Anestesia em pacientes de risco: um abordagem anestésica aos pacientes cardiopatas, nefropatas, hepatopatas, pediátricos e senis / Anesthesia in high-risk patients: an anesthetic approach to cardiac, nephropathic, hepatic, pediatric and senile patients

Este trabalho visa, por meio de levantamento de dados científicos, analisar a melhor abordagem anestésica para cada tipo de paciente de risco, mostrando um panorama geral e indicativo sobre os fármacos e sua funcionalidade para cada sistema. A revisão bibliográfica foi baseada na literatura encontrada em meios eletrônicos (plataformas PubMed, Scielo e Google Scholar) e físicos (livros de referência) nos últimos dez anos, dentro de artigos com relatos de caso, revisões de literatura e pesquisas inéditas. Dessa forma, obteve-se um levantamento amplo, abrangendo as principais classes farmacológicas utilizadas em procedimentos anestésicos em pacientes classificados como de risco, ou seja, cardiopatas, nefropatas, hepatopatas, pediátricos e senis, procurando determinar os que causam menor depressão cardiovascular e respiratória respeitando suas limitações. Sendo assim, para uma anestesia mais segura deve-se focar na prevenção de intercorrências anestésicas no transoperatório e pós-operatório. Observar, estudar, analisar o paciente e o protocolo a ser utilizado como um todo é necessário e indispensável na anestesiologia veterinária, associando a teoria com a prática.

This work aims, through research, with scientific data, to analyze the best anesthetic approach for each type of patient, showing a general and indicative overview about the drugs and their functionality for each system. The bibliographic review was based on the literature found in electronic media (PubMed, Scielo and Google Scholar platforms) and physical (reference books) in the last ten years, within articles with case reports, literature reviews and unpublished research. Thus, a broad survey was obtained, covering the main pharmacological classes used in anesthetic procedures in patients classified as at risk, that is, cardiopath, nephropath, liver disease, pediatric and senile patients, trying to determine those that cause less cardiovascular and respiratory depression respecting their limitations. Therefore, for safer anesthesia, focus must placed on preventing anesthetic complications in the intraoperative and postoperative periods. Observing, studying, analyzing the patient and the protocol to be used as a whole is necessary and indispensable in veterinary anesthesia, associating theory with practice.

Anestesia em pacientes de risco: um abordagem anestésica aos pacientes cardiopatas, nefropatas, hepatopatas, pediátricos e senis / Anesthesia in high-risk patients: an anesthetic approach to cardiac, nephropathic, hepatic, pediatric and senile patients

Este trabalho visa, por meio de levantamento de dados científicos, analisar a melhor abordagem anestésica para cada tipo de paciente de risco, mostrando um panorama geral e indicativo sobre os fármacos e sua funcionalidade para cada sistema. A revisão bibliográfica foi baseada na literatura encontrada em meios eletrônicos (plataformas PubMed, Scielo e Google Scholar) e físicos (livros de referência) nos últimos dez anos, dentro de artigos com relatos de caso, revisões de literatura e pesquisas inéditas. Dessa forma, obteve-se um levantamento amplo, abrangendo as principais classes farmacológicas utilizadas em procedimentos anestésicos em pacientes classificados como de risco, ou seja, cardiopatas, nefropatas, hepatopatas, pediátricos e senis, procurando determinar os que causam menor depressão cardiovascular e respiratória respeitando suas limitações. Sendo assim, para uma anestesia mais segura deve-se focar na prevenção de intercorrências anestésicas no transoperatório e pós-operatório. Observar, estudar, analisar o paciente e o protocolo a ser utilizado como um todo é necessário e indispensável na anestesiologia veterinária, associando a teoria com a prática.(AU)

This work aims, through research, with scientific data, to analyze the best anesthetic approach for each type of patient, showing a general and indicative overview about the drugs and their functionality for each system. The bibliographic review was based on the literature found in electronic media (PubMed, Scielo and Google Scholar platforms) and physical (reference books) in the last ten years, within articles with case reports, literature reviews and unpublished research. Thus, a broad survey was obtained, covering the main pharmacological classes used in anesthetic procedures in patients classified as at risk, that is, cardiopath, nephropath, liver disease, pediatric and senile patients, trying to determine those that cause less cardiovascular and respiratory depression respecting their limitations. Therefore, for safer anesthesia, focus must placed on preventing anesthetic complications in the intraoperative and postoperative periods. Observing, studying, analyzing the patient and the protocol to be used as a whole is necessary and indispensable in veterinary anesthesia, associating theory with practice.(AU)

Anesthetic risk in cats undergoing surgical procedures in a Veterinary Medical Teaching Hospital / Risco anestésico em gatos submetidos a procedimentos cirúrgicos em um Hospital Veterinário Universitário

