Junctional rhythm with severe hypotension following infiltration of lidocaine containing epinephrine during dental surgery

Jeon, Young Hoon; Shim, Jihye; Kim, Hyunjee

doi:10.17245/jdapm.2020.20.2.89

Cited by 3 publications

(2 citation statements)

References 13 publications

(12 reference statements)

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“…Identification of increased blood pressure is important as fatal subarachnoid hemorrhage and excessive bleeding from dental surgery has been reported [ 5 , 6 ]. Studies have shown that the rise in blood pressure during dental surgery results primarily from activation of the sympathetic nervous system [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure after Maxillary Infiltration Technique: A Triple-Blind Randomized Clinical Trial

Moaddabi

Soltani

Zamanzadeh

et al. 2021

International Journal of Dentistry

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Background. Many dental procedures begin with local anesthesia. Subsequent increase in blood pressure in healthy individuals commonly occurs and may be affected by several factors such as mental and physical stress, painful stimuli, and action of catecholamines present in local anesthetic solutions. The aim of the present study is to compare the effects of 4% articaine with 1 : 100000 epinephrine and 2% lidocaine with 1 : 80000 epinephrine on blood pressure after maxillary infiltration technique. Materials and Methods. In this randomized clinical trial, 102 patients were randomly assigned into two groups. One group received 4% articaine with 1 : 100000 epinephrine and the other group received 2% lidocaine with 1 : 80000 epinephrine for local maxillary infiltration. Systolic and diastolic blood pressure of both groups was determined twice: once before anesthetic injection and once 10 minutes after injection. The data were statistically analyzed using descriptive statistics, Shapiro–Wilks test, Levene test, chi-square test, independent t-test, and paired t-test. Results. The mean systolic blood pressure after anesthetic injection in the articaine and lidocaine groups was 125.00 ± 5.67 and 123.16 ± 6.417 mmHg, respectively, showing no statistically significant difference ( p = 0.127 ). The mean diastolic blood pressure after injection was 85.02 ± 7.331 in the articaine group and 81.35 ± 12.815 mmHg in the lidocaine group. These values show no statistically significant difference ( p = 0.080 ). In both groups, the mean systolic and diastolic blood pressures have increased significantly ( p < 0.001 ). Conclusion. Articaine can be regarded as a suitable alternative for lidocaine for maxillary local infiltration, as no significant difference was observed between the effects of the two anesthetic solutions on blood pressure.

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Section: Introductionmentioning

confidence: 99%

Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure after Maxillary Infiltration Technique: A Triple-Blind Randomized Clinical Trial

Moaddabi

Soltani

Zamanzadeh

et al. 2021

International Journal of Dentistry

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“…The perioperative serious electrocardiographic changes may be originated by a relative imbalance of autonomic activities due to excessive psychosomatic stress during dental care, or anesthetic and surgical procedures. 1 – 3 This study case shows a rare and unusual situation of the transient asystole as a serious sign of vasovagal reflex (VVR) likely to be triggered by venipuncture for peripheral intravenous access placement during anticipatory dental anxiety. On the best of our knowledge, there is no report regarding the management of intravenous sedation (IVS) during dental care in a dental phobic patient with the occurrence of asystole.…”

Section: Introductionmentioning

confidence: 93%

Transient asystole associated with vasovagal reflex in an oral surgery patient: A case report

Shimoda

Yamauchi

Takahashi

2023

SAGE Open Medical Case Reports

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The perioperative cardiac events may be brought about by a relative imbalance of autonomic activities due to excessive psychological and physical stress. The present case study focuses on the asystole that can occur as a serious cardiac adverse event associated with vasovagal reflex likely to be triggered by venipuncture for securing an intravenous line during dental care. In addition, we describe and discuss herein the management of intravenous sedation for a dental phobic patient who experienced the vasovagal reflex involved in an unexpected transient asystole. The patient with vasovagal reflex episodes in daily life, who had no past medical history relevant to cardiovascular disorders, was scheduled for dental extraction under intravenous sedation. Immediately after peripheral intravenous catheterization, she complained of discomfort and nausea, and a II-lead electrocardiogram revealed asystole following bradycardia associated with vasovagal reflex. Oxygenation and intravenous fluid loading in the supine position with elevation of the lower extremities restored sinus rhythm and normal hemodynamics without the intervention of cardiopulmonary resuscitation. With administration of intravenous atropine and betamethasone as premedication, she was uneventfully treated in stress-free psychosomatic conditions under optimal sedation with midazolam without any signs of cardiovascular disorders. After administration of flumazenil, the patient satisfactorily recovered from sedation without re-sedation. The present case suggests that an asystole associated with vasovagal reflex can be triggered by venipuncture for intravenous catheterization during dental anxiety likely to affect the imbalance between sympathetic and parasympathetic activities.

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Severe hypotension during junctional rhythm in a patient with multiple cerebral infarcts

Misumi

Yamakawa²,

Harada³

et al. 2023

Journal of Cardiology Cases

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Junctional rhythm with severe hypotension following infiltration of lidocaine containing epinephrine during dental surgery

Cited by 3 publications

References 13 publications

Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure after Maxillary Infiltration Technique: A Triple-Blind Randomized Clinical Trial

Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure after Maxillary Infiltration Technique: A Triple-Blind Randomized Clinical Trial

Transient asystole associated with vasovagal reflex in an oral surgery patient: A case report

Severe hypotension during junctional rhythm in a patient with multiple cerebral infarcts

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