Efectos cardiovasculares de la anestesia dental con articaína (40 mg con epinefrina 0.5 mg% y 40 mg con epinefrina 1 mg%) vs. mepivacaína (30 mg con epinefrina 1 mg %) en pacientes cardiópatas. Estudio cruzado, randomizado y ciego simple.
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Cardiovascular effect of dental anesthesia with articaine (40 mg with epinefrine 0,5 mg % and 40 mg with epinefrine 1 mg%) versus mepivacaine (30 mg and 20 mg with epinefrine 1 mg%) in medically compromised cardiac patients: a cross-over, randomized, single blinded study.
Torres-Lagares D, Serrera-Figallo MÁ, Machuca-Portillo G, Corcuera-Flores JR, Machuca-Portillo C, Castillo-Oyagüe R, Gutiérrez-Pérez JL.
Oral Surgery, Faculty of Odontology of Seville, Spain. gmachuca@us.es
Med Oral Patol Oral Cir Bucal. 2012 Jul 1;17(4):e655-60.
Abstract
OBJECTIVES:The aim of the present study is to compare cardiovascular safety profiles of two dental anesthetics: articaine versus two standard mepivacaine solutions used during etiological periodontal treatment in cardiovascular patients. STUDY DESIGN: Using a cross-over study design, ten cardiovascular patients were randomly assigned to dental treatment with 1.8 mL of a localanesthetic injected on each quadrant of the mouth: Articaine (40 mg with Epinephrine 0.5 mg % and 40 mg with Epinephrine 1mg %) or Mepivacaine (30 mg and 20 mg with Epinephrine 1mg %). A computer programme enabled continuous longitudinal data collection: O2 saturation, blood pressure (BP) and heart rate (HR). RESULTS: No severe clinical side effects were observed. During the treatment period, we observed statistically significant differences as regards HR between injections with and without adrenalin (p< 0.039) and as regards systolic (p< 0.046) and diastolic (p < 0.046) blood pressure during the stabilization period. In both cases, the parameters under study increase. Age, gender, jaw treated, treatment duration and the rest of cardiovascular variables did not affect the results. None of the patients underwent ischemic alterations or any other complication derived from the treatment or theanesthesia. CONCLUSIONS: According to the results of our study, dental anesthetics with standard concentrations of Epinephrine seem to alter HR and BP. Although no cardiac ischemic alterations or any other cardiovascular complications have been observed, we must be cautious with the administration of anesthetics containing vasoconstrictors in patients with cardiovascular diseases.
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Diploplia con anestesia local
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Diplopia with local anesthesia.
Pragasm M, Managutti A.
Department of Oral and Maxillofacial Surgery, Modern Dental College and Research Center, Indore, M.P., India.
Natl J Maxillofac Surg. 2011 Jan;2(1):82-5. doi: 10.4103/0975-5950.85861.
Abstract
A variety of local and systemic complications can occur during the administration of local anesthesia (LA). Diplopia is one of the very rarecomplications that follow a posterior superior alveolar (PSA) nerve block. This article describes a very rare case report and the possible mechanisms are discussed in detail. Diplopia is defined as double vision. The patient was administered PSA nerve block for the extraction of the upper right third molar tooth. After the extraction, the patient complained of double vision and not being able to gaze laterally with the right eye. The patient recovered completely after the anesthetic effect. Local and systemic complications do occur during and after administration of local anesthesia. The clinician needs to be aware of the complications and management.
KEYWORDS: Diplopia, local anesthesia, posterior superior nerve, pterygoid plexus of veins
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he incidence of complications associated with local anesthesia in dentistry.
Daubländer M, Müller R, Lipp MD.
Clinic of Oral Surgery, University of Mainz, Germany.
Anesth Prog. 1997 Fall;44(4):132-41.
Abstract
Local anesthetics are frequently administered in dentistry and thus can be expected to be a major source of drug-related complications in the dentaloffice. Additionally, the dentist will more often be confronted with the treatment of risk patients; thus, the incidence of side effects can be expected to rise. In this study, 2731 patients receiving dental anesthesia were evaluated by questionnaire for risk factors, type and dosage of local anesthetic applied, type and duration of treatment, and complications associated with the administration of the local anesthetic. Of all patients, 45.9% had at least one risk factor in their medical histories, with cardiovascular diseases and allergies being the most frequent. The overall incidence ofcomplications was 4.5%. It was significantly higher in risk patients (5.7%) than in nonrisk patients (3.5%). The most frequently observedcomplications (dizziness, tachycardia, agitation, nausea, tremor) were transient in nature and did not require treatment. Severe complications(seizure, bronchospasm) occurred in only two cases (0.07%). Articaine was found to be administered in over 90% of all dental anesthesias in Germany despite the great variety of local anesthetics available. Articaine 1:100,000 caused more sympathomimetic side effects than did articaine 1:200,000. Additionally, doses of local anesthetics proved not to be strictly determined according to body weight, especially for patients weighing less than 50 kg. In summary, it can be stated that dental local anesthesia can be considered safe. Nevertheless, the incidence of complications due todental anesthesia can be expected to be further reduced if (a) patients are routinely evaluated for risk factors with an adequate medical history prior todental treatment, (b) doses of local anesthetics are strictly determined according to body weight, (c) anesthetics with low concentrations of epinephrine are used, and (d) the concept of a differentiated dental anesthesia is applied.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148940/pdf/anesthprog00236-0020.pdf
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