Efecto del Anestésico local con Vasoconstrictor sobre la glucemia de pacientes diabéticos bajo terapia periodontal

Maria de los A Salas P, Arantxa Z Rivas D,, Belkis J Quiñonez M, Susana Arteaga A

Resumen


Los anestésicos locales son utilizados para controlar el dolor durante la atención de pacientes odontológicos, generalmente combinados con vasoconstrictores. A pesar de las ventajas de este método en algunos pacientes, el vasoconstrictor está contraindicado. Los pacientes diabéticos presentan patologías bucales como la enfermedad periodontal, cuyo tratamiento puede requerir anestesia local. Debido a que existen controversias en la literatura científica, se plantea evaluar el efecto del anestésico local con vasoconstrictor sobre los niveles de glucemia en pacientes diabéticos controlados sometidos a terapia periodontal. La muestra estuvo conformada por 36 pacientes, 18 sistémicamente sanos, 7 diabéticos tipo 1 (DM1) y 11 diabéticos tipo 2 (DM2). Se evaluaron los niveles de glucemia al inicio de la consulta, antes de la aplicación del anestésico local lidocaína al 2% con epinefrina 1:80.000 y 20 minutos después, a través de una muestra de sangre capilar utilizando el glucómetro SUMASENSOR SXT®. Los pacientes fueron atendidos en la Cátedra de Periodoncia de la Facultad de Odontología de la Universidad de Los Andes y en el Servicio de Odontología de la Alcaldía del Municipio Libertador, estado Mérida. Los resultados mostraron diferencia significativa entre los niveles de glucemia de los pacientes sistémicamente sanos, DM1 y DM2 en los tres momentos de evaluación (Prueba Kruskal Wallis p0,05). Se concluye que la administración de lidocaína al 2% con epinefrina 1:80.000 no modifica significativamente la glucemia de pacientes diabéticos controlados.

Palabras clave


anestésicos locales; vasoconstrictores; diabetes mellitus; glucemia; enfermedades periodontales

Texto completo:

PDF

Referencias


Qaranizade K, Lasemi E, Aghdam HM, Malihi F. Evaluation of Changing Serum Blood Glucose

Levels after Local Anesthetic Injection during Tooth Extraction. J Dentomaxillofacial Radiol

Pathol Surg [Internet]. 2015;4(2):15-19. Available from: http://3dj.gums.ac.ir/article-1-167-en.pdf

Byakodi S, Gurjar V, Soni S. Glucose levels and hemodynamic changes in patients submitted

to routine dental Extraction under Local Anesthesia with and without Adrenaline. J Contemp

Dent Pract. 2017;18(1):57-59.

Kaur P, Bahl R, Kaura S, Bansal S. Comparing hemodynamic and glycemic response to

local anesthesia with epinephrine and without epinephrine in patients undergoing tooth

extractions. Natl J Maxillofac Surg [Internet]. 2016;7(2):166-172. Available from: http://www.

njms.in/text.asp?2016/7/2/166/201370

Pradeep P, Prasad G, Padmanabh M, Palliyal S, Paul MM. Comparison of Glycemic Effect of

Adrenalin Containing Local Anesthetic in Diabetic and Non-Diabetic Patients Undergoing

Minor Oral Surgical Procedure. J Evid Based Med Healthc. 2015;2(53):8737-8740.

Hemani K, Bhoj M, Ganapathy D, Vadaguru A. Influence of adrenaline containing local

anesthesia on the glycemic level of patients undergoing tooth extraction. Drug Invent Today.

;11(3):545-549.

Santos-Paul M, Neves I, Neves R, Ramires J. Local anesthesia with epinephrine is safe and

effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a

prospective randomized study. Clinics [Internet]. 2015;70(3):185–189. Available from: https://

www.ncbi.nlm.nih.gov/pmc/articles/PMC4449474/pdf/cln-70-03-185.pdf

Martinez A. Anestesia Bucal. Guía Práctica. 1st ed. Editorial Medica Panamericana; 2009.

