What should not be used in hypertensive patients to minimize epinephrine exposure?

Epinephrine impregnated retraction cords are not advisable for use in hypertensive patients primarily because they can cause an increase in blood pressure due to the pharmacological effects of epinephrine. Epinephrine is a potent vasoconstrictor and sympathomimetic agent that can lead to elevated heart rate and blood pressure, exacerbating hypertension. In patients who are already hypertensive, exposure to additional epinephrine from these cords can lead to serious cardiovascular risks, including hypertensive emergencies.

In contrast, non-retention retraction cords, local anesthetics without vasoconstrictors, and intravenous sedatives can be more safely used because they either do not contain epinephrine or their effects on blood pressure are less significant. Non-retention retraction cords are generally safer alternatives for achieving tooth retraction without introducing excessive vasopressor exposure. Local anesthetics without vasoconstrictors do not carry the risks associated with increased blood pressure, and certain intravenous sedatives, depending on their properties, are also managed in a way that does not pose a risk for hypertensive patients.