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. 1988 May-Jun;35(3):102–115.

Cardiac Dysrhythmias with General Anesthesia during Dental Surgery

Chandra R Rodrigo
PMCID: PMC2168026  PMID: 3046439

Abstract

Dysrhythmias with general anesthesia during dental surgery have been frequently reported. The incidence appears higher in spontaneously breathing patients lightly anesthetized with halothane. Anxiety, sitting posture, hypoxia, Chinese race, and heart disease appear to aggravate the condition. Use of beta blockers or lidocaine prior to anesthesia, intravenous induction, controlled ventilation with muscle relaxants, and use of isoflurane or enflurane in spontaneously breathing patients appear to decrease the incidence. It is stressed that continuous cardiac monitoring should be done in patients undergoing dental surgery under anesthesia in order to detect diagnose and treat any dysrhythmia. The great majority of dysrhythmias disappear either spontaneously or when the stimulus is stopped. In some cases there may be an obvious cause that should be immediately corrected. The need for drug intervention is rare and must be used with great care when used.

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Selected References

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  1. ALLEN G. D., WARD R. J., TOLAS A., DANZIGER F. CARDIOVASCULAR RESPONSES DURING GENERAL ANESTHESIA OF DENTAL OUTPATIENTS. J Oral Ther Pharmacol. 1965 May;1:602–611. [PubMed] [Google Scholar]
  2. AUSTEN W. G., EBERT P. A., GREENFIELD L. J. Mechanism of cardiac arrest in acute hypoxia. Surgery. 1963 Jun;53:784–791. [PubMed] [Google Scholar]
  3. Adatia A. K., Gehring E. N. Bilateral inferior alveolar and lingual nerve block. Br Dent J. 1972 Nov 7;133(9):377–383. doi: 10.1038/sj.bdj.4802923. [DOI] [PubMed] [Google Scholar]
  4. Aellig W. H., O'Neil R., Laurence D. R., Verrill P. J. Cardiac effects of adrenaline and felypressin as vasoconstrictors in local anaesthesia for oral surgery under diazepam sedation. Br J Anaesth. 1970 Feb;42(2):174–176. doi: 10.1093/bja/42.2.174. [DOI] [PubMed] [Google Scholar]
  5. Al-Khishali T., Padfield A., Perks E. R., Thornton J. A. Cardio-respiratory effects of nitrous oxide:oxygen:halothane anaesthesia administered to dental outpatients in the upright position. Anaesthesia. 1978 Feb;33(2):184–188. doi: 10.1111/j.1365-2044.1978.tb08347.x. [DOI] [PubMed] [Google Scholar]
  6. Alexander J. P., Bekheit S., Fletcher E. Dysrhythmia and oral surgery. II. Junctional rhythms. Br J Anaesth. 1972 Nov;44(11):1179–1182. doi: 10.1093/bja/44.11.1179. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Alexander J. P., Murtagh J. G. Arrhythmia during oral surgery: fascicular blocks in the cardiac conducting system. Br J Anaesth. 1979 Feb;51(2):149–155. doi: 10.1093/bja/51.2.149. [DOI] [PubMed] [Google Scholar]
  9. Atlee J. L., 3rd, Rusy B. F. Atrioventricular conduction times and atrioventricular nodal conductivity during enflurane anesthesia in dogs. Anesthesiology. 1977 Dec;47(6):498–503. doi: 10.1097/00000542-197712000-00005. [DOI] [PubMed] [Google Scholar]
  10. Atlee J. L., 3rd, Rusy B. F. Halothane depression of A-V conduction studied by electrograms of the bundle of His in dogs. Anesthesiology. 1972 Feb;36(2):112–118. doi: 10.1097/00000542-197202000-00005. [DOI] [PubMed] [Google Scholar]
  11. BLACK G. W., LINDE H. W., DRIPPS R. D., PRICE H. L. Circulatory changes accompanying respiratory acidosis during halothane (fluothane) anaesthesia in man. Br J Anaesth. 1959 Jun;31:238–246. doi: 10.1093/bja/31.6.238. [DOI] [PubMed] [Google Scholar]
