• Restorative Dentistry and Endodontics
• /
• 제46권3호
• /
• pp.41.1-41.23
• /
• 2021

Objectives: This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. Materials and Methods: Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. Results: The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. Conclusions: Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제27권5호
• /
• pp.463-471
• /
• 2005

Recently, the number of diabetic patients have been increased with westernized living way and meal habitation. The regulation of blood sugar concentration is very important for diabetic patients to keep homeostasis and, to prevent acute or chronic complications. Epinephrine combined with lidocaine is used in dental clinic extensively. And epinephrine combined with lidocaine also effects on decreasing the blood leakage volume by constricting micro vessle and arteriole. But, So far there are few researches about the effect of epinephrine contained in dental local anesthetic agent on the blood sugar of diabetes during minor oral surgery. The purpose of this study was intended to investigate whether epinephrine which combined with dental local anesthetics influence body glucose level in diabetes patients by glucose monitoring. The subject of this study were 38 diabetic patients and 38 normal adults, each patient was checked body glucose after a meal 2 hours later with resting state, and injection 1:100000 epinephrine with dental lidocaine 54 ml or lidocaine 54 ml only. And then the body glucose level was checked 5 minutes and 30 minutes after injection. The results were analyzed by two way ANOVA test (p<0.05). The results were as follows: In the experimental group 1, the mean of the blood sugar level was 180.3 mg/dl before an anesthetic injection, 182.8 mg/dl after 5minutes of the anesthetic injection and 182.2 mg/dl after 30minutes of the anesthetic injection. The change of the blood sugar level was not statistically by two-way ANOVA tests (p<0.05). In the experimental group 2, the mean of the blood sugar level was 237 mg/dl before an anesthetic injection, 234.5 mg/dl after 5minutes of the anesthetic injection and 231.8 mg/dl after 30minutes of the anesthetic injection. The change of the blood sugar level was not statistically by two-way ANOVA tests (p<0.05). In the controlled group 1, the mean of the blood sugar level was 117.6 mg/dl before an anesthetic injection, 119.1 mg/dl after 5minutes of the anesthetic injection and 129.3 mg/dl after 30minutes of the anesthetic injection. The change of the blood sugar level was not statistically by two-way ANOVA tests (p<0.05). In the controlled group 2, the mean of the blood sugar level was 104.2 mg/dl before an anesthetic injection, 102 mg/dl after 5minutes of the anesthetic injection and 105.3 mg/dl after 30minutes of the anesthetic injection. The change of the blood sugar level was not statistically by two-way ANOVA tests (p<0.05).

• 한국산업간호협회지
• /
• 제17권4호
• /
• pp.43-43
• /
• 2010

• 한국콘텐츠학회논문지
• /
• 제15권1호
• /
• pp.350-356
• /
• 2015

본 연구는 벌자상에 대한 병원 전 응급처치와 약물투여가 환자의 예후에 미치는 영향정도를 파악하여 119 구급대의 병원 전 에피네프린 약물투여를 도입해 보고자 시도하였다. 본 연구는 소방본부 구급활동일지 정보를 통하여 벌자상 환자를 선별하여 후향적으로 조사하였다. 2013년 벌자상으로 119 구급대를 이용한 환자를 대상으로 하였다. 벌자상으로 이송된 22명을 대상으로 119 구급대원에 의해 작성된 구급활동일지와 아나필락시스 환자 응급처치 세부 상황표, 환자의 연령과 성별, 약물투여 여부, 환자 이송시간, 활력징후, 주요 증상, 응급처치내용 등을 조사하였다. 연구결과 환자의 중증도가 심해질수록 산소공급, 정맥로 확보 후 수액투여, ECG 모니터링, 항히스타민제 투여가 나타났다. 케이스별로 보면 의료지도 하에 병원 전 에피네프린을 투여한 경우 환자가 중증이었음에도 불구하고 생존하였다. 결론적으로 벌자상 아나필락시스 환자에 대한 119 구급대의 약물투여와 응급처치는 생존에 중요한 영향을 나타내었다. 산소공급, 기도유지, 정맥로 확보와 함께 약물투여가 환자의 생존에 큰 영향을 미치므로, 119 구급대가 에피네프린을 사용할 수 있는 법적장치를 마련하여 아나필락시스 환자의 생존율을 개선해야할 것이다.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제22권4호
• /
• pp.305-314
• /
• 2022

Introduction: This clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Methods: In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as "failed" anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as "no pain or faint/weak/mild pain" during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. Results: The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, 𝛘² = 9.07, df = 2). Conclusions: The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.

