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The oral and maxillofacial surgery model of anesthesia delivery is the subject of some controversy. However, a long track record of patient safety provides compelling support for the dual role of the oral and maxillofacial surgeon as proceduralist and anesthetist. Among the elements critical to continued success is a clear understanding of the pharmacology of the agents used to produce sedation and general anesthesia. This review highlights 6 sedation agents used as part of a balanced anesthesia technique in oral and maxillofacial surgery.

Ketamine is a phencyclidine (PCP) derivative that exerts its effects primarily through N -methyl-d-aspartate receptor inhibition.[1][1] At low doses (0.1–0.3 mg/kg), ketamine produces mainly analgesia. Dissociative anesthesia and psychomimetic effects occur with higher doses (≥ 1.0 mg/kg). Low

This study aimed to evaluate the effectiveness of acepromazine as an adjuvant to ketamine, midazolam and methadone in the chemical restraint and anesthesia of cats undergoing ovariohysterectomy. We allocated 14 cats in two groups: group ketamine (GK), premedicated with ketamine 8 mg/kg, midazolam 0.3 mg/kg and methadone 0.3 mg/kg and group acepromazine (GAK), premedicated with acepromazine 0.05 mg/kg in addition to the above-mentioned drugs. At baseline (T0) and every 5 mins up to 20 mins (T5, T10, T15 and T20) after premedication, the sedation score was evaluated at 0 to 24 points. The sedation score was significantly higher at T5, T10, T15 and T20 in both groups. There were no significant differences in extubation times (3.7 ± 1.3 mins in GK; 5.2 ± 2.6 mins in GAK) and the time to reach a score equal to 0 on the sedation scale (88 ± 63.9 mins in GK; 133 ± 39.7 mins in GAK); however, the time of anesthetic release was significantly higher in the GAK than in GK (19.7 ± 6.5 mins vs 11 ± 5.9 mins) (P = 0.023). Sedation was adequate in both groups. The results indicated that the administration of acepromazine did not contribute to sedation in the protocol and could delay the anesthetic release. El objetivo de este estudio fue evaluar el efecto de la acepromazina con adyuvante al protocolo de ketamina, midazolam y metadona sobre la contención química y la anestesia de gatos sometidos a ovariosalpingohisterectomía. Los animales fueron divididos en dos grupos: grupo ketamina (GK), premedicado con ketamina 8 mg/kg, midazolam 0,3 mg/kg y metadona 0,3 mg/kg, y el grupo acepromazina (GAK), premedicado con acepromazina 0,05 mg/kg asociado a los fármacos mencionados anteriormente. Al inicio (T0) y cada 5 minutos hasta 20 minutos (T5, T10, T15 y T20), después de la premedicación, se evaluó un puntaje de sedación de 0 a 24 puntos. La sedación fue significativamente mayor en T5, T10, T15 y T20 en ambos grupos. No hubo diferencias significativas en los tiempos de extubación (3,7 ± 1,3 minutos en GK; 5,2 ± 2,6 minutos en GAK); y a tiempo para lograr una puntuación igual a 0 en la escala de sedación (88 ± 63,9 minutos en GK; 133 ± 39,7 minutos en GAK); sin embargo, el tiempo de descarga anestésico era perceptiblemente más largo en GAK que en GK (19,7 ± 6,5 minutos contra 11 ± 5,9 minutos) (P = 0,023). La sedación fue adecuada en ambos grupos. La administración de acepromazina no contribuyó a la sedación y aumentó el tiempo de anestésico alto. O objetivo desse estudo foi avaliar o efeito da acepromazina com adjuvante ao protocolo de cetamina, midazolam e metadona na contenção química e anestesia de gatas submetidas a ovariosalpingohisterectomia. Os animais foram divididos em dois grupos: grupo cetamina (GK), premedicados com cetamina 8 mg/kg, midazolam 0,3 mg/kg e metadona 0,3 mg/kg, e o grupo acepromazina (GAK), premedicados com acepromazina 0,05 mg/kg associada aos fármacos citados anteriormente. No momento basal (T0) e a cada 5 minutos até 20 minutos (T5, T10, T15 e T20), após a premedicação, um escore de sedação foi avaliado de 0 a 24 pontos. A sedação foi significativamente maior nos T5, T10, T15 e T20 em ambos os grupos. Não teve diferença significativa nos tempos de extubação (3.7 ± 1.3 minutos no GK; 5.2 ± 2.6 minutos no GAK); e no tempo para alcançar escore igual a 0 na escala de sedação (88 ± 63.9 minutos no GK; 133 ± 39.7 minuto no GAK); entretanto, o tempo de alta anestésica foi significativamente maior no GAK do que no GK (19.7 ± 6.5 minutos contra 11 ± 5.9 minutos) (P = 0.023). A sedação foi adequada em ambos os grupos. A administração de acepromazina não contribuiu para a sedação e aumentou a o tempo de alta anestésica.

