Tratamento de tromboembolismo e preparo para implantação de prótese osteointegrada com oxigenioterapia hiperbárica em uma gata / Treatment of tromboembolism and preparation for an osseointegrated prothesis fixation with hyperbaric oxygen therapy in a kitten

Background: Ischemic neuromyopathy is the most common reason for amputation in cats. In veterinary medicine, the use of prosthetic limbs is not widespread; therefore, in most cases total limb amputation is indicated. However, hyperbaric oxygen therapy (HBOT) is an alternative with several benefits for the treatment of vascular disorders with reperfusion, ischemia, and infection. Therefore, this study aimed to report the positive effects of HBOT on the treatment of ischemic neuromyopathy secondary to arterial thromboembolism on the patient's clinical improvement, and on the preparation of the patient for insertion of an osseointegrated prosthesis. Case: A 6-month-old mixed-breed kitten returned for treatment after undergoing surgery seven days earlier for reduction of traumatic diaphragmatic hernia, during which it suffered a cardiorespiratory arrest. The patient presented with acute pelvic limb paralysis with 24-h evolution, absent femoral pulse, plantar cushions and dorsal part of the limbs cold and pale. After supportive therapy and diagnosis of aortic thromboembolism by arterial Doppler, the patient started adjunctive treatment with HBOT from the first day of hospitalization. Sessions took place in an exclusive hyperbaric chamber for animals and lasted 60 min at a pressure of 2.5 absolute atmospheres and 100% oxygen, initially every 12 h. However, during the first 5 days of hospitalization, the distal region of both pelvic limbs began to show tissue devitalization and edema, and hematologic parameters showed changes on the 7th day. The right pelvic limb (RPL) showed more involvement of superficial tissues, extending to the tarsometatarsal joint region. After 8 days of hospitalization, the devitalized tissue was debrided. The RPL had an extensive devitalized area with exposed bone in the phalanges and necrosis in the pads. The left pelvic limb (LPL) suffered minor complications, with involvement of the phalangeal region. After 12 days, with HBOT every 48 h, exuberant granulation tissue was observed. After 17 days, the patient was discharged, and HBOT sessions were performed weekly. Gangrene of the midfoot and lack of proprioception were observed in RPL, while LPL showed bone divulsion of the 1st, 3rd, and 4th phalanges. Because of the poor prognosis for limb viability, the RPL was partially amputated, and a self-threaded intraosseous prosthesis was inserted. Discussion: The cardiorespiratory arrest that occurred during the surgical procedure to reduce the diaphragmatic hernia without thromboprophylaxis may have contributed to the peripheral ischemia. HBOT was proposed for the adjuvant treatment of ischemic injury because it is especially indicated for cases of ischemia-reperfusion injury. The main hematological parameters were evaluated at an average interval of 7 days. While the platelet count and hematocrit increased, the leukocytosis decreased. This demonstrates the benefit of oxygen therapy in the reported patient. The use of HBOT in orthopedic injuries is known to result mainly in stimulation of osteoblasts, promoting osseointegration of the prosthesis. We conclude that the adjuvant treatment with HBOT helped to preserve a large segment of both pelvic limbs, prevent the progression of necrosis, and provide a healthy bed for fixation of an osseointegrated prosthesis in the RPL, resulting in clinical improvement of the patient.

Analgesia perioperatória de gatas submetidas a ovariohisterectomia eletiva - uso preemptivo de carprofeno ou grapiprant / Perioperative analgesia in cats undergoing elective ovariohysterectomy - preemptive use of carprofen or grapiprant

