Monitoring blood pressure during extraction

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This topic contains 5 replies, has 2 voices, and was last updated by  Dr. Jay Reznick Sat Aug 24, 2019 03:59 pm.

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  • #3974

    Firas Dabsie
    Participant

    The patient is having an extraction under local anesthesia. His blood pressure is monitored.

    At the beginning of the procedure his blood pressure is acceptable (160/90) but during the extraction his blood pressure rises, he got less than 2 cartridges of Lidocaine 2%, 1:100 000 epinephrine. The blood pressure rise occurred 10-15 min later, is this stress related ?

    My question is : what is considered normal rise in blood pressure during extractions and what is the limit and when should I stop the procedure ?

    Thank you for the great videos Dr Reznick.

    Firas

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  • #3975

    Dr. Jay Reznick
    Keymaster

    How high did his BP go? Was it mostly an increase in diastolic? Or syst/diast? How old is the patient? What other medical issues does he have? Those are all important to know.

    #3976

    Firas Dabsie
    Participant

    Patient age is around 70 years old. He had a prosthetic valve placed very long time ago (more than 10 years). Takes Coumadin.
    Blood pressure rise was more on the systolic, reached around 195.

    Thank you.

    #3977

    Dr. Jay Reznick
    Keymaster

    Systolic BP can increase due to stress or pain, and will reduce when those factors are removed. Systolic of 195 is never “normal” and should be taken seriously in a patient with cardiac issues. If patient came in in pain, had swelling or other signs of acute infection, the procedure was fairly straightforward and could be completed in a matter of minutes, the patient was numb, and exhibited no signs or symptoms of distress (tachycardia, bradycardia, anxiety, rapid breathing, etc.), then I would say getting the tooth out is the thing to do.
    If this was an elective procedure, and the BP got up to, let’s say 190/95, it would be most prudent to refer the patient to his internist/cardiologist for evaluation. If he was on BP meds, then perhaps they were becoming less effective. If he was not on meds, and had a starting BP of 160/90, the he needs to be on them.
    If his baseline BP was 160/90, that’s actually a little high. If he was not in pain or infected, he has time to see his MD to get his BP under better control before you take on an elective procedure. I’m a little more lenient when there is pain/infection, as removing the offending tooth will frequently result in a reduction of the BP.

    #3978

    Firas Dabsie
    Participant

    The patient was in pain when presented, vertical crack of 47, some swelling.

    During the procedure he didn’t show any signs of distress, but I noticed that he was very stressed when I was using the cowhorn forceps, I asked him many times if he was feeling any pain and he said no. The root fractured but it didn’t take that long to remove.

    At the end of the procedure his blood pressure returned to starting values.

    I will refer the patient to his physician.
    Thank you Dr Reznick for the detailed replies.

    #3979

    Dr. Jay Reznick
    Keymaster

    Sounds like all went well.

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