Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia (original) (raw)
Related papers
Basrah Journal of Surgery, 2018
Local anesthetic drugs are used in combination with vasoconstrictors, commonly adrenaline which increases their efficacy and duration of action and reduces bleeding at the operative site. However, adrenaline might have adverse hemodynamic effects, especially in patients with cardiovascular diseases. Hypertensive patients represent a risk group in dental practice. One major apprehension of the dentist is the sudden and dramatic increase in blood pressure that could lead to life-threatening complications including sudden death during a dental procedure. The aim of this study is to measure hemodynamic parameters, blood glucose, oxygen saturation and pain score in normotensive and hypertensive patients following intraoral injection of lidocaine with adrenaline and correlate these changes to the level of pain intensity and plasma metanephrine concentration. This prospective study was conducted at Basrah College of Dentistry from October 2016 to June 2017. One hundred patients were included in the study for teeth extraction under local anesthesia. Sixty normotensives, 30 had stage one hypertension (BP=140-159/90-99) and ten healthy volunteers for metanephrine assay. All patients were injected with two cartridges of 2% Lidocaine with 1:80,000 adrenaline. Systolic and diastolic blood pressure, heart rate, oxygen saturation, visual analogue scale, blood glucose and plasma metanephrine concentration were measured at different intervals; before anesthetic injection, 5 minutes after injection, during extraction and 10 minutes following the end of tooth extraction. Administration of local anesthesia with adrenaline in addition to the surgical procedure resulted in a significant increase in systolic blood pressure during tooth extraction (+8.7% and +16.6% mmHg for normotensive and hypertensive patients respectively, p<0.05), also heart rate similarly affected in both groups (10.6% and 13.4% respectively), this effect was significantly higher in the hypertensive group. The blood glucose showed a significant increase (P=0.00) 30 minutes after injection as compared to baseline. Generally, the peak changes in parameters were observed during tooth extraction procedure in both groups. Metanephrine peak plasma level occurs at 10 minutes following injection and it was significantly correlated with the systolic and diastolic blood pressure. In conclusions, the injection of lidocaine with adrenaline in addition to the surgical procedure produces significant increase in blood pressure and heart rate in both normal and hypertensive patients which were larger in the latter group. Similarly, plasma metanephrine concentration was increased during the dental procedure and linked to the increase in the systolic blood pressure.
2017
Aim- Comparative evaluation of the efficacy of lidocaine with adrenaline and lidocaine with clonidine in maxillary infiltration anaesthesia is the aim of study. Materials and method- study conducted in department of Oral and Maxillofacial surgery. 40 patients were selected and divided into two groups. Odd serial number patients in Group 1- 20 patients, received 2 mL of 2% lidocaine with epinephrine (1:80,000) and even number patients Group 2 - 20 patients, received 2 mL of 2% lidocaine with clonidine (150mg/mL). The systolic blood pressure (SBP), diastolic blood pressure, mean arterial pressure, heart rate (HR) was recorded before and during administration of local anesthesia, 5 minutes after administration of anesthesia, during extraction, 10 minutes after extraction, and 30 minutes after extraction. Results- The parameters of maxillary infiltration anesthesia produced were similar in both the groups, with the exception of a significant reduction in heart rate and systolic blood pr...
Induced Hypotension in Orthognathic Surgery: A Comparative Study of 2 Pharmacological Protocols
Journal of Oral and Maxillofacial Surgery, 2008
The objective of this comparative study was to report on the use of 2 different pharmaceutical protocols involving 2 different anesthetic techniques (IV and balanced) to induce hypotension in patients submitted to orthognathic surgery by assessing the patients' intra-and postoperative physiologic response and hemodynamic stability. Patients and Methods: Twenty ASA I patients, between 17 and 44 years of age who had dental and skeletal deformities were subdivided into 2 groups: group I (clonidine associated to remifentanil), and group II (dexmedetomidine associated to isoflurane), in addition, other drugs were common to both groups. The following responses were assessed: arterial blood pressure, heart rate, temperature during intra-and postoperative periods, incidence of nausea and vomiting, postoperative pain, awakening time, extubation time, and postanesthetic recovery time. Results: The results of the study using Repeated Measures Test statistical analysis showed that there were no significant differences between the 2 groups in respect to physiologic responses or surgery time. Conclusion: Both protocols tried in this study proved to be effective and safe, and they seem to be interesting alternatives in longer orthognathic surgeries with the expectation of an important blood loss. The choice for either protocol should be based on the inherent risks involved in their use and their cost-benefit ratio.
