Craniotomia para remoção de meningioma em cão: Relato de caso

Os meningiomas são neoplasias benignas que podem apresentar caráter biológico maligno devido às alterações intracranianas, e de acordo à sua localização causar compressão dos tecidos adjacentes. Estão entre as neoplasias mais comuns de sistema nervoso central em cães. Podem surgir em pacientes geriátricos e causam sintomas variáveis, dependendo da localização, extensão e taxa de crescimento. O tratamento definitivo é feito por ressecção cirúrgica e radioterapia. O objetivo desse trabalho é relatar um caso de meningioma intracraniano envolvendo o bulbo olfatório e lobo frontal esquerdos em um cão da raça Pastor de Shetland, com 10 anos de idade, encaminhado para o setor de diagnóstico por imagem para a realização de ressonância magnética após apresentar convulsões generalizadas e tetraparesia não deambulatória, bem como a escolha do protocolo anestésico e analgésico e cuidados pós-operatórios. Concluiu-se que pacientes submetidos à craniotomia devem ser submetidos à anestesia geral com protocolos seguros que considerem o procedimento cirúrgico e também às comorbidades. No pós-operatório desses pacientes se requer acompanhamento em unidades de terapia intensiva a fim de reduzir o risco de óbito e de complicações

Manejo anestésico do felino obstruído: Relato de caso

A Doença do Trato Urinário Inferior Felino (DTUIF) é a principal causa de obstrução uretral, incluindo obstruções idiopáticas, tampões uretrais, urolitíase e outras obstruções mecânicas, como estenoses e neoplasias. Essa predominância está diretamente relacionada aos machos jovens de meia idade, devido à uretra dos machos ser mais longa e estreita, aumentando a probabilidade de obstrução. Os sinais clínicos geralmente incluem hematúria, poliúria e, principalmente, estranguria, juntamente com uma bexiga repleta. Em casos mais graves, pode ocorrer instabilidade cardiovascular e azotemia. O diagnóstico da DTUIF é feito por meio do exame físico do paciente, que pode revelar dilatação vesical, histórico de dificuldade em urinar, com várias idas à caixa de areia, podendo ou não haver vocalização. O objetivo deste trabalho foi relatar um caso de obstrução uretral em um felino macho, fértil, de dois anos de idade, pesando cinco kg, com queixa de provável constipação. Durante o exame físico, o paciente apresentou muita dor na palpação abdominal, o que levou à sua sedação para um exame mais detalhado, revelando uma bexiga repleta e com aspecto enrijecido. Foi implementado um protocolo anestésico e terapêutico para realizar os procedimentos necessários e acompanhar a evolução do caso

Condutas anestésicas na endoscopia para remoção de corpo estranho esofágico: Relato de caso

A utilização de anestésicos em procedimentos endoscópicos apresenta diversas funções benéficas, tais como a redução da resposta ao estresse, melhora da função respiratória no pós-operatório e a diminuição da dor após a cirurgia. Por outro lado, entre suas desvantagens, pode-se mencionar a limitação da visualização do campo cirúrgico, o que pode resultar em uma cirurgia mais prolongada e em uma maior necessidade de uso desses anestésicos. No entanto, os benefícios superam tais desvantagens, uma vez que os prognósticos de recuperação dos pacientes são favoráveis. A endoscopia tem se tornado cada vez mais frequente na medicina veterinária devido à sua praticidade. É de extrema importância que o anestesista veterinário esteja preparado para proporcionar uma sedação adequada durante o procedimento. Durante o período transoperatório, o animal manteve-se estável, apesar da resistência do corpo estranho em lesar e persistir na região da mucosa esofágica cervical

Perspectives of bilateral thoracic sympathectomy for treatment of heart failure

Surgical neuromodulation therapies are still considered a last resort when standard therapies have failed for patients with progressive heart failure (HF). Although a number of experimental studies have provided robust evidence of its effectiveness, the lack of strong clinical evidence discourages practitioners. Thoracic unilateral sympathectomy has been extensively studied and has failed to show significant clinical improvement in HF patients. Most recently, bilateral sympathectomy effect was associated with a high degree of success in HF models, opening the perspective to be investigated in randomized controlled clinical trials. In addition, a series of clinical trials showed that bilateral sympathectomy was associated with a decreased risk of sudden death, which is an important outcome in patients with HF. These aspects indicates that bilateral sympathectomy could be an important alternative in the treatment of HF wherein pharmacological treatment barely reaches the target dose

