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Medically Compromised Patients Supporting Your Practice

Should vasoconstrictors be avoided in any patients with cardiovascular disease?

In patients at major risk of developing perioperative cardiovascular complications, vasoconstrictors should be used only in consultation with the patient’s physician who may recommend that vasoconstrictors be avoided.

Dentistry and Health EditedThis high-risk category includes the following conditions:

  • Acute or recent MI (between 7 to 30 days prior);
  • Decompensated heart failure; and
  • Significant arrhythmias (e.g., AV block, ventricular-related arrhythmia).

Some studies have shown that very modest quantities of a vasoconstrictor are safe in these high-risk patients when accompanied by oxygen, sedation, nitroglycerin, and adequate pain control.

 

Source: Dental Secrets, Elsevier, 2015

5 Comments

  1. Curious dentist August 12, 2015

    Can you explain what is meant by moderate amount of vasoconstrictor?
    1:100,000epi or
    1:200,000epi
    And how many carpules of these in 2 percent lido can be administered?

    Reply
    1. Dr. Bill Preshing August 18, 2015

      The textbooks always recommend a maximum dosage of 0.036 mg epinephrine. That’s two carpules of anesthetic in a 1:100,000 formulation, or four carpules in a 1:200,000 concentration.

      Reply
    2. ak August 19, 2015

      This might be a bit outdated but when I was in dental school it was said to be 2 carps of 1:200 000 epi

      Reply
    3. Peter Nkansah September 2, 2015

      The accepted maximum amount of vasoconstrictor (epinephrine) for a cardiovascularly compromised patient is 0.04 mg (40 mcg) per appointment. This translates into 2 cartridges of 1:100,000 epinephrine or 4 cartridges of 1:200,000 epinephrine. The math on this is derived from the fact that 1:1000 is equal to 1 mg/ml, and there are usually 1.8 ml of solution per cartridge.

      Reply
  2. R.Garry Graves August 22, 2015

    Endogenous release of adrenaline I feel would cause more harm than local anesthetic with 1:200,000 or 1:100,000 epinephrine if the level of anesthesia is inadequate . For longer procedures it is of benefit to the patient to have adequate and prolonged anesthesia . Let me know if this way of thinking is wrong.

    Reply

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