sábado, 3 de julio de 2010

Manejo Odontologico en Pacientes Hipertensos


La Hipertensión arterial es la elevación anormal y sostenida de la presión arterial sistémica. El odontólogo puede jugar un importante rol en la detección de la hipertensión y en el monitoreo de su tratamiento. Si el paciente está en desconocimiento de su condición, el odontólogo puede ser el primero en detectar una elevación de la presión arterial o síntomas de la enfermedad hipertensiva o ambos.
Antes de iniciar la atención odontológica es conveniente realizar una completa anamnesis del paciente, orientada a pesquisar historia familiar y personal de enfermedades cardíacas, información de consumo de cocaína o anfetaminas, síntomas sugerentes de hipertensión, evaluar el estilo de vida del paciente, consumo de fármacos y controles de presión arterial. Los pacientes con presión arterial óptima o normal, deben ser monitoreados anualmente o dos veces al año.
Una vez que iniciamos el tratamiento, se debe controlar la presión arterial después de la inyección del anestésico local, especialmente cuando se utiliza Epinefrina y el paciente consume bloqueadores beta no selectivos. Además no se debe utilizar más de 0.054 mg de Epinefrina (3 tubos carpule con Epinefrina al 1:100.000) en pacientes grupo C o con presión arterial estado 2 a 3. En los pacientes estado 3 o con síntomas hipertensivos no realizar atención odontológica electiva. No usar hilo retractor con Epinefrina en pacientes estado 1 a 3 y por último tener especial precaución cuando se usa anestesia en pacientes estado 3.
Después de haber realizado la terapia odontológica se debe controlar la PA antes de despedir al paciente, obtener una buena hemostasia en pacientes con elevada PA.
También se debe estar seguro de las interacciones farmacológicas entre los AINE y los inhibidores de la enzima convertidora, entre los betabloqueadores y los diuréticos.
Además se debe procurar mejorar la higiene oral en pacientes con hiperplasia gingival resultado de medicamentos y/o consultar al médico tratante sobre cambios en las medicaciones.
Por último, si se presenta una crisis hipertensiva durante la atención odontológica, se recomienda utilizar Nifedipino de 10 ó 20 mg en adultos y de 0.25 a 0.50 mg/Kg en niños en primera instancia. El otro medicamento utilizado en etapa aguda es el Captopril de 25-50 mg y en niños de 0.05-0.1 mg/Kg. Si fracasan los tratamientos anteriores, se usa Clonidina en una dosis de 0.150 mg cada 6 horas con dosis máxima de 0.7mg/día.

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