Ovarian contrast-enhanced ultrasonography and Doppler fluxometry in bitches during the postovulatory estrus and corpora lutea formation.

The aim of the present study was to evaluate the vascularization features of canine ovaries during the follicular phase and the formation of the corpora lutea by using Doppler ultrasonography and Contrast-Enhanced Ultrasound (CEUS). Eight healthy bitches were enrolled in the study and were evaluated at five different timepoints (T1 - T5) of the estrous cycle established by vaginal cytology and serum progesterone concentration. Ultrasonographic examinations were performed by a single operator using the ACUSON S2000/SIEMENS machine equipped with a linear multifrequency transducer (9.0 MHz). Color-coded Doppler evaluation of the ovarian parenchyma was performed to investigate the aspects of the signal detection throughout the different timepoints. Pulsed-wave Doppler of the intraovarian arteries was performed to evaluate spectral waveform and doppler velocimetric parameters of Systolic Peak Velocity (SPV cm/s), End Diastolic Velocity (EDV cm/s), Resistivity Index (RI) and Pulsatility Index (PI). CEUS evaluation of the ovaries was performed using a vascular contrast agent (SonoVue®, Bracco, Sao Paulo, Brazil) and the CADENCE™ Contrast Pulse Sequencing (CPS, Siemens) software, in order to perform both qualitative and quantitative analysis. Perfusion parameters of pixel number, peak intensity (PPI in %), time to peak intensity (TTP in s), mean transit time (MTT in s) and area under the curve (AUC in %). Colour-coded Doppler evaluation demonstrated an increase in signal detection as cycle progressed, with blood flow initially detected with few coloured pixels and mainly at the ventral surface of the ovaries. Further on, the number of coloured pixels increased and spreading to the central region, resulting in a circular-like pattern around the corpora hemorrhagica. The spectral waveform was consistent at all timepoints. SPV (cm/s) and EDV (cm/s) presented a numeric trend and a slight statistical difference at all timepoints, whereas no difference was found for RI and PI. CEUS evaluation demonstrated an increase in pixel intensity across all the timepoints. Quantitative CEUS analysis revealed a statistical difference in PPI (%), MTT (s) and AUC (%) at T5. CEUS evaluation of the ovaries was feasible and demonstrated a marked increase in perfusion parameters in the late postovulatory period, demonstrating its applicability in the assessment of canine corpora lutea development.

Comparação da pressão arterial mensurada pelos métodos oscilométrico ou invasivo em ovinos e caprinos / Comparison of blood pressure measured by oscillometric or invasive methods in sheep and goats / Comparación de la presión arterial medida por métodos oscilométricos o invasivos en ovinos y caprinos

Resumo A pressão arterial é um parâmetro indispensável na monitorização anestésica. A mensuração da pressão artéria invasiva (iPA) mediante cateterização arterial periférica é confiável, mas requer experiência e pode desencadear complicações. A técnica oscilométrica não é invasiva (NiPA), só requer um manguito sobre uma artéria periférica e a mensuração é automatizada. Não obstante a acurácia da NiPA tem sido pouco explorada e, por tal motivo, este estudo objetivou comparar esta técnica com a iPA em ovelhas e cabras. Foram utilizadas 20 ovelhas e 20 cabras que seriam submetidas a laparoscopia sob anestesia geral. Uma vez em plano anestésico, foi cateterizada a artéria auricular caudal e conectada a um transdutor eletrônico de pressão acoplado a monitor multiparamétrico para mensuração da iPA, sistólica (S), diastólica (D) e média (M). Ao mesmo tempo um manguito de tamanho apropriado foi posicionado sobre a artéria radial e conectado ao mesmo monitor. A cada 5 minutos foram registradas as pressões arteriais por ambos os métodos, posteriormente, comparadas pelo teste Student, correlacionados pelo Pearson e avaliada a concordância pelo Bland-Altman. Nas ovelhas, a PAD foi semelhante e correlacionada entre NiPA e iPA (P=0,69; r=0,65; viés 0,7 ± 13,1 mmHg), já a PAS e PAM foram superestimadas pela NiPA. Em Cabras, a PAM resultou semelhante e correlacionada entre NiPA e iPA (P=0,566; r=0,57; viés 2,4 ± 20,2 mmHg), enquanto PAS foi superestimada e PAD subestimada. Conclui-se que, em ovelhas apenas a PAD e em cabras a PAM, mensuradas pelo método oscilométrico, são alternativas acuradas, factíveis e confiáveis para a monitoração anestésica da pressão arterial.

