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Hemodynamic Changes by Drug Interaction of Adrenaline With Chlorpromazine
Hitoshi Higuchi DDS, PhD,
 Akiko Yabuki DDS,
 Minako Ishii-Maruhama DDS, PhD,
 Yumiko Tomoyasu DDS, PhD,
 Shigeru Maeda DDS, PhD, and
 Takuya Miyawaki DDS, PhD
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.150
Page Range: 150 – 154

Vasoconstrictors are included in local anesthetics to increase the duration of anesthesia, to prevent local anesthesia systemic toxicity, and to promote hemostasis in the local operative field. 1 Adrenaline (epinephrine) is the most common vasoconstrictor that is added to local anesthetics, and lidocaine and articaine with adrenaline are the most widely used local anesthetics for dental treatment. However, adrenaline has drug interactions with some medicines. It is widely believed that the combination of adrenaline with an antipsychotic can

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Figure 3.; The effect of adrenaline at each concentration on mean blood pressure (MBP) (a) and pulse rate (PR) (b) in chlorpromazine-pretreated rats (saline: n = 4; 1 μg/kg: n = 6; 10 μg/kg: n = 4; 100 μg/kg: n = 6). Adrenaline at each concentration induced hypotension and tachycardia, and 100 μg/kg adrenaline induced significant hemodynamic changes. P values are for the comparisons at each concentration of adrenaline by using 1-way analysis of variance with Dunnett's post hoc test (vs saline). Data represent means ± SD.
Hitoshi Higuchi,
 Akiko Yabuki,
 Minako Ishii-Maruhama,
 Yumiko Tomoyasu,
 Shigeru Maeda, and
 Takuya Miyawaki
Figure 3.
Figure 3.

The effect of adrenaline at each concentration on mean blood pressure (MBP) (a) and pulse rate (PR) (b) in chlorpromazine-pretreated rats (saline: n = 4; 1 μg/kg: n = 6; 10 μg/kg: n = 4; 100 μg/kg: n = 6). Adrenaline at each concentration induced hypotension and tachycardia, and 100 μg/kg adrenaline induced significant hemodynamic changes. P values are for the comparisons at each concentration of adrenaline by using 1-way analysis of variance with Dunnett's post hoc test (vs saline). Data represent means ± SD.

Figure 1.; The time course of percentage change of mean blood pressure (MBP) (a) and pulse rate (PR) (b) after the injection of saline or 100 μg/kg adrenaline (AD) in chlorpromazine (Ch)-pretreated rats and saline-pretreated rats (Ch + saline: n = 4; Ch + AD: n = 6; saline + AD: n = 4). P values are for between-agent comparisons (vs the value for Ch + saline) at specified time intervals by using 2-way analysis of variance with Bonferroni's post hoc test. Data represent mean ± SD.
Hitoshi Higuchi,
 Akiko Yabuki,
 Minako Ishii-Maruhama,
 Yumiko Tomoyasu,
 Shigeru Maeda, and
 Takuya Miyawaki
Figure 1.
Figure 1.

The time course of percentage change of mean blood pressure (MBP) (a) and pulse rate (PR) (b) after the injection of saline or 100 μg/kg adrenaline (AD) in chlorpromazine (Ch)-pretreated rats and saline-pretreated rats (Ch + saline: n = 4; Ch + AD: n = 6; saline + AD: n = 4). P values are for between-agent comparisons (vs the value for Ch + saline) at specified time intervals by using 2-way analysis of variance with Bonferroni's post hoc test. Data represent mean ± SD.

Figure 2.; The blockade effect of propranolol (Pro) on hemodynamic changes by drug interaction between adrenaline (AD) and chlorpromazine (Ch) on mean blood pressure (MBP) (a) and pulse rate (PR) (b) (Ch + saline: n = 4; Ch + Pro + AD: n = 3). AD induced modest hypertension, but did not significantly influence pulse rate change in Pro + Ch–pretreated rats. P values are for between-agent comparisons (vs the value for Ch + saline) at specified time intervals by using 2-way analysis of variance with Bonferroni's post hoc test. Data represent means ± SD.
Hitoshi Higuchi,
 Akiko Yabuki,
 Minako Ishii-Maruhama,
 Yumiko Tomoyasu,
 Shigeru Maeda, and
 Takuya Miyawaki
Figure 2.
Figure 2.

