title: Clinical assessment of the safe use local anaesthesia with vasoconstrictor agents in cardiovascular compromised patients: a systematic review.
abstract: BACKGROUND
  The use of vasoconstrictor agents has many advantages, but its use has been limited due to a fear of systemic absorption and the induction of adverse effects in cardiac compromised patients. The aim of this study was to review the literature to assess any scientific basis for the limited use of dental anaesthesia with a vasoconstrictor agent in cardiovascular compromised patients.
  
  
  METHODS
  A comprehensive database search was executed with the use of Medline (PubMed), ISI Web of Science, and Cochrane. The inclusion criteria were: a clearly defined dose of vasoconstrictor agent and the testing of at least 1 parameter (pressure, heart rate, or saturation) or occurrence of at least 1 cardiac incident (complication).
  
  
  RESULTS
  Among all complications, only 10 could be directly related to the use of local anaesthesia. It is noteworthy that 40% appeared after the administration of anaesthesia without vasoconstrictor agents. No severe adverse clinical effects were noted in the analysed studies.
  
  
  CONCLUSIONS
  The most frequent complications in cardiovascular compromised patients after dental local anaesthesia with a vasoconstrictor agent were disclosed in ECG arrhythmias. Most of these disclosed arrhythmias were clinically insignificant. The use of ≤ 4 ampules of lignocaine with epinephrine 1:100000 as a dental anaesthetic seems to be relatively safe for cardiovascular compromised patients.
authors.affiliation: Department of Dental Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Godzieba
authors.affiliation: Department of Dental Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smektała
authors.affiliation: Department of Dental Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Jędrzejewski
authors.affiliation: Department of Dental Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Sporniak-Tutak
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents