Hemodynamic assessment of local anesthetic administration by laser Doppler flowmetry

Evaluation of Anxiety, Pain, and Hemodynamic Changes during Surgical Removal of Lower Third Molar under Local Anesthesia

Aim:

The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure.

Materials and Methods:

Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant.

Results:

SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased.

Conclusion:

The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.

Hemodynamic changes and pain perception-related anxiety after experiencing an impacted-tooth removal: clinical practice outcome

BACKGROUND

Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status.

METHODS

Twenty-seven healthy patients aged 15-30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used.

RESULTS

The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05).

CONCLUSIONS

There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.

Evaluation of Anxiety Induced Cardiovascular Response in known Hypertensive Patients Undergoing Exodontia - A Prospective Study

INTRODUCTION

Anxiety towards exodontic procedures is a common occurrence in dental practice. In hypertensive patients this anxiety induced stress may have an effect on cardiovascular system which may be clinically significant.

AIM

To evaluate the cardiovascular changes in hypertensive patients that may manifest following anxiety induced stress in patients undergoing exodontic procedures under local anaesthesia.

MATERIALS AND METHODS

Eighty known hypertensive patients under medication reporting to Department of Oral and Maxillofacial surgery, Dayananda Sagar College of Dental Sciences Bangalore, Karnataka, India for extraction of teeth were taken up for the study. Anxiety was measured before local anaesthetic delivery using Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Cardiovascular response data including blood pressure, heart rate, pulse rate, oxygen saturation and electrocardiographic changes were measured pre-operatively, immediately after local anaesthesia administration and Post-operatively at five, ten and fifteen minutes interval. Kruskal-Wallis test was used to compare continuous variables before and after the injection of local anaesthesia including heart rate, pulse rate, oxygen saturation, and blood pressure. Repeated-measures analysis of variance (ANOVA) was used to analyse the significance of changes in heart rate, pulse rate, blood pressure, and oxygen saturation over time between groups.Chi-square test was used to analyse the significance of electrocardiographic changes.

RESULTS

The results revealed that the mean anxiety score before administration of local anaesthetic was 9.91(S.D ±2.9) with a range 4-20. Severe preoperative anxiety (<12) was associated with significantly increased heart rate, pulse rate, systolic blood pressure. At the pre-injection phase the mean values were systolic blood pressure (130.72±9.2), diastolic blood pressure (81.6±7.7), heart rate (72.7±11.9) and oxygen saturation (95.2±1.9). These values were increased immediately after local anaesthetic delivery and this relation was statistically significant for all parameters except oxygen saturation. Electrocardiographic abnormalities were found before and after injection of local anaesthetic (p>0.001). One patient showed right bundle branch block pattern.

CONCLUSION

Dental anxiety impacts the effects of delivery of local anaesthesia on blood pressure, heart rate, pulse rate and electrocardiograph and is significantly associated with the increase in systolic blood pressure, heart rate, pulse rate and changes in electrocardiograph. Thus, present study supported that increased anxiety in hypertensive patients who underwent extraction is associated with cardiovascular changes.

Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis

OBJECTIVE

The aim of this study was to assess the effects of dentoalveolar distraction osteogenesis (DD) on the pulpal blood flow (PBF) of maxillary canines.

MATERIALS AND METHODS

A laser Doppler flowmeter (LDF) was used to measure PBF in maxillary canines of 10 patients undergoing DD (study group) and 10 nonsurgical subjects who received no orthodontic treatment (control group). PBF was measured at baseline, at 4 and 7 days postoperatively, at the end of distraction and at the end of consolidation in the study group and at similar time-points in nonsurgical control subjects. Data were analyzed using paired and Student t tests, with the significance level set at 0.05.

RESULTS

Study findings showed that baseline PBF values did not differ significantly between groups. PBF in the control group did not vary over time; however, in the study group, an initial decrease in PBF was observed at 4 days postoperatively and was followed by a gradual increase to preoperative levels at the end of distraction.

CONCLUSIONS

During the DD latency period, there appears to be a short-lived ischemic phase when perfusion of pulp tissue declines; however, blood-flow returns to normal by the end of distraction.

Does the topical use of epinephrine for sinus floor augmentation affect systemic hemodynamics?

