Associação do bloqueio do plano transverso do abdomên (TAP-block) com o bloqueio do plano serrátil (SP-block) em cadelas submetidas a mastectomia

Orientador: Prof. Dr. Juan Carlos Duque MorenoCoorientadora: Profa. Dra. Tilde Rodrigues FroesDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa : Curitiba, 14/06/2019Inclui referências: p. 59-64Resumo: Objetivo Definir pontos de referência e a dispersão de diferentes volumes de injeção para o bloqueio do plano serrátil superficial (SSP block) em cadáveres de cães. Avaliar a analgesia intra e pós-operatória produzida com a associação do TAP block ao SSP block em cadelas submetidas a mastectomia total unilateral. Design experimental Estudos prospectivos, aleatórios, experimentais cadavérico e clínico. Animais Um cadáver de cão formalizado, quinze cadáveres de cães adultos descongelados e trinta e dois cães com neoplasias mamárias. Métodos A parede torácica do cadáver formalizado foi dissecada em um primeiro momento para identificação dos músculos da parede torácica e dos nervos encontrados no plano fascial entre os músculos músculo serrátil ventral torácico e grande dorsal. Em seguida, com um transdutor linear de ultrassom colocado sob a quarta e quinta costela, no nível da articulação do ombro, o bloqueio do SSP foi realizado nos dois hemitórax de 15 cadáveres de cães. Os 30 hemitórax foram distribuídos aleatóriamente para receber 0,3; 0,6; e 1 mL kg-1 de uma solução 1:1 de azul de metileno a 0,5% e ropivacaína a 0,375%. A solução foi depositada no plano fascial entre o músculo serrátil ventral torácico e grande dorsal e após 15 minutos os cadáveres foram dissecados para confirmar a correta localização e avaliar a dispersão da solução. Os cães com tumores mamários foram distribuídos em quatro grupos (n = 8) que receberam meloxicam (MxG), metadona (MtG), TAP block + SSP block (LG), ou todos os tratamentos combinados (TG). A resposta à estimulação nociceptiva foi avaliada durante a cirurgia e as pacientes foram avaliadas antes da pré-medicação e 1, 2, 3, 4, 6, 8, 12, 16, 20 e 24 horas após a extubação pela escala composta de Glasgow (CMPS-SF) e escala visual analógica. Dor foi considerada quando CMPS-SF ? 6 e metadona foi utilizada como resgate. Resultados A principal inervação no plano superficial serrátil são os ramos cutâneos laterais dos nervos intercostais. A taxa de sucesso do SSP block foi de 89.66% (26/29). Para os grupos 0,3; 0,6 e 1 mL kg-1 a dispersão do corante foi de 4,12 ± 1,12; 3,75 ± 0,93 e 5,00 ± 1,32 dermátomos, respectivamente. Não houve diferença significativa entre os grupos. No estudo clínico observou-se que todos os grupos necessitaram de resgate analgésico com fentanil durante a cirurgia. No período pós-operatório o número de animais resgatados nos grupos MxG, LG, TG e MtG foi de 0, 2, 1 e 3, respectivamente, sem diferenças entre grupos. Contudo, o número total de regates foi maior em MtG (15) do que em MxG (0), LG (3) e TG (1) (p = 0,002). Conclusão O SSP block pode ser facilmente realizado em cães e o volume de 0.3 mL kg-1 é suficiente para obter dispersão do anestésico local compatível com o bloqueio dos ramos cutâneos laterais de T1 a T9, conferindo analgesia da parede lateral do tórax em cães. A associação do SSP com o TAP block pode ser utilizada no contexto de analgesia multimodal, para proporcionar analgesia pósoperatória em cadelas submetidas à mastectomia total unilateral. Palavras-chave: Analgesia; anestesia local; cães; cirurgia oncológica; tórax.Abstract: Objective Cadaveric study of landmarks and volume dispersion of superficial serratus plane block (SSP block) in dogs and clinical evaluation of nociceptive and pain stimulation in dogs submitted to mastectomy receiving the association of TAP and SSP block. Study design Prospective experimental randomized cadaveric and clinical study Animals One formaldehyde solution-preserved dog cadaver, fifteen frozen adult dog cadavers and thirty-two dogs with mammary tumors. Methods The formaldehyde cadaver thoracic wall was dissected in the first moment. After that with the ultrasound transducer placed over the fourth and fifth ribs, at the level of the shoulder joint, SSP block was performed 30 times, using different volumes (0.3, 0.6 and 1 mL kg-1) of blue methylene solution, with a needle between the serratus ventralis thoracis and latissimus dorsi muscles. Cadavers were dissected to confirm and evaluate dispersion. Dogs with mammary tumors were divided in four groups (n = 8 each). Analgesia treatment was meloxicam (MxG), or methadone (MtG), or TAP + SSP block (LG), or all them combined (TG). Nociceptive stimulation was evaluated during surgery and patients were evaluated before premedication and at 1, 2, 3, 4, 6, 8, 12, 16, 20 and 24 hours after extubation, with CMPS-SF and VAS. Pain was considered when CMPF-SF scores ? 6 and methadone was used as rescue analgesia. Results The main innervation at the superficial serratus plane were the lateral cutaneous branches of intercostal nerves. SSP block success rate was 89.66% (26/29). For groups 0.3, 0.6 and 1 mL kg-1 dye dermatomal spread was of 4.12 ± 1.12, 3.75 ± 0.93 and 5.00 ± 1.32, respectively. No statistically significant difference was seen between groups. Clinical study results included that all groups needed analgesic rescue during surgery. At postoperative period the number of animals that receive rescue at MxG, LG, TG and MtG was of 0, 2, 1 and 3 respectively, without difference between the groups. However, the total number of rescues was higher at MtG (15) than in MxG (0), LG (3) and TG (1) (p = 0.002). Conclusion SSP block can be easily performed and a volume of 0.3 mL.kg-1 may be sufficient for hemithorax analgesia in dogs. The association of SSP and TAP block may be used in the context of multimodal analgesic protocol, to provide postoperative analgesia in dogs submitted to total unilateral mastectomy. Key-Words: Analgesia; dog; local anaesthesia; thorax; oncology

