Hemodynamic changes of local dental anesthesia in normotensive and hypertensive subjects

Hypertensive patients are an important group in dental treatment. In a prospectively randomised study the influence of 4 ml lidocaine 2% plain or with epinephrine 1:100,000 or norepinephrine 1:20,000 on heart rate and blood pressure before, during and after a small surgical intervention (tooth extraction) was investigated in a normotensive (n = 39) and a hypertensive group (n = 36). In both groups the changes of blood pressure and heart rate were nearly similar. The most remarkable alteration (rise in blood pressure, lowering of heart rate) was caused by norepinephrine. The vasoactive concentration of norepinephrine 1:20,000-1:30,000 as a component of local anesthetic preparations is contraindicated in hypertensive patients.