Tumescent local anesthesia with ropivacaine in different concentrations in bitches undergoing mastectomy: plasma concentration and post-operative analgesia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The Humidity in a Drager Primus Anesthesia Workstation Using Low or High Fresh Gas Flow and With or Without a Heat and Moisture Exchanger in Pediatric Patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Intraoperative and Anesthesia-Related Cardiac Arrest and Its Mortality in Older Patients: A 15-Year Survey in a Tertiary Teaching Hospital

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

PHYSIOLOGIC EFFECTS OF THREE DIFFERENT PROTOCOLS OF ISOFLURANE ANESTHESIA IN CAPTIVE BROWN BROCKET DEER (MAZAMA GOUAZOUBIRA)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparison of anesthetic efficacy and adverse effects associated with peribulbar injection of ropivacaine performed with and without ultrasound guidance in dogs

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Inguinal herniorrhaphy with local anesthesia

We review five years experience on inguinal hernia repair under local anesthesia in a small hospital in the interior of the State of São Paulo, Brazil. Sixty patients were submitted to repair and they were evaluated according to their immediate results, kind of hernia, anesthetic and operatory techniques and recurrences. The results were considered excellent in 20% of the cases, good in 65%, regular in 13.3% and in 1.7% the results were bad. No recurrence was observed up to now. Most of the patients were discharged within 24 hours. The proposed technique has provided reduced hospital expenses and low risks of infection.

Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study

We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.

Anesthesia-related and perioperative cardiac arrest in low- and high-income countries: a systematic review with meta-regression and proportional meta-analysis

The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesia-related CA rate has not yet been performed.This study aimed to analyze global data on anesthesia-related and perioperative CA rates according to country's Human Development Index (HDI) and by time. In addition, we compared the anesthesia-related and perioperative CA rates in low- and high-income countries in 2 time periods.A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with anesthesia-related and/or perioperative CA rates. Meta-regression and proportional meta-analysis were performed with 95% confidence intervals (CIs) to evaluate global data on anesthesia-related and perioperative CA rates according to country's HDI and by time, and to compare the anesthesia-related and perioperative CA rates by country's HDI status (low HDI vs high HDI) and by time period (pre-1990s vs 1990s-2010s), respectively.Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-regression showed that anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P = 0.024) and perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P = 0.005) CA rates decreased with increasing HDI, but not with time. Meta-analysis showed per 10,000 anesthetics that anesthesia-related and perioperative CA rates declined in high HDI (2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5-1.0] in the 1990s-2010s, P < 0.001; and 8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P < 0.001, respectively). In low-HDI countries, anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P = 0.14), whereas perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P = 0.03).Both anesthesia-related and perioperative CA rates decrease with increasing HDI but not with time. There is a clear and consistent reduction in anesthesia-related and perioperative CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the 2 time periods.

Anestesia peribulbar para enucleação em um felino: relato de caso

Foi atendido no Hospital Veterinário “Luiz Quintiliano de Oliveira”, o felino Nick, SRD, de quatro meses de idade, pesando 700 gramas, com histórico de trauma por arranhadura em bulbo ocular esquerdo. Ao exame físico específico, evidenciou-se úlcera profunda e prolapso de íris, sendo então indicada a enucleação. Ao exame físico geral, observou-se freqüência cardíaca (FC) de 160 batimentos.min-1, frequência respiratória (f) de 80 movimentos.min-1, tempo de preenchimento capilar menor do que dois segundos, temperatura retal (TR) de 39,2oC e mucosas normocoradas. Como medicação pré-anestésica, empregou-se acepromazina (0,04 mg.kg-1) e metadona (0,3 mg.kg-1), administradas pela via intramuscular. A veia femoral esquerda foi cateterizada com cateter 24G para administração de Ringer com Lactato de sódio (10 mL.kg-1.h- 1 ). A indução foi realizada por máscara facial tendo-se como agente o isofluorano em fluxo diluente de 100 mL.kg-1.min-1 de oxigênio a 100%, seguida de intubação orotraqueal com sonda n o 2,5 sem cuff. Seguiu-se a manutenção anestésica com a mesma mistura da indução, administrada por meio de circuito anestésico sem reinalação de gases, do tipo Baraka, mantendose o paciente sob ventilação assistida. Ato contínuo, realizou-se a técnica anestésica peribulbar de punção única inferior, utilizando-se lidocaína 2% com vasoconstritor (3mg.kg-1) associada a bupivacaína 0,5% sem vasoconstritor (0,8mg.kg-1), perfazendo um volume total de 0,3ml.kg-1 . Uma agulha 13x4,5 foi introduzida em todo o seu comprimento com o bisel voltado para a órbita, no terço lateral do fórnice conjuntival inferior da órbita esquerda, administrando-se a associação dos agentes anestésicos locais, seguida de compressão manual da área para facilitar a difusão dos mesmos. Durante o procedimento anestésico, realizou-se a monitoração da FC, f, pressão arterial sistólica (PAS), TR e saturação periférica da hemoglobina (SpO2). O tempo total de anestesia e cirurgia foi de 30 e 20 minutos, respectivamente, e a SpO2, concentração de isofluorano e TR mantiveram-se em 99±1%, 1,7±0,8% e 37,4±1,5oC, respectivamente. O plano anestésico manteve-se estável, sem a necessidade de resgate analgésico. Não houve a ocorrência de reflexo óculo-cardíaco (ROC) frente à manipulação do nervo óptico, o que pode ser atribuída provavelmente ao bloqueio peribulbar. A anestesia regional é frequentemente empregada para cirurgias oftálmicas em humanos, como a facoemulsificação, sendo que o manejo anestésico pode contribuir para o sucesso do procedimento. Pode-se concluir que, também na espécie felina, o bloqueio peribulbar pode ser uma boa alternativa para a realização de protocolos de anestesia balanceada para procedimentos oftálmicos.

