Utilização de alfaxalona associado com meperidina e midazolam em gato obstruído / Use of alphaxalone associated with meperidine and midazolam in an obstructed cat

Objetivou-se com esse trabalho avaliar o uso do anestésico alfaxalona associado à meperidina e midazolam para o procedimento de desobstrução uretral em um gato com doença do trato urinário inferior felino (DTUIF), analisando as qualidades de indução e recuperação, assim como as alterações fisiológicas. Um felino macho, quatro anos de idade, 3.1 Kg, castrado, foi atendido no setor de emergência do Hospital Veterinário da Universidade Federal Rural do Semi-árido com histórico de estrangúria, abdome distendido e vesícula urinária repleta, sendo diagnosticado com DTUIF obstrutiva. Para o procedimento de desobstrução uretral a MPA foi instituída com meperidina 3mg/Kg por via intramuscular (IM), dez minutos após, procedeu-se a indução anestésica: 0,4mg/Kg de midazolam seguido de 2mg/Kg de alfaxalona, ambos diluídos em água de injeção, dispostos separadamente em seringas individuais, e administrados pela via intravenosa (IV). A alfaxalona foi administrado lentamente, contabilizando 1 minuto para total fornecimento. Foram avaliadas a frequência cardíaca (FC), frequência respiratória (f), temperatura retal (TR), pressão arterial sistólica (PAS), média (PAM), diastólica (PAD) e hemogasometria venosa, antes, durante e após o procedimento anestésico. A alfaxalona em associação com o midazolam produziu perda rápida da consciência, do reflexo de deglutição e intenso relaxamento muscular, bem como boa qualidade de indução e recuperação. O protocolo utilizado produziu mínimas anormalidades clinico patológicas, sem alterações importantes nos parâmetros cardíacos e respiratórios durante todo o procedimento, com manutenção da pressão arterial. Portanto, o anestésico alfaxalona foi considerado seguro para o procedimento de desobstrução uretral emgato macho com DTUIF.(AU)

The aim of this study was to evaluate the use of the anesthetic alfaxalone in combination with meperidine and midazolam as an anesthetic protocol for managing urethral obstruction in a male cat with feline lower urinary tract disease (FLUTD), and verify the quality of the induction and recovery as well as the physiological changes. A male four-year-old cat, weighing 3.1 kg, was admitted to the emergency service of the Veterinary Hospital at the Federal Rural Semi-Arid University, with a clinical history of stranguria, haematuria, distended abdomen and an enlarged urinary bladder. To prepare to unblock the urethral obstruction, intravenous (IV) Lactated Ringers solution (RL) administration was initially performed. The anesthetic protocol used was 3mg.kg-1 meperidine IM, followed by 0.4 mg.kg-1 midazolam IV given immediately before 2 mg.kg-1 alfaxalone IV. Heart rate (HR), respiratory rate (RR), rectal temperature (RT), systolic arterial pressure (SAP), mean arterial pressure (MAP), diastolic arterial pressure (DAP) and venous blood gases were evaluated before, during and after the anesthesia. There was no significant variation in the analyzed parameters after administration of meperidine. Alfaxalone, in combination with midazolam, produced rapid loss of consciousness, swallowing reflex and intense muscle relaxation, as well as a good quality of induction and recovery. The presented protocol induced minimal clinical pathological abnormalities, no significant changes in cardiac and respiratory parameters throughout the procedure, with maintenance of the blood pressure. Therefore, the anesthetic alfaxalone was considered safe for managing urethral obstruction in male cat with FLUTD.(AU)

Meperidine prolongs lidocaine caudal epidural anaesthesia in the horse.

The aim of the study was to evaluate and compare the effects of caudal epidural administration of meperidine (MP), lidocaine (LD), and a combination of the two (MPLD) in six mature saddle horses. Horses were randomly assigned to receive three treatments (MP 0.3 mg/kg; LD 0.2 mg/kg; and MPLD: MP 0.3 mg/kg and LD 0.2 mg/kg), with at least 1 week between treatments. Drugs were injected into the epidural space between the first and second coccygeal areas in conscious standing horses. Analgesia, ataxia, sedation, cardiovascular and respiratory effects, and rectal temperature were recorded at different intervals before (baseline) and after administration. Epidural administration of MPLD resulted in a longer duration of analgesia of the tail, perineum, and upper hind limb regions than did administration of MP or LD alone.

Meperidine for dystocia during the first stage of labor: A randomized controlled trial.

OBJECTIVE: This study was undertaken to evaluate whether the administration of meperidine decreases the length of labor in patients with a diagnosis of dystocia during the first stage of labor. STUDY DESIGN: Women with term singleton pregnancies who received a diagnosis of dystocia and required an active management of labor were randomly assigned to receive either 100 mg of meperidine or placebo. The primary outcome measure was length of labor. RESULTS: Four hundred seven pregnant women were included. There were no significant statistical differences between meperidine and placebo groups in length of labor and operative delivery rates such as forceps and cesarean section by intention-to-treat analysis. Low Apgar scores, umbilical artery acidosis, and admission to neonatal care units were increased in the meperidine group. CONCLUSION: Because of the absence of any benefits in patients with dystocia in labor and the presence of harmful effects on neonatal outcomes, meperidine should not be used during labor for this specific indication.

Ability of blood group A-active glycosphingolipids to act as Escherichia coli heat-labile enterotoxin receptors in HT-29 cells.

We examined the ability of blood group A-active glycoconjugates to act as receptors for Escherichia coli heat-labile type I enterotoxin (LT-I) in HT-29 cells. These cells contained ~4 times more specific binding sites for LT-I than for cholera toxin (CT). Binding of LT-I could not be blocked by the B subunit of CT (CT-B), indicating the existence of LT-I receptors in addition to the glycosphingolipid GM1. LT-I was able to increase levels of cyclic adenosine monophosphate (AMP), even in the presence of CT-B. Helix pomatia and anti-blood group A antibody caused a dose-dependent inhibition of binding of LT-I to cells and production of cyclic AMP. LT-I recognized several complex blood group A-active glycosphingolipids from cells, and this interaction was also interfered with by H. pomatia. Treatment of cells with D,L-threo-1-phenyl-2-hexadecanoylamino-3-morpholino-1-propanol diminished surface expression of blood group A-active glycosphingolipids and binding of LT-I to non-GM1 receptors. These observations suggest that blood group A-active glycosphingolipids can function as alternative receptors for LT-I in HT-29 cells.

Perineal analgesia and hemodynamic effects of the epidural administration of meperidine or hyperbaric bupivacaine in conscious horses.

Epidural administration of bupivacaine and meperidine produces analgesia in several animal species and in humans. A prospective randomized study was conducted in 18 healthy horses to compare the effect of these 2 drugs administered by the epidural route. Animals were divided into 3 treatment groups of 6 animals each. All drugs were injected by the epidural route in all animals between the 1st and 2nd coccygeal vertebrae. Treatment 1 (BUP)--0.06 mg/kg of body weight of 0.5% hyperbaric bupivacaine; treatment 2 (MEP)--0.6 mg/kg of body weight of 5% meperidine; treatment 3 (SS)--0.9% saline solution (control group). Heart rate, arterial pressure, respiratory rate, rectal temperature, analgesia, sedation, and motor-blocking were determined before drug administration (baseline values); at 5, 10, 15, and 30 minutes after drug administration, and then at 30-minute intervals thereafter. Both hyperbaric bupivacaine and meperidine administered epidurally produced complete bilateral perineal analgesia in all horses. The onset of analgesia was 6, s = 2.6 minutes after injection of bupivacaine, as opposed to 9, s = 2 minutes after meperidine. The duration of analgesia was 240, s = 57 minutes for meperidine and 320, s = 30 minutes for bupivacaine. Heart and respiratory rates, arterial pressure, and rectal temperature did not change (P < 0.05) significantly from basal values after the epidural administration of bupivacaine, meperidine, or saline solution. To conclude, both bupivacaine and meperidine induced long-lasting perineal analgesia, with minimal cardiovascular effects. Analgesia was induced faster and lasted longer with bupivacaine.

Effects of two preanesthetic regimens for ophthalmic surgery on intraocular pressure and cardiovascular measurements in dogs.

The effects of different preanesthetic medications (acepromazine plus either meperidine or butorphanol) given before the induction of anesthesia with midazolam and ketamine on intraocular pressure, heart rate, and arterial blood pressure were investigated in 20 dogs. Following administration of preanesthetics and induction of anesthesia, dogs were intubated and anesthesia was maintained with halothane for 10 minutes. Intraocular pressure was significantly higher (P <.05) at several evaluations for dogs premedicated with acepromazine/meperidine than for those premedicated with acepromazine/butorphanol. Mean heart rate and diastolic arterial blood pressure were significantly (P <.05) higher 5 minutes after administration of acepromazine/meperidine than after acepromazine/butorphanol. Results of this study suggest that acepromazine/butorphanol is a satisfactory preanesthetic combination to use before induction of anesthesia with midazolam and ketamine for ophthalmic surgery in dogs.

