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Thursday, April 24, 2014
Safe general anesthetics in Porphyria patient
My question is this.. I have been quite debilitated with two diseases. One is AIP acute intermittent porphyria that I was diagnosed through the Mayo Clinic years back. The second is multiple sclerosis (I have multiple sclerotic plaques in my cervical spine) I have been bedridden for approximately 3 years and we have fortunately found a dentist who will come to the home (locally) and is going to remove a decayed-dead tooth. She has acquired all the proper equipment for in-home use. The tooth to be removed is Upper left molar. I have very serious reactions to chemicals of all kinds she is well aware of that, as are my doctors. I am wondering what you believe to be the best and safest general anesthetic to be used. I have high blood pressure and am on coreg for it (I am only 110 pounds, non-smoker eat healthy) she (the dentist) is talking about a local anesthetic with no epinephrine and a short acting. Do you feel that would be safest? I am having varied painful polyneuropathy at the moment we are hoping for a break so I can get this tooth removed, they believe it might be adding to my worsening of symptoms. I would very much appreciate your professional opinion. Thank you
Thank you for this interesting and challenging history. Firstly, I am unsure of your question regarding general anesthesia. Are you planning on a general anesthetic? In your home? There is generally no need for a true general anesthetic, whether with or without a breathing tube for a single tooth extraction. In fact, this is most commonly done with a local anesthetic alone. I would recommend this if at all possible.
As far as a local anesthetic, you may be more comfortable and have better bleeding control with a local anesthetic with epinephrine. In the upper jaw, there is a shorter duration of full anesthesia of the tooth with 3% mepivicaine, the most common non-epinephrine containing local anesthetic for dentistry. If the dentist expects a relatively quick extraction, this should be fine. Without the epinephrine, however, there may be increased bleeding, especially if this will be a surgical extraction.
The amount of drug used would be quite low and with slow, careful injection technique, the peak amount absorbed by your body will be very low. Coreg is an alpha and beta blocker and there is a low incidence of interactions with small amounts of epinephrine in dental local anesthetic solutions. In order to assure profound pain control, you may want to discuss with your dentist the use of one cartridge of 2% lidocaine with 1:100,000 epinephrine and if need be, supplement with 3% mepivicaine.
Either way, your dentist is clearly one of the "good guys", if I can use that terminology for her. It sounds like she will almost surely know what is best for you.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University