Shinohe Y
Ohu University Graduate School of Dentistry.
Ou Daigaku Shigakushi. 1990 Jul;17(2):155-67.
In the surgical operation for oral region, local anesthetic agent added with epinephrine is usually given to the site to be operated in order to obtain better hemostatic effect even under general anesthesia. However, there have been relatively few reports, which describe the circulatory changes after the injection into oral region, the fluctuation of plasma catecholamine concentration and the concentration of local anesthetic agent in plasma. In the present study, 1% lidocaine or distilled water added with 10 micrograms/ml epinephrine was locally injected at 0.5 ml/kg into the palatal submucosa of Wistar rat under anesthesia with 1% enflurane. With the increase of heart rate and arterial pressure, the catecholamine concentration in arterial blood was determined when heart rate reached the peak value. Further, in the 1% lidocaine group added with 10 micrograms/ml epinephrine, lidocaine concentration was measured under three different conditions of normoventilation, hypoventilation and hyperventilation. Also, for the normoventilation group under 1% enflurane anesthesia, the epinephrine concentration when several events of ventricular arrhythmia occurred and the lidocaine concentration required until the arrhythmia disappeared were measured. The results were as follows: 1. In the case of lidocaine group added with 10 micrograms/ml epinephrine, heart rate and arterial pressure showed less increase than the case of distilled water with 10 micrograms/ml epinephrine, and the time to the peak value of heart rate was shorter. 2. The concentration of plasma epinephrine when heart rate reached the peak value significantly increased compared with the control in both 1% lidocaine group added with 10 micrograms/ml epinephrine, and the distilled water group added with 10 micrograms/ml epinephrine, whereas the increase was more conspicuous in the former than the latter. The concentration of plasma epinephrine at the occurrence of ventricular arrhythmia was by about 2.3 times as much as that of 1% lidocaine group added with 10 micrograms/ml epinephrine when heart rate reached the peak value and by about 5.8 times as much as that of the distilled water group added with 10 micrograms/ml epinephrine. The correlation between plasma epinephrine concentration and the increase of heart rate was noted only in the distilled water group added with 10 micrograms/ml epinephrine. 3. The concentration of plasma norepinephrine when heart rate reached the peak value significantly increased compared with the control only in the distilled water group added with 10 micrograms/ml epinephrine. 4. The concentration of plasma lidocaine when heart rate reached the peak value was about 1/4 of the concentration required for protection against epinephrine-induced ventricular arrhythmia.(ABSTRACT TRUNCATED AT 400 WORDS)
在口腔区域的外科手术中,即使在全身麻醉下,通常也会在手术部位注射添加了肾上腺素的局部麻醉剂,以获得更好的止血效果。然而,描述口腔区域注射后循环变化、血浆儿茶酚胺浓度波动以及血浆中局部麻醉剂浓度的报告相对较少。在本研究中,在1%安氟醚麻醉下,将1%利多卡因或添加了10微克/毫升肾上腺素的蒸馏水以0.5毫升/千克的剂量局部注射到Wistar大鼠的腭黏膜下层。随着心率和动脉压的升高,当心率达到峰值时测定动脉血中的儿茶酚胺浓度。此外,在添加了10微克/毫升肾上腺素的1%利多卡因组中,在正常通气、低通气和高通气三种不同条件下测量利多卡因浓度。另外,对于1%安氟醚麻醉下的正常通气组,测量发生几次室性心律失常时的肾上腺素浓度以及心律失常消失所需的利多卡因浓度。结果如下:1. 在添加了10微克/毫升肾上腺素的利多卡因组中,心率和动脉压的升高幅度小于添加了10微克/毫升肾上腺素的蒸馏水组,且心率达到峰值的时间更短。2. 添加了10微克/毫升肾上腺素的1%利多卡因组和添加了10微克/毫升肾上腺素的蒸馏水组在心率达到峰值时血浆肾上腺素浓度均较对照组显著升高,且前者升高更明显。室性心律失常发生时的血浆肾上腺素浓度约为心率达到峰值时添加了10微克/毫升肾上腺素的1%利多卡因组的2.3倍,约为添加了10微克/毫升肾上腺素的蒸馏水组的5.8倍。仅在添加了10微克/毫升肾上腺素的蒸馏水组中观察到血浆肾上腺素浓度与心率升高之间的相关性。3. 仅在添加了10微克/毫升肾上腺素的蒸馏水组中,心率达到峰值时血浆去甲肾上腺素浓度较对照组显著升高。4. 心率达到峰值时的血浆利多卡因浓度约为预防肾上腺素诱导的室性心律失常所需浓度的1/4。(摘要截短至400字)