Different Anesthesia Combinations Recommended for Patients With Cardiovascular Issues

Dentistry Today


As the population of older adults grows, the need for pain management techniques that account for systemic diseases increases, according to researchers at the Tokyo Medical and Dental University and the Kyushu Dental University

For example, they noted, cardiovascular disease is one of the leading causes of morbidity and mortality in older adults. Finding a local anesthetic that does not affect blood pressure or heart rate during dental procedures is extremely important, the researchers said.

The researchers, then, have compared the use of two different drug combinations in older adults during tooth extractions to determine local anesthetic effects on blood pressure and heart rate.

The crossover study involved 22 adults between the ages of 65 and 86 in need of at least two maxillary tooth extractions. A combination of either lidocaine and adrenalin (L+AD) or prilocaine with felypressin (P+FP) was administered before tooth extraction. 

After anesthetic injection, blood pressure and heart rate were measured every 2.5 minutes for 20 minutes. Dental extractions in each subject were performed five days apart, with L+AD used for one extraction and P+FP for the other, so the researchers could examine the effect of both combinations on the same subject.

The researchers found and increase in both systolic and diastolic blood pressure in the P+FP group at all timepoints compared to the L+AD group. The systolic pressure did increase at the initial timepoint in the L+AD group but then stayed constant throughout the procedure.

When heart rate was measured, however, the researchers found an increase at all timepoints with L_AD and no real difference with P+FP.

In older adults with blood pressure concerns, a combination of L+AD should be considered when performing dental procedures, the researchers concluded. In older adults with increased heart rates, the P+FP combination should be administered.

The researchers suggest that further studies are necessary to find more information on selecting safe local anesthetics for older adults with cardiovascular disease during dental procedures.

The study, “Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study,” was published by Anesthesia Progress.

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