Parâmetros clínicos, eletrocardiográficos, hematológicos, bioquímicos e hemogasométricos em pacas (Cuniculus paca - Linnaeus, 1766) submetidas à laparoscopia, sob contenção farmacológica, anestesia geral e dois protocolos analgésicos
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Data
2016-06-21
Autores
Ramirez Uscategui, Ricardo Andres [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Considerando a escassa informação disponível para a espécie Cuniculus paca que permita a adequação de um protocolo anestésico seguro para a aspiração folicular laparoscópica (LOPU) e a monitorização consciente dos parâmetros fisiológicos nestes pacientes, propôs-se avaliar a eficácia, os efeitos cardiorrespiratórios e sobre os constituintes celulares e bioquímicos sanguíneos, da associação de cetamina e midazolam para a contenção química, isofluorano para a manutenção anestésica e tramadol ou metadona para o controle da dor pós-operatória em pacas hígidas de cativeiro submetidas à LOPU. Oito animais foram submetidos a três protocolos experimentais com intervalo de 15 dias recebendo aleatoriamente 0,5 mg/kg de metadona, 5 mg/kg de tramadol ou placebo no período anestésico. Após contenção física, foi aplicada por via intramuscular a associação de 0,5 mg/kg de midazolam e 25 mg/kg de cetamina para contenção farmacológica (CF). Posteriormente, realizou-se indução e manutenção anestésica com isofluorano. Realizou-se exame eletrocardiográfico, análise de gases arteriais, dos constituintes celulares sanguíneos e das concentrações de proteínas plasmáticas (PPT), creatinina, alanina aminotransferase, sódio, potássio, cloreto e cálcio ionizado, após CF e ao final do procedimento cirúrgico. Os parâmetros frequência cardíaca (FC), e respiratória (fR), temperatura retal (TR), saturação da oxihemoglobina (SpO2), pressão de CO2 ao final da expiração (PE'CO2), concentração de isofluorano expiratório (PE'ISO) e pressão arterial média (PAM) foram monitorados desde o CF e nas diferentes etapas da LOPU. A intensidade da dor nas 24 horas subsequentes à LOPU foi avaliada pela escala analógica visual (VAS). Os resultados foram comparados entre os tratamentos, momentos e períodos pelos testes de ANOVA e Friedman (p<0,05). O tempo médio, para CF foi 3,7 ± 1,53 min e para recuperação anestésica 78 ± 18 min. O traçado eletrocardiográfico em DII apresentou QRS com polaridade positiva, precedido por onda P da mesma polaridade e seguida por onda T de polaridade variável. A frequência cardíaca média foi de 150 ± 17 bpm e o eixo elétrico cardíaco de 33.4 ± 21.9°. Na anestesia geral foram observadas menores concentrações de hemoglobina, linfócitos, PPT, pH e maiores níveis de potássio, PaO2, PaCO2, HCO3, BE e AGap. A FC, PAM e PE´CO2, variaram em relação aos momentos cirúrgicos avaliados. A FC, PE´ISO e AGap foram menores nos grupos tratados com opióides. A PAM, PE´CO2, PaCO2, HCO3 maiores nos animais tratados com metadona, enquanto a FC, SpO2, e VAS menores. Em conclusão o protocolo de contenção farmacológica demostrou ser adequado e seguro. Já a anestesia geral somada à ação do capnopneumoperitônio, conduzem à elevação da PAM e do potássio sanguíneo, redução da FC, hipercapnia, acidose respiratória, depleção dos parâmetros eritrocitários, linfócitos e PPT. A administração da metadona parece piorar estes efeitos adversos, com limitadas vantagens sobre a dor pós-operatória.
