Parâmetros ecocardiográficos em cães saudáveis tratados com acepromazina, meperidina e sua associação / Echocardiographic parameters in healthy dogs treated with acepromazine, meperidine and their association

Objetivou-se avaliar os efeitos da tranquilização com meperidina, acepromazina e de sua associação sobre os parâmetros ecocardiográficos em cães. Foram utilizados 12 cães adultos, da raça Rottweiler, submetidos ao exame ecocardiográfico sem utilização de sedação (controle - TC) e a três protocolos de tratamento, utilizando-se meperidina (TM), acepromazina (TA) e a associação dos medicamentos (TMA). As variáveis foram analisadas pelo teste de Tukey (P<0,05). Observou-se que as médias obtidas na onda A do fluxo mitral em TA e TMA diminuíram significativamente com relação ao TM, que não diferiu do TC. Houve uma diminuição significativa no valor de movimento anular mitral (MAM) e excursão sistólica do plano anular tricúspide (ESPAT) no TA. Não houve diferença significativa para os valores de fração de encurtamento (FE) entre TA e os demais tratamentos. Entretanto, observou-se que 57,3% dos cães apresentaram valores de FE abaixo da normalidade. As alterações encontradas podem ser decorrentes dos efeitos hipotensores da acepromazina utilizada de forma isolada. Conclui-se que a meperidina ou sua associação com acepromazina não alteram os parâmetros ecocardiográficos em cães saudáveis e que a acepromazina, utilizada isoladamente, causa alteração nos parâmetros de função sistólica dos cães, não sendo recomendada para a contenção química dos cães submetidos ao ecocardiograma, o que poderia levar à má interpretação do exame.(AU)

The aim of this study was to evaluate the effects of sedation with meperidine, acepromazine and its association on the echocardiographic parameters in dogs. Twelve adult Rottweilers were used and subjected to the echocardiography examination without the use of sedation (control - CT) and subjected to three treatment protocols using meperidine (MT), acepromazine (AT), and the combination of drugs (MAT). Variables were analyzed by Tukey test (p<0,05). The averages obtained in A-wave of mitral inflow in AT and MAT decreased significantly compared to MT, which did not differ from CT. There was a significant decrease in the measurement of mitral annulus motion (MAM) and tricuspid annular plane systolic excursion (TAPSE) at TA. There was no significant difference in shortening fraction (SF) values between TA and other treatments. However, it was observed that 57.3% of the dogs showed SF values below the normal range for the species. All changes found may be due to the hypotensive effects of acepromazine used in isolation. In conclusion, meperidine or its association with acepromazine does not alter echocardiographic parameters in healthy dogs and acepromazine, used alone, causes changes in the parameters of systolic function and is not recommended for sedation of dogs submitted to echocardiogram, since it could cause a misinterpretation of the exam.(AU)

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma.

BACKGROUND/AIMS: Modified neuroleptanalgesia (m-NLA) with midazolam is often used for sedation and analgesia during endoscopic submucosal dissection (ESD) for gastrointestinal neoplasia. However, interruption due to poor response to midazolam is often experienced during ESD for esophageal squamous cell carcinoma (ESCC) because most patients with ESCC have a history of heavy alcohol intake. We examined the incidence and risk factors for poor response to m-NLA with midazolam and pethidine hydrochloride. METHODS: This retrospective cross-sectional study was conducted at a single institution. Between April 2007 and July 2013, 151 patients with superficial ESCC who underwent ESD under sedation using m-NLA with midazolam and pethidine hydrochloride were enrolled. Poor response to sedation was defined as the use of a second drug when Ramsay Sedation Score 1-2. RESULTS: Poor response to sedation occurred in 66.2% patients. Most cases of poor response were controlled by using additional flunitrazepam. Multivariate logistic regression analysis showed that cumulative alcohol intake and major specimen size were independent risk factors for poor response to sedation (OR 3.63, 95% CI 1.20-10.99, and OR 3.23, 95% CI 1.26-8.25). CONCLUSION: Our study indicated that cumulative alcohol intake and major specimen size were associated with poor response to m-NLA with midazolam and pethidine hydrochloride.

Influence of electroacupuncture on thermal changes in a soft tissue defect.

This study investigated thermal changes in the skin at locations where soft tissue defects existed and acupuncture needles stimulated by using bipolar electroacupuncture (EA) had been inserted. Under general anesthesia (GA), experimental defects were made at the dorsum site of five New Zealand rabbits. Bipolar EA was used for 20 minutes to stimulate the experimental defects, and the skin temperature was monitored at the sites where the acupuncture needles had been inserted and the soft tissue defects existed. The initial thermography of those defects had the same trend as that of the negative pole of EA stimulation at the first acupoint. Skin thermography during the first 3 minutes of bipolar EA indicated a centrifugal vasoconstriction and a vasodilatation at the negative and positive poles, respectively. After that, the thermal change in soft tissue undergoing EA stimulation was not modified by a different EA polarity. The local temperature at the defect and its surroundings under both positive and negative electric loads was increased by 0.2-0.3 °C for vasodilatation. This study indicates that EA influences sympathetic modulation of soft tissue defects and that selective sympathetic modulation caused by bipolar EA is responsible for the clinical perception.

Influence of electroacupuncture on the soft tissue healing process.

The aim of this study was to determine the effect of bipolar electroacupuncture (EA) on a soft tissue defect in rabbits. Ten clinically healthy New Zealand white rabbits were divided into two groups: the control group (Group C, n = 5) and the experimental (EA) group (Group T, n = 5). During neuroleptanalgesia, defects of soft tissue (skin and muscle) were made at the dorsum site on the rabbits in both groups, and those defects were stimulated using EA. The biopsy samples were collected on Day 2, Day 4, and Day 6, prepared for histology, and examined microscopically. On the 2(nd) day, in Group C, the inflammatory degree was higher than it was in Group T; on subsequent days, low or identical degrees of inflammation were observed in both groups. Proliferative fibrous activity was increased on Day 4 for Group T and identical for both groups on Day 6. The dynamics of the epidermal thickness were characterized by a high rate on Day 2, Day 4, and Day 6 for Group T. EA facilitates a low tissue mechanical stress and has a positive effect on the healing of muscular defects. EA enhances the healing process, with no side effects.

Electroacupuncture analgesia in a rabbit ovariohysterectomy.

This study investigated the effectiveness of electroacupuncture analgesia (EAA) at local and paravertebral acupoints for a rabbit undergoing an ovariohysterectomy. Twelve clinically healthy New Zealand white rabbits were chosen and divided into two groups: the control group (5 rabbits) and the experimental group (7 rabbits). A neuroleptanalgesic (ketamine + xylazine) was administered to the control group (NLA group); the experimental group received EAA treatment (EAA group). The EAA treatment includes one acupuncture formula for local stimulation at the incision site and systemic stimulation. Results of clinical research have shown postoperative analgesia using EAA treatment to be superior to that using NLA. The average postoperative recovery time was 5.2 times longer in the NLA group than in the EAA group. Because consciousness was maintained, EAA presented an advantage in thermoregulation. Animals administered NLA had prolonged thermal homeostasis because of neurovegetative disconnection. For the EAA group, the operative times were characterized as excellent (28%, p = 0.28) or good (72%, p = 0.72). Local stimulation at the incision site provided excellent analgesia of the abdominal wall (100%). In conclusion, EA can provide general analgesia with a considerable analgesic effect for a rabbit undergoing an ovariohysterectomy, resulting in a short postoperative recovery time.

Nociceptive thermal threshold testing in horses - effect of neuroleptic sedation and neuroleptanalgesia at different stimulation sites.

BACKGROUND: Aim of the study was to compare the effect of neuroleptic sedation with acepromazine and neuroleptanalgesia with acepromazine and buprenorphine on thermal thresholds (TT) obtained at the nostrils and at the withers. The study was carried out as a randomized, blinded, controlled trial with cross-over design. Thermal thresholds were determined by incremental contact heat applied to the skin above the nostril (N) or the withers (W). Eleven horses were treated with saline (S), acepromazine (0.05 mg/kg) (ACE) or acepromazine and buprenorphine (0.0075 mg/kg) (AB) intravenously (IV). Single stimulations were performed 15 minutes prior and 15, 45, 75, 105, 165, 225, 285, 405 and 525 minutes after treatment. Sedation score, gastrointestinal auscultation score and occurrence of skin lesions were recorded. Data were analysed with analysis of variance for repeated measurements. RESULTS: There were no significant differences in TT between N and W with all treatments. The TT remained constant after S and there was no difference in TT between S and ACE. After AB there was a significant increase above baseline in TT until 405 minutes after treatment. Restlessness occurred 30-90 minutes after AB in 7 horses. All horses had reduced to absent borborygmi after AB administration for 165 to 495 minutes. CONCLUSION: Thermal stimulation at both described body areas gives comparable results in the assessment of cutaneous anti-nociception in horses. There is no differential influence of neuroleptic sedation or neuroleptanalgesia on TTs obtained at N or W. Buprenorphine combined with acepromazine has a long lasting anti-nociceptive effect associated with the typical opioid induced side effects in horses.

