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Pökel C, Schulze A, Busse M. Cardiovascular and Vector-Cardiographic Effects of Articaine Anesthesia with Epinephrine. Int J Dent 2024; 2024:8610423. [PMID: 38962723 PMCID: PMC11221961 DOI: 10.1155/2024/8610423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/22/2024] [Accepted: 05/21/2024] [Indexed: 07/05/2024] Open
Abstract
The aim was to investigate the vector-cardiographic effects in patients submitted to dental extraction under local anesthesia. Twenty-one patients aged 36.6 ± 12.4 years with a clinical and radiographic indication of mandibular or maxillary tooth extraction were enrolled. The intervention was a local or mandibular nerve block anesthesia with 4% articaine hydrochloride containing epinephrine (1 : 100,000; 40 mg/ml + 10 μg/ml). Blood pressure (BP), heart rate (HR), pulse wave transit time, and vector-cardiography data were recorded throughout 3 min before and 5 min after injection. QRS- and T-wave area under the curve (QRS AUC/T AUC) were calculated from the X/Y/Z QRS-vector or T-vector. T-wave amplitude (T AM), T AUC values, and diastolic BP decreased, and HR significantly increased 4 min after injection. A transient moderate HR drop and a corresponding small increase in T AM and T AUC immediately after the injection procedure may be explained by a decreased sympathetic tone due to psychological relief. In dental anesthesia, the systemic epinephrine effects are represented by a decrease in T AUC. These effects are most pronounced in the X- and Y-leads. The 3D determination of vector planes or amplitudes is a simple method to register the sympathetic tone in local anesthesia independently of possible effects on T-wave characteristics in single leads. In conclusion, T-wave determination may help to detect even small increases in systemic adrenaline concentration in case of accidental intravascular injection. At the same time, full rhythm and spatial ischemia control is provided.
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Affiliation(s)
- Christoph Pökel
- General Outpatient Clinic of Sports MedicineUniversity Leipzig, Leipzig, Germany
| | - Antina Schulze
- Department of Sports DentistryInstitute of Sports MedicineUniversity Leipzig, Leipzig, Germany
| | - Martin Busse
- General Outpatient Clinic of Sports MedicineUniversity Leipzig, Leipzig, Germany
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Cazaubon Y, Mauprivez C, Feliu C, Binet L, Oget O, Gozalo C, Djerada Z. Population pharmacokinetics of articaine with 1:200,000 epinephrine during third molar surgery and simulation of high-dose regimens. Eur J Pharm Sci 2018; 114:38-45. [PMID: 29197630 DOI: 10.1016/j.ejps.2017.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Articaine is more and more used in third molar surgery under local anesthesia (LA). The objectives of this analysis were to characterize the pharmacokinetics of articaine for this type of surgery and to simulate dosing regimens. METHODS Non-linear mixed-effects modeling conducted in Monolix 4.4.0 was used to describe articaine plasma concentration-time data from 20 patients. Monte Carlo simulations were then performed to evaluate the probability of cardiotoxic target attainment (PCTA) of various dosage regimens. RESULTS Articaine concentration data were best described by a linear one-compartment model, with an additional depot compartment for submucosal route with a zero-order transfer to central compartment. Age and gender were found to influence duration transfer (Tk0) and elimination rate constant (Ke), respectively. Simulated maximum recommended dose regimen (7mg/kg) had a PCTA of 0%. Simulated higher doses of 10mg/kg and 15mg/kg had a PCTA of 0% and about 1-4%, respectively. CONCLUSIONS The model adequately described the articaine pharmacokinetics. This is the first PK model qualified for articaine administered by submucosal route. The simulations suggest that maximum recommended dose regimen is safe concerning the cardiotoxicity in healthy patients.
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Affiliation(s)
- Yoann Cazaubon
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France; Department of Pharmacology, EA3801, SFR CAP-santé, URCA Reims University, Reims 51100, France
| | - Cédric Mauprivez
- Department of Odontology, Reims University Hospitals, 45 rue Cognacq Jay, Reims 51092, France; EA4691, Biomatériaux et Inflammation en Site Osseux, URCA Reims University, 51 rue Cognacq Jay, Reims 51092, France
| | - Catherine Feliu
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France; Department of Pharmacology, EA3801, SFR CAP-santé, URCA Reims University, Reims 51100, France
| | - Laurent Binet
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France
| | - Olivier Oget
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France
| | - Claire Gozalo
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France
| | - Zoubir Djerada
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France; Department of Pharmacology, EA3801, SFR CAP-santé, URCA Reims University, Reims 51100, France.
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Végh D, Somogyi A, Bányai D, Lakatos M, Balogh M, Al-Khrasani M, Fürst S, Vizi E, Hermann P. Effects of articaine on [ 3 H]noradrenaline release from cortical and spinal cord slices prepared from normal and streptozotocin-induced diabetic rats and compared to lidocaine. Brain Res Bull 2017; 135:157-162. [DOI: 10.1016/j.brainresbull.2017.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
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Abstract
Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.
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Affiliation(s)
- Marc Snoeck
- Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Effects of articaine and ropivacaine on calcium handling and contractility in canine ventricular myocardium. Eur J Anaesthesiol 2010; 27:153-61. [DOI: 10.1097/eja.0b013e328331a37b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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