Resumo: Objetivou-se avaliar a anestesia raquidiana com ropivacaína em cães alterando a baricidade do anestésico local, investigando as alterações hemodinâmicas e complicações. Foram utilizados seis cães, Beagle, 4 anos, submetidos a anestesia inalatória com isofluorano e aos tratamentos: Ghipo = anestesia raquidiana hipobárica (0,5 mL NaCl 0,9% + 0,5 mL ropivacaína 0,75%); Giso = anestesia raquidiana isobárica (0,5 mL NaCl 1,53% + 0,5 mL ropivacaína 0,75%); Ghiper = anestesia raquidiana hiperbárica (0,5 mL glicose 10% + 0,5 mL ropivacaína 0,75%). Após indução anestésica e manutenção com isofluorano, os animais foram posicionados em decúbito lateral direito para a passagem de um cateter de artéria pulmonar pela veia jugular esquerda. Após esse procedimento, a punção subaracnóide foi realizada entre L5-L6 com uma agulha espinhal 22G, seguida da administração de 1 mL de anestésico local em 1 min. Os animais foram mantidos por 60 minutos anestesiados em decúbito ventral. A FC, f, PAM, DC, PAPm e TºC apresentaram aumento progressivo em todos os grupos enquanto que a PCPm, apenas no GHIPO, aumentou ao longo de todos os momentos. O IRPT no GISO apresentou valores significativamente superiores no M1, M5 e M10 comparado aos demais grupos, exceto no M5, em que o GISO diferiu somente do GHIPER. O IRVP no GISO aumentou no M5 em comparação ao MB. Foram observados efeitos adversos como déficit motor unilateral, atonia vesical, excitação, dor aguda e quemose. Conclui-se que as alterações hemodinâmicas não foram relevantes, embora a anestesia inalatória com isofluorano tenha influído sobre os resultados obtidos / Abstract:The aim of the study was to assess spinal anesthesia with ropivacaine in dogs altering the local anesthetic agent's baricity in order to investigate hemodynamic changes and complications. Six beagle dogs aged 4 years old were anesthetized with isoflurane and subjected to the treatments: Ghypo = spinal anesthesia with hypobaric ropivacaine (0.5 mL of 0.9% NaCl + 0.5 mL ropivacaine at 0,75%); Giso = isobaric spinal anesthesia (0.5 mL of 0,906% NaCl + 0.5 mL ropivacaine at 0,75%); Ghyper = hyperbaric spinal anesthesia (0.5 mL of 10% glucose + 0.5 mL ropivacaine at 0.75%). After induction to anesthesia and maintenance with isoflurane, animals were positioned in right lateral recumbency for pulmonary artery catheterization through the left jugular vein. Rightafter, spinal anesthesia was performed between L5-L6 using a 22G Quincke tip needle, followed by administration of 1 mL of local anesthetic during 1 minute. Animals were maintained under anesthesia for 60 minutes in ventral recumbency. HR, FR, MAP, CO, mPAP and body temperature progressively increased in all groups. whereas PCWP increased only in GHYPO at all time points. The TPRI showed significantly higher values in GISO at M1, M5 and M10 compared to the other groups, except for M5, during which GISO differed only from GHYPER. The PVRI increased at M5 compared to MB in GISO. Side effects such as unilateral motor deficit, bladder atony, excitation, acute pain and chemosis were observed. In conclusion, the hemodynamic changes were not relevant, although inhalation anesthesia with isoflurane might have influenced the results / Orientador:Valéria Nobre Leal de Souza Oliva / Banca:Luis Emiliano Cisneros Alvarez / Banca:Andre Escobar / Banca:Paulo Sergio Patto dos Santos / Banca: Wagner Luis Ferreira / Doutor

O propofol é o fármaco mais freqüentemente empregado na indução da anestesia de pequenos animais apesar de seu efeito depressor cardiovascular e respiratório. Sabe-se que a associação com outros fármacos pode determinar a redução de suas doses e essa possibilidade é pouco conhecida nos felinos. No presente estudo, foram avaliados os efeitos do emprego do midazolam associado ao propofol na indução da anestesia em gatas submetidas a ovariossalpingo-histerectomia. Foram utilizadas 30 gatas, jovens adultas, submetidas a ovariossalpingo-histerectomia. Após serem pré-tratadas com acepromazina e morfina, foram distribuídas em três grupos: o grupo GP recebeu indução somente com propofol; o grupo GMP recebeu midazolam imediatamente antes da indução com propofol; e o grupo GPM recebeu uma subdose de propofol, seguido por midazolam e novamente propofol até ser possível a intubação. Foi avaliada a redução da dose do propofol quando em associação com midazolam; a qualidade de intubação endotraqueal e grau de relaxamento muscular; a qualidade de indução da anestesia após a administração de propofol ou propofol em associação com midazolam, analisando qual a melhor seqüência de administração e a qualidade e o tempo de recuperação nas gatas submetidas à indução da anestesia com propofol ou propofol-midazolam. Foram também observados as freqüências cardíaca e respiratória, pressão arterial, oximetria, capnometria e hemogasometria. A partir dos resultados obtidos verificou-se que a dose de propofol para indução da anestesia em gatas é reduzida em 34% e 23% quando precedido ou antecedido pelo midazolam, respectivamente; a associação com midazolam não intensificou o relaxamento muscular promovido pelo propofol, não interferindo assim na qualidade de intubação endotraqueal das gatas; o uso prévio de midazolam em relação ao propofol na indução da anestesia