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Recurrent Coronary Artery Spasm Induced by Vasopressors During Two Operations in the Same Patient Under General Anesthesia
Naotaka KishimotoDDS, PhD,
Munenori KatoDDS,
Yasunori NakanishiDDS,
Akari HasegawaDDS, and
Yoshihiro MomotaDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 65: Issue 1
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-64-04-04
Page Range: 44 – 49

. The patient's BP and HR changed from 126/60 mm Hg and 68 bpm before induction of general anesthesia to 96/48 mm Hg and 72 bpm after induction, respectively. We administered ephedrine (4 mg); the BP then increased to 201/166 mm Hg, and marked ST-segment elevation was noted on the monitor ( Figure 2 B). The ST-segment elevation returned to baseline about 5 minutes later. The patient's BP and HR were 90/44 mm Hg and 72 bpm, respectively, 30 minutes after induction of anesthesia. We administered phenylephrine (0.1 mg); the patient's BP then rose to 196/110 mm Hg, and

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Comparative Efficacy of 2 Topical Anesthetics for the Placement of Orthodontic Temporary Anchorage Devices
Derek S. ReznikBS, DDS, MS,
Arthur H. JeskeDMD, PhD,
Jung-Wei ChenDDS, MS, PhD, and
Jeryl EnglishDDS, MS
Article Category: Research Article
Volume/Issue: Volume 56: Issue 3
Online Publication Date: Jan 01, 2009
DOI: 10.2344/0003-3006-56.3.81
Page Range: 81 – 85

intraoral dye marker. One of the 2 study drugs—20% benzocaine gel (HurriCaine Topical Anesthetic GEL, Beutlich LP Pharmaceuticals, Waukegan, Ill) or a combination product containing lidocaine 20%, tetracaine 4%, and phenylephrine 2% (TAC 20% Alternate Topical Anesthetic Gel Thick, Professional Arts Pharmacy, Lafayette, La)—was applied on the attached gingiva or alveolar mucosa overlying the intended anchorage site using a cotton-tipped applicator and was allowed to remain in contact with the tissue for the amount of time prescribed by the manufacturer (1.0 and 2.5 minutes

; Arrows indicate the timing each medication was administered. Ephedrine was given at 8 mg/bolus, phenylephrine at 0.05 mg/bolus, and dopamine at 2 μg/kg/min.
Naohiro Ohshita,
Shoko Gamoh,
Masahiko Kanazumi,
Masahiro Nakajima,
Yoshihiro Momota, and
Yasuo M. Tsutsumi

Arrows indicate the timing each medication was administered. Ephedrine was given at 8 mg/bolus, phenylephrine at 0.05 mg/bolus, and dopamine at 2 μg/kg/min.

Figure 2.; Mean changes in muscle blood flow during hypocapnia and after phenylephrine or butoxamine administration. MBF and QBF increased during hypocapnia, while the increase in MBF was larger than that in QBF. Both MBF and QBF decreased to about 90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; d P < .05 versus hypocapnia; c P < .05 between the 2 groups.
Kyotaro Koshika,
Rumi Kaneko,
Mai Shionoya,
Kotaro Shimizu,
Yuka Sendai,
Nobutaka Matsuura,
Yui Akiike, and
Tatsuya Ichinohe
Figure 2.
Figure 2.

Mean changes in muscle blood flow during hypocapnia and after phenylephrine or butoxamine administration.

MBF and QBF increased during hypocapnia, while the increase in MBF was larger than that in QBF. Both MBF and QBF decreased to about 90% to 95% of their baseline levels after phenylephrine or butoxamine administration. Data are expressed as the percentage change in respective baseline values. MBF, masseter muscle tissue blood flow; QBF, quadriceps muscle tissue blood flow. a P < .05 versus baseline; d P < .05 versus hypocapnia; c P < .05 between the 2 groups.

