Biomedical papers, 2016 (vol. 160), issue 4

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016, 160(4):571-577 | 10.5507/bp.2016.040

The impact of cardiovascular drugs on the efficacy of local anesthesia in dentistry

Мarko J. Milosavljevica, Slobodan M. Jankovicb
a Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Serbia
b Department of Pharmacology, Faculty of Medical Sciences, University of Kragujevac and Clinical Center Kragujevac, Serbia

Background and Aim. Drugs used chronically by patients with diseases of the cardiovascular system (group C of the ATC classification) may act on adrenergic receptors and/or certain ion channels, which gives them the potential to interact with the action of local dental anesthetics. The aim of the study was to investigate the effect of systemically administered chronic cardiovascular medication (oral route) on the efficacy of intraoral local anesthesia in patients with diseases of the cardiovascular system.

Patients and Methods: This was a prospective cohort study which analyzed the efficacy of local terminal anesthesia (onset of anesthesia, duration anesthetized area) in the upper jaw of 70 patients: 40 patients on medication for cardiovascular system disorders and 30 patients who were not using these drugs (the control group). The following cardiovascular drugs were used: beta blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, vasodilatators, diuretics, angiotensin receptor blockers, antiarrhythmics, statins and alfa blockers.

Results: The onset of anesthesia on the vestibular side was faster in those taking cardiovascular drugs (40.50±19.87 s) than the control patients (58.93±31.07 s; P = 0.004) and duration of anesthesia on this side was shorter. Although the difference was not significant, it was evident that on vestibular and palatal side the anesthetized area was more rapidly reduced in the patients taking cardiovascular drugs. The duration of cardiovascular therapy also had a significant impact on the anesthetized area.

Conclusion: Drugs acting on cardiovascular system may influence the effect of local anesthetics used in dentistry, possibly through interaction with autonomic receptors and ion channels.

Keywords: dental anesthesia, local anesthesia, beta blockers, cardiovascular agents, calcium channel blockers

Received: April 27, 2016; Accepted: July 21, 2016; Prepublished online: August 2, 2016; Published: December 12, 2016