Bloqueio de nervo pudendo em uretrostomia perineal felina: Relato de caso

Devido à frequência do acometimento de felinos machos a obstruções uretrais recorrentes, a cirurgia de uretrostomia perineal se mostra como um tratamento viável para a desobstrução permanente da uretra. O seguinte trabalho visa relatar um caso do uso de bloqueio locorregional do nervo pudendo como provedor de analgesia regional em uma cirurgia de uretrostomia perineal felina associada a penectomia. O paciente foi pré-medicado com metadona 0,15 mg/kg e acepromazina 0,01 mg/kg, induzido com propofol 3mg/kg e Cetamina 1,5mg/kg e mantido em plano anestésico com Isoflurano. Não foram visualizadas alterações significativas nos parâmetros fisiológicos durante o período transcirúrgico, e o paciente teve recuperação rápida e sem demonstração de dor ou alteração comportamental, comprovando a eficácia do bloqueio como ferramenta crucial de analgesia na cirurgia

Mesenteric hypoperfusion and inflammation induced by brain death are not affected by inhibition of the autonomic storm in rats

OBJECTIVES: Brain death is typically followed by autonomic changes that lead to hemodynamic instability, which is likely associated with microcirculatory dysfunction and inflammation. We evaluated the role of the microcirculation in the hemodynamic and inflammatory events that occur after brain death and the effects of autonomic storm inhibition via thoracic epidural blockade on mesenteric microcirculatory changes and inflammatory responses. METHODS: Male Wistar rats were anesthetized and mechanically ventilated. Brain death was induced via intracranial balloon inflation. Bupivacaine (brain death-thoracic epidural blockade group) or saline (brain death group) infusion via an epidural catheter was initiated immediately before brain death induction. Sham-operated animals were used as controls (SH group). The mesenteric microcirculation was analyzed via intravital microscopy, and the expression of adhesion molecules was evaluated via immunohistochemistry 180 min after brain death induction. RESULTS: A significant difference in mean arterial pressure behavior was observed between the brain death-thoracic epidural blockade group and the other groups, indicating that the former group experienced autonomic storm inhibition. However, the proportion of perfused small vessels in the brain death-thoracic epidural blockade group was similar to or lower than that in the brain death and SH groups, respectively. The expression of intercellular adhesion molecule 1 was similar between the brain death-thoracic epidural blockade and brain death groups but was significantly lower in the SH group than in the other two groups. The number of migrating leukocytes in the perivascular tissue followed the same trend for all groups. CONCLUSIONS: Although thoracic epidural blockade effectively inhibited the autonomic storm, it did not affect mesenteric hypoperfusion or inflammation induced by brain death

Effects of sympathectomy on cardiac remodeling in a doxorrubicin-induced dilated cardiomyopathy model

