In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-30, Impac Fac o : 8.048
IJCSRR @ 2025
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Changes In Ca dio espi a o y Ra e and Blood P essu e Unde Local
Anes hesia in Hype ensi e and No mo ensi e Pa ien s Unde going O al
Su ge y and Res o a i e T ea men s: A Scoping Re iew
Ma ías Huichacu a Medina1, Diego Vásquez A a ena1, Joaquín U izola Gómez1,2, Ma io Gu ié ez Ace edo3,
Lo enzo Opazo Basau 2,4
1DDS, Uni e sidad San Sebas ián, Concepción, Chile
2O al and Maxillo acial Su geon, Uni e sidad San Sebas ián, Concepción, Chile, Associa e P o esso o O al and Maxillo acial
Su ge y
3Fo me Maxillo acial Su geon, Depa men o O ola yngology – Head and Neck Su ge y, D . Guille mo G an Bena en e
Hospi al, Concepción. Di ec o and Academic P og am in O al and Maxillo acial Su ge y and T auma ology
4O al and Maxillo acial Su geon, He minda Ma in Hospi al Se ice, Chillan
ABSTRACT
In oduc ion: Den al p ocedu es such as oo h ex ac ions can inc ease blood p essu e and hea a e, ep esen ing po en ial isks,
pa icula ly in pa ien s wi h sys emic diseases. These a ia ions may be in luenced by su gical echnique, local anes he ic ype,
asocons ic o use, and como bidi ies. Unde s anding hese hemodynamic esponses is essen ial o sa e clinical managemen .
Objec i e: To e alua e he impac o o al su ge y/ oo h ex ac ion unde local anes hesia on blood p essu e and hea a e in
hype ensi e and no mo ensi e pa ien s.
Me hodology: A Scoping Re iew was pe o med ollowing PRISMA-ScR guidelines. Da abases consul ed: PubMed,
ScienceDi ec , Wiley Lib a y, O al Su ge y–O al Medicine–O al Pa hology–O al Radiology, JOMS, and AJH Ox o d. The Boolean
s a egy used was: (“Hype ensi e pa ien s” AND “No mo ensi e pa ien s” AND “local anes hesia” AND “den al ea men ” AND
(“blood p essu e” OR “a e ial p essu e”) AND “hea a e”), limi ed o publica ions om 1980–2024. Rayyan so wa e assis ed
sc eening and s udy selec ion. Twen y- wo s udies we e iden i ied, and 173 addi ional e e ences we e e iewed; 13 me he
inclusion c i e ia.
Resul s: Too h ex ac ion and o al su ge y unde local anes hesia p oduce measu able ca dio ascula esponses. On a e age, sys olic
p essu e inc eases by 5.6 mmHg and dias olic p essu e by 4.7 mmHg, wi h g ea e ises in hype ensi e o diabe ic pa ien s (6.2
mmHg s. 4.8 mmHg). The use o epineph ine in local anes hesia ampli ies hese changes, ein o cing he need o cau ious dosing
and moni o ing.
Conclusion: O al su ge y and oo h ex ac ion may ele a e blood p essu e and hea a e, especially in pa ien s wi h como bidi ies.
Con inuous moni o ing and indi idualized anes he ic managemen a e essen ial o educe ca dio ascula isk. Fu u e s udies should
include la ge samples and me a-analyses ocusing on hemodynamic changes unde local anes hesia in hype ensi e pa ien s.
KEYWORDS: Blood P essu e, Den al Ca e, den al ea men , Hype ension, local anes hesia, O al Su ge y.
1. INTRODUCTION
O al su ge y ep esen s a c i ical ield in den al p ac ice, whe e pa ien sa e y is pa amoun , especially in hose wi h hype ensi e
condi ions. Al hough local anes hesia is ou inely used and conside ed sa e, i s adminis a ion can gene a e hemodynamic a ia ions
in pa ien s wi h ca dio ascula disease. Elad e al., demons a ed ha anes he ic solu ions con aining epineph ine can modi y blood
p essu e and hea a e and he e o e equi e cau ious adminis a ion in pa ien s wi h ca dio ascula his o y1. Simila ly, Tsuchihashi
e al., obse ed ha blood p essu e2 luc ua es du ing den al p ocedu es, which may comp omise hemodynamic s abili y3.