Evaluation of the Effect of Nandrolone Decanoate on Experimental Spinal Cord Injury in Rats

Background: Acute spinal cord injury, a common cause of neurological dysfunction in humans and animals, impairs motor, sensory and autonomic functions and may result in permanent disability. Nandrolone decanoate (ND) is a steroid widely studied for its predominantly anabolic effect and low androgenic potential. Several researchers have described the positive interference of ND in neurological tissue, such as increased synthesis and release of neurotrophic substances, but to date no studies have evaluated the action of this steroid in acute spinal cord injury. The aim of this study was therefore to evaluate the effect of ND in rats subjected to acute spinal cord injury. Materials, Methods & Results: Thirty-two young adult Wistar rats (Rattus norvegicus), weighing between 240 and 260 g, were divided into three groups. The first group (GNAN) (n=13) was subjected to acute spinal cord injury and treated with ND; the control group (GCON) (n=13) was subjected to spinal cord injury without treatment; and the third group (GLAM) (n=6) underwent laminectomy without prior spinal cord injury, in order to control changes caused by the procedure. A 20 g metal device was released from a height of 25 cm to produce the spinal cord injury. After exposing the spinal canal, a 2-mm diameter metal rod was placed directly in contact with the spinal cord, and when the weight was released, the rod was struck, causing the spinal cord injury. An intramuscular injection of 2 mg/kg of ND was administered the immediate postoperative period. The animals were assessed to ascertain the recovery of their motor function on five occasions, namely at 24 h, 48 h, 72 h, 7 and 14 days after undergoing spinal cord injury. This assessment was performed using the Basso, Beattie and Bresnahan (BBB) model. The animals were euthanized 14 days post-op and fragments of the spinal cord and urinary bladder were collected for histological evaluation. Discussion: The animals subjected to spinal cord injury presented paraplegia, failing to score on the BBB scale in the first three assessments. Starting 7 days after surgery, the GNAN (0-13) and GCON (0-5) groups gradually began showing locomotor improvements, with scale variations. On day 14 after spinal cord injury, 22% of the animals in GNAN and 11% in GCON had failed to recover their locomotor function, scoring zero on the BBB scale. After spinal cord injury, all the animals showed urine retention. The urinary function returned on average on day 5 post surgery, with no significant difference between the groups. The locomotor assessment of the animals subjected to acute spinal cord injury revealed that the injury varied in intensity in GNAN and GCON, with signs of pelvic limb paraplegia and asymmetric non-ambulatory paraparesis. Time was a determining factor in the clinical evolution of the animals, with no evidence of the influence of ND. The histological findings revealed variations in the intensity of the injury, with a tendency for lower intensity in the cranial and epicentral segments of the lesion in the animals subjected to ND treatment, albeit without statistically significant evidence (P ≥ 0.05). The spinal cord assessments of the GLAM group indicated that the surgical procedure did not cause histological alterations, since the normal architecture of the neural tissue was preserved. The histopathological evaluations of the urinary bladder revealed an inflammatory response characterized by lymphohistiocytosis and neutrocytosis in the animals of GNAN and GCON, without interference of ND in the change (P ≥ 0.05). The method to elicit spinal cord injury reproduced functional, sensory and motor incapacity heterogeneously in rats. In the dose evaluated here, ND did not significantly influence the return of locomotor function and the intensity of spinal cord histopathological alterations.  

