Evaluación de los efectos cardiovasculares y la eficacia anestésica de dos infusiones continuas de dexmedetomidina en perros anestesiados con un infusión continua de alfaxalona

El desarrollo de cualquier práctica anestésica conlleva una depresión cardiovascular y respiratoria dosis dependiente, que puede llegar a poner en riesgo la vida de nuestro paciente. La finalidad del anestesista es asegurar una estabilidad cardiovascular y respiratoria, proporcionando además una hipnosis, analgesia y relajación muscular adecuadas durante todo el desarrollo quirúrgico. Por ello se recomienda emplear protocolos de anestesia balanceada, basados en la combinación de diferentes fármacos, aprovechando las propiedades sinérgicas entre los mismos para lograr una reducción en la dosis individual de cada uno de ellos, disminuyendo así los efectos adversos y aportando todos los principios necesarios para poder desarrollar una adecuada anestesia quirúrgica. La anestesia total intravenosa o TIVA es ampliamente utilizada en la anestesia veterinaria ya que presenta que presenta varias ventajas sobre la anestesia inhalatoria como son facilidad en la administración de los fármacos y mínimos requerimientos de equipamiento, además de seguridad para el entorno y para el personal que realiza la técnica. Los fármacos empleados en la TIVA se administran vía endovenosa, y deben presentar un efecto de corta duración, un rápido metabolismo y aclaramiento y la ausencia de acumulación en el organismo. Durante muchos años en la clínica de pequeños animales, el propofol ha sido el único fármaco disponible que reunía todos estos requisitos. Recientemente, la alfaxalona ha sido comercializada para su uso durante la inducción y el mantenimiento anestésico en perros y gatos, presentando un índice terapéutico 3-4 veces mayor que el propofol, una alta tolerancia y un amplio margen de seguridad. Al diseñar el proyecto de esta Tesis Doctoral, los efectos cardiorrespiratorios y anestésicos, así como la farmacocinética de un bolo de inducción de alfaxalona habían sido evaluados por escasos artículos en el perro (Ferre et al. 2006; Muir et al. 2008; Pasloske et al. 2009; Maddern et al. 2010), y tan sólo Ambros et al. (2008) habían estudiado los efectos cardiorrespiratorios de una TIVA de alfaxalona. Actualmente existen 6 estudios que emplean la alfaxolona en una TIVA (Ambros et al. 2008; Ambrisko et al. 2011; Suárez et al. 2012; Herbert et al. 2013; Raisis et al. 2015; Conde et al. in press), pero ninguno emplea un agente coadyuvante, como la dexmedetomidina durante el mantenimiento anestésico con alfaxalona. Una infusión de dexmedetomidina se ha utilizado como coadyuvante de agentes inhalatorios, demostrando una disminución de los requerimientos de los mismos, un aporte adicional de sedación y/o analgesia así como una mejora en la recuperación y estabilidad cardiorrespiratoria (Pascoe et al. 2006; Uilenreef et al. 2008; Pascoe et al. 2015)

Implementation of a pilot classroom of practical skills for the clinical subjects of the Veterinary Degree

Las limitaciones temporales en la docencia de las asignaturas clínicas del Grado en Veterinaria, así como el elevado ratio estudiantes/profesor y sobre todo estudiantes/paciente, condicionan en gran medida la formación del alumnado, comprometiendo la adquisición de competencias específicas. Así, el alumnado debe amortizar el tiempo que dedica al aprendizaje de estas materias, integrar los conocimientos adquiridos en ellas para llegar a conseguir el fin de las mismas y ser capaz de enfrentarse a situaciones clínicas con la consecuente realización de los necesarios procedimientos manuales. En este artículo, generado a partir de un proyecto de innovación docente, consideramos la enseñanza basada en la práctica con modelos inanimados o maniquíes como imprescindible para complementar la enseñanza de habilidades clínicas y adquisición de competencias. Debido al alto número de alumnos y al escaso tiempo que pasan por rotaciones clínicas con animales, y teniendo en cuenta las consideraciones éticas, es muy difícil que todos ellos puedan realizar las habilidades clínicas básicas e incluso puedan verlas en situaciones reales. El alumnado debe conocer estos procedimientos dentro de la materia de las asignaturas Propedéutica Clínica, Anestesiología y Cuidados Intensivos, Patología Quirúrgica y Medicina Interna, así como desarrollar estas habilidades, puesto que serán evaluados de esas competencias. Para ello hemos propuesto la implantación en el Departamento de Medicina y Cirugía Animal de un aula piloto donde los alumnos pueden practicar varias veces en los modelos, con el fin de adquirir la pericia necesaria para el dominio de las habilidades clínicas. De esta forma se fomentará una enseñanza integrativa, que mejorará el aprendizaje y el desarrollo de competencias específicas, además de adquirir otras competencias transversales que ayudarán al futuro veterinario en el ejercicio de su profesión.Time limitations in the teaching of clinical subjects of the Veterinary Degree, as well as the high student/teacher ratio and especially student/patient, determine the training of students and compromising the acquisition of specific competences. Thus, students should amortize the time devoted to learning these subjects, integrate the knowledge acquired in them and be able to face clinical situations with the consequent accomplishment of the necessary manual procedures. In the present study, derived from a teaching innovation project, we consider the practice-based teaching with inanimate models or mannequins as a complement of the teaching of clinical skills and acquisition of competences. Due to the high number of students, the short time they spend in clinical rotations with animals and bearing in mind the ethical considerations, it is very difficult for the students to perform the basic clinical skills and even to see them in real situations. The students must know these procedures within the subjects: Clinical Propedeutics, Anesthesiology and Intensive Care, Surgical Pathology and Internal Medicine, as well as to develop these abilities since they will be evaluated of those competences. We have proposed the implementation of a pilot classroom in the Department of Animal Medicine and Surgery where students can practice several times in the inanimate models in order to acquire the necessary expertise for the successful development of clinical skills. This initiative will promote an integrative teaching which will improve the learning and development of specific skills, as well as the acquisition of other transversal competences that will help the future veterinarian in the exercise of their profession

Preperitoneal ropivacaine infusion versus epidural ropivacaine–morphine for postoperative analgesia in dogs undergoing ovariohysterectomy: a randomized clinical trial

Objective To assess the effect of continuous wound infusion (CWI) with preperitoneal ropivacaine on postoperative analgesia and compare it with the epidural administration of ropivacaine and morphine in bitches undergoing ovariohysterectomy. Study design A parallel, randomized, clinical, prospective and nonblinded study. Animals A group of 38 Greyhound bitches. Methods In the catheter group (CathG), CWI with ropivacaine 1% (1 mg kg–1 + 0.8 mg kg–1 hour–1) was applied to the preperitoneal space over the surgical incision. In the epidural group (EpiG), ropivacaine 0.5% (1.3 mg kg–1) and morphine (0.1 mg kg–1) were epidurally administered. Occipital-coccygeal length was used to calculate the volume for the epidural. Pain was scored using a dynamic interactive visual analogue scale (DIVAS) and Glasgow composite measure pain scale–short form (CMPS-SF) before anaesthesia and at 2, 4, 6, 18, 21 and 24 hours after extubation. Incisional sensitivity using a dynamometer (MWTs-incision) was evaluated simultaneously. Plasma ropivacaine and cortisol concentrations, degree of sedation, motor blockade and response to interdigital clamping were measured or assessed. A two-way mixed analysis of variance and a Mann–Whitney U test were used to analyse data; p < 0.05. Results No differences were detected in the DIVAS (p = 0.301), CMPS-SF (p = 0.600) scores, MWTs-incision measurements (p = 0.257) and cortisol values (p = 0.878) between the groups. Rescue analgesia was required in two dogs, one in each group, at 2 hours. Sedation, motor blockade and negative response to interdigital clamping were detected in EpiG at 2, 4 and 6 hours. Mean plasma ropivacaine values were higher in CathG (0.475 ± 0.164 ng mL–1) than in EpiG (0.184 ± 0.213 ng mL–1; p = 0.001). Conclusion and clinical relevance Compared with epidural ropivacaine and morphine, CWI with preperitoneal ropivacaine is an effective analgesic technique for postoperative pain management in bitches undergoing ovariohysterectomy without motor blockade