não determinou agitação, tampouco excitação nas gatas; ambas as seqüências de administração da associação propofol-midazolam são factíveis, porém a seqüência propofol-midazolam se mostrou superior devido a menor dose empregada de propofol; do ponto de vista clínico, a associação com midazolam determinou prolongamento do tempo de recuperação das gatas, mas não determinou efeitos adversos no momento de despertar. / Propofol is the most frequent drug used for induction of anesthesia in small animals. Its cardiovascular and respiratory depressor effects are well known. The association with other drugs may determine a reduction of its dose, and this possibility is not well known in cats. The present study evaluated the effects of midazolam associated to propofol during induction of anesthesia in cats submitted to ovariohysterectomy. Thirty cats were enrolled in this study. After premedicated with acepromazine and morphine, they were distributed in three groups: GP group that received only propofol for induction; GMP group that received midazolam immediately before propofol induction; and GPM group that received a sub dose of propofol, followed by midazolam and propofol until intubation was possible. The dose reduction of propofol when associated to midazolam; the quality of endotracheal intubation and the muscle relaxation degree were evaluated; the quality of anesthetic induction after administration of propofol or propofol associated with midazolam was compared, in order to identify the best administration sequence. The quality and time of recovery were evaluated as well. Heart and respiratory rates, arterial blood pressure, oximetry, capnometry and hemogasometry were also accessed. The results showed that propofol dose for anesthesia induction was reduced in 34% and 23% when preceded or succeeded by midazolam, respectively; The association with midazolam did not increase muscle relaxation promoted by propofol, therefore not interfering in the quality of endotracheal intubation in cats; the use of midazolam previously to propofol on anesthetic induction did not cause agitation or excitement; both sequence of administration of the association of propofol-midazolam were effective, although the sequence propofol-midazolam was been shown to be better, since the propofol dose was lower; from the clinic point of view, the association with midazolam determined a prolongation of the recovery, however no side effects were noted.

O propofol é o fármaco mais freqüentemente empregado na indução da anestesia de pequenos animais apesar de seu efeito depressor cardiovascular e respiratório. Sabe-se que a associação com outros fármacos pode determinar a redução de suas doses e essa possibilidade é pouco conhecida nos felinos. No presente estudo, foram avaliados os efeitos do emprego do midazolam associado ao propofol na indução da anestesia em gatas submetidas a ovariossalpingo-histerectomia. Foram utilizadas 30 gatas, jovens adultas, submetidas a ovariossalpingo-histerectomia. Após serem pré-tratadas com acepromazina e morfina, foram distribuídas em três grupos: o grupo GP recebeu indução somente com propofol; o grupo GMP recebeu midazolam imediatamente antes da indução com propofol; e o grupo GPM recebeu uma subdose de propofol, seguido por midazolam e novamente propofol até ser possível a intubação. Foi avaliada a redução da dose do propofol quando em associação com midazolam; a qualidade de intubação endotraqueal e grau de relaxamento muscular; a qualidade de indução da anestesia após a administração de propofol ou propofol em associação com midazolam, analisando qual a melhor seqüência de administração e a qualidade e o tempo de recuperação nas gatas submetidas à indução da anestesia com propofol ou propofol-midazolam. Foram também observados as freqüências cardíaca e respiratória, pressão arterial, oximetria, capnometria e hemogasometria. A partir dos resultados obtidos verificou-se que a dose de propofol para indução da anestesia em gatas é reduzida em 34% e 23% quando precedido ou antecedido pelo midazolam, respectivamente; a associação com midazolam não intensificou o relaxamento muscular promovido pelo propofol, não interferindo assim na qualidade de intubação endotraqueal das gatas; o uso prévio de midazolam em relação ao propofol na indução da anestesia não determinou agitação, tampouco excitação nas gatas; ambas as seqüências de administração da associação propofol-midazolam são factíveis, porém a seqüência propofol-midazolam se mostrou superior devido a menor dose empregada de propofol; do ponto de vista clínico, a associação com midazolam determinou prolongamento do tempo de recuperação das gatas, mas não determinou efeitos adversos no momento de despertar. / Propofol is the most frequent drug used for induction of anesthesia in small animals. Its cardiovascular and respiratory depressor effects are well known. The association with other drugs may determine a reduction of its dose, and this possibility is not well known in cats. The present study evaluated the effects of midazolam associated to propofol during induction of anesthesia in cats submitted to ovariohysterectomy. Thirty cats were enrolled in this study. After premedicated with acepromazine and morphine, they were distributed in three