Evaluation of transsurgical stress in bitches submitted to ovariosalpingohisterectomy under infusions of fentanyl, lidocaine, and ketamine, associated or not with dexmedetomidine
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Keywords

analgesia
alpha 2-agonists
N-methyl-D-aspartate

How to Cite

Domingos de Melo, K. ., Monteiro Tenório, A. P. ., Tudury, E. A., de Araújo Penaforte Junior, M. ., Cândido Trajano, S. ., da Silva Ferreira, M. S. ., Ratis Galeas, G. ., & Silva Camargo, K. . (2021). Evaluation of transsurgical stress in bitches submitted to ovariosalpingohisterectomy under infusions of fentanyl, lidocaine, and ketamine, associated or not with dexmedetomidine. Brazilian Journal of Veterinary Medicine, 42(1), e105320. https://doi.org/10.29374/2527-2179.bjvm105320

Abstract

Ketamine and dexmedetomidine are analgesic drugs indicated to control surgical pain. This study analyzes the increase in cortisol and blood glucose levels in bitches undergoing continuous infusion of dexmedetomidine and ketamine in ovariosalpingohisterectomy. For that, we compared groups using these drugs with a group using FLK (fentanyl, lidocaine, and ketamine) and the control group (without transsurgical analgesia). The experiment included 40 young (3.8 ± 2.8 years) mixed-breed bitches with average body weight of 9.8 ± 2.4 kg. These animals were allocated into 5 groups according to the recommended anesthetic technique: GCO (control group for pain); GFLK (control group for analgesia), undergoing continuous infusion of fentanyl (50 μg/mL), lidocaine (150 mg), and ketamine (30 mg), or FLK diluted in 500 mL of 0.9% saline solution and infused, after fentanyl bolus (5 μg/kg), at a rate of 10 mg/kg/h, equivalent to: 0.03 μg/kg/min of fentanyl associated with 50 μg/kg/min of lidocaine and 10 μg/kg/min of ketamine, about 5 minutes before surgical incision; GCE, undergoing infusion of only ketamine at the time of surgery, at a rate of 10 μg/kg/min, after intravenous administration of this drug at 2 mg/kg; GDEX, undergoing infusion of dexmedetomidine (2 μg/kg diluted in 20 mL of 0.9% NaCl), starting with an infusion of 2 μg/kg for 5 minutes, followed by an infusion rate of 2 μg/kg/h; GDEXCE, which received dexmedetomidine bolus (2 μg/kg) plus ketamine (2 mg/kg diluted in 20 mL of 0.9% NaCl solution), intravenously, over a period of five minutes. Then, the alpha-2 agonist (diluted in 20 mL of 0.9% NaCl) was infused at a rate of 2 μg/kg/h, and ketamine was continuously infused at 10 μg/kg/min. The results showed a significant reduction of cortisol levels of animals in the GDEXCE group in comparison to the animals in the GCO group at moment 5 (M5). However, cortisol and blood glucose values after extubation were influenced by the action of drugs. Thus, cortisol and blood glucose are not considered effective parameters for assessing transsurgical stress in bitches submitted to ovariosalpingohisterectomy and anesthetized with dexmedetomidine plus ketamine. Considering hemodynamic and behavioral parameters, dexmedetomidine associated with ketamine reduced the surgical stress of animals in the GDEXCE group.

https://doi.org/10.29374/2527-2179.bjvm105320
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References

Afonso, J., & Reis, F. (2012). Dexmedetomidine: current role in anesthesia and intensive care. Revista brasileira de anestesiologia, 62(1), 118-133. http://dx.doi.org/10.1590/S0034-70942012000100015. PMid:22248773.

Aguado, D., Benito, J., & Gómez de Segura, I. A. (2011). Reduction of the minimum alveolar concentration of isoflurane in dogs using a constant rate of infusion of lidocaine–ketamine in combination with either morphine or fentanyl. Veterinary Journal (London, England), 189(1), 63-66. http://dx.doi.org/10.1016/j.tvjl.2010.05.029. PMid:20594878.

