Background
The use of local anesthetics (LA) with vasoconstrictor agents (CV) -mainly Epinephrine- in patients with a known history of Arterial Hypertension and/or patients with Coronary Heart Disease, is controversial. The reason is the adrenergic profile of epinephrine . Although an LA cartridge with 1:100,000 of epinephrine corresponds to a dose of 0.018 mg of epinephrine, very low compared to those administered for anaphylaxis or heart attacks (0.5 to 1 mg), doubt remains in the treatment of patients with cardiovascular risk
Epinephrine offers many advantages, such as reducing toxicity, increasing the anesthetic effect and improving hemostasis, thus being a useful tool for controlling intraoperative bleeding. However, it must be taken into account that this hemostatic effect has been associated with a delay in wound healing, an increased risk of infection, and determining harmful effects on soft tissue flaps, due to decreased blood flow. .
Coronary heart disease and high blood pressure are highly prevalent health problems worldwide, the latter being one of the most frequent pathologies in patients who attend dental clinics.
Local anesthetics (LA) with vasoconstrictor agents (VC) are known to be commonly used in dental practice. For the reasons mentioned above, dentists must know how to adapt to and treat patients with these dangerous conditions.
Aim
The objective of this study was to find out whether the use of local anesthetics (LA) in combination with vasoconstrictor agents (VC) in dental treatment presents a risk in patients with a known history of arterial hypertension and/or coronary heart disease.
Materials and methods
This systematic review was conducted in accordance with PRISMA guidelines and registered in the PROSPERO database (CRD42020187369). The search strategy was based on Mesh terms, the Boolean AND operator and the PICO model.
The study was designed to identify all randomized clinical trials (RCTs) published in the last 30 years, which evaluated whether the use of LA with VC agents in dental treatment produces a significant increase/decrease in hemodynamics in patients with a known history of Hypertension and/or coronary heart disease. The Cochrane Collaboration tool was used to assess the risk of bias of the included RCTs.
Results
An initial electronic search resulted in 87 articles; however, only 9 RCTs met the inclusion criteria. There were a total of 482 subjects (N = 482), of whom 412 had a known history of hypertension or coronary heart disease.
Conclusion
According to the literature reviewed, epinephrine is the most used VC agent in dental treatment. The use of 1 to 2 cartridges of LA with 1:80,000, 1:100,000 or 1:200,000 of epinephrine in patients with Arterial Hypertension and/or controlled Coronary Heart Disease is safe.
However, all RCTs reviewed included only controlled patients, which does not allow this conclusion to be applied to patients with poorly controlled hypertension and/or coronary heart disease or patients with severe cardiovascular diseases.
Randomized clinical trials with low risk of bias are needed to determine the safety or risk profile of using LA with VC agents in patients with poorly controlled coronary and hypertensive disease.
