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ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

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Mechanical vibration of the Achilles tendon is widely used to analyze the role of proprioception in postural control. The response to this tendon vibration (TV) has been analyzed in the upright posture, but the feet positions have varied in past research. Moreover, investigators have addressed only temporal parameters of the center of pressure (CoP). We investigated the effect of TV on both temporal and spectral characteristics of the CoP motion. Eighteen healthy young adults, stood barefoot, with one foot on each side of a dual platform, wearing glasses with opaque lenses. We applied 20 seconds of Achilles TV (bilaterally with inertial vibrators at a frequency of 80 Hz and an amplitude of .2-.5 mm). We analyzed CoP signals pre-vibration (PRE,4-seconds), during vibration (VIB,20 seconds), and after vibration cessation (REC,20 seconds). We repeated this protocol in natural and standardized positions (15° feet angular opening). For determining CoP amplitude and velocity, we divided the 20 seconds into five phases of four seconds each and calculated spectral parameters for the whole 20-second signals. There was an adaptation process in the speed of the CoP mediolateral (p < .01) and anteroposterior (p < .01) and in the displacement of the CoP anteroposterior (p < .01), with higher values in the VIB condition. Velocity and displacement decreased progressively in the REC condition. Median and peak frequencies were higher in the VIB condition when compared to the REC condition, but only in the mediolateral direction (p = .01). The standardized foot position led to increased speed in CoP mediolateral, anteroposterior, and mediolateral displacement (p < .01). CoP spectral characteristics were not affected by foot positioning. We concluded that adaptation of CoP motion in the presence of TV and after its cessation are observable both in time and frequency domains. Feet positioning influenced CoP motion in the presence of TV and after its cessation but it did not affect its spectral characteristics.

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OBJECTIVE: To determine the frequency and stages of chronic venous disease (CVD) in health staff and its impact on the quality of life. METHOD: Cross-sectional study on health workers, between the ages of 20 and 60, indistinct gender, to remain standing position ≥6.5 hours per day for at least 5 days a week. Socio demographic variables were recorded. The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) scale was used to stage the CVD; to measure the quality of life, the CIVIQ-20 (Chronic Venous Insufficiency Questionnaire) survey was applied at baseline, at 3 and 6 months. All patients underwent detailed clinical examination followed by color Doppler ultrasound and angiology review. RESULTS: Included 37 patients, 62.1% woman. Average age was 36.6 ± 8.8 years. By CEAP the 78.3% of the patients presented CVD and the highest prevalence was C1; corroborating by Doppler ultrasound only in 29.7% of the patients. The predominant symptoms were night cramps (54.5%). CONCLUSION: The frequency of CVD is like the literature. Patients with chronic venous disease have poor quality of life which improves with treatment.

OBJETIVO: Determinar la frecuencia y estadios de la enfermedad venosa crónica (EVC) en personal de salud y su impacto en calidad de vida. MATERIAL Y MÉTODOS: Estudio transversal en trabajadores de la salud, edad de 20 a 60 años, sexo indistinto, con bipedestación ≥ 6.5 horas/día por al menos 5 días a la semana. Se registraron variables sociodemográficas. La EVC se estadifico con la escala CEAP (Clinical-Etiology-Anatomy-Pathophysiology); la calidad de vida se midió basal, a 3 y 6 meses con la encuesta CIVIQ-20 (Chronic Venous Insufficiency Questionnaire 20). Además, se realizó examen clínico, ultrasonido Doppler y valoración por angiología. RESULTADOS: Incluyó 37 participantes, el 62.1% mujeres, edad promedio 36.6 ± 8.8 años. Acorde a la CEAP el 78.3% de los pacientes presentaron EVC (prevalencia mayor de C1). Se corroboró por ultrasonido Doppler en el 29.7%. El 54.5% presentaba calambres nocturnos. CONCLUSIONES: La frecuencia de EVC en personal de salud es similar a la reportada en la literatura; los individuos con EVC tienen mala calidad de vida.