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Associação do bloqueio do plano transverso do abdomên (TAP-block) com o bloqueio do plano serrátil (SP-block) em cadelas submetidas a mastectomia

Orientador: Prof. Dr. Juan Carlos Duque MorenoCoorientadora: Profa. Dra. Tilde Rodrigues FroesDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa : Curitiba, 14/06/2019Inclui referências: p. 59-64Resumo: Objetivo Definir pontos de referência e a dispersão de diferentes volumes de injeção para o bloqueio do plano serrátil superficial (SSP block) em cadáveres de cães. Avaliar a analgesia intra e pós-operatória produzida com a associação do TAP block ao SSP block em cadelas submetidas a mastectomia total unilateral. Design experimental Estudos prospectivos, aleatórios, experimentais cadavérico e clínico. Animais Um cadáver de cão formalizado, quinze cadáveres de cães adultos descongelados e trinta e dois cães com neoplasias mamárias. Métodos A parede torácica do cadáver formalizado foi dissecada em um primeiro momento para identificação dos músculos da parede torácica e dos nervos encontrados no plano fascial entre os músculos músculo serrátil ventral torácico e grande dorsal. Em seguida, com um transdutor linear de ultrassom colocado sob a quarta e quinta costela, no nível da articulação do ombro, o bloqueio do SSP foi realizado nos dois hemitórax de 15 cadáveres de cães. Os 30 hemitórax foram distribuídos aleatóriamente para receber 0,3; 0,6; e 1 mL kg-1 de uma solução 1:1 de azul de metileno a 0,5% e ropivacaína a 0,375%. A solução foi depositada no plano fascial entre o músculo serrátil ventral torácico e grande dorsal e após 15 minutos os cadáveres foram dissecados para confirmar a correta localização e avaliar a dispersão da solução. Os cães com tumores mamários foram distribuídos em quatro grupos (n = 8) que receberam meloxicam (MxG), metadona (MtG), TAP block + SSP block (LG), ou todos os tratamentos combinados (TG). A resposta à estimulação nociceptiva foi avaliada durante a cirurgia e as pacientes foram avaliadas antes da pré-medicação e 1, 2, 3, 4, 6, 8, 12, 16, 20 e 24 horas após a extubação pela escala composta de Glasgow (CMPS-SF) e escala visual analógica. Dor foi considerada quando CMPS-SF ? 6 e metadona foi utilizada como resgate. Resultados A principal inervação no plano superficial serrátil são os ramos cutâneos laterais dos nervos intercostais. A taxa de sucesso do SSP block foi de 89.66% (26/29). Para os grupos 0,3; 0,6 e 1 mL kg-1 a dispersão do corante foi de 4,12 ± 1,12; 3,75 ± 0,93 e 5,00 ± 1,32 dermátomos, respectivamente. Não houve diferença significativa entre os grupos. No estudo clínico observou-se que todos os grupos necessitaram de resgate analgésico com fentanil durante a cirurgia. No período pós-operatório o número de animais resgatados nos grupos MxG, LG, TG e MtG foi de 0, 2, 1 e 3, respectivamente, sem diferenças entre grupos. Contudo, o número total de regates foi maior em MtG (15) do que em MxG (0), LG (3) e TG (1) (p = 0,002). Conclusão O SSP block pode ser