Sidney Epstein

Levo-Arterenol (Levophed) as a Vasoconstrictor in Local Anesthetic Solutions:

NUMBER of vasoconstrictors have been introduced from time to time as substitutes for epinephrine in dental local anesthetic solutions. There has been a clinical impression that several of these, particularly nordefrin (Cobefrin) and phenylephrine hydrochloride (Neo-Synephrine) are safer agents than epinephrine, since their use has been attended by fewer reactions or toxic manifestations. Whether this impression is correct or not, the fact still remains that the ideal vasoconstrictor agent has not yet been found, although those now in use are highly satisfactory in most respects. Accordingly, when Tainter, Tullar and Luduena1 succeeded in resolving arterenol into its optical isomers, it appeared desirable to evaluate the levo form of this compound (available under the trademark name of Levophed) as a component of local anesthetic solutions. This compound appeared to be of special interest in view of the fact that toxicity figures indicate that for equivalent pressor doses, the safety of levoarterenol is approximately four times that of levo-epinephrine. The pharmacology of arterenol has been summarized by Luduena, Ananenko, Siegmund, and Miller2 and need not be reviewed here; however, it is of interest to note that arterenol is a hormone occurring naturally in the body. It has been isolated in chemically pure form from adrenal medulla extracts and has been shown to be present in tumors of the adrenal medulla, along with epinephrine. It is secreted by the normal adrenal gland in response to reflex stimulation, is present in sympathetic nerves, and is released from the nerve trunks in vitro during stimulation.3 It appears that arterenol, perhaps along with epinephrine, may be a hormone involved in the chemical transmission of peripheral nerveimpulses in the sympathetic nervous system. It has long been suspected that this hormone, if it could be isolated, might be preferable to epinephrine as the vasoconstrictor in local anesthetic solutions, since it is almost completely free of the vasodilator effects seen with epinephrine and which have been suspected of sometimes being implicated in postoperative hemorrhage. Dobbs4 has published a preliminary report on the effectiveness of levoarterenol as a vasoconstrictor in local anesthesia. As a result of his work, Dobbs concluded that a concentration of levo-arterenol greater than 1:50,000, and less than 1:30,000, will give comparable vasoconstriction to nordefrin 1:10,000 when combined in a similar anesthetic mixture. In the present study, levo-arterenol was employed at a concentration level of 1:30,000 in two different local anesthetic bases: (1) in combination with procaine 2 per cent, and (2) in combination with procaine (Novocaine) 2 per cent with tetracaine (Pontocaine) 0.15 per cent. Two other solutions were used for purposes of comparison: (3) epinephrine 1:50,000 with procaine 2 per cent, and (4) nordefrin 1:10,000 with procaine

Restorative dentistry for the hospitalized patient

In the past, restorative dental procedures were either difficult or impossible to perform in emotionally disturbed or physically handicapped patients. Now, however, a dentist team working with ancillary personnel in a hospital operating room can carry out restorative procedures in these patients.