Echeveste D. Contraindicaciones para el uso de vasoconstrictores. Actas Odontol [Internet].

;5(1):39–44. Available from: https://www.google.co.ve/l?sa=t&rct=j&q=&esrc=s&source=

web&cd=1&cad=rja&uact=8&ved=0ahUKEwiv2OPExfDWAhUDySYKHbt9BicQFggl-

MAA&url=https%3A%2F%2Frevistas.ucu.edu.uy%2Findex.php%2Factasodontologicas%2Farticle%

Fdownload%2F1110%2F1091&usg=AOvVaw3sL69duB42eCO

Kumar H, Hegde V, Sharma R. Assessment of effect of Epinephrine in diabetic patients

undergoing third molar extraction. J Oral Med Oral Surgery, Oral Pathol Oral Radiol.

;3(3):149-152.

Haji IUH, Siddiq M, Rao S, Rai G, Hiregoudar JS, Pitale U. Study on blood glucose

concentration in patients with diabetes undergoing dental extraction under local anesthesia

with and without adrenaline. J Basic Clin Physiol Pharmacol. 2012;23(4):169-171.

Tily FE, Thomas S. Glycemic effect of administration of epinephrine-containing local

anaesthesia in patients undergoing dental extraction, a comparison between healthy and

diabetic patients. Int Dent J. 2007;57(2):77-83.

Kalra P, Rana A, Peravali RK, Gupta D, Jain G. Comparative evaluation of local anaesthesia

with adrenaline and without adrenaline on blood glucose concentration in patients undergoing

tooth extractions. J Maxillofac Oral Surg [Internet]. 2011;10(3):230–235. Available from: https://

www.ncbi.nlm.nih.gov/pmc/articles/PMC3238546/pdf/12663_2011_Article_239.pdf

Santosh G, Ranganath N. Effect of Lignocaine with and without Adrenaline on Blood Glucose

Concentration in Patients Undergoing Extractions. Medica Innov. 2014;3(1):111-121.

Muntaha ST, Fazal M, Khalida B, Khan K. Evaluation of blood glucose concentration in patients

with diabetes undergoing tooth extraction after administration of local anesthesia with or

without adrenaline. Oral Maxillofac Surg. 2018;38(2):187-190.

Akinmoladun V, Okoje V, Akinosun O, Adisa A, Uchendu O. Evaluation of the haemodynamic

and metabolic effects of local anaesthetic agent in routine dental extractions. J Maxillofac

Oral Surg [Internet]. 2013;12(4):424–428. Available from: https://www.ncbi.nlm.nih.gov/pmc/

articles/PMC3847016/

Bortoluzzi MC, Manfro R, Nardi A. Glucose levels and hemodynamic changes in patients

submitted to routine dental treatment with and without local anesthesia. Clinics (Sao Paulo,

Brazil) [Internet]. 2010;65(10):975–978. Available from: https://www.ncbi.nlm.nih.gov/pmc/

articles/PMC2972604/

American Diabetes Association. Standards of Medical Care in Diabetes 2019. Diabetes

Care [Internet]. 2019;42:66. Available from: http://care.diabetesjournals.org/content/diacare/

suppl/2018/12/17/42.Supplement_1.DC1/DC_42_S1_Combined_FINAL.pdf

Lalla R, D’Ambrosio J. Dental management considerations for the patient with diabetes

mellitus. Jada. 2001;132(1):1425-1432.

Dávila L, Giménez X, Arteaga S, Sosa L. Enfermedades y condiciones periodontales y

periimplantares. Rev Odontológica Los Andes [Internet]. 2019;14(2):10-24. Available from: http://

www.saber.ula.ve/bitstream/handle/123456789/46470/1_articulo.pdf?sequence=1&isAllowed=y

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes

Care [Internet]. 2014;37(SUPPL.1):81-90. Available from: http://care.diabetesjournals.org/

content/37/Supplement_1/S81.full-text.pdf

O’Connell PAA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, et al. Effects

of periodontal therapy on glycemic control and inflammatory markers. J Periodontol.

