Minasian A, Yagiela J A
School of Dentistry, University of California, Los Angeles.
Oral Surg Oral Med Oral Pathol. 1988 Oct;66(4):405-15. doi: 10.1016/0030-4220(88)90256-3.
The use of amide local anesthetics in dental patients presumed to be susceptible to malignant hyperthermia (MH) is controversial. A literature review of 17 recent dental publications and their reference citations revealed that the recommendation to avoid local anesthetics of the amide type in dental treatment of MH-susceptible (MHS) patients is based on in vitro muscle investigations, unpublished communications, and a single case report suggestive of MH. Therefore, a survey of members of the Malignant Hyperthermia Association of the United States designed to determine what, if any, MH-like reactions have occurred in patients with MHS receiving dental treatment was conducted. Of a total of 307 MHS respondents, 36 (12%) reported adverse reactions to dental care. Only one respondent, however, reported symptoms suspicious of MH (fever, muscle pain) in which the administration of amide local anesthetics appeared to be closely linked. Fifty-six (18%) of the respondents have had difficulty obtaining routine dental care since being identified as MHS; this includes 27 who have been refused dental treatment or have had to undergo operative procedures without the benefit of local anesthesia. These results support the conclusions that amide local anesthetics may be administered to MHS patients without significant risk and that currently the diagnosis of MH susceptibility can adversely affect the quality of dental care.
对于那些被认为易患恶性高热（MH）的牙科患者，使用酰胺类局部麻醉药存在争议。对17篇近期牙科出版物及其参考文献进行的文献综述显示，在对MH易感性（MHS）患者进行牙科治疗时，建议避免使用酰胺类局部麻醉药，这一建议是基于体外肌肉研究、未发表的交流以及一份提示MH的单病例报告。因此，针对美国恶性高热协会的成员开展了一项调查，旨在确定接受牙科治疗的MHS患者是否发生过类似MH的反应。在总共307名MHS受访者中，36人（12%）报告了对牙科护理的不良反应。然而，只有一名受访者报告了疑似MH的症状（发热、肌肉疼痛），其中酰胺类局部麻醉药的使用似乎与之密切相关。56名（18%）受访者自被确定为MHS以来，在获得常规牙科护理方面遇到困难；这包括27人被拒绝牙科治疗或不得不接受无局部麻醉的手术操作。这些结果支持以下结论：酰胺类局部麻醉药可用于MHS患者，且风险不大；目前，对MH易感性的诊断可能会对牙科护理质量产生不利影响。
