Abstract
Objectives: To evaluate hemodynamic changes of blood pressure and heart rate on hypertensive patients undergoing tooth extraction using various types of local anesthesia (LA). Study Design: A prospective randomized clinical trial was conducted on 45 hypertensive patients who were divided equally into 3 parallel groups according to LA received. Group 1: Lidociane 2% with epinephrine 1: 80,000. Group 2: Prilocaine 3% with Felypressin 0.03 IU/ml. Group 3: Mepivacaine 3% plain. Inclusion criteria: hypertensive patients, under medical management with blood pressure ≤ 159/99. Exclusion criteria: Blood pressure ≥160 /100 and patients receiving β blockers. Negative aspiration was mandatory before the injection of 2 cartridges of LA. Blood pressure and heart rate were evaluated by Electronic Sphygmomanometer and Pulse Oximeters in 3 different time-points; 3 minutes before LA, three minutes after LA and three minutes after extraction. Results: The mean of systolic blood pressure (SBP) had increased after LA injection, and then decreased after extraction in the 3 groups of patients. Increase of SBP after extraction with (Mepivacaine plain) was higher than (Lidociane with Epinephrine) and the difference was statistically significant using ANOVA (p=0.037). The differences in the mean heart rates and mean diastolic blood pressures in the 3 groups were not significant. Conclusions: The increase of blood pressure with Epinephrine and Felypressin is negligible. Therefore, it is safe to use 2 cartridges of Lidociane 2% with Epinephrine 1:80,000 or Prilocaine 3% with Felypressin 0.03 IU/ml for hypertensive patients whose blood pressure ≤ 159/99 provided negative aspiration is verified before injection. Key words:Local anesthesia, tooth extraction, hypertensive patients, vasoconstrictors, epinephrine, Felypressin.
Highlights
Hypertension is defined as a systolic blood pressure [SBP] higher than 140 mHg or a diastolic blood pressure [DBP] higher than 90 mmHg
Dental treatment requires the use of local anesthetic agents combined with vasoconstrictors to counteract the localized vasodilator effects of local anesthetics; and to increase the duration of the anesthesia along with slow absorption of local anesthetics into the cardiovascular system that decreases the risk of toxicity; which is a great value in hemostasis during surgery [6]
The aim of the this study is to evaluate the hemodynamic changes of blood pressure and heart rate on hypertensive patients receiving three different types of local anesthetic cartridges; Lidociane 2% with epinephrine 1:80,000, Prilocaine 3% with Felypressin 0.03 IU/ml and Mepivacaine 3% plain
Summary
Hypertension is defined as a systolic blood pressure [SBP] higher than 140 mHg or a diastolic blood pressure [DBP] higher than 90 mmHg. One major concern of dental treatment for Hypertensive patients is the sudden and dramatic increase in blood pressure that could lead to life-threatening complications [3]. It was found that local anesthetics with Felypressin increase systolic and diastolic blood pressure without any significant change in heart rate. The clinically safe dosage of Felypressin in patients with essential hypertension is approximately 0.18 IU This corresponds to 6 ml of local anesthetics with 0.03 IU of Felypressin, which is commercially available as a local anesthetic for dental use [11,12]. The aim of the this study is to evaluate the hemodynamic changes of blood pressure and heart rate on hypertensive patients receiving three different types of local anesthetic cartridges; Lidociane 2% with epinephrine 1:80,000, Prilocaine 3% with Felypressin 0.03 IU/ml and Mepivacaine 3% plain
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