Cáceres Maria Teresa Fernández, Ludovice Ana Cristina P P, Brito Fabio Sândoli de, Darrieux Francisco Carlos, Neves Ricardo Simões, Scanavacca Mauricio Ibrahim, Sosa Eduardo A, Hachul Denise Tessariol
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Arq Bras Cardiol. 2008 Sep;91(3):128-33, 142-7. doi: 10.1590/s0066-782x2008001500002.
The routine use of local anesthetics associated to vasoconstrictors for the dental treatment of patients with cardiopathies is still controversial, due to the risk of adverse cardiovascular effects.
To evaluate and compare the hemodynamic effects of the use of local anesthetics with a non-adrenergic vasoconstrictor in patients with ventricular arrhythmia, when compared to the use of anesthetics without vasoconstrictor.
A prospective randomized study evaluated 33 patients with positive serology for Chagas' disease and 32 patients with coronary artery disease that presented complex ventricular arrhythmia at Holter monitoring (>10 EV/h and NSVT), of which 21 were females, aged 54.73 + 7.94 years, submitted to routine dental treatment with pterygomandibular anesthesia. These patients were divided in two groups: group I received prilocaine 3% associated with felypressin 0.03 IU/ml and group II received lidocaine 2% without vasoconstrictor. The number and complexity of extrasystoles were analyzed, as well as the heart rate and systemic arterial pressure of the patients on the day before, one hour before, during the procedure and one hour after the dental procedure.
No hemodynamic alterations or increase in the number and complexity of the ventricular arrhythmia related to the anesthetic used in the dental procedure were observed in either group.
The results suggest that prilocaine 3% associated to a felypressin 0.03 IU/ml can be safely used in patients with Chagas' disease or coronariopathy with complex ventricular arrhythmia.
由于存在心血管不良反应风险，在为心脏病患者进行牙科治疗时常规使用与血管收缩剂联用的局部麻醉剂仍存在争议。
与使用不含血管收缩剂的麻醉剂相比，评估并比较在室性心律失常患者中使用含非肾上腺素能血管收缩剂的局部麻醉剂的血流动力学效应。
一项前瞻性随机研究评估了33例查加斯病血清学阳性患者和32例冠状动脉疾病患者，这些患者在动态心电图监测中出现复杂室性心律失常（>10次室性早搏/小时和非持续性室性心动过速），其中21例为女性，年龄54.73±7.94岁，接受翼下颌麻醉下的常规牙科治疗。这些患者被分为两组：第一组接受3%丙胺卡因与0.03 IU/ml去氧肾上腺素联用，第二组接受不含血管收缩剂的2%利多卡因。分析了早搏的数量和复杂性，以及患者在牙科手术前一天、手术前一小时、手术期间和手术后一小时的心率和体动脉压。
两组均未观察到与牙科手术中使用的麻醉剂相关的血流动力学改变或室性心律失常数量及复杂性增加。
结果表明，3%丙胺卡因与0.03 IU/ml去氧肾上腺素联用可安全用于患有查加斯病或冠心病且伴有复杂室性心律失常的患者。