PURPOSE

Although epinephrine is one of the most commonly used vasoconstrictor in association with local anesthesia in dentistry, systemic effects of topical admission of epinephrine for sinus augmentation have not been investigated yet. The purpose of this study was to reveal the safety of epinephrine as a topical vasoconstrictor in sinus augmentation procedures.

PATIENTS AND METHODS

Forty-three healthy patients who require sinus floor augmentation for dental implant placement were included in this study. Patients were divided into 2 groups according to the application of either epinephrine-soaked cottonoid or saline-soaked cottonoid for sinus floor augmentation, and heart rate, systolic, and diastolic pressures were evaluated and compared before, during, and after the procedure.

RESULTS

Although there were changes in heart rate, systolic, and diastolic blood pressures, no statistical significance was observed for neither heart rate nor systolic and diastolic blood pressures (P > 0.05).

CONCLUSIONS

This study showed that the topical use of 1/100,000 epinephrine ensures efficacy by helping the clinician to elevate the sinus membrane and keeps the changes in systemic hemodynamics within safe limitations.

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

Objective

Local 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 Methods

Sixty-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.

Results

The 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.

Conclusion

Lidocaine, 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.

Parameters influencing increase in pulp chamber temperature with light-curing devices: curing lights and pulpal flow rates

This laboratory study examined the effects of curing lights with different light intensities and changing flow rate on the increase in pulpal temperature during the light curing process and the rate of the subsequent decrease in temperature after the termination of light curing. The tip of a temperature sensor was positioned on the pulpal dentinal wall of the buccal side of the maxillary premolar. Metal tubes were inserted in the palatal and buccal root of the tooth, one for water inflow and the other for water outflow. The tubes were connected to a pump to control the flow rate. The water flow rate was set to 4.2 microl/minute, 28 microl/minute or 70 microl/minute. At each flow rate, the unprepared tooth was light cured from the buccal side 1 mm from the buccalsurface, using four different curing lights. The temperature data were recorded and stored on a computer every second for three minutes. The curing lights that were used were: Astralis 10 (QTH(high), Ivoclar Vivadent), Bluephase 16i (LED(conv), Ivoclar Vivadent) and two experimental LED-curing lights (LED(exp2000), LED(exp3000), Ivoclar Vivadent). The power densities were 1200 mW/cm2, 1600 mW/cm2, 2000 mW/cm2 and 3000 mW/cm2, respectively. The curing lights, LED(conv), LED(exp2000) and LED(exp3000) were activated for 60 seconds, and the QTH(high) was activated for 30 sec- onds. The maximum intrapulpal temperature (TM) and rate of temperature change at 30 seconds after turning off the light (S(30LO)) were analyzed by two-way ANOVA with a post-hoc Tukey test (p < 0.05). The influencing factors were the flow rates and curing lights.

RESULTS

The T(MAX) ranged from 41.0 degrees C to 53.5 degrees C. There was a difference between the curing lights (p < 0.05), with LED(exp3000) > LED(exp2000) > LED(conv) > QTH(high). There was no difference in T(MAX) between the different flow rates (p > 0.05). Both the curing lights and flow rates affected the SE(30LO) (p < 0.05). The S(30LO) was LED(exp3000) < LED(exp2000) > LEDon, , QTH(high) (p < 0.05). The S(30LO) at 70 microl/minutes was higher than at 4.2 pd/minutes and 28 microl/minutes (p < 0.05).

CLINICAL IMPLICATION

Because the increase in temperature is directly related to the light intensity and exposure time, curing devices with high power density (> 1200 mW/cm2) should only be activated for a short period of time (< 15 seconds) even in teeth without cavity preparation. The flow rate had only a negligible effect on the temperature increase.

Locoregional anesthesia for dental treatment in cardiac patients: a comparative study of 2% plain lidocaine and 2% lidocaine with epinephrine (1:100,000)

OBJECTIVES

This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine.

METHODS

This randomized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brazil). Patients were separated into two groups with the help of an aleatory number table: 2% plain lidocaine (PL, n= 31) and 2% lidocaine with epinephrine (1:100,000) (LE, n= 28). Blood pressure, heart rate, oxygenation and electrocardiogram data were all recorded throughout the procedure. State and trait anxiety levels were measured.