The objective of this study was to evaluate the quality and recovery from anesthesia promoted by the tiletamine-zolazepam (TZ) combination administered intravenously (IV) continuously in bitches pre-medicated with acepromazine. Eight cross-bred, clinically healthy bitches weighing 13.7 ±1.9kg on average were used in this study. After a food fast of 12 h and a water fast of four hours, the animals were treated with acepromazine (0.1mg/kg, intramuscular) and, after 15 minutes, anesthesia was induced with a combination of tiletamine-zolazepam (2mg/kg, IV) immediately followed by continuous IV infusion thereof at a dose of 2mg/kg/h for 60 min. The following parameters were measured in all animals immediately before administration of acepromazine (M15), immediately before anesthetic induction (M0), and at 5, 10, 20, 30, 40, 50, and 60 min after initiation of continuous infusion (M5, M10, M20, M30, M40, M50, and M60): electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), body temperature (BT), and arterial hemogasometry, with the last performed only at experimental times M15, M0, M30, and M60. A subcutaneous electrical stimulator was used to evaluate the degree of analgesia. Myorelaxation and quality of anesthetic recovery were also assessed, classifying these parameters as excellent, good, and poor. Anesthetic recovery time was recorded in minutes. HR increased significantly at time M10 in relation to that at M-15, and at times M5, M10, M40, and M50 in relation to that at M0. MAP decreased significantly at M20 and M30 compared with the baseline. BT decreased significantly at M50 compared with that at M0, but no hypothermia was observed. RR showed significant reduction at M5, M10, and M20 in relation to that at M-15, and at M5 and M10 in relation to that at M0, and bradypnoea was observed during the first 20 min after anesthetic induction. Significant decreases in the PR interval at times M10, M40, and M50 were observed in relation to that at M15. Amplitude of the R wave showed significant decrease at M20 compared with that at M-15. In the other ECG parameters, no significant difference was observed between the times evaluated. Hemogasometric parameters and analgesia did not show significant alterations. Myorelaxation and quality of anesthetic recovery were considered excellent. Recovery time was 15.1±7.7 min for positioning of sternal decubitus and 45.5±23.1 minutes for return of ambulation. Continuous IV administration of TZ combination does not produce satisfactory analgesia and does not cause severe cardiorespiratory and hemogasometric effects in bitches pre-medicated with acepromazine. RESUMO: Objetivou-se avaliar a qualidade e a recuperação da anestesia promovida pela associação tiletamina-zolazepam, administrada por via intravenosa (IV) contínua, em cadelas pré-medicadas com acepromazina. Foram utilizadas oito cadelas, sem raças definidas, clinicamente sadias, pesando em média 13,7±1,9kg. Após jejum alimentar de 12 horas e hídrico de quatro horas, os animais foram medicados com acepromazina (0,1mg/kg, via intramuscular) e, após 15 minutos, a anestesia foi induzida com a associação tiletamina-zolazepam (2mg/kg, IV) seguida imediatamente pela infusão IV contínua da mesma, na dose de 2mg/kg/h, durante 60 minutos. Os parâmetros que foram mensurados em todos os animais, imediatamente antes da administração da acepromazina (M-15), imediatamente antes da indução anestésica (M0) e, aos 5, 10, 20, 30, 40, 50 e 60 minutos após o início da infusão contínua (M5, M10, M20, M30, M40, M50 e M60) foram os seguintes: eletrocardiografia (ECG), frequência cardíaca (FC), pressão arterial média (PAM), frequência respiratória (f), temperatura corpórea (TC) e hemogasometria arterial, esta sendo realizada apenas nos momentos M-15, M0, M30 e M60. Para avaliação do grau de analgesia foi empregado um estimulador elétrico subcutâneo. Também se avaliou o miorrelaxamento e a qualidade da recuperação anestésica, classificando estes parâmetros em: excelente, bom e ruim. O tempo de recuperação anestésica foi registrado em minutos. A FC aumentou significativamente no momento M10 em relação ao M-15, e nos momentos M5, M10, M40 e M50 em relação ao M0. A PAM diminuiu significativamente em M20 e M30 em comparação ao valor basal. A TC diminuiu significativamente em M50 em comparação ao M0, mas não foi observada hipotermia. A f apresentou uma redução significativa nos momentos M5, M10 e M20 em relação ao M-15, e em M5 e M10 em relação ao M0, sendo observado bradipneia durante os primeiros 20 minutos após a indução anestésica. Foram observadas diminuições significativas do intervalo PR nos momentos M10, M40 e M50, em relação ao M-15. A amplitude da onda R apresentou diminuição significativa em M20 em comparação ao M-15. Nos demais parâmetros da ECG não houve diferença significativa entre os momentos avaliados. Os parâmetros hemogasométricos e a analgesia não apresentaram alterações significativas. O miorrelaxamento e a qualidade da recuperação anestésica foram considerados excelentes. O período de recuperação foi de 15,1±7,7 minutos para posicionamento do decúbito esternal e 45,5±23,1 minutos para retorno da deambulação. A administração intravenosa contínua de tiletamina-zolazepam não produz analgesia satisfatória e não causa efeitos cardiorrespiratórios e hemogasométricos severos, em cadelas pré-tratadas com acepromazina.