;79(5):774-783.

Naiff P, Carneiro V, Guimarães MDC. Importance of mechanical periodontal therapy in patients

with diabetes type 2 and periodontitis. Int J Dent. 2018;2018.

Al-Maskari A, Al-Maskari M, Al-Sudairy S. Oral Manifestations and Complications of Diabetes

Mellitus. SQU Med J [Internet]. 2011;11(2):179-186. Available from: https://www.ncbi.nlm.nih.gov/

pmc/articles/PMC3121021/

Dávila L, Giménez X, Arteaga S, Solórzano E. Fundamentos básicos para el diagóstico clínico

periodontal. Primera ed. CPULA, editor. Mérida; 2014.

Garzón-Sanabria V, Olmos-Bringas M, Mota-Sanhua V, Enríquez-Bárcenas L, García-Ruiz E,

Rivas-Ayala L, et al. Terapia periodontal no quirúrgica en pacientes con diabetes mellitus tipo

en descontrol. Rev Med Inst Mex Seguro Soc [Internet]. 2013;51(1):86-91. Available from:

http://www.medigraphic.com/pdfs/imss/im-2013/im131l.pdf

Alves M. Monitorização da glicemia em tempo real durante cirurgia odontológica ambulatorial

em portadores de diabetes mellitus tipo 2: estudo comparativo entre anestésico local sem e

com vasoconstritor [Doctoral dissertation]. [Internet]. Universidad de Sao Paulo; 2013. Available

from: http://www.teses.usp.br/teses/disponiveis/5/5131/tde-23012014-120924/pt-br.php

Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis

and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21-31.

Ribeiro Fonseca C. Avaliação dos níveis glicêmicos, parâmetros hemodinâmicos e analgesia

pós-operatória em diabéticos não insulino dependentes com uso de articaína 4% com

epinefrina (1:100.000 e 1:200.000) em cirurgias periodontais [Doctoral dissertation].

Universidad de Sao Paulo; 2014.

Jones JA, Miller DR, Wehler CJ, Rich SE, Krall-Kaye EA, McCoy LC, et al. Does periodontal

care improve glycemic control? The Department of Veterans Affairs Dental Diabetes Study.

J Clin Periodontol [Internet]. 2007;34(1):46-52. Available from: http://www.nature.com/bdj/

journal/v203/n1/full/bdj.2007.590.html

Romero M. Salud bucal y diabetes. Tendencias en Med [Internet]. 2013;8(8):119–122. Available

from: http://www.tendenciasenmedicina.com/Imagenes/imagenes08p/art_19.pdf

Mauri-Obrados E, Melos A, Estrugo-Devesa A, Jané-Salas E, López-López J, Viñas M. Benefits

of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic

periodontitis: A randomized controlled trial. J Periodontol. 2018;45(3):345-353.

Peña M, Calzado M, Suárez W, Peña L, González E. Efectividad del tratamiento periodontal en

el control metabólico de pacientes diabéticos. MEDISAN. 2018;22(3):240-247.

Tsobgny-Tsague NF, Lontchi-Yimagou E, Nana ARN, Tankeu AT, Katte JC, Dehayem MY, et al.

Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes

patients (PARODIA 1 study): A randomized controlled trial in a sub-Saharan Africa population.

BMC Oral Health. 2018;18(1):1-8.

