Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients.
OBJECTIVE
To evaluate the occurrence of variables detecting myocardial ischemia during or after dental treatment under anesthesia with vasoconstrictor (epinephrine).


METHODS
A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes): group I (27 patients) using anesthetics with vasoconstrictor, and group II (27 cases) without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T) before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases.


RESULTS
Three patients in group I presented ST-segment depression (1.0 mm) during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study.


CONCLUSIONS
Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.
Conrado
Valeria C L S
VC
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil. v.conrado@uol.com.br
de Andrade
Januário
J
de Angelis
Gabriella A M C
GA
de Andrade
Ana Carolina P
AC
Timerman
Lilia
L
Andrade
Mercedes M
MM
Moreira
Dalmo R
DR
Sousa
Amanda G M R
AG
Sousa
J Eduardo M R
JE
Piegas
Leopoldo S
LS
D000368:Aged; D000766:Anesthesia, Dental / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000503:physiopathology; D052279:Creatine Kinase, MB Form / Q000097:blood; D017742:Dental Care for Chronically Ill / Q000379:methods*; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000175:diagnosis; D014081:Tooth Extraction / Q000009:adverse effects / Q000379:methods*; D020107:Troponin T / Q000097:blood; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
D015415:Biomarkers; D020107:Troponin T; D014662:Vasoconstrictor Agents; D052279:Creatine Kinase, MB Form; D004837:Epinephrine