Assessment of ST segment depression in patients with cardiac disease after local anesthesia
Article Abstract:
Myocardial ischemia, reduced blood flow to the heart muscle, is the leading cause of death in this country and can be induced by emotional or physical stress. It is estimated that more than two thirds of all cardiac episodes that occur in individuals go undetected. During dental treatment, adverse reactions to drugs and local anesthesia are always a concern; they may be very serious in the coronary patient. A number of cardiologists have recommended that their cardiac patients not receive local anesthesia containing epinephrine, as the use of such vasoconstrictors in patients with ischemic heart disease is controversial. Ischemic episodes may be detected by the evaluation of the ST segment, a particular wave length which appears on the electrocardiogram (ECG). In this study, 20 men between the ages of 55 and 82 years who had ischemic heart disease were monitored during dental treatments. These subjects received local anesthesia containing epinephrine, while being monitored for heart rate and blood pressure changes. Clinical symptoms were observed; a noninvasive monitor was used to measure blood pressure, and a Holter monitor provided a continuous ECG analysis of each individual. None of the patients showed evidence of myocardial ischemia as a result of treatment (two percent lidocaine with 1:1,000,000 epinephrine); ST depression was taken to indicate myocardial ischemia. The heart rates of all individuals remained stable, although some subjects experienced some minor fluctuations in blood pressure just after the anesthetic was administered. A range of responses was observed within the subject group and although it was concluded that, in general, the use of this anesthesia does not provoke ischemic episodes, further investigation is recommended to identify those individuals who may be at greater risk for an exaggerated response to local anesthesia. The need for close monitoring of these patients during local anesthesia as a part of routine dental care is emphasized by the authors. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1989
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Interactions associated with local anesthetics, sedatives and anxiolytics
Article Abstract:
Local anesthetics, sedatives, and antianxiety drugs in dentistry rarely interact adversely with other medications when they are used appropriately. Some oral medications can slow the metabolism of locally-injected anesthetics, but the effect is not generally significant. Barbiturates, benzodiazepines, antiulcer medicines, and some antibiotic drugs may interact with sedatives to increase the sedating effect or alter the blood level of the non-dental medication. Pediatric patients may be at greater risk of adverse reactions because their small size increases the risk of accidental overdose.
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1999
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Effect of beta-adrenoreceptor blockade with nadolol on the duration of local anesthesia
Article Abstract:
Some dental anesthetics may last longer in patients who take beta-blockers. Beta-blockers are commonly used to treat heart disease and hypertension. Epinephrine is a common ingredient in many dental anesthetics but it can interact with beta-blockers. If so, it could cause blood vessels to contract, producing hypertension and even cardiac arrest. A study of 10 male volunteers showed that the beta-blocker nadolol prolonged anesthesia by about 17 minutes. Dentists can avoid this reaction in patients by giving the anesthetic slowly and in small amounts.
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1999
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