Efeitos da solução de tumescência refrigerada ou aquecida, em cadelas submetidas à mastectomia unilateral radical
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Data
2022-02-01
Autores
Rocha, Fabiana Del Lama [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivou-se comparar os possíveis efeitos das soluções de tumescência refrigerada ou aquecida sobre parâmetros fisiológicos, perda sanguínea, consumo anestésico e níveis de sedação e analgesia pós-cirúrgica, de cadelas submetidas à mastectomia unilateral radical. Foram utilizadas 16 cadelas, distribuídas em 2 grupos (n = 8) tratados com solução de tumescência com lidocaína 0,1% acrescida de adrenalina 0,0002%. As fêmeas receberam, como auxílio de cânula de Klein, volume fixo de 15 mL/kg de solução aquecida entre 37 e 40 °C (grupo GA) ou refrigerada entre 8 e 12°C (grupo GR). Após pré medicação com clorpromazina (0,3 mg/kg) associada à meperidina (3 mg/kg), pela via intramuscular, as cadelas foram induzidas à anestesia com propofol e mantidas com isofluorano, em ventilação espontânea (FiO2 = 0,6). A coleta de dados iniciou-se no período pré-operatório (Mbasal), quando foram mensuradas as frequências cardíaca (FC) e respiratória (ƒ), pressão arterial sistólica (PAS) e temperatura retal (TR). No período transoperatório os momentos de aferição foram padronizados de acordo com o ato cirúrgico- anestésico e avaliou-se a FC, ƒ, pressão arterial média (PAM), consumo do anestésico inalatório e TR. Ao final, quantificou-se a perda sanguínea. Já no período pós-operatório, a coleta dos dados FC, ƒ, PAS e TR iniciou-se logo após a extubação (Mextub) e se estendeu por 480 minutos (M480). No período pós-operatório O grau de sedação foi obtido com auxílio de escala descritiva simples e a analgesia pós-operatória foi avaliada com o auxílio da Escala de dor da Universidade de Glasgow modificada (EDGM) entre 60 (M60) e 480 minutos (M480) após a extubação. As variáveis quantitativas foram analisadas por meio de Modelos Lineares Mistos, enquanto as qualitativas foram analisadas pelo Modelo Linear Generalizado Misto, seguidas pelo teste de Cramer-von Mises (p ≤ 0,05). As variáveis EDGM (2 ± 1,48 em GA; 1 ± 1,48 em GR), tempo de extubação (8,12 ± 3,18 em GA; 5,75 ± 2,06 em GR), sangramento transoperatório (9,68 ± 1,1 em GA; 7,81 ± 1,69 em GR) e tempo cirúrgico (49,17 ± 5,19 em GA; 62,33 ± 6,41 em GR) apresentaram diferença estatística entre grupos. Para as demais variáveis não se observaram diferenças significativas entre grupos. Acredita-se que a diferença na variável EDGM ocorreu devido às propriedades anti-inflamatórias e analgésicas do gelo, o que contribuiu com os menores escores de dor em GR. Soma-se a isso a provável vasodilatação promovida pela solução aquecida, fazendo com que ocorra diminuição do efeito da lidocaína no grupo GA, devido à sua maior absorção. Acredita-se que o uso da solução aquecida tenha facilitado a divulsão cirúrgica no grupo GA, diminuindo o tempo cirúrgico neste grupo, apesar de o sangramento transoperatório deste grupo ter sido consideravelmente maior que no grupo GR. Sendo assim, conclui-se que abas as soluções apresentam eficácia analgésica por, pelo menos, 8 horas de pós-operatório e que a solução aquecida determina menor tempo cirúrgico, apesar da maior perda sanguínea no período transoperatório.
