Dissertationen zum Thema „Epidural“
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HEBERT, NATHALIE. „Hematome epidural apres infiltration epidurale ou intradurale“. Paris 6, 2001. http://www.theses.fr/2001PA062044.
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Ashab, Hussam Al-Deen. „Ultrasound guidance for epidural anesthesia“. Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44306.
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We propose an augmented reality system to automatically identify lumbar vertebral levels and the lamina region in ultrasound-guided epidural anesthesia. Spinal needle insertion procedures require careful placement of a needle, both to ensure effective therapy delivery and to avoid damaging sensitive tissue such as the spinal cord. An important step in such procedures is the accurate identification of the vertebral levels, which is currently performed using manual palpation with a reported success rate of only 30%. In this thesis, we propose a system using a trinocular camera which tracks an ultrasound transducer during the acquisition of a sequence of B-mode images. The system generates a panorama ultrasound image of the lumbar spine, automatically identifies the lumbar levels in the panorama image, and overlays the identified levels on a live camera view of the patient’s back. Several experiments were performed to test the accuracy of vertebral height in panorama images, the accuracy of vertebral levels identification in panorama images, the accuracy of vertebral levels identification on the skin, and the impact on accuracy with spine arching. The results from 17 subjects demonstrate the feasibility of the approach and capability of achieving an error within a clinically acceptable range for epidural anesthesia. The overlaid marks on the screen are used to assist locating needle puncture site. Then, an automated slice selection algorithm is used to guide the operator positioning a 3D transducer such that the best view of the target anatomy is visible in a predefined re-slice of the 3D ultrasound volume. This re-slice is used to observe, in real time, the trajectory of a needle attached to the 3D transducer, towards the target. The method is based on Haar-like features and AdaBoost learning algorithm. We have evaluated the method on a set of 32 volumes acquired from volunteer subjects by placing the 3D transducer on L1-L2, L2-L3, L3-L4 and L4- L5 interspinous gaps on each side of the lumbar spine. Results show that the needle insertion plane can be identified with a root mean square error of 5.4 mm, accuracy of 99.6%, and precision of 78.7%.
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Holgado, Pascual Carmen María. „RESULTADO DEL PARTO CON ANALGESIA EPIDURAL: ESTUDIO OBSERVACIONAL DE COHORTES COMPARANDO PERFUSIÓN EPIDURAL CONTINUA CON BOLO INTERMITENTE PROGRAMADO MÁS ANALGESIA EPIDURAL CONTROLADA POR LA PACIENTE“. Doctoral thesis, Universitat Rovira i Virgili, 2020. http://hdl.handle.net/10803/670708.
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ANTECEDENTS: L'evidència científica mostra que el bolo epidural intermitent programat (PIEB) per a l'analgèsia del treball de part aconsegueix bons resultats obstètrics. Després d'implementar el nostre protocol institucional per a l'analgèsia epidural, comparem PIEB + analgèsia epidural controlada per la pacient (PCEA) versus perfusió epidural contínua (PEC).
MÈTODES: En un estudi de cohort observacional, comparem PEC amb ropivacaïna a l'0,2% + bolo inicial de fentanil de 100 mg versus PIEB+PCEA amb ropivacaïna a l'0,1% + fentanil 2 mg/ml en dones primípares. El objectiu principal va ser el tipus de part. Els objectius secundaris van ser la durada de la segona etapa del treball de part i les dosis totals de ropivacaïna i fentanil. Altres resultats estudiats al grup PIEB+PCEA, van ser: bloqueig motor, ús de PCEA i bolos de rescat, mobilitat materna i satisfacció materna. L'anàlisi estadística univariant es va realitzar mitjançant la prova de χ², anàlisi de variància o prova no paramètrica de Kruskal-Wallis. L'anàlisi multivariant es va realitzar mitjançant anàlisi de regressió logística múltiple.
RESULTATS: 221 pacients van completar l'estudi (PEC116; PIEB+PCEA 105). La regressió logística múltiple va mostrar que el grup PIEB+PCEA va tenir significativament menys cesàries [PEC (14%) vs. PIEB + PCEA (5%), p = 0.015] i menys parts instrumentats, després de corregir els factors de confusió [OR = 0.49; IC de el 95%: 0,27-0,89]. La segona etapa del part no va mostrar diferència estadísticament significativa entre els grups. La dosi total de ropivacaïna va ser significativament menor amb PIEB+PCEA. No hi va haver relació entre el bloqueig motor lleu i un major ús de PCEA en el grup PIEB+PCEA. El tipus de part i la durada de la segona etapa del part tampoc es van veure influenciats pel bloqueig motor. La satisfacció materna va ser alta.
CONCLUSIONS: PIEB+PCEA ofereix avantatges obstètriques i analgèsiques sobre PEC en la pràctica clínica diària.ANTECEDENTES: La evidencia científica ha mostrado que el bolo epidural intermitente programado (PIEB) para la analgesia del trabajo de parto logra buenos resultados obstétricos. Después de implementar nuestro protocolo institucional para la analgesia epidural, comparamos PIEB + analgesia epidural controlada por la paciente (PCEA) versus perfusión epidural continua (PEC). MÉTODOSː En un estudio de cohorte observacional, comparamos PEC con ropivacaína al 0,2% + bolo inicial de fentanilo de 100 μg versus PIEB+PCEA con ropivacaína al 0,1% + fentanilo 2 μg/ml en mujeres primíparas. El objetivo principal fue el tipo de parto. Los objetivos secundarios fueron la duración de la segunda etapa del parto y las dosis totales de ropivacaína y fentanilo. Otros objetivos en el grupo PIEB+PCEA fueron: bloqueo motor, uso de PCEA y bolo de rescate, movilidad materna y satisfacción materna. El análisis estadístico univariante se realizó mediante la prueba de χ², análisis de varianza o prueba no paramétrica de Kruskal-Wallis. El análisis multivariante se realizó mediante análisis de regresión logística múltiple. RESULTADOSː 221 pacientes completaron el estudio (PEC116; PIEB+PCEA 105). La regresión logística múltiple mostró que el grupo PIEB+PCEA tuvo significativamente menos cesáreas [PEC (14%) vs. PIEB+PCEA (5%), p = 0.015] y menos partos instrumentales, después de corregir los factores de confusión [OR = 0.49; IC del 95%: 0,27 a 0,89]. La diferencia en la segunda etapa del parto no fue estadísticamente significativa entre los grupos. La dosis total de ropivacaína fue significativamente menor con PIEB+PCEA. No hubo relación entre el bloqueo motor leve y un mayor uso de PCEA en el grupo PIEB+PCEA. El modo de parto y la duración de la segunda etapa del parto tampoco se vieron influenciados por el bloqueo motor. La satisfacción materna fue alta. CONCLUSIONESː PIEB+PCEA ofrece ventajas obstétricas y analgésicas sobre PEC en la práctica clínica diaria.
BACKGROUND: Scientific evidence shows that programmed intermittent epidural bolus (PIEB) for labour analgesia achieves good obstetric outcomes. After implementing our institutional standard for epidural analgesia, we compared PIEB + patient-controlled epidural analgesia (PCEA) versus continuous epidural infusion (CEI). METHODSː In an observational cohort study, we compared CEI with 0.2% ropivacaine + 100-μg fentanyl initial bolus versus PIEB+PCEA with 0.1% ropivacaine + 2 μg/ml fentanyl in primiparous women. The primary outcome was mode of delivery. Secondary outcomes were duration of the second stage of labour and total ropivacaine and fentanyl doses. Other outcomes, in the PIEB+PCEA group only, were motor block, use of PCEA and rescue bolus, maternal mobility and maternal satisfaction. Univariate statistical analysis was performed using the χ²-test, analysis of variance or nonparametric Kruskal-Wallis test. Multivariate analysis was performed using multiple logistic regression analysis. RESULTSː 221 patients completed the study (CEI 116; PIEB+PCEA 105). Multiple logistic regression showed that the PIEB+PCEA group had significantly fewer caesarean sections [CEI (14%) vs. PIEB+PCEA (5%), p=0.015] and instrumental deliveries, after correcting for confounders [OR = 0.49; 95% CI: 0.27–0.89]. The second stage of labour did not significantly differ between groups. Total ropivacaine dose was significantly lower with PIEB+PCEA. There was no relationship between mild motor block and increased use of PCEA in the PIEB+PCEA group. Mode of delivery and duration of the second stage of labour were not influenced by motor block either. Maternal satisfaction was high. CONCLUSIONSː PIEB+PCEA offers obstetric and analgesic advantages over CEI in daily clinical practice
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VILLELA, Ana Carolina Vasques. „Anestesia epidural toracolombar com lidocaína a 2% ou lidocaína hiperbárica a 5% pelo uso de cateter epidural totalmente implantado em cães“. Universidade Federal de Goiás, 2012. http://repositorio.bc.ufg.br/tede/handle/tde/886.
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Previous issue date: 2012-02-24A anestesia local se popularizou na medicina veterinária no século XX, mas alguns de seus recursos, como o cateter epidural e as soluções hiperbáricas, bastante utilizados no homem atualmente ainda são pouco estudados e aplicados em animais. Em seguida, outro estudo verificou a qualidade da anestesia epidural toracolombar com lidocaína a 2% ou hiperbárica a 5% e a influência do decúbito e o do tempo de permanência do cateter epidural na qualidade deste bloqueio. Para isso foram usados sete cães machos, adultos, pesando 12,76 +/-2,59 kh. Com os animais até o espaço T13-L1, tendo seu dispositivo sepultado no tecido subcutâneo. Em seguida, administrou-se 4 mg/kg de lidocaína isobárica a 2% com os animais em posição quadrupedal(IQ4) ou em decúbito lateral (IL4); 3 mg/kg de lidocaína hiperbárica a 5% em posição quadrupedal (HQ3) ou em decúbito lateral (HL3); e 4 mg/kg de lidocaína hiperbárica a 5% em posição quadupedal (HQ4) ou em decúbito lateral (HL4). Foram avaliadas a viabilidade da técnica de implantação; a ocorrência de complicações após a implantação ou retirada do cateter epidural; o tempo de permanência do cateter epidural; os efeitos da administração de lidocaína a 2% ou hiperbárica a 5% sobre a FC, , PAS, SPO2 e TR; a a qualidade do bloqueio anestésico (latência, extensão, simetria e duração do bloqueio anestésico); influência do decúbito e do tempo de permanência do cateter na qualidade do bloqueio anestésico. A implantação do cateter epidural foi viável e isenta de complicações; houve redução significativa somente nos valores de e TR em relação ao valor basal nos grupos IQ4, IL4, HQ3, HL3,HQ4. Não foram observadas diferenças significativas na FC, PAS, SPO2, latência, duração e extensão do bloqueio entre os grupos. O decúbito não influenciou significativamente a qualidade do bloqueio. O tempo de permanência do cateter no espaço epidural influenciou significativamente a duração máxima do bloqueio sensitivo. Em conclusão, o modelo descrito para implantação do cateter epidural é viável, porém o tempo que o cateter permaneceu no espaço epidural influenciou a duração do bloqueio anestésico e a lidocaína hiperbárica a 5% não mostrou vantagens em relação ao uso da lidocaína isobárica a 2% na anestesia epidural toracolombar.
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Ponne, Sanja. „Epidural vid förlossning : Bidrar epidural efter förlossningen till framtida ryggproblem samt ökar den risken för kejsarsnitt“. Thesis, Umeå universitet, Kemiska institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-88870.
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Tran, Denis. „Instrumentation and ultrasound for epidural anesthesia“. Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27488.
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Lumbar epidural anesthesia is used for alleviating the pain of labor and for surgery. Here, a catheter is threaded through a Tuohy needle that is traditionally inserted using the loss-of-resistance technique to confirm entry into the epidural space.
This research begins with a study of the loss-of-resistance through instrumentation. Sensors measure 1)the force applied at the plunger by the anesthesiologist, 2)the pressure at the needle tip and 3)the position of the plunger relative to the syringe. The “feel” in different tissues is quantified for porcine subjects ex vivo and human subjects in vivo.
A vertebra counting protocol is developed to identify the desired vertebral interspaces. Ultrasound is then used to measure anatomical distances such as the distance between the skin and ligamentum flavum and surrogate measures compared to the actual needle insertion depth. Good correlation is only found between skin-to-ligamentum flavum and the actual needle insertion depth.
Next, a real-time in-plane ultrasound technique is developed with a needle guide fixing the needle trajectory to the ultrasound transducer. This allows the anesthesiologist to guide the insertion of the epidural needle as an “aim-and-insert” method. In 18 of 19 subjects, the procedure was successfully performed.
The key limitation of ultrasound in this application is the image quality that inhibits interpretation of the images. A median-based spatial compounding with warping is performed to align the anatomical features of different beam-steered images and combine them to obtain a single enhanced image. This method is tested on image sets of phantoms and lumbar anatomy of 23 human subjects and shows a significant improvement in noise reduction and clarity.
Another limitation is the interpretation of ultrasounds of the spinal anatomy requires understanding of ultrasound. An automatic detection algorithm is developed based on the experienced sonographer’s method of detecting the ligamentum flavum in ultrasounds. This novel method is tested on ultrasounds of the lumbar anatomy in 20 human subjects and shows the method successfully detects the ligamentum flavum in 34 of 39 cases.
The main conclusion is that specialized ultrasound tools and protocols are needed to accomodate the range of patients and levels of experience of practitioners.
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Mastrocinque, Sandra. „Avaliação do emprego do tramadol epidural ou sistêmico e da morfina epidural em cadelas submetidas à ovariohisterectomia“. Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-28092006-173042/.
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O objetivo deste estudo foi o de comparar o emprego do tramadol, por via epidural ou sistêmica, com a morfina por via epidural, para controle da dor pós-operatória em cadelas submetidas à ovariohisterectomia, assim como determinar a ação dos agentes sobre o sistema cardiorespiratório e ocorrência de efeitos adversos. Para tanto, foram utilizadas 40 cadelas, distribuídas, aleatoriamente, em 4 grupos de 10 animais cada. O grupo 1 recebeu 2 /kg de tramadol por via epidural, o grupo 2 recebeu 2 mg/kg de tramadol por via intramuscular, o grupo 3 foi tratado com 0,1 mg/kg de morfina por via epidural e o grupo 4, determinado como controle, recebeu solução salina. Os fármacos foram administrados 30 minutos antes da indução anestésica, sendo o estudo caracterizado como prospectivo, clínico, tipo cego. Os animais foram pré-medicados com acepromazina, a indução anestésica realizada com propofol e o isofluorano foi empregado para manutenção da anestesia. As variáveis mensuradas foram: analgesia, sedação, freqüências cardíaca e respiratória, pressão arterial, concentração de isofluorano e dióxido de carbono no ar expirado, saturação periférica da oxihemoglobina, pH e gases sangüíneos, cortisol sérico e catecolaminas plasmáticas. Os animais foram avaliados por período de 24 horas após administração do fármaco analgésico. Os resultados foram submetidos à análise de variância, onde valores de P<0,05 foram considerados significantes. Não houve diferença entre os tratamentos com relação aos parâmetros de oxigenação, ventilação e cardiovasculares com exceção da pressão diastólica, que no grupo tratado com morfina apresentou menor valor que os demais grupos 6 horas após a administração dos analgésicos. Este grupo apresentou ainda menores escores de dor em vários momentos de avaliação, além de diminuir o requerimento de isofluorano em relação aos demais grupos aos 10 minutos de anestesia e aos 30 minutos, em comparação com o grupo controle, e menor valor de cortisol sérico 2 horas após a administração do fármaco analgésico em comparação ao grupo tratado com tramadol intramuscular e controle. Os grupos tratados com morfina epidural e tramadol epidural apresentaram menores valores de epinefrina que o grupo que recebeu tramadol intramuscular 2 horas após administração do agente analgésico. Os animais tratados com morfina não necessitaram medicação resgate durante o decorrer do estudo. Com base nos resultados obtidos, pode-se concluir que o emprego do tramadol epidural em cães é técnica segura, livre de efeitos adversos no sistema cardiorespiratório, porém o tratamento com morfina epidural foi superior a este e aos demais grupos com relação à qualidade da analgesia, sem apresentar efeitos adversos importantesThe aim of this study was to compare epidural or systemic tramadol and morphine to control postoperative pain in bitches submitted to ovariohysterectomy and to determine the effects of treatments on cardio and respiratory systems as well as side effects. Forty female dogs were randomly divided into four groups. Group 1 received 2 mg/kg of epidural tramadol, group 2 received 2 mg/kg of intramuscular tramadol, group 3 received 0,1 mg/kg of epidural morphine and group 4 as the control group, received saline solution. Treatments were administered 30 minutes before the induction of anesthesia and study was a prospective blinded clinical trial. Animals were premedicated with acepromazine, and anesthesia was induced with propofol. Isoflurane was used for the maintenance of anesthesia. Variables measured were: analgesia and sedation, cardiac and respiratory rates, arterial blood pressure, end-tidal isoflurane and carbon dioxide, oxyhemoglobin saturation, plasma catecholamines, serum cortisol, pH and blood gases. Patients were monitored for 24 hours after the administration of the analgesic agents. Data were submitted to analysis of variance. Values of p <0,05 were considered significant. There were no differences between groups with regard to oxygenation, ventilation and cardiovascular variables except for diastolic blood pressure which showed lower values in the morphine-treated group compared to other groups at six hours of evaluation, as well as lower pain scores at several evaluation moments. Rescue analgesia was not needed in the morphine group and the isoflurane concentration was significantly lower in relation to the other groups at 10 minutes of anesthesia, and at 30 minutes of anesthesia in relation to the control group. The epidural morphine group showed lower cortisol value at 2-hour evaluation as compared to intramuscular tramadol and control groups. The epidural tramadol and morphine groups had lower epinephrine value than intramuscular tramadol group. Based on the results of this study it can be concluded that epidural tramadol is a safe analgesia technique for dogs, free of undesirable effects, although epidural morphine was more effective than other groups without side effects
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Larsen, Kim M. „COMPARISON OF EPIDURAL AND INTRAVENOUS FENTANYL PATIENT-CONTROLLED ANALGESIA AFTER CESAREAN SECTION UNDER EPIDURAL ANESTHESIA WITH CHLOROPROCAINE“. VCU Scholars Compass, 1997. https://scholarscompass.vcu.edu/etd/5134.