  12. BOURNE J. G. Cyclopropane anaesthesia for dental extraction and other surgery in outpatients; review of 1000 cases. Lancet. 1952 Oct 11;2(6737):705–708. doi: 10.1016/s0140-6736(52)91320-2. [DOI] [PubMed] [Google Scholar]
  13. BOURNE J. G. Fainting and cerebral damage; a danger in patients kept upright during dental gas anaesthesia and after surgical operations. Lancet. 1957 Sep 14;273(6994):499–505. doi: 10.1016/s0140-6736(57)90820-6. [DOI] [PubMed] [Google Scholar]
  14. BREGGIN P. R. THE PSYCHOPHYSIOLOGY OF ANXIETY; WITH A REVIEW OF THE LITERATURE CONCERNING ADRENALINE. J Nerv Ment Dis. 1964 Dec;139:558–568. doi: 10.1097/00005053-196412000-00009. [DOI] [PubMed] [Google Scholar]
  15. Barker G. L., Briscoe C. E. The Pathfinder High-Speed E.C.G. Analyser. Use in detection of arrhythmias during oral surgery. Br J Anaesth. 1981 Oct;53(10):1079–1082. doi: 10.1093/bja/53.10.1079. [DOI] [PubMed] [Google Scholar]
  16. Barkin M. E., Middleton R. A. ECG monitoring of oral surgery patients receiving a local anesthetic. J Oral Surg. 1978 Oct;36(10):779–780. [PubMed] [Google Scholar]
  17. Bishop L. F., Reichert P. The interrelationship between anxiety and arrhythmias. Psychosomatics. 1970 Jul-Aug;11(4):330–334. doi: 10.1016/S0033-3182(70)71631-9. [DOI] [PubMed] [Google Scholar]
  18. Black G. W. A comparison of cardiac rhythm during halothane and methoxyflurane anaesthesia at normal and elevated levels of PaCO-2. Acta Anaesthesiol Scand. 1967;11(2):103–108. doi: 10.1111/j.1399-6576.1967.tb00374.x. [DOI] [PubMed] [Google Scholar]
  19. Blitt C. D., Raessler K. L., Wightman M. A., Groves B. M., Wall C. L., Geha D. G. Atrioventricular conduction in dogs during anesthesia with isoflurane. Anesthesiology. 1979 Mar;50(3):210–212. doi: 10.1097/00000542-197903000-00008. [DOI] [PubMed] [Google Scholar]
  20. Boas R. A., Covino B. G., Shahnarian A. Analgesic responses to i.v. lignocaine. Br J Anaesth. 1982 May;54(5):501–505. doi: 10.1093/bja/54.5.501. [DOI] [PubMed] [Google Scholar]
  21. Bourne J. G. Deaths with dental anaesthetics. Anaesthesia. 1970 Oct;25(4):473–481. doi: 10.1111/j.1365-2044.1970.tb00253.x. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. Brierley J. B., Miller A. A. Fatal brain damage after dental anaesthesia. Its nature, etiology, and prevention. Lancet. 1966 Oct 22;2(7469):869–873. doi: 10.1016/s0140-6736(66)91975-1. [DOI] [PubMed] [Google Scholar]
  24. CHRISTENSON G. R., HEBERT C. L., DRISCOLL E. J. Intravenous barbiturate anesthesia for dental outpatients. Anesth Analg. 1961 Jan-Feb;40:77–86. [PubMed] [Google Scholar]
  25. Carlsson S. G., Linde A., Ohman A. Reduction of tension in fearful dental patients. J Am Dent Assoc. 1980 Oct;101(4):638–641. doi: 10.14219/jada.archive.1980.0376. [DOI] [PubMed] [Google Scholar]
  26. Casson W. R., Jones R. M. Cardiac rate and rhythm during anaesthesia for dental extraction. A comparison of halothane, enflurane and isoflurane. Br J Anaesth. 1985 May;57(5):476–481. doi: 10.1093/bja/57.5.476. [DOI] [PubMed] [Google Scholar]
  27. Cattermole R. W., Verghese C., Blair I. J., Jones C. J., Flynn P. J., Sebel P. S. Isoflurane and halothane for outpatient dental anaesthesia in children. Br J Anaesth. 1986 Apr;58(4):385–389. doi: 10.1093/bja/58.4.385. [DOI] [PubMed] [Google Scholar]
  28. Clayton D. G., Allt-Graham J. Intravenous lignocaine in dental anaesthesia. The effect of pretreatment on the incidence of dysrhythmias. Anaesthesia. 1983 Nov;38(11):1066–1070. doi: 10.1111/j.1365-2044.1983.tb12481.x. [DOI] [PubMed] [Google Scholar]
  29. Clement A. J., Jenkins B. S. Dental anaesthesia. Lancet. 1969 Dec 13;2(7633):1302–1302. doi: 10.1016/s0140-6736(69)90838-1. [DOI] [PubMed] [Google Scholar]
