Sin ttulo de diapositiva

1
REMIFENTANIL INTRAOPERATIVE ANALGESIA. A
COMPARATIVE STUDY WITH FENTANYL IN DOGS
Rubio M, Redondo JI, Carrillo JMª, Sopena JJ,
Soler G
Facultad de Ciencias Experimentales y de la
Salud.Universidad Cardenal Herrera
-CEU.Valencia Hospital Veterinario Marina Alta.
Denia.Alicante
OBJECTIVES
The aim of this study was to evaluate the
intraoperative analgesia of remifentanil in
dogs, comparing with fentanyl and a placebo
solution as well as the study of the haemodynamic
and respiratory responses, and the patient
recovery after two hours of anesthesia.
MATERIAL Y METODO

• Anesthetic protocol
• Seven beagles dogs ASA I were anesthetized
  three times. All of them were anesthetized with
  the following anesthetic protocol medetomidine
  (10 ?g/kg IV), propofol (3 mg/kg IV), sevoflurane
  and atracurium (150 ?g/kg IV), every 30 minutes.
  At the end of the procedure we reverted the
  effects of atracurium with a combination of
  atropine (0.01 mg/kg) and neostigmine (5 ?g/kg)
  intravenous.
• 2. Analgesic protocol
• Three different analgesic protocols were used
  and they were classified in these groups
• RMF (remifentanil 0,5 ?g/kg IV induction doses
  0,25 ?g/kg/min maintenance doses).
• FEN (fentanyl 2 ?g/kg IV induction doses 0,1
  ?g/kg/min IV maintenance doses).
• PCB (glucosade fluid infussion).
• 3. Postanesthetic protocol
• The following postanesthetic analgesic protocol
  was used in all groups
• morphine (0,2 mg/kg IM) and meloxicam (0,2 mg/kg
  IV) 20 minutes before the end of the procedure
• 4. Painful evaluation
• During the procedure, several cardiovascular
  and respiratory variables were studied every 5
  minutes. Pain response was evaluated pinching
  with a forceps in the back paws for 1 minute. It
  was found that the animals were painful when the
  arterial pressure and heart rate increased by 10
  in relation to the last measure. Times and
  quality of the recuperation were also evaluated
  comparing all groups.

RESULTADOS
The results of the study showed that the RMF and
FEN groups presented a significantly lower EtSev
than PCB group, with a decrease of 28.57 and
29,73 respectively. RMF showed the highest
values in arterial pressures and PVC and
intermediate values in heart rate and compliance.
In this group, EtCO2 was lower than in the
others. The lowest values in heart rate and
arterial pressures were found in FEN group, while
the highest heart rate and intermediate values in
arterial pressures were observed in PCBs group.
The only value that was similar in the three
groups was SpO2, because of the animals were
inhalating 100 O2. The recuperation period was
good and peaceful in all the animals, but
recovery times were significantly lower in RMF
dogs.
CONCLUSIONES
Tanto el remifentanilo (Ultiva?), como el
fentanilo (Fentanest?), son dos fármacos útiles
para proporcionar analgesia intraoperatoria en
el perro.   Tanto el remifentanilo (Ultiva?) como
el fentanilo (Fentanest?) producen un descenso
significativo del 28,57 y 29,73 respectivamente
de la concentración mínima de sevoflurano
necesario para mantener un plano anestésico
adecuado que aboliera la respuesta del paciente a
los estímulos dolorosos.  El remifentanilo
(Ultiva?) administrado en perfusión continua
proporciona una mayor estabilidad hemodinámica y
cardiovascular que el fentanilo (Fentanest?)
administrado de la misma forma.  Tras una
anestesia de 120 minutos, la recuperación
postoperatoria es suave, tranquila y sin
complicaciones en el 100 animales, mostrando el
Grupo RMF tiempos de recuperación
significativamente inferiores a los grupos FEN y
PCB. El protocolo de meloxicam (Metacam?)-
morfina (cloruro mórfico?) a las dosis descritas
proporciona una buena cobertura analgésica en el
tratamiento del dolor postoperatorio.  Dada la
depresión respiratoria producida tanto por el
remifentanilo (Ultiva?), como por el fentanilo
(Fentanest?) es muy recomendable emplear
ventilación mecánica para asegurar la correcta
oxigenación y la normocapnia en los pacientes.