Dissertations / Theses: 'Anesthesia and Analgesia'

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Björnsson, Marcus. "Pharmacometric Models in Anesthesia and Analgesia." Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-205580.

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Modeling is a valuable tool in drug development, to support decision making, improving study design, and aid in regulatory approval and labeling. This thesis describes the development of pharmacometric models for drugs used in anesthesia and analgesia. Models describing the effects on anesthetic depth, measured by the bispectral index (BIS), for a commonly used anesthetic, propofol, and for a novel anesthetic, AZD3043, were developed. The propofol model consisted of two effect-site compartments, and could describe the effects of propofol when the rate of infusion is changed during treatment. AZD3043 had a high clearance and a low volume of distribution, leading to a short half-life. The distribution to the effect site was fast, and together with the short plasma half-life leading to a fast onset and offset of effects. It was also shown that BIS after AZD3043 treatment is related to the probability of unconsciousness similar to propofol. In analgesia studies dropout due to lack of efficacy is common. This dropout is not at random and needs to be taken into consideration in order to avoid bias. A model was developed describing the PK, pain intensity and dropout hazard for placebo, naproxen and a novel analgesic compound, naproxcinod, after removal of a wisdom tooth. The model provides an opportunity to describe the effects of other doses or formulations. Visual predictive checks created by simultaneous simulations of PI and dropout provided a good way of assessing the goodness of fit when there is informative dropout. The performance of non-linear mixed effects models in the presence of informative dropout, with and without including models that describe such informative dropout was investigated by simulations and re-estimations. When a dropout model was not included there was in general more bias. The bias increased with decreasing number of observations per subject, increasing placebo effect and increasing dropout rate. Bias was relatively unaffected by the number of subjects in the study. The bias had, in general, little effect on simulations of the underlying efficacy score, but a dropout model would still be needed in order to make realistic simulations.

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McCarthy, Jennifer F. M. "Multimodal Analgesia in Children Following Dental Rehabilitation under General Anesthesia." The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1242252421.

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Evangelista, Marina Cayetano. "Bloqueio dos nervos ciático e femoral em gatos: avaliação da dispersão da bupivacaína sob ressonância nuclear magnética e avaliação dos efeitos antinociceptivos." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-19092016-155909/.

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Os bloqueios perineurais são práticos, efetivos e amplamente utilizados para o manejo da dor perioperatória, porém os estudos em gatos são escassos. O objetivo do estudo era avaliar a dispersão da bupivacaína por meio do emprego da ressonância magnética (RM) em relação aos nervos ciático (NC) e femoral (NF) e avaliar a exequibilidade, eficácia e duração dos bloqueios dos mesmos, realizados com a bupivacaína isolada ou em associação com dexmedetomidina ou buprenorfina. Na primeira fase do estudo seis gatos adultos foram submetidos ao exame de RM sob anestesia geral com isoflurano. Foram obtidas imagens dos membros pélvicos nos planos sagital e transverso. Os bloqueios NC e NF guiados por um estimulador de nervos foram realizados com bupivacaína 0,5 % (0,1 mL/kg por ponto). As sequências da RM foram repetidas após cada bloqueio e as imagens analisadas de acordo com a distribuição (1; em contato com nervo ou 0; sem contato com o nervo alvo), localização da bupivacaína e presença ou ausência de hematoma e lesões nervosas. Na segunda fase do estudo, seis gatos adultos foram sedados com dexmedetomidina (25 µg/kg) e receberam os bloqueios NC e NF com 0,1 mL/kg de um dos tratamentos: salina 0,9% (CONTROLE), bupivacaína (0,46%; BUPI), bupivacaína e dexmedetomidina (1 µg/kg; BUPI-DEX) ou bupivacaína e buprenorfina (2,5 µg/kg; BUPI-BUPRE). A sedação foi revertida com atipamezole (250 µg/kg). Os escores de sedação, limiar de retirada do membro, capacidade de deambulação e resposta ao pinçamento digital foram avaliados até 24 horas após os bloqueios. De acordo com as imagens da RM, cinco de seis injeções do NC tiveram escore 1. O comprimento do NC em contato com a bupivacaína foi 25 ± 11 mm. Todas as injeções do NF tiveram escore 1. Em uma das injeções, a bupivacaína foi depositada distal à bifurcação do NF e do nervo safeno, apenas sobre o ramo motor do NF. Não foram observadas lesões nervosas e hemorragias. A técnica promoveu uma dispersão adequada e o volume foi considerado suficiente. Variações quanto à localização e distribuição do injetado poderiam explicar diferenças no bloqueio motor e sensitivo no contexto clínico. Todos os animais tratados com anestésico local demonstraram diminuição na função motora e alterações na antinocicepção. A capacidade de deambulação foi reduzida no tratamento BUPI de 30 min a 2 horas, no BUPI-DEX entre 1 e 2 horas e no BUPIBUPRE às 2h (p < 0,05). O bloqueio motor foi observado entre 1 e 3 horas. A analgesia, determinada pelo limiar de retirada do membro no tratamento BUPI foi maior de 1 a 6 horas em relação ao CONTROLE (p < 0,05) e atingiu valores acima de 2,4 N de 1 a 4 horas nos tratamentos BUPI-DEX e BUPI-BUPRE e de 1 a 8 horas nos animais que receberam o tratamento BUPI. As doses de buprenorfina e dexmedetomidina utilizadas como adjuvantes não aumentaram a magnitude e duração dos bloqueios dos NC e NF em gatos
Peripheral nerve blocks are practic, effective and widely used for the perioperative pain management, however studies in cats are scarce. The aim of this study was to evaluate the distribution of bupivacaine after sciatic (ScN) and femoral nerve (FN) blocks in cats using magnetic resonance imaging (MRI) and to determine the feasibility, effectiveness and duration of antinociception after ScN and FN blocks using bupivacaine alone, or in combination with either dexmedetomidine or buprenorphine. In the first phase of the study, six adult cats were anesthetized with isoflurane and underwent MRI. Transverse and sagittal plan sequences of pelvic limbs were obtained. The ScN and FN blocks were performed using an electric nerve stimulator-guided technique and bupivacaine 0.5% (0.1 mL/kg per site). The MRI sequences were repeated after each block and the images were analyzed according to the distribution (1; in contact with the nerve or 0; not in contact with the target nerve), bupivacaine location and presence or absence of hematomas and nerve injuries. In the second phase of the study, six adult cats were sedated with dexmedetomidine (25 µg/kg) and received the ScN and FN blocks with 0.1 mL/kg of one of the treatments: saline 0.9% (CONTROL), bupivacaine (0.46%; BUPI), bupivacaine and dexmedetomidine (1 µg/kg; BUPI-DEX) or bupivacaine and buprenorphine (2.5 µg/kg; BUPI-BUPRE). Atipamezole (250 µg/kg) was administered for reversal of sedation. Sedation scores, paw withdrawal thresholds, ability to walk and response to toe pinch were evaluated up to 24 hours after the blocks. According to MRI, five out of six ScN injections had distribution score of 1. Mean ± SD length of the ScN in contact with bupivacaine was 25 ± 11 mm. All FN injections had distribution score of 1. In one injection (FN), bupivacaine was administered distal to the bifurcation between the femoral and saphenous nerve and over the motor branch of FN. Nerve injury or acute hemorrhage were not observed. Nerve stimulator-guided ScN and FN injections produced a reliable bupivacaine spread over the target nerves and the volume was considered sufficient. Individual variability in regards to the injectate location may explain differences in sensory and motor blockade in the clinical setting. All local anesthetic-treated animals had motor function impairment and changes in antinociception. Walking ability was impaired in BUPI from 30 min to 2 hours, in BUPI-DEX between 1 and 2 hours and in BUPI-BUPRE at 2h (p < 0.05). Motor blockade was observed between 1 and 3 hours. Analgesia, determined by paw withdraw threshold, was higher from 1 to 6 hours in BUPI compared to CONTROL (p < 0.05) and reached values greater than 2.4 N from 1 to 4 hours in BUPI-DEX and BUPI-BUPRE and from 1 to 8 hours in BUPI. The chosen doses of buprenorphine and dexmedetomidine as adjuvant drugs did not enhance the magnitude and duration of the ScN and NF blocks in cats

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Ramstad, Marsha. "The Relationship between Epidural Analgesia during Childbirth and Childbirth Outcomes." Thesis, North Dakota State University, 2004. https://hdl.handle.net/10365/28727.

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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.

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Miller, Gary L. "The Incidence of Postoperative Retching and Vomiting in the Adult Patient Undergoing Abdominal Surgery Following Intraoperative Administration of Droperidol." VCU Scholars Compass, 1985. https://scholarscompass.vcu.edu/etd/5234.

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The complication of postoperative nausea and vomiting is still one of the most common today. The potential for secondary complications associated with retching and vomiting such as aspiration pneumonitis strain of suture line with possible hemorrhage, and potential fluid and electrolyte imbalance makes prevention of retching and vomiting a primary concern in the management of the postoperative patient. The use of antiemetic drugs to prevent or control postoperative nausea and vomiting is a long-standing practice. Droperidol, an antiemetic, routinely used since being introduced in 1963, has been found to be successful in treating postoperative nausea and vomiting. This study examines the effect of droperidol .018 mg/kg given intramuscularly one half hour prior to the end of anesthesia on postoperative emesis in the adult gynecological patient presenting for total abdominal hysterectomy. Twelve patients were in this double-blind study, six acted as controls and six were in the experimental group. All subjects were premedicated with morphine sulfate 0.1 mg/kg and glycopyrrolate 0.2 mg, intramuscularly administered. All were induced with pentathol 4 mg/kg preceded by curare 3 mg and followed by succinylcholine 1.5 mg/kg for intubation. The subjects were maintained on isoflurane, sixty percent nitrous in oxygen, and pancuronium for relaxation. The subjects were of similar age and weight. Duration of anesthesia was similar with a mean of 2.93 hours overall. The incidence of retching or vomiting was considered as the same result. The droperidol group had one subject retch only and another retch and vomit. This gave a 33 percent incidence of retching and vomiting. The control group had three subjects retch and vomit, giving a 50 percent incidence. The small sample size provided no statistical significance. The results showed a trend of decreased vomiting in the adult subject presenting for total abdominal hysterectomy. The routine use of droperidol in this particular population cannot be recommended from these results.

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Araujo, Daniele Ribeiro de. "Desenvolvimento e avaliação farmacologica de formulações de liberação controlada com anestesicos locais amino-amidas ciclicos : bupivacaina, mepivacaina e ropivacaina." [s.n.], 2005. http://repositorio.unicamp.br/jspui/handle/REPOSIP/314147.

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Orientadores: Eneida de Paula, Angelica de Fatima de Assunção Braga
Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: Dentre os fármacos usados para aliviar ou eliminar a dor, encontram-se os anestésicos locais (AL). Esses compostos, capazes de bloquear a excitação-condução em nervos periféricos, têm duração de ação relativamente curta e toxicidade para os sistemas nervoso central e cardiovascular. Com a finalidade de prolongar a duração de ação e reduzir a toxicidade sistêmica dos AL, pesquisas com diferentes tipos de sistemas carreadores têm sido desenvolvidas. Essas novas formulações, denominadas de liberação lenta, possibilitam a liberação controlada e evitam picos plasmáticos dos AL, prolongando a analgesia e reduzindo sua toxicidade. Neste trabalho objetivamos preparar, caracterizar (quanto a encapsulação ou complexação, estabilidade e liberação da droga) e avaliar in vitro (toxicidade celular) e in vivo, a atividade farmacológica (latência, intensidade, duração de ação e toxicidade local) de novas formulações anestésicas de liberação controlada, comparando-as com os fármacos disponíveis no mercado. Os AL de escolha foram as amino-amidas cíclicas: Bupivacaína (BVC), Mepivacaína (MVC) e Ropivacaína (RVC), bastante utilizadas em clínica médica e odontológica. Os sistemas carreadores de drogas adotados foram lipossomas unilamelares grandes (LUV de 400nm, compostos de fosfatidilcolina e colesterol) e as ciclodextrinas: ß-CD ou hidroxipropil ß-CD (HPß-CD). Ensaios de estabilidade física, por fluorescência, revelaram que os lipossomas mantêm o conteúdo encapsulado e que a presença do AL não interfere na permeabilidade dos mesmos, analisada em função do tempo e temperatura. O coeficiente de partição foi calculado e indicou o perfil esperado pelas substituições, i.e., MVCAbstract: Local anesthetics (LA) are among the different classes of pharmacological compounds used to attenuate or to eliminate pain. These drugs, which are able to reversibly block the excitation/transmission of the nerve impulse in axons have a relatively short action and a significant toxicity to the Central Nervous and Cardiovascular systems. In order to prolong the time of action and to reduce the systemic toxicity of LA, many investigations have been carried out with LA in drug-delivery systems. These novel formulations, called long-acting local anesthetics, allow the controlled release - avoiding high plasmatic concentrations to be reached ¿ in such a way that they prolong analgesia as well as they reduce LA¿s intrinsic toxicity. Our aim was to prepare, to characterize (the encapsulation, stability and drug-release) and to evaluate - both in vitro (cellular toxicity) and in vivo (latency, intensity and duration of anesthesia as well as local toxicity) the pharmacological activity of new drug-delivery systems for LA, in comparison to the commercially available anesthetics. We have chosen the cyclic amino-amide anesthetics Bupivacaine (BVC), Mepivacaine (MVC) and Ropivacaine (RVC), since they are largely used in medicine and dentistry. The drug-carrier systems used were large unilamellar liposomes (400 nm LUV, composed by phosphathidylcholine and cholesterol) and cyclodextrins: ß-CD and hydroxypropyl (HPß-CD). Stability tests showed that liposomes were able to keep their content and that LA incorporation did not change their permeability at different times and temperatures. Partition coefficients were measured and indicated the profile expected from the substitution degree, i.e. MVC < RVC < BVC (P values = 93, 132 and 136, respectively). Chemical stability was evaluated through oxidative tests and no changes in the lipid oxidation levels were observed up to 4 months after preparation and storage at 4ºC, with and without LA. Nevertheless, light-scattering measurements revealed an increase in the vesicles size after 30 days, restraining the use of the liposome formulations for a longer time. LA complexation with CDs was evidenced by Differential Scanning Calorimetry, which runs detected changes in the fusion temperature of the pure LA, as well as loss of the characteristic endothermic peak of dehydration of the cyclodextrin¿s (ß-CD and HPß-CD) cavity following complexation with BVC and RVC. Electron microscopy images revealed that LA:CD complexation leads to disappearance of the typical crystal structures of pure LA and CD, what was not noticed with juxtaposition (or physical mixture) of the compounds. Kinetic studies showed that complexation equilibrium is reached in a few hours, while phase-solubility tests detected an enhance in the water solubility of BVC and RVC in the presence of increasing CD concentrations, also allowing calculation of the association constants between LA:ß-CD (8.9 and 7.9 M-1) and LA:HPß-CD (14.7 and 10.0 M-1) for BVC and RVC, respectively. In vitro dialysis equilibrium tests disclosed a decrease in the release of BVC and RVC after complexation with HPß-CD or ß-CD as well as for liposomal RVC, when compared to free LA molecules, in a clear demonstration that the interaction with the carriers changed LA permeation through the membranes. Toxicity tests in vitro, including fibroblast cells culture and human erythrocyte hemolysis, have registered a decrease in the LA toxicity after complexation with both CDs (BVC and RVC) or encapsulation in liposomes (MVC and RVC). In vivo tests have shown, using the infraorbital nerve blockade test in rats, that liposomal formulations (MVCLUV and RVCLUV) prolonged the action and enhanced the intensity of the analgesia effect of free LA, as well as of vasoconstrictor associated-LA preparations (for MVC), suggesting that liposomal LA formulations could possible replace vasoconstrictors use in long-lasting surgical procedures or at the post-operatory period, specially for dentistry purposes. Motor blockade tests revealed that all the samples used: free, CD-complexed or liposome-encapsulated LA changed in a dose-dependent manner the motor function of the animals after caudal (intrathecal) or sciatic (infiltrative) injection, leading to the reversible loss of motor answer in all animals studied. None of the LA formulations tested (with ß-CD, HPß-CD or LUV), were able to prolong or to intensify the motor blockade induced by BVC and RVC. However, both BVCHPß-CD and RVCHPß-CD systems significantly reduced the latency for the motor blockade, indicating a fast onset of action, without changing the overall motor blockade, what is highly desirable for a LA. Evaluation of the sensorial blockade in the sciatic nerve of mice demonstrated that BVCHPß-CD and RVCHPß-CD, as well as RVCLUV formulation increased the intensity and duration of the analgesia effect, when compared to free or ß-CD-complexed LA, revealing that those systems can be of great interest at the post-operatory period. Intrathecal injection of 0.5% BVCHPß-CD enhanced the animals¿ nonciceptive limiar in relation to BVCß-CD and free BVC, revealing an increase in the analgesia potency and duration of action. This result allowed us to suggest that the enhance in the nonciceptive effect (ca 1.5 times) observed with the new LA formulations can be attributed, not only to the increase in total LA concentration available to the nerve fibers, but also to the lower protein-binding of the LA molecules, as well as to their lower clearance; altogether, these mechanisms keep the LA for a longer time in contact with the neuronal membrane. Morphological analysis of nervous¿ system cells disclosed neurotoxic signals in part of the animals treated with 0.5% BVCHPß-CD that were not observed if HPß-CD or BVC, alone, were used. The rise in the BVC toxic effect observed after complexation with HPß-CD can be explained by the enhanced availability of the LA molecules in contact with the neuronal membrane, what lead us to suggest that employment of the complex, at lower BVC dosages (0.25% for instance) could reduce the neurotoxic effect without changing the anesthetic potency. Besides, nephro-histological images did not detect any sign of morpho-functional alterations after intrathecal treatment of the animals with HPß-CD, BVC or BVCHPß-CD substantiating the potentiality of the clinical use of that LA formulation
Doutorado
Bioquimica
Doutor em Biologia Funcional e Molecular