  30. Cripps T. P., Edmondson R. S. Isoflurane for anaesthesia in the dental chair. a comparison of the incidence of cardiac dysrhythmias during anaesthesia with halothane and isoflurane. Anaesthesia. 1987 Feb;42(2):189–191. doi: 10.1111/j.1365-2044.1987.tb02997.x. [DOI] [PubMed] [Google Scholar]
  31. Cundy J. M. The anti-dysrhythmic effect of Althesin. Anaesthesia. 1973 Sep;28(5):544–545. doi: 10.1111/j.1365-2044.1973.tb00523.x. [DOI] [PubMed] [Google Scholar]
  32. DEL PIZZO A., ABELLA A. Halothane anesthesia for ambulatory dental patients. Oral Surg Oral Med Oral Pathol. 1961 Dec;14:1444–1455. doi: 10.1016/0030-4220(61)90247-x. [DOI] [PubMed] [Google Scholar]
  33. DODD R. B., SIMS W. A., BONE D. J. Cardiac arrhythmias observed during anesthesia and surgery. Surgery. 1962 Apr;51:440–447. [PubMed] [Google Scholar]
  34. DRISCOLL E. J., CHRISTENSON G. R., WHITE C. L. Physiologic studies in general anesthesia for ambulatory dental patients. Oral Surg Oral Med Oral Pathol. 1959 Dec;12:1496–1514. doi: 10.1016/0030-4220(59)90275-0. [DOI] [PubMed] [Google Scholar]
  35. Driscoll E. J., Smilack Z. H., Lightbody P. M., Fiorucci R. D. Sedation with intravenous diazepam. J Oral Surg. 1972 May;30(5):332–343. [PubMed] [Google Scholar]
  36. Edmondson H. D., Roscoe B., Vickers M. D. Biochemical evidence of anxiety in dental patients. Br Med J. 1972 Oct 7;4(5831):7–9. doi: 10.1136/bmj.4.5831.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. FINK B. R. Diffusion anoxia. Anesthesiology. 1955 Jul;16(4):511–519. doi: 10.1097/00000542-195507000-00007. [DOI] [PubMed] [Google Scholar]
  38. FOWLER N. O., SHABETAI R., HOLMES J. C. Adrenal medullary secretion during hypoxia, bleeding, and rapid intravenous infusion. Circ Res. 1961 Mar;9:427–435. doi: 10.1161/01.res.9.2.427. [DOI] [PubMed] [Google Scholar]
  39. Fisch C., Oehler R. C., Miller J. R., Redish C. H. Cardiac arrhythmias during oral surgery with halothane-nitrous-oxide-oxygen anesthesia. JAMA. 1969 Jun 9;208(10):1839–1842. [PubMed] [Google Scholar]
  40. Gotta A. W., Sullivan C. A., Pelkofski J., Kangwalklai S. R., Kozam R. Aberrant conduction as a precursor to cardiac arrhythmias during anesthesia for oral surgery. J Oral Surg. 1976 May;34(5):421–427. [PubMed] [Google Scholar]
  41. HARVEY W. P., LEVINE S. A. Paroxysmal ventricular tachycardia due to emotion; possible mechanism of death from fright. J Am Med Assoc. 1952 Oct 4;150(5):479–480. doi: 10.1001/jama.1952.63680050002012a. [DOI] [PubMed] [Google Scholar]
  42. Haden R. M. Cardiac dysrhythmias during dental surgery: a comparison of halothane and enflurane in children. Br Dent J. 1985 Jan 5;158(1):23–24. doi: 10.1038/sj.bdj.4805521. [DOI] [PubMed] [Google Scholar]
  43. Hanna M. H., Heap D. G., Kimberley A. P. Cardiac dysrhythmia associated with general anaesthesia for oral surgery. Its prevention by the prophylactic use of an oral beta-adrenergic blocker. Anaesthesia. 1983 Dec;38(12):1192–1194. doi: 10.1111/j.1365-2044.1983.tb12524.x. [DOI] [PubMed] [Google Scholar]
  44. Hannington-Kiff J. G. Fainting and collapse in dental practice. Dent Pract Dent Rec. 1969 Sep;20(1):2–7. [PubMed] [Google Scholar]
  45. Hashimoto K., Hashimoto K. The mechanism of sensitization of the ventricle to epinephrine by halothane. Am Heart J. 1972 May;83(5):652–658. doi: 10.1016/0002-8703(72)90405-x. [DOI] [PubMed] [Google Scholar]
  46. Hauswirth O. Effects of halothane on single atrial, ventricular, and Purkinje fibers. Circ Res. 1969 May;24(5):745–750. doi: 10.1161/01.res.24.5.745. [DOI] [PubMed] [Google Scholar]
  47. Hirshom W. I., Taylor R. G., Sheehan J. C. Arrhythmias produced by combinations of halothane and small amounts of vasopressor. Br J Oral Surg. 1964 Nov;2(2):131–136. doi: 10.1016/s0007-117x(64)80028-7. [DOI] [PubMed] [Google Scholar]
  48. 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]
