Hemodynamic changes in regular antipsychotic users after adrenaline-containing lidocaine injection under general anesthesia: a prospective study

Abstract Background: Local anesthetic containing adrenaline is commonly used in many operations to maintain hemostasis and prolong the duration of anesthesia. Antipsychotic drugs have an α-adrenergic receptor blocking action, and it is thought that β-adrenergic receptors predominate when adrenaline is administered in combination, thus inducing hypotension. Many general anesthetics have vasodilatory effects, and it is possible that blood pressure may decrease further if adrenaline-containing lidocaine is administered to antipsychotic users during anesthesia. This study aimed to assess the circulation dynamics in regular antipsychotics users administered adrenaline-containing lidocaine under general anesthesia in a dental procedure. Methods: Participants included 30 patients regularly using antipsychotics (butyrophenone, phenothiazine, and/or atypical antipsychotics) who were scheduled for dental treatment to be performed under general anesthesia. At five minutes after tracheal intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and percutaneous oxygen saturation (SpO2) were measured as a baseline. SBP, DBP, HR, and SpO2 were measured 2, 4, 6, 8, and 10 minutes after the injection of 1.8 mL of 2% lidocaine (32 mg) with 1:80,000 adrenaline (22.5 μg) into the oral cavity. Differences in the SBP, DBP, HR, and SpO2 between baseline and at each time point were analyzed using Dunnett’s test.Results: No significant changes were observed in the SBP, DBP, HR, and SpO2 compared to baseline until ten minutes after the administration of adrenaline-containing lidocaine. No adverse events were observed up to one hour after the administration of adrenaline-containing lidocaine.Conclusions: This study demonstrated that adrenaline used at the usual dose for dental treatment under general anesthesia is unlikely to affect the circulation dynamics of regular antipsychotic users.