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Souza, Marcio Antonio de. "Analgesia de parto : bloqueio combinado raqui-peridural versus bloquei peridural continuo em primigestas." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309851.

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Orientador: João Luiz de Carvalho Pinto e Silva
Dissertação ( mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: JUSTIFICATIVA E OBJETIVOS: O trabalho de parto produz desconforto e dor intensa à maioria das parturientes. O método de eleição que seria ideal para produzir analgesia deveria reduzir ao máximo os inconvenientes e a dor provocados pelo trabalho de parto, permitindo que a mãe participasse ativamente e com prazer da experiência de dar à luz. A analgesia combinada raqui-peridural (ACRP) apresentaria, como vantagens, a possibilidade de instalação precoce, rápido início de ação analgésica, uso de baixas doses de anestésicos locais, associando-se a trabalhos de partos mais curtos, menor bloqueio motor e ofereceria maior satisfação à parturiente. A analgesia peridural contínua (APC) utilizaria doses maiores de anestésicos locais, produzindo maior bloqueio motor, mas deveria ser realizada em fases mais adiantadas do período de dilatação. O potencial atrativo da ACRP seria o de incorporar as vantagens da administração intratecal de fármacos de ação analgésica rápida, com a manutenção de acesso através de um cateter peridural, disponível continuamente para complementação com novas doses ou adição de outras drogas, minimizando as desvantagens apresentadas por ambas as técnicas. O estudo compara os desfechos maternos e perinatais com a utilização da ACRP e APC em parturientes primigestas. SUJEITOS E MÉTODOS Foi realizado um ensaio clínico aleatorizado com 128 gestantes primigestas em trabalho de parto, divididas em dois grupos de igual tamanho (grupo APC e grupo ACRP) admitidas no pré-parto de duas maternidades na cidade de Jundiaí - SP, sendo estudadas as seguintes variáveis: tempo de latência de instalação da analgesia, intensidade da dor ao longo da analgesia, tempo total decorrido até a completa dilatação do colo uterino, Índice de Apgar de primeiro e quinto minutos, tempo de resolução do parto, grau de bloqueio motor, efeitos adversos como náuseas, vômitos, prurido, hipotensão arterial e o grau de satisfação materna. ANÁLISE DOS DADOS: A análise dos dados foi feita através do teste de Mann-Whitney para as variáveis contínuas não paramétricas. Utilizou-se também teste exato de Fisher e teste qui-quadrado de Pearson para variáveis categóricas. RESULTADOS: Não houve diferenças entre os grupos em relação à velocidade de dilatação cervical, tempo para resolução do parto, parâmetros hemodinâmicos maternos, vitalidade do recémnascido, complementações analgésicas durante o trabalho de parto e parto. Ocorreu maior rapidez de instalação da analgesia no grupo da ACRP. Com relação ao bloqueio motor também se observou diferença estatística significativa entre os dois grupos, sendo menor no grupo de APC. CONCLUSÕES: As duas técnicas mostraram-se seguras e eficientes, porém a ACRP ofereceu uma analgesia mais rápida, com alívio mais precoce da dor. O bloqueio motor menos intenso no grupo APC proporcionou movimentação mais ativa no leito e uma colaboração mais efetiva das gestantes durante o período expulsivo. A grande maioria das mulheres (97,6%) referiu satisfação com a analgesia recebida. As doses de anestésicos locais e opióides utilizadas em ambas as técnicas analgésicas propostas não produziram efeitos adversos maternos significativos e tampouco alteraram a vitalidade dos recém-nascidos dos dois grupos. Ambas as técnicas não mostraram qualquer predomínio de efeitos adversos
Abstract: PROBLEM AND OBJECTIVES: The childbirth arouses distress and intense pain to most of the parturients. The ideal method of producing analgesia must reduce the labor's pain and inconveniences to the utmost level, allowing the mother to participate on the delivery experience in an active and pleasant manner. The Combined Spinal-Epidural (CSE) analgesia offers the advantages of an early insertion, fast onset of analgesia, small dose of local anesthetic and reduced degree of motor block, being thus associated to short-time labors and yielding greater satisfaction to the puerpera. Otherwise, the Continuous Epidural Analgesia (CEA) would require larger doses of local anesthetics and a larger motor block as well, but it would be applied only in advanced stages of dilatation. The CSE analgesia has an attractive prospect, since it incorporates the advantages of the intrathecal administration of rapid onset pharmaceuticals, preserving this access through an epidural catheter that is uninterruptedly available for the insertion of other drugs and, at the same time, reducing the disadvantages that these both anesthesia techniques present. This study compares the combined spinal-epidural analgesia with the continuous epidural analgesia in primiparous parturients, through maternal and perinatal outcomes. APPROACH AND METHOD: 128 primiparous parturients in labor were recruited for the study. They were separated into two equal groups (CEA group and CSE group) when they applied to two of the maternity hospitals in Jundiaí city, during the pre-labor stage. A random clinical rehearsal was accomplished and the following variables were analyzed: latency time for the analgesia onset, pain intensity after its onset, total time elapsed until the complete cervical dilation, Apgar Index at the 1st and 5th minutes, time for delivery conclusion, degree of motor block, level of sensitive block, adverse effects (such as nausea, vomiting, pruritus and arterial hypotension) and degree of motherly approval. Data Analysis: The analysis was performed through the Mann-Whitney non-parametric test for continuous variables. Fisher's exact test and Pearson's chi-square test were also employed. RESULTS: Concerning the compared variables on the speed of cervical dilation, time for delivery conclusion, maternal hemodynamic parameters, newborn's healthiness, complementary analgesia during labor and labor, there were no significant statistic differences between the two groups studied. However, the CSE group had a faster analgesia insertion. In relation to the motor block, a significant statistic difference was detected between the two groups, revealing a reduced motor block in the group that received the CEA. CONCLUSIONS: Both techniques were proved as safe and efficient, though the CSE analgesia offered a faster analgesia and sooner pain relief. Due to a less intense motor block, the parturients from the CEA group were able to accomplish an active movement and effective collaboration during the expulsion stage. The major part of the women (95,4%) expressed satisfaction with the analgesia that was applied. The doses of local anesthetics and opioids, contained in both analgesia techniques, did not cause considerable adverse effects on the mothers and did not either affect the newborns in any of the two groups
Mestrado
Tocoginecologia
Mestre em Tocoginecologia

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Rane, Lindgren Kerstin. "Intrathecal adenosine for treatment of acute pain : safety assessments and evaluation in experimental, surgical and labour pain /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-750-9.

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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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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
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 Oliva
Banca: 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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11

Gasiūnaitė, Diana. "Comparison of general and combined anesthesia during laparoscopic colorectal surgery." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130930_092313-13566.

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The doctoral dissertation analyses and compares general endotracheal and combined endotracheal epidural anesthesia’s impact on organ systems and describes the systems parameters in laparoscopic colorectal surgery. Comparing two perioperative analgesia techniques used in laparoscopic colorectal surgery the hemodynamic and respiratory parameters trends; the impact of anesthesia and postoperative analgesia methods on patients’ tracheal extubation time, intestinal motility recovery rate, duration of hospitalization and inflammatory response have been determined. Laparoscopic colorectal resection, even being a minimally invasive technique for laparoscopic surgery, stimulates the body's response to stress and pro-inflammatory mediator’s secretion. Perioperative pain management may also influence the immune response. The doctoral dissertation analyses the impact of epidural analgesia method on the body stress response, investigating variations of cortisol and interleukin-6 levels. The results showed that analgesia and patient satisfaction using epidural analgesia method for perioperative pain management were better. Tracheal extubation time was significantly shorter. Recovery of intestinal motility using epidural analgesia was significant and much prior than using intravenous analgesia. The use of epidural analgesia in laparoscopic colorectal surgery caused less stress response – less cortisol levels increase. It has not showed the increase in number of complications.
Disertacijoje analizuojama ir lyginama bendrosios endotrachėjinės ir kombinuotos endotrachėjinės epiduralinės anestezijos įtaka atskiroms organų sistemoms ir tas sistemas apibūdinantiems rodikliams laparoskopinių kolorektalinių operacijų metu. Darbe nagrinėjama dviejų perioperacinių skausmo malšinimo būdų įtaka hemodinamikos ir kvėpavimo sistemos parametrų kitimo tendencijoms, pacientų trachėjos ekstubacijos laikui, žarnyno motorikos atsinaujinimo greičiui, hospitalizacijos trukmei bei organizmo uždegiminiam atsakui. Laparoskopinės storosios žarnos rezekcinės operacijos, net ir būdamos minimaliai invazinės dėl laparoskopinės operacijos technikos, sužadina stresinį organizmo atsaką bei uždegimo mediatorių išskyrimą. Perioperacinis skausmo valdymas taip pat gali daryti įtaką imuniniam atsakui. Disertacijoje nagrinėjama epiduralinės analgezijos metodo įtaka organizmo stresiniam atsakui tiriant kortizolio kiekio kitimus ir interleukino-6, kaip vieno pagrindinių uždegimą skatinančių citokinų, koncentracijos kitimą taikant epiduralinę analgezijos metodiką. Gauti rezultatai parodė, kad analgezijai pasitelkiant epiduralinį skausmo malšinimo metodą, perioperacinis pacientų skausmo valdymas ir pasitenkinimas yra geresnis, trachėjos ekstubacijos laikas patikimai trumpesnis, žarnyno peristaltikos atsitaisymas ankstyvesnis, sukeliamas stresinis organizmo atsakas mažesnis (mažesnis kortizolio koncentracijos padidėjimas) ir nenustatyta komplikacijų padaugėjimo.

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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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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.

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Orientador: Newton Nunes
Banca: 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
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14

Wang, Zuhao, and 汪祖昊. "Mechanistic study of circadian rhythms of tryptophan hydroxylase and serotonin receptors involved in acupuncture-induced analgesia." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46937031.