In addi ion, Ma sumu a e al., showed ha sys olic and dias olic p essu e ise du ing oo h ex ac ion unde local anes hesia,
especially in olde pa ien s, indica ing a sympa he ic au onomic esponse4. Likewise, Ma sumu a e al., epo ed ha he blood
p essu e inc ease du ing den al su ge y is mo e ela ed o ex ac ion di icul y and he amoun o anes he ic adminis e ed han o
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-30, Impac Fac o : 8.048
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baseline p essu e4. Ano he key con ibu ion is om Meille e al., who ound ha hype ensi e pa ien s unde going o al su ge y
expe ience blood p essu e luc ua ions like no mo ensi e pa ien s, showing no g ea e p ocedu al isk i p ope ly con olled3.
Mos no ably, Meye , demons a ed ha hype ensi e pa ien s ecei ing no epineph ine-con aining anes he ic solu ions exhibi he
g ea es blood p essu e ele a ion and e lex b adyca dia, ecommending ha no epineph ine (1:20,000–1:30,000) should no be
used in hype ensi e pa ien s5.
The e o e, unde s anding how local anes hesia in luences ca dio ascula physiology is essen ial o implemen clinical s a egies ha
minimize isks and imp o e su gical ou comes.
This Scoping e iew ocuses on analyzing changes in ca dio espi a o y a e and blood p essu e in hype ensi e and no mo ensi e
pa ien s unde going o al su ge y and es o a i e ea men s, seeking o iden i y pa e ns and ecommenda ions ha op imize den al
ca e in his isk g oup, especially in o al and maxillo acial su ge y.
Objec i e: To e alua e and analyze he impac o den al ex ac ions/o al su ge y on blood p essu e and hea a e.
2. MATERIALS AND METHODS
Compu e -assis ed comp ehensi e li e a u e sea ch (Rayyan), ollowing he PRISMA-ScR s a egy (P e e ed Repo ing I ems o
Sys ema ic e iews and Me a-Analyses ex ension o Scoping Re iews) wi h sea ch key ("Hype ensi e pa ien s"[All Fields] AND
"No mo ensi e pa ien s"[All Fields] AND "local anes hesia"[All Fields] AND "den al ea men "[All Fields] AND ("a e ial
p essu e"[All Fields] OR "blood p essu e"[All Fields]) AND "hea a e"[All Fields]) AND ("1980/01/01"[Da e]:
"2024/12/31"[Da e], associa i e p og amma ic boolean 'AND', 'OR', in da abases and jou nals PubMed, Science Di ec , Wiley
Lib a y, O al Su ge y-O al Medicine-O al Pa hology-O al Radiology, JOMS, AJH Ox o d, wi h speci ic pa ame e s o i s and
second s ep sc eening, de ined by he sc eening Ini ial, P ima y and Seconda y o il e ou any non-co esponding a icles, he
implemen a ion o he co esponding yea s was based on all a icles ound in he da abase o collec ALL he necessa y in o ma ion
om he li e a u e and e idence on he opic. (The choice o jou nals was by decision a he Qua ile le el ep esen ing he po en ial
ac o and su gical e idence, decision aken unanimously [Q1]).
Inclusion C i e ia: Pe iod 1980-2024, Spanish o English, [All Fields], human s udies, Associa ed wi h O al Su ge y, Jou nal.
Exclusion C i e ia: Ou side he Spanish-English language, ou side he es ablished pe iod, in i o s udies, animal s udies, g ey
li e a u e, duplica es, commen s, na a i e e iew, no ela ed o o al ca i y, books.
3. RESULTS
The esul s we e di ided wi h espec o he co esponding sc eens o he PRISMA s a emen ; 22 a icles we e ob ained om he
p ima y qua ile in he da abase sea ch engines, a e which he quan i a i e coun o he e e ences o he 7 a icles selec ed and
included was ca ied ou a e he p ima y sc een low diag am (Fig. 1), inding 173 e e ences in o al in he seconda y sc een (Fig.
2), o which only 13 we e selec ed h ough a p ima y sys ema ic il e sea ch and seconda y bibliog aphic e e ence and included in
his e iew.
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-30, Impac Fac o : 8.048
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Fig. 1. Flowcha o he s udy iden i ica ion and selec ion p ocess.
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-30, Impac Fac o : 8.048
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Fig. 2. Re e ence sea ch lowcha o seconda y selec ion
3.1 Compa ison o gene al da a om he 13 a icles
A compa a i e g aph and gene al da a on changes in blood p essu e, medica ion, como bidi ies and measu emen me hod o each
a icle was made o see wha le el o scale we will be subjec ed o d aw he necessa y conclusions and minimize biases (Tab. I).
