title: Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient.
abstract: A case is reported of unexpected atrial fibrillation in response to tooth extraction under intravenous sedation in a 70-yr-old patient with thoracic aneurysm of the aorta. Atrial fibrillation developed after the additional injection of a 2% solution of lidocaine containing 1:200,000 epinephrine. After 20 min, the arrhythmia disappeared spontaneously. The arrhythmia was associated with insufficient analgesia for tooth extraction, epinephrine in the local anesthetic, decreased blood pressure, and the presence of cardiovascular disease. Even when a low concentration of epinephrine is employed, caution should be paid to development of unexpected cardiovascular reactions in elderly patients with severe cardiovascular disease. We conclude that an electrocardiogram, blood pressure device, and pulse oximeter should be used in high-risk patients in order to prevent and detect potentially dangerous cardiovascular emergencies, even if dental treatment is scheduled under local anesthesia.
authors.affiliation: Department of Geriatric Dentistry, Tokyo Medical and Dental University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Umino
authors.forename: T
authors.initials: T
authors.lastname: Ohwatari
authors.forename: K
authors.initials: K
authors.lastname: Shimoyama
authors.forename: M
authors.initials: M
authors.lastname: Nagao
mesh_terms: D000368:Aged; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications; D001281:Atrial Fibrillation / Q000209:etiology*; D016321:Dental Care for Aged; D017742:Dental Care for Chronically Ill; D004837:Epinephrine / Q000009:adverse effects*; D006801:Humans; D008297:Male; D014081:Tooth Extraction / Q000009:adverse effects; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine