The changes of mean arterial pressure (MAP) and the heart rate after administration of. the anesthetic mixture was monitored and calculated using a physiological recording system. The most commonly used local anesthetic in dentistry is lidocaine (also called xylocaine or lignocaine) (Lustig and Zusman, 1999; Anesthetics, 2002). The addition of a vasoconstrictor to local anesthetic solution increases the depth and duration of local anesthesia by reducing systemic absorption (Robert and Ronald, 2000; Charlton et al., 2007).
Another benefit of using vasoconstrictors is the creation of a clear surgical field by reducing surgical site bleeding (Sveen, 1979; Syal, 2011) and could routinely provide patient comfort (Cawson et al., 1983) . However, anesthetic solutions containing epinephrine may cause side effects in patients with hemodynamic changes such as tachycardia and hypertension. These can be especially observed in hypertensive patients due to the systemic absorption of epinephrine (Clough, 1920; Hasse et al., 1986; Murakawa et al., 1998).
Patients with aortic regurgitation, mitral insufficiency, exophthalmic goiter or arteriosclerosis also need caution in the use of adrenaline containing local anesthetics (Bloom, 1934). More seriously, epinephrine can cause acute myocardial infarction (Christensen and Videbæk, 1974; Sorkin et al., 1982) in patients with underlying coronary artery disease during dental procedures. Interestingly, there are considerable differences of opinion as to what concentration of epinephrine in lidocaine is optimal for safe and effective local anesthesia for use in dentistry.
In this study we compared the changes of heart rate and blood pressure, anesthesia duration and amount of bleeding after the injection of 2% lidocaine without epinephrine (L0), 2% lidocaine with 1:200,000 epinephrine (L200), 2% epinephrine with 1: 100,000 epinephrine (L100), and 2%.
MATERIALS AND METHODS
- Animals
- Group setting and Drugs
- Measurement of blood pressure and heart rate
- Local anesthetic effect
- Analysis of bleeding
- Statistics
Changes in heart rate and blood pressure after administration of lidocaine containing any concentration of epinephrine were observed in each group of rats. Catheters were placed in a left carotid artery to measure systemic arterial blood pressure (IWX214 Data Recorder, iWorx/CB Sciences Inc., Dover, NH). After calibration of the system and a 10 minute equilibration period, baseline values of arterial blood pressure and heart rate were each measured.
Blood pressure and heart rate were measured continuously for 10 minutes after administration of the anesthetic mixture. Changes in mean arterial pressure (MAP) and heart rate were expressed as percentage changes in each subject's baseline mean arterial pressure and heart rate. Seven mg/kg of the anesthetic mixture was injected into the subcutaneous tissue on the plantar surface of the hind paw by slow infiltration with a 31-gauge needle and mechanically stimulated with a von Frey filament with a force that slightly bends the filament every 0.5 min.
Two minutes after administration of 7 mg/kg anesthetic mixture to the right thigh area by slow infiltration with a 31-gauge needle, the thigh muscle was cut 1 cm in length with a scalpel blade no. 11. Mean arterial pressure and heart rate were analyzed by one-way ANOVA followed by Tukey's post hoc test.
RESULTS
Measurement of MAP and heart rate
Local anesthetic effect
Analysis of hemostatic effect
The experiment was performed on the femoral area of the mouse and the blood after incision was absorbed by specially prepared filter paper (Figure 7A). Percent change of mean arterial pressure in rats after injection of 2% lidocaine with or without various concentrations of epinephrine. Percent change of heart rate in rats after injection of 2% lidocaine with or without various concentrations of epinephrine.
After drug injection on the femoral region, blood was collected with heparin-treated filter paper on incised section (A). Hemolysis assay in mice after injection of 2% lidocaine with or without different concentrations of adrenaline.