Parasympathetic Tone Changes in Anesthetized Horses after Surgical Stimulation, and Morphine, Ketamine, and Dobutamine Administration

Autonomic nervous system (ANS) activity can modify cardiovascular parameters in response to nociceptive stimuli or drugs in anesthetized animals. The aim of this study was to determine if a surgical nociceptive stimulus and morphine, ketamine, and dobutamine administration would modify ANS activity observed as a change in the mean parasympathetic tone activity (PTAm) in anesthetized horses. In 20 anesthetized horses, heart rate (HR), mean arterial pressure (MAP), and PTAm were monitored before and 1, 3, and 5 min after surgical incision, and before and 10 min after the administration of morphine (0.2 mg/kg IV). If nystagmus or spontaneous ventilation was observed, ketamine (0.5 mg/kg IV) was given, and the three variables were registered before and 3 and 5 min afterward. If MAP reached ≤ 62 mmHg, a dobutamine infusion was administered, and the three variables were recorded before and 5 min after starting/increasing the infusion (0.25 μg/kg/min IV every 5 min). The three variables were registered before and 1, 3, and 5 min after a PTAm decrease of ≥ 20%, HR increase of ≥ 10%, or MAP increase of ≥ 20%. The PTAm decreased 3 min after the administration of ketamine and 1 min after a PTA event. The surgical incision, dobutamine, and morphine did not modify PTAm. The absence of changes in ANS activity after the nociceptive stimulus and lack of correlation between PTAm and HR or MAP suggest that PTAm is a poor indicator of sympathetic activation under the study conditions. Ketamine seems to affect ANS activity by decreasing PTAm

Immunohistochemical analysis of knee chondral defect repair after autologous particulated cartilage and platelet-rich plasma treatment in sheep

This study performs an analysis that will enable the evaluation of the quality, durability, and structure of repaired cartilaginous extracellular matrix tissue using an autologous-based particulated autograft cartilage and platelet-rich plasma treatment (PACI + PRP). A single-blind controlled experiment was conducted on 28 sheep to evaluate the efficacy of the PACI + PRP treatment for cartilage defects. Full-thickness 8 mm diameter defects were created in the weight-bearing area of both knees. The right knees received PACI + PRP. The left knees were treated with Ringer’s lactate solution (RLS) or hyaluronic acid (HA) injections. Sheep were euthanized at 9- or 18-months post-surgery. An extensive immunohistochemical analysis was performed to assess collagen types (I, II, III, V, VI, IX, X, XI) and aggrecan positivity. A semiquantitative scoring system provided a detailed evaluation of immunostaining. Collagens and aggrecan scores in the PACI + PRP groups were similar to healthy cartilage. Significant differences were found in collagens associated with matrix maturity (II and V), degradation (IX), structure and mechanics (VI), and hypertrophy (X) between healthy cartilage and RLS- or HA-repaired cartilage. The PACI + PRP treatment advanced the repair cartilage process in chondral defects with mature hyaline cartilage and enhanced the structural and mechanical qualities with better consistent cartilage, less susceptible to degradation and without hypertrophic formation over tim

IMPLANTACIÓN DE UN AULA PILOTO DE HABILIDADES PRÁCTICAS PARA LAS ASIGNATURAS DE PERFIL CLÍNICO DEL GRADO EN VETERINARIA

Time limitations in the teaching of clinical subjects of the Veterinary Degree, as well as the high student/teacher ratio and especially student/patient, determine the training of students and compromising the acquisition of specific competences. Thus, students should amortize the time devoted to learning these subjects, integrate the knowledge acquired in them and be able to face clinical situations with the consequent accomplishment of the necessary manual procedures. In the present study, derived from a teaching innovation project, we consider the practice-based teaching with inanimate models or mannequins as a complement of the teaching of clinical skills and acquisition of competences. Due to the high number of students, the short time they spend in clinical rotations with animals and bearing in mind the ethical considerations, it is very difficult for the students to perform the basic clinical skills and even to see them in real situations. The students must know these procedures within the subjects: Clinical Propedeutics, Anesthesiology and Intensive Care, Surgical Pathology and Internal Medicine, as well as to develop these abilities since they will be evaluated of those competences. We have proposed the implementation of a pilot classroom in the Department of Animal Medicine and Surgery where students can practice several times in the inanimate models in order to acquire the necessary expertise for the successful development of clinical skills. This initiative will promote an integrative teaching which will improve the learning and development of specific skills, as well as the acquisition of other transversal competences that will help the future veterinarian in the exercise of their profession.Las limitaciones temporales en la docencia de las asignaturas clínicas del Grado en Veterinaria, así como el elevado ratio estudiantes/profesor y sobre todo estudiantes/paciente, condicionan en gran medida la formación del alumnado, comprometiendo la adquisición de competencias específicas. Así, el alumnado debe amortizar el tiempo que dedica al aprendizaje de estas materias, integrar los conocimientos adquiridos en ellas para llegar a conseguir el fin de las mismas y ser capaz de enfrentarse a situaciones clínicas con la consecuente realización de los necesarios procedimientos manuales. En este artículo, generado a partir de un proyecto de innovación docente, consideramos la enseñanza basada en la práctica con modelos inanimados o maniquíes como imprescindible para complementar la enseñanza de habilidades clínicas y adquisición de competencias. Debido al alto número de alumnos y al escaso tiempo que pasan por rotaciones clínicas con animales, y teniendo en cuenta las consideraciones éticas, es muy difícil que todos ellos puedan realizar las habilidades clínicas básicas e incluso puedan verlas en situaciones reales. El alumnado debe conocer estos procedimientos dentro de la materia de las asignaturas Propedéutica Clínica, Anestesiología y Cuidados Intensivos, Patología Quirúrgica y Medicina Interna, así como desarrollar estas habilidades, puesto que serán evaluados de esas competencias. Para ello hemos propuesto la implantación en el Departamento de Medicina y Cirugía Animal de un aula piloto donde los alumnos pueden practicar varias veces en los modelos, con el fin de adquirir la pericia necesaria para el dominio de las habilidades clínicas. De esta forma se fomentará una enseñanza integrativa, que mejorará el aprendizaje y el desarrollo de competencias específicas, además de adquirir otras competencias transversales que ayudarán al futuro veterinario en el ejercicio de su profesión

Sedation Quality and Cardiorespiratory, Echocardiographic, Radiographic and Electrocardiographic Effects of Intramuscular Alfaxalone and Butorphanol in Spanish Greyhound Dogs

The quality of sedation and changes in cardiorespiratory variables after the intramuscular administration of alfaxalone and butorphanol in Spanish greyhound dogs were evaluated. Twenty-one adult dogs were included. The dogs received alfaxalone (2 mg/kg) and butorphanol (0.2 mg/kg) intramuscularly. Sedation scoring, cardiorespiratory parameters (including blood gas analysis), echocardiography, thoracic radiography and electrocardiography were performed before sedation and 30 min after drug administration. Moderate sedation was observed, and side effects, such as tremors, nystagmus and auditory hyperesthesia, were noticed. Statistically significant changes in heart rate, invasive blood pressure, pH, arterial saturation of O2 and partial pressure of O2 and CO2 were found. Echocardiographic variables, including end-diastolic volume, left ventricular diameter in diastole, aortic and pulmonic flow, diastolic transmitral flow and left atrial/aortic ratio, and electrocardiography parameters, including PQ interval and QT interval, showed statistically significant changes. In conclusion, the intramuscular administration of alfaxalone and butorphanol to healthy dogs produced moderate sedation with mild cardiorespiratory, echocardiographic and electrocardiographic changes, without alterations in cardiac size on radiographic images