Lipp M, Dick W, Daubländer M, Fuder H, Stanton-Hicks M
Klinik für Anästhesiologie, Universität Mainz, Germany.
Reg Anesth. 1993 Jan-Feb;18(1):6-12.
To determine serum levels of catecholamines after local anesthesia for dental treatment, we used tritium-labeled epinephrine as a vasoconstrictor for dental local anesthesia.
Twenty healthy male outpatients undergoing standardized dental treatment (deep scaling) were studied. In all patients, only one quadrant was anesthetized even though the treatment was performed on all teeth. Two milliliters of articaine 4% (amide anesthetic) with 20 micrograms epinephrine was used as local anesthetic. Of the total epinephrine administered, 1.2% (100 microCi) consisted of tritium-labeled epinephrine. Blood samples were drawn through a central venous catheter before and at frequent intervals after the local anesthetic solution was administered.
A dramatic increase in exogenous epinephrine was observed in four patients during injection (up to 6937 pg/mL). The other 16 patients demonstrated a continuous increase in applied epinephrine that peaked on average at the 7th minute (631.5 +/- 41.4 pg/mL). A second increase occurred after the beginning of the dental procedure. The mean total epinephrine levels were always higher than those of the applied epinephrine. Extrasystoles were observed in two of four and tachycardia in three of four patients with high plasma levels of applied epinephrine. Increases in total epinephrine were associated with exogenous catecholamine administration, whereas the dental treatment did not significantly influence the plasma levels.
Despite aspiration in 20% of the patients, an unintended intravascular injection occurred. Although healthy young men tolerated large increases in central plasma epinephrine levels surprisingly well, this may not be the case in patients with concurrent cardiovascular disease. Patients at cardiovascular risk should be under continuous monitoring when an epinephrine-containing solution is applied.
为了测定牙科治疗局部麻醉后儿茶酚胺的血清水平，我们使用氚标记的肾上腺素作为牙科局部麻醉的血管收缩剂。
对20名接受标准化牙科治疗（深度洁治）的健康男性门诊患者进行研究。在所有患者中，尽管对所有牙齿进行治疗，但仅麻醉一个象限。使用2毫升含20微克肾上腺素的4%阿替卡因（酰胺类麻醉剂）作为局部麻醉剂。在给予的总肾上腺素中，1.2%（100微居里）为氚标记的肾上腺素。在给予局部麻醉溶液之前和之后频繁抽取血样，通过中心静脉导管采集。
在注射过程中，4名患者的外源性肾上腺素显著增加（高达6937 pg/mL）。其他16名患者的应用肾上腺素持续增加，平均在第7分钟达到峰值（631.5±41.4 pg/mL）。牙科治疗开始后出现第二次升高。总肾上腺素水平均值始终高于应用的肾上腺素水平。在应用肾上腺素血浆水平高的4名患者中，有2名出现早搏，4名中有3名出现心动过速。总肾上腺素增加与外源性儿茶酚胺给药有关，而牙科治疗对血浆水平无显著影响。
尽管20%的患者进行了回抽，但仍发生了意外的血管内注射。尽管健康年轻男性对中心血浆肾上腺素水平的大幅升高耐受性惊人地好，但合并心血管疾病的患者可能并非如此。当应用含肾上腺素溶液时，心血管风险患者应持续监测。
