title: Effects of mepivacaine 2% with epinephrine in the cardiovascular activity of patients undergoing third molar surgery: a prospective clinical study.
abstract: BACKGROUND
  Cardiovascular effects of epinephrine, especially on blood pressure (BP) and heart rate (HR), have been well documented. When present in dental local anesthetic solutions, epinephrine concentration ranges from 5 to 20 µg/mL. Doses less than 200 µg are recommended to be clinically safe.
  
  
  OBJECTIVE
  This study investigated the effects of the anesthetic solution of mepivacaine (2%) with epinephrine (10 µg/mL) in cardiovascular activity (HR and BP).
  
  
  METHODS
  Twenty-six patients underwent outpatient surgery for the removal of 2 unilateral (group I, n = 15) or 4 (group II, n = 11) third molars in a single session, being injected 5.4 and 10.8 mL of anesthetic solution, equivalent to 54 and 108 µg of epinephrine, respectively. The cardiovascular activity was monitored by cardioscope during the experimental period of 2 hours. Heart rate and BP were measured at the intervals of 0, 5, 10, 15, 20, 30, 40, 60, 90, and 120 minutes after anesthetic injection.
  
  
  RESULTS
  After application of 2-way analysis of variance test, comparison between groups was not statistically significant for HR (P = 0.1388), systolic BP (P = 0.0228), and diastolic BP (P = 0.9846). However, patients from group II presented significantly greater sway in HR (P < 0.0001), systolic BP (P = 0.0169), and diastolic BP (P < 0.0001) in the course of 2 hours.
  
  
  CONCLUSIONS
  Blood pressure did not present significant alterations after a local injection of 54 or 108 µg of epinephrine during surgery to remove 2 or 4 third molars. Although without significance, HR was more elevated in the 108-µg dose of epinephrine during the removal of 4 third molars.
authors.affiliation: From the *Division of Oral Surgery, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará; †Division of Oral Surgery, Dr. José Frota Institute Hospital, Ceará; Divisions of ‡Oral Surgery, §Division of Oral Radiology, Department of Clinical Dentistry, Federal University of Ceará, Fortaleza-CE, ∥Department of Clinical Dentistry, Federal University of Ceará, Fortaleza-CE; and ¶Division of Stomatology and Oral Surgery, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Ceará, Brazil.
authors.forename: Henrique Clasen
authors.initials: HC
authors.lastname: Scarparo
authors.forename: Raimundo Nonato
authors.initials: RN
authors.lastname: Maia
authors.forename: Soraia Rodrigues
authors.initials: SR
authors.lastname: de Gois
authors.forename: Fábio Wildson Gurgel
authors.initials: FW
authors.lastname: Costa
authors.forename: Thyciana Rodrigues
authors.initials: TR
authors.lastname: Ribeiro
authors.forename: Eduardo Costa Studart
authors.initials: EC
authors.lastname: Soares
mesh_terms: D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D011446:Prospective Studies; D014081:Tooth Extraction; D055815:Young Adult
chemical_list: D008619:Mepivacaine; D004837:Epinephrine