One of the aims of this thesis was to investigate the involvement of efflux proteins, such as the P-glycoprotein (Pgp), in the drug transport in different regions of the rat and the human intestine. The intestinal extrusion of intracellularly formed CYP3A4 metabolites, including whether this extrusion might be mediated by Pgp, was also studied. The model drugs used were local anaesthetics (LA), which have been evaluated for inflammatory bowel disease, such as ropivacaine, lidocaine and bupivacaine. The intestinal permeability to LAs was found to be high throughout all intestinal regions of the rat and human intestine. Results from the Ussing chamber model indicated only minor efflux involvement as the drug permeability was higher in the serosa to mucosa transport direction than in the opposite direction. However, the involvement of efflux in the absorption of LAs could not be verified using in situ single-pass perfusion of rat jejunum. The extrusion of the ropivacaine metabolite, 2´,6´-pipecoloxylidide (PPX), was polarized to the mucosal reservoir of the Ussing chamber for both rat and human intestinal samples, and was probably not caused by any Pgp involvement. The expression levels of CYP3A4 and efflux transporters were consistent with the enzymes’ activity in human intestine. PPX formation was mediated by CYP3A4 in human intestine, and cyp2c and cyp2d in rat intestine. Species differences were observed, as PPX was formed in rat colon, but not human colon. In conclusion, the permeability of ropivacaine, lidocaine and bupivacaine was not subjected to efflux transport of significance for their intestinal uptake. The transport of ropivacaine metabolites to the mucosal compartment was probably not mediated by Pgp. The Ussing chamber model showed consistent results with those from intestinal microsomes as far as intestinal metabolism is concerned, making it a suitable model for investigations of the interplay of efflux and metabolism.

Myringotomy plays an important role in otological therapy. The procedure requires an efficient anesthesia, which can be obtained without general anesthesia. However, the use of local anesthetics on the tympanic membrane (TM) has been abandoned in many places, as general anesthesia has been readily available. In the present study the effects of some commonly used topical anesthetics on the TM structure and inner ear were tested in an animal model (rat and guinea pig).Four different anesthetic compounds—Xylocaine®, Bonain's liquid, phenol and Emla®—were applied to the TMs of the animals, which were sacrificed 10 minutes to 5 months after application. Morphological effects regarding time after treatment and number of applications were elucidated. At sacrifice the tissue was fixed and the TMs analysed by light microscopy (LM) and transmission electron microscopy (TEM). In nine animals phenol, Xylocaine® Spray or Emla® was applied to the round window niche and ABR recordings were made at 24 h to 6 months after exposure. After the final ABR evaluation the animals were sacrificed and the cochleae prepared for LM and scanning electron microscopy (SEM).On the TM phenol and Bonain's liquid caused instant destruction of the keratinizing stratified squamous epithelium followed by long-lasting hyperplasia of this epithelium and the underlying connective tissue. A pronounced hyperplasia of these two layers was also noted for the Xylocaine® Spray group, but without immediate destruction of the keratinizing epithelium. The extent of structural changes differed in relation to the extent of spreading of the agent. Emla® showed little, if any, sign of epithelial reaction and had no effect on the connective tissue. Regarding the inner ear Emla®, Xylocaine® Spray and phenol induced significantly impaired ABR thresholds mainly affecting the higher frequencies. However, the impaired ABR thresholds were reversible and at the end of the experiment there was no significant impairment compared to the control data. All agents, except Xylocaine®, damaged the hair cells in the basal part of the cochlea as shown by cytocochleogram and SEM analysis.Instant destruction of the epidermis seems to be necessary for an instant anesthetic effect. All agents caused profound connective tissue