Parrales-Giraldo L. Complicaciones provocadas por los anestésicos locales en pacientes

diabéticos [Internet]. Universidad de Guayaquil; 2014. Available from: http://repositorio.ug.edu.

ec/handle/redug/6313

Teeuw WJ, Gerdes VEA, Loos BG. Effect of Periodontal Treatment on Glycemic Control of

Diabetic Patients A systematic review and meta-analysis. Diabetes Care [Internet]. 2010

[cited 2017 Mar 9];33(2):421-427. Available from: http://care.diabetesjournals.org/content/

diacare/33/2/421.full.pdf

D’Aiuto F, Gkranias N, Bhowruth D, Khan T, Orlandi M, Suvan J, et al. Systemic effects

of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre,

investigator-masked, randomised trial. Lancet Diabetes Endocrinol. 2018;6(12):954-965.

Madrid C, Courtois B, Vironneau M. Recommendations to use vasoconstrictors in dentistry

and Oral surgery. Médecine Buccale Chir Buccale [Internet]. 2003;9(2):1-30. Available

from: https://www.mbcb-journal.org/recommendations/256-recommendations-to-usevasoconstrictors-

in-dentistry-and-oral-surgery

Papapanou P, Sanz M, Buduneli N, Dietrich T, Feres M, Fine D, et al. Periodontitis: Consensus

report of workgroup 2 of the 2017World Workshop on the Classification of Periodontal and

Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;89:S173-182.

Malamed SF. Manual de anestesia local. 6th ed. Elsevier; 2013.

Macouzet C. Anestesia local en odontología. segunda. El Manual Moderno; 2008.

Mello R, Juliana R, Daiane P, Carllini V, Cristiane B, Rogério M. Evaluation of blood glucose in

type II diabetic patients submitted to local anesthesia with different vasoconstrictors. RGORev

Gaúcha Odontol [Internet]. 2016;64(4):425-431. Available from: http://www.scielo.br/pdf/

rgo/v64n4/1981-8637-rgo-64-04-00425.pdf

Smerilli A, Sacot N. Anestésicos Locales : Historia, Acción Farmacológica, Mecanismo de Acción,

Estructura Química y Reacciones Adversas. rev la Fac Odontol (UBA). 2004;19(46):19-24.

Khawaja NA, Khalil H, Parveen K, Alghamdi AM, Alzahrani RA, Alherbi SM. An influence of

adrenaline (1:80,000) containing local anesthesia (2% Xylocaine) on glycemic level of patients

undergoing tooth extraction in Riyadh. Saudi Pharm J [Internet]. 2014;22(6):545-549. Available

from: http://dx.doi.org/10.1016/j.jsps.2014.02.006

Meneses-Santos D, Amorim K, Dantas A, da Silva R, de Araújo J, Groppo F, et al. Comparison

of two vasoconstrictors on glycemic levels in diabetic patients. Clin Oral Investig [Internet].

; Available from: http://link.springer.com/10.1007/s00784-020-03327-z

Faria-Almeida R, Navarro A, Bascones A. Clinical and Metabolic Changes After Conventional

Treatment of Type 2 Diabetic Patients With Chronic Periodontitis. J Periodontol [Internet].

;77(4):591–598. Available from: https://www.researchgate.net/publication/7196330_

Clinical_and_Metabolic_Changes_After_Conventional_Treatment_of_Type_2_Diabetic_

Patients_With_Chronic_Periodontitis

Hayashi J, Hasegawa A, Hayashi K, Suzuki T, Ishii M, Otsuka H, et al. Effects of periodontal

treatment on the medical status of patients with type 2 diabetes mellitus: a pilot study. BMC

Oral Health [Internet]. 2017;17(1):77. Available from: http://bmcoralhealth.biomedcentral.com/

articles/10.1186/s12903-017-0369-2




 

Depósito Legal Electrónico: PPI 201202ME4105
ISSN Electrónico: 2244-8861

Creative Commons License
Todos los documentos publicados en esta revista se distribuyen bajo una
Licencia Creative Commons Atribución -No Comercial- Compartir Igual 4.0 Internacional.
Por lo que el envío, procesamiento y publicación de artículos en la revista es totalmente gratuito.