR, in addition to eating a good breakfast. And keep water someplace nearby if you can.

 

[monkey7247]

Thanks for the suggestions. Did fine in the OR today, so maybe some of this stuff is working. Good thing most ophtho cases are short with all the water I've been drinking.

 

[koolkatmd]

hey monkey7247~
i have experienced multiple episodes of 'vasovagal attacks' and know exatly what u are talking about (u feel sweaty and dizzy and very light headed). i actually had a whole workup on it bc it happens so freq with me, and i recently started taking a medication (florinef, fludrocortisone) and i have noted that it helps me alot!! i havent had an episode in a whiel now but i also make sure to drink lots of water...another med that my cardiologist had recommened was midodrine (an alpha agonist), but this is a very expensive med. i hope this helps and good luck..
im also interested in going into ophtho and hope this doesnt affect me that much either!

 

[azzarah]

Actually getting vasovagal is supposedly genetic and it's more common in people with migraines....
I have passed out 4 times in med school--One time, I even passed out and took the surgical field with me. Oops.
Here are my observations: I noticed that all these episodes occured when I wasn't doing anything and just watching the case passively. Like during laparoscopic cases. I never get a vasovagal reaction when I'm the one holding something or suturing or doing procedures. Let's put it this way, it usually happens when I mentally step out of the case and see the person as a person. So now I try really hard to focus on what's going on and I haven't passed out in a long time. [knock on wood] Also,
-eat breakfast (it totally helps)
-don't wear your mask too tight
-keep squeezing your calves to increase preload
-One of my friends who passes out a lot more than me actually wears TEDs to the OR and swears by them...