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Finding Safe Dental Anesthesia for Patients with Cardiovascular Disease

Anesthesia Progress – As the global population of older adults (aged > 65 years) grows, the need to find pain management techniques that take systemic diseases into account increases. Currently, 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.

Researchers from the Tokyo Medical and Dental University and the Kyushu Dental University published a study in the current issue of Anesthesia Progress that 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 researchers conducted a crossover study with 22 older adults, aged 65 to 86 years, 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 5 days apart, in which L + AD was used for one extraction and P + FP was used for the other, so the researchers were able to examine the effect of both drug combinations on the same subject.

The researchers found an increase in both systolic and diastolic blood pressure in the P + FP group at all timepoints compared with the L + AD group. The systolic pressure did increase at the initial timepoint in the L + AD but then stayed constant throughout the procedure. However, when heart rate was measured, the researchers found an increase at all timepoints with L + AD and no real difference with P + FP.

The researchers conclude that in older adults who have blood pressure concerns, a combination of L + AD should be considered when performing dental procedures. In older adults with increased heart rates, the P + FP combination should be administered. The researchers suggest further studies are necessary to find more information on selecting safe local anesthetics for older adults with cardiovascular disease during dental procedures.

Full text of the article, “Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study,” Anesthesia Progress, Vol. 66, No. 3, 2019, is now available here.

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About Anesthesia Progress
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit: http://www.adsahome.org/.

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