Skip to main content
NCBI home page
Anesthesia Progress logoLink to Anesthesia Progress
. 1994;41(3):77–80.

Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient.

M Umino 1, T Ohwatari 1, K Shimoyama 1, M Nagao 1
PMCID: PMC2148821  PMID: 8934964

Abstract

A case is reported of unexpected atrial fibrillation in response to tooth extraction under intravenous sedation in a 70-yr-old patient with thoracic aneurysm of the aorta. Atrial fibrillation developed after the additional injection of a 2% solution of lidocaine containing 1:200,000 epinephrine. After 20 min, the arrhythmia disappeared spontaneously. The arrhythmia was associated with insufficient analgesia for tooth extraction, epinephrine in the local anesthetic, decreased blood pressure, and the presence of cardiovascular disease. Even when a low concentration of epinephrine is employed, caution should be paid to development of unexpected cardiovascular reactions in elderly patients with severe cardiovascular disease. We conclude that an electrocardiogram, blood pressure device, and pulse oximeter should be used in high-risk patients in order to prevent and detect potentially dangerous cardiovascular emergencies, even if dental treatment is scheduled under local anesthesia.

Full text

PDF
77

Selected References

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

  1. Alexander J. P. Dysrhythmia and oral surgery. Br J Anaesth. 1971 Aug;43(8):773–778. doi: 10.1093/bja/43.8.773. [DOI] [PubMed] [Google Scholar]
  2. Barber W. B., Smith L. E., Zaloga G. P., Fletcher J. R., Cook D., Lake C. R., Chernow B. Hemodynamic and plasma catecholamine responses to epinephrine-containing perianal lidocaine anesthesia. Anesth Analg. 1985 Sep;64(9):924–928. [PubMed] [Google Scholar]
  3. Bradshaw E. G. Dysrhythmias associated with oral surgery. Anaesthesia. 1976 Jan-Feb;31(1):13–17. doi: 10.1111/j.1365-2044.1976.tb11739.x. [DOI] [PubMed] [Google Scholar]
  4. Cassidy J. P., Phero J. C., Grau W. H. Epinephrine: systemic effects and varying concentrations in local anesthesia. Anesth Prog. 1986 Nov-Dec;33(6):289–297. [PMC free article] [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. Chernow B., Balestrieri F., Ferguson C. D., Terezhalmy G. T., Fletcher J. R., Lake C. R. 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. doi: 10.1001/archinte.143.11.2141. [DOI] [PubMed] [Google Scholar]
  7. Cioffi G. A., Chernow B., Glahn R. P., Terezhalmy G. T., Lake C. R. The hemodynamic and plasma catecholamine responses to routine restorative dental care. J Am Dent Assoc. 1985 Jul;111(1):67–70. doi: 10.14219/jada.archive.1985.0038. [DOI] [PubMed] [Google Scholar]
  8. Goldstein D. S., Dionne R., Sweet J., Gracely R., Brewer H. B., Jr, Gregg R., Keiser H. R. 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. doi: 10.1097/00006842-198207000-00004. [DOI] [PubMed] [Google Scholar]
  9. Hasse A. L., Heng M. K., Garrett N. R. Blood pressure and electrocardiographic response to dental treatment with use of local anesthesia. J Am Dent Assoc. 1986 Oct;113(4):639–642. doi: 10.14219/jada.archive.1986.0245. [DOI] [PubMed] [Google Scholar]
  10. Hughes C. L., Leach J. K., Allen R. E., Lambson G. O. Cardiac arrhythmias during oral surgery with local anesthesia. J Am Dent Assoc. 1966 Nov;73(5):1095–1102. doi: 10.14219/jada.archive.1966.0339. [DOI] [PubMed] [Google Scholar]
  11. Jastak J. T., Yagiela J. A. Vasoconstrictors and local anesthesia: a review and rationale for use. J Am Dent Assoc. 1983 Oct;107(4):623–630. doi: 10.14219/jada.archive.1983.0307. [DOI] [PubMed] [Google Scholar]
  12. Ryder W. The electrocardiogram in dental anaesthesia. Anaesthesia. 1970 Jan;25(1):46–62. doi: 10.1111/j.1365-2044.1970.tb00158.x. [DOI] [PubMed] [Google Scholar]
  13. Thurlow A. C. Cardiac dysrhythmias in outpatient dental anaesthesia in children. The effect of prophylactic intravenous atropine. Anaesthesia. 1972 Oct;27(4):429–435. doi: 10.1111/j.1365-2044.1972.tb08249.x. [DOI] [PubMed] [Google Scholar]
  14. Tolas A. G., Pflug A. E., Halter J. B. 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. doi: 10.14219/jada.archive.1982.0114. [DOI] [PubMed] [Google Scholar]
  15. Vanderheyden P. J., Williams R. A., Sims T. N. Assessment of ST segment depression in patients with cardiac disease after local anesthesia. J Am Dent Assoc. 1989 Sep;119(3):407–412. doi: 10.14219/jada.archive.1989.0048. [DOI] [PubMed] [Google Scholar]
  16. WILLIAMS R. M., KEYES M., BECKER D. J., WILLIAMS R. A., WASSERMAN F. ELECTROCARDIOGRAPHIC CHANGES DURING ORAL SURGICAL PROCEDURES UNDER LOCAL ANESTHESIA. Oral Surg Oral Med Oral Pathol. 1963 Oct;16:1270–1275. doi: 10.1016/0030-4220(63)90351-7. [DOI] [PubMed] [Google Scholar]
  17. Yoshimura Y. The relation of tooth extraction to anginal attack. J Oral Maxillofac Surg. 1983 Jun;41(6):365–376. doi: 10.1016/s0278-2391(83)80007-x. [DOI] [PubMed] [Google Scholar]

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

RESOURCES