References

  1. Scholz A. Mechanisms of (local) anaesthetics on voltage-gated sodium and other ion channels. Br J Anaesth 2002;89(1):52-61. Go to original source... Go to PubMed...
  2. Skjevik AA, Haung BE, Lygre H, Teigen K. Intramolecular hydrogen bonding in articaine can be related to superior bone tissue penetration: a molecular dynamics study. Biophys Chem 2011;154(1):18-25. Go to original source... Go to PubMed...
  3. Lima-J˙nior JL, Dias-Ribeiro E, de Ara˙jo TN, Ferreira-Rocha J, Honfi-J˙nior ES, Sarmento CF, Seabra FR, de Sousa Mdo S. Evaluation of the buccal vestibule-palatal diffusion of 4 % articaine hydrochloride in impacted maxillary third molar extractions. Med Oral Patol Oral Cir Bucal 2009;14(3):E129-32. Go to PubMed...
  4. Hersh EV, Giannakopoulos H, Levin LM, Secreto S, Moore PA, Peterson C, Hutcheson M, Bouhajib M, Mosenkis A, Townsend RR. The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine. J Am Dent Assoc 2006; 137(11):1562-71. Go to original source... Go to PubMed...
  5. Tzeng JI, Cheng KI, Huang KL, Chen YW, Chu KS, Chu CC, Wang JJ. The cutaneous analgesic effect of class I antiarrhythmic drugs. Anesth Analg 2007;104(4):955-8. Go to original source... Go to PubMed...
  6. Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile haemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol 2010;74(4):338-42. Go to original source... Go to PubMed...
  7. Serrera Figallo MA, Velßzquez Cayˇn RT, Torres Lagares D, Corcuera Flores JR, Machuca Portillo G. Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies. Review of the literature published in the last decade. J Clin Exp Dent 2012;4(2):e107-11. Go to original source... Go to PubMed...
  8. BrkoviŠ B, Garda╣eviŠ M, RoganoviŠ J, JoviŠ N, TodoroviŠ Lj, StojiŠ D. Lidocaine+clonidine for maxillary infiltration anaesthesia: parameters of anaesthesia and vascular effects. Int J Oral Maxillofac Surg 2008;37(2):149-55. Go to original source... Go to PubMed...
  9. BrkoviŠ B, ZlatkoviŠ M, JovanoviŠ D, StojiŠ D. Maxillary infiltration anaesthesia by ropivacaine for upper third molar surgery. Int.J Oral Maxillofac Surg 2010;39(1):36-41. Go to original source... Go to PubMed...
  10. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175-91. Go to original source... Go to PubMed...
  11. Torres-Lagares D, Serrera-Figallo M┴, Machuca-Portillo G, Corcuera-Flores JR, Machuca-Portillo C, Castillo-OyagŘe R, GutiÚrrez-PÚrez JL. Cardiovascular effect of dental anesthesia with articaine (40 mg with epinefrine 0,5 mg % and 40 mg with epinefrine 1 mg%) versus mepivacaine (30 mg and 20 mg with epinefrine 1 mg %) in medically compromised cardiac patients: a cross-over, randomized, single blinded study. Med Oral Patol Oral Cir Bucal 2012;17(4):e655-60. Go to original source... Go to PubMed...
  12. Brkovic BM, Savic M, Andric M, Jurisic M, Todorovic Lj. Intraseptal vs. periodontal ligament anaesthesia for maxillary tooth extraction: quality of local anaestesia and hemodynamic response. Clin Oral Invest 2010;14(6):675-81. Go to original source...
  13. Kanaa MD, Whitworth JM, Meechan JG. A comparison of the efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in achieving pulpal anesthesia in maxillary teeth with irreversible pulpitis. J Endod 2012;38(3):279-82. Go to original source... Go to PubMed...
  14. Chen YW, Chu CC, Chen YC, Wang JJ, Hung CH. The dose-dependent study of verapamil and diltiazem on spinal anesthesia in the rat. Neurosci Lett 2010;482(1):76-80. Go to original source... Go to PubMed...
  15. Chen YW, Chu CC, Chen YC, Hung CH, Wang JJ. Intrathecal propranolol displays long-acting spinal anesthesia with a more sensory-selective action over motor blockade in rats. Eur J Pharmacol 2011;667(1-3):208-14. Go to original source... Go to PubMed...
  16. Chen YW, Chu CC, Chen YC, Hung CH, Wang JJ. Propranolol elicits cutaneous analgesia against skin nociceptive stimuli in rats. Neurosci Lett 2012;524(2):129-32. Go to original source... Go to PubMed...
  17. Ernberg M, Lundeberg T, Kopp S. Effect of propranolol and granisetron on experimentally induced pain and allodynia/hyperalgesia by intramuscular injection of serotonin into the human masseter muscle. Pain 2000;84(2-3):339-46. Go to original source... Go to PubMed...
  18. Laurito CE, Cohn SJ, Becker GL. Effects of subcutaneous verapamil on the duration of local anesthetic blockade. J Clin Anesth 1994;6(5):414-8. Go to original source... Go to PubMed...
  19. Akaike N, Ito H, Nishi K, Oyama Y. Further analysis of inhibitory effects of propranolol and local anaesthetics on the calcium current in Helix neurones. Br J Pharmacol 1982;76(1):37-43. Go to original source... Go to PubMed...
  20. Taussig R, Gilman AG. Mammalian membrane-bound adenylyl cyclases. J Biol Chem 1995;270(1):1-4. Go to original source... Go to PubMed...
  21. Trotz M, Jellison EJ, Hostetler KY. Propranolol inhibition of the neutral phospholipases A of rat heart mitochondria, sarcoplasmic reticulum and cytosol. Biochem Pharmacol 1987;36(24):4251-6. Go to original source... Go to PubMed...
  22. Soszynski D, Kozak W, Conn CA, Rudolph K, Kluger MJ. Beta-adrenoceptor antagonists suppress elevation in body temperature and increase in plasma IL-6 in rats exposed to open field. Neuroendocrinology 1996;63(5):459-67. Go to original source... Go to PubMed...
  23. Bloksma N, Hofhuis F, Benaissa-Trouw B, Willers J. Endotoxin-induced release of tumour necrosis factor and interferon in vivo is inhibited by prior adrenoceptor blockade. Cancer Immunol Immunother 1982;14(1):41-5. Go to original source... Go to PubMed...
  24. Millan MJ. The induction of pain: an integrative review. Prog Neurobiol 1999;57(1):1-164. Go to original source... Go to PubMed...
  25. Hyer SL, Taylor D, Barham J, Wilson J, Shaw J, Vince FP. The effects of propranolol and metoprolol on skin blood flow in diabeticpatients. Br J Clin Pharmacol 1987;23(6):769-71. Go to original source... Go to PubMed...
  26. Chen YW, Chu CC, Chen YC, Hung CH, Li YT, Wang JJ. Lidocaine for prolonged and intensified spinal anesthesia by coadministration of propranolol in the rat. Neurosci Lett 2011;503(1):63-7. Go to original source... Go to PubMed...
  27. Omote K, Iwasaki H, Kawamata M, Satoh O, Namiki A. Effects of verapamil on spinal anesthesia with local anesthetics. Anesth Analg 1995;80(3):444-8. Go to PubMed...
  28. 28Iwasaki H, Ohmori H, Omote K, Kawamata M, Sumita S, Yamauchi M, Namiki A. Potentiation of local lignocaine induced sensory block by calcium channel blockers in rats. Br J Anaesth 1996;77(2):243-7. Go to PubMed...
  29. Tallman RD Jr, Rosenblatt RM, Weaver JM, Wang YL. Verapamil increases the toxicity of local anesthetics. J Clin Pharmacol 1988;28(4):317-21. Go to original source... Go to PubMed...
  30. Smith FL, Davis RW, Carter R. Influence of Voltage-sensitive Ca(++) channel drugs on bupivacaine infiltration anesthesia in mice. Anesthesiology 2001;95(5):1189-97. Go to original source... Go to PubMed...
  31. Krikava I, Jarkovskř J, Stourac P, Novßkovß M, SevcÝk P. The effects of lidocaine on bupivacaine-induced cardiotoxicity in the isolated rat heart. Physiol Res 2010;59 Suppl 1:S65-9 Go to PubMed...