Itamara Lucia Itagiba Neves

Effects of epinephrine in local dental anesthesia in patients with coronary artery disease

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 randomly 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.

Locoregional Anesthesia for Dental Treatment in Cardiac Patients: A Comparative Study of 2% Plain Lidocaine and 2% Lidocaine with Epinephrine (1:100,000)

OBJECTIVES This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine. METHODS This randomized 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.

Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.

Maternal-fetal monitoring during dental procedure in patients with heart valve disease

BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.FUNDAMENTO: Los efectos de la anestesia local en odontologia con lidocaina y epinefrina, sobre los parametros cardiovasculares de gestantes portadoras de valvulopatias y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parametros de la cardiotocografia, de la presion arterial y electrocardiograficos de la gestante portadora de enfermedad valvular reumatica, al someterse a anestesia local con 1,8 ml de lidocaina 2% sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontologico restaurador. METODOS: Realizamos monitoreo ambulatorio de la presion arterial, electrocardiografia ambulatoria materna y cardiotocografia de 31 portadoras de cardiopatia reumatica, entre la 28a y la 37a semana de gestacion, divididas en dos grupos segun la presencia o no del vasoconstrictor. RESULTADOS: Se observo reduccion significativa de los valores de frecuencia cardiaca materna en los dos grupos, durante el procedimiento, al compararlo con los demas periodos (p 0,05). Lo mismo ocurrio (p > 0,05) con el numero de contracciones uterinas, nivel de variabilidad de la linea de base y numero de aceleraciones de la frecuencia cardiaca fetal. CONCLUSION: El uso de 1,8 ml de lidocaina 2% asociado a la adrenalina se mostro seguro y eficaz en procedimiento odontologico restaurador durante la gestacion de mujeres con cardiopatia valvular reumatica.

Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar

BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.FUNDAMENTO: Los efectos de la anestesia local en odontologia con lidocaina y epinefrina, sobre los parametros cardiovasculares de gestantes portadoras de valvulopatias y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parametros de la cardiotocografia, de la presion arterial y electrocardiograficos de la gestante portadora de enfermedad valvular reumatica, al someterse a anestesia local con 1,8 ml de lidocaina 2% sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontologico restaurador. METODOS: Realizamos monitoreo ambulatorio de la presion arterial, electrocardiografia ambulatoria materna y cardiotocografia de 31 portadoras de cardiopatia reumatica, entre la 28a y la 37a semana de gestacion, divididas en dos grupos segun la presencia o no del vasoconstrictor. RESULTADOS: Se observo reduccion significativa de los valores de frecuencia cardiaca materna en los dos grupos, durante el procedimiento, al compararlo con los demas periodos (p 0,05). Lo mismo ocurrio (p > 0,05) con el numero de contracciones uterinas, nivel de variabilidad de la linea de base y numero de aceleraciones de la frecuencia cardiaca fetal. CONCLUSION: El uso de 1,8 ml de lidocaina 2% asociado a la adrenalina se mostro seguro y eficaz en procedimiento odontologico restaurador durante la gestacion de mujeres con cardiopatia valvular reumatica.

Peripheral oxygen saturation, heart rate, and blood pressure during dental treatment of children with cyanotic congenital heart disease

OBJECTIVES: In this observational study, we evaluated the peripheral oxygen saturation (SpO2), heart rate, and blood pressure of children with cyanotic congenital heart disease who were undergoing dental extraction. METHODS: Forty-four patients between the ages of 6 and 12 years who underwent upper primary tooth extraction were included in the study. Of these, 20 patients were in the cyanotic congenital heart disease group and 24 were in the control group. RESULTS: Peripheral oxygen saturation, heart rate, and systolic blood pressure in the cyanotic congenital heart disease group varied quite significantly during the treatment protocol (p<0.05), with values of 80.5% (±7.6) to 82.8% (±7.8), 95.3 beats per minute (bpm) (±11.3) to 101.3 bpm (±9.8), and 93.6 mm Hg (±13,3) to 103.8 mm Hg (±12.7), respectively. The variations in the control group during the procedure were also significant. CONCLUSIONS: The changes observed during the study protocol, although statistically significant, were mild and lacked clinical relevance. The results indicate that dental treatment of children with cyanotic heart disease using a standardized protocol in decentralized offices without the support of a surgical center is safe.