Ahmad, R. A., Kinjavdekar, P., Aithal, H. P., Pawde, A. M., & Kumar, D. (2013). Potential use of dexmedetomidine for different levels of sedation, analgesia and anaesthesia in dogs. Veterinarni Medicina, 58(2), 87-95.

Amin, A. A., & Najim, I. M. (2011). Use of detomidine, butorphanol and ketamine for induction of general anesthesia in donkeys. Al-Anbar Journal of Veterinary Sciences, 4, 1-8.

Basso, P. C., Raiser, A. G., Brun, M. V., Müller, D. C. M., Lukarsewski, R., Serafini, G. M. C., & Marconato, F. (2014). Ovariossalpingo-histerectomia em cadelas: comparação da dor e análises cardiorrespiratória, pressórica e hemogasométrica nas abordagens convencional, por NOTES híbrida e NOTES total. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 66(5), 1329-1338. http://dx.doi.org/10.1590/1678-6671.

Belmonte, E. A., Nunes, N., Thiesen, R., Lopes, P. C. F., Costa, P. F., Barbosa, V. F., Moro, J. V., Batista, P. A. C. S., & Borges, P. A. (2013). Infusão contínua de morfina ou fentanil, associados à lidocaína e cetamina, em cães anestesiados com isofluorano. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 65(4), 1075-1083. http:// dx.doi.org/10.1590/S0102-09352013000400019.

Bottega, F. H., & Fontana, R. T. (2010). A dor como quinto sinal vital: utilização da escala de avaliação por enfermeiros de um hospital geral. Texto & Contexto Enfermagem, 19(2), 283-290. http://dx.doi.org/10.1590/ S0104-07072010000200009.

Caldeira, F. M. C., Oliveira, H. P., Melo, E. G., Martins, C., Vieira, M. S., & Silva, C. N. D. (2006). Cortisol sérico e glicemia em cadelas tratadas com tramadol e submetidas à ovário-histerectomia. Ciência Rural, 36(1), 155-160. http://dx.doi.org/10.1590/S0103-84782006000100023.

Castro Vaz, F., Molina, G. E., Porto, L. G. G., & Porto, A. L. (2013). Cortisol e atividade física: será o estresse um indicador do nível de atividade física espontânea e capacidade física em idosos?. BrasíliaMédica, 50(2), 143-152.

Chohan, A. S. (2010). Anesthetic considerations in orthopedic patients with or without trauma. Topics in Companion Animal Medicine, 25(2), 107-119. http://dx.doi.org/10.1053/j.tcam.2010.01.002. PMid:20515674.

Congdon, J. M., Marquez, M., Niyom, S., & Boscan, P. (2011). Evaluation of the sedative and cardiovascular effects of intramuscular administration of dexmedetomidine with and without concurrent atropine administration in dogs. Journal of the American Veterinary Medical Association, 239(1), 81-89. http://dx.doi.org/10.2460/ javma.239.1.81. PMid:21718200.

Deumens, R., Steyaert, A., Forget, P., Schubert, M., Lavand’homme, P., Hermans, E., & De Kock, M. (2013). Prevention of chronic postoperative pain: cellular, molecular, and clinical insights for mechanism-based treatment approaches. Progress in Neurobiology, 104, 1-37. http://dx.doi.org/10.1016/j.pneurobio.2013.01.002. PMid:23410739.

Dougdale, A. (2010). Small animal sedation and premedication. In A. Dougdale. Veterinary anaesthesia: principles to practice (pp. 30-44). Iowa: Blackwell Publishing.

Fein, A., Petrov, P., Francischi, J. N., & Ferreira, S. H. (2011). Nociceptores: as células que sentem dor. Ribeirão Preto: Dor On Linep. Retrieved in 2016, July 20, from http://www.dol.inf.br/html/LivroNociceptores/Nociceptores.pdf

Feldman, E. C., & Nelson, R. W. (1985) The adrenal gland. In E. C. Feldman & R. W. Nelson. Canine and feline endocrinology and reproduction (pp. 187-322). Philadelphia: Saunders.

