Hemodynamic changes in exodontia patients using 4% articaine with 1: 100,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine

Renuka Makani, Kumar Nilesh


This study was conducted to evaluate and compare the hemodynamic changes associated with intraoral injection of 4% articaine with 1: 100,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine in patients undergoing dental extraction.A prospective observational study was carried out in patients undergoing tooth extraction. Local anesthesia was administered using 4% articaine with 1:100,000 epinephrine to one group (A), while other group (B) received 2% lidocaine with 1:200,000 epinephrine. The parameters that were monitored at four different points of time (in waiting room, immediately after local anesthesia injection, during tooth extraction, and 15 minutes after tooth extraction) included systolic and diastolic blood pressures, pulse rate and oxygen saturation. No statistically significant differences were observed in systolic blood pressure, diastolic blood pressure and pulse rate at any evaluation time between both groups. However, measurement of oxygen saturation showed statistically significant differences at the time of local anesthesia administration and 15 minutes after tooth extraction, with group B showing higher values (P < 0.05). Administration of 2% lidocaine with 1:200,000 epinephrine and 4% articaine with 1:100000 epinephrine was safe during tooth extraction procedure with no statistically difference in hemodynamic status between the two groups. Only oxygen saturation showed statistically significant difference at the time of local anesthesia administration and 15 minutes after tooth extraction in group B.


Exodontia, vital signs, local anesthesia, Articaine, Lidocaine

Full Text:



Malamed SF, Gagnon S, Leblanc D. Efficacy of articaine: a new amide local anesthetic. J Am Dent Assoc 131:635-642, 2000.

Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 31:265-270, 2005.

Silva LC1, Santos TD, Santos JA, Maia MC, Mendonça CG. Articaine versus lidocaine for third molar surgery: a randomized clinical study. Med Oral Patol Oral Cir Bucal 17:e140-145, 2012.

Adewumi A, Hall M, Guelmann M, Riley J. The incidence of adverse reactions following 4% septocaine (articaine) in children. Pediatr Dent 30:424-428, 2008.

Gaffen AS, Haas DA. Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry. J Can Dent Assoc 75:579, 2009.

Garisto GA, Gaffen AS, Lawrence HP, Tenenbaum HC, Haas DA. Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc 141:836-844, 2010.

Hillerup S, Jensen RH, Ersboll BK. Trigeminal nerve injury associated with injection of local anesthetics: needle lesion or neurotoxicity? J Am Dent Assoc 142:531-539, 2011.

Hillerup S, Bakke M, Larsen JO, Thomsen CE, Gerds TA. Concentration-dependent neurotoxicity of articaine: an electrophysiological and stereological study of the rat sciatic nerve. Anesth Analg 112:1330-1338, 2011.

Cakarer S, Can T,Cankaya B, Erdem MA, Yazici S, Ayintap E et al. Peripheral facial nerve paralysis after upper third molar extraction. J Craniofac Surg 21:1825-1827, 2010.

de Morais HH, de Santana Santos T, da Costa Araújo FA, de Freitas Xavier RL, Vajgel A, de Holanda Vasconcellos RJ. Hemodynamic changes comparing 2% lidocaine and 4% articaine with epinephrine 1:100,000 in lower third molar surgery. J Craniofac Surg 23:1204-1211, 2012.

Perusse R, Goulet JP, Turcotte JY. Contraindications to vasoconstrictors in dentistry: Part I. Cardiovascular diseases. Oral Surg Oral Med Oral Pathol 74:679-686, 1992.

Delgado-Molina E, Tamarit-Borras M, Berini-Aytes L, Gay Escoda C. Evaluation and comparison of 2 needle models in terms of blood aspiration during truncal block of the inferior alveolar nerve. J Oral Maxillofac Surg 61:1011-1015, 2003.

Silvestre FJ, Salvador-Martínez I, Bautista D, Silvestre-Rangil J. Clinical study of hemodynamic changes during extraction in controlled hypertensive patients. Med Oral Patol Oral Cir Bucal 16: e354-358, 2011.

Aurelia AM,Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Hemodynamic changes during the surgical removal of lower third molars. March 66:453-461, 2008.

Hirota Y, Hori T, Kai K, Matsuura H. Effects of epinephrine and norepinephrine contained in 2% lidocaine on hemodynamics of the carotid and cerebral circulation in older and younger adults. Anesth Pain Control Dent 1:143-151, 1992.

Mestre Aspa R, Carrera Grano I, Berini Aytes L, Gay Escoda C. Pulsioxymetry monitorization during lower third molar extraction. A comparative study of three local anesthetics with epinephrine 1:100,000. Med Oral 6:195-204, 2001.

Dionne RA, Goldstein DS, Wirdzek PR. Effects of diazepam premedication and epinephrine-containing local anesthetic on cardiovascular and plasma catecholamine responses to oral surgery. Anesth Analg 63:640-646, 1984.

Meiller TF, Overholser CD, Kutcher MJ, Bennett R. Blood pressure fluctuations in hypertensive patients during oral surgery.J Oral Maxillofac Surg. 41:715-718, 1983.

Knoll-Kohler E, Knoller M, Brandt K, Becker J. Cardiohemodynamic and serum catecholamine response to surgical removal of impacted mandibular third molars under local anesthesia: a randomized double-blind parallel group and crossover study. J Oral Maxillofac Surg 49:957-962, 1991.

Troullos ES, Goldstein DS, Hargreaves KM, Dionne RA. Plasma epinephrine levels and cardiovascular response to high administered doses of epinephrine contained in local anesthesia. Anesth Prog 34: 10–13, 1987.

Viana AM, Campos AC, Morlin MT, Chin VK. Plasma catecholamine concentrations and hemodynamic responses to vasoconstrictor during conventional or Gow-Gates mandibular anesthesia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:415-419, 2005.

Lipp M, Dick W, Daublander M, Fuder H, Stanton-Hicks M. Exogenous and endogenous plasma levels of epinephrine during dental treatment under local anesthesia. Reg Anesth 18:6-12, 1993.

Campbell RL, Langston WG. A comparison of cardiac rate-pressure product and pressure-rate quotient in healthy and medically compromised patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 80:145-152, 1995.

Frabetti L, Checchi L, Finelli K. Cardiovascular effects of local anesthesia with epinephrine in periodontal treatment. Quintessence Int 23:19-24, 1992.

Sack U, Kleemann PP. Intraoral conduction anesthesia with epinephrine-containing local anesthetics and arterial epinephrine plasma concentration. Anesth Pain Control Dent 1:77-80, 1992.

Tolas AG, Pflug AE, Halter JB. Arterial plasma epinephrine concentrations and hemodynamic responses after dental injection of local anesthetic with epinephrine. J Am Dent Assoc 104:41-43, 1982.


  • There are currently no refbacks.

Best Quality Medical Supplies is a registered company in Untied States specializing in sales of medical equipment and supplies. We are a distributor for hospitals, doctor offices, medical clinics, nursing schools, and nursing homes within
the United States. We also provide services for overseas clients. Click here for details and orders.

My website has truly excellent support, going well beyond what's expected from the customer. Check them out here.