Made available in DSpace on 2014-06-11T19:35:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-21Bitstream added on 2014-06-13T21:07:07Z : No. of bitstreams: 1 campagnol_d_dr_botfm.pdf: 3603129 bytes, checksum: 6016b81a7cfcb53dc9f89a2b1a5dfcbe (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A metadona é um opióide que possui potência analgésica semelhante à da morfina. Doses elevadas de metadona intravenosa (0,5-1,0 mg/kg), apesar de reduzirem a concentração alveolar mínima do isoflurano (CAMISO), resultam em maior depressão cardíaca que a observada com a morfina intravenosa (1,0 mg/kg) em cães. Com a hipótese de que a metadona peridural poderia proporcionar vantagens clínicas em relação à metadona intravenosa (maior potencialização da anestesia inalatória e maior eficácia analgésica), os estudos apresentados objetivaram comparar aspectos farmacocinéticos e farmacodinâmicos destas vias de administração da metadona em cães. Nos dois estudos iniciais (Capítulos 1 e 2), os mesmos seis animais foram anestesiados com isoflurano e tratados com metadona (0,5 mg/kg) peridural ou intravenosa em ocasiões distintas. No primeiro estudo (Capítulo 1), para comparação da farmacocinética destas duas vias de administração, a concentração de metadona foi determinada no plasma e no líquor da cisterna magna antes e durante 450 minutos após a administração do opióide. No segundo estudo (Capítulo 2), a CAMISO foi mensurada antes e após 2,5 e 5 horas da administração da metadona, mediante a aplicação da estimulação nociceptiva em membro pélvico e torácico (via peridural) ou em membro pélvico apenas (via intravenosa). No último estudo (Capítulo 3), cadelas apresentando tumores mamários, após serem tratadas de forma preemptiva com metadona (0,5 mg/kg) peridural ou intravenosa (10 animais por grupo), foram submetidas à mastectomia unilateral. Nesta etapa, avaliou-se a concentração expirada de isoflurano (ETISO) necessária à realização da mastectomia e, no período pós-operatório, avaliou-se os escores de dor, limiares nociceptivos mecânicos (LNM) das cadeias mamárias e requerimento de resgates analgésicos. No estudo do Capítulo 1, a via... / Methadone is an opioid that has analgesic potency comparable to that of morphine. High doses of intravenous methadone (0.5-1.0 mg/kg), in spite of reducing the minimum alveolar concentration of isoflurane (MACISO), cause greater cardiac depression than intravenous morphine (1 mg/kg) in dogs. The studies presented here aimed to compare some pharmacokinetic and pharmacodynamic aspects of peridural and intravenous methadone in dogs, testing the hypothesis that peridural methadone could result in clinical advantages when compared to intravenous methadone (greater reduction in anesthetic requirements and greater analgesic efficacy). In the first 2 studies (Chapters 1 and 2), the same six animals underwent isoflurane anesthesia and were treated with methadone (0.5 mg/kg) administered via the peridural or intravenous routes during different occasions. During the first study (Chapter 1), in order to compare the pharmacokinetics of these two administration routes, methadone concentrations were determined in plasma and in the cisternal cerebrospinal fluid before and for 450 minutes after opioid injection. During the second study (Chapter 2), MACISO was measured before, 2.5 and 5 hours after methadone injection via nociceptive stimulation of the thoracic and pelvic limb (peridural) or the pelvic limb (intravenous). During the last series of studies (Chapter 3), bitches presented with mammary gland tumors were preemptively treated with peridural or intravenous methadone (0.5 mg/kg) (10 animals per group) and underwent unilateral mastectomy. The end-tidal isoflurane concentration (ETISO) necessary for maintaining surgical anesthesia was evaluated and, during the postoperative period, parameters evaluated included Glasgow pain scores, mechanical nociceptive thresholds (MNT) in the mammary glands, and requirement for supplemental analgesia. In first study (Chapter 1), peridural methadone prolonged... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:27:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-22Bitstream added on 2014-06-13T20:56:29Z : No. of bitstreams: 1 sisto_rka_me_botfm.pdf: 745882 bytes, checksum: 572ac4fa4785affeee08e0c89fedec4c (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Os agentes anticolinesterásicos (neostigmina), quando associados com agonistas de receptores alfa-2 adrenérgicos (clonidina) pela via espinhal, resultam sinergismo no que se refere à analgesia promovida em ratos, ovinos e humanos. Na presente pesquisa, formulou-se a hipótese de que a administração peridural de neostigmina potencializaria a redução da concentração alveolar mínima (CAM) do isoflurano proporcionada pela clonidina peridural em cães. Seis cadelas hígidas (14,9 ± 2,9 kg) foram anestesiadas com isoflurano em 3 ocasiões distintas, com intervalo de 7 dias. Durante as anestesias foi empregada a ventilação controlada a pressão para prevenção da hipercapnia (PaCO2 > 45 mmHg) e a temperatura esofágica foi mantida entre 37,5 a 38,5oC por meios de aquecimento artificiais. Em cada anestesia, os animais receberam aleatoriamente 1 de 3 tratamentos pela via peridural: neostigmina (10 μg/kg), clonidina (20 μg/kg), ou a associação clonidina (20 μg/kg) e neostigmina (10 μg/kg). A CAM do isoflurano, mensurada por meio de estimulação nociceptiva do membro pélvico (50 V, 50 Hz, 10 ms), foi registrada após 2 horas da indução da anestesia (CAM basal) e após 2,5 e 5 horas da administração dos tratamentos peridurais. Em um dos animais, tanto a clonidina como a clonidina/neostigmina resultou em elevação paradoxal da CAM (8-9 %). Nos demais animais estudados (n = 5), os valores de CAM basal (média ± desvio padrão) foram de 1,49 ± 0,26, 1,51 ± 0,23 e 1,49 ± 0,26 vol%, nos tratamentos clonidina, neostigmina e clonidina/neostigmina, respectivamente, não havendo diferença entre tratamentos. As reduções da CAM observadas após a administração peridural de neostigmina não foram significativas (p < 0,05) (reduções percentuais de 11 ± 5% e 8 ± 9% após 2,5 e 5 horas, respectivamente). Houve redução significativa da CAM após a administração peridural de... / Spinal administration of anticholinesterase drugs (neostigmine) in combination with alpha-2 adrenergic receptor agonists (clonidine) results in a synergistic analgesic effect in rats, sheep and humans. The hypothesis of the present study was that the epidural administration of neostigmine would enhance the isoflurane minimum alveolar concentration (MAC) reduction induced by the epidural injection of clonidine in dogs. Six healthy bitches (14,9 ± 2,0 kg ) were anesthetized with isoflurane on 3 distinct occasions, with 7 day intervals among experiments. During the anesthetic episodes, animals were maintained under pressure controlled ventilation to prevent hypercapnia (PaCO2 > 45 mmHg) and esophageal temperature was maintained between 37.5 and 38.5 oC by means of artificial heating devices. During each anesthetic, animals were randomly allocated to receive 1 of 3 epidural treatments: neostigmine (10 μg/kg), clonidine (20 μg/kg), or the combination of clonidine (20 μg/kg) and neostigmine (10 μg/kg). Isoflurane MAC, determined by means of electric stimulation of the pelvic limb (50 V, 50 Hz, 10 ms), was recorded 2 hours after induction of anesthesia (baseline MAC) and 2.5 and 5 hours after epidural injections. In 1 of the animals, clonidine and clonidine/neostigmine caused paradoxical increases in MAC (8-9 % increases). For the remaining animals (n = 5), baseline MAC values (mean ± standard deviation) were 1.49 ± 0.26, 1.51 ± 0.23 e 1.49 ± 0.26 vol%, in the clonidine, neostigmine, and clonidine/neostigmine treatments, respectively. Baseline MAC did not differ among treatments. The isoflurane MAC reductions recorded after epidural injection of neostigmine were not significant (p < 0.05) (percent reductions of 11 ± 5% and 8 ± 9% after 2.5 and 5 hours respectively). The MAC reductions observed after epidural injection of clonidine (35 ± 9% and 22 ± 14% after 2.5 and 5 hours, ... (Complete abstract click electronic access below)

