EFEITO ANTINOCICEPTIVO DA ANESTESIA LOCAL POR TUMESCÊNCIA EM CADELAS SUBMETIDAS À MASTECTOMIA COMPLETA BILATERAL

A técnica de anestesia local por tumescência (ALT) emprega grande volume de uma solução com baixa dose de anestésico local para dessensibilizar extensas áreas corporais. Este estudo avaliou o efeito da ALT em 32 cadelas submetidas à mastectomia completa bilateral que foram aleatoriamente distribuídas em quatro grupos. Todos os animais foram pré-medicados com acepromazina, midazolam e morfina; indução com propofol; isoflurano na manutenção anestésica. Em G1 (n=8), não foi realizado nenhum bloqueio locorregional. Em G2 (n=8), realizou-se ALT, sendo que cada paciente recebeu 7 mL/kg (SC) de uma solução com 20 mL de lidocaína 2% e 0,5 mL de adrenalina 1:1000 diluídos em 250 mL de ringer lactato. Em G3 (n=8), realizou-se a mesma técnica de ALT, todavia aplicou-se apenas ringer lactato. Em G4 (n=8), realizou-se a mesma técnica de ALT, todavia aplicou-se apenas NaCl 0,9%. Em G2 as frequências cardíaca e respiratória mantiveram-se mais estáveis; o consumo de isoflurano, o tempo de recuperação e o desconforto na recuperação anestésica foram menores que em G1, G3 e G4. O grau de dor foi aferido nas 24h após a cirurgia utilizando-se a escala visual analógica e os animais de G2 apresentaram valores significativamente menores que G1, G3 e G4. Conclui-se que a ALT à base de lidocaína em cadelas submetidas à mastectomia completa bilateral pode reduzir a dor nos períodos trans e pós-operatórios, melhora a recuperação anestésica e não altera as frequências cardíaca e respiratória

Gastrointestinal Syndrome in a Rabbit (Oryctolagus cuniculus)

Background: The term “rabbit gastrointestinal syndrome” (RGIS) refers to a decrease in peristaltic movements, which in some cases can progress to absolute inactivity of the digestive apparatus. This condition is mostly secondary to others that promote changes in gastrointestinal motility, such as dehydration, fiber deficiency, excess carbohydrates in diets, stress, and acute or chronic painful processes. Clinical manifestations are mostly nonspecific. Thus, a case of RGIS resulting from environmental change in a domestic rabbit (Oryctolagus cuniculus) is reported.Case: A 4-month-old male domestic rabbit weighing 0.962 kg was referred to a university veterinary hospital. The patient had a history of absence of defecation and anorexia for the past two days. The owner reported that the patient was apathetic but became aggressive when manipulated. The changes started after a move of residence. On physical evaluation, an increase in abdominal volume and a painful response to touch on the abdomen were observed. Complementary examinations were performed, such as a blood count and an ultrasound study. The blood tests showed no alterations, but the ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic structure associated with acoustic shading in the small intestine, all findings suggestive of obstruction. Given the failure of clinical management, the patient was referred for an exploratory laparotomy procedure followed by enterotomy. The obstruction point was located near the ileocecal junction. After surgery, analgesics, antibiotics, fluid therapy, anti-inflammatory drugs, intestinal motility inducers, and probiotics were prescribed. One week after the surgical procedure, the patient showed improvement in the clinical condition, with normal appetite, defecation, and docility.Discussion: RGIS is diagnosed based on the clinical history, clinical manifestations, and complementary examinations. In the reported case, the patient presented apathy, anorexia, absence of defecation, and aggressiveness on manipulation, which were associated with abdominal pain. In cases of RGIS, hematological changes may or may not be present, which matches the findings in this report. Imaging exams provide important information, such as the patient’s condition and evolution. Ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic, immobile acoustic shading structure in the small intestine. Ultrasound findings were compatible with those found in cases of foreign-body obstructions, a common complication in RGIS. Initially, a clinical approach was taken, but in view of the unfavorable evolution of the case, with worsening motility and alterations in the imaging examination, a surgical approach was instituted. Intestinal obstructions in rabbits are usually found either in the proximal duodenum or near the ileocecal junction. In the presently reported patient, an obstruction was identified in the ileocecal junction region and the content found was composed of hair and dehydrated food. There are several conditions that can alter intestinal peristalsis in rabbits; in the present case, it was considered that the distress caused by moving to a new household led to a condition of RGIS. Despite the reserved prognosis associated with surgical interventions in the gastrointestinal system of rabbits, as described in the literature, in the present case this approach made it possible to preserve the patient’s life, which returned to its normal activities and behavior

