Use of Homeopathic Arnica montana 30cH for Postoperative Analgesia in Female Dogs Undergoing Elective Ovariohysterectomy

Background Ovariohysterectomy (OH) is one of the most frequent elective surgical procedures in routine veterinary practice. Arnica montana is a well-known medicine in phytotherapy, with proven analgesic, anti-inflammatory, antiseptic, healing, antioxidant and immunomodulatory activity. However, there is still a shortage of studies on the action and effects of the homeopathic formulation of the medicine on animals. The aim of this study was to evaluate analgesia with Arnica montana 30cH during the postoperative period after elective OH. Methods Thirty healthy female dogs, aged 1 to 3 years, weighing 7 to 14 kg, were selected at the Veterinary Hospital in Campo Mourão, Paraná, Brazil. The dogs underwent the surgical procedure with an anaesthetic protocol and analgesia that had the aim of maintaining the patient's wellbeing. After the procedure, they were randomly divided into three groups of 10. One group received Arnica montana 30cH; another received 5% hydroalcoholic solution; and the third group, 0.9% NaCl saline solution. All animals received four drops of the respective solution sublingually and under blinded conditions, every 10 minutes for 1 hour, after the inhalational anaesthetic had been withdrawn. The Glasgow Composite Measure Pain Scale was used to analyse the effect of therapy. Analysis of variance (ANOVA) followed by the Tukey test was used to evaluate the test data. Statistical differences were deemed significant when p ≤0.05. Results The Arnica montana 30cH group maintained analgesia on average for 17.8 ± 3.6 hours, whilst the hydroalcoholic solution group did so for 5.1 ± 1.2 hours and the saline solution group for 4.1 ± 0.9 hours (p ≤0.05). Conclusion These data demonstrate that Arnica montana 30cH presented a more significant analgesic effect than the control groups, thus indicating its potential for postoperative analgesia in dogs undergoing OH.

The Effects of General Anaesthesia and Light on Behavioural Rhythms and GABAA Receptor Subunit Expression in the Mouse SCN

General anaesthesia (GA) is known to affect the circadian clock. However, the mechanisms that underlie GA-induced shifting of the clock are less well understood. Activation of γ-aminobutyric acid (GABA)-type A receptors (GABAAR) in the suprachiasmatic nucleus (SCN) can phase shift the clock and thus GABA and its receptors represent a putative pathway via which GA exerts its effect on the clock. Here, we investigated the concurrent effects of the inhalational anaesthetic, isoflurane, and light, on mouse behavioural locomotor rhythms and on α1, β3, and γ2 GABAAR subunit expression in the SCN of the mouse brain. Behavioural phase shifts elicited by exposure of mice to four hours of GA (2% isoflurane) and light (400 lux) (n = 60) were determined by recording running wheel activity rhythms in constant conditions (DD). Full phase response curves for the effects of GA + light on behavioural rhythms show that phase shifts persist in anaesthetized mice exposed to light. Daily variation was detected in all three GABAAR subunits in LD 12:12. The γ2 subunit expression was significantly increased following GA in DD (compared to light alone) at times of large behavioural phase delays. We conclude that the phase shifting effect of light on the mouse clock is not blocked by GA administration, and that γ2 may potentially be involved in the phase shifting effect of GA on the clock. Further analysis of GABAAR subunit expression in the SCN will be necessary to confirm its role.

General Anaesthesia Shifts the Murine Circadian Clock in a Time-Dependant Fashion

Following general anaesthesia (GA), patients frequently experience sleep disruption and fatigue, which has been hypothesized to result at least in part by GA affecting the circadian clock. Here, we provide the first comprehensive time-dependent analysis of the effects of the commonly administered inhalational anaesthetic, isoflurane, on the murine circadian clock, by analysing its effects on (a) behavioural locomotor rhythms and (b) PER2::LUC expression in the suprachiasmatic nuclei (SCN) of the mouse brain. Behavioural phase shifts elicited by exposure of mice (n = 80) to six hours of GA (2% isoflurane) were determined by recording wheel-running rhythms in constant conditions (DD). Phase shifts in PER2::LUC expression were determined by recording bioluminescence in organotypic SCN slices (n = 38) prior to and following GA exposure (2% isoflurane). Full phase response curves for the effects of GA on behaviour and PER2::LUC rhythms were constructed, which show that the effects of GA are highly time-dependent. Shifts in SCN PER2 expression were much larger than those of behaviour (c. 0.7 h behaviour vs. 7.5 h PER2::LUC). We discuss the implications of this work for understanding how GA affects the clock, and how it may inform the development of chronotherapeutic strategies to reduce GA-induced phase-shifting in patients.

Anaesthesia

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of anaesthesia. It reviews preoperative assessment, sedation, drugs used to induce anaesthesia, inhalational anaesthetic agents, intravenous anaesthetic agents, and muscle relaxants. It explores the practical conduct of anaesthesia, Difficult Airway Society (DAS) guidelines, maintaining and monitoring, rapid sequence induction aspiration, and intubation technique. It examines some complications of anaesthesia, end of anaesthesia, recovery, pain, and postoperative nausea and vomiting, and describes regional anaesthesia, including peripheral nerve blocks and neuraxial anaesthesia.

Pharmacology and fluids

Differences in pharmacokinetics and pharmacodynamics are important in small children. This chapter provides an overview of essential pharmacokinetic parameters and developmental aspects. Intravenous anaesthetic agents, including total intravenous anaesthesia models, are described. An overview of commonly used inhalational anaesthetic agents, sedatives, and neuromuscular blockers is given. The analgesic sections describe opioids, simple analgesics, and local anaesthetic agents. Paediatric indications, common side effects, and dosing are included for each agent. A fundamental understanding of developmental differences is key to the safe and effective use of anaesthetic drugs in children.

Comparison of postoperative recovery from desflurane and sevoflurane anaesthesia using laryngeal mask airway: a prospective randomized comparative study

Background: Ambulatory surgeries necessitate safe anaesthesia and faster recovery. Sevoflurane and desflurane are proved as such effective inhalational anaesthetic agents. The aim of this study was to compare early postoperative recovery profile in patient undergoing elective ambulatory surgical operations and receiving anaesthesia with sevoflurane or desflurane using supreme LMA.Methods: This prospective study was conducted at Jaslok Hospital and Research Centre, Dr. G. Deshmukh Marg, Mumbai, from August 2014 to April 2015. Patients were randomized into two groups receiving desflurane (Group D- n=40) and sevoflurane (Group S- n=40) for maintenance of anaesthesia. Patients were monitored for recovery by using fast track criteria (FTC) score at different time intervals.Results: The demographic characteristics, hemodynamic parameters were comparable in both the groups and no statistical significance was seen among them (p>0.05). The mean time taken for postoperative recovery characteristics were significantly lower in in Group D than Group S (p=0.00). The FTC score was significantly higher in group D as compared to group S at all times (p<0.05) for thirty minutes. The prevalence of consuming additional analgesic was 12.5% in group D and 15% in group S (p=1.000). The additional antiemetic requirement was seen in 10% patients in both the groups (p=1.000).The incidence of coughing was seen in among 5% of Group D patients and in none among Group S (p=0.152).Conclusion: The study concludes that desflurane is superior to sevoflurane with respect to time of eye opening, response to verbal commands, orientation, ability to sit, early recovery profile and duration of stay in recovery room.