Effects of Anesthetics Containing Epinephrine on Catecholamine Levels During Periodontal Surgery

Abstract

Nine stable cardiovascular disease patients were evaluated in a double-blind cross-over trial during periodontal surgery using 2% lidocaine with epinephrine 1:100,000 or lidocaine alone. In the lidocaine with epinephrine group, epinephrine levels increased from 198 +/- 54 pg/ml to 592 +/- 166 pg/ml at 2 minutes post-injection. In the lidocaine alone group, epinephrine levels increased from a baseline of 115 +/- 34 pg/ml to 150 +/- 34 pg/ml at 2 minutes post-injection. Despite these elevations in epinephrine, no significant changes in heart rate or mean arterial pressure were noted. Plain lidocaine provided unsatisfactory levels of hemostasis and/or anesthesia during periodontal surgery. This study documents acute elevations in plasma epinephrine levels following local dental anesthesia for periodontal surgery. These elevations in plasma epinephrine failed to produce a significant cardiovascular response in a group of stable cardiovascular disease patients. This suggests that the cardiac effects of local anesthetics containing epinephrine are small and that they can be safely used in stable cardiovascular disease patients.

Suppression of Cardiac Sympathetic Nervous System during Dental Surgery in Hypertensive Patients.

“…Peak value of plasma epinephrine concentration was obtained just after the administration of local anesthetic with epinephrine, while the peak value of plasma norepinephrine concentration was obtained during dental surgery (unpublished observations) . The time courses of plasma catecholamine concentrations were consistent with previous findings (13,14). These results suggest that epinephrine (1:80,000) administered in local anesthetic leaks into the systemic circulation.…”

Comparative Evaluation of Local Anaesthesia with Adrenaline and Without Adrenaline on Blood Glucose Concentration in Patients Undergoing Tooth Extractions

“…This enhances the local anesthetic effect by localizing it to the site of injection, decreases toxicity by retarding systemic absorption, prolongs the duration of anaesthesia, and may decrease the total dose of the local anaesthetic drug required [3]. Another secondary advantage to the use of vasoconstrictors in local anesthetic solutions is in the control of bleeding or Fig.…”

“…Another secondary advantage to the use of vasoconstrictors in local anesthetic solutions is in the control of bleeding or Fig. 1 Comparison of blood glucose concentration in healthy patients in Group A and Group B haemostatic effect that the vasoconstrictor provides [3].…”

Isolated atrial fibrillation (IAF) after local anaesthesia with epinephrine in an anxious dental patient

“…22 We want to stress here, that aspiration always must be carried out before deposing a volume of local anaesthetic, this manoeuvre dramatically minimises the possibility of an intravascular injection. Tolas et al 9 showed triplication of circulating epinephrine after upper maxillary infi ltration with 1.8 ml of 2% lidocaine and epinephrine 1:100,000, whereas Davenport et al 23 described a peak of circulating epinephrine two minutes after administration of the same local anaesthetic. The circulating levels of epinephrine that are achievable after administration of 1.8 ml of local anaesthetic with epinephrine 1:100,000 can yield only minor changes of heart rate and blood pressure.…”