Low risk of adverse effects from epinephrine in hypertensive patients, but relevant high-quality literature is sparse

Abstract

Objective To identify any additional risk of adverse cardiovascular outcomes in hypertensive patients from the use of epinephrine-containing anaesthetic solution or epinephrine-impregnated retraction cord.Data sources Medline, Embase and the Cochrane Controlled Trials Register were searched, along with reference lists from relevant studies.Study selection Only studies that had been conducted in a dental environment were selected. Those used included separate analysis of patients; administration of known concentrations of epinephrine, via block or infiltration local anaesthetic or impregnated retraction cord; and a wide range of haemodynamic and cardiovascular outcomes. Studies reporting on fewer than five hypertensive patients were excluded.Data extraction and synthesis Data extraction was performed independently by two reviewers. The principle outcomes, ie, diastolic and systolic blood pressure and heart rate, were tabulated and the unweighted mean for three studies was calculated.Results Six studies, representing 325 patients, met the inclusion criteria. No adverse outcomes were reported. Use of epinephrine in uncontrolled hypertensive patients was associated with small non-significant increases in blood pressure. Only one study examined controlled hypertensives. No studies addressed the effects of retraction cord.Conclusions Although there is only a small increase in the risk of adverse effects in hypertensive patients when epinephrine is used, the quality and quantity of the relevant available literature is poor.