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
DOI: 10.47191/ijcs /V8-i11-30, Impac Fac o : 8.048
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Tab. I. Compa ison and gene al da a on changes in blood p essu e, medica ion, como bidi ies and measu emen me hods
o each i em.
A icle Numbe o
Pa ien s
Inc ease in
sys olic blood
p essu e
(mmHg)
Inc ease in
dias olic blood
p essu e
(mmHg)
Medica ion
Como bidi ies
Measu emen
me hod
1 30
4.5
4.2
Yes
Diabe es
Pos ope a i e
2 70
4.7
5.0
No
Hype ension
Immedia e
3 45
6.5
4.6
Yes
Diabe es
Pos ope a i e
4 55
5.5
4.8
No
None
Immedia e
5 70
4.8
5.1
No
Hype ension
Immedia e
6 60
7.0
5.0
Yes
Hype ension
Pos ope a i e
7 60
6.1
4.7
No
Diabe es
Immedia e
8 40
5.3
4.6
Yes
Diabe es
Pos ope a i e
9 40
5.2
4.0
No
None
Immedia e
10 50
5.9
4.4
Yes
Hype ension
Pos ope a i e
11 55
6.0
4.8
No
None
Immedia e
12 65
5.2
4.9
Yes
None
Pos ope a i e
13 50
6.0
4.5
Yes
Hype ension,
Diabe es
Pos ope a i e
A a ic ligh cha (Fig. 3) was pe o med o assess he a e age le el o bias, which was accep able o he 13 a icles, as mos o
hem ell in o he low (0%-25%) o mode a e (25%-50%) anges in a leas ou o he i e ca ego ies assessed. Howe e , some
s udies had conside able bias in missing da a and measu emen (50%-75%), which may a ec he gene alizabili y o hei
conclusions. Despi e hese limi a ions, he e idence p o ided by he a icles appea s obus , being su icien o de i e easonable
conclusions on he opic. Calcula ing he a e age bias ac oss he 13 a icles, conside ing all ca ego ies, yields an o e all a e age
bias o 44%. This alue indica es ha he s udies ha e a mode a e le el o bias on a e age, which is easonable bu sugges s ha
some me hodological aspec s could be imp o ed in u u e s udies o educe he possibili y o bias.
In e na ional Jou nal o Cu en Science Resea ch and Re iew
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Fig. 3. T a ic Ligh Plo o Risk o Bias Assessmen
A compa a i e ba g aph (Fig. 4) was made o di e en s ipping and scaling p ocedu es compa ed o a daily es o a ion o obse e
he dias olic and sys olic changes in pa ien s unde going hese ea men s, i he sys olic blood p essu e ba shows an a e age change
o 5.8 mmHg. This change is ela i ely high compa ed o he o he p ocedu es, and he dias olic blood p essu e shows an a e age
change o 4.6 mmHg. This alue is also signi ican bu lowe compa ed o he sys olic p essu e.
Fig. 4. Compa a i e analysis o p ocedu es in he a e age change in blood p essu e.
Cla i ica ion: This g aph was made in Spanish by he p og amme "R", bu unde s andable o he in e p e a ion o
he speci ic poin s.
In e na ional Jou nal o Cu en Science Resea ch and Re iew
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3.2 Sys olic Blood P essu e, Hea Ra e, Body Tempe a u e and Pe iphe al Sa u a ion:
3.2.1 Sys olic Blood P essu e (I ems 1, 5, 8, 12, 13): In some i ems, sys olic blood p essu e inc eased signi ican ly du ing in asi e
den al p ocedu es such as oo h ex ac ion. Exac alues o change a e no a ailable in all s udies.
3.2.2 Hea Ra e (I ems 2, 6, 7, 9): An inc ease in hea a e was obse ed du ing oo h ex ac ion, wi h an a e age change o 17
bea s/min, based on da a om i ems 2 o 9.
3.2.3 Body Tempe a u e and Pe iphe al O2 Sa u a ion (I ems 3, 4, 10, 11): Scaling and es o a i e p ocedu es caused inc eases in
body empe a u e and pe iphe al oxygen sa u a ion.