Background: In order to reduce morbidity and mortality associated with anesthetic procedures in cats, it is important to carry out a thorough pre-anesthetic evaluation. The surgical risk depends on several factors related to the patient, the surgical procedure, and the anesthetic used. Evaluation of perioperative mortality and the identification of the main factors of death reduce mortality rates. This research was conducted to evaluate and obtain the classification of physical status and anesthetic risk in cats submitted for surgical procedures.Materials, Methods & Results: Ninety-two cats were classified into anesthetic categories according to the American Society of Anesthesiologists (ASA) classification. The group consisted of 62 females (67.39%) and 30 males (32.61%). In the ASA classification, the emergency qualifier was added, resulting in 52.17% (48/92) of the total number of surgeries being considered as emergencies. The ASA I patients constituted the majority of the study sample (33.69%, 31/92). There were no deaths among ASA I patients. The ASA II patients represented 20.65% (19/92), with surgeries divided into non-emergency (42.10%, 8/19) and emergency (57.89%, 11/19). All ASA II patients had mild localized infections, and there were no deaths. ASA III patients constituted 28.26% (26/92) of the study sample and had moderate systemic alterations. Surgeries in this group were also classified as emergency (24/26, 92.30%) or non-emergency (2/26, 7.69%). There was one postoperative death in this group. The ASA IV patients represented 17.39% (16/92) of the study sample. The emergency surgeries (81.25%, 13/16) had a greater percentage than the elective surgeries. In this group, two deaths occurring in the immediate postoperative period. The overall mortality for the entire study sample was 3.26% (3/92).[...]

Anesthetic risk in cats undergoing surgical procedures in a Veterinary Medical Teaching Hospital / Risco anestésico em gatos submetidos a procedimentos cirúrgicos em um Hospital Veterinário Universitário

Background: In order to reduce morbidity and mortality associated with anesthetic procedures in cats, it is important to carry out a thorough pre-anesthetic evaluation. The surgical risk depends on several factors related to the patient, the surgical procedure, and the anesthetic used. Evaluation of perioperative mortality and the identification of the main factors of death reduce mortality rates. This research was conducted to evaluate and obtain the classification of physical status and anesthetic risk in cats submitted for surgical procedures.Materials, Methods & Results: Ninety-two cats were classified into anesthetic categories according to the American Society of Anesthesiologists (ASA) classification. The group consisted of 62 females (67.39%) and 30 males (32.61%). In the ASA classification, the emergency qualifier was added, resulting in 52.17% (48/92) of the total number of surgeries being considered as emergencies. The ASA I patients constituted the majority of the study sample (33.69%, 31/92). There were no deaths among ASA I patients. The ASA II patients represented 20.65% (19/92), with surgeries divided into non-emergency (42.10%, 8/19) and emergency (57.89%, 11/19). All ASA II patients had mild localized infections, and there were no deaths. ASA III patients constituted 28.26% (26/92) of the study sample and had moderate systemic alterations. Surgeries in this group were also classified as emergency (24/26, 92.30%) or non-emergency (2/26, 7.69%). There was one postoperative death in this group. The ASA IV patients represented 17.39% (16/92) of the study sample. The emergency surgeries (81.25%, 13/16) had a greater percentage than the elective surgeries. In this group, two deaths occurring in the immediate postoperative period. The overall mortality for the entire study sample was 3.26% (3/92).[...](AU)

Anestesia geral inalatória ou total intravenosa associada à anestesia subaracnoidea, em ovinos / General inhalation anesthesia or total intravenous associated with subarachnoid anesthesia in sheep

Avaliou-se a eficácia e a segurança anestésica em ovinos mantidos sob anestesia geral inalatória com isofluorano ou anestesia total intravenosa com propofol, ambas associadas à anestesia subaracnoidea. Quatorze ovinos foram pré-medicados com 0,3mg.kg-1 de morfina IM, e cinco minutos após, receberam 20mcg.kg-1 de detomidina IV. Posteriormente, foram alocados aleatoriamente em dois grupos: GISO (n=7), os quais foram induzidos à anestesia geral com 0,5mg.kg-1 de diazepam e 5mg.kg-1 de cetamina IV, e mantidos em anestesia geral inalatória com isoflurano diluído em oxigênio a 100%; e GPRO (n=7), induzidos com 4mg.kg-1 de propofol IV seguido inicialmente de infusão contínua na taxa de 0,3mg.kg-1.min-1. Para realização da osteotomia bilateral, todos os animais receberam 0,5mg.kg-1 de ropivacaína 0,75% associado a 0,1mg.kg-1 de morfina pela via subaracnoidea. Houve redução de 40% nos valores médios de frequência cardíaca após sedação em ambos os grupos, permanecendo em média 23% reduzida até o final da avaliação. A pressão arterial média aumentou 16%, após a indução anestésica no GISO, mas se reduziu até o final do procedimento, assim como no GPRO. A EtISO média foi de 0,57V% e a taxa média de infusão do propofol foi de 0,24mg.kg-1.min-1. Os tempos totais de cirurgia, anestesia e extubação foram de 66±9,8, 92±13,8 e 7,0±1,5 minutos no GISO e 56±2,4, 82,9±4,6 e 5,4±1,5 minutos no GPRO, não havendo diferença significativa entre grupos. A manutenção anestésica com isoflurano ou propofol promoveu plano anestésico similar com mínimos efeitos cardiovasculares ou hemogasométricos, que são bem tolerados em ovinos hígidos.(AU)

The purpose of this study was to evaluate the efficacy and safety of sheep submitted to inhalation anesthesia with isoflurane or total intravenous anesthesia with propofol, both associated with subarachnoid anesthesia. Fourteen animals were pre-medicated with 0.3mg.kg-1 morphine IM, and 5 minutes later received 20mcg.kg-1 detomidine IV. Then they were allocated into two groups: GISO (n=7), which were induced with 0.5mg.kg-1 of diazepam and 5mg.kg-1 of ketamine IV, and anesthesia maintenance was performed by isoflurane diluted in 100% oxygen; or GPRO (n=7), where animals were induced with 4mg.kg-1 propofol IV and subsequent maintenance anesthesia with its own infusion of 0.3mg.kg.min-1. To perform the bilateral tibial osteotomy, all animals received 0.5mg.kg-1 0.75% ropivacaine combined with 0.1mg.kg-1 morphine by the intrathecal route. There was a 40% reduction in mean heart rate after the sedative protocol in both groups, resulting in a 23% average reduction until the end of the review. Mean arterial pressure showed transient elevation of around 16%, after induction of anesthesia in GISO, but reducing it to the end of the procedure, as well as in GPRO. The average EtISO was 0.57 V% and average infusion rate of propofol was 0.24mg.kg-1.min-1. The total time of surgery, anesthesia and extubation was 66± 9.8, 92±7.0 and 13.8±1.5 minutes in GISO and 56±2.4, 82.9±4.6 and 5.4±1.5 minutes in GPRO. The maintenance of anesthesia with propofol or isoflurane produced similar anesthesia with minimal cardiovascular and blood gas effects, which are well tolerated in healthy sheep.(AU)

Anestesia por perfusão de saco aéreo em arara (Ara chloropterus): relato de caso / Anesthesia by infusion of air sac in a macaw (Ara chloropterus): a case report

O presente relato descreve a utilização da técnica anestésica deperfusão em saco aéreo durante a cirurgia para correção do bicode uma arara (Ara chloropterus). Esse tipo de abordagem anestésicaé recomendado para procedimentos em que se faz necessáriaa manipulação da região de cabeça e pescoço das aves. Após contençãofísica do animal, a anestesia foi induzida com auxílio demáscara facial, conectada ao sistema de Maplesson D (Baraka),utilizando isofluorano e fluxo diluente de oxigênio de 1L/min. Opreparo da cânula e posterior introdução em saco aéreo torácicocaudal foi estabelecido de modo similar ao descrito por Gunkele Lafortune (2005). A técnica mostrou-se adequada e bastantesegura; contudo, para ser empregada, é necessário que o profissionalanestesista conheça a anatomia e fisiologia das aves.

This report describes the use of an anesthetic perfusiontechnique applied in the air sac of a Macaw (Ara chloropterus)during surgery for correction of its broken beak. This anestheticapproach is recommended for procedures in which manipulationof the avian head or neck is necessary. After appropriateimmobilization of the animal, the anesthetic is introduced withthe help of a face mask connected to the Mapleson D (Baraka)system, using isoflurane with 1L-min. flow of diluent oxygen.The cannula preparation and introduction into the caudalthoracic air sac was performed is a way similar to that describedby Gunkel and Lafortune (2005). The technique proved to beappropriate and very safe, but the anesthetic professional musthave thorough of avian anatomy and physiology.

Anestesia por perfusão de saco aéreo em arara (Ara chloropterus): relato de caso / Anesthesia by infusion of air sac in a macaw (Ara chloropterus): a case report

O presente relato descreve a utilização da técnica anestésica deperfusão em saco aéreo durante a cirurgia para correção do bicode uma arara (Ara chloropterus). Esse tipo de abordagem anestésicaé recomendado para procedimentos em que se faz necessáriaa manipulação da região de cabeça e pescoço das aves. Após contençãofísica do animal, a anestesia foi induzida com auxílio demáscara facial, conectada ao sistema de Maplesson D (Baraka),utilizando isofluorano e fluxo diluente de oxigênio de 1L/min. Opreparo da cânula e posterior introdução em saco aéreo torácicocaudal foi estabelecido de modo similar ao descrito por Gunkele Lafortune (2005). A técnica mostrou-se adequada e bastantesegura; contudo, para ser empregada, é necessário que o profissionalanestesista conheça a anatomia e fisiologia das aves.(AU)

This report describes the use of an anesthetic perfusiontechnique applied in the air sac of a Macaw (Ara chloropterus)during surgery for correction of its broken beak. This anestheticapproach is recommended for procedures in which manipulationof the avian head or neck is necessary. After appropriateimmobilization of the animal, the anesthetic is introduced withthe help of a face mask connected to the Mapleson D (Baraka)system, using isoflurane with 1L-min. flow of diluent oxygen.The cannula preparation and introduction into the caudalthoracic air sac was performed is a way similar to that describedby Gunkel and Lafortune (2005). The technique proved to beappropriate and very safe, but the anesthetic professional musthave thorough of avian anatomy and physiology.(AU)

Effects of ropivacaine combined with morphine at 0.15 and 0.2 mg kg-1 in bitches undergoing epidural anesthesia1

PURPOSE: To investigate cardiorespiratory effects and serum concentration of ropivacaine combined with morphine at different doses. METHODS: Sixteen healthy adult female dogs weighting 9.8±4.1 kg were included in the study. Twenty minutes after being premedicated with acepromazine and midazolam, the animals were randomly assigned to receive an epidural injection according to each group: RM0.15 = ropivacaine + morphine (0.15 mg kg-1) and RM0.2 = ropivacaine + morphine (0.2 mg kg-1). Variables recorded consisted of: heart rate and cardiac rhythm, respiratory rate, oxyhemoglobin saturation, inspired oxygen fraction, end-tidal carbon dioxide tension, systolic, mean and diastolic arterial pressures, serum cortisol, plasma ropivacaine and morphine. RESULTS: SAP, MAP and DAP were significantly increased at TPR in RM0.15 but returned to normal values at the end of the procedure. Arterial pH was decreased in T30 and TESu in both groups and also returned to acceptable ranges at TR. Both PaO2 and PaCO2 were increased along the duration period of the epidural blockade (T30 and TESu) and returned to acceptable values at TR. Serum cortisol was lower at TB, T30 and TR when compared to TESu. CONCLUSION: The procedures were performed safely and minimal changes in cardiovascular and respiratory variables.(AU)

Bispectral index in calves anesthetized with xylazine, midazolam, ketamine, isoflurane and subjected to continuous rate infusion of lidocaine

PURPOSE: To assess the bispectral index (BIS) and recovery in calves anesthetized with xylazine, midazolam, ketamine and isoflurane and subjected to CRI of lidocaine. METHODS: Xilazine was administered followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane using mechanical ventilation. Lidocaine (2 mg kg-1 bolus) or saline (0.9%) was administered IV followed by a CRI (100 µg kg-1 minute-1) of lidocaine (L) or saline (C). Were recorded BIS, heart rate (HR), mean arterial pressure (MAP) and rectal temperature (RT) before administration of premedication (TB) and 15 minutes after (TX), before administering lidocaine (T0) and 20, 40, 60 and 80 minutes after the start of the CRI . Time do sternal recumbency (SRE) and standing (ST) and plasma lidocaine concentration also evaluated. RESULTS: In both treatments BIS decreased significantly at all times compared to TB. TX was higher than the subsequent times. HR decreased from baseline at all times and decreased from T40 in L compared to C. SRE was higher in L compared to C. CONCLUSIONS: Bispectral index values were consistent with the degree of hypnosis of the animals. Lidocaine did not potentiate isoflurane anesthesia assessed by BIS in unstimulated calves anesthetized with constant E´Iso. Lidocaine increased the time to sternal recumbency.(AU)

Hemodynamic changes with two lipid emulsions for treatment of bupivacaine toxicity in swines

PURPOSE: To compare the hemodynamic changes following two different lipid emulsion therapies after bupivacaine intoxication in swines. METHODS: Large White pigs were anesthetized with thiopental, tracheal intubation performed and mechanical ventilation instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, 5 mg.kg-1 of bupivacaine by intravenous injection was administered and new hemodynamic measures were performed 1 minute later; the animals were than randomly divided into three groups and received 4 ml.kg-1 of one of the two different lipid emulsion with standard long-chaim triglyceride, or mixture of long and medium-chain triglyceride, or saline solution. Hemodynamic changes were then re-evaluated at 5, 10, 15, 20 and 30 minutes. RESULTS: Bupivacaine intoxication caused fall in arterial blood pressure, cardiac index, ventricular systolic work index mainly and no important changes in vascular resistances. Both emulsion improved arterial blood pressure mainly increasing vascular resistance since the cardiac index had no significant improvement. On the systemic circulation the hemodynamic results were similar with both lipid emulsions. CONCLUSION: Both lipid emulsions were efficient and similar options to reverse hypotension in cases of bupivacaine toxicity.(AU)

The investigation of airway management capacity of v-gel and cobra-PLA in anaesthetised rabbits