General Anesthesia in Red-footed Tortoise (Chelonoides carbonaria) for Gastric Foreign Body Removal

Background: The anatomical, physiological, and pharmacological characteristics of reptiles make anesthesia in chelonians particularly challenging. Specific literature regarding safe anesthetic protocols that provide immobilization, antinociception, amnesia, and unconsciousness are scarce. Thus, this paper aims to report the case of a red-footed tortoise submitted to long-duration general anesthesia to celiotomy for foreign body removal.  Case: An adult red-footed tortoise (Chelonoides carbonaria), 5.9 kg, was admitted due to hyporexia after ingesting a metallic fishhook. Serial radiographs confirmed the diagnosis and location of the foreign body in the stomach. The animal was premedicated with 0.03 mg/kg dexmedetomidine, 6 mg/kg ketamine, and 0.4 mg/kg butorphanol intramuscularly. After 90 min we inserted a 22G jugular catheter and proceeded to anesthesia induction with 5 mg/kg propofol. We intubated the animal with a 2.5 mm uncuffed endotracheal and started fluid therapy at a rate of 5 mL/kg/h. Surgical anesthesia was maintained with isoflurane in 0.21 oxygen, in a non-rebreathing circuit (baraka), under spontaneous breathing. Expired isoflurane was maintained between 3 and 4.5%. Due to reduced respiratory rate and hypercapnia, we opted for implementing manually-assisted positive pressure ventilation. Morphine (0.5 mg/kg) was administered at 10 and 87 min after the beginning of the surgery for further analgesia when the isoflurane requirement increased significantly. We did not detect any alterations in heart and body temperature. Surgical anesthesia lasted 6 h. During anesthesia recovery, voluntary head retraction and coordinated movement of the limbs occurred at 240 and 540 min after the extubation, respectively. In 2 days, the patient returned to voluntary feeding, being very active and responsive to stimulus. The post-surgical hematologic evaluation was unremarkable. Discussion: Pre-anesthetic medication aimed to promote sedation and preemptive analgesia. Due to its minimal cardiorespiratory depression, we chose the combination of ketamine, dexmedetomidine, and butorphanol. Dexmedetomidine reduced the ketamine dose and caused sufficient muscle relaxation and immobilization to perform the jugular catheter placement. Butorphanol is an agonist-antagonist opioid; that is why we decided to add it to the protocol for antinociception. However, due to signs of nociceptive response (increased isoflurane requirements and heart rate), and considering the evidence of a predominance of μ receptors in reptiles, we administered low-dose morphine twice during the procedure. Propofol was chosen as an induction agent at a dose sufficient to allow endotracheal intubation. Since reptilians often show apnea in the presence of 100% oxygen, we used a 0.21 oxygen fraction. Despite this, the patient showed respiratory depression. Due to right to left cardiac shunt, sudden changes in the direction of the blood can lead to very rapid changes in the serum concentrations of isoflurane, which leads to frequent oscillations in the anesthetic depth and consequently the need for vaporizer adjustments, which may justify the high expired isoflurane fraction during the procedure. Despite that, physiological parameters were maintained within normal ranges for the species, with slight variations during the surgical procedure. We conclude that the proposed anesthetic protocol is safe for long-duration anesthesia in chelonians, ensuring cardiovascular and respiratory stability. Thus, this report may help veterinarians to perform safe anesthesia in tortoises submitted to invasive surgical procedures.  Keywords: testudines, dexmedetomidine, ketamine, butorphanol. Descritores: testudines, dexmedetomidina, cetamina, butorfanol

Correction of a Complication of the Use of a Nasoesophageal Feeding Tube in a Southern Tiger Cat (Leopardus guttulus)