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The objective was to investigate the concurrent validity of inertial sensors for measuring balance control in patients with chronic low back pain and asymptomatic individuals. Thirty-nine patients with chronic low back and 39 age- and sex-matched asymptomatic individuals were included. Balance control analysis was performed in quiet standing with two inertial sensors positioned at the lumbar region and the sternum and compared to the results of a force plate. The variables analysed with either device were Root Mean Square (RMS), index of smoothness (JERK), trajectory length (PATH) and area (AREA). Spearman's correlation coefficient investigated the correlation. Patients with chronic low back pain showed moderate correlation with the inertial sensor positioned on the lumbar for RMS (rs = 0.59; p < 0.01), PATH (rs = 0.42, p = 0.01) and AREA (rs = 0.59; p < 0.01) and weak correlation with the inertial sensor positioned on the sternum for PATH (rs = 0.36, p = 0.04). The asymptomatic group showed statistically significant correlations for RMS for the lumbar (rs = 0.38; p = 0.03) and sternum inertial sensor (rs = 0.42; p = 0.02). Inertial sensors showed weak to moderate correlations compared to data obtained from a force plate.

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BACKGROUND: The study purpose was to determine the safety and efficacy of different doses of epidural fentanyl plus local anesthetics on ambulation for patients who had elective cesarean delivery. METHODS: A prospective study at a single community hospital used posturography to compute Sway area for assessment of standing stability [ISRCTN14517337]. Continuous epidural infusion of 0.2% ropivacaine containing either 2.5 mcg.mL-1 (Group 1, n = 8) or 5 mcg.mL-1 fentanyl (Group 2, n = 8) was randomly assigned to an individual and started at a rate of 5 mL.h-1 postoperatively and continued for 48 hours after cesarean delivery in addition to standing acetaminophen and ibuprofen. Posturography measured with SYMPACK™ was used to compute Sway area for investigation of standing stability. The unpaired t-test was used to compare continuous variables between groups. Analysis of variance (ANOVA) was used to assess differences of Sway area measured repeatedly within groups. RESULTS: Participants' demographics, pain status, and leg motor function one day after cesarean delivery were not different between groups. Sway area in Group 1 was not different across three repeated measurements. Sway area of Group 2 on postoperative day 1, with epidural analgesia, was significantly higher than at the baseline (4.1 ± 2.8 vs. 3.1 ± 1.1 cm2, p < 0.05). CONCLUSIONS: Because both low and high concentrations of epidural fentanyl allowed participants to ambulate with the same pain effect, the lower concentration of continuous epidural fentanyl (2.5 mcg.mL-1 at 5 mL.h-1) is warranted to avoid potential adverse events during ambulation after cesarean delivery.

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Although pharmacokinetic studies of drugs administered by intravenous regional limb perfusion (IRLP) to treat equine orthopedic infections suggest efficient drug distribution in the limbs, it remains unclear whether drug perfusion is affected by the position of the horse during the procedure. This study compared the perfusion of a radiopaque contrast into tissues of the extremities of horses maintained in standing and recumbent positions during an IRLP. Radiopaque contrast was administered through IRLP into the cephalic vein of 10 healthy adult horses under general anesthesia and right lateral recumbency (RG) or under sedation and standing (SG). The same animals were used in both groups, respecting a two-week washout period. Sequential radiographic images were performed immediately at the beginning of contrast administration (T0) and after 10, 20, 30, 40, and 50 minutes. Tourniquets were removed after 30 minutes. The time required for the contrast to reach the hooves was compared between groups. Contrast reached the hooves faster in SG (114 ± 15 seconds) compared with RG (236 ± 29 seconds) (P < 0.5). SG showed more uniform perfusion of the limb vessels, whereas RG showed more deposition of the contrast in the lateral digital vein, with smaller amounts reaching the hooves. From T10 onward, soft tissue radiopacity increased, albeit more markedly in standing than in recumbent animals, remaining until T50. Contrast radiography evidenced that IRLP performed in standing position leads to a quicker and more uniform perfusion of the vasculature and a more noticeable diffusion to the tissues than in recumbent horses.

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Resumo Fundamento A hipotensão ortostática (HO) tem sido negligenciada na clínica não havendo estudos sobre sua prevalência na população brasileira. Objetivo Determinar a prevalência de HO e a variação da pressão arterial (PA) após manobra postural no Estudo Longitudinal da Saúde do Adulto. Métodos No presente estudo descritivo da linha de base (N = 14.833 indivíduos, 35-74 anos), os participantes ficavam deitados por 20 minutos e então levantavam ativamente, com a medida da PA em supino e aos 2, 3, e 5 minutos de ortostase. A HO foi definida por queda ≥ 20 mmHg na PA sistólica e/ou queda ≥ 10 mmHg na PA diastólica aos 3 minutos, sendo determinada a sua prevalência com intervalo de confiança de 95% (IC95%). A distribuição da variação da PA após a manobra postural foi determinada numa subamostra (N = 8.011) após remoção de participantes com morbidade cardiovascular e/ou diabetes. Resultados A prevalência de HO foi de 2,0% (IC95%: 1,8 - 2,3), crescente com a idade. Se o critério for a mesma queda pressórica em qualquer das medidas, a prevalência aumenta para 4,3% (IC95%: 4,0 - 4,7). Em presença de HO houve relato de sintomas (tontura, escotomas, náuseas, etc.) em 19,7% dos participantes (IC95%: 15,6 - 24,6) e em apenas 1,4% (IC95%: 1,2 - 1,6) dos sem HO. Os escores-Z −2 das variações da PA antes e após manobra postural na subamostra foram de −14,1 mmHg na PA sistólica e −5,4 mmHg na diastólica. Conclusão A prevalência de HO varia em função do momento da aferição da PA. Os pontos de corte atuais podem subestimar a ocorrência de HO na população. (Arq Bras Cardiol. 2020; 114(6):1040-1048)

Abstract Background Orthostatic hypotension (OH) has been neglected in clinical practice, and there are no studies on its prevalence in the Brazilian population. Objective To determine the prevalence of OH and blood pressure (BP) changes after the postural change maneuver in participants of the Longitudinal Study of Adult Health. Methods In this descriptive study of baseline data (N = 14,833 adults, ages 35 - 74 years), participants remained lying down for 20 minutes and subsequently stood up actively. BP measurements were taken while the participants were supine and at 2, 3, and 5 minutes after standing. OH was defined as a reduction of ≥ 20 mmHg in systolic BP and/or a reduction of ≥ 10 mmHg in diastolic BP at 3 minutes, and its prevalence was determined with a 95% confidence interval (CI). The distribution of BP variation after the postural change maneuver was determined in a subsample (N = 8,011) obtained by removing patients with cardiovascular morbidity and/or diabetes. Results The prevalence of OH was 2.0% (95% CI: 1.8 - 2.3), increasing with age. If the criterion applied were a BP reduction during any measurement, the prevalence would increase to 4.3% (95% CI: 4.0 - 4.7). Symptoms (dizziness, scotoma, nausea, etc.) were reported by 19.7% of participants (95% CI: 15.6 - 24.6) with OH and 1.4% (95% CI: 1.2 - 1.6) of participants without OH. The −2 Z-scores of BP variation before and after the postural change maneuver in the subsample were −14.1 mmHg for systolic BP and −5.4 mmHg for diastolic BP. Conclusion Prevalence of OH varies depending on when BP is measured. Current cutoff points may underestimate the actual occurrence of OH in the population. (Arq Bras Cardiol. 2020; 114(6):1040-1048)

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Abstract Background: Arterial compliance reduction has been associated with aging and hypertension in supine position. However, the dynamic effects of orthostatism on aortic distensibility has not been defined. Objective: We sought to determine the orthostatic influence and the interference of age, blood pressure (BP) and heart rate (HR) on the great arteries during gravitational stress. Methods: Ninety-three healthy volunteers (age 42 ± 16 years). Carotid-femoral pulse wave velocity (PWV) assumed as aortic stiffness was assessed in supine position (basal phase), during tilt test (TT) (orthostatic phase) and after return to supine position (recovery phase). Simultaneously with PWV acquisition, measures of BP and HR rate were recorded. Results: PWV during TT increased significantly compared to the basal and recovery phases (11.7 ± 2.5 m/s vs. 10.1 ± 2.3 m/s and 9.5 ± 2.0 m/s). Systolic BP (r = 0.55, r = 0.46 and r = 0.39) and age (r = 0.59, r = 0.63 and r = 0.39) correlated with PWV in all phases. The significance level for all tests was established as α = 0.05. Conclusion: We conclude that there is a permanent increase in PWV during orthostatic position that was returned to basal level at the recovery phase. This dynamic pattern of PWV response, during postural changes, can be explained by an increase in hydrostatic pressure at the level of abdominal aorta which with smaller radius and an increased elastic modulus, propagates the pulse in a faster way. Considering that it could increase central pulse reflection during the orthostatic position, we speculate that this mechanism may play a role in the overall adaptation of humans to gravitational stress.

