O USO DA ADRENALINA E FELIPRESSINA NA ANESTESIA LOCAL ODONTOLÓGICA EM PACIENTES CARDIOPATAS: REVISÃO DA LITERATURA

RESUMO A discussão sobre a utilização ou não dos vasoconstritores em odontologia para pacientes cardiopatas é grande. A presença dos vasoconstritores oferece vantagens, tais como, retardar a absorção de anestésicos locais, diminuir a necessidade de uma quantidade maior do sal anestésico, com isso, reduzindo o risco de toxicidade, proporcionar um maior controle do sangramento e conforto ao paciente. Porém, sua utilização em pacientes com cardiopatias é um pouco controversa para alguns autores. O objetivo do estudo é revisar a literatura sobre a utilização dos dois principais vasoconstritores utilizados na odontologia (Epinefrina/Adrenalina e Felipressina) em pacientes com cardiopatias. Palavras-Chave: Vasoconstritores, Cardiopatias, Anestésicos locais. ABSTRACT The discussion on the use or not of vasoconstrictors in dentistry for patients with heart disease is great. The presence of the vasoconstrictor offers benefits such as delaying the absorption of local anesthetics, reduce the need for a larger amount of the anesthetic, thereby reducing the risk of toxicity, providing greater control of bleeding and patient comfort. However, the use in patients with heart disease is controversial for some authors. The aim of the study is review the literature on the use of two vasoconstrictors used in dentistry (Epinephrine / Adrenaline and Felypressin) in patients with heart disease. Keywords: Vasoconstrictor Agents, Heart Diseases, Anesthetics.

Vasodilator responses to acetylcholine are not mediated by the activation of soluble guanylate cyclase or TRPV4 channels in the rat

The effects of 1H-[1,2,4]-oxadizaolo[4,3-]quinoxaline-1-one (ODQ), an inhibitor of the activation of soluble guanylate cyclase (sGC) on responses to NO donors acetylcholine (ACh) and bradykinin (BK) were investigated in the pulmonary and systemic vascular beds of the rat. In these studies the administration of ODQ in a dose of 5 mg/kg iv attenuated vasodilator responses to five different NO donors without inhibiting responses to ACh and BK in the systemic and pulmonary vascular beds of the rat. Vasodilator responses to ACh were not inhibited by l-NAME or the transient receptor vanilloid type 4 (TRPV4) antagonist GSK-2193874, which attenuated vasodilator responses to the TRPV4 agonist GSK-1016790A. ODQ did not inhibit vasodilator responses to agents reported to act in an NO-independent manner or to vasoconstrictor agents, and ODQ did not increase blood methemoglobin levels, suggesting that off target effects were minimal. These results show that ODQ in a dose that inhibited NO donor-mediated responses did not alter vasodilator responses to ACh in the pulmonary and systemic vascular beds and did not alter systemic vasodilator responses to BK. The present results indicate that decreases in pulmonary and systemic arterial pressures in response to ACh are not mediated by the activation of sGC or TRPV4 channels and that ODQ can be used to study the role of the activation of sGC in mediating vasodilator responses in the rat.