Effects of epinephrine in local dental anesthesia in patients with coronary artery disease.
BACKGROUND
The use of vasoconstrictors for local anesthesia in patients with coronary heart disease is controversial in the literature, and there is concern regarding risk of cardiac decompensation.


OBJECTIVE
To evaluate electrocardiographic and blood pressure parameters during restorative dental procedure under local anesthesia with and without a vasoconstrictor in patients with coronary artery disease.


METHODS
Sixty-two patients were included in the study, ages ranging from 39 to 80 (mean 58.7 +/- 8.8), 51 (83.2%) of whom were male. Thirty patients were randomly assigned to receive 2% lidocaine with epinephrine (epinephrine group), and the remaining patients, 2% lidocaine without epinephrine (non-epinephrine group) for local anesthesia. All patients underwent 24-hour ambulatory blood pressure monitoring and dynamic electrocardiography. Three periods were considered in the study: 1) baseline--recordings obtained during the 60 minutes prior to the procedure; 2) procedure--recordings obtained from the beginning of anesthesia to the end of the procedure and 3) 24 hours.


RESULTS
There was an increase in blood pressure in both groups during the procedure, compared with baseline values; but when the two groups were compared no significant difference was detected between them. Heart rate remained unchanged in both groups. No ST-segment depression > 1 mm occurred either at baseline or during the procedure. Seven patients (12.5%) experienced more than ten arrhythmia episodes per hour during the procedure, four (13.8%) in the non-epinephrine group and three (11.1%) in the epinephrine group.


CONCLUSIONS
No difference was observed in blood pressure, heart rate, or evidence of ischemia and arrhythmias in either group. The use of vasoconstrictor has proved to be safe within the range of the present study.
Neves
Ricardo Simões
RS
Instituto do Coração, Hospital das Clínicas, FM, USPSão Paulo, SP, Brazil. ricardo.neves@incor.usp.br
Neves
Itamara Lucia Itagiba
IL
Giorgi
Dante Marcelo Artigas
DM
Grupi
Cesar José
CJ
César
Luís Antonio Machado
LA
Hueb
Whady
W
Grinberg
Max
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D003324:Coronary Artery Disease; D017742:Dental Care for Chronically Ill / Q000379:methods*; D004562:Electrocardiography; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine