Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.

Citations

Citations to this article as recorded by  

• Expert consensus on apical microsurgery
  Hanguo Wang, Xin Xu, Zhuan Bian, Jingping Liang, Zhi Chen, Benxiang Hou, Lihong Qiu, Wenxia Chen, Xi Wei, Kaijin Hu, Qintao Wang, Zuhua Wang, Jiyao Li, Dingming Huang, Xiaoyan Wang, Zhengwei Huang, Liuyan Meng, Chen Zhang, Fangfang Xie, Di Yang, Jinhua Yu
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Effects of nasal desmopressin spray versus topical epinephrine on surgical field clarity and hemodynamics in endonasal dacryocystorhinostomy: a randomized clinical study
  Mohamed G.M. El Sayed, Marwa M. Medhat, Dina A.E. Salem, Marwa A.M. Khedr, Alshaimaa A.F. Kamel
  Research and Opinion in Anesthesia & Intensive Care.2024; 11(1): 1.     CrossRef
• Is 1:1000 adrenaline as a topical haemostat an effective alternative to control bleeding in dentistry and oral surgery?
  Raj D. Aslam, Jonathan Liew, Eleni Besi
  British Dental Journal.2023; 235(1): 29.     CrossRef
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  Young Hyun Koo, Geun Joo Choi, Hyun Kang, Yong Hun Jung, Young Cheol Woo, Young-Jun Choi, Chong Wha Baek
  Journal of Personalized Medicine.2022; 12(3): 416.     CrossRef
• Hemostatic agents in periapical surgery: The systematic review
  Z. S. Khabadze, D. A. Nazarova, E. S. Shilyaeva, A. P. Kotelnikova, Yu. A. Bakayev, S. M. Abdulkerimova, Kh. O. Omarova
  Endodontics Today.2021; 19(3): 184.     CrossRef
• THE EFFECT OF ADRENALINE ON DYNAMICS OF CARBOHYDRATE METABOLISM INDICES IN RATS
  S. Shkurashivska, H. Ersteniuk
  Visnyk of Lviv University. Biological series.2017; (75): 151.     CrossRef
• The Correlation between the Blood Sugar and Allergy of the Trauma Patient
  Jeong Soo Lee, Sung Hee Hyun, Ji-Sook Lee, In Sik Kim
  Korean Journal of Clinical Laboratory Science.2014; 46(1): 22.     CrossRef
• Biologic response of local hemostatic agents used in endodontic microsurgery
  Youngjune Jang, Hyeon Kim, Byoung-Duck Roh, Euiseong Kim
  Restorative Dentistry & Endodontics.2014; 39(2): 79.     CrossRef