Study on anesthesia protocols for pregnant goat during intrauterine cardiac intervention for the fetus

doi:10.3877/cma.j.issn.1673-5250.2015.04.003

Objective

To explore the effects of different 4.0% chloral hydrate administered modes of anesthesia for pregnant goat during fetal goat intrauterine cardiac intervention program to provide basis of anesthesia for fetal intrauterine cardiac intervention program.

Methods

A total of 40 pregnant goats who were being pregnant for 110-127 d were divided into infusion group (4.0% chloral hydrate continuous intravenous infusion) and injection group (4.0% chloral hydrate intermittent intravenous injection after load) in accordance with random digits table, and each group contained 20 pregnant goats.To observe anesthesia effect and recovery time, and whether anesthesia state could meet the operation requirements or not of two groups of pregnant goats, recorded total sedative dose.Detected 10 kinds of indicators including heart rate, mean arterial blood pressure(MAP), blood pH value, arterial partial pressure of oxygen(PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), blood glucose, blood lactic acid, epinephrine, norepinephrine and cortisol of pregnant goats at 2 time points of preoperative and postoperative.Compared difference of anesthesia effect between two groups and differences of these 10 kinds of indicators between different groups and time points.There were no significant differences between two groups in pregnant goat body mass and gestational age(P>0.05).

Results

①Comparison of anesthesia between two groups, preoperative intramuscular injection medicine, route of administration, duration of anesthesia and airway control were all the same, both two kinds of anesthesia could meet the requirements of intrauterine intervention for fetal goat, but there were slightly difficult for infusion group to control anesthesia depth.There were no significant differences between two groups in anesthesia effective time and postoperative starting recovery time (P>0.05). Ketamine doses in infusion group was less than injection group [(116.3±22.5) mg vs (209.3±20.8) mg], while 4.0% chloral hydrate and diazepam dose were more than injection group [(216.7±39.7) mL vs (165.4±19.5) mL, (19.2±3.4) mg vs (10.1±2.9) mg], the postoperative full recovery time was longer than injection group [(273.5±26.2) min vs (191.9±33.1) min], and there were significant differences(P<0.05). ②There were no significant differences between two groups in these 10 kinds of indicator before intervention(P>0.05). The level of blood lactate, epinephrine, norepinephrine and cortisol of pregnant goats after intervention were all higher than those of before intervention in infusion group [(6.0±0.8) mmol/L vs (3.7±0.6) mmol/L, (626.3±99.4) ng/L vs (167.3±35.4) ng/L, (6 631.9±753.2) ng/L vs (1 938.5±393.3) ng/L, (509.0±133.6) ng/L vs (219.9±33.3) ng/L]; and the same results in injection group[(5.0±0.6) mmol/L vs (3.2±0.8) mmol/L, (336.5±58.6) ng/L vs (189.6±32.4) ng/L, (4 063.5±834.7) ng/L vs (2 133.8±323.7) ng/L, (305.9±64.7) ng/L vs (187.3±31.5) ng/L]; the levels of these 4 kinds of indicator in infusion group after intervention were higher than those in injection group after intervention [(6.0±0.8) mmol/L vs (5.0±0.6) mmol/L, (626.3±99.4) ng/L vs (336.5±58.6) ng/L, (6 631.9±753.2) ng/L vs (4 063.5±834.7) ng/L, (509.0±133.6) ng/L vs (305.9±64.7) ng/L], and there were significant differences above all(P<0.05). There were no significant differences between any two groups or in the same group in any time point in pregnancy goat heart rate, MAP, blood pH value and PaO₂(P>0.05).

Conclusions

The anesthesia program of 4.0% chloral hydrate intermittent injection combine with ketamine and diazepam in pregnant goat during fetal goat intrauterine cardiac intervention program was more secure and easier to operate because of the reduction dose of 4.0% chloral hydrate and diazepam.

