Cardiovascular and Vector-Cardiographic Effects of Articaine Anesthesia with Epinephrine

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.

Figure 1

Changes in HR, T_AM, T_AUC, and QRS_AUC values within the observation period of 3 min before and 5 min after the injection, expressed as percentage and displayed as ΔHR, ΔT_AM, ΔT_AUC, and ΔQRS in 10 s intervals.

Figure 2

Cardiovascular and cardiographic parameters: absolute values (a, c) and changes (Δ) in comparison to baseline values (b, d) with an indication of the standard deviation. HR, heart rate; T_AM, T-wave amplitude; T_AUC, T-wave area under the curve; SBP, systolic blood pressure; DBP, diastolic blood pressure; MAP, mean arterial blood pressure.

Figure 3

T-wave area under the curve (T_AUC) in the X-, Y- and Z-leads and combined X/Y/Z T-vector magnitude 3 min before and 5 min after anesthetic injection. §: significant.