Estudio de los vasoconstrictores en las soluciones de anestesia dental

Résumé

Documentation available on vasoconstrictors used in dental anesthetics is reviewed. The are divided into two types: sympathetic and vasopressin derived agents. Advantages to be considered are: (1) increased analgesic effect, (2) more lasting anesthesia, (3) haemostatic action, and (4) reduction of toxic effects from local anesthetics. However, when solutions of anesthetics and sympathetic vasoconstrictors reach the bloodstream in great amounts, the cause cardiovascular reactions and greater toxicity than solutions lacking a vasoconstrictor. Among sympathetic vasoconstrictors, adrenalin stands out as the most potent and best studied. Among vasopressin derived agents felypressin is the most used drug, albeit less eficacious than adrenaline. Vasopressin derived agents are contraindicated in ischemic heart disease and pregnancy, whereas sympathetic agents are contraindicated in (1) uncontrolled hyperthyroid patients, (2) cardiovascular patients placed in the 4th level according to the American Society of Anesthesiology's classification of physical status, and (3) patients receiving any of the following drugs (relative contra-indication): beta-blockers, hypotensive agents as guanethidine, reserpine or rauwolfia alkaloids; general anesthesia by halothane; and, last but not least, tricyclic antidepressants.