• 대한약리학회지
• /
• 제19권2호
• /
• pp.9-16
• /
• 1983

현재 사용되고 있는 강심제로는 디지탈리스 배당체가 유일한 약물이지란 그 안전역이 대단히 좁아서 보다 안전한 강심제의 개발이 요구되고 있다. 최근 강심작용이 현저할 뿐 아니라 안전역이 비교적 넓을 것으로 인정되는 higenamine이 개발되어 그 작용기전을 밝히려는 시도가 많이 있었다. 본 연구에서는 higenamine의 강심작용 기전을 규명하기 위한 연구의 일환으로 수축빈도-수축력 상관관계(interval-strength relationship)에 있어서 1) Rested-state수축력 2) Positive inotropic effect of activation(PIEA) 3) Negative inotropic effect of activation(NIEA)에 대한 higenamine의 영향을 $Ca^{++}$및 epinephrine과 비교 분석하였다. 실험결과 칼슘은 PIEA를 증가시키기 보다는 오히려 NIEA의 소멸을 촉진함으로써 강심작용을 나타내며 epinephrine 및 higenamine은 PIEA를 증가시키고 NIEA에는 거의 영향을 미치지 않았다.

• 대한약리학회지
• /
• 제8권1호
• /
• pp.41-47
• /
• 1972

The author studied the adrenotropic receptors of isolated vas deferens from Ditrema temmincki Bleeker, using adrenergic activators such as epinephrine, norepinephrine, isoproterenol and phenylephrine, and adrenergic blocking agents such as phenoxybenzamine and propranolol. The results are as follows: 1. The vas deferens was stimulated by epinephrine, norepinephrine and phenylephrine, but not affected by isoproterenol. 2. The excitatory effect of phenylephrine on the vas deferens was completely blocked by phenoxybenzamine, but more stimulated by propranolol. 3. The excitatory effects of epinephrine and norepinephrine were markedly reduced by phenoxybenzamine, but stimulated by propranolol. 4. The vas deferens pretreated with phenoxybenzamine and propranolol was not affected by epinephrine and norepinephrine. 5. The vas deferens was not affected by isoproterenol and also not affected by the pretreatment with either kind of blocking agent plus isoproterenol. 6. It seemed that the vas deferens had both alpha-excitatory receptor and beta-receptor, but it was difficult to detect the character of beta-receptor whether it was inhibitory or excitatory.

• Journal of Korean Biological Nursing Science
• /
• 제9권2호
• /
• pp.143-152
• /
• 2007

Purpose: The purpose of this study was to ascertain the effects of anesthetic information on preoperative state anxiety, plasma glucose, cortisol and epinephrine for patients under tonsillectomy and to provide generic data with anesthetic nursing intervention. Method: Data were collected from 60 patients who had tonsillectomy from November 1, 2003 to April 30, 2004. The group were divided into experimental group and control group: an experiment group of 30 patients was provided with an anesthetic information prepared by the researchers; a control group of another 30 patients was provided with general information. Data were analyzed through chi-squared test, t-test, repeated measure ANOVA using SPSS Program(version 12.0). Result: There were no significant difference between the experimental group and the control group in pre-operative state anxiety, glucose and cortisol. However, there were statistically significant difference between the above two groups in pre-operative pre-operative blood pressure(p=.001), heart beat(p=.000), and epinephrine(p=.035). Conclusion: The authors, with the results of this study, concluded that the preoperative anesthetic information for patients under tonsillectomy had direct effect on lessening pre-operative anxiety.

• Archives of Plastic Surgery
• /
• 제40권2호
• /
• pp.129-133
• /
• 2013

Background A pneumatic tourniquet is generally used to achieve a bloodless operation field in hand surgery. However, this has changed with tumescent solution-based wide-awake surgery. This study is a preliminary prospective case series study to elaborate the formula and indications of the tumescent technique in hand surgery without a tourniquet. Methods Seven patients (age range, 4 months to 37 years) underwent hand or upper extremity surgery for conditions such as nerve palsy, electric burn defect, fingertip injury, contracture, constriction ring syndrome, or acrosyndactyly. A "one-per-mil" tumescent solution (epinephrine 1:1,000,000+20 mg lidocaine/50 mL saline) was used to create a bloodless operating field without a tourniquet. Observation was performed to document the amount of solution injected, the operation field clarity, and the postoperative pain. Results The "one per mil" epinephrine solution showed an effective hemostatic effect. The tumescent technique resulted in an almost bloodless operation field in the tendon and in the constriction ring syndrome surgeries, minimal bleeding in the flap and contracture release surgeries, and acceptable bleeding in acrosyndactyly surgery. The amount of solution injected ranged from 5.3 to 60 mL. No patient expressed significant postoperative pain. Flap surgeries showed mixed results. One flap was lost, while the others survived. Conclusions Epinephrine 1:1,000,000 in saline solution is a potential replacement for a tourniquet in hand surgery. Further studies are needed to delineate its safety for flap survival.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제20권4호
• /
• pp.223-231
• /
• 2020

Background: The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods: Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results: We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion: The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.