Plasma mepivacaine concentrations in patients undergoing third molar surgery.

BACKGROUND: Local anaesthetic-related systemic toxicity mainly results from elevated plasma concentrations of these drugs. We hypothesized that intraoral injection of submaximal doses of mepivacaine does not lead to toxic levels of this drug in blood. This study evaluated the plasma levels of mepivacaine in third molars surgeries. METHODS: Twenty-one patients were randomly assigned into two groups: group I (two unilateral third molars; submaximal dose of mepivacaine 108 mg with epinephrine 54 µg) and group II (four third molars; submaximal dose of mepivacaine 216 mg with epinephrine 108 µg). Blood samples were collected before anaesthesia, and 5, 10, 15, 20, 30, 40, 60, 90 and 120 min after anaesthesia. RESULTS: Individual peak plasma concentrations ranged 0.77-8.31 µg/mL (group I) and from 2.36-7.72 µg/mL (group II). An increase in the average dose of mepivacaine from 1.88 ± 0.12 mg/kg (group I) to 3.35 ± 0.17 mg/kg (group II) increased the mean mepivacaine peak plasma levels from 2.33 ± 0.58 to 4.01 ± 0.69 µg/mL, respectively. Four patients obtained plasma levels of mepivacaine above the threshold for toxicity (5 µg/mL). CONCLUSIONS: Toxic levels of mepivacaine are possible, even when a submaximal dose is used. A twofold increase in the dose of mepivacaine caused the mean peak plasma concentration to increase proportionally, indicating that they may be predicted based on the relation of dose per bodyweight.

Avaliação da qualidade de amostras comerciais de leite de janaguba (Himatanthus drasticus (Mart. ) Plumel) em Fortaleza – Ceará / Quality assessment of commercial samples of janaguba’s milk (Himatanthus drasticus (Mart. ) Plumel) in Fortaleza – Ceará.

RESUMO Os fitoterápicos à base de leite de janaguba (Himatanthus drasticus (Mart.) Plumel), usados para o tratamento de câncer, úlcera gástrica e outras doenças, são muito vendidos em mercados públicos de Fortaleza (CE). No entanto, registros mencionam que é comum a troca deste leite por látex de mangabeira (Hancornia speciosa Gomes). O trabalho objetivou avaliar a qualidade físico-química, química e microbiológica de amostras comerciais do leite de janaguba. Dez amostras comerciais foram adquiridas de um mercado de Fortaleza; quatro amostras autênticas de látex de janaguba foram obtidas da chapada do Araripe e uma amostra de látex de mangabeira foi obtida em Paracuru (CE). Foram determinados o aspecto geral, densidade, pH, resíduo seco, volume de sedimentação, perfil cromatográfico e qualidade microbiológica das amostras. Os resultados mostraram elevada contaminação microbiológica nas preparações comerciais e adulteração em seis destas amostras, o que aponta a urgente implantação de uma efetiva farmacovigilância dos fitoterápicos a fim de tornar seu consumo mais seguro e racional.

ABSTRACT The herbal medicines made from janaguba milk (Himatanthus drasticus (Mart.) Plumel), used to treat gastric ulcer, cancer and other diseases, and arewidely sold in the public markets of Fortaleza (CE). However, records mention that it is common to make fake copies of the milk by using mango tree latex (Hanconia speciosa Gomes). This study aimed to evaluate the chemical, physical-chemical and microbiological quality of commercial samples of janaguba milk. Ten commercial samples were purchased from a Fortaleza market; four authentic samples of janaguba latex were obtained from the Araripe plateau, and one mango tree latex sample was obtained in Paracuru (CE). We determined the general appearance, density, pH, dry residue, sedimentation volume, chromatographic profile and microbiological qualities. Results showed high microbiological contamination in the commercial preparations and evidence of tampering in six of these samples, which indicates the need for an urgent implementation of an effective pharmacovigilance strategy for herbal medicines in order to make its consumption more secure and rational.

Estudo etnofarmacológico e etnobotânico de Himatanthus drasticus (Mart. ) Plumel (janaguba) / Ethnopharmacological and ethnobotanical study of Himatanthus drasticus (Mart. ) Plumel (janaguba).

RESUMO Himatanthus drasticus (Mart.) Plumel, janaguba, produz um látex em seu caule que é usado para o tratamento de alguns tipos de câncer, vermes intestinais, febre, menstruações irregulares, infertilidade feminina e úlceras gástricas. Estudos fitoquímicos revelaram a presença de acetato de lupeol e proteínas; e estudos farmacológicos, os efeitos antiúlcera, antitumoral, imunomodulador, analgésico e anti-inflamatório. O presente trabalho objetivou realizar levantamento etnobotânico e etnofarmacológico sobre H. drasticus como contribuição ao conhecimento científico da referida espécie. Foi elaborado um questionário, que foi aplicado em entrevista a 21 raizeiros nos mercados das cidades de Crato, Fortaleza e Pacajus do estado do Ceará (CE). Observou-se que 38,1% dos raizeiros têm mais de 10 anos de serviço e 47,6%, estão na faixa etária de 40 a 59 anos, o que representa um fator positivo quanto à experiência com plantas medicinais. Aproximadamente 85,7% dos raizeiros relataram o uso do látex da H. drasticus para tratamento de úlcera; 66,7% para inflamação; 66,7% para câncer. Verificou-se que as principais indicações terapêuticas relatadas pelos raizeiros sobre esta espécie estão de acordo com as informações científicas. Os levantamentos etnobotânicos e etnofarmacológicos exercem um papel primordial no resgate do conhecimento tradicional, nos meios rurais e urbanos, tanto por seu valor histórico-cultural, como também pela necessidade de confirmação das indicações de uso.

ABSTRACT The Himatanthus drasticus (Mart.) Plumel, janaguba, produces a latex whose stem is used to treat some types of cancer, intestinal worms, fever, irregular menses, female infertility and gastric ulcers. Phytochemical studies revealed the presence of lupeol acetate and proteins in the latex; and pharmacological studies indicated antiulcer, anti-tumor, immunomodulating, analgesic and anti-inflammatory effects. This study aimed to conduct surveys on ethnopharmacological and ethnobotanical species H. drasticus as a contribution to the scientific knowledge about the species. A questionnaire and interviews were made with 21 healers in the markets of the cities of Crato, Fortaleza and Pacajús, in state of Ceara (CE). It was observed that 38.1% of the healers have more than 10 years of service, and 47.6% are between 40-59 years old, which is a positive factor about the experience with medicinal plants. Approximately 85.7% of the healers reported to apply latex H. drasticus for the treatment of ulcers, 66.7% for inflammation, and 66.7% for cancer. It was found that the main therapeutic indications mentioned by the healers about this species are consistent with the scientific information available. The ethnobotanical and ethnopharmacological surveys play an essential role on keeping the traditional knowledge in rural and urban areas, both for its historical and cultural value, but also for the need of confirmation of the intended use.