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Adrenaline Cardiac Patient — MFDS Part 1 MCQ

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ModeratePharmacologyAdrenaline Cardiac PatientMFDS Part 1

A 62-year-old patient with stable, medically controlled coronary artery disease requires a dental extraction. There are no symptoms of unstable angina or decompensated heart failure, and the medication review identifies no interaction requiring a further restriction. If 2% lidocaine with adrenaline 1:80,000 is required, which precautionary limit is most appropriate in primary dental care?

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Correct answer: D — Limit administration to two cartridges, using careful aspiration and slow incremental injection

The best answer is D. Low-dose adrenaline can be used cautiously when cardiovascular disease is stable and medically controlled. Evidence in patients with controlled hypertension or coronary disease supports limiting treatment to one or two adrenaline-containing cartridges. For lidocaine with adrenaline 1:80,000, two common UK cartridge volumes provide approximately 45–55 micrograms. Use an aspirating syringe and inject slowly and incrementally to reduce inadvertent intravascular administration. Complete avoidance may produce inadequate anaesthesia, increasing pain and endogenous catecholamine release. Ten cartridges or an unrestricted dose would create unnecessary cardiovascular and local-anaesthetic exposure, while half a cartridge is not an evidence-based universal limit and may provide inadequate anaesthesia. Unstable or decompensated cardiovascular disease requires separate assessment and cannot be managed using this routine precaution alone.

Reference: Seminario-Amez M et al. Use of local anesthetics with a vasoconstrictor agent during dental treatment in hypertensive and coronary disease patients: a systematic review. Journal of Evidence-Based Dental Practice. 2021;21:101569. https://pubmed.ncbi.nlm.nih.gov/34391560/