The use of rocuronium in giant Amazon turtle Podocnemis expansa (Schweigger, 1812) (Testudines, Podocnemididae) / Uso do rocurônio em tartaruga da Amazônia Podocnemis expansa (Schweigger, 1812) (Testudines, Podocnemididae)

PURPOSE: To determine whether rocuronium would provide safe, short-term immobilization in Podocnemis expansa. METHODS: Twenty P. expansa, weighing on average 1.59 ± 0.28 kg, were subjected to two protocols: G1 0.25 mg/kg IM of rocuronium and 0.07 mg/kg IM of neostigmine, while G2 received 0.50 mg/kg IM of rocuronium and 0.07 mg/kg IM of neostigmine. The drugs were applied, respectively, in the left and right thoracic members. Assessments were made of the anesthetic parameters of respiratory frequency, heartbeat, righting reflex, cloacal relaxation, palpebral and pupilar reflexes, easy handling, muscle relaxation, locomotion, response to pain stimuli in the right thoracic members, pelvic members and tail, ambient humidity and temperature. RESULTS: They were not found statistical differences between the dosages for the majority of the assessments. G1 was as efficient as G2. A consistent neuromuscular blockade effect was recorded 12 ± 4.21 minutes in G1 and G2. All the animals were recovered in 150 minutes. CONCLUSIONS: Administration of rocuronium at dose of 0.25 to 0.5 mg/kg IM is a safe and effective adjunct to clinical proceedings or pre-anesthetics in P. expansa. Because rocuronium does not provide any analgesic or sedative effects, the duration of neuromuscular blockade without anesthesia should be minimized to avoid undue stress.

OBJETIVO: Determinar se o rocurônio promove imobilização segura e de curta duração em Podocnemis expansa. MÉTODOS: Vinte P. expansa com média de peso 1,59 ± 0,28 kg, foram submetidas a dois protocolos: G1 recebeu rocurônio 0,25 mg/kg IM e neostigmina 0,07 mg/kg IM enquanto G2 rocurônio 0,50 mg/kg IM e neostigmina 0,07 mg/kg IM, aplicados no membro torácico esquerdo e direito, respectivamente. Observaram-se os parâmetros anestésicos: freqüência respiratória e cardíaca, reflexo de endireitamento, relaxamento do esfíncter da cloaca, reflexo palpebral e pupilar, facilidade de manipulação, relaxamento muscular, locomoção, resposta aos estímulos dolorosos no membro torácico direito, nos membros pelvinos e na cauda, temperatura e umidade ambiental. RESULTADOS: Não foram encontradas diferenças estatísticas entre as doses para a maioria dos parâmetros e o G1 foi tão eficiente quanto o G2. Um bloqueio neuromuscular consistente foi observado aos 12 ± 4,21 minutos tanto no G1 como no G2. A recuperação de todos os animais ocorreu em até 150 minutos. CONCLUSÕES: Administração de rocurônio nas doses 0,25 e 0,50 mg/kg IM é segura e efetiva para os procedimentos clínicos ou pré-anestésicos em P. expansa. Como o rocurônio não produz efeitos sedativos ou analgésicos, a duração do bloqueio neuromuscular sem anestesia deverá ser minimizado para evitar estresse.

Efeitos da metadona ou do neostigmine, associados à lidocaína administrados pela via epidural em cães / Effects of methadone or neostigmine in combination with lidocaine for epidural anesthesia in dogs

Seis cães adultos, de raças e sexos variados, com peso de 13,3±3,4kg (média±DP), foram utilizados no estudo. Os animais foram tranqüilizados com acepromazina (0,1mg/kg, IV) e, após 30 minutos, foram aleatoriamente submetidos à anestesia epidural com um dos seguintes tratamentos: lidocaína 2 por cento 0,25ml/kg (controle); neostigmine 0,01mg/kg+lidocaína (NEO); metadona 0,3mg/kg+lidocaína (MET). Todos os animais foram submetidos aos três tratamentos com intervalo mínimo de uma semana. Foram mensuradas as freqüências cardíaca (FC) e respiratória (FR), a pressão arterial sistólica (PAS), o tempo para a perda do reflexo interdigital, a duração e a altura do bloqueio sensitivo, durante um período de 90 minutos. Não houve diferença significativa entre os tratamentos nos valores de FC, PAS e FR, bem como na duração do bloqueio sensitivo e no tempo para a perda do reflexo interdigital. No grupo MET, houve diminuição de FC dos 30 aos 90 minutos em relação ao valor basal. Bloqueio sensitivo mais cranial também foi observado em MET. A associação de neostigmine ou metadona não prolongou o período hábil de anestesia epidural produzido pela lidocaína em cães. A metadona, mas não o neostigmine, parece estender mais cranialmente o bloqueio epidural pela lidocaína.

Six mature mongrel dogs of both genders, weighing 13.3±3.4kg (mean±SD) were used in the present research. Thirty minutes after premedication with intravenous acepromazine (0.1mg/kg, IV), dogs were randomly assigned to receive epidural administration of one of following three treatments: 2 percent lidocaine 0.25ml/kg (control), or neostigmine 0.01mg/kg plus lidocaine (NEO), or methadone 0.3mg/kg plus lidocaine (MET). All dogs received all treatments in a cross-over design with at least one-week interval. Heart rate (HR), respiratory rate (RR), systolic arterial pressure (SAP), time to loss of pedal withdrawal reflex, duration of epidural anesthesia, and cranial spread of epidural anesthesia were evaluated for 90 minutes. No differences among treatments in HR, RR, SAP, duration of anesthesia, and time to loss of pedal withdrawal reflex were found. In MET, HR decreased from 30 to 90 minutes compared to baseline and there was a higher cranial spread of epidural anesthesia than in controls and NEO animals. Neostigmine or methadone did not prolong epidural anesthesia with lidocaine in dogs. Methadone, but not neostigmine, appeared to result in more cranial spread of epidural anesthesia with lidocaine.

Less tachycardia in adults when using atropine 0.9 mg compared with 1.2 mg plus neostigmine 2.5 mg.

OBJECTIVE: Compare the increase in heart rate in adults after 0.9 vs. 1.2 mg of atropine plus neostigmine 2.5 mg as the non-depolarizing muscle relaxant reversal agent. MATERIAL AND METHOD: A randomized, double blind, controlled trial on 46 adults ASA I-II, undergoing elective gynecological or general surgery with balanced general anesthesia was performed. The subjects were randomized into two groups, After surgery, the study group received 0.9 mg of atropine, while the control group received 1.2 mg of atropine. Both groups received 2.5 mg of neostigmine simultaneously. RESULTS: The heart rate and blood pressure were taken at 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, and 30 min after the injection. The increase in heart rate and blood pressure between the two groups were compared. The heart rate (at 3, 4, 5, and 6 min) of patients in the study group increased significantly less than that of patients in the control group. There was no significant difference in blood pressure between groups and no side effects occurred. CONCLUSION: The authors conclude that 0.9 mg of atropine with 2.5 mg neostigmine can be safely used as the reversal agent for a non-depolarizing muscle relaxant, particularly in patients for whom any increase in heart rate would be harmful.

