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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

ConcentraÃÃes plasmÃticas de mepivacaÃna em pacientes submetidos à cirurgia de terceiros molares

Raimundo Nonato Maia 30 January 2009 (has links)
A remoÃÃo cirÃrgica dos terceiros molares em regime ambulatorial fazendo uso de anestÃsicos locais tem grande emprego no dia-a-dia da prÃtica odontolÃgica. Estas sÃo drogas seguras quando usadas da forma recomendada; porÃm, quando empregadas em quantidade ou concentraÃÃes elevadas, poderÃo resultar em respostas indesejadas. Baseado no conhecimento de tais princÃpios e na prÃtica da clÃnica cirÃrgica, onde nÃveis de concentraÃÃo de anestÃsico local na corrente sanguÃnea poderÃo chegar a valores muito prÃximos do nÃvel de toxicidade, foi realizado estudo com mensuraÃÃo da concentraÃÃo sistÃmica de anestÃsico local, atravÃs de coleta e anÃlise, em equipamento de High-Performance Liquid Chromatography (HPLC), de amostra de sangue de pacientes que foram submetidos a anestesia local com mepivacaÃna 2% e adrenalina 1:100000 para a remoÃÃo dos terceiros molares. O estudo teve sua relevÃncia justificada visto que, para as cirurgias ambulatÃrias de terceiros molares inclusos, a mepivacaÃna à utilizada com muita frequÃncia, sendo assim importante investigar o comportamento dos nÃveis plasmÃticos e suas possÃveis manifestaÃÃes tÃxicas. A amostra constou de vinte e seis pacientes, de ambos os sexos, subdivididos em dois grupos conforme a cirurgia de dois ou quatro terceiros molares removidos em sessÃo Ãnica, respectivamente, sendo o monitoramento feito com uso de oxÃmetro de pulso, medidas regulares da pressÃo arterial, frequÃncia cardÃaca e eletrocardiograma em cardioscÃpio, de acordo com as recomendaÃÃes mÃnimas da AssociaÃÃo Americana de CirurgiÃes Orais e Maxilofaciais (DâERAMO et al., 2003). No intervalo de 120 minutos, foram colhidas 10 amostras de 4ml, apÃs injeÃÃo do anestÃsico local, e a anÃlise quantitativa das concentraÃÃes plasmÃticas de mepivacaÃna foi realizada em HPLC. Os nÃveis plasmÃticos de mepivacaÃna em ambos os grupos foram crescentes e significativos entre si em todos os respectivos intervalos de coletas das amostras sanguÃneas. Os resultados foram obtidos e comparados os valores nos respectivos momentos correspondentes entre os dois grupos, mostrando que as mÃdias da PA sistÃlica e diastÃlica de todos os intervalos nÃo foram significantes quando comparados com os valores obtidos na consulta prÃ-operatÃria. De acordo com os resultados deste estudo, foi possÃvel concluir que a cirurgia de terceiros molares sob anestesia local, com mepivacaÃna 2% e adrenalina 1:100000, quando respeitadas as margens de seguranÃas recomendadas pelo fabricante, à um procedimento seguro e que nÃo existe diferenÃa clÃnica sistÃmica para o paciente hÃgido quando no uso de doses de 108mg (5,4ml) e 216mg (10,8ml). / Surgical removal of the third molars in clinical regime making use of local anesthetics plays a great role in the everyday practice of odontology. These drugs are safe when used in the proper way, but they can lead to undesirable outcomes when used in the wrong quantities or concentrations. Based on the knowledge of such principle and on surgical clinical practice, where levels of anesthetic concentration in the blood can reach near-toxic levels, a study measuring the systemic concentration of local anesthetic was made by collecting and analyzing, in equipment of High-performance liquid chromatography (HPLC), blood samples of patients who were submitted to local anesthesia with mepivacaine 2% and adrenaline 1:100000 for the removal of the third molars. The study was relevant because mepivacaine is frequently used in ambulatory surgeries of third molars, making it important to investigate the behavior of plasmatic levels and their possible toxic manifestations. The sample consisted of twenty-six patients of both sexes, subdivided in two groups according to the number of third molars removed: one group had two removed in a single session, the other group had four. Monitoring was done using pulse oxymetre, regular measuring of blood pressure, heart rate, and electrocardiogram in radioscopic, according to the minimum recommendations of the American Association of Oral and Maxillofacial Surgeons (DÂERAMO et al, 2003). In the interval of 120 minutes there were collected 10 samples of 4 mL after the injection of local anesthetic, and the quantitative analysis of the plasmatic concentrations of mepivacaine was done in HPLC. The plasmatic levels of mepivacaÃna in both groups were growing and significant amongst themselves in all the respective intervals of collections of the sanguine samples. After the results were obtained, the values at each corresponding moment for both groups were compared, showing that the averages of the systolic and diastolic pressure of all of the intervals were not significant when compared with the values obtained in the preoperative consultation. According to the results this study it was possible to conclude that the surgery of third molars under local anesthesia, with mepivacaine 2% and adrenaline 1:100000, when respecting the safety margins recommended by the manufacturer, is a safe procedure and that there are no clinical systemic differences to the healthy patient when doses between 108mg (5,4mL) and 216mg (10,8mL) are used.

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