Periodontal disease in pregnant patients with rheumatic valvular disease: clinical and microbiological study

FUNDAMENTO: A doenca periodontal representa risco a gestante portadora de valvopatia reumatica, seja para contrair endocardite infecciosa, seja por propiciar complicacoes obstetricas. OBJETIVO: Estudar a frequencia da doenca periodontal em portadoras de valvopatia reumatica durante a gravidez. METODOS: Foram estudadas 140 gestantes, comparaveis quanto a idade e o nivel socioeconomico, divididas em: 70 portadoras de doenca valvar reumatica e 70 mulheres saudaveis. Todas se submeteram a: 1) avaliacao clinica odontologica que incluiu a analise dos seguintes parâmetros: 1.1) profundidade a sondagem, 1.2) distância da linha esmalte-cemento a margem gengival, 1.3) nivel clinico de insercao, 1.4) indice de sangramento, 1.5) indice de placa bacteriana, e, 1.6) comprometimento de furca; e, 2) exame microbiologico nas amostras de saliva e do cone que considerou o controle positivo para as cepas das bacterias Porphyromonas gingivalis, Tannerella forsithia e Aggregobacter actinomycetemcomitans. RESULTADOS: A lesao valvar mitral foi prevalente (65 casos = 92,8%) dentre as gestantes cardiopatas. A comparacao entre os grupos mostrou nao haver diferencas entre idade e a paridade, e embora tenham sido verificadas diferencas entre as medidas da distância da linha esmalte-cemento a margem gengival (p = 0,01) e o indice de placa (p=0,04), a frequencia da doenca periodontal identificada em 20 (14,3%) gestantes, nao foi diferente entre os grupos (p = 0,147). O exame microbiologico mostrou uma proporcao maior da bacteria P. gingivalis na saliva de gestantes saudaveis (p = 0,004). CONCLUSAO: O estudo clinico e microbiologico periodontal durante a gravidez demonstrou igual frequencia da doenca periodontal em portadoras de valvopatia reumatica quando comparada as mulheres saudaveis.BACKGROUND The periodontal disease during pregnancy of women with rheumatic valve disease imply infective endocarditis risks and higher rate of preterm birth and low birth weight. OBJECTIVE To study the periodontal disease rate of women with rheumatic valve disease during pregnancy. METHODS We studied 140 pregnant women who included 70 patients with rheumatic valve disease and 70 healthy women. The periodontal examination included: 1) periodontal clinical exam regard the follow variables: a) probing depth; b) gingival margin; c) clinical attachment level; d) bleeding on probing; e) plaque index and f) gingival index; and 2) microbiological test was performed in samples serum and gingival crevicular fluid and considered positive controls to Porphyromonas gingivalis, Tannerella forsithia e Aggregobacter actinomycetemcomitans. RESULTS Age and parity were similar between groups; as single or combined the mitral valve disease was prevalent among the rheumatic valve lesion in 45 (32.1%) e 20 (28.5%) cases, respectively. Among the periodontal variables gingival margin (p=0.01) and plaque index (p=0.04) were different between groups. The periodontal disease was identified in 20 (14,3%) pregnant women, seven (10%) of them were patients with valve rheumatic disease and the remain 13 (18,6%) were healthy women, its percentual was not different between groups (p=0,147). Microbiological analyses of oral samples showed higher percentual of P. gingivalis in healthy pregnant women (p=0.004). CONCLUSION The clinical and microbiological study during pregnancy showed comparable incidence of periodontal disease between women with rheumatic valve disease and healthy women.

Enfermedad periodontal en portadoras de valvopatía durante la gravidez: estudio clínico y microbiológico

