Use of Epinephrine

Clinical studies on local anesthetics containing epinephrine have consistently shown negligible influences on blood pressure in hypertensive patients.

Numerous studies in young healthy patients with no known history of cardiovascular disease show that injection of local anesthetic with epinephrine is associated with an increased plama epinephrine level (almost double), but no corresponding significant hemodynamic effect.

Epinephrine is included in the anesthetic solution to delay systemic absorption and increase the duration and profoundness of the local anesthesia.  The preponderance of data in regard to epinephrine-containing local anesthetics shows that blood pressure and heart rate are minimally affected by the typically low doses of the drug used in dentistry.

Furthermore, the exogenous epinephrine contained in anesthetic solution may actually help prevent the release of excessive endogenous epinephrine. Less-than-profound anesthesia has been associated with increased release of endogenous epinephrine.  

Many physicians are unfamiliar with many aspects of dentistry, including how much epinephrine is commonly used during dental procedures. It is important when consulting with a patient's physician that you state the concentration of epinephrine and the total amount of epinephrine that you plan on using. For example:  I will use no more than 4.0 mL of 2% lidocaine with 1:100,000 epinephrine for a total of 0.04 mg.