Severe Anxiety-Induced Respiratory Alkalosis During Repeat Percutaneous Endoscopic Lumbar Discectomy: A Case Report

Severe Anxiety-Induced Respiratory Alkalosis During Repeat Percutaneous Endoscopic Lumbar Discectomy: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Severe Anxiety-Induced Respiratory Alkalosis During Repeat Percutaneous Endoscopic Lumbar Discectomy: A Case Report Tianfei Han, Wenyong Han, Fei Wang, Jiying Zhang, Mengnan Fei, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6376813/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A 44-year-old male with recurrent lumbar disc herniation developed severe anxiety-induced respiratory alkalosis during repeat percutaneous endoscopic lumbar discectomy (PELD) under monitored anesthesia care (MAC). Despite using dexmedetomidine and propofol for sedation, the patient exhibited extreme agitation, necessitating increased anesthetic dosages and subsequent management of metabolic disturbances in the post-anesthesia care unit (PACU). This case underscores the challenges of managing anxiety in minimally invasive spinal surgeries and emphasizes the need for individualized perioperative strategies to prevent complications. The patient recovered fully with appropriate medical intervention and supportive care. Percutaneous endoscopic lumbar discectomy Anesthesia Anxiety Respiratory alkalosis Dexmedetomidine Propofol Intraoperative complications Postoperative recovery Patient Presentation and Anesthetic Management A 44-year-old male (height 172 cm, weight 80 kg) was admitted with a 10-day history of left lower limb numbness and pain. Diagnosed with lumbar disc herniation, he underwent planned "percutaneous endoscopic lumbar discectomy (PELD) at L5-S1." The patient had no significant medical history, normal baseline vital signs (temperature 36.6°C, HR 78 bpm, BP 137/91 mmHg, RR 18 breaths/min), and an unremarkable ECG showing sinus rhythm. Chest X-ray revealed slightly prominent pulmonary markings, while blood tests showed glucose at 6.42 mmol/L and no otherabnormalities. He had previously undergone PELD at L4-5 under monitored anesthesia care (MAC) with successful recovery one year prior, with no known drug allergies or family history of illness. Intraoperative Course Upon entering the operating room, routine monitoring (HR 80 bpm, BP 140/94 mmHg, SpO₂ 98%) was initiated. An intravenous infusion of Ringer's lactate at 10 mL/h was started. Anesthesia was induced with dexmedetomidine (0.2 μg/kg/h) and dezocine (6 mg) for sedation and analgesia. The patient was positioned in the right lateral decubitus position, and the surgeon administered a layered local anesthetic infiltration with 0.25% ropivacaine combined with 0.5% lidocaine from the incision site to the epidural space before initiating the procedure. Ten minutes into the surgery, the patient became extremely agitated and uncooperative, necessitating an additional 50 mg of propofol titrated to deepen sedation. After approximately one hour, severe restlessness recurred, prompting a 70 mg bolus of propofol and a continuous infusion of 4 mg/kg/h to maintain anesthesia until the end of the procedure. Vital signs were closely monitored throughout, with emergency protocols in place. Postoperative Recovery and Complications The patient was transferred to the post-anesthesia care unit (PACU) 25 minutes post-surgery, where he complained of urinary retention and unbearable lower limb numbness. Immediate catheterization was performed, and the surgeon was notified. Considering possible adhesions, nerve irritation, dural tear, or spinal cord hyperpressure syndrome, methylprednisolone 40 mg was administered intravenously. At 50 minutes in the PACU, the patient's agitation worsened, accompanied by rapid breathing and intensified limb numbness. Arterial blood gas analysis revealed severe respiratory alkalosis (pH 7.49, pCO₂ 17.2 mmHg, pO₂ 132 mmHg, Ca²⁺ 1.11 mmol/L, Lac 7.0 mmol/L). Ventilation was adjusted with a face mask to increase CO₂ rebreathing, and 1 g of calcium gluconate was administered intravenously. The patient was sedated with 20 mg of propofol in divided doses, and by 12:56, he regained consciousness with stable respirations. Repeat blood gas analysis showed improvement (pH 7.42, pCO₂ 25.5 mmHg, pO₂ 117 mmHg, HCO₃⁻ 16.4 mmol/L, BE -7.2 mmol/L, Ca²⁺ 1.21 mmol/L, Lac 6.4 mmol/L). Aldrete score was 10, and the patient was discharged to the ward for further observation. Seven hours postoperatively, repeat blood gases were stable (pH 7.42, pCO₂ 28.2 mmHg, pO₂ 106 mmHg, HCO₃⁻ 17.9 mmol/L, BE -4.2 mmol/L, Ca²⁺ 1.17 mmol/L, Lac 6.28 mmol/L), with the patient reporting significant relief of