Este estudo teve como objetivo determinar a dose capaz de prevenir o movimento frente a um estímulo nocivo em 50% dos indivíduos (DE50) da combinação tiletamina-zolazepam-cetamina-xilazina (TCX) e TCX associada a 0,3 mg/kg de metadona (TCXM) em cães submetidos a cirurgia de orquiectomia. Trinta cães receberam aleatoriamente a administração do TCX (n = 14) ou TCXM (n = 16) pela via IM. A determinação da DE50 foi baseada no método up-and-down relatado por Dixon. O estímulo nociceptivo avaliado consistiu na incisão pré-escrotal de pele e tecido subcutâneo. Cada mL de TCX apresentou 50 mg de tiletamina, 50 mg de zolazepam, 80 mg de cetamina e 20 mg de xilazina. O volume inicial administrado no primeiro animal de cada grupo foi de 0,020 mL/kg. No caso de resposta positiva, a dose do TCX foi aumentada em 0,005 mL/kg para o paciente seguinte do mesmo grupo e o contrário ocorrendo frente a uma resposta negativa. Quando o anestesista julgava a anestesia inadequada, era administrado a complementação de 0,01 mL/kg de TCX pela via intramuscular e o bloqueio anestésico com lidocaína era realizado. Os animais permaneceram sob respiração espontânea em ar ambiente e foram avaliados parâmetros cardiovasculares e respiratórios. Os escores de sedação foram avaliados nos tempos basal e 15 minutos após a aplicação do tratamento. Os protocolos TCX e TCXM apresentaram curto período de latência (3 versus 4 minutos, respetivamente). Os cães de ambos os grupos apresentaram escores de sedação significativamente mais elevados 15 minutos após a aplicação do tratamento (medianas [intervalo interquartil]:TCX: 17 [6-20]; TCXM: 17 [13-21]) em relação ao basal (TCX: 3 [1-5]; TCXM: 3 [0-4]), sem diferença significativa entre grupos. Não houve diferença significativa na DE50 encontrada nos tratamentos TCX (0,024 ± 0,004 mL/kg) e TCXM (0,022 ± 0,005 mL/kg). Houve diferença significativa entre os grupos em relação a dose total de TCX para concluir a cirurgia de orquiectomia (P = 0,0001) e no grupo TCX, um maior número de complementações foi necessário (2 ± 1 versus 1 ± 1). A associação de metadona ao TCX não reduz a DE50 do TCX em cães, mas reduz o número de complementações e dose total necessária para concluir a cirurgia de orquiectomia. Os protocolos demonstram ser alternativa para rápida contenção química quando administrados em doses próximas à DE50. This study aimed to investigate the dose preventing movement in 50% of individuals in response to a noxious stimulus (ED50) of tiletamine-zolazepam-ketamine-xylazine (TCX) and tiletamine-zolazepam-ketamine-xylazine-methadone (TCXM) anesthetic combinations in dogs undergoing orchiectomy. Thirty dogs were randomly assigned to receive either TCX (n = 14) or TCXM (n = 16) IM. The ED50 value was obtained with Dixon's up-and-down method. The noxious stimulus applied was skin and subcutaneous pre-scrotal incision. Each milliliter of TCX contained 50 of tiletamine, 50 mg of zolazepam, 80 mg of ketamine and 20 mg of xylazine. The TCX anesthetic combination was injected intramuscularly and the initial dose administered in the first animal of each group was 0,020 mL/kg. When the individuals showed a positive response to the painful stimulus the dose was increased by 0,005 mL/kg to the next individual of the same group and the opposite occurred when a negative response was presented. In the TCXM group the patients received the TCX anesthetic combination plus 0,3 mg/kg methadone mixed in the same syringe. The TCX anesthetic combination was injected intramuscularly (0,01 mL/kg) and local anesthesia with lidocaine was performed when signs of inadequate anesthesia were observed. Anesthesia was maintained in dogs breathing room air spontaneously and cardiovascular and respiratory parameters were evaluated. Sedation scores were evaluated at baseline and 15 minutes after the treatment. The TCX and TCXM anesthetic combinations showed short latency period (3 versus 4 minutes respectively). The dogs showed significantly higher sedation scores 15 minutes after administration of treatments (median [interquartil range]: TCX: 17 [6-20]; TCXM: 17 [13-21]) when compared to baseline (TCX: 3 [1-5]; TCXM: 3 [0-4]), but there was no significant difference between groups. There was no significant difference between the ED50 of the TCX (0,024 ± 0,004 mL/kg) and TCXM (0,022 ± 0,005 mL/kg) groups. The total dose of TCX to completed the orchiectomy procedure was significantly higher in TCX than in TCXM (P = 0,0001). A larger number of additional doses of TCX was necessary in the TCX group than in TCXM (2±1 versus 1±1). The association of methadone with TCX does not reduce the ED50 of the TCX anesthetic combination, although it reduces the total dose required to complete the orchiectomy surgery. When administered in doses close to the ED50, TCX and TCXM seem to be a good alternative when rapid immobilization is required.

The aim of this study was to assess the cardiopulmonary effects, the onset time after the administration of a detomidine/ketamine combination, and the recovery from anesthesia of cougars (Puma concolor) anesthetized with detomidine/ketamine and isoflurane or sevoflurane for abdominal ultrasound imaging. Fourteen animals were randomly allocated into two experimental groups: GISO (n=7) and GSEVO (n=7). Chemical restraint was performed using 0.15mg/kg detomidine combined with 5mg/kg ketamine intramuscularly; anesthesia induction was achieved using 2mg/kg propofol intravenously and maintenance with isoflurane (GISO) or sevoflurane (GSEVO). The following parameters were assessed: heart rate, respiratory rate, systolic and diastolic arterial blood pressure, mean arterial blood pressure, oxyhemoglobin saturation, rectal temperature, central venous pressure, and end-tidal carbon dioxide. The time to sternal recumbency (TSR) and time to standing position (TSP) were also determined. There was not statistically significant difference for the cardiopulmonary variables or TSP whereas TSR was significantly shorter in GSEVO. The time to onset of anesthesia was 11.1±1.2 minutes and 11.3±1.8 minutes for GISO and GSEVO, respectively. The anesthesia of cougars with detomidine/ketamine and isoflurane or sevoflurane was conducted with safety, cardiopulmonary stability, and increased time to sternal recumbency in the GISO group.

Intimo-intimal intussusception is a very rare and unusual complication of type A dissections, typically noted on TEE exam. It has been reported in a few cases in the cardiothoracic surgical and radiology literature, and even more rarely in the cardiac anesthesia/TEE literature. This uncommon variation occurs in severe, acute, type A dissections when the ascending aortic intima circumferentially strips and detaches from the media and forms a tube-like structure which may either prolapse antegrade into the ascending aortic lumen or retrograde into the left ventricular (LV) outflow tract and LV cavity. Antegrade intussusceptions may be severe enough to partially or completely occlude the ostia of the innominate, left common carotid, and left subclavian arteries producing acute neurologic symptoms. Retrograde intussusceptions may severely impair LV filling in diastole, can worsen aortic insufficiency, mitral regurgitation, as well as produce occlusion of the coronary ostia and acute coronary ischemia. Here, we describe the incidental finding of a retrograde intussusception that was not visualized on computed tomography scan but by intraoperative TEE examination, in a patient with a severe, extensive type A dissection.

Thromboembolism continues to be a major concern in patients with mechanical heart valves, especially in those with unsatisfactory anticoagulation levels. The new On-X valve (On-X Life Technologies, Austin, TX, USA) has been reported as having unique structural characteristics that offer lower thrombogenicity to the valve. We report a case where the patient received no or minimal systemic anticoagulation after placement of On-X mitral and aortic valves due to development of severe mucosal arterio-venous malformations yet did not show any evidence of thromboembolism. This case report reinforces the findings of recent studies that lower anticoagulation levels may be acceptable in patients with On-X valves and suggests this valve may be particularly useful in those in whom therapeutic levels of anticoagulation cannot be achieved due to increased risk of bleeding.

Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.

EnglishThe present study evaluated the minimum alveolar concentration of isoflurane (ISOMAC) in twenty three dogs premedicated with acepromazine (0.02mgkg-1) and morphine (0.5mgkg-1) and administered racemic (RK) or S(+)-ketamine (SK). Dogs randomly received a single dose (3mgkg-1, IM) of either RK or SK 15minutes after anesthetic induction with propofol. The ISOMAC was determined by the up-and-down method. Approximately 20 minutes after administration of RK or SK, a surgical noxious stimulus was applied and the response evaluated. The ISOMAC was 0.50±0.01% in the RK group (n=10) and 0.31±0.04% in the SK group (n=13). The ISOMAC was 38% lower in the SK group compared to the RK group. Results of the present study revealed that in dogs premedicated with acepromazine and morphine, IM administration of 3mgkg-1 ketamine approximately 20 minutes before the noxious stimulus produced clinically important reduction in the ISOMAC and the MAC-sparing effect was significantly greater with SK compared to RK. Key words: dissociative anesthesia; MAC; NMDA antagonist; phencyclidine derivative; preemptive analgesia portuguesNo presente estudo, foi avaliada a concentracao alveolar minima do isoflurano (CAMISO) em vinte e tres caes premedicados com acepromazina (0,02mgkg-1) e morfina (0,5mgkg-1) e tratados com cetamina racemica (CR) ou S(+) (CS). Os caes receberam aleatoriamente dose unica (3mgkg-1, IM) de CR ou CS, decorridos 15 minutos da inducao anestesica com propofol. A CAMISO foi determinada pelo metodo up-and-down. Aproximadamente 20 minutos apos a administracao da CR ou CS, um estimulo nociceptivo (cirurgico) foi aplicado e a resposta avaliada. A CAMISO foi 0,50±0,01% no CR (n=10) e 0,31±0,04% no CS (n=13). A CAMISO foi 38% menor no CS comparado ao CR. Os resultados deste estudo revelaram que, em caes premedicados com acepromazina e morfina, a administracao IM de 3mgkg-1 de cetamina, aproximadamente 20 minutos antes do estimulo nociceptivo, causou reducao clinicamente importante na CAMISO e o efeito redutor na CAMISO e significativamente maior com CS do que com CR. Palavras-chave: anestesia dissociativa; CAM; antagonista NMDA; derivados da fenciclidina; analgesia pre-emptiva

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:50:51Z No. of bitstreams: 1 S0100-736X2009001200009.pdf: 35543 bytes, checksum: 8347b7aa8360eacaeedc858515d7acb1 (MD5) Made available in DSpace on 2013-08-22T18:50:51Z (GMT). No. of bitstreams: 1 S0100-736X2009001200009.pdf: 35543 bytes, checksum: 8347b7aa8360eacaeedc858515d7acb1 (MD5) Previous issue date: 2009-12-01 Made available in DSpace on 2013-09-30T18:15:59Z (GMT). No. of bitstreams: 2 S0100-736X2009001200009.pdf: 35543 bytes, checksum: 8347b7aa8360eacaeedc858515d7acb1 (MD5) S0100-736X2009001200009.pdf.txt: 27778 bytes, checksum: 1b864c35abb4c39a2bc602ca397dfce7 (MD5) Previous issue date: 2009-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:59Z No. of bitstreams: 2 S0100-736X2009001200009.pdf: 35543 bytes, checksum: 8347b7aa8360eacaeedc858515d7acb1 (MD5) S0100-736X2009001200009.pdf.txt: 27778 bytes, checksum: 1b864c35abb4c39a2bc602ca397dfce7 (MD5) Made available in DSpace on 2014-05-20T13:38:59Z (GMT). No. of bitstreams: 2 S0100-736X2009001200009.pdf: 35543 bytes, checksum: 8347b7aa8360eacaeedc858515d7acb1 (MD5) S0100-736X2009001200009.pdf.txt: 27778 bytes, checksum: 1b864c35abb4c39a2bc602ca397dfce7 (MD5) Previous issue date: 2009-12-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) O trabalho teve por objetivo avaliar por meio de estudos goniométricos os membros pélvicos de pacas criadas em cativeiro. Foram utilizadas oito pacas (Cuniculus paca), sendo três fêmeas e cinco machos, com peso entre 6,0 kg e 8,2 kg, nos quais foi aferido o movimento de extensão e flexão das articulações coxofemoral, joelho e tarsocrural utilizando-se um goniômetro de plástico. Foram realizadas duas aferições para cada membro pelo mesmo avaliador, com intervalo de uma semana entre cada aferição, com os animais sob anestesia dissociativa. Não houve diferença estatística nas aferições dos ângulos entres os momentos. As variações entre as medidas de flexão e extensão, efetuadas em cada momento pelo mesmo avaliador, foi entre 1º e 5º para cada membro. Os valores goniométricos médios foram: flexão de 43,96º±7,62 e extensão de 118,31º±9,79 para a articulação coxofemoral; flexão de 54,25º±10,24 e extensão 131,53º±7,89 para o joelho; flexão de 45,94º±7,16 e extensão de 145,03º±5,06 para a articulação tarsocrural. Sendo assim, observou-se que a amplitude de movimento das pacas é maior na articulação tarsocrural, seguida respectivamente do joelho e da articulação coxofemoral. The aim of this study was to evaluate by goniometry the hind limbs of pacas raised in captivity. Eight mature pacas (Cuniculus paca), three females and five males, weighing 6.0-8.2 kg, were used. The quantity of joint flexion and extension motion of the hip joint, stifle joint and tarsocrural joint was measured using a plastic standard goniometer. Under dissociative anesthesia, two measures were made for each member in each animal by the same observer at an interval of one week. There were no statistical differences of the quantity of joint motion between the moments. The flexion and extension angles varied from 1º to 5º in each moment for the same observer. The mean values of the angles of flexion and extension were, respectively, 43.96º±7.62 and 118.31º±9.79 for hip joint, 54.25º±10.24 and 131.53º±7.89 for stifle joint, and 45.94º±7.16 and 145.03º±5.06 for tarsocrural joint. Thus, it was observed that the range of motion of the pacas is greater in the tarsocrural joint, followed respectively by stifle and hip joints. Universidade Estadual Paulista Faculdade de Medicina Veterinária e Zootecnia Departamento de Cirurgia e Anestesiologia Veterinária Unesp FMVZ Departamento de Cirurgia e Anestesiologia Veterinária Unesp Faculdade de Ciências Agrárias e Veterinárias Departamento de Morfologia e Fisiologia Animal Unesp Instituto de Biociências Departamento de Bioestatística Universidade Estadual Paulista Faculdade de Medicina Veterinária e Zootecnia Departamento de Cirurgia e Anestesiologia Veterinária Unesp FMVZ Departamento de Cirurgia e Anestesiologia Veterinária Unesp Faculdade de Ciências Agrárias e Veterinárias Departamento de Morfologia e Fisiologia Animal Unesp Instituto de Biociências Departamento de Bioestatística

Equine field practice commonly requires short- to medium-term anesthesia being induced in horses for either minor surgical or diagnostic procedures or for urgent medical care in emergency situations. Performing a general anesthetic in the field further increases the risk associated with equine anesthesia which already is high when compared with small animal or human anesthesia, even under best of hospital conditions. For this reason, cases for field anesthesia should be carefully selected and appropriate anesthesia protocols chosen by taking into account the peculiar setting of the location, the physical condition of the patient, and the specific circumstances of the surgical, diagnostic, or other procedures planned. This review provides an overview of the anesthetic techniques suitable for field anesthesia. First, the approach to the equine patient under field as compared with hospital conditions is addressed, followed by a detailed discussion of common field anesthetic protocols reported for use in adult horses and in foals. Finally, anesthetic protocols suitable for horses suffering injuries during or immediately after maximum exercise are addressed.

Safety is always the primary concern of surgeons and patients in any office-based procedure. With the growing use of safe intravenous sedation in this setting, a need for a standardized protocol for dissociative anesthesia exists. We have accomplished this task by using a sedation monitoring system, which could easily be implemented in any existing office-based operating setting. Our sedation monitor, abbreviated SeMo, provides a standardized means of monitoring deep intravenous sedation administration to patients in the operating room setting. The idea of SeMo is to develop a stand-alone system capable of integrating all facets of the operating room staff through a common communication media to improve efficiency and safety.

We investigated the contribution of NO-cyclic GMP (cGMP) pathway to the antinociceptive effects of ketamine in mice by using the nitric oxide synthase inhibitor nitro(g)-L-arginine methyl ester (L-NAME). Intraperitoneal (i.p.) (1 5 or 10 mg/kg) or intrathecal (i.th.) (10 30 or 60 mug/mouse) administration of ketamine produced dose-dependent antinociceptive effects in the acetic acid-induced writhing and formalin tests but not in the tail-flick nor in hot-plate tests. pretreatment of mice with L-NAME (10 mg/kg i.p.) which produced no antinociception on its own significantly inhibited the antinociceptive effect of ketamine (1 5 or 10 mg/kg i.p.). However L-NAME (30 mug/mouse) was given intrathecally it neither modified the antinociceptive effect of i.th. ketamine (10 3 0 or 60 mug/mouse) nor did it produce an antinociceptive effect alone. These data suggest that the activation of the NO-cGMP pathway probably at the supraspinal level but not spinal level contributes to the antinociceptive effects of ketamine. (C) 2002 Published by Elsevier Science Inc.

