Therapeutic study - level III.

No abstract

RESUMO Objetivou-se avaliar os efeitos fisiológicos e sobre o consumo do propofol, relativos à anestesia epidural com levobupivacaína isolada ou associada a diferentes doses de tramadol. Para tal, 18 cadelas foram pré-tratadas com acepromazina, utilizando-se propofol para indução e manutenção anestésicas. Conforme o protocolo epidural instituído, formaram-se três grupos (n=6) tratados com levobupivacaína isolada (1,5mg/kg) (GL) ou acrescida de 2mg/kg (GLT2) ou 4mg/kg (GLT4) de tramadol, respectivamente. As fêmeas foram submetidas à mastectomia e à ovário-histerectomia (OH), registrando-se as variáveis fisiológicas nos períodos pré (TB e T0) e transanestésicos (T10 a T70), bem como a taxa mínima de propofol necessária. Houve redução da FC para o GL e o GLT4 em relação ao GLT2 (T30 a T70), detectando-se, no GL, redução da PAS e da PAD em relação ao TB. Maiores taxas de infusão do propofol foram necessárias para o GL (0,70±0,12mg/kg/min) em relação ao GLT2 (0,50±0,19mg/kg/min) e ao GLT4 (0,50±0,19mg/kg/min). Conclui-se que o tramadol potencializou o propofol, ao ofertar analgesia, independentemente da dose administrada. Todos os protocolos testados foram seguros e eficazes em cadelas submetidas à mastectomia e à OH.

Background: Mammary tumors are the most common neoplasms in female dogs. Surgical removal of the mammary gland chain is considered the standard treatment and is usually performed along with ovariohysterectomy (OH) to suppress ovarian hormonal influence. Mastectomies cause moderate to severe pain and require preferential multimodal analgesic protocols. The aim of this study was to compare the postoperative analgesic efficacy and the recovery times on female dogs undergoing mastectomies and OH between those treated with epidural levobupivacaine alone and those treated with associated doses of tramadol and anesthetized with propofol. Materials, Methods & Results:Eighteen female dogs were pretreated with acepromazine (0.03 mg/kg), using propofol (4 mg/kg) for induction and anesthesia maintenance. The dogs were randomly divided into three groups (n = 6) treated with epidural anesthesia with levobupivacaine alone at 1.5 mg/kg (GL) or associated with tramadol at doses of 2 mg/kg (GLT2) or 4 mg/kg (GLT4). After anesthesia, the mean propofol infusion rate for each group were calculed. During the postoperative period, the degree of analgesia according to the University of Melbourne Pain Scale for 6 hours were determined, considering seven time points for evaluation (M30, M60, M90, M120, M180, M240, and M360). Supplemental analgesia with morphine (0.5 mg/kg) to those dogs with scores ≥13 were provided. During the recovery period, the time intervals between the end of anesthesia, and the following events: extubation (EX), the first head movement (MC), and the establishment of sternal (PE) and quadrupedal (PQ) positions were measured. Data were subjected to the Friedman test for analysis of non-parametric variables within the same group and to the Mann-Whitney test for independent variables, comparing the mean scores between groups (statistical significance was set at P < 0.05). In the GL group, a higher mean propofol infusion rate than in either the GLT2 or GLT4 groups were found. The EX, PE, and PQ times were similar between the groups with a lower MC interval (P = 0.041) for dogs in the GLT2 group. The pain assessment revealed higher scores for dogs in the GL group than for those in the GLT4 group (M30 to M120 and M360). Over time, the initial scores increased after M90 (GL group) and after M120 (in all groups) and additional analgesia were required only in GL dogs. Discussion: Mammary tumors were more frequent in middle-aged and elderly female dogs, corroborating current literary data. Regarding anesthesia recovery, no differences in the time for extubation and sternal and quadrupedal positions were found, probably due to similar propofol infusion times and to similar metabolism among the dogs, independent of the higher mean infusion rates used in the group treated only with the local anesthetic. The post-surgical analgesic evaluation revealed lower pain scores in the groups in which tramadol was associated with levobupivacaine, in agreement with studies reporting its analgesic potential to approach surgical pain at doses...

Discussão: Na nossa revisão a taxa de sucesso terapêutico encontra-se dentro do esperado, com uma percentagem de falência inferior ao descrito na literatura. Apresentamos a instilação intrapleural de fibrinolítico e a toracoscopia videoassistida num mesmo protocolo de atuação, tendo como primeira linha terapêutica o fibrinolítico. Conclusão: A opção terapêutica apresentada teve uma baixa taxa de falência e permitiu evitar um procedimento cirúrgico mais agressivo. Consideramos que esta é uma opção de tratamento eficaz e que, na nossa amostra, cursou com uma baixa taxa de sequelas. Palavras-chave: Derrame Pleural; Empiema Pleural; Fibrinolíticos. ABSTRACT Introduction:The treatment of complicated pleural parapneumonic effusions with intrapleural instillation of fibrinolytics, has shown similar results as surgical treatment. The present study aimed to evaluate the results of the use of intrapleural instillation of fibrinolytics in the treatment of complicated pleural parapneumonic effusions, in patients followed in our hospital. Material and Methods:A retrospective review of all the patients (aged between one month and 18 years) diagnosed with complicated parapneumonic effusions, which had chest drain insertion with intrapleural instillation of fibrinolytic, between January 2005 and December 2013, was undertaken.Results: A total of 37 patients were identified. Mean duration of hospital stay was 17 ± 7.60 days. Chest drain was placed in the first 48 h of hospital admission in most of the patients (89.2%), with a mean of six days of drainage. Treatment failure was reported in 2.7% of cases and was related with effusion recurrence. This patient underwent video-assisted thoracoscopic surgery with the need to convert to open thoracotomy. A favorable outcome was achieved in 96.9 % of cases. Discussion: In our review, therapeutic success rate was as expected, with a failure rate below those reported in literature. We present intrapleural instillation of fibrinolytics and video-assisted thoracoscopic surgery as part of the same protocol, in which fibrinolytic therapy is the first-line treatment. Conclusion:The therapeutic option presented shows a low failure rate and avoids a more aggressive surgical procedure. We consider this an effective treatment option, with low sequelae rate.