Leg Maneuvers to Prevent Dental Extraction Syncope

A pilot study was designed since we have advocated a novel method to prevent syncope during extraction. This pilot study was designed with a total of 30 patients. This study included only patients with a previous history of syncope and dental anxiety. Patients were divided into two groups consisting of 15 patients each. The study group consisted of 15 patients who were taught leg raise and leg fold maneuvers and were asked to perform the maneuver at regular intervals during extraction, and the control group consisted of 15 patients who underwent extraction in the conventional method.
Inclusion criteria
This study includes subjects ranging from 18-75 years of age with a previous history of syncope and dental anxiety.
Exclusion criteria
Patients with musculoskeletal disease; patients with suspected or overt heart disease with a high likelihood of cardiac syncope; patients with orthostatic hypotension; patients with episodes of loss of consciousness different from syncope; patients who are psychologically, physically, or cognitively unable to participate; patients with doubtful compliance; patients with inaccessibility to follow-up; patients who are unwilling or unable to give informed consent; and patients who are pregnant are all excluded.
Leg raise and leg fold physical maneuver technique
Group I (study group) patients undergoing extraction were educated few physical maneuvers that are to be done by the patients at regular intervals. Before extraction, the patients were educated about the physical maneuver that consists of leg lifts and leg folds. The clinician taught the patient to do this maneuver before local anesthesia administration, intraoperatively at regular intervals, if required postoperatively. The patient will raise his/her leg for five times to a minimum height of at least 15 cm (Figure 1) while sitting in the dental chair. Each leg is done individually or combined according to the patient's preference.
Once the leg raise maneuver is completed, the patient will fold the leg and stretch each leg five times using the knee joint (Figure 2). During the maneuver, sudden jerky movements should be avoided, and the patient is advised to focus primarily on physical activity.
Group II (Control group) patients conventionally underwent extraction. Informed consent was obtained from all the patients. The parameters for this study included monitoring blood pressure, SpO₂, and pulse, which were monitored preoperatively, postoperatively, and verbally. Blood pressure was monitored using a manual sphygmomanometer. Pulse rate and SpO₂ were assessed using a pulse oximeter. While extracting, if the patient develops any signs of unrest requiring emergency care, the procedure will be completely stopped, and maintenance of the chair in reverse trendelenburg and protocols for standard management of syncope will be followed.