PURPOSE: To evaluate the applicability and airway management capacity of v-gel® and Cobra PLA in rabbit anaesthesia during assisted (AV) or controlled ventilation (CV). METHODS: This study was carried out in 44 adult New Zealand white rabbit. Baseline arterial pH, PaCO2 and PaO2 values were recorded. Anaesthesia was induced with 5 mg/kg xylasine and 35 mg/kg ketamine HCI combination. AV rabbits were assigned as; control (CG-AV; n=5), LMA (LMA-AV; n=5), cobra PLA (PLA-AV; n=5) and v-gel (v-gelAV; n=5). Rabbits have CV were also assigned as; ET (ET-CV; n=6), LMA (LMA-CV; n=6), cobraPLA (PLA-CV; n=6) and v-gel (v-gelCV; n=6). All measurements were repeated 1st, 5th, 15th and 30th mins during anaesthesia. RESULTS: The less insertion time, number of attempt and complications are recorded in v-gel applied rabbits compared to other apparatus. For arterial pH values significant differences are recorded in especially at 15th and 30th min between groups of CV (p<0.005 or p<0.001). All groups had similar results with each other during anaesthesia for PaCO2 except for LMA-CV group. CONCLUSION: The v-gel may be used as airway device in rabbit anaesthesia undergoing AV or CV and also can be a suitable alternative to endotracheal tubes and laryngeal mask airway.(AU)

The effect of different doses of chloroprocaine on saddle anesthesia in perianal surgery

To investigate a saddle anesthesia with different doses of chloroprocaine in perianal surgery. METHODS: Total 60 Patients aged 18-75 years (Anesthesiologists grade I or II) scheduled to receive perianal surgery. Patients using saddle anesthesia were randomized to group A, group B and group C with the same concentration (0.5%) chloroprocaine with different doses 1.0 mL, 0.8 mL and 0.6 mL, respectively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and the sensory and motor block were recorded to evaluate the anesthesia effect of chloroprocaine in each group. RESULTS: The duration of sensory block of group C is shorter than those of group A and B. The maximum degree of motor block is observed (group C: 0 level, group A: III level; and group B: I level) after 15 minutes. Besides, there was a better anesthetic effect in group B than group A and group C, such as walking after saddle anesthesia. However, there is also no significant difference of blood pressure decreasing in these three groups. CONCLUSION: It's worth to employ a saddle anesthesia with appropriate doses of chloroprocaine in clinical perianal surgery.(AU)

Effects of epidural nalbuphine on intraoperative isoflurane and postoperative analgesic requirements in dogs

To measure the change in the minimum alveolar concentration of isoflurane (EtISO) associated with epidural nalbuphine and the postoperative analgesic requirements in dogs after ovariohysterectomy. METHODS: Twenty four healthy female dogs were randomly assigned to receive saline or nalbuphine at 0.3 or 0.6 mg/kg (n=8 for each group) administered via lumbosacral epidural catheter introduced cranially into the epidural canal. Changes in heart and respiratory rates and arterial blood pressure during surgery were recorded along with the corresponding EtISO. Immediately after tracheal extubation, analgesia, sedation, heart rate, respiratory rate, and arterial blood pressure were measured at predetermined intervals and every 60 min thereafter until the first rescue analgesic. RESULTS: A significant decrease in EtISO was associated with epidural nalbuphine at 0.3 mg/kg (26.3%) and 0.6 mg/kg (38.4%) but not with saline in ovariohysterectomized dogs. In the postoperative period, VAS and Colorado analgesic scores were lower for the dogs that received the higher nalbuphine dose, which only required supplemental analgesia 10 h following its administration, compared with dogs that received the lower dose. CONCLUSION: Epidural nalbuphine significantly reduces the intra-operative isoflurane requirement and provides prolonged postoperative analgesia after ovariohysterectomy in dogs.(AU)

Tranquilização de asininos com acepromazina associada ou não ao diazepam / Tranquilization of donkeys using acepromazine or acepromazine/diazepam

Avaliaram-se os efeitos da acepromazina isolada ou associada ao diazepam em asininos. Cinco asininos foram submetidos a dois protocolos anestésicos: os do grupo acepromazina (AC) receberam acepromazina, 0,1mg/kg/IV, e os do grupo acepromazina-diazepam (ACD), acepromazina na mesma dose e via do AC, associada ao diazepam, 0,1mg/kg/IV. Foram mensuradas as frequências cardíaca (FC) e respiratória (FR) e a temperatura retal (TR) e analisadas variáveis eletrocardiográficas, tranquilização, período de latência, início do prolapso peniano e grau de ataxia. A tranquilização iniciou-se aos 10,4±0,9 minutos nos asininos do AC e aos 4,8±1,1 nos do ACD. Ocorreu prolapso peniano aos 4,2±1,3min no AC e aos 2,7±0,4 no ACD. A FC elevou-se aos 15 e 30min no AC. Não ocorreu variação significativa nas variáveis eletrocardiográficas e na temperatura retal. A FR diminuiu no AC a partir de 60min e no ACD a partir de 30min. A distância focinho-solo reduziu-se significativamente em ambos os grupos e nos momentos a partir de 15min. Concluiu-se que a acepromazina promove tranquilização discreta, e a adição do diazepam potencializa a tranquilização, diminui o período de latência e aumenta a ataxia.(AU)

