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1.
J Zoo Wildl Med ; 50(4): 868-873, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926517

RESUMO

Blue poison dart frogs (Dendrobates tinctorius azureus) are commonly maintained in zoological institutions and are becoming popular in the pet trade industry. Sedation or light anesthesia is required for safe and effective handling of this species. In this study, the sedative effects of subcutaneously administered alfaxalone-midazolam-dexmedetomidine (AMD) (20, 40, 5 mg/kg, respectively) and ketamine-midazolam-dexmedetomidine (KMD) (100, 40, 5 mg/kg, respectively) were compared in a prospective, randomized, blinded, crossover study in juvenile blue poison dart frogs (n = 10). Both protocols were partially reversed 45 min after administration of either protocol with subcutaneously administered flumazenil (0.05 mg/kg) and atipamezole (50 mg/kg). Heart rate, pulmonic respiratory rate, various reflexes, and behavioral parameters were monitored after drug administration. Both protocols resulted in rapid loss of righting reflex [median (range): AMD, 5 min (5-5 min); KMD, 5 min (5-10 min)]. Time to complete recovery was similar with both protocols (mean ± SD: AMD, 97.5 ± 11.4 min; KMD, 96.5 ± 25.4 min). The AMD protocol resulted in pulmonic respiratory depression, whereas no significant difference in heart rate was found between the two protocols. All frogs were observed eating within 24 hr of chemical restraint. Gastric prolapses occurred in four frogs (AMD 3, KMD 1) that were easily reduced with a cotton-tip application. No other adverse reactions were observed. The results of this study provide two different subcutaneous chemical restraint protocols in juvenile blue poison dart frogs.


Assuntos
Dexmedetomidina/farmacologia , Midazolam/farmacologia , Pregnanodionas/farmacologia , Antagonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Envelhecimento , Analgésicos/administração & dosagem , Analgésicos/farmacologia , Anestésicos/administração & dosagem , Anestésicos/farmacologia , Animais , Antídotos/administração & dosagem , Antídotos/farmacologia , Anuros , Sedação Consciente , Estudos Cross-Over , Dexmedetomidina/administração & dosagem , Quimioterapia Combinada , Flumazenil/administração & dosagem , Flumazenil/farmacologia , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Imidazóis/administração & dosagem , Imidazóis/farmacologia , Ketamina/administração & dosagem , Ketamina/farmacologia , Midazolam/administração & dosagem , Pregnanodionas/administração & dosagem
3.
Vet Clin North Am Equine Pract ; 35(3): 515-527, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587973

RESUMO

The number of donkeys in the world may not be increasing but awareness of their use and concern for welfare and pain recognition and treatment are receiving increasing veterinary interest. Therefore, accurate information about anesthesia and analgesia in donkeys and mules is important to more equine practitioners. This review highlights the current knowledge on various anesthetic and analgesic approaches in donkey and mules. The authors emphasize that there is still much information that is not available about donkeys and mules; in many circumstances, the clinician must use available equine information to treat the patient, while monitoring for differences in response.


Assuntos
Anestesia/veterinária , Equidae , Doenças dos Cavalos/terapia , Manejo da Dor/veterinária , Analgésicos/administração & dosagem , Anestésicos/administração & dosagem , Animais , Doenças dos Cavalos/fisiopatologia , Cavalos , Hipnóticos e Sedativos/administração & dosagem
4.
Artigo em Alemão | MEDLINE | ID: mdl-31639858

RESUMO

The rapid sequence induction (RSI) is a not evidence-based technique designed to minimize the chance of pulmonary aspiration in high-risk patients requiring general anesthesia. Primary aim of this anesthetic technique is, therefore, a fast airway protection with an endotracheal tube to reduce the chance of passive or active regurgitation. This article discusses the anesthetic management of patients with an increased risk of aspiration, and, particularly, refers to the medications required for RSI.


