CATECHOLAMINE SECRETION RATES (dental patients)

Source Epinephrine Norepinephrine

Adrenal Medulla (Patient resting) 7 g/min 1.5 g/min

Adrenal Medulla (dental pain) 280 g/min 56 g/min

Local Anesthetic (one carpule 18 g with 1:100,000 epi)

Conclusion: stress associated with pain causes 40 fold increase in epinephrine blood levels, and approximately a 37 fold increase in norepinephrine levels!! This is much more likely to cause a cardiac event than your 1, 2, or 3 carpules of epinephrine at 1:100,000.

COMPARE THE RISKS WITH EPINEPHRINE!

Anxiety/ stress (adrenal medulla): 280 g/min (systemic)

2 Carpules @ 1:100,000: (18 g x 2) 36 g (local)

Primatene mist: 220 g/ puff (inhalation)*

Bronkaid: 250 g/ puff (inhalation)*

Retraction Cord (8%): 80 mg/ml (topical)**

* may be repeated every 1-2 minutes if necessary to relieve bronchospasm. These are available OTC (no prescription needed!)

** 8% gingival retraction solutions (cord) deliver 40 times more epi than is given when epi is administered as an emergency drug (1:1,000)! (Epinephrine impregnated retraction cord is not used anymore, instead we substitute ferric sulfate as our hemostatic agent of choice)

Category: Pharmacology Notes