reactions. The manner of application, depending on the physical properties of the agent, determined the extent of the structural changes. The changes of the connective tissue were concentrated to the submucosal layer, which seems to be the area for reconstruction of the damaged TM. All agents caused functional inner ear changes. With the exception of Xylocaine® they also caused morphological alterations of the cochlea. The functional changes were partly reversible. Topical anesthetics applied to the TM should be used with caution and when used in an appropriate manner they can be considered safe, especially in an inflamed middle ear, with a thickened round window membrane, which should prevent the agents from reaching the inner ear structures. / digitalisering@umu

O objetivo deste estudo foi comparar a eficácia anestésica da articaína 4%, da lidocaína 2% e da mepivacaína 2%, todas associadas à epinefrina 1:100.000, durante pulpectomia em pacientes com pulpite irreversível em molares mandibulares. Sessenta e seis voluntários do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo receberam, aleatoriamente, 3,6ml de um dos anestésicos locais para o bloqueio convencional do nervo alveolar inferior (NAI). No caso de falha do bloqueio, foram administrados 3,6ml da mesma solução como injeção complementar no ligamento periodontal. O sinal subjetivo de anestesia do lábio, a presença de anestesia pulpar e ausência de dor durante a pulpectomia foram avaliados, respectivamente, por indagação ao paciente, por meio do aparelho estimulador pulpar elétrico (pulp tester) e por uma escala analógica verbal. A análise estatística foi realizada por meio dos testes Qui-quadrado, Kruskal Wallis e Razão de Verossimilhancas. Todos os pacientes reportaram anestesia no lábio após o bloqueio do NAI. A mepivacaína apresentou valores superiores (68,2%) para a anestesia pulpar após o bloqueio do NAI e a lidocaína (90%) após a injeção no ligamento periodontal. A mepivacaína apresentou valores superiores para a analgesia (72,7%) após o bloqueio no NAI e a lidocaína (90%) após a injeção no ligamento periodontal. Após a falha do bloqueio do NAI, a dor na câmara pulpar foi a mais frequente e após a falha da injeção no ligamento periodontal, a dor no canal. No entanto, essas diferenças não foram estatisticamente significantes. Portanto as três soluções anestésicas locais se comportam de forma semelhante e não apresentam efetivo controle da dor no tratamento da pulpite irreversível em molares mandibulares. / The aim of this study was to compare the anesthetic efficacy of 4% articaine, lidocaine 2% and 2% mepivacaine, all associated with epinephrine 1:100,000 during pulpectomy in patients with irreversible pulpitis in mandibular molars. Sixty-six volunteers Sector Emergency Faculty of Dentistry, Universidade de São Paulo randomly received 3.6 ml of a local anesthetic to block conventional inferior alveolar nerve. In case of failure of the lock, were administered 3.6 ml of the same solution as in the periodontal ligament injection complement. The signal subjective lip anesthesia, the presence of pulpal anesthesia and no pain during pulpectomy were evaluated respectively by questioning the patient, via the stimulating device electrical pulp (pulp tester) and a verbal analogue scale. Statistical analysis was performed using the chi-square test, Kruskal Wallis and likelihood ratio. All patients reported lip anesthesia after blockade of the inferior alveolar nerve. The mepivacaine showed higher values (68.2%) for pulpal anesthesia after blockade of the inferior alveolar nerve and lidocaine (90%) after injection in the periodontal ligament. The mepivacaine showed higher values for analgesia (72.7%) after blocking the inferior alveolar nerve and lidocaine (90%) after injection in the periodontal ligament. After the failure of the blockade of the inferior alveolar nerve, the pain in the pulp chamber was the most frequent and after the failure of the periodontal ligament injection, pain in the channel. However, these differences were not statistically significant. Therefore, the three local anesthetic solutions behave similarly and did not exhibit effective pain management in treating irreversible pulpitis in mandibular molars.

Orientador: Angelica de F. de Assunção Braga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T23:53:56Z (GMT). No. of bitstreams: 1 Loyola_YolandaChristinadeSousa_D.pdf: 22412843 bytes, checksum: 64766635e73a046988de0b090a234fe6 (MD5) Previous issue date: 2006 / Resumo: Os anestésicos locais comumente empregados na prática clínica podem interagir com os bloqueadores neuromusculares e potencializar seus efeitos. Muitos autores estudaram esta interação mas o mecanismo envolvido na potencialização do bloqueio neuromuscular e a ação dos anestésicos locais nos sítios pré e pós juncionais não foram completamente elucidados. Neste trabalho através de experimentos específicos na junção neuromuscular foram estudados os seguintes parâmetros: o efeito dos anestésicos locais procaína e lidocaína na transmissão neuromuscular; a sua influência no bloqueio neuromuscular produzido pela d-tubocurarina e pelo rocurônio; a eficácia da neostigmina e da 4-aminopirídina na reversão do bloqueio produzido pela associação anestésicos locais - bloqueadores neuromusculares; os efeitos dos anestésicos locais nos potenciais de membrana e potenciais de placa terminal em miniatura. Avaliou-se também em preparações diafragma de rato cronicamente desnervado e biventer cervicis de pintainho os efeitos dos anestésicos locais na ação contraturante da acetilcolina. Os resultados foram expressos em médias e desvios padrão e analisados através dos testes de Wilcoxon e Mann-Witney, adotando-se um nível de significância de 5% (p < 0,05). Nas preparações nervo frênico - diafragma de rato, sob estimulação elétrica indireta, os anestésicos locais nas concentrações empregadas, não alteraram a amplitude das respostas musculares mas potencializaram os efeitos da d- tubocurarina e do rocurônio.. Este bloqueio foi parcialmente e totalmente revertido pela neostigmina e pela 4-aminopiridina, respectivamente. A procaína e a lidocaína não causaram alteração significativa nos potenciais de membrana, não demonstrando ação despolarizante na fibra muscular. A procaína causou diminuição na amplitude e na freqüência dos potenciais de placa terminal em miniatura (pptms) e a lidocaína, ao contrário, promoveu um aumento inicial na freqüência dos pptms seguida de bloqueio. Nas preparações biventer cervicis de pintainho e diafragma de rato cronicamente desnervado, a procaína e a lidocaína promoveram diminuição significativa na resposta contraturante da acetilcolina evidenciando um efeito pós-juncional. Os resultados obtidos demonstram um sinergismo entre as drogas devido principalmente a um efeito pós-juncional / Abstract: Local anesthetics commonly used in clinical practice can interact with neuromuscular blockers and potentiate their effects. Many authors studied this interaction, but the mechanism involved in the potentiation of neuromuscular blockers and the action of local anesthetics in the pre and postjunctional sites were not completely elucidated- In this study, in specific experiments in the neuromuscular junction the following parameters were studied: the effects of the local anesthetics procaine and lidocaine in the neuromuscular transmission; its influence on the neuromuscular blockade produced by d-tubocurarine and by rocuronium; the efficacy of neostigmine and of 4-aminopyhdine in the reversion of the blockade produced by the association of local anesthetics - neuromuscular blockers; the effects of local anesthetics on the membrane potentials and miniature end - plate potentials. It was also evaluated in chronically denervated rat diaphragm preparation and chick biventer cervicis preparation the effects of local anesthetics on acetylcholine contracture. The results were expressed in average and standard deviation and analyzed through the Wilcoxon and Mann-Witney tests, adopting a level of significance of 5% (p <0.05). In rat phrenic nerve diaphragm preparations under indirect electric stimulation, local anesthetics in the concentrations used did not change the amplitude of the muscle response but potentiated the effects of d-tubocurarine and of rocuronium. This blockade was partially and totally reverted by neostigmine and by 4-aminopyridine, respectively. Procaine and lidocaine caused no significant alteration in the membrane potentials, not demonstrating depolarizing action in the muscle fiber. Procaine caused a decrease in the amplitude and frequency of the miniature end - plate potentials {meps) and lidocaine, in contrast, promoted an initial increase in the frequency of meps followed by blockade. In chick biventer cervicis preparations and chronically denervated rat diaphragm, procaine and lidocaine promoted a significant decrease in the response to acetylcholine contracture evidencing a post-junctional effect. The results obtained demonstrate a synergism among the drugs mainly due to a postjunctional effect / Doutorado / Doutor em Farmacologia

