[Adverse drug reactions of local anesthetics used in dentistry]. / Nezhelatel'nye reaktsii na mestnye anestetiki pri ikh primenenii v stomatologii.

The aim. Study the adverse drug reactions (ADR) that occur when using local anesthetics (LA) in patients living in the Republic of Crimea and registered during the period 2010-2018. MATERIAL AND METHODS: The objects of the study were 122 notification forms about LA ADR recorded in the regional base (Register) of spontaneous reports called ARCADe (Adverse Reactions in Crimea, Autonomic Database). In most cases, ADR was associated with the use of amide LA Lidocaine - 69 cases (56.55% of the total number of cases for LA ADR), less often, ADR was caused by combinations containing Articaine (34 cases, 27.87%). Rare cases of ADR were reported for Novocaine/Procaine (9 cases, 7.38%), Bupivacaine (8 cases, 6.56%) and Mepivacaine (2 cases, 1.64%). The main clinical manifestations of reactions were hypersensitivity-like reactions (38 cases), cardiac and vascular disorders (29 cases) and central nervous system disorders (19 cases). Lack of effectiveness of LA occurred in 13 cases (10.66%). RESULTS: A study of the outcome of ADR revealed a high incidence of life-threatening conditions associated with LA use - 31 cases (25.4%), which indicates the severity of the event and the need to cancel the suspected drug and prescribe additional medications for correction. The need for hospitalization or prolongation of hospitalization was necessary in 7 cases (5.8%), and temporary disability of patients was revealed in 5 cases (4.1%). Of particular interest are 2 cases (1.6%) of the development of a fatal outcome as a result of the suspected anaphylactic shock (1 case) and disorders of the central nervous system (convulsions, development of respiratory failure). CONCLUSION: The high frequency and severity of unwanted effects resulted from the use of LA requires healthcare professionals to make rational choices and strictly monitor patient safety.

Altered sympathetic tone in hypertensives with angina and lowered threshold for pacing ischemia.

To determine the role of the sympathetic nervous system in myocardial ischemia with essential hypertension, plasma norepinephrine, heart rate (HR), blood pressure (BP), and the HR.BP double product at the time of silent ischemia during pacing and exercise treadmill test (ETT) were compared with basal values in 20 patients with sustained essential hypertension and stable angina, 3 to 60 days (12.6 +/- 11.6) after discontinuation of all antihypertensive and coronary vasodilator therapy. Group I (N = 6) had silent ischemia with a higher HR.BP product at ETT than at pacing (ratio = 157 +/- 10.4% [+/- SD] v a value in group II [N = 5] of 102 +/- 18.8 [P less than .01]. Group III (N = 9) had no silent ischemia at ETT or pacing. Group I v group II plasma norepinephrine levels at rest and with pacing silent ischemia were 76 +/- 37 v 138 +/- 36 pg/mL, P less than .02, and 101 +/- 50 v 230 +/- 43 pg/mL, P less than .01, respectively. In groups I and II plasma norepinephrine levels were significantly lower than those of group III. Eleven of 20 patients had ischemia on pacing or ETT. Left ventricular myocardial mass were greater (224 +/- 49 v 180 +/- 28 g, p less than .05), HR (67 +/- 13 v 76 +/- 11 beats/min, P = NS) and plasma norepinephrine levels at rest (104 +/- 47 v 241 +/- 99 pg/mL, P less than .01), pacing (160 +/- 81 v 338 +/- 94 pg/mL, P less than .01), and ETT (758 +/- 268 v 1203 +/- 611 pg/mL, P less than .05), were lower in patients with ischemia (N = 11, group II) than in patients without ischemia (N = 9, group III) on pacing or ETT. Eight patients were on reserpine prestudy; reserpine prestudy was associated with lower basal HR (63 +/- 9 v 76 +/- 12 beats/min, P less than .05) and plasma norepinephrine (106 +/- 48 v 169 +/- pg/mL, P less than .07) and greater ratio of HR.BP double product on ETT/pacing, (141 +/- 33 v 111 +/- 19, P less than .02). The sympathetic nervous tone of group I was low at baseline but there may have been raised alpha/beta-receptor responsiveness to laboratory stresses with concomitant micro/macrovascular constriction at higher oxygen demand.(ABSTRACT TRUNCATED AT 400 WORDS)

Silent myocardial ischemia in patients with essential hypertension.

The aim of this study was to determine the significance of the "coronary factor" in patients with essential hypertension (EH). Electrocardiogram Holter monitoring was performed in 61 patients with EH stage II (according to the World Health Organization criteria). Silent, ie, painless ST-segment depression, was found in 34 patients on whom echocardiography, a treadmill test, and transesophageal pacing were performed. In 21 patients with EH and silent ischemia, the examination included 201Tl stress scintigraphy, coronary angiography, and a platelet aggregation test. In 15 patients, catecholamines and beta-endorphins were obtained in blood samples during silent ischemia. 201Tl scintigraphy showed transient defects of perfusion without clearance abnormalities (group I) and with clearance abnormalities (group II). The patients in group I had more severe left ventricular hypertrophy (LVH) and a significantly higher platelet aggregation response to 0.5 mumol/L adenosine diphosphate; one patient in this group had coronary atherosclerosis. LVH and the platelet aggregation response was less pronounced in the patients in group II, but atherosclerotic lesions of a coronary artery were observed in four patients. In both groups, norepinephrine and beta-endorphin levels were increased during silent episodes of ischemia. The results suggest that there are different pathogenetic mechanisms of coronary insufficiency in patients with EH, a hypertensive heart, and silent ischemia.