Evaluation of a flash glucose monitoring system in dogs with diabetic ketoacidosis.

The flash glucose monitoring system (FGMS) Freestyle Libre provides estimates of blood glucose by constantly measuring the glucose concentration of the interstitial fluid through a sensor inserted in the subcutaneous space. The aim of this study was to evaluate the applicability and accuracy of the FGMS in dogs with diabetic ketoacidosis (DKA). Seven dogs with DKA examined at the Veterinary Hospital of the State University of Londrina were included in this study. The sensor was placed on the dorsal cervical region, shortly after the diagnosis of DKA was confirmed and maintained for 5 d. The measurement of blood glucose was performed simultaneously with the veterinary portable blood glucose meter (PBGM) AlphaTRAK 2 every 2 to 4 h and with the hexokinase method every 12 h. The PBGM's precision was evaluated following the ISO15197:2013 criteria. Blood glucose estimates were strongly associated (r = 0.89; P < 0.0001), and the mean absolute relative difference in relation to the PBGM was 25.2% (-70.4% to 101.9%). The evaluation of these data using the consensus error grid analysis showed that 95.4% and 94.8% of the samples were in Zones A and B (clinically acceptable) using the PBGM and the hexokinase method as a reference, respectively. The ISO15197:2013 criteria were not met. There was no difference in the accuracy of the device among days (P = 0.74); however, there was a difference between the hydration status (P = 0.019) and blood glucose ranges (hypoglycemic, euglycemic, and hyperglycemic; P < 0.0001), in which it was less precise in measuring the blood glucose range in hypoglycemic dogs. Therefore, it can be concluded that in spite of the fact that the device did not meet the ISO 15197:2013 criteria, the FGMS evaluated presents good clinical precision and can be a valuable tool in treating dogs with diabetic DKA.

S(+)-ketamine for control of perioperative pain and prevention of post thoracotomy pain syndrome: a randomized, double-blind study.

BACKGROUND: Post-thoracotomy pain syndrome (PTPS) often complicates the long term outcome of patients; its appearance has been related to perioperative acute pain. The main goal of this study was to evaluate a possible role of S(+)-ketamine in the prevention of PTPS up to 6 months and secondarily its efficacy in the control of perioperative pain when added to thoracic epidural analgesia (TEA) and adjuvants. METHODS: Sixty-six patients underwent thoracotomy under general anesthesia. A thoracic epidural catheter was placed for levobupivacaine and sufentanil administration. Thirty-three patients received an i.v. infusion of S(+)-ketamine (Group S(+)K) for 60 hours and 33 patients received i.v. placebo (Group PLAC). Pain was evaluated by Numeric Rating Scale (NRS) during the whole study. All patients had supplementary doses of analgesics, as needed, to have NRS targeted to a value of ≤3 in the 1st and <3 in the following days. Neuropathic Pain Symptom Inventory (NPSI) was evaluated at 1, 3 and 6 months. RESULTS: All patients had NRS ≤3 in the early postoperative period and NPSI was less or equal to 1 in the follow-up control for each group with no significant difference at three (P=0.67, OR 0.8 [IC95% 0.3-2.2]) and at six months (P=0.23, OR 1.9 [0.7-5.4]). Incidence of moderate PTPS was 24.6% at 3 and 21.1% at six months while severe PTPS was 6.6% at 3 and 1.8% at six months. No difference was detected in NRS and NPSI at 3 and 6 months between groups. CONCLUSION: S(+)-ketamine had no effects in respect to placebo in the prevention of PTPS at 3 and 6 months but had a significant role in maintaining a NRS≤3 in the early postoperative period. A tight control of perioperative pain seems to be associated with a low incidence of moderate and severe PTPS.

Thoracic epidural analgesia in post-thoracotomy patients: comparison of three different concentrations of levobupivacaine and sufentanil.

BACKGROUND: Relative effects of dosage, volume and concentration of local anaesthetics used for postoperative thoracic epidural analgesia are still under debate. In this randomized, prospective, double-blinded study, we evaluated the incidence of side-effects such as changes in arterial pressure, postoperative nausea, vomiting, and pruritus in patients admitted for thoracic surgery during continuous thoracic epidural infusion using levobupivacaine and sufentanil mixture in three different volumes. METHODS: We studied 150 patients who underwent thoracotomy with a thoracic epidural catheter placed between T4 and T7. The patients were randomized into three groups which received 10 mg h(-1) of levobupivacaine at three different concentrations (0.5%, 0.25%, and 0.15%), in combination with sufentanil at 2.6 microg h(-1). Haemodynamic effects, pruritus, nausea, vomiting, sensory and motor block, pain score, additional analgesic requirement, sedation, and patient satisfaction were registered immediately after the surgical operation and on the first, second, and third postoperative days. RESULTS: We did not detect any differences in the incidence of side-effects such as changes in arterial pressure, and also postoperative nausea, vomiting, and pruritus. The three groups were also similar with regard to patient characteristics, sensory and motor block, pain score, analgesic rescue dose, sedation, and patient satisfaction. CONCLUSIONS: The same dose of a mixture of levobupivacaine and sufentanil administered in three different volumes and concentrations during continuous thoracic epidural infusion for thoracotomy provided an equal incidence of adverse haemodynamic effects, nausea, vomiting, or pruritus.