Dental Procedures---pots And Reactions To Local Anesthetics Without Epi

[Maxine]

Yesterday I heard from my EDS specialist via e-mail when I e-mailed him with concerns about my reactions to lidocaine without epi. I know SOME people with POTS don't respond well with epi ------and others may be OK. However, this is not the issue for me----it's lidocaine without epi. I have adverse reactions---------tachycardia, tremors, nausea, severe anxiety, and feel like I'm going to jump out of my skin. Some of the Docs I see----(even the ones who you would think would know better) do not seem to take this seriously.

Well they better start taking this seriously, as folks who have hyper mobile EDS---(especially with vascular involvement--(which I have) can absorb the local anesthetics more systematically. (I wonder if epi being added would be useful in this case---considering that is a vasoconstrictor and may prevent a "systematic" reaction.

Anyway the EDS Doc said that patients with EDS can have a poor response to local anesthetics ------- and also said it's likely there an extracellular make-up does not hold the local as well and allows systemic circulation. He said that most dental problems concern peridontal disease and TMJ--------------------but some EDS patients have weaker teeth-----and it's unclear why. He was very nice to respond, and offered to help me with any more concerns. Then he said that due to my current health issues he would like me to make an appointment to see him ASAP.

Here is an article that validates lidocaine should be used properly----( and abviously with caution with EDS patients, or cardiac patients).

http://www.emedicine.com/med/topic1297.htm

So last year when the doctor injected a large amount of lidocaine around the loaded vascular area of my chest to insert the cardiac loop recorder--------------------I WASN'T GOING CRAZY----------------the reaction was tachycardia, lightheaded, dizzyness, nausea, extreme anxiety------and I thought I was going to jump out of my skin. No one would have ever figured this at the time. I was instructed I could get right off the bed after the procedure and go about my business---as only "local anesthetic" was used. Sounds logical---------------------and my vitals were fine at the time, so why not. Well after getting on my feet and walking to the cafeteria I found that the floor was moving under me, and the next thing I know I'm in deep do do.

I was sick with the above list of symptoms for over 12 hours----the worst of it being the first 4 hours. I didn't tell the doctor or any of the nurses in the Cardiac Cath area-----------------I was sure they would think I was crazy, that it was not possible that I would have a reaction like this.

Well it turns out the EDS combined with POTS could have allowed me to absorb the licocaine more systematically---thus the adverse reaction. At some point I will discuss this information I found out from the EDS Doctor with the doctor that did the procedure to implant ther cardiac loop recorder. At the time he had no idea what was going on because I didn't tell him----------------I just hung around the hospital until I felt safe to go home--------meanwhile I just sat there and shook......................

I did discuss some concerns with licocaine at a later appointment, and told him I had this reaction, and the symptoms I had. I never really heard much of a response----maybe he didn't know why..........

Maxine :0)

[Tessa]

Hi, Maxine

I have read your post with great interest, because it was similar to my reaction in 1997. Therefore I think you are right...

Well, I had an injection of Novocaine (into my neck). At first it all seemed to be fine. A few minutes later we had to stand in a line in order to get an app. for another day.

I felt an accute chest pain and tachycardia and thought I would pass out. In fact, I did.

Because we were at the Hospital, I was taken into the ER.

The doctor who injected the drug rushed to the ER. They seemed to be very worried but had no idea of what had happened and mentioned it was just an adverse reaction.

Novocaine is an anesthetic and I think that we should take these reactions seriously and avoid the situation. I did not know it was a vasoconstrictor until you have mentioned it.

On my Tilt Table Test (a few months ago) I had a similar reaction when I was given Nitroglicerine (also vasoconstrictor) and had a syncope. BTW, when they tilted me down in order to recover, I did not recover inmediately. It took a while and time (plus 10 days being ill)... When I finally woke up, I noticed that they were worried and scared.

I was going to start a post asking about this when I read yours.

I wonder if I should avoid all kind of vasoconstrictor drugs. Doctors (as it happened to you) do not seem to understand exactly what is going on with us and why we have such a reaction. My Cardiologist (who is not specialized in POTS) thinks it is just a normal reaction for POTS patients, but I wonder if we could have a stronger reaction the next time... And it worries me.

I have been checking the results of my TTT and 5 minutes after the Nitroglicerine my bp was at 64/26 but the report mentions that I passed out 3 minutes after the Nitrogicerine and I have not been able to find any data about my hr and bp when I fainted...

64/26 must be the lecture I had when I gained consciousness... But, what before?

I do not think this is so simple. I am for it being a bad reaction to that kind of drugs and I wonder if the next reaction can be serious... Should we avoid these drugs?

What do you suggest? Any comments?

Love,

Tessa

[Maxine]

seriously----------------this is pretty important--------I found the article pretty interesting.

I hope you get a chance to read this...........................

[Maxine]

Tessa-----The Epi is a vasoconstricter--(helps prevent bleeding, and extends the effects of the anesthetic----------but the local without it is not----it's a central nervous system depressent, but I think we have the vasoconstrictor effects even without epi-----or so it seems that way with systematic circulation because the symptoms mimic what we have when we have a "hyper-adrengic" attack with our pots. But then again my BP was not taken at the time I had the reaction-----I was stable-----but my BP was pretty high when I read the surgical report. My reaction was delayed, and it hit me like a ton of bricks when I walked to the cafeteria. I was very weak when the symptoms first hit, then I think my body overcompensated to recover-------then the tremors, tachycardia ect.