DISCUSSION
Lidocaine is usually necessary to mix with a small amount of epinephrine to expect sustained anesthesia and hemostasis for less bleeding during surgical operations (Carvalho et al., 2007; Ghali et al., 2008). Because adrenaline is a hormone, also a neurotransmitter, overdose of adrenaline during surgery can cause increased blood pressure and heart rate via stimulation of the sympathetic nervous system (Serrera et al., 2012; Neema and Kapur, 2013). We estimated the biological safety of lidocaine with 1:200,000 adrenaline through hemodynamic experiments in an animal model.
Figure 1 (A) presented the blood pressure changes in each group at 1 min intervals for 10 min after injection. Blood pressure is one of the hemodynamic variables most sensitive to the amount of epinephrine. In this study, MAP increased in a dose-dependent manner in response to epinephrine.
Although MAP L100 and L80 increased after administration of the anesthetic mixture, MAP L0 and L200 changed little over 10 min. L80 heart rate was slightly increased while L0 was decreased. 2002) showed that no specific hemodynamic response to lidocaine with epinephrine was observed in healthy young patients. 2001) also reported that intraoral injection of 1.8 mL of 2% lidocaine with 1:80,000 epinephrine was safe in patients with cardiovascular disease. However, 1.8 ml of 2% lidocaine with 1:80,000 epinephrine was less than the dose actually used in the clinical field. 1989) reported that adverse cardiovascular effects may follow systemic absorption of the drug in some cardiac patients.
1998) mentioned that the use of epinephrine-containing anesthetics would be considered based on the cardiac condition of each patient. These reports suggest that epinephrine dosage should be minimized for patients with significant cardiac disease. L100 and L80, local anesthetic mixtures containing a higher concentration of epinephrine, showed adverse hemodynamic changes: increased MAP and heart rate.
First, we conducted this study in the experimental setting with an animal model, not humans. The hemostatic effect measured in this study was shown to be an objective result using an objective procedure. Despite these limitations, the use of lidocaine containing 1:200,000 epinephrine (L200) can be expected to support patient safety in clinical surgery and developing dentistry.
CONCLUSION
Evaluation of effect of ephedrine on transport of drugs from the nasal cavity to the systemic circulation and central nervous system. Antinociceptive curcuminoid, KMS4034, effects on inflammatory and neuropathic pain likely via modulating TRPV1 in mice. Use of anesthetics associated with vasoconstrictors for dentistry in patients with cardiopathies: review of the literature published in the last decade.
Effect of addition of a vasoconstrictor to the local anesthetic solution on operative and postoperative bleeding, analgesia and wound healing.
다양한 농도의 에피네프린을 함유한 2% 리도카인의 효능과 안전성. 심박수, 혈압, 마취효과 정도, 출혈량을 비교하는 실험을 진행하였다. 국소마취제를 주입하는 동안 쥐의 평균동맥혈압과 심박수를 생리기록프로그램을 이용하여 모니터링하고 계산하였다.
또한 시간이 지남에 따라 마우스의 발바닥을 찔러서 마우스의 다리 근육이 손상되었을 때 방출되는 혈액 내 헤모글로빈 수치를 분광광도계를 사용하여 측정하여 국소마취의 효과를 관찰하였다. 에피네프린을 함유한 리도카인 투여군에서는 주사 후 평균 동맥압의 증가가 관찰되었습니다. L80의 평균 동맥압은 L0에 비해 유의하게 증가했습니다.
평균 동맥압과 심박수의 변화에 대한 혈역학적 반응은 L200에서 상대적으로 큰 변동 없이 일정한 결과를 보여주었습니다. 모든 군에서 마취효과 발현시간은 1분 이내였으며, 에피네프린을 함유한 국소마취제의 지속시간은 에피네프린을 함유하지 않은 군에 비해 유의하게 연장되었다(p<0.05). 또한 L0군에 비해 모든 에피네프린 함유군에서 출혈량이 감소한 것으로 나타났다.
결론적으로, L200은 현재 치과용 국소마취제로 널리 사용되고 있는 L100, L80에 비해 상대적으로 적은 양의 에피네프린을 주입하여 에피네프린 부작용이 있는 환자에게 유용한 마취제로 사용될 수 있음을 시사한다.
