Search

The antinociceptive and behavioral effects of methadone (MET) alone or combined with detomidine (DET) were studied in horses. Intravenous treatments were randomly administered in a two-phase crossover study. In phase 1, six horses were treated with saline (control) or 0.2 or 0.5 mg/kg methadone (MET0.2; MET0.5, respectively). In phase 2, six horses were treated with 0.01 mg/kg DET alone or with DET combined with 0.2 mg/kg MET (DET/MET0.2). Thermal nociceptive threshold (TNT) and electrical nociceptive thresholds (ENT) were recorded by using a heat projection lamp and electrodes placed in the coronary band of the thoracic limbs, respectively. Spontaneous locomotor activity (SLA) was studied by movement sensors in the stall (phase 1). Chin-to-floor distance was assessed in phase 2. In phase 1, the TNT increased significantly for 30 minute after MET0.5 but not after saline or MET0.2. Hyperesthesia and ataxia were observed in 2 of 6 and 6 of 6 horses after MET0.2 and MET0.5, respectively. SLA increased significantly for 120 minutes after MET in a dose-dependent way, but not after placebo. In phase 2, DET and DET/MET0.2 significantly increased the TNT and ENT above baseline for 15 and 30 minutes, respectively; thresholds were significantly higher with DET/MET0.2 than with DET at the same times. Chin-to-floor distance decreased significantly from baseline for 30 minutes, and no excitatory behavior was observed in both treatments. Although the higher dose of MET induced short-acting antinociception, the associated adverse effects may contraindicate its clinical use. The lower dose of MET potentiated DET-induced antinociception without adverse effects, which might be useful under clinical circumstances.

Summary Reasons for performing study: Bradycardia may be implicated as a cause of cardiovascular instability during anaesthesia. Hypothesis: Hyoscine would induce positive chronotropism of shorter duration than atropine, without adversely impairing intestinal motility in detomidine sedated horses. Methods: Ten minutes after detomidine (0.02 mg/kg bwt, i.v.), physiological saline (control), atropine (0.02 mg/kg bwt) or hyoscine (0.2 mg/kg bwt) were randomly administered i.v. to 6 horses, allowing one week intervals between treatments. Investigators blinded to the treatments monitored cardiopulmonary data and intestinal auscultation for 90 min and 24 h after detomidine, respectively. Gastrointestinal transit was assessed for 96 h via chromium detection in dry faeces. Results: Detomidine significantly decreased heart rate (HR) and cardiac index (CI) from baseline for 30 and 60 min, respectively (control). Mean ± s.d. HR increased significantly 5 min after atropine (79 ± 5 beats/min) and hyoscine (75 ± 8 beats/min). After this time, HR was significantly higher after atropine in comparison to other treatments, while hyoscine resulted in intermediate values (lower than atropine but higher than controls). Hyoscine and atropine resulted in significantly higher CI than controls for 5 and 20 min, respectively; but this effect coincided with significant hypertension (mean arterial pressures >180 mmHg). Auscultation scores decreased from baseline in all treatments. Time to return to auscultation scores ≥12 (medians) did not differ between hyoscine (4 h) and controls (4 h) but atropine resulted in significantly longer time (10 h). Atropine induced colic in one horse. Gastrointestinal transit times did not differ between treatments. Conclusion: Hyoscine is a shorter acting positive chronotropic agent than atropine, but does not potentiate the impairment in intestinal motility induced by detomidine. Because of severe hypertension, routine use of anticholinergics combined with detomidine is not recommended. Potencial relevance: Hyoscine may represent an alternative to atropine for treating bradycardia.

Made available in DSpace on 2018-12-11T17:04:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-01-01 Catecholamines and arginine vasopressin (AVP) release can affect arterial blood pressure (ABP) and hemodynamic stability in standing, sedated horses. Six mature horses were included in this prospective, randomized, crossover, blinded, experimental study. All the horses were sedated with detomidine (DET) alone (0.01 mg/kg, IV) or combined with methadone (MET) (0.01 mg/kg DET and 0.2 mg/kg MET, IV). Cardiopulmonary data and blood samples were collected 30 minutes before (prebaseline and baseline) and for 120 minutes postinjection. The combination DET/MET produced a significant increase (31%) in mean ABP (MAP) 5 minutes after drug administration which lasted for 120 minutes. Detomidine alone induced only a short-term increase in MAP (15%) at 5 minutes compared with baseline. There were significant differences between groups at 5, 15, and from 60 to 120 minutes. Plasma AVP concentrations were higher in horses receiving the treatment DET from 60 to 120 minutes than those in the combination group, for the same period. There were no significant differences in norepinephrine and epinephrine serum concentrations respect to baseline and between treatments. Detomidine induces a short-term MAP increase, and this effect was prolonged and potentiated by MET association. There is no evidence of AVP, norepinephrine, and epinephrine involvement in this effect. Department of Anesthesiology School of Medicine UNESP—Univ Estadual Paulista Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science UNESP—Univ Estadual Paulista Department of Biochemistry Escola Paulista de Medicina Federal University of São Paulo Department of Anesthesiology School of Medicine UNESP—Univ Estadual Paulista Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science UNESP—Univ Estadual Paulista