Key words: Chloral hydrate, Ultrasonography, interventional, Cardiac surgical procedures, Anesthesia, Goats

表1 两组孕羊麻醉方案及效果比较(±s)

组别	羊数	孕羊体质量(kg)	孕龄(d)	术前肌内注射阿托品剂量(mg)	麻醉药物及总量			麻醉给药途径
组别	羊数	孕羊体质量(kg)	孕龄(d)	术前肌内注射阿托品剂量(mg)	4.0%水合氯醛(mL)	氯胺酮(mg)	地西泮(mg)	麻醉给药途径
滴注组	20	41.4±6.7	111.3±8.6	0.5	216.7±39.7	116.3±22.5	19.2±3.4	静脉、肌内注射
推注组	20	38.2±7.3	113.8±9.5	0.5	165.4±19.5	209.3±20.8	10.1±2.9	静脉、肌内注射
t值		0.90	0.60	－	3.30	7.80	5.75	－
P值		>0.05	>0.05	－	<0.05	<0.05	<0.05	－
组别	羊数	麻醉最快显效时间(min)	麻醉维持时间	控制麻醉深浅的难易程度	麻醉能否满足胎羊宫内介入手术	呼吸道控制情况(气管插管)	术后开始复苏时间(min)	术后完全复苏时间(min)
滴注组	20	3.9±1.7	持续	稍难	能	好	11.9±3.8	273.5±26.2
推注组	20	4.1±1.9	持续	易	能	好	13.1±2.6	191.9±33.1
t值		0.30	－	－	－	－	0.70	5.50
P值		>0.05	－	－	－	－	>0.05	<0.05

表1 两组孕羊麻醉方案及效果比较(±s)

组别	羊数	孕羊体质量(kg)	孕龄(d)	术前肌内注射阿托品剂量(mg)	麻醉药物及总量			麻醉给药途径
组别	羊数	孕羊体质量(kg)	孕龄(d)	术前肌内注射阿托品剂量(mg)	4.0%水合氯醛(mL)	氯胺酮(mg)	地西泮(mg)	麻醉给药途径
滴注组	20	41.4±6.7	111.3±8.6	0.5	216.7±39.7	116.3±22.5	19.2±3.4	静脉、肌内注射
推注组	20	38.2±7.3	113.8±9.5	0.5	165.4±19.5	209.3±20.8	10.1±2.9	静脉、肌内注射
t值		0.90	0.60	－	3.30	7.80	5.75	－
P值		>0.05	>0.05	－	<0.05	<0.05	<0.05	－
组别	羊数	麻醉最快显效时间(min)	麻醉维持时间	控制麻醉深浅的难易程度	麻醉能否满足胎羊宫内介入手术	呼吸道控制情况(气管插管)	术后开始复苏时间(min)	术后完全复苏时间(min)
滴注组	20	3.9±1.7	持续	稍难	能	好	11.9±3.8	273.5±26.2
推注组	20	4.1±1.9	持续	易	能	好	13.1±2.6	191.9±33.1
t值		0.30	－	－	－	－	0.70	5.50
P值		>0.05	－	－	－	－	>0.05	<0.05

表2 滴注组孕羊术前及术后10项监测指标比较(±s)

时间点	羊数	心率(次/min)	MAP(mmHg)	血pH值	PaO₂(mmHg)	PaCO₂(mmHg)	血糖(mmol/L)	血乳酸(mmol/L)	肾上腺素(ng/L)	去甲肾上腺素(ng/L)	皮质醇(ng/L)
术前	20	129±18	75.2±6.8	7.31±0.05	89.6±8.4	34.2±5.6	4.2±1.0	3.7±0.6	167.3±35.4	1 938.5±393.3	219.9± 33.3
术后	20	137±25	69.5±9.7	7.29±0.04	78.9±9.1	33.8±4.9	7.5±1.8	6.0±0.8	626.3±99.4	6 631.9±753.2	509.0±133.6
t值		1.16	2.00	1.39	1.60	3.86	7.05	3.70	4.50	24.70	54.90
P值		>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表2 滴注组孕羊术前及术后10项监测指标比较(±s)

时间点	羊数	心率(次/min)	MAP(mmHg)	血pH值	PaO₂(mmHg)	PaCO₂(mmHg)	血糖(mmol/L)	血乳酸(mmol/L)	肾上腺素(ng/L)	去甲肾上腺素(ng/L)	皮质醇(ng/L)
术前	20	129±18	75.2±6.8	7.31±0.05	89.6±8.4	34.2±5.6	4.2±1.0	3.7±0.6	167.3±35.4	1 938.5±393.3	219.9± 33.3
术后	20	137±25	69.5±9.7	7.29±0.04	78.9±9.1	33.8±4.9	7.5±1.8	6.0±0.8	626.3±99.4	6 631.9±753.2	509.0±133.6
t值		1.16	2.00	1.39	1.60	3.86	7.05	3.70	4.50	24.70	54.90
P值		>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表3 推注组孕羊术前及术后10项监测指标比较(±s)

