title: Maternal-fetal monitoring during dental procedure in patients with heart valve disease.
abstract: BACKGROUND
  The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood.
  
  
  OBJECTIVE
  To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment.
  
  
  METHODS
  Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor.
  
  
  RESULTS
  A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate.
  
  
  CONCLUSIONS
  The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. itamara@incor.usp.br
authors.forename: Itamara Lucia Itagiba
authors.initials: IL
authors.lastname: Neves
authors.forename: Walkiria Samuel
authors.initials: WS
authors.lastname: Avila
authors.forename: Ricardo Simões
authors.initials: RS
authors.lastname: Neves
authors.forename: Dante Marcelo Artigas
authors.initials: DM
authors.lastname: Giorgi
authors.forename: Jorge Francisco Kuhn dos
authors.initials: JF
authors.lastname: Santos
authors.forename: Ricardo Martins
authors.initials: RM
authors.lastname: Oliveira Filho
authors.forename: Cesar José
authors.initials: CJ
authors.lastname: Grupi
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000009:adverse effects*; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001794:Blood Pressure / Q000187:drug effects; D015148:Cardiotocography; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D018670:Monitoring, Ambulatory / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D012214:Rheumatic Heart Disease / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine