Skip to main content
NCBI home page
Anesthesia Progress logoLink to Anesthesia Progress
. 1989 May-Jun;36(3):79–87.

Modification of local anesthetic toxicity by vasoconstrictors.

S E Taylor, R L Dorris
PMCID: PMC2148661  PMID: 2700426

Abstract

We studied the effects of epinephrine or levonordefrin on the toxicity (convulsions) and lethality of four local anesthetics in mice. Appropriate doses of procaine, lidocaine, tetracaine or bupivacaine--either alone or in combination with 15 mcg/kg epinephrine or levonordefrin--were injected intravenously into the tail vein of male mice. Dose-response curves were constructed from the data obtained, and the CD50 and LD50 values for each local anesthetic alone and in combination with each of the vasoconstrictors were calculated by probit analysis. Both epinephrine and levonordefrin decreased the toxicity and lethality of procaine with respect to dose. Epinephrine, but not levonordefrin, increased the toxicity and lethality of bupivacaine as well as the lethality of tetracaine. Neither vasoconstrictor significantly affected the toxicity of lidocaine in mice but in rats epinephrine markedly increased lidocaine's lethality under identical conditions. Tight physical restraint decreased the LD50 values of all four local anesthetics and eliminated any modifying effect of the vasoconstrictor.

Full text

PDF
79

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASTROEM A., PERSSON N. H., ORTENGREN B. THE EFFECT OF ADRENALINE ON THE TOXICITIES AND ABSORPTIONS OF L 67 (CITANEST) AND SOME OTHER LOCAL ANAESTHETICS STUDIED IN MICE AND RABBITS. Acta Pharmacol Toxicol (Copenh) 1964;21:161–171. doi: 10.1111/j.1600-0773.1964.tb01779.x. [DOI] [PubMed] [Google Scholar]
  2. Akerman B. On felypressin (octapressin) as an adjunct to lidocaine and prilocaine--an experimental study in animals. Acta Pharmacol Toxicol (Copenh) 1966;24(4):377–388. [PubMed] [Google Scholar]
  3. Besse J. C., Furchgott R. F. Dissociation constants and relative efficacies of agonists acting on alpha adrenergic receptors in rabbit aorta. J Pharmacol Exp Ther. 1976 Apr;197(1):66–78. [PubMed] [Google Scholar]
  4. Bishop P. T. Frequency of accidental intravascular injection of local anaesthetics in children. Br Dent J. 1983 Feb 5;154(3):76–77. doi: 10.1038/sj.bdj.4804999. [DOI] [PubMed] [Google Scholar]
  5. Cawson R. A., Curson I., Whittington D. R. The hazards of dental local anaesthetics. Br Dent J. 1983 Apr 23;154(8):253–258. doi: 10.1038/sj.bdj.4805046. [DOI] [PubMed] [Google Scholar]
  6. Ciarlone A. E. Alteration of lidocaine- or procaine-induced convulsions by manipulation of brain amines. J Dent Res. 1981 Feb;60(2):182–186. doi: 10.1177/00220345810600021701. [DOI] [PubMed] [Google Scholar]
  7. Dionne R. A., Goldstein D. S., Wirdzek P. R. 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] [Google Scholar]
  8. Moore D. C., Bridenbaugh L. D., Thompson G. E., Balfour R. I., Horton W. G. Bupivacaine: a review of 11,080 cases. Anesth Analg. 1978 Jan-Feb;57(1):42–53. doi: 10.1213/00000539-197801000-00009. [DOI] [PubMed] [Google Scholar]
  9. Moore D. C., Scurlock J. E. Possible role of epinephrine in prevention or correction of myocardial depression associated with bupivacaine. Anesth Analg. 1983 Apr;62(4):450–453. [PubMed] [Google Scholar]
  10. Newcomb G. M. Contraindications to the use of catecholamine vasoconstrictors in dental local analgesics. N Z Dent J. 1973 Jan;69(315):25–30. [PubMed] [Google Scholar]
  11. Robertson V. J., Taylor S. E., Gage T. W. Quantitative and qualitative analysis of the pressor effects of levonordefrin. J Cardiovasc Pharmacol. 1984 Sep-Oct;6(5):929–935. doi: 10.1097/00005344-198409000-00029. [DOI] [PubMed] [Google Scholar]
  12. Ruffolo R. R., Jr Interactions of agonists with peripheral alpha-adrenergic receptors. Fed Proc. 1984 Nov;43(14):2910–2916. [PubMed] [Google Scholar]
  13. Troullos E. S., Goldstein D. S., Hargreaves K. M., Dionne R. A. Plasma epinephrine levels and cardiovascular response to high administered doses of epinephrine contained in local anesthesia. Anesth Prog. 1987 Jan-Feb;34(1):10–13. [PMC free article] [PubMed] [Google Scholar]
  14. Yagiela J. A. Intravascular lidocaine toxicity: influence of epinephrine and route of administration. Anesth Prog. 1985 Mar-Apr;32(2):57–61. [PMC free article] [PubMed] [Google Scholar]

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

RESOURCES