时间点	羊数	心率(次/min)	MAP(mmHg)	血pH值	PaO₂(mmHg)	PaCO₂(mmHg)	血糖(mmol/L)	血乳酸(mmol/L)	肾上腺素(ng/L)	去甲肾上腺素(ng/L)	皮质醇(ng/L)
术前	20	131±21	70.3±5.9	7.28±0.06	85.3±12.8	36.4±6.3	5.1±1.1	3.2±0.8	189.6±32.4	2 133.8±323.7	187.3±31.5
术后	20	133±21	73.5±8.8	7.27±0.05	79.4±11.5	37.1±4.9	6.7±1.8	5.0±0.6	336.5±58.6	4 063.5±834.7	305.9±64.7
t值		0.30	1.30	0.57	1.50	0.39	3.40	7.50	9.80	9.60	7.40
P值		>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表3 推注组孕羊术前及术后10项监测指标比较(±s)

时间点	羊数	心率(次/min)	MAP(mmHg)	血pH值	PaO₂(mmHg)	PaCO₂(mmHg)	血糖(mmol/L)	血乳酸(mmol/L)	肾上腺素(ng/L)	去甲肾上腺素(ng/L)	皮质醇(ng/L)
术前	20	131±21	70.3±5.9	7.28±0.06	85.3±12.8	36.4±6.3	5.1±1.1	3.2±0.8	189.6±32.4	2 133.8±323.7	187.3±31.5
术后	20	133±21	73.5±8.8	7.27±0.05	79.4±11.5	37.1±4.9	6.7±1.8	5.0±0.6	336.5±58.6	4 063.5±834.7	305.9±64.7
t值		0.30	1.30	0.57	1.50	0.39	3.40	7.50	9.80	9.60	7.40
P值		>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表4 两组孕羊术后10项监测指标比较(±s)

组别	羊数	心率(次/min)	MAP(mmHg)	血pH值	PaO₂(mmHg)	PaCO₂(mmHg)	血糖(mmol/L)	血乳酸(mmol/L)	肾上腺素(ng/L)	去甲肾上腺素(ng/L)	皮质醇(ng/L)
滴注组	20	137±25	69.5±9.7	7.29±0.04	78.9± 9.1	33.8±4.9	7.5±1.8	6.0±0.8	626.3±99.4	6 631.9±753.2	509.0±133.6
推注组	20	133±21	73.5±8.8	7.27±0.05	79.4±11.5	37.1±4.9	6.7±1.8	5.0±0.6	336.5±58.6	4 063.5±834.7	305.9± 64.7
t值		0.55	1.30	1.40	0.15	2.12	1.38	4.49	11.21	10.21	6.11
P值		>0.05	>0.05	>0.05	>0.05	<0.05	>0.05	<0.05	<0.05	<0.05	<0.05

表4 两组孕羊术后10项监测指标比较(±s)

组别	羊数	心率(次/min)	MAP(mmHg)	血pH值	PaO₂(mmHg)	PaCO₂(mmHg)	血糖(mmol/L)	血乳酸(mmol/L)	肾上腺素(ng/L)	去甲肾上腺素(ng/L)	皮质醇(ng/L)
滴注组	20	137±25	69.5±9.7	7.29±0.04	78.9± 9.1	33.8±4.9	7.5±1.8	6.0±0.8	626.3±99.4	6 631.9±753.2	509.0±133.6
推注组	20	133±21	73.5±8.8	7.27±0.05	79.4±11.5	37.1±4.9	6.7±1.8	5.0±0.6	336.5±58.6	4 063.5±834.7	305.9± 64.7
t值		0.55	1.30	1.40	0.15	2.12	1.38	4.49	11.21	10.21	6.11
P值		>0.05	>0.05	>0.05	>0.05	<0.05	>0.05	<0.05	<0.05	<0.05	<0.05

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