Resumo Fundamento: A redução da complacência arterial tem sido associada ao envelhecimento e à hipertensão na postura supina. Entretanto, os efeitos dinâmicos do ortostatismo na distensibilidade aórtica não foram definidos. Objetivo: Determinar a influência ortostática e a interferência da idade, pressão arterial (PA) e frequência cardíaca (FC) sobre as grandes artérias durante o estresse gravitacional. Métodos: Noventa e três voluntários saudáveis (idade de 42 ± 16 anos). A velocidade da onda de pulso carotídeo-femoral (VOP), assumida como rigidez aórtica, foi avaliada na posição supina (fase basal) durante o teste de inclinação (TT) (fase ortostática) e após o retorno à posição supina (fase de recuperação). Simultaneamente à aquisição da PWV, registrou-se as medidas de PA e FC. Resultados: A VOP durante o TT aumentou significativamente em comparação com as fases basal e de recuperação (11,7 ± 2,5 m/s vs. 10,1 ± 2,3 m/se 9,5 ± 2,0 m/s). PA sistólica (r = 0,55, r = 0,46 e r = 0,39) e idade (r = 0,59, r = 0,63 e r = 0,39) correlacionaram-se com a VOP em todas as fases. O nível de significância para todos os testes foi estabelecido como = 0,05. Conclusão: Observou-se um aumento permanente da VOP durante a postura ortostática, que retornou ao nível basal na fase de recuperação. Esse padrão dinâmico de resposta da VOP, durante as alterações posturais, pode ser explicado pelo aumento da pressão hidrostática no nível da aorta abdominal que, com raio menor e aumento do módulo de elasticidade, propaga o pulso de maneira mais rápida. Considerando-se que poderia aumentar a reflexão do pulso central durante a posição ortostática, podemos especular que esse mecanismo pode desempenhar um papel na adaptação global do humano ao estresse gravitacional.

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OBJECTIVE: This study aimed to examine the reliability of postural variables analyzed by photogrammetry obtained at different instances on the same day and between 2 different days. METHODS: A sample composed of 24 healthy adult individuals of both sexes was submitted to photogrammetric postural assessment. From 35 seconds of filming, 7 photographs (of time instance at 0 second, 05 seconds, 10 seconds, 15 seconds, 20 seconds, 25 seconds, and 30 seconds) were extracted and digitalized on digital image-based postural assessment software. One factor repeated-measures analysis of variance quantified the alterations in the magnitude of the variables within and between sessions (factor time and factor day, respectively). The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to verify the repeatability and reproducibility. RESULTS: The repeatability shows that postural variables did not present significant differences in the comparison among the 7 instances; all the variables had excellent and significant ICCs, and SEM and MDC values indicated measurement errors lower than 5%. The intrarater reproducibility shows that postural variables did not present significant differences between 2 days of evaluation; most of the variables had excellent and significant ICCs, and SEM and MDC values were between 0.9% and 12.5%. CONCLUSION: The results for repeatability and reproducibility show that most of the variables have excellent and significant ICCs. Postural evaluation by photogrammetry can be performed at any time within a 30-second interval counting from the positioning of the participant for assessment. Therefore, we conclude that a single photograph can represent the static posture of an individual in the postural evaluation, which is reliable enough and useful to determine the effects of an intervention either in clinical practice or in research.

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RESUMEN Fundamento: las alteraciones de la marcha y el equilibrio en la tercera edad son la causa principal de caídas. Son necesarios métodos de valoración válidos y fiables para identificar el riesgo de caídas. Objetivo: determinar las relaciones de algunos indicadores del test escala de equilibrio avanzado de Fullerton y la edad, en adultos mayores. Métodos: se realizó un estudio exploratorio, descriptivo y transversal entre septiembre y diciembre de 2017 en los círculos de abuelos del combinado deportivo 5 del municipio Cienfuegos. Para ello se seleccionaron 115 adultos mayores. Fueron seleccionadas como variables generales: la edad y el sexo. Se tomaron cuatro de los diez incisos que conforman el test de Fullerton. Se aplicaron el coeficiente de correlación de Spearman y el coeficiente Gamma, se trabajó al 95 % de confianza. Los resultados se expusieron mediante el uso de tablas. Resultados: el grupo de edades más representado fue el de 71-75 años (40,9 %), con una prevalencia del sexo masculino (16 %). En la aplicación del test de Fullerton los adultos mayores lograron mantener el equilibrio en bipedestación, en más del 25 % de los casos; pudieron o bien tomar el objeto sin mover los pies o bien mediante un paso; en el control ortostático los valores más altos se concentran en el grupo de 71-75 años (40 %). Conclusiones: predominaron los adultos mayores que lograron mantener el equilibrio en bipedestación con los ojos cerrados, pudieron o bien tomar el objeto sin mover los pies o bien mediante un paso con supervisión, en el control ortostático los valores más altos se concentran en el grupo de 71-75 años.

