Use of local anaesthetics in heart transplant patients

Key Points

• Transplanted hearts are supersensitive to the effects of circulating catecholamines. This paper examines the haemodynamic effects of dental local anaesthetics containing 1:80,000 epinephrine (adrenaline) in patients with cardiac transplants.

• The epinephrine in dental local anaesthetics did not affect blood pressure in cardiac transplant recipients.

• Epinephrine contained in dental local anaesthetics significantly increased heart rate in cardiac transplant recipients before periodontal surgery.

• Surgery did not mask the haemodynamic changes produced by the local anaesthetic in cardiac transplant recipients.

• Epinephrine-free solutions may be preferred for dental local anaesthesia in cardiac transplant recipients.

Abstract

ObjectiveTo investigate the cardiovascular responses of cardiac transplant recipients to dental local anaesthetic solutions with and without epinephrine (adrenaline).

Materials and methods A clinical study employing 30 patients (20 cardiac transplant recipients and ten healthy) awaiting gingival or minor oral surgery under local anaesthesia receiving either 4.4 ml lidocaine (lignocaine) with 1:80,000 epinephrine or 4.4 ml 3% prilocaine with 0.03IU/ml felypressin.

Results Cardiac transplant patients experienced a significant tachycardia 10 minutes after injection of the epinephrine-containing solution. No significant change in heart rate was detected after the injection of an epinephrine-free solution. Blood pressure was not affected. Periodontal surgery did not affect the responses to the local anaesthetics in the transplant recipients.

Conclusions The cardiovascular response to dental local anaesthesia in cardiac transplant recipients is governed by the solution injected.

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