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Pereira, Daniele Amaro [UNESP]. "Efeitos cardiorrespiratórios e perfil analgésico da metadona, pela via intramuscular e intravenosa, em cadelas submetidas à ovariossalpingohisterectomia." Universidade Estadual Paulista (UNESP), 2010. http://hdl.handle.net/11449/101113.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A metadona é um opioide pouco utilizado na prática veterinária, sendo que existem ainda, questionamentos quanto ao seu uso. Dessa maneira, objetivou-se comparar o emprego da metadona, administrada por via intramuscular e intravenosa e seus efeitos sobre os parâmetros cardiorrespiratórios e profundidade anestésica em cadelas submetidas à ovariossalpingohisterectomia. Utilizaram-se 16 cadelas (103 kg), pré-medicadas com levomepromazina (0,5 mg/kg, IM). Transcorridos 20 minutos, a indução anestésica foi realizada com propofol (5 mg/kg, IV) e a manutenção com isofluorano. Após 10 minutos, os animais receberam metadona pelas vias IM (GIM) e IV (GIV), na dose de 0,3 mg/kg, diluídos em solução fisiológica (volume total=1ml/5kg). As mensurações das variáveis frequências cardíaca (FC) e respiratória (f), pressões arteriais (PAS, PAD e PAM), eletrocardiografia (ECG), temperatura esofágica (TE), pressão parcial de dióxido de carbono no final da expiração (EtCO2), saturação da oxihemoglobina (SpO2) e índice biespectral (BIS) iniciaram-se antes da administração do opioide (M0), 20 minutos após M0 (M1) e a cada 10 minutos (M2 a M5). As mensurações do cortisol foram obtidas em M0 (antes do opioide), M2, M5 (30, 60 minutos após a metadona), M6, M7 e M8 (1, 3 e 6 horas após OSH). A análise estatística utilizada foi a de Perfil, testes t, de Tuckey, e Kruskal-Wallis (5%). Foram observados tempos de extubação e recuperação maiores no GIV. Com relação à f, FC, PAM, TE, EtCO2, SpO2 e BIS não foram observadas diferenças significativas entre grupos e momentos. Não foi observada diferença entre grupos para os níveis de cortisol. Entre momentos, no GIM, as concentrações de cortisol em M0 foram menores do que em M7. Para a escala descritiva (escores) não foram observadas diferenças entre grupos e momentos
Methadone is an opioid little used in veterinary practice, and there are still questions about its use.Thus, the aim of this study was to compare the effects of intramuscular (IMG) and intravenous (IVG) administration of methadone on cardiopulmonary parameters, biespectral index and analgesic requirements in female dogs submitted to ovariohysterectomy. Sixteen female dogs were used (10±3 kg), premedicated with levomepromazine (0,5 mg/kg, IM). After 20 minutes, propofol (5 mg/kg) was used for induction and the anesthesia was maintained with isoflurane. After 10 minutes, methadone at 0.3 mg/kg was administered intravenously in IVG and intramuscularly in IMG, diluted in physiological saline (total volume of 1ml/5kg). The initial measurement of heart ( HR) and respiratory rates (RR), arterial pressures (SAP, DAP and MAP), electrocardiogram (ECG), body temperature (BT), concentration of end-tidal carbon dioxide (PECO2), peripheral oxygen saturation (SpO2) and biespectral index (BIS) was performed immediately before the administration of opioid (M0), after 20 minutes (M1) and then at 10-minute intervals (M2, M3, M4 and M5). Serum cortisol concentrations (Sc) were measured at M0, M2, M5 (30 and 60 minutes after opioid, and 1(M6), 3 (M7) and 6 (M8) hours after the end of surgery. The statistical analysis used was profile and tests “t”, Tuckey and Kruskal-Wallis (5%). Times of extubation and recovery were higher in IVG. HR, RR, APM, BT, PECO2, SpO2 and BIS did not differ significantly among times or between groups at any time. No differences were observed between groups for Sc. Between moments, in IMG, Sc at M0 were lower than at M7. For the descriptive scale (scores), no differences between groups or among times were observed

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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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Yu, Sui-cheung. "Cost effectiveness of intravenous patient controlled analgesia versus intrathecal morphine for post-operative pain after caesarean section : a randomised controlled trial /." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724311.

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Pereira, Daniele Amaro. "Efeitos cardiorrespiratórios e perfil analgésico da metadona, pela via intramuscular e intravenosa, em cadelas submetidas à ovariossalpingohisterectomia /." Jaboticabal : [s.n.], 2010. http://hdl.handle.net/11449/101113.

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Orientador: José Antonio Marques
Banca: Paulo Sérgio Patto dos Santos
Banca: Priscila Viau Furtado
Banca: Angélica Trazzi Bento de Moraes
Banca: Newton Nunes
Resumo: A metadona é um opioide pouco utilizado na prática veterinária, sendo que existem ainda, questionamentos quanto ao seu uso. Dessa maneira, objetivou-se comparar o emprego da metadona, administrada por via intramuscular e intravenosa e seus efeitos sobre os parâmetros cardiorrespiratórios e profundidade anestésica em cadelas submetidas à ovariossalpingohisterectomia. Utilizaram-se 16 cadelas (103 kg), pré-medicadas com levomepromazina (0,5 mg/kg, IM). Transcorridos 20 minutos, a indução anestésica foi realizada com propofol (5 mg/kg, IV) e a manutenção com isofluorano. Após 10 minutos, os animais receberam metadona pelas vias IM (GIM) e IV (GIV), na dose de 0,3 mg/kg, diluídos em solução fisiológica (volume total=1ml/5kg). As mensurações das variáveis frequências cardíaca (FC) e respiratória (f), pressões arteriais (PAS, PAD e PAM), eletrocardiografia (ECG), temperatura esofágica (TE), pressão parcial de dióxido de carbono no final da expiração (EtCO2), saturação da oxihemoglobina (SpO2) e índice biespectral (BIS) iniciaram-se antes da administração do opioide (M0), 20 minutos após M0 (M1) e a cada 10 minutos (M2 a M5). As mensurações do cortisol foram obtidas em M0 (antes do opioide), M2, M5 (30, 60 minutos após a metadona), M6, M7 e M8 (1, 3 e 6 horas após OSH). A análise estatística utilizada foi a de Perfil, testes t, de Tuckey, e Kruskal-Wallis (5%). Foram observados tempos de extubação e recuperação maiores no GIV. Com relação à f, FC, PAM, TE, EtCO2, SpO2 e BIS não foram observadas diferenças significativas entre grupos e momentos. Não foi observada diferença entre grupos para os níveis de cortisol. Entre momentos, no GIM, as concentrações de cortisol em M0 foram menores do que em M7. Para a escala descritiva (escores) não foram observadas diferenças entre grupos e momentos
Abstract: Methadone is an opioid little used in veterinary practice, and there are still questions about its use.Thus, the aim of this study was to compare the effects of intramuscular (IMG) and intravenous (IVG) administration of methadone on cardiopulmonary parameters, biespectral index and analgesic requirements in female dogs submitted to ovariohysterectomy. Sixteen female dogs were used (10±3 kg), premedicated with levomepromazine (0,5 mg/kg, IM). After 20 minutes, propofol (5 mg/kg) was used for induction and the anesthesia was maintained with isoflurane. After 10 minutes, methadone at 0.3 mg/kg was administered intravenously in IVG and intramuscularly in IMG, diluted in physiological saline (total volume of 1ml/5kg). The initial measurement of heart ( HR) and respiratory rates (RR), arterial pressures (SAP, DAP and MAP), electrocardiogram (ECG), body temperature (BT), concentration of end-tidal carbon dioxide (PECO2), peripheral oxygen saturation (SpO2) and biespectral index (BIS) was performed immediately before the administration of opioid (M0), after 20 minutes (M1) and then at 10-minute intervals (M2, M3, M4 and M5). Serum cortisol concentrations (Sc) were measured at M0, M2, M5 (30 and 60 minutes after opioid, and 1(M6), 3 (M7) and 6 (M8) hours after the end of surgery. The statistical analysis used was profile and tests "t", Tuckey and Kruskal-Wallis (5%). Times of extubation and recovery were higher in IVG. HR, RR, APM, BT, PECO2, SpO2 and BIS did not differ significantly among times or between groups at any time. No differences were observed between groups for Sc. Between moments, in IMG, Sc at M0 were lower than at M7. For the descriptive scale (scores), no differences between groups or among times were observed
Doutor

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Laporte, Jilma Maria Aleman. "Refinamento das técnicas de anestesia injetável visando garantir o bem-estar de ratos de laboratório em procedimentos experimentais." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/10/10133/tde-04082017-103501/.

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

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Kärrvall, Sofie, and Isaksson Anette Guerrieri. "Opioidfri anestesi : En litteraturöversikt om alternativ för analgesi." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-385497.

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

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Allen, Kellie. "The effect of timing of oral meloxicam administration on physiological responses in calves after dehorning with local anesthesia." Thesis, Kansas State University, 2013. http://hdl.handle.net/2097/15561.

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Master of Science
Department of Clinical Sciences
Hans Coetzee
Dehorning is a painful husbandry procedure that is commonly performed in dairy calves. Parenteral meloxicam combined with local anesthesia mitigates the physiological and behavioral effects of dehorning in calves. The purpose of this study was to determine the influence of timing of oral meloxicam administration on physiological responses in calves after dehorning. Thirty Holstein bull calves 8- 10 weeks of age (28-70 kg) were randomly assigned to one of three treatment groups: placebo-treated control group (CONT) (n=10), calves receiving meloxicam administered orally (1 mg/kg) in powdered milk replacer 12 h prior to cautery dehorning (MEL-PRE) (n=10) and calves receiving meloxicam administered as an oral bolus (1 mg/kg) at the time of dehorning (MEL-POST) (n=10). Following cautery dehorning, blood samples were collected to measure cortisol, substance P (SP), haptoglobin, ex-vivo prostaglandin E2 (PgE2) production after lipopolysaccharide stimulation and meloxicam concentrations. Maximum ocular temperature (MOT) and mechanical nociceptive threshold (MNT) was also assessed. Data were analyzed using non-compartmental pharmacokinetic analysis and repeated measures ANOVA models. Mean peak meloxicam concentrations were 3.61 ± 0 .21 μg/mL and 3.27 ± 0.14 μg/mL with average elimination half-lives of 38.62 ± 5.87 h and 35.81 ± 6.26 h in the MEL-PRE and MEL-POST groups respectively. Serum cortisol concentrations were lower in meloxicam-treated calves compared with control calves at 4 h post-dehorning (P=0.0004). SP concentrations were significantly higher in control calves compared with meloxicam-treated calves at 120 h after dehorning (P=0.038). PgE2 concentrations were lower in meloxicam-treated calves compared with control calves (P=0.001). MNT was higher in control calves at 1 h after dehorning (P=0.02) but meloxicam-treated calves tended to have a higher MNT at 6 h after dehorning (P=0.07). There was no effect of timing of meloxicam administration on plasma cortisol concentrations (P= 0.69), SP concentrations (P=0.86), haptoglobin concentrations (P=0.86), MOT (P=0.90), or MNT (P=0.99). However, PgE2 concentrations in MEL-PRE calves were similar to CONT calves after 12h post-dehorning, while MEL-POST calves had lower PgE2 concentrations for 3 d post dehorning. These findings suggest that meloxicam reduced cortisol, SP and PgE2 after dehorning but only PgE2 production was significantly affected by the timing of meloxicam administration.

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Loadsman, John Anthony. "Perioperative Sleep and Breathing." Thesis, The University of Sydney, 2005. http://hdl.handle.net/2123/689.

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Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.

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Loadsman, John Anthony. "Perioperative Sleep and Breathing." University of Sydney. College of Health Sciences, 2005. http://hdl.handle.net/2123/689.

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Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.

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Fukagawa, Hiroshi. "κ-Opioid receptor mediates the antinociceptive effect of nitrous oxide in mice." Kyoto University, 2015. http://hdl.handle.net/2433/199168.

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Canôa, Jiancarlo Tortoza Bignelli e. [UNESP]. "Analgesia peridural com ropivacaína associada ao midazolam em cadelas submetidas a ovário-salpingo-histerectomia." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/92213.

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Made available in DSpace on 2014-06-11T19:25:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-24Bitstream added on 2014-06-13T19:12:40Z : No. of bitstreams: 1 canoa_jtb_me_araca.pdf: 7064516 bytes, checksum: 9ec9f5c1485210ad8d9d967a430df0f7 (MD5)
O presente estudo teve como objetivos avaliar os efeitos paramétricos, analgésico, sedativo e a dose mais adequada de midazolam (50 ou 100μg/kg) associado à ropivacaína pela via peridural em cadelas submetidas à OSH eletiva. Participaram do estudo, 24 cadelas sadias, adultas, de diferentes raças, com peso médio de 8,25 kg, as quais foram pré-medicadas com acepromazina (0,05mg/kg, IM), seguindo-se a indução e a manutenção anestésica com propofol (5 mg/kg) e isofluorano, respectivamente, sendo alocadas em três grupos experimentais: GR - ropivacaína 0,2 mL/kg, GM100 - midazolam (100μg/kg) + ropivacaína 0,2mL/kg e GM50 - midazolam (50μg/kg) + ropivacaína 0,2mL/kg. Foram avaliados: frequências cardíaca e respiratória, pressão arterial sistólica, temperatura retal, saturação de oxigênio na hemoglobina, variáveis hemogasométricas, concentração plasmática de cortisol, grau de analgesia pós-operatória e sedação. Os dados foram submetidos à ANOVA, seguidas pelo teste Tukey no programa SAS (p<0.05). Para as variáveis qualitativas ordinais foram realizados os testes Kruskal- Wallis, teste de Friedman e o teste de Dunn. Foram observados efeitos analgésicos mais duradouros do anestésico local no grupo dos animais em que se utilizou a dose de 100μg/kg de midazolam, quando comparados ao grupo que utilizou 50μg/kg e 50% dos animais do grupo GM100 receberam analgesia resgate 12 horas após a cirurgia. A associação do midazolam na dose de 100μg/kg à ropivacaína apresentou efeito superior à dose de 50μg/kg de midazolam, que não potencializou o efeito analgésico, porém, prolongou o período de analgesia residual pós-operatório. Concluiu-se que a associação do midazolam à ropivacaína não produziu alterações paramétricas significativas, nem efeitos adicionais sobre a sedação, entretanto o midazolam na dose de 100μg/kg pode ser pode ser mais...
This research aimed evaluate the parametric, analgesic, sedative effects and most appropriate dose of midazolam (50 or 100μg.kg) for epidural anesthesia bitches submitted the elective ovariosalpingohisterectomy. Twenty-four bitches tool part study, adults, different breeds, mediun weigh 8.25 kg and premedicated with acepromazine (0.05 mg.kg, IM), followed by anesthetic induction and maintenance with propofol (5mg.kg) and isoflurane, respectively, and allocated in three experimental groups: GR - ropivacaine 0.2 mL.kg, GM50 - midazolam (50μg.kg) + ropivacaine 0.2 mL.kg and GM100 - midazolam (100μg.kg) + ropivacaine 0.2 mL.kg. Were evaluated: heart and respiratory rate, indirect systolic arterial pressure, rectal temperature, oxygen saturation in hemoglobin, blood gas variables, plasma cortisol, degree of postoperative analgesia and sedation. The results was submitted to ANOVA followed by Tukey test in the SAS (p <0.05). From the qualitative variables were performed ordinal tests Kruskal-Wallis, Friedman and Dunn tests. Were observed effects more durable local anesthetic in the group of animals that used the 100μg/kg dose of midazolam as compared to the group that used 50μg.kg and 50% of the animals tested GM100 received rescue analgesia 12 hours after surgery. The combination of midazolam in the dose of ropivacaine had 100μg/kg the upper end of the dose of midazolam 50μg.kg, not increasing the analgesic effect, however, extending the period of residual postoperative analgesia. It was concluded that the association of midazolam to ropivacaine did not produce significant parametric changes or additional sedation effects, but midazolam in 100μg.kg may be another option in releave post-operative pain on OSH bitches surgery (procedure) in bitches subjected the OSH.