Background: The nonsteroidal anti-inflammatory drugs (NSAIDs) exert their analgesic effect through peripheral inhibition of prostaglandin synthesis and a variety of other peripheral and central mechanisms. However, NSAIDs are associated with some adverse effects, mainly related to the gastrointestinal, renal, and hepatic systems, highlighting the need for research to develop safer drugs. Therefore, the aim of this study was to evaluate the efficacy of preoperative oral administration of carprofen or grapiprant in female cats submitted to elective ovariohysterectomy on the quality of perioperative analgesia and the need for hypnotic and analgesic drugs. Materials, Methods & Results: Thirty-three adult female cats were selected, without defined breed and healthy based on physical examination, routine laboratory analyses (complete blood count, total protein, Heinz body investigation and serum quantification of alanine transaminase [ALT], aspartate transaminase [AST], gamma glutamyl transpeptidase [GGT], alkaline phosphatase [ALP], urea, frutosamine, and glucose) and negative tests for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV). After 3 days of adaptation, they were submitted to ovariohysterectomy by celiotomy and randomly allocated into 2 groups according to the preoperative drug used: GCAR [carprofen - 4 mg/kg, VO, 2 h before surgery; n = 11] and GGRA (grapiprant - 2 mg/kg IV, 2 h before surgery; n = 21]. The cats were pre-medicated with acepromazine 0.05 mg/ kg IV and later submitted to general anesthesia with propofol intravenously. Anesthesia was maintained with isoflurane in 100% oxygen. After anesthetic induction, a continuous infusion of remifentanil at a rate of 10 µg/kg/h was initiated. During the transanesthetic period, the parameters of heart rate; respiratory rate; systolic, mean, and diastolic arterial pressure using the oscillometric method; electrocardiogram; rectal temperature; partial pressure of CO2 at the end of expiration: and partial saturation of O2 in hemoglobin were continuously monitored. The evaluation of nociception was based on the changes in the aforementioned physiological parameters. The rate of remifentanil used did not change over time with the use of carprofen. However, animals that received grapiprant required a lower remifentanil dose at 20, 25, and 30 min during the procedure. The female cats that received carprofen showed an increase in mean heart rate at 30 min compared to that at 20 and 25 min. In the Grapiprant group, the heart rate at 35 min was higher only than that observed at 25 min. Discussion: The remifentanil rate did not differ between the groups, even between the times for GCAR. However, the remifentanil rate was lower from 20 min of the procedure for GGRA. This decrease may be related to a decrease in the need for anesthetics and analgesics by decreasing temperature, which causes decreases in metabolism and surgical stimulation. The increase in systolic, mean, diastolic, and heart rate arterial pressure parameters observed in both treatments after 15 min of anesthesia is related to the nociceptive stimulus resulting from traction and ligation of the ovarian pedicles and maneuvers for exteriorization of the uterus. These are considered the moments of greater surgical stimulus during ovariohysterectomy, evidenced by the greater release of cortisol and increase in physiological parameters. The results of this study show that the administration of carprofen or grapiprant was clinically similar when used preemptively for perioperative analgesia in cats submitted to elective ovariohysterectomy.

Evidence of pituitary hypoplasia associated with partial central diabetes insipidus in a young Persian cat

Background: Congenital anomalies are an uncommon pituitary hypofunction cause associated to multiple hormone deficiencies. Congenital hyposomatotropism is often related to an inherited anomaly, characterized mainly by delayed growth. It is not uncommon to find associated thyroid-stimulating hormone and gonadotropin deficiencies. Pituitary malformation may be associated to progressive cystic lesion expansion. Central diabetes insipidus (CDI) is another rare disease associated to polyuria (PU) and polydipsia (PD) secondary to antidiuretic hormone (ADH) deficient secretion. The aim of this report is to describe a likely case of pituitary hypoplasia, associated with partial CDI in a cat. Case: A 9-month-old unneutered male Persian cat weighing 2 kg was presented due to severe polyuria and polydipsia associated with growth deficit when compared with its sibling. After clinical and laboratory evaluations during the months in which the patient was monitored, reduced serum concentration of insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), thyroid hormones, and testosterone were documented, confirming the diagnosis of hyposomatotropism, hypogonadism, and secondary hypothyroidism. Furthermore, therapeutic diagnosis with desmopressin revealed partial central diabetes insipidus (CDI). As the sibling showed normal development aging 13-months, a radiographic examination of the forelimb (carpus) was performed on both cats. There was lack of growth plate fusion in the patient, without any other evidence of dysgenesis, whereas complete epiphyseal closure was observed in the sibling. Despite therapeutic prescriptions of desmopressin and levothyroxine, the owners refused further follow-up to the...

Evidence of pituitary hypoplasia associated with partial central diabetes insipidus in a young Persian cat

Background: Congenital anomalies are an uncommon pituitary hypofunction cause associated to multiple hormone deficiencies. Congenital hyposomatotropism is often related to an inherited anomaly, characterized mainly by delayed growth. It is not uncommon to find associated thyroid-stimulating hormone and gonadotropin deficiencies. Pituitary malformation may be associated to progressive cystic lesion expansion. Central diabetes insipidus (CDI) is another rare disease associated to polyuria (PU) and polydipsia (PD) secondary to antidiuretic hormone (ADH) deficient secretion. The aim of this report is to describe a likely case of pituitary hypoplasia, associated with partial CDI in a cat. Case: A 9-month-old unneutered male Persian cat weighing 2 kg was presented due to severe polyuria and polydipsia associated with growth deficit when compared with its sibling. After clinical and laboratory evaluations during the months in which the patient was monitored, reduced serum concentration of insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), thyroid hormones, and testosterone were documented, confirming the diagnosis of hyposomatotropism, hypogonadism, and secondary hypothyroidism. Furthermore, therapeutic diagnosis with desmopressin revealed partial central diabetes insipidus (CDI). As the sibling showed normal development aging 13-months, a radiographic examination of the forelimb (carpus) was performed on both cats. There was lack of growth plate fusion in the patient, without any other evidence of dysgenesis, whereas complete epiphyseal closure was observed in the sibling. Despite therapeutic prescriptions of desmopressin and levothyroxine, the owners refused further follow-up to the...(AU)

