Cardiovascular changes in hypertensive patients undergoing dental treatment under local anesthesia with vasoconstrictors / Avaliação de parametros cardiovasculares em pacientes hipertensos submetidos a tratamento odontologico sob anestesia local com vasoconstritor

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

This double-blind crossover study evaluated cardiovascular parameters of twenty hypertensive patients under periodontal treatment with 3.6 ml of 2% lidocaine with 1:100,000 epinephrine or 3% prilocaine with 0.03UI/ml felypressin. Heart rate (HR), systolic (SBP), and diastolic (DBP) arterial blood pressures were recorded before, during and after the dental treatment by a noninvasive ambulatory blood pressure device (NABPD) and the incidence of cardiac arrhythmias, ST segment depression and elevation were recorded on a continuous Holter monitoring system for 24 hours in the sessions: Basal - the patients were connected to a Holter monitor for 24 hours; Simulation: they were connected to a NABPD for 5 hours and to a Holter monitor for 24 hours; Epinephrine and Felypressin sessions: the monitorization was similar to Simulation session and the subjects received periodontal tteatment after inf1lttation anesthesia with one of the anesthetic solutions each session, at random. The means obtained with NABPD were compared among seven periods of each session: 1- before dental treatment; 2- 10min before anesthesia; 3- 5min after anesthesia; 4- between 5 and 10min after anesthesia; 5- between 10 and 15min after anesthesia; 6- the last 35min of dental treatment and 7- 2h after dental treatment. The means of each electrocardiographic change were compared among eight periods of each session: 1 to 7- the same periods evaluated for NABPD, and 8. remaining time. The Corah dental anxiety scale was applied in all sessions and the pain was measured by using the 11- point box scale in the 3rd and 4th sessions. The results of blood pressure and heart rate were statistically analyzed by ANOV A with repeated measures and Tukey test (p<0.05). The results of Holter monitor and anxiety were compared by the Friedman test (p<0.05) and the values of 11-point box scale were analyzed by paired Wilcoxon test (p<0.05).Statistically significant differences (p<0.05) were observed for: SBP, HR, ventricular premature beat (VPB) and supraventricular premature beats (SPB). SBP values were higher in the period 6 than period 7 in all sessions. HR values were higher in the period 7 than in the others period in all sessions. VPB and SPB were higher in the period 8 than in other periods. There were no significant differences among equivalent periods of the sessions. No significant differences were observed in relation to anxiety (p=0.81) and pain, considering chronological order of the treatment session (p=0.33) and local anesthetic solution (p=1.00). The results show that the cardiovascular effects of local anesthetics containing epinephrine or felypressin are small and they can be safely used in hypertensive stage 1 patients. The control of pain and anxiety are important to avoid clinically relevant cardiovascular alterations

ASSUNTO(S)

local anesthetics hypertension anestesia local doenças cronicas hipertensão chronic diseases

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