Physiological responses to different ischemic periods during laparoscopic infrarenal aortic cross-clamping: evaluation in an experimental animal model.

Our aim was to study the physiological repercussions of varying ischemic times during laparoscopic aortic surgery. After quarantine, laparoscopy was performed in 24 healthy pigs, which were randomly allocated to four study groups: group I (n=6), laparoscopic infrarenal abdominal aortic surgery with 30 min of crossclamping; group II (n=6), laparoscopic infrarenal abdominal aortic surgery with 60 min of cross-clamping; group III (n=6), laparoscopic infrarenal abdominal aortic surgery with 120 min of cross-clamping; group IV (n=6), 120 min pneumoperitoneum in the absence of aortic cross-clamping (control group). Hematological, biochemical, hormone, hemodynamic, and ventilatory studies were conducted during and after surgery; and a postoperative neurological evaluation was performed 10 days after surgery. Group III evidenced an increase in arterial blood pressure and heart rate that was significantly higher than those present in the other groups. Significant decreases in pH were observed in groups II and III, whereas no changes in this parameter were seen in groups I and IV. Catecholamine levels during surgery were similar in all groups (a significant [p<0.001] increase in plasmatic adrenaline and noradrenaline was seen immediately after pneumoperitoneum creation in all groups). A positive association was found between the duration of aortic clamping and hormone values at 30 and 60 min after declamping but not after 24hr. A significant increase in the renal resistive index (RRI) and a significant decrease in urine output were evidenced during laparoscopy, with significantly lower RRI values seen in group IV immediately after surgery. Thus, a synergic effect of pneumoperitoneum and aortic cross-clamping was seen in this study. These two factors together cause a hemodynamic compromise, with decreased renal perfusion and acidosis, thus negatively affecting the patient's general state during this type of surgery. Despite being well tolerated in healthy pigs, a laparoscopic aortic cross-clamping time over 60min produces significant hemodynamic, metabolic, and hormonal changes. Careful patient selection is mandatory to avoid any severe complications.

Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment--preliminary study in pigs.

PURPOSE: To prospectively evaluate the technical feasibility and safety of transcatheter arterial embolization (TAE) of the prostate in healthy pigs. MATERIALS AND METHODS: The study was approved by the institutional ethics committee for animal research. Sixteen large white male pigs were randomly assigned to the embolization group (n = 8) or control group (n = 8). Selective angiography was performed in all animals after general anesthesia was induced. In the embolization group, microspheres 500-700 microm in diameter were used to occlude the prostatic branches. Three months later, the animals' sexual function while breeding with female pigs was subjectively evaluated by using a three-point scale. At necropsy, the prostates were removed for size measurement and histopathologic examination. Paired Student t and Wilcoxon rank sum tests were used for statistical analysis. RESULTS: TAE was technically successful in all animals, without associated complications. The mean prostate volume after embolization was significantly (P < .001) reduced compared with the mean prostate volume for the group control. No significant difference (P = .328) in sexual function was noted between the two groups. Histologic examination revealed that the microspheres had occluded the arterioles of the prostate, with disappearance of the nearby partially normal gland structure and atrophy of the residual gland tissue. CONCLUSION: TAE of the prostate can induce shrinkage of the prostate without compromising the sexual desire and erectile function of animals. This finding suggests that TAE has potential as an alternative treatment for symptomatic benign prostatic hyperplasia in humans.

The measurement of neurovegetative activity during anesthesia and surgery in swine: an evaluation of different techniques.

In this study we evaluated, in 10 sevoflurane-anesthetized pigs undergoing abdominal surgery, different techniques for measuring autonomic nervous system (ANS) activity: ANSiscope index, spectral analysis of heart-rate variability, hemodynamic variables, and plasma catecholamines and cortisol levels. Animals underwent a 120-min anesthesia during which unilateral ovariectomy was performed. Cardiovascular and respiratory responses were monitored. ANSiscope indices (ANSindex sympathetic, ANSindex parasympathetic and balANSindex) were used to monitor ANS activity. Spectral analysis was performed using an autoregressive model with a parametric method. The low frequency (LF) and high frequency (HF) components were used to interpret the power spectral density of short-term electrocardiograms (ECGs). The relationship LF/(LF+HF) reflects sympathetic activity, HF/(LF+HF) indicates parasympathetic activity, and the LF/HF ratio gives the predominance of the system. Plasma concentrations of adrenaline, noradrenaline, and cortisol were determined at different times. Correlation (P < 0.01) was found between the balANSindex and adrenaline levels and between LF/HF ratio and plasma adrenaline concentrations. Moreover, a significant (P < 0.01) correlation was found between the balANSindex and LF/HF ratio. However, no correlation was seen between the registered ANSiscope indices and hemodynamic variables. The correlation seen in this study suggests that the balANSindex could be a useful tool to monitor ANS activity during anesthesia and surgery.

Bispectral index, spectral edge frequency 95% and median frequency recorded at varying desflurane concentrations in pigs.

