A 40-year-old female presented with anxiety, and occasional heart palpitations during times of high stress, alongside elevated cortisol and a heightened nervous system response. The case specifically focuses on the patient's need to undergo maxillofacial dental surgery requiring local anaesthesia with adrenaline.

Initial Consultation

The patient presented to the clinic several weeks prior to a scheduled dental surgery involving 1 to 2 hours in the chair under a maxillofacial surgeon. The procedure required local anaesthesia containing adrenaline to reduce oral bleeding. Due to a history of anxiety and heightened sensitivity to stimulants including caffeine, green tea, and chocolate, the patient was concerned about her ability to tolerate the anaesthetic.

Prescription

At the time of presentation, she was already taking:

• Calming Magnesium Powder: 2 scoops (12 g) daily; containing magnesium 300 mg (as citrate), Withania somnifera root 1.5 g, potassium 100 mg, glycine 1.5 g, glutamine 1.5 g, taurine 1.5 g, ascorbic acid 250 mg, vitamin B5 45.8 mg, vitamin B6 50 mg, zinc 14.6 mg
• Herbal liquid blend: 7.5 mL twice daily; containing Withania somnifera (Withania), Rehmannia glutinosa (Rehmannia), Passiflora incarnata (Passionflower) amd Eleutherococcus senticosus (Siberian Ginseng)

To further support her during the dental procedure, the patient was prescribed:

• Calming Herbal Tablets; containing Matricaria chamomilla (Chamomile) flower 500 mg, Melissa officinalis (Lemon Balm) leaf 650 mg, Passiflora incarnata (Passionflower) herb 1.4 g and Ziziphus jujuba var. spinosa (Zizyphus) seed 3 g; with instructions to take 3 tablets 30 minutes prior to the surgery.

First Procedure Outcome

The patient followed the pre-surgical protocol exactly and reported feeling calm and grounded during the entire procedure. She experienced no palpitations or anxiety symptoms despite the use of adrenaline. The surgery was completed without any issues, and she was able to drive herself home and resume normal activities later that day.

Unexpected Second Procedure

Two weeks following the surgery, the patient returned to the surgeon after a complication. She was unaware that a second round of local anaesthesia containing adrenaline would be required for the repair.

Because this procedure was unplanned, the patient did not take the Calming Herbal Tablets beforehand. During the 5 minute procedure, she experienced acute symptoms of overstimulation: heart palpitations, hand tremors, and a strong sense of panic that made her attempt to get out of the chair. While she was eventually able to complete the procedure, she was left weak and shaky and was unable to drive herself home.

Clinical Reflections

This case highlights the value of short term nervine and anxiolytic herbal support during acute stress. Targeted dosing of Calming Herbal Tablets prior to the initial procedure helped the patient manage anxiety effectively. In contrast, during an unplanned follow up without herbal support, she experienced notable anxiety, heart palpitations, and post-procedural exhaustion, reinforcing its clinical relevance.