Vasoconstrictores en pacientes con enfermedades cardiacas

Original Article
Effects of Epinephrine in Local Dental Anesthesia in Patients with Coronary Artery Disease
Ricardo Simões Neves, Itamara Lucia Itagiba Neves, Dante Marcelo Artigas Giorgi, Cesar José Grupi, Luís Antonio Machado César, Whady Hueb, Max Grinberg
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sâo Paulo – FMUSP – São Paulo, SP - BrazilSummary

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 withcoronary artery disease. Methods:

Results: There was an increase in blood pressure in both groups during the procedure, compared with baseline values;

Conclusion: group. The use of vasoconstrictor has proved to be safe within the range of the present study. Key words: Epinephrine/adverse effects; anesthesia, local; dental restoration, permanent; coronary arteriosclerosis.

Introduction
Theliterature is controversial regarding the use of vasoconstrictors in local dental anesthesia in patients with heart disease. Most studies were conducted either with healthy patients1-10 or those with heart disease of various etiologies11,12. In addition, many authors13-15 failed to include a control group comparing the effects of the anesthetic with and without a vasoconstrictor, making itdifficult to extrapolate these results to CAD patients. We investigated the behavior of systemic blood pressure and 24-hour electrocardiogram (Holter monitoring) in patients with clinical symptoms of stable angina and on drug therapy, positive exercise testing, and angiographically proven coronary stenosis > 70% in at least one major artery and who underwent restorative dental treatment underanesthesia with and without a vasoconstrictor.

Methods
Sixty-two patients were followed up on at the outpatient clinic of the Coronary Care Unit of Incor (Hospital das Clínicas Heart Institute of the University of SãoPaulo Medical School), 51 (82.3%) of whom were male. Ages ranged from 39 to 80 (mean 58.7 ± 8.8), and body mass index (BMI), from 18.8 to 39.4 (mean 27.4). Twenty-four patients (38.7%)were diagnosed with systemic hypertension and 24, with diabetes (38.7%) All patients continued their medication for coronary artery disease and possible comorbidities, especially beta-blockers (87.1%), lipid-lowering agents (87.1%), antiplatelets (83.9%), and nitrates (54.8%). Patients were enrolled after Institutional Ethics Committee approval, and all of them read and signed an Informed Consentafter receiving thorough verbal explanation of the study and its attendant risks. Inclusion criteria were the following: - Personal: patients of both genders from 30 to 80 years of age;

Rua Alves Guimarães 689/11 - 05410-001 – São Paulo, SP - Brazil E-mail: ricardo.neves@incor.usp.br Manuscript received October 4, 2006; revised manuscript received December 28, 2006; accepted February 13, 2007.Dental anesthesia and coronary artery disease

Original Article
lumen stenosis) and exercise stress test positive for myocardial ischemia performed within less than three months in the absence of recent acute myocardial infarction; - Dental: fully or partially dentate requiring lower molar, premolar, or canine restoration. Exclusion criteria were the following: - Clinical: neoplasias,septicemia, pregnancy, unstable angina, and malignant hypertension. Coronary angiography revealed single-vessel disease in seven (11.3%) patients, two-vessel disease in 18 (29%) patients, and three-vessel disease in 37 (59.7%) patients. Thirty patients were randomly assigned to receive 2% lidocaine and 1:100,000 epinephrine (epinephrine group), and 32 to receive 2% lidocaine without epinephrine...