Bakgrund: Mycket i litteraturen tyder på att ouppmärksammad och underbehandlad smärta hos äldre demenssjuka är vanligt förekommande. Detta strider mot principerna om människors lika värde, den enskildes värdighet och det humana i att lindra. Det finns många typer av demenssjukdom och attityden förekommer att demenssjuka inte känner smärta. Demenssjuka har ofta problem med att kommunicera eller lokalisera smärtan. Observations- och självsmärtskattningsinstrument används inte i större utsträckning. Syfte: Syftet med denna litteraturstudie var att belysa smärtproblematik och smärtlindring i omvårdnaden av äldre personer med demenssjukdom. Metod: Detta är en litteraturstudie där tio kvantitativa vetenskapliga artiklar har analyserats med hjälp av en manifest innehållanalys. Artiklarnas resultat presenteras i fyra kategorier med underkategorier som beskriver smärtproblematik och smärtlindring hos äldre patienter med demenssjukdom. Resultat: Äldre med demenssjukdom var ofta underbehandlade för smärta och risken ökade med stigande kognitiv nedsättning. Underskattning av smärta var vanligt förekommande även när smärtskattningsinstrument användes. Personer med förmodad vaskulär demens rapporterade ofta mer smärta och med Alzheimers sjukdom mindre smärta än icke-dementa äldre. Hos en del demenssjuka uteblev förväntningseffekten av analgetika. Slutsats: Underbehandling av smärta hos demenssjuka äldre var vanligt förekommande och mer forskning behövs om smärtbedömning hos kognitivt nedsatta personer. / Background: Literature reveals that undiagnosed and untreated pain among older persons with dementia are common occurrences. This is in contrast to the principles of equal value among human beings, the dignity of the individual, and the alleviation of human suffering. There are many types of dementia, and there exists a belief that persons with dementia feel no pain. A common consequence of dementia is inability to communicate or locate the origin of pain. Selfassessment and observational pain scales are frequently not used. Aim: The aim of this literature review was to shed light upon the challenges associated with pain and the practice of pain relief in the care of older adults with dementia. Method: This is literature review study, where ten quantitative scientific articles have been analyzed using manifest context analysis. The results of the articles were sorted into four categories, each with subcategories, that describe the challenges associated with pain and the practice of pain relief. Results: The following result was obtained. Older persons with dementia often received inadequate pain relief, and the risk for under treatment increased with increasing level of cognitive impairment. Under treatment of pain was common even when pain assessment scales were used. Persons with assumed vascular and Alzheimer's dementia often stated that they felt more pain and less pain, respectively, than older adults with no cognitive impairment did. A group of persons with dementia were shown to experience no anticipatory effect of analgesics. Conclusion: Under treatment of pain was a common occurrence among older persons with dementia and more research is needed regarding how to estimate pain in persons with cognitive impairment.

Les récepteurs couplés aux protéines G (RCPG) de classe A sont les cibles de plus de 25% des médicaments sur le marché et nombreux sont ceux impliqués dans le traitement de la douleur. Les enjeux dans les traitements de la douleur chronique est énorme puisque nombreux sont ceux qui ne répondent pas à la médication usuelle. La recherche de nouvelles avenues thérapeutiques est indispensable afin d’aider les patients dont le soulagement est limité. Le récepteur de la neurotensine de type 2 (NTS2) et le récepteur APJ de l’apéline sont deux RCPG qui pourraient être des cibles pour deux éventuels traitements contre la douleur. Les objectifs de cette thèse étaient de caractériser des analogues synthétiques ciblant les récepteurs NTS2 ou APJ, examiner la distribution de ces récepteurs dans le cerveau, la moelle épinière et les ganglions spinaux pour ensuite déterminer leur implication dans la régulation du contrôle descendant au niveau spinal et supraspinal dans la région bulbaire rostro-ventrale (RVM) en conditions de douleurs aiguë et tonique. Nous avons observé que l’immunoréactivité du récepteur NTS2 était distribuée dans l’axe rostrocaudal de la substance grise périaqueductal (SGPA) et dans tous les noyaux de la RVM. Les résultats sont similaires avec l’anticorps anti-APJ démontrant que ces deux récepteurs sont impliqués dans le contrôle de la douleur. Aussi, les résultats en immunohistochimie dans la moelle épinière ont illustré la présence du récepteur APJ dans les laminae superficielles. Dans les ganglions spinaux, APJ colocalise dans les neurones substance P. Les résultats aux tests comportementaux avec administration intra-RVM d’analogues modifiés neurotensinergiques ont montré une analgésie impliquée par l’activation de NTS2 dans la RVM. L’analgésie provoquée par le récepteur NTS2 serait médiée via la relâche de sérotonine au niveau de la moelle épinière en conditions de douleurs aiguë et tonique. Les résultats en douleur tonique avec les analogues Apeline-13 modifiés en position carboxy-terminale illustrent que les modifications comportant les groupements 2-naphtalenalanine (2 Nal) et de l’acide aminoisobutyrique (Aib) permettent une plus forte analgésie générale, cependant nos expériences à ce jour ne nous permettent pas de statuer sur les différentes voies de signalisation activées dans ces conditions. La modélisation moléculaire pourrait nous aider davantage afin d’explorer les différentes caractéristiques des ligands biaisés. Ces études sur la relation structure-activité, distribution et fonctions des récepteurs NTS2 et APJ dans la modulation de douleur ne sont qu’un début vers des nouveaux traitements contre la douleur.

Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to guide practice. Since tapering routines vary among practitioners, it is not uncommon to see signs and symptoms of opioid withdrawal. A prospective, descriptive study was conducted to describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. The sample of 25 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children’s Hospital of Richmond Pediatric Intensive Care Unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age. Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever. For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.

Résumé : L’hémiplégie laryngée (HP) est une affection courante et une cause majeure de contre-performances dans l’espèce équine. Plusieurs études ont montré que la prévalence était variable selon les races et les disciplines étudiées. De plus, un développement important des techniques chirurgicales peu invasives ont émergé ces dernières années. Les objectifs de ce travail étaient de 1) déterminer la prévalence de l’HL chez une population de Trotteurs Français (TF) à l’entrainement et son impact sur les performances, 2) évaluer la pertinence des protocoles actuels de sédanalgésie utilisés lors d’interventions chirurgicales sur cheval debout.Deux études ont été réalisées pour répondre aux objectifs. La première étude portait sur 112 TF en situation d’entrainement. La prévalence a été calculée sur l’ensemble de l’effectif puis une étude longitudinale sur l’évolution du grade HL a été réalisée sur 18 chevaux. La prévalence de l’HL chez ces chevaux était relativement importante mais aucune corrélation avec les performances, ni le sexe ou l’âge des animaux n’a pu être montrée. Une large proportion de chevaux voit son grade d’abduction se dégrader avec le temps. La deuxième étude a comparé 4 protocoles de sédanalgésie. Huit juments saines ont été utilisées et les effets des protocoles ont été notés. Les protocoles testés étaient adéquats pour les interventions envisagées mais des différences notoires ont été démontrées. L’utilisation du butorphanol entrainait des mouvements involontaires et brusques de la tête, tandis que la lidocaïne pouvait engendrer un collapsus pharyngé. Des recommandations pour l’utilisation de ces protocoles ont été émises. / Abstract : Laryngeal hemiplegia (LH) is a common disease in sport- and racehorses, but also a frequent cause of poor performance. Several studies have shown that the prevalence of the disease is rather variable among the different breeds and disciplines. Furthermore, minimally invasive surgical therapies to correct this condition have recently gained popularity. The objectives of our work were to 1) determine the prevalence of LH in a population of French Trotters in training and 2) assess the efficacy of sedation and analgesia protocols in minimally invasive upper airway surgery. Two experiments were conducted. The first experiment investigated the prevalence of LH in 112 French Trotters horses in training, showing that a large number of horses were affected but it did not severely impact their performance. A longitudinal study was performed in 18 of these horses showing that the LH grade decreased with time in a large proportion of horses. The second study compared 4 sedation/analgesia protocols used in upper airway standing surgery. All protocols tested were adequate to provide sedation and analgesia of the pharynx and larynx but there were some important differences between protocols. Butorphanol induced frequent head jerking as lidocaine caused pharyngeal collapse, which can impair proper surgical accuracy. Recommandations were made for the use of these protocols in upper airway surgery.

Bakgrund: Varje år behöver mer än 10 000 nyfödda barn i Sverige vård på en neonatalvårdsavdelning. Vårdtiden präglas av åtskilliga blodprovstagningar som orsakar barnet smärta och ökat vårdlidande. Sjuksköterskans ansvar innefattar att agera för barnets bästa i alla situationer, men det kan saknas tydliga riktlinjer för hur detta ska ske på arbetsplatsen. Syfte: Syftet med studien är att beskriva sjuksköterskors resonemang och arbetssätt vid blodprovstagning på barn på neonatalvårdsavdelning, samt att undersöka hur barnets bästa finns i fokus vid proceduren. Metod: Studien utformades med en kvalitativ studiedesign i avsikt att generera kunskap om sjuksköterskornas erfarenheter vid blodprovstagning. Tolv intervjuer genomfördes utifrån en semistrukturerad intervjuguide med sjuksköterskor verksamma vid en neonatalvårdsavdelning på ett svenskt universitetssjukhus. Den insamlade datan analyserades genom en induktiv innehållsanalys. Resultat: Vilken stickmetod sjuksköterskorna använde var anpassat efter barnet och situationen. De såg till barnets förutsättningar och planerade provtagningen efter vad barnet klarade av, i samråd med föräldrarna. Sjuksköterskorna strävade efter föräldranärvaro vid provtagningen och åtog adekvata smärtlindringsmetoder i den mån som situationen tillät. Slutsats: Sjuksköterskorna hade genomgående barnets bästa i fokus vid provtagningsproceduren. De såg en komplexitet i sin roll att både vara den som orsakar barnet smärta, men även vara den som ska minska barnets vårdlidande. / Background: Every year, more than 10 000 newborn children require hospitalization in a neonatal intensive care unit. During this time, they are subjected to several painful blood sampling procedures that will cause them suffering to some extent. The nurses’ responsibility is to act on what is best for each child at all times but clearer guidelines for how that should be executed in practical nursing care might be needed. Aim: To describe the reasoning and the working manner of the nurses when performing blood sampling on children. The study also aims to examine how the child’s best interest is taken into account before and during this procedure. Method: A qualitative design was used for this study. Semi-structured interviews were conducted with 12 registered nurses who work in the neonatal intensive care unit at a Swedish University Hospital. Collected data were analysed using inductive content analysis. Results: Regardless of which technique the nurses chose when performing blood sampling it was assessed as the most appropriate one for each child. They took the children’s prerequisites and ability to cope into account and planned the procedure in consensus with their parents. Nurses strove to encourage parents to stay close to and support their children when blood sampling was conducted, and adequate analgesic actions were undertaken. Conclusion: Nurses had the children’s best at heart all through the process of blood sampling. Their role as both inflicting and relieving pain was considered to be complex in the aim to avoid suffering.

Bakgrund: Användningen av höga doser av opioider under generell anestesi är numera mycket vanligt. Biverkningar orsakade av opioider är väl känt inom anestesin och sjukvården och senare evidens tyder på att opioider även kan bidra till smärtutveckling. Av denna anledning har studier de senaste 20 åren ifrågasatt användningen av opioider och intresset för att minska opioidbehovet och utveckla opioidfria metoder för anestesi har växt. Syfte: Att beskriva opioidfri analgesi i generell anestesi, och hur detta påverkar den perioperativa smärtupplevelsen, jämfört med patienter i generell anestesi som fått traditionell smärtlindring med opioider. Metod: En litteraturöversikt med systematisk ansats. Artikelsökningen genomfördes i PubMed, Cinahl och Scopus. Resultatet sammanställdes utifrån 15 granskade artiklar med kvantitativ design. Resultat: Litteraturöversikten visar att det finns ett stort antal läkemedel som kan användas inom opioidfri anestesi, samt deras för- och nackdelar för smärtupplevelsen jämfört opioider. De protokoll som användes vid opioidbaserad anestesi eller för opioidsparande anestesi är inte standardiserade och därför är det inte möjligt att syntetisera resultatet och ställa olika metoder mot varandra i denna litteraturöversikt. De flesta artiklar visade att det går att minska intraoperativt och postoperativt opioidbehov för patienter och ändå erbjuda likvärdig smärtlindring. De patienter som fick en opioidfri eller opioidsparande anestesi hade inte en försämrad perioperativ smärtupplevelse. Den mängd metoder som beskrevs indikerar att analgesi kan anpassas efter patientens individuella förutsättningar. Slutsats: Litteraturöversikten visade att olika läkemedel och metoder kan användas för att ge analgesi till patienten vid opioidfri anestesi samt dess effekt på smärtupplevelsen