Effects of dexmedetomidine on hemodynamic, oxygenation, microcirculation, and inflammatory markers in a porcine model of sepsis

Purpose: To determine whether dexmedetomidine aggravates hemodynamic, metabolic variables, inflammatory markers, and microcirculation in experimental septic shock. Methods: Twenty-four pigs randomized into: Sham group (n = 8), received saline; Shock group (n = 8), received an intravenous infusion of Escherichia coli O55 (3 × 109 cells/mL, 0.75 mL/kg, 1 hour); Dex-Shock group (n = 8), received bacteria and intravenous dexmedetomidine (bolus 0.5 mcg/kg followed by 0.7 mcg/kg/h). Fluid therapy and/ornorepinephrine were administered to maintain a mean arterial pressure > 65 mmHg. Hemodynamic, metabolic, oxygenation, inflammatory markers, and microcirculation were assessed at baseline, at the end of bacterial infusion, and after 60, 120, 180, and 240 minutes. Results: Compared to Shock group, Dex-Shock group presented a significantly increased oxygen extraction ratio at T180 (23.1 ± 9.7 vs. 32.5 ± 9.2%, P = 0.0220), decreased central venous pressure at T120 (11.6 ± 1 vs. 9.61 ± 1.2 mmHg, P = 0.0214), mixed-venous oxygen saturation at T180 (72.9 ± 9.6 vs. 63.5 ± 9.2%, P = 0.026), and increased plasma lactate (3.7 ± 0.5 vs. 5.5 ± 1 mmol/L, P = 0.003). Despite the Dex-Shock group having a better sublingual vessel density at T240 (12.5 ± 0.4 vs. 14.4 ± 0.3 mL/m2; P = 0.0003), sublingual blood flow was not different from that in the Shock group (2.4 ± 0.2 vs. 2.4 ± 0.1 mL/kg, P = 0.4418). Conclusions: Dexmedetomidine did not worsen the hemodynamic, metabolic, inflammatory, or sublingual blood flow disorders resulting from septic shock. Despite inducing a better sublingual vessel density, dexmedetomidine initially and transitorily increased the mismatch between oxygen supply and demand.

Animal model of continuous peritoneal lavage with vacuum peritoneostomy

Purpose: To establish and evaluate the feasibility of continuous peritoneal lavage with vacuum peritoneostomy in an animal model. Methods: Eight pigs aged 3-4 months, females, were anesthetized and submitted to laparotomy and installation of a continuous peritoneal lavage with vacuum peritoneostomy. The sta-bility of the system, the physiological effects of washing with NaCl 0.9% and the sys-tem clearance were evaluated. Results: Stability of vacuum peritoneostomy was observed, with no catheter leaks or obstructions and the clearance proved adequate, however, the mean volume of fluids aspirated by the peritoneostomy at the end of the experiment was higher than the volume infused by the catheters (p=0.02). Besides that, the animals presented a progressive increase in heart rate (p=0.04) and serum potassium (p=0.02). Conclusion: The continuous peritoneal lavage technique with vacuum peritoneostomy is feasible and presents adequate clearance.(AU)

Sevoflurane preconditioning during myocardial ischemia-reperfusion reduces infarct size and preserves autonomic control of circulation in rats

PURPOSE:To investigate the myocardial ischemia-reperfusion with sevoflurane anesthetic preconditioning (APC) would present beneficial effects on autonomic and cardiac function indexes after the acute phase of a myocardial ischemia-reperfusion.METHODS:Twenty Wistar rats were allocated in three groups: control (CON, n=10), myocardial infarction with sevoflurane (SEV, n=5) and infarcted without sevoflurane (INF, n=5). Myocardial ischemia (60 min) and reperfusion were performed by temporary coronary occlusion. Twenty-one days later, the systolic and diastolic function were evaluated by echocardiography; spectral analysis of the systolic arterial pressure (SAPV) and heart rate variability (HRV) were assessed. After the recording period, the infarct size (IS) was evaluated.RESULTS:The INF group presented greater cardiac dysfunction and increased sympathetic modulation of the SAPV, as well as decreased alpha index and worse vagal modulation of the HRV. The SEV group exhibited attenuation of the systolic and diastolic dysfunction and preserved vagal modulation (square root of the mean squared differences of successive R-R intervals and high frequency) of HRV, as well as a smaller IS.CONCLUSION:Sevoflurane preconditioning better preserved the cardiac function and autonomic modulation of the heart in post-acute myocardial infarction period.(AU)

Ceratoplastia lamelar em cães usando membrana amniótica equina. Estudo clínico e morfológico / Lamelar keratoplasty in dogs using equine amniotic membrane. Clinical and morphological study