Field, A. (2009). Descobrindo a estatística usando o SPSS-5. Porto Alegre: Penso Editora.

González-Gil, A., Villa, A., Millán, P., Martínez-Fernández, L., & Illera, J. C. (2015). Effects of dexmedetomidine and ketamine–dexmedetomidine with and without buprenorphine on corticoadrenal function in rabbits. Journal of the American Association for Laboratory Animal Science; JAALAS, 54(3), 299-303. PMid:26045456.

Goutal, C. M., Brugmann, B. L., & Ryan, K. A. (2012). Insulinoma in dogs: a review. Journal of the American Animal Hospital Association, 48(3), 151-163. http://dx.doi.org/10.5326/JAAHA-MS-5745. PMid:22474047.

Greene, S. A. (2010). Chronic pain: pathophysiology and treatment implications. Topics in Companion Animal Medicine, 25(1), 5-9. http://dx.doi.org/10.1053/j.tcam.2009.10.009. PMid:20188333.

Gündüz, M., Sakalli, Ş., Güneş, Y., Kesiktaş, E., Özcengiz, D., & Işik, G. (2011). Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients. Journal of Anaesthesiology, Clinical Pharmacology, 27(2), 220-224. http://dx.doi.org/10.4103/0970-9185.81823. PMid:21772684.

Gutierrez-Blanco, E., Victoria-Mora, J. M., Ibancovichi-Camarillo, J. A., Sauri-Arceo, C. H., Bolio-González, M. E., Acevedo-Arcique, C. M., Marin-Cano, G., & Steagall, P. V. (2013). Evaluation of the isoflurane‐sparing effects of fentanyl, lidocaine, ketamine, dexmedetomidine, or the combination lidocaine‐ketamine‐dexmedetomidine during ovariohysterectomy in dogs. Veterinary Anaesthesia and Analgesia, 40(6), 599-609. http://dx.doi.org/10.1111/vaa.12079. PMid:23910822.

Hatschbach, E., Massone, F., Bechara, J. N., Balieiro, J. C. C., & Barreiro, R. H. (2005). Avaliação paramétrica do cloridrato de dexmedetomidina em cães pré-tratados ou não pela atropina e tratados ou não pela quetamina. Ars Veterinária, 21(1), 22-29.

Hergovich, N., Singer, E., Agneter, E., Eichler, H. G., Graselli, U., Simhandl, C., & Jilma, B. (2001). Comparison of the effects of ketamine and memantine on prolactin and cortisol release in men: a randomized, double-blind, placebo-controlled trial. Neuropsychopharmacology, 24(5), 590-593. PMDI 1395602.

Klaumann, P. R., Wouk, A. F. P. F., & Sillas, T. (2008). Patofisiologia da dor. Archives of Veterinary Science, 13(1), 1-12. http://dx.doi.org/10.5380/avs.v13i1.11532.

Lacerda, M. S., & Nunes, T. C. (2008). Efeitos do cetoprofeno e flunixin meglumine na modulação neuroendócrina à dor pós-operatória em cadelas submetidas à ovário-histerectomia. Bioscience Journal, 24(4)

Lemke, K. A. (2013) Anticolinérgiocos e sedativos. In W. J. Tranquilli, J. C. Thurmon & K. A. Grimm. Lumb e Jones. Anestesiologia e Analgesia Veterinária (pp. 230-269). São Paulo: Roca.

Lin, H. C. (2007). Dissociative anesthetics. In W. J. Tranquilli, J. C. Thurmon & K. A. Grimm. Lumb and Jones Veterinary Anesthesia and Analgesia (pp. 301-354). Malden: Blackwell Publishing.

