title: Impact of Epinephrine Contained in Local Anesthetic Solution on Serum Lactate Level During Orthognathic Surgery.
abstract: OBJECTIVE
  There have been many discussions of a relation between endogenous and exogenous epinephrine and hyperlactatemia. This study aimed to identify the impact of epinephrine contained in a local anesthetic solution on serum lactate levels in patients who underwent orthognathic surgery.
  
  
  METHODS
  This study was a retrospective record review of cases of maxillary and mandibular osteotomy at the Tokyo University Hospital (Tokyo, Japan) from January 2006 through December 2014. One hundred ninety-three patients were enrolled in this study.
  
  
  RESULTS
  The maximum intraoperative serum lactate level was 22.3 ± 14.7 mg/dL. Of 193 patients, 91 showed an intraoperative serum lactate level that was higher than the normal maximum of 19.8 mg/dL (2.2 mmol/L), and 16 of these had a level that was at least 40 mg/dL (≥4.49 mmol/L). Multiple logistic regression analysis showed 2 factors that could increase the serum lactate level: the amount of epinephrine contained in the local anesthetic solution injected into the oral cavity (odds ratio [OR] = 1.014; 95% confidence interval [CI], 1.006-1.022; P = .0001) and the absence of intraoperative treatment with propranolol (OR, 0.105; 95% CI, 0.019-0.434; P = .0013). Patients with severe serum lactate concentrations (ie, ≥40 mg/dL [≥4.49 mmol/L]) had slight metabolic acidosis. All patients survived 90 days. The number of postoperative hospitalization days for patients with severe serum lactate concentrations was 12.8 ± 2.6 days and that for patients without severe serum lactate concentration was 16.0 ± 8.6 days.
  
  
  CONCLUSIONS
  Increases in intraoperative serum lactate levels during orthognathic surgery are associated, at least in part, with increased aerobic glycolysis because of β2-adrenergic signaling. Lactate increase caused by epinephrine contained in a local anesthetic solution does not result in a poor postoperative outcome.
authors.affiliation: Assistant Professor, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan. Electronic address: kurodahidetaka@tdc.ac.jp.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Kuroda
authors.affiliation: Assistant Professor, Department of Anesthesiology, The University of Tokyo, Tokyo, Japan.
authors.forename: Gaku
authors.initials: G
authors.lastname: Kawamura
authors.affiliation: Assistant Professor, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Soya
authors.affiliation: Professor, Department of Anesthesiology, Toho University Sakura Medical Center, Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Professor, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: Professor, Department of Anesthesiology, The University of Tokyo, Tokyo, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects*; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D065906:Hyperlactatemia / Q000097:blood / Q000139:chemically induced*; D007431:Intraoperative Complications / Q000097:blood / Q000139:chemically induced*; D007564:Japan; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D063168:Mandibular Osteotomy; D063166:Maxillary Osteotomy; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D019344:Lactic Acid; D004837:Epinephrine