Mohajerani Hassan, Latifi Fatemeh, Tabrizi Reza, Shafiei Shervin, Moslemi Hamidreza, Ebadi Maryam
Dept. of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Postgraduate student, Dept. of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Dent (Shiraz). 2022 Mar;23(1):29-32. doi: 10.30476/DENTJODS.2021.88011.1306.
Methemoglobinemia is a potentially life-threatening rare medical condition, which refers to an increase in the level of oxidized form of hemoglobin (methemoglobin). Excessive replacement of hemoglobin with methemoglobin leads to functional hypoxia and even fatal conditions.
The aim of this study was to evaluate the effect of two common local anesthetic agents namely lidocaine and articaine administered for hemostasis during surgery on methemoglobin level.
This prospective cohort study was conducted from January 2017 to December 2019. Demographic data including age, gender, and weight of patients were collected. Sixty patients were randomly divided into three groups (n=20) regarding the local anesthetic agent administered for hemostasis during surgery as lidocaine group (group 1), articaine group (group 2), and control group (no local anesthetic; group 3). The patients were candidates for orthognathic surgery, reconstruction of the maxillary and mandibular atrophic ridges with autogenous grafts, and reconstruction of maxillofacial fractures. The methemoglobin level was measured before surgery and six hours after the initiation of surgery.
The mean age and weight of patients were not significantly different among the three groups (= 0.891 and = 0.416, respectively). No significant differences were observed among the three groups regarding the gender distribution (= 0.343) or type of surgery (p= 0.990). Statistical analysis did not show any significant difference in the mean baseline methemoglobin level among the three groups (= 0.109). Although the mean methemoglobin values increased in the three groups, paired sample t-test did not show any significant change in the values at six hours after the initiation of surgery compared with baseline in any of the three groups (= 0.083 for group 1, = 0.096 for group 2, and = 0.104 for group 3).
The results demonstrated that administration of lidocaine and articaine plus epinephrine for hemostasis during general anesthesia are equally safe.
高铁血红蛋白血症是一种潜在威胁生命的罕见病症，指血红蛋白氧化形式（高铁血红蛋白）水平升高。高铁血红蛋白过度替代血红蛋白会导致功能性缺氧甚至致命情况。
本研究旨在评估两种常见局部麻醉剂利多卡因和阿替卡因在手术中用于止血时对高铁血红蛋白水平的影响。
本前瞻性队列研究于2017年1月至2019年12月进行。收集患者的人口统计学数据，包括年龄、性别和体重。60名患者根据手术中用于止血的局部麻醉剂随机分为三组（每组n = 20），即利多卡因组（第1组）、阿替卡因组（第2组）和对照组（未使用局部麻醉剂；第3组）。这些患者均为正颌手术、自体骨移植修复上颌和下颌萎缩牙槽嵴以及颌面骨折修复的候选者。在手术前和手术开始后6小时测量高铁血红蛋白水平。
三组患者的平均年龄和体重无显著差异（分别为= 0.891和= 0.416）。三组在性别分布（= 0.343）或手术类型（p = 0.990）方面未观察到显著差异。统计分析显示三组的平均基线高铁血红蛋白水平无显著差异（= 0.109）。虽然三组的平均高铁血红蛋白值均有所升高，但配对样本t检验显示，与基线相比，三组中任何一组在手术开始后6小时的值均无显著变化（第1组= 0.083，第2组= 0.096，第3组= 0.104）。
结果表明，在全身麻醉期间使用利多卡因和阿替卡因加肾上腺素进行止血同样安全。
