Electrocardiographic changes in cardiac patients having dental extractionsunder a local anesthetic containing a vasopressor

Purpose: This study attempted to identify which group of cardiac patients i s most at risk when dental extractions are performed under a local anesthet ic with a vasopressor. Patients and Methods: Forty cardiac patients who had dental extractions und er local anesthesia were connected to a Holter monitor for 24 hours, starti ng an hour before the procedure. The electrocardiogram was analyzed for the number of premature beats, ST depression, and cardiac rhythm. A mean rate was calculated for the first 2 hours after injection of the local anestheti c and for the subsequent 22 hours. The preoperative electrocardiogram was c ompared with the electrocardiogram performed 1 week before treatment. Results: Electrocardiographic changes were observed in 15 patients (37.5%), and all occurred during the first 2 hours after injection of the local ane sthetic. Of the 15 patients, eight were being treated with digoxin. Conclusions: Cardiac patients being treated with digoxin had more electroca rdiographic changes after administration of a local anesthetic than other c ardiac patients. When the local anesthetic contained a vasopressor, there w as a greater incidence of tachycardia but less arrhythmia or ST depression.