Avaliação hemodinâmica e metabólica da cetamina e cetamina S(+) após a reposição volêmica com hidroxietilamido 130/0,4 e solução salina hipertônica 7,5%
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Data
2008-08-01
Autores
Oleskovicz, Nilson
Duque, Juan Carlos
Guirro, Erica Cristina Prado
Valadão, Carlos Augusto Araújo [UNESP]
Fantoni, Denise Tabacchi
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Universidade Federal de Santa Maria (UFSM)
Resumo
O objetivo deste estudo foi avaliar os efeitos hemodinâmicos e metabólicos, após a administração de solução salina hipertônica (NaCL) 7,5% ou em associação ao hidroxietilamido (HES), em cães com hipovolemia induzida e tratados com cetamina. Após a indução da hipovolemia, administrou-se NaCl 7,5% (4,0ml kg-1) no grupo hipertônica levógira (GHL) e grupo hipertônica racêmica (GHR) ou HES 130/0,4 na mesma proporção de sangue retirado, associado a NaCl 7,5% (4ml kg-1) no grupo hipertônica colóide levógira (GHCL) e no grupo hipertônica colóide racêmica (GHCR). Após 30 minutos, administrou-se, por via IV, cetamina levógira (CL) (5mg kg-1) no GHL e GHCL ou cetamina racêmica (CR) (10mg kg-1) no GHR e GHCR. Empregou-se a análise de variância de uma única via com repetições múltiplas (ANOVA) e o teste de Student Newman Keuls (P£0,05). A frequência cardíaca e a pressão arterial sistólica foram menores após a hipovolemia e após a CR. As pressões arteriais média e diastólica foram menores após a hipovolemia e cetamina. A pressão venosa central foi maior após a administração do colóide. Os índices cardíaco e sistólico foram menores após a hipovolemia em todos os grupos e, após a fase de expansão no GHL e GHR. A pressão média da artéria pulmonar foi menor após a hipovolemia em todos os grupos. A pressão de oclusão da artéria pulmonar foi maior após o colóide. O índice do trabalho ventricular esquerdo foi menor após a hipovolemia no GHCL e GHCR. O índice da resistência periférica total foi maior após a hipovolemia e menor após a CL. Observou-se acidose metabólica após a hipovolemia e após a cetamina. Ocorreu acidose respiratória após a cetamina no GHL e GHR. Conclui-se que a administração de NaCl 7,5% associado ao HES 130/0,4 promove o restabelecimento imediato dos parâmetros hemodinâmicos e metabólicos no paciente hipovolêmico; a administração isolada de NaCl 7,5% não é capaz de restaurar a PAM no período imediato, mas melhora os demais parâmetros hemodinâmicos e metabólicos; a administração de CR ou CL produz efeitos hemodinâmicos e metabólicos similares no paciente hipovolêmico.
The objective of this study was to evaluate the hemodynamics and hemogasometrics effects, after the administration of hypertonic solution (NaCl 7.5%) or in association with hidroxyethyl starch 130/0.4 (HES), in dogs with induced experimental hypovolemia and treated with racemic ketamine (RK) or S(+) ketamine (SK). After the hypovolemia induction, administration of NaCl 7.5% (4 ml kg-1) was performed in two groups called hypertonic S(+) group (HSG) and hypertonic racemic group (HRG), or NaCl 7.5% (4 ml kg-1) in association with HES, in the same ratio of removed blood, in two groups called hypertonic colloid S(+) group (HCSG) and hypertonic colloid racemic group (HCRG). After 30 minutes, it was administered by intravenous injection, SK (5tymg kg-1) in HSG and HCSG groups, or RK (10 mg kg-1) in HRG and HCRG groups. To evaluate the significance of the results, it was used One-way Analysis of variance (ANOVA) for repeated measures and Student Newman Keuls method (P£0.05). The heart rate and the systolic arterial pressure were reduced after hypovolemia and administration of the RK. Mean and diastolic arterial pressure were reduced after hypovolemia and either SK or RK administration. The central venous pressure was increased after administration of the colloid. The cardiac output, index cardiac, and index systolic were reduced after hypovolemia in all groups and, after phase of expansion in HSG and HRG. The pulmonary arterial occlusion pressure was increased after colloid administration. The left ventricular work index was reduced after hypovolemia in HCSG and HCRG. The systemic vascular resistance index was increased after hypovolemia and decreased after administration of the SK. The CO2 concentration to the end of the expiration increased after administration of ketamine in HCSG and HCRG. Metabolic acidosis was observed after hypovolemia and after administration of ketamine in all groups. Ketamine in HSG and HRG produced respiratory acidosis. It has been concluded that the administration of NaCl 7.5% by itself or in association with HES immediately restores homodynamic and metabolic parameters of the hypovolemic patient. However, the administration of NaCl 7.5% does not increase the mean arterial pressure of these patients. The administration of either SK or RK produces similar homodynamic effects in hypovolemic patients.
The objective of this study was to evaluate the hemodynamics and hemogasometrics effects, after the administration of hypertonic solution (NaCl 7.5%) or in association with hidroxyethyl starch 130/0.4 (HES), in dogs with induced experimental hypovolemia and treated with racemic ketamine (RK) or S(+) ketamine (SK). After the hypovolemia induction, administration of NaCl 7.5% (4 ml kg-1) was performed in two groups called hypertonic S(+) group (HSG) and hypertonic racemic group (HRG), or NaCl 7.5% (4 ml kg-1) in association with HES, in the same ratio of removed blood, in two groups called hypertonic colloid S(+) group (HCSG) and hypertonic colloid racemic group (HCRG). After 30 minutes, it was administered by intravenous injection, SK (5tymg kg-1) in HSG and HCSG groups, or RK (10 mg kg-1) in HRG and HCRG groups. To evaluate the significance of the results, it was used One-way Analysis of variance (ANOVA) for repeated measures and Student Newman Keuls method (P£0.05). The heart rate and the systolic arterial pressure were reduced after hypovolemia and administration of the RK. Mean and diastolic arterial pressure were reduced after hypovolemia and either SK or RK administration. The central venous pressure was increased after administration of the colloid. The cardiac output, index cardiac, and index systolic were reduced after hypovolemia in all groups and, after phase of expansion in HSG and HRG. The pulmonary arterial occlusion pressure was increased after colloid administration. The left ventricular work index was reduced after hypovolemia in HCSG and HCRG. The systemic vascular resistance index was increased after hypovolemia and decreased after administration of the SK. The CO2 concentration to the end of the expiration increased after administration of ketamine in HCSG and HCRG. Metabolic acidosis was observed after hypovolemia and after administration of ketamine in all groups. Ketamine in HSG and HRG produced respiratory acidosis. It has been concluded that the administration of NaCl 7.5% by itself or in association with HES immediately restores homodynamic and metabolic parameters of the hypovolemic patient. However, the administration of NaCl 7.5% does not increase the mean arterial pressure of these patients. The administration of either SK or RK produces similar homodynamic effects in hypovolemic patients.
Descrição
Palavras-chave
hypertonic solution, hidroxyethyl starch, Ketamine, Dog, hypovolemia, solução hipertônica, hidroxietilamido, cetamina, Cão, Hipovolemia
Como citar
Ciência Rural. Universidade Federal de Santa Maria (UFSM), v. 38, n. 4, p. 1017-1023, 2008.