|June 4, 2007
|June 4, 2008
|July 2005 (final data collection date for primary outcome measure)
|Maternal: Blood Pressure, Heart Rate and Extrasystoles; Maternal-Fetal: Fetal Heart Rate, number of uterine contractions, motility and fetal reactivity pattern, in function of presence or not of epinephrine 1:100000 in the 2% solution.of lidocaine [ Time Frame: 4 periods Maternal: (1) Baseline - 60 minutes before the procedure, (2) Procedure, (3) Post-Procedure - 20 minutes, and (4) mean 24-hour; 3 periods Maternal-Fetal: (1) Baseline: 20 minutes before, (2) Procedure, and (3) Post-Procedure - idem maternal ] [ Designated as safety issue: Yes ]
|Pregnant women with valvar heart disease [ Time Frame: between the 28th and. 37th week of gestation ]
|Complete list of historical versions of study NCT00482573 on ClinicalTrials.gov Archive Site
|They had been the same analyses used for the Primary Outcome Measures, in function of the gestational age (GA): sub-group GA1 (15 pregnant women between 28 and 31 weeks) and sub-group GA2 (16 pregnant women between 28 and 31 weeks). [ Time Frame: They had been the same periods established for the Time Frame of Primary Outcome Measure ] [ Designated as safety issue: Yes ]
|Rheumatic Heart Disease, undergone the surgery or not [ Time Frame: With the diagnosis of the disease, followed by a cardiologist and a gynecologist, until the moment of this trial ]
|Dental Anesthesia in Pregnant Women With Rheumatic Heart Disease
|Maternal-Fetal Monitoring of Patients With Rheumatic Heart Disease During Dental Procedure Under Local Anesthesia
The hemodynamic parameters of 31 pregnant women with rheumatic valve disease, undergoing restorative dentistry under local anesthesia with 2% solution of lidocaine, divided in two groups, with (Group LE) and without 1:100,000 epinephrine solution (Group LNE), were studied by 24-hour ambulatory electrocardiographic monitoring, intermittent blood pressure monitoring and continuous cardiotocography, during three standard time periods. A significant decrease in the values of maternal heart rate was seen during the procedure, in comparison with the other two time periods in the two groups, as well as, the occurrence of cardiac arrhythmia in 9 (29.1%) patients, being 7 (41.8%) of them in the group receiving epinephrine anesthesia. We conclude the use of 2% lidocaine in association with epinephrine proved safe during dental procedure in pregnant women with rheumatic valve disease.
During pregnancy, the organic systems of a woman are subjected to physiological modifications consequential to hormonal, anatomic and metabolical alterations. The most significant modification in the circulatory system is an increased cardiac output from the first three months of gestation. Women with heart disease may present with severe complications during the gestational period, because of inappropriate adaptation of her body to this hemodynamic overload, even those patients who are thought to have an appropriate functional capacity during early pregnancy. There are scant studies in the literature on the effects of local anesthetics, with and without vasoconstrictor, used in dental procedures on the cardiovascular variables of pregnant women with valvar disease, as well as on their concepti. Driven by this shortage, we decided to have this subject studied, by assessing and analyzing cardiotocographic parameters, such as fetal heart rate (FHR), fetal motility(FM) and uterine contractions (UC), in addition to blood pressure (BP) and electrocardiographic variables, such as heart rate (HR) and extrasystoles (ES), in pregnant women with rheumatic valvar disease who undergo local anesthesia with lidocaine, with and without vasoconstrictor, during restorative dental procedure. For this, 31 rheumatic heart disease patients who were in their 28th to 37th week of gestation, had 24-hour ambulatory monitoring of their BP and Holter electrocardiography (Holter-ECG), and cardiotocography (CTG), performed during: (1) baseline - 60 minutes before the procedure for BP and Holter-ECG monitoring, and 20 minutes before the procedure for CTG; (2) procedure - 56±15.5 minutes (mean±SD); (3) post-procedure - 20 minutes; and (4) mean 24-hour HR and ES measurement, and mean wake and sleeping periods BP monitoring. Variation of the above variables was analyzed in two groups, one with infusion of a 2% solution of lidocaine without vasoconstrictor (Group LNE) composed of 14 patients, and the other with infusion of a 2% solution of lidocaine with epinephrine 1:100,000 (Group LE) composed of 17 patients, randomized drawing and single blind. The investigator wise person which solution of lidocaine was being used, therefore the proper local vasoconstriction denounced if it was infiltrated or not epinephrine. The used technique was of the modified periodontal ligament (PDLm injection), by means of the equipment The Wand, infusing 1.8 ml (one cartridge) in six minutes. We use the technique of analysis of variance (ANOVA) with repeated measures to calculate the size of the sample and for the analysis and multiple interpretation of the variable in three distinct periods, on the basis of the table of Vonesh and Shork (15 patients in each group, considering a correlation enters the measures of next value the 0,4, a level of significance of 5% and to be able of test of 80%). All the variable had been initially analyzed descriptive. For the quantitative variable this analysis was made through the comment of the minimum and maximum values, and of the calculation of medium averages and shunting line-standard and. For the qualitative variable we calculate absolute and relative frequencies. The level of significance used for the tests was of 5% (p<0,05).The maternal HR values obtained during the procedure showed a significant reduction only in comparison with the other time periods (P<0.001)in the two groups. The comparison of the groups LE e LNE did not reveal any significant difference (P>0.05). ES was detected in 9 (29.0%) patients, being 7 of them (41.8%) from the Group LE. BP did not show any significant difference neither between time periods, nor between groups (P>0.05). The same occurred in the comparative analysis of the fetal parameters obtained during CTG - number of UC, level and variability from baseline of the FHR, number of accelerations of the FHR and fetal reactivity pattern. Our conclusion was that the use of 2% solution of lidocaine in association with epinephrine proved safe during dental procedure in pregnant women with rheumatic valvar cardiopathy.
