A Randomized Controlled Clinical Trial to Evaluate Blood Pressure Changes in Patients Undergoing Extraction under Local Anesthesia With Vasopressor Use

Abstract

The control of hypertensive patients' blood pressure and heart rate using vasoconstrictors during surgical procedures under anesthesia is still a major concern in everyday surgical practice. This clinical trial aimed to evaluate the variation of blood pressure and heart rate in nonhypertensive and controlled hypertensive voluntary subjects undergoing oral surgery under local anesthesia with lidocaine hydrochloride and epinephrine at 1:100,000 (Alphacaine; DFL, Brazil), performed in the Oral Surgery Department, Dentistry School, Fluminense Federal University. In total, 25 voluntary subjects were divided into 2 groups: nonhypertensive (n = 15) and controlled hypertensives (n = 10). Blood pressure and heart rate were measured at 4 different times: T0, in the waiting room; T1, after placement of the surgical drapes; T2, 10 minutes after anesthesia injection; and T3, at the end of the surgical procedure. A statistically significant difference (P < 0.05) between the groups was found at times T0 and T2 for the systolic pressure but only at time T0 for the diastolic pressure. The assessment of the heart rate of both groups showed a statistically significant difference (P < 0.05) at time T1. An analysis of the employed anesthetic volume indicated no statistically significant difference (P > 0.05) between the amount administered to nonhypertensive and hypertensive subjects. It was concluded that the local anesthetics studied could safely be used in controlled hypertensive and nonhypertensive patients in compliance with the maximum recommended doses.

Do Local Anesthetics Containing Epinephrine Affect Blood Pressure in the Elderly?

“…Therefore, treatment approaches to older patients are gaining more and more importance, and the present study included 479 patients over the age of 60. HTN is the most frequently encountered disease in elderly people who are admitted to dental clinics all over the world [11,14]. In the present study, among the 479 included patients, HTN and other cardiovascular diseases were the most common disorders reported, while only 125 patients reported no comorbidities ( Table 1).…”

“…Insufficient doses of epinephrine in local anesthetics lead to inadequate pain control and poor hemostasis, which can cause dissatisfaction for the patient and physician. On the other hand, an excessive dose of epinephrine may cause unwanted cardiovascular or other effects [9,11]. Two cases have been reported, in patients aged 52 and 35 years, in which cardiac arrest occurred during dental treatment after local anesthetic infiltration containing epinephrine between 0.065 and 0.075 mg.…”

“…The stress generated by pain, anxiety, and distress can cause changes in blood pressure and heart rate. Subjects with HTN are part of a special group of patients because these individuals are more likely to experience the complications of hypertensive crises, such as angina, heart attack, and stroke (ischemic or hemorrhagic) [11]. During our literature review, we did not encounter many studies assessing the effect of local anesthetics containing epinephrine on hemodynamic status in elderly patients.…”

“…The American Heart Association (AHA) reports the prevalence of hypertension (male/female, respectively) as 52/52% in individuals aged between 55 and 64 years; 63.9/70.8% in those aged between 65 and 74 years; and 72.1/80.1% in those aged 75 years and over [10]. In addition to the fact that a significant number of elderly people may be unaware of their HTN, an increase in blood pressure is also expected during dental treatment due to fear or anxiety [11,12]. Dental surgical procedures can generate disturbances in many patients who develop psychosomatic changes during treatment.…”

“…Although there is no difference in the use of local anesthetics containing vasoconstrictors between healthy elderly and younger patients, it has been reported that a reduction in the dose and cautious treatment is required for the former group [1]. Furthermore, in patients aged over 60 years, problems related to the cardiovascular system, including hypertension (HTN) and coronary ischemia, are frequently observed [10,11]. The American Heart Association (AHA) reports the prevalence of hypertension (male/female, respectively) as 52/52% in individuals aged between 55 and 64 years; 63.9/70.8% in those aged between 65 and 74 years; and 72.1/80.1% in those aged 75 years and over [10].…”