Malm, C., Savassi-Rocha, P. R., Gheller, V. A., Oliveira, H. P., Lamounier, A. R., & Foltynek, V. (2005). Ovário-histerectomia: estudo experimental comparativo entre as abordagens laparoscópica e aberta na espécie canina-III. estresse pela análise do cortisol plasmático. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 57(5), 584-590. http://dx.doi.org/10.1590/S0102-09352005000500003.

Marangoni, M. A., Castiglia, Y. M. M., & Medeiros, T. P. (2005). Eficácia analgésica da dexmedetomidina comparada ao sufentanil em cirurgias intraperitoneais: estudo comparativo. Revista Brasileira de Anestesiologia, 55(1), 19-27. http://dx.doi.org/10.1590/S0034-70942005000100003. PMid:19471805.

Marik, P. E., & Bellomo, R. (2013). Stress hyperglycemia: an essential survival response! Critical Care (London, England), 17(2), 305. PMid:23470218.

Matičić, D., Stejskal, M., Pećin, M., Kreszinger, M., Pirkić, B., Vnuk, D., Smolec, O., & Rumenjak, V. (2010). Correlation of pain assessment parameters in dogs with cranial cruciate surgery. Veterinarski Arhiv, 80(5), 597-609.

Meintjes, R. A. (2012). An overview of the physiology of pain for the veterinarian. Veterinary journal (London, England : 1997), 193(2), 344-348. http://dx.doi.org/10.1016/j.tvjl.2012.03.001. PMid:22503719.

Muir, W. W., & Gaynor, J. S. (2009). Pain behaviors. In J. Gaynor & W. W. Muir (Eds.), Handbook of veterinary pain management (2nd ed., pp. 62-79). Mosby: Missouri. http://dx.doi.org/10.1016/B978-032304679-4.10005-X.

Murrell, J. C., & Hellebrekers, L. J. (2005). Medetomidine and dexmedetomidine: a review of cardiovascular effects and antinociceptive properties in the dog. Veterinary Anaesthesia and Analgesia, 32(3), 117-127. http:// dx.doi.org/10.1111/j.1467-2995.2005.00233.x. PMid:15877658.

Naddaf, H., Varzi, H. N., Sabiza, S., & Falah, H. (2014). Effects of xylazine-ketamine anesthesia on plasma levels of cortisol and vital signs during laparotomy in dogs. Open Veterinary Journal, 4(2), 85-89. PMid:26623345.

Oklü, E., Bulutcu, F. S., Yalçın, Y., Ozbek, U., Cakalı, E., & Bayındır, O. (2003). Which anesthetic agent alters the hemodynamic status during pediatric catheterization? Comparison of propofol versus ketamine. Journal of Cardiothoracic and Vascular Anesthesia, 17(6), 686-690. http://dx.doi.org/10.1053/j.jvca.2003.09.009. PMid:14689405.

Oliveira, C. M. B. D., Sakata, R. K., Issy, A. M., & Garcia, J. B. S. (2004). Cetamina e analgesia preemptiva. Revista Brasileira de Anestesiologia, 54(5), 739-752. http://dx.doi.org/10.1590/S0034-70942004000500016. PMid:19471784.

Persson, J. (2013). Ketamine in pain management. CNS Neuroscience & Therapeutics, 19(6), 396-402. http://dx.doi. org/10.1111/cns.12111. PMid:23663314.

Redondo, J. I., Rubio, M., Soler, G., Serra, I., Soler, C., & Gómez-Villamandos, R. J. (2007). Normal values and incidence of cardiorespiratory complications in dogs during general anaesthesia. A review of 1281 cases. Journal of Veterinary Medicine Series A, 54(9), 470-477. http://dx.doi.org/10.1111/j.1439-0442.2007.00987.x. PMid:17931219.