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
- Rheumatic Heart Disease
- Dental Caries
- Procedure: Dental local anesthesia
- 2% lidocaine solution with epinephrine 1:100,000
- infusion of 1,8 mL (one cartridge)
- Technic: modified anesthesia of the periodontal ligament (PDLm injection) was performed applying The Wand II Computerized System (Milestone International)
- Alphacaine® 2% with epinephrine 1:100,000 - DFL
- - fab/man 06/2003 - val/exp 06/2005 - lot 0306D11 and
- - fab/man 04/2004 - val/exp 04/2006 - lot 0404D05
- Procedure: Dental local anesthesia
- 2% lidocaine solution without vasoconstrictor
- infusion of 1,8 mL (one cartridge)
- Technic: modified anesthesia of the periodontal ligament (PDLm injection) was performed applying The Wand II Computerized System (Milestone International)
- Xylestesin® 2% without vasoconstrictor - Cristália
- - fab/man 06/2003 - val/exp 06/2006 - lot 3062010
- Experimental: Group LE
Seventeen (54.8%) patients, composed group LE, were randomly assigned for the infusion of 1.8 mL (one cartridge) by the modified anesthesia into the periodontal ligament (PDLm injection) of 2% lidocaine solution with epinephrine 1:100,000. Their ages were ranging from 18 to 44 years (mean:29.6), they were diagnosed as having rheumatic valve disease, in a functional class I or II according to classification of the NYHA. Gestation age ranged from 28 to 36 weeks (mean:31.8), and the BMI from 18.7 to 32.9 (mean:23.8) kg/m2. All the patients had the restauration done in their inferior premolar and/or molar teeth.
Intervention: Procedure: Dental local anesthesia
- Active Comparator: Group LNE
Fourteen (45.2%) patients, composed group LNE, were randomly assigned for the infusion of 1.8 mL (one cartridge) by the modified anesthesia into the periodontal ligament (PDLm injection) of 2% lidocaine solution without epinephrine. Their ages were ranging from 22 to 33 years (mean:26.6), they were diagnosed as having rheumatic valve disease, in a functional class I or II according to classification of the NYHA. Gestation age ranged from 29 to 37 weeks (mean:32.1), and the BMI from 18.5 to 38.1 (mean:22.8) kg/m2. All the patients had the restauration done in their inferior premolar and/or molar teeth.
Intervention: Procedure: Dental local anesthesia
- Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G Jr. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation. 1997 Jul 1;96(1):358-66. Review.
- Aellig WH, O'Neil R, Laurence DR, Verrill PJ. Cardiac effects of adrenaline and felypressin as vasoconstrictors in local anaesthesia for oral surgery under diazepam sedation. Br J Anaesth. 1970 Feb;42(2):174-6.
- Ahn J, Pogrel MA. The effects of 2% lidocaine with 1:100,000 epinephrine on pulpal and gingival blood flow. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Feb;85(2):197-202.
- AKUTSU A, CHIBA T, TAKAHASHI H, SHIMODA M, SUEMATSU T. MANAGEMENT OF DENTAL PROBLEMS IN PATIENTS WITH CARDIOVASCULAR DISEASE. J Am Dent Assoc. 1964 Mar;68:333-42.
- Anwari JS, Butt AA, Al-Dar MA. Obstetric admissions to the intensive care unit. Saudi Med J. 2004 Oct;25(10):1394-9.
- Asghar F, Kokab H. Evaluation and outcome of pregnancy complicated by heart disease. J Pak Med Assoc. 2005 Oct;55(10):416-9.
- Assem ES, Punnia-Moorthy A. Allergy to local anaesthetics: an approach to definitive diagnosis. A review with an illustrative study. Br Dent J. 1988 Jan 23;164(2):44-7. Review.
- AXELROD J. Metabolism of epinephrine and other sympathomimetic amines. Physiol Rev. 1959 Oct;39:751-76.
- Beller GA, Smith TW, Abelmann WH, Haber E, Hood WB Jr. Digitalis intoxication. A prospective clinical study with serum level correlations. N Engl J Med. 1971 May 6;284(18):989-97.
- Bennett JA, Riegel B, Bittner V, Nichols J. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung. 2002 Jul-Aug;31(4):262-70.
- Brent RL. Commentary on JAMA article by Hujoel et al. Health Phys. 2005 Apr;88(4):379-81.
- Bryant EE, Douglas BH, Ashburn AD. Circulatory changes following prolactin administration. Am J Obstet Gynecol. 1973 Jan 1;115(1):53-7.
- Bush RK, Taylor SL, Holden K, Nordlee JA, Busse WW. Prevalence of sensitivity to sulfiting agents in asthmatic patients. Am J Med. 1986 Nov;81(5):816-20.
- Capeless EL, Clapp JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol. 1989 Dec;161(6 Pt 1):1449-53.
- Caruana P, Pateromichelakis S, Rood JP. The effects of adrenaline on lignocaine nerve block anaesthesia. J Dent. 1982 Jun;10(2):140-3.
- Cawson RA, Curson I, Whittington DR. The hazards of dental local anaesthetics. Br Dent J. 1983 Apr 23;154(8):253-8. Review.
- Cintron G, Medina R, Reyes AA, Lyman G. Cardiovascular effects and safety of dental anesthesia and dental interventions in patients with recent uncomplicated myocardial infarction. Arch Intern Med. 1986 Nov;146(11):2203-4.
- Colman JM, Sermer M, Seaward PG, Siu SC. Congenital heart disease in pregnancy. Cardiol Rev. 2000 May-Jun;8(3):166-73. Review.
- Cox JL, Gardner MJ. Treatment of cardiac arrhythmias during pregnancy. Prog Cardiovasc Dis. 1993 Sep-Oct;36(2):137-78. Review.
- Cruz SS, Costa Mda C, Gomes Filho IS, Vianna MI, Santos CT. [Maternal periodontal disease as a factor associated with low birth weight]. Rev Saude Publica. 2005 Oct;39(5):782-7. Epub 2005 Oct 24. Portuguese.
- Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatrics. 1995 Oct;96(4 Pt 1):758-64.
- Davenport ES, Williams CE, Sterne JA, Murad S, Sivapathasundram V, Curtis MA. Maternal periodontal disease and preterm low birthweight: case-control study. J Dent Res. 2002 May;81(5):313-8.
- Davenport ES, Williams CE, Sterne JA, Sivapathasundram V, Fearne JM, Curtis MA. The East London Study of Maternal Chronic Periodontal Disease and Preterm Low Birth Weight Infants: study design and prevalence data. Ann Periodontol. 1998 Jul;3(1):213-21.
- De Kock M, Gautier P, Vandewalle F, Renotte MT. Digoxin enhances bupivacaine toxicity in rats. Reg Anesth. 1991 Sep-Oct;16(5):272-7.
