No description available.

No description available.

Pain management options for the equine orthopedic patient are limited and can have harmful systemic effects. Methods of local drug delivery such as intravenous regional limb perfusion (IVRLP) are able to provide more focal therapy with a decreased risk of systemic side effects. The primary goal of the present study was to develop a novel, targeted pain management approach able to mitigate the complications encountered with systemic opioid administration. There were two main objectives with respect to elucidating the usefulness of a butorphanol IVRLP. The first of these was to evaluate the feasibility of IVRLP to deliver butorphanol to the treated limb, and the second was to develop a method for evaluating the analgesic efficacy of the procedure. The findings suggest butorphanol IVRLP is well tolerated, results in measurable levels of butorphanol in the treated limb and may be of analgesic benefit.

No description available.

The objective of this study was to determine if administering epidural ketamine before or after the induction of a sodium urate crystal synovitis provides analgesia in dogs. In Part I, sixteen dogs were anesthetized with propofol (4 mg kg-1 intravenously). A sodium urate crystal synovitis was induced in the right stifle and allowed to develop for 12 hours. These dogs were again anesthetized with propofol and an epidural injection at the lumbosacral space of either ketamine (2 mg kg-1) or placebo (saline containing not more than 0.1 mg ml-1 benzethonium chloride) was performed. Analgesia was measured with a force platform and a numerical rating scale (NRS). Assessments were performed before and at 12, 14, 16, 18, 20 and 24 hours after the induction of synovitis. Vertical ground reaction forces were significantly decreased and numerical rating scale scores of total pain were significantly increased after the induction of synovitis in all dogs (p<0.05). No significant differences in ground reaction forces or total pain scores were measured between the ketamine and the control groups at any assessment period. In Part II, synovitis was induced in the right stifle as described in Part I. Epidural injections at the lumbosacral space followed immediately. Analgesia was assessed at 2, 4, 6, 8, and 12 hours after the epidural injection and the induction of synovitis. Dogs that received ketamine had significantly lower NRS scores two hours after treatment (p < 0.05). NRS scores did not differ between the two treatment groups at any other evaluation. Vertical ground reaction forces did not significantly differ between treatment groups at any assessment period. Results of this study indicate that ketamine, when administered epidurally at a dose of 2 mg kg-1 after the induction of a chemical synovitis, does not provide a significant level of analgesia. However, administration of ketamine immediately before the induction of synovitis resulted in a significantly decreased subjective pain score at two hours, but not at later evaluation periods. / Master of Science

The purpose of this research was to investigate the effect of parent education on maternal confidence and predictions of pain medication use in labor. The variables in this study were maternal age, parity, self-efficacy, prediction of pain medication usage, and parent education attendance. A convenience sample of 100 pregnant women enrolled in parent education classes at a major metropolitan tertiary care system was used. Data were collected through surveys administered by parent educators prior to the first class in the series and at the end of the last class. Instruments included the Childbirth Self-Efficacy Inventory and a questionnaire regarding maternal preference for pain control during tabor. The findings indicated that the parent education classes had a positive effect on the women's childbirth self-efficacy and outcome expectancy. Additionally, at the end of the classes a significant number of women reported they were less certain that they would have an epidural or use narcotic pain medication during labor. The findings, however, demonstrated no significant difference among the CBSEI scores of women with different preferences for pain control during labor.

