Extradural Anesthesia With Lidocaine Combined With Fentanyl or Methadone to Ovariohisterectomy in Dogs.
Extradural anesthesia with lidocaine combined with fentanyl or methadone to ovariohisterectomy in dogs.
Acta Cir Bras. 2013 Jul; 28(7): 531-536
Diniz MS, Kanashiro GP, Bernardi CA, Nicácio GM, Cassu RN
To compare the cardiopulmonary effects and the quality of anesthesia of the extradural lidocaine in combination with fentanyl or morphine in bitches undergoing ovariohysterectomy.Sixteen female dogs, were sedated with intramuscular acepromazine (0.05mg kg-1), followed by anesthetic induction with intravenous propofol (4mg kg-1), to perform the lumbosacral puncture. The animals were randomly assigned to two treatments: T-F (n=8) extradural administration of fentanyl (5µg kg-1), T-M (n=8) extradural administration of methadone (0.3mg kg-1). In both treatment groups, opioids were combined with lidocaine, in order to make up a final volume of 0.4mL kg-1. Heart rate (HR), respiratory rate (RR), systolic arterial blood pressure (SABP), intra-operative anesthetic supplementation, blood gases and adverse effects were investigated.HR, arterial pH and blood gases did not differ between treatments at any time point. RR and SABP decreased after epidural anesthesia, but the values were in terms of the physiological range of dogs. Intra-operative anesthetic supplementation was required in 50% and 62.5% of the fentanyl and methadone treated dogs, respectively.The extradural lidocaine in combination with fentanyl or morphine allowed cardiopulmonary stability, however sufficient sensitive blockade was not provided in 100% of the dogs.
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Enhanced antinociceptive efficacy of epidural compared with i.v. methadone in a rat model of thermal nociception.
Br J Anaesth. 2013 Jul 10;
Haroutiunian S, Kagan L, Yifrach-Damari I, Davidson E, Ratz Y, Hoffman A
/st>The properties of methadone suggest a potential advantage for epidural over i.v. administration for pain relief, but little supportive evidence exists./st>To investigate the pharmacokinetic and the pharmacodynamic properties of epidural and i.v. methadone, four doses of methadone (0.1, 0.25, 0.5, and 0.75 mg kg(-1)) were investigated by each route in a rat model. The tail-flick and hot water tail immersion test were used for thermal nociception. The magnitude of antinociceptive efficacy was expressed as per cent maximal possible effect (%MPE) of tail withdrawal latency, and the area under the %MPE vs time curve indicated the cumulative antinociceptive effect. A pharmacokinetic model describing the disposition and elimination of methadone was established./st>The pharmacokinetic profiles of methadone were not significantly different after epidural and i.v. administration. A two-compartment model with saturable elimination provided a good fit of the experimental data. At equivalent doses, epidural methadone produced higher cumulative antinociceptive effect in both thermal models. Supraspinal opioid effect, assessed by pinna reflex presence, was significantly lower with epidural methadone at equivalent doses. The duration of antinociceptive effect was longer with epidural administration of 0.5 and 0.75 mg kg(-1) doses./st>Epidural administration of methadone in rats resulted in systemic exposure similar to that after i.v. administration, but improved thermal antinociceptive efficacy, and reduced supraspinal undesired effects. The findings suggest the presence of local effect at the spinal cord level, in addition to the systemic effect produced by epidural methadone.
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An evaluation of the parents under pressure programme: a study protocol for an RCT into its clinical and cost effectiveness.
Trials. 2013 Jul 11; 14(1): 210
Barlow J, Sembi S, Gardner F, Macdonald G, Petrou S, Parsons H, Harnett P, Dawe S
Many babies in the UK are born to drug-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment, with around a quarter of these children being subject to a child protection plan. Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant’s physical and emotional needs. The poor outcomes that are associated with such drug dependency appear to be linked to the multiple difficulties experienced by such parents.An increase in understanding about the crucial importance of early relationships for infant well-being has led to a focus on the development and delivery of services that are aimed at supporting parenting and parent–infant interactions. The Parents under Pressure (PuP) programme is aimed at supporting parents who are dependent on psychoactive drugs or alcohol by providing them with methods of managing their emotional regulation, and of supporting their new baby’s development. An evaluation of the PuP programme in Australia with parents on methadone maintenance of children aged 3 to 8 years found significant reductions in child abuse potential, rigid parenting attitudes and child behaviour problems.Methods/design: The study comprises a multicentre randomised controlled trial using a mixed-methods approach to data collection and analysis in order to identify which families are most able to benefit from this intervention.The study is being conducted in six family centres across the UK, and targets primary caregivers of children less than 2.5 years of age who are substance dependent. Consenting participants are randomly allocated to either the 20-week PuP programme or to standard care.The primary outcome is child abuse potential, and secondary outcomes include substance use, parental mental health and emotional regulation, parenting stress, and infant/toddler socio-emotional adjustment scale.This is one the first UK studies to examine the effectiveness of a programme targeting the parenting of substance-dependent parents of infants and toddlers, in terms of its effectiveness in improving the parent–infant relationship and reducing the potential for child abuse.Trial registration: International Standard Randomised Controlled Trial Number Register: ISRCTN47282925.
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