Analgesia postoperatoria por administracion de meperidina por via subdural vs. peridural / Postoperative analgesia by meperidina via subdural vs peridural

Se estudiaron 90 pacientes programados para cirugia que requerian anestesia conductiva en el H.O. y H.S.G. de la ciudad de La Paz. Los objetivos del estudio fueron, determinar la analgesia postanestesica administrando meperidina por via peridural y subdural, evaluar su duracion ademas de los efectos indeseables y su tratamiento. El estudio fue prospectivo longitudinal comparativo, dividido en tres grupos; al grupo A se administro lidocaina al 5 por ciento via subdural; al grupo B lidocaina al 5 por ciento mas meperidina tambien subdural y al grupo C Bupivacaina al 0.5 por ciento mas meperidina por via peridural. Como conclusiones se observo que la meperidina prolonga el efecto analgesico del anestesico de base, aparentemente la via subdural es la que prolonga un mayor tiempo esta analgesia, pero no en la totalidad de pacientes. La meperidina por via conductiva ocasiona en la mayoria de los pacientes efectos secundarios como nauseas, vomitos, sedacion, somnolencia, los dos ultimos pueden ser efectos deseables y los dos primeros son suceptibles de ser tratados efectivamente

Infusión epidural continua con una mezcla de bupivacaina 0.1 y meperidina para analgesia post-operatoria / Epidural infusion of a mixture of bupivaine and mepridine for postoperative analgesia

Estudiamos la seguridad y la eficacia de la analgesia epidural por infusión continua con una mezcla de meperidina-bupivacaína. Métodos: los catéteres epidurales se colocaron desde el preoperatorio y fueron utilizados para anestesia (epidural o epidural más general ligera). La infusión epidural se preparó con sol. salina 250 ml, meperidina 200 mg y bupivacaína 0.1 por ciento y se inició al llegar el paciente a la sala de recuperación a una velocidad de 10 ml/hora. Los pacientes fueron evaluados a intervalos de 4 - 6 horas y se valoraron dolor en reposo y con la inspiración (EVA 0 - 10), sedación (0 - 3) y aparición de efectos indeseables y complicaciones. Resultados: el estudio incluyó a 110 pacientes sometidos a cirugía abdominal mayor (47), ortopédica (21), urológica (17), ginecológica (17) y vascular (8). Los catéteres epidurales fueron usados por 1 (16 por ciento), 2 (32 por ciento) ó 3 (52 por ciento) días. Un 26 por ciento de los casos necesitaron algún AINE durante el primer día. La calidad de la analgesia fue muy buena en todos los casos con una EVA promedio menor a 3 desde las 6 horas del postoperatorio. La incidencia de efectos indeseable fue baja y no hubo ningún caso de depresión respiratoria. Conclusión: la infusión epidural continua de una mezcla de meperidina-bupivacaína 0.1 por ciento es segura y eficaz, pudiendo emplearse en salas generales de hospitalización

Uso de opioides en la analgesia epidural postoperatoria / Opioids use in epidural postoperative analgesia

En este estudio se hizo una revisión bibliográfica (1980 a 1994), en la cual se revisaron distintos opioides, los cuales son usados por vía epidural para el control del dolor en el periodo postoperatorio y con los cuales contamos en nuestro medio hospitalario. Se analizaron uno por uno de estos pioides, con el fin de corroborar que la vía epidural es una buena y segura opción para el control del dolor postoperatorio, y que todos los opioides en mayor o menor grado presentan efectos indeseables como son: náusea, vómito, prurito, sedación, llegada alguna de ellos a provocar depresión respiratoria con intervalos de apnea hasta de 30 segundos. La duración analgésica fue de 130 minutos hasta 20 horas dependiendo del tipo de opiáceo que se haya administrado. Debiéndose de seleccionar el pioide dependiendo del tipo de paciente, sitio de la cirugía, tipo de la cirugía y tiempo de estancia hospitalaria

Buprenorfina sublingual versus meperidina intramuscular en el manejo del dolor postoperatorio en pacientes sometidas a cirugía ginecológica / Sublingual buprenorphine versus intramuscular meperidine in the post-operative pain management in patients submitted to ginecological surgery

