Psychosomatic Medicine, Vol 44, Issue 3 259-272, Copyright © 1982 by American Psychosomatic Society

ORIGINAL ARTICLES

Circulatory, plasma catecholamine, cortisol, lipid, and psychological responses to a real-life stress (third molar extractions): effects of diazepam sedation and of inclusion of epinephrine with the local anesthetic

DS Goldstein, R Dionne, J Sweet, R Gracely, HB Brewer Jr, R Gregg and HR Keiser

We studied the circulatory, psychological, plasma catecholamine, cortisol, and lipid responses to a real-life stress--third molar extractions--in 21 patients and the effects of sedation with intravenous diazepam and of inclusion of epinephrine with the local anesthetic. Across all patients, the surgery was associated with significantly increased heart rate (25%), systolic blood pressure (13%) and cardiac output--as indicated using impedance cardiography (34%)--without a significant change in diastolic blood pressure. Plasma norepinephrine increased by 60% during the surgery in nonsedated patients. Diazepam sedation abolished the norepinephrine response to the surgery, without significantly affecting the heart rate or systolic pressure responses. Receipt of epinephrine with the local anesthetic resulted in a fivefold increase in mean plasma epinephrine 5 min after the injection, as well as increased cardiac output. The direct effect of epinephrine accounted for the cardiac output increase observed during the surgery. The results suggest the participation of the sympathetic nervous system in producing the circulatory responses to dental surgery. The elimination of sympathetic recruitment by diazepam-induced sedation, however, without concomitant reductions in heart rate or systolic pressure responses, suggests that other systems besides the sympathetic nervous system influence the circulatory response to this real-life stress.

This article has been cited by other articles:

				S. M. GORDON and R. A. DIONNE The integration of clinical research into dental therapeutics: Making treatment decisions J Am Dent Assoc, December 1, 2005; 136(12): 1701 - 1708. [Abstract] [Full Text] [PDF]

				S. B. Manuck, S. Cohen, B. S. Rabin, M. F. Muldoon, and E. A. Bachen Individual Differences in Cellular Immune Response to Stress Psychological Science, March 1, 1991; 2(2): 111 - 115. [PDF]

				E. Knoll-Kohler, A. Frie, J. Becker, and D. Ohlendorf Changes in Plasma Epinephrine Concentration after Dental Infiltration Anesthesia with Different Doses of Epinephrine Journal of Dental Research, June 1, 1989; 68(6): 1098 - 1101. [Abstract] [PDF]

				M. V. Rudorfer, R. J. Ross, M. Linnoila, M. A. Sherer, and W. Z. Potter Exaggerated Orthostatic Responsivity of Plasma Norepinephrine in Depression Arch Gen Psychiatry, December 1, 1985; 42(12): 1186 - 1192. [Abstract] [PDF]

				K.M. Hargreaves, R.A. Dionne, and G.P. Mueller Plasma Beta-Endorphin-like Immunoreactivity, Pain and Anxiety Following Administration of Placebo in Oral Surgery Patients Journal of Dental Research, November 1, 1983; 62(11): 1170 - 1173. [Abstract] [PDF]

				B. Chernow, F. Balestrieri, C. D. Ferguson, G. T. Terezhalmy, J. R. Fletcher, and C. R. Lake Local Dental Anesthesia With Epinephrine: Minimal Effects on the Sympathetic Nervous System or on Hemodynamic Variables Arch Intern Med, November 1, 1983; 143(11): 2141 - 2143. [Abstract] [PDF]