The aim of the study was to compare the effect of cold or heated tumescence solutions on bleeding and hypothermia during the transoperative period, of bitches submitted to radical unilateral mastectomy. Sixteen bitches were used, distributed in 2 groups (n = 8) that received tumescent solution with 0.1% lidocaine plus adrenaline 0.0002%, which were differentiated by the temperature of the solution. The animals of the GA group received a heated solution between 37 and 40 °C and to the GR group, a chilled solution was administered between 8 and 12 °C, using a Klein cannula to infiltrate the solutions and a fixed volume of 15 mL/kg. Chlorpromazine (0.3 mg/kg) was associated with meperidine (3 mg/kg), intramuscularly, as pre-anesthetic medication, induction was proceeded with propofol, intravenously, and maintenance with isofluorane, in spontaneous ventilation. Data collection started in the preoperative period (Baseline), when heart (HR) and respiratory (ƒ) rates, systolic blood pressure (SBP) and rectal temperature (RT) were measured. In the transoperative period, the measurement moments were standardized according to the anesthetic-surgical procedure and HR, ƒ, mean arterial blood pressure (MAP), inhalation anesthetic consumption and RT were evaluated. In the post-operative period, the collection of data FC, ƒ, PAS and TR started immediately after extubation (Mextub) and extended for 480 minutes (M480). The postoperative analgesia time was assessed with short-form of the Glasgow pain Scale (GMPS-SF), between 60 (M60) and 480 minutes (M480) after extubation. The degree of sedation, with the aid of a simple descriptive scale and transoperative bleeding were also evaluated. Quantitative variables were analyzed using Mixed Linear Models, while qualitative variables were analyzed using the Mixed Generalized Linear Model, followed by the Cramer-von Mises test (p ≤ 0.05). The variables GMPS-SF (2 ± 1.48 in GA; 1 ± 1.48 in GR), extubation time (8.12 ± 3.18 in GA; 5.75 ± 2.06 in GR), intraoperative bleeding (9.68 ± 1.1 in GA; 7.81 ± 1.69 in GR) and surgical time (49.17 ± 5.19 in GA; 62.33 ± 6.41 in GR) showed statistical differences between groups. In the other variables, there was no significant differences between groups. It is believed that the difference in the EDGM variable was due to the anti-inflammatory and analgesic properties of ice, which contributed to the lower pain scores in GR. Added to this is the probable vasodilation promoted by the heated solution, causing a decrease in the effect of lidocaine in the GA group, due to its greater absorption. It is believed that the use of the heated solution facilitated the surgical divulsion in the GA group, reducing the surgical time in this group, despite the fact that the intraoperative bleeding in this group was considerably higher than in the GR group. Therefore, it is concluded that both solutions have analgesic efficacy for at least 8 hours postoperatively and that the heated solution determines a shorter surgical time, despite the greater blood loss in the intraoperative period.
The aim of the study was to compare the effect of cold or heated tumescence solutions on bleeding and hypothermia during the transoperative period, of bitches submitted to radical unilateral mastectomy. Sixteen bitches were used, distributed in 2 groups (n = 8) that received tumescent solution with 0.1% lidocaine plus adrenaline 0.0002%, which were differentiated by the temperature of the solution. The animals of the GA group received a heated solution between 37 and 40 °C and to the GR group, a chilled solution was administered between 8 and 12 °C, using a Klein cannula to infiltrate the solutions and a fixed volume of 15 mL/kg. Chlorpromazine (0.3 mg/kg) was associated with meperidine (3 mg/kg), intramuscularly, as pre-anesthetic medication, induction was proceeded with propofol, intravenously, and maintenance with isofluorane, in spontaneous ventilation. Data collection started in the preoperative period (Baseline), when heart (HR) and respiratory (ƒ) rates, systolic blood pressure (SBP) and rectal temperature (RT) were measured. In the transoperative period, the measurement moments were standardized according to the anesthetic-surgical procedure and HR, ƒ, mean arterial blood pressure (MAP), inhalation anesthetic consumption and RT were evaluated. In the post-operative period, the collection of data FC, ƒ, PAS and TR started immediately after extubation (Mextub) and extended for 480 minutes (M480). The postoperative analgesia time was assessed with short-form of the Glasgow pain Scale (GMPS-SF), between 60 (M60) and 480 minutes (M480) after extubation. The degree of sedation, with the aid of a simple descriptive scale and transoperative bleeding were also evaluated. Quantitative variables were analyzed using Mixed Linear Models, while qualitative variables were analyzed using the Mixed Generalized Linear Model, followed by the Cramer-von Mises test (p ≤ 0.05). The variables GMPS-SF (2 ± 1.48 in GA; 1 ± 1.48 in GR), extubation time (8.12 ± 3.18 in GA; 5.75 ± 2.06 in GR), intraoperative bleeding (9.68 ± 1.1 in GA; 7.81 ± 1.69 in GR) and surgical time (49.17 ± 5.19 in GA; 62.33 ± 6.41 in GR) showed statistical differences between groups. In the other variables, there was no significant differences between groups. It is believed that the difference in the EDGM variable was due to the anti-inflammatory and analgesic properties of ice, which contributed to the lower pain scores in GR. Added to this is the probable vasodilation promoted by the heated solution, causing a decrease in the effect of lidocaine in the GA group, due to its greater absorption. It is believed that the use of the heated solution facilitated the surgical divulsion in the GA group, reducing the surgical time in this group, despite the fact that the intraoperative bleeding in this group was considerably higher than in the GR group. Therefore, it is concluded that both solutions have analgesic efficacy for at least 8 hours postoperatively and that the heated solution determines a shorter surgical time, despite the greater blood loss in the intraoperative period.
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Palavras-chave
Cães, Dor, Hipotermia, Isoflurano, Tumor de mama