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Updated: May 16, 2026

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Published on: January 13, 2017

Cardiovascular Effects of 4% Articaine with 1:100,000 versus 1:200,000 Epinephrine during Inferior Alveolar Nerve

Marcele Cruz da Silva¹, Bruno Teixeira Gonçalves Rodrigues², Estephani Martins Barcellos de Carvalho²

¹DDS, OMFS, MsC. Oral & Maxillofacial Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.

Journal of Clinical and Experimental Dentistry

|May 15, 2026

Abstract

Background:

Local anesthetic solutions containing epinephrine are widely used in oral surgery to prolong anesthesia and improve hemostasis; however, their sympathomimetic effects may influence cardiovascular parameters. Evidence comparing different epinephrine concentrations in articaine during third-molar surgery remains limited. This randomized clinical trial compared the cardiovascular effects and clinical performance of 4% articaine with epinephrine 1:100,000 (A100) and 1:200,000 (A200) during mandibular third-molar extraction.

Material And Methods:

A prospective, randomized, split-mouth, double-blind clinical trial was conducted in 40 healthy patients undergoing bilateral impacted mandibular third-molar extraction. Each participant received A100 on one side and A200 on the contralateral side in randomized order with a 15-day interval. Heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2) were recorded at baseline, immediately after injection, and at 5 and 15 minutes. Intraoperative bleeding, pain (VAS), and need for supplemental anesthesia were also assessed. Paired statistical tests were applied ( = 0.05).

Results:

Eighty procedures were analyzed. Intraoperative bleeding incidence was similar between A100 (10%) and A200 (12.5%) (p = 1.000). Supplemental anesthesia was required in 3.8% of procedures, with no difference between concentrations (p = 1.000). HR increased with both formulations but was significantly higher with A100 at 5 and 15 minutes (p = 0.035 and p = 0.003). BP showed no significant differences at any time point. SpO2 remained within normal limits, with slightly higher values for A200 at intermediate times. Pain scores did not differ significantly.

Conclusions:

Both epinephrine concentrations in 4% articaine provided comparable anesthetic efficacy and hemostasis with minimal cardiovascular effects in healthy patients undergoing mandibular third-molar extraction. The 1:200,000 concentration produced a smaller heart-rate increase, suggesting a potential advantage in patients with cardiovascular risk, while 1:100,000 remains suitable when greater vasoconstriction is desired.

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