Introdução: A dor lombar crônica é uma das doenças mais prevalentes no Brasil; entre suas causas podemos citar: as síndromes miofasciais, alterações dos discos intervertebrais (lombalgia discogênica) e alterações nas articulações facetárias (lombalgia facetária). A lombalgia crônica facetária, foco deste estudo, tem prevalência variável, dependendo do método usado no seu diagnóstico. O uso de bloqueio controlado do ramo medial vem se tornando o principal método diagnóstico da lombalgia de origem facetária. O poder diagnóstico do bloqueio se baseia na assumpção de que a anestesia da articulação facetária ou do seu ramo mediano dorsal resultaria em alívio da dor. Um resultado positivo, ou seja, alívio, provavelmente significa que a articulação facetária é o local de origem da dor. O objetivo do presente estudo foi determinar a prevalência de lombalgia facetária após bloqueios controlados do ramo medial dorsal e verificar se o resultado dos bloqueios tem correlação com variáveis sócio-demográficas. Métodos: Foi realizado um estudo transversal diagnóstico da dor lombar crônica facetária diagnosticada através de bloqueios controlados do ramo medial e com acompanhamento por três meses. Foram realizados bloqueios do ramo medial controlados em pacientes selecionados através de uma triagem específica, e foram avaliadas características sócio-demográficas, como sexo, raça, idade, tempo de dor, escolaridade e benefício do INSS (Instituto Nacional de Seguridade Social), sendo analisadas as correlações entre essas variáveis e o diagnóstico através dos bloqueios. Resultados: Foram realizados 104 bloqueios controlados do ramo medial, sendo que 54 pacientes (52%) obtiveram melhora da dor maior que 50% após o procedimento. Com o acompanhamento de 3 meses, 36 pacientes mantiveram sua melhora e somente 18 pacientes voltaram a sentir dor com escore na Escala Visual Analógica (EVA) > 4, sendo assim, feito o diagnóstico de lombalgia crônica facetária. O resultado do bloqueio não mostrou relação com os dados sócio-demográficos. O acompanhamento por três meses após o bloqueio do ramo medial conseguiu excluir 36 pacientes (67% de falsos positivos). Conclusões: O método diagnóstico através dos bloqueios do ramo medial mostrou-se efetivo, não estando relacionado com as variáveis categóricas citadas acima, sendo necessário acompanhamento de até três meses para evitar um número alto de falsos positivos. A prevalência da lombalgia facetária em nosso meio é semelhante àquela encontrada em outros estudos / Introduction: Chronic low back pain is one of the most prevalent diseases in Brazil, and it is possible to mention as possible causes: myofascial syndrome, discal degeneration (discogenic pain) and facet joint degeneration (facet pain). The chronic lumbar facet joint pain, focus of this study, has a variable prevalence depending on the method used in its diagnosis. The controlled medial branch anesthetic block has become the main method for diagnosis. The diagnostic power of the blockade is based on the assumption that anesthetizing the facet joint or its medial dorsal branch would result in pain relief. A positive result, i.e., pain relief, would mean that the facet joint is the site where pain originates. The objective of this study was to determine the prevalence of low back pain after controlled facet medial dorsal branch blocks and to verify if the result of the blockages correlates with socio- demographic variables. Methods: We conducted a cross-sectional study diagnosis of chronic facet joint low back pain diagnosed by controlled medial branch blocks, with three months follow-up. Controlled medial branch block was performed in patients selected through a specific screening, and socio demographic characteristics, such as sex, race, age, pain duration, level of education and social security benefit, were assessed. We then searched for correlations between these variables and diagnosis through the blocks Results: 104 controlled medial branch blocks were performed and 54 patients (52%) had improvements in pain greater than 50% after blockade. After three months, 36 patients maintained their improvement and lumbar pain returned in only 18 patients, with a score in the visual analogue scale (VAS) > 4. Therefore, in these patients the diagnosis of chronic facet low back pain was concluded. The blockade results was not correlated to demographic data. The three-months follow-up after the medial branch block was able to exclude 36 patients (67%) false positives. Conclusion: The diagnostic method through the medial branch block has proved effective but it was not related to categorical variables mentioned above. There is a need for a three-months follow-up to avoid a high number of false positives. The prevalence of low back pain facet in our service is similar to that found in other studies