numbness and stable mood. The following day, he denied any residual numbness. Discussion Percutaneous endoscopic spinal surgery has become a preferred treatment modality due to its minimally invasive nature and rapid recovery profile [1] 1 However, severe anxiety-induced hyperventilation during local anesthesia-assisted spinal endoscopy is uncommon 2 This patient underwent two PELD procedures, both managed with continuous dexmedetomidine and intermittent boluses of propofol, under the care of the same experienced surgeon. While the first surgery proceeded smoothly, the second required significantly higher total sedative doses, resulting in postoperative respiratory alkalosis. This was accompanied by hemodynamic changes (elevated blood pressure and heart rate) and gradual resolution of anxiety with improved patient comfort. This case highlights the importance of closely monitoring patients during minimally invasive, local anesthesia-assisted surgeries. For anxious patients, perioperative individualized strategies should be employed to mitigate anxiety and its adverse effects. In cases where deep sedation is contraindicated or ineffective, timely consideration of alternative anesthesia methods is crucial to ensure patient safety and procedural success. Although the clinical presentation, surgical course, and blood gas analysis strongly supported the diagnosis (Table 1), similar symptoms in spinal endoscopy should be differentiated from spinal cord hyperpressure syndrome to guide appropriate management However, this study has several limitations. First, as a case report, the findings are based on a single patient and cannot be generalized to the entire population undergoing PELD. The patient’s specific psychological profile and his experience with a repeat procedure might not be representative of all anxious patients. Furthermore, it was not possible to definitively rule out all underlying physiological or psychological factors that may have contributed to his severe reaction. Despite these limitations, this report provides valuable insight into a rare but significant complication and reinforces the importance of individualized perioperative strategies for anxious patients. Table 1. Blood Gas Analysis and Electrolyte Profile During Postoperative Anesthesia Recovery in the Patient Table 2. Postoperative Vital Signs Profile of the Patient During Anesthesia Recovery Abbreviations PELD: Percutaneous Endoscopic Lumbar Discectomy MAC: Monitored Anesthesia Care PACU: Post-Anesthesia Care Unit HR: Heart Rate BP: Blood Pressure RR: Respiratory Rate ECG: Electrocardiogram SpO₂: Oxygen Saturation pCO₂: Partial Pressure of Carbon Dioxide pO₂: Partial Pressure of Oxygen Ca 2 ⁺ : Calcium Ion Concentration Lac: Lactate HCO ₃ ⁻ : Bicarbonate BE: Base Excess SBP: Systolic Blood Pressure DBP: Diastolic Blood Pressure Declarations Ethics approval and consent to participate This case report was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Due to the nature of this study as a case report, formal ethics committee approval was not required. The patient provided written informed consent to participate. Consent for publication Informed consent was obtained from the patient for the publication of this case report and any accompanying images. Availability of data and materials The data supporting the findings of this study are available within the article. Further clinical data are not publicly available due to patient privacy protection but are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Conception and design: HW, HT. Data acquisition: WF, JZ, MF, NL. Analysis and interpretation: YL, LM, HW. Drafting of the manuscript: HT, HW. Critical revision of the manuscript: HW. All authors were involved in the surgical management of the patient, and all authors have read and approved the final manuscript. Acknowledgements Not applicable. References Lokhande PV. Full endoscopic spine surgery. J Orthop. 2023 Apr 29;40:74-82. doi: 10.1016/j.jor.2023.04.010. PMID: 37197373; PMCID: PMC10183645. Wang ZP, Xue W, Liu L, et al. A case of severe respiratory alkalosis during percutaneous transforaminal endoscopic discectomy for lumbar disc herniation under local anesthesia [J]. China Journal of Orthopaedics and Traumatology, 2020, 33(5): 476-478. [in Chinese] Ren GS, Lun DX, Chen WS, et al. The mechanism and preventive measures of spinal cord hyperpressure-like syndrome [J]. The Journal of Practical Orthopaedics, 2023, 29(3): 231-234. DOI:10.13795/j.cnki.sgkz.2023.03.013. [in