The Evaluation of Perioperative Safety of Local Anesthesia with Lidocaine Containing Epinephrine in Patients with Ischemic Heart Disease
-
Mehdi Sanatkar
,
Mostafa Sadeghi
,
Nafiseh Esmaeili
,
Mohammad Hassan Naseri
,
Hossein Sadrossadat
,
Mehrdad Shoroughi
,
Hamid Reza Fathi
,
Shahrokh Ghazizadeh
Abstract
The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study. All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5%) were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%). The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044). The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes.
Moore PA, Boynes SG, Hersh EV, DeRossi SS, Sollecito TP, Goodson JM, Leonel JS, Floros C, Peterson C, Hutcheson M. The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: two controlled clinical trials. J Am Dent Assoc 2006;137(11):1572-81.
Franklin SS, Jacobs MJ, Wong ND, L'Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension 2001;37(3):869-74.
E. Knoll-Kohler, G. Fortsch. Knoll-Köhler E, Förtsch G.Pulpal anesthesia dependent on epinephrine dose in 2% lidocaine. A randomized controlled double-blind crossover study. Oral Surg Oral Med Oral Pathol 1992;73(5):537-40.
Elad S, Admon D, Kedmi M, Naveh E, Benzki E, Ayalon S, Tuchband A, Lutan H, Kaufman E. The cardiovascular effect of local anesthesia with articaine plus 1:200,000 adrenalin versus lidocaine plus 1:100,000 adrenalin in medically compromised cardiac patients: a prospective, randomized, double blinded study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(6):725-30.
Nakamura Y, Matsumura K, Miura K, Kurokawa H, Abe I, Takata Y. Cardiovascular and sympathetic responses to dental surgery with local anesthesia. Hypertens Res 2001;24(3):209-14.
HOLROYD SV, WATTS DT, WELCH JT. The use of epinephrie in local anesthetics for dental patients with cardiovascular disease: a review of the literature. J Oral Surg Anesth Hosp Dent Serv 1960;18:492-503.
Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient onvistal source. 6th ed. CV Mosby, St Louis 2002; p. 73-6.
T. Pallasch. Vasoconstrictors and the heart. J Calif Dent Assoc 1998;26(9):668-73.
Kubota Y, Toyoda Y, Kubota H, Asada A. Epinephrine in local anesthetics does indeed produce hypokalemia and ECG changes. Anesth Analg 1993;77(4):867-8.
Niwa H, Hirota Y, Sibutani T, Idohji Y, Hori T, Sugiyama K, Joh S, Kuji A, Matsuura H. The effects of epinephrine and norepinephrine administered during local anesthesia on left ventricular diastolic function. Anesth Prog 1991;38(6):221-6.
Henslee TM, Hodson SB, Lamy CJ, Palladino SJ. Vasoconstrictive agents commonly used in combination with local anesthetics: a literature review. J Foot Surg 1987;26(6):504-10.
Brand HS, Gortzak RA, Palmer-Bouva CC, Abraham RE, Abraham-Inpijn L. Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. Int Dent J 1995;45(1):45-8.
Knoll-Köhler E, Knöller M, Brandt K, Becker J. Cardiohemodynamic and serum catecholamine response to surgical removal of impacted mandibular third molars under local anesthesia: a randomized double-blind parallel group and crossover study. J Oral Maxillofac Surg 1991;49(9):957-62.
Chernow B, Balestrieri F, Ferguson CD, Terezhalmy GT, Fletcher JR, Lake CR. Local dental anesthesia with epinephrine. Arch Intern Med 1983;143:2141-3.
Cioffi GA, Chernow B, Glahn RP, Terezhalmy GT, Lake CR. The hemodynamic and plasma catecholamine responses to routine restorative dental care. J Am Dent Assoc 1985;111(1):67-70.
Torres-Lagares D, Serrera-Figallo MÁ, Machuca-Portillo G, Corcuera-Flores JR, Machuca-Portillo C, Castillo- Oyagüe R, Gutiérrez-Pérez JL. Cardiovascular effect of dental anesthesia with articaine (40 mg with epinefrine 0,5 mg % and 40 mg with epinefrine 1 mg%) versus mepivacaine (30 mg and 20 mg with epinefrine 1 mg%) in medically compromised cardiac patients: a cross-over, randomized, single blinded study. Med Oral Patol Oral Cir Bucal 2012;17(4):e655-60.