  49. Hutchinson R. I. The accuracy and efficiency of general anaesthetic machines in dental practice. An investigation. Br Dent J. 1975 Sep 2;139(5):187–189. doi: 10.1038/sj.bdj.4803553. [DOI] [PubMed] [Google Scholar]
  50. IVERSEN L. L. INHIBITION OF NORADRENALINE UPTAKE BY DRUGS. J Pharm Pharmacol. 1965 Jan;17:62–64. doi: 10.1111/j.2042-7158.1965.tb07572.x. [DOI] [PubMed] [Google Scholar]
  51. JOHNSTONE M., NISBET H. I. Ventricular arrhythmia during halothane anaesthesia. Br J Anaesth. 1961 Jan;33:9–16. doi: 10.1093/bja/33.1.9. [DOI] [PubMed] [Google Scholar]
  52. Johnston R. R., Eger EI I. I., Wilson C. A comparative interaction of epinephrine with enflurane, isoflurane, and halothane in man. Anesth Analg. 1976 Sep-Oct;55(5):709–712. doi: 10.1213/00000539-197609000-00021. [DOI] [PubMed] [Google Scholar]
  53. Johnstone M., Barron P. T. The cardiovascular effects of propanidid. A study in radiotelemetry. Anaesthesia. 1968 Apr;23(2):180–193. doi: 10.1111/j.1365-2044.1968.tb00039.x. [DOI] [PubMed] [Google Scholar]
  54. KAHLER R. L., GOLDBLATT A., BRAUNWALD E. The effects of acute hypoxia on the systemic venous and arterial systems and on myocardial contractile force. J Clin Invest. 1962 Jul;41:1553–1563. doi: 10.1172/JCI104612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. KATZ R. L. EPINEPHRINE AND PLV-2: CARDIAC RHYTHM AND LOCAL VASOCONSTRICTOR EFFECTS. Anesthesiology. 1965 Sep-Oct;26:619–623. [PubMed] [Google Scholar]
  56. KAUFMAN L. CARDIAC ARRHYTHMIAS IN DENTISTRY. Lancet. 1965 Aug 7;2(7406):287–287. doi: 10.1016/s0140-6736(65)92406-2. [DOI] [PubMed] [Google Scholar]
  57. Katz R. L., Bigger J. T., Jr Cardiac arrhythmias during anesthesia and operation. Anesthesiology. 1970 Aug;33(2):193–213. doi: 10.1097/00000542-197008000-00013. [DOI] [PubMed] [Google Scholar]
  58. Katz R. L., Epstein R. A. The interaction of anesthetic agents and adrenergic drugs to produce cardiac arrhythmias. Anesthesiology. 1968 Jul-Aug;29(4):763–784. doi: 10.1097/00000542-196807000-00021. [DOI] [PubMed] [Google Scholar]
  59. Katz R. L., Katz G. J. Surgical infiltration of pressor drugs and their interaction with volatile anaesthetics. Br J Anaesth. 1966 Sep;38(9):712–718. doi: 10.1093/bja/38.9.712. [DOI] [PubMed] [Google Scholar]
  60. Katz R. L. Neural factors affecting cardiac arrhythmias induced by halopropane. J Pharmacol Exp Ther. 1966 Apr;152(1):88–94. [PubMed] [Google Scholar]
  61. Kaufman L. Unforeseen complications encountered during dental anaesthesia. Cardiac arrhythmias during dental anaesthesia. Proc R Soc Med. 1966 Aug;59(8):731–734. doi: 10.1177/003591576605900822. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Kraut R. A., Carcia J. C. Electrocardiographic changes during outpatient oral surgery. SAAD Dig. 1986 Apr;6(6):132–136. [PubMed] [Google Scholar]
  63. Kraut R. A. Transcutaneous oxygen monitoring of patients undergoing surgical removal of wisdom teeth utilizing general anesthesia. Anesth Prog. 1982 Sep-Oct;29(5):132–134. [PMC free article] [PubMed] [Google Scholar]
  64. Leon A. S., Abrams W. B. The role of catecholamines in producing arrhythmias. Am J Med Sci. 1971 Jul;262(1):9–13. doi: 10.1097/00000441-197107000-00002. [DOI] [PubMed] [Google Scholar]
  65. Long G., Dripps R. D., Price H. L. Measurement of anti-arrhythmic potency of drugs in man: effects of dehydrobenzperidol. Anesthesiology. 1967 Mar-Apr;28(2):318–323. doi: 10.1097/00000542-196703000-00005. [DOI] [PubMed] [Google Scholar]
  66. MODICA R., OLIVERO S. Rilievi elettrocardiografici durante interventi odontoiatrici in anestesia locale. Minerva Anestesiol. 1956 Mar;22(3):97–106. [PubMed] [Google Scholar]
