***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To document safety for use , through recording changes in blood pressure and pulse rate , after administering 3.6 ml of a 2 % lignocaine with 1:100,000 epinephrine dental local anaesthetic in a group of hypertensive patients . METHODOLOGY The present study was conducted at Shaikh Zayed Medical Complex , Lahore , from May to December 2008 , using a convenience sampling technique . The first 60 walk-in patients in the dental outpatient department planned for tooth extraction were enrolled in the study . Out of these 60 patients , 10 had pre-hypertension ( BP = 130/90 ) , 10 had stage 1 hypertension ( BP = 140 - 159/90 - 99 ) and 10 study subjects were suffering from stage 2 hypertension ( BP = 160 - 179/100 - 109 ) . Thirty age and sex matched normo-tensive patients requiring tooth extraction acted as the control group . All patients were administered two cartridges each of 1.8 ml of dental local anaesthesia containing 2 % Lignocaine with 1:100,000 epinephrine .  Blood pressure and pulse rate ( PR ) were the risk indicators that were measured thrice ; pre-injection , 2 minutes and 5 minutes after injection . RESULTS A decrease in systolic in stage 2 hypertension patients after 2 and 5 minutes of injections was noted . The diastolic BP ( DBP ) fell in all the groups after injections . Mean pulse rate increased from three to four beats per minute in all groups except in stage 2 hypertension patients where it slightly decreased . CONCLUSION Epinephrine containing dental local anaesthesia decreased systolic blood pressure in stage 2 hypertension patients included in this study . There was an observed decrease of 21 mm Hg in systolic blood pressure hypertension patients but with no adverse effects OBJECTIVE To evaluate the efficacy and safety of the vasoconstrictor used in local anesthesia during dental extraction in controlled hypertensive patients . STUDY DESIGN A prospect i ve observational study was carried out in hypertensive patients ( n=97 ) with a mean age of 60.45±9.60 years . The following parameters were monitored at three different timepoints ( before the procedure , 3 minutes after local anesthesia infiltration , and 3 minutes after the operation ) : blood pressure ( diastolic and systolic ) , heart rate , and oxygen saturation .  Anesthesia ( 1 - 3 carpules ) was provided in the form of articaine with 4 % epinephrine as vasoconstrictor in one group , while another group received 3 % mepivacaine without vasoconstrictor . RESULTS All patients presented primary hypertension ( n=97 ) ( grade I in 57.7 % of the cases and grade II in 42.3 % ) . The most widely used antihypertensive drugs were angiotensin II receptor antagonists ( ARA II ) . The only significant differences observed corresponded to systolic blood pressure measured before and after dental extraction in the group of hypertensive patients anesthetized with vasoconstrictor . CONCLUSIONS In procedures such as dental extraction , no significant hemodynamic changes in well controlled hypertensive patients are seen attributable to anesthetic use with a vasoconstrictor , when fewer than three local anesthetic carpules are administered OBJECTIVE This study was conducted to determine the changes in blood pressure and the pulse rate of patients with controlled hypertension having dental extraction under local anaesthesia utilizing 2 % lignocaine with adrenaline  , and to evaluate whether these changes in blood pressure were are attributable to addition of adrenaline . METHODS This prospect i ve study was carried out in 33 consecutive hypertensive patients who presented at the exodontia clinic of the Department of Oral and Maxillofacial Surgery , Lagos University Teaching Hospital ( LUTH ) , Idi-Araba , Lagos , from December 2004 to August 2005 for intra-alveolar tooth extraction . Patients were r and omly allocated to two groups according to the type of anaesthetic solution employed . Group A had tooth extraction done under 2 % lignocaine with 1:80 000 adrenaline while group B had tooth extraction done under 2 % lignocaine without vasoconstrictor ( plain lignocaine ) . One tooth was extracted from each patient . Blood pressure and pulse rate measurements were recorded in the waiting room before surgery , in the surgery after local anaesthetic injection , during tooth extraction and 15 minutes after tooth extraction . RESULTS The sample consisted of 20 females and 13 males age range 24 to 75 years ( mean + /- SD = 50.1 + /- 11.7 years ) . There was no statistically significant difference between the systolic and diastolic blood pressure and pulse rate in the two groups after administration of local anaesthesia . However the highest alteration in parameters was observed during tooth extraction in the two groups . CONCLUSION The haemodynamic changes induced by injecting 2 % lignocaine with adrenaline in patients with controlled hypertension during tooth extraction is within normal range and is not different from that induced by 2 % lignocaine without adrenaline . We consider it essential that all pre caution s to prevent inadvertent intravascular injection be undertaken by the care provider OBJECTIVES This study compared cardiovascular safety profiles of 2 local anesthetics ( LA ) : articaine ( Ubistesine ) versus st and ard lidocaine solution in cardiovascular patients . STUDY DESIGN Fifty cardiovascular patients were r and omly assigned to dental treatment using 1.8 mL of one of two LA injections : articaine 4 % and adrenalin 1:200,000 or lidocaine 2 % and adrenalin 1:100,000 . A computerized system enabled continuous longitudinal data collection : electrocardiography ( ECG ) , O(2)-saturation , blood pressure ( BP ) , and heart rate ( HR ) . Patients scored pain level at the end of the LA injection ( on a 0 to 10 scale ) . RESULTS There were no clinical severe adverse effects . One transient local parasthesia occurred ( lidocaine group ) , which lasted 4 weeks . There were no statistically significant differences between the 2 groups in HR , systolic or diastolic-BP , and O(2 ) saturation . Age , gender , jaw treated , treatment duration , and the pain level did not influence the results of the comparison . In 3 patients asymptomatic ischemic changes were noted on ECG ( 1 in the lidocaine group and 2 in the articaine group ) . CONCLUSIONS LA with articaine 4 % with adrenalin 1:200,000 was comparably as safe as LA with st and ard concentrations of lidocaine and adrenalin in cardiovascular patients .  