title: Electrocardiographic changes in cardiac patients having dental extractions under a local anesthetic containing a vasopressor.
abstract: OBJECTIVE
  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.
  
  
  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.affiliation: Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Blinder
authors.forename: Y
authors.initials: Y
authors.lastname: Manor
authors.forename: J
authors.initials: J
authors.lastname: Shemesh
authors.forename: S
authors.initials: S
authors.lastname: Taicher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D000075202:Contraindications; D017742:Dental Care for Chronically Ill / Q000009:adverse effects*; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced; D014081:Tooth Extraction; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D004077:Digoxin; D008012:Lidocaine; D004837:Epinephrine