- Fagade OO, Oginni FO. Intra-operative pain perception in tooth extraction--possible causes. Int Dent J. 2005 Aug;55(4):242-6.
- Finder RL, Moore PA. Adverse drug reactions to local anesthesia. Dent Clin North Am. 2002 Oct;46(4):747-57, x. Review.
- Fisher JD. New York Heart Association Classification. Arch Intern Med. 1972 May;129(5):836.
- Frabetti L, Checchi L, Finelli K. Cardiovascular effects of local anesthesia with epinephrine in periodontal treatment. Quintessence Int. 1992 Jan;23(1):19-24.
- Frazier DT, Narahashi T, Yamada M. The site of action and active form of local anesthetics. II. Experiments with quaternary compounds. J Pharmacol Exp Ther. 1970 Jan;171(1):45-51.
- Gall H, Kaufmann R, Kalveram CM. Adverse reactions to local anesthetics: analysis of 197 cases. J Allergy Clin Immunol. 1996 Apr;97(4):933-7. Review.
- Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes. 1985;9(2):147-53.
- Gei AF, Hankins GD. Cardiac disease and pregnancy. Obstet Gynecol Clin North Am. 2001 Sep;28(3):465-512. Review.
- Gilson GJ, Samaan S, Crawford MH, Qualls CR, Curet LB. Changes in hemodynamics, ventricular remodeling, and ventricular contractility during normal pregnancy: a longitudinal study. Obstet Gynecol. 1997 Jun;89(6):957-62.
- Gortzak RA, Abraham-Inpijn L, Peters G. Non-invasive 27-hour blood pressure registration including dental checkups in some dental practices. Clin Prev Dent. 1992 Sep-Oct;14(5):5-10.
- Gortzak RA, Stegeman A, Ten Brinke R, Peters G, Abraham-Inpijn L. Ambulant 24-hour blood pressure and heart rate of dentists. Am J Dent. 1995 Oct;8(5):242-4.
- Haas DA. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002 Oct;68(9):546-51. Review.
- Hainsworth R. Reflexes from the heart. Physiol Rev. 1991 Jul;71(3):617-58. Review.
- Hainsworth R, Ledsome JR, Carswell F. Reflex responses from aortic baroreceptors. Am J Physiol. 1970 Feb;218(2):423-9.
- Hartung WH. Epinephrine and related compounds: influence of structure on physiologic activity. Chem Rev 9:389-465, 1931.
- Hasse AL, Heng MK, Garrett NR. Blood pressure and electrocardiographic response to dental treatment with use of local anesthesia. J Am Dent Assoc. 1986 Oct;113(4):639-42. Erratum in: J Am Dent Assoc 1986 Dec;113(6):868.
- Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Massachussets: Littleton; 1977.
- Hibbard LT. Maternal mortality due to cardiac disease. Clin Obstet Gynecol. 1975 Sep;18(3):27-36.
- HOLTER NJ. New method for heart studies. Science. 1961 Oct 20;134(3486):1214-20.
- Houston JB, Appleby RC, DeCounter L, Callaghan N, Funk DC. Effect of r-epinephrine-impregnated retraction cord on the cardiovascular system. J Prosthet Dent. 1970 Oct;24(4):373-6.
- Hunter L, Hunter B. Oral and dental problems associated with pregnancy. Oral healthcare in pregnancy and infancy. London: Macmillan Press Ltd; 1997. p. 27-34.
- Jackson D, Chen AH, Bennett CR. Identifying true lidocaine allergy. J Am Dent Assoc. 1994 Oct;125(10):1362-6.
- Johnson R, Swartz MH. A simplified approach to electrocardiography. New York: Saunders Company; 1986. p. 72-8.
- Kaplan EL. Cardiovascular disease in dental practice. In: Kaplan EL, editor. Dallas: American Heart Association. 1986
- Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation. 1978 Sep;58(3 Pt 1):434-41.
- Kaufman E, LeResche L, Sommers E, Dworkin SF, Truelove EL. Intraligamentary anesthesia: a double-blind comparative study. J Am Dent Assoc. 1984 Feb;108(2):175-8.
- Kohase H, Umino M. Allergic reaction to epinephrine preparation in 2% lidocaine: two case reports. Anesth Prog. 2004;51(4):134-7.
- Lands AM, Arnold A, McAuliff JP, Luduena FP, Brown TG Jr. Differentiation of receptor systems activated by sympathomimetic amines. Nature. 1967 May 6;214(5088):597-8.
- Lands AM, Luduena FP, Buzzo HJ. Differentiation of receptors responsive to isoproterenol. Life Sci. 1967 Nov 1;6(21):2241-9.
- Lieb R. Anxiety disorders: clinical presentation and epidemiology. Handb Exp Pharmacol. 2005;(169):405-32.
- Lipp M, Dick W, Daubländer M, Fuder H, Stanton-Hicks M. Exogenous and endogenous plasma levels of epinephrine during dental treatment under local anesthesia. Reg Anesth. 1993 Jan-Feb;18(1):6-12.
- LITWIN MS, GLEW DH. MANAGEMENT OF DENTAL PROBLEMS IN PATIENTS WITH CARDIOVASCULAR DISEASE. JAMA. 1964 Mar 14;187:848-9.
- López NJ, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol. 2005 Nov;76(11 Suppl):2144-53.
- López NJ, Smith PC, Gutierrez J. Higher risk of preterm birth and low birth weight in women with periodontal disease. J Dent Res. 2002 Jan;81(1):58-63.
- López NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial. J Periodontol. 2002 Aug;73(8):911-24.
- López R. Periodontal disease, preterm birth and low birthweight. Evid Based Dent. 2005;6(4):90-1.
- Louro PM, Fiori HH, Filho PL, Steibel J, Fiori RM. [Periodontal disease in pregnancy and low birth weight]. J Pediatr (Rio J). 2001 Jan-Feb;77(1):23-8. Portuguese.
- Lue HC, Wu MH, Wang JK, Wu FF, Wu YN. Long-term outcome of patients with rheumatic fever receiving benzathine penicillin G prophylaxis every three weeks versus every four weeks. J Pediatr. 1994 Nov;125(5 Pt 1):812-6.
- Lue HC, Wu MH, Wang JK, Wu FF, Wu YN. Three- versus four-week administration of benzathine penicillin G: effects on incidence of streptococcal infections and recurrences of rheumatic fever. Pediatrics. 1996 Jun;97(6 Pt 2):984-8.