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This study compared two methods of postcesarean fentanyl patient- controlled analgesia (PCA). Fentanyl was administered intravenously (PCAI) or epidurally (PCAE) following cesarean section under epidural chloroprocaine anesthesia. Twenty-one ASA I and II parturients were randomly assigned to receive fentanyl PCAI (n = 9) or PCA (n = 12). At surgical completion fentanyl 1.0 mcg/kg was given and the PCA initiated with a dose of 30 mcg, a lockout interval of 10 minutes, a maximum dose of 180 mcg/hr, and no basal rate. Data were collected over 24 hours including visual analog scale (VAS) pain scores, plasma fentanyl levels, total fentanyl usage, and side effects.
Surgical time was significantly longer for the PCA, group (p = 0.0213). There was no difference in VAS scores until 24 hours when the PCAE group’s were significantly lower (p = 0.0295). The PCAE group almost always had lower VAS scores. Total fentanyl usage was significantly lower for the PCAE group (p = 0.050). There was no significant difference in plasma fentanyl levels, side effects, or patient satisfaction. The data revealed that both methods provided adequate postoperative analgesia and epidural fentanyl provided both local and systemic mediated analgesia.
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Gering, Ana Paula [UNESP]. „Avaliação de duas doses de lidocaína, administradas à altura da primeira vértebra lombar sobre a analgesia trans-cirúrgica e parâmetros cardiorrespiratórios em cadelas submetidas à ovariohisterectomia“. Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/88968.
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A anestesia epidural, quando comparada à anestesia geral, apresenta algumas vantagens como redução dos custos, minimização dos riscos anestésicos por ocasionar poucas alterações respiratórias e cardiovasculares. Mas tem sido utilizada basicamente para cirurgias no membro posterior e inguinais já que o anestésico local quando administrado no espaço compreendido entre a sétima vértebra lombar e a primeira vértebra sacral proporciona bloqueio máximo até a quarta vértebra lombar. Uma alternativa para bloqueios mais craniais é a utilização do cateter epidural. Tal estudo avaliou, comparativamente os efeitos de duas doses de lidocaína (4 e 6 mg/Kg) administradas por via epidural na altura da primeira vértebra lombar em cadelas submetidas à ovariohisterectomia. Foram utilizadas 16 cadelas SRD, pesando entre 4 e 20 Kg e entre 1 e 6 anos. Todas receberam butorfanol e etomidato, ambos por via intravenosa nas doses de 0,4 mg/Kg e 2 mg/Kg respectivamente. Foram avaliados parâmetros cardiovasculares, hemogasométricos, ventilometricos e relacionados à analgesia. Os parâmetros fisiológicos avaliados não apresentaram diferença entre os grupos em com o uso de diferentes doses de lidocaína. Relativamente à analgesia, 25% dos animais do G4 apresentaram escore de dor considerado insuficiente. Contudo conclui-se que as duas doses de lidocaína, depositadas na altura da primeira vértebra lombar, não interferem nos parâmetros ventilométricos, hemogasométricos e cardiovasculares. E a dose de 6 mg/Kg determina melhor analgesia que a de 4 mg/Kg
Epidural anesthesia compared to general anesthesia has some advantages such as reducing cost, minimizing the risks of anesthesia by causing fewer respiratory and cardiovascular changes. But it has been used primarily for surgery in the posterior limb and inguinal as the local anesthetic when administered in the space between the seventh lumbar and first sacral vertebra provides maximum block until the fourth lumbar vertebra. An alternative to more bloks cranial is the use of epidural catheter. This study evaluated the comparative effects of two doses of lidocaine (4 and 6 mg/Kg) administered epidurally at the time of the first lumbar vertebra en bitches submitted to ovariohisterectomy. !6 mongrel dogs were used, weighing between 4 and 20 Kg ande between 1 and 6 years old. All received butorphanos and etomidate, both intravenously ins doses of 0,4mg/Kg to 2 mg/Kg respectively. We assessed cardiovascular, blood gas ventilometric and analgesia. The physiological parameters evaluated did not differ between the groups using different doses of lidocaine. For analgesia, 25% of animals in G4 had a pain score considered insufficient. However, it is conclused that two doses os lidocaine, deposited at the time of the first lumbar vertebra, the parameters do not interfere ventilometric, blood gas and cardiovascular diseases. And the dose of 6 mg/Kg determines the better analgesia of 4 mg/Kg
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Silva, Bruno Monteiro da. „Avaliação cardiorrespiratória e analgésica da ropivacaína isolada e associada ao fentanil ou ao tramadol, administrados pela via peridural em cães /“. Araçatuba : [s.n.], 2007. http://hdl.handle.net/11449/92199.
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Orientador: Valéria Nobre Leal de Souza OlivaBanca: Paulo Sérgio Patto dos Santos
Banca: Carmen Esther Grumadas Machado
Resumo: A anestesia peridural é amplamente difundida no meio veterinário, utilizando-se o anestésico local isolado ou associado aos opióides, capazes de promover aumento do efeito analgésico. A ropivacaína é um fármaco relativamente novo, ainda pouco utilizado em Veterinária. O fentanil é um opióide agonista e o tramadol é um opióide de ação mista. Neste experimento, oito cães foram tranqüilizados com acepromazina, submetidos à peridural com um dos protocolos a seguir: GR (ropivacaína), GRF (ropivacaína + fentanil), GRT (ropivacaína + tramadol), em volume total de 0,25 mL/kg. Durante o procedimento foram avaliados e comparados os seguintes parâmetros vitais (FC, f, temperatura retal, pressão arterial, e gasometria do sangue arterial), os bloqueios sensitivo e motor (latência e duração de ação), o grau de sedação, e a ocorrência de possíveis efeitos indesejáveis advindos da administração de ropivacaína isolada ou em associação. A diminuição mais intensa na FC ocorreu nos grupos GRF e GRT, e ocorreu hipotermia significativa nos animais do GRF. Todos os grupos apresentaram sedação, sendo severa nos grupos GRF e GRT. De maneira geral, o período de recuperação foi mais curto nos animais do grupo GRT do que nos demais. O GRT também foi o que apresentou bloqueio mais cranial. Foram observadas bradicardia, hipotermia e síndrome de Shiff- Sherrington no período trans-anestésico em animais de todos os grupos. Decorridas 24 horas de período pós-anestésico, não foram evidenciados efeitos indesejáveis, em nenhum dos grupos. GRF foi o grupo com maior duração de anestesia e analgesia, GRT apresentou a menor duração de anestesia com analgesia intermediária, e GR apresentou duração intermediária, com menor analgesia.
Abstract: Peridural anesthesia is broadly applied in the Veterinary field, using the isolated local anesthetic or in combination with opiates capable to increase the analgesic effect. The ropivacaine is a relatively new drug, not much used in the Veterinary field yet. The fentanil is an agonist opiate and tramadol is a mixed action opiate. In this experiment, eight dogs were sedated with acepromazine and subjected to the epidural anesthesia with one of the following protocols: GR (ropivacaine), GRF (ropivacaine + fentanyl), GRT (ropivacaine + tramadol), in 0,25mL/Kg of total volume. During the procedure, following vital signs were evaluated and compared (heart rate, respiratory rate, rectal temperature, blood pressure and gasometry of arterial blood), the sensory and motor blockade (latency and length of action), level of sedation and the occurrence of possible side effects due to administration of ropivacaine individually or in combination with other drugs. The highest decrease in the heart rate occurred in the following GRF and GRT and also significant hypothermia in animals of GRF. All groups presented sedation, even severe in the period of recovering was shorter in the animals belonging to GRT than in others. The GRT was also the one that presented the most cranial block. Bradycardia, hypothermia and Shiff- Sherrington syndrom were observed in the transanesthetic period in animals belonging to all of the groups. Twenty-four hours after the postanesthetic period, no side effects were observed, in none of the groups. The GRF was the one with higher length of anesthesia and analgesia, GRT presented the length of anesthesia with intermediate analgesia and, GR group presented intermediate length, with lower analgesia.
Mestre
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Hor, King Wei. „Instrumentation and ultrasound imaging for epidural anesthesia“. Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/32735.
Annotation:
The loss-of-resistance technique in epidural anesthesia is the accepted standard for
indicating the entry of the needle into the epidural space. In conventional epidurals, it is
also the only feedback mechanism to confirm needle entry. Unsuccessful epidurals due to
the technical difficulties can result in mild to severe complications. These difficulties
include correctly choosing the puncture site and needle trajectory, which are determined
solely by palpation and the experience of the anesthesiologist. Instrumentation of the
thumb's force on the plunger of the syringe, displacement of the plunger and fluid
pressure is developed for laboratory and clinical trials to study the dynamics of the loss-of-
resistance technique. Instrumentation of the loss-of-resistance technique was
performed on culled domestic pigs using standard epidural procedures. A static and decay
model, based on physical properties and empirical data, are used for estimating the
pressure from the force and displacement values. The decay model is shown to be
reasonably accurate and allows the omission of the pressure sensor in clinical trials.
Furthermore, the accuracy of decay model is further improved for the "smooth" protocol
performed by the anesthesiologist, over the "bouncing" protocol. The loss-of-resistance,
indicated orally by the anesthesiologist, is consistent with the rapid fall in all three
measurements. The oral indication of the loss-of-resistance slightly lags that of the
measured values and is consistent with the lag in oral communication. The
instrumentation of the loss-of-resistance is further confirmed by direct and indirect
measurements from ultrasound images of the epidural space and needle. However,
obtaining good image quality is difficult due to the steep needle angle and the
surrounding bone structures. An adaptive spatial compounding algorithm is developed to
improve important features such as the bone and epidural space. A specially constructed
phantom with speed-of-sound distortion is used to compare several variations of the
algorithm. The adaptive spatial compounding using median-based averaging produced
image quality with the best balance for point resolution, edge resolution and noise
reduction in homogeneous regions. In porcine studies, the technique shows visible
improvements of the epidural space and surrounding features.Applied Science, Faculty of
Electrical and Computer Engineering, Department of
Graduate
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Skjodt, Neil. „Respiratory compensation after epidural acute spinal paralysis“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0021/MQ48044.pdf.
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Wright, Peter Malcolm Colin. „Cardiovascular and gastrointestinal aspects of epidural anaesthesia“. Thesis, Queen's University Belfast, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317453.
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Silva, Bruno Monteiro da [UNESP]. „Avaliação cardiorrespiratória e analgésica da ropivacaína isolada e associada ao fentanil ou ao tramadol, administrados pela via peridural em cães“. Universidade Estadual Paulista (UNESP), 2007. http://hdl.handle.net/11449/92199.
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silva_bm_me_araca.pdf: 714415 bytes, checksum: 4284ea80f77d46ba33ff1b217f1eb4a5 (MD5)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
A anestesia peridural é amplamente difundida no meio veterinário, utilizando-se o anestésico local isolado ou associado aos opióides, capazes de promover aumento do efeito analgésico. A ropivacaína é um fármaco relativamente novo, ainda pouco utilizado em Veterinária. O fentanil é um opióide agonista e o tramadol é um opióide de ação mista. Neste experimento, oito cães foram tranqüilizados com acepromazina, submetidos à peridural com um dos protocolos a seguir: GR (ropivacaína), GRF (ropivacaína + fentanil), GRT (ropivacaína + tramadol), em volume total de 0,25 mL/kg. Durante o procedimento foram avaliados e comparados os seguintes parâmetros vitais (FC, f, temperatura retal, pressão arterial, e gasometria do sangue arterial), os bloqueios sensitivo e motor (latência e duração de ação), o grau de sedação, e a ocorrência de possíveis efeitos indesejáveis advindos da administração de ropivacaína isolada ou em associação. A diminuição mais intensa na FC ocorreu nos grupos GRF e GRT, e ocorreu hipotermia significativa nos animais do GRF. Todos os grupos apresentaram sedação, sendo severa nos grupos GRF e GRT. De maneira geral, o período de recuperação foi mais curto nos animais do grupo GRT do que nos demais. O GRT também foi o que apresentou bloqueio mais cranial. Foram observadas bradicardia, hipotermia e síndrome de Shiff- Sherrington no período trans-anestésico em animais de todos os grupos. Decorridas 24 horas de período pós-anestésico, não foram evidenciados efeitos indesejáveis, em nenhum dos grupos. GRF foi o grupo com maior duração de anestesia e analgesia, GRT apresentou a menor duração de anestesia com analgesia intermediária, e GR apresentou duração intermediária, com menor analgesia.
Peridural anesthesia is broadly applied in the Veterinary field, using the isolated local anesthetic or in combination with opiates capable to increase the analgesic effect. The ropivacaine is a relatively new drug, not much used in the Veterinary field yet. The fentanil is an agonist opiate and tramadol is a mixed action opiate. In this experiment, eight dogs were sedated with acepromazine and subjected to the epidural anesthesia with one of the following protocols: GR (ropivacaine), GRF (ropivacaine + fentanyl), GRT (ropivacaine + tramadol), in 0,25mL/Kg of total volume. During the procedure, following vital signs were evaluated and compared (heart rate, respiratory rate, rectal temperature, blood pressure and gasometry of arterial blood), the sensory and motor blockade (latency and length of action), level of sedation and the occurrence of possible side effects due to administration of ropivacaine individually or in combination with other drugs. The highest decrease in the heart rate occurred in the following GRF and GRT and also significant hypothermia in animals of GRF. All groups presented sedation, even severe in the period of recovering was shorter in the animals belonging to GRT than in others. The GRT was also the one that presented the most cranial block. Bradycardia, hypothermia and Shiff- Sherrington syndrom were observed in the transanesthetic period in animals belonging to all of the groups. Twenty-four hours after the postanesthetic period, no side effects were observed, in none of the groups. The GRF was the one with higher length of anesthesia and analgesia, GRT presented the length of anesthesia with intermediate analgesia and, GR group presented intermediate length, with lower analgesia.
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Gering, Ana Paula. „Avaliação de duas doses de lidocaína, administradas à altura da primeira vértebra lombar sobre a analgesia trans-cirúrgica e parâmetros cardiorrespiratórios em cadelas submetidas à ovariohisterectomia /“. Jaboticabal : [s.n.], 2012. http://hdl.handle.net/11449/88968.
Annotation:
Orientador: Newton NunesBanca: Roberta Carareto
Banca: João Moreira da Costa Neto
Resumo: A anestesia epidural, quando comparada à anestesia geral, apresenta algumas vantagens como redução dos custos, minimização dos riscos anestésicos por ocasionar poucas alterações respiratórias e cardiovasculares. Mas tem sido utilizada basicamente para cirurgias no membro posterior e inguinais já que o anestésico local quando administrado no espaço compreendido entre a sétima vértebra lombar e a primeira vértebra sacral proporciona bloqueio máximo até a quarta vértebra lombar. Uma alternativa para bloqueios mais craniais é a utilização do cateter epidural. Tal estudo avaliou, comparativamente os efeitos de duas doses de lidocaína (4 e 6 mg/Kg) administradas por via epidural na altura da primeira vértebra lombar em cadelas submetidas à ovariohisterectomia. Foram utilizadas 16 cadelas SRD, pesando entre 4 e 20 Kg e entre 1 e 6 anos. Todas receberam butorfanol e etomidato, ambos por via intravenosa nas doses de 0,4 mg/Kg e 2 mg/Kg respectivamente. Foram avaliados parâmetros cardiovasculares, hemogasométricos, ventilometricos e relacionados à analgesia. Os parâmetros fisiológicos avaliados não apresentaram diferença entre os grupos em com o uso de diferentes doses de lidocaína. Relativamente à analgesia, 25% dos animais do G4 apresentaram escore de dor considerado insuficiente. Contudo conclui-se que as duas doses de lidocaína, depositadas na altura da primeira vértebra lombar, não interferem nos parâmetros ventilométricos, hemogasométricos e cardiovasculares. E a dose de 6 mg/Kg determina melhor analgesia que a de 4 mg/Kg
Abstract: Epidural anesthesia compared to general anesthesia has some advantages such as reducing cost, minimizing the risks of anesthesia by causing fewer respiratory and cardiovascular changes. But it has been used primarily for surgery in the posterior limb and inguinal as the local anesthetic when administered in the space between the seventh lumbar and first sacral vertebra provides maximum block until the fourth lumbar vertebra. An alternative to more bloks cranial is the use of epidural catheter. This study evaluated the comparative effects of two doses of lidocaine (4 and 6 mg/Kg) administered epidurally at the time of the first lumbar vertebra en bitches submitted to ovariohisterectomy. !6 mongrel dogs were used, weighing between 4 and 20 Kg ande between 1 and 6 years old. All received butorphanos and etomidate, both intravenously ins doses of 0,4mg/Kg to 2 mg/Kg respectively. We assessed cardiovascular, blood gas ventilometric and analgesia. The physiological parameters evaluated did not differ between the groups using different doses of lidocaine. For analgesia, 25% of animals in G4 had a pain score considered insufficient. However, it is conclused that two doses os lidocaine, deposited at the time of the first lumbar vertebra, the parameters do not interfere ventilometric, blood gas and cardiovascular diseases. And the dose of 6 mg/Kg determines the better analgesia of 4 mg/Kg
Mestre
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Stafford, M. A. „Epidural steroid injections for the treatment of sciatica“. Thesis, Queen's University Belfast, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411804.
