Ketamine

Report
ANALGESIA, ANESTHESIA AND POST-OPERATIVE
CARE IN LABORATORY ANIMALS
Thiago Vignoli, PhD
Médico Veterinário
CRMV SP 20615
Initial Considerations
• Procedures involving pain or discomfort to the animals, included euthanasia
• Essential knowledge: physical restraint/handling, routes of administration,
appropriate equipment, vital parameters
• Anti-inflammatories, antibiotics, sedatives, tranquillizers, analgesics and
anesthetics
• Copy or know that you are using!
Choice of Technique
Species-responses to agents
Temperament and physical condition of the animal
Familiarity with the animal
Degree of invasiveness and duration of the procedure
Prior experience with certain anesthetics
Availability of equipment and drugs, as well as staff training
Factors Influencing Anesthesia
• Fasting*
• Usual medication
• Age
• Species/Animal strain
• Nutrition
• Body and environmental
temperature
• Stress
• Gestation
• PAM
• Invasive procedures, duration,
etc.
Surgical Procedure
Steps
• Preparation laboratory: surgical field, anesthetics and solutions
• Animal Care: housing, handling, drug administration (Respect!)
• Environmental Care: Asepsis, noise, movement of people, light
and odors
PRE-ANESTHETIC MEDICATION
• Reduce stress of handling, aggressiveness and fear
• Facilitates the preparation for surgery and other procedures
• Reduces anesthetic dose and their undesirable effects
PRE-ANESTHETIC MEDICATION
1) ANTICHOLINERGICS
- Parasympatholytic action; reduction of bronchial and salivary secretions
(Flecknell et al., 1990; Harrison et al., 2006)
Atropine 0,04 mg/Kg (SC, IP, IM)
2) TRANQUILLIZERS
- Produce calming effect, drowsiness, reduced fear / anxiety, hypnotic,
anticonvulsant (Pieri, 1981; Amrein, 1990)
Neuroleptics: Acepromazine
Benzodiazepines: Dizepan, Midazolan
PRE-ANESTHETIC MEDICATION
3) SEDATIVES
- Produce sedation, hypnosis, muscle relaxation, ataxia, analgesia *
(Murrell and Hellebrekers, 2005; Kastner, 2008)
Alpha-2-adrenergic agonist: Xylazine, Medetomidine
4) OPIOIDS ANALGESICS
- Produce moderate sedation and profound analgesia, without loss of consciousness
(Breivik, 1994; Grape and Tramer, 2007)
Fentanyl* (30 min), Tramadol (4-5h), Meperidine (1-2h), Sufentanyl (100x)
 NSAIDs: Preemptive analgesia
ANESTHETIC INDUCTION AND MAINTENANCE
1) INJECTABLE ANESTHETICS
- Produce unconsciousness (narcosis), neurovegetative protection, muscle
relaxation, mild analgesia (Glen and Hunter, 1984; Murayama et al., 2005)
Ketamine / Tiletamine (dissociative)
Barbiturates (peritonitis), Propofol (without cumulative effect / exclusive IV)
2) INHALATIONAL ANESTHETICS
- Globally depress the CNS (no analgesia)
- Great advantages!
- Orotracheal intubation (cannulae or scalpe PE) or mask
- Vaporizer: Induction 5% and Maintenance 1-3%
Halothane*, Isoflurane, Sevoflurane
ANESTHETICS AGENTS IN ASSOCIATION
• Ketamine (60 a 80 mg/Kg) + Xylazine (10 a 30 mg/Kg)
Diazepan (2 mg/Kg)
ou
• Ketamine (40 a 60 mg/Kg) + Xylazine (10 a 15 mg/Kg)
Acepromazine (1 mg/Kg)
ou
Tramadol (2 mg/Kg)
Flecknell, 2009; Unifesp, 2005
• Physiological Monitoring
• Ophthalmic ointment or liquid tears to prevent
damage to the cornea
• Responses to Painful Stimuli: pedal withdrawal reflex!