Cardiac ischemic changes on ECG did not appear to be related to the LA BACKGROUND The use of vasoconstrictors for local anesthesia in patients with coronary heart disease is controversial in the literature , and there is concern regarding risk of cardiac decompensation . OBJECTIVE To evaluate electrocardiographic and blood pressure parameters during restorative dental procedure under local anesthesia with and without a vasoconstrictor in patients with coronary artery disease . METHODS Sixty-two patients were included in the study , ages ranging from 39 to 80 ( mean 58.7 + /- 8.8 ) , 51 ( 83.2 % ) of whom were male . Thirty patients were r and omly assigned to receive 2 % lidocaine with epinephrine ( epinephrine group ) , and the remaining patients , 2 % lidocaine without epinephrine ( non-epinephrine group ) for local anesthesia . All patients underwent 24-hour ambulatory blood pressure monitoring and dynamic electrocardiography . Three periods were considered in the study : 1 ) baseline -- recordings obtained during the 60 minutes prior to the procedure ; 2 ) procedure -- recordings obtained from the beginning of anesthesia to the end of the procedure and 3 ) 24 hours . RESULTS There was an increase in blood pressure in both groups during the procedure , compared with baseline values ; but when the two groups were compared no significant difference was detected between them . Heart rate remained unchanged in both groups . No ST-segment depression > 1 mm occurred either at baseline or during the procedure . Seven patients ( 12.5 % ) experienced more than ten arrhythmia episodes per hour during the procedure , four ( 13.8 % ) in the non-epinephrine group and three ( 11.1 % ) in the epinephrine group . CONCLUSION No difference was observed in blood pressure , heart rate , or evidence of ischemia and arrhythmias in either group . The use of vasoconstrictor has proved to be safe within the range of the present study Hypertensive patients are an important group in dental treatment . In a prospect ively r and omised study the influence of 4 ml lidocaine 2 % plain or with epinephrine 1:100,000 or norepinephrine 1:20,000 on heart rate and blood pressure before , during and after a small surgical intervention ( tooth extraction ) was investigated in a normotensive ( n = 39 ) and a hypertensive group ( n = 36 ) . In both groups the changes of blood pressure and heart rate were nearly similar . The most remarkable alteration ( rise in blood pressure , lowering of heart rate ) was caused by norepinephrine . The vasoactive concentration of norepinephrine 1:20,000 - 1:30,000 as a component of local anesthetic preparations is contraindicated in hypertensive patients OBJECTIVES This study analyzes hemodynamic changes in patients with cardiac valvular diseases su bmi tted to dental treatment under local anesthesia containing epinephrine . METHODS This r and omized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo ( Brazil ) . Patients were separated into two groups with the help of an aleatory number table : 2 % plain lidocaine ( PL , n= 31 ) and 2 % lidocaine with epinephrine ( 1:100,000 ) ( LE , n= 28 ) . Blood pressure , heart rate , oxygenation and electrocardiogram data were all recorded throughout the procedure . State and trait anxiety levels were measured . RESULTS Fifty-nine patients were selected for the LE group ( n=28 ) , with an average age of 40.3 ± 10.9 , or for the PL group ( n=31 ) , age 42.2 ± 10.3 . No differences were shown in blood pressure , heart rate and pulse oximetry values before , during and after local anesthesia injection between the two groups . State and trait anxiety levels were not different . Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment . Complaints of pain during the dental procedure were more frequent within the PL group , which received a higher amount of local anesthesia . CONCLUSION Lidocaine with epinephrine ( 1:100,000 ) provided effective local anesthesia . This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases Nine stable cardiovascular disease patients were evaluated in a double-blind cross-over trial during periodontal surgery  using 2 % lidocaine with epinephrine 1:100,000 or lidocaine alone . In the lidocaine with epinephrine group ,  epinephrine levels increased from 198 + /- 54 pg/ml to 592 + /- 166 pg/ml at 2 minutes post-injection . In the lidocaine alone group , epinephrine levels increased from a baseline of 115 + /- 34 pg/ml to 150 + /- 34 pg/ml at 2 minutes post-injection . Despite these elevations in epinephrine , no significant changes in heart rate or mean arterial pressure were noted . Plain lidocaine provided unsatisfactory levels of hemostasis and /or anesthesia during periodontal surgery . This study documents acute elevations in plasma epinephrine levels following local dental anesthesia for periodontal surgery . These elevations in plasma epinephrine failed to produce a significant cardiovascular response in a group of stable cardiovascular disease patients . This suggests that the cardiac effects of local anesthetics containing epinephrine are small and that they can be safely used in stable cardiovascular disease patients As part of a large pragmatic study , the authors investigated heart rate , blood pressure , dysrhythmic and ischemic responses to lidocaine 2 % with a combination vasoconstrictor ( noradrenaline 1:50,000 and vasopressin 0.25 IU/mL ) , and midazolam sedation in a medically compromised population . There were anesthesia-induced physiological changes to both hemodynamics and the electrocardiogram . The use of midazolam significantly ameliorated the sympathoadrenal response to stress , and the greatest hemodynamic and electrocardiographic changes were observed during surgery 
    Output:
    
The most frequent complications in cardiovascular compromised patients after dental local anaesthesia with a vasoconstrictor agent were disclosed in ECG arrhythmias .
Most of these disclosed arrhythmias were clinical ly insignificant .
The use of ≤ 4 ampules of lignocaine with epinephrine 1:100000 as a dental anaesthetic seems to be relatively safe for cardiovascular compromised patients