Estudo eletrocardiográfico em cães geriátricos submetidos à anestesia geral com isofluorano

The purpose of this study was to clarify the degree of influence of anesthetic agents commonly used during anesthesia on the heart conduction systems of geriatric dogs, with or without the presence of electrocardiographic changes in the pre-anesthetic electrocardiogram and also to determine the possible causes of ST-segment and T-wave changes during anesthesia, by monitoring ventilation and oxygenation. 36 geriatric dogs were evaluated. In addition to electrocardiographic evaluation, the pre-anesthetic study included serum levels of urea, creatinine, total protein, albumin and electrolytes. The pre-anesthetic medication consisted of acepromazine (0.05mg kg-1) in association with meperidine (3.0mg kg-1) by IM injection. Anesthesia was induced with propofol (3.0 to 5.0mg kg-1) by IV injection and maintained with isoflurane in 100% oxygen. During the anesthesia, the animals were monitored by continued computerized electrocardiogram. Systemic blood pressure, heart rate, respiratory rate, end-tidal carbon dioxide, partial pressure of carbon dioxide in arterial blood, arterial oxygen saturation, partial pressure of arterial oxygen and oxygen saturation of hemoglobin were closely monitored. During maintenance anesthesia, normal sinus rhythm was more common (78%). ST-segment and T-wave changes during the anesthetic procedure were quite common and were related to hypoventilation. The use of isoflurane did not result in arrhythmia, being therefore a good choice for this type of animal; Electrocardiographic findings of ST-segment and T-wave changes during the maintenance anesthesia were evident in animals with hypercapnia, a disorder that should be promptly corrected with assisted or controlled ventilation to prevent complicated arrhythmias.Os objetivos deste estudo foram esclarecer a influência dos agentes anestésicos comumente utilizados durante a anestesia no sistema de condução cardíaco em cães idosos, com ou sem alterações eletrocardiográficas prévias, e determinar as possíveis causas de alterações no segmento ST e onda T durante a anestesia, por meio da monitoração da ventilação e da oxigenação. Para tanto, foram avaliados 36 cães idosos. Os exames pré-anestésicos incluíram o eletrocardiograma e os níveis séricos de uréia, creatinina, proteína total, albumina e eletrólitos. A medicação pré-anestésica foi realizada com acepromazina (0,05mg kg-1) associada à meperidina (3,0mg kg-1) por via intramuscular. A indução da anestesia foi realizada com propofol e a manutenção foi feita com isofluorano com oxigênio a 100%. Durante a anestesia, os animais foram monitorados continuamente com um eletrocardiógrafo computadorizado. A pressão arterial sistêmica, a freqüência cardíaca, a freqüência respiratória, o dióxido de carbono expirado, a pressão parcial arterial de dióxido de carbono, a saturação de oxigênio arterial, a pressão parcial de oxigênio arterial e a saturação de oxigênio na hemoglobina também foram monitorados durante a anestesia. Durante a manutenção da anestesia, 78% dos animais apresentaram ritmo sinusal normal. As alterações no segmento ST e onda T foram freqüentes e relacionadas à hipoventilação. O isofluorano não promoveu o aparecimento de arritmias, sendo assim um fármaco indicado em animais idosos. As alterações em segmento ST e onda T foram evidentes em animais com hipercapnia. A correção da hipercapnia deve ser implementada por meio de ventilação controlada e/ou assistida a fim de prevenir arritmias mais complicadas

Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele

Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14–8.23; P < 0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19–3.77; P = 0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08–3.47; P = 0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10–5.50; P = 0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30–0.72; P = 0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01–1.04; P < 0.001) and age (OR, 1.17; 95% CI, 1.08–1.26; P < 0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54–0.69) and a specificity of 0.63 (95% CI, 0.59–0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.Supplemental Table S1. Number of dogs included from each institution and years reviewed.Supplemental Table S2. Included breeds.Supplemental Table S3. Distribution of various reasons given for performing cholecystectomy in the 179 subclinical dogs with gallbladder mucocele (GBM).Supplemental Table S4. Distribution of clinical signs associated with systemic illness in 982 dogs with gallbladder mucocele.Supplemental Table S5. Distribution of reasons for death in-hospital (i.e. euthanized and died) in 179 dogs with gallbladder mucocele that underwent cholecystectomy.http://www.elsevier.com/locate/tvjlhj2020Companion Animal Clinical Studie