A membrana amniótica (MA) consolidou-se no tratamento de afecções na superfície ocular. O objetivo deste estudo foi avaliar a viabilidade do implante de MA equina em ceratoplastia lamelar de cães. As membranas amnióticas foram preservadas em glicerina (98%). A eficácia do implante foi acompanhada por avaliação clínica, tempo de cicatrização, resposta inflamatória e reconstrução da arquitetura da córnea. Foram selecionados 12 cães, que foram divididos em quatro grupos de três animais. Em cada animal, foi realizada ceratotomia lamelar com 5 mm de diâmetro, seguida de aplicação do implante de MA. Após cirurgia, os animais foram avaliados em diferentes tempos: 2, 7, 21 e 40 dias. Duran- te o período de observação, os exames oftalmológicos foram realizados com intervalo de 48 h e, após a última avaliação, os animais foram submetidos à eutanásia. Os olhos foram enucleados, fixados e corados com hematoxilina-eosina (HE), ácido periódico de Schiff (PAS) e picrossirius. Os implantes foram completamente epitelizados em cerca de 10 dias após a cirurgia. Os neovasos apresentaram involução progressiva a partir de 21 dias e não foram detectados ao final de 40 dias pós-cirurgia, restando apenas uma nébula no local da lesão. À microscopia óptica, observou-se resposta inflama- tória moderada, presença de epitélio pavimentoso estratificado aos sete dias e epitelização completa aos 21 dias. Aos 40 dias, a membrana basal do epitélio apresentou-se reconstituída. Assim, concluímos que a membrana amniótica equina é viável como implante em córnea de cão, sendo incorporada ao estroma e resultando em restabelecimento parcial da transparência.(AU)

Amniotic membranes have been successfully used in the treatment of superficial corneal diseases. The purpose of this study was to assess the feasibility of use of equine amniotic membrane (AM) in lamellar keratoplasty of dogs. Amniotic membranes were preserved in glycerol (98%). Implant efficacy was assessed by clinical evaluation, time of healing, in-flammatory response, and the corneal architectural configuration. Twelve dogs were divided into four groups of three animals. In each animal, a 5-mm diameter lamellar keratectomy was performed, and followed by implantation of the AM. The animals were evaluated at the 2th, 7th, 21th, and 40th days after surgery. During this period, ophthalmological exams were performed at 48-h intervals, and the animals were euthanized after the last evaluation. The eyes were enu-cleated, included, fixed, and stained with hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and picrosirius. Epitheli-zation of the implants was completed in about ten days after surgery. New vessels progressively diminished from 21 days on, were not detected on day 40 after surgery, and only a nebula was observed in the implant area. Optical microscopy revealed a mild inflammatory response, presence of squamous epithelium on day seven, and total epithelization on day 21 after surgery. On day 40, the basal epithelial membrane was shown to be reformed. Therefore, we conclude that use of equine amniotic membranes is feasible as implant for dog cornea since it is incorporated to the corneal stroma, and a relative transparency can be obtained.(AU)

Estudo comparativo entre sutura mecânica e manual em brônquio após pneumonectomia esquerda em cães (Canis familiaris): uma avaliação anatomopatológica / Comparative study between mechanical and manual sutures in the bronchus after left pneumonectomy in the dogs (canis familiaris): a pathological-anatomic evaluation

O objetivo deste estudo foi realizar um estudo experimental comparando-se sob o ponto de vista anatomopatológico as suturas manual e mecânica em brônquio principal após pneumonectomia esquerda em cães. Foram utilizados 18 cães, sadios, machos e fêmeas, adultos, sem raça definida, pesando entre 9 e 27,5 kg. Foram separados em 2 grupos de 9 cães, de acordo com o tipo de sutura empregada: Grupo A - sutura manual com fio polipropileno 5-0; Grupo B sutura mecânica com grampeador mecânico modelo TL- 30. Cada grupo foi subdividido em 3 subgrupos de 3 animais, sendo estabelecido estudo temporal aos 7, 15 e 36 dias de pós-operatório, onde foi realizada avaliação anatomopatológica da cicatrização das suturas manual e mecânica. Na avaliação histopatológica foram avaliados, qualitativamente e semi-quantitativamente, intensidade da inflamação, fibrose, vasos neoformados e presença ou não de tecido de granulação, granuloma tipo corpo estranho e necrose. Os resultados encontrados foram analisados estatisticamente. Com relação à análise rustopatológica, ocorreu a formação de granuloma tipo corpo estranho no coto brônquico esquerdo em 88,9% dos cães submetidos à sutura manual e em nenhum dos cães submetidos à sutura mecânica. Houve, ainda, diferença estatística significativa nos cães dos Grupos A e B em relação à intensidade da inflamação, sendo de maior intensidade nos cães submetidos à sutura manual. Concluiu-se que os 2 tipos de sutura promoveram cicatrização adequada do coto brônquico principal esquerdo, embora tenha ocorrido maior intensidade de inflamação e maior ocorrência de granuloma tipo corpo estranho nos cães submetidos à sutura manual.(AU)