groups: GP group that received only propofol for induction; GMP group that received midazolam immediately before propofol induction; and GPM group that received a sub dose of propofol, followed by midazolam and propofol until intubation was possible. The dose reduction of propofol when associated to midazolam; the quality of endotracheal intubation and the muscle relaxation degree were evaluated; the quality of anesthetic induction after administration of propofol or propofol associated with midazolam was compared, in order to identify the best administration sequence. The quality and time of recovery were evaluated as well. Heart and respiratory rates, arterial blood pressure, oximetry, capnometry and hemogasometry were also accessed. The results showed that propofol dose for anesthesia induction was reduced in 34% and 23% when preceded or succeeded by midazolam, respectively; The association with midazolam did not increase muscle relaxation promoted by propofol, therefore not interfering in the quality of endotracheal intubation in cats; the use of midazolam previously to propofol on anesthetic induction did not cause agitation or excitement; both sequence of administration of the association of propofol-midazolam were effective, although the sequence propofol-midazolam was been shown to be better, since the propofol dose was lower; from the clinic point of view, the association with midazolam determined a prolongation of the recovery, however no side effects were noted.

Fentanyl has historically been used to reduce inhalant anesthetic requirements in the dog, with the end goal of reducing detrimental cardiovascular effects seen with their use. While fentanyl has been investigated in this context with the older agent enflurane, this agent is no longer in common use. In the current literature, no studies exist that compare the effects of low and high doses of fentanyl on cardiovascular function in dogs anesthetized with isoflurane. In previous literature, a high dose of fentanyl improved cardiovascular function in enflurane anesthetized dogs only following correction of bradycardia associated with its use. The objective of this study was to evaluate the effect of two doses of fentanyl on isoflurane requirement in the dog, followed by an evaluation of cardiovascular function in the isoflurane-anesthetized dog at equivalent depth of anesthesia. The hypothesis was that fentanyl would reduce inhalant requirements in a dose dependent fashion, and that cardiovascular function would increase with fentanyl administration only following correction of bradycardia. A total of 8 healthy adult male beagle dogs were enrolled in this study, which was performed in a randomized cross-over design. Minimum Alveolar Concentration (MAC) was determined in these dogs via a 30 mA electric stimulation both before and after administration of a low (loading dose 30 µg/kg, continuous rate infusion (CRI) of 0.2 µg/kg/minute) or high (loading dose 90 µg/kg, CRI 0.8 µg/kg/min) dose of fentanyl. A 7-day washout was observed between experimental days. Following MAC determination, in a subsequent anesthetic episode animals were placed at a MAC multiple of 1.3 and cardiovascular and blood gas parameters were evaluated before and after each fentanyl dose in the presence and absence of bradycardia. Fentanyl decreased MAC in a dose-dependent fashion (p < 0.001), with the low dose reducing MAC by about 42% and the high dose by about 77%. MAC reduction, however, did not translate into improvement in cardiovascular function, with a significant reduction in cardiac index and oxygen delivery noted with both doses (p < 0.01) that was not different between treatments. Normal mean arterial pressures were maintained with both treatments despite these effects. Only with the high dose, however, correction of bradycardia caused an increase in both cardiac index and oxygen delivery (p < 0.02) when compared to isoflurane alone. In clinically healthy dogs, administration of a high dose of fentanyl increased cardiac function following correction of bradycardia, but a decrease was observed when bradycardia went uncorrected. Further studies are needed in order to evaluate these effects in clinical patients. / Master of Science / Fentanyl, a potent opioid painkiller, has historically been used to reduce inhalant anesthetic requirements in the dog, with the end goal of reducing detrimental effects on the heart and blood vessels seen with their use. While fentanyl has been investigated in this context with the older agent enflurane, this agent is no longer in common use. In the current literature, no studies exist that compare the effects of low and high doses of fentanyl on heart function in dogs anesthetized with isoflurane. In previous literature, a high dose of fentanyl improved blood flow in enflurane anesthetized dogs only following correction of the low heart rate associated with its use. The objective of this study was to evaluate the effect of two doses of fentanyl on isoflurane requirement in the dog, followed by an evaluation of heart function and blood flow in the isoflurane-anesthetized dog at equivalent depth of anesthesia. The hypothesis was that fentanyl would reduce isoflurane requirements in a dose dependent fashion, and that heart function would increase with fentanyl administration only following correction of low heart rate. A total of 8 healthy adult male beagle dogs were enrolled in this study, which was performed in a randomized cross-over design. Inhalant anesthetic requirement was assessed with an electric stimulation both before and after administration of a low or high dose of fentanyl. A 7-day washout was observed between experimental days. In a subsequent anesthetic episode animals were placed at a surgical anesthetic depth and cardiac and blood gas parameters were evaluated before and after each fentanyl dose in the presence and absence of low heart rate. Fentanyl decreased inhalant requirements in a dose-dependent fashion. This did not translate into improvement in cardiovascular function, with a significant reduction in blood flow and oxygen delivery noted with both doses that was not different between treatments. Normal blood pressure was maintained with both treatments despite these effects. Only with the high dose, however, correction of low heart rate caused an increase in both blood flow and oxygen delivery when compared to isoflurane alone. In clinically healthy dogs, administration of a high dose of fentanyl increased heart function following correction of low heart rate, but a decrease was observed when the low rate went uncorrected. Further studies are needed in order to evaluate these effects in clinical patients.

Submitted by CAIO JOSÉ XAVIER ABIMUSSI null (caioabimussi@fmva.unesp.br) on 2016-01-17T16:54:36Z No. of bitstreams: 1 TESE_VERSÃO FINAL_CORRIGIDA.pdf: 2286468 bytes, checksum: 496c8f6ffc7595636c5c52c061679bc7 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-01-18T15:52:49Z (GMT) No. of bitstreams: 1 abimussi_cjx_dr_araca.pdf: 2286468 bytes, checksum: 496c8f6ffc7595636c5c52c061679bc7 (MD5) / Made available in DSpace on 2016-01-18T15:52:49Z (GMT). No. of bitstreams: 1 abimussi_cjx_dr_araca.pdf: 2286468 bytes, checksum: 496c8f6ffc7595636c5c52c061679bc7 (MD5) Previous issue date: 2015-12-14 / Não recebi financiamento / Objetivou-se avaliar a anestesia raquidiana com ropivacaína em cães alterando a baricidade do anestésico local, investigando as alterações hemodinâmicas e complicações. Foram utilizados seis cães, Beagle, 4 anos, submetidos a anestesia inalatória com isofluorano e aos tratamentos: Ghipo = anestesia raquidiana hipobárica (0,5 mL NaCl 0,9% + 0,5 mL ropivacaína 0,75%); Giso = anestesia raquidiana isobárica (0,5 mL NaCl 1,53% + 0,5 mL ropivacaína 0,75%); Ghiper = anestesia raquidiana hiperbárica (0,5 mL glicose 10% + 0,5 mL ropivacaína 0,75%). Após indução anestésica e manutenção com isofluorano, os animais foram posicionados em decúbito lateral direito para a passagem de um cateter de artéria pulmonar pela veia jugular esquerda. Após esse procedimento, a punção subaracnóide foi realizada entre L5-L6 com uma agulha espinhal 22G, seguida da administração de 1 mL de anestésico local em 1 min. Os animais foram mantidos por 60 minutos anestesiados em decúbito ventral. A FC, f, PAM, DC, PAPm e TºC apresentaram aumento progressivo em todos os grupos enquanto que a PCPm, apenas no GHIPO, aumentou ao longo de todos os momentos. O IRPT no GISO apresentou valores significativamente superiores no M1, M5 e M10 comparado aos demais grupos, exceto no M5, em que o GISO diferiu somente do GHIPER. O IRVP no GISO aumentou no M5 em comparação ao MB. Foram observados efeitos adversos como déficit motor unilateral, atonia vesical, excitação, dor aguda e quemose. Conclui-se que as alterações hemodinâmicas não foram relevantes, embora a anestesia inalatória com isofluorano tenha influído sobre os resultados obtidos. / The aim of the study was to assess spinal anesthesia with ropivacaine in dogs altering the local anesthetic agent’s baricity in order to investigate hemodynamic changes and complications. Six beagle dogs aged 4 years old were anesthetized with isoflurane and subjected to the treatments: Ghypo = spinal anesthesia with hypobaric ropivacaine (0.5 mL of 0.9% NaCl + 0.5 mL ropivacaine at 0,75%); Giso = isobaric spinal anesthesia (0.5 mL of 0,906% NaCl + 0.5 mL ropivacaine at 0,75%); Ghyper = hyperbaric spinal anesthesia (0.5 mL of 10% glucose + 0.5 mL ropivacaine at 0.75%). After induction to anesthesia and maintenance with isoflurane, animals were positioned in right lateral recumbency for pulmonary artery catheterization through the left jugular vein. Rightafter, spinal anesthesia was performed between L5-L6 using a 22G Quincke tip needle, followed by administration of 1 mL of local anesthetic during 1 minute. Animals were maintained under anesthesia for 60 minutes in ventral recumbency. HR, FR, MAP, CO, mPAP and body temperature progressively increased in all groups. whereas PCWP increased only in GHYPO at all time points. The TPRI showed significantly higher values in GISO at M1, M5 and M10 compared to the other groups, except for M5, during which GISO differed only from GHYPER. The PVRI increased at M5 compared to MB in GISO. Side effects such as unilateral motor deficit, bladder atony, excitation, acute pain and chemosis were observed. In conclusion, the hemodynamic changes were not relevant, although inhalation anesthesia with isoflurane might have influenced the results.