Nitroglycerin----------"It is also used medically as a vasodilator to treat heart conditions''-----your blood pressure would have shot UP if it was a vasoconstricter----(they would never treat someone they suspect is having a heart attack with a vasoconstrictor. You crashed because your vessels dialated---------------as folks with POTS will have near syncope--or syncope when the vessels vasodilate.

All I know is that I have a pretty bad reaction-----------and before I got the vasoconstrictor response---------- I felt like a wet noodle along with extreme lightheadedness, and I thought I was going to hit the floor.

This stuff is pretty serious stuff, and needs to be taken seriously.................

Sounds like you are absorbing the locals systematically as well.

I don't know what to suggest---other then have your cardiologist read the report from dina kids on dental care:

http://www.dynakids.org/Documents/Brooks_April_2006_JADA.pdf

And also read the e-medicine report----the link is in my first post. The docs really need to be alerted to this.........

I wish I could help you more--------------I'm just now trying to figure this stuff out myself.

Maxine :0)

[Tessa]

Thank you for the information, Maxine. I have read both texts. Interesting. I keep a copy of it.

I am still worried about our reaction and confused... Does it mean I have to avoid vasoconstrictors?

Love,

Tessa

[Sunfish]

tessa -

what maxine was trying to make the distinction about was that nitro is a vasoDILATOR whereas epi is a vasoCONSTRICTOR. thus they're essentially the opposite. in this way - in theory - one would think that if one caused problems the other might be helpful. (this is the case for me...vasoconstrictors help keep my BP up whereas vasodilators are bad news).

this doesn't mean that you can't have bad reactions to both, but there's probably more to the reaction(s) than "just" the issue of vasodilating or vasoconstricting.

hope this helps,

melissa

[Maxine]

Thanks Melissa-------------

That is exactly right-----I should have explained better.

I think the reaction is more then just the vosodilator---vasoconstrictor effects.

As I mentioned I had a vasoconstrictor like response, because it felt like what a vasoconstrictor would make me feel like if I was given too high of a dose, but my CNS was probably overstimulated-------------I'm not really sure----my symptoms feel like I'm having a very bad hyper-adrengic attack.

It has more to do with the CNS--------and sometimes affects the cardiovascular in higher doses according to the reports I have read on adverse reactions---(that is if one has an adverse reaction). Lots of people with EDS just can't get local anesthetics to work for them ---period-----so the dentist in no picnic.

I never had a problem until 2000. Before that I even had locals with epi, and I never noticed anything other then it numbed the area. This is why it's so puzzling-------------why would I have such nasty reactions now? I was born with EDS and POTS.

Even "normal" people can end up with an adverse reaction if it's not administered correctly---and ends up in the vascular circulation.

I Just think it's something that the ANS Docs need to pay attention to a little more closely.

Maxine :0)

[Tessa]

Thanks Melissa

I am sorry that I am feeling so confused. I wish I had a doctor specialized in POTS nearby to ask, but I have no other option than to know by myself...

I am on a betablocker (Bisoprolol) to control my high hr when I am standing and the Cardiologist told me to add Florinef in order to increase my bp

I am still waiting to see if I will be able to get access to Florinef.... But, in the meantime, I was trying to understand the reactions I had to Novocaine (years ago) and to Nitroglicerine (during the TTT) I wonder if these reaction can become worse and what they mean... I agree with Maxine that doctors should be more cautious...

BTW, Melissa, glad to see you taking part on the forum, I hope you are feeling better.

Love,

Tessa

[yogini]

I think lidocaine and novocaine are the same thing. Novocaine is a brand name of lidocaine (or maybe it's the other way around). I haven't heard of lidocaine without epi, so not sure if that exists. One of the downsides of epi is that tachycardia is a side effect. That's why it's a risk for us POTS patients, even though we respond well to some other vasoconstrictors like midodrine. I've had several cavities filled/re-filled and, yes, even a tooth extraction since getting POTS, all using carbocaine. I didn't have any adverse reaction to carbocaine. The only downside is that it is weaker and wears off quickly, so you have to get many shots (I usually get 6 per tooth) and may need more shots in the middle of the procedure. But once you are numb, you can't feel the additional shots. (Now, getting a tooth extracted while being wide awake was still a traumatic experience even if it had nothing to do with the anesthesia, but that's a whole other story).

All this dental work makes me wonder whether I have EDS, although I am not flexible.

[Maxine]

rqt9191,

Lidocaine can be used wthout epi. Epi is added to control bleeding and to help the local last longer. It's used most of the time as standered unless an individual requests that it NOT be used.

I'll have to ask the oral surgeon about carbocaine. I'm not thrilled about this tooth extraction----------especially with my cervcal spine/cranial instability, but I have to say my fears lie more with the reactions to the anesthetic.

If you read the links I posted it discusses lidocaine with epi, and without. More lidocaine can be used if it's used with epi. The dentist/oral surgeon---or physicians using it must be careful on the dosage when used without epi--(the dose is more controlled, and less is used.).. I'm gathering that because of the vosoconstrictive effects from the epi, it's helpful in preventing systematic circulation and adverse reactions. However the epi aggrivates POTS symptoms----causing the tachycardia ect...........

Maxine :0)