FUNDAMENTO: A doenca periodontal representa risco a gestante portadora de valvopatia reumatica, seja para contrair endocardite infecciosa, seja por propiciar complicacoes obstetricas. OBJETIVO: Estudar a frequencia da doenca periodontal em portadoras de valvopatia reumatica durante a gravidez. METODOS: Foram estudadas 140 gestantes, comparaveis quanto a idade e o nivel socioeconomico, divididas em: 70 portadoras de doenca valvar reumatica e 70 mulheres saudaveis. Todas se submeteram a: 1) avaliacao clinica odontologica que incluiu a analise dos seguintes parâmetros: 1.1) profundidade a sondagem, 1.2) distância da linha esmalte-cemento a margem gengival, 1.3) nivel clinico de insercao, 1.4) indice de sangramento, 1.5) indice de placa bacteriana, e, 1.6) comprometimento de furca; e, 2) exame microbiologico nas amostras de saliva e do cone que considerou o controle positivo para as cepas das bacterias Porphyromonas gingivalis, Tannerella forsithia e Aggregobacter actinomycetemcomitans. RESULTADOS: A lesao valvar mitral foi prevalente (65 casos = 92,8%) dentre as gestantes cardiopatas. A comparacao entre os grupos mostrou nao haver diferencas entre idade e a paridade, e embora tenham sido verificadas diferencas entre as medidas da distância da linha esmalte-cemento a margem gengival (p = 0,01) e o indice de placa (p=0,04), a frequencia da doenca periodontal identificada em 20 (14,3%) gestantes, nao foi diferente entre os grupos (p = 0,147). O exame microbiologico mostrou uma proporcao maior da bacteria P. gingivalis na saliva de gestantes saudaveis (p = 0,004). CONCLUSAO: O estudo clinico e microbiologico periodontal durante a gravidez demonstrou igual frequencia da doenca periodontal em portadoras de valvopatia reumatica quando comparada as mulheres saudaveis.BACKGROUND The periodontal disease during pregnancy of women with rheumatic valve disease imply infective endocarditis risks and higher rate of preterm birth and low birth weight. OBJECTIVE To study the periodontal disease rate of women with rheumatic valve disease during pregnancy. METHODS We studied 140 pregnant women who included 70 patients with rheumatic valve disease and 70 healthy women. The periodontal examination included: 1) periodontal clinical exam regard the follow variables: a) probing depth; b) gingival margin; c) clinical attachment level; d) bleeding on probing; e) plaque index and f) gingival index; and 2) microbiological test was performed in samples serum and gingival crevicular fluid and considered positive controls to Porphyromonas gingivalis, Tannerella forsithia e Aggregobacter actinomycetemcomitans. RESULTS Age and parity were similar between groups; as single or combined the mitral valve disease was prevalent among the rheumatic valve lesion in 45 (32.1%) e 20 (28.5%) cases, respectively. Among the periodontal variables gingival margin (p=0.01) and plaque index (p=0.04) were different between groups. The periodontal disease was identified in 20 (14,3%) pregnant women, seven (10%) of them were patients with valve rheumatic disease and the remain 13 (18,6%) were healthy women, its percentual was not different between groups (p=0,147). Microbiological analyses of oral samples showed higher percentual of P. gingivalis in healthy pregnant women (p=0.004). CONCLUSION The clinical and microbiological study during pregnancy showed comparable incidence of periodontal disease between women with rheumatic valve disease and healthy women.

Monitoreo maternofetal durante procedimiento odontológico en portadora de cardiopatía valvular

BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.FUNDAMENTO: Los efectos de la anestesia local en odontologia con lidocaina y epinefrina, sobre los parametros cardiovasculares de gestantes portadoras de valvulopatias y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parametros de la cardiotocografia, de la presion arterial y electrocardiograficos de la gestante portadora de enfermedad valvular reumatica, al someterse a anestesia local con 1,8 ml de lidocaina 2% sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontologico restaurador. METODOS: Realizamos monitoreo ambulatorio de la presion arterial, electrocardiografia ambulatoria materna y cardiotocografia de 31 portadoras de cardiopatia reumatica, entre la 28a y la 37a semana de gestacion, divididas en dos grupos segun la presencia o no del vasoconstrictor. RESULTADOS: Se observo reduccion significativa de los valores de frecuencia cardiaca materna en los dos grupos, durante el procedimiento, al compararlo con los demas periodos (p 0,05). Lo mismo ocurrio (p > 0,05) con el numero de contracciones uterinas, nivel de variabilidad de la linea de base y numero de aceleraciones de la frecuencia cardiaca fetal. CONCLUSION: El uso de 1,8 ml de lidocaina 2% asociado a la adrenalina se mostro seguro y eficaz en procedimiento odontologico restaurador durante la gestacion de mujeres con cardiopatia valvular reumatica.