Abstract Blood pressure is an indispensable parameter in anesthetic monitoring. The measurement of invasive artery pressure (IBP) using peripheral arterial catheterization is reliable but requires experience and can lead to complications. The oscillometric technique is non-invasive (NIBP), it only requires a cuff over a peripheral artery and the measurement is automated. However, the accuracy of PANI has been little explored and, for this reason, this study aimed to compare this technique with PAI in sheep and goats. 20 sheep and 20 goats needed laparoscopy were used under general anesthesia. Once in anesthetic plane, the caudal auricular artery was catheterized and connected to an electronic pressure transducer, coupled to a multiparameter monitor to measure IBP, systolic (S), diastolic (D) and mean (M). At the same time, an appropriately sized cuff was placed over radial artery and connected to the same monitor. Every 5 minutes, blood pressures were recorded by both methods, subsequently compared by the Student test, correlated by Pearson and agreement assessed by the Bland-Altman. In sheep, DBP was similar and correlated between NIBP and IBP (P=0.69; r=0.65; bias 0.7 ± 13.1 mmHg), whereas SBP and MBP were overestimated by NIBP. In goats, MAP was similar and correlated between NIBP and IBP (P=0.566; r=0.57; bias 2.4 ± 20.2 mmHg), while SBP was overestimated and DBP underestimated. It is concluded that, in sheep only DBP and in goats, MBP, measured by the oscillometric method, are accurate, feasible and reliable alternatives for anesthetic monitoring of blood pressure.

Resumen La presión arterial es un parámetro indispensable en la monitorización anestésica. La medición de la presión arterial invasiva (PAI) mediante cateterismo arterial periférico es fiable, requiere experiencia y puede dar complicaciones. La técnica oscilométrica no es invasiva (PANI), requiere un manguito sobre una arteria periférica y medición automatizada. No obstante, la precisión de PANI ha sido poco explorada, por esta razón, este estudio tuvo por objetivo comparar esta técnica con la PAI en ovinos y caprinos. Se utilizaron 20 ovejas y 20 cabras que requerían laparoscopia bajo anestesia general. Una vez en plano anestésico, se cateterizó la arteria auricular caudal y se conectó a transductor de presión electrónico acoplado a monitor multiparamétrico para medir la PAI, sistólica (S), diastólica (D) y media (M). Al mismo tiempo, se colocó un manguito de tamaño adecuado sobre la arteria radial y se conectó al mismo monitor. Cada 5 minutos se registraron las presiones por ambos métodos, posteriormente se compraron por test de Student, correlacionaron por Pearson y se evaluó concordancia por Bland-Altman. En ovejas, la PAD fue similar y se correlacionó entre PANI y PAI (P=0,69; r=0,65; sesgo 0,7 ± 13,1 mmHg), mientras que PAS y MAP fueron sobreestimadas por PANI. En Cabras, la PAM fue similar y se correlacionó entre PANI y PAI (P=0,566; r=0,57; sesgo 2,4 ± 20,2 mmHg), mientras PAS se sobreestimó y PAD se subestimó. Se concluye que, en ovinos solo PAD y en caprinos PAM, medidas por el método oscilométrico son alternativas precisas, factibles y confiables para el monitoreo anestésico de la presión arterial.

Ultrasonography of the nuchal translucency of healthy and abnormal English Bulldog fetuses.

The aim of this study was to measure the nuchal translucency (NT) of canine fetuses to establish reference values ​​for healthy gestational processes and to verify its effectiveness in the diagnosis of congenital abnormalities. On day 34 of gestation, the NT of three fetuses from each of the 26 English bulldog female dogs was measured. The first fetus was the one located immediately cranial to the bladder, the second was selected from the left side of the abdomen, and the third from the right side. The reference values for healthy animals were offset using descriptive statistics. The diagnostic ability of the test to identify fetal malformations was studied using receiver operating characteristic curve analysis. Of the 26 litters, only 18 had healthy fetuses, 4 had fetuses with anasarca, 3 had fetuses with abdominal wall defects, and 1 had both types of abnormalities. The NT was higher in canine fetuses that presented anasarca in the litter than in normal litters (1.8 ± 0.77 mm vs. 1.4 ± 0.48 mm; P = 0.0249), with a cut-off value of NT > 1.45 mm (sensitivity = 61.54%, specificity = 70.18%). NT greater than 1.45 mm seems to be a diagnostic tool for the identification of anasarca during gestation of bulldogs. Considering the unprecedented use of this parameter in canine species and the limitations found during the study, further studies will be needed in order to use it on clinical practice.

Ultrasonographic assessment of renal perfusion in bitches with mammary carcinoma treated with long-term carprofen.

The aim of this study was to evaluate renal hemodynamics, routine clinical and laboratory parameters used to estimate renal function, and clinical evolution during six months in bitches with mammary carcinomas that underwent mastectomy and were treated (TG) or not (CG) with carprofen for three months after surgery. Twenty-six bitches with mammary carcinoma were equally distributed into TG that received carprofen 4.4 mg/kg/day for 90 days and CG that did not receive anti-inflammatory medication. Renal artery Doppler flowmetry, contrast-enhanced ultrasound (CEUS) of renal parenchyma, haematological, biochemical and clinical analyses were obtained once a month. These data were compared between groups and time via analysis of variance (ANOVA) in a completely randomized design with repeated measures (P < 0.05). On B-mode ultrasound, the area of the renal artery was greater (P = 0.0003) in the TG. Regarding laboratory findings, haematocrit and haemoglobin were similar in both groups, showing a significant and gradual increase after three months of treatment; MCV, MHC, and MCHC were increased (P < 0.05) and lymphocyte and band counts decreased (P < 0.05) in the TG. Regarding biochemical tests, ALT was the only parameter with a significant difference, being higher (P = 0.0272) in the treated group. It can be concluded that the use of carprofen for 90 days causes minimal changes in renal perfusion, erythrocyte parameters and ALT activity, and reduces the proportion of blood inflammatory cells. Therefore, use of this medication can be carried out safely in patients who require auxiliary cancer treatment.

B-mode ultrasound and ecobiometric parameters to assess embryonic and fetal development and estimate gestational age in goats.

The aim of this study was to monitor maternal-fetal ecobiometric parameters during physiological pregnancy in goats using ultrasound to predict gestational age by establishing mathematical equations. Twenty-five Saanen goats were included in the study. Assessments were performed weekly from the 21st day of pregnancy until parturition. The abdominal, thoracic, biparietal, and eye socket diameters; distance from the neck to snout; crown-rump, humerus, radius-ulna, metacarpal, femur, tibia, metatarsal, and placentome lengths; kidney height and length; and heart area were measured. Heart rate was obtained using the pulsed Doppler mode. The variables were correlated with gestational age using Spearman's test, and the adjustment of these variables to simple and multiple regression models was done to determine the mathematical formulas for calculating the gestational age. The highest obtained coefficients of determination (R2) were for humerus length (96.2), heart area (95.6), and distance from the neck to the snout (95.3). Only the placentome length and fetal heart rate presented low determination coefficients (R2 = 54.3, R2 = 45.0). The results indicated significant correlations between measures of maternal-fetal structures and gestational age, and can be used as reference values for detection of abnormalities during fetal development.

Contrast-enhanced ultrasound evaluation of placental perfusion in brachicephalic bitches.