ABSTRACT Foundation: alterations in gait and balance in the elderly are the main cause of falls. Valid and reliable valuation methods are necessary to identify the risk of falls. Objective: to determine the relationships between some indicators of the Fullerton advanced equilibrium scale test and age in older adults. Methods: a descriptive cross sectional exploratory study was conducted between September and December 2017 in elder Day Care Centers of the Combined Sports Center N0 5 of the Cienfuegos Municipality. For this, 115 elderly adults were selected. The general variables were: age and sex. Four of the ten items that make up the Fullerton test were taken. The Spearman correlation coefficient and the Gamma coefficient were applied, with 95 % confidence. The results were exposed through the use of tables. Results: the most represented age group was 71-75 years (40.9 %), with a prevalence of males (16 %). In the application of the Fullerton test older adults managed to maintain balance in standing, in more than 25 % of cases, could take the object either without moving the feet or by a step, in the orthostatic control the highest values they are concentrated in the group of 71-75 years (40 %). Conclusions: older adults who managed to maintain balance in standing with their eyes closed, could either take the object without moving the feet or through a step with supervision, in the orthostatic control the highest values are concentrated in the group of 71-75 years.

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AIM: To compare the effect of breathing type on the activity of respiratory muscles at different body positions. METHODOLOGY: Two groups of 20 subjects each, one with upper costal and the other with costodiaphragmatic breathing, were studied. Electromyographic activity of sternocleidomastoid (SCM), diaphragm (DIA), external intercostal (EIC), and latissimus dorsi (LAT) muscles was recorded at standing and lateral decubitus positions during swallowing and maximal voluntary clenching. RESULTS: All muscles showed higher activity during standing in upper costal breathing subjects except the SCM muscle. EIC activity was higher during standing in the costodiaphragmatic breathing group. Subjects with upper costal breathing showed higher DIA activity than subjects with costodiaphragmatic breathing at both body positions and higher SCM activity at lateral decubitus position, whereas, EIC activity was only higher during swallowing. CONCLUSIONS: Subjects with upper costal breathing presented higher respiratory effort than subjects with costodiaphragmatic breathing, being most prominent at the lateral decubitus position.

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As afecções dentárias são de alta incidência em equinos, muitas vezes evoluindo para os alvéolos dentários causando periostites e sinusites. Quando afetam molares e pré-molares a exodontia faz-se imprescindível, sendo que duas técnicas mais citadas: trepanação óssea e repulsão de molares sob anestesia geral e extração intraoral sob neuroleptoanalgesia. Uma égua de 18 anos, raça Campolina, com sinais clínicos de inapetência e perda de peso foi atendida no ambulatório do GRUPEQUI-UFAL. Ao exame radiográfico lateral obliquo, apresentou imagens sugestivas de reabsorção do dente 109 e alvéolo-periostite do 108, além de área de radiopacidade sobre as raízes, confirmando diagnóstico de sinusite secundária. A opção cirúrgica foi a trepanação óssea e repulsão de molares sob neuroleptoanalgesia, em posição quadrupedal, pouco citada na literatura. A sedação foi realizada com detomidina (0,6 ucg/kg/IV), o bloqueio anestésico foi efetuado de maneira local subcutânea na linha de incisão e perineural infiltrativa no nervo maxilar, com Lidocaina 2% sem vasoconstritor, com volumes respectivos de 10 e 20 mL. Para o bloqueio do nervo maxilar, foi utilizada a técnica de acesso ventral ao processo zigomático e dorsal aos vasos faciais transversos. Conseguiu-se a extração dos dentes 108 e 109 em 45 minutos. Após a extração, inseriu-se uma sonda de Foley, para limpeza e drenagem nos primeiros 4 dias pós-operatório. A sutura foi de Cushing no espaço subcutâneo com Poliglactina 910 nº0 e interrompida simples com Nylon n°0 na pele. O pós cirúrgico foi de rotina com Penicilina benzatina (40000 UI/Kg/IMq48 horas/3 aplicações), Metronidazol (10 mg/kg/V0/12hs/5 dias) e Flunixin Meglumine intramuscular (1,1 mg Kg/IM/24 hs/5 dias). As lavagens da boca com mangueira foram realizadas quatro vezes por dia, após as alimentações, além de utilização de Líquido de Dakin no alvéolo periostal. Os curativos externos eram realizados com povidine e spray repelente. Os pontos foram retirados com 15 dias. A trepanação óssea e extração de molares com o animal sob neuroleptoanalgesia, utilizando detomidina e bloqueio perineural maxilar, apresentou-se como técnica satisfatória para a extração de molares em equinos idosos.

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