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KMID : 0355620160420050295
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Journal of Korean Association of Oral and Maxillofacial Surgeons
2016 Volume.42 No. 5 p.295 ~ p.300
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Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases
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Son Hee-Won
Park Se-Hun
Cho Hyun-Oh
Shin Yong-Joon
Son Jang-Ho
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Abstract
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Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.
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KEYWORD
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Epinephrine, Orthognathic surgery, Local anesthesia, Lactic acidosis, Topical administration
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