Dental Anaesthesia on Patients with Cardiovascular Diseases

Epinephrine and Cardiovascular Diseases 

Epinephrine, commonly known as adrenaline, is often included in local anaesthetics formulation to increase their duration of action and reduce bleeding. However, its vasoconstrictive properties can increase heart rate and blood pressure, presenting risks for patients with cardiovascular conditions such as hypertension, vascular disease, or coronary heart disease ^{1 2}. 

Patients with cardiovascular diseases may experience increased stress during dental procedures, leading to the release of endogenous catecholamines such as epinephrine. This can further elevate cardiac workload and stress their cardiovascular system ¹. 

Drug Interactions 

Standard treatments of cardiovascular diseases, including acetylsalicylic acid (ASA), statins, beta-blockers, and ACE inhibitors, may interact with dental anaesthetics. These interactions may enhance the effects of epinephrine, leading to adverse cardiovascular events ¹ . 

Monitoring  

Dental professionals should closely monitor patients with cardiovascular diseases in case that any signs of toxicity or adverse events appear during or after procedures. Communication with the patient's cardiologist is crucial to ensure safe treatment decisions ^{1 3}. 

Anaesthetic Options 

• Mepivacaine: Plain mepivacaine is often considered a saferthe safest option as it does not contain epinephrine. However, caution is still advised ⁴. 

• Articaine: Its use should be minimized in patients with severe cardiovascular complications ¹. 

• Lidocaine: Requires monitoring in patients treated with class III antiarrhythmic drugs ¹. 

• Bupivacaine: Contraindicated in several severe cardiovascular conditions ¹. 

Epinephrine-containing local anaesthetics can be used in controlled cardiovascular patients at the lowest effective concentration (1:200,000) and volume ^{3 5}. 

In conclusion, administering dental anaesthesia to patients with cardiovascular diseases requires a tailored approach to minimize risks. By selecting appropriate anaesthetics and maintaining open communication with these patients and their cardiologists, dental professionals can ensure safer outcomes. 

References 

1. Aspects of Pain Control for Patients With Cardiovascular Complications. In: Inibsa [Internet] . Available from: https://inibsa.com/en/blog/general-odontology/aspects-of-paincontrol-for-patients-with-cardiovascular-complications/46 
2. Epinephrine. In: PubChem [Internet] Accessed Febrary 14, 2023. Available from: https://pubchem.ncbi. nlm.nih.gov/compound/Epinephrine 
3. Godzieba A, et al. Clinical assessment of the safe use local anaesthesia with vasoconstrictor agents in cardiovascular compromised patients: a systematic review. Med Sci Monit. 2014; 20:393-398. 
4. Guimaraes CC, et al. Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis. BMJ Open. 2021; 11(7): e044357. 
5. Brockmann WG. Mepivacaine: a closer look at its properties and current utility. Gen Dent. 2014; 62(6):70-76.