A indução da anestesia no cão obeso é de grande desafio para o anestesista veterinário, pois estes pacientes apresentam alterações respiratórias e cardiovasculares. Além disso, há carência de protocolos anestésicos na literatura. Desta forma, objetivou-se comparar a indução da anestesia em cães obesos (escore corporal igual ou superior a 8) com propofol empregando-se a dose baseada no peso de massa magra ou baseada no peso total. Trinta e cinco cães foram distribuídos em três grupos: 13 cães de peso normal no grupo controle (GC); 15 cães obesos no grupo peso total (GPT) e sete cães obesos no grupo peso de massa magra (GPMM). Todos os cães foram avaliados com auxílio de escala escore de condição corporal (ECC) de 9 pontos e também tiveram a composição de condição corporal determinada por meio do método de diluição de isótopos de deutério. A anestesia foi induzida com 150 mg/kg/h com auxílio de bomba de infusão de propofol até os animais perderem a consciência. Os animais do GPT receberam a infusão de propofol baseado no peso total; os animais do GPMM receberam infusão de propofol baseado no peso de massa magra; e os cães do GC receberam propofol baseado no peso total. Os parâmetros fisiológicos como frequência cardíaca, pressão arterial sistêmica, saturação de oxi-hemoglobina e presença de apneia foram registrados antes e após a indução. A dose empregada de propofol foi 10,7 ± 2,8mg/kg, 14,1 ± 4,7mg/kg e 7,6 ± 1,5mg/kg nos grupos GC, GPMM e GPT, respectivamente, sendo a diferença significante (p<0,001). Na comparação entre os diferentes momentos dentro de cada grupos, observou-se diferença significativa no GC em relação à PAS, onde os valores obtidos após a indução da anestesia (150,8 ± 32,2mmHg) foram menores do que o basal (180,0 ± 34,8mmHg) (p=0,048). No grupo GPMM observou-se diferença na PAD, sendo que os valores basais (103,6 ± 29,1mmHg) foram mais elevados do que após a indução anestésica (79,3 ± 22,8) (p=0,018). Em relação a oxi-hemoglobina periférica houve diferença significativa entre os valores basais e os obtidos após indução da anestesia em todos os grupos sendo. p=0,027, p=0,006 e p=<0,001, respectivamente nos grupos GC, GPMM e GPT. O presente estudo demonstrou que cães obesos requerem dose menor de propofol (7,6 ± 1,5mg/kg) na indução da anestesia em relação aos cães com peso normal (10,7 ± 2,8mg/kg) ao serem anestesiados com a dose baseada no peso total. Não foi possível demostrar que cães obesos que tiveram a dose calculada baseada apenas no peso de massa magra (14,1 ± 4,7mg/kg) necessitem de doses similares a de cães com peso normal com o calculo baseado no peso total (10,7 ± 2,8mg/kg) / The anesthesia induction of the obese dog poses a great challenge to the veterinary anesthesiologist since these patients present respiratory and cardiovasvular alterations. Besides that, there is little information on anesthetic protocols in the literature. Therefore, the objective was to compare the anesthesia induction in obese dogs (body score condicional equal to or greater than 8) using propofol in dosages based on lean body weight or total body weight. Thirty-five dogs were distributed in three groups: 13 dogs with average weight in the control group (CG); 15 obese dogs in total body weight group (TBWG) and seven obese dogs in lean body weight group (LBWG). All dogs were evaluated according to a body condition score chart (BCS) of 9 points and also had their body composition determined using the deuterium dilution method. Anesthesia was inducted with 150 mg/kg/h through a propofol infusion pump until animals lost consciousness. Animals in TBWG received propofol infusion based on total body weight; the animals in LBWG received propofol infusion based on lean body mass, and the dogs in CG received propofol infusion based on total body weight. Physiological parameters such as heart rate, systemic arterial pressure, oxyhemoglobin saturation and the presence of apnea were recorded previous to and post induction. Propofol dose used was 10.7 ± 2.8mg/kg, 14.1 ± 4.7mg/kg and 7.6 ± 1.5mg/kg in groups CG, LBWG and TBWG, respectively, with a significant difference (p<0.001). Comparing different moments within each group, there was a significant difference in GC related to SAP, where values obtained post induction (150.8 ± 32.2) were smaller than basal (180 ± 34.8) (p=0.048). In LBWG there was a difference in DAP, where basal values (103.6 ± 29.1) were higher than post induction (79.3 ± 22.8) (p=0.018). There were significant differences in peripheral oxyhemoglobin saturation between basal values and post anesthesia induction values in all groups with p=0.027, p=0.006 and p<0.001 in CG, LBWG and TBWG, respectively. The current study shows that obese dogs require smaller propofol doses (7.6 ± 1.5mg/kg) than average weight dogs (10.7 ± 2.8mg/kg) when induction anesthesia based on total body weight dosage. It was not possible to demonstrate that obese dogs with doses based on lean body mass (14.1 ± 4.7mg/kg) have propofol dosage needs similar to average weight dogs with dosage based on total body weight (10.7 ± 2.8mg/kg)

Foram estudadas 456 gestantes adolescentes « 18 anos) atendidas em pré-natal multiprofissional no Hospital das Clínicas da FMUSP entre agosto de 1997 e maio de 2002, sem patologias clínicas e com início do pré-natal antes da 283 -semana, Investigou-se retrospectivamente fatores que pudessem estar associados com o alto risco descrito de pré-eclâmpsia para esse grupo etário. A incidência de pré-eclâmpsia (PA ~ 140x90 em duas ocasiões e proteinúria significativa) foi de 6,14%, embora em adicionais 13% tenha ocorrido hipertensão sem confirmação da doença em questão, perfazendo a taxa de 19,74% para a presença de qualquer tipo de hipertensão na gravidez. As pacientes com pré-eclâmpsia receberam dieta hipossódica em 59% das vezes e medicação hipotensora, em 43% , sendo a média de proteinúria de 1,27g em 24 h. Tais pacientes apresentaram mais parto cesárea, principalmente por desproporção céfalo-pélvica e distocia funcional, que estava associada com maior risco para indução do parto. O tempo de intemação e de analgesia foi significantemente maior, assim como o uso de anestesia tipo bloqueio (raqui ou peridural). A gravidez resultou em mais recém nascidos grandes para a idade gestacional (GIG), assim como mais recém-nascidos pequenos para a idade gestacional, com os demais dados neonatais equivalentes com o resto das adolescentes. Na análise univariada, estiveram associadas com o diagnóstico de pré- eclâmpsia as seguintes variáveis: estado conjugal solteira ao final da gravidez, a raça negra, o antecedente familiar de pré-eclâmpsia, o peso matemo ao início do pré- natal, o ácido úrico com 32 e 36 semanas, a hipocalciúria com 36 semanas e a placenta localizada lateralmente com 26 e 30 semanas, assim como o ganho de peso semanal a partir da 213 semana e a pressão arterial sistólica e diastólica a partir da 253 semana. Na análise multivariada, permaneceram independentes e significativos apenas as variáveis antecedente familiar (OR=3,85), estado civil solteira (OR=2,80) e o ácido úrico com 32 sem (OR=I,76). Assim, parece que o mecanismo fisiopatológico associado a pré-eclâmpsia comporta não somente dados biológicos e genéticos, como também questões psicossociais e nutricionais, que necessitam ser melhor estudadas / They were studied 456 adolescent pregnant woman «18 years) assisted in comprehensive prenatal care in the Hospital das Clinicas of the College of Medicine of the São Paulo University between August of 1997 and May of 2002, without clinical pathologies and with beginning of the prenatal before for 28th week. It was investigated in retrospective study factors that could be associated with the high described risk of preeclampsia for that age group. The preeclampsia (~140x90 in two occasions and significant proteinuria) incidence it was of 6,14%, although in additional 13% have happened hypertension without confirmation of the disease, with the global rate of 19,74% for the presence of any hypertension type in the pregnancy. The patients with preeclampsia received low sodium diet in 59% of the times and medication, in 43%, being the average of proteinuria of 1,27g in 24 h. These patients had more Cesarean section, mainly for cefalo-pelvic disproportion and functional distocia, that was associated with larger risk for induction of the labor. The time of intemment and of analgesia it were larger, as well as the use of block