Orientador: Francisco José Teixeira Neto / Banca: Eduardo Raposo Monteiro / Banca: Silvia Renata Gaido Cortopassi / Resumo: Os agentes anticolinesterásicos (neostigmina), quando associados com agonistas de receptores alfa-2 adrenérgicos (clonidina) pela via espinhal, resultam sinergismo no que se refere à analgesia promovida em ratos, ovinos e humanos. Na presente pesquisa, formulou-se a hipótese de que a administração peridural de neostigmina potencializaria a redução da concentração alveolar mínima (CAM) do isoflurano proporcionada pela clonidina peridural em cães. Seis cadelas hígidas (14,9 ± 2,9 kg) foram anestesiadas com isoflurano em 3 ocasiões distintas, com intervalo de 7 dias. Durante as anestesias foi empregada a ventilação controlada a pressão para prevenção da hipercapnia (PaCO2 > 45 mmHg) e a temperatura esofágica foi mantida entre 37,5 a 38,5oC por meios de aquecimento artificiais. Em cada anestesia, os animais receberam aleatoriamente 1 de 3 tratamentos pela via peridural: neostigmina (10 μg/kg), clonidina (20 μg/kg), ou a associação clonidina (20 μg/kg) e neostigmina (10 μg/kg). A CAM do isoflurano, mensurada por meio de estimulação nociceptiva do membro pélvico (50 V, 50 Hz, 10 ms), foi registrada após 2 horas da indução da anestesia (CAM basal) e após 2,5 e 5 horas da administração dos tratamentos peridurais. Em um dos animais, tanto a clonidina como a clonidina/neostigmina resultou em elevação paradoxal da CAM (8-9 %). Nos demais animais estudados (n = 5), os valores de CAM basal (média ± desvio padrão) foram de 1,49 ± 0,26, 1,51 ± 0,23 e 1,49 ± 0,26 vol%, nos tratamentos clonidina, neostigmina e clonidina/neostigmina, respectivamente, não havendo diferença entre tratamentos. As reduções da CAM observadas após a administração peridural de neostigmina não foram significativas (p < 0,05) (reduções percentuais de 11 ± 5% e 8 ± 9% após 2,5 e 5 horas, respectivamente). Houve redução significativa da CAM após a administração peridural de ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Spinal administration of anticholinesterase drugs (neostigmine) in combination with alpha-2 adrenergic receptor agonists (clonidine) results in a synergistic analgesic effect in rats, sheep and humans. The hypothesis of the present study was that the epidural administration of neostigmine would enhance the isoflurane minimum alveolar concentration (MAC) reduction induced by the epidural injection of clonidine in dogs. Six healthy bitches (14,9 ± 2,0 kg ) were anesthetized with isoflurane on 3 distinct occasions, with 7 day intervals among experiments. During the anesthetic episodes, animals were maintained under pressure controlled ventilation to prevent hypercapnia (PaCO2 > 45 mmHg) and esophageal temperature was maintained between 37.5 and 38.5 oC by means of artificial heating devices. During each anesthetic, animals were randomly allocated to receive 1 of 3 epidural treatments: neostigmine (10 μg/kg), clonidine (20 μg/kg), or the combination of clonidine (20 μg/kg) and neostigmine (10 μg/kg). Isoflurane MAC, determined by means of electric stimulation of the pelvic limb (50 V, 50 Hz, 10 ms), was recorded 2 hours after induction of anesthesia (baseline MAC) and 2.5 and 5 hours after epidural injections. In 1 of the animals, clonidine and clonidine/neostigmine caused paradoxical increases in MAC (8-9 % increases). For the remaining animals (n = 5), baseline MAC values (mean ± standard deviation) were 1.49 ± 0.26, 1.51 ± 0.23 e 1.49 ± 0.26 vol%, in the clonidine, neostigmine, and clonidine/neostigmine treatments, respectively. Baseline MAC did not differ among treatments. The isoflurane MAC reductions recorded after epidural injection of neostigmine were not significant (p < 0.05) (percent reductions of 11 ± 5% and 8 ± 9% after 2.5 and 5 hours respectively). The MAC reductions observed after epidural injection of clonidine (35 ± 9% and 22 ± 14% after 2.5 and 5 hours, ... (Complete abstract click electronic access below) / Mestre