  67. MUSHIN W. W., THOMPSON P. W. Cyclopropane in non-explosive mixture for outpatient anaesthesia. Br Med J. 1958 Jun 14;1(5084):1376–1378. doi: 10.1136/bmj.1.5084.1376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Mann P. E., Hatt S. D., Dixon R. A., Griffin K. D., Perks E. R., Thornton J. A. A minimal increment methohexitone technique in conservative dentistry. A comparison with treatment under local analgesia. Anaesthesia. 1971 Jan;26(1):3–21. doi: 10.1111/j.1365-2044.1971.tb04709.x. [DOI] [PubMed] [Google Scholar]
  69. Maze M., Hayward E., Jr, Gaba D. M. Alpha 1-adrenergic blockade raises epinephrine-arrhythmia threshold in halothane-anesthetized dogs in a dose-dependent fashion. Anesthesiology. 1985 Dec;63(6):611–615. doi: 10.1097/00000542-198512000-00010. [DOI] [PubMed] [Google Scholar]
  70. McClure R. D., Behrmann V. G., Hartman F. W. The Control of Anoxemia during Surgical Anesthesia with the Aid of the Oxyhemograph. Ann Surg. 1948 Oct;128(4):685–706. [PMC free article] [PubMed] [Google Scholar]
  71. Miller J. R., Redish C. H., Fisch C., Oehler R. C. Factors in arrhythmia during dental outpatient general anesthesia. Anesth Analg. 1970 Sep-Oct;49(5):701–706. [PubMed] [Google Scholar]
  72. Miller R. D., Way W. L., Katzung B. G. The neuromuscular effects of quinidine. Proc Soc Exp Biol Med. 1968 Oct;129(1):215–217. doi: 10.3181/00379727-129-33288. [DOI] [PubMed] [Google Scholar]
  73. Molin C., Seeman K. Disproportionate dental anxiety. Clinical and nosological considerations. Acta Odontol Scand. 1970 May;28(2):197–212. doi: 10.3109/00016357009032028. [DOI] [PubMed] [Google Scholar]
  74. Myerburg R. J., Stewart J. W., Hoffman B. F. Electrophysiological propertiesf the canine peripheral A-V conducting system. Circ Res. 1970 Mar;26(3):361–378. doi: 10.1161/01.res.26.3.361. [DOI] [PubMed] [Google Scholar]
  75. NAHAS G. G., MATHER G. W., WARGO J. D., ADAMS W. L. Influence of acute hypoxia on sympathectomized and adrenalectomized dogs. Am J Physiol. 1954 Apr;177(1):13–15. doi: 10.1152/ajplegacy.1954.177.1.13. [DOI] [PubMed] [Google Scholar]
  76. Nainby-Luxmoore R. C. Some hazards of dental gas machines. The report of a survey. Anaesthesia. 1967 Oct;22(4):545–555. doi: 10.1111/j.1365-2044.1967.tb10152.x. [DOI] [PubMed] [Google Scholar]
  77. Noble F. P. Office experience with nitrous oxide-halothane anesthesia. J Oral Surg. 1967 Sep;25(5):439–445. [PubMed] [Google Scholar]
  78. Ostroff L. H., Goldstein B. H., Pennock R. S., Weiss W. W., Jr Cardiac dysrhythmias during outpatient general anesthesia--a comparison study. J Oral Surg. 1977 Oct;35(10):793–797. [PubMed] [Google Scholar]
  79. PORJE I. G., RUDEWALD B. OBSERVATIONS ON ARTERIAL HEMODYNAMICS IN VENTRICULAR EXTRASYSTOLES. Acta Med Scand. 1965 May;177:529–533. doi: 10.1111/j.0954-6820.1965.tb01859.x. [DOI] [PubMed] [Google Scholar]
  80. Pelkofski J. J. Cardiac arrhythmia in oral surgery: a literature review. Anesth Prog. 1974 Sep-Oct;21(5):132-3, 136-43. [PMC free article] [PubMed] [Google Scholar]
  81. Plowman P. E., Thomas W. J., Thurlow A. C. Cardiac dysrhythmias during anaesthesia for oral surgery. The effect of local blockade. Anaesthesia. 1974 Sep;29(5):571–575. doi: 10.1111/j.1365-2044.1974.tb00719.x. [DOI] [PubMed] [Google Scholar]
  82. Poulton T. J., James F. M., 3rd Cough suppression by lidocaine. Anesthesiology. 1979 May;50(5):470–472. doi: 10.1097/00000542-197905000-00018. [DOI] [PubMed] [Google Scholar]
  83. Pratila M. G., Pratilas V. Anesthetic agents and cardiac electromechanical activity. Anesthesiology. 1978 Nov;49(5):338–360. doi: 10.1097/00000542-197811000-00007. [DOI] [PubMed] [Google Scholar]
  84. Propper R. H. Prefatal cardiac arrhythmias. J Oral Surg. 1975 Dec;33(12):929–935. [PubMed] [Google Scholar]