Dionne RA, Goldstein DS, Wirdzek PR. Effects ofdiazepam premedication and epinephrine-containing local anesthetic on cardiovascular and plasma catecholamine responses to oral surgery. Anesth Analg 1984;63(7):640-6.
Troullos ES, Goldstein DS, Hargreaves KM, Dionne RA. Plasma epinephrine levels and cardiovascular response to high administered doses of epinephrine contained in local anesthesia. Anesth Prog 1987;34(1):10-3.
Niwa H, Sugimura M, Satoh Y, Tanimoto A. Cardiovascular response to epinephrine-containing local anesthesia in patients with cardiovascular disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92(6):610-6.
Hasse AL, Heng MK, Garrett NR. Blood pressure and electrocardiographic response to dental treatment with use of local anesthesia. J Am Dent Assoc 1986;113(4):639-42.
CHERASKIN E, PRASERTSUNTARASAI T. Use of epinephrine with local anesthesia in hypertensive patients. IV. Effect of tooth extraction on blood pressure and pulse rate. J Am Dent Assoc 1959;58(1):61-8.
Abraham-Inpijn L, Borgmeijer-Hoelen A, Gortzak RA. Changes in blood pressure, heart rate, and electrocardiogram during dental treatment with use of local anesthesia. J Am Dent Assoc 1988;116(4):531-6.
de Morais HH, Vasconcellos RJ, de Santana Santos T,Rocha NS, da Costa Araújo FA, de Carvalho RW. Clinical study of hemodynamic changes comparing 4% articaine hydrochloride with 1:100,000 and 1:200,000 epinephrine. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;116(1):e14-22.
Chaudhry S, Iqbal HA, Izhar F, Mirza KM, Khan NF, Yasmeen R, Khan AA. Effect on blood pressure and pulserate after administration of an epinephrine containingdental local anaesthetic in hypertensive patients. J Pak Med Assoc 2011;61(11):1088-91.
Ogunlewe MO, James O, Ajuluchukwu JN, Ladeinde AL, Adeyemo WL, Gbotolorun OM. Evaluation of haemodynamic changes in hypertensive patients during tooth extraction under local anaesthesia. West Indian Med J 2011;60(1):91-5.
Cintron G, Medina R, Reyes AA, Lyman G. Cardiovascular effects and safety of dental anesthesia and dental interventions in patients with recent uncomplicated myocardial infarction. Arch Intern Med 1986;146(11):2203-4.
Vanderheyden PJ, Williams RA, Sims TN. Assessment of ST segment depression in patients with cardiac disease after local anesthesia. J Am Dent Assoc 1989;119(3):407-12.
Niwa H, Hirota Y, Sibutani T, Idohji Y, Hori T, SugiyamaK, Joh S, Kuji A, Matsuura H. The effects of epinephrineand norepinephrine administered during local anesthesia on left ventricular diastolic function. Anesth Prog 1991;38(6):221-6.
Meyer FU. Hemodynamic changes of local dental anesthesia in normotensive and hypertensive subjects. Int J Clin Pharmacol Ther Toxicol 1986;24(9):477-81.
Meechan JG. Plasma potassium changes in hypertensive patients undergoing oral surgery with local anesthetics containing epinephrine. Anesth Prog 1997;44(3):106-9.
New York Heart Association. Use of epinephrine in connection with procaine in dental procedures. J Am Med Assoc. 1955 Mar 5;157(10):854.
Report of a Working Conference Jointly Sponsored by the American Dental Association and American Heart Association. Management of Dental Problems in Patients with Cardiovascular Disease. J Am Dent Assoc 1964;68:333-42.
Niwa H, Satoh Y, Matsuura H. Cardiovascular responses to epinephrine-containing local anesthetics for dental use: a comparison of hemodynamic responses to infiltration anesthesia and ergometer-stress testing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90(2):171-81.
Meyer FU. Haemodynamic changes under emotional stress following a minor surgical procedure under local anaesthesia. Int J Oral Maxillofac Surg 1987;16(6):688-94.
| Files | ||
| Issue | Vol 51, No 8 (2013) | |
| Section | Original Article(s) | |
| Keywords | ||
| Anesthesia Epinephrine Ischemic heart disease Lidocaine | ||
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