Restitutti, F., Raekallio, M., Vainionpää, M., Kuusela, E., & Vainio, O. (2012). Plasma glucose, insulin, free fatty acids, lactate and cortisol concentrations in dexmedetomidine-sedated dogs with or without MK-467: a peripheral α-2 adrenoceptor antagonist. Veterinary journal (London, England : 1997), 193(2), 481-485. http:// dx.doi.org/10.1016/j.tvjl.2011.12.010. PMid:22277719.

Rodrigues, M. C., Coelho, M. C. O. C., Quessada, A. M., Lima, D. A. S. D., Sousa, J. M., & Carvalho, C. C. (2012). Ovariosalpingohisterectomia em cadelas: comparação entre a técnica de tração uterina por via vaginal associada à celiotomia pelo flanco ea abordagem ventral mediana. Revista Portuguesa de Ciências Veterinárias, 111, 165-172.

Rosero, E. B., & Joshi, G. P. (2014). Preemptive, preventive, multimodal analgesia: what do they really mean?. Plastic and Reconstructive Surgery, 134(4S-2), 85S-93S. https://doi.org/10.1097/PRS.0000000000000671. PMID: 25255012.

[[Q7: Q7]]Sampaio, I. B. M. (2007). Estatística aplicada à experimentação animal (No. 519.5). Belo Horizonte: Fundação de Estudo e Pesquisa em Medicina Veterinaria.

Santos Otero, A. R., Barbosa, V. F., Carneiro, R. L., Martins Filho, E. F., Azevedo, M. C., Santos, B. C. P., & Costa Neto, J. M. (2016). Avaliação da infusão contínua de dexmedetomidina ou dexemedetomidina-midazolam sobre variáveis cardiorrespiratórias e qualidade da recuperação anestésica, em cadelas submetidas à ovariosalpingohisterectomia. Brazilian Journal of Veterinary Medicine, 38(2), 168-174.

Santos, L. C. D. C., Fernandes, L. S., Sepulveda, R. V., Pereira, V. G., Eleotério, R. B., & Favarato, L. S. C. (2015). Eletroacupuntura na analgesia trans e pós-operatória de cadelas submetidas à ovariosalpingohisterectomia. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 67(6), 1554-1562. http://dx.doi.org/10.1590/1678-4162-7987.

Uilenreef, J. J., Murrell, J. C., McKusick, B. C., & Hellebrekers, L. J. (2008). Dexmedetomidine continuous rate infusion during isoflurane anaesthesia in canine surgical patients. Veterinary Anaesthesia and Analgesia, 35(1), 1-12. http://dx.doi.org/10.1111/j.1467-2995.2007.00344.x. PMid:18211626.

Vasiljević, M., Ristanović, D., Jovanović, M., Davitkov, D., Bošnjak, I., Krstić, V., & Stanimirović, Z. (2015). Comparative analysis of parameters of intraoperative and postoperative pain in bitches undergoing laparoscopic or conventional ovariectomy. Acta Veterinaria, 65(4), 488-495. http://dx.doi.org/10.1515/acve-2015-0041.

Villela, N. R., Nascimento Júnior, P. D., & Carvalho, L. R. D. (2003). Efeitos cardiovasculares de duas doses de dexmedetomidina: estudo experimental em cães. Revista Brasileira de Anestesiologia, 53(6), 784-796. http:// dx.doi.org/10.1590/S0034-70942003000600009. PMid:19471697.

Zanella, R., Thomazi, G., Guizzo Junior, N., Spagnolo, J. D., Guimarães, L. D., & Brun, M. V. (2009). Cortisol plasmático como indicador de estresse em colopexias laparoscópicas com implante de tela de polipropileno em cães. Acta Scientiae Veterinariae, 37(3), 231. http://dx.doi.org/10.22456/1679-9216.16335.

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Copyright (c) 2020 Kleyton Domingos de Melo, Ana Paula Monteiro Tenório, Eduardo Alberto Tudury, Mauro de Araújo Penaforte Junior, Sabrina Cândido Trajano, Maria Sheila da Silva Ferreira, Gabriela Ratis Galeas, Karine Silva Camargo