The effects of acepromazine isolated or associated with diazepam were evaluated in five donkeys were underwent in two anesthetic protocols, in the acepromazine group (AC), animals received acepromazine (0.1mg/kg/IV) and in acepromazine-diazepam group (ACD), acepromazine at the same dose and route of AC, associated with diazepam (0.1 mg/kg/IV). Heart frequency (HR), respiratory frequency (RF) and rectal temperature (RT) were measured and electrocardiographic variables analyzed, in addition to tanquilization, latency, beginning of the penile prolapse and degree of ataxia. The tanquilization began at 10.4±0.9 minutes (min) in the AC donkeys and 4.8±1.1 in ACD. Penile prolapse occurred at 4.2±1.3 minutes in AC and 2.7±0.4 in ACD. The HR increased to 15 and 30min. Electrocardiographic parameters and rectal temperature not varied significantly. RF decreased from AC in 60min and 30min from ACD. The muzzle-to-ground distance reduced significantly in both groups and at times from 15min. It was concluded that the acepromazine promotes discreet tanquilization and the adition of diazepam potentiates the tranquilization, decreases the latency period and increases ataxia caused by acepromazine.(AU)

DNA damage and antioxidant status in medical residents occupationally exposed to waste anesthetic gases

To investigate the effects of occupational exposure to waste anesthetic gases on genetic material and antioxidant status in professionals during their medical residency. The study group consisted of 15 medical residents from Anesthesiology and Surgery areas, of both genders, mainly exposed to isoflurane and to a lesser degree to sevoflurane and nitrous oxide; the control group consisted of 15 young adults not exposed to anesthetics. Blood samples were drawn from professionals during medical residency (eight, 16 and 22 months of exposure to waste anesthetic gases). DNA damage was evaluated by comet assay, and antioxidant defense was assessed by total thiols and the enzymes glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT). When comparing the two groups, DNA damage was significantly increased at all time points evaluated in the exposed group; plasma thiols increased at 22 months of exposure and GPX was higher at 16 and 22 months of exposure. Young professionals exposed to waste anesthetic gases in operating rooms without adequate scavenging system have increased DNA damage and changes in redox status during medical residency. There is a need to minimize exposure to inhalation anesthetics and to provide better work conditions.(AU)

Spinal anesthesia for elective ceasarean section: use of different doses of hyperbaric bupivacaine associated with morphine and clonidine

PURPOSE: To comparatively study the efficacy and maternal and fetal side-effects of two doses of bupivacaine associated with morphine and clonidine, administered by the subarachnoid route for cesarean section. METHODS: The study included 66 pregnant women at term, distributed into two groups. GI: bupivacaine 8.0 mg (1.6mL) + clonidine 75µg (0.5mL) + morphine 100µg (1.0mL) and GII: bupivacaine 10mg (2.0mL) + clonidine 75µg (0.5mL) + morphine 100µg (1.0mL). The following parameters were assessed: onset and maximum level of sensory block; quality of intraoperative and postoperative analgesia; degree and duration of motor block; maternal repercussions and Apgar score. RESULTS: The onset of sensory block, quality of intraoperative analgesia and total duration of analgesia were similar in both groups; maximum extent of sensory block predominated in T4; maximum degree of motor block (Bromage 3); time motor block regression was significantly longer in GII; Hemodynamic, respiratory repercussions, adverse maternal effects and Apgar scores were similar between groups. In both groups, there was a predominance of drowsy or sleeping patients. CONCLUSION: The addition of morphine and clonidine to low doses of hyperbaric bupivacaine produced adequate anesthesia for cesarean section and good postoperative analgesia, without any maternal and fetal repercussions.(AU)

Avalição hematologica e bioquímica renal de coelhos sob anestesia no acuponto yinrang com tiletamina e zolazepam / Renal hematological and biochemical evaluation on rabbits under anesthesia at the yintang acupont with tiletamine and zolazepam / Evaluación hematologica y bioquímica renal en conejos bajo anestesia en el acupunto yintang con tiletamina y zolacepam

Seis animais foram submetidos à farmacupuntura com tiletamina e zolazepam intramuscular (Grupo I) e seis (Grupo II) receberam 10% da dose no acuponto yintang. Os do grupo GI permaneceram em decúbito lateral. Depois de 20 minutos, dois apresentaram sonolência com capacidade de locomoção durante todo período de avaliação e um permaneceu em decúbito esternal. Todos os coelhos do grupo II apresentavam aos 20 minutos em decúbito esternal. Notou-se em ambos os grupos a presença dos reflexos corneal, auricular, interdigital e palpebral. Nos animais do GI ocorreu aumento significativo dos leucócitos e nos dois grupos observou-se aumento de eritrócitos, hematócrito e plaquetas. A associação tiletamina-zolazepam, quando administrado no acupontoyintang ocasiona modificações moderadas dos parâmetros fisiológicos e alterações hematológicas, sem alterar as funções fisiológicas dos coelhos. Os fármacos injetados no acuponto permitem à contenção química dos animais durante 20 minutos.(AU)