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Canôa, Jiancarlo Tortoza Bignelli e. "Analgesia peridural com ropivacaína associada ao midazolam em cadelas submetidas a ovário-salpingo-histerectomia /." Araçatuba : [s.n.], 2009. http://hdl.handle.net/11449/92213.

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Resumo: O presente estudo teve como objetivos avaliar os efeitos paramétricos, analgésico, sedativo e a dose mais adequada de midazolam (50 ou 100μg/kg) associado à ropivacaína pela via peridural em cadelas submetidas à OSH eletiva. Participaram do estudo, 24 cadelas sadias, adultas, de diferentes raças, com peso médio de 8,25 kg, as quais foram pré-medicadas com acepromazina (0,05mg/kg, IM), seguindo-se a indução e a manutenção anestésica com propofol (5 mg/kg) e isofluorano, respectivamente, sendo alocadas em três grupos experimentais: GR - ropivacaína 0,2 mL/kg, GM100 - midazolam (100μg/kg) + ropivacaína 0,2mL/kg e GM50 - midazolam (50μg/kg) + ropivacaína 0,2mL/kg. Foram avaliados: frequências cardíaca e respiratória, pressão arterial sistólica, temperatura retal, saturação de oxigênio na hemoglobina, variáveis hemogasométricas, concentração plasmática de cortisol, grau de analgesia pós-operatória e sedação. Os dados foram submetidos à ANOVA, seguidas pelo teste Tukey no programa SAS (p<0.05). Para as variáveis qualitativas ordinais foram realizados os testes Kruskal- Wallis, teste de Friedman e o teste de Dunn. Foram observados efeitos analgésicos mais duradouros do anestésico local no grupo dos animais em que se utilizou a dose de 100μg/kg de midazolam, quando comparados ao grupo que utilizou 50μg/kg e 50% dos animais do grupo GM100 receberam analgesia resgate 12 horas após a cirurgia. A associação do midazolam na dose de 100μg/kg à ropivacaína apresentou efeito superior à dose de 50μg/kg de midazolam, que não potencializou o efeito analgésico, porém, prolongou o período de analgesia residual pós-operatório. Concluiu-se que a associação do midazolam à ropivacaína não produziu alterações paramétricas significativas, nem efeitos adicionais sobre a sedação, entretanto o midazolam na dose de 100μg/kg pode ser pode ser mais... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: This research aimed evaluate the parametric, analgesic, sedative effects and most appropriate dose of midazolam (50 or 100μg.kg) for epidural anesthesia bitches submitted the elective ovariosalpingohisterectomy. Twenty-four bitches tool part study, adults, different breeds, mediun weigh 8.25 kg and premedicated with acepromazine (0.05 mg.kg, IM), followed by anesthetic induction and maintenance with propofol (5mg.kg) and isoflurane, respectively, and allocated in three experimental groups: GR - ropivacaine 0.2 mL.kg, GM50 - midazolam (50μg.kg) + ropivacaine 0.2 mL.kg and GM100 - midazolam (100μg.kg) + ropivacaine 0.2 mL.kg. Were evaluated: heart and respiratory rate, indirect systolic arterial pressure, rectal temperature, oxygen saturation in hemoglobin, blood gas variables, plasma cortisol, degree of postoperative analgesia and sedation. The results was submitted to ANOVA followed by Tukey test in the SAS (p <0.05). From the qualitative variables were performed ordinal tests Kruskal-Wallis, Friedman and Dunn tests. Were observed effects more durable local anesthetic in the group of animals that used the 100μg/kg dose of midazolam as compared to the group that used 50μg.kg and 50% of the animals tested GM100 received rescue analgesia 12 hours after surgery. The combination of midazolam in the dose of ropivacaine had 100μg/kg the upper end of the dose of midazolam 50μg.kg, not increasing the analgesic effect, however, extending the period of residual postoperative analgesia. It was concluded that the association of midazolam to ropivacaine did not produce significant parametric changes or additional sedation effects, but midazolam in 100μg.kg may be another option in releave post-operative pain on OSH bitches surgery (procedure) in bitches subjected the OSH.
Orientador: Valéria Nobre Leal de Souza Oliva
Coorientador: Renata Navarro Cassu
Banca: Lídia Mitsuko Matsubara
Banca: Paulo Sérgio Patto dos Santos
Mestre

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Biaggi, Ricardo Hélio. "Estudo comparativo da sensação dolorosa em pacientes submetidos à facoemulsificação com diferentes temperaturas da solução de irrigação ocular." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/17/17150/tde-13012014-232537/.

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O presente estudo objetivou comparar a eficácia analgésica entre dois tipos de técnicas anestésicas (tópica e tópica associada a crioanalgesia) utilizadas para realização da cirurgia de catarata. Vinte e cinco pacientes com catarata senil em ambos os olhos, classificadas de acordo com o critério de LOCS III em NO3 NC3 e NO4 NC4, acuidade visual inferior a 20/40 e indicação cirúrgica foram randomizados para serem submetidos à facoemulsificação com uso de solução de irrigação ocular em temperatura ambiente (23°C) em um olho (Grupo 1; n = 25) e gelada (4°C) no olho contralateral (Grupo 2; n = 25). A dor do procedimento foi avaliada através do uso de escala analógica visual 15 minutos após a realização da facoemulsificação. Esta escala varia de 0 a 100, onde o ponto 0 representa nenhuma dor e 100 representa a dor mais intensa que poderia ter sentido durante todo o procedimento cirúrgico. A perda celular endotelial, a variação da espessura corneana e o ganho de visão foram avaliados 30 ± 2 dias após cada cirurgia. A média da dor no Grupo 1 foi de 26.02 (DP=18.58) e no Grupo 2 foi de 21.28 (DP=18.20). Os valores das medianas da dor relacionada ao procedimento nos grupos 1 e 2 foram, respectivamente, 22.5 (0 66.5) e 17 (0 75.5). Após um mês de acompanhamento, a perda média de células endoteliais foi de 10% e 9.88% respectivamente, não havendo diferença estatisticamente significativa entre os grupos (teste de Wilcoxon). Não houve correlação estatisticamente significativa entre os valores médios de tempo de cirurgia, volume de irrigação, tempo de ultrassom, poder de ultrassom e ganho de visão com a perda celular ou com o escore de dor (análise de correlação de mínimos quadrados). O estudo demonstrou que não houve diferença no controle da intensidade da dor durante o procedimento de facoemulsificação com o uso de anestesia tópica ou anestesia tópica associada à crioanalgesia.
The study aimed to compare the analgesic efficacy between two types of anesthetic techniques (topical and topical associated with cryoanalgesia) during cataract surgery. Twenty-five patients with senile bilateral cataract, classified in NO3 NC3 and NO4 NC4 according to LOCS III criteria, visual acuity less than 20/40 and surgical indication were randomized to undergo phacoemulsification with the use of ocular irrigation solution at room temperature (23°C) for an eye (Group 1, n = 25) and cold solution in the contralateral eye (Group 2, n = 25). The pain of the procedure was assessed by using a visual analogue scale 15 minutes after the completion of phacoemulsification. This scale ranges from 0 to 100, being the point \"0\" representation of \"no pain\" and \"100\" the \"worst pain you might have felt\" throughout the surgical procedure. Endothelial cell loss, change in corneal thickness and vision improvement were evaluated 30 ± 2 days after each surgery. Operation time, irrigation volume, ultrasound time and ultrasound power were related to cell loss between groups. Mean pain in Group 1 was 26.02 (SD=18.58) and in Group 2 was 21.28 (SD=18.20). Median (range) pain related to the procedure in groups 1 and 2 were, respectively, 22.5 (066.5) and 17 (075.5). After one month follow-up, the mean endothelial cell loss was 10% and 9.88% respectively, with no statistical difference between groups. There were no statistically significant correlation between surgery time, irrigation volume, ultrasound time, ultrasound power and vision improvement means with cell loss or pain scores (bivariate fit). Study showed no difference in controlling the intensity of pain during phacoemulsification with the use of topical anesthesia or topical anesthesia associated with cryoanalgesia.

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Demétrio, Laís Villa. "Bloqueio ecoguiado do plano transverso abdominal comparado à infusão de morfina, lidocaína e cetamina em cadelas submetidas à mastectomia." Universidade do Estado de Santa Catarina, 2016. http://tede.udesc.br/handle/handle/2554.

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The surgical procedure mastectomy is the most appropriate treatment in cases of tumors of the mammary glands in female dogs. In addition to the drug combinations that seek multimodal anesthesia, the use of regional anesthesia techniques can also be used for this procedure. Blockade of the transversus abdominis plane (TAP) is a regional anesthetic technique designed to desensitize the branches that innervate the abdominal muscles, abdominal subcutaneous tissue and parietal peritoneum, with the deposition of the local anesthetic in the fascia between the internal oblique and transversus abdominis identified by ultrasound. The objective of this study was to evaluate the analgesic effectiveness of the TAP block, associated with intercostal blocks in trans and postoperative of animals submitted at radical unilateral mastectomy, compared to analgesia with continuous infusion of morphine, lidocaine, and ketamine (MLK), and testing sensitivity to rescue analgesics three different methods for assessing acute pain in dogs: Visual Analogue Scale (VAS), Glasgow Composite pain Scale and Melbourne Scale. The project was carried out from April to July of 2016, with animals from the clinical routine Veterinary Hospital HCV-CAV / UDESC. Three groups were used with 6 dogs each: TAP Group, submitted to the transversus abdominis block associated with intercostal blocks, performed with bupivacaine without vasoconstrictor; Group MLK subjected to intravenous infusion of morphine, lidocaine and ketamine (MLK) during surgeries; and control group, with animals that did not receive any locoregional anesthesia or analgesics infusion. The application of analgesic rescues with fentanyl was higher in the control group during the trans-operative assessment and did not differ between TAP and MLK groups. In the postoperative assessments, there were no differences between the groups in relation to the request redemptions of morphine, however, Glasgow and EVA were more sensitive. The TAP block associated with intercostal blocks can replace the infusion of MLK in bitches submitted to unilateral mastectomy
O procedimento cirúrgico de mastectomia é o tratamento mais indicado nos casos de tumores de glândulas mamárias em cadelas. Além das associações medicamentosas que buscam a anestesia multimodal, o emprego de técnicas de anestesia locorregional também podem ser utilizadas para esse procedimento. O bloqueio do plano transverso abdominal (TAP), é uma técnica de anestesia regional projetada para dessensibilizar os ramos que inervam os músculos abdominais, tecido subcutâneo abdominal e peritônio parietal, por meio da deposição do anestésico local na fáscia entre o músculo oblíquo interno e transverso abdominal identificados através da ecografia. O objetivo deste trabalho, foi avaliar a eficiência analgésica do bloqueio TAP, associado aos bloqueios intercostais, no trans e pós-operatórios de animais submetidos à mastectomia unilateral radical, comparativamente à analgesia com infusão continua de morfina, lidocaína e cetamina (MLK), testando a sensibilidade ao resgate analgésicos de três diferentes métodos de avaliação de dor aguda em cães: Escala Visual Analógica (EVA), Escala Composta de Dor de Glasgow e Escala de Melbourne. O projeto foi desenvolvido no período de Abril a Julho do ano de 2016, com animais provenientes da rotina clínica do Hospital de Clínicas Veterinárias HCV-CAV/UDESC. Foram utilizados três grupos com 6 cadelas cada: Grupo TAP, submetido ao bloqueio transverso abdominal associado a bloqueios intercostais, realizados com bupivacaína sem vasoconstritor; Grupo MLK, submetido a infusão intravenosa de morfina, lidocaína e cetamina (MLK) durante o transoperatório; e Grupo controle, com animais que não receberam nenhum tipo de anestesia locorregional ou infusão de analgésicos. O requerimento de resgastes analgésico com fentanil, foi maior no grupo Controle durante a avaliação trans-operatória, e não diferiu entre os grupos TAP e MLK. Nas avaliações de pós-operatório, não houveram diferenças entre os grupos em relação ao requerimento de resgates com morfina, no entanto, Glasgow e a EVA mostraram-se mais sensíveis. O bloqueio TAP associado aos bloqueios intercostais, causa analgesia similar à infusão de MLK em cadelas submetidas a mastectomia unilateral

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Lewis, Kerrie Anne. "Effect of 4 Analgesic Protocols on Comfort and Sedation of Dogs for 24 hours after Stifle Surgery." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366606136.

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Yu, Sui-cheung, and 俞瑞昌. "Cost effectiveness of intravenous patient controlled analgesia versus intrathecal morphine for post-operative pain after caesarean section: a randomised controlled trial." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39724311.

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Krasauskaitė, Ieva. "Smulkiųjų gyvūnų bendroji nejautra ir gyvybinių funkcijų stebėjimas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140305_141948-81212.

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Magistro darbas buvo parengtas Lietuvos sveikatos mokslų universitete, Veterinarijos akademijoje 2012 – 2013 metais. Magistro darbas susideda iš turinio, įvado , literatūros apžvalgos , rezultatų ir jų aptarimo, išvadų bei padėkos .Visą darbą sudaro 41 puslapiai , 10 lentelių ir 6 diagramos. Tikslas: Įvertinti Lietuvos sveikatos mokslų universiteto Veterinarijos akademijos dr. L.Kriaučeliūno smulkiųjų gyvūnų klinikoje chirurginėje praktikoje naudojamų bendrosios nejautros metodų efektyvumą ir gyvybinių funkcijų stebėsenos svarbą. Darbo uždaviniai:1. Išnagrinėti bendrosios nejautros būdų taikymą smulkiųjų gyvūnų klinikoje.2. Įvertinti stebėjimo (monitoravimo) rodiklius.3. Stebėti ir įvertinti pasitaikančias komplikacijas, taikomus būdus joms pašalinti bei jų prevenciją.
This master work was prepared in Lithuanian University of Health Sciences, Veterinary Academy in 2012 – 2013 years. This master work compiles from a content, introduction, review of literature, results, consideration, conclusion, and thanks. The master work consists of 41 pages and includes 10 tables and 6 pictures. The aim: Rate of small animal surgical techniques used in general anesthesia effectiveness and the importance of monitoring vital functions. The tasks: 1. Examine general anesthesia techniques by the small animal clinic.2. Monitoring indicators.3. Monitoring of common complications, their prevention and ways to remove them. After study shows that the development is an important vital functions the animal's age, breed, health status, complexity of procedures performed and the medicinal use for its intended purpose.

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Menezes, Daniel Carvalho de [UNESP]. "Utilização do sufentanil durante indução anestésica em anestesia venosa total com remifentanil em infusão contínua." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/137901.

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Introdução: a presença de dor pós-operatória é uma grande preocupação quando o remifentanil é usado em Anestesia Venosa Total (AVT) devido à meia-vida muito curta desse fármaco e possíveis mecanismos de hiperalgesia e tolerância. Opioides com duração de ação mais prolongada - como sufentanil – têm sido usados durante a indução da AVT com infusão contínua de remifentanil no intuito de suplantar essa limitação. Contudo, a efetividade desta estratégia carece de evidência decorrente de ensaios clínicos. Objetivo: avaliar a eficácia e a segurança da estratégia de administrar sufentanil durante a indução de AVT com remifentanil na analgesia pós-operatória por meio de ensaio clínico randomizado. Método: quarenta pacientes em programação de cirurgia abdominal aberta eletiva foram randomizados para receber infusão contínua de remifentanil em anestesia venosa total, com ou sem a administração de uma dose única de sufentanil, durante a indução da anestesia. Foram avaliados a intensidade da dor pós-operatória, o consumo de morfina e a ocorrência de complicações como náuseas, vômitos, prurido, agitação, sonolência e depressão respiratória, até 48 horas após a cirurgia. O desfecho primário foi o consumo de morfina durante as primeiras 24 horas após a cirurgia. Resultados: a média do consumo de morfina durante as primeiras 24 horas após a cirurgia foi 21,55 mg e 26,68 mg para o grupo que recebeu a dose única de sufentanil e para o grupo controle, respectivamente (p = 0,31). Os pacientes que receberam sufentanil necessitaram de menor quantidade de morfina durante o tempo na Sala de Recuperação Pós-anestésica (SRPA) (média do consumo de morfina total de 7,77 mg versus 15,63 mg, p= 0,02). As diferenças nos escores de dor durante todo o período de estudo e no consumo de morfina após a alta da SRPA não alcançaram significância estatística. A frequência de efeitos adversos não foi estatisticamente diferente entre os grupos. Conclusão: a administração de sufentanil durante a indução anestésica de anestesia venosa total com remifentanil em infusão contínua apresentou superioridade analgésica pós-operatória no período até a alta da SRPA, sem a ocorrência de uma maior proporção de efeitos adversos em relação ao grupo que não recebeu sufentanil.
Background: the presence of postoperative pain is a major concern when remifentanil is used for Total Intravenous Anesthesia (TIVA) because of the very short half-life of this medication and possible mechanisms of hyperalgesia and tolerance. Longer acting opioids – such as sufentanil – have been used during induction of remifentanil-based TIVA as a means to overcome this shortcoming. However, the effectiveness of the strategy still lacks evidence from randomized clinical trials. Objective: we conducted a randomized clinical trial to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based TIVA. Methods: forty patients scheduled for elective open abdominal surgery were randomized to receive remifentanil-based TIVA with or without the administration of a single dose of sufentanil during anesthesia induction. We assessed postoperative pain intensity, morphine consumption and the occurrence of complications such as nausea, vomiting, pruritus, agitation, somnolence and respiratory depression up to 48 hours after surgery. The primary outcome was morphine consumption during the first 24 hours after surgery. Results: the mean morphine consumption during the first 24 hours after surgery was 21,55 mg and 26,68 mg for the group that received sufentanil and the control group, respectively (P=0,31). Patients in the sufentanil group required less morphine during their time in the Post-Anesthetic Care Unit (PACU) (mean total morphine consumption of 7,77 mg versus 15,63 mg, P=0,02). Differences in pain scores during the whole study period and morphine consumption after discharge from PACU were not statistically significant. The frequency of adverse effects did not statistically vary between the groups. Conclusion: the administration of sufentanil during anesthetic induction of remifentanil-based TIVA continuous infusion showed superior postoperative analgesic efficacy in the period until discharge from PACU and did not increase the incidence of adverse effects.

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Menezes, Daniel Carvalho de. "Utilização do sufentanil durante indução anestésica em anestesia venosa total com remifentanil em infusão contínua." Botucatu, 2016. http://hdl.handle.net/11449/137901.

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Orientador: Fernanda Bono Fukushima
Resumo: Introdução: a presença de dor pós-operatória é uma grande preocupação quando o remifentanil é usado em Anestesia Venosa Total (AVT) devido à meia-vida muito curta desse fármaco e possíveis mecanismos de hiperalgesia e tolerância. Opioides com duração de ação mais prolongada - como sufentanil – têm sido usados durante a indução da AVT com infusão contínua de remifentanil no intuito de suplantar essa limitação. Contudo, a efetividade desta estratégia carece de evidência decorrente de ensaios clínicos. Objetivo: avaliar a eficácia e a segurança da estratégia de administrar sufentanil durante a indução de AVT com remifentanil na analgesia pós-operatória por meio de ensaio clínico randomizado. Método: quarenta pacientes em programação de cirurgia abdominal aberta eletiva foram randomizados para receber infusão contínua de remifentanil em anestesia venosa total, com ou sem a administração de uma dose única de sufentanil, durante a indução da anestesia. Foram avaliados a intensidade da dor pós-operatória, o consumo de morfina e a ocorrência de complicações como náuseas, vômitos, prurido, agitação, sonolência e depressão respiratória, até 48 horas após a cirurgia. O desfecho primário foi o consumo de morfina durante as primeiras 24 horas após a cirurgia. Resultados: a média do consumo de morfina durante as primeiras 24 horas após a cirurgia foi 21,55 mg e 26,68 mg para o grupo que recebeu a dose única de sufentanil e para o grupo controle, respectivamente (p = 0,31). Os pacient... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Background: the presence of postoperative pain is a major concern when remifentanil is used for Total Intravenous Anesthesia (TIVA) because of the very short half-life of this medication and possible mechanisms of hyperalgesia and tolerance. Longer acting opioids – such as sufentanil – have been used during induction of remifentanil-based TIVA as a means to overcome this shortcoming. However, the effectiveness of the strategy still lacks evidence from randomized clinical trials. Objective: we conducted a randomized clinical trial to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based TIVA. Methods: forty patients scheduled for elective open abdominal surgery were randomized to receive remifentanil-based TIVA with or without the administration of a single dose of sufentanil during anesthesia induction. We assessed postoperative pain intensity, morphine consumption and the occurrence of complications such as nausea, vomiting, pruritus, agitation, somnolence and respiratory depression up to 48 hours after surgery. The primary outcome was morphine consumption during the first 24 hours after surgery. Results: the mean morphine consumption during the first 24 hours after surgery was 21,55 mg and 26,68 mg for the group that received sufentanil and the control group, respectively (P=0,31). Patients in the sufentanil group required less morphine during their time in the Post-Anesthetic Care... (Complete abstract click electronic access below)
Mestre

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Ceccheti, Marcelo Minharro. "Eficácia analgésica pós-operatória e ação anestésica adjuvante do cloridrato de tramadol utilizado localmente após exodontias de terceiros molares inferiores impactados." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/23/23149/tde-30082010-150907/.

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Foi estudado o efeito analgésico e anestésico adjuvante do cloridrato de tramadol aplicado localmente, após extração do terceiro molar inferior impactado. Um total de 52 pacientes foi submetido à exodontia sob anestesia local (mepivacaína 2% 1:20 000 corbadrina), em estudo duplo-cego, dose única, cruzado, controlado por placebo. Pacientes e os lados dos procedimentos foram distribuídos aleatoriamente para receberem 2 ml de tramadol (100%) (grupo T) ou 2 ml de solução salina 0,9% (grupo P). Ambas as soluções foram injetadas na submucosa gengival e alvéolo, imediatamente após as cirurgias realizadas por um mesmo cirurgião. Impacção dental e quantidade anestésica foram pareadas. Dados do consumo e a hora de uso de analgésico de resgate (dipirona 500 mg) foram utilizados para avaliar o efeito analgésico de tramadol. Uma Escala Analógica Visual (EAV) de dor foi aplicada após término da anestesia, 4, 8, 24, 48 e 72 horas após cirurgia, com os dados submetidos ao teste de Wilcoxon (p < 0,05). Não houve diferença no bloqueio anestésico e efeitos adversos entre os grupos. O grupo T requisitou um número significativamente menor (p = 0,008) de comprimidos de dipirona durante o período de avaliação (3,37 ± 4,65) do que o grupo P (4,4 ± 3,71). O grupo T levou mais minutos para usar a dipirona após a primeira cirurgia (303,72 ± 416,01) do que o grupo P (185,4 ± 59,4) (p = 0,006). O grupo T apresentou menor média de dor na EAV após término da anestesia (3,55 ± 2,27) do que no grupo P (5,26 ± 2,49) (p = 0,001). O tramadol administrado localmente após exodontia de terceiros molares inferiores melhora a qualidade da analgesia pós-operatória, porém não prolonga a duração da anestesia local com mepivacaína.
The present study sought to assess the analgesic and adjuvant anesthetic effects of surgical site administration of tramadol hydrochloride immediately after extraction of impacted mandibular third molars. In this double-blind, placebo-controlled, singledose, crossover investigation, 52 patients underwent bilateral extraction of impacted mandibular third molars under local anesthesia (mepivacaine 2% with levonordefrin 1:20 000). Patients and procedures, by side of intervention, were randomly assigned to receive either 2 mL of tramadol (100%) (Group T, n = 52) or 2 mL of normal saline, 0.9% (Group P, n = 52). Medications were administered by submucosal injection at the level of the third molar immediately after surgery. All patients were operated on by the same surgeon; patients were paired for technical difficulty and amount of anesthetic solution. Use of supplementary analgesics (500 mg metamizole) and time to first postoperative use of a rescue drug were used to assess the analgesic effect of tramadol. Pain level on both sides (Group T and P) was recorded on a visual analog scale (VAS 010 cm) immediately after cessation of anesthetic effect and at 4, 8, 24, 48, and 72 hours postoperatively. Data were compared using the Wilcoxon test (p < 0.05). There was no difference in anesthetic blockade between groups. There were no differences in reported adverse effects. In the 72 hours following surgery, patients in group T took significantly fewer (p = 0.008) metamizole tablets (3.37 ± 4.65) than did those in group P (4.4 ± 3.71). Time to first dose of a rescue drug (in minutes) was longer in Group T (303.72 ± 416.01) than in Group P (185.4 ± 59.4) (p = 0.006). Tramadol reduced pain intensity values (VAS) significantly in Group T (3.55 ± 2.27) as compared to Group P (5.26 ± 2.49) after anesthetic effect had worn off (p = 0.001). Local administration of tramadol after oral surgery improves the quality of postoperative analgesia, but does not extend the duration of anesthetic action.

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Cançado, Thais Orrico de Brito. "Avaliação de dor crônica pós-cesariana. Influência da técnica anestésico-cirúrgica e da analgesia pós-operatória." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-20052013-154715/.

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INTRODUÇÃO: O Brasil ocupa o primeiro lugar entre os países com maiores taxas de cesariana no mundo. Pouco se sabe a respeito das consequências futuras deste procedimento, sobre a saúde materna. Este estudo investigou a influência da técnica anestésico-cirúrgica e analgesia pós-operatória, no aparecimento de dor crônica após a cesariana. Procuramos também identificar os fatores de risco de dor crônica pós-cesariana. MÉTODO: Este estudo prospectivo com distribuição aleatória foi conduzido em 443 pacientes que foram submetidas à cesariana (eletivas e emergenciais), com diferentes doses de bupivacaína 0,5% hiperbárica e opioides na raquianestesia, bem como uso de anti-inflamatórios não esteroidais peri-operatório. Os grupos foram: G8SMA- 8 mg bupivacaína hiperbárica + 2,5 mcg sufentanil + 100 mcg morfina; G10SMA- 10 mg bupivacaína hiperbárica + 2,5 mcg sufentanil + 100 mcg morfina; G12,5MA- 12,5 mg bupivacaína hiperbárica + 100 mcg morfina; G15MA- 15 mg bupivacaína hiperbárica + 100 mcg morfina; G12,5M - 12,5 mg bupivacaína hiperbárica + 100 mcg morfina. Somente as pacientes do grupo G12,5M não receberam AINE no peri-operatório. Dor em repouso e em movimento foram avaliadas no pós-operatório imediato. Fatores peri-operatórios, cirúrgicos e obstétricos foram investigados. Contato telefônico foi realizado, após três e seis meses do procedimento cirúrgico, para identificação das pacientes com dor crônica. RESULTADOS: A incidência de dor crônica nos grupos foi: G8SMA= 20%, G10SMA= 13%; G12,5MA= 7,1%; G15MA= 2,2% e G12,5M= 20,3%. Pacientes que apresentaram escores de dor mais elevados no período pós- operatório imediato, que referiram doenças crônicas em tratamento, que apresentaram maior tempo em trabalho de parto sem analgesia, tiveram maior incidência de dor crônica (p<0,05). CONCLUSÃO: A incidência de dor crônica diminui com emprego de doses maiores de anestésicos locais e uso de anti-inflamatórios não esteroidais. Escores mais elevados de dor no período pós-operatório imediato tiveram associação com aparecimento de dor crônica após a cesariana. Os fatores de risco encontrados foram: doença crônica em tratamento, maior tempo em trabalho de parto sem analgesia e escores de dor elevados no pós- operatório imediato
INTRODUCTION: Brazil holds first place in cesarean section rate in the world. Little is known about the consequences upon maternal health. This study investigated the influence of anesthetic, surgical techniques and postoperative analgesia on chronic pain after cesarean section. We also tried to identify risk factors for chronic pain after cesarean section. METHODS: A prospective randomized study was conducted among 443 patients who underwent elective or emergency cesarean section with different doses of hyperbaric bupivacaine 0.5% and opioids in spinal anesthesia, associated or not to non steroidal anti-inflamatory drugs. The groups were: G8SMA- 8mg hyperbaric bupivacaine + 2.5 mcg sufentanil + 100 mcg morphine; G10SMA- 10 mg hyperbaric bupivacaine + 2.5 mcg sufentanil + 100 mcg morphine; G12.5MA- 12.5 mg hyperbaric bupivacaine + 100 mcg morphine; G15MA- 15 mg hyperbaric bupivacaine + 100 mcg morphine; G12.5M- 12.5 mg hyperbaric bupivacaine + 100 mcg morphine (only in this group, non-steroidal anti-inflammatory drug was not used). Pain at rest and during movement were evaluated on the first two postoperative days using the verbal numerical rating scale. Perioperative, surgical and obstetric factors were investigated. Phone survey was conducted after three and six months to identify patients with chronic pain RESULTS: Incidences of chronic pain in groups were: G8SMA= 20%, G10SMA= 13%; G12.5MA= 7.1%; G15MA= 2.2% and G12.5M= 20.3 %. Patients with co-morbidities, and who had been more than 15 hours in labor before the cesarean (without analgesia) had more chance to have chronic pain than those who did not have pain. Patients who had higher pain scores on the two postoperative days were associated to chronic pain (p<0.05).!! CONCLUSION: The incidence of chronic pain decreases with higher doses of local anesthetic and the use of non-steroidal anti-inflammatory drugs. Patients who had higher pain scores in the immediate postoperative period were more likely to develop chronic pain. The only predictors of chronic pain were: previous history of disease, longer time in labor, intensity of postoperative pain and the use of lower doses of local anesthetic in spinal anesthesia

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Castillo, Daniela Lima Chow. "AnÃlise comparativa do perfil de seguranÃa e eficÃcia analgÃsica da S(+) cetamina com ou sem morfina na anestesia peridural para histerectomia abdominal." Universidade Federal do CearÃ, 2009. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4561.