Evolution of central venous saturation oxygen, lactate and base deficit in severe sepsis and septic shock patients submitted to early volemic resuscitation

A sepse é uma síndrome clínica que promove alterações características na microcirculação, dificultando a avaliação da perfusão tecidual. No homem, estudos demonstram a importância de estabelecer a terapia baseando-se nas avaliações clínicas rotineiras, bem como nas variáveis de oxigenação e de perfusão tecidual como saturação venosa central de oxigênio, o lactato e a diferença de base. Assim, o objetivo deste estudo foi avaliar a evolução desses parâmetros durante as seis primeiras horas de reposição volêmica, buscando identificar o valor destas variáveis como marcadores de prognóstico. Foram incluídas 30 cadelas com sepse grave e choque séptico submetidas à reposição volêmica com 40 ml/kg/hora de solução cristalóide durante as seis primeiras horas de tratamento intensivo. Durante este período, a pressão arterial sistólica, o débito urinário, a pressão venosa central, o lactato, o déficit de base e a saturação venosa central de oxigênio foram monitorados a cada 90 minutos. A prevalência de algumas características clínicas dos animais, analisando a relação destas características com o desfecho (alta ou óbito) foi realizada através do teste de qui-quadrado ou teste exato de Fisher. A saturação venosa central de oxigênio, o déficit de base e o lactato foram comparados entre os sobreviventes e não- sobreviventes utilizando análise de variância com dois fatores. Foi considerada estatística significativa com p< 0,05. A taxa de mortalidade foi de 36,7%. Os sobreviventes apresentaram valores de saturação venosa central acima de 70% quando comparados aos não sobreviventes (p<0,001). Níveis séricos de lactato mais elevados também foram observados no grupo de não sobreviventes (p<0,001), bem como os valores de déficit de base também foram mais elevados no grupo de sobreviventes quando comparado aos animais que vieram a óbito (p<0,001). O suporte intensivo aos animais com sepse grave é fundamental na redução da mortalidade desses animais. Os valores de lactato, saturação venosa central de oxigênio e de déficit de base podem ser considerados bons marcadores de prognóstico. A utilização destes parâmetros como metas da reposição volêmica durante as seis horas iniciais do atendimento parece reduzir a mortalidade, no entanto, estudos multicêntricos são necessários para definir esta relação.Sepsis is a clinical syndrome that causes changes in the microcirculation characteristics, making the assessment of tissue perfusion. In humans, studies have shown the importance of establishing a therapy based on routine clinical assessments and the variables of oxygenation and tissue perfusion and central venous saturation of oxygen, lactate and base deficit. The aim of this study was to evaluate the evolution of these parameters during the first six hours of resuscitation in order to identify the value of these variables as prognostic markers. We included 30 dogs with severe sepsis and septic shock underwent replacement with 40 ml / kg / hour of crystalloid solution during the first six hours of intensive care. During this period, the systolic blood pressure, urine output, central venous pressure, lactate, base deficit, and central venous saturation of oxygen were monitored every 90 minutes. The prevalence of some clinical characteristics of the animal, analyzing the relationship of these characteristics with the outcome (discharge or death) was performed using chi-square or Fisher\'s test. The central venous saturation of oxygen, base deficit and lactate were compared between survivors and nonsurvivors using analysis of variance with two factors. It was considered statistically significant with p <0.05. The mortality rate was 36.7%. The survivors had values of central venous oxygen saturation above 70% when compared to non-survivors (p <0.001). Serum lactate higher were also observed in the non survivors (p <0.001), and the values of base deficit were also higher in the group of survivors compared to animals that eventually died (p <0.001). The intensive support to animals with severe sepsis is essential to reduce the mortality of these animals. The values of lactate, central venous saturation of oxygen and base deficit can be considered good markers of prognosis. Using these criteria as goals of resuscitation during the initial six hours of care appears to reduce mortality; however, multicenter studies are needed to define this relationship

Electrocardiographic study on geriatric dogs undergoing general anesthesia with isoflurane Estudo eletrocardiográfico em cães geriátricos submetidos à anestesia geral com isofluorano

