心血管病患者使用阿替卡因肾上腺素心电监护拔牙的临床疗效观察

目的探讨应用含微量肾上腺素的阿替卡因局部麻醉药对心血管病患者拔牙的安全性。方法对1224名心血管病患者应用含微量肾上腺素的局部麻醉药,在心电监护下拔牙,观察并监测手术过程中麻醉前后、拔牙前后的血压、心率变化,进行对比分析。结果 1224名患者均较顺利完成手术;麻醉前、后,麻醉前与拔牙术中,拔牙术中、术后及麻醉前与拔牙术后10min的收缩压变化均有统计学差异;拔牙后10min的收缩压、舒张压及心率较麻醉前显著下降。结论对经过全身系统治疗、病情稳定的心血管病患者,麻药中加入少量肾上腺素局麻下拔牙是安全有效的。     

Cardiovascular responses to epinephrine-containing local anesthetics for dental use: a comparison of hemodynamic responses to infiltration anesthesia and ergometer-stress testing

OBJECTIVE: Cardiovascular effects of infiltration anesthesia have been documented in numerous studies. However, few studies have been carried out to compare the effects of infiltration anesthesia with the effects of exercise-stress testing. The purpose of this study was to examine this issue.Study Design: Eight young and 13 older subjects were given infusions of epinephrine to produce cardiovascular responses comparable with those found in subjects undergoing infiltration anesthesia with 3.6 mL of lidocaine with 1:80,000 epinephrine (L-E). Cardiovascular responses to this drug treatment were evaluated with echocardiography and compared with those produced by ergometer exercise. RESULTS: The hemodynamic effects of L-E infiltration anesthesia were less than those produced by ergometer-stress testing at 25 watts (W) in young subjects and at 15 W in the older subjects. The workload of this ergometer-stress testing was about 4 metabolic equivalents (METS), which is approximately equivalent to the workload of walking 4.8 km/hr, doing light yard work (ie, raking leaves, weeding, or pushing a power mower), painting, or doing light carpentry. CONCLUSION: With the exception of some specific pathologic conditions, such as serious arrhythmia, infiltration anesthesia with 3.6 mL of L-E can be carried out safely on the patients who have exercise capacity of more than 4 METS.     

An echocardiographic study of patients with cardiovascular disease during dental treatment using local anesthesia

The cardiac function of nine patients who had various cardiovascular diseases was investigated by echocardiography during dental treatment in which local anesthetics were administered. The administration of lidocaine with epinephrine enhanced the cardiac output of all patients. Increased heart rate was responsible for the increased cardiac output in four cases, whereas increased stroke volume was responsible in the other five cases. The administration of prilocaine with felypressin caused less of an increase in cardiac function than did lidocaine, with only one patient showing a significant change in cardiac dynamics.     

Cardiovascular effects of local anesthesia with epinephrine in periodontal treatment.

To assess if the association of epinephrine with local anesthesia involves cardiovascular risks, 14 patients undergoing periodontal treatment were observed. Systolic and diastolic blood pressures and mean and maximal heart rates were analyzed. The comparison of basal and postanesthetic periods revealed a trend (nonsignificant) toward an increase in systolic blood pressure and a small, statistically significant increase in diastolic blood pressure; the heart rate increased in only a few patients, and never by more than 10 beats/min. The whole group showed a statistically significant reduction in mean and maximal heart rates from the basal period to an end-session period. Thus, in these patients, the given epinephrine doses resulted in negligible changes in heart rate and blood pressure. The reduction in heart rates at the end of treatment underlines the important role of the autonomic nervous system in the modulation of the cardiovascular response during dental sessions.     

Assessment of ST segment depression in patients with cardiac disease after local anesthesia

This study found that dental treatment with 2% lidocaine with 1:100,000 epinephrine did not provoke myocardial ischemia, as assessed by greater than or equal to 1 mm of ST segment depression. Although in some cases systolic and diastolic blood pressure and rate pressure product increased slightly after local anesthetic administration, these changes were not statistically significant. Because these patients were medically supervised and compliant with cardiac therapy, this study suggests that such patients are not at great risk while receiving local anesthesia with 1:100,000 epinephrine for routine dental care.     

Cardiovascular, biochemical, and hormonal responses to intravenous sedation with local analgesia versus general anesthesia in patients undergoing oral surgery

The effects of intravenous conscious sedation and general anesthesia on a number of stress variables were compared in healthy patients undergoing oral surgery. In the intravenous sedation group only the levels of plasma growth hormone and prolactin rose significantly. In the general anesthesia group significant rises were seen in heart rate; systolic blood pressure; mean arterial pressure; levels of plasma adrenaline, adrenocorticotropic hormone, cortisol, and prolactin; and levels of blood glucose, all indicative of a stress response. This study demonstrates that oral surgery under intravenous conscious sedation with local analgesia is associated with less patient stress than is oral surgery under general anesthesia.     

The cardiovascular response of oral and maxillofacial surgeons during administration of local and general anesthesia

The heart rate and rhythm of 15 oral and maxillofacial surgeons were monitored during the administration of local and general anesthesia. Preinduction heart rates were higher in both groups than at rest. The group using general anesthesia reached a maximum increase (59%) one minute after induction. The increase in heart rate in the general anesthesia group was statistically greater than in the local anesthesia group and remained higher during the five-minute study period. There appears to be more stress associated with the administration of general anesthesia than with local anesthesia.     

Dental local anesthesia in patients with diabetes mellitus]

In 51 tooth extractions in medicinally controlled diabetics, adrenaline and noradrenaline (used as vasoconstricting additives to the local anaesthetic) did not differ in their effects on the blood-sugar level. A clinically important or lasting disturbance of the carbohydrate metabolism was observed in no case. The general preference given to noradrenaline as a vasoconstrictor in diabetics is not supported by the present study.     

Blood pressure and electrocardiographic response to dental treatment with use of local anesthesia

The incidence of ST segment depression during tooth extraction was significantly higher in patients with cardiac disease than it was in patients without cardiac disease, indicating that the cardiac patients experienced myocardial ischemia. The almost equivalent incidence of ST segment depression during anesthetic administration and surgery suggests that the administration of local anesthetic is as stressful as tooth extraction for cardiac patients. Medical consultation before dental treatment and use of stress-reduction techniques may be indicated for patients with or suspected to have cardiac disease.     

Cardiovascular behavior after local anesthesia in the jaw region with added vasoconstrictor agents]

The authors studied the cardiovascular behaviour after injection of different amounts of xylocitin added with adrenalin (1:80 000) and noradrenalin (1:20 000), respectively. The evaluation of the blood-pressure values, pulse rates and electrocardiograms leads to the conclusion that noradrenalin produces considerable side effects at the above-mentioned concentration. The well-known headache phenomena caused by the addition of noradrenalin are analysed.     

Reversal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients

BACKGROUND: The authors evaluated the safety and efficacy of a formulation of phentolamine mesylate (PM) as a local anesthesia reversal agent for pediatric patients. METHODS: A total of 152 pediatric subjects received injections of local anesthetic with 2 percent lidocaine and 1:100,000 epinephrine before undergoing dental procedures. The authors then randomized subjects to receive a PM injection or a control injection (sham injection in which a needle does not penetrate the tissue) in the same sites as the local anesthetic was administered in a 1:1 cartridge ratio after the procedure was completed. Over a two- to-four-hour period, they measured the duration of soft-tissue anesthesia and evaluated vital signs, pain and adverse events. RESULTS: The median recovery time to normal lip sensation was 60 minutes for the subjects in the PM group versus 135 minutes for subjects in the control group. The authors noted no differences in adverse events, pain, analgesic use or vital signs, and no subjects failed to complete the study. CONCLUSIONS: PM was well-tolerated and safe in children 4 to 11 years of age, and it accelerated the reversal of soft-tissue local anesthesia after a dental procedure in children 6 to 11 years of age. CLINICAL IMPLICATIONS: PM can help dental clinicians shorten the post-treatment duration of soft-tissue anesthesia and can reduce the number of posttreatment lip and tongue injuries in children.     

Glycemic effect of administration of epinephrine-containing local anaesthesia in patients undergoing dental extraction, a comparison between healthy and diabetic patients

OBJECTIVES: To compare the effect of administration of epinephrine (in the dental local anesthetic solution) on blood glucose concentration in healthy and diabetic dental patients after extraction. To determine if there is any correlation between blood glucose level changes and the number of carpules injected, number of teeth extracted and the gender of the patient. MATERIALS AND METHOD: An open study of 60 patients (30 healthy and 30 diabetics) visiting the Oral Surgery clinic of Ajman University of Science and Technology. A drop of blood was taken from the tip of the patient's finger and placed on a glucometer strip to determine the pre-operative blood glucose level. Dental local anaesthesia (1.8 ml carpule each) containing 1:80,000 epinephrine was injected either through infiltration or block. Extraction was carried out atraumatically and 10 minutes post-extraction the glucose measurement was taken. RESULTS: The difference in the blood glucose levels pre- and post operatively were not significantly different (p > 0.05) when a comparison was made between the healthy and diabetic groups. Comparison of glucose changes in diabetics who had taken their hypoglycaemic medication and those who had not, showed a significant difference (p < 0.05). Statistical analysis showed no correlation between the blood glucose level changes and the number of carpules used, number of teeth extracted and gender. CONCLUSION: Dental local anaesthetic solution containing epinephrine is safe to use in all healthy and diabetic patients (irrespective of their gender), excepting those diabetics who have not taken their pre-operative hypoglycaemic medication. There is no relation between the post-extraction glucose changes and the number of carpules used, number of teeth extracted or gender.