Local Anesthetics Local Anesthetics and Medically Complex Patients (original) (raw)
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Local Anesthetics in Patients with Cardiovascular Diseases
Journal of IMAB - Annual Proceeding (Scientific Papers), 2015
A significant problem in the dental medicine is pain alleviation. Many studies in the dental anesthesiology result in the production of new agents for locoregional anesthesia. Objective: This article aim to present the results of the last studies on the effect of the local anesthetics used in the oral surgery on patients with cardiovascular diseases. Material: A general review of the existing literature on the effect of the adrenaline, included as vasoconstrictor in the local anesthetics, used in patients with cardiovascular diseases is made. The benefits of vasoconstrictors for the quality of the anesthetic effect are proven. Conclusion: A small amount of adrenaline in the anesthetic solution does not result in complications development in patients with controlled cardiovascular diseases. Articaine is recommended agent of first choice for local anesthesia in the oral surgery.
The impact of cardiovascular drugs on the efficacy of local anesthesia in dentistry
Biomedical Papers, 2016
Background and Aim. Drugs used chronically by patients with diseases of the cardiovascular system (group C of the ATC classification) may act on adrenergic receptors and/or certain ion channels, which gives them the potential to interact with the action of local dental anesthetics. The aim of the study was to investigate the effect of systemically administered chronic cardiovascular medication (oral route) on the efficacy of intraoral local anesthesia in patients with diseases of the cardiovascular system. Patients and Methods. This was a prospective cohort study which analyzed the efficacy of local terminal anesthesia (onset of anesthesia, duration anesthetized area) in the upper jaw of 70 patients: 40 patients on medication for cardiovascular system disorders and 30 patients who were not using these drugs (the control group). The following cardiovascular drugs were used: beta blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, vasodilatators, diuretics, angiotensin receptor blockers, antiarrhythmics, statins and alfa blockers. Results. The onset of anesthesia on the vestibular side was faster in those taking cardiovascular drugs (40.50±19.87 s) than the control patients (58.93±31.07 s; P = 0.004) and duration of anesthesia on this side was shorter. Although the difference was not significant, it was evident that on vestibular and palatal side the anesthetized area was more rapidly reduced in the patients taking cardiovascular drugs. The duration of cardiovascular therapy also had a significant impact on the anesthetized area. Conclusion. Drugs acting on cardiovascular system may influence the effect of local anesthetics used in dentistry, possibly through interaction with autonomic receptors and ion channels.
Contraindications to vasoconstrictors in dentistry: Part I
Oral Surgery, Oral Medicine, Oral Pathology, 1992
This article reviews the main contraindications of vasoconstrictors in cardiac patients, notably unstable angina, recent myocardial infarction, recent coronary artery bypass surgery, refractory arrhythmias, untreated or uncontrolled hypertension, and untreated or uncontrolled congestive heart failure. Extensive survey of the literature has been completed, giving specific guidelines for a rational use of vasoconstrictors in this category of medically compromised patients. (ORALSURGORALMEDORALPATHOL 1992;74:679-86) E pinephrine and levonordefrin (Neo-Cobefrin) are
Arquivos brasileiros de cardiologia, 2007
To evaluate the occurrence of variables detecting myocardial ischemia during or after dental treatment under anesthesia with vasoconstrictor (epinephrine). 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 ...
