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.

Fratura de úmero em uma curicaca (Theristicus caudatus) - manejo anestésico e cirúrgico / Humerus fracture in a buff-necked ibis (Theristicus caudatus) - anesthesia and surgical procedures

Background: The medical science of birds, with the exception of aviculture, has a very short history compared to other subdisciplines of veterinary medicine. With this in mind, the current work aims to report the case of a buff-necked ibis with an open fracture of the left humerus, presenting the surgical treatment and anesthetic protocol used, in order to contribute to the avian medical literature. Case: An adult buff-necked ibis (Theristicus caudatus) was referred to the University Veterinary Hospital with an open fracture of the left humeral shaft, 7 days after rescue. During the physical examination, a skin lesion was identified in the fracture area, with signs of low vascularization, devitalization, necrotic tissues, and purulent secretions being noted. On radiographic examination, the fracture was classified as comminuted, with exposure of the left humeral shaft. After evaluating the limb, it was decided to amputate the wing, and 24 h later, the patient was referred to the operating room after fasting for 4 h. As pre-anesthetic medication, ketamine (20 mg/kg) and midazolam (1 mg/kg) were administered, both intramuscularly. Orotracheal intubation was performed, after which the tracheal tube was connected to a Baraka-type gas-free system and the supply of isoflurane was started through a universal vaporizer, diluted in 100% oxygen. For transoperative analgesia, brachial plexus block was performed using 2% lidocaine (2 mg/kg). During the surgical procedure, an incision was made in the skin and subcutaneous tissue in the middle third of the left humerus, and detachment of the greater deltoid muscle was performed with a periosteal elevator, followed by excision of the tensor propatagialis. In the ventrodorsal region, circular ligation of the brachial vein, ulnar vein and artery, and median-ulnar nerve was carried out, and disarticulation of the scapulacoracoid-humeral region. Subsequently, abolition of dead space and a myorrhaphy were performed, followed by demorrhaphy. In the immediate post-operative period, morphine (5 mg/kg), meloxicam (0.1 mg/kg), and enrofloxacin (10 mg/kg) were administered intramuscularly. The patient was discharged from the hospital 6 h after the end of the surgical procedure. Discussion: Interest in the conservation of wild birds is one of the causes of the increased demand for anesthetic and surgical procedures in these species. However, it is a challenge for professionals in the field. The use of analgesics is recommended for reasons of well-being, but also because of the possibility of reducing the concentration of inhalational anesthetics in surgical procedures. Ketamine associated with midazolam promotes sufficient sedation and muscle relaxation in the patient, enabling safe preoperative management, in addition to reducing the amount of inhaled anesthetics used during the transoperative period. Isofluorane promotes safe general anesthesia for birds and has an advantage over injectable drugs, as it provides better dynamic control of anesthetic depth in these species. The brachial plexus block performed is a simple procedure that promotes quality anesthesia and analgesia in the perioperative period. The choice for amputation was due to the absence of musculature for closure, severe skin, muscle, and bone devitalization, and the infectious process in the region, factors that would prevent osteosynthesis. Although amputation through the bone is preferable, the disarticulation technique was used due to the absence of a healthy proximal humeral fragment. The patient's death can be explained by the poor nutritional status the bird was in, as it presented an open fracture with severe contamination, a concomitant injury that occurred during the possible trauma, and the excessive time between the day of the trauma and the day of medical attendance. However, the surgical and anesthetic procedures were adequate and satisfactory for the patient. The importance of identifying and treating diseases secondary to contaminated fractures in these species is emphasized.

Systolic blood pressure in anesthetized bitches measured with photoplethysmography