kontra opioider. De flesta alternativa läkemedel som används i artiklarna gav ett mer gynnsamt eller likvärdigt utfall för patienten. Genom utveckling av fler metoder för analgesi under anestesi kan anestesin i större omfattning utgå från individens behov och förutsättningar, vilket bidrar till en mer personcentrerad vård. Litteraturöversiktens resultat visar på en stor spridning och det är därför svårt att bedöma vilka läkemedel som är bäst lämpade. Det krävs således mer forskning inom detta ämne för att möjliggöra jämförelser och utarbeta protokoll som gör opioidfri anestesi till etablerad och säker metod för patienten. / Background: High dose opioids during general anesthesia are frequently used. The side effects caused by opioids are well known in anesthesia and healthcare and recent evidence implies opioides can contribute to the development of pain. For this reason, studies over the past 20 years have questioned the use of opioids and an interest has grown in reducing the need of opioids and developing opioid-free methods for anesthesia. Aim: To describe opioid-free analgesia in general anesthesia, and how this affects the perioperative pain experience, compared to patients in general anesthesia who have received traditional opioid-based pain relief. Method: A literature study with systematic approach. The article search was performed in PubMed, Cinahl and Scopus. The result was compiled based on 15 reviewed articles with quantitative design. Result: The literature review shows that there are a large number of drugs that can be used in opioid-free anesthesia and the advantages and disadvantages of these drugs versus opioids. The protocols used for opioid-based anesthesia or for opioid-saving anesthesia are not standardized and therefore it is not possible to synthesize the results or set different methods against each other in this review. Most articles found that it is possible to reduce the intraoperative and postoperative need of opioid for patients and still offer equivalent pain relief. The patients receiving opioid-free or opioid-sparing anesthesia did not suffer a worsened pain-related experience. The amount of methods described indicates that the analgesia can be customized accordingly to the patient's individual circumstances. Conclusion: The literature review described various drugs and methods that can be used to give analgesia to the patient during opioid-free anesthesia and the effect on the pain-related experience. Most of the alternative drugs used in the articles gave a more favorable or equivalent outcome for the patient. By developing more methods for analgesia during anesthesia, it is in a greater extent possible to adjust the anesthesia depending on the individuals needs, which contributes to a more person-centered care. The result shows a wide spread and it is therefore difficult to assess which drugs are best suited. Thus, more research is required in this subject to prepare protocols that make opioid-free anesthesia an established and safe method for the patient.

Introdução. A dor lombar crônica configura como uma das condições mais incapacitantes e terapeuticamente desafiadoras que acomete a população. Para tratamento da dor lombar, diversas técnicas têm sido empregadas, dentre elas, a eletroacupuntura (EA). Tal técnica é um método não farmacológico que associa acupuntura e estimulação elétrica no acuponto e promove a liberação de neurotransmissores que atuarão direta ou indiretamente na dor. Objetivos. Avaliar os efeitos da EA sobre o limiar nociceptivo e a capacidade funcional de pacientes com dor lombar crônica de origem inespecífica. Método. Foi realizado um estudo quase-experimental com uma sessão semanal de EA em um grupo composto por 20 indivíduos que foram avaliados em três momentos, antes do início do tratamento (AV1), após uma semana (AV2) e após um mês (AV3). As avaliações constaram de: a) Escala Visual Analógica de Dor (EVA); b) Questionário de dor McGill; c) Questionário Roland-Morris Brasil (QRM-Br); d) algometria de pressão; e) termografia; f) eletromiografia (EMG) e; g) coleta de sangue para mediadores inflamatórios (TNF-α e IL-6). As sessões de EA tiveram uma frequência de uma vez na semana, por quatro semanas, 2 Hz por 20 minutos nos acupontos (BP6, B23, B31, B32 e B33). Para análise estatística foi utilizada a ANOVA de medidas repetidas seguida do pós-teste de Bonferroni. Resultados. Os indivíduos apresentaram uma redução na média do índice da EVA de 7,30 na AV1 para 6,65 na AV2 e 4,35 na AV3( F2,59= 15,43, p<0,05); no índice de McGill de 14,55 na AV1 para 13,10 na AV2 e 9,35 na AV3 (F2,59= 5,75, p<0,05); no QRM-Br de 10,15 na AV1 para 8,65 na AV2 e 5,95 na AV3 (F2,59= 2,95, p<0,05); na algometria de pressão aumento da média na AV1 de 5,58 e 5,29, do lado direito e esquerdo respectivamente, para 8,63 e 8,34 na AV2 e 12,15 e 11,43 na AV3 (F5,119= 15,97); na EMG um aumento de 50% na contração isométrica em AV3 e; na termografia e avaliação dos mediadores inflamatórios (TNF-α e IL-6) não houve diferença estatisticamente significativa entre as avaliações. Conclusão. Nossos dados indicam que a EA de 2 Hz nos acupontos BP6, B23, B31, B32 e B33, reduz os índices de percepção de dor (EVA e McGill), melhora a capacidade funcional da coluna lombar (QRM-Br), aumentam o limiar de pressão na algometria e, atividade muscular em isometria (EMG) após quatro semanas de tratamento. / Introduction. Chronic low back pain is the most incapacitating and therapeutic challenging condition that affect the population. For the treatment of low back pain, many techniques have been employed as electroacupuncture (EA). This technique is a non-pharmacological method that combines acupuncture and electrical stimulation in acupoint and promotes the release of neurotransmitters that will act directly on pain. Objectives. Evaluate the effects of EA on the nociceptive threshold and the functional capacity of patients with chronic low back pain by unspecific origin. Methods. A quasi-experimental study was established with a weekly session of EA in a group of 20 individuals who were evaluated in three times: before the treatment (AV1), after one week (AV2) and after one month (AV3). The outcomes involved: a) Visual Analog Score of Pain (VAS); b) McGill Questionnaire; c) Roland-Morris Brazil Questionnaire (QRM-Br); d) pressure algometry; e) thermography; f) electromyography (EMG), and; g) evaluation of blood inflammatory cytokines (TNF-α and IL-6). EA sessions had a frequency of once a week, for four weeks, 2 Hz for 20 minutes in acupoints (BP6, B23, B31, B32 and B33). For statistical analysis we used repeated measures ANOVA followed by Bonferroni post-test. Results. The subjects had a reduction in mean VAS index of 7.30 in AV1 to 6.65 in AV2 and 4.35 in AV3 (F2,59 = 15.43, p <0.05); in McGill Index of 14.55 in AV1 to 13.10 in AV2 and 9.35 in AV3 (F2,59 = 5.75, p <0.05); in QRM-Br 10.15 in AV1 to 8.65 in AV2 and 5.95 in AV3 (F2,59 = 2.95, p <0.05); in algometry was found an increase in average of 5.58 and 5.29 in AV1, the right and left respectively, to 8.63 and 8.34 in the AV2 and 12.15 and 11.43 in AV3 (F5,119 = 15.97); EMG had an increase of 50% in isometric contraction in AV3, thermography and blood cytokines had no difference in all times evaluated. Conclusion. Our data show that 2Hz EA in the acupoints BP6, B23, B31, B32 and B33, reduces pain perception index (VAS and McGill), improves the functional capacity of the lumbar spine (QRM-Br), increase the threshold pressure in algometry and in isometric muscle activity (EMG) after four weeks of treatment.

Os animais, assim como os seres humanos, são suscetíveis a estímulos lesivos que venham a desencadear a sensação dolorosa. O manejo inadequado da dor pode acarretar danos sérios no animal, principalmente no que tange o período pós-operatório, retardando significativamente o tempo de recuperação. Visando reduzir ou atenuar o desconforto no pós-cirúrgico, vários estudos estão sendo realizados com a administração de analgésicos opióides e antiinflamatórios, de forma preemptiva. Nessa modalidade o paciente recebe o fármaco anteriormente ao estímulo com o intuito de minimizar a dor pós-operatória. Neste pressuposto, o presente trabalho tem como principal objetivo o emprego de modelagem matemática no sentido de validar o uso preemptivo do Cloridrato de Tramadol para o controle da dor em cadelas submetidas ao procedimento de ovariohisterectomia (OSH). O estudo ocorreu no Hospital Veterinário da Unijuí, em cadelas submetidas à ovariohisterectomia eletiva. O delineamento experimental ocorreu em três blocos casualizados com sete repetições, levando em consideração o grupo controle, bem como os tempos distintos de administração preemptiva do fármaco. A posteriori a coleta dos dados experimentais, foi realizada a modelagem matemática, partindo das médias da avaliação da dor pós-cirúrgica, buscando validar o efeito preemptivo do Cloridrato de Tramadol. Além disso, reproduzir na forma de um Sistema Baseado em Regras Fuzzy (SBRF) pela Escala de Glasgow, um controlador capaz de auxiliar o médico veterinário na aferição da dor em animais. A análise de variância das variáveis: tempo de uso do Tramadol e tempo de avaliação da dor, apresentou efeito significativo apenas para a variável e tempo de avaliação da dor, ou seja, a aplicação deste fármaco de forma preemptiva não se mostrou eficiente no controle da dor pós-operatória. A regressão polinomial permitiu encontrar a equação linear mais adequada para este experimento, sendo esta capaz de estimar o tempo da dor limite ou a intensidade de dor em um determinado tempo. É possível a partir de um escore já estabelecido de aferição álgica, simular através do SBRF, o tempo em que o animal sentirá dor, necessitando reintervenção medicamentosa. / 82 f.

Assegurar o bem-estar dos animais de laboratório e evitar a dor e o sofrimento desnecessários são as principais considerações na experimentação. Por isso, a investigação em busca de novos protocolos anestésicos que garantam um mínimo ou nulo desconforto dos animais tem-se convertido num tema prioritário. Neste estudo realizou-se a comparação do efeito da combinação de xilazina (X) e ketamina (K) com acepromazina (A) e opióides [metadona (Me), morfina (Mo) e tramadol (T)] com a finalidade de avaliar sua influência nos parâmetros fisiológicos de ratos de laboratório, para ambos os sexos, bem como seu poder analgésico e o efeito da oxigenação sobre os mesmos. A associação XKA para ratos machos e fêmeas e a associação XKMe para fêmeas foram as mais seguras e eficazes para procedimentos anestésicos. Porém, os resultados do teste de formalina com a medição da vocalização ultrassônica (VUS) sugerem que o protocolo de XKA tem um poder analgésico baixo, não sendo indicado para procedimentos que possam gerar dor moderada ou severa. Todas as associações anestésicas tiveram efeitos importantes como diurese, manutenção dos olhos abertos e hiperglicemia, os quais devem ser considerados quando possam influenciar nos resultados experimentais. Também, se conseguiu demonstrar que a oxigenação melhora a saturação de oxigênio (SO2) e os valores da pressão parcial de oxigênio (pO2) confirmando que sua utilização deveria ser sempre parte dos procedimentos experimentais com anestesia injetável para evitar a hipoxemia. Não obstante, observou-se uma acidose respiratória por aumento da pressão parcial do CO2 (pCO2) e diminuição do pH, cuja causa se relacionou à hipoventilação por depressão respiratória e acúmulo de CO2 durante o transcorrer da anestesia. Tal situação demonstra a necessidade de oxigenar os animais desde a indução da anestesia e de administrar medicamentos para reverter a depressão respiratória como a naloxona, bem como utilizar animais que não apresentem nenhum tipo de comprometimento respiratório. Portanto, a inclusão de analgesia e a oxigenação nos protocolos anestésicos injetáveis devem ser utilizadas de forma rotineira garantindo a mínima presença de dor e, com isso, resultados mais confiáveis nos procedimentos experimentais. / Ensuring the wellbeing of laboratory animals and avoiding unnecessary pain and suffering is one of the main considerations in experimentation. Therefore, the investigation of new anesthetic protocols that guarantee a minimum or null discomfort of the animals has become a priority theme. In this study, it was made an evaluation of the effect of the combination of xylazine (X) and ketamine (K) with acepromazina (A) and opioids [methadone (Me), morphine (Mo) e tramadol (T)] with the purpose of comparing their influence on the physiological parameters of laboratory rats, for both sexes, and evaluating their analgesic power and the effect of the oxygenation on them. The XKA protocol for male and females rats and the XKMe protocol for females were the safest and most effective for anesthetic procedures. However, the results of the formalin test with the measurement of the ultrasonic vocalization (VUS) suggest that the XKA protocol had a low analgesic power, and it is not indicated for procedures that can generate moderate or severe pain. All anesthetic protocols had important effects as diuresis, maintenance of open eyes, and hyperglycemia; these effects should be considered when they could influence in the experimental results. It was demonstrated that oxygenation improves oxygen saturation (SO2) and oxygen partial pressure (pO2) confirming that its use should be considered in the experimental procedures with injectable anesthesia to avoid hypoxemia. Nevertheless, a respiratory acidosis was observed due to the increase in partial pressure of CO2 (pCO2) and the decrease in pH, that could be caused for the hypoventilation due to respiratory depression and CO2 accumulation during the course of anesthesia. This leads to consider the need to pre-oxygenate animals from induction, to use drugs to reverse respiratory depression such as naloxone, and to work with animals that are not respiratory compromised. Therefore the inclusion of analgesia and oxygenation in anesthesia protocols should begin to be used routinely ensuring minimal presence of pain and thus more reliable results in the experimental procedures.

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:27:34Z : No. of bitstreams: 1 mannarino_r_me_botfm.pdf: 1143230 bytes, checksum: e78de0e8beeaacc11674b6664d6aa357 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A vantagem da anestesia injetável é a facilidade de produzir os componentes da anestesia (inconsciência, analgesia, relaxamento muscular e proteção neurovegetativa) com doses definidas dos diversos fármacos. Existem controvérsias sobre as doses de propofol necessárias para prover analgesia para realização de cirurgias. Objetivaram-se definir as taxas mínimas de infusão do propofol isoladamente e em associação com a lidocaína para anestesia intravenosa em cães, e a possível potencialização analgésica da lidocaína, avaliando-se os efeitos cardiovasculares e grau de hipnose. As DE50 do propofol e propofol associado a lidocaína foram calculadas em 10 cães (12,85 l 1,22 kg), sem raça definida, anestesiados 2 vezes com intervalo de 15 dias. G1: indução anestésica com propofol (6 mg/kg/iv) e manutenção inicial na velocidade de 0,7 mg/kg/min. G2: indução anestésica com propofol (6 mg/kg) e lidocaína (1,5 mg/kg) e manutenção inicial com propofol (0,7 mg/kg/min) e lidocaína em velocidade constante (0,25 mg/kg/min). A analgesia foi avaliada através do pinçamento de membrana interdigital dos membros posteriores e da ponta da cauda por 15 (quinze) segundos. De acordo com a resposta, a velocidade foi aumentada ou diminuída em 0,05 mg/kg/min, verificando-se a analgesia 10 (dez) minutos após até a determinação da velocidade na qual não havia respostas aos dois estímulos. Esta velocidade foi mantida por mais 2 (duas) mensurações. Em não havendo resposta era considerada a DE50. A média entre as velocidades (com e sem resposta) foi utilizada na determinação da taxa de infusão mínima de cada grupo. Esta DE50 foi utilizada na 2o etapa. Doze cães (12,28 l 1,37 kg) foram divididos em 2 grupos de seis. G3: indução anestésica com 6 mg/kg de propofol e manutenção... / There is a controversy on the doses of propofol to produce sufficient surgical analgesia. This study aimed to define the minimum infusion rate of propofol and propofol combined to lidocaine for IV anesthesia in dogs. The ED50 of propofol and propofol combined with lidocaine was calculated in 10 dogs, weighing 12.85 l 1.22 kg, anesthetized twice with a interval of 15 days. Anesthesia was induced (6 mg/kg/iv) and maintained with propofol (0.7 mg/kg/min.) (G1) and induced with propofol (6 mg/kg) and lidocaine (1.5 mg/kg) and maintained with propofol (0.7 mg/kg/min) and lidocaine (0.25 mg/kg/min) (G2). Analgesia was investigated by tail clamping and podal reflex. The infusion rate was increased or reduced in 0.05 mg/kg/min, until no painful response was observed. The infusion rate was maintained for more 2 (two) evaluations, with a 10 minutes interval and this rate was considered the DE50 of propofol. The mean infusion rate between no pain response and positive response was considered the mean minimal infusion rate and was used in the second part of the study. Other 12 dogs (12.28 l 1.37 kg) were divided in 2 groups of 6 animals. G3 was treated with the same protocol as G1 and G4 as G2, with the propofol infusion rates previously calculated. Anesthesia was maintained for 2 hours. Hemodynamic and respiratory variables as well as BIS and temperature were measured during anesthesia. There was a smaller cardiovascular depression and greater vascular resistance and acidosis in animals treated with propofol and lidocaine. The BIS was maintained between 40 and 60 in both groups. Lidocaine potentiated in 21% the analgesia produced by propofol. The minimum infusion rate of propofol was 1.25 mg/kg/min when used alone and 0.985 mg/kg/min when combined to lidocaine. Lidocaine potentiated hypnosis and analgesia produced by propofol and minimized the cardiovascular depression, increasing recovery.