Assessment of midazolam, fentanyl, or neostigmine as an adjuvant to bupivacaine spinal anaesthesia

The aim of this study is to evaluate the postoperative analgesic and side effects of intrathecal midazolam, fentanyl, and neostigmine on bupivacaine spinal blockade. A total of 60 patients undergoing lower limb surgery were randomized to one of four groups. All patients received 10mg hyperbaric bupivacaine plus 2ml of the test drug intrathecally [1T]. The control group [B] received saline as the test drug. The midazolam group [BM] received 2mg midazolam, the fentanyl group [BF] received 20ug fentanyl, and the neostigmine group [BN] received 25ug neostigmine. Extent and duration of sensory and motor blockade were evaluated. Adequacy of analgesia and incidence of adverse effects were also recorded. The groups were demographically similar. The time required for first rescue postoperative analgesic was shorten in the control group compared to the other groups [p<0.001]. The frequency of postoperative analgesic intake was significantly more in control group [p<0.001]. Preoperative sedation was noted to be significantly higher in midazolam group. More patients in fentanyl group reported pruritus, whereas more patients in neostigmine group experienced nausea and vomiting than did the other groups. The mixtures of midazolam-bupivacane, fentanyl-bupivacaine, or neostigmine-bupivacaine intrathecally lengthened postoperative analgesic duration and reduce analgesic consumption postoperative, however making choice between the three drugs, side effects related to each one must he considered and careful monitoring is mandatory

Analgesic efficacy and safety of intrathecal neostigmine in patients undergoing total knee replacement

In recent human and animal studies, intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity. Intrathecal neosrtigmine has been used as an adjunct to intrathecal local anaesthetic or opioid to prolong regional analgesia and improve haemodynamic stability, with variable results. The present study was designed to compare the effects of the addition of IT neostigmine or IT morphine on the characteristics of spinal anesthesia with bupivacaine and to assess their postoperative analgesic efficacy and safety in patients undergoing total knee replacement surgery under spinal anesthesia. Sixty patients scheduled for elective total knee replacement under spinal anesthesia were randomly divided into three equal groups which received IT 0.5% hyperbaric bupivacaine 15 mg with either normal saline 0.5 mL, neostigmine 50 micro g. or morphine 300 micro g. The maximal level of sensory block, duration of analgesia, time to use of rescue analgesics, the overall 24-hr and four-hour interval visual analogue scale [VAS] pain score, and the incidence of adverse effects were recorded for 24 hr after administration. There was no significant difference in maximal level of sensory block among the three groups. The morphine group had a later onset of postsurgical pain and longer time to first rescue analgesics than the neostigmine group [P <0.05]. Overall 24-hr VAS pain scores were significantly higher in the saline group vs the morphine and neostigmine groups [P <0.05]. Motor block lasted significantly longer in the neostigmine group than in the morphine and saline groups [P <0.05]. The incidence of adverse effects was similar in the neostigmine and morphine groups except for pruritus [70%] occurring more frequently in the morphine group than in the neostigmine and saline groups [0%; P <0.05]. Overall satisfaction rates were better in the neostigmine group than in the morphine and saline groups [P <0.05]. IT neostigmine 50 pg produced postoperative analgesia lasting about seven hours with fewer side effects and better satisfaction ratings than IT morphine 300 micro g

Avaliação do bloqueio neuromuscular residual e da recurarização tardia na sala de recuperação pós-anestésica / Evaluation of residual neuromuscular block and late recurarization in the post-anesthetic care unit

JUSTIFICATIVA E OBJETIVOS: O bloqueio neuromuscular residual altera a patência das vias aéreas aumentando o risco de graves complicações no pós-operatório. Nos pacientes que recebem o anticolinesterásico, a transmissão neuromuscular é incrementada pelo acúmulo de acetilcolina na placa motora, mas que, findo o efeito da neostigmina, teoricamente é possível uma "recurarização", visto que o agente antagonista não desloca o bloqueador neuromuscular do seu local de ação. Foi objetivo deste trabalho quantificar o grau de paralisia residual em Sala de Recuperação Pós-Anestésica (SRPA) e averiguar se os pacientes que receberam neostigmina apresentam fenômeno de "recurarização" tardia. MÉTODO: Foram estudados na SRPA 119 pacientes adultos que receberam bloqueadores neuromusculares para diferentes tipos de procedimentos. Ao chegarem na SRPA, a transmissão neuromuscular foi quantificada através de um monitor por método acelerográfico. Os eletrodos estimuladores foram instalados no trajeto do nervo ulnar no punho, e empregou-se a seqüência de 4 estímulos, com correntes de 30 mA, na periodicidade de 15 até 120 minutos. Nesta pesquisa considerou-se como resíduo de bloqueio neuromuscular uma relação T4/T1 abaixo de 0,9. No tempo de permanência da SRPA foram igualmente registrados os sintomas clínicos sugestivos de bloqueio neuromuscular residual e aferidos os sinais vitais. Para análise estatística foram empregadas medidas descritivas tais como média e freqüência absoluta. RESULTADOS: Os pacientes que receberam pancurônio apresentaram maior incidência de resíduo de bloqueio neuromuscular, principalmente os idosos. Nos pacientes que receberam neostigmina houve expressivo percentual de bloqueio neuromuscular residual. Em nenhum grupo observou-se o fenômeno de "recurarização" tardia. CONCLUSÕES: Constatou-se expressivo número de pacientes com resíduo de bloqueio neuromuscular, quando utilizado o pancurônio. A fase de recuperação, quando foi usada a neostigmina não se seguiu...

Intrathecal neostigmine versus intrathecal morphine, their combination for postoperative analgesia in patients undergoing herniorrhaphy

We designed this study to evaluate the postoperative analgesic efficacy and safety of intrathecal [IT] neostigmine, intrathecal [IT] morphine, and their combination in patients undergoing herniorrhaphy under spinal anesthesia. Eighty adult patients were randomly divided into four groups to receive isotonic sodium chloride solution 0.5 ml, neostigmine 100ug, morphine 0.3 mg or the combination of IT neostigmine 50 ug and morphine 0.15 mg with IT 0.5 0/0 hyperbaric bupivacaine 15 mg. There were no significant differences among the four groups with regard to spinal anesthesia, age, heart rate, or mean arterial blood pressure. Postoperative analegisa was provided by IM diclofenac. Compared with the saline group, the time to first use of analgesic was significantly longer in neostigmine group [p= 0.02], with lower 24 h analgesic consumption [p=0.001]. Nausea and vomiting were the most common side effects of IT neostigmine 60 0/0. Analgesic effectiveness was similar between the neostigmine and morphine groups. Compared with the neostigmine group, the combination group had significantly longer analgesic effects [P=0.02] with less incidence of nausea and vomiting [p=0.04]. Compared with the morphine group, the combination group tended to have prolonged times to first use of analgesic [p=0.02] with lower incidence of pruritus [p=0.03]. the combination of IT neostigmine 50 ug and IT morphine 0.15 mg produce longer postoperative analgesia with fewer side effects than IT neostigmine 100ug or IT morphine 0.3 mg alone. Intrathecal [IT] neostigmine 100ug produced postoperative analgesia for herniorraphy similar to [IT] morphine 0.3mg, but with high incidence of nausea and vomiting, morphine group had high incidence of pruritus. Thus, combination of both has higher analgesic effects with lower side effects than single drug alone

Analgesia postoperatoria con y sin neostigmina espinal / Postoperative analgesia with and without the addition of spinal neostigmine

Se realizó un estudio anestésico prospectivo, longitudinal y compartivo en 30 pacientes del sexo femenino a quienes se les practicó artroplastía de la cadera o de la rodilla. Se clasificaron en grupos de 15 integrantes cada uno; el grupo A, de estudio se manejó con 15 mg de bupivacaína al 0.5 por ciento con 50 µg de metilsulfato de neostigmina por vía intratecal, mientras que al lote control se les administró por la misma vía, 15 mg de bupivacaína al 0.5 por ciento con 1 ml de glucosa al 5 por ciento. Se observó analgesia más significativa y de mayor duración en el grupo tratado con neostigmina, sin embargo, presentaron mayor frecuencia de náusea, vómito, bradicardia e hipotensión arterial