A 52-year-old male patient reported to the dental clinic with severe pain and swelling associated with an impacted mandibular third molar. He was a known hypertensive patient and was taking antihypertensive medications regularly.
His blood pressure at the appointment was 150/92 mmHg.
The extraction was expected to be difficult and lengthy, requiring profound local anesthesia.
The dentist administered 2% lignocaine with 1:100,000 epinephrine, performed careful aspiration before injection, and completed the extraction successfully without any systemic complications.
Questions:
• What is the maximum recommended adrenaline dose for a controlled hypertensive/cardiac patient during dental treatment?
• Why is aspiration mandatory before administering local anesthesia ?
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The recommended dose of adrenaline is 0.04mg.
Aspiration during the anaesthesia is necessary to avoid injecting it into blood vessels which may lead to toxicity.
0.04 mg of adrenaline per appointment.
. If local anesthetic is accidentally injected intravascularly, it can lead to:
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Rapid systemic absorption
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Toxic reactions
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Sudden cardiovascular stimulation
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Tachycardia and hypertension
Answers:
• Maximum adrenaline dose:
For controlled hypertensive or cardiac patients, the recommended maximum is 0.04 mg (40 µg) of epinephrine.
• Why aspiration is mandatory:
Aspiration ensures the needle is not in a blood vessel, preventing intravascular injection, which could cause a sudden spike in epinephrine levels leading to tachycardia, hypertension, or other cardiovascular complications.
The maximum recommended dosage is 0.04 mg for controlled hypertensive or cardiac patient during dental treatments. Aspiration is important before administration of LA ro prevent injecting it into a blood vessel , if done so it leads to systemic toxicity , sudden spike in blood pressure and increased heart rate .