The objective of this study was to perform an experimental studyto be compared under the pathological-anatomic, point of view,the manual and mechanical sutures in the main bronchus after leftpneumonectomy in dogs. Eighteen adult mongrel, healthy dogs,both male and female, were utilized weighing from 9 to 27.5 kg.The dogs were submitted to a selective intubation and left thoraxincision in the 5 th intercostal space where a pneumonectomy wasperformed. Were separated into 2 groups of 9 dogs according tothe type of suture employed: Group A - a manual suture withpolypropylene 5-O; Group B a mechanical suture with amechanical stapler, model TL-30. Each group was subdivided into3 subgroups of 3 animals and a temporal postoperative study wasestablished at 7, 15 and 36 days where an pathological-anatomicevaluation was made on the healing of the manual and mechanicalsutures. During the histopathological evaluation, the intensity ofinflammation, fibrosis, neoformed vessels, and the presence orabsence of granulation tissue, foreign body reaction and necrosis were evaluated qualitatively and semi-quantitatively. The results foundwere analyzed statistically. Regarding the histopathologic analysis,foreign body reaction occured in the left bronchial stump in 88,9% ofthe dogs submitted to a manual suture and in none of the dogssubmitted to a mechanical suture. There is still, significant statisticaldifference in the dogs in Groups A and B in relation to the intensityof the inflammation, the greatest intensity being in the dogssubmitted to the manual suture. It is concluded that both types ofsutures brought an adequate healing of the main left bronchial stump,although there was a greater intensity of inflammation and a greateroccurence of foreign body reaction in the dogs submitted to themanual suture. (AU)

Estudo comparativo entre sutura manual e mecânica de coto brônquico em cães submetidos à pneumonectomia esquerda: avaliação histopatológica do pulmão direito e avaliação eletrocardiográfica / Comparative study between manual and mechanical suture of bronchial stamp in dogs submited to left pneumonectomy: histopahological evaluation of right lung and electrocardiographical evaluation

O presente estudo teve como objetivo avaliar as possíveis alterações eletrocardiográficas e as alterações histopatológicas no pulmão de cães submetidos à pneumonectomia esquerda em abordagem comparativa entre dois tipos de sutura de coto brônquico (manual e mecânica). Foram utilizados doze cães, machos e fêmeas, adultos, sem raça definida, pesando entre quinze e vinte quilos sendo avaliados as alterações microscópicas apresentadas pelo pulmão direito e as alterações do eletrocardiograma. Todos os animais apresentaram-se em condições clínicas satisfatórias no período pós-operatório. As principais alterações eletrocardiográficas observadas no período pós-operatório foram desvio de eixo cardíaco, bloqueio sinoatrial e isquemia de miocárdio. No exame histopatológico, constatou-se atelectasia pulmonar, proliferação de epitélio de bronquíolo tendendo à obliteração, bronquiolite obliterante e enfisema pulmonar. O estudo sugere ainda que o pulmão direito foi submetido à hipertensão pulmonar. (AU)

The study had purpose to evaluate the possible electrocardiographical alterations and the histopathological alterations in the lung of dogs submited by left pneumonectomy with comparative approach between two types of suture of bronchial stamp (manual and mechanical). We used twelve dogs, males and females, adults, mongrel dogs, weighting between 15 and 20 kilograms and evaluated the macroscopic alterations of right lung and the alterations of electrocardiogram. All animals showed clinical condition satisfactory in the post operated time. The electrocardiographical alterations were deviation of cardiac axis, sinoatrial block and miocardial isquemia. The histopathological alterations were pulmonary atelectasis, proliferations of bronchiole epithelium tended to obliterations and pulmonary emphysema. The study suggested that right lung was submited to pulmonary hipertension. (AU)

Hemodiluição normovolêmica aguda: estudo experimental comparativo utilizando amido hidroxietílico a 6% ou solução de Ringer lactato / Acute normovolemic hemodilution: comparative evaluation with hydroxyethyl starch and Lactated Ringers

