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A Case of Methemoglobinemia Thought to Have Been Caused by the Combined Use of Propitocaine and Nitroglycerin During General Anesthesia
Takayuki HojoDDS, PhD,
Yukifumi KimuraDDS, PhD,
Daisuke OhiwaDDS, and
Toshiaki FujisawaDDS, PhD
Article Category: Brief Report
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-67-03-06
Page Range: 170 – 171

Acquired methemoglobinemia can occur following exposure to oxidizing agents including high doses of certain local anesthetics. 1 Many studies have investigated the dose at which each causative drug causes methemoglobinemia. However, few studies have reported methemoglobinemia being caused by the combined use of causative drugs or agents. 2 This is a report of a methemoglobinemia case presumably caused by the combined use of prilocaine (propitocaine in Japan) and nitroglycerin (NTG) during general anesthesia. CASE REPORT

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Fig. 1; Schematic diagram 1) Administration of propitocaine with felypressin (FP) into labial gingiva of incisor tooth 2) A catheter was inserted into left ventricule via common carotid artery for CMS injection 3) A catheter was inserted into left femoral artery for CMS collection 4) A catheter was inserted into right femoral artery for measurement of heart rate and blood pressure
Fig. 1
Fig. 1

Schematic diagram

1) Administration of propitocaine with felypressin (FP) into labial gingiva of incisor tooth

2) A catheter was inserted into left ventricule via common carotid artery for CMS injection

3) A catheter was inserted into left femoral artery for CMS collection

4) A catheter was inserted into right femoral artery for measurement of heart rate and blood pressure

Fig. 2; Time table of experimental steps 1) Inject CMS immediately after start of blood collection over 80 seconds 2) Measurement of heart rate and blood pressure before CMS injection 3) Administration of propitocaine with felypressin (FP) into gingiva 4) Inject CMS 5 minutes after administration of FP 5) Extract heart
Fig. 2
Fig. 2

Time table of experimental steps

1) Inject CMS immediately after start of blood collection over 80 seconds

2) Measurement of heart rate and blood pressure before CMS injection

3) Administration of propitocaine with felypressin (FP) into gingiva

4) Inject CMS 5 minutes after administration of FP

5) Extract heart

Figure 1.; (A) Pulpal blood flow (PBF) changes relative to baseline after injection. PBF was significantly lower for 2% lidocaine with 1:80,000 epinephrine (LE) as compared with propitocaine (prilocaine) with 0.03 IU felypressin (PF) and saline placebo for 35 minutes. PBF was significantly lower for PF compared with saline placebo for 20 minutes. PBF did not change after the saline placebo injection. (B) Pulpal oxygen tension (PpulpO2) changes relative to baseline after injection. PpulpO2 was significantly lower for LE and PF compared with saline placebo at 5 minutes. PpulpO2 was significantly lower for LE compared with PF and saline at 20 minutes. PpulpO2 did not change after the saline placebo injection. *LE versus PF. †LE versus normal saline. ‡PF versus normal saline. P < .05.
Keikoku Tachibana,
Masataka Kasahara,
Nobuyuki Matsuura, and
Tatsuya Ichinohe
Figure 1.
Figure 1.

(A) Pulpal blood flow (PBF) changes relative to baseline after injection. PBF was significantly lower for 2% lidocaine with 1:80,000 epinephrine (LE) as compared with propitocaine (prilocaine) with 0.03 IU felypressin (PF) and saline placebo for 35 minutes. PBF was significantly lower for PF compared with saline placebo for 20 minutes. PBF did not change after the saline placebo injection. (B) Pulpal oxygen tension (PpulpO2) changes relative to baseline after injection. PpulpO2 was significantly lower for LE and PF compared with saline placebo at 5 minutes. PpulpO2 was significantly lower for LE compared with PF and saline at 20 minutes. PpulpO2 did not change after the saline placebo injection. *LE versus PF. †LE versus normal saline. ‡PF versus normal saline. P < .05.

Figure. ; Vial of 1% methylene blue.
Takayuki Hojo,
Yukifumi Kimura,
Daisuke Ohiwa, and
Toshiaki Fujisawa
Figure. 
Figure. 

Vial of 1% methylene blue.

Effects of Local Anesthetics With Vasoconstrictors on Dental Pulp Blood Flow and Oxygen Tension
Keikoku TachibanaDDS, PhD,
Masataka KasaharaDDS, PhD,
Nobuyuki MatsuuraDDS, PhD, and
Tatsuya IchinoheDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 68: Issue 4
Online Publication Date: Dec 15, 2021
DOI: 10.2344/anpr-68-02-09
Page Range: 214 – 219

pulp O 2 following administration of either 1 of 2 conventionally used local anesthetic solutions containing vasoconstrictors (lidocaine with epinephrine or propitocaine [prilocaine] with felypressin) or a saline placebo and to assess the potential relationship between PBF and P pulp O 2 . METHODS AND MATERIALS Animal Preparations This study was approved by the animal experiment ethics committee of Tokyo Dental College (approval no. 302503). A total of 21 male Japanese White rabbits (lidocaine with epinephrine group

Continuous Infusion Propofol General Anesthesia for Dental Treatment in Patients With Progressive Muscular Dystrophy
Hiroyoshi KawaaiDDS, PhD,
Kazuho TanakaDDS, PhD, and
Shinya YamazakiDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 52: Issue 1
Online Publication Date: Mar 01, 2005
DOI: 10.2344/0003-3006(2005)52[12:CIPGAF]2.0.CO;2
Page Range: 12 – 16

( Figure 1 ). An additional supplemental dose of 50 mg propofol was given to facilitate the topical anesthesia of the nasopharyngeal cavity with 4% lidocaine with 1 : 100,000 epinephrine and to spray the vocal cords with 4% lidocaine. Nasotracheal intubation was performed easily without muscle relaxants. Anesthesia was maintained with a continuous infusion of 6–10 mg/kg propofol per hour with 67% nitrous oxide and 33% oxygen. After the intraoral injection of 4.3 mL of 3% propitocaine with felypressin, 9 teeth were conservatively treated, 2 pulpectomies were performed

JDSA Abstracts
Article Category: Meeting Report
Volume/Issue: Volume 55: Issue 2
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006(2008)55[58:JJA]2.0.CO;2
Page Range: 58 – 68

anesthetic solution for dental patients with cardiovascular disease. Effect of Propitocaine with Felypressin on Myocardial Blood Flow and Cardiac Output in Spontaneous Hypertensive Rats Kentaro Ouchi and Katsuhisa Sunada, Department of Dental Anesthesiology, The Nippon Dental University, School of Life Dentistry at Tokyo (Chief: Prof. Katsuhisa SUNADA) We measured the effect of propitocaine with felypressin (FP) on myocardial blood flow and cardiac output in spontaneous hypertensive rats (SHR). This study was motivated by our desire to

JDSA Journal Abstracts
Article Category: Research Article
Volume/Issue: Volume 56: Issue 1
Online Publication Date: Jan 01, 2009
DOI: 10.2344/0003-3006-56.1.23
Page Range: 23 – 32

decreased, DDP also decreased significantly. Mean values ± SD were shown for n = 9. Figure 4b. % change of DDP for DEX 10 µM + lidocaine 100 µM. When DEX 10 µM + Lidocaine 100 µM administered to the sciatic nerve, AP was significantly decreased from the control. When DEX 10 µM + Lidocaine 100 µM was rinsed by saline, AP recovered to the control value. When AP decreased, DDP also decreased significantly. / Mean values ± SD were shown for n = 9. Randomized Controlled Study of Felypressin-Propitocaine And

Oral Mucosal Injection of a Local Anesthetic Solution Containing Epinephrine Enhances Muscle Relaxant Effects of Rocuronium
Asako NinomiyaDDS,
Yui TerakawaDDS, PhD,
Nobuyuki MatsuuraDDS, PhD,
Tatsuya IchinoheDDS, PhD, and
Yuzuru KanekoDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 59: Issue 1
Online Publication Date: Jan 01, 2012
DOI: 10.2344/10-17.1
Page Range: 18 – 21

The action of muscle relaxants is affected by a variety of drugs. Ephedrine shortens onset time, while β-receptor blocker prolongs it. 1 Aminoglycoside antibiotics, 2 calcium channel blockers, and magnesium sulphate prolong duration, 3 , 4 whereas anticonvulsant drugs including carbamazepine shorten it. 5 Propitocaine, lidocaine, and other local anesthetics prolong duration, 6 while epinephrine produces dual effects of antagonizing neuromuscular relaxation through α-adrenergic effects and enhancing neuromuscular relaxation through β-adrenergic effects