The blockade effect of propranolol (Pro) on hemodynamic changes by drug interaction between adrenaline (AD) and chlorpromazine (Ch) on mean blood pressure (MBP) (a) and pulse rate (PR) (b) (Ch + saline: n = 4; Ch + Pro + AD: n = 3). AD induced modest hypertension, but did not significantly influence pulse rate change in Pro + Ch–pretreated rats. P values are for between-agent comparisons (vs the value for Ch + saline) at specified time intervals by using 2-way analysis of variance with Bonferroni's post hoc test. Data represent means ± SD.

Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery
Naotaka Kishimoto DDS, PhD,
 Ikue Kinoshita DDS, and
 Yoshihiro Momota DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 64: Issue 3
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-64-03-08
Page Range: 165 – 167

. General anesthesia was maintained with air 5 L/min, oxygen 1 L/min, target-controlled intravenous infusion of propofol 4.5–5.0 μg/mL, remifentanil 0.1–0.15 μg/kg/min, and a bolus of fentanyl 250 μg. At 40 minutes after induction of anesthesia, local anesthesia with 12 mL of 1% lidocaine and 1:100,000 adrenaline was administered. Left inferior alveolar nerve block was established first, followed by infiltration anesthesia to the patient's left mandibular buccal gingiva and left leading edge of the coronoid process. After mandibular split and plate fixation of the left

Figure 4 ; Regular users of antipsychotics who received lidocaine hydrochloride solution containing adrenaline during dental treatment
<bold>Figure 4</bold>
Figure 4

Regular users of antipsychotics who received lidocaine hydrochloride solution containing adrenaline during dental treatment

Figure 3 ; Hospitals in which lidocaine hydrochloride solution containing adrenaline was administered to regular users of antipsychotics during dental treatment
<bold>Figure 3</bold>
Figure 3

Hospitals in which lidocaine hydrochloride solution containing adrenaline was administered to regular users of antipsychotics during dental treatment

Figure 5 ; Adverse effects after the administration of lidocaine hydrochloride solution containing adrenaline to regular users of antipsychotics
<bold>Figure 5</bold>
Figure 5

Adverse effects after the administration of lidocaine hydrochloride solution containing adrenaline to regular users of antipsychotics

Figure 5.; Concentrations of radioactivity derived from 14C-lidocaine in the serum. After 20 µl of 2% 14C-lidocaine with (•) and without (○) 10 µg/ml adrenaline was injected into the right palatal mucosa proximal to the first molar, the radioactive concentration (dpm/ml) in the serum was measured with a liquid scintillation counter. The serum lidocaine concentration after the injection of lidocaine with adrenaline was significantly lower from 2 to 50 minutes and higher after 60 minutes than that when injected alone. Data are mean ± SD (n  =  7), * p<0.05 plain lidocaine vs lidocaine with adrenaline.
Figure 5.
Figure 5.

Concentrations of radioactivity derived from 14C-lidocaine in the serum.

After 20 µl of 2% 14C-lidocaine with (•) and without (○) 10 µg/ml adrenaline was injected into the right palatal mucosa proximal to the first molar, the radioactive concentration (dpm/ml) in the serum was measured with a liquid scintillation counter. The serum lidocaine concentration after the injection of lidocaine with adrenaline was significantly lower from 2 to 50 minutes and higher after 60 minutes than that when injected alone.

Data are mean ± SD (n  =  7), * p<0.05 plain lidocaine vs lidocaine with adrenaline.

Fig. 3; Change of RBF in each group. Data are expressed as mean ± SD (Adrenaline or DEX in Lidocaine) * : p<0.01 L vs LA ⋇: p<0.01 L vs LD † : p<0.01 vs Baseline in LA
Fig. 3
Fig. 3

Change of RBF in each group. Data are expressed as mean ± SD (Adrenaline or DEX in Lidocaine)

* : p<0.01 L vs LA

⋇: p<0.01 L vs LD

† : p<0.01 vs Baseline in LA