; Figure 5. Cardiovascular effects of epinephrine and phenylephrine. Epinephrine increases heart rate (HR) by activating beta-1 receptors in the sinoatrial node, the heart's normal pacemaker. It also activates beta-1 receptors on myocardial cells, increasing their contractility and increasing systolic blood pressure (SBP). However, at low doses such as those provided in local anesthetic formulations, it activates beta-2 receptors on systemic arteries, producing vasodilation. This decline in arterial resistance produces a reduction in diastolic pressure (DBP). The sum of these effects results in little change of mean arterial pressure (MAP). In contrast, phenylephrine activates only alpha receptors, increasing arterial resistance and diastolic pressure. Systolic pressure also rises as the heart compensates for this increase in resistance by increasing its contractility and venoconstriction increases venous return (preload). The net effect is an increase in mean arterial pressure, which is sensed in baroreceptors, and a reflex slowing of heart rate supervenes. (Adapted from Westfall et al.11)
Daniel E. Becker

Figure 5. Cardiovascular effects of epinephrine and phenylephrine. Epinephrine increases heart rate (HR) by activating beta-1 receptors in the sinoatrial node, the heart's normal pacemaker. It also activates beta-1 receptors on myocardial cells, increasing their contractility and increasing systolic blood pressure (SBP). However, at low doses such as those provided in local anesthetic formulations, it activates beta-2 receptors on systemic arteries, producing vasodilation. This decline in arterial resistance produces a reduction in diastolic pressure (DBP). The sum of these effects results in little change of mean arterial pressure (MAP). In contrast, phenylephrine activates only alpha receptors, increasing arterial resistance and diastolic pressure. Systolic pressure also rises as the heart compensates for this increase in resistance by increasing its contractility and venoconstriction increases venous return (preload). The net effect is an increase in mean arterial pressure, which is sensed in baroreceptors, and a reflex slowing of heart rate supervenes. (Adapted from Westfall et al.11)

Figure 1 ; Preoperative 12-lead electrocardiography. An incomplete right bundle branch block and sinus bradycardia (heart rate, 56 bpm) were present.
Naotaka Kishimoto,
Munenori Kato,
Yasunori Nakanishi,
Akari Hasegawa, and
Yoshihiro Momota
<bold>Figure 1</bold>
Figure 1

Preoperative 12-lead electrocardiography. An incomplete right bundle branch block and sinus bradycardia (heart rate, 56 bpm) were present.

Figure 2 ; Intraoperative electrocardiography during the first operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.
Naotaka Kishimoto,
Munenori Kato,
Yasunori Nakanishi,
Akari Hasegawa, and
Yoshihiro Momota
<bold>Figure 2</bold>
Figure 2

Intraoperative electrocardiography during the first operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.

Figure 3 ; Intraoperative electrocardiography during the second operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.
Naotaka Kishimoto,
Munenori Kato,
Yasunori Nakanishi,
Akari Hasegawa, and
Yoshihiro Momota
<bold>Figure 3</bold>
Figure 3

Intraoperative electrocardiography during the second operation. (A) Before induction of general anesthesia. (B) Immediately after administration of ephedrine during general anesthesia.

Figure 1; Diagram of Quattro temporary intraosseous orthodontic anchorage device (GAC International Inc) (enlargement approximately 13×).
Derek S. Reznik,
Arthur H. Jeske,
Jung-Wei Chen, and
Jeryl English
Figure 1
Figure 1

Diagram of Quattro temporary intraosseous orthodontic anchorage device (GAC International Inc) (enlargement approximately 13×).

Involvement of α- and β-Adrenergic Receptors in Skeletal Muscle Blood Flow Changes During Hyper-/Hypocapnia in Anesthetized Rabbits
Kyotaro KoshikaDDS, PhD,
Rumi KanekoDDS,
Mai ShionoyaDDS,
Kotaro ShimizuDDS,
Yuka SendaiDDS,
Nobutaka MatsuuraDDS,
Yui AkiikeDDS, PhD, and
Tatsuya IchinoheDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-70-02-02
Page Range: 58 – 64

muscle which predominantly has fast-twitch fibers. 11 , 12 METHODS Forty Japanese White rabbits (Sankyo Labo) weighing ∼2.5 kg were used in this study. All animals received humane care in accordance with the National Institute of Health guidelines for the care and use of laboratory animals and The Guidelines for the Treatment of Experimental Animals of Tokyo Dental College. 13 The animals were randomly allocated evenly (n = 8) into 1 of 5 groups: (1) phentolamine, (2) metaproterenol, (3) phenylephrine, (4) butoxamine, and (5) atropine