Posted by mattdds on July 31, 2003, at 21:52:28
In reply to Anaesthetic and antidepressants, posted by colin wallace on July 31, 2003, at 15:59:11
Hi,
I'm a fourth year dental student. During my training, they told us that the main concern with local anesthetics is the epinephrine contained in lidocaine 2% solution. The epinephrine is only in 1:100,000. This is an extremely tiny dose of epinephrine!
It is my opinion that the only reason clinicians avoid vasopressors in local anesthetics for folks taking MAOI's is for medicolegal reasons (i.e. they want to save their butt from being sued!).
Stanley Malamed, an authority on local anesthetics at UCLA, has done some research on this. He showed that the amount of epinephrine entering the bloodstream from lidocaine with epinephrine is negligible, and there is no evidence that they should be avoided with MAOI's. I also believe that local anesthetics WITHOUT vasopressors are markedly inferior (at least in my experience). For example, the other night, I did an extraction with mepivacaine without epinephrine, and the patient was squirming in the chair the whole time, even though I gave a high dose of it! I never have this problem with LA's with epinephrine, and imagine the amount of epinephrine released naturally by this patient well exceeded the amount I would have given her had I used lidocaine with epinephrine! I felt terrible about this.
My thinking is, get good anesthesia, and that will reduce anxiety about the procedure. As we know, anxiety releases loads of epinephrine into the bloodstream (the exact same epinephrine in lidocaine 2%, just LOTS more of it!). So if you go for good anesthesia, you are actually less likely to experience a hypertensive crisis.
That being said, local anesthetics containing *levonordefrin* ARE contraindicated with MAOI's and TCA's!
This is not medical advice, just general information. I'm just a dental student, not a physician, but hopefully some of this may help.
Best,
Matt
poster:mattdds
thread:247107
URL: http://www.dr-bob.org/babble/20030728/msgs/247198.html