RESULTS

Fifty-nine patients were selected for the LE group (n=28), with an average age of 40.3 +/- 10.9, or for the PL group (n=31), age 42.2 +/- 10.3. No differences were shown in blood pressure, heart rate and pulse oximetry values before, during and after local anesthesia injection between the two groups. State and trait anxiety levels were not different. Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment. Complaints of pain during the dental procedure were more frequent within the PL group, which received a higher amount of local anesthesia.

CONCLUSION

Lidocaine with epinephrine (1:100,000) provided effective local anesthesia. This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases.

Cardiovascular Alterations After Injection of 2% Lidocaine With Norepinephrine 1:50,000 (Xylestesin) in Rats

The purpose of the present study is to determine the cardiovascular effects produced by intravascular injection of 2% lidocaine with 20 microg/mL of norepinephrine on systolic, diastolic, and mean arterial pressures and heart rate of rats at the following times: control period, during the injection (first 15 seconds), during the first minute, and at the end of 1, 2, 3, 4, 5, 10, 15, 20, 25, and 30 minutes after drug administration. The study was performed on 13 male Wistar rats with weights between 200 grams and 220 grams that were awake during the recording of these parameters. The dose administered was proportional to 1 cartridge of local anesthetic (1.8 mL) in an average-size human, which is equivalent to 0.51 mg/kg of lidocaine hydrochloride and 0.51 microg/kg of norepinephrine hydrochloride. The average time of injection was 15.7 seconds. The results of this study showed significant increases in systolic, diastolic, and mean arterial pressure and a noticeable decrease in heart rate. The greatest variation occurred in the systolic blood pressure. The greatest alterations occurred during injection and within the first minute following administration of the anesthetic solution. We would anticipate these changes in the parameters analyzed to be clinically significant. Thus, dentists using 2% lidocaine with norepinephrine 20 mug/mL should be very careful to avoid intravascular injection.

Effect of anesthetics containing lidocaine and epinephrine on cardiovascular changes during dental implant surgery

The purpose of this study was to evaluate cardiovascular changes during dental implant surgery using 2% lidocaine with 1:80 000 epinephrine. Eleven normotensive subjects, ranging from 18 to 56 years, were selected to undergo dental implant surgery in the jaw. They were monitored in the pre-, intra-, and postsurgical periods by continuous noninvasive automatic arterial pressure and cardiac frequency measurements taken every 2 minutes. Parameter scores were obtained for the following phases: P1, 15 minutes during preparation of the patient (control period); P2, before anesthesia; P3, immediately after anesthesia; P4, 2 minutes into anesthesia; P5, during incision and detachment; P6, during perforation; P7, during implant placement; P8, during suturing; P9, on completion; and P10, 10 minutes after termination. Individualized statistical analysis for each group during the pre-, intra-, and postoperative periods were performed by analysis of variance. The greatest variations in systolic pressure were increases of 2.29% during phase P2 and 2.59% in phase P5. Diastolic pressure decreased during phase P6 (-2.58%) and increased in P10 (3.27%). The greatest changes in heart rate occurred in phase P10 (-3.24%). There were no statistically significant changes among the evaluated phases (P > .05). In conclusion, there were no changes in the analyzed cardiocirculatory parameters during dental implant surgery (systolic, diastolic, and mean arterial blood pressures and heart rate) in normotensive subjects anesthetized with 2% lidocaine with epinephrine 1:80000.

Assessment of cardiovascular parameters during dental procedures under the effect of benzodiazepines: a double blind study

The purpose of this study was to evaluate cardiovascular parameters during dental procedures: systolic, diastolic, and mean blood pressures, and heart rate. Nineteen healthy normotensive patients (18-56 years of age) received restorative treatment on three maxillary molars. The patients were continuously monitored by a non-invasive automatic monitor for blood pressure and heart rate during the pre-, trans-, and post-operative periods at the following stages: 15 min prior to anesthesia; during topical anesthesia; during infiltrative anesthesia; for 5 minutes immediately after; during cavity preparation; during restorative procedure; for 10 min after completion. Patients were divided into three groups: A (without pre-medication), B (preceded by 10 mg diazepam), and C (preceded by placebo). All patients received infiltrative anesthesia containing 1.8 mL of 2% lidocaine (36 mg) with epinephrine 1:100,000 (18 µg). There were no changes in the parameters during the clinical procedures. When groups were compared, there were significant differences in diastolic arterial pressures during anesthesia.