Hemodiluição normovolêmica aguda é um procedimento utilizado para diminuir a necessidade de transfusões sangüíneas em diversas cirurgias de grande porte. Poucos trabalhos avaliam as alterações hemodinâmicas e perfusão tecidual através de estudo ecocardiográfico e tonometria gástrica. Foram utilizados 23 porcos (peso 46.6 ± 6.0 kg) anestesiados com quetamina, fentanil e propofol e instrumentados para monitorização hemodinâmica convencional. Os animais foram randomizados em três grupos 30 minutos após estabilização da anestesia: Grupo I (Controle), Grupo II (amido hidroxietílico) e Grupo III (Ringer lactato). Os animais do grupo II e III foram submetidos ao protocolo de hemodiluição com hematócrito alvo de 15%. A retirada de sangue foi realizada em 30 minutos e a expansão plasmática feita simultaneamente com amido hidroxietílico ou Ringer lactato nas proporções de 1:1 ou 1:3 em relação ao sangue retirado. Os parâmetros hemodinâmicos e de oxigenação, pH gástrico, ecocardiografia transesofágica (fração de ejeção através do método Simpson) foram coletados antes da hemodiluição (T0), no fim do procedimento de hemodiluição (T1) e após uma e duas horas (T2, T3). Os dados foram submetidos a análise de variância para medidas repetidas, seguida pelo teste Tukey e teste T student. Resultados: Em relação aos parâmetros do grupo controle, não houve diferença significante durante todo o procedimento. No grupo II e grupo III, houve aumento no índice cardíaco após hemodiluição (T0=5,80±1,46; T1=10,64±1,69 L.min-1.m2 e T0=5,53±1,18, T1=7,91±1,40 L.min-1.m2 respectivamente), e diminuição do índice de resistência vascular sistêmica (T0=1753±336, T1=822±140 dina.s.cm-5.m-2 e T0=1673±566, T1=1026±190 dina.s.cm-5.m-2 respectivamente), ambos estatisticamente significante. A fração de ejeção apresentou aumento significativo após a hemodiluição no grupo II. O pH gástrico diminuiu significativamente no grupo III. O lactato arterial aumentou de forma significante no grupo III após a hemodiluição. A microscopia eletrônica do ventrículo esquerdo mostraram discreta destruição de miofilamentos no grupo II. Houve destruição importante nas miofibrilas no grupo III. Conclusão: Estes resultados sugerem que na hemodiluição moderada a grave, o amido hidroxietílico consegue preservar melhor a estabilidade hemodinâmica do que a solução de Ringer lactato

Normovolemic acute hemodilution is a procedure utilized to decrease the needs of blood transfusion during a variety of surgical procedures. Nevertheless, there are few works that evaluate its pulmonary effects as well as hemodynamic changes by means of echocardiography and tonometric evaluation. Methods: 23 anesthetized pigs (weight 46.6 ± 6.0 kg) were instrumented for standard hemodynamic monitoring. In order to prevent possible effects of inhaled anesthetics on pulmonary mechanics, intravenous anesthesia was chosen and consisted of ketamine, fentanyl and propofol administered throughout the study. Thirty minutes after anesthesia stabilization animals were randomized in three groups: Group I (Control), Group II (hydroxyethyl starch) and Group III (Lactated Ringers). Animals of group II and III were submitted to acute normovolemic hemodilution to reach a pre-established hematocrit around 15%. Blood withdrawal was accomplished in thirty minutes and plasma expansion was performed simultaneously with hydroxyethyl starch or Lactated Ringers administered in a proportion of 1:1 or 3:1 in relation to the amount of bloods withdrawn. Hemodynamic, gastric pH, transesophageal echography (ejection fraction, by Simpon method) and oxygen transport were measured before blood withdrawal (T0), at the end of hemodilution (T1), one and two hours after the end of hemodilution (T2, T3). Data were submitted to analysis of Variance for repeated measures followed by the Tukey test and also to a student T test. Results: In regard to all parameters of Group I (Control), there were no significant difference during the whole procedure. In Group II and Group III, there was an increase in cardiac index after hemodilution (T0=5.80±1.46; T1=10.64±1.69 L.min-1.m2 and T0=5.53±1.18, T1=7.91±1.40 L.min-1.m2), and a decrease in systemic vascular resistance index (T0=1753±336, T1=822±140 dyne.s.cm-5.m-2 and T0=1673±566, T1=1026±190 dyne.s.cm-5.m-2), both statistically significant. Ejection Fraction increased significantly after hemodilution in group II. Gastric pH decreased significantly in Group III, and arterial lactate increased significantly after hemodilution in group III. Electron microscopy of left ventricular bipsies showed a slight destruction in filament and preserved myofibrillar ultrastructure in group II. There was important destruction in myofibrillar ultrastructure in group III. Conclusion: These results suggest that in severe hemodilution, hydroxyethyl starch preserves hemonodynamic stability better than Lactate Ringers