[Evaluation of efficacy and safety of optimized based on the ketamine modified neuroleptanalgesia during operations on the biliary tract and liver].

A comparative analysis of efficacy and safety of the neuroleptanalgesia (NLA) and balanced general anesthesia during operations on the biliary tract and liver. Analysis of the results of comprehensive studies of hemodynamic, humoral homeostasis, liver function and clinical anesthesia showed that the optimized on the basis of ketamine modified NLA provides effective neurovegetative protection during operations on the organs of the hepatobiliary system, accompanied by obscure variations in the studied parameters. Traditional methods of the modified NLA is characterized by insufficient anesthesia, accompanied by pronounced physical inactivity circulation and a large number of "critical incidents".

[Dexmedetomidine for sedation during voice monitoring surgery in a patient with an episode of seizure].

We present a rare case of 26-year-old male patient without a history of epilepsy, who underwent a voice monitoring surgery under local anesthesia plus sedation using modified neuroleptanalgesia. As he developed generalized tonic-clonic seizure probably due to pentazocine, the operation was cancelled. Later, the same surgery was rescheduled. After a premedication with intramuscular phenobarbital, the patient was sedated with dexmedetomidine and locally anesthetized, showing sedation of high quality with no respiratory depression and no seizure. Dexmedetomidine was used succesfully for voice monitoring surgery.

Treatment of medial condylar fractures of the third metatarsus in three horses with fibreglass casts under standing neuroleptanalgesia.

Minimally displaced condylar fractures propagating into the third metatarsal diaphysis were treated conservatively in one thoroughbred and two Arabian racehorses. In each case a neuroleptanalgesic protocol provided adequate pain relief for a rigid fibreglass cast to be applied in a weight-bearing position. The fractures healed completely and the three horses recovered uneventfully. Two of them returned successfully to racing and the third was used for breeding.

[Clinical application of brain hypothermia therapy for acute brain insults].

Brain hypothermia therapy has been expected to lead to good neurological outcome in acute brain insults. There are a few positive results which have been proven by multicenter randomized clinical trials (RCT) in the cardiopulmonary arrest (CPA) in patients with ventricular fibrillation. Among these clinical trials, early application of hypothermia, maintenance of cerebral blood flow during hypothermia therapy and prevention of quick rewarming are pointed out to result in good outcome from clinical experiences. For brain hypothermia therapy to become an effective method for acute brain insults, indications, brain oriented intensive cares and biomarkers for the therapy must be established. RCT in acute brain insults beside CPA victims are needed in the near future.

Postoperative impairment of cognitive function in rats: a possible role for cytokine-mediated inflammation in the hippocampus.

BACKGROUND: Postoperative cognitive dysfunction is being increasingly reported as a complication. The authors investigated the role of cytokine-mediated inflammation within the central nervous system in the development of cognitive dysfunction in a rat model. METHODS: Adult rats were subjected to neuroleptic anesthesia (20 microg/kg fentanyl plus 500 microg/kg droperidol, intraperitoneal) for splenectomy or no surgery. On postanesthetic days 1, 3, and 7, cognitive function was assessed in a Y maze. To evaluate the immune response in the hippocampus, the authors measured glial activation, as well as transcription and expression of key proinflammatory cytokines interleukin 1beta and tumor necrosis factor alpha. To determine propensity for apoptosis, they measured expression of Bax and Bcl-2. RESULTS: Cognitive function in splenectomized animals was impaired at days 1 and 3 after surgery compared with cognitive function in nonanesthetized rats. At all times, anesthetized rats that were not subjected to surgery were no different from control rats. Glial activation was observed in the hippocampus only in splenectomized rats at postsurgery days 1 and 3. Interleukin-1beta messenger RNA (mRNA) was significantly increased at postsurgery days 1 and 3, with an increase in protein expression detected on day 1. There was a significant increase in tumor necrosis factor-alpha mRNA on day 1 after surgery, although this was not associated with an increase in protein expression. The ratio of Bcl-2:Bax was significantly decreased in the splenectomized animals. CONCLUSION: These results suggest that splenectomy performed during neuroleptic anesthesia triggers a cognitive decline that is associated with a hippocampal inflammatory response that seems to be due to proinflammatory cytokine-dependent activation of glial cells.