Uso e efeitos da dexmedetomidina na anestesia de ratos e camundongos / Use and effects of dexmedetomidine in rats and mice anesthesia

O uso de agonistas dos receptores α-2 adrenérgicos possui ampla difusão no campo da medicina veterinária, tendo a xilazina como principal representante deste grupo anestésico. A dexmedetomidina, um isômero da medetomidina, demonstra altíssima especificidade aos adrenorreceptores α-2 e com isso vem ganhando espaço devido a seus potentes efeitos analgésicos e anestésicos e sua utilização em ratos e camundongos. Seu uso é justificado tanto como agente isolado, bem como associado a outros fármacos, visando reduzir as doses e os efeitos indesejados. A praticidade da existência de um reversor específico, o atipamezole, juntamente com a disponibilidade de administração por diversas vias, faz da dexmedetomidina uma droga adequada para utilização em roedores. Sua resposta é dose-dependente, e, por isso, deve-se avaliar cautelosamente o tipo de anestesia desejada previamente à sua administração. A dexmedetomidina demostra uma série de efeitos anti-inflamatórios e protetores sistêmicos, visto que inibe citocinas pró-inflamatórias. No entanto, tais mecanismos de ação ainda não foram completamente elucidados. A especificidade da dexmedetomidina aliada a seu potente potencial analgésico e anestésico, além de seus efeitos secundários como anti-inflamatório e protetor sugerem sua utilização na anestesia de ratos e camundongos de forma segura.(AU)

The use of α-2 agonist adrenoreceptors is widespread in veterinary, and xilazine represents the major role of the group. Dexmedetomidine, a medetomidine isomer, is highly specific to the α-2 adrenoreceptors and due to analgesic and anesthetic effects, its use in rats and mice can be seen as single agent or associated with other drugs, to reduce dose and minimize the side effects. The convenience of having a specific revert drug, atipamezole, makes dexmedetomidine a safe drug to be administered to rodents, besides the possibility of being administered by multiple ways. The response of dexmedetomidine is dose-dependent and, because of that, the anesthesia protocol should be careful evaluated before its administration. Besides, the drug shows several anti-inflammatory and protective effects decurrent of its use, inhibiting pro-inflammatory citokines, but the mechanisms havent been completely elucidated. The high specifity of dexmedetomidine associated to the analgesic and anesthetic effects, plus its secondary effects as anti-inflammatory and protector suggests a safe use in rats and mice anesthesia.(AU)

Uso e efeitos da dexmedetomidina na anestesia de ratos e camundongos / Use and effects of dexmedetomidine in rats and mice anesthesia

O uso de agonistas dos receptores α-2 adrenérgicos possui ampla difusão no campo da medicina veterinária, tendo a xilazina como principal representante deste grupo anestésico. A dexmedetomidina, um isômero da medetomidina, demonstra altíssima especificidade aos adrenorreceptores α-2 e com isso vem ganhando espaço devido a seus potentes efeitos analgésicos e anestésicos e sua utilização em ratos e camundongos. Seu uso é justificado tanto como agente isolado, bem como associado a outros fármacos, visando reduzir as doses e os efeitos indesejados. A praticidade da existência de um reversor específico, o atipamezole, juntamente com a disponibilidade de administração por diversas vias, faz da dexmedetomidina uma droga adequada para utilização em roedores. Sua resposta é dose-dependente, e, por isso, deve-se avaliar cautelosamente o tipo de anestesia desejada previamente à sua administração. A dexmedetomidina demostra uma série de efeitos anti-inflamatórios e protetores sistêmicos, visto que inibe citocinas pró-inflamatórias. No entanto, tais mecanismos de ação ainda não foram completamente elucidados. A especificidade da dexmedetomidina aliada a seu potente potencial analgésico e anestésico, além de seus efeitos secundários como anti-inflamatório e protetor sugerem sua utilização na anestesia de ratos e camundongos de forma segura.

The use of α-2 agonist adrenoreceptors is widespread in veterinary, and xilazine represents the major role of the group. Dexmedetomidine, a medetomidine isomer, is highly specific to the α-2 adrenoreceptors and due to analgesic and anesthetic effects, it’s use in rats and mice can be seen as single agent or associated with other drugs, to reduce dose and minimize the side effects. The convenience of having a specific revert drug, atipamezole, makes dexmedetomidine a safe drug to be administered to rodents, besides the possibility of being administered by multiple ways. The response of dexmedetomidine is dose-dependent and, because of that, the anesthesia protocol should be careful evaluated before its administration. Besides, the drug shows several anti-inflammatory and protective effects decurrent of its use, inhibiting pro-inflammatory citokines, but the mechanisms haven’t been completely elucidated. The high specifity of dexmedetomidine associated to the analgesic and anesthetic effects, plus its secondary effects as anti-inflammatory and protector suggests a safe use in rats and mice anesthesia.

Uso de dipirona como analgésico no pós-operatório de cães / The use of dipyrone as an analgesic in the post-operative of dogs

A dipirona é uma das drogas mais utilizadas no tratamento da dor de pequenos animais, especialmente de cães. Seu efeito analgésico é atribuído a seus dois principais metabólitos ativos (MAA e AA), os quais inibem as isoenzimas COX-1 e 2, além de bloquearem a síntese central e periférica de PGE2 e a ativação dos sistemas opioide e canabinoide. Seu uso em cães parece ser seguro, não havendo relatos de efeitos adversos importantes nessa espécie. Embora vários estudos acessando os efeitos analgésicos da dipirona em humanos e roedores estejam disponíveis, poucos trabalhos sobre seu uso em cães foram publicados. O objetivo deste trabalho foi realizar uma revisão de literatura sobre o uso de dipirona como analgésico no pós-operatório de cães. Os resultados da busca permitem concluir que o tratamento com dipirona promove analgesia pós-cirúrgica quando a dor é de intensidade leve a moderada, mas que, quando combinada com outras drogas analgésicas, seu efeito tende a ser mais evidenciado.(AU)

Dipyrone is one of the drugs most commonly used in the treatment of small animal pain, especially dogs. Its analgesic effect is attributed to its two main active metabolites (MAA and AA), which inhibit the COX-1 and 2 isoenzymes, besides blocking the central and peripheral synthesis of PGE2 and the activation of the opioid and cannabinoid systems. Its use in dogs appears to be safe and there are no reports of significant adverse effects in this species. Although several studies addressing the analgesic effects of dipyrone in humans and rodents are available, few papers on its use in dogs have been published. The aim of this work was to perform a literature review on the use of dipyrone as an analgesic in the postoperative period of dogs. The results of the search endorse the conclusion that dipyrone treatment promotes post-surgical analgesia when the pain is of mild to moderate intensity, but when combined with other analgesic drugs, its effect tends to be more evident.(AU)

Uso de dipirona como analgésico no pós-operatório de cães / The use of dipyrone as an analgesic in the post-operative of dogs

A dipirona é uma das drogas mais utilizadas no tratamento da dor de pequenos animais, especialmente de cães. Seu efeito analgésico é atribuído a seus dois principais metabólitos ativos (MAA e AA), os quais inibem as isoenzimas COX-1 e 2, além de bloquearem a síntese central e periférica de PGE2 e a ativação dos sistemas opioide e canabinoide. Seu uso em cães parece ser seguro, não havendo relatos de efeitos adversos importantes nessa espécie. Embora vários estudos acessando os efeitos analgésicos da dipirona em humanos e roedores estejam disponíveis, poucos trabalhos sobre seu uso em cães foram publicados. O objetivo deste trabalho foi realizar uma revisão de literatura sobre o uso de dipirona como analgésico no pós-operatório de cães. Os resultados da busca permitem concluir que o tratamento com dipirona promove analgesia pós-cirúrgica quando a dor é de intensidade leve a moderada, mas que, quando combinada com outras drogas analgésicas, seu efeito tende a ser mais evidenciado.

Dipyrone is one of the drugs most commonly used in the treatment of small animal pain, especially dogs. Its analgesic effect is attributed to its two main active metabolites (MAA and AA), which inhibit the COX-1 and 2 isoenzymes, besides blocking the central and peripheral synthesis of PGE2 and the activation of the opioid and cannabinoid systems. Its use in dogs appears to be safe and there are no reports of significant adverse effects in this species. Although several studies addressing the analgesic effects of dipyrone in humans and rodents are available, few papers on its use in dogs have been published. The aim of this work was to perform a literature review on the use of dipyrone as an analgesic in the postoperative period of dogs. The results of the search endorse the conclusion that dipyrone treatment promotes post-surgical analgesia when the pain is of mild to moderate intensity, but when combined with other analgesic drugs, its effect tends to be more evident.