RESUMEN
OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.
Asunto(s)
Anestesia Local/métodos , Enfermedad Coronaria/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Epinefrina/administración & dosificación , Extracción Dental/métodos , Vasoconstrictores/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales , Ansiedad/fisiopatología , Glucemia/análisis , Presión Sanguínea/efectos de los fármacos , Combinación de Medicamentos , Métodos Epidemiológicos , Femenino , Índice Glucémico/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Humanos , Lidocaína , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Objetivo Avaliar o efeito do diazepam, nifedipina, propranolol e da associação nifedipina e propranolol, por via sublingual, na crise hipertensiva (CH). Métodos Oitenta pacientes em CH, compressão arterial diastólica (PAD) maior de 120mmHg, com idade de 54,0 ± 7,4 anos, sendo 47 homens. A pressão arterial (PA) foi medida com esfigmomanômetro aneróide, em mmHg. com o paciente em posição ortostática, antes do tratamento e 10, 20, 30 e 60 minutos após. A freqüência cardíaca (FC) em um minuto também foi medida nos períodos acima. Os pacientes foram divididos aleatoriamente em 4 grupos e tratados com uma das seguintes alternativas: 110 mg de diazepam; 2 - 10 mg de nifedipina; 340 mg de propranolol e 4 - 10 mg de nidedipina associado a 40 mg de propranolol, todos administra dos por via sublingual. Resultados Observou-se redução significativa e gradativa da pressão arterial sistólica (PAS) e da PAD nos 4 grupos. A porcentagem de redução após 60 minutos, da PAS para os grupos de I a IV foi respectivamente de 10,1%, 12,9%;15,4% e 16%, e para a PAD foi de 7,7%, 11,3%, 13,6% e 13%. A FC manteve-se inalterada nos grupos I e II, com redução significativa nos grupos III (p = 0,002) e IV (p = 0,009)...
Purpose To evaluate the effects of sublingual administration of diazepan, nifedipine, propranolol and the association of nifedipine with propranolol patients with hypertensive crisis. Methods Eighty patients with hypertensive crisis, DAP > 120 mmHg, and mean age of 54 ± 7,4 years, 33 women and 47 men, were evaluated. The AP was measured with an aneroid sphygmomanometer, in mmHg, in orthostatic position, before and after 10, 20, 30 and 60 minutes of treatment. The heart rate in one minute was also measured at the same intervals. The patients were divided randomily into four groups and treated, respectively, with 10 mg of diazepan, 10 mg of nifedipine, 40 mg of propranolol and 10 mg of nifedipine associated with 40 mg of propranolol. Results A significant and gradual reduction of SAP and DAP were observed in all groups of patients. The percentage of reduction, after 60 minutes, for SAP was, respectively, 10.1%, 12.9%.15.4% and 16%, and for DAP 7.7%, 11.3%, 13.6% and 13% in groups I to IV. The heart rate did not change in groups I and II, but significative reduction was observed in groups III (p= 0.002) and IV (p =0.009)...