Epidural anesthesia and postoperatory analgesia with alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy in bitches

The aim of this study was to determine the viability and cardiorespiratory effects of the association of epidural alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy (OH) in bitches. Forty-two bitches were spayed under epidural anesthesia with 2.5 mg/kg body weight (BW) of 1% lidocaine with adrenaline (CON) or in association with 0.25 mg/kg BW of xylazine (XYL), 10 mu g/kg BW of romifidine (ROM), 30 mu g/kg BW of detomidine (DET), 2 mu g/kg BW of dexmedetomidine (DEX), or 5 mu g/kg BW of clonidine (CLO). Heart rate (HR), respiratory rate (f(R)) and arterial pressures were monitored immediately before and every 10 min after the epidural procedure. Blood gas and pH analysis were done before, and at 30 and 60 min after the epidural procedure. Animals were submitted to isoflurane anesthesia if they presented a slightest sign of discomfort during the procedure. Time of sensory epidural block and postoperative analgesia were evaluated. All animals in CON and DEX, 5 animals in ROM and CLO, 4 animals in XYL, and 3 in DET required supplementary isoflurane. All groups, except CLO, showed a decrease in HR. There was an increase in arterial pressures in all groups. Postoperative analgesia lasted the longest in XYL. None of the protocols were totally efficient to perform the complete procedure of OH; however, xylazine provided longer postoperative analgesia than the others.

Extracorporeal Circulation Interference on Emergence from Anesthesia in Patients Submitted to Myocardial Revascularization

Background and objectives: Extracorporeal circulation (ECC) may change drug pharmacokinetics as well as brain function. The objectives of this study are to compare emergence time and postoperative sedation intensity assessed by the bispectral index (BIS) and the Ramsay sedation scale in patients undergoing myocardial revascularization (MR) with or without ECC. Method: Ten patients undergoing MR with ECC (ECC group) and 10 with no ECC (no-ECC group) were administered with sufentanyl, propofol 2.0 mu g.mL(-1) and pancuronium target controlled infusion. After surgery, propofol infusion was reduced to 1 mu g.mL(-1) and suspended when extubation was indicated. Patients BIS, Ramsay scale and time to wake up were assessed. Results: The ECC group showed lower BIS values beginning at 60 minutes after surgery (no-ECC = 66 +/- 13 and ECC = 53 +/- 14, p = 0.01) until 120 minutes after infusion (no-ECC = 85 +/- 8 and ECC = 73 +/- 12, p = 0.02). Sedation level measured by the Ramsay scale was higher in the ECC group at 30 minutes after the end of the surgery (no-ECC = 5 +/- 1 and ECC = 6 +/- 0, p = 0.021), at the end of infusion (no-ECC = 5 +/- 1 and ECC = 6 +/- 1, p = 0.012) and 5 minutes after the end of infusion (no-ECC = 4 +/- 1 and ECC = 5 +/- 0.42, p = 0.039). Emergence from anesthesia time was higher in the ECC group (no-ECC = 217 +/- 81 and ECC = 319 +/- 118, p = 0.038). Conclusions: There was a higher intensity of sedation after the end of surgery and a longer wake up time in ECC group, suggesting changes in the pharmacokinetics of propofol or effects of ECC on central nervous system.

Inhibition of Autonomic Storm by Epidural Anesthesia Does Not Influence Cardiac Inflammatory Response After Brain Death in Rats

Background. After brain death (BD) donors usually experience cardiac dysfunction, which is responsible for a considerable number of unused organs. Causes of this cardiac dysfunction are not fully understood. Some authors argue that autonomic storm with severe hemodynamic instability leads to inflammatory activation and myocardial dysfunction. Objectives. To investigate the hypothesis that thoracic epidural anesthesia blocks autonomic storm and improves graft condition by reducing the inflammatory response. Methods. Twenty-eight male Wistar rats (250-350 g) allocated to four groups received saline or bupivacaine via an epidural catheter at various times in relation to brain-death induction. Brain death was induced by a sudden increase in intracranial pressure by rapid inflation of a ballon catheter in the extradural space. Blood gases, electrolytes, and lactate analyses were performed at time zero, and 3 and 6 hours. Blood leukocytes were counted at 0 and 6 hours. After 6 hours of BD, we performed euthanasia to measure vascular adhesion molecule (VCAM)-1, intracellular adhesion molecule (ICAM)-1, interleukin (IL)-1 beta, tumor necrosis factor (TNF)-alpha, Bcl-2 and caspase-3 on cardiac tissue. Results. Thoracic epidural anesthesia was effective to block the autonomic storm with a significant difference in mean arterial pressure between the untreated (saline) and the bupivacaine group before BD (P < .05). However, no significant difference was observed for the expressions of VCAM-1, ICAM-1, TNF-alpha, IL-1 beta, Bcl-2, and caspase-3 (P > .05). Conclusion. Autonomic storm did not seem to be responsible for the inflammatory changes associated with BD; thoracic epidural anesthesia did not modify the expression of inflammatory mediators although it effectively blocked the autonomic storm.