口腔内局所麻酔およびストレス負荷時の血中カテコールアミンと循環動態に関する研究

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  • Plasma catecholamine and hemodynamic responses after dental infiltrative anesthesia and stress-inducing stimuli.

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The author examined increases in blood catecholamine concentrations and circulatory aspects under conditions of local oral anesthesia, pain and emotional stress.<BR>Subjects consisted of 16 healthy adults. Local anesthesia consisted of 1.8 ml of either 2% lidocaine or 2% lidocaine containing 1/80, 000 epinephrine injected into the gingivobuccal fold of the maxillary premolar and palatum for 2 minutes. The pain stimulus was induced by injection of 1 ml of physiological saline solution into the gingivobuccal fold of the maxillary premolar for 1 minute. The emotional stress was given by using an unfunctional electrical pulp tester to the subject for 1 minute. Serum concentrations of epinephrine (E), norepinephrine (NE), dopamine (DA) were measured before anesthesia and stress and 0, 1, 3, 5, 10, 20 and 30 minutes after completion of anesthesia and stress, using the radioenzymatic assay. Blood pressure, heart rate, rate pressure product (RPP), and fingertip plethysmogram were measured simultaneously.<BR>1. At the time of infiltrative anesthesia with the 2% lidocaine containing E, the blood levels of E, NE and DA all showed significant increase and peaked after 1 minute of anesthesia gradually decreasing thereafter. However, blood E concentration alone had not returned to normal resting values 30 minutes later.<BR>2. When performing anesthesia with 2% lidocaine, the blood DA concentration showed significant increase at 1 minute after anesthesia, reaching a peak at 1-3 minutes after anesthesia.<BR>3. When applying pain stress, blood concentrations of NE and DA showed significant increases and peaked at 1 minute of stress.<BR>4. When applying emotional stress, the blood concentrations of E, NE and DA showed significant increases and peaked at 1 minute after the stress.<BR>5. When using infiltrative anesthesia employing 2% lidocaine containing E, the heart rate and the RPP increased but plethysmogram wave height decreased.<BR>6. The RPP increased using 2% lidocaine infiltrative anesthesia but the diastolic blood pressure and plethysmogram wave height.<BR>7. Systolic blood pressure and plethysmogram wave height decreased under stress pain.<BR>8. The heart rate increased at the beginning of the emotional stress but plethysmogram wave height decreased.<BR>The above results showed changes in the blood concentrations of E, NE and DA upon application of emotional stress. However, when infiltrative anesthesia was performed with lidocaine containing E, the blood E concentration reached levels 5.7 times that of pre-experimental resting time values within 1 minute, and even after 30 minutes the levels were still high, being 1.8 times as high as pre-experimental resting stage. Consequently, when performing dental treatment or oral surgery in cases in which the underlying disease involves cardiovascular and circulatory disorders or endocrine abnormalities, it is extremely important to obtain a mentally calm state to control increased secretion of endogenous catecholamine and also to select a local anesthesia with vasopresser effects.

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