- LUND A. Release of adrenaline and noradrenaline from the suprarenal gland. Acta Pharmacol Toxicol (Copenh). 1951;7(4):309-20.
- Mabie WC, DiSessa TG, Crocker LG, Sibai BM, Arheart KL. A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol. 1994 Mar;170(3):849-56. Review.
- Malamed SF. Ação clínica de agentes específicos. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. Avaliação física e psicológica. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. Neurofisiologia. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. O tubete. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. Allergy and toxic reactions to local anesthetics. Dent Today. 2003 Apr;22(4):114-6, 118-21.
- Mashini IS, Albazzaz SJ, Fadel HE, Abdulla AM, Hadi HA, Harp R, Devoe LD. Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy. Am J Obstet Gynecol. 1987 May;156(5):1208-13.
- Mather LE, Long GJ, Thomas J. The binding of bupivacaine to maternal and foetal plasma proteins. J Pharm Pharmacol. 1971 May;23(5):359-65.
- Mazhar SB, Gul-e-Irum. Fetomaternal outcome in pregnancy with cardiac disease. J Coll Physicians Surg Pak. 2005 Aug;15(8):476-80.
- Meadows M. Pregnancy and the drug dilemma. FDA Consum. 2001 May-Jun;35(3):16-20.
- Meiller TF, Overholser CD, Kutcher MJ, Bennett R. Blood pressure fluctuations in hypertensive patients during oral surgery. J Oral Maxillofac Surg. 1983 Nov;41(11):715-8.
- Menezes Ada S Jr, Moreira HG, Daher MT. Analysis of heart rate variability in hypertensive patients before and after treatment with angiotensin II-converting enzyme inhibitors. Arq Bras Cardiol. 2004 Aug;83(2):169-72; 165-8. Epub 2004 Aug 17. English, Portuguese.
- Meral G, Tasar F, Sayin F, Saysel M, Kir S, Karabulut E. Effects of lidocaine with and without epinephrine on plasma epinephrine and lidocaine concentrations and hemodynamic values during third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Aug;100(2):e25-30.
- Montoya ME, Karnath BM, Ahmad M. Endocarditis during pregnancy. South Med J. 2003 Nov;96(11):1156-7.
- Moreu G, Téllez L, González-Jaranay M. Relationship between maternal periodontal disease and low-birth-weight pre-term infants. J Clin Periodontol. 2005 Jun;32(6):622-7.
- Morrow LA, Linares OA, Hill TJ, Sanfield JA, Supiano MA, Rosen SG, Halter JB. Age differences in the plasma clearance mechanisms for epinephrine and norepinephrine in humans. J Clin Endocrinol Metab. 1987 Sep;65(3):508-11.
- Narahashi T, Frazier T, Yamada M. The site of action and active form of local anesthetics. I. Theory and pH experiments with tertiary compounds. J Pharmacol Exp Ther. 1970 Jan;171(1):32-44.
- Neville BW, Damm DD, Alen CMA,Bouquot JE. Patologia oral & Maxilo facial. Rio de Janeiro: Guanabara Koogan; 1998.
- Newman MG, Takei HH, Carranza FA. Periodontia clínica. 9ª ed. Rio de Janeiro: Guanabara Koogan; 2004.
- Niwa H, Sato Y, Matsuura H. Safety of dental treatment in patients with previously diagnosed acute myocardial infarction or unstable angina pectoris. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jan;89(1):35-41.
- Niwa H, Satoh Y, Matsuura H. Cardiovascular responses to epinephrine-containing local anesthetics for dental use: a comparison of hemodynamic responses to infiltration anesthesia and ergometer-stress testing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Aug;90(2):171-81.
- Niwa H, Sugimura M, Satoh Y, Tanimoto A. Cardiovascular response to epinephrine-containing local anesthesia in patients with cardiovascular disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Dec;92(6):610-6.
- USE OF epinephrine in connection with procaine in dental procedures. J Am Med Assoc. 1955 Mar 5;157(10):854.
- Nusstein J, Burns Y, Reader A, Beck M, Weaver J. Injection pain and postinjection pain of the palatal-anterior superior alveolar injection, administered with the Wand Plus system, comparing 2% lidocaine with 1:100,000 epinephrine to 3% mepivacaine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Feb;97(2):164-72.
- Nusstein J, Reader A, Beck FM. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks. Gen Dent. 2002 Jul-Aug;50(4):372-5; quiz 376-7.
- Offenbacher S, Lieff S, Boggess KA, Murtha AP, Madianos PN, Champagne CM, McKaig RG, Jared HL, Mauriello SM, Auten RL Jr, Herbert WN, Beck JD. Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction. Ann Periodontol. 2001 Dec;6(1):164-74.
- Oliver G, Schäfer EA. The Physiological Effects of Extracts of the Suprarenal Capsules. J Physiol. 1895 Jul 18;18(3):230-76.
- Pallasch TJ. Vasoconstrictors and the heart. J Calif Dent Assoc. 1998 Sep;26(9):668-73, 676. Review.
- Patterson R, Anderson J. Allergic reactions to drugs and biologic agents. JAMA. 1982 Nov 26;248(20):2637-45.
- Poppas A, Shroff SG, Korcarz CE, Hibbard JU, Berger DS, Lindheimer MD, Lang RM. Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load. Circulation. 1997 May 20;95(10):2407-15.
- Poppers PJ. Evaluation of local anaesthetic agents for regional anaesthesia in obstetrics. Br J Anaesth. 1975 Feb;47 suppl:322-7.
- PRITCHARD JA. CHANGES IN THE BLOOD VOLUME DURING PREGNANCY AND DELIVERY. Anesthesiology. 1965 Jul-Aug;26:393-9. Review.
- Ray P, Murphy GJ, Shutt LE. Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth. 2004 Sep;93(3):428-39. Epub 2004 Jun 11. Review.
- Ritchie JM, Greene NM. Anestésicos locais. In: Gilman AG,Goodman LS, Rall TW, Murad F, editors. As bases farmacológicas da terapêutica. 7ª ed. Rio de Janeiro: Editora Guanabara; 1987. p. 198-210.
- Ritchie JM, Ritchie B, Greengard P. The active structure of local anesthetics. J Pharmacol Exp Ther. 1965 Oct;150(1):152-9.