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No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-09-21 / BACKGROUND. Untreated pain leads to postoperative complications that prolong hospital stay. The association of analgesic drugs with different mechanisms of action, such as clonidine, allows the use of smaller doses of medication for better control of pain. OBJECTIVES. This dissertation aims to evaluate the use of multimodal analgesia in the control of postoperative pain in patients submitted to videolaparoscopic cholecystectomy (VLC); to compare the analgesic activities of intrathecal and intravenous clonidine for postoperative analgesia; to analyze the need for analgesic drugs in the immediate postoperative (tramadol / morphine) and to identify possible complications. METHOD. A prospective, randomized clinical trial was conducted with patients divided into three blocks, with 20 patients each one: Group I (n = 20) control, submitted to standard anesthesia; Group II (n = 20) intrathecal clonidine, submitted to standard anesthesia associated with the use of intrathecal clonidine; Group III (n = 20) intravenous clonidine, submitted to standard anesthesia associated with the use of intravenous clonidine. RESULTS. The pain scores between the groups did not present significant differences, but a greater analgesic need was observed in the control group (p = 0.005), as well as a higher incidence of nausea and vomiting (p = 0.240), probably due to side effects of morphine as rescue medication. Groups II and III presented a significant reduction of heart rate (p ˂ 0.001), but without clinical repercussion. CONCLUSIONS. In patients undergoing VLC there is evidence that the perioperative administration of alpha 2-agonists preserves hemodynamic stability, decreases opioid consumption and the incidence of nausea and vomiting in the postoperative. / JUSTIFICATIVA. A dor não tratada leva a complicações pós-operatórias que prolongam o tempo de internação hospitalar. A associação de fármacos analgésicos com diferentes mecanismos de ação, como a clonidina, permite usar doses menores de medicamentos para melhor controle da dor. OBJETIVOS. Esta dissertação tem por objetivo avaliar o emprego de analgesia multimodal no controle da dor pós-operatória de pacientes submetidos à colecistectomia por videolaparoscopia (CVLP); comparar as atividades analgésicas da clonidina intratecal e endovenosa para analgesia pós-operatória; analisar a necessidade de drogas analgésicas no pós-operatório imediato (tramadol/morfina) e identificar possíveis complicações. MÉTODO. Foi realizado um estudo de ensaio clínico prospectivo, experimental e randômico, com os pacientes divididos em 03 blocos, com 20 pacientes cada: Grupo I (n=20) controle, submetido à anestesia padrão; Grupo II (n=20) clonidina intratecal, submetido à anestesia padrão associada ao uso de clonidina intratecal; Grupo III (n=20) clonidina endovenosa, submetido à anestesia padrão associada ao uso de clonidina endovenosa. RESULTADOS. Os escores de dor entre os grupos não apresentaram valores com diferenças significativas, porém foi observada maior necessidade analgésica do uso da morfina no grupo controle (p = 0,005), assim como maior incidência de náuseas e vômitos (p=0,240), provavelmente devido aos efeitos colaterais da morfina como medicação de resgate. Os grupos II e III apresentaram uma redução significativa da frequência cardíaca (p ˂0,001), porém sem repercussão clínica. CONCLUSÕES. Nos pacientes submetidos à CVLP há evidências de que a administração perioperatória de alfa 2-agonistas preserva a estabilidade hemodinâmica, diminui o consumo de opióides e a incidência de náuseas e vômitos no pós-operatório.