Orientador: Francisco José Teixeira Neto / Banca: Stelio Pacca Loureiro Luna / Banca: Carlos Augusto Araújo Valadão / Banca: Adriano Carregaro / Banca: Juliana Tabarelli Brondani / Resumo: A metadona é um opióide que possui potência analgésica semelhante à da morfina. Doses elevadas de metadona intravenosa (0,5-1,0 mg/kg), apesar de reduzirem a concentração alveolar mínima do isoflurano (CAMISO), resultam em maior depressão cardíaca que a observada com a morfina intravenosa (1,0 mg/kg) em cães. Com a hipótese de que a metadona peridural poderia proporcionar vantagens clínicas em relação à metadona intravenosa (maior potencialização da anestesia inalatória e maior eficácia analgésica), os estudos apresentados objetivaram comparar aspectos farmacocinéticos e farmacodinâmicos destas vias de administração da metadona em cães. Nos dois estudos iniciais (Capítulos 1 e 2), os mesmos seis animais foram anestesiados com isoflurano e tratados com metadona (0,5 mg/kg) peridural ou intravenosa em ocasiões distintas. No primeiro estudo (Capítulo 1), para comparação da farmacocinética destas duas vias de administração, a concentração de metadona foi determinada no plasma e no líquor da cisterna magna antes e durante 450 minutos após a administração do opióide. No segundo estudo (Capítulo 2), a CAMISO foi mensurada antes e após 2,5 e 5 horas da administração da metadona, mediante a aplicação da estimulação nociceptiva em membro pélvico e torácico (via peridural) ou em membro pélvico apenas (via intravenosa). No último estudo (Capítulo 3), cadelas apresentando tumores mamários, após serem tratadas de forma preemptiva com metadona (0,5 mg/kg) peridural ou intravenosa (10 animais por grupo), foram submetidas à mastectomia unilateral. Nesta etapa, avaliou-se a concentração expirada de isoflurano (ETISO) necessária à realização da mastectomia e, no período pós-operatório, avaliou-se os escores de dor, limiares nociceptivos mecânicos (LNM) das cadeias mamárias e requerimento de resgates analgésicos. No estudo do Capítulo 1, a via... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Methadone is an opioid that has analgesic potency comparable to that of morphine. High doses of intravenous methadone (0.5-1.0 mg/kg), in spite of reducing the minimum alveolar concentration of isoflurane (MACISO), cause greater cardiac depression than intravenous morphine (1 mg/kg) in dogs. The studies presented here aimed to compare some pharmacokinetic and pharmacodynamic aspects of peridural and intravenous methadone in dogs, testing the hypothesis that peridural methadone could result in clinical advantages when compared to intravenous methadone (greater reduction in anesthetic requirements and greater analgesic efficacy). In the first 2 studies (Chapters 1 and 2), the same six animals underwent isoflurane anesthesia and were treated with methadone (0.5 mg/kg) administered via the peridural or intravenous routes during different occasions. During the first study (Chapter 1), in order to compare the pharmacokinetics of these two administration routes, methadone concentrations were determined in plasma and in the cisternal cerebrospinal fluid before and for 450 minutes after opioid injection. During the second study (Chapter 2), MACISO was measured before, 2.5 and 5 hours after methadone injection via nociceptive stimulation of the thoracic and pelvic limb (peridural) or the pelvic limb (intravenous). During the last series of studies (Chapter 3), bitches presented with mammary gland tumors were preemptively treated with peridural or intravenous methadone (0.5 mg/kg) (10 animals per group) and underwent unilateral mastectomy. The end-tidal isoflurane concentration (ETISO) necessary for maintaining surgical anesthesia was evaluated and, during the postoperative period, parameters evaluated included Glasgow pain scores, mechanical nociceptive thresholds (MNT) in the mammary glands, and requirement for supplemental analgesia. In first study (Chapter 1), peridural methadone prolonged... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:35:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-12-14Bitstream added on 2014-06-13T20:45:54Z : No. of bitstreams: 1 monteiro_er_dr_botfm.pdf: 797553 bytes, checksum: 2573adacef9a78a933d99b600257058f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O efeito do remifentanil sobre a concentração alveolar mínima do isoflurano (CAMISO) foi estudado em seis cães com peso médio de 27,7±4,3 kg. Os animais foram anestesiados com isoflurano sob ventilação mecânica, mantendo-se normocapnia (PaCO2 média: 38,5 mm Hg) e normotermia (temperatura corpórea média: 38,1oC). A CAMISO, determinada por meio da estimulação nociceptiva (50V/50Hz/10ms) do membro torácico, foi mensurada antes (basal), durante a infusão contínua de diferentes doses de remifentanil (0,15; 0,30; 0,60 e 0,90 μg/kg/min) e aproximadamente 80 minutos após o término da infusão do opióide. Após um intervalo de 7 dias, a CAMISO foi determinada às 2, 4 e 6 horas após o início da infusão de 0,15 μg/kg/min de remifentanil. As variáveis foram analisadas por meio de ANOVA seguida pelo teste de Tukey ou Dunnett (P<0,05). A CAMISO redeterminada ao término da infusão (1,22±0,20%) não diferiu da CAMISO basal (1,38±0,20%). Os valores da CAMISO foram significativamente mais baixos nas três maiores taxas de infusão em relação à menor (0,15 μg/kg/min). Observou-se redução significativa da CAMISO com todas as taxas de infusão de remifentanil (reduções percentuais em relação ao valor basal de 43±10%, 59±10%, 66±9% e 71±9% para as taxas de 0,15; 0,30; 0,60 e 0,90 μg/kg/min, respectivamente). Embora o valor da CAMISO não tenha diferido entre as taxas de infusão de 0,30; 0,60 e 0,90 μg/kg/min, a percentagem de redução na CAMISO foi maior com a dose de 0,90 em relação à dose de 0,30 μg/kg/min. A CAMISO não se modificou ao longo do tempo com a taxa de 0,15 μg/kg/min. Em uma segunda etapa de experimentos, os efeitos hemodinâmicos da anestesia com remifentanil e isoflurano foram estudados nos mesmos cães. Adicionalmente, amostras de sangue foram colhidas para mensurar a concentração plasmática de arginina vasopressina... / The isoflurane-sparing effect of remifentanil on the minimum alveolar concentration (MACISO) was evaluated in six dogs weighing 27.7±4.3 kg. The dogs were anesthetized with isoflurane and mechanically ventilated to maintain eucapnia (mean PaCO2: 38.5 mm Hg). Mean core temperature was kept at 38.1oC. Noxious stimulation (50V/50Hz/10ms) was applied to the thoracic limb for determination of MACISO before (baseline), during different infusion rates of remifentanil (0.15, 0.30, 0.60 and 0.90 μg/kg/min) and approximately 80 minutes after stopping remifentanil infusion. After a 7-day washout period, MACISO was determined within 2, 4 and 6 hours of a constant rate infusion of remifentanil (0.15 μg/kg/min). Data were analyzed by ANOVA followed by a Tukey or Dunnett test whenever appropriate (P<0.05). After stopping remifentanil infusion, MACISO (1.22±0.20%) did not differ from baseline MACISO (1.38%±0.20). Mean values of MACISO were significantly lower during the infusion rates of 0.30, 0.60 and 0.90 μg/kg/min compared to the lowest infusion rate (0.15 μg/kg/min). All infusion rates of remifentanil decreased MACISO significantly (percentage reductions compared to baseline MACISO were 43±10%, 59±10%, 66±9% and 71±9% for the infusion rates of 0.15, 0.30, 0.60 and 0.90 μg/kg/min, respectively). Although MACISO did not differ among the three highest infusion rates of remifentanil, the percentage reduction in MACISO was significantly greater during 0.90 μg/kg/min compared to 0.30 μg/kg/min. The effect of remifentanil on MACISO was stable during a prolonged constant rate infusion (0.15 μg/kg/min). In a second set of experiments, the hemodynamic changes during remifentanil-isoflurane anesthesia were evaluated in the same six dogs. Additionally, blood samples were collected to determine plasma concentrations of arginine vasopressin. In a randomized cross-over design, the dogs received... (Complete abstract click electronic access below)

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.

Orientador: Francisco José Teixeira Neto / Banca: Antônio José de Araújo Aguiar / Banca: Denise Tabacchi Fantoni / Banca: Silvia Renata Gaido Cortopassi / Banca: Carlos Augusto Araújo Valadão / Resumo: O efeito do remifentanil sobre a concentração alveolar mínima do isoflurano (CAMISO) foi estudado em seis cães com peso médio de 27,7±4,3 kg. Os animais foram anestesiados com isoflurano sob ventilação mecânica, mantendo-se normocapnia (PaCO2 média: 38,5 mm Hg) e normotermia (temperatura corpórea média: 38,1oC). A CAMISO, determinada por meio da estimulação nociceptiva (50V/50Hz/10ms) do membro torácico, foi mensurada antes (basal), durante a infusão contínua de diferentes doses de remifentanil (0,15; 0,30; 0,60 e 0,90 μg/kg/min) e aproximadamente 80 minutos após o término da infusão do opióide. Após um intervalo de 7 dias, a CAMISO foi determinada às 2, 4 e 6 horas após o início da infusão de 0,15 μg/kg/min de remifentanil. As variáveis foram analisadas por meio de ANOVA seguida pelo teste de Tukey ou Dunnett (P<0,05). A CAMISO redeterminada ao término da infusão (1,22±0,20%) não diferiu da CAMISO basal (1,38±0,20%). Os valores da CAMISO foram significativamente mais baixos nas três maiores taxas de infusão em relação à menor (0,15 μg/kg/min). Observou-se redução significativa da CAMISO com todas as taxas de infusão de remifentanil (reduções percentuais em relação ao valor basal de 43±10%, 59±10%, 66±9% e 71±9% para as taxas de 0,15; 0,30; 0,60 e 0,90 μg/kg/min, respectivamente). Embora o valor da CAMISO não tenha diferido entre as taxas de infusão de 0,30; 0,60 e 0,90 μg/kg/min, a percentagem de redução na CAMISO foi maior com a dose de 0,90 em relação à dose de 0,30 μg/kg/min. A CAMISO não se modificou ao longo do tempo com a taxa de 0,15 μg/kg/min. Em uma segunda etapa de experimentos, os efeitos hemodinâmicos da anestesia com remifentanil e isoflurano foram estudados nos mesmos cães. Adicionalmente, amostras de sangue foram colhidas para mensurar a concentração plasmática de arginina vasopressina... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The isoflurane-sparing effect of remifentanil on the minimum alveolar concentration (MACISO) was evaluated in six dogs weighing 27.7±4.3 kg. The dogs were anesthetized with isoflurane and mechanically ventilated to maintain eucapnia (mean PaCO2: 38.5 mm Hg). Mean core temperature was kept at 38.1oC. Noxious stimulation (50V/50Hz/10ms) was applied to the thoracic limb for determination of MACISO before (baseline), during different infusion rates of remifentanil (0.15, 0.30, 0.60 and 0.90 μg/kg/min) and approximately 80 minutes after stopping remifentanil infusion. After a 7-day washout period, MACISO was determined within 2, 4 and 6 hours of a constant rate infusion of remifentanil (0.15 μg/kg/min). Data were analyzed by ANOVA followed by a Tukey or Dunnett test whenever appropriate (P<0.05). After stopping remifentanil infusion, MACISO (1.22±0.20%) did not differ from baseline MACISO (1.38%±0.20). Mean values of MACISO were significantly lower during the infusion rates of 0.30, 0.60 and 0.90 μg/kg/min compared to the lowest infusion rate (0.15 μg/kg/min). All infusion rates of remifentanil decreased MACISO significantly (percentage reductions compared to baseline MACISO were 43±10%, 59±10%, 66±9% and 71±9% for the infusion rates of 0.15, 0.30, 0.60 and 0.90 μg/kg/min, respectively). Although MACISO did not differ among the three