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Şimşek, Esma Meltem Yavuz Lütfi. „Epidural anesteziye bağlı hipotansiyonda profilaktik oral efedrinin etkisi /“. Isparta : SDÜ Tıp Fakültesi, 2004. http://tez.sdu.edu.tr/Tezler/TT00164.pdf.
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Riedel, Bernard J. C. J. „Epidural analgesia for coronary artery bypass graft surgery“. Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/25890.
Annotation:
On reviewing the medical literature, there is a clear resurgence of interest in the use of TEA (thoracic epidural analgesic) in cardiac anaesthesia. This resurgence was brought about by laboratory-based evidence that TEA-induced sympatholysis may be cardioprotective through the promotion of myocardial blood flow to areas at-risk and subsequent early, small clinical studies suggesting that TEA was feasible, and possibly also beneficial in CABG surgery [Joachimsson et. al, 1989; Liem (1-3) et. al, 1992; Stenseth et. al, 1994]. Despite the positive results of these early studies and suggestions that TEA may be the preferred anaesthetic/analgesic technique in select groups of patients (promoting early extubation and fast-tracking) undergoing cardiac surgery, many anaesthetists are still reluctant, however, to use this technique because of the theoretical increased risk of the patient suffering a spinal haematoma and subsequent paraplegia. In order to outweigh this theoretical risk it is important that we show that added benefit, in addition to the provision of analgesia and expedited postoperative convalescence, can be obtained by using TEA. It is therefore our duty as anaesthetists and perioperative physicians to determine whether TEA may also affect the pathophysiology of the disease process, especially in the perioperative period - and thereby influencing the subsequent long term outcome and quality of life of the patient. An example of this latter point would be the potential role of TEA in; • reducing the incidence of perioperative myocardial infarction (P-MI), through the suggested cardioprotective effects of TEA, • reducing the incidence of early postoperative graft failure, through either; * reduction of native coronary artery and/or graft (conduit) spasm, or * reduction of postoperative hypercoagulability.
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FERNANDES, Thaiza Helena Tavares. „Anestesia epidural na cirurgia descompressiva lombossacral de cães“. Universidade Federal Rural de Pernambuco, 2012. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5872.
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The objective of this study was to evaluate the feasibility, effectiveness, advantages and disadvantages of lumbosacral epidural anesthesia associated with inhalation anesthesia in surgical decompression of cauda equina, seeing as this is a lengthy procedure with a painful recovery from anesthesia. Eleven adult dogs were selected from the Veterinary Hospital, without distinction of sex, which showed clinical signs of cauda equina syndrome, diagnosed by neurological examination and radiographs. The dogs were submitted to general inhalation anesthesia and left at a superficial stage, after which epidural anesthesia with bupivacaine 0.5% via spinal tap in L7-S1 was performed in six of 11 patients. To confirm epidural block, the patellar and flexor reflexes were tested, along with evalluation of muscle tone and skin dermatomes, with the animals in a superficial anesthetic plane. The approach to spinal column was then performed by the neurosurgery team. Physiological parameters (heart, vascular, respiratory and body temperature) were measured before the preanesthetic medication, 10 minutes after, 30 minutes after epidural block, after opening the spine and 60 minutes, 90 minutes, both in the animals with and without an epidural. The amount of isoflurane used and time to extubation were also noted. Animals that had epidurals showed a significant reduction in the consumption of isoflurane and time until extubation. There were no neurological deficits caused by the epidural anesthesia when compared with the group without epidural anesthesia. It was concluded that epidural anesthesia is effective in lumbosacral decompression surgeries, leading to a lower anesthetic risk for the animals.
Objetivou-se neste trabalho avaliar a viabilidade, eficácia, vantagens e desvantagens da anestesia epidural lombossacral junto à anestesia geral inalatória em cirurgias de descompressão da cauda equina, tendo em vista que essa cirurgia é um procedimento longo e doloroso. Para isso, foram utilizados 11 cães adultos do atendimento de rotina do Hospital Veterinário, sem distinção de sexo, que apresentaram sinais clínicos de síndrome da cauda equina, diagnosticada através de exames neurológicos e radiográficos. Os cães foram submetidos à anestesia geral inalatória e deixados no estágio anestésico mais superficial. Depois, realizou-se a anestesia epidural em seis dos 11 pacientes, por punção espinhal em L7-S1, com o anestésico bupivacaína a 0,5%. Para a certificação do bloqueio foi realizado teste dos reflexos patelar e flexor, tônus muscular e dermátomos cutâneos, com os animais em plano anestésico superficial. Posteriormente, realizou-se a abordagem cirúrgica à coluna pela equipe de neurocirurgia. Os parâmetros fisiológicos (cardíacos, vasculares, respiratórios, temperatura corporal e glicemia) foram aferidos antes da medicação pré-anestésica (MPA), 10 minutos após a MPA, 30 minutos depois da epidural, depois da laminectomia, assim como após 60 minutos e 90 minutos, tanto no grupo com epidural quanto no sem epidural. Também se verificaram a quantidade de isofluorano consumido e o tempo de extubação. Os animais que possuíam bloqueio epidural apresentaram redução significativa no consumo de anestésico inalatório e no tempo de extubação. Não apresentaram déficits neurológicos causados pela anestesia epidural, quando comparados com o grupo sem anestesia epidural. Conclui-se que a técnica de anestesia epidural é eficiente e vantajosa na realização de cirurgias descompressivas lombossacrais, levando ao um menor risco anestésico para o animal.
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Campagnol, Daniela [UNESP]. „Efeitos da administração epidural de dexmedetomidina sobre a concentração alveolar mínima do isofluorano em cães“. Universidade Estadual Paulista (UNESP), 2007. http://hdl.handle.net/11449/97723.
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campagnol_d_me_botfm.pdf: 1816065 bytes, checksum: eea006d91fee7f915efbe5633c51ab40 (MD5)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
A administracao intravenosa de dexmedetomidina reduz significativamente a concentracao alveolar minima (CAM) dos agentes halogenados. No entanto, esse beneficio e frequentemente acompanhado por efeitos colaterais tipicos dos agonistas 2, como hipertensao, bradicardia e reducao do debito cardiaco. Ha indicios de que a administracao epidural de doses reduzidas de dexmedetomidina pode potencializar e prolongar seu efeito analgesico. Hipotetizou-se que a administracao epidural de dexmedetomidina reduziria a CAM do isofluorano de forma dose e tempo-dependente, sem ocasionar depressao cardiovascular significativa. Objetivou-se tambem caracterizar as alteracoes do indice bispectral (BIS) induzidas pela estimulacao nociceptiva empregada na mensuracao da CAM, bem como o efeito da dexmedetomidina epidural sobre essas alteracoes. Seis caes higidos (18,8}4,0 kg) foram anestesiados com isofluorano em 4 ocasioes distintas, com intervalo de 7 dias. Em cada anestesia, os animais receberam aleatoriamente 1 de 4 tratamentos pela via epidural. No tratamento controle, administrou-se solucao salina, enquanto nos tratamentos DEX1.5, DEX3 e DEX6, administrou-se dexmedetomidina nas doses de 1,5 . 3,0 e 6,0 Êg/kg, respectivamente. A CAM do isofluorano foi mensurada as 2 e 4,5 horas apos os tratamentos epidurais, por meio de estimulacao nociceptiva supramaxima (50V, 50 Hz e 10 ms) no membro pelvico. O valor medio de CAM (} desvio padrao) no tratamento controle foi de 1,57}0,23% e 1,55}0,25% as 2 e 4,5 horas, respectivamente. Quando comparado ao tratamento controle, o valor de CAM observado no tratamento DEX1,5 foi reduzido em 13% as 2 horas (1,35}0,11%), enquanto que a reducao as 4,5 horas (7% de reducao, CAM: 1,43}0,23%) nao foi significativa. No tratamento DEX3, a CAM foi significativamente reduzida em 29% (1,12}0,18%) e 13% (1,33}0,16%) as 2 e 4,5 horas, respectivamente. Reducoes de maior magnitude foram observadas...
Intravenous administration of dexmedetomidine significantly reduces the minimum alveolar concentration (MAC) of inhalant anesthetics. However, this beneficial effect is often associated with side effects such as hypertension, bradycardia, and a decrease in cardiac output. There are evidences epidural administration of relatively low doses of dexmedetomidine may result in more prolonged analgesia than intravenous administration of higher doses. The hypothesis of the present study is that epidural administration of dexmedetomidine would reduce isoflurane MAC in a dose and time-related fashion, without causing marked cardiovascular changes. This study aimed also to characterize the changes in bispectral index (BIS) induced by nociceptive stimulation used for MAC determinations and the effects of epidural dexmedetomidine on these changes. Six healthy dogs (18.8 8l4,0 kg) were anesthetized with isoflurane at 4 different occasions with at least 1-week intervals. On each anesthetic procedure, animals received 1 of 4 epidural treatments. Physiologic saline solution was administered in the control treatment, while for the treatments DEX1.5, DEX3, and DEX6, dexmedetomidine was administered at the doses of 1.5, 3.0, and 6.0 ìg/kg, respectively. Isoflurane MAC was assessed at 2 and 4.5 hours after epidural injections by means of supramaximal nociceptive stimulation (50V, 50 Hz e 10 ms) administered to the pelvic limb. Mean (l SD) isoflurane MAC in the control treatment was 1.57l0.23% and 1.55l0.25% at 2 e 4,5 hours, respectively. When compared to controls, mean MAC values observed in the DEX1.5 treatment were significantly reduced by 13% at 2 hours (1.35l0.11%), while the reduction observed at 4.5 hours (7% reduction, MAC: 1.43l0.23%) was not statistically significant... (Complete abstract click electronic access below)
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Oliveira, Guillermo Carlos Veiga de [UNESP]. „Avaliação da eficácia e dos efeitos respiratórios da anestesia peridural torácica em cães“. Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/86636.
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oliveira_gcv_me_botfm.pdf: 521554 bytes, checksum: 4e1594735e9b4ade8985592087d02570 (MD5)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Foi realizado estudo experimental em cães para avaliar a eficácia da anestesia peridural torácica e seus efeitos na respiração, comparando-se dois volumes, 0,25 e 0,33 ml/kg do anestésico local ropivacaína a 0,75%. Para isso foram utilizados oito animais, sem raça definida, com idade entre um e três anos, com peso médio de 24,7 ± 6,3 Kg, em boas condições de saúde. Para isso foi necessária anestesia prévia dos animais a fim de se determinar a concentração anestésica mínima na qual o animal apresentasse resposta positiva a um estímulo elétrico. Sendo assim a indução foi realizada com isofluorano na concentração inicial de 5% no vaporizador calibrado, através de máscara facial e a intubação foi efetuada. O estímulo elétrico foi realizado com corrente de 50 V em 50 ciclos/s de 10 milisegundos. Se a resposta fosse negativa, a concentração era reduzida em 0,2%, sendo o procedimento repetido até que o animal apresentasse resposta positiva para a determinação do estímulo supra máximo positivo. Um cateter peridural foi introduzido do espaço lombossacro até a região torácica das vértebras T1-T2. Foi administrada ropivacaína e as avaliações foram realizadas por dois avaliadores que não tinham conhecimento do tratamento utilizado. Os parâmetros aferidos foram freqüência cardíaca, respiratória, pressões arteriais, ritmo cardíaco, concentração expirada de CO2, volume minuto, volume corrente, hemogasometria e temperatura esofágica. A avaliação do bloqueio sensitivo foi realizada através da avaliação do estímulo elétrico e de pinçamento da pele para avaliação do panículo nervoso. Houve redução da freqüência cardíaca e de pressão arterial, o que revela um bloqueio simpático com os dois grupos. Houve depressão respiratória, pois os dois grupos apresentaram elevação do CO2, e foram colocados sob ventilação controlada...
Experimental study was conducted in dogs to assess the effectiveness of the thoracic epidural anesthesia and their effects on respiration, compared two volumes, 0.25 and 0.33 ml / kg of local anesthetic ropivacaine at 0.75%. For that eight animals were used, mixed breed, aged between one and three years, with average weight of 24.7 ± 6.3 kg, in good health. For this was required anesthesia of the animals prior to find the minimum anesthesia concentration that the animal had a positive response to electrical stimulation. Thus the induction was performed with isoflurane in the initial concentration of 5% in precision vaporizer by face mask and intubation was performed. The electrical stimulation was performed with current of 50 V at 50 cycles / s, 10 milliseconds. If the purposeful gross movement was negative, the concentration was reduced by 0.2%, and the procedure repeated until the animal had a positive response for determining the maximum positive stimulus above. An epidural catheter was introduced into the space lombossacro to the region of thoracic vertebrae T1-T2. Ropivacaine was administered and the evaluations were conducted by two evaluators who were not aware of treatment used. The parameters were measured heart rate, breathing, blood pressure, heart rate, expired concentration of CO2, minute volume, tidal volume, blood gas and esophageal temperature. The assessment of sensory block was done through evaluation of electrical stimulation and clamping the skin to assess the panículous nervous. Decreased heart rate and blood pressure, which shows a sympathetic block with the two groups. There was respiratory depression, since both groups had elevation of CO2, and were placed under controlled ventilation, which prevented the evaluation of spontaneous ventilation. The pinch of the skin test showed a blockage in extensive loss of nerve panículous in two groups, with no statistical... (Complete abstract click electronic access below)
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Albuquerque, Verônica Batista de [UNESP]. „Ropivacaína isolada ou associada à morfina, butorfanol ou tramadol pela via peridural em cadelas para realização de ovariosalpingohisterectomia“. Universidade Estadual Paulista (UNESP), 2008. http://hdl.handle.net/11449/86643.
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albuquerque_vb_me_araca.pdf: 508052 bytes, checksum: f5bfe0202134876e0b52b05728bc52f8 (MD5)A utilização da anestesia local peridural tem alcançado grande ênfase nos últimos anos, sobretudo com a utilização de opióides. O presente trabalho teve como objetivo investigar a utilização da ropivacaína isolada ou em associação a diferentes opióides, na anestesia peridural de cadelas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Participaram do estudo duplamente encoberto 32 cadelas sadias, adultas, de diferentes raças, pesando entre seis e 15 kg e pré-medicadas com acepromazina (0,05mg/kg, IM) associada ao midazolam (0,2mg/kg, IM), distribuídas em quatro grupos distintos: Grupo 1: ropivacaína: 0,3 mL/kg; Grupo 2: ropivacaína + morfina (0,1 mg/kg); Grupo 3: ropivacaína + butorfanol (0,1 mg/kg); e Grupo 4: ropivacaína + tramadol (0,5 mg/kg) administrados pela via peridural. Em cada momento experimental foram mensurados: freqüência cardíaca; freqüência respiratória; pressão arterial sistólica; temperatura retal; pressão parcial dos gases sangüíneos (arterial); pH sangüíneo; além da avaliação não-paramétrica do grau de sedação, grau de sangramento e de relaxamento muscular seguindo tabelas de escores. Os dados foram submetidos à ANOVA e comparados pelos testes de Kruskal-Wallis, Friedman, Dunn e Tukey (p< 0,05). Concluiu-se que a utilização da ropivacaína isolada ou associada à morfina, ao butorfanol ou ao tramadol pela via peridural não promoveu depressão cardiorrespiratória ou alterações hemodinâmicas significativas, sendo que a ropivacaína associada ao butorfanol permitiu a realização de OSH em cadelas.
