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AI-Generated response:

My patient has an allergy to “local anesthetics” and on further questioning, reports a racing heart rate after a dental procedure. Should I be concerned?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Yes, you should be concerned about the reported racing heart rate after a dental procedure involving local anesthetics, as it may indicate a reaction to the anesthetic or its additives, such as epinephrine.

  • Local anesthetics like lidocaine can cause adverse cardiovascular effects including arrhythmias, especially at high doses or in sensitive individuals.[1]

  • Epinephrine, often added to local anesthetics to prolong their effect, can cause palpitations, tachycardia, and other cardiovascular symptoms.[1]

  • True allergic reactions to amide local anesthetics (e.g., lidocaine) are extremely rare; symptoms like tachycardia are more likely due to systemic toxicity or reactions to other components like epinephrine.[1-2]

  • Patients reporting adverse reactions to local anesthetics should undergo evaluation by an allergist/immunologist to accurately diagnose the cause of their symptoms and to identify safe alternatives for future procedures.[2]

  • Monitoring and supportive care, including oxygen therapy and IV fluids, are recommended if significant cardiovascular symptoms occur following the administration of local anesthetics.[1]

Additional info

Given the patient's reported symptoms and the potential for both toxic and hypersensitivity reactions, it is crucial to carefully review the patient's medical history and the specifics of the anesthetic used during the dental procedure. The presence of epinephrine in the anesthetic formulation could be a key factor in the patient's reaction, as it can significantly impact cardiovascular dynamics. A detailed assessment and possibly a referral for further testing might be necessary to prevent similar incidents in the future and to ensure the patient's safety during subsequent dental or medical procedures. Additionally, considering alternative anesthetic options that do not contain epinephrine or using different classes of local anesthetics might be advisable, depending on the outcome of the allergist/immunologist's evaluation.

References

Reference 1

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: May 2, 2024.

Adverse Reactions Cardiac effects of local anesthetics such as xylocaine dental are due to the interference of conduction within the myocardium. Cardiac effects are seen at very high systemic doses and usually occur after the onset of CNS toxicity. Xylocaine Dental-induced adverse cardiovascular effects include myocardial depression, sinus bradycardia, hypotension, cardiovascular collapse, and cardiac arrest. These effects typically occur with high plasma drug concentrations but have occurred with smaller doses in rare instances. Cardiovascular and CNS side effects resulting from xylocaine dental administration should be treated with general supportive physiologic measures such as oxygen therapy, assisted ventilation, and IV fluids. Monitor blood pressure and the electrocardiogram during intravenous xylocaine dental administration. If cardiovascular side effects such as hypotension, arrhythmia exacerbation, or excessive depression of cardiac conduction occur (e.g., prolonged PR interval or widened QRS complex), discontinue xylocaine dental administration and re-evaluate treatment options. Combining xylocaine dental with a vasoconstrictor increases the likelihood of producing anxiety, palpitations, dizziness, headache, restlessness, tremor, angina, and hypertension.

Reference 2

2.

Solensky, Roland, Sicherer, Scott H. (2025). In Nelson Textbook of Pediatrics (pp. 1453). DOI: 10.1016/B978-0-323-88305-4.00193-0

ADRs associated with local anesthetic agents are primarily nonallergic and include vasovagal, psychomotor, sympathetic stimulation, and toxic reactions. IgE-mediated reactions are exceedingly rare. Patients with suspected local anesthetic allergy should be referred to an allergist/immunologist for skin testing followed by a graded challenge. This procedure invariably finds a local anesthetic the patient is able to tolerate, in the rare individuals who are allergic to one of these agents. Although local anesthetics can be broadly grouped into esters (group I) and amides (group II), allergic cross reactivity within these groups is only relevant for delayed Gell and Coombs type IV reactions, not type I reactions.

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