Given the limited information available in Cuniculus Paca that allows suitability and safe anesthetic protocol for laparoscopic ovum pick up (LOPU) and conscious physiological parameters monitoring in these patients, it was proposed to evaluate efficacy, cardiorespiratory, hematology and biochemical effects of ketamine/midazolam association chemical restraint, isoflurane anesthesia and tramadol or methadone for postoperative pain control in healthy, captivity pacas submitted to LOPU. Eight animals subjected to three experimental protocols with 15 days interval randomly receiving methadone 0.5 mg/kg, tramadol 5 mg/kg or placebo postinduction. After physical restraint midazolam 0.5 mg/kg plus ketamine 25 mg/kg was applied intramuscularly for pharmacological restraint (MFR). Anesthesia was induced and maintained with isoflurane. The electrocardiographic parameters, blood gas analysis, blood cell counts, plasma protein (PPT), creatinine, alanine aminotransferase, sodium, potassium, chloride and ionized calcium concentrations, were evaluated after MFR and at end of surgical procedure. Heart (HR), and respiratory rate (fR), rectal temperature (TR), oxyhemoglobin saturation (SpO2), End tidal CO2 (PE'CO2), isoflurane expiratory concentration (PE'ISO) and mean arterial pressure (MAP) were monitored from MFR and at LOPU stages. Pain intensity was evaluated for 24 hours after LOPU by visual analogic scale (VAS). The results were compared between treatments, moments and periods by Friedman and ANOVA tests (p <0.05). Time for chemical restraint 3.7 ± 1.53 min and anesthetic recovery 78 ± 18 min. The electrocardiographic tracing in DII presented a QRS complex with positive polarity, preceeded by same polarity P wave and proceeded by variable polarity T wave. Heart rate mean was 150 ± 17 bpm, and cardiac electrical axis 33.4 ± 21.9°. In general anesthesia were observed lower hemoglobin, lymphocytes, PPT and pH concentrations and higher potassium, PaO2, PaCO2, HCO3, BE and AGAP levels. HR, MAP and PE'CO2 varied according surgical times. HR, PE'ISO and AGap were lower in opioids treated groups. MAP, PE'CO2, PaCO2 and HCO3 were higher in methadone treated animals, while HR, SpO2 and VAS were lower. Conclusion, chemical restraint protocol proved to be safe and adequate. While general anesthesia plus capnopneumoperitoneum action, led to MAP and blood potassium increase, HR reduction, hypercapnia, respiratory acidosis, and depletion of red cell parameters, lymphocytes, PPT. The methadone administration seems to worsen these adverse effects, with limited advantages over post-operative analgesia.
Given the limited information available in Cuniculus Paca that allows suitability and safe anesthetic protocol for laparoscopic ovum pick up (LOPU) and conscious physiological parameters monitoring in these patients, it was proposed to evaluate efficacy, cardiorespiratory, hematology and biochemical effects of ketamine/midazolam association chemical restraint, isoflurane anesthesia and tramadol or methadone for postoperative pain control in healthy, captivity pacas submitted to LOPU. Eight animals subjected to three experimental protocols with 15 days interval randomly receiving methadone 0.5 mg/kg, tramadol 5 mg/kg or placebo postinduction. After physical restraint midazolam 0.5 mg/kg plus ketamine 25 mg/kg was applied intramuscularly for pharmacological restraint (MFR). Anesthesia was induced and maintained with isoflurane. The electrocardiographic parameters, blood gas analysis, blood cell counts, plasma protein (PPT), creatinine, alanine aminotransferase, sodium, potassium, chloride and ionized calcium concentrations, were evaluated after MFR and at end of surgical procedure. Heart (HR), and respiratory rate (fR), rectal temperature (TR), oxyhemoglobin saturation (SpO2), End tidal CO2 (PE'CO2), isoflurane expiratory concentration (PE'ISO) and mean arterial pressure (MAP) were monitored from MFR and at LOPU stages. Pain intensity was evaluated for 24 hours after LOPU by visual analogic scale (VAS). The results were compared between treatments, moments and periods by Friedman and ANOVA tests (p <0.05). Time for chemical restraint 3.7 ± 1.53 min and anesthetic recovery 78 ± 18 min. The electrocardiographic tracing in DII presented a QRS complex with positive polarity, preceeded by same polarity P wave and proceeded by variable polarity T wave. Heart rate mean was 150 ± 17 bpm, and cardiac electrical axis 33.4 ± 21.9°. In general anesthesia were observed lower hemoglobin, lymphocytes, PPT and pH concentrations and higher potassium, PaO2, PaCO2, HCO3, BE and AGAP levels. HR, MAP and PE'CO2 varied according surgical times. HR, PE'ISO and AGap were lower in opioids treated groups. MAP, PE'CO2, PaCO2 and HCO3 were higher in methadone treated animals, while HR, SpO2 and VAS were lower. Conclusion, chemical restraint protocol proved to be safe and adequate. While general anesthesia plus capnopneumoperitoneum action, led to MAP and blood potassium increase, HR reduction, hypercapnia, respiratory acidosis, and depletion of red cell parameters, lymphocytes, PPT. The methadone administration seems to worsen these adverse effects, with limited advantages over post-operative analgesia.
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Palavras-chave
Roedores, Midazolam, Cetamina, Metadona, Tramadol, Isofluorano, Rodents, Ketamine, Methadone, Isoflurane