The use of epidural local anesthesia has been reaching great emphasis for the last years, overcoat with the opioids using. This research ained the use of ropivacaine with or without association the different opioids, for epidural anesthesia biches submitted the elective ovariosalpingohisterectomy (OSH). 32 bitches tool part is this double-blind study, adult, different breed, weighing between 6 and 15kg and pré-medicated with acepromazine (0.05mg/kg, IM) associated to the midazolam (0.2mg/kg, IM), distributed in for different groups: Group 1: ropivacaine: 0.3 mL/kg; Group 2: ropivacaine + morphine (0.1 mg/kg); Group 3: ropivacaine + butorphanol (0.1 mg/kg); and Group 4: ropivacaine + tramadol (0.5 mg/kg) administered epidural. The following parameters were studied: heart frequency; breathing frequency; systolic arterial pressure; rectal temperature; blood gas partial pressures (arterial); blood pH; besides non-parametric of sedation grade, bleeding grade and muscular relaxation following tables scores. The results were submitted by ANOVA and compared by Kruskal-Wallis, Friedman, Dunn and Tukey test (p< 0.05). It was conclude that the use of only ropivacaine or associated with morphine, with butorphanol or tramadol for the epidural administration didn't promote depression cardiorrespiratory or significant hemodinamycs alterations and the ropivacaine associated to the butorphanol allowed OSH in bitches accomplishment.
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Albuquerque, Verônica Batista de. „Ropivacaína isolada ou associada à morfina, butorfanol ou tramadol pela via peridural em cadelas para realização de ovariosalpingohisterectomia /“. Araçatuba, 2008. http://hdl.handle.net/11449/86643.
Annotation:
Orientador: Valéria Nobre Leal de Souza OlivaBanca: Paulo Sérgio Patto dos Santos
Banca: Juan Carlos Duque Moreno
Resumo: A utilização da anestesia local peridural tem alcançado grande ênfase nos últimos anos, sobretudo com a utilização de opióides. O presente trabalho teve como objetivo investigar a utilização da ropivacaína isolada ou em associação a diferentes opióides, na anestesia peridural de cadelas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Participaram do estudo duplamente encoberto 32 cadelas sadias, adultas, de diferentes raças, pesando entre seis e 15 kg e pré-medicadas com acepromazina (0,05mg/kg, IM) associada ao midazolam (0,2mg/kg, IM), distribuídas em quatro grupos distintos: Grupo 1: ropivacaína: 0,3 mL/kg; Grupo 2: ropivacaína + morfina (0,1 mg/kg); Grupo 3: ropivacaína + butorfanol (0,1 mg/kg); e Grupo 4: ropivacaína + tramadol (0,5 mg/kg) administrados pela via peridural. Em cada momento experimental foram mensurados: freqüência cardíaca; freqüência respiratória; pressão arterial sistólica; temperatura retal; pressão parcial dos gases sangüíneos (arterial); pH sangüíneo; além da avaliação não-paramétrica do grau de sedação, grau de sangramento e de relaxamento muscular seguindo tabelas de escores. Os dados foram submetidos à ANOVA e comparados pelos testes de Kruskal-Wallis, Friedman, Dunn e Tukey (p< 0,05). Concluiu-se que a utilização da ropivacaína isolada ou associada à morfina, ao butorfanol ou ao tramadol pela via peridural não promoveu depressão cardiorrespiratória ou alterações hemodinâmicas significativas, sendo que a ropivacaína associada ao butorfanol permitiu a realização de OSH em cadelas.
Abstract: The use of epidural local anesthesia has been reaching great emphasis for the last years, overcoat with the opioids using. This research ained the use of ropivacaine with or without association the different opioids, for epidural anesthesia biches submitted the elective ovariosalpingohisterectomy (OSH). 32 bitches tool part is this double-blind study, adult, different breed, weighing between 6 and 15kg and pré-medicated with acepromazine (0.05mg/kg, IM) associated to the midazolam (0.2mg/kg, IM), distributed in for different groups: Group 1: ropivacaine: 0.3 mL/kg; Group 2: ropivacaine + morphine (0.1 mg/kg); Group 3: ropivacaine + butorphanol (0.1 mg/kg); and Group 4: ropivacaine + tramadol (0.5 mg/kg) administered epidural. The following parameters were studied: heart frequency; breathing frequency; systolic arterial pressure; rectal temperature; blood gas partial pressures (arterial); blood pH; besides non-parametric of sedation grade, bleeding grade and muscular relaxation following tables scores. The results were submitted by ANOVA and compared by Kruskal-Wallis, Friedman, Dunn and Tukey test (p< 0.05). It was conclude that the use of only ropivacaine or associated with morphine, with butorphanol or tramadol for the epidural administration didn't promote depression cardiorrespiratory or significant hemodinamycs alterations and the ropivacaine associated to the butorphanol allowed OSH in bitches accomplishment.
Mestre
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TAKAYASU, MASAKAZU, KOJI OSUKA, YOSHIHISA KITAMURA, AKIRA TAMASE, KATSUYOSHI MIYASHITA, KENTARO MORI, MOTOHIRO NOMURA, MUNEYOSHI YASUDA und HIROSHI SHIMA. „A SPINAL EPIDURAL HEMATOMA WITH SYMPTOMS MIMICKING CEREBRAL STROKE“. Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16040.
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Rafii-Tari, Hedyeh. „Panorama ultrasound for navigation and guidance of epidural anesthesia“. Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/37439.
Annotation:
Epidural anesthesia is a common but challenging procedure in obstetrics and surgery, especially for the obese patient, and can result in complications such as dural puncture and nerve injury. Ultrasound has the potential to significantly improve epidural needle guidance, by being able to depict the spinal anatomy and the epidural space. An ultrasound guidance system is therefore proposed, using a transducer-mounted camera to create 3D panorama images of the spine relative to markings on the skin. Guidance will include depiction of the spinal anatomy, identification of individual vertebrae, and selection of a suitable puncture site, trajectory and depth of needle insertion.
The camera tracks the transducer movement using a specialized strip of markers attached to the skin surface. This enables 6-DOF absolute position estimation of the transducer with respect to the patient over the full range of the spine. The 3D panorama image can then be resliced in various parasagittal planes to show either the target epidural spaces or the laminae. The overall accuracy of the panorama reconstruction is validated by measuring inter-feature distances of a phantom of steel beads against measurements obtained from an optical tracking system (Optotrak), resulting in an average error of 0.64 mm between camera and Optotrak. The algorithm is then tested in vivo by creating panorama images from human subjects (n=20), obtaining measurements for depth of insertion to the epidural space, intervertebral spacings, and registration of interspinous gaps to the skin, and validating these against independent measurements by an experienced sonographer. The results showed an average error of 1.69 mm (4.23%) for the depth measurements, average error of 4.44 mm (15.2%) for the interspinous distance measurements, and an average error of 6.65 mm for registering the interspinous gaps to the skin (corresponding to 18.5% of the interspinous distances). Tracking of ultrasound images with respect to the marker is implemented in real time and visualized using the 3D Slicer software package.
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Hill, David A. „Alfentanil and diamorphine : epidural and intrathecal effects in labour“. Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261929.
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Giagka, V. „Flexible active electrode arrays for epidural spinal cord stimulation“. Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1460520/.
Annotation:
In spinal cord injured (SCI) individuals the neural pathway between the brain and the extremities is damaged. However, there is still the capacity to elicit muscle activation despite the absence of any supraspinal input. Recent studies have proposed epidural spinal cord electrical stimulation (ESCS) as a means to facilitate locomotor recovery in SCI humans. In epidural stimulation a number of electrodes are placed in the spine, outside the dura, and stimulus current pulses are used to ‘tune’ the spinal circuitries. Some rat studies have supported this concept, but further testing is required to increase our understanding and optimise the stimulation parameters. Testing protocols are currently limited by the available technology. More specifically, the number of electrodes one can use seriously limits the paradigms that could be investigated. For this reason, electrode arrays, as opposed to the conventional pairs of electrodes, can be used to investigate the effect of ESCS at different sites. The development of epidural electrode arrays for chronic testing in rats is a challenging task due to their small size. The difficulties increase radically when a large number of electrodes need to be independently controlled. It has been well documented in the literature that a large number of connections (wires) is highly undesirable because it either makes the implantation procedure more challenging, or, if the device is successfully placed in the body, it could imperil perfusion, result in infections, tissue damage, or simply cause the device to fail. The development of a flexible epidural electrode array suitable for chronic implantation in rats was the main goal of this work. For the first generation of the system, flexible passive 12-electrode arrays, using silicone rubber and annealed platinum foil, were designed and fabricated—suitable for use with an external stimulator. In vivo evaluation of these devices showed that they failed quickly, 87.5% of the connections after a week inside the spine of a rat. The failure analysis performed highlighted the need to reduce the number of connections to avoid inflammation and improve the mechanical stability of the implants. To overcome the connections ‘bottleneck’ without compromising the number of electrodes (which was necessary for the planned paradigm), our approach was to develop application-specific integrated circuits (ASICs) to be embedded on the arrays, acting as electrode drivers. The ASICs reduce the number of connections to 3, feature a very small silicon footprint (less than 0.36 mm2 core area), consume very low power (up to 114 μW during a full stimulation cycle), and allow for the necessary versatility for the testing with a real-time control system, developed by our collaborators (in the FP7 NEUWalk project). A custom designed ‘hub’, designed by Dr. Clemens Eder, is used to electronically – rather than manually – manage the stimulus parameters and the operation of the ASICs. It can be programmed via a graphical user interface (GUI) or the real-time controller. Moving to the second generation of the system, active (with embedded ASICs) epidural arrays were designed, developed and evaluated. For this version, platinum iridium foil, was preferred, due to its superior mechanical strength. The next part of the work focused on the the different aspects of the fabrication and assembly processes. More specifically, size restrictions related to the implantation site dictated the need to use thinned ASICs. To post-process the already fabricated chips, a method for purely mechanical silicon thinning at individual die level was developed and characterised. For the integration of the ASICs on the arrays an evaluation study was conducted to examine the mechanical reliability of the bonds produced by electrical rivet bonding. Combining all the above, a new fabrication process was developed for the active arrays. Despite the fact that, so far, chronic in vivo testing has not been yet implemented, the produced prototypes were electrically and mechanically evaluated in vitro, and results are satisfactory, as no failed tracks were observed during the chronic tests in the lab. The current setup allows power and data to be transferred to the implant real-time through a connector fixed on the rat’s head, while the animal is on a treadmill or on a runway. This implies that there is no need for a wireless system at this stage. However, more complex experiments where the rats would be able to move freely and interact with other rats unrestricted, developing a behaviour that is closer to their natural, could provide significant new knowledge in the future. Although there are still many things to understand regarding epidural stimulation and its effect before planning an experiment like this, this was kept in mind throughout the whole design and development phases of this system. On this basis, the developed subcomponents are compatible with a system level design of a fully implantable platform to be used in freely moving rats, stimulated for 3 – 4 hours per day. This system comprises the active electrode array, which is the focus of this thesis, together with a miniaturised, battery-powered implantable version of the previously mentioned hub (which is on-going work, and is not presented here).
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Alvarez, Negrón Wilbert. „Evaluación de los efectos del midazolam con bupivacaína epidural“. Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2004. https://hdl.handle.net/20.500.12672/1753.
Annotation:
OBJETIVO: El presente estudio investigó la interacción entre bupivacaína al 0.5% mas midazolam 5mg vía epidural, evaluándose: periodo de latencia, tiempo que se queda dormido el paciente, altura del bloqueo, tiempo de analgesia, cantidad de analgésico de rescate, parámetros hemodinámicas (PAM, FC), FR, Score de Ramsay.
MÉTODOS: Es un estudio doble ciego, randomizado, prospectivo, en el cual participaron 60 pacientes ASA I-II, los cuales recibieron bupivacaína al 0.5% 100mg mas midazolam 5mg (grupo I n = 30) y bupivacaína al 0.5% 100mg mas suero fisiológico 1cc (grupo II n = 30). Luego se hizo mediciones de tiempo de latencia, altura de bloqueo, tiempo en que se queda dormido el paciente, analgesia postoperatoria y variables hemodinámicas y de sedación.
RESULTADOS: En las características de los pacientes no hubo diferencias significativas. La cirugía duró en promedio 69min. en el grupo I y 70min en el grupo II. El tiempo de latencia promedio fue de 9min en el grupo I y 15min en el grupo II (p<0.05). El tiempo en que los pacientes se quedan dormidos fue en promedio de11min en grupo I y 41min en el grupo II (p<0.05). El tiempo de analgesia fue en promedio de 379min para el grupo I y 318 para el grupo II (p = 0.055). El tiempo en que se requiere la primera dosis de analgésico de rescate fue en promedio 410min para el grupo I y 345min en el grupo II (p = 0.042). La dosis de analgésico de rescate en las primeras 24horas fue en promedio de 130mg de ketorolaco en el grupo I y 132mg en el grupo II. La altura de bloqueo alcanzada fue entre T4-T7 (90%) grupo I y T8-T10 (100%) en el grupo II.
Los parámetros hemodinámicas como PAM calculada no muestra diferencia significativa al inicio del estudio, pero después de los 5 min. los promedios difieren significativamente (p<0.05). La frecuencia cardiaca no varía significativamente en cada momento de la evaluación. La frecuencia respiratoria al inicio no difiere significativamente pero si después de los 5 min. . La Escala de Ramsay no muestra diferencia significativa al inicio, a los 5 min. y 60 min. en ambos grupos, pero entre los 5-60 min. los promedios difieren significativamente (p<0.05).
Los eventos adversos fueron hipotensión y bradicardia presentes en 9/30(30%) en el grupo I y 4/30(13%) del grupo II no difieren significativamente (p<0.05).
CONCLUSIONES: El midazolam adicionado a la bupivacaína al 0.5% epidural acorta el periodo de latencia de inicio de la cirugía, aumenta la altura de bloqueo, da un buen nivel de sedación del paciente, retarda el inicio de analgesia postoperatoria, pero; existe mayor incidencia de hipotensión que el grupo control.PURPOSE: This Study investigated the interactions between bupivacaína 0.5% plus midazolam 5mg via epidural. Including the latency time, the sleep time, block height, analgesic time, quantity of rescue analgesic, hemodynamic variables(PAM, HF), Ramsay Score, breath frequency. METHODS: In a double blind, controlled, randomized and prospective study , 60 ASA I-II patients, received bupivacaína 0.5% 100mg plus midazolam 5mg(group I n = 30) and bupivacaína 0.5% 100mg plus Saline Solution 1cc(group II n=30) .then we measured latency time, block height, sleep time, postoperative analgesic and hemodynamic variables. RESULTS: Patients characteristics were similar in both groups. Surgery lasted in average 69minutes in group I and 70 minutes in group II. Latency time average was 9 minutes in group I and 15 minutes in group II (p<0.05). Sleep time average was 11 minutes in group I and 41 minutes in group II (p<0.05). Analgesic time was 379 minutes in group I and 318 minutes in group II (p 0 0.055). The first time of rescue analgesic was in 410 minutes in group I and 345 minutes in group II(p = 0.042). Quantity of rescue analgesic in 24 hours was 130mg of ketorolaco in group I and 132mg in group II. The block height was T4-T7 (90%) in group I and T8-T10 (100%) in group Ii. The parameters, PAM calculated didn’t have significative difference at onset but after 5 minutes the average was different (p<0.05). Hearth frequency wasn’t different in all time. The breath frequency wasn’t different in onset but after had significative difference. The Ramsay score wasn’t different in onset, 5 minutes and 60 minutes but between 5 and 60 minutes was different(p<0.05) Unfavorable effects were hypotension and bradicardia present in 9/30 (30%) in group I and 4/30 (13%) in group II. They weren’t statistically different (p>0.05% CONCLUSIONS: Midazolam adjunct to bupivacaína 0.5% diminish latency time. This gives a good sedation nivel, increase block height. This delayed the beginning postoperative analgesic. But it existed more hypotension than control group.
Tesis de segunda especialidad
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Amah, O. O. E., und D. Okoye. „Prevention of perioperative nausea and vomiting during epidural anesthesia“. Thesis, Sumy State University, 2017. http://essuir.sumdu.edu.ua/handle/123456789/58267.
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Morrongiello, Laura Ann. „Cesarean section outcome in primiparous women receiving epidural anesthesia /“. Staten Island, N.Y. : [s.n.], 1999. http://library.wagner.edu/theses/nursing/1999/thesis_nur_1999_morro_cesar.pdf.
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Souza, Sérgio dos Santos. „Efeitos da dexmedetomidina, por via epidural ou infusão contínua intravenosa, em gatas anestesiadas com propofol e isofluorano e submetidas a ovariossalpingohisterectomia“. Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-06032007-151544/.
