Anesthesia Progress Blog - Part 133

Nondiabetic Diabetic DISCUSSIONAlthough it is well known that stress can increase blood glucose levels, as shown in previous experimental studies in *diabetic and nondiabetic animals and humans, it is difficult to standardize the type of stress and to generalize the conclusions from one study to another.

Some authors consider dental treatment a stressing procedure, and as such it could induce an increase in blood glucose levels.

Although there are conflicting reports regarding the effect of diazepam on blood glucose concentration in humans, the use of benzodiazepines to control anxiety is widely accepted.

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The Figure shows the pooled values of all volunteers for each session and time of blood collection. In the Table, it can be seen that there were significant differences between the 2 groups, diabetics and nondiabetics, among sessions and times of blood samples (P = .00003); the diabetic group showed higher values than the nondiabetic group. In each group no differences were found among sessions and times of blood samples (P > .05).

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Ethical approval for this investigation was obtained from the Ethical Committee in Research at the Piracicaba Dental School/University of Campinas (UNICAMP). Twenty volunteers took part in this study: 10 *non-insulin-dependent subjects (mean age 48.4 ± 6.65 years) and 10 healthy subjects (mean age 41.9 ± 11.67 years).

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Nondiabetic and Non-Insulin-dependent Diabetic

Anxiety and fear are frequently related to dental treatment and are of major concern to dentists. Stress can lead to an undesirable increase of heart rate, blood pressure, and blood glucose levels. The fight or flight response caused by stress includes sympathetic discharge and elevations in circulating levels of catecholamines, glucocorticoids, and growth hormone, resulting in an increase of blood glucose levels.

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Local Anesthesia

The application of capsaicin to the rat TMJ region resulted in an inflammatory reaction illustrated by the expansion of the periarticular tissue and plasma extravasation as demonstrated by Evan’s blue dye staining in this area of interest. Since capsaicin binds to VR1 receptors located on primary sensory afferents innervating the rat TMJ region to produce edema and plasma extravasation, the findings in this study suggest that acute inflammation of the rat TMJ region encompasses a neurogenic component. In addition, sustained and reversible increase in ipsilateral masseter and digastric muscle activities were evoked with the deposition of capsaicin into the rat TMJ region.

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Local Anesthesia. RESULTS

Among the 64 rats used in this experiment, only data obtained from 48 rats were deemed suitable for analysis. Twelve rats either responded to the injection of saline and the resultant increased EMG activity did not return to baseline levels prior to the injection of capsaicin/ve-hicle, or the application of the preload agent failed to induce a straight lateral movement of the edema measurement needle. In 2 rats, the application of 1% capsaicin to the bupivacaine pretreated TMJ region led to reflex jaw muscle activity, which indicated an unsuccessful nerve conduction blockade. Moreover, there was an absence of blue PE staining in the TMJ region of 2 other rats. Therefore, for the measurement of tissue expansion, each experimental group consisted of 8 rats each, and for the EMG recording of jaw muscle activity, groups 1 and 2 consisted of 6 rats, group 3 consisted of 10 rats, and groups 4-6 consisted of 8 rats each.

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The University of Toronto Animal Care Committee in accordance with the regulations of the Ontario Animal Research Act (Canada) approved the following protocol. Sixty-four male Sprague-Dawley rats weighing between 225 and 400 g each were prepared for the continuous measurement of one-dimensional tissue expansion, as previously described by Fiorentino et al and Wong et al, and for the acute recording of jaw muscle EMG activity as previously described by Cairns et al. Therefore, only a brief description of the methodology follows.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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