BZP, NLT
GENERAL ANESTHETICS XYLAZINE
VDI
VAP
OPIOIDS
KETAMINE
POST-SURGICAL: PAIN
1) NON-STEROIDAL ANTI-INFLAMMATORY:
• Dipirone (10-20mg/Kg, VO, SC / BID or TID) and Acetominophen (200-300
mg/Kg, VO / BID or TID)
• Ketoprofen (2-5 mg/Kg, VO, SC / SID)
• Carprofen (5 mg/Kg, VO / BID)
Hawk and Leary, 2005 ; Unifesp, 2005
POST-SURGICAL: PAIN
1) NON-STEROIDAL ANTI-INFLAMMATORY:
• Meloxicam (1-5 mg/Kg, VO, SC, IM / BID)
• Flunixin Meglumin (1 - 2,5 mg/Kg, VO, SC / SID)
2) OPIOIDS ANALGESICS :
• Tramadol (5 mg/Kg, VO, SC, IM / SID or BID)
Hawk and Leary, 2005 ; Unifesp, 2005
POST-SURGICAL: INFECTION
3) ANTIBIOTICS:
• Enrofloxacin (5-10 mg/Kg, VO, SC / BID)
• Ampicillin (100-150 mg/Kg, VO, SC / BID)
• Sulfamethoxazole/Trimethoprim
(15-30 mg/Kg, VO, SC / BID)
Hawk and Leary, 2005 ; Unifesp, 2005
POST-SURGICAL: INFECTION
3) ANTIBIOTICS:
 Pregnancy and Lactation
• Penicillin (100.000 UI/Kg, SC, IM / SID)
• Cephalexin (60 mg/Kg, VO / BID)
Hawk and Leary, 2005 ; Unifesp, 2005
• House them separately after surgery (blood / cages)
• Low light, noise and manipulations
• Temperature: 27-30°C adults and 35-37°C neonates until restore
parameters (mice!)
• Administration of SC or IP fluids
• Evaluate the parameters of pain and stress!!!
EVALUATIN OF
GENERAL
ACTIVITY
Unrest
Movement
reduction
EVALUATION OF
SURGICAL SITE
Abdominal writhe
PHYSIOLOGICAL
CHANGES
Edema
RR/ HR
Licked
Body temperature
Points
CHANGE IN EATING
BEHAVIOR
PARAMETERS OF
EVALUATION
PAIN/STRESS
APPEARANCE
Piloerection
Porphyrin
Food and water
comsuption
Back arch
Weight loss
Urine/Faeces
BEHAVIOR
VOCALIZATION
Aggression
Social interaction
reduced
Stasiak, et al., 2003
Facial Expression of Pain (Grimace Scale)
Dr Mary Lynch (president of the Canadian Pain Society), Nature 2010; Sotocinal, et al., 2010, 2011
Orbital
tightening
Cheek
flattening
Nose shape
Whisker
position
Ear position
(Keating, 2012; Flecknell, et al, 2012)
Piloerection
Porphyrin
“All species, including
humans, feel pain with the
same quality and intensity”
TODAY IT’S A MORAL AND ETHICAL DUTY OF
MAN TO MINIMIZE ANIMAL SUFFERING
(WHO, 2006)
Thiago Vignoli, MV, PhD
[email protected]
Tel: (11) 99715-5508
 If you were to ask any of the monkeys why they were
knocking other monkeys that tryed to pick up bananas,
maybe the answer would be: “I do not know, things
have always been so here!”
 The conformism and inertia make human being limited by
choice.
“The mind that opens to a new idea never
returns to its original size.”
ALBERT EINSTEIN
REFERENCES
• Manual de Terapêutica Veterinária (3° ed), Silvia Franco Andrade, 2008
• Anestesiologia Veterinária – Farmacologia e Técnicas (6° ed), Flávio
Massone, 2011
• Princípios Éticos e Práticos do uso de Animais de Experimentação,
Universidade Federal de São Paulo, 2005
• Laboratory Animal Anaesthesia (3rd edition), Paul Flecknell, 2009
• Formulary for Laboratory Animals (3rd edition), C. Terrance Hawk and
Steven L. Leary, 2005
• Canadian Council on Animal Care (CCAC)

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