In order to clarify the influence of epinephrine in local anesthetics on endogenous epinephrine, we examined the concentration of plasma catecholamines (epinephrine and norepinephrine) and hemodynamics by administering 4 ml of 2% lidocaine containing different concentrations of epinephrine. Forty-three healthy adult male volunteers were divided into five groups according to epinephrine concentration: 0-microg (group I), 10-microg (group II), 20-microg (group III), 40-microg (group IV), and 50-microg (group V). The parameters were examined immediately, and at 1, 2, 3, 4, 5, 10, 15, and 20 min after the injection. In groups II, III, IV, and V, the plasma epinephrine concentration was elevated to peak at 5 min after the injection, after which it started to decline. The amount of increase in the plasma epinephrine concentration at 5 min showed a highly positive correlation with the amount of epinephrine added to the local anesthetic in groups II, III, and IV. In group V the plasma epinephrine concentration showed a marked increase as compared to the baseline level. Plasma norepinephrine concentrations were found to be significantly elevated at 15 and 20 min in group V. A decrease in systolic blood pressure was observed at 4 and 5 min in group II. A decrease in diastolic blood pressure was observed at 5 min in group II; at 3, 4, and 5 min in group IV; and at 2, 3, 4, and 5 min in group V. Heart rate revealed no significant differences from baseline level in any of the groups and there were no significant differences among the groups. It is suggested that exogenous epinephrine added to a local anesthetic may stimulate the presynaptic beta2 receptors on sympathetic nerve endings and on the adrenomedulla, and accelerate the release of endogenous epinephrine.
The extraction of impacted third molars is a rather invasive procedure among dental treatments. In this study, how the sound and stress of the extraction of impacted third molars affects patients was objectively evaluated by examining changes in plasma catecholamine concentrations and hemodynamics. We also examined whether intravenous sedation was useful for the management of problems associated with extraction.Twenty healthy patients who had impacted third molars (Class I Position A) were randomly assigned to receive local anesthesia (LA group, n=9) or intravenous sedation with midazolam (IVS group, n=11). Both groups received infiltration anesthesia with 3.6ml of 3 % hydrochloric acid propitocaine with felypressin.The bone was removed with a bone chisel and mallet. Study variables were measured at five time points: after local anesthesia, before bone removal, during bone removal, after bone removal, and just after the end of operation.The plasma epinephrine concentration in the WS group was significantly lower than that in the LA group at all time points. The plasma norepinephrine concentration in the WS group was significantly lower than that in the LA group before and during bone removal. Hemodynamics did not significantly differ between the groups.Intravenous sedation with midazolam was considered a useful method to suppress the stress of patients caused by bone removal during the extraction of impacted third molars.
We determined the intra- and postoperative plasma concentrations of cytokines (tumor necrosis factor [TNF]-Alpha, interleukin [IL]-1Beta, IL-6, and IL-8) in oral surgery patients with procedures ranging in duration from 20 to 375 min and investigated their relationship to the intensity of the surgical stress over time. No significant differences from baseline levels were observed in the levels of TNF-Alpha, IL-1Beta, and IL-8. By contrast, increased IL-6 levels were noted only on the first postoperative day, when they reached 1500% of the baseline level, after which they decreased to preoperative levels by the third postoperative day and tended to reflect the intensity of surgical stress.
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