Key result
Epinephrine-free local anesthesia is associated with keeping blood pressure below ischemic thresholds during IHD dental care.
Why the study?
Does plain local anesthesia compared to epinephrine-containing anesthesia or no anesthesia improve hemodynamic stability in patients with stable ischemic heart disease undergoing dental treatment?
Observational (n=20)
Does plain local anesthesia compared to epinephrine-containing anesthesia or no anesthesia improve hemodynamic stability in patients with stable ischemic heart disease undergoing dental treatment?
Plain local anesthesia without epinephrine is the preferred analgesic modality for severely compromised ischemic heart disease patients undergoing routine dental procedures to minimize hemodynamic stress.
May support epinephrine-free anesthesia to limit hemodynamic stress in IHD dental patients; hypothesis-generating and requires randomized confirmation.
Twenty patients with stable ischemic heart disease in functional capacity Class II-IV underwent dental treatment. Scaling was performed in seven patients without local anesthesia. In the remaining 13 patients, pain control for restoration placement was obtained by local anesthesia: in seven patients, the anesthetics contained epinephrine, while in six this drug was omitted. Heart rate, blood pressure, and electrocardiograph were continuously monitored during the dental session. All patients had elevated systolic blood pressure and rate pressure product during treatment. In the patients who received plain local anesthetics only, the elevation in systolic blood and rate pressures was, however, significantly lower than the ischemic threshold. Arrhythmia or ST segment depression of > or = 1 millimeter were not recorded in any of the subjects. In severely compromised ischemic heart disease patients undergoing routine dental procedures of limited chair time, plain local anesthesia seems to be the preferred analgesic modality.
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Leviner et al. (1992) conducted an observational in Stable ischemic heart disease (n=20). Plain local anesthesia (without epinephrine) vs. Local anesthesia with epinephrine or no anesthesia was evaluated on Elevation in systolic blood pressure and rate pressure product. Plain local anesthesia without epinephrine kept systolic blood pressure and rate pressure product elevations significantly below the ischemic threshold during dental treatment in patients with IHD.
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