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nÃo hÃ
A s(+)cetamina Ã o isÃmero levÃgiro da cetamina, antagonista do receptor NMDA para glutamato que estÃ envolvido na gÃnese e manutenÃÃo do processo doloroso. A analgesia multimodal consiste na utilizaÃÃo de combinaÃÃo de fÃrmacos objetivando controle adequado da dor com reduÃÃo dos efeitos adversos. O objetivo deste estudo foi avaliar a eficiÃncia da s(+)cetamina isoladamente e da associaÃÃo morfina/cetamina comparadas Ã morfina isoladamente combinadas a mistura enantiomÃrica de bupivacaÃna (R75l25%) na anestesia peridural e analgesia pÃs-operatÃria em pacientes submetidas Ã histerectomia abdominal. Foi realizado estudo prospectivo, duplo cego e aleatÃrio, com aprovaÃÃo do ComitÃ de Ãtica e Pesquisa da Universidade Federal do CearÃ. Participaram do estudo 36 pacientes ASA I ou II com idade de 20 a 60 anos submetidas Ã histerectomia abdominal com anestesia peridural. As pacientes foram alocadas em trÃs grupos: Grupo 1 - Grupo Cetamina (GC): administraÃÃo de mistura enantiomÃtrica (R75-S25) de bupivacaÃna associada Ã s(+)cetamina; Grupo 2 â Grupo Morfina (GM): administraÃÃo de mistura enantiomÃtrica (R75-S25) de bupivacaÃna associada Ã morfina e Grupo 3 - Grupo Cetamina/Morfina(GCM): administraÃÃo de mistura enantiomÃtrica (R75-S25) de bupivacaÃna associada Ã morfina e s(+)cetamina. Foram avaliados nÃvel de bloqueio motor e sensitivo, grau de sedaÃÃo e parÃmetros hemodinÃmicos: pressÃo arterial e frequÃncia cardÃaca a cada 15 minutos durante a cirurgia. No perÃodo pÃs-operatÃrio foi avaliado o consumo de analgÃsicos em 6 e 24 horas, alÃm da incidÃncia de nÃuseas, vÃmitos e prurido. A anÃlise estatÃstica foi realizada utilizando os softwares graphpad prisma 4.0 e Excel 2007. NÃo houve diferenÃa entre a idade, tempo cirÃrgico e o estado fÃsico (ASA) entre os grupos (p<0,05). A frequÃncia cardÃaca e pressÃo arterial mantiveram-se dentro dos valores estabelecidos como normal sem variaÃÃo significativa entre os grupos. A avaliaÃÃo da incidÃncia de efeitos adversos (nÃuseas, vÃmitos e prurido) nÃo foi diferente entre os grupos. A analgesia pÃs-operatÃria avaliada por consumo de analgÃsicos 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 adiÃÃo de s(+)cetamina e morfina nas doses avaliadas Ã segura, eficaz e permite a reduÃÃo de 50% na dose da morfina epidural mantendo-se o perfil de controle de dor no pÃs operatÃrio. No entanto, nÃo se verificou reduÃÃo da incidÃncia de nÃuseas, vÃmitos e prurido.
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. Bromageâs 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.

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Damico, Nicole K. "Factors That Predict Incident Reporting Behavior in Certified Registered Nurse Anesthetists." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3614.

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Improving patient safety through reduction of medical errors is a national priority. One of the strategies widely utilized to address this issue is the use of incident reporting systems. The purpose of this study was to describe factors that predict the likelihood that Certified Registered Nurse Anesthetists (CRNAs) will use incident reporting systems, guided by the theory of planned behavior (Ajzen, 1991). A non-experimental, correlational research design was utilized to achieve the study aims. Following IRB approval, a cross-sectional survey was administered electronically to a random sample of practicing CRNAs. Correlational analyses and a standard logistic regression were utilized to determine the relationship between cognitive factors and CRNAs' use of incident reporting systems. Two hundred and eighty-three practicing CRNAs participated in this study. These CRNAs value incident reporting, perceive social pressure to report, and feel in control over reporting, yet had not consistently used existing incident reporting systems in the past 12 months. A CRNA’s attitude toward reporting and the degree to which he or she perceived social pressure to report, were determined to be significant predictors of the likelihood that a CRNA would use an incident reporting system. Social pressure to report was the most important factor in the prediction model. The results of this study revealed that there are missed opportunities for learning from patient safety incidents in anesthesia practice. The information gained in this study has the potential to assist organizations in the design of strategies to promote incident reporting by practicing CRNAs.

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Mombachi, Verônica Santos. "Dexmedetomidina associada à ropivacaína em anestesia locorregional para analgesia trans e pós-operatória em procedimentos cirúrgicos de joelho em cães." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/127072.

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Bloqueios regionais periféricos têm sido frequentemente utilizados em uma variedade de procedimentos na rotina veterinária, para promover analgesia durante e após as cirurgias. Ropivacaína é um anestésico local de longa ação e farmacologicamente semelhante à bupivacaína, porém parece oferecer margem de segurança maior e menor cardiotoxicidade em comparação com a bupivacaína. A dexmedetomidina é um agonista α2-adrenérgico altamente seletivo para receptores α2. Estudos utilizando ratos como modelo experimental e diferentes doses de dexmedetomidina adicionada à bupivacaína ou ropivacaína, demonstraram prolongar a ação sensitiva e motora da anestesia periférica do nervo ciático. Em pacientes humanos, este efeito também foi comprovado. O presente trabalho testou a hipótese de que a dexmedetomidina associada à ropivacaína aumentaria o bloqueio sensitivo quando comparada à ropivacaína ou bupivacaína sem adjuvante, na anestesia periférica do membro pélvico de cães submetidos a cirurgias ortopédicas de joelho. Um total de 25 cães (três para estudo piloto) que foram submetidos a cirurgias de ruptura de ligamento cruzado cranial ou luxação de patela foram selecionados. Os dois principais nervos do plexo lombossacral (femoral e ciático) foram identificados através de neuroestimulação. 22 cães foram randomizados em um dos três grupos. No grupo ROPI (n=7) 0,2 ml.kg-1 de ropivacaína 0,75%, no grupo BUPI (n=7) 0,2 ml.kg-1 de bupivacaína 0,5% e no grupo ROPIDEX (n=8) 0,2 ml.kg-1 de ropivacaína 0,75% + dexmedetomidina 0,5 mcg.ml-1 de solução anestésica foram administrados. Inicio do bloqueio sensitivo, duração dos bloqueios, duração da analgesia e a estimativa de dor foram registrados. Características dos cães e tipo de cirurgia foram semelhantes entre os grupos. O inicio do bloqueio sensitivo foi similar entre os grupos (P= 0,102). A duração da ação sensitiva foi significativamente maior no grupo ROPIDEX (645 ±127,3 minutos) em comparação aos grupos ROPI (440±65,3 minutos) e BUPI (502±105,5 minutos) P= 0,004. O grupo ROPIDEX também teve a ação motora mais longa que o grupo ROPI (P= 0,035), 540±160 e 365±96 minutos respectivamente. A analgesia foi mais duradoura no grupo ROPIDEX (720 ±150 minutos) em comparação aos grupos ROPI (437±107 minutos) e BUPI (541±105 minutos) - P= 0,001. Não houve diferença significativa nas avaliações de dor entre os grupos nos momentos comparados. Um animal do grupo ROPIDEX apresentou bradicardia após a realização do bloqueio. Durante o período transanestésico o grupo ROPIDEX apresentou valores de pressão significativamente mais baixos nos momentos T3 e T5, mas nenhum paciente apresentou hipotensão. Bloqueio do membro contralateral foi observado em 1 caso (4,5%) no grupo ROPIDEX. Três pacientes (2 no grupo BUPI e 1nogrupo ROPIDEX ) tiveram que receber analgesia complementar com fentanil no período cirúrgico, 86% dos cães foi resgatado apenas após a recuperação total da anestesia local. Concluiu-se que o uso de dexmedetomidina associada à ropivacaína para a anestesia regional periférica dos nervos femoral e ciático prolonga a duração dos bloqueios sensitivo e motor e também da analgesia pós-operatória de procedimentos ortopédicos em joelhos de cães.
Peripheral nerve blocks are used frequently in a variety of procedures in veterinary practice for surgical anesthesia and postoperative pain. Ropivacaine is a local anesthetic with long duration, having similar pharmacology to bupivacaine; however, it has a wider safety margin and was shown to possess less cardiotoxicity in comparison with bupivacaine. Many additives to local anesthetics have been investigated in attempt to increase the duration of the block in order to improve postoperative pain. Dexmedetomidine is a α2-receptor agonist highly selective. Previous studies showed that different doses of dexmedetomidine enhanced the duration of sensory and motor blockade when added to bupivacaine and ropivacaine in a sciatic nerve block model in rat. In humans this results also has been reported. The present tested the hypothesis that dexmedetomidine added to ropivacaine, when compared to ropivacaine or bupivacaine alone, enhances the duraction of sensory blockade for peripheral femoral and sciatic nerve block for knee surgeries in dogs. 22 patients scheduled for elective hind limb surgery were divided into three goups in a randomized fashion. The two main nerves of the lumbosacral plexus (femoral and sciatic) were identified using neural stimulation. Pacients were assigned to one of the three group. In group ROPI (n=7) 0,2 ml.kg-1 of ropivacaine 0,75%, in group BUPI 0,2 ml.kg-1of bupivacaine 0,5% and in group ROPIDEX 0,2 ml.kg-1+0,5 mcg.ml-1of anesthetic solution were given. Sensory block onsetime, motor and sensory block duration and duration of analgesia were recorded. Demographic data and surgical characteristics were similar in all groups. Sensory block onset time were not different between groups (P= 0,102). Sensory block duration were longer in ROPIDEX group (645 ±127,3 minutes) than ROPI (440±65,3 minutes) or BUPI (502±105,5 minutes) (P= 0,004). Motor block duration were longer in ROPIDEX than ROPI (P= 0,035), 540±160 e 365±96 minutos respectively, but not differ from BUPI. Duration of analgesia was longer in ROPIDEX group (720 ±150 minutes) when compared to ROPI (437±107 minutes) or BUPI (541±105 minutes) (P=0,001). There were no different between pain score evaluation among groups. One dog had bradycardia after peripheral block with ROPIDEX and during the anesthetic period arterial pressure levels were lower at T3 and T5 moments, but without hypotension. Contralateral hind limb block was present in one case (4,5%)in ROPIDEX group. Three dogs needed additional analgesia (2 in BUPI and 1 in ROPIDEX) during surgery while 86% of patients received rescue analgesia only when totally recovered from local anesthesia. It was concluded that dexmedetomidine added to ropivacaine for lateral pre-iliac and paravertebral lumbosacral plexus block prolongs the duration the block and the duration of postoperative analgesia in dogs undergoing pelvic limbs orthopedic surgery.

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Mannarino, Rodrigo [UNESP]. "Determinação da taxa de infusão mínima de propofol e propofol associado a lidocaína em cães (Cannis familaris)." Universidade Estadual Paulista (UNESP), 2002. http://hdl.handle.net/11449/86635.

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

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Mannarino, Rodrigo. "Determinação da taxa de infusão mínima de propofol e propofol associado a lidocaína em cães (Cannis familaris) /." Botucatu : [s.n.], 2002. http://hdl.handle.net/11449/86635.

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

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Silva, Christiane Rodrigues da, (092) 98802-0128, and https://orcid org/0000-0002-7735-809X. "Estudo comparativo do uso de clonidina administrada por via venosa, versus subaracnóidea, em pacientes submetidos à colecistectomia videolaparoscópica." Universidade Federal do Amazonas, 2018. https://tede.ufam.edu.br/handle/tede/6719.