Assuntos
Anestesia Geral , Anestésicos , Anestésicos/administração & dosagem , Anestésicos/farmacologia , Humanos , Intubação Intratraqueal
7.
Cochrane Database Syst Rev ; 9: CD003843, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31557307

RESUMO

BACKGROUND: The use of clinical signs, or end-tidal anaesthetic gas (ETAG), may not be reliable in measuring the hypnotic component of anaesthesia and may lead to either overdosage or underdosage resulting in adverse effects because of too deep or too light anaesthesia. Intraoperative awareness, whilst uncommon, may lead to serious psychological disturbance, and alternative methods to monitor the depth of anaesthesia may reduce the incidence of serious events. Bispectral index (BIS) is a numerical scale based on electrical activity in the brain. Using a BIS monitor to guide the dose of anaesthetic may have advantages over clinical signs or ETAG. This is an update of a review last published in 2014. OBJECTIVES: To assess the effectiveness of BIS to reduce the risk of intraoperative awareness and early recovery times from general anaesthesia in adults undergoing surgery. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and Web of Science on 26 March 2019. We searched clinical trial registers and grey literature, and handsearched reference lists of included studies and related reviews. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs in which BIS was used to guide anaesthesia compared with standard practice which was either clinical signs or end-tidal anaesthetic gas (ETAG) to guide the anaesthetic dose. We included adult participants undergoing any type of surgery under general anaesthesia regardless of whether included participants had a high risk of intraoperative awareness. We included only studies in which investigators aimed to evaluate the effectiveness of BIS for its role in monitoring intraoperative depth of anaesthesia or potential improvements in early recovery times from anaesthesia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence with GRADE. MAIN RESULTS: We included 52 studies with 41,331 participants; two studies were quasi-randomized and the remaining studies were RCTs. All studies included participants undergoing surgery under general anaesthesia. Three studies recruited only participants who were at high risk of intraoperative awareness, whilst two studies specifically recruited an unselected participant group. We analysed the data according to two comparison groups: BIS versus clinical signs; and BIS versus ETAG. Forty-eight studies used clinical signs as a comparison method, which included titration of anaesthesia according to criteria such as blood pressure or heart rate and, six studies used ETAG to guide anaesthesia. Whilst BIS target values differed between studies, all were within a range of values between 40 to 60.BIS versus clinical signsWe found low-certainty evidence that BIS-guided anaesthesia may reduce the risk of intraoperative awareness in a surgical population that were unselected or at high risk of awareness (Peto odds ratio (OR) 0.36, 95% CI 0.21 to 0.60; I2 = 61%; 27 studies; 9765 participants). However, events were rare with only five of 27 studies with reported incidences; we found that incidences of intraoperative awareness when BIS was used were three per 1000 (95% CI 2 to 6 per 1000) compared to nine per 1000 when anaesthesia was guided by clinical signs. Of the five studies with event data, one included participants at high risk of awareness and one included unselected participants, four used a structured questionnaire for assessment, and two used an adjudication process to identify confirmed or definite awareness.Early recovery times were also improved when BIS was used. We found low-certainty evidence that BIS may reduce the time to eye opening by mean difference (MD) 1.78 minutes (95% CI -2.53 to -1.03 minutes; 22 studies; 1494 participants), the time to orientation by MD 3.18 minutes (95% CI -4.03 to -2.33 minutes; 6 studies; 273 participants), and the time to discharge from the postanaesthesia care unit (PACU) by MD 6.86 minutes (95% CI -11.72 to -2 minutes; 13 studies; 930 participants).BIS versus ETAGAgain, events of intraoperative awareness were extremely rare, and we found no evidence of a difference in incidences of intraoperative awareness according to whether anaesthesia was guided by BIS or by ETAG in a surgical population at unselected or at high risk of awareness (Peto OR 1.13, 95% CI 0.56 to 2.26; I2 = 37%; 5 studies; 26,572 participants; low-certainty evidence). Incidences of intraoperative awareness were one per 1000 in both groups. Only three of five studies reported events, two included participants at high risk of awareness and one included unselected participants, all used a structured questionnaire for assessment and an adjudication process to identify confirmed or definite awareness.One large study (9376 participants) reported a reduced time to discharge from the PACU by a median of three minutes less, and we judged the certainty of this evidence to be low. No studies measured or reported the time to eye opening and the time to orientation.Certainty of the evidenceWe used GRADE to downgrade the evidence for all outcomes to low certainty. The incidence of intraoperative awareness is so infrequent such that, despite the inclusion of some large multi-centre studies in analyses, we believed that the effect estimates were imprecise. In addition, analyses included studies that we judged to have limitations owing to some assessments of high or unclear bias and in all studies, it was not possible to blind anaesthetists to the different methods of monitoring depth of anaesthesia.Studies often did not report a clear definition of intraoperative awareness. Time points of measurement differed, and methods used to identify intraoperative awareness also differed and we expected that some assessment tools were more comprehensive than others. AUTHORS' CONCLUSIONS: Intraoperative awareness is infrequent and, despite identifying a large number of eligible studies, evidence for the effectiveness of using BIS to guide anaesthetic depth is imprecise. We found that BIS-guided anaesthesia compared to clinical signs may reduce the risk of intraoperative awareness and improve early recovery times in people undergoing surgery under general anaesthesia but we found no evidence of a difference between BIS-guided anaesthesia and ETAG-guided anaesthesia. We found six studies awaiting classification and two ongoing studies; inclusion of these studies in future updates may increase the certainty of the evidence.