Background: The southern tiger cat (Leopardus guttulus) is a vulnerable wild felid whose occurrence is restricted to the Atlantic Forest biome of Brazilian South and Southwest regions. Various strategies must be used to improve the conservation of species of felids, including preservation of forests and greater therapeutic support for animals in poor health condition. Enteral nutrition through a nasoesophageal tube is an option for patients in poor or critical condition; however, this procedure carries the risk of accidental ingestion of the tube. The objective of this work is to describe a conservative approach for the management of ingestion of a linear foreign body in a Leopardus guttulus patient.Case: A young female southern tiger cat was taken for veterinary treatment. The patient had an estimated age of nine weeks, 0.846 kg of body weight, and exhibited cachexia, hypothermia, severe dehydration, and apathy. During the examination, blood samples were taken, and initial treatment commenced with fluid therapy, antibiotic therapy, and anti-inflammatory therapy along with administration of analgesics and a gastric protector. Since the patient did not want to eat, it received a nasoesophageal feeding tube under mild sedation. The patient was positioned in sternal recumbency, its head was tilted up, and a no. 6 nasoesophageal tube was ventromedially inserted through the right nostril. The tube was later confirmed to be correctly positioned at the ninth intercostal space by a radiographic study. The feeding tube allowed administration of drugs and microenteral nutrition with a hypercaloric diet; this minimized handling of the patient, which preserved its wild behavior. After the seventh day of treatment, a piece of the tube was found lying at the bottom of the cage. Since ingestion of the remainder of the tube by the patient was suspected, it was taken to the diagnostic imaging division. At the ultrasonographic exam, the stomach exhibited hypermotility and was filled with a moderate amount of mucous content. The stomach wall was thin, and its stratified structure was preserved. Ultrasound imaging did not reveal any alterations suggestive of obstruction or inflammation such as free liquid, thickened wall, or loss of the stratified structure of the layers of the stomach. A hyperechoic tubular structure compatible with the feeding tube used was detected in the fundus of the stomach. After verification of the presence of the tube-derived material in the digestive system, the medical team opted for a conservative therapy consisting of administration of fibers, to increase intestinal motility. The patient was followed up daily by means of imaging exams. The patient did not exhibit signs of intestinal obstruction during the follow-up period. Two days after commencement of the conservative therapy, the remnant of the feeding tube that had been ingested by the patient was expelled along with the feces.Discussion: In spite of the accidental ingestion of the feeding tube by the patient, the use of this device was effective to provide nutritional and pharmacological support to the Leopardus guttulus cub, leading to its recovery. Managing malnutrition is fundamental for the recovery of any patient. Inappetence is alarming especially in felines, which quickly develop hepatic lipidosis during extended periods of anorexia. The conservative approach used, with the aid of serial imaging exams, was enough to treat ingestion of the linear foreign body by the patient

Use of omental flap to induce vascularization and bone healing in a dog

Este trabalho relata o caso de uma cadela da raça whippet, de 10 anos, com união retardada de tíbia e fíbula esquerdas, exposta, cotaminada e com grande perda de massa muscular e óssea e de pele causada por instabilidade óssea decorrente de duas intervenções cirúrgicas realizadas anteriormente. Foi realizado retalho de omento maior em camada simples, alcance ao foco de fratura via túnel subcutâneo e recobrimento por enxerto cutâneo em malha. O objetivo do trabalho foi avaliar a capacidade de indução vascular do omento maior para foco de fratura e consequentemente consolidação óssea, tendo como hipótese a acentuada função de angiogênese do omento maior. A tíbia e fíbula esquerdas foram estabilizadas com fixador circular externo. Após 80 dias, houve consolidação óssea da tíbia, volta do apoio do membro e retirada do implanteThis research reports the case of a whippet female dog, 10 years old, with delayed union of left tibia and fibula, exposure of the fracture focus with localized infection, and extensive loss of, muscle, bone and skin after instability caused by two surgical interventions accomplished previously. A flap was made of the greater omentum in a single layer. The fracture site was reached through the subcutaneous tunnel and the coating by mesh skin grafts. The objective of this study was to evaluate the ability of the larger omentum to induce angiogenesis to the fracture site and the subsequent bone healing, considering the strong role of angiogenesis. The left tibia and fibula were stabilized with external circular fixator. After 80 days there was bone healing of the tibia around the support member and removal of the implant. Postoperative complications included partial necrosis of the cutaneous (25%) flap and shortening of the tibia with consequent laxity ligament of the membe