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BACKGROUND. Untreated pain leads to postoperative complications that prolong hospital stay. The association of analgesic drugs with different mechanisms of action, such as clonidine, allows the use of smaller doses of medication for better control of pain. OBJECTIVES. This dissertation aims to evaluate the use of multimodal analgesia in the control of postoperative pain in patients submitted to videolaparoscopic cholecystectomy (VLC); to compare the analgesic activities of intrathecal and intravenous clonidine for postoperative analgesia; to analyze the need for analgesic drugs in the immediate postoperative (tramadol / morphine) and to identify possible complications. METHOD. A prospective, randomized clinical trial was conducted with patients divided into three blocks, with 20 patients each one: Group I (n = 20) control, submitted to standard anesthesia; Group II (n = 20) intrathecal clonidine, submitted to standard anesthesia associated with the use of intrathecal clonidine; Group III (n = 20) intravenous clonidine, submitted to standard anesthesia associated with the use of intravenous clonidine. RESULTS. The pain scores between the groups did not present significant differences, but a greater analgesic need was observed in the control group (p = 0.005), as well as a higher incidence of nausea and vomiting (p = 0.240), probably due to side effects of morphine as rescue medication. Groups II and III presented a significant reduction of heart rate (p ˂ 0.001), but without clinical repercussion. CONCLUSIONS. In patients undergoing VLC there is evidence that the perioperative administration of alpha 2-agonists preserves hemodynamic stability, decreases opioid consumption and the incidence of nausea and vomiting in the postoperative.
JUSTIFICATIVA. A dor não tratada leva a complicações pós-operatórias que prolongam o tempo de internação hospitalar. A associação de fármacos analgésicos com diferentes mecanismos de ação, como a clonidina, permite usar doses menores de medicamentos para melhor controle da dor. OBJETIVOS. Esta dissertação tem por objetivo avaliar o emprego de analgesia multimodal no controle da dor pós-operatória de pacientes submetidos à colecistectomia por videolaparoscopia (CVLP); comparar as atividades analgésicas da clonidina intratecal e endovenosa para analgesia pós-operatória; analisar a necessidade de drogas analgésicas no pós-operatório imediato (tramadol/morfina) e identificar possíveis complicações. MÉTODO. Foi realizado um estudo de ensaio clínico prospectivo, experimental e randômico, com os pacientes divididos em 03 blocos, com 20 pacientes cada: Grupo I (n=20) controle, submetido à anestesia padrão; Grupo II (n=20) clonidina intratecal, submetido à anestesia padrão associada ao uso de clonidina intratecal; Grupo III (n=20) clonidina endovenosa, submetido à anestesia padrão associada ao uso de clonidina endovenosa. RESULTADOS. Os escores de dor entre os grupos não apresentaram valores com diferenças significativas, porém foi observada maior necessidade analgésica do uso da morfina no grupo controle (p = 0,005), assim como maior incidência de náuseas e vômitos (p=0,240), provavelmente devido aos efeitos colaterais da morfina como medicação de resgate. Os grupos II e III apresentaram uma redução significativa da frequência cardíaca (p ˂0,001), porém sem repercussão clínica. CONCLUSÕES. Nos pacientes submetidos à CVLP há evidências de que a administração perioperatória de alfa 2-agonistas preserva a estabilidade hemodinâmica, diminui o consumo de opióides e a incidência de náuseas e vômitos no pós-operatório.

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Gasiūnaitė, Diana. "Bendrosios ir kombinuotos anestezijos metodų palyginimas pacientams, kuriems atliekamos storosios žarnos laparoskopinės operacijos." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130930_092326-27467.

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Disertacijoje analizuojama ir lyginama bendrosios endotrachėjinės ir kombinuotos endotrachėjinės epiduralinės anestezijos įtaka atskiroms organų sistemoms ir tas sistemas apibūdinantiems rodikliams laparoskopinių kolorektalinių operacijų metu. Darbe nagrinėjama dviejų perioperacinių skausmo malšinimo būdų įtaka hemodinamikos ir kvėpavimo sistemos parametrų kitimo tendencijoms, pacientų trachėjos ekstubacijos laikui, žarnyno motorikos atsinaujinimo greičiui, hospitalizacijos trukmei bei organizmo uždegiminiam atsakui. Laparoskopinės storosios žarnos rezekcinės operacijos, net ir būdamos minimaliai invazinės dėl laparoskopinės operacijos technikos, sužadina stresinį organizmo atsaką bei uždegimo mediatorių išskyrimą. Perioperacinis skausmo valdymas taip pat gali daryti įtaką imuniniam atsakui. Disertacijoje nagrinėjama epiduralinės analgezijos metodo įtaka organizmo stresiniam atsakui tiriant kortizolio kiekio kitimus ir interleukino-6, kaip vieno pagrindinių uždegimą skatinančių citokinų, koncentracijos kitimą taikant epiduralinę analgezijos metodiką. Gauti rezultatai parodė, kad analgezijai pasitelkiant epiduralinį skausmo malšinimo metodą, perioperacinis pacientų skausmo valdymas ir pasitenkinimas yra geresnis, trachėjos ekstubacijos laikas patikimai trumpesnis, žarnyno peristaltikos atsitaisymas ankstyvesnis, sukeliamas stresinis organizmo atsakas mažesnis (mažesnis kortizolio koncentracijos padidėjimas) ir nenustatyta komplikacijų padaugėjimo.
The doctoral dissertation analyses and compares general endotracheal and combined endotracheal epidural anesthesia’s impact on organ systems and describes the systems parameters in laparoscopic colorectal surgery. Comparing two perioperative analgesia techniques used in laparoscopic colorectal surgery the hemodynamic and respiratory parameters trends; the impact of anesthesia and postoperative analgesia methods on patients’ tracheal extubation time, intestinal motility recovery rate, duration of hospitalization and inflammatory response have been determined. Laparoscopic colorectal resection, even being a minimally invasive technique for laparoscopic surgery, stimulates the body's response to stress and pro-inflammatory mediator’s secretion. Perioperative pain management may also influence the immune response. The doctoral dissertation analyses the impact of epidural analgesia method on the body stress response, investigating variations of cortisol and interleukin-6 levels. The results showed that analgesia and patient satisfaction using epidural analgesia method for perioperative pain management were better. Tracheal extubation time was significantly shorter. Recovery of intestinal motility using epidural analgesia was significant and much prior than using intravenous analgesia. The use of epidural analgesia in laparoscopic colorectal surgery caused less stress response – less cortisol levels increase. It has not showed the increase in number of complications.

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Lumpkins, Logan, and Craig Wassinger. "Effects of Lower Extremity Aerobic Exercise and Conditioned Pain Modulation on Evoked Shoulder Pain." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/434.

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Background: Emerging evidence suggests that aerobic exercise and conditioned pain modulation may be advocated in treating patients with musculoskeletal pain. The effects of lower extremity aerobic exercise and conditioned pain modulation on evoked shoulder pain are not known. Purpose: To determine the acute effects of lower extremity aerobic exercise and conditioned pain modulation on outcomes of evoked shoulder pain from pain pressure threshold measurements. Study Design: Repeated measures. Methods: Thirty (30) healthy volunteers were tested over the course of two sessions. Session 1 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a conditioned pain modulation with cool water. Session 2 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a bout of lower extremity aerobic exercise on a recumbent stepper apparatus. Results: Pain pressure threshold was not significantly influenced by the conditioned pain modulation using cool water (p=0.725). Pain pressure threshold was significantly increased immediately following the lower extremity exercise session (P<0.001). Conclusion: Conditioned pain modulation with cool water did not produce any significant changes in pain pressure threshold. Lower extremity aerobic exercise acutely increased pain pressure threshold in participants with experimentally induced shoulder pain. Physical therapists may consider lower extremity aerobic exercise to produce short-term hypoalgesic effects and facilitate the application of more active interventions.

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Santos, Luciana Moraes dos. "Morfina subaracnóidea associada à anestesia geral para revascularização miocárdica: efeitos sobre a função respiratória, a analgesia, o consumo de morfina e seus níveis plasmáticos no pós-operatório." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-25062009-094224/.

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INTRODUÇÃO: Existem poucas evidências de benefícios da analgesia regional na disfunção respiratória observada no pós-operatório (PO) de cirurgia cardíaca. Os objetivos deste estudo foram avaliar os efeitos da morfina intratecal sobre a função respiratória, a analgesia, o consumo de morfina e seus níveis plasmáticos no PO de pacientes submetidos à anestesia geral para revascularização do miocárdio (RM). MÉTODOS: Foram estudados 42 pacientes submetidos à RM com circulação extracorpórea e randomizados para receberem anestesia geral associada ou não a morfina intratecal na dose de 400 g (grupo controle, n=22 e grupo morfina, n=20). A anestesia geral foi padronizada com sufentanil e isoflurano e no PO imediato, instalou-se dispositivo de analgesia controlada pelo paciente, com bolus de 1 mg, em livre demanda e dipirona se necessário. Com espirômetro digital, avaliou-se a capacidade vital forçada (CVF), o volume expiratório forçado no primeiro segundo (VEF1), a relação VEF1/CVF e, pela análise da gasometria artérial, calculou-se a relação PaO2/FIO2 no pré-operatório, primeiro e segundo dias de PO. A intensidade da dor, avaliada com escala visual numérica (0-10), o número de solicitações e o consumo de morfina venosa, assim como seus níveis plasmáticos, foram avaliados até 36 horas de PO. A análise estatística consistiu de análise de variância para medidas repetidas e teste de Mann-Whitney, considerando-se significativo p<0,05. RESULTADOS: Em ambos os grupos houve redução da CVF (grupo controle=1,45 L e 1,38 L, grupo morfina= 1,18 L e 1,26 L no primeiro e segundo dias de PO, respectivamente), sem diferença entre os mesmos (p=0,06). Não foram observadas diferenças entre os grupos no VEF1 (p=0,085), nas relações VEF1/CVF (p=0,68) e PaO2/FiO2 (p=0,08) nos tempos avaliados. O grupo morfina apresentou valores significativamente menores de dor no repouso e inspiração profunda e, principalmente, durante a tosse após 18 horas (grupo controle=4,73 e grupo morfina=1,80, p=0,001), 24 horas (grupo controle=4,41 e grupo morfina=1,40, p=0,022) e 36 horas (grupo controle=3,09 e grupo morfina=1,55, p=0,015) de PO. Observou-se redução do consumo cumulativo de morfina venosa após 18 horas (grupo controle=20,14 mg e grupo morfina=14,10 mg, p=0,037) e 24 horas de PO (grupo controle= 27,8 mg e grupo morfina= 13,55 mg, p=0,028). Após 24 horas de PO, o grupo que recebeu opióide intratecal apresentou menores níveis plasmáticos de morfina (grupo controle=16,41 ng/mL e grupo morfina=4,08 ng/mL, p=0,029). CONCLUSÕES: O efeito central da morfina intratecal não minimizou a disfunção respiratória mas promoveu redução da intensidade da dor, com diminuição do consumo venoso e menores níveis plasmáticos de morfina no PO de pacientes submetidos à cirurgia de RM.
BACKGROUNDS: Few evidence exists on beneficial effects of intrathecal analgesia in lung dysfunction observed in postoperative (PO) of cardiac surgery. The objective of this study was to evaluate the effects of intrathecal morphine on pulmonary function, analgesia, morphine consumption and plasma morphine levels in PO of patients undergoing coronary artery bypass graft surgery (CABG). METHODS: Were studied 42 patients undergoing on-pump CABG randomized (control group, n=22 and morphine group, n=20) to receive general anesthesia with or not 400 g of intrathecal morphine. Anesthesia was standardized and in immediate PO, patients received a patient controlled-analgesia pump, 1 mg bolus of morphine, free demand and dipirone if necessary. Forced vital capacity (CVF), expiratory forced volume in first second (EFV1) and EFV1/FVC ratio were measured using spirometry and arterial blood samples obtained preoperatively, in first and second PO days. Intensity of pain, evaluated using visual numeric scale (0-10), morphine solicitation and consumption and plasma morphine levels were evaluated until 36 hours of PO. Statistical analysis was done with repeated measures analysis of variance and Mann-Whiney test (*p<0.05). RESULTS: Both groups had reduction of FVC in PO (control group=1.45 L and 1.38 L, and morphine group=1.18 L and 1.26 L, respectively in first and second PO (p= 0.06) without differences between them. There were no differences in EFV1 (p=0.085), VEF1/CVF (p=0.68) and PaO2/FiO2 ratio between groups (p=0.08). In morphine group was observed reduction in intensity of pain at rest and profound inspiration but most significatively at cough after 18 hours PO (control group=4.73 and morphine group=1.80, p=0.001), 24 hours (control group=4.41 and morphine group=1.40, p=0.022) and 36 hours (control group=3.09 and morphine group=1.55, p=0.015). Was observed reduction in morphine consumption after 18 hours PO (control group=20.14 mg and morphine group=14.10 mg, p=0.037) and after 24 hours (control group=27.8 mg and morphine group= 13.55, p=0.028). After 24 hours of PO, morphine group has reduced plasma morphine levels (control group=16,41 ng/mL and morphine group=4.08 ng/mL, p=0.029). CONCLUSIONS: Central neuraxial effect of morphine did not reduced postoperative pulmonary dysfunction but promoted better postoperative analgesia, reducing pain scores, venous morphine consumption and lower plasma morphine levels in CABG.

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Hansen, Emma. "Alternativ till obedövad kastrering av smågrisar : - Ur ett ekonomiskt och djurhälsomässigt perspektiv." Thesis, Halmstad University, School of Business and Engineering (SET), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-4501.

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This degree project aims to evaluate alternative methods to the unanaesthetized castration of piglets. Castration of piglets is performed to prevent the development of boar taint. Boar taint can cause great financial losses for the pig manufacturer. Unanaesthetized castration of piglets is not regarded to be satisfactory from an animal welfare perspective and the procedure will for that reason be outlawed in the near future.

Several alternative methods are used in countries all over the world with promising result. The purpose of this study is to evaluate if this methods could be applied in Swedish pig production.

A literature study has been combined with interviews; field studies, questionnaires and a small study on male pig production.

To be applicable to and applied in Swedish pig production the alternative method must be financially accepted by the manufacturers but also accepted from an animal welfare perspective.

Castration is the only way to guarantee a meat free of boar taint. Therefore the conclusion of this study is that the best result is achieved by a combination of anesthesia in combination with analgesia. This is the most inexpensive alternative which also causes the piglet the least amount of distress.

Examensarbetet har genomförts med syftet att undersöka och utvärdera alternativa metoder till dagens obedövade kastrering av smågrisar. Kastrering utförs för att motverka att hangrisarna utvecklar så kallad galtlukt som kan medföra stora ekonomiska förluster för grisproducenten. Dagens kirurgiska kastrering kommer att förbjudas inom den närmaste framtiden eftersom ingreppet inte anses djurhälsomässigt acceptabelt.

Flera av metoderna tillämpas idag på besättningar runt om i världen på ett välfungerande vis och syftet var att undersöka om dessa alternativ skulle fungera i den svenska grisproduktionen.

Arbetet har utförts med hjälp av en litteraturstudie som kompletterats med intervjuer, studiebesök, frågeformulär, enkätundersökning och ett mindre genomfört försök med hangrisuppfödning.

För att anses som lämplig måste den alternativa metoden vara acceptabel både ur ett ekonomiskt och djurhälsomässigt perspektiv. Detta för att kunna tillämpas i den svenska grisproduktionen.

Det enda sätt som garanterar att galtlukt inte förekommer i köttet är kastrering. Därför är slutsatsen av utvärderingen är att metoderna lokalbedövning i kombination med smärtlindring i samband med kastrering är det bästa alternativet. Detta eftersom det är ett av de billigaste alternativen som dessutom ger bäst bedövning och smärtlindring för grisen.

