PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of anesthprogLink to Publisher's site
 
Anesth Prog. 1986 December; 33(6): 289–297.
PMCID: PMC2148562

Epinephrine: Systemic Effects and Varying Concentrations in Local Anesthesia

Abstract

The range of vasoconstrictors available for use with local anesthetics in dentistry has been reviewed with emphasis on epinephrine and its physiological effects. All of the vasoconstrictors reviewed provide satisfactory results in dental anesthetic solutions when administered in appropriate concentrations and volumes. Possible drug interactions of concern to dentists include the use of vasoconstrictors with inhalational anesthetics, tricyclic antidepressants, beta blockers and, possibly, phenothiazines. Data reviewed indicates that the amounts of epinephrine used in dentistry can result in significant elevations in circulating levels of ephinephrine and concomitant physiologic changes. Evidence reviewed suggests that 1:200,000 epinephrine concentration results in optional duration and depth of local anesthesia. With the potential for adverse effects from epinephrine concentrations that are needlessly increased, it appears that in most clinical situations a 1:200,000 concentration of epinephrine can be used in an efficacious manner.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Jastak JT, Yagiela JA. Vasoconstrictors and local anesthesia: a review and rationale for use. J Am Dent Assoc. 1983 Oct;107(4):623–630. [PubMed]
  • Brown G. The influence of adrenaline, noradrenaline vasoconstrictors on the efficiency of lidocaine. J Oral Ther Pharmacol. 1968 May;4(5):398–405. [PubMed]
  • BRAID DP, SCOTT DB. THE SYSTEMIC ABSORPTION OF LOCAL ANALGESIC DRUGS. Br J Anaesth. 1965 Jun;37:394–404. [PubMed]
  • KEESLING GR, HINDS EC. Optimal concentration of epinephrine in lidocaine solutions. J Am Dent Assoc. 1963 Mar;66:337–340. [PubMed]
  • Gangarosa LP, Halik FJ. A clinical evaluation of local anaesthetic solutions containing graded epinephrine concentrations. Arch Oral Biol. 1967 May;12(5):611–621. [PubMed]
  • Sveen K. Effect of the addition of a vasoconstrictor to local anesthetic solution on operative and postoperative bleeding, analgesia and wound healing. Int J Oral Surg. 1979 Aug;8(4):301–306. [PubMed]
  • Meyer R, Allen GD. Blood volume studies in oral surgery. I. Operative and postoperative blood losses in relation to vasoconstrictors. J Oral Surg. 1968 Nov;26(11):721–726. [PubMed]
  • Lindorf HH. Investigation of the vascular effect of newer local anesthetics and vasoconstrictors. Oral Surg Oral Med Oral Pathol. 1979 Oct;48(4):292–297. [PubMed]
  • Milam SB, Giovannitti JA., Jr Local anesthetics in dental practice. Dent Clin North Am. 1984 Jul;28(3):493–508. [PubMed]
  • Cawson RA. Effects of vasoconstrictors. J Am Dent Assoc. 1984 Apr;108(4):462–466. [PubMed]
  • Robertson VJ, Taylor SE, Gage TW. Quantitative and qualitative analysis of the pressor effects of levonordefrin. J Cardiovasc Pharmacol. 1984 Sep-Oct;6(5):929–935. [PubMed]
  • Axelrod J, Weinshilboum R. Catecholamines. N Engl J Med. 1972 Aug 3;287(5):237–242. [PubMed]
  • Buhrow JA, Bastron RD. A comparative study of vasoconstrictors and determination of their safe dose under halothane anesthesia. J Oral Surg. 1981 Dec;39(12):934–937. [PubMed]
  • Maxwell GM. The cardiovascular effects of octapressin. Arch Int Pharmacodyn Ther. 1965 Nov;158(1):17–23. [PubMed]
  • Newcomb GM, Waite IM. The effectiveness of two local analgesic preparations in reducing haemorrhage during periodontal surgery. J Dent. 1972 Oct;1(1):37–42. [PubMed]
  • KATZ RL. EPINEPHRINE AND PLV-2: CARDIAC RHYTHM AND LOCAL VASOCONSTRICTOR EFFECTS. Anesthesiology. 1965 Sep-Oct;26:619–623. [PubMed]
  • Milam SB. General anesthetics: a comparative review of pharmacodynamics. Anesth Prog. 1984 May-Jun;31(3):116–123. [PMC free article] [PubMed]
  • Johnston RR, Eger EI II, Wilson C. A comparative interaction of epinephrine with enflurane, isoflurane, and halothane in man. Anesth Analg. 1976 Sep-Oct;55(5):709–712. [PubMed]
  • Katz RL, Epstein RA. The interaction of anesthetic agents and adrenergic drugs to produce cardiac arrhythmias. Anesthesiology. 1968 Jul-Aug;29(4):763–784. [PubMed]
  • Hilley MD, Milam SB, Giescke AH, Jr, Giovannitti JA. Fatality associated with the combined use of halothane and gingival retraction cord. Anesthesiology. 1984 Jun;60(6):587–588. [PubMed]
  • Yagiela JA, Duffin SR, Hunt LM. Drug interactions and vasoconstrictors used in local anesthetic solutions. Oral Surg Oral Med Oral Pathol. 1985 Jun;59(6):565–571. [PubMed]
  • Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Prichard BN. Interactions between sympathomimetic amines and antidepressant agents in man. Br Med J. 1973 Feb 10;1(5849):311–315. [PMC free article] [PubMed]
  • Elis J, Laurence DR, Mattie H, Prichard BN. Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure. Br Med J. 1967 Apr 8;2(5544):75–78. [PMC free article] [PubMed]
  • Cawson RA, Curson I, Whittington DR. The hazards of dental local anaesthetics. Br Dent J. 1983 Apr 23;154(8):253–258. [PubMed]
  • Alvarez-Mena SC, Frank MJ. Phenothiazine-induced T-wave abnormalities. Effects of overnight fasting. JAMA. 1973 Jun 25;224(13):1730–1733. [PubMed]
  • Persson G, Siwers B. The risk of potentiating effect of local anaesthesia with adrenalin in patients treated with tricyclic antidepressants. Sven Tandlak Tidskr. 1975;68(1):9–18. [PubMed]
  • Chernow B, Balestrieri F, Ferguson CD, Terezhalmy GT, Fletcher JR, Lake CR. Local dental anesthesia with epinephrine. Minimal effects on the sympathetic nervous system or on hemodynamic variables. Arch Intern Med. 1983 Nov;143(11):2141–2143. [PubMed]
  • Tolas AG, Pflug AE, Halter JB. Arterial plasma epinephrine concentrations and hemodynamic responses after dental injection of local anesthetic with epinephrine. J Am Dent Assoc. 1982 Jan;104(1):41–43. [PubMed]
  • Dionne RA, Goldstein DS, Wirdzek PR. Effects of diazepam premedication and epinephrine-containing local anesthetic on cardiovascular and plasma catecholamine responses to oral surgery. Anesth Analg. 1984 Jul;63(7):640–646. [PubMed]
  • Goldstein DS, Dionne R, Sweet J, Gracely R, Brewer HB, Jr, Gregg R, Keiser HR. Circulatory, plasma catecholamine, cortisol, lipid, and psychological responses to a real-life stress (third molar extractions): effects of diazepam sedation and of inclusion of epinephrine with the local anesthetic. Psychosom Med. 1982 Jul;44(3):259–272. [PubMed]
  • Clutter WE, Bier DM, Shah SD, Cryer PE. Epinephrine plasma metabolic clearance rates and physiologic thresholds for metabolic and hemodynamic actions in man. J Clin Invest. 1980 Jul;66(1):94–101. [PMC free article] [PubMed]
  • Taylor S, Achola K, Smith G. Plasma catecholamine concentrations. The effects of infiltration with local analgesics and vasoconstrictors during nasal operations. Anaesthesia. 1984 Jun;39(6):520–523. [PubMed]
  • Donlon JV, Jr, Moss J. Plasma catecholamine levels during local anesthesia for cataract operations. Anesthesiology. 1979 Nov;51(5):471–473. [PubMed]
  • Smith GN, Walton RE. Periodontal ligament injection: distribution of injected solutions. Oral Surg Oral Med Oral Pathol. 1983 Mar;55(3):232–238. [PubMed]
  • Lilienthal B, Reynolds AK. Cardiovascular responses to intraosseous injections containing catecholamines. Oral Surg Oral Med Oral Pathol. 1975 Nov;40(5):574–583. [PubMed]
  • Rawson RD, Orr DL., 2nd Vascular penetration following intraligamental injection. J Oral Maxillofac Surg. 1985 Aug;43(8):600–604. [PubMed]
  • Kennedy WF, Jr, Bonica JJ, Ward RJ, Tolas AG, Martin WE, Grinstein A. Cardiorespiratory effects of epinephrine when used in regional anesthesia. Acta Anaesthesiol Scand Suppl. 1966;23:320–333. [PubMed]
  • Fink BR, Aasheim GM, Levy BA. Neural pharmacokinetics of epinephrine. Anesthesiology. 1978 Apr;48(4):263–266. [PubMed]
  • Dhunér KG, Lewis DH. Effect of local anaesthetics and vasoconstrictors upon regional blood flow. Acta Anaesthesiol Scand Suppl. 1966;23:347–352. [PubMed]
  • Yagiela JA. Intravascular lidocaine toxicity: influence of epinephrine and route of administration. Anesth Prog. 1985 Mar-Apr;32(2):57–61. [PMC free article] [PubMed]
  • Gerke DC, Crabb GA, Frewin DB, Frost BR. The effect of storage on the activity of adrenaline in local anaesthetic solutions: an evaluation using bioassay and fluorometric techniques. Aust Dent J. 1977 Dec;22(6):423–427. [PubMed]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology