RESUMEN

The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m-2 who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190-197 [165-200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174-185.5 [121-200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.

Asunto(s)

Analgésicos Opioides/uso terapéutico , Gastroplastia/métodos , Laparoscopía/métodos , Metadona/uso terapéutico , Morfina/uso terapéutico , Adulto , Analgesia Controlada por el Paciente , Analgésicos Opioides/efectos adversos , Periodo de Recuperación de la Anestesia , Método Doble Ciego , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Metadona/efectos adversos , Persona de Mediana Edad , Morfina/efectos adversos , Manejo del Dolor , Dimensión del Dolor/efectos de los fármacos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Náusea y Vómito Posoperatorios/epidemiología , Resultado del Tratamiento

RESUMEN

AIM: Vein reconstruction using grafts may prevent sequelae of venous interruption or lesion. Autologous vein is sometimes unsuitable or absent for a vascular restoration. The aim of this study was to study glutaraldehyde-treated homologous vein graft as vein substitute and compare it with autologous vein as a substitute for a vena cava segment in rabbits. METHODS: Sixty rabbits were allocated into two groups: autologous vein graft (AG), and glutaraldehyde-treated homologous vein graft (HG). Each group was subdivided into three subgroups (N.=10) to be studied at: 24 hours, 14 days, and 28 days. The veins were treated in 0.19% glutaraldehyde, pH=7.4, for 1 hour and kept at 4 degrees C in saline with added gentamicin and amphotericin B. The animals received benzanthine penicillin on the day of graft implantation and heparin only during surgery. The grafts were implanted into the vena cava. Anastomosis was performed with interrupted sutures. Cavography was performed, after surgery, and at the time the animals were killed. Evaluation of the veins was made macroscopically and by light and scanning electron microscopy. RESULTS: Fibrosis was seen around the grafts at 14 and 28 days, with no difference in intensity between the groups. Cavography performed before euthanasia of the animals showed 4 partial thrombi in AG (2 at 24 hours and 2 at 14 days), 3 in HG (2 at 24 hours and 1 on day 14), and 4 occlusive thombi in HG (3 at 14 days and 1 at 28 days). Macroscopic examination did not show any thrombus in AG. In HG, two partial thrombi were confirmed at 24 hours and three occlusive thrombi at 14 days. There was no statistical difference in relation to patency between the two groups. At 14 and 28 days, the histological sections showed intimal hyperplasia of similar intensity and variable distribution in both groups. Evaluation by electron microscopy showed at 24 hours lesion areas characterized by absence of the endothelium on the graft surface, presence of inflammatory cells, and, at some sites, presence of mural thrombi in AG and HG. Both groups at 14 and 28 days showed endothelial cells covering the lesion area on the graft surface, this covering being larger in AG than in HG. CONCLUSIONS: In the studied model, both grafts behaved similarly in relation to patency and morphological characteristics. This suggests that the glutaraldehyde-treated graft can be a promising alternative for vein reconstruction, justifying further animal studies with the aim of using it in human surgery.

Asunto(s)

Bioprótesis , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Fijadores , Glutaral , Fijación del Tejido/métodos , Vena Cava Inferior/trasplante , Animales , Flebografía , Diseño de Prótesis , Conejos , Factores de Tiempo , Trasplante Autólogo , Trasplante Homólogo , Grado de Desobstrucción Vascular , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Vena Cava Inferior/fisiopatología

RESUMEN

AIM: Diclofenac sodium is a non-steroidal anti-inflammatory drug commonly used to attenuate painful inflammatory reactions in surgery. However, it may delay healing in the skin and gastrointestinal tract. The aim of this study was to evaluate the influence of Diclofenac in vascular healing. METHODS: Ninety rabbits had their carotid arteries sectioned and reconstructed by end-to-end anastomosis with interrupted sutures. The animals were randomly allocated into 3 groups of 30 each and treated by intramuscular route with saline (control), 5 mg/kg/day of diclofenac sodium (DS-5), and 10 mg/kg/day of diclofenac sodium (DS-10). Treatment began on the day of surgery and lasted 4 days. Angiography, biomechanical properties (failure load, failure elongation, yield point, yield point elongation, and stiffness were obtained from the load/elongation curve), macroscopic and histological examinations (hematoxylin-eosin, Masson, Calleja, Picrossirius-red), and scanning electron microscopy were studied in both arteries on the 3rd and 15th postoperative days. RESULTS: No significant differences in biomechanical properties were observed either in the 3 groups or the experimental times. The carotid artery healing process was similar in the 3 groups. CONCLUSION: Diclofenac sodium did not cause alterations nor delayed carotid artery healing.