Annotation:
Este estudo determinou e comparou os efeitos da administração epidural ou infusão contínua intravenosa de dexmedetomidina em gatas anestesiadas com propofol e isofluorano para realização de ovariossalpingohisterectomia. Vinte e uma gatas (peso: 3.06±0.35 kg) foram pré-tratadas com dexmedetomidina (4 mcg.kg-1, IM). Quinze minutos depois, administrou-se propofol para permitir entubação orotraqueal seguido de manutenção anestésica com isofluorano diluído em oxigênio por um circuito Mapleson D com respiração espontânea. As gatas foram distribuídas aleatoriamente, em três grupos, onde receberam, por via epidural, lidocaína (1 mg.kg-1, G1, n=7) ou lidocaína (1 mg.kg-1) + dexmedetomidina (4 mcg.kg-1, G2, n=7) ou lidocaína (1 mg.kg-1) + infusão contínua intravenosa de dexmedetomidina (0,25 mcg.kg-1.min-1, G3, n=7). O volume da solução para administração epidural foi ajustada para 0.3 mL.kg-1 com solução salina. A profundidade anestésica foi realizada por um único avaliador que não possuía conhecimento dos fármacos empregados pela via epidural e intravenosa. Foram mensurados freqüência cardíaca (FC) e respiratória (FR), pressão arterial sistólica (PAS) e temperatura retal (TR) antes e quinze minutos após a medicação pré-anestésica. Durante a anestesia, FC, FR, pressões arteriais, concentração expirada de CO2, concentração expirada de isofluorano (ISOe), TR e grau de relaxamento muscular foram avaliados em intervalos de 15 minutos de 20 até 80 minutos. A hemogasometria foi realizada aos 20 e 80 minutos após a indução anestésica. Os valores de FC, FR, TR, escore de analgesia, qualidade e os tempos de recuperação anestésica foram avaliados por três horas após o término da anestesia. Utilizou-se o teste t pareado para avaliar os efeitos do pré-tratamento e os valores hemogasométricos nos dois momentos. O teste análise de variância seguido de Tukey e Friedmann seguido de Dunn foram realizados para variáveis paramétricas e não paramétricas respectivamente (p<0.05). O pré-tratamento com dexmedetomidina reduziu a FC, FR, PAS e TR. A dose de propofol utilizada para indução anestésica foi 7.4±1.4 mg.kg-1. Quando comparado ao G1, a dexmedetomidina, por via epidural, reduziu significativamente a FC dos 20 aos 65 minutos da anestesia e aos 150 e 180 minutos após o término da anestesia, entretanto, por infusão contínua intravenosa reduziu a FC em todos os momentos avaliados da anestesia e recuperação anestésica. Quando comparado ao G2, a infusão contínua intravenosa de dexmedetomidina reduziu a FC aos 60 e 90 minutos da recuperação anestésica. No G1 a média±DP ISOe variou de 0.86±0.28% a 1.91±0.63% de 20 a 80 minutos. Neste período, ISOe foi significativamente menor no G2 (variação de 0.70±0.12% a 0.97±0.20%) e G3 (variação de 0.69±0.12% to 1.17±0.25%). Aos 20 minutos, a PaCO2 foi significativamente superior em G3 em relação ao G1. Os tempos de recuperação anestésica foram significativamente menores no G1, exceto o tempo de extubação se comparado ao G2. Não houve diferença significativa nas outras variáveis entre os três grupos. Conclui-se que o pré-tratamento com dexmedetomidina promoveu depressão cardiorrespiratória. A administração epidural e a infusão contínua intravenosa de dexmedetomidina reduziram o consumo do agente inalatório e produziram recuperação de melhor qualidade e mais prolongada. As administrações de dexmedetomidina causaram bradicardia, porém sem afetar a pressão arterial.This study compared the effects of epidural or continuous intravenous infusion of dexmedetomidine in isoflurane-anesthetized cats undergoing ovariohysterectomy. Twenty-one cats (weight: 3.06±0.35 kg) were premedicated with dexmedetomidine (4 mcg.kg-1, IM). Fifteen minutes later, propofol was titrated to allow endotracheal intubation and anesthesia was maintained in spontaneously breathing cats with isoflurane in oxygen using a Mapleson D system. Cats were randomly allocated to receive either epidural lidocaine (1 mg.kg-1, G1, n=7) or epidural lidocaine (1 mg.kg-1) + dexmedetomidine (4 mcg.kg-1, G2, n=7) or epidural lidocaine (1 mg.kg-1) + continuous intravenous infusion of dexmedetomidine (0,25 mcg.kg-1. min-1, G3, n=7). The volume of either epidural injection was adjusted to 0.3 mL.kg-1 with saline. The individual controlling depth of anesthesia was blinded to the drug being administered epidurally and intravenouslly. Heart (HR) and respiratory (RR) rates, systolic arterial blood pressure (SAP) and rectal temperature (RT) were recorded before and after 15 minutes of premedication. During anesthesia, heart (HR) and respiratory (RR) rates, invasive arterial blood pressures, end-tidal CO2, end-tidal isoflurane (ISOe), RT and muscular relaxation were recorded at 15 minute intervals from 20 until 80 minutes. Arterial blood gases were measured at 20 and 80 min after induction. HR, RR, RT, analgesia score, and recovery quality and times were compared for 3 hours after end of anesthesia. Paired t test were performed to compare the premedication effects and arterial blood gases at differents intervals. ANOVA with Tukey post-test and Friedmann with Dunn post-test were performed to parametric and nonparametric values, respectively (P<0.05). Dexmedetomidine premedication decreased HR, RR, SAP and RT. The induction dose of propofol was 7.4±1.4 mg.kg-1. When compared to the G1, epidural dexmedetomidine significantly decreased HR from 20 to 65 minutes of anesthesia and 150 and 180 minutes after end of anesthesia, however, continuous intravenous infusion decreased HR all times during anesthesia and recovery time. When compared to G2, continuous intravenous infusion of dexmedetomidine decreased HR at 60 and 90 minutes during recovery. In the G1 mean±SD ISOe concentrations ranged form 0.86±0.28% to 1.91±0.63% from 20 to 80 min. At the same time interval, ISOe concentrations were significantly lower in the G2 (ISOe ranged from 0.70±0.12% to 0.97±0.20%) and G3 (ISOe ranged from 0.69±0.12% to 1.17±0.25%). PaCO2 was significantly greater in G3 than G1 at 20 minutes. The recovery times were significantly lower in the G1 except for extubation time when compared with G2. There were no significant differences among groups for the remaining variables. It was concluded that premedication with dexmedetomidine produced cardiorespiratory depression. Epidural administration and continuous intravenous infusion of dexmedetomidine significantly reduced inhalant requirements for maintaining anesthesia and produced a better anesthesia recovery although of longer duration. Dexmedetomidine administration may cause bradycardia, however reduced HR does not affect arterial blood pressure.
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Cótes, Lourenço Candido. „Avaliação do emprego epidural de morfina ou morfina-fentanil, associados à lidocaína, em cães“. Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-09102012-105723/.
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Os opióides de curta duração e de alta potencia analgésica, como o fentanil, embora amplamente utilizados em cães, ainda são pouco empregados pela via epidural nesta espécie. O presente estudo teve como objetivo avaliar a associação do anestésico local lidocaína à morfina ou à combinação morfina-fentanil, pela via epidural. Foram analisados os efeitos cardiovasculares, respiratórios bem como a analgesia pós-operatória, em cães submetidos a cirurgia de joelho. Para tanto, 24 animais da espécie canina foram aleatoriamente divididos em 2 grupos. Todos os animais receberam acepromazina (0,05 mg/kg), foram induzidos com propofol (5 mg/kg) e mantidos em anestesia inalatória. Os animais do GRUPO I foram tratados com lidocaína (5mg/kg) associada a morfina (0,1mg/kg) e os animais do GRUPO II receberam, pela via epidural, a combinação lidocaína-morfina-fentanil, sendo este último na dose de 2µ/kg. Parâmetros como frequência cardíaca, respiratória, pressão arterial (sistólica, média e diastólica) foram mensurados, bem como pH e gases sanguíneos. Para a avaliação da analgesia foram utilizadas a escala Analógica-visual (EAV), a escala proposta por Lascelles, 1994 e a termoalgimetria. Amostras de sangue foram coletadas para posterior dosagem de cortisol e Interleucina-06. O período de avaliação imediata foi de 06 horas após a cirurgia, sendo os animais reavaliados no período de 24 horas após o procedimento. No tocante aos parâmetros cardiorrespiratórios os grupos se comportaram de maneira muito semelhante. Entretanto, pode-se observar que os animais tratados com a combinação lidocaína-fentanil-morfina apresentaram menor escore de dor quando avaliados pelas escalas do estudo no período pós-operatório. De fato verificou-se diferença significativa nos escores da EAV (p <0,05) nos tempos T180 e T360; na escala de Lascelles obteve-se diferença estatística nos tempos T180, T360 e T24h e na termoalgimetria houve diferença estatística nos tempos T180, T360 e T24h. A analgesia de resgate foi necessária em 3 animais do Grupo II, enquanto no Grupo I a necessidade desta medicação foi observada em 6 animais. Pode-se concluir, com os resultados obtidos, que a associação do fentanil no protocolo de anestesia epidural, promoveu adequada analgesia perioperatória, além de produzir um efeito sinérgico-residual, o que melhorou a analgesia pós-operatória, diminuindo a necessidade de analgesia de resgate.Short duration opioids and high potency analgesics such as fentanyl, although widely used in dogs are seldom used for epidural anesthesia in this species. This study aimed to evaluate the association of lidocaine with morphine or morphine-fentanyl combination, epidurally. 24 dogs were randomly divided into two groups. All animals received acepromazine intramuscularlly (0.05 mg / kg), were induced with propofol (5 mg / kg) and maintained under inhalation anesthesia. The animals in group I were treated with lidocaine (5 mg / kg) combined with morphine (0.1 mg / kg) epidurally and the animals of group II received epidurally, the combination lidocaine-morphine-fentanyl, the latter at the dose of 2µ/kg. Parameters such as heart and respiratory rate, blood pressure (systolic, mean and diastolic), blood gases and pH were measured. For the assessment of analgesia were used visual-analogue scale (VAS), the scale proposed by Lascelles and thermoalgimetry. Blood samples were collected for later determination of cortisol and interleukin-06. The evaluation period was 06 hours after surgery, the animals were re-evaluated within 24 hours after the procedure. Except the cardiorespiratory parameters, the groups were similarly. However, was observed that animals treated with the combination lidocaine-fentanyl-morphine had lower pain scores in the postoperative period. In fact there were significant differences in VAS scores (p <0.05) at times T180 and T360; in Lascelles scores at times T180, T360 and T24h and there were no statistical diferences in thermoalgimetry at times T180, T360 and T24h. The rescue analgesia was required in three animals in Group II, and six animals in Group I. It can be concluded that the combination of fentanyl in epidural anesthesia protocol, promoted adequate perioperative analgesia, producing synergistic and residual effects, which improved postoperative analgesia.
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Salgado, Paula Fialho Saraiva [UNESP]. „Efeitos da associação de dexmedetomidina à ropivacaína 0,75% na anestesia peridural“. Universidade Estadual Paulista (UNESP), 2008. http://hdl.handle.net/11449/95058.
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salgado_pfs_me_botfm.pdf: 586553 bytes, checksum: 17d680942bf6fdaf73679a18bc55679a (MD5)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Os efeitos clínicos e o potencial sinergismo entre a dexmedetomidina e a ropivacaína ainda não foram estudados em pacientes sob anestesia peridural. O objetivo deste estudo foi avaliar as características clínicas da anestesia peridural realizada com ropivacaína associada à dexmedetomidina. Método – Quarenta pacientes, estado físico ASA 1 ou 2, submetidos à correção cirúrgica de hérnia inguinal ou varizes de membros inferiores sob anestesia peridural, participaram deste estudo duplamente encoberto. Os pacientes foram divididos em: Grupo Controle (n = 20), ropivacaína 0,75%, 20 mL (150 mg); e Grupo Dexmedetomidina (n = 20), ropivacaína 0,75%, 20 mL (150 mg), mais dexmedetomidina, 1 mg.kg-1. As seguintes variáveis foram estudadas: tempo de latência do bloqueio sensitivo, nível (dermátomo) máximo de anestesia, tempo de duração dos bloqueios analgésico e motor, intensidade do bloqueio motor, nível de sedação, variáveis hemodinâmicas intrer- e pósoperatórias, analgesia pós-operatória e ocorrência de efeitos colaterais. Resultados – A dexmedetomidina não influenciou o tempo de latência da anestesia nem o nível máximo do bloqueio sensitivo (p > 0,05), mas prolongou o tempo de duração dos bloqueios analgésico e motor (p < 0,05) e da 8 analgesia pós-operatória (p < 0,05), além de determinar bloqueio motor de maior intensidade (p < 0,05). Os valores do índice bispectral foram menores no Grupo Dexmedetomidina (p < 0,05). Não houve diferença na incidência de hipotensão arterial e de bradicardia (p > 0,05). A ocorrência de efeitos colaterais (tremor, náuseas e SpO2 < 90%) foi baixa e semelhante entre os grupos (p > 0,05). Há sinergismo evidente entre a dexmedetomidina e a ropivacaína na anestesia peridural. A dexmedetomidina aumentou o tempo de duração dos bloqueios analgésico e motor, prolongou a analgesia pósoperatória, intensificou...
Clinical effects and the potential synergism between dexmedetomidine and ropivacaine have not been studied in patients undergoing epidural anesthesia. This study aimed to evaluate the clinical characteristics of the epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. Methods – Forty patients ASA physical status 1 and 2, scheduled for hernia repair or varicose vein surgeries under epidural anesthesia, participated in this double-blinded study. They were assigned for: Control Group (n = 20), 0.75% ropivacaine, 20 mL (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 mL (150 mg), plus dexmedetomidine, 1 mg.kg-1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, consciousness status, intra and postoperative hemodynamics, postoperative analgesia and incidence of side effects. Results – Epidural dexmedetomidine did not affect onset time nor the upper level of anesthesia (p > 0.05) but prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and resulted in a more intense motor block, as well (p < 0.05). Values of bispectral index were lower in 10 Dexmedetomidine Group (p < 0.05).There was no difference in incidence of hypotension and bradycardia (p > 0.05). Side effects occurrence (shivering, vomiting and SpO2 < 90%) was low and similar between groups (p > 0.05). There is a clear synergism between epidural dexmedetomidine and ropivacaine. Dexmedetomidine increased sensory and motor block duration time, prolonged postoperative analgesia, enhanced motor block intensity, and did not cause hemodynamic instability. Sedation not associated with hypoxemia is an advantage of the association between ropivacaine and dexmedetomidine in epidural anesthesia.
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Ishiy, Helcya Mime [UNESP]. „Uso da lidocaína isolada ou associada à quetamina ou ao butorfanol, em anestesia epidural em cães: avaliação cardiorrespiratória e analgésica“. Universidade Estadual Paulista (UNESP), 2001. http://hdl.handle.net/11449/86637.
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ishiy_hm_me_botfm.pdf: 2335235 bytes, checksum: a5502e4b5a245d692a73e68b697160de (MD5)A anestesia epidural empregando-se anestésicos locais normalmente produz anestesia apenas da região retro umbilical. O trabalho investiga e compara o uso da lidocaína isolada ou associada ao butorfanol ou à quetamina, em anestesia epidural lombo-sacra de cães, no seu aspecto cardiorrespiratório e analgésico. Todos os animais foram tranquilizados com 0,1 mg/kg de acepromazina IV. Na primeira fase, seis cães adultos, foram anestesiados, em três ocasiões distintas, em ordem aleatória, com: 5 mg/kg lidocaína 2% com vasoconstritor (GAL); 1 mg/kg de quetamina (GAQ) e 0,1 mg/kg de butorfanol (GAB), nestes dois últimos complementando-se o volume de 1 ml/4 kg com lidocaína 2% com vasoconstritor. Foram avaliados: freqüência cardíaca, pressão arterial sistólica, freqüência respiratória, concentração expirada de CO2, volume minuto e corrente e temperatura retal. Ainda observou-se período de latência, duração do bloqueio, região bloqueada, duração da cirurgia e grau de miorrelaxamento. Na segunda fase, dezoito cadelas foram divididas em três grupos de mesmo número, anestesiadas com os mesmos protocolos anestésicos da primeira fase (GCL, GCQ, GCB) e submetidas à ovariosalpingohisterectomia. Para análise estatística dos dados paramétricos foram utilizadas a análise de variância, seguida do teste de Student-Newman-Keuls, para comparação entre momentos. Para comparação entre grupos, foi utilizado o teste T. Para as variáveis não paramétricas...
The aim of this study was to compare the cardiorespiratory effects and duration of lumbosacral epidural anaesthesia produced by lidocaine alone or combined with ketamine or butorphanol in dogs submitted or not to ovariohysterectomy. In the first stage, six mixed breed adult dogs (mean weight 14,0 ± 3,1 kg) were used in three different occasions: lidocaine 2% with adrenaline – 5 mg/kg (GAL), ketamine – 1 mg/kg (GAQ) or butorphanol – 0,1 mg/kg (GAB). In groups GAQ and GAB, the total volume of 1 ml/4 kg was completed with lidocaine. Heart heat, sistolic arterial blood pressure, respiratory rate, expired CO2, tidal and minute volume and rectal temperature were measured 15 minutes after pre-medication and every 30 minutes after epidural anesthesia until 120 minutes. The time to loss the interdigital reflex, duration and region of block were observed. In the second stage, eighteen mixed breed female dogs (mean weight 13,4 ± 3,5 kg) were divided in three groups(GCQ, GCB and GCL), anaesthetised as before and submitted to ovariohysterectomy. All animals were sedated with acepromazine 0,1 mg/kg IV. Data were analysed using ANOVA, followed by Student-Newman-Keuls test or Kruskal-Wallis and Friedman tests as appropriate. The rectal temperature reduced in all groups. Muscle relaxation was better in the GCQ and GCB groups than the in GCL group. Anaesthesia was not sufficient for ovariohysterectomy in animals treated with lidocaine and general anaesthesia... (Complete abstract click electronic access below)
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Salgado, Paula Fialho Saraiva. „Efeitos da associação de dexmedetomidina à ropivacaína 0,75% na anestesia peridural /“. Botucatu : [s.n.], 2008. http://hdl.handle.net/11449/95058.
