title: Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study.
abstract: OBJECTIVE
  To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine.
  
  
  METHODS
  This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated.
  
  
  RESULTS
  There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters.
  
  
  CONCLUSIONS
  The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.
authors.affiliation: Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Marcela Alves Dos
authors.initials: MA
authors.lastname: Santos-Paul
authors.affiliation: Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Itamara Lucia Itagiba
authors.initials: IL
authors.lastname: Neves
authors.affiliation: Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Ricardo Simões
authors.initials: RS
authors.lastname: Neves
authors.affiliation: Department of Cardiology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local; D001007:Anxiety / Q000503:physiopathology; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects; D003327:Coronary Disease / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004338:Drug Combinations; D004812:Epidemiologic Methods; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D038321:Glycemic Index / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014081:Tooth Extraction / Q000379:methods*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D001786:Blood Glucose; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine