Orientador: Flávio Massone / Resumo: Empregou-se a dexmedetomidina em associação com a quetamina e midazolam, ou diazepam, observando-se assim os efeitos das benzodiazepinas em cães. Esta técnica anestésica foi aplicada em 30 cães hígidos com pesos e idades variáveis, machos ou fêmeas, distribuídos em três grupos (GI, GII, GIII). O GI recebeu um pré-tratamento com atropina, na dose de 0,04 mg/kg SC, e após 15 minutos, a dexmedetomidina a 3 æg/kg IV, em dose única durante 2 minutos, seguida de dose de manutenção pela dexmedetomidina 3 æg/kg, associada à quetamina na dose de 2 mg/kg, ambas na mesma seringa completando-se o volume em 20ml de solução fisiológica para infusão contínua, no período de uma hora de aplicação. O GII recebeu o mesmo tratamento de GI, entretanto, adicionou-se à dexmedetomidina o midazolam na dose de 0,2mg/kg durante os dois minutos iniciais e outra dose, de 0,2 mg/kg com a dose de manutenção da dexmedetomidina e quetamina obedecendo volume e período de G I. Em GIII obedeceu-se o mesmo tratamento de GII substituindo-se o midazolam pelo diazepam na dose de 0,5mg/kg na dose de indução e mais 0,5mg/kg junto com a dose de manutenção. Avaliou-se o efeito das benzodiazepinas para se evitarem as contraturas causadas pela quetamina sobrepondo-se à dexmedetomidina. Observaram-se as alterações paramétricas respiratórias, oxicapnométricas, índice bispectral e período de recuperação. Conclui-se diante dos resultados obtidos que: ao se aplicar a dexmedetomidina anteriormente à quetamina, não ocorrem contraturas apesar da leve redução do índice bispectral. Já a associação com benzodiazepínicos mostrou-se mais eficiente, demonstrando ser o midazolam mais eficiente na sedação e miorrelaxamento quando comparado ao diazepam... / Abstract: Dexmedetomidine in combination with ketamine and midazolam, or diazepam was used, observing the effects of the benzodiazepines in dogs. The anesthetic technique was applied in 30 healthy dogs, males or females with varied weight, divided into three groups (GI, GII and GIII). The first group (GI) received a pretreatment with atropine at 0,044 mg/kg, and 15 minutes later, dexmedetomidine at 3 æg/kg intravenous, during two minutes, for induction. For maintenance was applied the same dose of dexmedetomidine (3 æg/kg) in combination with ketamine, all diluted in 20 ml of distilled water, during one-hour infusion. Group II (GII) received the same treatment as GI, however, midazolam was administered at 0.2 mg/kg in combination with dexmedetomidine, and another dose of 0.2 mg/kg, in combination with dexmedetomidine and ketamine in one-hour infusion. Group III (GIII) received the same treatment as GII, but diazepam was used instead of midazolam, 0.5 mg/kg for induction and 0.5 mg/kg for maintenance. It was evaluated the benzodiazepines effects to prevent the cataleptic effects (contraction) caused by ketamine, even with dexmedetomidine, the respiratory and oxycapnometric parameters, bispectral index and recovery period. From the results it could be conclude that dexmedetomidine administered before ketamine does not cause muscle contractions even with less reduction in bispectral index. Benzodiazepines association with ketamine showed more reliable effects, with synergic interaction, with good sedation and muscle relaxation, being midazolam better when compared to diazepam... / Mestre

Introduction: The management of type 1 diabetes through the use of Continuous Subcutaneous Insulin Infusion (CSII); also known as insulin pump therapy, has become an increasingly popular option for children and adolescents. A systematic review of studies that measured Quality of Life (QoL) in children associated with CSII was conducted. Eighteen studies were reviewed, and the results showed insufficient evidence to conclude that CSII improves QoL in children and adolescents with type 1 diabetes. The current study aimed to address the gap in the literature by exploring children and parents’ perspectives on the use of CSII for managing diabetes. Method: Data were gathered from five children aged 8 – 14 years (and five parents), using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results: Five super-ordinate themes were identified for parents: ‘Parenting a Child with Diabetes’; ‘Worth the Hard Work’; ‘Strive for Normality’; The Pump as an Enabler’; and ‘An eye on the Future’. Three Super-ordinate themes were identified for children ‘Feeling Different’; Grappling for Control’; and ‘Better…’ which were associated with a central theme of ‘Developing a Relationship with the Pump’. Children’s data is presented separately within a journal article format. Discussion: Findings suggest that parents value the insulin pump, despite acknowledging the challenges, particularly the hard work required to manage it. Children seemed to have an ambivalent but developing relationship with the insulin pump. They experience a number of benefits and drawbacks associated with the use of CSII and it seems to affect their identity and their locus of control. Conclusion: This research provides a greater insight into the lived experience of CSII for children and their parents. The benefits of CSII seemed to outweigh the challenges involved particularly for parents; and children seemed to be developing a relationship with the pump within the realms of their relationship with diabetes.

Orientador: Carlos Augusto Araújo Valadão / Banca: Paulo Sérgio Patto dos Santos / Banca: Carmen Esther Grumadas Machado / Resumo: Avaliaram-se, 8 equinos, sob anestesia geral inalatoria com isofluorano (1CAM) e infusao continua de xilazina (0,35mg/kg/h) ou medetomidina (3,5£gg/kg/h), em relacao a frequencia cardiaca, ritmo cardiaco, frequencia respiratoria, pressao arterial, hemogasometria arterial, tonus muscular e temperatura, nos tempos T0 (imediatamente antes do inicio da infusao continua) e T10 ao T60 (intervalos de 10 minutos, apos inicio da infusao continua), alem da qualidade da tranquilizacao, inducao e recuperacao anestesica. Os dados parametricos foram submetidos a analise de variancia para repeticoes multiplas, seguido pelo teste de Student-Newman-Keuls e, entre os grupos, teste-t de Student. Para os dados nao parametricos utilizou-se teste de Friedman e entre os grupos, teste de Mann-Whitney (p-T0,05). Houve reducao da frequencia cardiaca e da temperatura e elevacao da pressao arterial media. A paCO2 (no GM) e a ctCO2 elevaram-se e a paO2 mostrou-se maior no GM que no GX. Os dois farmacos mostraram-se eficientes para tranquilizacao, mas o GM demonstrou melhor miorrelaxamento e qualidade de inducao anestesica que o GX. Da mesma forma, a recuperacao anestesica apresentada pelo GM foi de melhor qualidade, embora mais prolongada. Conclui-se que a infusao continua de doses equipotentes de xilazina e medetomidina, durante anestesia geral inalatoria, com isofluorano, em equinos, promove alteracoes cardiocirculatorias, respiratorias e hemogasometricas discretas e equivalentes. / Abstract: Eight equines under inhalatory general anesthesia with isoflurane (1MAC) and continuous infusion of xylazine (0.35mg/kg/h) or medetomidine (3.5-Êg/kg/h) were evaluated for heart rate and rhythm, respiratory rate, arterial blood pressure, arterial blood gas analysis, muscle relaxation and temperature immediately before the beginning of the continuous infusion (T0) and in intervals of 10 minutes after the beginning of the continuous infusion (T10 to T60) and also for tranquillization, induction and anesthetic recovery quality. The parametric data were evaluated by one way repeated measures ANOVA, followed by Student-Newman-Keuls and between groups Student t-test. Non-parametric data were evaluated by Friedman test and between groups Mann-Whitney test (p.0.05). Heart rate and temperature decreased and mean Heart rate and temperature decreased and mean aaarrrttteeerrriiiaaalll ppprrreeessssssuuurrreee increased. PaCO2 (in GM) and ctCO2 increased and GM showed a higher paO2 than GX. Both drugs were efficient in tranquilization but GM showed better muscle relaxation and induction quality than GX. In the same way, GM presented better anesthetic recovery even though it took more time. We conclude that equipotent doses of continuous infusion of medetomidine and xylazine during inhalatory general anesthesia with isoflurane in equines promote slight and equivalent cardiocirculatory, respiratory and arterial blood gases changes. / Mestre

Les gliomes de haut-grades sont des les tumeurs primitives les plus fréquentes du système nerveux central. Le traitement de cette pathologie associe chirurgie, radiothérapie et chimiothérapie. Les principales faiblesses de ces traitements sont le caractère infiltrant de la tumeur au sein d’un parenchyme hautement fonctionnel, l’existence de la barrière hémato-encéphalique limitant le passage trans-vasculaire de la chimiothérapie et la radiorésistance naturelle des cellules gliomateuses.Parmi les stratégies proposées pour outre-passer cette barrière hémato-encéphalique, une injection directe au sein du parenchyme a été évoquée. Afin d’optimiser cette délivrance le concept d’infusion convective a été développé, il s’agit d’une injection intra-parenchymateuse à un débit lent et contrôlé.Le bevacizumab est un anticorps dirigé contre le VEGF-A, un des principaux facteurs angiogéniques. Le but de ce traitement est de lutter contre l’ angiogénèse et de freiner la croissance tumorale.Dans un premier temps, la pharmacocinétique d’une injection intracérébrale de bevacizumab a été étudiée en comparaison avec une administration systémique plus classique. Les résultats permettent de mettre en évidence une concentration locale équivalente avec des concentrations systémiques beaucoup plus faibles avec une injection intra-tumorale. Un point important de cette étude est que la concentration dans l’hémisphère controlatéral à l’injection est aussi importante que lors d’une injection systémique.Puis l’efficacité d’une injection intratumorale de bevacizumab a été comparée à un traitement systémique sur un modèle de gliome chez la souris. L’efficacité du traitement est claire sur la survie de l’animal avec un avantage pour une injection intratumorale par rapport à une injection systémique. D’un point de vue microscopique cet avantage de survie peut être corrélé à une angiogénèse et une prolifération tumorale moins importante an cas d’injection directe au sein de la tumeur.Contrairement aux études pré-cliniques chez les rongeurs, les principaux essais cliniques n’ont pas permis de mettre en évidence un avantage d’une injection intra-tumorale directe. Principalement du à une mauvaise délivrance liée à des fuites et des reflux. Une des limites du modèle petit animal est l’absence de sillon cortical, vecteur de fuite. Le développement d’un modèle de gliome anatomiquement pertinent permettrait de simuler au mieux ces fuites et simultanément la mise au point de technologies de délivrance implantable à l’échelle humaine. Nous avons donc développé le premier modèle de gliome chez le porc. L’immunotolérance a été induite par un traitement par ciclosporine, des cellules de gliomes humains U87 et G6 ont été implantés, permettant se développer des tumeurs.Afin de dépister une mauvaise délivrance et anticiper les fuites ou les reflux, nous avons étudié les profils de pression le long de la ligne d’injection corrélés à l’existence de fuites ou de reflux. Nous avons pu identifier un profil pressionnel typique d’une injection de qualité. Les injections ne répondant pas à ces critères ont systématiquement conduits à des fuites ou reflux.L’étape suivante a été l’injection au sein d’une tumeur chez des porcs grâce à un système innovant implanté. Cette injection a été possible sans complication infectieuse avec une bonne tolérance locale et neurologique.La dernière étape de ce travail est l’étude anatomique de la diffusion d’un colorant injecté par une technique d’infusion convective. Cette étude s’intéressait notamment à la diffusion depuis la corona-radiata vers les différentes voies de substance blanche. La diffusion est anisotrope le long des fibres de substance blanche cependant la diffusion suit des voies différentes en fonction de la position du cathéter par rapport à elle. L’injection semble ouvrir des voies d’impédances rhéologiques faibles préférentielles nécessitant une adaptation anatomique aux voies qui seront la cible du traitement. / High grade gliomas are the most frequent primitive central nervous system tumor. The standard treatment is an association of surgery, radiotherapy and chemotherapy. The mains issues with these treatments are the infiltrative properties of the tumour in a highly functional parenchyma, the blood-brain barrier limiting the transvascular transport of chemotherapy and the inherent radioresistance of glioma cells.Upon different strategy to overpass the blood-brain barrier, a direct injection in the brain was advocated. In order to maximize this delivery, the concept of convection enhanced delivery was developed; it consists in a direct injection in the parenchyma with a low flow-rate.Bevacizumab is an anti-VEGF A antibody, VEGF is one of the most important angiogenic factors. The goal of this treatment is to inhibit the angiogenesis and slow down the tumor growth.We propose to study the use of this antibody in a direct intra-cerebral infusion.First, we focalize on the pharmacokinetic properties of an intratumoral injection by convection –enhanced delivery compared to a systemic administration. This shows an equivalent intratumoral concentration with systemic concentrations significantly lower with the intra-tumoral injection. An important result is the similar concentration in the controlateral hemisphere with the two routes of infusion. Convection-enhanced delivery is suitable to carry far from the infusion site high molecular weight proteins. An intra-tumoral bevacizumab may theoretically provide similar efficiency with less systemic side-effect.Then, the efficiency of an intra-tumoral infusion of bevacizumab is compared to a systemic injection on a mouse glioma model. In terms of survival the intra-tumoral treatment is significantly more efficient with an important decrease of angiogenesis and tumoral proliferation.If convection-enhanced delivery rodent study were promising, clinical trials failed to show any efficiency of intra-tumoral injection mainly due to inadequate delivery secondary to backflows and leakages. One of the limits of the rodent model is the absence of cortical sulci, main leakage provider. The development of a model anatomically relevant could simulate real conditions of injection and develop implantable device of injection in realistic conditions. We have developed the first induced model of glioma in a large animal. We choose the pig for the similarity of its brain anatomy and its size. The animals have been treated with ciclosporin to induce an immunosuppression, human glioma cells have been implanted, leading to the development of brain tumor.We have studied the pressure on the infusion line and correlate it to backflow and leakage. We have identified a pattern of pressure for successful infusion. Different pressure pattern have systematically led to backflow or leakage. These pressures criteria could permit to us an early detection of inadequate infusion to replace the catheter and avoid the failure of precedent clinical trials.Next step have been the intra-tumoral injection via an implanted device on pig glioma model. No infectious complication has been related with a good local and neurologic tolerance. The injections have led to a relevant diffusion through the tumor with a rapid flow to the periphery due to the interstitial pressure gradient between the tumor and the periphery.Last step of this work have been the anatomical study of a dye distribution by convection-enhanced delivery in a human encephalon. Indeed if pig brain is similar to human brain, human white matter structure is unique. This work is focalized on the diffusion from the corona-radiata to the main white matter tracts. The distribution is anisotropic following white matter but the diffusion is different depending on the position of the catheter. The infusion seems to open low rheological impedance paths the position of the catheter have to be adapted to the white matter tract to target.

Submitted by MICHELE CRISTINA BATISTON (mbatiston@bol.com.br) on 2018-08-08T22:41:37Z No. of bitstreams: 1 dissertaçao_mestrado_michele_batiston.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-09T14:06:35Z (GMT) No. of bitstreams: 1 batiston_mc_me_bot.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) / Made available in DSpace on 2018-08-09T14:06:35Z (GMT). No. of bitstreams: 1 batiston_mc_me_bot.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) Previous issue date: 2018-07-12 / O objetivo deste trabalho foi avaliar a evidência científica disponível sobre o uso das bombas de infusão inteligentes em pacientes hospitalizados. Foi realizado um estudo, de acordo com Diretrizes Metodológicas propostas pelo Ministério da Saúde para a elaboração de pareceres técnico-científicos (PTC). Foi realizada uma busca até 14 de novembro de 2017 nas bases de dados The Cochrane Library, EMBASE, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e de Avaliações de Tecnologias de Saúde (ATS), não houve restrição de idioma e ano de publicação do artigo. Os resultados das bases de dados foram agrupados e eliminados os estudos em duplicatas. Em seguida, aplicados os critérios de elegibilidade para os títulos e resumos, restando 51 estudos para leitura completa. Após leitura dos artigos na íntegra, foram selecionados 6 estudos, que incluíram revisão sistemática sem metanálise, três estudos observacionais sem comparador e dois estudos observacionais do tipo antes e depois. Os estudos não apresentaram dados conclusivos para redução do número de eventos ocorridos. Para a interceptação de erros/prevenção de erros, os estudos demonstraram que a bomba inteligente interceptou e impediu diversos erros como frequência, dose e programação erradas. Para os custos, o estudo de revisão sistemática sem metanálise inclui um estudo que apresentou redução de custos da Bomba de Infusão Inteligente pelos possíveis eventos adversos evitáveis. A recomendação é incerta, indicando a necessidade de elaboração de novos estudos como ensaios clínicos randomizados e avaliações econômicas. / Title: Intelligent Infusion Pump versus Conventional Infusion Pump: Comparison of cost and safety. Recommendation for the use of technology: ( ) In favor of (X) Uncertain ( ) Against Brief justification for the recommendation: Studies with little scientific evidence, the costs with the materials, the need to qualify, the construction of a library, among other strategies. Population: Patients hospitalized Technology: Intelligent Infusion Pumps Comparator: Conventional Infusion Pumps Search and analysis of scientific evidence: A search was performed to 2017, November 14 in the databases The Cochrane Library, EMBASE, PubMed and Latin American, Caribbean Literature in Health Sciences (LILACS) and the Health Technology Assessment (ATS). There was no language restriction and year of publication of the article. The results of the databases were grouped and the duplicate studies were eliminated. Then, the eligibility criteria for titles and abstracts were applied, leaving 51 studies for complete reading. After reading the articles in full, 06 studies were selected. Summary of results of selected studies: Six studies were included: one systematic review without meta-analysis, three observational studies without comparator, and two before-after observational studies. The studies did not present conclusive data to reduce the number of events that occurred. For error interception / error prevention, studies have shown that the smart pump intercepted and prevented various errors such as frequency, dose and wrong programming. For costs, the systematic review study without meta-analysis includes a study that presented cost savings of the Smart Infusion Pump for possible avoidable adverse events. Quality of Evidence: The included studies were considered of low evidence quality. Synthesis of Economic Information: The average cost of the inputs of conventional peristaltic infusion pumps is R $ 17.00 (equipment only), for intelligent peristaltic pumps it is R $ 38.00 (value of equipment only, pumps syringe infusion are conventional or intelligent use the same input that costs on average $ 8.50 (20 ml syringe and extender).

Many countries across the globe are undergoing rapid economic and social change; and there are increasing efforts to reform, revamp and revitalise education – to equip students for the ever-changing future. Education is considered to be transformative; but the area of transformative learning has been mainly theorised in the field of adult education. Comparatively, teaching approaches designed to bring about such transformation or transformative teaching has been less explored or understood. Connecting various related literature, this study places deeper learning at the centre of transformation through learning. Aiming to fill a gap within the literature, this study explores transformation through learning in a comprehensive school setting at a K-5 School in the North East of the United States by asking the following questions, ‘What are the teachers’ and students’ lived experiences of transformation through music and arts infused creative learning as practiced at an Elementary School in Northeast of USA?’ and ‘What is the role of the arts and music in this process?’. Located within the interpretive paradigm, this ethnographic case study included 7 – 14-year-old students (Grade 2 – Grade 5) and staff, aimed at investigating the phenomenon of ‘transformation through learning’ through a range of sources within its natural environment. Various data collection methods were used, including semi-structured interviews, observations (field notes, video-recordings, still images), conceptual drawing and learning walks. These provided rich, in-depth data, permitting triangulation which strengthened the findings and allowed for an illuminating understanding of the topic. An iteratively developed framework representing elements or behaviours relating to transformation was utilised as a lens to identify relevant critical incidents during the data collection process. Employing thematic analysis on the data collected resulted in eight themes that represent the lived experiences of transformation through learning. These thematic findings highlight that relevance, mindsets and placing arts at centre of the school culture are key to providing transformative learning experiences. The study connects two arguments, that fostering deeper learning enables students to meet new expectations and demands of the changing future; and that it is vital to provide students with a well-rounded curriculum with rich arts education to prepare them for success in the future. Thus, the findings of this study develop the understanding of ‘transformation through learning’ and offer a model framework from the practice at this research site from which others could create their own.

This thesis focuses on the fluid replacement therapies and the use of blood products in intensive care which is part of the daily routine for the mutidisciplinary team on intensive care including the intensive care nursing staff. These therapies span wide array of functions, including but not limited to fluid status management, electrolyte replacement and optimisation, therapeutic purposes and the delivery of nutritional requirements. The administration of blood products is vital in modern day medicine, partyicularly in the intensive care setting, and although there has been significant improvements in the standard of safety it is not completely without risk. The role of the intensive care nurse is vital not only in the preparation and administraton of blood products but also to watch for potential complications and side effects that may arise. They are also responsible for meticulous care of venous access ports as these are frequently used in the intensive care setting and must be well looked after to ensure patency and to prevent infection. This thesis is divided into parts in an attempt to cover the main issues surrounding fluid managemnet and the administration of blood products. The first part aims to summarise the relevant physiology underlying fluid balance, transfusion medicine and homeostasis. Next, based on reviewing the current literature, we aim to describe the current terminology approaches to fluid management and summarise the most commonly used products. The following sections are written with a focus on nursing care the tasks involved and their responsibilities and an overview of the possible complications that may arise with fluid replacement strategies. The important aspects of transfusion medicine are described by first defining the available blood products commonly used on intensive care followed by the basic principles underpinning the indications for their usage. We go on further to highlight the possible complications of these respective therapies and what nursing staff should be vigilant for when involved in the care of patients receiving blood products. We also address the role of the nurse in the care of the patient in hypovolemic shock. This encompasses the principles and therapies previously described in an acute setting. We describe the principles of management of such patients together with the clinical implications and practical considerations that need to be taken into account. We also focus on the particular responsibilities of the nurse in the care of such patients on intensive care. At the end of this thesis we summarised the safe concept of intravenous therapy. The second aim of this paper was based on the literature search to summarise and compare modern trends in fluid management.

Made available in DSpace on 2014-06-11T19:31:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-06Bitstream added on 2014-06-13T19:20:12Z : No. of bitstreams: 1 mendes_mc_dr_jabo.pdf: 1115485 bytes, checksum: e823340e5516e711eac803ea3a0e9a1a (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Com base na ação do amitraz (AMZ) e da romifidina (RMF) em receptores alfa-2 adrenérgicos e nas possíveis vantagens da associação destes fármacos com agentes inalatórios para uma anestesia geral segura, compararamse os efeitos clínicos, cardiocirculatórios e hemogasométricos da infusão contínua (IC) de AMZ ou de RMF associada ao isofluorano. Relacionaram-se os efeitos observados à concentração plasmática do amitraz (CPA) e investigaram-se possíveis efeitos farmacodinâmicos do diluente lipídico (DIL) utilizado na sua formulação. A medicação pré-anestésica (MPA) intravenosa (IV) para cada grupo foi: RMF - 60 μg/kg; AMZ - 0,2 mg/kg; DIL - 60 μg/kg de RMF. Induziu-se a anestesia com midazolam (0,1 mg/kg IV) e cetamina S(+) (0,2 mg/kg IV). A manutenção foi feita com 1,3 V% de isofluorano associado às ICs (RMF - 60 μg/kg.h; AMZ - 0,2 mg/kg.h; DIL - 0,1 mL/kg.h) por 60 minutos. Um minuto após a MPA a CPA média foi 396 ng/mL, aumentando durante a IC (de 93 ng/mL para 257 ng/mL) e diminuindo na recuperação, atingindo 47 ng/mL em 60 minutos. A RMF causou boa sedação e indução, com intubação fácil; manteve a FC estável e aumentou gradualmente a PAM, alterando pouco o CO2; resultou em recuperação ideal. O AMZ causou sedação leve e manteve planos anestésicos mais superficiais do que a RMF, com hipotensão durante a IC; a indução e a intubação foram de boa qualidade; o miorrelaxamento foi maior do que com RMF; a recuperação não teve boa qualidade. O DIL não causou sedação e resultou em recuperação de má qualidade, sendo inerte em relação aos efeitos do AMZ. Concluiu-se que há possibilidade do uso clínico do AMZ, ficando indicados estudos complementares. / Based on the action of amitraz (AMZ) and romifidine (RMF) on alpha-2 adrenergic receptors and in the possible advantages of combining them with inhalation anesthetics for a safe general anesthesia, the clinical, cardiocirculatory and hemogasometric effects of the continuous infusion (CI) of AMZ or RMF in association with isoflurane anesthesia were compared. The observed effects were related to the AMZ plasmatic levels (APL). The existence of pharmacodynamic effects of the lipid vehicle (LV) used for AMZ formulation was also investigated. The intravenous (IV) pre-anesthetic medications (PAM) were: RMF - 60 μg/kg; AMZ - 0.2 mg/kg; LV - 60 μg/kg de RMF. Anesthesia was inducted with midazolam (0.1 mg/kg IV) and S-ketamine (0.2 mg/kg IV) and maintained with 1.3 V% isoflurane, in association with the CIs (RMF - 60 μg/kg.h; AMZ - 0.2 mg/kg.h; LV - 0.1 mL/kg.h) for 60 minutes. One minute after PAM, APL was 396 ng/mL. During the CI, APL increased from 93 to 257 ng/mL. On recovery, APL decreased to 47 ng/mL in 60 minutes. With RMF there were good sedation and induction and the intubation was easy; HR was stable and MAP increased, with little CO2 alterations; the recovery was ideal. AMZ had less sedative effect and reached superficial anesthesia compared to RMF, with hypotension during CI; there were good induction and easy intubation; miorelaxation was greater with AMZ than with RMF; recovery was not good. The LV did not induce sedative effects and resulted in a poor recovery; it did not influence AMZ effects. The clinical use of AMZ is possible, but further studies are indicated.

Made available in DSpace on 2014-06-11T19:35:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-29Bitstream added on 2014-06-13T21:07:06Z : No. of bitstreams: 1 castro_vb_dr_botfm.pdf: 811446 bytes, checksum: c21c255ab07d1f8809f7e545477272d8 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O emprego de procedimentos de anestesia intravenosa total em cães tem sido mais freqüente, devido ao melhor conhecimento do perfil farmacocinético dos fármacos empregados. Como ainda não existe um único fármaco que produza todas as características desejáveis em uma anestesia geral, há a necessidade de se associar ao hipnótico, agentes com propriedades analgésicas. O objetivo desse estudo foi avaliar os efeitos hemodinâmicos causados pela associação do cloridrato de dexmedetomidina, nas doses de 1 e 2 μg/kg/h, e propofol na dose de 0,3 mg/kg/min, administrada em infusão intravenosa contínua em cães, bem como o tempo de recuperação anestésica após duas horas de infusão. Seis cães, clinicamente sadios, sem raça definida, pesando 17,6±1,8 kg, foram submetidos a três tratamentos com intervalo de uma semana e em seqüência aleatória. Todos os animais foram inicialmente anestesiados com isofluorano a 5V% com fluxo de 3 l/min de O2. Após a indução e intubação, os animais foram posicionados em decúbito lateral esquerdo e mantidos com isofluorano na concentração de 1,8V%. As veias cefálicas e a artéria dorsal podal foram cateterizadas e um cateter de Swan Ganz 5F foi introduzido pela veia jugular. Após fixação dos cateteres na pele, a administração do isofluorano foi interrompida. Os cães permaneceram despertos por 1 hora, e após esse período, foi realizada a avaliação das variáveis hemodinâmicas. Em seguida os cães receberam um dos seguintes tratamentos: Controle: indução com propofol (6 mg/kg/30s) e solução de NaCl 0,9% (5 ml/10min) seguida de manutenção com propofol (0.3 mg/kg/min) e NaCl 0,9% (4 ml/h); Dex 1: indução com propofol (6 mg/kg/30s) e cloridrato de dexmedetomidina (1 μg/kg/10min) seguida de manutenção com propofol (0.3 mg/kg/min)... / Total intravenous anesthesia in dogs has been more frequently used, the pharmacokinetic profile of the new drugs is better understood. No injectable anesthetic produces all of the components of a general anesthesia, it is required to associate additional analgesics with hypnotic. The aim of this study was to evaluate the hemodynamic effects caused by the association of 1 and 2 μg/kg/h of dexmedetomidine and 0,3 mg/kg/min of propofol, administered by continuous intravenous infusion, as well time of anesthetic recovery after 2 hours of infusion. Six healthy dogs weighting 17,6±1,8 kg were randomly allocated to 3 treatments with at least one week intervals between each treatment. All animals were initially anesthetized with 5V% of isoflurane and 3 l/min of oxygen. After induction and intubation, the animals were posicionated in left lateral recumbence and maintained with 1.8% end tidal. All animals were instrumented with a cephalic veins and arterial catheter and a Swan Ganz catheter in order to a monitor hemodynamic parameters. After instrumentation isoflurane was interrupted and animals were awake and remained awake for one hour. After that, baselines parameters were taken. Dogs received each one of these treatments: Control: was induced with propofol (6 mg/kg/30s) and saline (5 ml/10 min), maintenance was with propofol (0.3 mg/kg/min) and saline (4 ml/h). Dex 1 was induced with propofol (6 mg/kg30s) and dexmedetomidine (1 μg/kg10 min), maintenance with propofol (0.3 mg/kg/min) and dexmedetomidine (1 μg/kg/h). Dex 2 was induced with propofol (6 mg/kg30s) and dexmedetomidine (2 μg/kg/10min), maintenance with propofol (0.3 mg/kg/min) and dexmedetomidine (2 μg/kg/h) during 120 minutes. The parameters (HR, SBP, MAP, DAP, CI, SI, CVP, PAP, POPA, SVRI, PVRI, RR, ETCO2, SaO2, pHa, PaO2, PaCO2, HCO3, Hb, CaO2, IDO2, temperature) were taken at 15, 30, 60, 90 e 120 minutes after induction... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:35:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-24Bitstream added on 2014-06-13T20:06:20Z : No. of bitstreams: 1 hatschbach_e_dr_botfm.pdf: 353236 bytes, checksum: 3540e90d79e3d99755eddf9db2abf5c2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A anestesia venosa total possui muitas vantagens, não polui ar ambiente, fácil de usar em lugares remotos, estabilidade cardiovascular e boa qualidade de recuperação. O propofol, devido sua farmacologia, é um dos fármacos mais usados em infusões contínuas. Recentes avanços têm acontecido na anestesia venosa total com a utilização de infusões alvo controlada, baseados em simulações farmacodinâmicas e farmacocinéticas dos fármacos em tempo real, inclusive na Medicina Veterinária. Em função disso, pretendeu-se colocar em prática este tipo de anestesia, utilizando-a em cadelas para a realização de cirurgias de ovariosalpingohisterectomia. Para isso foram anestesiadas 20 cadelas, após o consentimento livre e esclarecido dos proprietários. Sendo divididos em dois grupos (GI e GII). Em GI, os animais foram pré-tratados com levomepromazina na dose de 0,5mg/kg IV e anestesiados com propofol por infusão alvo controlada na dose de indução de 3,5æg/ml e na dose de manutenção de 1,5 æg/ml IV, através bomba de infusão Harvard pump, associado com remifentanila na dose de 0,3æg/kg/min, através de bomba de seringa. Em GII, os animais receberam o mesmo tratamento de GI, só que ao invés de receberem o propofol por infusão alvo controlada, receberam o propofol a 5mg/kg como dose de indução e como manutenção, receberam o propofol em infusão contínua de velocidade fixa, na dose de 0,2mg/kg/min. Assim, compararam-se as duas técnicas de infusão, a de velocidade fixa e a alvo controlada, concluindo-se que as doses de propofol utilizadas em ambas as técnicas, após o pré-tratamento de levomepromazina e associadas ao opióide, foram eficazes para a realização cirúrgica, promovendo bradicardia e discreta hipotensão, porém estabilidade hemogasométrica e respiratória... / Total venous anesthesia has many advantages as it does not pollute environmental air, can be easily used in remote sites, provides cardiovascular stability and good recovery quality. Due to its pharmacology, propofol is one of the most frequently used drugs in continuous infusions. Recently, advances have also been observed in total venous anesthesia with the use of target-controlled infusions based on real-time pharmacodynamic and pharmacokinetic drug simulations in Veterinary Medicine. As a result, this study aimed at applying this type of anesthesia by using it in female dogs for the performance of ovariosalpingohysterectomy surgery. To that end, twenty female dogs were anesthetized after free consent was given by their owners. The animals were divided into two groups (GI and GII). In GI, the dogs were pre-treated with methotrimeprazine at a dose of 0.5mg/kg IV and anesthetized with propofol by target-controlled infusion at an induction dose of 3.5æg/ml and a maintenance dose of 1.5 æg/ml IV by means of a Harvard infusion pump associated with remifentanil at a dose of 0.3æg/kg/min by means of a syringe pump. In GII, the animals received the same treatment as that given to GI, except that instead of receiving propofol by target-controlled infusion, they were given propofol at 5mg/kg as an induction dose. As maintenance, they received propofol by single-speed continuous infusion at a dose of 0.2mg/kg/min. Hence, two infusion techniques, fixed-speed infusion and target-controlled infusion, were compared, leading to the conclusion that the doses of propofol used in both techniques, after pre-treated with methotrimeprazine, associated with the opioid were efficient for surgery performance as they promoted bradycardia and discreet hypotension, but hemogasometric and respiratory stability, futher good muscle relaxation, more evident in fixed-speed infusion... (Complete abstract click electronic access below)