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Orientador: Paulo do Nascimento JuniorBanca: Norma Sueli Pinheiro Módolo
Banca: Francisco Ricardo Marques Lobo
Resumo: Os efeitos clínicos e o potencial sinergismo entre a dexmedetomidina e a ropivacaína ainda não foram estudados em pacientes sob anestesia peridural. O objetivo deste estudo foi avaliar as características clínicas da anestesia peridural realizada com ropivacaína associada à dexmedetomidina. Método - Quarenta pacientes, estado físico ASA 1 ou 2, submetidos à correção cirúrgica de hérnia inguinal ou varizes de membros inferiores sob anestesia peridural, participaram deste estudo duplamente encoberto. Os pacientes foram divididos em: Grupo Controle (n = 20), ropivacaína 0,75%, 20 mL (150 mg); e Grupo Dexmedetomidina (n = 20), ropivacaína 0,75%, 20 mL (150 mg), mais dexmedetomidina, 1 mg.kg-1. As seguintes variáveis foram estudadas: tempo de latência do bloqueio sensitivo, nível (dermátomo) máximo de anestesia, tempo de duração dos bloqueios analgésico e motor, intensidade do bloqueio motor, nível de sedação, variáveis hemodinâmicas intrer- e pósoperatórias, analgesia pós-operatória e ocorrência de efeitos colaterais. Resultados - A dexmedetomidina não influenciou o tempo de latência da anestesia nem o nível máximo do bloqueio sensitivo (p > 0,05), mas prolongou o tempo de duração dos bloqueios analgésico e motor (p < 0,05) e da 8 analgesia pós-operatória (p < 0,05), além de determinar bloqueio motor de maior intensidade (p < 0,05). Os valores do índice bispectral foram menores no Grupo Dexmedetomidina (p < 0,05). Não houve diferença na incidência de hipotensão arterial e de bradicardia (p > 0,05). A ocorrência de efeitos colaterais (tremor, náuseas e SpO2 < 90%) foi baixa e semelhante entre os grupos (p > 0,05). Há sinergismo evidente entre a dexmedetomidina e a ropivacaína na anestesia peridural. A dexmedetomidina aumentou o tempo de duração dos bloqueios analgésico e motor, prolongou a analgesia pósoperatória, intensificou... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Clinical effects and the potential synergism between dexmedetomidine and ropivacaine have not been studied in patients undergoing epidural anesthesia. This study aimed to evaluate the clinical characteristics of the epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. Methods - Forty patients ASA physical status 1 and 2, scheduled for hernia repair or varicose vein surgeries under epidural anesthesia, participated in this double-blinded study. They were assigned for: Control Group (n = 20), 0.75% ropivacaine, 20 mL (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 mL (150 mg), plus dexmedetomidine, 1 mg.kg-1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, consciousness status, intra and postoperative hemodynamics, postoperative analgesia and incidence of side effects. Results - Epidural dexmedetomidine did not affect onset time nor the upper level of anesthesia (p > 0.05) but prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and resulted in a more intense motor block, as well (p < 0.05). Values of bispectral index were lower in 10 Dexmedetomidine Group (p < 0.05).There was no difference in incidence of hypotension and bradycardia (p > 0.05). Side effects occurrence (shivering, vomiting and SpO2 < 90%) was low and similar between groups (p > 0.05). There is a clear synergism between epidural dexmedetomidine and ropivacaine. Dexmedetomidine increased sensory and motor block duration time, prolonged postoperative analgesia, enhanced motor block intensity, and did not cause hemodynamic instability. Sedation not associated with hypoxemia is an advantage of the association between ropivacaine and dexmedetomidine in epidural anesthesia.
Mestre
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MATSUI, HIROKI, NAOKI ISHIGURO, TOMOHIRO MATSUMOTO, AKIO MURAMOTO, RYOJI TAUCHI, KENICHI HIRANO, KEI ANDO, ZENYA ITO und SHIRO IMAGAMA. „Chronic Spontaneous Lumbar Epidural Hematoma Simulating Extradural Spinal Tumor : A Case Report“. Nagoya University School of Medicine, 2014. http://hdl.handle.net/2237/19498.
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Aguilera, i. Cuchillo Lluís. „Pressió generada per la tos. tècniques alternatives de mesura i efectes de l’analgèsia epidural i la laparotomia mediana“. Doctoral thesis, Universitat Autònoma de Barcelona, 2019. http://hdl.handle.net/10803/669350.
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Interès i objectius: La pressió generada per la tos (PTOS) com a expressió de la força de la musculatura expiratòria es sol mesurar amb catèters esofàgics (gold-standard) o gàstrics, que son incòmodes i molestos pels pacients. Per altra banda, no es coneixen els efectes de l’anestèsia epidural i de la laparotomia mediana sobre la PTOS. Els nostres objectius han estat: 1/ trobar alternatives als catèters esofàgic i gàstric per mesurar la PTOS, 2/ mesurar l’efecte de l’analgèsia epidural sobre la força de la tos, i 3/ mesurar l’efecte de la laparotomia mediana sobre la força de la tos, sense la interferència del dolor postoperatori.
Mètodes: Estudi prospectiu observacional en pacients programats per a cirurgia de còlon per laparotomia mediana, que es va articular en 3 protocols: 1/ Protocol 1 (9 pacients): comparar la PTOS mesurada en diverses localitzacions anatòmiques (esòfag, estómac, vena cava superior, bufeta urinària i recte), 2/ Protocol 2 (14 pacients): mesurar els efectes de la bupivacaïna 0.25% epidural toràcica sobre la PTOS i 3/ Protocol 3 (11 pacients): mesurar els efectes de la laparotomia mediana sobre la PTOS, sense la influència del dolor o de fàrmacs anestèsics sistèmics. Prèviament a la cirurgia, es va col·locar un catèter epidural a nivell T8-T10 i catèters a les localitzacions anatòmiques a estudi. En decúbit supí es va fer tossir als pacients el més fort possible, enregistrant-se simultàniament les PTOS obtingudes. Seguidament es va administrar bupivacaïna 0.25% amb adrenalina 1:200.000 epidural fins obtenir nivell sensitiu T6 i es va mesurar novament la PTOS als pacients. Després de la cirurgia, es va administrar la mateixa dosi de bupivacaïna 0.25% que al Protocol 2 i es va repetir la mesura de la PTOS. Als primers subjectes se’ls mesurava la PTOS en totes les localitzacions anatòmiques i quan es van obtenir resultats del Protocol 1 es va continuar l’estudi usant el catèter menys molest per als pacients. Per l’anàlisi estadística es va usar el coeficient de correlació intraclasse, els límits de Bland-Altman i el Wilcoxon signed-rank test.
Resultats: PTOS [cmH2O, mediana (1r quartil, 3r quartil)]: esòfag 112 (89,148), estómac 105 (92,156), vena cava superior 102 (91,149), bufeta 118 (93,157), i recte 103 (88,150). S’observà una excel·lent repetibilitat per a cada pacient a cada localització (p<0.001) i una excel·lent concordança entre les pressions a recte i vena cava superior i la pressió a l’esòfag (p<0.004). El catèter rectal va ser el menys molest. La mesura de PTOS a la bufeta urinària va ser precisa però lleugerament superior. La bupivacaïna 0.25% epidural va provocar un descens de la PTOS del 16% (p=0.001), i després de la laparotomia mediana no es van objectivar canvis significatius en la PTOS.
Conclusions: La PTOS pot ser mesurada de manera indistinta a l’esòfag, estómac, vena cava superior o recte, i la sonda rectal va ser la menys molesta. També es pot mesurar la PTOS de forma precisa a la bufeta urinària, però els valors registrats seran lleugerament superiors. La bupivacaïna 0.25% administrada per via epidural toràcica (nivell anestèsic T6) disminueix significativament la pressió generada per la tos. La laparotomia mediana no canvia la pressió generada per la tos si s’administra bupivacaïna 0.25% per via epidural toràcica (nivell anestèsic T6). En absència de dolor, l’agressió quirúrgica causada per la laparotomia no sembla provocar una disminució rellevant de la força de la tos.
El treball ha generat fins ara una publicació: Aguilera LG, Gallart L, Álvarez JC, Ramos I, Vallès J, Gea J. Rectal, central venous, gastric and bladder pressures versus esophageal pressure for the measurement of cough strength: a prospective clinical comparison. Respir Res 2018; 19:191. https://doi.org/10.1186/s12931-018-0897-6Background and objectives: Cough pressure (PCOUGH), as expression of expiratory muscle strength, is usually measured with esophageal (gold-standard) or gastric balloons, but these catheters can be uncomfortable for the patient or their placement impractical. Furthermore, the effects of epidural anesthesia and laparotomy on PCOUGH are unknown. This study aimed to: 1/ find alternatives to esophageal and gastric balloons to measure PCOUGH, 2/ measure the effect of epidural analgesia on cough strength, and 3/ measure the effect of midline laparotomy on cough strength, without the interference of postoperative pain. Methods: Prospective observational study of patients scheduled for colon surgery via midline laparotomy, and articulated in 3 protocols: 1/ Protocol 1 (9 patients): comparison of PCOUGH measurement in different anatomical locations (esophagus, stomach, superior vena cava, bladder and rectum), 2/ Protocol 2 (14 patients): measurement of the effects of thoracic epidural bupivacaine 0.25% on PCOUGH and 3/ Protocol 3 (11 patients): measurement of the effects of midline laparotomy on PCOUGH, without the influence of pain or systemic anesthetic drugs. Prior to surgery, an epidural catheter was placed at T8-T10 level as well as catheters in the anatomical locations under study. In supine position, patients were asked to cough as forcefully as possible while PCOUGH was recorded. Afterward, epidural 0.25% bupivacaine with adrenaline 1:200.000 was administered until T6 sensory level was obtained, and PCOUGH was measured again. After surgery, the same dose of bupivacaine 0.25% used in Protocol 2 was administered and PCOUGH measurements were repeated. PCOUGH of the first studied subjects was measured in all anatomical locations and when results of Protocol 1 were obtained, the study was continued using the least unpleasant alternative catheter. The intraclass correlation coefficient, Bland–Altman plots and Wilcoxon signed-rank test were used as statistical analyses. Results: PCOUGH [cmH2O, median (1st quartil, 3rd quartil)]: esophagus 112 (89,148), stomach 105 (92,156), superior vena cava 102 (91,149), bladder 118 (93,157), and rectum 103 (88,150), showing excellent within-site repeatability of the measurements (p < 0.001) and excellent agreement between pressures recorded at superior cava and rectum and recorded at esophagus (p < 0.004). Bladder pressure was precise but slightly higher. Rectal catheter was the least unpleasant alternative. Epidural 0.25% bupivacaine decreased PCOUGH by 16% (p = 0.001), while significant changes in PCOUGH measurement were not observed after midline laparotomy. Conclusions: PCOUGH can be measured in the esophagus, stomach, superior vena cava or rectum, since their values are similar. It can also be measured in the bladder, although the value will be slightly higher. The rectal catheter was the least unpleasant. Thoracic epidural bupivacaine 0.25% (anesthetic level T6) significantly decreases cough pressure. Midline laparotomy does not change cough pressure if thoracic epidural bupivacaine 0.25% is administered (T6 anesthetic level). In the absence of pain, the surgical aggression caused by laparotomy does not seem to cause a relevant decrease in cough strength. Since now, a publication was generated: Aguilera LG, Gallart L, Álvarez JC, Ramos I, Vallès J, Gea J. Rectal, central venous, gastric and bladder pressures versus esophageal pressure for the measurement of cough strength: a prospective clinical comparison. Respir Res 2018; 19:191. https://doi.org/10.1186/s12931-018-0897-6
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Bopp, Simone. „CLONIDINA OU SUFENTANIL EPIDURAL EM CÃES SUBMETIDOS À OVÁRIO-HISTERECTOMIA“. Universidade Federal de Santa Maria, 2004. http://repositorio.ufsm.br/handle/1/10103.
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The objective of this study was to evaluate the cardiovascular, respiratory and analgesic effects of epidural clonidine and sufentanil associated with halothane anesthesia and in the immediate postoperative period. In order to study this, twenty female dogs, healthy, among 10 to 20 kg from the routine of Veterinary Hospital of UFSM underwent ovario-histerectomy. The dogs were distributed in two groups. One received epidural clonidine and other received epidural sufentanil. In the P0 period (baseline values), heart rate (HR), systolic arterial pressure (SAP), hemoglobin saturation (SatO2), respiratory rate (RR) and temperature (T°C) were measured, also heart rhythm was evaluate and collected the first sample of arterial blood to gas analysis (P0G). Two another samples of arterial blood were collected, one 30 minutes after epidural (P1G) and other four hours after epidural (P2G) to analyze pH, parcial arterial press of CO2 (PaCO2), parcial arterial press of O2 (PaO2), hemoglobin saturation (SatO2), base excess (BE), bicarbonate (HCO3) and total CO2 (TCO2). In the P1 (15 minutes after epidural) and in the other periods (P2, P3 and P4 at 15 minutes intervals until the end of the procedure) were measured HR, RR, SatO2,, SAP, tidal volume (VT) and minute ventilation (VE), heart rhythm, T°C and halothane concentration release from the vaporizator (V%). As for the level anesthetic, 0,5 to 1 V% were diminished in each measure. Passed one hour to the end of the surgery was realizated the first pospoperative avaliation of analgesia, repeated each hour during five hours of postoperative by the modificated Firth&Haldane scale. The results show that epidural clonidine and epidural sufentanil provide adequated intra-operative analgesia with minimal cardiovascular and respiratory effects associated with halothane anesthesia in dogs undergoing ovario-histerectomy and adequate analgesia in the immediate postoperative period, with sufentanil
exhibiting lesser punctuation by the scores obtained by the modificated Firth&Haldane scaleO presente estudo se propôs a avaliar os efeitos cardiovasculares, respiratórios e analgésicos da clonidina e do sufentanil epidural associados à anestesia com halotano e no pós-operatório imediato, em cães submetidos à ovário-histerectomia. Para isso foram utilizados 20 cães sem raça definida (SRD), fêmeas adultas, hígidas, com peso entre 10 e 20 kg, oriundas da rotina hospitalar do Hospital Veterinário da Universidade Federal de Santa Maria, separados aleatoriamente em dois grupos. Grupo clonidina (CLO) recebeu analgesia epidural com clonidina e o grupo sufentanil (SUF) recebeu como analgésico sufentanil, também via epidural. No tempo intitulado T0 foram avaliados: freqüência cardíaca (FC), freqüência respiratória (f), pressão arterial sistólica (PAS), temperatura (T°C), saturação de oxigênio (SatO2), ritmo cardíaco e coletada primeira amostra de sangue arterial para realização do exame de gasometria (T0G valores basais). Em relação ao exame gasométrico, foram coletadas mais duas amostras de cada animal, uma 30 minutos após realizada epidural (T1G) e a outra quatro horas depois (T2G), e foram analisados pH, pressão parcial arterial de CO2 (PaCO2), pressão parcial arterial de O2 (PaO2), saturação de O2 na hemoglobina (SatO2), excesso de base (BE), bicarbonato (HCO3) e CO2 total (TCO2). No tempo intitulado T1 (quinze minutos após epidural) e a seguir nos demais tempos (T2, T3 e T4 - a cada quinze minutos até o final do procedimento) foram mensurados: FC, f, SatO2, PAS, Volume corrente (VT) e Volume minuto (VM), ritmo cardíaco, T°C, e concentração de halotano emitida pelo vaporizador (V%). Em relação ao plano anestésico, a cada mensuração foi diminuído 0,5 V% de halotano, ou, encontrando-se o animal em plano muito profundo até 1V%. Após uma hora do fim do procedimento cirúrgico foi realizada a primeira avaliação pós-operatória, sendo repetida a cada hora durante cinco horas através da escala de Firth&Haldane modificada. Pode-se concluir que tanto a clonidina como o sufentanil epidural produzem adequada analgesia intra-operatória com mínimos efeitos cardiovasculares e respiratórios associados à anestesia com halotano em cães submetidos a ovário-histerectomia e adequada analgesia no período pósoperatório imediato, com o sufentanil apresentando menor pontuação, de acordo com a escala de Firth&Haldane modificada.
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Coelho, Cássia Maria Molinaro [UNESP]. „Avaliação da viabilidade de cateter epidural totalmente implantado em equídeos“. Universidade Estadual Paulista (UNESP), 2014. http://hdl.handle.net/11449/121887.