The purpose of this study was to clarify the degree of influence of anesthetic agents commonly used during anesthesia on the heart conduction systems of geriatric dogs, with or without the presence of electrocardiographic changes in the pre-anesthetic electrocardiogram and also to determine the possible causes of ST-segment and T-wave changes during anesthesia, by monitoring ventilation and oxygenation. 36 geriatric dogs were evaluated. In addition to electrocardiographic evaluation, the pre-anesthetic study included serum levels of urea, creatinine, total protein, albumin and electrolytes. The pre-anesthetic medication consisted of acepromazine (0.05mg kg-1) in association with meperidine (3.0mg kg-1) by IM injection. Anesthesia was induced with propofol (3.0 to 5.0mg kg-1) by IV injection and maintained with isoflurane in 100% oxygen. During the anesthesia, the animals were monitored by continued computerized electrocardiogram. Systemic blood pressure, heart rate, respiratory rate, end-tidal carbon dioxide, partial pressure of carbon dioxide in arterial blood, arterial oxygen saturation, partial pressure of arterial oxygen and oxygen saturation of hemoglobin were closely monitored. During maintenance anesthesia, normal sinus rhythm was more common (78%). ST-segment and T-wave changes during the anesthetic procedure were quite common and were related to hypoventilation. The use of isoflurane did not result in arrhythmia, being therefore a good choice for this type of animal; Electrocardiographic findings of ST-segment and T-wave changes during the maintenance anesthesia were evident in animals with hypercapnia, a disorder that should be promptly corrected with assisted or controlled ventilation to prevent complicated arrhythmias.<br>Os objetivos deste estudo foram esclarecer a influência dos agentes anestésicos comumente utilizados durante a anestesia no sistema de condução cardíaco em cães idosos, com ou sem alterações eletrocardiográficas prévias, e determinar as possíveis causas de alterações no segmento ST e onda T durante a anestesia, por meio da monitoração da ventilação e da oxigenação. Para tanto, foram avaliados 36 cães idosos. Os exames pré-anestésicos incluíram o eletrocardiograma e os níveis séricos de uréia, creatinina, proteína total, albumina e eletrólitos. A medicação pré-anestésica foi realizada com acepromazina (0,05mg kg-1) associada à meperidina (3,0mg kg-1) por via intramuscular. A indução da anestesia foi realizada com propofol e a manutenção foi feita com isofluorano com oxigênio a 100%. Durante a anestesia, os animais foram monitorados continuamente com um eletrocardiógrafo computadorizado. A pressão arterial sistêmica, a freqüência cardíaca, a freqüência respiratória, o dióxido de carbono expirado, a pressão parcial arterial de dióxido de carbono, a saturação de oxigênio arterial, a pressão parcial de oxigênio arterial e a saturação de oxigênio na hemoglobina também foram monitorados durante a anestesia. Durante a manutenção da anestesia, 78% dos animais apresentaram ritmo sinusal normal. As alterações no segmento ST e onda T foram freqüentes e relacionadas à hipoventilação. O isofluorano não promoveu o aparecimento de arritmias, sendo assim um fármaco indicado em animais idosos. As alterações em segmento ST e onda T foram evidentes em animais com hipercapnia. A correção da hipercapnia deve ser implementada por meio de ventilação controlada e/ou assistida a fim de prevenir arritmias mais complicadas

Colloid osmotic pressure during and after surgical interventions in adult and geriatric dogs

ABSTRACT: The objective this study is to evaluate colloid osmotic pressure (COP) fluctuations in adult and senile dogs during surgical interventions. Thirty-six healthy dogs to surgical interventions, distributed in two groups, A and B, according to their age, and were all subjected to the same anesthetic protocol. Values of albumin, total plasmatic protein and COP were evaluated from samples collected before pre-anesthetic medication, fifteen minutes after pre-anesthetic medication, and shortly after the end of the intervention. Results were tested using t-test to compare among groups and ANOVA for repeated measures followed by Tukey’s test to compare different moments within the same group. Statistical significance was set at p<0.05. In both groups, significant decreases were observed in colloid osmotic pressure, as well as albumin and total proteins (p<0.001). Despite slightly lower COP values for the group of adult animals, this difference was not significant as there was a high individual variation within groups. The results therefore indicate no difference in colloid osmotic pressure values or fluctuation patterns among adult and senile dogs (p=0.124). The observed results indicate that colloid osmotic pressure decreases significantly during surgical procedures, due to hypotension caused by the anesthetic drugs and to hemodilution caused by the fluid administration but there is no difference between groups. However, in both adult and senile dogs, these variables recover gradually after the animals awaken, through increased urine production and recovery of vascular tonus, indicating the successful reestablishment of homeostasis