Introduction: The main cause of cardiac transplantation is dilated cardiomyopathy (DCM), in which there are ventricular dilation and systolic dysfunction, leading to congestive heart failure. Ventricular remodeling involves activation of the sympathetic nervous and renin-angiotensin- aldosterone systems. As such, classic treatments include angiotensin-converting enzyme inhibitors (ACEI), beta-blockers and mineralocorticoid receptor antagonists. Once such treatments only delay the development of the disease, it is important to look for better therapeutic options. Experimental models demonstrated the benefits of sympathetic blockade on preserving ventricular function and preventing left ventricle remodeling after myocardial infarction. Objective: We evaluated the influence of bilateral thoracic sympathectomy on left ventricle remodeling and function in a rat model of doxorubicin induced DCM. Methodology: Animals were randomly divided into 4 groups of 7 rats each. DCM only, bilateral sympathectomy (BS) with DCM, ACEI with DCM and also a negative control group (SHAM). DCM was inducted in the experimental groups through weekly intraperitoneal injection of doxorubicin. Fifteen days after the beginning of DCM induction, bilateral sympathectomy was performed by chemical sclerosis of stellate ganglion with ethanol in the BS group. From this same time point until the end of experimental protocol, animals of the ACEI group received daily, through water ingestion, a enalapril maleate dilution. Ten weeks later, left ventricular function was evaluated with the use of a microtip pressureconductance catheter. Also, extracellular fibrosis were evaluated and BCL-2 expression on myocardial tissue were quantified. Partial Results: DCM group showed an increased left ventricular (LV) end-diastolic volume in relation to Sham group(p=0.034). Also, a significant decrease was observed in LV ejection fraction in DCM group, while bilateral sympathectomy were able to preserve this parameter (p=0,001). Furthermore, both treated groups showed an increased LV stroke work compared to DCM group (p=0,002). Myocardial extracellular fibrosis were more present in control group, whereas both BS and ACE inhibitor treatments reduced the areas of fibrotic tissue (p<0,0001), which can be associated with increased expression of anti-apoptotic BCL-2 in treated groups (p=0,0004). Discussion and Conclusion: Sympathetic blockade was able to suppress myocardial tissue fibrosis, most likely due to increasing anti-apoptotic BCL-2 expression. Moreover, LV function was maintained as observed through LV ejection fraction,stroke work and cardiac efficiency levels. Although ACE inhibitor was also able to inhibit extracellular fibrosis and increase BCL- 2 expression, cardiac function has not been preserved as in BS group. Therefore, we conclude that BS was able to decrease myocardial tissue deterioration and also to preserve LV in a doxorubicin model of DCM in rats. Keywords: Sympathectomy; Cardiomyopathy; Cardiac transplantation; Doxorubicin

Mesenteric Microcirculatory Dysfunctions and Translocation of Indigenous Bacteria in a Rat Model of Strangulated Small Bowel Obstruction

PRUPOSE: Bacterial translocation has been shown to occur in critically ill patients after extensive trauma, shock, sepsis, or thermal injury. The present study investigates mesenteric microcirculatory dysfunctions, the bacterial translocation phenomenon, and hemodynamic/metabolic disturbances in a rat model of intestinal obstruction and ischemia. METHODS: Anesthetized (pentobarbital 50 mg/kg, i.p.) male Wistar rats (250-350 g) were submitted to intestinal obstruction or laparotomy without intestinal obstruction (Sham) and were evaluated 24 hours later. Bacterial translocation was assessed by bacterial culture of the mesenteric lymph nodes (MLN), liver, spleen, and blood. Leukocyte-endothelial interactions in the mesenteric microcirculation were assessed by intravital microscopy, and P-selectin and intercellular adhesion molecule (ICAM)-1 expressions were quantified by immunohistochemistry. Hematocrit, blood gases, lactate, glucose, white blood cells, serum urea, creatinine, bilirubin, and hepatic enzymes were measured. RESULTS: About 86% of intestinal obstruction rats presented positive cultures for E. coli in samples of the mesenteric lymph nodes, liver, and spleen, and 57% had positive hemocultures. In comparison to the Sham rats, intestinal obstruction induced neutrophilia and increased the number of rolling (~2-fold), adherent (~5-fold), and migrated leukocytes (~11-fold); this increase was accompanied by an increased expression of P-selectin (~2-fold) and intercellular adhesion molecule-1 (~2-fold) in the mesenteric microcirculation. Intestinal obstruction rats exhibited decreased PaCO2, alkalosis, hyperlactatemia, and hyperglycemia, and increased blood potassium, hepatic enzyme activity, serum urea, creatinine, and bilirubin. A high mortality rate was observed after intestinal obstruction (83% at 72 h vs. 0% in Sham rats). CONCLUSION: Intestinal obstruction and ischemia in rats is a relevant model for the in vivo study of mesenteric microcirculatory dysfunction and the occurrence of bacterial translocation. This model parallels the events implicated in multiple organ dysfunction (MOD) and death