Evidence map›Paper›PMID 34266837›Full record

SynthesisBMJ open2021

Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis.

Caio Chaves Guimaraes, Luciane Cruz Lopes, Cristiane de Cássia Bergamaschi, Juliana Cama Ramacciato, Marcus Tolentino Silva, Jimmy de Oliveira Araújo, Natalia Karol de Andrade, Rogério Heládio Lopes Motta

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Caio Chaves GuimaraesFaculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil drcaio_cg@hotmail.com.ORCID 0000-0002-1672-528X
Luciane Cruz LopesDepartment of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil.ORCID 0000-0002-3684-3275
Cristiane de Cássia BergamaschiDepartment of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil.ORCID 0000-0002-6608-1806
Juliana Cama RamacciatoDivision of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil.
Marcus Tolentino SilvaDepartment of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil.ORCID 0000-0002-7186-9075
Jimmy de Oliveira AraújoFaculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil.
Natalia Karol de AndradeFaculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil.
Rogério Heládio Lopes MottaDivision of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil.ORCID 0000-0002-6983-7883

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThere is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD.

designSystematic review and meta-analysis.

methodsWe have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

resultsTen RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference -0.95, 95% CI -1.35 to -0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile.

conclusionsThe results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results. PROTOCOL REGISTRATION: PROSPERO (CRD42016045421).

Indexed as

Cardiovascular DiseasesMyocardial InfarctionAdultAnesthesia, LocalAnesthetics, LocalHumansVasoconstrictor AgentsAnesthetics, LocalVasoconstrictor Agentsadult anaesthesiaanaesthesia in cardiologyoral & maxillofacial surgeryoral medicine

Identifiers

PMID34266837
PMCPMC8286772

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.