Locoregional Anesthesia for Dental Treatment in Cardiac Patients: A Comparative Study of 2% Plain Lidocaine and 2% Lidocaine with Epinephrine (1:100,000)

Abstract

OBJECTIVES: This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine. METHODS: This randomized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brazil). Patients were separated into two groups with the help of an aleatory number table: 2% plain lidocaine (PL, n= 31) and 2% lidocaine with epinephrine (1:100,000) (LE, n= 28). Blood pressure, heart rate, oxygenation and electrocardiogram data were all recorded throughout the procedure. State and trait anxiety levels were measured. RESULTS: Fifty-nine patients were selected for the LE group (n=28), with an average age of 40.3 ± 10.9, or for the PL group (n=31), age 42.2 ± 10.3. No differences were shown in blood pressure, heart rate and pulse oximetry values before, during and after local anesthesia injection between the two groups. State and trait anxiety levels were not different. Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment. Complaints of pain during the dental procedure were more frequent within the PL group, which received a higher amount of local anesthesia. CONCLUSION: Lidocaine with epinephrine (1:100,000) provided effective local anesthesia. This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases

Clinical study of hemodynamic changes during extraction in controlled hypertensive patients

“…This could be more closely related to patient anxiety or discomfort, as has already been seen in healthy individuals (14). Likewise, Laragnoit et al (3) reported no increases in heart rate or blood pressure in patients with heart disease during dental treatment with local anesthesia plus a vasoconstrictor. Neves et al (5), in patients with …”

Anesthésie locale en chirurgie buccale chez les sujets cardiaques

“…Chez les sujets coronariens, dans une étude publiée en 1986 chez 40 patients ayant fait un IDM de moins de trois semaines, aucune complication cardiovasculaire grave n'est survenue lors d'extractions dentaires avec un anesthé-sique associé à de l'adrénaline [11]. En 2007, deux essais thérapeutiques, incluant chacun 54 et 62 malades atteints d'une maladie coronarienne, ont évalué l'effet de l'adrénaline en anesthésie locale sur les paramètres hémodynamiques et l'ECG [12,13] ; il n'y avait aucune différence pour la pression artérielle, la fréquence cardiaque, l'ischémie myocardique et l'arythmie cardiaque entre les deux groupes de malades (avec ou sans vasoconstricteur d'effets délétères de l'adrénaline sur les paramètres hémody-namiques et l'ECG [14]. Avec les β-bloquants, aucun cas d'interaction médicamen-teuse néfaste n'a été rapporté en chirurgie buccale [1].…”

Dental Management of the Cardiovascular Compromised Patient: A Clinical Approach

“…Patients with cardiovascular disease are at a greater risk of massive endogenous adrenalin release secondary to deficient local anesthesia than of reaction to the small amount of vasoconstrictor used in local anesthetics. 9,10,11,12 Nevertheless, vasoconstrictor use should be limited, taking care not to exceed 0.04 mg of adrenaline. this occurs following thrombus formation secondary to an atheroma plaque that occludes the arterial lumen, though other factors such as cold, physical exercise or stress can act as coadjuvant factors or (less frequently) trigger the event themselves.…”