  85. Rafel S. S. Electrocardiographic changes during outpatient oral surgery. J Oral Surg. 1972 Dec;30(12):898–899. [PubMed] [Google Scholar]
  86. Reinikainen M., Pöntinen P. On cardiac arrhythmias during anesthesia and surgery. Acta Med Scand Suppl. 1966;457:1–36. [PubMed] [Google Scholar]
  87. Reynolds A. K., Chiz J. F., Pasquet A. F. Halothane and methoxyflurane--a comparison of their effects on cardiac pacemaker fibers. Anesthesiology. 1970 Dec;33(6):602–610. doi: 10.1097/00000542-197012000-00005. [DOI] [PubMed] [Google Scholar]
  88. Rodrigo M. R., Moles T. M., Lee P. K. A comparison of the incidence and nature of cardiac dysrhythmias occurring during enflurane and isoflurane anaesthesia for dental surgery. Anaesth Intensive Care. 1987 May;15(2):179–184. doi: 10.1177/0310057X8701500211. [DOI] [PubMed] [Google Scholar]
  89. Rodrigo M. R., Moles T. M., Lee P. K. Comparison of the incidence and nature of cardiac arrhythmias occurring during isoflurane or halothane anaesthesia. Studies during dental surgery. Br J Anaesth. 1986 Apr;58(4):394–400. doi: 10.1093/bja/58.4.394. [DOI] [PubMed] [Google Scholar]
  90. Roelofse J. A. Kardiale disritmieë tydens halotaan- en enfluraannarkose vir tandheelkundige prosedures 'n vergelyking. S Afr Med J. 1983 Sep 17;64(12):448–450. [PubMed] [Google Scholar]
  91. Rollason W. N., Bennetts F. E., Clarke I. Cardiac dysrhythmias during outpatient dental anaesthesia with enflurane. The role of "beta blockade". Acta Anaesthesiol Scand. 1984 Oct;28(5):497–502. doi: 10.1111/j.1399-6576.1984.tb02106.x. [DOI] [PubMed] [Google Scholar]
  92. Rollason W. N., Fidler K., Hough J. M. Althesin in outpatient dental anaesthesia. Br J Anaesth. 1974 Nov;46(11):881–884. doi: 10.1093/bja/46.11.881. [DOI] [PubMed] [Google Scholar]
  93. Rollason W. N., Hall D. J. Dysrhythmias during inhalational anaesthesia for oral surgery. Incidence and prevention and treatment with practolol. Anaesthesia. 1973 Mar;28(2):139–145. doi: 10.1111/j.1365-2044.1973.tb00305.x. [DOI] [PubMed] [Google Scholar]
  94. Rollason W. N., Russell J. G. Intravenous metoprolol and cardiac dysrhythmias. An evaluation in the management of dysrhythmias in outpatient dental anaesthesia. Anaesthesia. 1980 Aug;35(8):783–789. doi: 10.1111/j.1365-2044.1980.tb03920.x. [DOI] [PubMed] [Google Scholar]
  95. Ryder W. Cardiac rhythm during dental anaesthesia. Proc R Soc Med. 1971 Jan;64(1):82–83. doi: 10.1177/003591577106400149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  96. Ryder W., Charlton J. E., Gorman P. B. Oral atropine and practolol premedication in dental anaesthesia. Br J Anaesth. 1973 Jul;45(7):745–749. doi: 10.1093/bja/45.7.745. [DOI] [PubMed] [Google Scholar]
  97. 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]
  98. Ryder W., Wright P. A. Halothane and enflurane in dental anaesthesia. Anaesthesia. 1981 May;36(5):492–497. doi: 10.1111/j.1365-2044.1981.tb10285.x. [DOI] [PubMed] [Google Scholar]
  99. SHANKS C. A. INTRAVENOUS OCTAPRESSIN DURING HALOTHANE ANAESTHESIA: A PILOT STUDY. Br J Anaesth. 1963 Oct;35:640–644. doi: 10.1093/bja/35.10.640. [DOI] [PubMed] [Google Scholar]
  100. SHANKS C. A. THE COMPATIBILITY OF OCTAPRESSIN WITH CYCLOPROPANE, TRICHLORETHYLENE AND HALOTHANE. N Z Med J. 1964 Mar;63:156–159. [PubMed] [Google Scholar]
  101. Sale J. P., Poobalasingam N., Dalal S. D. Controlled ventilation in dental outpatients. Controlled ventilation with atracurium and alfentanil analgesia compared with halothane. Anaesthesia. 1985 Jan;40(1):3–7. doi: 10.1111/j.1365-2044.1985.tb10492.x. [DOI] [PubMed] [Google Scholar]
  102. Shafto C. E. Continuous intravenous anaesthesia for paediatric dentistry. Br J Anaesth. 1969 May;41(5):407–416. doi: 10.1093/bja/41.5.407. [DOI] [PubMed] [Google Scholar]
