The cardiovascular effect of local anesthesia with articaine plus 1:200,000 adrenalin versus lidocaine plus 1:100,000 adrenalin in medically compromised cardiac patients: a prospective, randomized, double blinded study.
OBJECTIVE
This study compared cardiovascular safety profiles of 2 local anesthetics (LA): articaine (Ubistesine) versus standard lidocaine solution in cardiovascular patients.


METHODS
Fifty cardiovascular patients were randomly assigned to dental treatment using 1.8 mL of one of two LA injections: articaine 4% and adrenalin 1:200,000 or lidocaine 2% and adrenalin 1:100,000. A computerized system enabled continuous longitudinal data collection: electrocardiography (ECG), O(2)-saturation, blood pressure (BP), and heart rate (HR). Patients scored pain level at the end of the LA injection (on a 0 to 10 scale).


RESULTS
There were no clinical severe adverse effects. One transient local parasthesia occurred (lidocaine group), which lasted 4 weeks. There were no statistically significant differences between the 2 groups in HR, systolic or diastolic-BP, and O(2) saturation. Age, gender, jaw treated, treatment duration, and the pain level did not influence the results of the comparison. In 3 patients asymptomatic ischemic changes were noted on ECG (1 in the lidocaine group and 2 in the articaine group).


CONCLUSIONS
LA with articaine 4% with adrenalin 1:200,000 was comparably as safe as LA with standard concentrations of lidocaine and adrenalin in cardiovascular patients. Cardiac ischemic changes on ECG did not appear to be related to the LA.
Elad
Sharon
S
Oral Medicine Service, Hadassah University Hospital, Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. eladhome@md.huji.ac.il
Admon
Dan
D
Kedmi
Meirav
M
Naveh
Eitan
E
Benzki
Esti
E
Ayalon
Sharon
S
Tuchband
Alex
A
Lutan
Haim
H
Kaufman
Eliezer
E
D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D002355:Carticaine / Q000008:administration & dosage; D017742:Dental Care for Chronically Ill; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D002355:Carticaine; D010100:Oxygen; D004837:Epinephrine