Use of epinephrine with local anesthesia in hypertensive patients. III. Effect of epinephrine on blood pressure and pulse rate.

In the first report,1 it was shown that the systolic, diastolic, mean and pulse pres­ sures of the dental patient in the waiting room are significantly higher than those obtained under basal conditions. In a second report,2 it was demonstrated that only the systolic, mean and pulse pres­ sures of the hypertensive patient in the waiting room could be reduced signifi­ cantly in 45 minutes by the oral adminis­ tration of 1^2 grains of secobarbital. It is the aim of this third report to continue the study of the dental patient as he moves along through the dental expe­ rience by now investigating the effects of the injection of local anesthetic with and without epinephrine. T he question might be raised why lidocaine hydrochloride and epinephrine were used as the local anesthetic solution and vasoconstrictor in this study. It should be recalled that this experiment was set up in such a fashion as to simu­ late the procedure followed in the aver­ age dental practitioner’s office.1 In keep­ ing with this policy, a survey was con­ ducted to learn what the average dental practitioner administers to a patient when local anesthesia is indicated and a vaso­ constrictor desirable. The survey showed that the agents employed in this study are used widely in dental practice. Thus, in order to m aintain the philosophy of the experiment as in the past,1’ 2 it was felt that lidocaine hydrochloride and epi­ nephrine should be used. In this m an­ ner, it was hoped to continue to “relive” the general office procedure and thus to be able to tell the practitioner not what to do but what he has been doing in terms of local anesthesia. In order to appreciate fully the rami­ fications of this problem, it is necessary to understand the effects of lidocaine hy­ drochloride and epinephrine on blood pressure and pulse rate.