Asunto(s)

Antiinflamatorios no Esteroideos/uso terapéutico , Arterias Carótidas/cirugía , Diclofenaco/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica , Animales , Fenómenos Biomecánicos , Arterias Carótidas/patología , Arterias Carótidas/fisiopatología , Conejos

RESUMEN

The venom of Lonomia obliqua caterpillar may induce a hemorrhagic syndrome in humans, and blood incoagulability by afibrinogenemia when intravenously injected in laboratory animals. The possible antithrombotic and thrombolytic activities of L. obliqua caterpillar bristle extract (LOCBE) were evaluated in this study. The minimal intravenous dose of the extract necessary to induce afibrinogenemia and anticoagulation was 3.0 and 10.0 microg protein/kg body weight for rabbits and rats, respectively. In rabbits, this dose induced total blood incoagulability for at least 10 h and did not reduce the weight of preformed venous thrombi, in contrast to streptokinase (30,000 IU/kg). In rats, pretreatment with 5.0 and 10.0 microg/kg LOCBE prevented the formation of thrombi induced by venous stasis or by injury to the venous endothelium. The dose of 5.0 microg/kg LOCBE did not modify blood coagulation assay parameters but increased bleeding time and decreased plasma factor XIII concentration. When the extract was administered to rats at the dose of 10.0 microg/kg, the blood was totally incoagulable for 6 h. These data show that LOCBE was effective in preventing experimental venous thrombosis in rats, justifying further studies using purified fractions of the extract to clarify the mechanisms of this effect.

Asunto(s)

Anticoagulantes/farmacología , Venenos de Artrópodos/farmacología , Coagulación Sanguínea/efectos de los fármacos , Fibrinolíticos/farmacología , Trombosis de la Vena/prevención & control , Animales , Anticoagulantes/uso terapéutico , Venenos de Artrópodos/uso terapéutico , Tiempo de Sangría , Factor XIII/análisis , Fibrinolíticos/uso terapéutico , Venas Yugulares/efectos de los fármacos , Masculino , Conejos , Ratas , Ratas Wistar , Venas Cavas/efectos de los fármacos

RESUMEN

The venom of Lonomia obliqua caterpillar may induce a hemorrhagic syndrome in humans, and blood incoagulability by afibrinogenemia when intravenously injected in laboratory animals. The possible antithrombotic and thrombolytic activities of L. obliqua caterpillar bristle extract (LOCBE) were evaluated in this study. The minimal intravenous dose of the extract necessary to induce afibrinogenemia and anticoagulation was 3.0 and 10.0 æg protein/kg body weight for rabbits and rats, respectively. In rabbits, this dose induced total blood incoagulability for at least 10 h and did not reduce the weight of preformed venous thrombi, in contrast to streptokinase (30,000 IU/kg). In rats, pretreatment with 5.0 and 10.0 æg/kg LOCBE prevented the formation of thrombi induced by venous stasis or by injury to the venous endothelium. The dose of 5.0 æg/kg LOCBE did not modify blood coagulation assay parameters but increased bleeding time and decreased plasma factor XIII concentration. When the extract was administered to rats at the dose of 10.0 æg/kg, the blood was totally incoagulable for 6 h. These data show that LOCBE was effective in preventing experimental venous thrombosis in rats, justifying further studies using purified fractions of the extract to clarify the mechanisms of this effect

Asunto(s)

Animales , Ratas , Conejos , Masculino , Anticoagulantes , Venenos de Artrópodos , Coagulación Sanguínea , Fibrinolíticos , Trombosis de la Vena , Anticoagulantes , Venenos de Artrópodos , Tiempo de Sangría , Factor XIII , Fibrinolíticos , Venas Yugulares , Ratas Wistar , Venas Cavas

RESUMEN

Heparin is the most frequently used drug for the prevention and treatment of thrombosis. Its use, however, is restricted by its side-effects. To study the efficacy of other glycosaminoglycans that could substitute heparin in the management of arterial thrombosis, 60 guinea-pigs were randomly allocated into 6 groups: G1 = control, G2 = heparin (150 IU/kg), G3 = heparan sulfate from beef pancreas (2.5 mg/kg), G4 = heparan sulfate from beef lung (2.5 mg/kg), G5 = N-acetylated heparan from beef pancreas, G6 = dermatan sulfate from beef intestine (2.5 mg/kg). Ten minutes after intravenous injection of the drugs, thrombosis was induced by the injection of a 50% glucose solution into a segment of the right carotid artery isolated between 2 thread loops during 10 minutes. Three hours later the artery was re-exposed and if a thrombus was present it was measured, withdrawn and weighed. Thrombin time and activated partial thromboplastin time were measured in all animals. Thrombus developed in 90% of the animals in the control group, 0% in G2 and G3, 62.5% in G4, 87.5% in G5 and G6. Only in the animals treated with heparin the coagulation tests were prolonged. In conclusion, in the used dose only the heparan sulfate from beef pancreas presented an antithrombotic effect similar to heparin in this experimental model.