Hemodynamic changes following intraoral injection
Local anesthetic drugs are used in combination with vasoconstrictors, commonly adrenaline which increases their efficacy and duration of action and reduces bleeding at the operative site. However, adrenaline might have adverse hemodynamic effects, especially in patients with cardiovascular diseases. Hypertensive patients represent a risk group in dental practice. One major apprehension of the dentist is the sudden and dramatic increase in blood pressure that could lead to life-threatening complications including sudden death during a dental procedure. The aim of this study is to measure hemodynamic parameters, blood glucose, oxygen saturation and pain score in normotensive and hypertensive patients following intraoral injection of lidocaine with adrenaline and correlate these changes to the level of pain intensity and plasma metanephrine concentration. This prospective study was conducted at Basrah College of Dentistry from October 2016 to June 2017. One hundred patients were included in the study for teeth extraction under local anesthesia. Sixty normotensives, 30 had stage one hypertension (BP=140-159/90-99) and ten healthy volunteers for metanephrine assay. All patients were injected with two cartridges of 2% Lidocaine with 1:80,000 adrenaline. Systolic and diastolic blood pressure, heart rate, oxygen saturation, visual analogue scale, blood glucose and plasma metanephrine concentration were measured at different intervals; before anesthetic injection, 5 minutes after injection, during extraction and 10 minutes following the end of tooth extraction. Administration of local anesthesia with adrenaline in addition to the surgical procedure resulted in a significant increase in systolic blood pressure during tooth extraction (+8.7% and +16.6% mmHg for normotensive and hypertensive patients respectively, p<0.05), also heart rate similarly affected in both groups (10.6% and 13.4% respectively), this effect was significantly higher in the hypertensive group. The blood glucose showed a significant increase (P=0.00) 30 minutes after injection as compared to baseline. Generally, the peak changes in parameters were observed during tooth extraction procedure in both groups. Metanephrine peak plasma level occurs at 10 minutes following injection and it was significantly correlated with the systolic and diastolic blood pressure. In conclusions, the injection of lidocaine with adrenaline in addition to the surgical procedure produces significant increase in blood pressure and heart rate in both normal and hypertensive patients which were larger in the latter group. Similarly, plasma metanephrine concentration was increased during the dental procedure and linked to the increase in the systolic blood pressure.
Periodicum Biologorum, 2009
The aim of this study was to determine the effect of local infiltration of adrenaline- containing lidocaine solution during septoplasty under general anaesthesia on systemic haemodynamics and the visibility of the operative field, and to compare it to the topical application of ephedrine. A retrospective, comparative, non-randomised, open study on 72 ASA physical status I and II patients, aged 20 to 73 years, scheduled for septoplasty was performed. Lidocaine/adrenaline-ephedrine group (group LA-E ; n=18) received four cotton pledgets soaked with 1 % ephedrine, and then the submucosal infiltration of 2% lidocaine containing adrenaline solution (2ml) plus plain 2% lidocaine solution (5ml). Lidocaine/adrenaline group (LA group ; n=25) received the submucosal infiltration of 2% lidocaine containing adrenaline solution (2ml) plus plain 2% lidocaine solution (5ml). Ephedrine group (E group ; n=29) received four cotton pledgets soaked with 1% ephedrine. Heart rate (HR) and mean arterial p...
2021
Introduction: Local anesthetic used for dental extraction is 2% lidocaine hydrochloride with adrenaline (1:200000). Lidocaine is cardiac depressant and adrenaline is cardiac stimulant; it decreases or increases blood pressure respectively. Methods: A total of 100 patients (50 controlled hypertensive and 50 non-hypertensive) were selected. The study was conducted over a period of 14 months from January 2020 to February 2021. Blood pressure was measured for patients who were planned for dental extraction by auscultatory method. Following that, 1.5-3 ml (depending upon the nerve block) 2% lidocaine with adrenaline (1:200000) was injected using a 3ml syringe (26 Gauge). Blood pressure was re-recorded after 10 minutes from the time of injection. Visual analog scale pain score was obtained during administration of local anesthesia. Paired t-test was applied to compare blood pressure change before and after administration of local anesthesia in controlled hypertensive and non-hypertensive ...
Journal of Dental Anesthesia and Pain Medicine, 2015
Background: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. Methods: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. Results: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). Conclusions: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2005
Lidocaine with epinephrine is currently the most common local anesthetic agent used for impacted third molar surgery. The purpose of the present study was to define the adverse hemodynamic effects and plasma concentrations of lidocaine and epinephrine on 17 healthy patients during the impacted teeth operations. Arterial blood pressure (systolic blood pressure, diastolic blood pressure), heart rate, peripheral oxygen saturation range, and electrocardiography were measured by an automatic noninvasive pressure device and monitor. High-performance liquid chromatography was used to measure the changes of plasma concentrations of epinephrine and lidocaine from blood samples taken 5 different times during the operation. We concluded that lidocaine-epinephrine is effective local anesthetic and had no important adverse events in healthy patients during the third molar surgery.
Journal of Nepalese Society of Periodontology and Oral Implantology, 2020
Introduction: Most of the minor oral surgical procedures are performed under local anaesthesia (LA). Vasoconstrictor present in LA decreases the rapid absorption of LA, decreases systemic toxicity, increases duration of LA and provides local hemostasis which favor clinicians for better work performance. But it is also known to increase heart rate (HR) and blood pressure (BP). Objective: To evaluate the effect of vasoconstrictor adrenaline 1:80,000 in 1.8 ml of 2% Lidocaine on systolic and diastolic blood pressure, pulse rate and oxygen saturation of normotensive patients. Methods: A prospective randomized study was conducted on 70 patients who were divided randomly into 2 parallel groups according to the LA received. Group 1 (G1): lidocaine 2% without adrenaline and Group 2 (G2): lidocaine 2% with adrenaline 1:80,000. Blood pressure, pulse rate and oxygen saturation were measured before and 10 minutes after LA administration for each patient. Results: Statistically significant rise ...