Chinese] Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6376813","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":487782210,"identity":"bb03d0aa-3410-4564-bd81-b2a68e15a999","order_by":0,"name":"Tianfei Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACgwMMDAc+VEjUs7H3P3zwoYI4LYwHZ5yxSODjOcNsOOMMcVqYD3O2VCTISeSwCXO2EaPl+NkDhxkbJPLYeM4eY2acZy3bwH746AZ8WuzP5CUcLtwhUczG3pf2uHBbunEDT1raDfwOyzE4PPOMBGMbzwFz45nbDic2SPCY4ddy/o3BYd42oBaJBDNp3jnEaLmRA9aS2CaRA9TSQJSWNwbAQJYwZuM5lmw441i6cRtBv5zPMf7woaJOTr69+eCDDzXWsv3sh4/h1YIOmBmJiRo0LQ2kahkFo2AUjIJhDwAFfFdhN0YMZQAAAABJRU5ErkJggg==","orcid":"","institution":"Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Tianfei","middleName":"","lastName":"Han","suffix":""},{"id":487782212,"identity":"b159b1d9-7bc4-4481-b0e8-8a8f513e8ca4","order_by":1,"name":"Wenyong Han","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenyong","middleName":"","lastName":"Han","suffix":""},{"id":487782213,"identity":"16f99496-3a9e-44d0-bcb8-a9f24705cbcd","order_by":2,"name":"Fei Wang","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fei","middleName":"","lastName":"Wang","suffix":""},{"id":487782214,"identity":"27fba9bf-583c-4fb8-b022-d277ddc88dd9","order_by":3,"name":"Jiying Zhang","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiying","middleName":"","lastName":"Zhang","suffix":""},{"id":487782215,"identity":"7b6aadfe-94d6-4003-9eee-415513b22190","order_by":4,"name":"Mengnan Fei","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mengnan","middleName":"","lastName":"Fei","suffix":""},{"id":487782216,"identity":"f21a7a82-46f3-4623-950a-dfaf461fd136","order_by":5,"name":"Nianfang Lu","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nianfang","middleName":"","lastName":"Lu","suffix":""},{"id":487782217,"identity":"510e5794-62f8-459f-ad54-79d4bad2bfa5","order_by":6,"name":"Liyun Yu","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liyun","middleName":"","lastName":"Yu","suffix":""},{"id":487782218,"identity":"7682c217-4fb4-4a13-bf57-a342b18ade37","order_by":7,"name":"Min Li","email":"","orcid":"","institution":"Capital Medical University Electric Teaching Hospital, Beijing Electric Power Hospital","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-04-04 14:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6376813/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6376813/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93374373,"identity":"34be0899-5069-4a31-9c5b-d15721d53a85","added_by":"auto","created_at":"2025-10-13 07:32:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":429206,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6376813/v1/49d214b1-091b-4dd2-a774-bbf6322a6799.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Severe Anxiety-Induced Respiratory Alkalosis During Repeat Percutaneous Endoscopic Lumbar Discectomy: A Case Report","fulltext":[{"header":"Patient Presentation and Anesthetic Management","content":"\u003cp\u003eA 44-year-old male (height 172 cm, weight 80 kg) was admitted with a 10-day history of left lower limb numbness and pain. Diagnosed with lumbar disc herniation, he underwent planned \u0026quot;percutaneous endoscopic lumbar discectomy (PELD) at L5-S1.\u0026quot; The patient had no significant medical history, normal baseline vital signs (temperature 36.6\u0026deg;C, HR 78 bpm, BP 137/91 mmHg, RR 18 breaths/min), and an unremarkable ECG showing sinus rhythm. Chest X-ray revealed slightly prominent pulmonary markings, while blood tests showed glucose at 6.42 mmol/L and no otherabnormalities. He had previously undergone PELD at L4-5 under monitored anesthesia care (MAC) with successful recovery one year prior, with no known drug allergies or family history of illness.\u003c/p\u003e\n"},{"header":"Intraoperative Course","content":"\u003cp\u003eUpon entering the operating room, routine monitoring (HR 80 bpm, BP 140/94 mmHg, SpO₂ 98%) was initiated. An intravenous infusion of Ringer\u0026apos;s lactate at 10 mL/h was started. Anesthesia was induced with dexmedetomidine (0.2 \u0026mu;g/kg/h) and dezocine (6 mg) for sedation and analgesia. The patient was positioned in the right lateral decubitus position, and the surgeon administered a layered local anesthetic infiltration with 0.25% ropivacaine combined with 0.5% lidocaine from the incision site to the epidural space before initiating the procedure. Ten minutes into the surgery, the patient became extremely agitated and uncooperative, necessitating an additional 50 mg of propofol titrated to deepen sedation. After approximately one hour, severe restlessness recurred, prompting a 70 mg bolus of propofol and a continuous infusion of 4 mg/kg/h to maintain anesthesia until the end of the procedure. Vital signs were closely monitored throughout, with emergency protocols in place.