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Nearly every oral-surgical procedure represents a hyperadrenergic situation whose gravity increases fear and pain. Procedures such as tooth extraction, local anesthesia, and subgingival debridement seem to have the highest impact on hemodynamic changes (Brand, 1999). The implications of anxious reaction to the dental procedure, vasoconstrictors in the local anesthetic solution, and their cumulative effect on the hemodynamic and cardiac changes are still uncleared. A few studies suggest that the vasoconstrictors in the local anesthetic solution, such as epinephrine, which are the source of exogenous catecholamines, applied at prescribed doses do not have a significant role in hemodynamic changes. These changes are more likely to occur due to emotional stress (Liau et al., 2005). Anxiety-related to both minor surgery and the local anesthetic injection could provoke a catecholamine surge, leading to increased cardiac oxygen demand, and thus, the heart can become arrhythmic (Chernow et al. 1987). The secretion of endogenous catecholamines in stressful situations is more than ten times higher than at the basal level (Brand et al. 1995), which can threaten the health of a group of hypertensive, cardiac, cerebrovascular, and senior patients. Healthy individuals usually deal with stress well, but sudden and asymptomatic heart rhythm disorders and conduction irregularities may occur during oral- surgical procedures (Davenport et al., 1990). In particular, hypertension might be presented without any apparent symptoms so that every patient may be at risk (Hill et al., 2009). That is why in some dental procedures, monitoring of vital signs is recognized and used (Lambrecht et al., 2011).
Monitoring oral- surgical procedures enables surgeons and dental staff to determine an early heart disorder to respond to them appropriately and avoid possible further complications (Lambrecht et al., 2011).
Vital signs during some dental procedures are currently monitored only by pulse oximetry. The main reason for that is the impracticality of using 12-lead electrocardiographic (ECG) devices during dental surgery.
Recent technological advances resulted in wearable wireless devices for monitoring physiological parameters. These devices are being increasingly used in healthcare both in clinics and remotely (Ding et al. 2020). Modern portable ECG systems consist of an ECG body sensor, smartphone applications, Cloud, and personal computers. These systems may provide an alternative to the standard 12-lead ECG or Holter devices. The main advantage of wireless and mobile ECG systems is creating ECG measurements by one or a few wireless and non-invasive personal sensors. They can potentially measure other physiological parameters such as heart rate, blood pressure, respiration, oxygen saturation, body temperature. They are also easy to use, inexpensive, and reliable (Tomasic et al., 2018). The ECG system used in this study consisted of a single ECG sensor with two closely positioned electrodes applied to the patients' chest. The most advanced C.E. marked patch ECG sensor called Savvy ECG has already been used extensively for research and medical purposes. In contrast to similar devices, it enables real-time wireless data acquisition and access to the raw data, which is crucial for research purposes (Rashkovska et al. 2020). Additional justification for the usage of Savvy patch ECG monitor during a dental surgery comes from the fact that it can detect life-threatening events immediately, particularly for patients with cardiovascular diagnoses and heart-related multi-morbidities.
The purpose of this study was to evaluate cardiac activity changes in healthy subjects during surgical extraction of impacted lower third molars, under local anesthesia, considering patients' gender and dental anxiety levels. In doing so, Savvy ECG's utility for monitoring vital signs during the surgical procedure was also assessed.