Incidence and significance of cardiac arrhythmia in geriatric oral surgery patients

Campbell, John H.; Huizinga, Paul J.; Das, Sunil K.; Rodríguez, Juan Pablo Sánchez; Gobetti, John P.

doi:10.1016/s1079-2104(96)80376-3

Cited by 21 publications

(4 citation statements)

References 11 publications

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“…An animal study also demonstrated that lidocaine may decrease the HR 2 and mepivacaine can also cause bradycardia 3 . It has been reported that abnormal electrocardiography changes may occur during local anesthesia delivery and oral surgery in 15 %-37.5 % of the patients 5,7 . The differences among the studies may have been due to different study populations or to the dose of anesthetic used.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients

et al. 2010

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ObjectiveLocal anesthetic solutions with vasoconstrictors are not contraindicated in hypertensive patients, but due to their hemodynamic effects, local anesthetics without vasoconstrictors are mainly preferred by the clinicians. The aim of this study was to compare hemodynamic effects of three different local anesthetics without vasoconstrictors during tooth extraction in hypertensive patients.Material and MethodsSixty-five mandibular molars and premolars were extracted in 60 hypertensive patients (29 females and 31 males; mean age: 66.95 ± 10.87 years; range: 38 to 86 years old). Inferior alveolar and buccal nerve blocks were performed with 2% lidocaine hydrochloride (HCl), 2% prilocaine HCl or 3% mepivacaine HCl without vasoconstrictor. Hemodynamic parameters namely systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), saturation rate (SR), rate pressure product (RPP) and pressure rate quotient (PRQ) were investigated before and at different intervals after anesthetic injection.ResultsThe hemodynamic effects of the three agents were similar to each other, although some significance was observed for DBP, MAP, RPP and PRQ values in the lidocaine, prilocaine and mepivacaine groups.ConclusionLidocaine, prilocaine and mepivacaine solutions without vasoconstrictor can be safely used in hypertensive patients. It is advisable that dental practitioners select anesthetic solutions for hypertensive patients considering their cardiovascular effects in order to provide patient comfort and safety.

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Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients

et al. 2010

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“…Atrial flutter (AFL) may be induced by sympathetic hypertonia due to excessive mental and physical stresses. It is reported that negative emotions such as anxiety or anger increased the likelihood of an atrial fibrillation episode [1, 2], and significantly more arrhythmias occurred before administration of anesthesia than during administration of epinephrine-containing local anesthetics [3]. Before starting the oral surgical procedure for an outpatient, we observed an electrocardiographic finding of paroxysmal AFL.…”

Section: Introductionmentioning

confidence: 80%

“…Patients with previous aversive painful experiences or unnecessary anxiety or preconception about pain during dental surgery are particularly susceptible to such psychological stresses [2]. In this respect, it is indicated that a frequently postulated mechanism relating the risk of arrhythmia to psychological distress is sympathetic predominance and parasympathetic withdrawal [3, 4]. Furthermore, it is concluded that negative emotions including anger, anxiety, and so forth trigger symptomatic atrial fibrillation [5].…”

Section: Discussionmentioning

confidence: 99%

Management of paroxysmal atrial flutter that occurred in an outpatient prior to dental surgery: a case report

Shimoda

Takahashi

2019

BMC Oral Health

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BackgroundIt is essential to accomplish the appropriate emergency care particularly in patients undergoing stressful dento-oral surgical procedures. Atrial flutter may be induced by sympathetic hypertonia due to excessive mental and physical stress. There is no report regarding dental care in patients with atrial flutter. Herein, we describe a rare case of the antiarrhythmic management in an outpatient who presented with an electrocardiographic finding of paroxysmal atrial flutter before the initiation of the dento-oral surgical procedure.Case presentationA 60-year-old male patient was scheduled for a dental extraction. He had a history of angina pectoris, diabetes mellitus, and paroxysmal atrial fibrillation with medication. The preoperative electrocardiogram (ECG) revealed left ventricular hypertrophy and ST-T segment abnormality. Immediately before the dental extraction, II-lead ECG revealed atrial flutter; however, he complained of few subjective symptoms, such as precordial discomfort or palpitation. Observing the vital signs, ECG findings, and the general condition of the patient, low dose diltiazem was immediately administered by continuous infusion in order to control the heart rate and prevent atrial flutter-induced supraventricular tachyarrhythmia. Special attention was paid to prevent any critical cardiovascular condition under a preparation of intravenous disopyramide and verapamil and a defibrillator. The intravenous administration of diltiazem progressively restored the sinus rhythm after converting atrial flutter into atrial fibrillation, resulting in the prevention of tachycardia, and then was found to be appropriate as a prophylactic therapy of tachyarrhythmia.ConclusionsThe present case suggests that it is possible to successfully manage some of such patients using our method during dento-oral surgery which is likely to be associated with mental and physical stress. Therefore, it is essential to accomplish an initial emergency care in parallel to the differential diagnosis of unforeseen serious medical conditions or paroxysmal arrhythmia such as atrial flutter.

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“…The stimulation of excessive amounts of adrenaline from the body and the use of external adrenaline in the local anesthetic solution may produce life threatening arrhythmias in several patients (Campbell et al, 1996). The use of local anesthetics in patients with ICD should be carefully evaluated.…”

Section: Discussionmentioning

confidence: 99%

Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment

Shah

Khalil

Kola

2015

The Saudi Dental Journal

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Automated Implantable Cardioverter Defibrillators (AICD), simply known as an Implantable Cardioverter Defibrillator (ICD), has been used in patients for more than 30 years. An Implantable Cardioverter Defibrillator (ICD) is a small battery-powered electrical impulse generator that is implanted in patients who are at a risk of sudden cardiac death due to ventricular fibrillation, ventricular tachycardia or any such related event. Typically, patients with these types of occurrences are on anticoagulant therapy. The desired International Normalized Ratio (INR) for these patients is in the range of 2-3 to prevent any subsequent cardiac event. These patients possess a challenge to the dentist in many ways, especially during oral surgical procedures, and these challenges include risk of sudden death, control of post-operative bleeding and pain. This article presents the dental management of a 60 year-old person with an ICD and concomitant anticoagulant therapy. The patient was on multiple medications and was treated for a grossly neglected mouth with multiple carious root stumps. This case report outlines the important issues in managing patients fitted with an ICD device and at a risk of sudden cardiac death.

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Incidence and significance of cardiac arrhythmia in geriatric oral surgery patients

Cited by 21 publications

References 11 publications

Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients

Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients

Management of paroxysmal atrial flutter that occurred in an outpatient prior to dental surgery: a case report

Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment

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