Vagal reaction

The risk of adverse reactions is low, and includes mainly vaso-vagal reactions, which can partly be prevented by the patient lying down in connection with the application. The vaso-vagal reaction is characterized by a fall in blood pressure, bradycardia, pallor and, rarely, loss of consciousness and convulsions. Infiltration of larger amounts of anaesthetics, e.g. in a fracture hematoma, increases the risk of systemic toxic reactions with paraesthesias, metal taste and visual disturbances. The infiltration should be stopped when there are such symptoms, which could precede the more serious reactions (loss of consciousness and convulsions). 

ETCA does not require any type of anesthetic, sedation or analgesics. Any mild pain caused by the application of the ETCA solution can be dealt with immediately, as soon as frosting occurs, by applying the post-peel cream. No pulse oximetry monitoring is necessary and no vagal reaction has been described, perhaps because it is a short procedure. 

Every patient must be properly monitored with pulse oximetry and electrocardiography (EGG). Even if the peel is done by the book and even when the simplest and least aggressive techniques are used, stress can cause vagal reactions, low blood pressure and tachycardia. Pulse oximeter monitoring can pick up on any drop in oxygen saturation that could accentuate myocardial irritability and cause arrhythmias. 

Without monitoring, a simple vagal reaction can go undetected, and if it is not treated correctly, the patient can... 

Allergies to local anesthetics (LAs) are rare, and the term allergy is often used to describe numerous problems that are more likely an overdose or a vagal reaction. Publications report that the frequency of allergic reactions to LAs is no more than 1% of aU the side-effects met with. Lidocaine is an amide local anesthetic that does not cause many allergies. 

Fainting as a result of the vagal reaction, shortly before or after injection, is an adverse reaction that can, of course, occur with some of the biologies, which are likewise injectables. Allergic reactions can occur to the formulation components of... 

Physiologic origin, due to an intrinsically slow pulse rate (common in athletes) or an acute vaso-vagal reaction. 

PROCARBAZINE ANALGESICS-OPIOIDS Unpredictable reactions may occur associated with hypotension and respiratory depression when procarbazine is co-administered with alfentanil, fentanyl, sufentanil or morphine Opioids cause hypotension due to arterial and venous vasodilatation, negative inotropic effects and a vagally induced bradycardia. Procarbazine can cause postural hypotension. Also attributed to an accumulation of serotonin due to inhibition of MAO Recommended that a small test dose (one-quarter of the usual dose) be administered in initially to assess the response... 

Most severe reactions to contrast media are associated with cardiovascular manifestations, causing hypotensive shock and in some cases ventricular fibrillation and cardiac arrest these events are reversible in most cases in which prompt treatment is given. In a case of hypotensive collapse reported in 1977, and followed by a small number of others, there was disseminated intravascular coagulation (50). In milder cases there is only hypotension, which can be transient and symptomless in some cases there is bradycardia (due apparently to vagal overactivity) rather than tachycardia. 

Before a fuU-face phenol peel, the patient is always put on a drip, electrocardiographic monitoring, pulse oximeter and blood pressure monitor. The doctor has everything he needs at his disposal in case of any allergic, vagal or other reactions. Although bupivacaine, ropivacaine or mepivacaine can be employed for FNB, these products should not be used for the reasons set out above, and anesthesia should consist of FNB with lidocaine without adrenaline and with deep sedation. 

TheophyUine decreases peripheral resistance, increases cardiac output, and causes a central vagal effect. Palpitations, sinus bradycardia, extrasystoles, hypotension, ventricular tachycardia, premature ventricular contractions (PVCs), and cardiac arrest have been reported. Although cardiovascular effects are generaUy mUd and transient, serious reactions, such as ventricular arrhythmias, can develop without warning. Patients should be carefuUy monitored. 

Vasopressin appears to help maintain arterial blood pressure during episodes of severe hypovolemia/hypotension. There is no convincing evidence for a role of vasopressin in essential hypertension. The effects of vasopressin on the heart (reduced cardiac output and heart rate) are largely indirect and result from coronary vasoconstriction, decreased coronary blood flow, and alterations in vagal and sympathetic tone. Some patients with coronary insufficiency experience angina even in response to the relatively small amounts of vasopressin required to control diabetes insipidus, and vasopressin-induced myocardial ischemia has led to severe reactions and even death. 

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