Les pathologies vésicales sont nombreuses et nécessitent la plupart du temps un traitement médicamenteux. Il peut alors être administré par voie intravésicale, augmentant son efficience et limitant les effets indésirables systémiques. Nous nous sommes intéressés à quatre thérapeutiques : l’alun de potassium, le chlorhydrate de lidocaïne, l’hemisuccinate de méthylprednisolone, la mitomycine C et le bacille de Calmette et Guérin (BCG) en application locale directement dans la vessie. La perméabilité de l’aluminium à travers la vessie a été étudiée au travers d’un cas clinique et des expériences ex vivo ont été réalisées pour définir les paramètres de perméabilité et proposer un algorithme de prédiction de la quantité d’aluminium absorbée dans l’organisme après irrigation intravésicale à l’alun de potassium. Cet algorithme dépend du poids du patient, de la durée de l’irrigation et du volume de la solution utilisée en irrigation vésicale. Des études de perméation ont aussi été réalisées pour le chlorhydrate de lidocaïne, l’hemisuccinate de méthylprednisolone, la mitomycine C et le BCG afin de sécuriser l’emploi de ces thérapeutiques par voie intravésicale. Les études réalisées permettent de prédire, selon les caractères physico-chimiques des molécules, la pénétration dans la membrane vésicale. Une nouvelle formulation galénique réalisée à base d’un gel thermosensible a été étudiée pour optimiser les thérapeutiques intravésicales. Des études de perméation ont été faites avec la nouvelle formulation galénique. Pour finir, une culture de cellules cancéreuses urothéliales a été mise au point et un test de viabilité a été réalisé pour la mitomycine C et le BCG / Bladder diseases are numerous and mostly require medication. Drugs can be administered by intravesical route, thereby increasing efficiency and reducing systemic side effects. We are interested in four drugs: potassium alum, lidocaine hydrochloride, methylprednisolone hemisuccinate, mitomycin C and bacillus Calmette- Guérin (BCG). Mathematical modelling of drug transport through bladder wall is proposed considering scarce literature on this route of administration. The permeability of aluminum through bladder wall was studied through a clinical case and ex vivo experiments were performed to propose a simplified algorithm for the calculation of aluminium dose absorbed in patient with impaired renal function as function of volume of 1% alum solution in the bladder, duration of intravesical irrigation and patient body weight. Permeation studies were also conducted for lidocaine hydrochloride, methylprednisolone hemisuccinate, mitomycin C and BCG to secure intravesical administration of these drugs. Practical outcome of this study could drive compounding optimisation towards improvement of safety and efficacy in patient undergoing intravesical administration. A new pharmaceutical formulation including hrydrogel has been studied in an attempt to improve treatment administered by intravesical route. Permeation studies were made with the new formulation. Finally, an urothelial cancer cells culture has been developed and a viability test was performed with mitomycin C and BCG

No description available.

INTRODUÇÃO: A segurança da administração de anestésicos locais com vasoconstritor em pacientes diabéticos submetidos à cirurgia oral não está bem fundamentada na literatura. OBJETIVO: Investigar a ocorrência de variação da glicemia nos períodos pré, trans e pós-operatório de exodontia de dentes superiores, sob anestesia local com lidocaína 2% sem e com adrenalina 1:100.000, em portadores de diabetes mellitus tipo 2. Secundariamente, avaliar os efeitos hemodinâmicos e o grau de ansiedade. MÉTODOS: Estudo prospectivo e randomizado com pacientes portadores de diabetes acompanhados na Unidade Clinica de Coronariopatia Crônica do Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. A monitorização contínua da glicemia durante 24 horas foi realizada através do MiniMed Continuous Glucose Monitoring System (CGMS, Medtronic). Os pacientes foram divididos em dois grupos: LSA - que recebeu 5,4 mL lidocaína 2% sem adrenalina e LCA - que recebeu 5,4 mL de lidocaína 2% com adrenalina 1:100.000. Os