Veterinary anaesthesia and analgesia
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To systematically review published studies evaluating pain associated with onychectomy in cats, and to assess the efficacy of the analgesic therapies applied. ⋯ Twenty manuscripts published in refereed journals were reviewed. These included papers reporting 18 clinical trials and two studies conducted in conditioned research cats. Twelve analgesics were evaluated, including seven opioids, four non-steroidal anti-inflammatory drugs and one local anesthetic. Nine studies involved a direct comparison of analgesic agents. Limb use was abnormal when measured at 2 and 12 days following onychectomy, and neither fentanyl patch nor butorphanol administration resulted in normal use of the surgical limb. In another study, cats evaluated at 6 months after this surgery were not lame. Differing surgical techniques were compared in six studies; the results indicated that pain scores were lower after laser surgery than after scalpel surgery. The difficulties associated with assessing pain in cats and the lack of sensitivity of the evaluation systems utilized were highlighted in many of the studies. Huge variations in dose and dosing strategies had significant impacts on drug efficacy. Statistically significant differences among treatments were found in most studies; however, no clearly superior analgesic treatment was identified. A combination of meloxicam or robenacoxib with an opioid may provide more effective analgesia and should be evaluated.
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To review the beneficial and adverse effects of therapeutic hypothermia (TH) applicable to cardiac surgery with cardiopulmonary bypass (CPB) in the contexts of various temperature levels and techniques for achieving TH. ⋯ Therapeutic hypothermia is an essential measure of neuroprotection during cardiac surgery that may be achieved most effectively by intravascular cooling using hypothermic CPB. For most cardiac surgical procedures, mild to modest (32-36 °C) TH will be sufficient to assure neuroprotection and will avoid most of the adverse effects of hypothermia that occur at lower body core temperatures.
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To review the evidence regarding the reversal of neuromuscular block (NMB) in companion animals with emphasis on the development and use of newer agents. ⋯ Residual NMB has been shown to increase morbidity and mortality in humans and needs to be avoided. It can be detected only by adequate neuromuscular monitoring. The proper use of reversal agents avoids residual NMB and recurarization should not occur. Anticholinesterase inhibitors, such as edrophonium and neostigmine have been used to reverse NMB when the need for this has been established. Reversal is influenced by several factors and a number of undesirable side- effects of these drugs have been reported. Sugammadex, a γ-cyclodextrin, which was designed specifically to encapsulate rocuronium, is more rapid in its actions, has fewer side effects and can reverse profound NMB induced by aminosteroidal muscle relaxants.
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To review the literature with regard to the use of different intravenous agents as supplements to inhalational anaesthesia in horses. The Part 2 of this review will focus in the use of opioids and α2 -agonists. ⋯ Different drugs and their combinations can be administered systemically in anaesthetized horses aiming to reduce the amount of the volatile agent while improving the recovery qualities and providing a multimodal analgesic approach. However, full studies as to whether these techniques improve cardiopulmonary status are not always available and potential disadvantages should also be considered.
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Review
The immune response to anesthesia: part 2 sedatives, opioids, and injectable anesthetic agents.
To review the immune response to injectable anesthetics and sedatives and to compare the immunomodulatory properties between inhalation and injectable anesthetic protocols. ⋯ Sedatives, injectable anesthetics, opioids, and local anesthetics have immunomodulatory effects that may have positive or negative consequences on disease processes such as endotoxemia, generalized sepsis, tumor growth and metastasis, and ischemia-reperfusion injury. Therefore, anesthetists should consider the immunomodulatory effects of anesthetic drugs when designing anesthetic protocols for their patients.