Jul 2026· Pakistan journal of medicine and dentistry· Vol 15· 0 citations
TL;DR
Adrenaline-containing local anesthesia was associated with a measurable but moderate short-term rise in random blood sugar, with a greater response among diabetic participants.
Abstract
Background: Tooth extraction under local anesthesia is common in dental practice, and lidocaine/lignocaine with adrenaline is frequently used to improve anesthetic efficacy and hemostasis. However, adrenaline may influence glucose metabolism through adrenergic stimulation, particularly in patients with type II diabetes mellitus.
Objective: To evaluate the acute glycemic response following administration of adrenaline 1:80,000-containing local anesthesia in healthy individuals and patients with type II diabetes mellitus undergoing tooth extraction.
Methods: This comparative analysis included 90 participants divided equally into healthy and diabetic groups. Random blood sugar was assessed before local anesthesia, 5 minutes after local anesthesia, and immediately after extraction. Between-group differences, within-group changes, repeated-measures glycemic response, and adverse events were analyzed.
Results: In the healthy group, mean random blood sugar increased from 110.76 ± 26.82 mg/dL at baseline to 117.00 ± 28.26 mg/dL after local anesthesia and 119.50 ± 27.94 mg/dL after extraction. In the diabetic group, values increased from 161.63 ± 36.87 mg/dL to 171.56 ± 41.48 mg/dL and 175.80 ± 42.84 mg/dL, respectively. The net rise from baseline to post-extraction was greater in diabetic participants than in healthy participants, at 14.17 mg/dL versus 8.74 mg/dL. Repeated-measures analysis showed significant effects of time, group, and time-by-group interaction. Minor adverse events were more frequent in diabetic participants but were not statistically significant. Conclusion: Adrenaline-containing local anesthesia was associated with a measurable but moderate short-term rise in random blood sugar, with a greater response among diabetic participants. Prospective validation using actual patient-level data is required.
LA solutions can elicit systemic metabolic responses, and caution is warranted when using lignocaine containing adrenaline in patients with T2DM patients, and Clinicians should consider plain LA alternatives for diabetic patients when prolonged anaesthesia or enhanced haemostasis is not essential.
Harshawardhan Kadam, CV Pattanshetti, Swapnil U. Shinde et al.· Journal of Clinical and Diag...· 0 citations
Objective: To compare pre and post surgical blood glucose levels in non diabetic healthy individuals undergoing dental extraction.
Study Design: Comparative analytical study.
Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Oct 2023 to Apr 2024.
Methodology: The study included 85 patients of 20 to 50 years of age presented for tooth extraction under local anesthesia. Patients were kept fasting for 10 to 12 hours before attending for tooth extraction. Pre surgical blood glucose levels were checked with blood glucose meter. Tooth extraction was carried out using anxiety reduction protocol and after completion of extraction procedure post surgical blood glucose levels were again checked with same device.
Results: The mean fasting time of participants before procedure was 10.7+1.03 hours. There was no difference in blood glucose level pre surgery mean 92.11+5.25 mg/dl to post surgery mean 91.86+5.62 mg/dl, out of 85 patients none of patient develop signs and symptoms of hypoglycemia during dental extraction.
Conclusion: Dental extraction under local anaesthesia can be carried out safely in fasting non diabetic healthy individuals. Dental surgeon must be fully aware of clinical signs and symptoms of hypoglycemia for its early recognition and must be well prepared to manage the patient in case of any such event.
Adnan Babar, Shafi Ullah Khan, Syed Junaid Hussain Bukhari et al.· Pakistan Armed Forces Medica...· 0 citations
Background: The growing number of surgical patients requiring long-term anticoagulation or presenting with coagulopathies necessitates a precise understanding of how anesthetic induction agents affect the hemostatic system.
Objective: To evaluate the acute impact of propofol and sufentanil induction on primary and secondary hemostasis using rotational thromboelastometry (ROTEM) and flow cytometry (FC).
Methods: A prospective pilot study was conducted on 7 adult patients (ASA physical status I) scheduled for elective surgery. Blood samples were collected immediately before and 5–7 minutes after intravenous induction with propofol and sufentanil (prior to surgical incision to exclude surgical trauma influence). Hemostatic parameters evaluated included ROTEM (EXTEM/INTEM: CT, CFT, Alpha angle, MCF, A10, A20) and FC (total and activated platelet counts). Nonparametric paired data were analyzed using the Wilcoxon signed-rank test.
Results: A statistically significant increase in the EXTEM Alpha angle was observed post-induction (p = 0.047), indicating an accelerated rate of clot formation. A trend toward hypercoagulability was noted for EXTEM CFT (p = 0.063) and INTEM CT (p = 0.108). Other ROTEM parameters (MCF, A10, A20) showed no significant changes. Flow cytometry revealed less than a 5% difference in total and activated platelet counts (p > 0.50), indicating no clinically relevant alterantion of platelet function.
Conclusion: Induction of general anesthesia with propofol and sufentanil in ASA I patients exerts minimal influence on hemostasis, displaying only a slight trend toward hypercoagulability. Both agents can be safely administered without compromising perioperative coagulation dynamics.