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Bedin, Antonio. "A duloxetina como analgésico reduz o consumo de opioides após cirurgia de coluna, estudo duplo encoberto, aleatório e controlado." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-04012018-093145/.

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Introdução: a analgesia multimodal é amplamente usada para o controle da dor perioperatória em um esforço para reduzir o uso de opioides. A duloxetina é um inibidor seletivo da recaptação da serotonina e noradrenalina com eficácia para estados de dor crônica. O objetivo principal deste estudo foi avaliar a eficácia de duas doses orais de 60 mg de duloxetina em termos de consumo de fentanil durante o período pós-operatório em pacientes submetidos à cirurgia eletiva de artrodese de coluna lombar. Método: este estudo foi um ensaio clínico prospectivo, duplo encoberto, aleatório e controlado com placebo. Os pacientes receberam 60 mg de duloxetina ou placebo idêntico uma hora antes da cirurgia e 24 horas depois. Os sujeitos do estudo foram divididos em dois grupos: grupo C (controle) de indivíduos que receberam o placebo; e grupo D (duloxetina) de indivíduos que receberam 60 mg de duloxetina. O consumo total de fentanil administrado pelo próprio paciente em 24 e 48 horas após a cirurgia foi mensurado. Os desfechos secundários foram os escores de dor e a presença ou ausência de efeitos adversos, tais como cefaleia, náuseas, vômitos, prurido, tonturas e sonolência. Resultados: as características demográficas não diferiram entre os grupos. Houve uma diferença significativa no consumo de fentanil nas primeiras 24 horas entre os grupos C e D (diferença média, 223,11 ± 39,32 ?g; p < 0,001). O consumo de fentanil também diferiu entre os grupos C e D após 48 horas (diferença média, 179,35 ± 32,55 ug; p < 0,00). Os escores de dor em mais de 48 horas não diferiram significativamente entre os grupos. A incidência de efeitos colaterais foi semelhante nos dois grupos. Conclusão: a duloxetina foi associada à redução do consumo de fentanil no pós-operatório de cirurgias sobre a coluna lombar, portanto, sendo eficaz como adjuvante para a analgesia pós-operatória e redução do consumo de opioides
Background: Multimodal analgesia is widely advocated for the control of perioperative pain in an effort to reduce the use of opioids. Duloxetine is a selective serotonin and noradrenaline reuptake inhibitor with efficacy for chronic pain states. The main objective of this study was to evaluate the efficacy of two oral doses of 60 mg duloxetine in terms of fentanyl submitted to elective lumbar spine arthrodesis surgery. Method: This study was prospective, double blind, randomized, and placebo controlled clinical trial. Patients received duloxetine 60 mg or identical placebo one hour before surgery and 24 hours later. The study subjects were divided into two groups: group C (control) of subjects who received placebo; and group D (duloxetine) from subjects received 60 mg. The total fentanyl consumption by the patient himself at 24 and 48 hours after surgery was measured. Secondary outcomes were pain scores and the presence or absence of adverse effects such as headache, nausea, vomiting, pruritus, dizziness and drowsiness. Results: Demographic characteristics did not differ between groups. There was a significant difference in fentanyl consumption in the first 24 hours between groups C and D (mean difference, 223.11 ± 39.32 ?g; p < 0.001). Fentanyl consumption also differed between groups C and D after 48 hours (mean difference, 179.35 ± 32.55 ?g; p < 0.00). Pain scores in more than 48 hours did not differ significantly between groups. The incidence of side effects was similar in both groups. Conclusion: Duloxetine was associated with reduction of fentanyl consumption in the postoperative period of surgeries on the lumbar spine, therefore, it was effective as adjuvant for postoperative analgesia and reduction of opioid consumption

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Silva, Flávia Augusta de Orange Lins da Fonseca e. "Anestesia combinada para parto vaginal e temperatura materna intraparto : ensaio clínico randomizado." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311731.

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Orientadores: Renato Passini Junior, Melania Amorim
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: o uso de analgesia peridural durante o parto está associado ao aumento da temperatura corporal materna e risco de febre, sem sinais de infecção. No entanto, a associação desses achados com a técnica combinada (raquidiana e peridural - AC) permanece desconhecida. O objetivo deste estudo foi determinar a associação entre analgesia combinada e temperatura materna intraparto. Métodos: foi realizado um ensaio clinico randomizado, aberto, incluindo 70 parturientes das quais 35 receberam AC e 35 receberam apenas métodos não-farmacológicos para alívio da dor do parto. Calculou-se o risco de aumento da temperatura materna intraparto e febre materna, além de outros desfechos maternos e perinatais, de acordo com a realização ou não de AC. Os dados foram analisados utilizando-se o X2 ou teste exato de Fisher para as variáveis categóricas e, para as variáveis numéricas o teste t de student ou Mann Whitney, de acordo com a distribuição de Gauss. Considerou-se o nível de significância de 5%. Resultados: a temperatura materna foi signicativamente maior no grupo que recebeu analgesia combinada sendo que cinco (14,%), desenvolveram febre intraparto. Nenhuma sãs parturientes que receberam métodos não farmacológicos para alívio da dor apresentou febre intraparto (p=0,027). Dentre as parturientes que apresentaram febre, nenhuma recebeu antibioticoterapia ou foi submetida a investigação para infecção materna, evoluindo sem intercorrências. Não foram verificados casos de corioamnionite ou outras formas de infecção materna ou neonatal. Conclusão: o uso de analgesia combinada está associado a aumento significativo da temperatura materna intraparto e da incidência de febre materna, mas isto não parece produzir efeitos maternos e neonatais desfavoráveis
Abstract: Background: the use of epidural anesthesia during labor is associated with an increased maternal body temperature and risk of fever, albeit with no signs of infection. Nevertheless, the association between maternal fever and combinedspinal and epidural (CSE) anesthesia remains unknown. The objective of the present study was to determine the association between combined analgesia and maternal intrapartum temperature. Methods: A randomized, open clinical trial was performed with 70 pregnant women, 35 of whom received CSE, while the remaining 35 received only nonpharmacological methods of pain relief during labor. The risks of an increase in maternal intrapartum temperature and fever were calculated together with other maternal and perinatal outcomes according to whether CSE was given or not. The data were analyzed using the chi-square test or Fisher's exact test for categorical variables, and Student's ttest or the Mann-Whitney test for numerical variables, in accordance with the Gauss distribution. Significance level was defined as 5%. Results: Maternal temperature was significantly higher in the group receiving combined anesthesia. Of the 35 women in this group, five (14%) developed intrapartum fever, while no cases of fever were detected in the group receiving only onpharmacological methods of pain relief (p=0.027). Nevertheless, none of the women who developed fever received antibiotics or was submitted to further investigation for maternal infection and all progressed without complication. No cases of chorioamnionitis or any form of maternal or neonatal infection were detected. Conclusions: The use of CSE is associated with a significant increase in maternal intrapartum temperature and in the incidence of maternal fever; however, the increase in maternal temperature does not appear to result in any deleterious effects on the mother or child
Doutorado
Ciencias Biomedicas
Doutor em Tocoginecologia

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Valinétti, Emilia Aparecida. "Efeito da bupivacaína racêmica e da mistura enantiomérica de bupivacaína associadas ou não com a clonidina, para anestesia caudal em crianças." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-07102014-104430/.

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Este é um estudo clínico, prospectivo, aleatório, e duplamente encoberto realizado em 40 crianças submetidas a cirurgia infra-umbilical de pequeno porte, sob anestesia epidural sacra realizada com a mistura enantiomérica de bupivacaína (S75R25) comparada com a bupivacaína racêmica (SR50) isoladas ou em associação com a clonidina. O objetivo foi avaliar a duração do bloqueio motor e sensitivo, o consumo de sevoflurano e as variações da pressão arterial sistólica (PAS) e freqüência cardíaca (FC). O bloqueio motor foi avaliado pela escala de Bromage, durante o período de oito horas de observação no pós-operatório. A analgesia foi avaliada pelos escores obtidos com escala objetiva para análise da dor e a duração da analgesia foi considerada como o tempo entre a administração do anestésico local no espaço epidural sacro e a primeira dose de analgésico administrado. Os resultados obtidos foram submetidos à análise estatística onde p< 0,05 foi considerado significante. Os resultados mostraram que houve aumento significativo do bloqueio motor somente na primeira hora quando a bupivacaína SR50 foi associada a clonidina, mas não ocorreu o mesmo com a bupivacaína S75R25. Em relação a analgesia não houve diferença significante entre a bupivacaína SR50 e a bupivacaína S75R25 associadas ou não à clonidina. Não houve diferença significativa no consumo de sevoflurano entre os grupos estudados quando a clonidina foi associada aos anestésicos. Os valores da PAS e FC no pós-operatório, nos grupos onde a clonidina foi associada com ambos anestésicos locais, foram inferiores em todos os momentos de avaliação, porém sem significância estatística
This is a prospective, randomized double-blind clinical trial performed in 40 children using an enantiomeric mixture of bupivacaine (S75R25) compared to racemic bupivacaine SR50 plain or associated with clonidine, to caudal blockade. The aim of this study was to investigate the motor and sensitive block, sevoflurane requirement, blood pressure (PAS) and heart rate (FC) in children scheduled to sub-umbelical surgeries. The motor block was evaluated by Bromage scale for eight hours during the postoperative period. The analgesia was evaluated postoperatively for eight hours by an objective pain scale and the analgesia duration was taken as the time between the local anesthetic administration into epidural space and the first analgesic rescue. The results obtained were submitted to statistical analysis test where p< 0,05 was considered significant. There was a significant increase in the motor block at first hour on postoperative period when bupivacaine SR50 was associated to clonidine, but it did not occurr with the enantiomeric mixture of bupivacaine S75R25. There was no difference between bupivacaine SR50 and bupivacaine S75R25 associated or not to clonidine regarding to analgesia duration. There was no difference in the requirement of sevoflurane between groups in spite of the clonidine admixture to the local anesthetics. There was an absolut decrease in the PAS and FC values on the postoperative evaluation, but it was not statistically significant

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Pretto, Giorgio. "Avaliação dos efeitos psíquicos, hemodinâmicos e da qualidade da analgesia, relacionados ao uso combinado de clonidina, S+ cetamina e midazolam durante a realização de curativos ou debridamentos cirúrgicos em pacientes grandes queima." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-24102014-101638/.

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INTRODUÇÃO: A clonidina é um agonista seletivo do receptor adrenérgico alfa2 com propriedades sedativas, analgésicas e possibilita a redução do consumo de outros anestésicos. Suas ações podem mitigar o impacto hemodinâmico e psíquico da S+ Cetamina. Os grandes queimados são de difícil manejo e ainda não existe uma técnica anestésica padrão para estes pacientes, sendo a cetamina amplamente utilizada nestes pacientes em regimes muito variados, apresentando várias vantagens. Os objetivos do estudo foram avaliar os efeitos hemodinâmicos e psíquicos da interação da clonidina e da S+ cetamina e propor uma técnica anestésica para grandes queimados. MÉTODOS: O estudo foi prospectivo, duplo encoberto, aleatório e placebo controlado, planejado para 48 pacientes adultos grandes queimados, estado físico ASA II ou III, que foram agendados para trocas de curativos ou debridamentos cirúrgicos. Para a anestesia foi usado midazolam 0,07mg/kg e duas doses de 1 mg/kg de S+ cetamina. No Grupo Clonidina foi usada a dose de 2 mcg/kg e soro fisiológico no Grupo Placebo. Foram avaliadas as alterações hemodinâmicas durante o intra-operatório. Durante as duas primeiras horas foram avaliadas detalhadamente as alterações psíquicas utilizando 13 variáveis, o retorno da consciência, a analgesia e a ocorrência de complicações. Após 24 horas foram avaliadas a analgesia, a ocorrência de sonhos e delírios. RESULTADOS: O Grupo Clonidina apresentou redução estatisticamente significativa nas pressões arteriais durante o procedimento. Dentre as 13 variáveis psíquicas analisadas, 5 foram menores com significância estatística no Grupo Clonidina durante a avaliação de 30 minutos, incluindo Corpo, Arredores, Pensamento, Sonolento e Ansioso. Na avaliação de duas horas, apenas a variável Ansioso teve redução estatisticamente significativa no Grupo Clonidina. A frequência cardíaca, a ocorrência de delírio e sonhos e a analgesia pós-operatória foram similares nos dois grupos. Não houve diferença entre os grupos na ocorrência de complicações. CONCLUSÃO: O uso de Clonidina em anestesia para pacientes grandes queimados, com S+ cetamina e midazolam reduz as pressões arteriais durante o procedimento e os efeitos psíquicos, sem aumentar a ocorrência de complicações
Abstract: Clonidine is a selective alpha2-adrenoceptor agonist with sedative, analgesic and anesthetic sparing properties. Because of its sympathoinhibitory activity, it may reduce the hemodynamic and psychic effects of S+ ketamine and improve analgesia. The ketamine is commonly used in burned patients worldwide. The objectives of this study were to evaluate the interactions between clonidine and ketamine in hemodynamic and psychic effects and also to propose an anesthetic technique for major burned patients. Method: A prospective, double-blind, placebo controlled study designed for 48 patients with major burns, aged 18-60 years, physical status ASA II or III, that were scheduled for dressing changes and wound debridements. For the anesthesia was used midazolam 0,07mg/kg, two doses of S+ ketamine 1 mg/kg, placebo or clonidine 2mcg/kg. Intraoperative hemodynamic alterations over time were assessed. During the first two hours after the procedures were evaluated, psychic effects in detail using 13 variables, the return of conscience, analgesia, dreaming and delirium and after 24 hours, analgesia, dreaming and delirium. Results: The Clonidine Group had low arterial pressure during the procedure. At the 30 minute evaluation of the psychic variables 5 out of 13 were lower in the Clonidine Group with statistically significance, these being Body, Surroundings, Thoughts, Drowsy and Anxious. At the 2 hour evaluation only the Anxious variable was lower in the Clonidine Group with statistically significance. Cardiac frequency, postoperative analgesia, occurrence of delirium and dreaming weren\'t different between both groups. There wasn\'t any difference in complication rates between both groups. Conclusion: We concluded that the use of Clonidine in S+ ketamine plus midazolam anesthesia in patients with major burns reduces the arterial pressures and the postoperative psychic effects, without increasing the complications

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Ledin, Eriksson Susanne. "Central-block techniques for relief of labour pain /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-911-0/.

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