Assuntos
Anestesia Geral , Anestésicos/administração & dosagem , Consciência no Peroperatório , Monitorização Intraoperatória/métodos , Período de Recuperação da Anestesia , Eletroencefalografia , Humanos , Consciência no Peroperatório/prevenção & controle , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Vet Clin North Am Exot Anim Pract ; 22(3): 419-439, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395323

RESUMO

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.


Assuntos
Analgesia/veterinária , Anestesia/veterinária , Animais Exóticos/fisiologia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/veterinária , Analgesia/tendências , Anestesia/tendências , Anestésicos/administração & dosagem , Animais , Aves/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/veterinária , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/tendências , Endoscopia/veterinária , Humanos , Mamíferos/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Bloqueio Nervoso/veterinária , Manejo da Dor , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/tendências , Respiração Artificial/veterinária
9.
Anaesthesia ; 74(11): 1425-1431, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31373391

RESUMO

Syringe infusion pumps are used for the administration of short-acting drugs in anaesthesia and critical care medicine, but are prone to flow irregularities at low flow rates. A flow-controlled syringe infusion pump using an integrated flow sensor for feedback control represents a new approach to overcoming these limitations. This study compares the performance of a prototype flow-controlled syringe pump both at start-up, and during vertical displacement manoeuvres, with that of a standard infusion syringe pump. The novel pump almost completely eliminated delays at start-up and flow irregularities during hydrostatic pressure changes. Related fluctuations in plasma drug concentration were minimised and the known disadvantages of standard syringe infusion pumps currently used in clinical practice were reduced. Besides providing fast start-up to steady-state flow and precise continuous drug delivery at low flow rates during hydrostatic pressure changes, the new pump offers the potential for the development of target-controlled infusion algorithms for short-acting cardiovascular and other drugs.


Assuntos
Anestésicos/administração & dosagem , Sistemas de Liberação de Medicamentos/instrumentação , Desenho de Equipamento , Bombas de Infusão , Infusões Intravenosas/instrumentação , Seringas , Anestesia/métodos , Projetos de Pesquisa , Fatores de Tempo
10.
Anesth Analg ; 129(3): 794-803, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425222

RESUMO

BACKGROUND: Noise in the operating room may cause distractions during critical periods and impair reliable communication between staff. Even momentary inefficiency while administering anesthesia can lead to errors and serious consequences for the patient. Distractions to an anesthesia provider during critical periods such as induction and emergence are a patient safety issue. Because of concerns regarding unacceptable noise levels and distractions during induction of general anesthesia, our institution developed a quality improvement initiative, the "Distraction-Free Induction Zone." The specific aim of this project was to decrease the percentage of cases with a distraction, described as music, unnecessary conversations, or loud noises, occurring during induction of general anesthesia in pediatric otolaryngology operating rooms from 61% to 15%. METHODS: To complete this quality improvement initiative, a multidisciplinary team used improvement science methods, including The Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We used tools such as the Key Driver Diagram, Pareto Charts, Process Flow Chart, and Plan-Do-Study-Act worksheets. Data were manually collected and entered weekly in an Excel spreadsheet. Statistical process control methods, including a run chart and a P-control chart, were used for data analysis. Our measure was a composite measure in which observation of 1 of the 3 distractions during induction of general anesthesia categorized the case as a case with a distraction. RESULTS: We tested and implemented several interventions via Plan-Do-Study-Act cycles in which 3 main interventions collectively were associated with an observed decrease in distractions during induction of general anesthesia. These included educating the perioperative staff present in the operating room to help them understand that distractions to anesthesia providers represent a patient safety issue, the operating room circulating nurse taking responsibility to pause any music on arrival to the operating room, and the anesthesiologist reminding the staff in the operating room of induction time and/or asking for quiet during induction if a distraction occurs. The percentage of cases with a distraction during induction of general anesthesia in our pediatric otolaryngology operating rooms decreased from 61% to 15% by April 15, 2017 and to 10% by June 5, 2017. CONCLUSIONS: Using improvement science methods, we observed a decrease in distractions during induction of general anesthesia, improved a process, and encouraged change in culture at a large academic children's hospital to enhance the quality and safety of the anesthetic care we provide our patients.


Assuntos
Centros Médicos Acadêmicos/normas , Anestesia Geral/normas , Pessoal de Saúde/normas , Hospitais Pediátricos/normas , Cuidados Pré-Operatórios/normas , Melhoria de Qualidade/normas , Centros Médicos Acadêmicos/métodos , Anestesia Geral/métodos , Anestésicos/administração & dosagem , Humanos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários
11.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289170

RESUMO

Diencephalic syndrome is one of the rare causes of failure to thrive in infants and young children. It is caused by a tumour in diencephalon (thalamus and hypothalamus), characterised by profound emaciation with uniform loss of body weight despite normal or slightly decreased appetite, locomotor hyperactivity, euphoria and visual symptoms. Anaesthetic considerations due to decreased body fat include positioning to avoid pressure necrosis, measures to avoid hypothermia, proper drug dosing, treating electrolyte imbalances and delayed recovery. We report successful anaesthetic management of a child with diencephalic syndrome scheduled for an endoscopic biopsy of suprasellar space occupying lesion under general anaesthesia.


Assuntos
Anestesia/métodos , Diencéfalo/patologia , Doenças Hipotalâmicas/patologia , Doenças da Hipófise/patologia , Anestésicos/administração & dosagem , Biópsia , Criança , Insuficiência de Crescimento/etiologia , Humanos , Doenças Hipotalâmicas/diagnóstico por imagem , Doenças Hipotalâmicas/metabolismo , Unidades de Terapia Intensiva Pediátrica/normas , Cuidados Intraoperatórios , Masculino , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Cuidados Pré-Operatórios , Prognóstico , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/métodos
12.
Zebrafish ; 16(5): 451-459, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31188070

RESUMO

Since the use of the zebrafish Danio rerio genetic model organism within the scientific research community continues to grow rapidly, continued procedural refinement to support high-quality, reproducible research and improve animal welfare remains an important focus. As such, anesthesia remains one of the most frequent procedures conducted. Here, we compared the effectiveness of clove oil (active ingredient eugenol) and AQUI-S (active ingredient iso-eugenol) with the currently most commonly used tricaine/MS-222 (ethyl 3-aminobenzoate methanesulfonate) and benzocaine anesthesia. We focused on embryos (1 day postfertilization), larvae (5 days postfertilization), and adults (9-11 months) and for the first time used exposure times that are the most relevant in research settings by using zebrafish as a genetic model system. For each age, tricaine and benzocaine achieved the most reproducible, robust anesthesia with the quickest induction and recovery. For some experimental procedures, specific clove oil concentrations in embryos and larvae may represent suitable alternatives. Although different aquatic species at specific ages respond differentially to these agents, the systematic study of comparable effective dosages for procedures most commonly employed represent an important step toward refinement.


Assuntos
Anestesia/veterinária , Anestésicos/farmacologia , Óleo de Cravo/farmacologia , Embrião não Mamífero/efeitos dos fármacos , Eugenol/farmacologia , Peixe-Zebra/embriologia , Anestésicos/administração & dosagem , Animais , Larva/efeitos dos fármacos
13.
Int J Surg ; 68: 35-39, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185312

RESUMO

BACKGROUND: Paravertebral block (PVB) as a sole anesthetic technique is difficult even in experienced hands. Hence, this study was undertaken to study the safety and efficacy of PVB and to compare with subarachnoid block (SAB) for inguinal hernia repair surgery (IHRS) in elderly male patients. MATERIALS AND METHODS: Sixty-five male patients aged 65 to 89 scheduled for IHRS were allocated randomly by computer-generated randomisation sequence into two groups. They underwent PVB (Group PVB: 33 patients were injected with 10 ml ropivacaine 0.5% at each level from T12 to L1) or SAB (Group SAB: 32 patients were injected with 15 mg ropivacaine 0.5% at L3-L4 level). Primary outcomes were hemodynamic changes and duration of postoperative analgesia. Secondary outcomes were dosage of remedial analgesics, time to perform the block, side effects and satisfaction of patients. RESULTS: The hemodynamics in the Group PVB were more stable than those in the Group SAB during surgery (P < 0.05). The duration of post-operative analgesia was significantly longer in the Group PVB (P < 0.001). The total dose of fentanyl was smaller in the Group PVB in the first 24 h (P < 0.001). The time to perform the block was significantly longer in the Group PVB (P < 0.001). There was a significant difference in the visual analogue scales (VAS) scores between the two groups at 4 h, 6 h, 8 h and 10 h (P < 0.05) but not at 2 h, 12 h and 24 h (P > 0.05). The VAS scores were lowest at 2 h for both the 2 groups, highest at 12 h for Group PVB and at 8 h for Group SAB respectively. The Group PVB had fewer adverse effects (P < 0.05) and higher satisfaction of patients (P < 0.05). CONCLUSION: Ultrasound-guided PVB can ensure the anesthetic effects of unilateral-opened IHRS in elderly male patients. It has a small impact on hemodynamics, a longer postoperative analgesia time and less complications.


Assuntos
Raquianestesia/métodos , Anestésicos/administração & dosagem , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Bloqueio Nervoso/métodos , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Herniorrafia/efeitos adversos , Humanos , Injeções , Masculino , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Coluna Vertebral/inervação , Espaço Subaracnóideo , Resultado do Tratamento
14.
A A Pract ; 13(4): 155-157, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31206385

RESUMO

Eye drops such as topical ß-blockers are widely used to treat glaucoma and other ocular diseases. We provide an overview of ophthalmic solutions, including ß-adrenergic receptor antagonists, for anesthesiologists and others involved in perioperative care. We summarize current evidence about systemic effects of topical ß-blockers and other commonly used ophthalmic agents such as parasympathomimetic eye drops, carbonic anhydrase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and emerging products such as combinations of multiple substances. We call for careful preoperative assessment and perioperative management of individuals using eye drops, especially critically ill patients, children, or those undergoing major surgery.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Soluções Oftálmicas/efeitos adversos , Assistência Perioperatória/métodos , Antagonistas Adrenérgicos beta/farmacologia , Idoso , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Criança , Estado Terminal , Feminino , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/fisiologia , Hemodinâmica/efeitos dos fármacos , Humanos , Pulmão/efeitos dos fármacos , Pulmão/fisiologia , Masculino , Soluções Oftálmicas/farmacologia
15.
Vet Anaesth Analg ; 46(4): 458-465, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31196750

RESUMO

OBJECTIVE: To determine time to first passage of feces, total fecal piles and incidence of colic in the first 24 hours postprocedure in horses undergoing standing sedation with detomidine, or general anesthesia with or without detomidine. STUDY DESIGN: Retrospective cohort study. ANIMALS: A total of 246 horses. METHODS: Records of all horses that underwent standing sedation or general anesthesia between December 2012 and March 2016 were reviewed. Horses aged <6 months, admitted for colic or cesarean section, with inadequate data, and those not administered xylazine and/or detomidine were excluded. Records included patient signalment, fasting duration, procedure performed, drugs administered, time to first feces, number of fecal piles during 24 hours postprocedure and mention of colic. Chi-square, Fisher's exact and Tukey's post hoc comparison tests were used. Parametric data were reported as mean ± standard deviation with significance defined as p <0.05. RESULTS: In total, 116 and 57 horses underwent general anesthesia without detomidine (group GA) and with detomidine (group GA-D), respectively, and remaining 73 horses underwent standing sedation with detomidine (group S-D). Detomidine dose was significantly higher in group S-D than in group GA-D. Time to first feces was longer (7.1 ± 4.2 hours), and group S-D horses passed one fewer fecal pile (6.3 ± 2.4) than group GA horses. There was no interaction between detomidine treatment and preprocedure food withholding and the time to first feces or the number of fecal piles in the first 24 hours postprocedure. Overall, seven horses (2.8%) showed signs of colic (five, one and one in GA, GA-D and S-D, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: Detomidine administration, as part of an anesthetic protocol or for standing sedation procedures, should not be expected to contribute to postprocedural colic.


Assuntos
Cólica/veterinária , Sedação Consciente/veterinária , Fezes , Motilidade Gastrointestinal/fisiologia , Doenças dos Cavalos/cirurgia , Imidazóis/farmacologia , Anestesia/veterinária , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Anestésicos/farmacologia , Animais , Cólica/etiologia , Sedação Consciente/efeitos adversos , Feminino , Cavalos , Imidazóis/administração & dosagem , Masculino , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos
16.
Vet Anaesth Analg ; 46(4): 435-442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202619

RESUMO

OBJECTIVE: To compare the effect of chemical and mechanical stimulation on arytenoid cartilage motion during anaesthetic induction with alfaxalone, thiopentone or propofol. STUDY DESIGN: Masked, randomized, crossover study. ANIMALS: A group of eight adult Beagle dogs. METHODS: Anaesthesia was induced with thiopentone (7.5 mg kg-1), propofol (3 mg kg-1) or alfaxalone (1.5 mg kg-1) intravenously (IV), which were concurrently paired with either chemical (doxapram at 2.5 mg kg-1 IV) or mechanical (gentle pressure to the corniculate process of the right arytenoid cartilage using a cotton bud) stimulation for enhanced assessment of laryngeal motion, in random order, with a 1 week wash-out period between treatments. If deemed inadequately anaesthetized, supplemental boli of thiopentone (1.8 mg kg-1), propofol (0.75 mg kg-1) or alfaxalone (0.4 mg kg-1) were administered. Assessment of number of arytenoid motions and vital breaths, among others, was initiated immediately after induction. Chemical (doxapram) and mechanical stimulation were begun 2 minutes after anaesthetic induction. Data were collected at 2, 3 and 5 minutes after anaesthetic induction and the Friedman rank-sum or repeated-measures analysis of variance tests were used when applicable for statistical analysis. RESULTS: The duration of examination time was shorter among treatments combined with chemical stimulation (p=0.001). Examination time during induction was longer for alfaxalone-chemical (8.9 minutes) and -mechanical (10.9 minutes) compared to both induction with thiopentone-chemical (3.8 minutes) and propofol-chemical (4.0 minutes). The median number of arytenoid motions for both thiopentone (67) and propofol (59) induction combined with chemical stimulation was significantly higher in comparison to that of alfaxalone (1), thiopentone (2) and propofol (2), when combined with mechanical stimulation at 3 minutes after induction. CONCLUSION AND CLINICAL RELEVANCE: Among the regimens for assessing laryngeal motion assessed in the present study, combinations of thiopentone or propofol with doxapram are the most effective means of stimulating arytenoid motion and could improve the accuracy of diagnosis of laryngeal paralysis in dogs.


Assuntos
Doenças do Cão/diagnóstico , Cães , Pregnanodionas/farmacologia , Propofol/farmacologia , Tiopental/farmacologia , Paralisia das Pregas Vocais/veterinária , Anestesia/veterinária , Anestésicos/administração & dosagem , Anestésicos/farmacologia , Anestésicos Intravenosos/farmacologia , Animais , Estudos Cross-Over , Laringe/efeitos dos fármacos , Laringe/patologia , Pregnanodionas/administração & dosagem , Propofol/administração & dosagem , Distribuição Aleatória , Tiopental/administração & dosagem , Paralisia das Pregas Vocais/diagnóstico
17.
Semin Musculoskelet Radiol ; 23(3): e58-e67, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31163510

RESUMO

Pain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/tratamento farmacológico , Neuropatia Femoral/tratamento farmacológico , Artropatias/diagnóstico por imagem , Artropatias/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Corticosteroides/administração & dosagem , Anestésicos/administração & dosagem , Neuropatia Femoral/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Ácido Hialurônico/administração & dosagem , Dor/tratamento farmacológico , Ossos Pélvicos/diagnóstico por imagem , Pelve/diagnóstico por imagem
18.
Vet Anaesth Analg ; 46(4): 483-487, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31178411

RESUMO

OBJECTIVE: To describe clinically relevant, physiological measurements collected during a 3 hour duration of alfaxalone total intravenous anaesthesia. STUDY DESIGN: Case series. ANIMALS: A total of 112 client-owned middle-aged or older dogs. METHODS: Dogs were premedicated with intramuscular acepromazine (0.03 mg kg-1). Anaesthesia was induced and subsequently maintained for up to 3 hours with alfaxalone administered intravenously. Dogs breathed 100% oxygen via an endotracheal tube. Heart rate, respiratory rate and blood pressure were evaluated 30 minutes after administration of acepromazine and used as baseline values for comparisons of intra-anaesthetic data. Blood glucose was measured 1 week prior to anaesthesia and every hour during alfaxalone anaesthesia. Quality and duration of recovery were recorded. Mean data for physiological variables were compared over three time points-before induction of anaesthesia, for the first hour of anaesthesia and from 60 minutes to discontinuation of anaesthesia. RESULTS: Mean induction dose of alfaxalone was 1.4 mg kg-1 [95% confidence interval (CI) 1.3-1.5). Post induction apnoea for >60 seconds occurred in 13 (11.6%) dogs. Mean alfaxalone infusion rate during the first 60 minutes of anaesthesia was 0.099 mg kg-1 minute-1; mean infusion rate was 0.092 mg kg-1 minute-1 from 60 minutes until discontinuation of anaesthesia. Heart rate was well maintained; hypotension (mean arterial blood pressure < 60 mmHg) was encountered in 23 (21%) dogs. Blood glucose levels did not alter during anaesthesia. Median time between discontinuation of alfaxalone infusion and extubation was 17 (7-35 minutes), time to assuming sternal recumbency was 75 (58-110 minutes), and time to standing was 109 (88-140 minutes). CONCLUSIONS AND CLINICAL RELEVANCE: Alfaxalone infusion provided effective anaesthesia in this population. In a minority of cases, respiratory and haemodynamic support of the patient was required.


Assuntos
Anestesia Intravenosa/veterinária , Anestésicos/farmacologia , Doenças do Cão/diagnóstico por imagem , Osteoartrite/veterinária , Pregnanodionas/farmacologia , Radiografia/veterinária , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Animais , Apneia/induzido quimicamente , Apneia/veterinária , Glicemia , Pressão Sanguínea/efeitos dos fármacos , Dióxido de Carbono/sangue , Estudos de Casos e Controles , Cães , Feminino , Frequência Cardíaca/efeitos dos fármacos , Masculino , Osteoartrite/diagnóstico por imagem , Oxigênio/sangue , Pregnanodionas/administração & dosagem , Pregnanodionas/efeitos adversos , Respiração/efeitos dos fármacos
19.
Vet Anaesth Analg ; 46(4): 421-428, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31178412