The present study aimed to investigate placental hemodynamics to determine quantitative and qualitative parameters for pregnant brachycephalic bitches as well as describe placental vascularization and perfusion in females with fetal abnormalities close to delivery. Forty-four healthy fetuses from 22 brachycephalic bitches and 9 fetuses with gestational abnormalities (anasarca and hydrocephalus) from 8 brachycephalic bitches were evaluated. All female dogs were artificially inseminated intravaginally and underwent cesarean section at the end of gestation. Pregnancy diagnosis was made on the 25th day and experimental evaluations were performed on Days 25 (M1), 45 (M2), and 58 (M3) of gestation in normal pregnancies. Fetuses with gestational abnormalities were evaluated at the last time point. Biometric values of the fetuses were determined by B-mode and vascular indices by Doppler fluxometry of the umbilical artery, whereas qualitative assessment of contrast filling and quantitative parameters of placental perfusion were performed using CEUS. Parameter comparisons among the examined fetuses (normal and abnormal) and between the moments (M1, M2, and M3) were performed by Student's t-test and ANOVA tests, and then correlated using the Spearman test. In healthy fetuses, systolic and diastolic velocities as well as the time averages of minimum and maximum velocities increased significantly from M2 to M3 (P < 0.05), whereas the pulsatility index (P < 0.043) and vascular resistance (P < 0.001) decreased. Contrast distribution was always homogeneous in placental tissues and CEUS filling parameters remained constant during the evaluated periods (P < 0.05). In fetuses with hydrops, Doppler values were similar to those obtained in healthy subjects (P > 0.05), but CEUS evaluation demonstrated a heterogeneous distribution with lower intensity of placental tissue filling and a delay in perfusion time (P < 0.05) with a diagnostic accuracy of 75%. The association of dopplerfluxometry and CEUS allowed evaluation of qualitative and quantitative parameters of physiological pregnancy hemodynamics in all gestational thirds without evidence of significant changes in the physiology of the maternal-fetal binomial, and CEUS was shown to be applicable in the detection of failures in placental vascular filling (tissue dysfunction) in fetuses with anasarca and hydrocephaly.

Maternal and fetal ultrasonographic characteristics, vulvar temperature, and vaginal mucous impedance as variables associated with the onset of parturition in term and induced pre-term ewes.

The aim of this study was to assess and compare ultrasonographic characteristics of maternal and fetal structures, vulvar temperatures, and vaginal mucous impedance in pregnant ewes in the term parturition group (TPG, n = 15) and induced pre-term parturition group (IPPG; n = 15). All the measurements were taken every 12 h throughout the last gestational week. Maternal and fetal structures and the fetal heart rate (HR) were assessed using ultrasonography. The vulvar temperature and vaginal mucous impedance were determined using a non-contact infrared thermometer, and an electronic estrous detector, respectively. The vulvar temperature was less in the TPG and greater in the IPPG; the end-diastolic velocities (EDVs) of the arteries of the placentome and uterus gradually increased before parturition in the IPPG (P = 0.02, P = 0.02 and P = 0.009, respectively). The placentome shear wave velocity (SWV) was greater in the ewes of the IPPG than TPG 48, 36, and 0 h before parturition (P = 0.001). The following variables were associated with the onset of parturition within the next 12 h in the ewes of the IPPG: resistance index (< 0.54) and EDV (> 0.34 cm/s) of the uterine artery; and vulvar temperature (> 37.3 °C). A fetal kidney SWV of < 1.31 m/s was associated with the onset of parturition in the next 12 h in all the ewes. Results indicate vulvar temperature and certain maternal and fetal factors detected using ultrasonograpy may aid in determining fetal maturity and/or the time of parturition in ewes.

Early luteal development in Santa Inês ewes superovulated with reduced doses of porcine follicle-stimulating hormone.

The aim was to compare the early luteal development in ewes superovulated with different doses of pFSH. Twenty-nine Santa Inês ewes received a progesterone device (CIDR®) for 8 days. Gonadotrophic treatment started on Day 6: G200 (control, n = 9, 200 mg); G133 (n = 10, 133 mg); and G100 (n = 10, 100 mg of pFSH). On Day 6, all females received eCG (300 IU). B-mode and spectral Doppler ultrasonography were performed daily during the early luteal phase (Days 11-15) to monitor the development of corpora lutea (CLs; dimensions) and ovarian arteries indices. CLs were also classified as normal or prematurely regressed (PRCL) on Day 15 by videolaparoscopy. Ewes from G100 and G133 showed gradual increase in luteal diameter during the early luteal phase (p < 0.001), whereas G200 animals presented increase from Day 11 to Day 13, and then decrease on Days 14 and 15 (p < 0.001). The G200 females showed greater percentage of PRCL (45.20%) than those of the other groups (p < 0.001). The normal CLs number was greater in G100 than in G133 (p = 0.04), while the PRCL number was greater in G200 than in the other groups (p = 0.03). Resistive index (RI) was greater in G200 than in G100 (p = 0.02). RI was lower in Day 12 than Day 15 (p = 0.02). Pulsatility index (PI) was greater on Days 14 and 15 (p < 0.01). In conclusion, the lowest dose of pFSH (100 mg) can be considered sufficient for an efficient superovulatory response in sheep, producing better CLs development dynamic in early luteal phase and ovarian blood perfusion and smaller number of PRCL than the traditional (200 mg) pFSH dose.