Background: Photoplethysmography is widely used in human medicine, with few studies on its use in veterinary medicine. Its sensor detects fluctuations in blood volume at the site, providing direct readings of cardiac pulse and peripheral oxygen saturation, as well as estimating cardiac output, respiratory rate and blood pressure. This study aimed to evaluate the use of photoplethysmography and compare it to vascular Doppler ultrasound as an indirect method of measuring systolic blood pressure in bitches undergoing elective ovariohysterectomy, using the invasive assessment of systolic blood pressure as a reference. Materials, Methods and Results: After clinical and laboratory evaluation, 34 healthy bitches were selected to undergo elective ovariohysterectomy. After food and water fasting, patients received pethidine hydrochloride intramuscularly as pre-anesthetic medication, followed by anesthetic induction with fentanyl citrate and propofol intravenously. General anesthesia was maintained by inhalation with isoflurane diluted in 100% oxygen. Intraoperative analgesia consisted of continuous infusion of fentanyl citrate intravenously. The animals were randomly divided into 2 groups, the thoracic limb group (TLG) and the pelvic limb group (PLG). In each patient, non-invasive blood pressure measurement was obtained simultaneously with Doppler (DOP) and photoplethysmography (PPG). The sensors of both devices were placed on the end of the same limb. The PPG sensor was positioned in the interdigital region. In patients belonging to the TLG, the Doppler sensor was placed in the ventral region of the thoracic limb, under the ulnar artery. In PLG patients, the Doppler sensor was placed in the dorsal region of the pelvic limb, over the dorsal artery of the foot. The sphygmomanometer was positioned close to the sensors. For systolic blood pressure (SBP) measurement, the cuff was inflated until the Doppler sound signal and the plethysmographic wave were lost. The cuff was then deflated until the Doppler pulse sound resumed and the photoplethysmography showed at least 2 continuous waves on a regular basis. The corresponding pressure value observed on the manometer consisted of the SBP. The same 2 evaluators performed all SBP measurements: 1 responsible for the DOP method and the other for the PPG method; both were blind to the other's findings, thus minimizing potential bias in the results. All animals underwent cannulation of the auricular artery for invasive measurement of systolic blood pressure, using a multiparameter monitor. All blood pressure measurements were performed at 5-min intervals, as well as obtaining additional parameters (heart and respiratory rate, esophageal temperature, partial tissue oxygen saturation, carbon dioxide concentration) and electrocardiographic monitoring. All parameters were documented for further statistical analysis. A strong correlation (r² = 0.95) was obtained between the DOP and PPG methods regardless of the limb on which the sensors were placed. There was a low correlation between the invasive method of measuring systolic blood pressure and the other methods. There was better agreement between the DOP and PPG methods (r2 = -0.0061; P = 0.85) when systolic blood pressure was measured in the TLG. Discussion: In the PLG, the values obtained with the DOP and PPG methods were significantly higher than those obtained with the invasive method, while the values obtained in the TLG differed slightly. It was found that the best measurement site by non-invasive methods was the thoracic limb. It was concluded that the non-invasive methods showed a low correlation with the invasive method; however, both methods had similar characteristics and photoplethysmography can be used to replace the vascular Doppler method.

Analgesia pós-operatória com Fentanil transdérmico ou Metadona intramuscular em cães submetidos à hemilaminectomia toracolombar / Postoperative analgesia with transdermal Fentanyl or intramuscular Methadone in dogs submitted to thoracolumbar hemilaminectomy

Background: Postoperative care after thoracolumbar hemilaminectomy in dogs generally includes rest, physical therapy,and analgesics such as opioids. Currently, there is no established standard for the management of postoperative pain inpatients undergoing hemilaminectomy. Ideally, an analgesic protocol should provide adequate pain relief with limited sedation, low adverse effects, and postoperative patient comfort. Therefore, this study aimed to evaluate postoperative analgesiausing transdermal fentanyl or intramuscular methadone in dogs undergoing thoracolumbar hemilaminectomy associatedwith intervertebral disc fenestration (HT) for the treatment of intervertebral disc extrusion (IVDE).Materials, Methods & Results: Eight dogs from the Department of Neurology and Neurosurgery of a Veterinary TeachingHospital, submitted to HT for the treatment of IVDE, were included. The dogs were randomly distributed into 2 groups ofequal numbers, namely the transdermal fentanyl (FT) group and the intramuscular methadone (IM) group. At the end ofthe surgical procedure, a fentanyl adhesive patch was applied to the animals in the FT group, which remained there for 72h. In the IM group, analgesia was induced by intramuscular administration of methadone at intervals of 6 h until 72 h aftersurgery. The animals were evaluated using the short form of the Glasgow Composite Measure Pains Scale (CMPS-SF).Evaluations of physiological parameters, side effects, and pain were performed by 2 assessors who had experience usingthe pain scale and were blinded to the analgesic protocol. Pain evaluations were performed every 2 h (from T4) until 24h after the surgical procedure. Evaluations were performed every 4 h from 24 h to 48 h after the surgical procedure and...