facilmente realizado em cães e o volume de 0.3 mL kg-1 é suficiente para obter dispersão do anestésico local compatível com o bloqueio dos ramos cutâneos laterais de T1 a T9, conferindo analgesia da parede lateral do tórax em cães. A associação do SSP com o TAP block pode ser utilizada no contexto de analgesia multimodal, para proporcionar analgesia pósoperatória em cadelas submetidas à mastectomia total unilateral. Palavras-chave: Analgesia; anestesia local; cães; cirurgia oncológica; tórax.Abstract: Objective Cadaveric study of landmarks and volume dispersion of superficial serratus plane block (SSP block) in dogs and clinical evaluation of nociceptive and pain stimulation in dogs submitted to mastectomy receiving the association of TAP and SSP block. Study design Prospective experimental randomized cadaveric and clinical study Animals One formaldehyde solution-preserved dog cadaver, fifteen frozen adult dog cadavers and thirty-two dogs with mammary tumors. Methods The formaldehyde cadaver thoracic wall was dissected in the first moment. After that with the ultrasound transducer placed over the fourth and fifth ribs, at the level of the shoulder joint, SSP block was performed 30 times, using different volumes (0.3, 0.6 and 1 mL kg-1) of blue methylene solution, with a needle between the serratus ventralis thoracis and latissimus dorsi muscles. Cadavers were dissected to confirm and evaluate dispersion. Dogs with mammary tumors were divided in four groups (n = 8 each). Analgesia treatment was meloxicam (MxG), or methadone (MtG), or TAP + SSP block (LG), or all them combined (TG). Nociceptive stimulation was evaluated during surgery and patients were evaluated before premedication and at 1, 2, 3, 4, 6, 8, 12, 16, 20 and 24 hours after extubation, with CMPS-SF and VAS. Pain was considered when CMPF-SF scores ? 6 and methadone was used as rescue analgesia. Results The main innervation at the superficial serratus plane were the lateral cutaneous branches of intercostal nerves. SSP block success rate was 89.66% (26/29). For groups 0.3, 0.6 and 1 mL kg-1 dye dermatomal spread was of 4.12 ± 1.12, 3.75 ± 0.93 and 5.00 ± 1.32, respectively. No statistically significant difference was seen between groups. Clinical study results included that all groups needed analgesic rescue during surgery. At postoperative period the number of animals that receive rescue at MxG, LG, TG and MtG was of 0, 2, 1 and 3 respectively, without difference between the groups. However, the total number of rescues was higher at MtG (15) than in MxG (0), LG (3) and TG (1) (p = 0.002). Conclusion SSP block can be easily performed and a volume of 0.3 mL.kg-1 may be sufficient for hemithorax analgesia in dogs. The association of SSP and TAP block may be used in the context of multimodal analgesic protocol, to provide postoperative analgesia in dogs submitted to total unilateral mastectomy. Key-Words: Analgesia; dog; local anaesthesia; thorax; oncology

Total intravenous anesthesia for endodontic treatment in Panthera leo: case report