B-mode ultrasonography and ecobiometric parameters for assessment of embryonic and fetal development in sheep.

The aim in this study was to evaluate the maternal-fetal development during physiological gestation in sheep by means of ultrasonography and to predict the gestational age by mathematical formulae. Thirty Santa Inês sheep were included. Evaluations were performed weekly from the 3rd to 21st gestational week. The Shapiro test was used to determine normality of the data, and Spearman test was used for determining correlations of real or transformed measurements as gestation advanced. If there was a significant difference detected, variable adjustments and gestational weeks were tested using regression models. Significance level was set at 5% and the results presented as mean ± SD. Principal components analysis (PCA) was used for data clustering and graphic analysis. The gestational vesicle, abdominal, thoracic, biparietal, ocular orbit, and placentome diameters; and the lengths of crown-to-rump, nuchal to snout, scapula, humerus, radius, metacarpus, femur, tibia, metatarsal, heart length, heart width and kidneys were measured. Using pulsed Doppler ultrasonography, heart rate (HR) was obtained. The greatest coefficients of determination (r²) were obtained for the biparietal diameter (BPD; 96.5%) and metacarpus length (MCAR; 93%), followed by the abdominal diameter (AD; 91.7%) and heart width (HTW; 90.2%). The PCA analysis indicated graphically that at week 8 to 9, there was no significant change related to technique, whereas, at weeks 19, 20, and 21 a decrease in growth was observed, with the greatest data variability at week 19. Ultrasonographic assessments indicated there were significant correlations between developmental stages of all maternal-fetal structures and the gestational age, which can be used as reference values for gestational age assessments and detection of development abnormalities.

Studies on bacterial community composition are affected by the time and storage method of the rumen content.

The objective of this study was to investigate three storage methods and four storage times for rumen sampling in terms of quality and yield of extracted metagenomic DNA as well as the composition of the rumen bacterial community. One Nellore steer fitted with a ruminal silicone-type cannula was used as a donor of ruminal contents. The experiment comprised 11 experimental groups: pellet control (PC), lyophilized control (LC), P-20: pellet stored frozen at -20°C for a period of 3, 6, and 12 months, P-80: pellet stored frozen at -80°C for a period of 3, 6, and 12 months, and L-20: lyophilized sample stored frozen at -20°C for a period of 3, 6, and 12 months. Metagenomic DNA concentrations were measured spectrophotometrically and fluorometrically and ion torrent sequencing was used to assess the bacterial community composition. The L-20 method could not maintain the yield of DNA during storage. In addition, the P-80 group showed a greater yield of metagenomic DNA than the other groups after 6 months of storage. Rumen samples stored as pellets (P-20 and P-80) resulted in lower richness Chao 1, ACE, and Shannon Wiener indices when compared to PC, while LC and PC were only different in richness ACE. The storage method and storage time influenced the proportions of 14 of 17 phyla identified by sequencing. In the P-20 group, the proportion of Cyanobacteria, Elusimicrobia, Fibrobacteres, Lentisphaerae, Proteobacteria, and Spirochaetes phyla identified was lower than 1%. In the P-80 group, there was an increase in the proportion of the Bacteroidetes phylum (p = 0.010); however, the proportion of Actinobacteria, Chloroflexi, SR1, Synergistetes, TM7, and WPS.2 phyla were unchanged compared to the PC group (p > 0.05). The class Clostridium was the most abundant in all stored groups and increased in its proportion, especially in the L-20 group. The rumen sample storage time significantly reduced the yield of metagenomic DNA extracted. Therefore, the storage method can influence the abundance of phyla, classes, and bacterial families studied in rumen samples and affect the richness and diversity index.

Efectos de la hipotermia moderada en los niveles de glucemia de caninos / Efeitos da hipotermia moderada nas concentrações de glicemia de caninos

Con el objetivo de evaluar las variaciones de la glucemia en caninos sometidos a hipotermia moderada se utilizaron ocho canes adultos, anestesiados con etomidato e isofluorano y sometidos a tres franjas de temperatura: 32-33°C, 34-35°C y normotermia 38,5± 1°C, durante 150 min. La glucosa sérica de estos animales fue evaluada en el periodo basal y cada 30 min durante el periodo experimental. La glucemia fue mayor durante los 60, 90 y 120 min, comparada con las concentraciones basales; fue similar en las franjas de temperatura estudiadas y se mantuvo siempre dentro de los rangos para la especie. La aplicación de hipotermia moderada no altera las concentraciones de glucosa, lo que se constituye en un aspecto relevante en la neuroprotección.

Effects of Moderate Hypothermia in Canine Blood Glucose Concentrations.

With the purpose of evaluating variations in the blood glucose of dogs subjected to moderate hypothermia, eight adult dogs were used, anesthetized with etomidate and isoflurane and subjected to three temperature ranges: 32-33°C, 34-35°C and 38.5 ± 1°C normothermia for 150 minutes. The serum glucose of these animals was assessed at baseline and every 30 min during the experimental period. Blood glucose was higher during 60, 90 and 120 min, compared with basal concentrations; it was similar in the temperature ranges studied and was always within the range for the species. The application of moderate hypothermia does not alter glucose concentrations, which constitutes an important aspect in neuroprotection.

Com o objetivo de avaliar as variações da glicemia em caninos submetidos à hipotermia moderada, se utilizaram oito cães adultos, anestesiados com etomidato e isoflurano e submetidos a três franjas de temperatura: 32-33°C, 34-35°C e normotermia 38,5± 1°C, durante 150 min. A glucose sérica destes animais foi avaliada no período basal e a cada 30 minutos durante o período experimental. A glicemia foi maior durante os 60, 90 e 120 minutos comparada com as concentrações basais; foi similar nas faixas de temperatura estudadas e se manteve sempre dentro dos níveis para a espécie. A aplicação de hipotermia moderada não altera as concentrações de glucose, o que se constitui em um aspecto relevante na neuroproteção.

Control de hipotermia con colchón térmico en perras durante ovario-histerectomía / Hypothermia control with thermal mats in dogs during ovary-hysterectomy

La hipotermia transoperatoria es una complicación común en pacientes sometidos a anestesia general para procedimientos quirúrgicos. En este trabajo se evalúa el uso de un colchón térmico eléctrico como método de control de temperatura en 18 hembras caninas de aproximadamente seis meses de edad, sometidas a ovario-histerectomía (OVH) electiva, bajo anestesia general. Fueron evaluadas las constantes fisiológicas y los tiempos de recuperación, comparando tres grupos distribuidos aleatoriamente: G1, control, sin control de temperatura; G2, uso de colchón térmico a 38 °C durante el periodo trans y posoperatorio, y G3, control de temperatura de la misma manera pero solo en el periodo posoperatorio. El colchón térmico es una medida efectiva y segura para el control de la hipotermia perioperatoria mostrando mejores resultados cuando es usado en todos los momentos y no solo en el posoperatorio...

Intraoperative hypothermia is a common complication in patients undergoing general anesthesia for surgical procedures. This paper evaluates the use of an electric thermal mat as a temperature control method in 18 female dogs, approximately six month pregnant, subject to elective ovary-hysterectomy (OVH) under general anesthesia. Physiological constants and recovery times were evaluated by comparing three groups, randomly distributed: G1, control, without temperature control; G2, use of thermal mattress at 38 °C during and after surgery, and G3, temperature control in the same way but only during the postoperative period. The thermal mat is an effective and safe method to control perioperative hypothermia, showing better results when used at all times and not only during the postoperative period...

A hipotermia transoperatória é uma complicação comum em pacientes submetidos à anestesia geral para procedimentos cirúrgicos. Neste trabalho avalia-se uso de um colchão térmico elétrico como método de controle de temperatura em 18 fêmeas caninas de aproximadamente seis meses de idade, submetidas a ovário-histerectomia (OVH) opcional, sob anestesia geral. Foram avaliadas as constantes fisiológicas e os tempos de recuperação, comparando três grupos distribuídos aleatoriamente: G1, controle, sem controle de temperatura; G2, uso do colchão térmico a 38 °C durante o período trans e pós-operatório, e G3, controle de temperatura da mesma maneira, mas só no período pós-operatório. O colchão térmico é uma medida efetiva e segura para o controle da hipotermia perioperatória mostrando melhores resultados quando é usado em todos os momentos e não só no pós-operatório...