Objectives: The use of a local anesthesia solution with vasoconstrictor for the dental procedure of patients with heart disease is controversial since it could generate adverse cardiovascular risk. Also, its safety has not been investigated in heart failure (HF) patients. This study sought to determine the efficacy and safety of a vasoconstrictor in dental interventions in heart failure (HF) patients with left ventricular reduced ejection fraction (HFrEF) and optimized treatment. Study Design: prospective, parallel group, controlled, double-blind study (Tooth HF study). Materials and Methods: HF patients with ejection fraction <45% and with optimized therapy were randomized to dental intervention using anesthesia solution lidocaine without epinephrine (LSE) or anesthetic solution lidocaine with epinephrine (LCE). Results: Seventy-two patients were randomized to LSE (n=36) or LCE (n=36). A high prevalence of poor oral health was observed. Reduced pain was observed in LCE patients during dental extraction but not during dental restorations. Ten LSE patients had pain versus 4 LCE patients (p=0.037). No differences between the LSE and LCE patients were observed concerning 24-hour monitored systemic blood pressure, heart rate, and arrhythmia. However, systemic blood pressure increased, and heart rate significantly decreased in relation to the baseline phase during and after the procedure in both groups. Conclusion: Association of local anesthesia with a vasoconstrictor was more effective for pain control in HFrEF patients without compromising safety. These results will benefit millions of HFrEF patients around the world in need of dental intervention. Clinical Trial: ClinicalTrials.gov Identifier NCT02228083.
Pharmacological interactions of vasoconstrictors
Medicina oral, patología oral y cirugía bucal, 2009
This article is the first of a series on pharmacological interactions involving medicaments commonly prescribed and/or used in odontology: vasoconstrictors in local anaesthetics and anti-inflammatory and anti-microbial analgesics. The necessity for the odontologist to be aware of adverse reactions as a result of the pharmacological interactions is due to the increase in medicament consumption by the general population. There is a demographic change with greater life expectancy and patients have increased chronic health problems and therefore have increased medicament intake. The presence of adrenaline (epinephrine) and other vasoconstrictors in local odontological anaesthetics is beneficial in relation to the duration and depth of anaesthesia and reduces bleeding and systemic toxicity of the local anaesthetic. However, it might produce pharmacological interactions between the injected vasoconstrictors and the local anaesthetic and adrenergic medicament administered exogenically whic...
Journal of Clinical and Experimental Dentistry
Background: To determine the influence of dental anxiety and the vasoconstrictor used in local anesthesia upon different hemodynamic parameters-systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and peripheral oxygen saturation (SatO2)-during dental extraction and oral hygiene. The safety of local anesthesia with vasoconstrictor in patients with medically controlled hypertension was also assessed. Material and Methods: A total of 159 patients were divided into two groups according to the dental treatment received: tooth extraction (n = 106) and oral hygiene (n = 53). The hemodynamic parameters (SBP, DBP, HR and SatO2) were recorded throughout dental treatment. Patient anxiety was assessed using the Beck Anxiety Inventory (BAI), the Modified Corah's Dental Anxiety Scale (MDAS) and the Hamilton test. Results: The HR increased after anesthetic infiltration with vasoconstrictor and decreased after the tooth extraction. However, HR remained stable in the oral hygiene group, in both hypertensive and non-hypertensive patients. The SatO2 values decreased after anesthetic infiltration with vasoconstrictor. These slight changes associated with the vasoconstrictor agent were observed in patients without anxiety, but not in patients with mild or moderate anxiety. Both SBP and DBP remained constant after local anesthetic infiltration with vasoconstrictor, regardless of whether the patients presented hypertension or moderate anxiety. Conclusions: The vasoconstrictor used in local anesthesia may induce a very subtle increase in HR, with no significant increase in patients who experience anxiety.
The Influence of Vasoconstritor Use in Local Anesthesia in Individuals with Chronic Renal Failure
Journal of Health Sciences, 2019
Individuals with chronic renal failure (CRD) undergo hemodialysis to compensate for systemic-based disease and often develop systemic arterial hypertension (SAH). Such individuals, when needing dental treatment, carry with them the consideration of which type of anesthetic to be used in clinical and surgical interventions. The objective of this study was to evaluate the action of anesthetics with vasoconstrictor (AwV) and without vasoconstrictor (AoV) in individuals with chronic renal failure. Research subjects needed dental treatment, with dental restorations, on the right and left lower dental arch in premolars and / or molars, thus receiving the model of a split-mouth clinical study. In a randomized study, each side of the mandible was subjected to an anesthetic infiltration with only one 1.8 mL tube in two different moments with a minimum interval of 7 days (for one moment with AwV and another AoV moment). The parameters of oxygen saturation (SaO2), heart rate (HR), systolic blo...