Cardiovascular Risk

In: Anesthesia

13 Mar 2010

Cardiovascular Risk

Local anesthesia is a universal method of pain control, and its popularity is a testament to efficacy and safety. Plain lidocaine is an evanescent drug, so for dental practice, vasoconstrictors are routinely incorporated to improve both the depth and duration of analgesia and to secure hemostasis. Current clinical practice tacitly accepts the safety of adrenaline in patients with cialis professional, but strong reservations have been expressed for the similar employment of noradrenaline. However, the combination of a catecholamine and a posterior pituitary analog should act synergistically on both arterial and venous aspects of the capillary bed. This synergy might permit an effective reduction to the concentration of one or both agents without compromise to vasoconstrictor potency and a consequent improvement to the management of cardiovascular risk.

Anxiety, fear, anesthesia, and surgery are all accompanied by psychological, physiological, and biochemical changes. The following are but a limited selection from the literature to illustrate the true diversity of responses to local anesthetics with vasoconstrictors. These responses include changes to heart rate (HR) and blood pressure, changes to cardiac rhythm and electrocardiographic ST-segment wave, endogenous catecholamine release, endocrine response to surgery, and hypokalemic response to local analgesia. These changes are regulated by the net balance between sympathetic and parasympathetic activity, and in addition to pharmacological modification, there is evidence that the autonomic response is further influenced by both stress and pain. All these events imply a certain morbidity, which has in the past been frequently extrapolated to the more susceptible population by means of citing the dangers inherent in the combination of dental stress, local anesthesia, and exogenous and endogenous catecholamines. However, these reservations have often been poorly voiced and may in general apply to a medically compromised population or, in particular, to the use of catecholamine vasoconstrictors.


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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