La buprenorfina, de reciente introducción en nuestro medio, es un agonista parcial de los receptores opioides del subtipo µ con gran biodisponibilidad al ser administrada por vía sublingual (s.1) y larga duración de acción. El propósito del trabajo fue evaluar la calidad de la analgesia producida por la buprenorfina s.1 en el postoperatorio de pacientes sometidas a cirugía ginecológica, comparándola con un esquema de meperidina intramuscular (i.m.). Estudiamos en forma prospectiva, randomizada y doble ciego 27 pacientes (42 ñ 9 años), ASA i-II, sometidas a cirugía ginecológica electiva bajo anestesia general. Luego de la inducción anestésica, las pacientes fueron randomizadas en: grupo 1 (n= 12) que recibió meperidina 100 mg i.m. (intraoperatorio) y luego 50 mg i.m. c/6 horas por 48 horas; y, el grupo 2 (n= 15) que reciió buprenorfina 0,3 mg i.m. (intraoperatorio) y luego 0,2 mg s.1 c/6 horas por 48 horas en el posoperatorio. En caso de dolor se administró clonixino 100 mg i.v. a solicitud de la paciente. La evaluación posoperatoria duró 72 horas. Los pacientes que recibieron buprenorfina, tuvieron menos dolor durante todo el período en estudio que las pacientes del grupo meperidina, siendo esta diferencia significativa sólo a las 6 horas (p= 0,024). No hubo diferencias significativas en los requerimientos d clonixino, así como en el nivel de sedación, náuseas y vómitos, parámetros hemodinámicos y frecuencia respiratoria entre ambos grupos. Dos pacientes, una de cada grupo, presentaron depresión ventilaroria clínica (frecuencia respiratoria < 10 por minuto) sin problemas posteriores. Si bien beprenorfina s.1 como meperidina i.m. ofrecen un alivio adecuado del dolor después de cirugía ginecológica, la anagesia producida por la buprenorfina es superior con una incidencia similar de efectos adversos. La buprenorfina, por su facilidad de administración, se presenta como una buena alternativa para el manejo del dolor posoperatorio en cirugía de abdomen bajo

Estudio comparativo de nalbufina contra meperidina durante el trabajo de parto / A comparative study of nalbufine vs meperidine during labor

A fin de valorar la eficacia y seguridad de dosis analgésicas de nalbufina en comparación con mepreidina, así como cotejar los efectos que uno y otro fármaco ejercen sobre el recién nacido, fueron seleccionados 51 embarazadas a término. Se formaron dos grupos: el primero con 26 pacientes, siendo nueve primíparas y 17 multíparas; el segundo con 25, ocho primíparas y 17 multíparas. Los resultados mostraron que la administración de clorhidrato de nalbufina en analgesia obstétrica, a dosis de 10 mg por vía endovenosa, seguidos de 10 mg por vía intramuscular, proporciona una buena analgesia, comparable a la que producen 25 mg de meperidina por vía endovenosa seguidos de otros 25 mg por vía intramuscular. En ambos grupos la dilatación cervical fue de un mínimo de res centímetros. Sin embargo, el índice de Apgar tuvo modificaciones importantes al nacimiento y a los cinco minutos

Naloxone reversal of mild neurobehavioral depression in normal newborn infants after routine obstetric analgesia.

To investigate the presence of subtle narcotic depression following maternal narcotic analgesia, we have evaluated the effects of naloxone versus placebo in a double-blind parallel group study in 43 normal term newborn infants whose mothers had received routine narcotic analgesia within six hours prior to delivery. Infants were given either an intramuscular injection of 20 microgram/kg naloxone or 0.20 ml/kg placebo after determination of the one-minute Apgar score, and the following measurements were compared: Apgar scores at one and five minutes, capillary blood gas values at one, 60, 120, and 240 minutes, and neurobehavioral assessments at one, 4, and 24 hours. No adverse effects from naloxone were observed. Neither Apgar scores nor capillary blood gas determinations differed significantly between the two groups. Response to sound was significantly higher in the naloxone group at 24 hours. The alertness score was significantly higher for the naloxone group at one and four hours; the general assessment score for the naloxone group was significantly higher at four and 24 hours. Average scores of naloxone and placebo groups were also different at four and 24 hours of age. These data demonstrate that maternal narcotic analgesia may produce subtle changes in alertness and general behavior not reflected by Apgar scores or respiratory status, potentially reversible by administration of naloxone shortly following delivery.

A clinical trial of Hyoscine-N-Butylbromide in labour

Buscopan was administered to 62 primigravidae in labour and its effects were compared with those in a control group receiving Pethidine. There was a significant acceleration of labour in the group receiving Buscopan, but this drug was not useful in relieving labour pains (AU)