highest infusion rates of remifentanil, the percentage reduction in MACISO was significantly greater during 0.90 μg/kg/min compared to 0.30 μg/kg/min. The effect of remifentanil on MACISO was stable during a prolonged constant rate infusion (0.15 μg/kg/min). In a second set of experiments, the hemodynamic changes during remifentanil-isoflurane anesthesia were evaluated in the same six dogs. Additionally, blood samples were collected to determine plasma concentrations of arginine vasopressin. In a randomized cross-over design, the dogs received... (Complete abstract click electronic access below) / Doutor

This thesis has, commissioned by Dräger, an international company at the forefront of medical and safety technology, examined how the use of inhalational anesthetics affects the climate and environment. The purpose of this work is to examine how the Swedish healthcare sector currently works with inhalational anesthetics, how different anesthetic machines affect the emissions, as well as alternatives available to reduce anesthetic gases emissions. Climate change is a current issue in today’s society, but the impact of anesthetic gases on the climate is not widely known, despite their everyday use in the healthcare sector. Through data collection from two Swedish hospitals; Linköping University Hospital and Örebro University Hospital, an interview with medical and medical engineering staff, as well as a literature study the main question of the thesis could be answered; How do the most common anesthetic gases affect the environment? The results are presented in the form of diagrams showing the amount of anesthetic gas used in the aforementioned hospitals during surgeries. The results have been analyzed and discussed based on the research questions, and the different results from each hospital have been compared to each other. It can be seen that Dräger’s anesthesia machines have a relatively low consumption of sevoflurane, but it is impossible to draw any definitive conclusions due to lack of data, and lack of access to machines from other manufacturers. / Detta examensarbete har, på uppdrag av Dräger, ett internationellt företag i framkant inom medicin- och säkerhetsteknik, undersökt hur användning av inhalationsanestetika påverkar miljön. Målet med arbetet är att undersöka hur den svenska sjukvården för närvarande arbetar med inhalationsanestetika, hur olika anestesimaskiner påverkar utsläppen, samt alternativ som finns tillgängliga för att minska dessa utsläpp. Klimatförändringar är en aktuell fråga i dagens samhälle men påverkan av anestesigaser på klimatet är inte allmänt känt, trots att dessa används dagligen i hälsovården. Genom datainsamling från två svenska sjukhus; Linköpings Universitetssjukhus och Örebro Universitetssjukhus, intervjuer med medicinsk- och medicinteknisk personal, samt en litteraturstudie har arbetets problemställning besvarats; Hur påverkar de mest frekvent använda anestesigaserna miljön? Resultaten visar i diagramform hur mycket anestesi gas som använts i tidigare nämnda sjukhus under operationer. Resultaten har analyserats och diskuterats utifrån forskningsfrågorna, dessutom har de olika resultaten från respektive sjukhus jämförts med varandra. Det kan ses att Drägers anestesimaskiner har en relativt låg konsumtion av sevofluran, men brist på data samt brist på tillgång till maskiner från andra producenter gör det omöjligt att dra en konkret slutsats.