The objective of this study is to evaluate the usefulness of bispectral index (BIS), spectral edge frequency 95% (SEF) and median frequency (MED) in relation to a simple descriptive scale (SDS) as indicators of anaesthetic depth at different desflurane concentrations in swine. Sixteen pigs were randomly allocated to four groups. Electroencephalograms (EEG) were recorded during desflurane anaesthesia, and BIS, SEF and MED were calculated from the EEG. The agent was administered in pure oxygen at 1, 1.25, 1.5 and 1.7 MAC in randomized order. Anaesthetic depth was evaluated on a SDS. BIS decreased significantly (P<0.001) at the different anaesthetic dosages used. SEF decreased significantly (P<0.001) from basal to 1 MAC of desflurane. MED decreased significantly (P<0.001) from basal to 1 MAC and from 1 to 1.75 MAC. Good correlation was seen between SDS scores and BIS values and between SDS scores and MED values. BIS appeared to be useful to predict changes in anaesthetic depth at clinically used dosages of inhalant anaesthesia.

Relationships between a proprietary index, bispectral index, and hemodynamic variables as a means for evaluating depth of anesthesia in dogs anesthetized with sevoflurane.

OBJECTIVE: To evaluate relationships among various techniques for monitoring anesthetic depth in sevoflurane-anesthetized dogs undergoing orthopedic surgery. ANIMALS: 10 dogs. PROCEDURE: Dogs were medicated with acepromazine (0.05 mg/kg, IM), buprenorphine (0.01 mg/kg, IM), and atropine (0.04 mg/kg, IM). Anesthesia was induced and maintained with sevoflurane. Cardiovascular and respiratory responses were monitored. Anesthetic depth was monitored by use of the bispectral index (BIS), and a proprietary index was used to monitor activity of the autonomic nervous system. RESULTS: A significant decrease in BIS was seen after induction but concurrent changes were not observed for the other techniques. The proprietary index increased significantly after intubation, but no changes were seen for the other techniques. No significant changes were detected during incision or when higher nociceptive stimuli were applied. We did not identify a correlation between BIS and the proprietary index, the proprietary index and hemodynamic variables, or the BIS and hemodynamic variables during induction and maintenance. A significant increase in the proprietary index and BIS was detected at the time of resumption of reflexes. During anesthetic recovery, a correlation was found between the proprietary index and BIS but not between hemodynamic variables and the other techniques. CONCLUSIONS AND CLINICAL RELEVANCE: A significant increase in the proprietary index, but not the BIS or hemodynamic variables, was detected during intubation. Anesthetic induction with sevoflurane did not prevent the sympathetic stimulus attributable to tracheal intubation. Monitoring of hemodynamic variables does not provide sufficient information to allow clinicians to evaluate stress during anesthetic recovery.

Assessment of the relationship of bispectral index values, hemodynamic changes, and recovery times associated with sevoflurane or propofol anesthesia in pigs.

OBJECTIVE: To evaluate bispectral index (BIS) values in pigs during anesthesia maintained with sevoflurane-fentanyl or propofol-fentanyl as a predictor of changes in hemodynamic parameters and duration of recovery from anesthesia. ANIMALS: 12 pigs. PROCEDURE: Pigs were randomly allocated to undergo 1 of 2 anesthetic regimens. Anesthesia was induced with propofol (2 mg/kg, i.v.); 6 pigs were administered sevoflurane via inhalation (1 minimum alveolar concentration [MAC] at a fresh gas flow rate of 3 L/min; group I), and 6 were administered propofol (11 mg/kg/h, i.v.; group II). All pigs received fentanyl (2.5 mg/kg, i.v., q 30 min). After abdominal surgery, pigs were allowed to recover from anesthesia. Cardiovascular variables and BIS values were recorded at intervals throughout the procedure; duration of recovery from anesthesia was noted. RESULTS: No correlation was established between arterial blood pressure and BIS and between heart rate and BIS. Mean BIS at discontinuation of administration of the anesthetic agent was greater in group-II pigs (65.2 +/- 10.6 minutes) than in group-I pigs (55.8 +/- 2.9 minutes). However, recovery from anesthesia was significantly longer in group II (59.80 +/- 2.52 minutes) than in group I (9.80 +/- 2.35 minutes). CONCLUSIONS AND CLINICAL RELEVANCE: In swine anesthetized with sevoflurane or propofol and undergoing abdominal surgery, the BIS value derived from an electroencephalogram at the end of anesthesia was not useful for predicting the speed of recovery from anesthesia. Moreover, BIS was not useful as a predictor of clinically important changes in arterial blood pressure and heart rate in those anesthetized pigs.

Bispectral index, spectral edge frequency 95%, and median frequency recorded for various concentrations of isoflurane and sevoflurane in pigs.

