Effect of local anesthetics with and without vasoconstrictor agent in patients with ventricular arrhythmias.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Maria Teresa Fernández
MT
Cáceres
Ana Cristina P P
AC
Ludovice
Fabio Sândoli de
FS
Brito
Francisco Carlos
FC
Darrieux
Ricardo Simões
RS
Neves
Mauricio Ibrahim
MI
Scanavacca
Eduardo A
EA
Sosa
Denise Tessariol
DT
Hachul
D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D001794:Blood Pressure / Q000187:drug effects; D002598:Chagas Cardiomyopathy / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005259:Felypressin / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011318:Prilocaine / Q000009:adverse effects; D011446:Prospective Studies; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D055815:Young Adult
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D011318:Prilocaine; D005259:Felypressin; D008012:Lidocaine