- Ritchie JM, Ritchie B, Greengard P. The effect of the nerve sheath on the action of local anesthetics. J Pharmacol Exp Ther. 1965 Oct;150(1):160-4.
- Roberts DH, Sowray JH. Local analgesia in dentistry. 3rd ed. Bristol: Harcourt Publishers Ltd; 1987. 192 p.
- Roberts GJ, Simmons NB, Longhurst P, Hewitt PB. Bacteraemia following local anaesthetic injections in children. Br Dent J. 1998 Sep 26;185(6):295-8.
- Rogers MC. Principles and practice of anesthesiology. St. Louis: Mosby; 1993.
- Rogers SN. Dental attendance in a sample of pregnant women in Birmingham, UK. Community Dent Health. 1991 Dec;8(4):361-8.
- Rood JP. Adverse reaction to dental local anaesthetic injection--'allergy' is not the cause. Br Dent J. 2000 Oct 14;189(7):380-4.
- Rood JP. Local analgesia during pregnancy. Dent Update. 1981 Oct;8(7):483-5.
- Rood JP, Cannell H. Plasma levels of lignocaine after peri-oral injections of two different concentrations. Pharmacol Ther Dent. 1978;3(1):45-7.
- Rood JP, Pateromichelakis S, Prokopiou AA. The effects of adrenaline on lignocaine anaesthesia of the isolated nerve. J Dent. 1982 Dec;10(4):342-5.
- Rosivack RG, Koenigsberg SR, Maxwell KC. An analysis of the effectiveness of two topical anesthetics. Anesth Prog. 1990 Nov-Dec;37(6):290-2.
- Rubler S, Damani PM, Pinto ER. Cardiac size and performance during pregnancy estimated with echocardiography. Am J Cardiol. 1977 Oct;40(4):534-40.
- Sachs BP, Brown DA, Driscoll SG, Schulman E, Acker D, Ransil BJ, Jewett JF. Hemorrhage, infection, toxemia, and cardiac disease, 1954-85: causes for their declining role in maternal mortality. Am J Public Health. 1988 Jun;78(6):671-5.
- Sadaniantz A, Kocheril AG, Emaus SP, Garber CE, Parisi AF. Cardiovascular changes in pregnancy evaluated by two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1992 May-Jun;5(3):253-8.
- Sadler L, McCowan L, White H, Stewart A, Bracken M, North R. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG. 2000 Feb;107(2):245-53.
- Schmaltz AA, Neudorf U, Winkler UH. Outcome of pregnancy in women with congenital heart disease. Cardiol Young. 1999 Jan;9(1):88-96. Review.
- Seng GF, Gay BJ. Dangers of sulfites in dental local anesthetic solutions: warning and recommendations. J Am Dent Assoc. 1986 Nov;113(5):769-70.
- Seng GF, Kraus K, Cartwright G, Nerone R, Pacione R. Confirmed allergic reactions to amide local anesthetics. Gen Dent. 1996 Jan-Feb;44(1):52-4.
- Setnikar I. Ionization of bases with limited solubility. Investigation of substances with local anesthetic activity. J Pharm Sci. 1966 Nov;55(11):1190-5.
- Sindel LJ, deShazo RD. Accidents resulting from local anesthetics. True or false allergy? Clin Rev Allergy. 1991 Fall-Winter;9(3-4):379-95. Review.
- Smith C. Pharmacology of local anaesthetic agents. Br J Hosp Med. 1994 Nov 2-15;52(9):455-60. Review.
- Strichartz G. Molecular mechanisms of nerve block by local anesthetics. Anesthesiology. 1976 Oct;45(4):421-41.
- Sveen K. Effect of the addition of a vasoconstrictor to local anesthetic solution on operative and postoperative bleeding, analgesia and wound healing. Int J Oral Surg. 1979 Aug;8(4):301-6.
- Tagger E, Tagger M, Sarnat H, Mass E. Periodontal ligament injection in the dog primary dentition: spread of local anaesthetic solution. Int J Paediatr Dent. 1994 Sep;4(3):159-66.
- Tagger M, Tagger E, Sarnat H. Periodontal ligament injection: spread of the solution in the dog. J Endod. 1994 Jun;20(6):283-7.
- Tarasoutchi F, Spina GS. Profilaxia da febre reumática. Rev Soc Cardiol Estado de São Paulo 15(1): 85-91, 2005.
- Teerlink JR, Foster E. Valvular heart disease in pregnancy. A contemporary perspective. Cardiol Clin. 1998 Aug;16(3):573-98, x. Review.
- Thomson PD, Melmon KL, Richardson JA, Cohn K, Steinbrunn W, Cudihee R, Rowland M. Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann Intern Med. 1973 Apr;78(4):499-508.
- Tucker GT. Plasma binding and disposition of local anesthetics. Int Anesthesiol Clin. 1975 Winter;13(4):33-59.
- Vanderheyden PJ, Williams RA, Sims TN. Assessment of ST segment depression in patients with cardiac disease after local anesthesia. J Am Dent Assoc. 1989 Sep;119(3):407-12.
- VERNALE CA. Cardiovascular responses to local dental anesthesia with epinephrine in normotensive and hypertensive subjects. Oral Surg Oral Med Oral Pathol. 1960 Aug;13:942-52.
- Walton RE, Garnick JJ. The periodontal ligament injection: histologic effects on the periodontium in monkeys. J Endod. 1982 Jan;8(1):22-6.
- Weiner N, Taylor P. Transmissão neuro-humoral: sistemas nervosos autônomo e motor somático. In: Gilman AG, Goodman LS,Rall TW, Murad F, editors. As bases farmacológicas da terapêutica. 7ª ed. Rio de Janeiro: Guanabara Koogan; 1987. p. 43-65.
- West GA, Reid KH, Bastawi AE. Autonomic responses to dental procedures in pedodontic patients during a standard restoration session. J Dent Res. 1983 Jun;62(6):728-32.
- Wildsmith JA, Tucker GT, Cooper S, Scott DB, Covino BG. Plasma concentrations of local anaesthetics after interscalene brachial plexus block. Br J Anaesth. 1977 May;49(5):461-6.
- Yagiela JA. Local anesthetics: a century of progress. Anesth Prog. 1985 Mar-Apr;32(2):47-56.