anesthesia. The pregnancy resulted in more newborn big for the gestational age (010), as well as newborn small for the gestational age, with the other neonatal data equivalent with the general population of teenagers. In the univariate analysis, It was associated with the preeclampsia diagnosis the following variables: unmarried woman at the end ofthe pregnancy, the black race, the antecedent ofpreeclampsia in the relatives, the maternal weight at the beginning of the prenatal care, the uric acid with 32 and 36 weeks, the hipocalciuria with 36 weeks and the lateral placenta with 26 and 30 weeks, as well as the weekly gain of weight after the 21 st week and the systolic and diastolic blood pressure after the 25th week. ln the multivariate analysis , the following variables were independent and significant: family antecedent (OR=3,85), unmarried woman (OR=2,80) and the uric acid with 32 weeks (OR=1,76). Thus, it seems that the mechanism associated with preeclampsia behaves not only biological and genetic data, as well as subjects psychosocial and nutritional issues, that need to be studied better

A antinocicepção é descrita como redução na capacidade de perceber a dor, sendo importante componente para o organismo, quando este está envolvido em situações de emergência. Muitos neurotransmissores e seus receptores estão envolvidos nas diversas formas de analgesia, como por exemplo, monoaminas, acetilcolina e opióides endógenos. A analgesia pós-ictal é uma das muitas formas de antinocicepção em que o recrutamento de cada um desses neurotransmissores é descrito. Algumas evidências mostram o envolvimento de estruturas mesencefálicas em processos antinociceptivos (GEBHART & TOLEIKIS, 1978; COIMBRA e col., 1992; COIMBRA & BRANDÃO, 1997; CASTILHO e col., 1999) O colículo inferior é a estrutura mesencefálica responsável pela origem e expressão de crises audiogênicas (MCCOWN e col, 1987). Estruturas como a substância cinzenta periaquedutal, camadas profundas do colículo superior e núcleo central do colículo inferior, têm sido implicadas em processos convulsivos (DE PAULIS e col., 1990; CARDOSO e col., 1994, MCCOWN e col., 1984). Recentes relatos demonstraram que a estimulação dessas estruturas, em cujo substrato neural há neurônios positivos para beta-endorfina e leu-encefalina (EICHENBERGER e col., 2002; OSAKI e col., 2003) pode gerar processos antinociceptivos (CASTILHO e col., 1999; GEBHART & TOLEIKIS, 1978), seja de natureza opióide (NICHOLS e col., 1989), seja de natureza monoaminérgica (COIMBRA e col., 1992; COIMBRA & BRANDÃO, 1997). Neste trabalho, foi realizado o estudo periférico para investigar o envolvimento, mais especificamente, dos receptores opióides µ1 na analgesia que segue as crises convulsivas evocadas pela administração de um antagonista de canais de Cl- ligados ao GABA, como é o caso do pentilenotetrazol, administrado por via intraperitoneal, após o pré-tratamento com o bloqueador opióide específico, o naloxonazine, administrado em diferentes doses. Assim também, estudou-se a participação do colículo inferior nesse processo de inibição de dor, mensurado pelo teste de retirada de cauda. O pré-tratamento com naloxonazine, administrado por via intraperitoneal por tempo prolongado (24h), mas não agudamente (10 min), antagonizou a antinocicepção evocada por convulsões tônico-clônicas. Microinjeções de naloxonazine realizadas nos núcleos central, cortical externo e cortical dorsal do colículo inferior antagonizaram a analgesia induzida por crises convulsivas tônico-clônicas, efeito que segue uma curva dose-resposta, bem como, causaram a redução do tempo do processo convulsivo induzido pelo bloqueio ionóforo de canais de cloro ligados ao GABA. Em vista disso, podemos sugerir o envolvimento de receptores µ1-opióides e das redes neurais do colículo inferior na elaboração da analgesia pós-ictal, e na modulação de crises convulsivas tônico-clônicas. / The post-ictal analgesia is an impressive kind of antinociception, in wich the involvement of many neural systems has been demonstrated. The inferior colliculus is a brainstem structure responsible for the origin and elaboration of convulsive responses (MCCOWN e col, 1987) in the presence of audiogenic stimulus or during the treatment