Made available in DSpace on 2018-12-11T17:00:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-01-01 In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital. In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/conditionrelated. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs). A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0-19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7-16.9) followed by surgery-related (2.2, 95% CI: 1.0-3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III-V), emergency, cardiac or vascular surgeries, and multiple surgeries performed under the same anesthetic technique (P < 0.0001). There were no anesthesia-related deaths. However, the high mortality rate caused by the poor physical conditions of some patients suggests that primary prevention might be the key to reducing perioperative mortality. These findings demonstrate the need to improve medical perioperative practices for high-risk patients in under-resourced settings. Anesthesia Cardiac Arrest and Mortality Study Commission Department of Anesthesiology Botucatu Medical School UNESP University Estadual Paulista Department of Biostatistics Institute of Biosciences UNESP University Estadual Paulista Anesthesia Cardiac Arrest and Mortality Study Commission Department of Anesthesiology Botucatu Medical School UNESP University Estadual Paulista Department of Biostatistics Institute of Biosciences UNESP University Estadual Paulista

Objective To evaluate the agreement between invasive blood pressure (IBP) and Doppler ultrasound blood pressure (DUBP) using three cuff positions and oscillometric blood pressure (OBP) in anesthetized dogs. Study design Prospective study. Animals Nine adult dogs weighing 14.5–29.5 kg. Methods The cuff was placed above and below the tarsus, and above the carpus with the DUBP and above the carpus with the OBP monitor. Based on IBP recorded via a dorsal pedal artery catheter, conditions of low, normal, and high systolic arterial pressures [SAP (mmHg) 140, respectively] were induced by changes in isoflurane concentrations and/or dopamine administration. Mean biases ± 2 SD (limits of agreement) were determined. Results At high blood pressures, regardless of cuff position, SAP determinations with the DUBP underestimated invasive SAP values by more than 20 mmHg in most instances. With the DUBP, cuff placement above the tarsus yielded better agreement with invasive SAP during low blood pressures (0.2 ± 16 mmHg). The OBP underestimated SAP during high blood pressures (−42 ± 42 mmHg) and yielded better agreement with IBP for mean (MAP) and diastolic (DAP) arterial pressure measurements [overall bias: 2 ± 15 mmHg (MAP) and 0.2 ± 16 mmHg (DAP)]. Conclusions Agreement of SAP determinations with the DUBP is poor at SAP > 140 mmHg, regardless of cuff placement. Measurement error of the DUBP with the cuff placed above the tarsus is clinically acceptable during low blood pressures. Agreement of MAP and DAP measurements with this OBP monitor compared with IBP was clinically acceptable over a wide pressure range. Clinical relevance With the DUBP device, placing the cuff above the tarsus allows reasonable agreement with IBP obtained via dorsal pedal artery catheterization. Only MAP and DAP provide reasonable estimates of direct blood pressure with the OBP monitor evaluated.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:44:06Z No. of bitstreams: 1 S1807-59322012000400012.pdf: 100696 bytes, checksum: 4e7ee5010b3dd13a913f9a2bf6d9d5df (MD5) Made available in DSpace on 2013-08-22T18:44:06Z (GMT). No. of bitstreams: 1 S1807-59322012000400012.pdf: 100696 bytes, checksum: 4e7ee5010b3dd13a913f9a2bf6d9d5df (MD5) Previous issue date: 2012-01-01 Made available in DSpace on 2013-09-30T18:15:58Z (GMT). No. of bitstreams: 2 S1807-59322012000400012.pdf: 100696 bytes, checksum: 4e7ee5010b3dd13a913f9a2bf6d9d5df (MD5) S1807-59322012000400012.pdf.txt: 38341 bytes, checksum: e6a7fe778b83ae9cb79acb86dd480d07 (MD5) Previous issue date: 2012-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:16Z No. of bitstreams: 2 S1807-59322012000400012.pdf: 100696 bytes, checksum: 4e7ee5010b3dd13a913f9a2bf6d9d5df (MD5) S1807-59322012000400012.pdf.txt: 38341 bytes, checksum: e6a7fe778b83ae9cb79acb86dd480d07 (MD5) Made available in DSpace on 2014-05-20T13:32:16Z (GMT). No. of bitstreams: 2 S1807-59322012000400012.pdf: 100696 bytes, checksum: 4e7ee5010b3dd13a913f9a2bf6d9d5df (MD5) S1807-59322012000400012.pdf.txt: 38341 bytes, checksum: e6a7fe778b83ae9cb79acb86dd480d07 (MD5) Previous issue date: 2012-01-01 This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (