Hypotension After Local Anesthetic Infiltration Into The Oral Submucosa During Oral And Maxillofacial Surgery

We have noted hypotensive episodes in close association with submucosal infiltration of adrenaline contained in lidocaine. We investigated the effects of adrenaline contained in lidocaine on hemodynamics during oral and maxillofacial surgery under general anesthesia. Sixteen patients with an American Society of Anesthesiologists physical status of I scheduled to undergo sagittal splitting ramus osteotomy were included in this study. The patients comprised 6 men and 10 women with a mean age of 22.3 years and mean weight of 58.5 kg. We measured the patients’ systolic arterial pressure (SAP), mean arterial pressure (MAP), diastolic arterial pressure (DAP), and pulse rate (PR). The patients exhibited a mean 30% decrease in SAP, mean 29% decrease in MAP, mean 33% decrease in DAP, and mean 13% increase in PR. All data were normalized to the values immediately before infiltration and expressed as a relative percentage. The average time from injection to minimum pressure was 88 seconds, and the mean duration of the trough was about 60 seconds. This study suggests that there is an approximately 90-second lag time in hemodynamic changes after local anesthetic injection into the oral submucosa. Local anesthetic infiltration with adrenaline contained in lidocaine elicits temporary but severe hypotension.