- Yagiela JA. Vasoconstrictor agents for local anesthesia. Anesth Prog. 1995;42(3-4):116-20. Review.
- ACOG practice bulletin. Antepartum fetal surveillance. Number 9, October 1999 (replaces Technical Bulletin Number 188, January 1994). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000 Feb;68(2):175-85.
- Electronic fetal heart rate monitoring: research guidelines for interpretation. National Institute of Child Health and Human Development Research Planning Workshop. Am J Obstet Gynecol. 1997 Dec;177(6):1385-90. Review.
- Status report: the periodontal ligament injection. Council on Dental Materials, Instruments, and Equipment. J Am Dent Assoc. 1983 Feb;106(2):222-4.
- Avila WS, Rossi EG, Ramires JA, Grinberg M, Bortolotto MR, Zugaib M, da Luz PL. Pregnancy in patients with heart disease: experience with 1,000 cases. Clin Cardiol. 2003 Mar;26(3):135-42.
- Aberg G. Studies on the duration of local anesthesia: a possible mechanism for the prolonging effect of "vasoconstrictors" on the duration of infiltration anesthesia. Int J Oral Surg. 1980 Apr;9(2):144-7.
- Abraham-Inpijn L, Borgmeijer-Hoelen A, Gortzak RA. Changes in blood pressure, heart rate, and electrocardiogram during dental treatment with use of local anesthesia. J Am Dent Assoc. 1988 Apr;116(4):531-6.
- BADER RA, BADER ME, ROSE DF, BRAUNWALD E. Hemodynamics at rest and during exercise in normal pregnancy as studies by cardiac catheterization. J Clin Invest. 1955 Oct;34(10):1524-36.
- Beck FM, Weaver JM 2nd. Blood pressure and heart rate responses to anticipated high-stress dental treatment. J Dent Res. 1981 Jan;60(1):26-9.
- Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet. 2003 Aug;82(2):153-9.
- Biehl D, Shnider SM, Levinson G, Callender K. Placental transfer of lidocaine: effects of fetal acidosis. Anesthesiology. 1978 Jun;48(6):409-12.
- Blinder D, Shemesh J, Taicher S. Electrocardiographic changes in cardiac patients undergoing dental extractions under local anesthesia. J Oral Maxillofac Surg. 1996 Feb;54(2):162-5; discussion 165-6.
- Blinder D, Manor Y, Shemesh J, Taicher S. Electrocardiographic changes in cardiac patients having dental extractions under a local anesthetic containing a vasopressor. J Oral Maxillofac Surg. 1998 Dec;56(12):1399-402; discussion 1402-3.
- Brand HS, Gortzak RA, Abraham-Inpijn L. Anxiety and heart rate correlation prior to dental checkup. Int Dent J. 1995 Dec;45(6):347-51.
- Brand HS, Gortzak RA, Palmer-Bouva CC, Abraham RE, Abraham-Inpijn L. Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. Int Dent J. 1995 Feb;45(1):45-8. Review.
- Braunwald E, Bloodwell RD, Goldberg LI, Morrow AG. STUDIES ON DIGITALIS. IV. OBSERVATIONS IN MAN ON THE EFFECTS OF DIGITALIS PREPARATIONS ON THE CONTRACTILITY OF THE NON-FAILING HEART AND ON TOTAL VASCULAR RESISTANCE. J Clin Invest. 1961 Jan;40(1):52-9.
- Brooks VL, Kane CM, Van Winkle DM. Altered heart rate baroreflex during pregnancy: role of sympathetic and parasympathetic nervous systems. Am J Physiol. 1997 Sep;273(3 Pt 2):R960-6.
- Buckley JA, Ciancio SG, McMullen JA. Efficacy of epinephrine concentration in local anesthesia during periodontal surgery. J Periodontol. 1984 Nov;55(11):653-7.
- Cannell H, Kerawala C, Webster K, Whelpton R. Are intraligamentary injections intravascular? Br Dent J. 1993 Oct 23;175(8):281-4.
- Cannell H, Walters H, Beckett AH, Saunders A. Circulating levels of lignocaine after peri-oral injections. Br Dent J. 1975 Feb 4;138(3):87-93.
- Cioffi GA, Chernow B, Glahn RP, Terezhalmy GT, Lake CR. The hemodynamic and plasma catecholamine responses to routine restorative dental care. J Am Dent Assoc. 1985 Jul;111(1):67-70.
- Clark S, Hofmeyr GJ, Coats AJ, Redman CW. Ambulatory blood pressure monitoring during pregnancy: validation of the TM-2420 monitor. Obstet Gynecol. 1991 Jan;77(1):152-5.
- Corah NL. Development of a dental anxiety scale. J Dent Res. 1969 Jul-Aug;48(4):596.
- Danzell JD. Pregnancy and pre-existing heart disease. J La State Med Soc. 1998 Feb;150(2):97-102. Review.
- Davenport RE, Porcelli RJ, Iacono VJ, Bonura CF, Mallis GI, Baer PN. Effects of anesthetics containing epinephrine on catecholamine levels during periodontal surgery. J Periodontol. 1990 Sep;61(9):553-8.
- Dawes GS, Moulden M, Redman CW. Criteria for the design of fetal heart rate analysis systems. Int J Biomed Comput. 1990 May;25(4):287-94.
- Defosse O. [Local anesthesia with and without vasoconstrictors: indications, contra-indications and complications in relation to the health of the patient]. Rev Belge Med Dent (1984). 1999;54(4):242-58. Review. French.
- Druzin ML, Fox A, Kogut E, Carlson C. The relationship of the nonstress test to gestational age. Am J Obstet Gynecol. 1985 Oct 15;153(4):386-9.
- Edmondson HD, Roscoe B, Vickers MD. Biochemical evidence of anxiety in dental patients. Br Med J. 1972 Oct 7;4(5831):7-9.
- Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005 Jul 19;46(2):223-30. Review.
- Evertson LR, Gauthier RJ, Schifrin BS, Paul RH. Antepartum fetal heart rate testing. I. Evolution of the nonstress test. Am J Obstet Gynecol. 1979 Jan 1;133(1):29-33.
- Friedman MJ, Hochman MN. A 21st century computerized injection system for local pain control. Compend Contin Educ Dent. 1997 Oct;18(10):995-1000, 1002-3; quiz 1004. Review.