A L’Abbé able (Fig. 5) was cons uc ed and used o e eal a gene al endency o inc eased espi a o y a e in hype ensi e pa ien s
when local anes hesia is applied du ing den al su gical p ocedu es, as demons a ed by mos s udies. This may be ela ed o he
ac i a ion o he sympa he ic ne ous sys em due o s ess o anxie y in hese pa ien s, exace ba ed by he hype ensi e condi ion
Fig. 5. L’Abbé. Respi a o y a e wi h local anes hesia s. wi hou anes hesia in hype ensi e pa ien s
Cla i ica ion: This g aph was made in Spanish by he p og amme "R", bu unde s andable o he in e p e a ion o
he speci ic poin s.
3.3 Hea a e and local anes he ics in a e ial hype ension:
The analysis o 13 s udies (Tab. II) e eals a consis en pa e n ega ding he ca dio ascula e ec s o local anes he ics in pa ien s
wi h a e ial hype ension. The mos equen ly used anes he ic was 2% lidocaine, bo h wi h and wi hou epineph ine (1:100,000).
When combined wi h epineph ine, a mild o mode a e inc ease in hea a e was commonly obse ed, hough gene ally con olled
and clinically manageable. In con as , o mula ions wi hou asocons ic o s, such as plain lidocaine, mepi acaine 3%, o p ilocaine
wi h elyp essin, we e o en p e e ed o pa ien s wi h mode a e o se e e hype ension due o hei educed ca dio ascula impac .
In e es ingly, p ilocaine wi h elyp essin showed less impac on hea a e compa ed o epineph ine-con aining solu ions, sugges ing
a sa e p o ile o hype ensi e indi iduals. Simila ly, mepi acaine wi hou asocons ic o was epea edly indica ed o a oid
ca dio ascula complica ions.
These indings highligh he impo ance o anes he ic selec ion in hype ensi e pa ien s. While epineph inecon aining anes he ics
a e gene ally sa e when ca e ully adminis e ed, clinicians o en op o asocons ic o - ee o mula ions o minimize ca dio ascula
s ess, especially in pa ien s wi h uncon olled o se e e hype ension.
In e na ional Jou nal o Cu en Science Resea ch and Re iew
ISSN: 2581-8341
Volume 08 Issue 11 No embe 2025
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Tab. II. Types o anes hesia used o he s udies o he 13 a icles s udied
A icle
Anes he ic used
Vasocons ic o
Obse a ions
1
2% Lidocaine
Epineph ine 1:100,000
No signi ican changes in blood
p essu e we e obse ed.
2
2% Lidocaine
Epineph ine 1:100,000
Con olled changes in hea a e in
hype ensi e pa ien s
3
3% Mepi acaine
Wi hou asocons ic o
Indica ed o p e en ca dio ascula
complica ions in hype ensi e
pa ien s.
4
2% Lidocaine
Wi hou asocons ic o
I is used o minimize ca dio ascula
e ec s in
hype ensi e pa ien s.
5
2% Lidocaine
Epineph ine 1:100,000
Mode a e changes in hea a e, bu
unde con ol
6
4% A icaine
Epineph ine 1:100,000
Mild inc ease in hea a e in
complex p ocedu es
7
2% Lidocaine
Wi hou asocons ic o
P e e ed o educing
ca dio ascula isk in hype ensi e
pa ien s.
8
2% Lidocaine
Epineph ine 1:100,000
Mino bu con olled
ca dio ascula e ec s we e
obse ed.
9 2% Lidocaine
Wi hou asocons ic o
I is used o p e en ca dio ascula
e ec s in pa ien s wi h se e e
hype ension.
10 2% Lidocaine
Epineph ine 1:100,000
The e a e no signi ican changes in
blood p essu e.
11 4% A icaine
Epineph ine 1:100,000
Recommenda ion o ca e ul
adminis a ion in hype ensi e
pa ien s
12 3% P ilocaine
Felyp essin
Less impac on he ca dio ascula
sys em in pa ien s wi h mode a e
hype ension
13 2% Lidocaine
Epineph ine 1:100,000
Mild inc ease in hea a e in
hype ensi e pa ien s
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4. DISCUSSION
This scoping e iew shows ha o al su ge y and es o a i e p ocedu es unde local anes hesia consis en ly p oduce ca dio ascula
changes, mainly inc eases in blood p essu e and hea a e. These a ia ions occu ega dless o whe he pa ien s a e hype ensi e
o no mo ensi e, al hough hype ensi e pa ien s show a g ea e magni ude o esponse. Se e al s udies demons a ed ha in asi e
den al p ocedu es ac i a e he sympa he ic ne ous sys em and inc ease blood p essu e and pulse. Ma sumu a e al. showed ha
bo h sys olic and dias olic p essu e ise signi ican ly du ing oo h ex ac ion, pa icula ly in middle-aged o olde adul s, sugges ing
age-dependen au onomic hype eac i i y6. Simila ly, Ma sumu a e al. con i med ha inc eases in blood p essu e a e associa ed
wi h he di icul y o ex ac ion and he olume o anes he ic, a he han baseline blood p essu e4,6.