Animais presentes em zoológicos frequentemente necessitam de captura e anestesia para a realização de procedimentos clínicos e cirúrgicos. A anestesia total intravenosa apresenta vantagens como redução do estresse cirúrgico e menor depressão cardiovascular e respiratória, entretanto, ainda são escassas as pesquisas dedicadas dentro deste contexto. Nesse sentido, o objetivo deste relato foi avaliar o protocolo anestésico empregado, visando um procedimento seguro e passível de reversão para a espécie silvestre selecionada. Acompanhou-se a anestesia de um leão (Panthera leo), macho, adulto, proveniente do Zoológico Municipal de Curitiba, submetido a procedimento endodôntico. A medicação pré-anestésica constituiu-se de dexmedetomidina (6µg/kg), metadona (0,2mg/kg), midazolam (0,1mg/kg) e tiletamina-zolazepam (1,2mg/kg). A indução foi realizada com propofol (1mg/kg) e o animal foi intubado. Visando promover analgesia local, fora realizado bloqueio infraorbitário esquerdo com 5mL de lidocaína a 2%. A manutenção foi realizada por meio do fornecimento de propofol (0,02-0,1mg/kg/h), dexmedetomidina (0,5mg/kg/h) e remifentanil (5mg/kg/h). Pôde-se concluir que o protocolo realizado se mostrou tanto eficaz quanto seguro para a referida espécie encaminhada ao procedimento em questão

Open Surgical Thrombectomy and Coronary Stent Placement for Treatment of Aortic Thrombotic Disease in a Bitch

Background: The thrombotic aortic disease in dogs and cats is characterized by the pathological formation of blood clots that can rupture and obstruct the blood flow. Abdominal ultrasonography can identify the location and extension of thrombus in the main vasculature and using the doppler it is possible to observe the blood flow around the thrombus. Stents are expandable tube-shaped endoprosthesis characterized as a metal mesh and used to prevent or repair stenoses, allowing liquid, gas, or solids to flow. This report aims to describe the surgical and medical treatment of aortic thrombotic disease followed by coronary stents placement in a bitch.Case: An 8-year-old Shih Tzu bitch, presented for evaluation of a 1-month progressive hind limbs paresis. Nociception was present in both limbs, but the patient presented discomfort and vocalization when manipulating the pelvic limbs. A complete blood count demonstrated anemia, mild neutrophilia, and lymphopenia. Serum biochemistry found an increase in ALT, ALP, blood urea nitrogen, and CK. Abdominal ultrasonography detected mild bulging of the caudal aorta and trifurcation of the iliac arteries. Increased intraluminal echogenicity and absence of blood flow were also detected using duplex doppler. The initial medical treatment was ineffective in improving clinical signs, therefore surgical repair was performed. The aorta was isolated and clamped with Satinsky forceps and incised. The thrombus fragmented during removal. A non-compliant high-pressure balloon was used to dilated and remove small fragments of blood clots from the right and left external iliac arteries. Coronary stents of 32 mm length by 2.75 mm diameter were placed to keep both iliac arteries free. Immediately after the procedure, there was a detectable distal pulse in both hind limbs. Despite intensive medical treatment, the patient evolved to respiratory distress and died on the sixth day after surgery. At necropsy, there were thrombi in the lumen of the arteries and several organs in addition to a large hyaline thrombus occluding 80-90% of the aortic lumen and left femoral artery. In the trifurcation region, clots were present, and stents placed in the iliac arteries were also occluded.Discussion: The occurrence of aortic and iliac thrombosis is associated with several conditions, including neoplasia, chronic kidney disease, heart failure, gastric dilatation-volvulus, hypothyroidism, and hyperadrenocorticism (HAC). In this case, the underlying cause of thromboembolism was supposed to be related to an endocrine condition, since the patient had clinical signs compatible with HAC; however, the low-dose dexamethasone suppression test was borderline and further examination could not be afforded. The diagnosis of thrombosis at the iliac trifurcation was obtained through ultrasonographic examination. Computed tomographic and nuclear resonance imaging could have been applied as well. The medical management of the thromboembolic disease was based on anticoagulant therapy with both heparin and clopidogrel in association with surgical thrombectomy and coronary stents placement. Despite the efforts, the patient died shortly after the surgical procedure, which was expected since high rates of mortality and morbidity is often related to the thromboembolic ischemia. The necroscopic examination of the animal found thrombi at the stents, cranial aorta, and microscopically in several tissues. The failure to directly treat the cause of the thrombus, which could not be diagnosed in time, may negatively interfered in patient survival time. The thrombectomy and coronary stents placement reestablished the femoral pulse immediately after surgery, which has been reported in other studies. The surgical resolution of aortic thrombus should be addressed in further studies