- Galili D, Kaufman E, Garfunkel AA, Michaeli Y. Intraligamentary anesthesia--a histological study. Int J Oral Surg. 1984 Dec;13(6):511-6.
- Garcia G, Kuhn J. Curso intensivo teórico-prático de cardiotocografia. Course's manual, 150p. 2004.
- Gauthier RJ, Evertson LR, Paul RH. Antepartum fetal heart rate testing. II. Intrapartum fetal heart rate observation and newborn outcome following a positive contraction stress test. Am J Obstet Gynecol. 1979 Jan 1;133(1):34-9.
- Giuliani M, Grossi GB, Pileri M, Lajolo C, Casparrini G. Could local anesthesia while breast-feeding be harmful to infants? J Pediatr Gastroenterol Nutr. 2001 Feb;32(2):142-4.
- Goldstein MA, Michelson EL, Dreifus LS. The electrocardiogram in valvular heart disease. Cardiovasc Clin. 1993;23:55-64. Review.
- Gortzak RA, Abraham-Inpijn L. Blood pressure measurements during dental checkups representative of 26-hour registration. Oral Surg Oral Med Oral Pathol. 1990 Dec;70(6):730-3.
- Gortzak RA, Abraham-Inpijn L. Pain-induced hypertensive episode in the dental office. Gen Dent. 1995 May-Jun;43(3):274-6.
- Gortzak RA, Abraham-Inpijn L, Oosting J. Blood pressure response to dental checkup: a continuous, noninvasive registration. Gen Dent. 1991 Sep-Oct;39(5):339-42.
- Gray RJ, Lomax AM, Rood JP. Periodontal ligament injection: with or without a vasoconstrictor? Br Dent J. 1987 Apr 11;162(7):263-5.
- Grinberg M, Ávila WS, Amaral FMC. Modificações hemodinâmicas da gravidez. In: Andrade J, Ávila WS, editors. Doença cardiovascular, gravidez e planejamento familiar. São Paulo: Atheneu; 2003. p. 11-20.
- Haas DA, Pynn BR, Sands TD. Drug use for the pregnant or lactating patient. Gen Dent. 2000 Jan-Feb;48(1):54-60. Review.
- Hochman M, Chiarello D, Hochman CB, Lopatkin R, Pergola S. Computerized local anesthetic delivery vs. traditional syringe technique. Subjective pain response. N Y State Dent J. 1997 Aug-Sep;63(7):24-9.
- Jastak JT, Yagiela JA. Vasoconstrictors and local anesthesia: a review and rationale for use. J Am Dent Assoc. 1983 Oct;107(4):623-30. Review.
- Kim S. Ligamental injection: a physiological explanation of its efficacy. J Endod. 1986 Oct;12(10):486-91.
- Krochak M, Friedman N. Using a precision-metered injection system to minimize dental injection anxiety. Compend Contin Educ Dent. 1998 Feb;19(2):137-40, 142-3, 146 passim; quiz 150.
- Kubo SH, Schulman S, Starling RC, Jessup M, Wentworth D, Burkhoff D. Development and validation of a patient questionnaire to determine New York Heart Association classification. J Card Fail. 2004 Jun;10(3):228-35.
- Lopes AC. Alterações anátomo-fisiológicas do sistema cardiocirculatório na gravidez. In: Lopes AC, Delascio D, editors. Cardiopatia e gravidez. São Paulo: Sarvier; 1986. p. 5-13.
- LUND A. Elimination of adrenaline and noradrenaline from the organism. Acta Pharmacol Toxicol (Copenh). 1951;7(4):297-308.
- Lund CJ, Donovan JC. Blood volume during pregnancy. Significance of plasma and red cell volumes. Am J Obstet Gynecol. 1967 Jun 1;98(3):394-403.
- Malamed SF. Farmacologia dos anestésicos locais. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. Farmacologia dos vasoconstritores. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. Técnicas de injeção suplementares. In: Malamed SF, editor. Manual de anestesia local. Rio de Janeiro: Guanabara Koogan; 2001. p. 43-65.
- Malamed SF. The periodontal ligament (PDL) injection: an alternative to inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol. 1982 Feb;53(2):117-21.
- Mancia G, Bertinieri G, Grassi G, Parati G, Pomidossi G, Ferrari A, Gregorini L, Zanchetti A. Effects of blood-pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet. 1983 Sep 24;2(8352):695-8.
- Mauri L, O'Gara PT. Valvular Heart Disease in the Pregnant Patient. Curr Treat Options Cardiovasc Med. 2001 Feb;3(1):7-14.
- Meechan JG. Intraligamentary anaesthesia. J Dent. 1992 Dec;20(6):325-32. Review.
- Meyer FU. Haemodynamic changes under emotional stress following a minor surgical procedure under local anaesthesia. Int J Oral Maxillofac Surg. 1987 Dec;16(6):688-94.
- Meyer FU. Hemodynamic changes of local dental anesthesia in normotensive and hypertensive subjects. Int J Clin Pharmacol Ther Toxicol. 1986 Sep;24(9):477-81.
- Moore PA. Selecting drugs for the pregnant dental patient. J Am Dent Assoc. 1998 Sep;129(9):1281-6. Review.
- Morishima HO, Heymann MA, Rudolph AM, Barrett CT, James LS. Transfer of lidocaine across the sheep placenta to the fetus. Hemodynamic and acid-base responses of the fetal lamb. Am J Obstet Gynecol. 1975 Jul 1;122(5):581-8.
- Mount GJ. A new classification and techniques for simple restorative dentistry. Ann R Australas Coll Dent Surg. 1998 Oct;14:94-8. Review.
- Mount GJ, Hume WR. A new cavity classification. Aust Dent J. 1998 Jun;43(3):153-9.
- Mount GJ, Hume WR. A revised classification of carious lesions by site and size. Quintessence Int. 1997 May;28(5):301-3.
- Naftalin LW, Yagiela JA. Vasoconstrictors: indications and precautions. Dent Clin North Am. 2002 Oct;46(4):733-46, ix. Review.
- Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006 May;107(5):1120-38. Review.
- Naidoo DP, Desai DK, Moodley J. Maternal deaths due to pre-existing cardiac disease. Cardiovasc J S Afr. 2002 Jan-Feb;13(1):17-20. Review.
- Nakamura Y, Matsumura K, Miura K, Kurokawa H, Abe I, Takata Y. Cardiovascular and sympathetic responses to dental surgery with local anesthesia. Hypertens Res. 2001 May;24(3):209-14.
