Impact of Epinephrine Contained in Local Anesthetic Solution on Serum Lactate Level during Orthognathic Surgery

Publication date: Available online 3 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hidetaka Kuroda, Gaku Kawamura, Manabu Soya, Takayuki Kitamura, Tatsuya Ichinohe, Yoshitsugu Yamada
PurposeThere have been many discussions of a relationship between endogenous and/or exogenous epinephrine and hyperlactatemia. This study aimed to identify the impact of epinephrine contained in a local anesthetic solution on serum lactate levels in patients who underwent orthognathic surgery.MethodsThis study was a retrospective record review of cases of maxillary and/or mandibular osteotomy at the Tokyo University Hospital between January 2006 and December 2014. A total of 193 patients were enrolled in this study.ResultsThe maximum intraoperative serum lactate level was 22.3 ± 14.7 mg/dL. Out of 193 patients, 91 showed an intraoperative serum lactate level that was higher than the normal maximum of 19.8 mg/dL (2.2 mmol/L), and 16 of these had a level that was 40 mg/dL (4.49 mmol/L) or higher. A multiple logistic regression analysis revealed two factors that could possibly affect elevation of the serum lactate level: the amount of epinephrine contained in the local anesthetic solution injected into the oral cavity (p = 0.0001; odds ratio [OR], 1.014; 95% confidence interval [CI], 1.006-1.022) and the absence of intraoperative treatment with propranolol (p = 0.0013; OR, 0.105; 95% CI, 0.019-0.434). Patients with severe serum lactate concentrations (i.e., 40 mg/dL [4.49 mmol/L] or higher) had slight metabolic acidosis. All patients survived 90 days. The number of postoperative hospitalization days for patients with severe serum lactate concentrations was 12.8 ± 2.6 days, and that for patients without severe serum lactate concentration was 16.0 ± 8.6 days.ConclusionIncreases in intraoperative serum lactate levels during orthognathic surgery are associated, at least in part, with increased aerobic glycolysis due to β2-adrenergic signaling. Lactate elevation caused by epinephrine contained in a local anesthetic solution does not result in a poor postoperative outcome.



http://ift.tt/2l3sNTX