Rega ding hea a e changes, Nicolosi e al. obse ed an inc ease du ing den al p ocedu es in hype ensi e pa ien s unde going
local anes hesia in A gen ina7, while Salma e al. demons a ed ha e en es o a i e and scaling p ocedu es can p oduce measu able
ca dio espi a o y changes, including inc eased oxygen sa u a ion due o anxie y-induced hype en ila ion8.
The ype o local anes he ic in luences ca dio ascula esponse. Elad e al. compa ed lidocaine s. a icaine wi h di e en
concen a ions o epineph ine in ca diac-comp omised pa ien s and ound no clinically signi ican ad e se e ec s, suppo ing he
sa e use o epineph ine in con olled doses1. Bade e al. also concluded ha epineph ine is sa e in hype ensi e den al pa ien s when
medically con olled9. In con as , Meye showed ha no epineph ine causes he g ea es ise in blood p essu e and e lex
b adyca dia, ecommending ha no epineph ine NOT be used in hype ensi e pa ien s5.
Compa ing anes he ic o mula ions, Niwa e al. demons a ed ha e en low epineph ine concen a ions can igge ca dio ascula
esponses in ca diac pa ien s10. In ano he s udy, Pa amaes a an & Kingon epo ed ha ex ac ion wi hou asocons ic o educed
hese luc ua ions11. Miu a e al. ound ha den al su ge y supp esses ca diac sympa he ic ac i i y in hype ensi e pa ien s, possibly
as a e lex au onomic modula ion12.
Two ea ly s udies, Meille e al., and Alemany-Ma ínez e al., epo ed ha blood p essu e luc ua ions in con olled hype ensi e
pa ien s a e no signi ican ly g ea e han in no mo ensi e indi iduals, indica ing ha hype ension alone does no necessa ily
inc ease p ocedu al isk when anes hesia is managed p ope ly3,13.
5. CONCLUSION
I is e ealed ha he e is an a e age inc ease o 5.6 mmHg in sys olic blood p essu e (SBP) and 4.7 mmHg in dias olic blood
p essu e (DBP) in ou ine o al su gical p ocedu es. The a iabili y in hese inc eases is due o ac o s such as managemen p o ocols
and indi idual pa ien cha ac e is ics, being mo e signi ican in hose wi h como bidi ies such as hype ension and diabe es. In
addi ion, pa ien s no ecei ing an ihype ensi e ea men p esen g ea e inc eases in BP. Mo e complex p ocedu es, such as
mul iple ex ac ions, also gene a e a g ea e inc ease in BP. In gene al, he impo ance o moni o ing BP and adjus ing p e- and
pos ope a i e managemen s a egies o mi iga e isks and imp o e clinical ou comes in hese pa ien s is highligh ed based on he
choice o local anes he ic and mul imo bidi y, whe he in no mo ensi e o unc ionally hype ensi e pa ien s
6. ACKNOWLEDGEMENTS
We since ely hank he co-au ho s o hei ongoing suppo as e iewe s and he collabo a o s o hei aluable con ibu ions,
especially he “R” p og amme , who is independen o he s udy and has no con lic s o in e es .
We also hank he g adua e o Telecommunica ions Enginee ing om he Facul y o Enginee ing a he Uni e si y o Concepción
o c ea ing and e ining he g aphics included in his wo k, using R 4.4.1 so wa e.
7. CONFLICT OF INTEREST
The au ho s decla e no con lic s o in e es ela ed o he de elopmen , analysis, o publica ion o his manusc ip . No ins i u ion,
company, o comme cial en i y in luenced he s udy design, da a collec ion, da a in e p e a ion, o manusc ip p epa a ion.
8. FUNDING
This s udy ecei ed no ex e nal inancial suppo om public o p i a e o ganiza ions. The esea ch was ca ied ou independen ly
by he au ho s.
