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cardiovascular monitoring. General anesthesia has significant influences on the heart and blood pressure, but there is general agreement that moderate and even deep sedation have minimal impact on cardiovascular function. 2 The rationale for cardiovascular monitoring during sedation stems from the realization that sedation may blunt appropriate autonomic responses associated with procedural stresses. Furthermore, if sedation is inadequate, the patient may respond with potentially detrimental autonomic responses such as tachycardia and hypertension. Early detection of these

Felypressin (FEL), a synthetic analogue of vasopressin (AVP), has been widely used as a substitute for epinephrine (EPI) in anesthetic solutions to promote local vasoconstriction during medical and dental practices. 1 , 2 Because it has no interaction with adrenergic receptors, it is suggested that FEL has fewer side effects than EPI. 3 Hence, FEL causes fewer cardiovascular 4 and metabolic 5 side effects, and it has a higher median lethal dose (LD50) 6 than EPI. However, the mechanisms and the receptors used by FEL to induce

. With only a few exceptions, there is little reason to discontinue any medication prescribed for cardiovascular disease. Diuretics can be withheld until after the appointment to minimize need for micturition. Their long-term use may be associated with hypokalemia and risk for cardiac arrhythmias; any irregularity in the patient's baseline pulse should be viewed with suspicion. It may be wise to order a serum potassium level if a general anesthetic is planned. Antihypertensive drugs can potentiate the hypotensive influences of sedatives and anesthetics, but there is

During oral surgery under general anesthesia, local anesthetics containing epinephrine are frequently used to reduce general anesthetic requirements and bleeding from the surgical field. 1 Epinephrine is a sympathomimetic catecholamine that directly stimulates both postsynaptic alpha and beta adrenoreceptors, generally leading to cardiovascular stimulation manifested as increases in heart rate (HR) and blood pressure. Additionally, exogenous epinephrine has been reported to stimulate the sympathetic nervous system by enhancing the secretion

Complications attributed to moderate and deep levels of sedation are more often associated with respiratory compromise and have been reviewed in a previous continuing education article in this journal. 1 Sedation, and general anesthesia for that matter, have minimal influence on overall cardiovascular function in reasonably healthy patients. In fact, cardiovascular complications may be even more likely during dental procedures using local anesthesia alone than when sedation is provided. However, respiratory compromise, excessive drug dosages, or inadequate

serum epinephrine levels and increase the potential for adverse cardiovascular effects. 9 In contrast, although topical epinephrine may be absorbed through mucous membranes and bleeding tissues, it causes local vasoconstriction, which decreases systemic absorption. Administration of topical epinephrine has been shown to result in elevation of serum concentrations 140 times less than injections of even dilute epinephrine preparations. 10 , 11 Complications associated with use of topical epinephrine are extremely rare, and changes in cardiovascular outcomes

Cardiovascular disease and stroke are very prevalent health ailments seen throughout the United States population. According to the American Heart Association's 2013 Update for Heart Disease and Stroke Statistics, in 2009 alone, cardiovascular disease–related deaths accounted for 32.3% of all deaths in the United States. 1 Patients with these diseases are regularly seen at the dental office, and although rare, complications from their illnesses may occur during treatment. Problems may present with a seemingly benign tachypnea and span

procedures. By reducing fear and anxiety, there is less stress on the cardiovascular system, and vasovagal reactions are less likely to occur. When compared with local anesthesia alone, the two most significant negative variables introduced by moderate sedation, as well as deep sedation and general anesthesia, are the added risks for either respiratory depression, ie, hypoventilation, or airway obstruction in the deeply sedated or unconscious patient. Respiratory depression may present as a decrease in depth and/or rate of ventilation and is attributed to depression of

Local anesthetics are the most common drugs used by dentists in clinical practice. A reversible anesthetic effect and a wide margin of safety when administered in proper doses to obtain anesthesia are hallmarks of this drug class. However, high blood concentrations obtained via intravascular injections or frank overdoses may produce significant toxic effects to the central nervous system and the cardiovascular system. 1 , 2 Other physiologic changes caused by the administration of local anesthetics may be due to the drug

Recent statistics point to an increasing number of patients in North America with cardiovascular implantable electronic devices (CIEDs), which include implantable cardiac pacemakers, implanted cardioverter-defibrillators (ICDs), cardiac resynchronization devices, and implantable cardiac monitors. In 2012, it was estimated that at least 3 million patients have these devices implanted and more than 250,000 new devices are implanted each year. 1 Of major concern to the dentist practitioner is the possibility of electromagnetic