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败血症犬麻醉手术中与吸入麻醉或全静脉麻醉相关的术前液体治疗方案比较。

Comparison of preoperative fluid therapy protocols associated with inhalational or total intravenous anesthesia for anesthetic procedures in dogs with sepsis.

作者信息

Lima Vírgínia Conceição Tavares, Peixoto Anna Julia Rodrigues, Fernandes Maria Eduarda Dos Santos Lopes, Oliveira Lucinéia Costa, Campos Ana Carolina de Souza, de Oliveira Ágatha Ferreira Xavier, Stocco Naiara Vidal, Baldani Cristiane Divan, Barros Felipe Farias Pereira da Câmara, Coelho Cássia Maria Molinaro

机构信息

Veterinarian MSc., Programa do Pós-Graduação em Medicina Veterinária (PPGMV), Departamento de Medicina e Cirurgia Veterinária (DMCV), Instituto de Veterinária (IV), Universidade Federal do Rio de Janeiro (UFRRJ), Seropédica, RJ, Brazil.

Veterinarian DSc., DMCV, IV, UFRRJ, Seropédica, RJ, Brazil.

出版信息

Braz J Vet Med. 2022 Sep 8;44:e001222. doi: 10.29374/2527-2179.bjvm001222. eCollection 2022.

Abstract

This randomized clinical trial aimed to evaluate different fluid therapy protocols associated with inhalational or total intravenous anesthesia in the cardiorespiratory stability of bitches with sepsis subjected to a surgical procedure to control the infectious focus. Thirty-two bitches diagnosed with pyometra and sepsis and treated at the University Veterinary Hospital between 2018 and 2019 were recruited. After admission, diagnosis, clinical, and laboratory evaluation, patients were randomly distributed into the following groups: propofol 5 (P[5]: preoperative restrictive fluid therapy-5mL/kg/h and intravenous general anesthesia); propofol 10 (P[10]: preoperative liberal fluid therapy-10mL/kg/h and intravenous general anesthesia); and isoflurane 5 (I[5]: preoperative restrictive fluid therapy-5mL/kg/h and inhalational general anesthesia). Lactate on admission (LAC1) and release (LAC2), heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), rectal temperature (RT), oxygen saturation (SpO), and carbon dioxide extraction rate (EtCO) were analyzed at PRE, T10, T20, T30, T40, T50, TEXT, and TDIS. Clearance of 20% of lactate occurred in 18 dogs, with the P[10] group displaying the best performance. There was no statistical difference in vasopressor requirements among the groups. Liberal fluid therapy showed greater cardiovascular stability than restrictive therapy in the perioperative period. Regarding general anesthesia, isoflurane showed greater cardiorespiratory stability than propofol during anesthetic maintenance. In conclusion, although the three proposed protocols are safe and there is no difference in their superiority, some observed changes may be relevant and considered when it is possible to individualize the therapy for the patient.

摘要

这项随机临床试验旨在评估与吸入麻醉或全静脉麻醉相关的不同液体治疗方案对患有败血症的母犬在接受控制感染灶的外科手术时心肺稳定性的影响。招募了2018年至2019年间在大学兽医医院诊断为子宫蓄脓和败血症并接受治疗的32只母犬。入院后,经过诊断、临床和实验室评估,将患者随机分为以下几组:丙泊酚5组(P[5]:术前限制性液体治疗-5mL/kg/h和静脉全身麻醉);丙泊酚10组(P[10]:术前开放性液体治疗-10mL/kg/h和静脉全身麻醉);异氟烷5组(I[5]:术前限制性液体治疗-5mL/kg/h和吸入全身麻醉)。在术前(PRE)、T10、T20、T30、T40、T50、手术结束时(TEXT)和出院时(TDIS)分析入院时的乳酸水平(LAC1)和释放时的乳酸水平(LAC2)、心率(HR)、呼吸频率(RR)、收缩压(SBP)、直肠温度(RT)、血氧饱和度(SpO)和二氧化碳呼出率(EtCO)。18只犬的乳酸清除率达到20%,其中P[10]组表现最佳。各组之间血管升压药的使用需求没有统计学差异。在围手术期,开放性液体治疗比限制性治疗显示出更大的心血管稳定性。关于全身麻醉,在麻醉维持期间,异氟烷比丙泊酚显示出更大的心肺稳定性。总之,虽然提出的三种方案都是安全的,且在优越性方面没有差异,但在可能为患者个体化治疗时,一些观察到的变化可能是相关的且应予以考虑。

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