Abstract
OBJECTIVE: Evaluate the cardiovascular effects by infiltration of 1:100.000 epinephrine and 1:2.500 phenylephrine associated with 2% lidocaine compared with the effects by infiltration of 0.03 IU/ml felypressin with 3% prilocaine, during surgery of third molars in ASA I patients.METHODS: Eighteen patients were divided into two groups. In group I (GI), the effects of epinephrine vs felypressin were evaluated and in group II (GII), the effects of phenylephrine vs felypressin. Cardiovascular parameters: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (SatO2) were measured in pre, trans and post-operative periods.RESULTS: Statistical analysis (T-TEST) on the cardiovascular parameters demonstrated with significance that, GI: felypressin presented HR average reduction in the postoperative period and SatO2 average reduction in trans and postoperative periods. For GII: felypressin presented SatO2 average reduction in the postoperative period; SBP averages for patients submitted to phenylephrine increased in trans and postoperative periods; and DBP averages for patients submitted to phenylephrine increased in pre and trans-operative periods.COCLUSION: We can conclude that phenylephrine may lead to increased SBP and DBP and felypressin generated a reduction in HR and SatO2. All these changes were well tolerated by ASA I patients.
Highlights
Vasoconstrictors are widely used in dentistry as adjuncts to local anesthetics for their recognized effect on increasing the quality and duration of anesthetic blockade, decreasing the vasodilatory action of the local anesthetic, delaying its absorption through the systemic circulation, reducing the systemic toxicity of local anesthesia and bleeding at the surgical site [2,3,4,5]
Some studies have shown that there are no significant changes in the cardiovascular parameters of healthy individuals [2, 6] or of patients with cardiovascular alterations [3, 7, 8], who received local anesthetic solutions containing adrenaline as vasoconstrictor, other studies have shown that changes occur and may be more significant, depending on the concentration of the vasoconstrictor used and the degree of impairment of the individual’s health [9, 10]
In group I (GI), 9 patients were included to evaluate the cardiovascular effects of 2% lidocaine with adrenaline 1:100,000 compared to 3% prilocaine with felypressin 0.03 IU/ml
Summary
Felypressin, a derivative of vasopressin (antidiuretic hormone), is a option as a vasoconstrictor in dentistry, presenting a mechanism of action different from sympathomimetic vasoconstrictors. It acts on vasopressin V1 receptors present on the smooth muscle of the blood vessel wall [11]. It is suggested that, because it is analogous to vasopressin, it promotes these effects through the same mechanisms [12], raising blood pressure through the activation of vascular V1 receptors and enhancing baroreflex through V1 receptors in the postrema area [12]. This regulation may play an important role in maintaining blood pressure, because through it vasopressin increases the baroreflex gain, preventing significant increases in blood pressure [12]
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