USPOREDBA DVAJU ANESTEZIOLOŠKIH PROTOKOLA U OPERACIJI CARSKOG REZA TE NJIHOV UTJECAJ NA KUJU I VITALNOST PREŽIVLJAVANJA ŠTENADI

master's thesis

• Title (english): Comparison of two anesthetic protocols for cesarean section and effects on the bitch and vitality of the newborn puppies
• Author: Klara Klašterka
• Mentor: Nino Maćešić (mentor)
• Mentor: Ivan Butković (mentor)
• Committee member: Tugomir Karadjole (predsjednik povjerenstva)
• Committee member: Nino Maćešić (član povjerenstva)
• Committee member: Ivan Butković (član povjerenstva)
• Committee member: Ivan Folnožić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Veterinary Medicine; Zagreb
• Defense date and country: 2022-06, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Ne postoji idealni anesteziološki protokol za gravidnu životinju. Važno je odabrati onaj
protokol koji će osigurati vitalnost i dobrobit i kuje i štenadi. Posljednja dva desetljeća opioidi
se intenzivno koriste u svrhu kontrole boli, ali i za osiguravanje sedacije te hemodinamičke
stabilnosti tijekom anestezije. Glavna prednost je sigurno korištenje u kritično bolesnih te
nestabilnih pacijenata. S korištenjem opioida povezane su i nuspojave koje uključuju depresiju
respiratornog sustava, ileus te razvoj ovisnosti koja je dokazana i u životinja. Svojom
sposobnošću prolaska posteljice uzrokuju i značajnu depresiju središnjeg živčanog te
respiratornog sustava u mladunčadi. Neonatalni organizam nije u potpunosti razvijen, te kao
takav vrlo je osjetljiv na prethodno navedene učinke. Opioid free anaesthesia oblik je
multimodalne analgezije, koja uključuje korištenje lijekova i tehnika koji osiguravaju kvalitetnu
opću anesteziju bez potrebe korištenja opioida, Prema novijim istraživanjima korištenje
medetomidina u premedikaciji zahvata carskog reza nije povezano s depresijom
kardiovaskularnog sustava i sniženom APGAR ocjenom ili preživljavanjem kuje i štenaca.
Medetomidin pruža odgovarajuću sedaciju, analgeziju i miorelaksaciju, te je reverzibilan. U
istraživanje je bilo uključeno 26 kuja, podijeljenih u dvije skupine. Svaka grupa primila je jedan
od dva standardno korištena anesteziološka protokola u zahvatu carskog reza. Grupa 1 u
premedikaciji je primila opioid (fentanil) te antikolinergik (atropin), praćen indukcijom sa brzo
djelujućim hipnotikom (propofolom). Anestezija se tijekom zahvata održavala volativnim
anestetikom (izofluranom), koji se primijenio nakon ekstrakcije štenaca iz maternice. Grupa 2
u premedikaciji je primila α2 agonist adrenergičnih receptora (medetomidin), dok su indukcija
i održavanje anestezije bili identični kao u grupe 1 Štenci iz grupe koja je u premedikaciji
primila medetomidin imali su veće izglede za bolju pojedinačnu i ukupnu APGAR vrijednost
5 i 15 minuta nakon poroda, u odnosu na štence iz grupe koja je primila fentanil, ali 30 minuta
nakon poroda nije bilo značajne razlike. Korištenje medetomidina nije utjecalo na APGAR
ocjenu, ni na preživljavanje kuje i/ili štenadi, dok je fentanil povezan s nižim APGAR
vrijednostima, te izraženošću neuroloških refleksa 5 i 15 minuta nakon carskog reza.

Abstract (english)

The ideal anesthetic protocol for the pregnant animal does not exist. It is important to choose
the one that will provide vitality and wellbeing of the bitch and puppies. Last two decades
opioids have been excessively used, not just to control the pain, but also to provide sedation
and hemodynamic stability during anesthesia. The main advantage is their safety for critical
and unstable patients. Side effects related with the opioids are depression of the respiratory
system, ileus and addiction (even in animals). Their ability to pass the placenta causes a
depression of the central nervous and respiratory system in the puppies. The metabolism of the
neonates is underdeveloped which makes them prone to mentioned side effects. Opioid free
anesthesia is a form of multimodal analgesia which involves using multiple drugs and
techniques that provide a good quality anesthesia without needing opioids. New research has
shown that the use of medetomidine in the premedication for cesarean section did not cause
cardiovascular depression nor a bad APGAR score or vitality of the puppies. Medetomidine
provides an adequate sedation, analgesia, myorelaxation and it is reversable. In our study 26
bitches were included and divided into two groups. In both groups we used one of the two
standard anesthetic protocols for cesarean section. Group 1 was premedicated with an
anticholinergic (atropine) and opioid (fentanyl) followed by induction with a hypnotic
(propofol). Anesthesia was maintained with a violative agent (isoflurane) after the puppies were
extracted from the uterus. Group 2 was premedicated with an α2 agonist of adrenergic receptors
(medetomidine). The rest of the protocol was the same as in group 1. Puppies from the group 2
had a better chance for individual and total APGAR score 5 i 15 minutes after the birth. After
30 minutes there was no difference between the groups. Fentanyl was associated with a lower
APGAR score and neurological reflexes expression while medetomidine wasn’t.

• Keywords: medetomidin; fentanil; opioidi; kuja; štenci; carski rez; APGAR ocjena
• Keywords (english): medetomidine; fentanyl; opioids; bitch; puppies; cesarean section; APGAR score
• Language: croatian
• URN:NBN: urn:nbn:hr:178:706310
• Study programme: Title: Veterinary Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica veterinarske medicine (doktor/doktorica veterinarske medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-07-11 07:43:51