Pre- and postoperative monitoring is required, since increased blood pressure can result in a greater risk of postoperative bleeding. It should be noted that the patient taking antihypertensive drugs may be susceptible to hypertension when undergoing general anaesthesia.
Patients suffering from recent infarctions, i.e. within the previous 6 months, should not have surgery. Patients with coronary artery disease and angina require careful monitoring of the amount of lignocaine and adrenaline administered. Glyceryl trinitrate tablets or sublingual spray should be readily available when undertaking the surgery in the case of patients with angina.
As with all intra-oral surgical procedures, antibiotic cover will be necessary for patients who have:
• heart valve lesions;
• septal defects or a patent ductus arteriosus;
• prosthetic heart valves;
• a history of bacterial endocarditis.
No long-term studies have been reported on the relative risks of placing implants in patients with these conditions. A careful decision has to be made as to the risk-benefit ratio. There must be a very good reason why an implant is placed in these cases over any of the alternative treatment options for filling the space. Therefore, the patient should be fully aware of all the alternatives and the potential dangers of infective endocarditis in the placement of implants.
Anticoagulant therapy may result in extended pre-and postoperative bleeding, as well as postoperative haematomas. For patients taking either heparin or warfarin following a thrombosis or cardiac surgery, the INR (international normal ratio) should be determined in the period immediately preceding surgery and be within a therapeutic range of 2.0-4.0. It should be less than 2.5 for safe surgery.
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