In patients at major risk of developing perioperative cardiovascular complications, vasoconstrictors should be used only in consultation with the patient’s physician who may recommend that vasoconstrictors be avoided.
- Acute or recent MI (between 7 to 30 days prior);
- Decompensated heart failure; and
- Significant arrhythmias (e.g., AV block, ventricular-related arrhythmia).
Some studies have shown that very modest quantities of a vasoconstrictor are safe in these high-risk patients when accompanied by oxygen, sedation, nitroglycerin, and adequate pain control.
Source: Dental Secrets, Elsevier, 2015
Can you explain what is meant by moderate amount of vasoconstrictor?
1:100,000epi or
1:200,000epi
And how many carpules of these in 2 percent lido can be administered?
The textbooks always recommend a maximum dosage of 0.036 mg epinephrine. That’s two carpules of anesthetic in a 1:100,000 formulation, or four carpules in a 1:200,000 concentration.
This might be a bit outdated but when I was in dental school it was said to be 2 carps of 1:200 000 epi
The accepted maximum amount of vasoconstrictor (epinephrine) for a cardiovascularly compromised patient is 0.04 mg (40 mcg) per appointment. This translates into 2 cartridges of 1:100,000 epinephrine or 4 cartridges of 1:200,000 epinephrine. The math on this is derived from the fact that 1:1000 is equal to 1 mg/ml, and there are usually 1.8 ml of solution per cartridge.
Endogenous release of adrenaline I feel would cause more harm than local anesthetic with 1:200,000 or 1:100,000 epinephrine if the level of anesthesia is inadequate . For longer procedures it is of benefit to the patient to have adequate and prolonged anesthesia . Let me know if this way of thinking is wrong.