níveis de glicemia foram avaliados nas 24 horas (período basal) e nos tempos determinados: uma hora antes, durantes e até uma hora após a exodontia (período de procedimento). Os parâmetros hemodinâmicos foram avaliados por meio de um medidor de pressão arterial digital automático e o nível de ansiedade através de uma escala. RESULTADOS: Dos 400 pacientes avaliados, 70 foram incluídos no estudo, sendo 35 randomizados no grupo LSA e 35 no grupo LCA. A análise das médias da glicemia nos grupos LSA e LCA durante os períodos (basal e procedimento) não demonstrou diferença estatisticamente significativa (p=0,229 e p=0,811, respectivamente). Também não houve diferença significativa (p=0,748) na glicemia entre os grupos em cada tempo avaliado. Entretanto, nos dois grupos houve decréscimo significativo da glicemia (p < 0,001) ao longo dos tempos avaliados. Os grupos LSA e LCA não apresentaram diferenças significativas em relação à PAS (p=0,176), à PAD (p=0,913), à FC (p=0,570) e ao nível de ansiedade. CONCLUSÃO: A administração de 5,4mL de lidocaína 2% com adrenalina 1:100.000 não provocou alteração significativa da glicemia, parâmetros hemodinâmicos e nível de ansiedade em relação ao grupo sem vasoconstritor / INTRODUCTION: The safety of administration of local anesthetics with epinephrine for diabetic patients undergoing oral surgery is not well grounded in the literature. OBJECTIVE: To investigate the occurrence of variation of glucose in the pre, intra and postoperative extraction of upper teeth under local anesthesia with lidocaine 2% with and without 1:100.000 epinephrine in patients with type 2 diabetes mellitus. Secondly, to evaluate the hemodynamic effects and degree of anxiety. METHODS: A prospective randomized study of patients with diabetes attended in Coronary Chronic Clinics Unit, Heart Institute, Hospital das Clinicas in University of São Paulo Medical School. Continuous monitoring of blood glucose for 24 hours was performed using MiniMed Continuous Glucose Monitoring System (CGMS, Medtronic) and the patients were divided into two groups: LSA - which received 5.4 mL of 2% lidocaine without epinephrine and LCA - which received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Blood glucose levels were assessed at 24 hours (baseline period) and at certain times: one hour before, during, and up to one hour after oral surgery (procedure period). We evaluated the hemodynamic parameters through a digital automatic pressure meter and anxiety level was measured by the scale. RESULTS: Of 400 patients evaluated, 70 were included in these study, 35 were randomized in the LSA group and 35 in the group LCA. The analysis of mean glicemia in groups LSA and LCA during the baseline period and procedure showed no statistically significant difference (p = 0.229 and p = 0.811, respectively). There was no difference in blood glucose (p = 0.748) between the groups at each time evaluated. However, in both groups there was a significant decrease in blood glucose (p < 0.001) over the time periods studied. The groups showed no significant differences regarding SBP (p = 0.176), DBP (p = 0.913), HR (p = 0.570) and anxiety level. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine 1:100.000 caused no significant change in blood glucose, hemodynamic parameters and level of anxiety compared to the group without vasoconstrictor

Estudamos 62 pacientes, que com teste ergométrico positivo, manifestaram angina estável e estavam sob controle farmacológico. Todos apresentavam cinecoronariografia mostrando obstrução >70% em pelo menos uma das principais artérias coronárias. Objetivamos avaliar parâmetros eletrocardiográficos e de pressão arterial, durante procedimento odontológico restaurador sob anestesia local com e sem vasoconstritor em presença de doença arterial coronária. As idades variaram de 39 a 80, média de 58,7±8,8 anos, sendo 51 (82,3%) homens. Trinta pacientes foram randomizados para receber anestesia local com solução de lidocaína a 2% com adrenalina 1:100.000 e os demais para lidocaína a 2% sem vasoconstritor. Todos os pacientes foram submetidos à monitorização ambulatorial da pressão arterial (MAPA) e eletrocardiografia dinâmica por 24 horas, iniciados 2 horas antes do procedimento odontológico. Consideramos 3 períodos de registro: (1) basal - os 60 minutos que antecederam ao procedimento odontológico; (2) procedimento - desde o início da anestesia até o final do procedimento odontológico restaurador; (3) subseqüente completar das 24 horas. A análise de variância com medidas repetidas mostrou que houve elevação significativa da pressão arterial sistólica e diastólica do período