Pharmacology

Adrenaline in LA for cardiac patients

How much vasoconstrictor is safe in heart disease.

Benefits (deeper, longer anaesthesia, less stress-induced adrenaline) usually outweigh risks.
Significant cardiovascular disease: limit to 0.04 mg adrenaline per visit ≈ 2 cartridges of 1:80,000 (2.2 mL) or 2 cartridges of 1:100,000 (1.8 mL).
Aspirate and inject slowly.
Interactions: non-selective β-blockers (propranolol) — risk of hypertension with reflex bradycardia; tricyclic antidepressants — use lower doses.
Defer elective care in uncontrolled hypertension (see Hypertension topic).

Sources

Checked against these sources on 2026-10-22. Guidelines change — open the source to confirm.

Summarised from the sources above. Always verify against current local guidelines and the patient's medical history.