Efectos adversos de los anestésicos locales con vasoconstricción en pacientes hipertensos.

Abstract

Vasoconstrictor local anesthetics are widely used in dentistry, especially in surgical procedures, due to their ability to prolong anesthesia, reduce bleeding, and decrease systemic toxicity. However, their use in hypertensive patients is a cause for concern, as this condition is one of the most prevalent chronic conditions. The use of vasoconstrictors, such as epinephrine or felypressin, may cause hemodynamic alterations; therefore, it is essential to evaluate their safety in this population. Objective: To evaluate the adverse effects of local anesthetics with vasoconstriction in hypertensive patients. Methodology: A literature review was conducted according to the PRISMA 2020 guidelines by searching scientific databases. Clinical, observational, and controlled trials that evaluated hemodynamic parameters in hypertensive patients during dental procedures were included. Results: In seven studies analyzed, controlled hypertensive patients who received anesthetics such as lidocaine, articaine, prilocaine, or mepivacaine with vasoconstrictor had no clinically significant hemodynamic variations; and no relevant adverse effects were reported. Discussion: The available evidence suggests that the use of local anesthetics with vasoconstrictors is safe in controlled hypertensive patients, provided the recommended doses are respected and constant monitoring is performed. Conclusion: Local anesthetics with vasoconstrictors do not produce clinically significant adverse effects in controlled hypertensive patients, showing minimal variations in blood pressure. However, these results should not be extrapolated to uncontrolled patients, for whom the risk may be higher. Keywords: local anesthetics, vasoconstrictor, hypertensive patients.