D Blinder1, Y Manor, J Shemesh, S Taicher. 1. Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
Abstract
PURPOSE: This study attempted to identify which group of cardiac patients is most at risk when dental extractions are performed under a local anesthetic with a vasopressor. PATIENTS AND METHODS: Forty cardiac patients who had dental extractions under local anesthesia were connected to a Holter monitor for 24 hours, starting an hour before the procedure. The electrocardiogram was analyzed for the number of premature beats, ST depression, and cardiac rhythm. A mean rate was calculated for the first 2 hours after injection of the local anesthetic and for the subsequent 22 hours. The preoperative electrocardiogram was compared with the electrocardiogram performed 1 week before treatment. RESULTS: Electrocardiographic changes were observed in 15 patients (37.5%), and all occurred during the first 2 hours after injection of the local anesthetic. Of the 15 patients, eight were being treated with digoxin. CONCLUSIONS: Cardiac patients being treated with digoxin had more electrocardiographic changes after administration of a local anesthetic than other cardiac patients. When the local anesthetic contained a vasopressor, there was a greater incidence of tachycardia but less arrhythmia or ST depression.
PURPOSE: This study attempted to identify which group of cardiac patients is most at risk when dental extractions are performed under a local anesthetic with a vasopressor. PATIENTS AND METHODS: Forty cardiac patients who had dental extractions under local anesthesia were connected to a Holter monitor for 24 hours, starting an hour before the procedure. The electrocardiogram was analyzed for the number of premature beats, ST depression, and cardiac rhythm. A mean rate was calculated for the first 2 hours after injection of the local anesthetic and for the subsequent 22 hours. The preoperative electrocardiogram was compared with the electrocardiogram performed 1 week before treatment. RESULTS: Electrocardiographic changes were observed in 15 patients (37.5%), and all occurred during the first 2 hours after injection of the local anesthetic. Of the 15 patients, eight were being treated with digoxin. CONCLUSIONS: Cardiac patients being treated with digoxin had more electrocardiographic changes after administration of a local anesthetic than other cardiac patients. When the local anesthetic contained a vasopressor, there was a greater incidence of tachycardia but less arrhythmia or ST depression.
Authors: Ana Carolina Guimarães Oliveira; Itamara Lucia Itagiba Neves; Luciana Sacilotto; Natália Quintella Sangiorgi Olivetti; Marcela Alves Dos Santos-Paul; Tânia Cristina Pedroso Montano; Cíntia Maria Alencar Carvalho; Tan Chen Wu; Cesar José Grupi; Sílvio Alves Barbosa; Carlos Alberto Pastore; Nelson Samesima; Denise Tessariol Hachul; Maurício Ibrahim Scanavacca; Ricardo Simões Neves; Francisco Carlos Costa Darrieux Journal: J Am Heart Assoc Date: 2019-07-19 Impact factor: 5.501