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Which vasoconstrictors are used in dentistry and what are their properties?

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Dental SyringeThe addition of vasoconstrictors to anesthetic solutions assists in hemostasis and duration of the anesthesia action.

Properties of Adrenaline or Epinephrine

  • Prolongs duration of action for lidocaine and enhances margin of safety
  • Beta-adrenergic activity which may cause blood pressure to rise
  • Alpha actions, such as vasoconstriction of blood vessels in skin and mucosa
  • Cardiac effects may be minimal but can be significant
  • Increases cardiac output in healthy as well as cardiac patients
  • Debate as to whether to avoid epinephrine in cardiac patients or those taking beta-blockers
  • May induce a decrease in plasma levels of potassium or increases in glucose levels but not clinically significant
  • Contraindicated in patients intoxicated with cocaine
  • Local anesthetics with epinephrine may cause delayed wound healing and increased incidence of dry sockets
  • Epinephrine is metabolized in the liver and metabolites are largely excreted in the urine

Felypressin

  • A synthetic analogue of vasopressin
  • Does not have oxytocin-like actions or anti-diuretic actions of vasopressin
  • Minimal toxic effects even if delivered intravenously
  • No evidence that prilocaine with felypressin is safer than lidocaine with epinephrine

Source: Anesthesia Complications in the Dental Office, Wiley Blackwell 2015.

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