N. Bordun, Beata Drobná Sániová, O. Tarabrin et al.· ВІДНОВЛЕННЯ УКРАЇНИ: МІЖГАЛУ...· 0 citations
Background: Shivering is an undesirable, and very common, postoperative event that causes a great deal of physiological stress. While several pharmacologic treatments are available, the efficacy of prophylactic (long-term) intravenous (IV) acetaminophen treatment has yet to be thoroughly studied. Objectives: To compare the effectiveness of prophylactic intravenous acetaminophen in preventing postoperative shivering in patients undergoing surgery under general anaesthesia. Methods: This was a randomized controlled trial that was carried out in the department of Anaesthesiology, Shalamar Hospital, a tertiary care hospital Lahore, from March 2026 to Jun 2026. 76 adult patients (ASA I/II) undergoing elective surgeries under general anesthesia were included. Participants were randomly assigned to either receive a 100 mL of normal saline with 1 g of IV acetaminophen over 15 minutes after induction (Group A, n = 38) or to receive a 100 mL of normal saline placebo for 15 minutes after induction (Group S, n = 38). We assessed shivering in the post anesthesia care unit using a standard 0–4 scale. Results: The incidence of postoperative shivering was significantly less in the acetaminophen group (13.2%) than in the placebo group (52.6%) (p < 0.001). In addition, Group A had a later start of shivering with a significant decrease in the number of anti-shivering rescue calls (p<0.05). Complication profiles did not differ significantly between the groups. Conclusions: IV acetaminophen administration during surgery can effectively reduce the incidence and intensity of postoperative shivering during general anesthesia, thereby improving the comfort of patients during surgery.
I. Khalid, Aamir Waseem, H. Babar et al.· Aposta: Revista de Ciencias...· 0 citations
PURPOSE
Postoperative nausea and vomiting (PONV) are one of the most common complications following anesthesia. PONV causes discomfort in various individuals. Additionally, some studies have shown that administering high concentrations of oxygen during surgery reduces PONV. Furthermore, studies have indicated that inhaling cinnamon oil extract reduces nausea and vomiting after chemotherapy. The purpose of this study was to investigate the effect of inhaling a combination of different concentrations of oxygen and cinnamon during surgery on reducing nausea and vomiting after cesarean section under spinal anesthesia.
DESIGN
Double-blind, randomized clinical trial.
METHODS
In this, randomized clinical trial,1 60 patients who were candidates for cesarean section under spinal anesthesia were randomly divided into 4 groups: group 1: 28% oxygen + normal saline, group 2: 28% oxygen + cinnamon leaf oil (8% v/v), group 3: 40% oxygen + normal saline, and group 4: 40% oxygen + cinnamon leaf oil (8% v/v). The information from this study, particularly the severity of nausea, was compared between the groups using the Visual Analog Scale (VAS).
FINDINGS
Based on the number of vomiting episodes and the severity of nausea at the end of recovery and 6 h after surgery, there was no statistically significant difference between the mentioned groups (P > 0.05).
CONCLUSION
High concentrations of oxygen alone or in combination with cinnamon oil cannot reduce nausea severity during first 6 houres after a cesarean section under spinal anesthesia.
N. Sadeghi, F. Nasimi, Somayeh Zeidabadinejad et al.· Journal of Perianesthesia Nu...· 0 citations
AIM
Achieving profound pulpal anaesthesia in patients with symptomatic irreversible pulpitis (SIP) remains a significant clinical challenge, as standard inferior alveolar nerve blocks (IANB) frequently fail due to localized inflammation. This clinical trial evaluated the effect of preoperative systemic enzyme therapy [trypsin, bromelain, and rutoside (TBR)] on anaesthetic success and postoperative pain in patients with symptomatic irreversible pulpitis.
METHODOLOGY
In this randomized, triple-blind, parallel-arm clinical trial, 124 healthy adults with SIP in a single mandibular molar were randomly allocated (1:1:1:1) to four groups (n = 31): Group FG (trypsin 100 mg/bromelain 90 mg/rutoside 48 mg), Group DF (diclofenac potassium 50 mg), Group PD (prednisolone 20 mg), or Group PB (placebo). One hour after premedication, a standard IANB (1.8 mL 4% articaine, 1:100 000 epinephrine) was administered. The primary outcome was anaesthetic success, defined as the ability to complete endodontic procedures with no or mild pain (NRS ≤ 3). Secondary outcomes included postoperative pain intensity (NRS 0-10) recorded at 6, 12, 24, 48, 72 h, and 7 days, and rescue analgesic intake.
RESULTS
Data of all 124 enrolled patients was analysed. Premedication significantly influenced IANB success (p < 0.001). Group FG (87.1%) and group PD (83.9%) achieved significantly higher success rates than group PB (35.5%); the RR of success for group FG compared to PB was 2.45 (99.17% CI: 1.26, 4.77), and for group PB compared to PD was 0.44 (99.17% CI: 0.22, 0.87). Group FG also showed significantly higher success than group DF RR of success for group DF compared to FG was 0.59 (99.17% CI: 0.36, 0.97). Group FG demonstrated significantly lower postoperative pain scores through 72 h compared to the placebo (p < 0.05). There were no significant differences in rescue analgesic intake (p = 0.320) or reported adverse events.
CONCLUSIONS
Premedication with the TBR combination significantly improved the success rate of IANB and reduced postoperative pain in mandibular molars with SIP with clinical efficacy comparable to prednisolone.
CLINICAL IMPLICATIONS
Systemic enzyme therapy may offer a viable, natural, and potentially safer alternative to corticosteroids or NSAIDs for enhancing pulpal anaesthesia and managing postoperative pain in symptomatic irreversible pulpitis.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT06298383.
Maha Nasr, Nermine Hassan· International Endodontic Jou...· 0 citations