ADA GUIDELINES WITH RESPECT TO EPINEPHRINE

“Before performing any dental procedure with a patient with cardiovascular disease, the dentist should evaluate the patient’s blood pressure, heart rate and regularity of rhythm. If local anesthetics solutions containing epinephrine are deemed necessary, no more than 40 g of epinephrine should be used for successive injections in patients with cardiovascular disease. Additional injections of local anesthetics with epinephrine can be given after approximately 5-10 minutes if vital signs are satisfactory”

(remember, 2 carpules of anesthetic should contain 36 g of epinephrine if it is at a 1:100,000 concentration)

Why is epinephrine preferred and most frequently used as a vasoconstrictor with local anesthetic, as opposed to norepinephrine?

Epinephrine has a nice mix between alpha-1 agonist activity (to get vasoconstriction) and beta-2, so that you don’t get such a severe vasoconstriction.

Category: Pharmacology Notes