Introduction: We describe a patient scheduled for elective surgery who regularly consumed approximately 12 to 15 times the maximum recommended daily dose of dextromethorphan. We describe the clinical pharmacology of dextromethorphan and discuss its anesthetic implications. Case Presentation: A 30-year-old man with a history of a nasal fracture was scheduled to undergo an elective septorhinoplasty. He reported daily consumption of large quantities (1440 to 1800 mg) of dextromethorphan for six years. He was previously treated for dextromethorphan dependency on several occasions with urine dextromethorphan levels exceeding 2000 ng/mL. He described marked dissociative effects when abusing the drug, but had abstained from use for 48 hours before his elective surgery. Considering that dextromethorphan has a relatively short half-life and that the patient did not suffer major withdrawal symptoms after voluntarily discontinuing the drug, the authors proceeded with the case while recognizing that the drug has significant neuropsychiatric and sympathetic nervous system stimulant effects resulting from its actions as a N-methyl-D-aspartate receptor antagonist. Conclusions: Anesthesiologists need to be aware of dextromethorphan’s clinical pharmacology because recreational abuse of the drug has become increasingly common in adolescents and young adults.

Lima D.A.S.D., Souza A.P., Borges O.M.M., Santana V.L., Araújo A.L., Figueirêdo L.C.M., Nóbrega Neto P.I. & Lima W.C. [Comparative study of the association of Ketamine to Dexmedetomidine, Medetomidine or Xylazine in rabbits.] Estudo comparativo da associação de Cetamina à Dexmedetomidina, Medetomidina ou Xilazina em coelhos. Revista Brasileira de Medicina Veterinária 36(1):35-41, 2014. Programa de Pós-Graduação em Medicina Veterinária, Centro de Saúde e Tecnologia Rural, Universidade Federal de Campina Grande, Av. Universitária, s/n, Patos, PB 58708-110, Brasil. E-mail: dayannevet@yahoo.com.br There are a variety of different anesthetic techniques that aim to overcome the various problems of anesthesia in rabbits, such as handling stress and apnea during induction with inhalational anesthetic agents, reducing the risks of the procedure. The objective of this study was to compare the anesthetic effects promoted by ketamine associated/mixed with three different agonists α2 -adrenergics in rabbits. Were used 6 healthy animals, (SRD) mixed breed, weighing 2.42+0.36 kg, submerged to treatments called GCX, GCD and GCM. The fixed-dose ketamine (15 mg/kg) combined with xylazine (10 mg/kg) was administered intramuscularly in the GCX, the dexmedetomidine (0.05 mg/ kg) in GCD and medetomidine (0.25 mg/kg) in the GCM. Were evaluated the heart rate (HR), respiratory rate (ƒ), rectal temperature (RT), oxyhemoglobin saturation (SpO2 ), mean arterial pressure (MAP), glucose (GLI), variables electrocardiography (Pms, PmV, PRms, QRSms, RmV, QTms, RRms), latency, able anesthetic and recovery period. The records of the variables were initiated before drug administration (basal) and every 5 minutes after taking them for 50 minutes. Data were subjected to ANOVA followed by the Tukey test (P

In 1974, the author began to use ketamine in association with diazepam for cosmetic and reconstructive procedures. Since then, through courses in the United States and abroad, well over a thousand plastic surgeons have been taught the technique. Ketamine, by itself, ablates sensory input of pain at the thalamic level but has been associated with hallucinations, bad dreams, and other untoward effects. These can be prevented by the use of benzodiazepines, which "bracket" the use of ketamine. If the patient is sedated and awakens under the influence of these agents, there is no adverse ketamine effect. Specific techniques and adjunct agents are described.

Made available in DSpace on 2021-07-14T10:44:54Z (GMT). No. of bitstreams: 0 Previous issue date: 1992-12. Added 1 bitstream(s) on 2021-07-14T11:37:20Z : No. of bitstreams: 1 S0103-84781992000300006.pdf: 832709 bytes, checksum: e87c3bbb6ad0c2ddddd65da616158616 (MD5) O objetivo deste trabalho foi verificar a viabilidade do droperidol como agente tranqüilizante em potros, associado a quetamina como droga produtora de anestesia dissociativa de curta duração. Foram empregados 10 potros, com idade de 2 a 6 meses, de ambos os sexos e com pesos compreendidos entre 50 e 210kg. Cada animal recebeu, por via intravenosa, 0,8mg/kg de droperidol e, decorridos 10 minutos, pela mesma via, 2mg/kg de quetamina Foram avaliados os parâmetros referentes às freqüências cardíaca e respiratória, temperatura retal, gases sanguíneos, pH e eletrólitos, imediatamente antes e após a aplicação das drogas a intervalos de 10, minutos, durante 30 minutos. A análise estatística mostrou estabilidade de parâmetros, exceto a freqüência respiratória e a temperatura retal, que decresceram durante o experimento. Conclui-se que o método é seguro e eficaz na produção de anestesia dissociativa em eqüinos jovens. The aim of this work was evaluate the effect of droperidol associated to ketamine on some parameters as body temperature, heart rate, respiratory frequency, blood gases, pH eletrolites in foals. To 10 foals with 2 to 6 months average age and 50 to 210kg average weight was administered intravenously 0.8mg/kg, droperidol and 10 minutes after, by the same way, 2mg/kg, ketamine. The parameters were evaluated during 30 minutes at 10 minutes intervals, showing no significant differences, except the respiratory frequency and the body temperature that decreased during the experiment. The procedure can be used safely in foals. Universidade Estadual Paulista, Departamento de Clínica e Cirurgia Veterinária Universidade Federal de Minas Gerais, Escola de Veterinária Universidade Estadual Paulista, Departamento de Clínica e Cirurgia Veterinária

Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

Truncus arteriosus (TA) is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

Made available in DSpace on 2016-07-19T13:51:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-02-01. Added 1 bitstream(s) on 2016-07-19T14:08:05Z : No. of bitstreams: 1 S0102-86502005000100007.pdf: 153737 bytes, checksum: d847c6ca9bda07c77c88714309a50dd6 (MD5) Quantificar a dor em cães sob anestesia dissociativa através de estímulo térmico e pressórico e o período hábil de dois analgésicos opióides. MÉTODOS: Empregaram-se 30 cães alocados em três grupos (n=10), onde os animais de GI receberam levomepromazina e midazolam associado na mesma seringa à quetamina. Os animais de GII receberam o mesmo tratamento de GI porém associado ao butorfanol e por fim os animais de GIII receberam o mesmo tratamento de GI associando-se a buprenorfina. Procedeu se a avaliação paramétrica rotineira, empregando-se, entretanto, a termoalgimetria mensurada em °C em média de 52°C e a pressoalgimetria em kg. RESULTADOS: Na termoalgimetria houve diferença significativa em GI nos momentos M0 e M1,e em M4 e M5. Em GII houve diferença em M0, M1, M5 e M6. Em GIII houve diferença entre momentos M0 e M1. Na pressoalgimetria houveram diferenças em GI em diferentes momentos: M0, M2 e M3. Em GII observaram-se diferenças em todos os momentos. Em GIII observaram-se diferenças em M0 e M9. Ocorreram diferenças entre os grupos, sendo o M2 de GII menor que GI e GIII. Já em M4 e M5 de GIII demonstrou-se maior que GI e GII. E na avaliação dos períodos observou-se um período de latência significativamente maior em GI, porém com período hábil e de recuperação menor em relação à GII e GIII. Já a recuperação do tônus postural foi maior em GIII seguido de GII e finalmente de GI. CONCLUSÃO: O método empregado para mensuração do estímulo álgico foi eficiente, observando-se um período hábil analgésico de 3 horas para o butorfanol e de 6 horas para a buprenorfina. This study aimed at quantifies the pain in dogs under dissociative anesthesia, across thermal and pressoric stimulus and quantify the reasonable period between two different opioids analgesics. In this study, 30 dogs were used and, divided into three groups of 10 animals each, in which the animals of GI received methotrimeprazine and midazolam put on the same syringe with ketamine. The animals of GII received the same treatment of GI but associated with butorphanol and finally the animals of GIII received the same treatment of GI but associated with buprenorphine. The routine parametric evaluations has been proceeded, although using the thermo algimetry measured in degrees C with the average of 52 degrees C and the pressoric algimetry in Kg. In the thermo algimetry, there has been significant difference in GI at the moments M0, M1, M4 and M5; in GII it was found at M0, M1, M5 and M6 and in GIII it was observed the significant at M0 and M1. It has also been shown in pressoric algimetry significant difference in GI at the moments M0, M2 and M3. Among GII it has observed significant difference at all moments and it has found at M0, M9 in GIII. Thus, it has observed significant differences between all groups; for such the M2 of GII smaller than the others; and M4, M5 of GIII bigger than GI and GII. In the assessment of all periods it was observed significant latent period bigger in GI, however, with reasonable period and short recovery in GII and GIII. In the order hand, the postural tonus recovery it was longer in GIII, followed by GII and finally GI. The used method for the measurement of algic stimulus was efficient, noticing a reasonable analgesic period of 3 hours for butorphanol and 6 hours for buprenorphine. Universidade Metodista de São Paulo Faculdade de Medicina Veterinária Centro Cirúrgico PROVET Faculdade de Medicina Veterinária Serviço de Anestesiologia Veterinária - Centro UNESP Faculdade de Medicina Veterinária Universidade Estadual Paulista, Departamento de Cirurgia e Anestesiologia Veterinária, Faculdade de Medicina Veterinária e Zootecnia de Botucatu