Hemodynamic Changes after Infiltration of Local Anesthetic into Oral Mucosa during Oral Maxillofacial Surgery

Background: Episodes of hypotension occur in association with local anesthetic infiltration of the oral mucosa during oral maxillofacial surgery. We investigated the hemodynamic and cerebral circulation effects of local anesthetic infiltration of the oral mucosa with a combination of adrenaline and lidocaine during general anesthesia. Materials and Methods: Sixteen patients (five men, 11 women; mean age, 21 ± 5 years; mean weight, 60.4 ± 6.2 kg) with an American Society of Anesthesiologists physical status of I who were scheduled to undergo sagittal split ramus osteotomy were included in the study. We measured patients’ systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, pulse rate, and the concentrations of cerebral oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and cytochrome oxidase. Results: There was a mean 36.8% decrease in systolic arterial pressure, a mean 31.4% decrease in mean arterial pressure, a mean 32.7% decrease in diastolic arterial pressure, and a mean 14.8% increase in pulse rate after infiltration of local anesthetic with adrenaline. Data were normalized to the values immediately before infiltration and expressed as a relative percentage. The average time from infiltration to minimum arterial pressure was 96.8 ± 20.6 s; the mean duration of the trough was approximately 1 min. Oxyhemoglobin decreased by 2.4 ± 1.6 nmol/L, deoxyhemoglobin increased by 0.6 ± 1.3 nmol/L, total hemoglobin decreased by 1.6 ± 0.5 nmol/L, and cytochrome oxidase increased by 0.4 ± 0.3 nmol/L after infiltration (mean ± standard deviation). Conclusions: Infiltration of the oral mucosa with lidocaine solutions containing adrenaline causes temporary but severe hypotension, which affects cerebral blood circulation.

Author(s): Kenichi Satoh, Mami Chikuda and Shigeharu Joh

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