basal para o procedimento nos dois grupos estudados (aproximadamente 14mmHg e 5 a 7mmHg) respectivamente, quando analisados separadamente e quando confrontados não apresentaram diferença de comportamento entre si. A freqüência cardíaca não se alterou nos dois grupos estudados. Depressão do segmento ST >1mm ocorreu em 10 (17,9%) pacientes; todos os eventos ocorreram no mínimo 2 horas após o término do procedimento odontológico. Extra - sístoles supra-ventriculares e/ou extra-sístoles ventriculares em número maior do que 10/hora estiveram presentes em 17 (30,4%) pacientes durante as 24 horas e durante o período do procedimento em 7 (12,5%), sendo 4 (13,8%) do grupo que recebeu anestesia sem adrenalina e 3 (11,1%) do grupo que recebeu anestesia com adrenalina e o teste Exato de Fisher não mostrou diferença entre os grupos. Concluímos que não houve diferença em relação ao comportamento de pressão arterial, freqüência cardíaca, evidência de isquemia e arritmias entre os grupos. O uso associado de vasoconstritor mostrou-se, portanto, seguro dentro dos limites do estudo. / We enrolled 62 patients with positive exercise stress test who presented with stable angina and were receiving drug therapy. All had a coronary angiography screening showing >70% obstruction in at least one of the main coronary arteries. The study aimed to compare electrocardiographic and blood pressure parameters during restorative dentistry procedure under local anesthesia, both with and without vasoconstrictor, in the presence of coronary artery disease. Ages ranged from 39 to 80, (mean ± SD) 58.7±8.8 years, 51 (82.3%) of them were male. Thirty patients were randomly assigned to receive 2% lidocaine local anesthesia with 1:100,000 epinephrine, the others receiving 2% lidocaine without vasoconstrictor. All the patients underwent ambulatory blood pressure and 24-hour Holter monitoring, beginning two hours ahead of the dental procedure. Recording were made during (1) baseline - 60-minute period before dental procedure began; (2) procedure - from beginning of anesthesia until the end of the procedure; and (3) subsequent 24-hour period. Analysis of variance with repeat measures showed significant diastolic and systolic blood pressure increases from baseline to the period of the procedure, in the two study groups (approximately 14 mm Hg, and 5 to 7 mm Hg, respectively); both in a separate analysis and in a comparative analysis no significant difference between them could be confirmed. Heart rate did not change in neither of the two groups. ST-segment >1 mm depression was detected in 10 (17.9%) patients; all these events occurred at least two hours after the end of the dentistry procedure. Premature supraventricular systoles and/or premature ventricular systoles in a greater number than 10/hour were seen in 17 (30.4%) patients in the 24-hours period after the procedure; during the procedure they occurred in 7 (12.5%) patients, of whom 4 (13.8%) were in the group without, and 3 (11.1%) in the group with vasoconstrictor. The Fisher\'s exact test revealed no difference between the groups. We concluded that there was no difference of blood pressure, heart rate, evidence of ischemia or arrhythmia episodes between the groups. Thus, the associated use of vasoconstrictor proved to be safe within the limits of this study

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-12-16T17:15:33Z No. of bitstreams: 1 marcellofonsecasalgadofilho.pdf: 9000247 bytes, checksum: a234119931ed8da56fb969e17bc8b078 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-12-19T13:03:57Z (GMT) No. of bitstreams: 1 marcellofonsecasalgadofilho.pdf: 9000247 bytes, checksum: a234119931ed8da56fb969e17bc8b078 (MD5) / Made available in DSpace on 2016-12-19T13:03:57Z (GMT). No. of bitstreams: 1 marcellofonsecasalgadofilho.pdf: 9000247 bytes, checksum: a234119931ed8da56fb969e17bc8b078 (MD5) Previous issue date: 2010-04-14 / Introdução: O bloqueio do nervo dorsal do pênis (BNDP) e a anestesia local tópica (LT) com uma mistura eutética de prilocaína e lidacaína são técnicas de uso rotineiro, fácil aplicação e baixo índice de complicações na cirurgia de postectomia. Propôs-se avaliar qual delas apresenta melhor analgesia com menor efeito hemodinâmico na cirurgia de postectomia por Plastibell® em crianças. Pacientes e métodos: Este ensaio clínico randomizado foi conduzido com 41 meninos, submetidos à postectomia por Plastibell® divididos em dois grupos: LT e BNDP. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Humanos segundo as normas da declaração de Helsinki e pelo Clinical trials/FDA. Nos pacientes sorteados para a técnica LT, a pomada de mistura eutética de prilocaína e lidacaína era aplicada no prepúcio uma hora antes da cirurgia. Antes da indução anestésica, todas as crianças eram monitoradas com estetoscópio precordial e monitor multiparâmetro Datex Omeda®. A indução anestésica era padrão para os dois grupos, com concentração inspirada de sevoflurano a 8% sob máscara facial e ventilação espontânea. No grupo BNDP, fez-se o bloqueio do nervo dorsal do pênis com levobupivacaína a 0,5% na dose de 2mg/kg. Avaliaram-se a frequência cardíaca, a pressão arterial média, a frequência respiratória e os movimentos involuntários durante os momentos de indução anestésica, de bloqueio do nervo dorsal do pênis, um minuto após a incisão e no pós-operatório imediato. A dor foi avaliada na primeira e na vigésima quarta hora de pós-operatório, pela escala análogo visual de dor. Resultados: Os grupos foram homogêneos quanto à idade, peso, diâmetro da glande, comprimento do pênis e tempo cirúrgico. No grupo LT, observou-se uma tendência a aumento da freqüência cardíaca no momento 1 minuto pós-incisão (p = 0,073) e da pressão arterial media no momento 1 minuto pósincisão (p = 0,046). No grupo BNDP, houve aumento da freqüência cardíaca (p = 0,004) e da pressão arterial média (p = 0,016) no momento do bloqueio. Comparando os momentos de maiores estímulos hemodinâmicos em cada grupo (T2 no grupo LT e T1 no grupo BNDP), observamos um estímulo mais intenso no BNDP, com aumento significante da freqüência cardíaca (p = 0,001) e maior incidência de movimentos involuntários (p = 0,002). Não houve diferença na dor 7 na primeira e na vigésima quarta hora de pós-operatório entre os grupos estudados. A incidência de hematoma e edema em 24 horas de pós--operatório foi maior no grupo BNDP. Conclusão: A anestesia LT com a pomada de mistura eutética de prilocaína e lidacaína proporciona menor repercussão hemodinâmica e analgesia satisfatória ao procedimento de postectomia por Plastibell®, controle da dor pós-operatório e baixa incidência de complicações pós-operatórias em relação ao BNDP, quando ambas as técnicas estão associadas à anestesia geral inalatória com sevoflurano. / Introduction: The dorsal penile nerve block (DPNB) and local topical anesthesia (LT) with eutetic mixture lidocaine and prilocaine are current techniques with easy implementation and low complication rate in circumcision surgery. Herein, we evaluated which anesthetic technique provides better analgesia with less hemodynamic stimulation during circumcision with Plastibell® in children. Patients and methods: Forty-one boys who underwent circumcision with Plastibell® were divided at random into two groups: LT and DPNB. In LT group the ointment eutetic mixture lidocaine and prilocaine was applied to the foreskin one hour before surgery. Before inhalatory induction, all children were completely monitored. Inhalatory induction was standard for the two groups with 8% end-tidal concentration of sevoflurane on a facemask and spontaneous ventilation. After 10 minutes of anesthesia induction, the end-tidal sevoflurane concentration was decreased to 2%. In the DPNB a dorsal penile nerve block was done with levobupivacaine 0.5% (2 mg/kg). We evaluated the heart rate, respiratory rate mean arterial pressure, and involuntary movements in the moments of induction of anesthesia (T0); dorsal penile nerve block (T1); 1 minute post-incision (T2) and 1 minute after end of surgery (T3). And also pain 1 hour and 24 hours after surgery. Results: The groups were homogeneous when compared age, weight, diameter of the glands, penile length and surgical duration. In the LT group there was a tendency to increase Heart Rate at T2 (p = 0.073) and an increase of Mean Arterial Pressure at T2 (p = 0.046) when compared to the induction time. The DPNB group had an increase in Heart Rate (p = 0.004) and Mean Arterial Pressure (p = 0.016) at the block time (T1) when compared to T0 time. Comparing the moments of greatest hemodynamic stimulus for each group (T2 for LT and T1 for DPNB) we observed a more intense stimulus in DPNB group with a significant increase in Heart Rate (p = 0.001) and greater incidence of involuntary movements (57.1% vs. 10%; p = 0.002). There was no difference in the incidence of pain between the study groups. Post-operative complications were higher in DPNB, especially hematoma and edema. Conclusions: Anesthesia with eutetic mixture lidocaine and prilocaine provides satisfactory hemodynamic stable during circumcision with Plastibell®, pain control and less complication in the post 9 operative period when this technique is associated with general anesthesia with sevoflurane.