Asunto(s)

Trombosis de las Arterias Carótidas/prevención & control , Dermatán Sulfato/uso terapéutico , Heparitina Sulfato/uso terapéutico , Animales , Secuencia de Carbohidratos , Bovinos , Dermatán Sulfato/aislamiento & purificación , Disacáridos/análisis , Evaluación Preclínica de Medicamentos , Cobayas , Heparitina Sulfato/aislamiento & purificación , Intestinos/química , Pulmón/química , Masculino , Datos de Secuencia Molecular , Páncreas/química , Tiempo de Tromboplastina Parcial , Tiempo de Trombina

RESUMEN

Venous rethrombosis following thrombectomy is a common event. The aim of the present study was to verify the action of heparin, heparin plus acetyl salicylic acid (ASA) and dipyridamole, and of an arteriovenous fistula (AVF) in the prevention of this complication. Thrombosis was induced in 48 male rabbits by the injection of thrombin in a segment of the left jugular vein, in which the blood flow was arrested for 10 minutes. After 48 hours, the animals were randomly allocated into one of 4 groups of treatment: (1) control, (2) subcutaneous heparin (600 S.I. Units/kg--8/8 hours), (3) heparin, in the same dose, plus ASA (10 mg/kg/once a day), and dipyridamole (0.5 mg/kg thrice a day), (4) an AVF was surgically constructed between the left carotid artery and the left maxillar vein. After 30 minutes, thrombectomy was performed. The venous blood flow, the hematocrit, activated partial thromboplastin time and thrombin time tests were performed before, right after the thrombectomy and 48 hours after thrombectomy. Venography was performed after thrombectomy and at the end of the experiment. The animals were killed 48 hours after thrombectomy and the veins were examined macroscopically. Venous rethrombosis was significantly prevented only in the AVF group (9/12), when compared to control group (0/12), heparin group (1/12) and heparin plus antiaggregating agents group (2/12). These results validate further clinical and experimental investigations with the use of AVF to prevent rethrombosis after venous thrombectomy, when a reduction of venous flow is present.

Asunto(s)

Derivación Arteriovenosa Quirúrgica , Aspirina/administración & dosificación , Dipiridamol/administración & dosificación , Heparina/uso terapéutico , Tromboflebitis/prevención & control , Animales , Quimioterapia Combinada , Hematócrito , Heparina/administración & dosificación , Masculino , Tiempo de Tromboplastina Parcial , Conejos , Distribución Aleatoria , Recurrencia , Tiempo de Trombina , Tromboflebitis/sangre , Tromboflebitis/cirugía

RESUMEN

The action of three different topical heparinoids on the evolution of experimental thrombophlebitis was studied. Thrombophlebitis was induced in the marginal vein of the ear of rabbits by stasis and injection of hypertonic glucose solution. Forty-eight hours later the animals were allocated to three treatment groups and a control group. The substances were applied over the affected vein three times a day for 6 days and the ears inspected daily by transilumination. After 7 days, the animals were killed and anatomopathological studies performed. No difference in thrombus frequency or inflammatory reaction was observed between the animals treated with heparinoids and the control groups, or among the treated groups.

Asunto(s)

Heparinoides/farmacología , Tromboflebitis/tratamiento farmacológico , Animales , Oído/irrigación sanguínea , Solución Hipertónica de Glucosa , Conejos , Tromboflebitis/inducido químicamente , Venas

RESUMEN

The action of threem different topical heparinoids on the evolution of experimental thrombophlebitis was studies. Thrombophlebitis was induced in the marginal vein of the ear of rabbits by stasis and inection of hypertonic glucose solution. Forty-eight hours later animals were allocated to three treatment groups and a control group. The substances were applied over the affected vein three times a day for 6 days and the ears inspected daily by transillumination. After 7 days, the animals were killed and anatomopathological studies performed. No difference in thrombus frequency or inflamatory reaction was observed between the animals treated with heparinoids and the control group, or among the treated groups

Asunto(s)

Conejos , Animales , Heparinoides/farmacología , Tromboflebitis/inducido químicamente