The effect of medetomidine-ketamine anesthesia on hemodynamic parameters during hemorrhagic shock in minipigs.

Hemorrhagic shock (HS) represents an acute event with high mortality. The optimal combination of anesthetics that would prevent hemodynamic collapse and allow damage control surgery has not yet been determined. We tested the hypothesis that a combination of dissociative anesthetic ketamine with alpha2-agonist medetomidine (MK group, n=10) would provide superior hemodynamic control compared to propofol-remifentanil (PR group, n=10) during HS in minipigs. A modified Wiggers' model of HS with a target mean arterial pressure (MAP) of 40 mm Hg and 2 h duration was used. All minipigs survived. HS led to a ~50 % decrease in cardiac output in both groups (P<0.001 for baseline vs. HS 120 min) with no differences between groups. Total volume of removed blood was larger in the MK group (1321+/-133 ml vs. 1111+/-246 ml in the PR group, respectively; P<0.05). MAP was higher during the initial phases of HS in the MK group than in PR group (P<0.05 at HS 30-90 min). HR was lower in the MK group at the late phases of HS (P<0.05 at HS 60-120 min). In conclusion, medetomidine-ketamine provides a feasible and possibly a more favorable alternative to the propofol-remifentanil combination in our model of HS in minipigs.

Experience with a naphthylmedetomidine-ketamine-hyaluronidase combination in inducing immobilization in anthropoid apes.

BACKGROUND: The aim of the study was to compare the effect of naphthylmedetomidine to medetomidine on the behavior of orangutans and chimpanzees. METHODS: The immobilization was performed as part of a medical examination in five chimpanzees and three orangutans. Following pre-medication with midazolam (0.70-1.20 mg/kg p.o.), naphthylmedetomidine (50-70 microg/kg), or medetomidine (20-30 microg/kg) was given with ketamine (3 mg/kg) and hyaluronidase (150 M.U.) into musculus deltoideus. RESULTS: We observed the distinct anti-aggressive effect of naphthylmedetomidine. The immobilization with naphthylmedetomidine was shallower and the influence on cardiac frequency less substantial compared to medetomidine. The overall sedative effect of naphthylmedetomidine lasted for less time, and its effect was incompletely antagonized with atipamezole in comparison to medetomidine. CONCLUSIONS: Naphthylmedetomidine could replace medetomidine for inducing immobilization and sedation. A combination of naphthylmedetomidine-ketamine is suitable for relocating animals to other cages or for painless medical examinations.

[Endovascular treatment of carotid artery stenosis with cerebral protection: 5-year experience]. / Endovaskulární lécba stenóz karotických tepen s pouzitím cerebrální protekce: petileté zkusenosti.

BACKGROUND: Percutaneous transluminal angioplasty and stenting with cerebral protection is a minimally invasive method for carotid artery stenosis treatment, which may be an alternative to surgical endarterectomy. The aim of our study is to evaluate results of endovascular treatment in patients at high risk of endarterectomy. PATIENTS AND METHODS: Between years 2001-2006, 210 carotid artery stenoses in 204 patients were treated in our department. Fourty seven percent of patients suffered from symptomatic stenosis, asymptomatic stenosis was proved in 53% of patients. All asymptomatic patients had stenosis more than 70% measured according to NASCET, mostly with contralateral carotid artery occlusion. RESULTS: The procedure was technically successful in 99% of patients, mortality was 0.49%. Periprocedural embolic complications based on transient ischemic attack were observed in 2.39% of patients, symptoms of minor stroke in 0.47% and symptoms of major stroke in 0.47% of patients. The mortality and disabled morbidity rate in the whole group was 0.96%. One hundred and fifty three patients (73%) were followed up, during this time, 7 patients (3.9%) developed hemodynamically significant restenosis. CONCLUSION: Endovascular carotid artery stenosis treatment with cerebral protection seems to be a safe method of treatment with acceptable short-term results. However, long-term follow-up is needed to get enough data about safety and effectiveness of this method compared to endarterectomy and best medical therapy.