Hemodynamic changes following injection of local anesthesia with vasoconstrictor agent in controlled hypertensive patients

Abstract

Local anesthesia is considered the most commonly used in dentistry. Vasoconstrictors are added to its composition to maximize its advantages. However, it is considered a tourniquet and acts on beta 1 and 2 receptors. This causes augmentation of heart rate and blood pressure. This study aimed to evaluate the safety of vasoconstrictors during simple tooth extraction in controlled hypertensive patients by monitoring the changes in blood pressure, heart rate and oxygen saturation. A prospective clinical study was carried out in a control group (normotensive patients n=60) and study group (hypertensive patients) (n=60). The following hemodynamic parameters (blood pressure [diastolic and systolic], heart rate and oxygen saturation) were monitored at four different time points (before infiltration of local anesthesia (R1), after 3 minutes of local anesthesia (R2), immediately after extraction (R3) and 25 minutes after local anesthesia infiltration (R4). One carpule of local anesthesia for each patient was provided in the form of lidocaine 2% with adrenaline as vasoconstrictor 1/100,000; (3) Results: Mean heart rate increased from one to four beats per minute in all groups, but the increment was lesser in hypertensive group. The increase of systolic blood pressure in hypertensive patients during (R2, R3 and R4) was significantly lower than in the normotensive group (p<0.001). The diastolic blood pressure reading fell in the hypertensive group more than in the normotensive group during (R2, R3 and R4). No changes in oxygen saturation were recorded between both groups; (4) Conclusions: no adverse effects in well-controlled hypertensive patients were seen during simple tooth extraction. One carpule of local anesthesia with 1\100,000 adrenaline does not induce blood pressure augmentation in hypertension patients included in this study. The changes in heart rate were within the safe limits. Keywords: local anesthesia, adrenaline, vasoconstrictors, hypertensive patients, hemodynamic changes.