Resultados clínicos e radiográficos de placas ósseas bloqueadas em 13 casos

A Placa Óssea Bloqueada (POB) consiste em um novo sistema de fixação interna, onde a placa apresenta orifícios duplos, um liso para compressão e outro rosqueado para fixação do parafuso que se fixa à placa. Promove grande estabilidade à fratura, sendo possível associar parafusos neutros e compressivos. Parafusos tradicionais comprimem a placa ao osso, nas placas bloqueadas não existe esta força e o encaixe da cabeça do parafuso à placa resulta em menores danos ao suporte vascular periosteal. Treze cães com distúrbios ortopédicos diversos foram tratados cirurgicamente com placa bloqueada com resultados satisfatórios. A placa bloqueada pode ser utilizada na medicina veterinária, porém, é técnica que requer cuidado e planejamento pré-operatório, especialmente na sequência de aplicação dos diferentes tipos de parafusos. Apresenta custo elevado, mas confere estabilidade rígida do foco de fratura e minimiza a possibilidade de perda prematura da interface parafuso e osso, diminuindo a possibilidade de instabilidade precoce e soltura do implante.Locking plate is a new internal fixation system where the plate features has double holes, one smooth for compression and other threaded for screw fixing that attaches the plate. It leads to greater stability to the fracture being possible to associate neutral and compressive screws. Traditional screws compress the plate to the bone, in the locking plates there are no such strength and the fit of the screw head to the plate results in less damage to the vascular periosteal support. Thirteen dogs with various orthopedic disorders were treated surgically by locking plate with satisfactory results. The locking plate can be used in veterinary medicine, however, it is a technique that requires care and preoperative planning, especially in the order of applying different types of screws. It is expensive, but provides rigid stability of the fracture site and minimizes the likelihood premature loss of the screw and bone interface, reducing the possibility of instability and early loosening of the implant

Ruptura de menisco associada à ruptura de ligamento cruzado cranial em cães

The following study describes meniscus ruptures associated to cranial cruciate ruptures, in 34 dogs of different breeds, ages and weights. Before surgery the animals underwent clinical and radiographic examinations. All animals presented either total or partial cranial cruciate ruptures: 21 (24.14%) of the animals didn’t present any meniscus lesions, and the rest (75.86%) presented only a medial meniscus lesion. The lesions found in the medial meniscus were the following: 33 stifles (37.93%) presented with eversion of the caudal pole (Type 1), 15 (17.24%) showed a bucked handle lesion (Type 6), 3 (3.45%) presented with fibrillation lesion (Type 4), 3 (3.45%) multiple fibrillation lesion (Type 3), 3 (3.45%) longitudinal lesion (Type 2), 1 (1.15%) lesion type 7 and 10 (11.49%) presented multiple lesion. Surgical procedure for cranial cruciate rupture included: tibial tuberosity advancement (TTA) (49 stifle), tibial plateau leveling osteotomies (TPLO) (15 stifle), closing wedge osteotomy (CWO) (14 stifle), extracapsular (4 stifle) and meniscectomy alone (5 stifle), and all these techniques guaranteed weight baring and return to function in the first week after surgery, with no complications. Through this study we could demonstrate that meniscus tear is highly associated to cranial cruciate rupture and that the most common is type 1 (eversion of the caudal pole) and that cronicity of the lesion increases the probability of meniscus tear.O trabalho descreve as lesões de menisco associadas com ruptura do ligamento cruzado cranial em 82 pacientes de diferentes raças, idades e pesos, com o objetivo de avaliar o tipo de ruptura de menisco associada a lesões do ligamento cruzado cranial. No período pré-operatório, os animais foram submetidos à avaliação clínica e radiológica. Todos os animais apresentaram ruptura total ou parcial do ligamento cruzado cranial; 21 (24,14%) animais não apresentaram nenhuma lesão de menisco, os restantes (75,86%) apresentaram apenas lesão no menisco medial. As lesões encontradas no menisco medial foram as seguintes: 33 joelhos (37,93%) apresentaram eversão do corno caudal (Tipo 1); 15 (17,24%) apresentaram lesão em alça de balde (Tipo 6); 3 (3,45%) lesão de fibrilação (Tipo 4); 3 (3,45%) ruptura longitudinal múltipla (Tipo 3); 3 (3,45%) lesão longitudinal (Tipo 2); 1 (1,15%) lesão tipo 7; e 10 (11,49) apresentaram lesões múltiplas. A meniscectomia parcial do menisco medial foi realizada em 63 (72,41%) joelhos e a meniscectomia total em 3 (13,04%). O procedimento cirúrgico para a resolução da ruptura do ligamento cruzado cranial incluiu: avanço da tuberosidade tibial (TTA) (49 joelhos), osteotomia niveladora do platô tibial (TPLO) (15 joelhos), osteotomia em cunha da tíbia (CWO) (14 joelhos), extracapsular (quatro joelhos) e meniscectomia (cinco joelhos). Todos os casos evoluíram com o retorno à função habitual do membro pélvico acometido na primeira semana do período pós-operatório, e com a ausência de complicações. A alta porcentagem (75,86%) de ruptura do menisco medial encontrada no presente trabalho demonstra a importância da avaliação prévia dos meniscos antes da realização da técnica de estabilização da articulação femorotibiopatelar