Comparative study of clinical cardiorespiratory parameters and recovery times in bitches submitted to ovariohysterectomy and anesthetized with halothane, isoflurane or sevoflurane

Objetivou-se comparar os efeitos cardiorrespiratórios, bem como sobre a recuperação em cadelas submetidas à ovariosalpingohisterectomia, e anestesiadas pelo halotano, isofluorano ou sevofluorano. Para tanto, utilizaram-se vinte e quatro cadelas sem raça definida, com peso médio de 15,03 e idade média de 3,93 anos, clinicamente saudáveis, avaliadas por meio de hemograma completo, contagem de plaquetas, bioquímica hepática e renal e teste de coagulação, sendo distribuídas em três grupos de oito animais. Todos os animais receberam acepromazina na dose de 0,1 mg/kg i.m., como pré-tratamento e após 15 minutos a anestesia foi induzida com propofol na dose de 5 mg/kg i.v.. Para a manutenção utilizou-se halotano (grupo GAH), isofluorano (GAI) ou sevofluorano (GAS). Não houve diferença estatística entre os grupos em relação aos parâmetros cardiovasculares, observando redução discreta dos valores pressóricos após a indução, devido provavelmente a ação do propofol. A temperatura retal diminuiu gradativamente em função do tempo de anestesia, não apresentando diferença entre os grupos, porém GAI e GAS obtiveram valores inferiores dessa variável. Houve depressão respiratória nos três grupos, evidenciada pelo aumento da PaCO2 com consequente diminuição do pH arterial, porém sem diferença entre os grupos. O período obtido para extubação foi semelhante entre os grupos, no entanto, GAS apresentou menor tempo para posição quadrupedal comparado com GAH e GAI. A partir desses dados, conclui-se que diante dessa categoria animal e procedimento cirúrgico, o halotano, isofluorano e sevofluorano apresentaram características similares em relação aos parâmetros cardiovasculares, todos promoveram depressão respiratória e a recuperação foi mais rápida quando se optou pelo sevofluoranoThe cardiopulmonary effects and recovery times of halothane, isoflurane and sevoflurane were compared in bitches submitted to ovariohysterectomy. Twenty-four mongrel dogs were assigned in three groups of eight animals, with medium weight 15.03 kg and 3.93 years of age, designed groups GAH, GAI and GAS. All dogs received acepromazine (0.1 mg/kg, i.m.) as premedication and after 15 minutes, anesthesia was induced with propofol (5.0 mg/kg, i.v.) and maintenance anesthetics were halothane (GAH), isoflurane (GAI) and sevoflurane (GAS). No statistic difference was observed in cardiovascular parameters, but the SAP, DAP and MAP decreased slighty in moment M1 and this effect was associated with propofol. The rectal temperature decreased in function of the time of anesthesia, without difference among groups, but the AI and AS groups presented the lowest values of this parameter. Respiratory rate decreased in all groups, with an increase in the PaCO2 and a decrease in the pH, without statistic differences. The extubation times were similar in the three groups. Time to standing was shorter in the AS group when compared with the GAH and GAI groups. On the basis of the results, for this animal category and surgical procedure halothane, isoflurane and sevoflurane were similar in cardiovascular parameters. All agents caused respiratory depression and the recovery times were shorter in sevofluorano groupFAPES

Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome

Objective To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome. Design Prospective observational study. Setting ICU of a veterinary university medical center. Animals Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU. Measurements and Main Results Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO2), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO2, lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P &lt; 0.001, respectively). ScvO2 and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis. Conclusion Our study suggests that ScvO2 and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO2 and lower base deficit at admission to the ICU have a lower probability of death.FAPESP-Foundation of Support to Research of the State of Sao Paul