OBJECTIVE: To evaluate bispectral index (BIS), spectral edge frequency 95% (SEF), and median frequency (MED) in relation to a visual analogue scale (VAS) as indicators of anesthetic depth for various concentrations of sevoflurane and isoflurane in pigs. ANIMALS: 32 pigs. PROCEDURE: Pigs were randomly allocated to 8 groups (4 pigs/group). An electroencephalogram (EEG) was recorded in each conscious pig. Pigs were then anesthetized by use of sevoflurane (n = 16) or isoflurane (16). Agents were administered in oxygen at minimum alveolar concentrations (MACs) of 1, 1.25, 1.5, and 1.75 MAC in a randomized order. End-tidal sevoflurane and isoflurane concentrations were maintained for 30 minutes, after which an EEG was recorded for 5 minutes; BIS, SEF, and MED were then calculated. Anesthetic depth was evaluated by use of the VAS. Cardiovascular and EEG responses to nociceptive stimuli were evaluated for each anesthetic agent. RESULTS: BIS decreased significantly for the various concentrations of each anesthetic. At equivalent MACs, BIS values were significantly higher during sevoflurane-induced anesthesia than during isoflurane-induced anesthesia. Values of MED and SEF decreased significantly from basal values to 1 MAC of sevoflurane and isoflurane. For both agents, there was good correlation between VAS scores and BIS values and between VAS scores and SEF values. CONCLUSIONS AND CLINICAL RELEVANCE: BIS was useful for predicting changes in anesthetic depth at clinical dosages of inhalant anesthetics. Values of BIS, SEF, and MED were significantly higher during anesthesia induced by administration of sevoflurane than during anesthesia induced by administration of isoflurance at equivalent MACs.

Ultrasonographic assessment of metallic clip carotid anastomosis in sheep.

The aim of this study was to use ultrasonography to assess an experimental carotid arteriotomy followed by end-to-end anastomosis in the lamb. Animals were subjected to an experimental surgical procedure consisting of a right carotid artery arteriotomy and subsequent end-to-end anastomosis with nonpenetrating metallic clips. Left side arteries were used as control. Duplex ultrasonography was performed postoperatively to assess the evolution of the experimental anastomosis. Measurements were made on the right carotid to assess blood flow, peak systolic velocity, and end diastolic velocity, as well as arterial diameter. Animals were periodically checked during the six-month postoperative period. Operated vessels appeared normal during follow up, with pulsatile movements and size similar to non operated carotid arteries. A hyperechoic band, perpendicular to the vessel main axis, was seen on the longitudinal image in operated arteries, but not in the control group. This band corresponded to the anastomosis area, where the clips were positioned. No image suggestive of thrombosis was observed in any operated artery, and blood flow was maintained through the experiment. Finally, a decrease of vessel lumen diameter was evidenced at the level of the anastomosis during the first 30 postoperative days, but it was not present after the 90th postsurgical day. Duplex ultrasonography is a useful imaging technique for the assessment of anatomical details, acoustical properties of the vascular lumen, and study of the intimal surface and vessel wall in growing arteries subjected to surgery. Metallic clips as suturing technique in arterial anastomosis allow for normal vascular growth, as shown by the evolution of flow velocity and vessel diameter.

Endocrine, haematological and metabolic responses to sevoflurane anaesthesia in lambs.

Objective To compare the magnitude and duration of the peri-operative haematological, endocrine and metabolic effects of surgery performed under sevoflurane anaesthesia. Study Design Prospective randomized study. Animals Ten, 55-day-old lambs of both sexes, mean weight 20.8 ± 0.3 kg (range 18.5-23.6 kg). Methods Animals were randomly allocated to two equal groups. All were anaesthetized with sevoflurane for 3 hours. Surgery (end-to-end anastomosis of the right carotid artery and right jugular vein) was performed in animals of Group 1 only. The electrocardiogram, pulse oximetry, cardiac output and noninvasive arterial blood pressure (NIBP) were monitored. Venous blood samples (5 mL) were taken 30 minutes before induction of anaesthesia (T = 0) and 1 (T1), 24 (T2), 48 hours (T3) and 7 days (T4) after anaesthesia in order to measure plasma cortisol, ACTH, insulin, cyclic adenosine monophosphate (cAMP), glucose, protein concentrations and haematological variables. Results Sevoflurane decreased NIBP (minimum mean value: 64 ± 3 mm Hg) in both groups. Plasma cortisol and ACTH concentration increased in Group 1 (maximum mean values: cortisol: 136.2 nmol L-1, ACTH: 54.5 pmol L-1) and Group 2 (maximum mean values: cortisol: 128.7 nmol L-1, ACTH: 44.0 pmol L-1). Cyclic AMP increased only in Group 1 (9.3 nmol) 1 hour after anaesthesia. Neutrophilia, lymphopaenia and a decreased PCV were observed in both groups 1 hour after anaesthesia. Plasma protein and glucose concentrations did not change. Conclusions Increased ACTH and cortisol concentrations recorded 1 hour after anaesthesia suggest that sevoflurane induces a stress response in lambs. Clinical relevance The study did not identify the mechanism by which sevoflurane induces a stress response although hypotension is implicated.