\u003c/p\u003e\n"},{"header":"Postoperative Recovery and Complications","content":"\u003cp\u003eThe patient was transferred to the post-anesthesia care unit (PACU) 25 minutes post-surgery, where he complained of urinary retention and unbearable lower limb numbness. Immediate catheterization was performed, and the surgeon was notified. Considering possible adhesions, nerve irritation, dural tear, or spinal cord hyperpressure syndrome, methylprednisolone 40 mg was administered intravenously. At 50 minutes in the PACU, the patient\u0026apos;s agitation worsened, accompanied by rapid breathing and intensified limb numbness. Arterial blood gas analysis revealed severe respiratory alkalosis (pH 7.49, pCO₂ 17.2 mmHg, pO₂ 132 mmHg, Ca\u0026sup2;⁺ 1.11 mmol/L, Lac 7.0 mmol/L). Ventilation was adjusted with a face mask to increase CO₂ rebreathing, and 1 g of calcium gluconate was administered intravenously. The patient was sedated with 20 mg of propofol in divided doses, and by 12:56, he regained consciousness with stable respirations. Repeat blood gas analysis showed improvement (pH 7.42, pCO₂ 25.5 mmHg, pO₂ 117 mmHg, HCO₃⁻ 16.4 mmol/L, BE -7.2 mmol/L, Ca\u0026sup2;⁺ 1.21 mmol/L, Lac 6.4 mmol/L). Aldrete score was 10, and the patient was discharged to the ward for further observation. Seven hours postoperatively, repeat blood gases were stable (pH 7.42, pCO₂ 28.2 mmHg, pO₂ 106 mmHg, HCO₃⁻ 17.9 mmol/L, BE -4.2 mmol/L, Ca\u0026sup2;⁺ 1.17 mmol/L, Lac 6.28 mmol/L), with the patient reporting significant relief of numbness and stable mood. The following day, he denied any residual numbness.\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003ePercutaneous endoscopic spinal surgery has become a preferred treatment modality due to its minimally invasive nature and rapid recovery profile\u0026nbsp;[1]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, severe anxiety-induced hyperventilation during local anesthesia-assisted spinal endoscopy is uncommon\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis patient underwent two PELD procedures, both managed with continuous dexmedetomidine and intermittent boluses of propofol, under the care of the same experienced surgeon. While the first surgery proceeded smoothly, the second required significantly higher total sedative doses, resulting in postoperative respiratory alkalosis. This was accompanied by hemodynamic changes (elevated blood pressure and heart rate) and gradual resolution of anxiety with improved patient comfort.\u003c/p\u003e\n\u003cp\u003eThis case highlights the importance of closely monitoring patients during minimally invasive, local anesthesia-assisted surgeries. For anxious patients, perioperative individualized strategies should be employed to mitigate anxiety and its adverse effects. In cases where deep sedation is contraindicated or ineffective, timely consideration of alternative anesthesia methods is crucial to ensure patient safety and procedural success. Although the clinical presentation, surgical course, and blood gas analysis strongly supported the diagnosis (Table 1), similar symptoms in spinal endoscopy should be differentiated from spinal cord hyperpressure syndrome to guide appropriate management\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, this study has several limitations. First, as a case report, the findings are based on a single patient and cannot be generalized to the entire population undergoing PELD. The patient\u0026rsquo;s specific psychological profile and his experience with a repeat procedure might not be representative of all anxious patients. Furthermore, it was not possible to definitively rule out all underlying physiological or psychological factors that may have contributed to his severe reaction. Despite these limitations, this report provides valuable insight into a rare but significant complication and reinforces the importance of individualized perioperative strategies for anxious patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Blood Gas Analysis and Electrolyte Profile During Postoperative Anesthesia Recovery in the Patient\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1753106295.png\"\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 2. Postoperative Vital Signs Profile of the Patient During Anesthesia Recovery\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1753106328.png\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026nbsp; PELD: Percutaneous Endoscopic Lumbar Discectomy\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; MAC: Monitored Anesthesia Care\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; PACU: Post-Anesthesia Care