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Case Reports in Dentistry
Volume 2014 (2014), Article ID 656045, 5 pages
http://dx.doi.org/10.1155/2014/656045
Case Report

Orthostatic Dysregulation during Postural Change on the Dental Chair and Intraoperative Monitoring by Heart Rate Variability Analysis

1Department of Oral Medicine, Institute of Health Biosciences, The University of Tokushima Graduate Faculty of Dentistry, Kuramoto 3-18-15, Tokushima 770-8504, Japan
2Department of Dental Anesthesiology, Institute of Health Biosciences, The University of Tokushima Graduate Faculty of Dentistry, Tokushima 770-8504, Japan
3Department of Oral Surgery, Institute of Health Biosciences, The University of Tokushima Graduate Faculty of Dentistry, Tokushima 770-8504, Japan

Received 26 January 2014; Accepted 2 June 2014; Published 17 June 2014

Academic Editor: Kai-Yuan Fu

Copyright © 2014 Yukihiro Momota et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This is the first case report of orthostatic dysregulation (OD) manifested during postural change on the dental chair and intraoperatively monitored by heart rate variability (HRV) analysis. OD-associated autonomic dysfunction is induced by postural changes and easily leads to disturbance in circulatory dynamics; however, most dental practices have not yet realized the importance of managing OD. We measured autonomic activity in a patient with OD during dental therapy and assessed the clinical significance of HRV analysis for OD. The patient was a 17-year-old Japanese female. She was diagnosed with impacted wisdom teeth and had no previous history of a distinct systemic disease. A surgical procedure to extract the teeth was safely performed under both local anesthesia and sedation with nitrous oxide and midazolam. After the surgery, her postural change to sitting induced orthostatic hypotension. HRV variables showed parasympathetic dominance due to the upright position. Subsequently, her posture was returned to supine, and atropine sulfate administration for the immediate treatment of OD returned her blood pressure to normal levels. HRV variables showed relative sympathetic dominance due to an atropine-derived parasympathetic blockade. HRV analysis revealed OD-associated autonomic dysfunction and should become a standard tool for safe and secure dental management of OD.