- Nusstein J, Claffey E, Reader A, Beck M, Weaver J. Anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in patients with irreversible pulpitis. J Endod. 2005 May;31(5):354-8.
- Palatini P, Frigo G, Bertolo O, Roman E, Da Cortà R, Winnicki M. Validation of the A&D TM-2430 device for ambulatory blood pressure monitoring and evaluation of performance according to subjects' characteristics. Blood Press Monit. 1998 Aug;3(4):255-260.
- Partyka W, Pajszczyk-Kieszkiewicz T, Januszewicz-Witorzeńć J, Swatko-Piotrowska K. [Effect of oral surgery on the fetus and uterus in complicated pregnancy]. Pol Tyg Lek. 1977 Aug 8;32(32):1245-7. Polish.
- Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol. 1989 Apr;256(4 Pt 2):H1060-5.
- Rosner B. Fundamentals of biostatistics. 2nd ed. Boston: PWS Publishers; 1986. p. 584.
- SHIP II. The response of systolic and diastolic blood pressures to dental stress. Oral Surg Oral Med Oral Pathol. 1960 Apr;13:499-507.
- Silberman SL, Cohen LA, Meydrech EF. Dental anxiety and needs in low-income pregnant women. Community Dent Oral Epidemiol. 1980 Apr;8(2):114-5.
- Siu SC, Sermer M, Harrison DA, Grigoriadis E, Liu G, Sorensen S, Smallhorn JF, Farine D, Amankwah KS, Spears JC, Colman JM. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation. 1997 Nov 4;96(9):2789-94.
- Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol. 2003 Jun 1;91(11):1382-5.
- Smith JH, Dawes GS, Redman CW. Low human fetal heart rate variation in normal pregnancy. Br J Obstet Gynaecol. 1987 Jul;94(7):656-64.
- Szekely P, Turner R, Snaith L. Pregnancy and the changing pattern of rheumatic heart disease. Br Heart J. 1973 Dec;35(12):1293-303.
- Thornburg KL, Jacobson SL, Giraud GD, Morton MJ. Hemodynamic changes in pregnancy. Semin Perinatol. 2000 Feb;24(1):11-4. Review.
- Timm NH. Multivariate analysis with applications in education and psychology. Monterrey: CA Brooks/Cole; 1975.
- Trierweiler MW, Freeman RK, James J. Baseline fetal heart rate characteristics as an indicator of fetal status during the antepartum period. Am J Obstet Gynecol. 1976 Jul 1;125(5):618-23.
- Ueland K, Metcalfe J. Circulatory changes in pregnancy. Clin Obstet Gynecol. 1975 Sep;18(3):41-50.
- van Mook WN, Peeters L. Severe cardiac disease in pregnancy, part I: hemodynamic changes and complaints during pregnancy, and general management of cardiac disease in pregnancy. Curr Opin Crit Care. 2005 Oct;11(5):430-4. Review.
- van Mook WN, Peeters L. Severe cardiac disease in pregnancy, part II: impact of congenital and acquired cardiac diseases during pregnancy. Curr Opin Crit Care. 2005 Oct;11(5):435-48. Review.
- Villablanca AC. Heart disease during pregnancy. Which cardiovascular changes are normal or transient? Postgrad Med. 1998 Oct;104(4):183-4, 187-92. Review.
- Villablanca AC. Heart disease during pregnancy. Which cardiovascular changes reflect disease? Postgrad Med. 1998 Nov;104(5):149-56. Review.
- Vonesh EF, Schork MA. Sample sizes in the multivariate analysis of repeated measurements. Biometrics. 1986 Sep;42(3):601-10.
- Walton RE, Abbott BJ. Periodontal ligament injection: a clinical evaluation. J Am Dent Assoc. 1981 Oct;103(4):571-5.
- Wood M, Reader A, Nusstein J, Beck M, Padgett D, Weaver J. Comparison of intraosseous and infiltration injections for venous lidocaine blood concentrations and heart rate changes after injection of 2% lidocaine with 1:100,000 epinephrine. J Endod. 2005 Jun;31(6):435-8.
- Yagiela JA. Intravascular lidocaine toxicity: influence of epinephrine and route of administration. Anesth Prog. 1985 Mar-Apr;32(2):57-61.
- Yagiela JA, Duffin SR, Hunt LM. Drug interactions and vasoconstrictors used in local anesthetic solutions. Oral Surg Oral Med Oral Pathol. 1985 Jun;59(6):565-71.
|July 2005 (final data collection date for primary outcome measure)
- Clinical criteria: women with rheumatic valvar disease as diagnosed by the clinical history and physical examination, and documented by Doppler echocardiography, either having undergone surgical or percutaneous intervention before becoming pregnant or not, in functional class (FC) I or II, according to classification of the New York Heart Association (NYHA).
- Obstetrical criteria: one fetus pregnancy, gestational age (GA) between 28 and 37 weeks.
- Odontological criteria: total or partial dentition, with the presence of lower premolar and/or molar teeth in need of restorative dentistry due to development of dental caries (Black Class I, II and/or V), or due to the presence of restorations with edge infiltration clinically and/or radiographically diagnosed recurrent caries.
- Clinical criteria: heart failure, uncontrolled chronic arterial hypertension, or complex and/or symptomatic ventricular arrhythmia.
- Obstetrical criteria: preeclampsia, uterine growth restriction, and labor.
- Odontological criteria: dental caries in lower premolar or molar tooth with clinical and/or radiographic diagnosis of pulpal exposure, pulpitis, or pulpal necrosis, fracture or destruction of the tooth crown with prognostic of endodontic treatment or rehabilitation by prosthesis, or indication for extraction.
- Psychiatric criteria: patients with anxiety disorders such as panic, agoraphobia, social or specific phobias and obsessive-compulsive disorders, posttraumatic stress, or chemically-induced anxiety, according to the classification of the American Psychiatric Association (APA).
|18 Years and older
|Contact information is only displayed when the study is recruiting subjects
|Noedir Stolf, Faculdade de Medicina da Universidade de São Paulo
|University of Sao Paulo
|Fundação de Amparo à Pesquisa do Estado de São Paulo
||Itamara LI Neves, PhD
||Heart Institute (InCor) of University of São Paulo Medical School - Sao Paulo, Brazil
|University of Sao Paulo