[Comparative analysis of antiarrhythmic and proarrhythmogenic effects of drugs for neuroleptanalgesia, ataralgesia, and antidepranalgesia in experimental acute myocardial infarction].

Proarrhythmogenic and antiarrhythmic effects of drugs for neuroleptanalgesia (NLA), ataralgesic (ATA) and antidepranalgesia (ADA) in chronic experiments on sleepless rabbits with acute myocardial infarction, with and without tachyarrhythmias, were studied using ECG, intraventricular electromanometry and tetropolar rheography. NLA (phentanylum, 1 microg/kg + droperidol, 5 microg/kg), ADA (pyrazidole, 1 mg/kg + tramal, 1 mg/kg) and ATA (diazepam, 1 mg/kg + promedol 0.5 mg/kg) produce antiarrhythmic effect with maximum manifestation of NLA on the 3rd day, and of ATA and ADA on 3-5th day. This medication increased blood supply and contractility of ischemic myocardium. Proarrhythmogenic effects of this medication were not observed.

[Anesthetic management of laser surgery with bronchial stenting for a tracheal tumor].

Anesthetic management during surgery for a tracheal tumor is extremely difficult in terms of airway management. We managed a patient with a tracheal tumor who was successfully treated without complication. The trachea of a 66-year-old woman was narrowed by a tumor to one-third of its original diameter, for which Nd-YAG laser surgery with insertion of an intratracheal Dumon stent was performed. Anesthesia was maintained with neuroleptanalgesia using fentanyl and droperidol, supplemented with a TCI infusion of propofol under spontaneous breathing. High frequency jet ventilation (HFJV) was prepared for intraoperative poor oxygenation and/or ventilation. The patient was able to maintain a good respiratory condition throughout the operation without special respiratory support, including use of HFJV. We conclude that the maintenance of spontaneous breathing is essential for anesthetic management in the present case, while an intraoperative airway strategy based on the preoperative breathing condition of the patient is also important.

[Effect of neuroleptnarcosis on the change of hemodynamic parameters during tissues transplantation].

Changes of the central and peripheral hemodynamics indexes during operation for the tissues purulent-trophic defects closure by free muscular--nerve--vascular flap, arising during neuroleptnarcosis and in immediate postoperative period, were discussed.

Airway management during the laryngoscopic surgery for the benign laryngeal obstructive disease.

The airway management and anesthesia maintenance during the laryngoscopic surgery is essential for a safe operation. For the benign laryngeal obstructive disease such as a large mass or a foreign body of the upper airway, it is difficult to secure the airway. Sometimes they might be hazardous and potentially lethal. We present two cases of a large laryngeal polyp and a laryngeal foreign body of pressthrough-package (PTP). They were successfully operated on with laryngomicrosurgery under neuroleptanalgesia (NLA) without intubation. The choice of the operation and airway management were discussed.

Antipsicóticos a altas dosis: ¿evidencia científica o intento a la desesperada? / High-dose antipsychotics:desperation or data driven?

No disponible

[Surgical stress: clinical-and-laboratory parallels under activation of the natural stress-limiting systems]. / Khirurgicheskii stress. Kliniko-laboratornye paralleli v usloviiakh aktivatsii estestvennykh stress-limitiruiushchikh sistem.

Three hundred and eighty-seven patients, who were operated on the scheduled basis for different surgical pathologies, were examined. The purpose of the case study was definition of the clinical-and-laboratory parallels related with pronouncement of surgical stress in an advanced variation of neuroleptanalgesia.