Six rabbits were submitted to pharmacopuncture with intramuscular tiletamine (Group I) and six (Group II) received 10% of the dose in the yintang acupoint. Group I remained in lateral recumbency. After 20 minutes, two presented drowsiness with the capacity of locomotion throughout the assessment period, and one remained in sternal recumbency. All rabbits in Group II stayed 20 minutes in sternal recumbency. In both groups, the presence of corneal, ear, eyelid and interdigital reflections could be noticed. In the animals in GI, there was a significant increase in leukocytes, and both groups presented an increase in erythrocytes, hematocrit and platelet count. The tiletamine-zolazepam association, when administered in the yintang acupoint, causes moderate changes in physiological parameters and hematological changes without altering the physiological functions of rabbits. The drugs injected at the acupoint allow the chemical restraint of animals for 20 minutes.(AU)

Seis animales fueron sometidos a farmacupuntura con tiletamina y zolacepam intramuscular (Grupo I) y seis (Grupo II) recibieron 10% de la dosis en el acupunto yintang. Los del grupo GI permanecieron en decúbito lateral. Despuésde 20 minutos, dos presentaron somnolencia con capacidad de locomoción durante todo el período de evaluación y uno permanecióen decúbito esternal. Todos los conejos del grupo II presentaron a los 20 minutos decúbito esternal. Se observó en ambos los grupos la presencia de reflejos corneal, auricular, interdigital y de párpado. En los animales del GI ocurrió aumento significativo de leucocitos y en los dos grupos se observó aumento de eritrocitos, hematocrito y plaquetas. La asociación de tiletamina-zolacepam, cuando administrado en el acupunto yintang provoca cambios moderados de los parámetros fisiológicos y alteraciones hematológicas, sin alterar las funciones fisiológicas de los conejos. Los medicamentos inyectados en el acupunto permiten la contención química de los animales durante 20 minutos.(AU)

O uso da dexmedetomidina na sedação de gatos hígidos para realização de pequenos procedimentos: revisão bibliográfica / The use of Dexmedetomidine in health cats in small procedures: bibliographical review / El uso de Dexmedetomidina en gatos saludables en pequeños procedimientos: revisión bibliográfica

O emprego de agonistas adrenérgicos dos receptores a2 traz benefícios na Anestesiologia clínica, em especial a dexmedetomidina, por seu aspecto farmacológico e alta especificidade. Contudo, suas vantagens e desvantagens devem ser melhor elucidadas por meio de estudos clínicos tanto na Medicina Humana quanto na Veterinária. Dentro da Medicina Veterinária, a realização de pequenos procedimentos, principalmente em felinos, requer sedação intensa ou mesmo anestesia geral, o que prolonga o tempo de recuperação do paciente, exige maior monitoramento e envolve maior incidência de efeitos colaterais. Portanto, o desenvolvimento de protocolos de sedação que permitam a realização destes procedimentos sem a necessidade de anestesia geral mostra-se viável, como já se faz presente na Medicina em pacientes pediátricos. O desenvolvimento de protocolos seguros, de rápida duração e que apresentem antídotos se faz necessário, especialmente em felinos cujo manejo envolve maior estresse e contenção. A presente revisão aborda o uso dos agonistas adrenérgicos dos receptores a2, em especial a dexmedetomidina, em gatos hígidos para a realização de pequenos procedimentos, o mecanismo de ação, bem como a possibilidade de reversibilidade farmacológica destes fármacos na espécie.(AU)

The use of the a2 adrenergic agonists has benefits in clinical anesthesiology, especially dexmedetomidine, because of its pharmacological aspect and high specificity. However, its advantages and disadvantages should be better elucidated through clinical studies in both Human and Veterinary Medicine. Within Veterinary Medicine, small procedures, especially in cats, require intense sedation or even general anesthesia, which prolongs the patient's recovery time, requires greater monitoring and involves a higher incidence of side effects. Therefore, the development of sedation protocols that allow the performance of these procedures without the need for general anesthesia is feasible, as is already present in human pediatric patients. The development of safe, fast and antidepressant protocols is necessary, especially in cats whose management involves greater stress and containment. The present review addresses the use of a2, adrenergic agonists, especially dexmedetomidine, in healthy cats to perform small procedures, the mechanism of action, as well as the possibility of pharmacological reversibility of these drugs in the specie.(AU)

El empleo de agonistas adrenérgicos de los receptores a2 trae beneficios en la Anestesiología clínica, en particular la dexmedetomidina, por su aspecto farmacológico y alta especificidad. Sin embargo, sus ventajas y desventajas deben ser mejor elucidadas por medio de estudios clínicos tanto en la Medicina Humana y en la Veterinaria. En la Medicina Veterinaria, la realización de pequenos procedimientos, principalmente en felinos, requiere sedación intensa o incluso anestesia general, lo que prolonga el tiempo de recuperación del paciente, exige mayor monitoreo e involucra mayor incidencia de efectos colaterales. Por lo tanto, el desarrollo de protocolos de sedación que permitan la realización de estos procedimientos sin la necesidad de anestesia general se muestra viable, como ya se hace presente en la Medicina en pacientes pediátricos. El desarrollo de protocolos seguros, de rápida duración y que presenten antídotos se hace necesario, especialmente en felinos cuyo manejo involucra mayor estrés y contención. La presente revisión aborda el uso de los agonistas adrenérgicos de los receptores a2, en particular la dexmedetomidina, en gatos hígidos para la realización de pequenos procedimientos, el mecanismo de acción, así como la posibilidad de reversibilidad farmacológica de estos fármacos en la especie.(AU)

