Cardiovascular and Sympathetic Responses to Dental Surgery with Local Anesthesia.

Abstract

We investigated changes in blood pressure and blood variables, including plasma catecholamines, serum glucose and insulin concentrations, during dental surgery. The study included 11 normotensive patients (age, 22.5+/-0.7 years) who underwent tooth extraction at Kyushu Dental College Hospital. Three to 7 days prior to dental surgery, blood pressure, pulse rate, and heart rate variability were measured every 30 min over 24 h. The low frequency (LF: 0.05 to 0.15 Hz) and high frequency (HF: 0.15 to 0.40 Hz) powers were calculated, and the ratio of LF to HF (LF/HF) and HF were used as indexes of sympathetic and parasympathetic activities, respectively. Lidocaine, 2% with epinephrine (1:80,000), was used as the local anesthetic for all patients. Systolic blood pressures significantly increased during dental surgery (+10.8+/-3.5 mmHg); however, this increase failed to correlate not only with baseline systolic blood pressure but with 24-h averaged blood pressures, LF/HF or HF. On the other hand, plasma epinephrine and norepinephrine concentrations increased during dental surgery, and peak values of these variables were obtained after local anesthesia and during tooth extraction, respectively. Serum glucose level increased after local anesthesia (control vs. local anesthesia: 5.16+/-0.11 vs. 5.62+/-0.10 mmol/l; p<0.01); however, plasma insulin concentrations did not change significantly. These results suggest that 1) ambulatory measurements of blood pressure and heart rate variability over 24 h cannot predict the responses of blood pressure during dental surgery, and that 2) administration of local anesthetic and tooth extraction activate sympathoadrenal outflow, resulting in an increase in serum glucose level in normotensive subjects.

Evaluation of the Haemodynamic and Metabolic Effects of Local Anaesthetic Agent in Routine Dental Extractions

“…Variations in glucose plasma levels during dental treatment have been the subject of study and controversy in the literature [26][27][28]. Tily and Thomas [26] compared the effect of adrenaline administration in the dental local anaesthetic solution on blood glucose concentrations in Fig.…”

“…They observed no significant differences in pre-and post-operative blood glucose levels. Nakamura et al [27] investigated the changes in blood pressure, plasma catecholamines, glucose, and insulin concentrations in 11 normotensive patients during dental surgery and found that the administration of both local anaesthetics and tooth extraction activates sympathoadrenal outflow, resulting in increases of the systolic blood pressure, heart rate, plasma epinephrine, and serum glucose concentrations. They concluded that the adrenaline concentration increased and reached its peak just after the administration of local anaesthetics, yet the peak of adrenaline occurred within a time period similar to that of the increase of the serum glucose level, suggesting that there is a close relationship between the two variables.…”

Local Anesthetics and Antipsychotic Phenothiazines Interact Nonspecifically with Membranes and Inhibit Hexose Transporters in Yeast

“…Administration of volatile and local anesthetics is known to increase blood glucose levels in animals and humans (Diltoer and Camu 1988;Nakamura et al 2001). Antipsychotic drugs, including phenothiazines, are also known to induce hyperglycemia irrespective of whether the drugs are typical or atypical (Haupt and Newcomer 2001).…”

Reduced Membrane-Bound Catechol-O-Methyltransferase in the Liver of Spontaneously Hypertensive Rats

“…The released NE acts on α-receptors and blood pressure increases. Since plasma NE is mainly derived from sympathetic nerve endings, the concentration of NE could be used as an index of the baroreflex-mediated sympathetic nerve activity (1,2). For example, hypotensive responses caused by calcium antagonists in rats have been shown to correlate with the increases of plasma NE concentrations.…”