RESUMO

OBJECTIVE: To investigate alfaxalone total intravenous anaesthesia (TIVA) following premedication with methadone combined with acepromazine (ACP) or dexmedetomidine in bitches undergoing ovariohysterectomy. STUDY DESIGN: Prospective, blinded, randomized, experimental study. ANIMALS: A group of 12 female Beagles. METHODS: Dogs were premedicated intravenously with methadone (0.2 mg kg-1) combined with ACP (20 µg kg-1, group AM) or dexmedetomidine (5 µg kg-1, group DM). Anaesthesia was induced with alfaxalone (2 mg kg-1). Anaesthetic maintenance was obtained with an alfaxalone variable rate infusion (VRI) started at 0.15 mg kg-1 minute-1 and adjusted every 5 minutes based on clinical assessment. Mechanical ventilation was initiated when necessary to maintain normocapnia. Anaesthetic monitoring included electrocardiogram, heart rate (HR), invasive diastolic (DAP), systolic (SAP) and mean arterial blood pressure, arterial haemoglobin oxygen saturation, respiratory variables and oesophageal temperature. Data were recorded every 5 minutes. A mixed model statistical approach was used to compare cardiovascular variables within and between groups (α = 0.05). A Wilcoxon rank-sum test was used to compare body temperature, VRI alfaxalone rate, administered rescue analgesia, sedation, induction, intubation, recovery scores and recovery times between treatments. RESULTS: Overall HR, SAP and DAP differed between groups (p = 0.001, 0.016, 0.019, respectively). The mean VRI dose rate of alfaxalone differed between groups DM [0.13 (0.11-0.14) mg kg-1 minute-1] and AM [0.18 (0.13-0.19) mg kg-1 minute-1; p = 0.030]. Rescue analgesia was administered more in group AM (p = 0.019). No significant difference in recovery times and scores was observed between protocols. CONCLUSIONS AND CLINICAL RELEVANCE: Alfaxalone TIVA following dexmedetomidine/methadone premedication produced a more stable plane of anaesthesia to perform ovariohysterectomy than ACP/methadone. A dose reduction of alfaxalone of 27.7% was obtained in group DM compared with group AM. Recovery quality and recovery times were comparable between both groups.


Assuntos
Acepromazina/farmacologia , Dexmedetomidina/farmacologia , Cães , Pregnanodionas/farmacologia , Pré-Medicação , Acepromazina/administração & dosagem , Anestésicos/administração & dosagem , Anestésicos/farmacologia , Animais , Dexmedetomidina/administração & dosagem , Antagonistas de Dopamina/administração & dosagem , Antagonistas de Dopamina/farmacologia , Feminino , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Histerectomia/veterinária , Metadona , Ovariectomia/veterinária , Pregnanodionas/administração & dosagem , Distribuição Aleatória
20.
J Vet Med Sci ; 81(6): 937-945, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31080189

RESUMO

The anesthetic effects of alfaxalone combined with medetomidine and butorphanol were investigated for ICR, BALB/c, and C57BL/6 mice. Mice were administered a combination of 0.5 or 0.75 mg/kg medetomidine and 5 mg/kg butorphanol with 30 or 40 mg/kg alfaxalone (0.5MBA30, 0.75MBA30 and 0.75MBA40, respectively). The drug combinations were administered subcutaneously and were compared with a widely used combination of 0.3 mg/kg medetomidine, 4 mg/kg midazolam, and 5 mg/kg butorphanol (MMB). All three MBA combinations achieved surgical anesthesia, although the recovery time was longer with 0.75MBA30 and 0.75MBA40 compared with 0.5MBA30. Furthermore, several mice exhibited a considerable jumping reaction immediately after injection with 0.75MBA30 and 0.75MBA40. Therefore, 0.5MBA30 may be suitable for inducing surgical anesthesia in the mouse strains tested. The anesthetic scores for 0.5MBA30 were improved compared with those of MMB in all three mouse strains; however, the body temperature drop in C57BL/6 mice was greater with 0.5MBA30. Our results show that the alfaxalone combination, 0.5MBA30, should allow surgical operations that are more stable in more strains of mice than MMB, although the combination may cause hypothermia, especially in C57BL/6 mice.


Assuntos
Anestesia/veterinária , Anestésicos/farmacologia , Butorfanol/farmacologia , Medetomidina/farmacologia , Pregnanodionas/farmacologia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacologia , Anestésicos/administração & dosagem , Anestésicos Combinados , Animais , Temperatura Corporal/efeitos dos fármacos , Butorfanol/administração & dosagem , Injeções Subcutâneas/veterinária , Medetomidina/administração & dosagem , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos ICR , Pregnanodionas/administração & dosagem , Organismos Livres de Patógenos Específicos
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