  103. Smith D. C., O'Connell P. Cardiac dysrhythmias during oral surgery. Comparison of hyoscine and droperidol premedication. Anaesthesia. 1986 Jul;41(7):745–748. doi: 10.1111/j.1365-2044.1986.tb12845.x. [DOI] [PubMed] [Google Scholar]
  104. Smith D. C., O'Connell P. The influence of premedication on the occurrence of dysrhythmias during oral surgery. Anaesthesia. 1987 Aug;42(8):882–884. doi: 10.1111/j.1365-2044.1987.tb04118.x. [DOI] [PubMed] [Google Scholar]
  105. Smith E. R., Dresel P. E. Site of origin of halothane--epinephrine arrhythmia determined by direct and echocardiographic recordings. Anesthesiology. 1982 Aug;57(2):98–102. doi: 10.1097/00000542-198208000-00006. [DOI] [PubMed] [Google Scholar]
  106. Standaert F. G., Levitt B., Roberts J., Raines A. Antagonism of ventricular arrhythmias induced by digitalis--a neural phenomenon. Eur J Pharmacol. 1969;6(3):209–216. doi: 10.1016/0014-2999(69)90177-0. [DOI] [PubMed] [Google Scholar]
  107. Stoelting R. K. Blood pressure and heart rate changes during short-duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lidocaine. Anesth Analg. 1978 Mar-Apr;57(2):197–199. doi: 10.1213/00000539-197803000-00009. [DOI] [PubMed] [Google Scholar]
  108. Strunin L., Strunin J. M., Phipps J. A., Corall I. M. A comparison of halothane and enflurance (ethrane) for out-patient dental anaesthesia. Br Dent J. 1979 Dec 4;147(11):299–301. doi: 10.1038/sj.bdj.4804347. [DOI] [PubMed] [Google Scholar]
  109. TRIEGER N. Fluothane anesthesia for ambulatory oral surgery patients. Evaluation of 400 cases. Oral Surg Oral Med Oral Pathol. 1963 Jan;16:31–34. doi: 10.1016/0030-4220(63)90359-1. [DOI] [PubMed] [Google Scholar]
  110. Taggart P., Carruthers M. Endogenous hyperlipidaemia induced by emotional stress of racing driving. Lancet. 1971 Feb 20;1(7695):363–366. doi: 10.1016/s0140-6736(71)92207-0. [DOI] [PubMed] [Google Scholar]
  111. Taggart P., Carruthers M., Somerville W. Electrocardiogram, plasma catecholamines and lipids, and their modification by oxyprenolol when speaking before an audience. Lancet. 1973 Aug 18;2(7825):341–346. doi: 10.1016/s0140-6736(73)93190-5. [DOI] [PubMed] [Google Scholar]
  112. Taggart P., Gibbons D., Somerville W. Some effects of motor-car driving on the normal and abnormal heart. Br Med J. 1969 Oct 18;4(5676):130–134. doi: 10.1136/bmj.4.5676.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  113. Taggart P., Hedworth-Whitty R., Carruthers M., Gordon P. D. Observations on electrocardiogram and plasma catecholamines during dental procedures: the forgotten vagus. Br Med J. 1976 Oct 2;2(6039):787–789. doi: 10.1136/bmj.2.6039.787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  114. Thomas V. J., Thomas W. J., Thurlow A. C. Cardiac arrhythmia during outpatient dental anaesthesia: the advantages of a controlled ventilation technique. Br J Anaesth. 1976 Sep;48(9):919–922. doi: 10.1093/bja/48.9.919. [DOI] [PubMed] [Google Scholar]
  115. 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]
  116. Titel J. H., Lowe H. J. Rubber-gas partition coefficients. Anesthesiology. 1968 Nov-Dec;29(6):1215–1216. doi: 10.1097/00000542-196811000-00020. [DOI] [PubMed] [Google Scholar]
  117. Tolas A. G., Allen G. D. Propranolol in prevention of cardiac arrhythmia. J Oral Surg. 1970 Mar;28(3):181–183. [PubMed] [Google Scholar]
  118. Tolas A. G., Allen G. D., Ward R. J., Kennedy W. F., Jr, Bonica J. J. Comparison of effects of methods of induction of anesthesia on cardiac rhythm. J Oral Surg. 1967 Jan;25(1):54–59. [PubMed] [Google Scholar]
  119. Tomlin P. J. Death in outpatient dental anaesthetic practice. Anaesthesia. 1974 Sep;29(5):551–570. doi: 10.1111/j.1365-2044.1974.tb00718.x. [DOI] [PubMed] [Google Scholar]
