Patients With Low Cardiac Output Syndrome Undergoing Local Dental Anesthesia

Inclusion Criteria: * Patients with advanced heart failure, in INTERMACS III using dobutamine at 5 to 20 µg/kg/minute due to low cardiac output syndrome * Presence of periodontal disease, in the 4th or 6th sextant with indication of supragingival and/or subgingival periodontal scaling; * Residual root or teeth with periodontal disease in the jaw, with simple extraction indicated. Exclusion Criteria: * Patients with a ventricular assist device such as an intra-aortic balloon implanted less than 24 hours after the dental procedure or with extracorporeal membrane oxygenation (ECMO); * Using other inotropes; * On mechanical ventilation; * Continuously using a non-invasive ventilation mask; * In septic shock; * Presence of acute myocardial infarction \<30 days; * Patients with terminal non-cardiac disease, cyanotic congenital heart disease or cardiomyopathies with arrhythmogenic potential (arrhythmogenic dysplasia, hypertrophic cardiomyopathy, non-compacted myocardium); * Pregnant women; * History of sudden death recovered \< 1 month ago; * In the recent postoperative period of cardiac surgery (5 days); * Allergic to sodium bisulfite and methylparaben, preservatives of epinephrine and the anesthetic cartridge, respectively.