The Use of Moderate Sedation for the Secondary Prevention of Adverse Vasovagal Reactions

• Published in: Pain medicine (Malden, Mass.) Vol. 16; no. 4; pp. 673 - 679
• Main Authors: Kennedy, David J., Schneider, Byron, Smuck, Matthew, Plastaras, Christopher T.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.04.2015
• Subjects: Anesthesia; Birth control; Block; Confidence intervals; Conscious Sedation - methods; Epidural (Injection Space); Facet Joint; Fainting; Fentanyl - therapeutic use; Fluoroscopy; Humans; Hypnotics and Sedatives - therapeutic use; Injections, Spinal - adverse effects; Low Back Pain - therapy; Midazolam - therapeutic use; Retrospective Studies; Safety; Secondary Prevention - methods; Sedation; Spine; Syncope, Vasovagal - etiology; Syncope, Vasovagal - prevention & control; Epidural (Injection Space); Spine; Block; Fluoroscopy; Safety; Sedation; Facet Joint
• DOI: 10.1111/pme.12632
• ISSN: 1526-2375

Background Vasovagal reactions can occur with spine procedures and may result in premature procedure termination or other adverse events. Objective To evaluate if moderate sedation is an effective means of secondary prevention for vasovagal reactions. Methods Prospectively collected data on 6,364 consecutive spine injections. Results Of the 6,364 spine injections, 6,150 spine injections were done without moderate sedation and resulted in 205 vasovagal reactions (3.3% [95% confidence interval {CI} 2.9–3.8%]). One hundred thirty‐four spine procedures were performed on patients that had a history of prior vasovagal reaction during a spine procedure. Of these, 90 procedures were performed without moderate sedation, and 21/90 (23.3% [95% CI 15.2–32.1%]) were complicated by a repeat vasovagal reaction. None of 44 repeat injections that utilized moderate sedation experienced a repeat vasovagal reaction (0% [95% CI 0–9.6%]) (χ2 = 12.17, P < 0.00048). The rate of vasovagal reaction in patients with a history of prior reaction undergoing repeat injection without conscious sedation was significantly higher (23.3% [95% CI 15.2–32.1%]) than the rate in patients with no such history (3.0% [95% CI 2.6–3.5%] [χ2 = 113.4, P < 1.78E‐26]). Conclusions A history of vasovagal reaction is a strong predictor of experiencing a vasovagal reaction on subsequent procedures. No vasovagal reactions occurred with the use of moderate sedation, including in the 44 injections in patients that had a history of vasovagal reaction during spine procedures. The overall low rate of vasovagal reactions is low, and greater benefits of moderate sedation were observed when utilized as secondary prevention of repeat vasovagal reactions.