Unit\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; HR: Heart Rate\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; BP: Blood Pressure\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; RR: Respiratory Rate\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; ECG: Electrocardiogram\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; SpO₂: Oxygen Saturation\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; pCO₂: Partial Pressure of Carbon Dioxide\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; pO₂: Partial Pressure of Oxygen\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Ca\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e⁺\u003c/sup\u003e: Calcium Ion Concentration\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Lac: Lactate\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; HCO\u003csub\u003e₃\u003c/sub\u003e\u003csup\u003e⁻\u003c/sup\u003e: Bicarbonate\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; BE: Base Excess\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; SBP: Systolic Blood Pressure\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; DBP: Diastolic Blood Pressure\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case report was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Due to the nature of this study as a case report, formal ethics committee approval was not required. The patient provided written informed consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patient for the publication of this case report and any accompanying images. Availability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available within the article. Further clinical data are not publicly available due to patient privacy protection but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: HW, HT.\u003c/p\u003e\n\u003cp\u003eData acquisition: WF, JZ, MF, NL.\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation: YL, LM, HW.\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: HT, HW.\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript: HW.\u003c/p\u003e\n\u003cp\u003eAll authors were involved in the surgical management of the patient, and all authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLokhande PV. Full endoscopic spine surgery. J Orthop. 2023 Apr 29;40:74-82. doi: 10.1016/j.jor.2023.04.010. PMID: 37197373; PMCID: PMC10183645.\u003c/li\u003e\n \u003cli\u003eWang ZP, Xue W, Liu L, et al. A case of severe respiratory alkalosis during percutaneous transforaminal endoscopic discectomy for lumbar disc herniation under local anesthesia [J]. China Journal of Orthopaedics and Traumatology, 2020, 33(5): 476-478. [in Chinese]\u003c/li\u003e\n \u003cli\u003eRen GS, Lun DX, Chen WS, et al. The mechanism and preventive measures of spinal cord hyperpressure-like syndrome [J]. The Journal of Practical Orthopaedics, 2023, 29(3): 231-234. DOI:10.13795/j.cnki.sgkz.2023.03.013. [in Chinese]\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Percutaneous endoscopic lumbar discectomy, Anesthesia, Anxiety, Respiratory alkalosis, Dexmedetomidine, Propofol, Intraoperative complications, Postoperative recovery","lastPublishedDoi":"10.21203/rs.3.rs-6376813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6376813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 44-year-old male with recurrent lumbar disc herniation developed severe anxiety-induced respiratory alkalosis during repeat percutaneous endoscopic lumbar discectomy (PELD) under monitored anesthesia care (MAC). Despite using dexmedetomidine and propofol for sedation, the patient exhibited extreme agitation, necessitating increased anesthetic dosages and subsequent management of metabolic disturbances in the post-anesthesia care unit (PACU). This case underscores the challenges of managing anxiety in minimally invasive spinal surgeries and emphasizes the need for individualized perioperative strategies to prevent complications. The patient recovered fully with appropriate medical intervention and supportive care.\u003c/p\u003e","manuscriptTitle":"Severe Anxiety-Induced Respiratory Alkalosis During Repeat Percutaneous Endoscopic Lumbar Discectomy: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-21 14:08:45","doi":"10.21203/rs.3.rs-6376813/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"883a119c-dae7-485c-a72c-318cd6de897e","owner":[],"postedDate":"July 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T07:24:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-21 14:08:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6376813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6376813","identity":"rs-6376813","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}