of supralimiar administration of GABAergic antagonists. Mesencephalic structures such as the periaqueductal gray matter, the deep layers of the superior colliculus and the central nucleus of the inferior colliculus have been implicated in convulsive processes (DE PAULIS e col., 1990; CARDOSO e col., 1994, MCCOWN e col., 1984). The stimulation of these areas, in whose neural substrates there are beta-endorphin- and leu-enkephalin-positive neurons (EICHENBERGER e col., 2002; OSAKI e col., 2003) evokes antinociceptive processes (CASTILHO e col., 1999; GEBHART & TOLEIKIS, 1978), of either opioid (NICHOLS e col., 1989) or monoaminergic COIMBRA e col., 1992; COIMBRA & BRANDÃO, 1997) nature. The aim of the present work is to investigate the involvement of the µ1-opioid receptor-mediated system in the post-ictal analgesia. The antinociceptive responses were recorded by the tail-flick test, after the pre-treatment with the specific opioid antagonist naloxonazine, administrated either by peripheral (intraperitoneally) or central (into the inferior colliculus neural network) way, in different doses. The peripheral lon-lasting (24h) but not acute (10 min) pre-treatment with naloxonazine antagonized the analgesia evoked by tonic-clonic convulsions. Microinjections of naloxonazine in the central, dorsal cortical and external cortical nuclei of inferior colliculus antagonized the analgesia induced by tonic-clonic reactions, whose effect followed a dose-response curve. Also, microinjections of naloxonazine into the inferior colliculus decrease the time of convulsions reactions. These findings suggest the involvement of µ1-opiate receptors and the neural networks of the inferior colliculus in this antinociceptive phenomenon, and, in addition, the involvement of these receptors in the modulation of tonic-clonic convulsive reactions has been suggested. In conclusion, the endogenous opioid peptides-mediated system of the neural networks of the inferior colliculus is clearly implicated in the elaboration of the post-ictal antinociception and in the modulation of tonic-clonic convulsions. In theses processes, µ1-opioid receptors of the central nucleus, as well as of the cortical dorsal and cortical external nuclei of the inferior colliculus are crucially involved.

A dor aguda pós-operatória tem suscitado grande interesse por seu potencial risco de cronicidade caso não seja adequadamente tratada, podendo piorar a recuperação e a qualidade de vida do paciente. Este estudo comparativo foi realizado de maneira prospectiva, aleatória e encoberta para se avaliar os efeitos sedativos, analgésicos e na resposta inflamatória da administração de metadona ou tramadol. Foram incluídos 28 cães com ruptura de ligamento cruzado e submetidos a osteotomias corretivas, distribuídos em três grupos: TRA - 4 mg/kg de tramadol; MET0,5 - 0,5 mg/kg de metadona e MET0,7 - 0,7 mg/kg de metadona, administrados por via intramuscular na medicação pré-anestésica (MPA). A indução da anestesia foi realizada com propofol e os animais foram intubados e mantidos com isofluorano em oxigênio a 100%. Parâmetros fisiológicos (frequências cardíaca, respiratória e pressão arterial) foram avaliados nos dados momentos: TBL (basal), T1 (uma hora após a MPA), T2 (duas horas após, transcirúrgico), T4 (quatro horas após, pós-cirúrgico), T6 (seis horas após) e T24 (24 horas após). Escores de sedação e dor foram avaliados por escalas em TBL, T1, T4, T6 e T24. Coletas de sangue para mensuração de IL-6 foram realizadas em TBL, T1, T6 e T24. Animais apresentando escores na escala análoga visual maiores que 4, na escala de Glasgow maiores que 5 ou na escala de Colorado maiores que 2, recebiam analgesia complementar com o fármaco do grupo em que foram alocados. Utilizou-se análise de variância para medidas repetidas (ANOVA) com pós teste de Tukey para análise estatística dos parâmetros fisiológicos. Escores de dor e sedação foram comparados entre diferentes momentos por teste de Friedman, seguido de teste de Tukey. Os grupos foram comparados em um mesmo momento, por teste não-paramétrico Kruskal-Wallis, seguido de teste post hoc de Dunn. Valores de p<0,05 expressam diferença significativa. Não houve diferença entre os grupos com relação a idade, peso e sexo, além de tempos de cirurgia e extubação. Os valores de frequência cardíaca, respiratória e pressão arterial mantiveram-se dentro dos parâmetros aceitáveis nas condições avaliadas, havendo redução nos valores em T2 nos grupos MET0,5 e MET 0,7 com relação ao TBL. Para os escores na escala análoga visual, dentro do grupo TRA houve aumento significativo em T4 comparado a TBL, T1 e T24 e entre T1 e T6 (p<0,001). No grupo MET0,5, houve aumento significativo de T1 para T4 (p<0,001). Os grupos TRA e MET0,5 apresentaram médias±DP mais altas (3,4±2,5 e 2,5±2,6, respectivamente) que MET0,7 (1,1±1,5) em T4. Na escala de dor de Glasgow, em MET0,5, houve aumento significativo no momento T4 com relação aos momentos T6 e T24 (p<0,001). No grupo MET0,7, houve aumento significativo no momento T4 para TBL e T24 (p<0,001). Houve maior necessidade de resgate no grupo TRA (quatro animais em T4 e dois em T6), contudo após um incremento na dose do fármaco, obteve-se controle adequado da dor. Não foram observadas diferenças estatísticas significativas quanto ao grau de sedação, escala de Colorado e interleucinas séricas entre os grupos e momentos avaliados. A metadona e o tramadol foram eficazes em promover analgesia pós-operatória quando administrados antes do procedimento cirúrgico e suas doses ajustadas no resgate analgésico. Ambos parecem ter tido efeito sobre a liberação de IL-6, sugerindo modulação da resposta inflamatória aguda / Acute postoperative pain has aroused great interest because of their potential risk of chronification if not treated properly, may worsen the recovery and quality of life of the patient. This clinical trial was conducted in a prospective, randomized, double-blind comparison to evaluate the efficacy of methadone and tramadol as premedication in dogs. 28 animals with ruptured cruciate ligament undergoing corrective osteotomies were divided into three groups: TRA - received 4 mg/kg of tramadol; MET0.5 - received 0.5 mg/kg of methadone and MET0.7 - received 0.7 mg/kg of methadone intramuscularly. Anesthesia induction was performed with propofol and animals intubated for general anesthesia with isoflurane in 100% oxygen. Physiological parameters (heart and respiratory rate and blood pressure) were evaluated at specified times (in hours): TBL (baseline), T1, T2, T4, T6 and T24. Pain and sedation scores were described by use of visual analogue scale (VAS), composite modified Glasgow scale and Colorado scale at TBL, T1, T4, T6 and T24. Blood samples for measurement of IL-6 were performed in moments TBL, T1, T6 and T24. Statistical analysis was performed by ANOVA for repeated measurements. Pain and sedation scores were compared in different times by Friedman\'s test followed by Tukey test. Groups were compared by non-parametric Kruskal-Wallis test followed by post hoc Dunn\'s test. Values with p <0.05 were considered significant. There was no statistically significant difference among groups with respect to age, weight, gender, time of surgery and time for extubation. Heart rate, respiratory rate and blood pressure values were maintained within acceptable values and a reduction was observed in T2 in groups MET0.5 and MET0.7 in relation to TBL. Increases in VAS scores were observed in TRA in T4 compared to TBL, T1 and T24 and between T1 and T6 (p<0.001). In MET0.5 there was a significant increase in T4 when compared to T1 (p<0.001). Groups TRA and MET0.5 showed higher mean±SD values (3.4±2.5 and 2.5±2.6, respectively) than MET0.7 (1.1±1.5) in T4. In Glasgow pains scale, there was significant increase in T4 when compared to T6 and T24 (p<0.001). In MET0.7, T4 showed higher scores than TBL and T24 (p<0.001). TRA showed greater demand of rescue analgesia (four animals in T4 and two in T6), however after a dose adjustment pain was controlled. There were no statistically significant differences in degree of sedation, Colorado acute pain scale and serum interleukin among groups and time points assessed. Both drugs were effective in promoting postoperative analgesia when administered prior to surgical procedure and the doses adjusted according to demand. The drugs appear to have an effect on the release of IL-6, suggesting acute inflammatory response modulation