Download evaluation of the effect of lidocain induced local anaesthesia on

Ananta Venkata Raman T and Chandraprakash C. / Journal of Science / Vol 5 / Issue 6 / 2015 / 446-448.
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EVALUATION OF THE EFFECT OF LIDOCAIN INDUCED LOCAL
ANAESTHESIA ON COMPOSITION OF SALIVA DURING DENTAL
PROCEDURES
T. Ananta Venkata Raman* and C. Chandraprakash
Department of Anaesthesiology, Mallareddy Institute of Medical Sciences, Quthabullapur, Hyderabad, Telangana, India.
ABSTRACT
In this study we have investigated the effect of Lidocain a local anaesthetic drug on salivary cortisol, salivary alphaamylase levels and calcium (salivary biomarkers) in selected subjects undergoing extraction of wisdom tooth. During
experimentation, total two saliva samples were gathered: one 1 hour prior to dental procedure, second one 1 hour later to
procedure. We have observed increased in cortisol, amylase and calcium levels after the procedure compared to normal. The
significant increase in these salivary components may be due to the oxidative stress induced by the Lidocain during the local
anaesthesia. These salivary biomarkers may be a valuable tool for evaluating oxidative stress and psychological stress while
performing the dental procedures.
Keywords: Lidocain, Cortisol, Amylase, Calcium, Oxidative stress.
INTRODUCTION
Lidocain is the well-known local anaesthetic
drug frequently used in simple dental treatment. Previous
studies have shown that Lidocain is responsible for
generation of free radicals and in turn contributing for
increase in oxidative stress [1-3]. Meanwhile, simple
dental treatment is often considered anxiety-producing
and stressful. Any kind of stress is defined as Stress- is
physiological and psychological reactions that mobilize
an organism’s defence against external or internal threats
(stressors) [4-6]. Lidocain along with some inflammatory
makers could be increasing stressful events in patient’s
body that may be evidenced by evaluating the changes in
salivary biomarkers [3]. Salivary cortisol is one of the
stress combating hormones and it is always released in
stressful conditions from the adrenal cortex, another
salivary biomarker Salivary Alpha Amylase (sAA) is also
secreted more in quantity due to the another stress
handling mechanism of human body, that is stimulation of
sympathetic nervous system during the local anaesthesia
or local incision [6-8].
Thus, the impact of Lidocain induced oxidative
stress can be non-invasively assessed through salivary
biomarkers. The evaluation of cortisol, salivary alpha
amylase and calcium level help us to understand the
individual’s mechanism of hormonal axis and nervous
regulation in combating the stress.
MATERIALS AND METHODS
Patients
This study comprised of 30 patients undergoing
for wisdom tooth extraction, without having previous
history of any other disease was selected as an
experimental group. The study has got the approval from
Institutional Ethics Committee; Informed Consent was
obtained from every individual who has participated in
this study.
The patients were divided in to following groups:
Pre-anaesthesia group: This group of patients were not
subjected to and waiting for a dental treatment (tooth
extraction).
Post- anaesthesia group: This group includes patients
who were administered with Lidocain as a local
Corresponding Author:- T. Ananta Venkata Raman Email:- [email protected]
anaesthetic and subsequently underwent tooth extraction.
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Ananta Venkata Raman T and Chandraprakash C. / Journal of Science / Vol 5 / Issue 6 / 2015 / 446-448.
Local anaesthetic syringe 1.8 ml (lidocaine –
hamein 2% with 1:80,000 adrenalin) was used to induce
local anaesthesia by infiltration to maxillary teeth.
Collection and Storage of Saliva samples
Unstimulated saliva was collected from patients
before and after administration of local anesthesia into
sterile graduated disposable sterile plastic containers.
Patients were asked to rinse the mouth with 10 ml of
water to remove food debris then a simple cotton dental
roll of specialized devices is sucked or chewed in patients
mouth (cheek, floor of mouth, and over the tongue) for a
1 minute allowing the saliva to be absorbed and collected
in the swab in an easy and hygienic fashion. Then the
swab is pressed against syringe holder and clear saliva is
collected into plastic graduated containers. Samples were
further centrifuged at 4,000 rpm for 12 min, and a clear
fluid at the bottom of centrifuge tube was transferred in
sterile eppendroff tube. Further these saliva containing
eppendroff tubes were stored at deep freeze for a
temperature of -20C to -40C for following assays.
Estimation of Cortisol level
Salivary cortisol was assayed using a
commercial, highly sensitive enzyme immunoassay kit.
30μL of whole saliva was added to each well of the
microtiter plate, which was read at 450 nm in a microplate
reader [9].
Estimation of Salivary Alpha-amylase (sAA)
sAA activity was assayed using a kit. The assay
employs a chromogenic substrate, 2-chloro-p-nitrophenol,
linked to maltotriose [10]. The enzymatic action of alphaamylase on this substrate yields 2-chloro-p-nitrophenol,
which can be spectrophotometrically measured at 405 nm
using
a
spectrophotometer
(DU800
UV/Vis,
Spectrophotometer).
Estimation of Calcium Level
Calcium reacts with Cresolphthalein complex in
8-hydroxyquinolinem to form a colored complex (purple
color) that absorbs at 570 nm (550 – 580 nm) [11].
RESULTS
Results shown in Table 1, express the general
physical and anthropometric characteristics of the selected
subjects, which were undergoing wisdom tooth extraction.
Results depicted in Table 2, presents the
comparative analysis of pulse rate and blood pressure
changes in Pre-local and Post-local anaesthesia group.
Post-local group shows significant changes in pulse rate
and blood pressure.
Results represented in Table 3, shows the
comparative analysis of Cortisol, Salivary Alpha Amylase
and Calcium levels in pre-local and post-local anaesthesia
group. There is increase in these salivary biomarkers from
the post-local anaesthesia group.
Table 1. General anthropometric characteristics of selected subjects
Parameter
Age
Gender (M/F)
BMI (kg/m2)
Smoker
Systolic Blood Pressure
Diastolic Pressure
The Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
Control Group
26±4
22/8
22.4 ± 0.7
5%
118 ± 6.04
78 ± 6
Table 2. Comparison of blood pressure and pulse rate in pre-local and post-local anaesthesia group
Parameter
Pre-local Anaesthesia (One hour before)
Post-local Anaesthesia (One hour after)
Systolic Blood Pressure
122.84 ± 16.22
128.86 ± 22.66
Diastolic Blood Pressure
79.42 ± 18.24
80.96 ± 14.28
Pulse Rate
76.82 ± 14.06
82.64 ± 12.42
The Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
Table 3. Estimation of Cortisol, Salivary Alpha Amylase and Calcium levels in pre-local and post-local anaesthesia
group
Post-local Anaesthesia
Parameter
Pre-local Anaesthesia (One hour before)
(One hour after)
Cortisol (ng/ml)
18.72±3.86
22.64±4.27
Salivary Alpha Amylase (IU/L)
6975.82 ± 578.25
7884.48 ± 257.42
Calcium (mmol/L)
0.16± 0.62
0.21 ±0.16
The Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
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Ananta Venkata Raman T and Chandraprakash C. / Journal of Science / Vol 5 / Issue 6 / 2015 / 446-448.
DISCUSSION AND CONCLUSION
Lidocaine is a common local anesthetic and
antiarrhythmic drug used intravenously for the treatment
of ventricular arrhythmias and in refractory cases of status
epilepticus. Inhaled lidocaine can also be used as a cough
suppressor acting peripherally below the larynx. It is also
used as a common dental anesthetic for minor surgery.
Regional dental anesthesia can be divided into component
parts, depending on the technique employed. There are
three different techniques used in dental anesthesia: local
infiltration technique, nerve block and periodontal
ligament injection. Lidocaine is suitable for infiltration,
block and surface anesthesia. Topical lidocaine is used to
relieve post herpetic neuralgia [12].
During stressful conditions Salivary glands not
only act as an amplifier but also regulate the saliva flow
and body temperature [4, 5]. In the present study, it was
observed that the Lidocain may contribute for excess
oxidative stress, thus it resulted into significant increase
in the levels of salivary biomarkers. The present study
also reveals that the changes in saliva concentration could
be attributed to some individuals are more sensitive to
oxidative stress than others; so, the person’s physical
characteristics must be looked. Our results highlight that
elevation of cortisol, salivary amylase and calcium levels
can be the result of both Lidocain induced local
anaesthesia and psychological stress [13, 14]. The overall
results shows that subject body initiated co-ordinate
response for the oxidative stress and anxiety, results
clearly indicates that there is significant changes in
hemodynamic parameter (Blood Pressure, Pulse Rate) and
Salivary Biomarkers. These changes are due to the
activation of two endogenous stress combating
mechanism in body i.e. hormonal axis and sympathetic
regulation [15-17].
We would like to conclude that the assessment of
these salivary biomarkers, hemodynamic parameter and
physical characteristics could play an important role to
counteract the oxidative stress induced by local
anaesthetic drug Lidocain or psychological stress.
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