  120. Trieger N. Halothane anesthesia for oral surgery patients treated in the office. J Oral Surg. 1965 Nov;23(7):595–599. [PubMed] [Google Scholar]
  121. Tuohy O. Cardiac arrythmias during oral surgical procedures. Br Dent J. 1968 May 7;124(9):417–419. [PubMed] [Google Scholar]
  122. UNGERLEIDER H. E. The prognostic implications of the electrocardiogram. Am J Cardiol. 1960 Jul;6:35–44. doi: 10.1016/0002-9149(60)90033-3. [DOI] [PubMed] [Google Scholar]
  123. Usubiaga J. E., Moya F. Neuromuscular effects of six local anaesthetics on anaesthetized subjects. Can Anaesth Soc J. 1968 Jan;15(1):56–62. doi: 10.1007/BF03005869. [DOI] [PubMed] [Google Scholar]
  124. Usubiaga J. E. Neuromuscular effects of beta-adrenergic blockers and their interaction with skeletal muscle relaxants. Anesthesiology. 1968 May-Jun;29(3):484–492. doi: 10.1097/00000542-196805000-00021. [DOI] [PubMed] [Google Scholar]
  125. Usubiaga J. E., Standaert F. The effects of local anesthetics on motor nerve terminals. J Pharmacol Exp Ther. 1968 Feb;159(2):353–361. [PubMed] [Google Scholar]
  126. Vanik P. E., Davis H. S. Cardiac arrhythmias during halothane anesthesia. Anesth Analg. 1968 May-Jun;47(3):299–307. [PubMed] [Google Scholar]
  127. Vick R. L. Effects of altered heart rate on chloroformepinephrine cardiac arrhythmia. Circ Res. 1966 Mar;18(3):316–322. doi: 10.1161/01.res.18.3.316. [DOI] [PubMed] [Google Scholar]
  128. 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]
  129. Ward-Booth P., Rubin P., Macfarlane P., Hillis S. Metoprolol in the prevention of dysrhythmias during minor dental surgery. Am Heart J. 1983 Apr;105(4):689–690. doi: 10.1016/0002-8703(83)90497-0. [DOI] [PubMed] [Google Scholar]
  130. Warren J. B. Althesin in the dental chair. Postgrad Med J. 1972 Jun;48(Suppl):130–132. [PubMed] [Google Scholar]
  131. Whalley D. G., Tidnam P. F., Tyrrell M. F., Thompson D. S. A comparison of the incidence of cardiac arrhythmia during two methods of anaesthesia for dental extractions. Br J Anaesth. 1976 Dec;48(12):1207–1210. doi: 10.1093/bja/48.12.1207. [DOI] [PubMed] [Google Scholar]
  132. Whitehead M. H., Whitmarsh V. B., Horton J. N. Metoprolol in anaesthesia for oral surgery. The effect of pretreatment on the incidence of cardiac dysrhythmias. Anaesthesia. 1980 Aug;35(8):779–782. doi: 10.1111/j.1365-2044.1980.tb03919.x. [DOI] [PubMed] [Google Scholar]
  133. Willatts D. G., Harrison A. R., Groom J. F., Crowther A. Cardiac arrhythmias during outpatient dental anaesthesia: comparison of halothane with enflurane. Br J Anaesth. 1983 May;55(5):399–403. doi: 10.1093/bja/55.5.399. [DOI] [PubMed] [Google Scholar]
  134. Wise C. C., Robinson J. S., Heath M. J., Tomlin P. J. Physiological responses to intermittent methohexitone for conservative dentistry. Br Med J. 1969 May 31;2(5656):540–543. doi: 10.1136/bmj.2.5656.540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  135. Wong K. C., Wyte S. R., Martin W. E., Crawford E. W. Antiarrhythmic effects of skeletal muscle relaxants. Anesthesiology. 1971 May;34(5):458–462. doi: 10.1097/00000542-197105000-00022. [DOI] [PubMed] [Google Scholar]
  136. Wright C. J. Dysrhythmias during oral surgery. A comparison between halothane and enflurane anaesthesia. Anaesthesia. 1980 Aug;35(8):775–778. doi: 10.1111/j.1365-2044.1980.tb03918.x. [DOI] [PubMed] [Google Scholar]
  137. Zink J., Sasyniuk B. I., Dresel P. E. Halothane-epinephrine-induced cardiac arrhythmias and the role of heart rate. Anesthesiology. 1975 Nov;43(5):548–555. doi: 10.1097/00000542-197511000-00012. [DOI] [PubMed] [Google Scholar]

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