O uso da dexmedetomidina na sedação de gatos hígidos para realização de pequenos procedimentos: revisão bibliográfica / The use of Dexmedetomidine in health cats in small procedures: bibliographical review / El uso de Dexmedetomidina en gatos saludables en pequeños procedimientos: revisión bibliográfica

O emprego de agonistas adrenérgicos dos receptores a2 traz benefícios na Anestesiologia clínica, em especial a dexmedetomidina, por seu aspecto farmacológico e alta especificidade. Contudo, suas vantagens e desvantagens devem ser melhor elucidadas por meio de estudos clínicos tanto na Medicina Humana quanto na Veterinária. Dentro da Medicina Veterinária, a realização de pequenos procedimentos, principalmente em felinos, requer sedação intensa ou mesmo anestesia geral, o que prolonga o tempo de recuperação do paciente, exige maior monitoramento e envolve maior incidência de efeitos colaterais. Portanto, o desenvolvimento de protocolos de sedação que permitam a realização destes procedimentos sem a necessidade de anestesia geral mostra-se viável, como já se faz presente na Medicina em pacientes pediátricos. O desenvolvimento de protocolos seguros, de rápida duração e que apresentem antídotos se faz necessário, especialmente em felinos cujo manejo envolve maior estresse e contenção. A presente revisão aborda o uso dos agonistas adrenérgicos dos receptores a2, em especial a dexmedetomidina, em gatos hígidos para a realização de pequenos procedimentos, o mecanismo de ação, bem como a possibilidade de reversibilidade farmacológica destes fármacos na espécie.

The use of the a2 adrenergic agonists has benefits in clinical anesthesiology, especially dexmedetomidine, because of its pharmacological aspect and high specificity. However, its advantages and disadvantages should be better elucidated through clinical studies in both Human and Veterinary Medicine. Within Veterinary Medicine, small procedures, especially in cats, require intense sedation or even general anesthesia, which prolongs the patient's recovery time, requires greater monitoring and involves a higher incidence of side effects. Therefore, the development of sedation protocols that allow the performance of these procedures without the need for general anesthesia is feasible, as is already present in human pediatric patients. The development of safe, fast and antidepressant protocols is necessary, especially in cats whose management involves greater stress and containment. The present review addresses the use of a2, adrenergic agonists, especially dexmedetomidine, in healthy cats to perform small procedures, the mechanism of action, as well as the possibility of pharmacological reversibility of these drugs in the specie.

El empleo de agonistas adrenérgicos de los receptores a2 trae beneficios en la Anestesiología clínica, en particular la dexmedetomidina, por su aspecto farmacológico y alta especificidad. Sin embargo, sus ventajas y desventajas deben ser mejor elucidadas por medio de estudios clínicos tanto en la Medicina Humana y en la Veterinaria. En la Medicina Veterinaria, la realización de pequenos procedimientos, principalmente en felinos, requiere sedación intensa o incluso anestesia general, lo que prolonga el tiempo de recuperación del paciente, exige mayor monitoreo e involucra mayor incidencia de efectos colaterales. Por lo tanto, el desarrollo de protocolos de sedación que permitan la realización de estos procedimientos sin la necesidad de anestesia general se muestra viable, como ya se hace presente en la Medicina en pacientes pediátricos. El desarrollo de protocolos seguros, de rápida duración y que presenten antídotos se hace necesario, especialmente en felinos cuyo manejo involucra mayor estrés y contención. La presente revisión aborda el uso de los agonistas adrenérgicos de los receptores a2, en particular la dexmedetomidina, en gatos hígidos para la realización de pequenos procedimientos, el mecanismo de acción, así como la posibilidad de reversibilidad farmacológica de estos fármacos en la especie.

Suínos como modelos experimentais / Swine as experimental model

Uma abordagem sobre a utilização de suínos como modelos experimentais em diferentes áreas de pesquisa biomédica será apresentada, com ênfase em genética, modelos para xenotransplantes e alotransplantes, comportamento, instalações, condições de ambiente, manejo, contenção, dieta, estado sanitário, dados fisiológicos, anestesia, cuidados pós-operatórios, coleta de amostras, vias de acesso e administração de medicamento.

As approach of pigs as experimental models in different areas of biomedical research is presented, with emphasis on genetic models for xenotransplantation and allotransplantation, behavior, facilities, environmental conditions, handling, restraint, diet, health status, physiological data, anesthesia, post-operative care, sampling, access routes and drug delivery.