Cardiovascular Effects of Epinephrine on Hypertensive Dental Patients. Evidence Report/Technology Assessment Number 48

摘要

Hypertension affects one quarter of the adult U.S. population. A systematic review of the literature was conducted to identify the additional risks of adverse cardiovascular outcomes to controlled and uncontrolled hypertensive individuals represented by the use of epinephrine-containing anesthetic solutions and epinephrine-impregnated retraction cords during dental treatment. Two parallel searches of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were conducted to identify reports involving cardiovascular and hemodynamic outcomes associated with the use of epinephrine in the dental treatment of hypertensive individuals. One search identified reports involving epinephrine in local anesthetic solutions, the other epinephrine in gingival retraction materials. The gray literature was not searched, and only reports in English were included in the search. We included any report where epinephrine was administered, and one or more cardiovascular parameters (blood pressure, heart rate, cardiac output, plasma epinephrine concentration, EKG changes including transient arrhythmias) or adverse events (headache, syncope, angina, hypertensive crisis, longer-term arrhythmia, cerebral vascular accident, myocardial infarction) was reported for hypertensive individuals.