Annotation:
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000814986.pdf: 1142307 bytes, checksum: 48f47338a6adc9acf25b91194bf8ab98 (MD5)Pacientes candidatos à analgesia espinhal por tempo prolongado são geralmente portadores de dores crônicas ou com afecções álgicas agudas com alto índice de cronicidade. Ainda que os equídeos sejam comumente acometidos por afecções que justifiquem o uso da técnica, observa-se que o uso de cateteres espinhais se restringe quase que exclusivamente a pesquisa, principalmente devido a extremidade proximal de o cateter permanecer exteriorizada, o que requer cuidado intensivo e restrição de movimento do animal. Diante deste desafio, este estudo desenvolveu uma técnica para a implantação de cateter epidural totalmente implantado (sistema port-a-cath) em equinos e asininos, objetivando a patência prolongada da via epidural em animais mantidos em piquetes e isentos de cuidados intensivos. Para tanto, foram selecionados 10 equinos e seis asininos, nos quais foi implantado um cateter epidural de poliuretano, através de incisão em elipse na região sacrococcígea. A extremidade proximal foi transposta para a região glútea e conectada a um portal totalmente implantado, sepultado na mesma região. Após a implantação os animais permaneceram em baias individuais em média 20 dias e depois foram alojados em piquetes coletivos, nos quais permaneceram com o cateter implantado por períodos de 4 a 14 meses. A cada 15 dias foi realizado a administração de 2mL de água destilada estéril para teste da patência da via. A manipulação e a administração percutânea foram bem toleradas, sendo a patência da via epidural viável, exceto em dois asininos, durante todo o experimento. Nenhum animal apresentou alterações comportamentais ou fisiológicas pela implantação e permanência do cateter e portal. Dois equinos apresentaram vazamentos transitórios pelo portal e 5/6 asininos desenvolveram úlceras sobre o portal, complicações que não inviabilizaram o uso do dispositivo. Diante destes resultados, concluiu-se que a técnica ...
Long term spinal analgesia typically performed in patients suffering from chronic pain or acute painful conditions with high chronicity. Although the horses are commonly affected by disorders that justify the use of this technique, it is observed that the use of spinal catheters is almost exclusively to research purposes, especially because the proximal end of the catheter remain externalized, which requires an intensive care and animal's movement restrictions. Facing this challenge, this study developed a technique to implant an epidural port-a-cath system in horses and donkey, aiming long term epidural patency in animals kept in paddocks and without intensive care. Ten horses and six donkeys were selected in which a polyurethane epidural catheter was implanted through elliptical incision in the sacrococcygeal region. The proximal end catheter was transposed to the gluteal region and connected to the port, buried in this area. After implantation the animals were kept in individual stall on average 20 days and then were housed in collective paddocks whereas remained with the catheter implanted for 8 to 14 months. The percutaneous administrations were well tolerated and the patency still viable, excepting two donkeys. None animal showed behavioral or physiological alterations caused by the surgery procedure or the catheter permanence. Two horses had transient leakage through the port and 5/6 donkeys developed skin ulcers on the port, complications that not did prevent the use of the device. Considering these results, it was concluded that the epidural port-cath system implantation technique is feasible for equine and asinine species and the system was able to maintain a prolonged epidural patency without nosocomial infections and intensive care, which allows the use for research purposes and in patients with painful conditions
40
Coelho, Cássia Maria Molinaro. „Avaliação da viabilidade de cateter epidural totalmente implantado em equídeos /“. Jaboticabal, 2014. http://hdl.handle.net/11449/121887.
Annotation:
Orientador: Carlos Augusto Araújo ValadãoBanca: Andrigo Barboza de Nardi
Banca: Juan Carlos Duque Moreno
Banca: Stelio Pacca Loureiro Luna
Banca: Rafael Resende Faleiros
Resumo: Pacientes candidatos à analgesia espinhal por tempo prolongado são geralmente portadores de dores crônicas ou com afecções álgicas agudas com alto índice de cronicidade. Ainda que os equídeos sejam comumente acometidos por afecções que justifiquem o uso da técnica, observa-se que o uso de cateteres espinhais se restringe quase que exclusivamente a pesquisa, principalmente devido a extremidade proximal de o cateter permanecer exteriorizada, o que requer cuidado intensivo e restrição de movimento do animal. Diante deste desafio, este estudo desenvolveu uma técnica para a implantação de cateter epidural totalmente implantado (sistema port-a-cath) em equinos e asininos, objetivando a patência prolongada da via epidural em animais mantidos em piquetes e isentos de cuidados intensivos. Para tanto, foram selecionados 10 equinos e seis asininos, nos quais foi implantado um cateter epidural de poliuretano, através de incisão em elipse na região sacrococcígea. A extremidade proximal foi transposta para a região glútea e conectada a um portal totalmente implantado, sepultado na mesma região. Após a implantação os animais permaneceram em baias individuais em média 20 dias e depois foram alojados em piquetes coletivos, nos quais permaneceram com o cateter implantado por períodos de 4 a 14 meses. A cada 15 dias foi realizado a administração de 2mL de água destilada estéril para teste da patência da via. A manipulação e a administração percutânea foram bem toleradas, sendo a patência da via epidural viável, exceto em dois asininos, durante todo o experimento. Nenhum animal apresentou alterações comportamentais ou fisiológicas pela implantação e permanência do cateter e portal. Dois equinos apresentaram vazamentos transitórios pelo portal e 5/6 asininos desenvolveram úlceras sobre o portal, complicações que não inviabilizaram o uso do dispositivo. Diante destes resultados, concluiu-se que a técnica ...
Abstract: Long term spinal analgesia typically performed in patients suffering from chronic pain or acute painful conditions with high chronicity. Although the horses are commonly affected by disorders that justify the use of this technique, it is observed that the use of spinal catheters is almost exclusively to research purposes, especially because the proximal end of the catheter remain externalized, which requires an intensive care and animal's movement restrictions. Facing this challenge, this study developed a technique to implant an epidural port-a-cath system in horses and donkey, aiming long term epidural patency in animals kept in paddocks and without intensive care. Ten horses and six donkeys were selected in which a polyurethane epidural catheter was implanted through elliptical incision in the sacrococcygeal region. The proximal end catheter was transposed to the gluteal region and connected to the port, buried in this area. After implantation the animals were kept in individual stall on average 20 days and then were housed in collective paddocks whereas remained with the catheter implanted for 8 to 14 months. The percutaneous administrations were well tolerated and the patency still viable, excepting two donkeys. None animal showed behavioral or physiological alterations caused by the surgery procedure or the catheter permanence. Two horses had transient leakage through the port and 5/6 donkeys developed skin ulcers on the port, complications that not did prevent the use of the device. Considering these results, it was concluded that the epidural port-cath system implantation technique is feasible for equine and asinine species and the system was able to maintain a prolonged epidural patency without nosocomial infections and intensive care, which allows the use for research purposes and in patients with painful conditions
Doutor
41
Ramstad, Marsha. „The Relationship between Epidural Analgesia during Childbirth and Childbirth Outcomes“. Thesis, North Dakota State University, 2004. https://hdl.handle.net/10365/28727.
Annotation:
Epidural analgesia has increased in usage dramatically in the United States as a means
of comfort for labor pain. Prior studies have connected epidural analgesia to an increase in
cesarean birth rate, an increase in use of instrumentation, an increase in length of labor,
episiotomy rate, and maternal fever. Epidural analgesia has produced additional costs to
the patient and society. The purpose of this study is to examine the relationship between
epidural analgesia during childbirth and childbirth outcomes. The data for this study were obtained from a retrospective patient record review of 200
systematically selected labor patients who delivered in 2002 at a midwestern hospital. The
epidural analgesia rate was 72% at this facility in 2002, a signi?cant increase from the
previous 5 years. Using the Chi-square test of independence, 3 relationship was established
between epidural analgesia and four of the variables examined. A statistically signi?cant
relationship was found to exist between epidural analgesia and cesarean birth rate, pitocin
augmentation, and the ?rst and second stages of labor with the total sample. The results of
the study are important for healthcare providers who are relaying in?uential wellness
information to childbearing women and their partners. The results indicate a need for further education for healthcare providers on alternative methods of pain relief for their patients during childbirth.
42
Almeida, Tatiana Ferrante de. „Uso da bupivacaína isolada e associada ao fentanil e sufentanil em anestesia epidural em cadelas“. Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/10/10132/tde-13092007-160517/.
Annotation:
Os opióides, como o fentanil e o sufentanil, embora amplamente utilizados em cães são raramente empregados pela via epidural nesta espécie. O presente estudo teve como objetivo avaliar comparativamente os efeitos cardiovasculares e sistêmicos bem como a analgesia no período pós-operatório imediato e tardio da anestesia epidural realizada com fentanil ou sufentanil associados a bupivacaína ou desta sozinha em cadelas, sedados com infusão contínua de propofol. Para tanto foram utilizadas 30 fêmeas da espécie canina, submetidas a ovariosalpingohisterectomia eletiva, distribuídas aleatoriamente em 3 grupos de 10 animais cada. Todos os animais deste estudo receberam acepromazina (0,1 mg/kg), e infusão contínua de propofol para sedação. Os animais do grupo I foram então tratados com o fentanil (2 µg/kg) e bupivacaína (1,0 mg/kg), os do grupo II com sufentanil (1µg/kg) e bupivacaína (1,0 mg/kg), e os do grupo III com bupivacaína (1,0 mg/kg). Os agentes foram administrados pela via epidural, no espaço lombo-sacral, e diluídos em solução salina para um volume total de 0,36 ml/kg. A freqüência cardíaca, freqüência respiratória, e pressões arterial sistólica, média e diastólica foram mensuradas bem como pH e gases sangüíneos. Para avaliação de parâmetros sistêmicos relacionados á qualidade da analgesia no trans e pós-operatório foram analisados grau de analgesia e sedação e catecolaminas. A avaliação da extensão do bloqueio foi realizada através do teste do panículo. Para avaliação da latência e duração de ação motora e sensitiva dos fármacos foi realizado o pinçamento do espaço interdigital de membros pélvicos e da região perianal. O período total de avaliação foi de 6 horas após a realização da anestesia epidural. Não foram verificadas diferenças significativas quanto a alterações no sistema cardiovascular e respiratório, nem quanto a alterações na avaliação da sedação. Pode-se observar que o grupo tratado com bupivacaína e sufentanil obteve menores escores de dor no período pós-operatório, mas os demais grupos obtiveram valores satisfatórios em relação a este parâmetro. Pelos resultados obtidos, pode-se concluir que todos os protocolos permitiram a realização do procedimento cirúrgico, e produziram analgesia adequada, nos animais estudados, com modulação da resposta neuroendócrina à dor e mínimos efeitos adversos.Potent opioids such as fentanyl and sufentanil, althought largely used in dogs, are rarely employed at the epidural space on this species. The aim of the present study was to compare the cardiovascular and systemics effects, as well as the analgesic action on the post operative period of epidural anaesthesia performed with bupivacaine alone or associated with fentanyl and sufentanil, in bitches sedated with continuous infusion of propofol. Thirty female dogs, submitted to ovariosalpingohisterectomy, allocated in three groups of ten animals each were used. All the animals received acepromazine (0,1 mg/kg), and continuous infusion of propofol for sedation. The animals of group I received fentanyl (2µg/kg) and bupivacaine (1 mg/kg), animals of group II received sufentanil (1µg/kg) and bupivacaine (1 mg/kg) and those of group III received bupivacaine (1mg/kg). The agentes were administered at the lumbosacral space, and diluted in saline soluction to a total volume of 0,36 ml/kg. Cardiac and respiratory rate, arterial blood pressure were evaluated, as well as pH and blood gases. Analgesia and sedation levels, and plasmatic cathecolamines were measured for the evaluation of systemic parameters. The evaluation of blook extension was performed by the panniculus test. Pinprick performed at the interdigital space and at perineum region were utilized to evaluate onset time of sensitive and motor blockage. All parameters were evaluated during a total time of 6 hours. No significant changes related to the cardiovascular, respiratory and sedation parameters were observed during the study. The degree of analgesia observed at the post operative period were higher in the sufentanil group. However both fentanyl and bupivacaine groups also obtained a sufficient level of analgesia. Based on the results obtained, the authors concluded that the surgical procedure could be performed by means of the three anesthetic techniques employed producing sufficient analgesia and an acceptable neuroendocrine modulation of pain with minimal adverse effects.
43
Oliveira, Guillermo Carlos Veiga de. „Avaliação da eficácia e dos efeitos respiratórios da anestesia peridural torácica em cães /“. Botucatu : [s.n.], 2009. http://hdl.handle.net/11449/86636.
Annotation:
Orientador: Valéria Nobre Leal de Souza OlivaBanca: Denise Tabachi Fantoni
Banca: Stélio Pacca Loureiro Luna
Resumo: Foi realizado estudo experimental em cães para avaliar a eficácia da anestesia peridural torácica e seus efeitos na respiração, comparando-se dois volumes, 0,25 e 0,33 ml/kg do anestésico local ropivacaína a 0,75%. Para isso foram utilizados oito animais, sem raça definida, com idade entre um e três anos, com peso médio de 24,7 ± 6,3 Kg, em boas condições de saúde. Para isso foi necessária anestesia prévia dos animais a fim de se determinar a concentração anestésica mínima na qual o animal apresentasse resposta positiva a um estímulo elétrico. Sendo assim a indução foi realizada com isofluorano na concentração inicial de 5% no vaporizador calibrado, através de máscara facial e a intubação foi efetuada. O estímulo elétrico foi realizado com corrente de 50 V em 50 ciclos/s de 10 milisegundos. Se a resposta fosse negativa, a concentração era reduzida em 0,2%, sendo o procedimento repetido até que o animal apresentasse resposta positiva para a determinação do estímulo supra máximo positivo. Um cateter peridural foi introduzido do espaço lombossacro até a região torácica das vértebras T1-T2. Foi administrada ropivacaína e as avaliações foram realizadas por dois avaliadores que não tinham conhecimento do tratamento utilizado. Os parâmetros aferidos foram freqüência cardíaca, respiratória, pressões arteriais, ritmo cardíaco, concentração expirada de CO2, volume minuto, volume corrente, hemogasometria e temperatura esofágica. A avaliação do bloqueio sensitivo foi realizada através da avaliação do estímulo elétrico e de pinçamento da pele para avaliação do panículo nervoso. Houve redução da freqüência cardíaca e de pressão arterial, o que revela um bloqueio simpático com os dois grupos. Houve depressão respiratória, pois os dois grupos apresentaram elevação do CO2, e foram colocados sob ventilação controlada... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Experimental study was conducted in dogs to assess the effectiveness of the thoracic epidural anesthesia and their effects on respiration, compared two volumes, 0.25 and 0.33 ml / kg of local anesthetic ropivacaine at 0.75%. For that eight animals were used, mixed breed, aged between one and three years, with average weight of 24.7 ± 6.3 kg, in good health. For this was required anesthesia of the animals prior to find the minimum anesthesia concentration that the animal had a positive response to electrical stimulation. Thus the induction was performed with isoflurane in the initial concentration of 5% in precision vaporizer by face mask and intubation was performed. The electrical stimulation was performed with current of 50 V at 50 cycles / s, 10 milliseconds. If the purposeful gross movement was negative, the concentration was reduced by 0.2%, and the procedure repeated until the animal had a positive response for determining the maximum positive stimulus above. An epidural catheter was introduced into the space lombossacro to the region of thoracic vertebrae T1-T2. Ropivacaine was administered and the evaluations were conducted by two evaluators who were not aware of treatment used. The parameters were measured heart rate, breathing, blood pressure, heart rate, expired concentration of CO2, minute volume, tidal volume, blood gas and esophageal temperature. The assessment of sensory block was done through evaluation of electrical stimulation and clamping the skin to assess the panículous nervous. Decreased heart rate and blood pressure, which shows a sympathetic block with the two groups. There was respiratory depression, since both groups had elevation of CO2, and were placed under controlled ventilation, which prevented the evaluation of spontaneous ventilation. The pinch of the skin test showed a blockage in extensive loss of nerve panículous in two groups, with no statistical... (Complete abstract click electronic access below)
Mestre
44
Kelly, Mary Clare. „Maternal and fetal effects of intrathecal analgesia in obstetrics“. Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.361287.
45
Almeida, José Laurindo Sasso de. „Anestesia peridural para cesariana com fentanil associado a bupivacaina“. [s.n.], 1991. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308804.
