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Hemodynamic Impact of Drug Interactions With Epinephrine and Antipsychotics Under General Anesthesia With Propofol

Yoshiki Shionoya DDS, PhD,

Eishi Nakamura DDS,

Gentaro Tsujimoto DDS, PhD,

Takayuki Koyata DDS,

Asako Yasuda DDS, PhD,

Kiminari Nakamura DDS, PhD, and

Katsuhisa Sunada DDS, PhD

Article Category: Research Article

Volume/Issue: Volume 68: Issue 3

Online Publication Date: Oct 04, 2021

DOI: 10.2344/anpr-68-02-01

Page Range: 141 – 145

Successful local anesthesia is essential to virtually all dental procedures. Many local anesthetics used today are combined with a vasoconstrictor (eg, epinephrine), which provides several advantages including increased anesthetic duration, decreased local anesthetic systemic toxicity, surgical site hemostasis, and enhanced neural blockade. 1 – 4 Because typical (first-generation) and atypical (second-generation) antipsychotic drugs have an α-1 adrenergic receptor blocking action, 5 it is thought that β-2 adrenergic receptor activity

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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 2 ; Medically compromised patients and regular users of antipsychotics among the new patients

Figure 2

Medically compromised patients and regular users of antipsychotics among the new patients

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

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

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

Figure 5

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

Figure 1 ; Patient partitioning. Data were excluded from analyses if patients had eaten 1 hour prior to saliva collection, were scheduled for intravenous sedation, had been diagnosed with xerostomia, were taking beta-blockers, or were taking antidepressant and/or antipsychotic medications.

Kevin C. Lee and

Jennifer P. Bassiur

Figure 1

Patient partitioning. Data were excluded from analyses if patients had eaten 1 hour prior to saliva collection, were scheduled for intravenous sedation, had been diagnosed with xerostomia, were taking beta-blockers, or were taking antidepressant and/or antipsychotic medications.

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.

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.

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.

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.

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.