Annotation:
Orientadores : Denise Yvonne Janovitz Norato, Alvaro Guilherme Bizerril EugenioDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-07-14T01:40:23Z (GMT). No. of bitstreams: 1 Almeida_JoseLaurindoSassode_M.pdf: 1307391 bytes, checksum: a7e26807a45e37d23bb793dd959f83a9 (MD5) Previous issue date: 1991
Resumo: A anestesia peridural para cesárea, utilizando-se a bupivacaina, pode permitir a ocorrência de desconforto transoperatório em algumas pacientes mesmo naquelas pacientes em que o nível de anestesia é considerado ideal. A tentativa de resolver este problema esbarra na falta de previsibilidade da anestesia peridural, na toxicidade da bupivacaina e na maior suscetibilidade das membranas nervosas e musculares das gestantes a esses efeitos, limitando a dose dos anestésicos locais. A associação de pequenas doses de opióides como tentativa de resolver o desconforto transoperatório, sem aumentar os riscos e efeitos colaterais maternos e fetais, com a vantagem adicional da possibilidade de aumentar o período de analgesia efetiva é uma alternativa possível. Para avaliar a qualidade da anestesia produzida pela associação de bupivacaina e fentanil em cesárea, a progressão da anestesia feita em dose única a influência de fatores antropométricos no resultado da anestesia, a necessidade de complementação com drogas analgésicas endovenosas no transoperat6rio, o tempo de analgesia efetiva e os efeitos adversos maternos, foram estudadas 104 gestantes a termo, submetidas a cesárea eletiva divididas em três grupos, sendo o primeiro composto de 52 pacientes anestesiadas com bupivacaina a 0,51. com epinefrina 1:200.000 dose de 100 miligramas e volume total de 20 m 1 ; o segundo com 26 pacientes onde foi adicionado 100 microgramas de fentanil, volume de 2 ml, totalizando um volume de 22m 1 ; e o terceiro grupo, com 26 pacientes onde foi adicionado água destilada 2 ml com volume total de 22ml, para controle de volume. Dos resultados deste trabalho conclui-se que a associação do fentanil nas doses e volumes utilizados neste trabalho melhora o nível da anestesia peridural quando comparada com a utilização de bupivacaina isolada, e que essa melhora ocorre a partir de 20 minutos e anestesia, que o nível de bloqueio peridural não tem correlação com as variáveis antropométricas, que há melhora do conforto materno no período trans-operatório, que o tempo de analgesia efetiva é prolongado e que não aumenta a freqüência de efeitos adversos maternos
Abstract: The epidural anaesthesia to cesaria, utilizing bupivacaine, can lead to a transoperative disconfort in some patients, even in those patients in which the anaesthesia leveI is considered ideal. The attempt to solve this problem runs up against the lack of epidural anaesthesia previsibility~ bupivacaine toxicity and muscular membrane susceptibility of the pregnant women limiting the local anaesthetics dose. A possible alternative is the asssociation of opioids small doses as an attempt to solve the transoperative discomfort without increasing the fetal and maternal risks and collateral effects,with the extra advantage of the possibility of increasing the effective analgesia period. In order to evaluate the anaesthesia produced by the fentanyl and bupivacaine association in caesarean, he anaesthesia progression in single dose, the influence of antropometrics factors in anaesthesiia results the necessity of complement with intravenous analgesic drugs in the transoper-ative~ the effective analgesia per-iod and the maternal collateral effects, 104 patients were studied and undergone an elective caesarean. They werre divided in three groups, the first consisting of 52 patients anaesthetized with 0,5% bupivacaine, with 1:200.000 epinephrine, a dose of 100 ml. and a total volume of 20 ml; the second with 26 patients, where it was added 100 micrograms of fentanyl, volume of 2ml. totalizing a volume of 22 ml and a third one with 26 patients, where it was added distilled water 2 ml . with a total volume of 22ml. just for volume control. According to this work it can be concluded that the fentanyl association, on dose and volume here in utilized improves the anaesthesia level after- 20 minutos from it; that the final epidural level has no relatiohship with the antropometrics variants; that there is an improvement on the matérnal comfort during the tr-ansoperative period; that the effective anaesthesia period is increased and that there is no increase of maternal adverse effects
Mestrado
Mestre em Medicina
46
Ishiy, Helcya Mime. „Uso da lidocaína isolada ou associada à quetamina ou ao butorfanol, em anestesia epidural em cães : avaliação cardiorrespiratória e analgésica /“. Botucatu : [s.n.], 2001. http://hdl.handle.net/11449/86637.
Annotation:
Orientador: Stelio Pacca Loureiro LunaResumo: A anestesia epidural empregando-se anestésicos locais normalmente produz anestesia apenas da região retro umbilical. O trabalho investiga e compara o uso da lidocaína isolada ou associada ao butorfanol ou à quetamina, em anestesia epidural lombo-sacra de cães, no seu aspecto cardiorrespiratório e analgésico. Todos os animais foram tranquilizados com 0,1 mg/kg de acepromazina IV. Na primeira fase, seis cães adultos, foram anestesiados, em três ocasiões distintas, em ordem aleatória, com: 5 mg/kg lidocaína 2% com vasoconstritor (GAL); 1 mg/kg de quetamina (GAQ) e 0,1 mg/kg de butorfanol (GAB), nestes dois últimos complementando-se o volume de 1 ml/4 kg com lidocaína 2% com vasoconstritor. Foram avaliados: freqüência cardíaca, pressão arterial sistólica, freqüência respiratória, concentração expirada de CO2, volume minuto e corrente e temperatura retal. Ainda observou-se período de latência, duração do bloqueio, região bloqueada, duração da cirurgia e grau de miorrelaxamento. Na segunda fase, dezoito cadelas foram divididas em três grupos de mesmo número, anestesiadas com os mesmos protocolos anestésicos da primeira fase (GCL, GCQ, GCB) e submetidas à ovariosalpingohisterectomia. Para análise estatística dos dados paramétricos foram utilizadas a análise de variância, seguida do teste de Student-Newman-Keuls, para comparação entre momentos. Para comparação entre grupos, foi utilizado o teste T. Para as variáveis não paramétricas... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The aim of this study was to compare the cardiorespiratory effects and duration of lumbosacral epidural anaesthesia produced by lidocaine alone or combined with ketamine or butorphanol in dogs submitted or not to ovariohysterectomy. In the first stage, six mixed breed adult dogs (mean weight 14,0 ± 3,1 kg) were used in three different occasions: lidocaine 2% with adrenaline - 5 mg/kg (GAL), ketamine - 1 mg/kg (GAQ) or butorphanol - 0,1 mg/kg (GAB). In groups GAQ and GAB, the total volume of 1 ml/4 kg was completed with lidocaine. Heart heat, sistolic arterial blood pressure, respiratory rate, expired CO2, tidal and minute volume and rectal temperature were measured 15 minutes after pre-medication and every 30 minutes after epidural anesthesia until 120 minutes. The time to loss the interdigital reflex, duration and region of block were observed. In the second stage, eighteen mixed breed female dogs (mean weight 13,4 ± 3,5 kg) were divided in three groups(GCQ, GCB and GCL), anaesthetised as before and submitted to ovariohysterectomy. All animals were sedated with acepromazine 0,1 mg/kg IV. Data were analysed using ANOVA, followed by Student-Newman-Keuls test or Kruskal-Wallis and Friedman tests as appropriate. The rectal temperature reduced in all groups. Muscle relaxation was better in the GCQ and GCB groups than the in GCL group. Anaesthesia was not sufficient for ovariohysterectomy in animals treated with lidocaine and general anaesthesia... (Complete abstract click electronic access below)
Mestre
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Gallivan, Sean Thomas. „Safety of Epidurally Administered Ketorolac in Dogs“. Thesis, Virginia Tech, 1999. http://hdl.handle.net/10919/33874.
Annotation:
The objective of this study was to evaluate the clinical, cerebrospinal fluid (CSF), and histopathologic effects of an epidurally administered NSAID (ketorolac) in dogs. This was performed as a blinded, placebo controlled study using twenty-two adult mixed breed dogs with 16 treatment and 6 control dogs. Dogs were anesthetized and epidural catheters were placed at the lumbosacral space. Catheter placement was evaluated fluoroscopically. Ketorolac (0.4 mg/kg) or placebo (5% ethanol) was administered epidurally over a 52 hour period, with 5 injections given at 12 hour intervals. At 1, 2, 4, or 8 hours after the first and last injection of ketorolac, dogs were anesthetized and CSF was obtained. Control dogs had CSF sampled 1 hour after the first and last ethanol injection. Neurologic function and pain response was evaluated before and during the study. Selected dogs were then euthanized and necropsies performed.
None of the dogs exhibited any clinical or neurological abnormalities during the study. No statistical difference was noted in pain response or CSF analysis between treatment and control dogs. Gross necropsy revealed gastrointestinal ulceration of varying degrees in all treatment dogs. Histopathologic analysis of the spinal cord and meninges revealed minimal focal leptomeningeal phlebitis in 2 of 8 treatment dogs and minor subdural inflammation in one control dog. No changes to the neural structures were noted in any dogs.
Epidural administration of ketorolac did not cause clinical signs, alteration in CSF values, or pathologic changes to the spinal cord when used for short duration. Gastrointestinal ulceration was common when ketorolac was administered epidurally at 0.4 mg/kg every 12 hours for 5 treatments.
This study documented the safety of epidurally administered ketorolac in dogs before an efficacy trial can be performed. Gastrointestinal ulceration may limit use to short duration or single injection.Master of Science
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Castillo, Daniela Lima Chow. „Análise comparativa do perfil de segurança e eficácia analgésica da S(+) cetamina com ou sem morfina na anestesia peridural para histerectomia abdominal“. reponame:Repositório Institucional da UFC, 2009. http://www.repositorio.ufc.br/handle/riufc/2275.
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CASTILLO, Daniela Lima Chow. Análise comparativa do perfil de segurança e eficácia analgésica da S(+) cetamina com ou sem morfina na anestesia peridural para histerectomia abdominal. 2009. 82 f. Dissertação (Mestrado em Farmacologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza-Ce, 2009.Submitted by denise santos (denise.santos@ufc.br) on 2012-03-09T16:13:03Z No. of bitstreams: 1 2009_dis_dlccastillo.pdf: 661639 bytes, checksum: 91cdeb76ba8d9db2cf06167d2117d981 (MD5)
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Made available in DSpace on 2012-03-12T12:13:46Z (GMT). No. of bitstreams: 1 2009_dis_dlccastillo.pdf: 661639 bytes, checksum: 91cdeb76ba8d9db2cf06167d2117d981 (MD5) Previous issue date: 2009
The association of drugs with different mechanisms of action in the dorsal horn of the spinal cord decreases postoperative pain, with a reduction in the incidence of side effects. The aim of this study was to evaluate some intraoperative parameters as well as postoperative analgesia and sedation by epidural morphine, S(+)ketamine and S(+) ketamine- morphine associated with Bupivacaine Enantiomeric Mixture (R75L25%) for abdominal hysterectomy. In this prospective, randomized, and double-blinded clinical trial, the efficacy and safety of the administration of epidural S(+)ketamine alone or with morphine were compared with epidural morphine alone (control group) for efficacy and safety comparisons after abdominal hysterectomy. 36 female patients, physical status ASA I and II, participated in this study. These patients were randomly allocated to one of the three treatment groups for having the following drugs administered epidurally: 1. Ketamine Group - Bupivacaine Enantiomeric Mixture (R75L25%) associated with S(+) ketamine (0.4 mg.kg-1); 2. Ketamine-Morphine Group - Bupivacaine Enantiomeric Mixture (R75L25%) associated S(+) ketamine (0.4 mg.kg-1) and morphine (1 mg) 3. Morphine Group, Bupivacaine Enantiomeric Mixture (R75L25%) was associated with morphine (2mg). During the intraoperative period the parameters analyzed were: blood pressure, heart rate, motor blockade level, sensitive level, intraoperative use of vasoconstrictor and sedation level. The time interval between each dada collection was 15 minutes. In the postoperative period, analgesia were evaluated using analogue visual scale 2h, 6h and 24h after the end of the surgery as well as the total amount of analgesics drugs requirement during the first 24 postoperative hours. Values were analyzed statistically using GraphPad Prisma 4.0 and Excel 2007. There were no differences between the three groups with respect to age, sex, weight, or duration of the surgical procedures (p<0,05). No differences were found between the groups during intraoperative analysis related to blood pressure, heart rate, Ramsay scores, vasoconstrictor use, and sensitive blockade level. Bromage’s scores were lower in the morpine/s+ketamine group during the first fifteen minutes analysis. Sedation scores were similar in both groups. The epidural blockade alone was not enough for surgical anesthesia resulting in conversion to general anesthesia in 4 patients who belong to Ketamine-morphine (02 patients) and Morphine (02 patients) groups, respectively. None of the patients in either group developed respiratory depression. Other side effects, such as pruritus, nausea, and vomiting, were also similar in both groups. The addiction of s(+) ketamine was safety and efficient to Bupivacaine Enantiomeric Mixture (R75L25%) in comparison with morphine.
A s(+)cetamina é o isômero levógiro da cetamina, antagonista do receptor NMDA para glutamato que está envolvido na gênese e manutenção do processo doloroso. A analgesia multimodal consiste na utilização de combinação de fármacos objetivando controle adequado da dor com redução dos efeitos adversos. O objetivo deste estudo foi avaliar a eficiência da s(+)cetamina isoladamente e da associação morfina/cetamina comparadas à morfina isoladamente combinadas a mistura enantiomérica de bupivacaína (R75l25%) na anestesia peridural e analgesia pós-operatória em pacientes submetidas à histerectomia abdominal. Foi realizado estudo prospectivo, duplo cego e aleatório, com aprovação do Comitê de Ética e Pesquisa da Universidade Federal do Ceará. Participaram do estudo 36 pacientes ASA I ou II com idade de 20 a 60 anos submetidas à histerectomia abdominal com anestesia peridural. As pacientes foram alocadas em três grupos: Grupo 1 - Grupo Cetamina (GC): administração de mistura enantiométrica (R75-S25) de bupivacaína associada à s(+)cetamina; Grupo 2 – Grupo Morfina (GM): administração de mistura enantiométrica (R75-S25) de bupivacaína associada à morfina e Grupo 3 - Grupo Cetamina/Morfina(GCM): administração de mistura enantiométrica (R75-S25) de bupivacaína associada à morfina e s(+)cetamina. Foram avaliados nível de bloqueio motor e sensitivo, grau de sedação e parâmetros hemodinâmicos: pressão arterial e frequência cardíaca a cada 15 minutos durante a cirurgia. No período pós-operatório foi avaliado o consumo de analgésicos em 6 e 24 horas, além da incidência de náuseas, vômitos e prurido. A análise estatística foi realizada utilizando os softwares graphpad prisma 4.0 e Excel 2007. Não houve diferença entre a idade, tempo cirúrgico e o estado físico (ASA) entre os grupos (p<0,05). A frequência cardíaca e pressão arterial mantiveram-se dentro dos valores estabelecidos como normal sem variação significativa entre os grupos. A avaliação da incidência de efeitos adversos (náuseas, vômitos e prurido) não foi diferente entre os grupos. A analgesia pós-operatória avaliada por consumo de analgésicos nas primeiras 6 horas não foi diferente entre os grupos. Houve maior grau de bloqueio motor no grupo Cetamorf no tempo T15. Houve conversão para anestesia geral em 4 pacientes por falha de bloqueio, nos grupos cetamina-morfina (02 pacientes) e morfina (02 pacientes). Os dados sugerem que a adição de s(+)cetamina e morfina nas doses avaliadas é segura, eficaz e permite a redução de 50% na dose da morfina epidural mantendo-se o perfil de controle de dor no pós operatório. No entanto, não se verificou redução da incidência de náuseas, vômitos e prurido.
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Duncan, Fiona. „Prospective observational study of postoperative epidural analgesia for major abdominal surgery“. Thesis, University of Salford, 2009. http://usir.salford.ac.uk/26643/.
Annotation:
The number of surgical procedures is increasing worldwide. The Audit Commission set a target that only 5% of patients should experience severe post-operative pain. Major abdominal surgery is a cause of severe post-operative pain. Epidural analgesia is regarded as the "gold standard" for treating this category of post-operative pain. A randomised controlled trial conducted by the author suggested that it was possible to have 95% of patients pain controlled, but with a high incidence of hypotension. Hypotension can restrict rather than enhance a patient's recovery after surgery. Building on this work, this thesis will explore whether it is possible to provide good analgesia without serious side effects in the workplace. Methods This study reports the results of a prospective observational study (n = 480) designed to both describe the technique and examine the association of various factors with pain scores and the incidence of hypotension. Classical statistics and statistical process control methods, a unique feature of the study, were employed to analyse and learn from the data. Results Twenty-eight percent of patients reported severe pain. Lower pain scores were associated with female gender and elective surgery. An association exists between increasing age and decreasing pain scores on the first day. The incidence of hypotension was 56%. Low pain scores strongly correlated with hypotension. Many failures occurred due to technical problems. Recommendations It is important for nursing professionals to know the true risk/benefit profile of postoperative epidural analgesia as it is ward nursing staff who are primarily responsible for monitoring the effectiveness of the technique, the patients' safety, and intervening to improve poor quality pain control. The results of this study suggest that epidural analgesia is far from the gold standard for postoperative analgesia. An urgent debate needs to take place to establish its true place in the management of postoperative pain.
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Grewal, Rajdeep S. „Efficacy of epidural steroid injections in treatment of lumbar spinal stenosis“. Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33404.
Annotation:
Epidural steroid injections (ESI) are used as a conservative therapy for treating lumbar spinal stenosis (LSS), yet there is no concrete justification for them. Data from a randomized control trial evaluating the effectiveness of ESI in LSS patients was analyzed. Main outcomes were measured by French-translated LSS symptom severity, physical function, and satisfaction scales over 3 months. The first stage of the analyses evaluated psychometric properties of the scales and showed high internal consistency and test-retest reliability. The main analyses addressed ESI efficacy. Repeated measures analysis of variance over the first 3 months showed a marginally statistically significant improvement in symptom severity, physical function, and satisfaction in the ESI group, compared to placebo. Treatment effectiveness tended to decrease over time. Differences between groups were not significant at 6 and 12 months. All scales had a significant interaction between treatment and high blood pressure (HBP): subjects without HBP responded substantially better.