Automated vs. manual cerebrospinal fluid cell counts: a work and cost analysis comparing the Sysmex XE-5000 and the Fuchs-Rosenthal manual counting chamber

INTRODUCTION

Cerebrospinal fluid (CSF) cell counts are traditionally performed by manual microscopy using the Fuchs-Rosenthal counting chamber. This procedure is time-, labour- and cost-intensive and requires experienced laboratory staff.

METHODS

The Sysmex XE-5000 haematology analyzer offers a channel to quantify the total cell count of body fluids. We compared technical sensitivity and specificity, intra-assay variability, turn-around time (TAT) and costs for the determination of CSF cell counts between both methods.

RESULTS

The mean coefficients of variation (CV) for total cell counts in CSF of the Fuchs-Rosenthal chamber and the XE-5000 were 15.2% (range: 2.8-47.5%) and 12.5% (range: 1.9-50.6%). Setting the Fuchs-Rosenthal chamber as 'gold standard', our results revealed a sensitivity of 100% and a specificity of 75% for the XE-5000 to detect a pathological cell count (≥ 6 cells/μL), whereas the sensitivity and specificity to detect a severely pathological cell count (≥ 20 cells/μL) were 100% for both. Bland and Altman analysis revealed slightly higher cell counts with the XE-5000. The approximate duration of a single CSF cell count analysis was 635 s for the manual vs. 85 s for the automated method. Total analytical performance costs for the counting chamber were 6.74 EUR per mean analysis and 1.22 EUR for the XE-5000.

CONCLUSION

Our study revealed a lower mean CV for the total cell count for the XE-5000 method. The fully automated CSF cell count results in a 7.5-fold reduction in TAT and leads to a significant decrease in total analytical performance costs.

Favorable outcome in infants with AML after intensive first- and second-line treatment: an AML-BFM study group report

Infants <1 year of age have a high prevalence of prognostically unfavorable leukemias and a presumed susceptibility to treatment-related toxicities. A total of 125 infants with acute myeloid leukemia (AML) were treated in studies AML-BFM-98 (n = 59) and -2004 (n = 66). Treatment regimens of both studies were comparable, consisting of intensive induction followed by four courses (mainly high-dose cytarabine and anthracyclines). Allogeneic-hematopoietic stem-cell-transplantation (allo-HSCT) in 1st remission was optional for high-risk (HR) patients. Most infants (120/125=96%) were HR patients according to morphological, cytogenetic/molecular genetic and response criteria. Five-year overall survival was 66 ± 4%, and improved from 61 ± 6% in study-98 to 75 ± 6% in study-2004 (P(logrank) 0.14) and event-free survival rates were 44 ± 6% and 51 ± 6% (P(logrank) 0.66), respectively. Results in HR infants were similar to those of older HR children (1-<2- or 2-<10-year olds, P(logrank) 0.90 for survival). Survival rates of HSCT in 1st remission, initial partial response and after relapse were high (13/14, 2/8 and 20/30 patients, respectively). The latter contributes to excellent 5-year survival after relapse (50±8%). Despite more severe infections and pulmonary toxicities in infants, treatment-related death rate was identical to that of older children (3%). Our data indicate that intensive frontline and relapse AML treatment is feasible in infants, toxicities are manageable, and outcome is favorable.

Cloning and functional analysis of the GSH1/MET1 gene complementing cysteine and glutathione auxotrophy of the methylotrophic yeast Hansenula polymorpha

The Hansenula polymorpha GSH1/MET1 gene was cloned by complementation of glutathione-dependent growth of H. polymorpha gsh1 mutant isolated previously as N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) resistant and cadmium ion sensitive clone. The H. polymorpha GSH1 gene was capable of restoring cadmium ion resistance, MNNG sensitivity, normal glutathione level and cell proliferation on minimal media without addition of cysteine or glutathione, when introduced into the gsh1 mutant cells. It was shown that the H. polymorpha GSH1 gene has homology to the Saccharomyces cerevisiae MET1 gene encoding S-adenosyl-L-methionine uroporphyrinogen III transmethylase, responsible for the biosynthesis of sulfite reductase cofactor, sirohaem. The H. polymorpha GSH1/MET1 gene deletion cassette (Hpgsh1/met1::ScLEU2) was constructed and corresponding null mutants were isolated. Crossing data of the point gsh1 and null gsh1/met1 mutants demonstrated that both alleles were located to the same gene. The null gsh1/met1 mutant showed total growth restoration on minimal media supplemented with cysteine or glutathione as a sole sulfur source, but not with inorganic (sulfate, sulfite) or organic (methionine, S-adenosylmethionine) sources of sulfur. Moreover, both the point gsh1 and null gsh1/met1 mutants displayed increased sensitivity to the toxic carbon substrate methanol, formaldehyde, organic peroxide and cadmium ions.

The metabolic activity of gut microbiota in obese children is increased compared with normal-weight children and exhibits more exhaustive substrate utilization

Objective:

The gut microbiota contribute otherwise impossible metabolic functions to the human host. Shifts in the relative proportions of gut microbial communities in adults have been correlated with intestinal disease and have been associated with obesity. The aim of this study was to elucidate differences in gut microbial compositions and metabolite concentrations of obese versus normal-weight children.

Materials and methods:

Fecal samples were obtained from obese (n=15; mean body mass index (BMI) s.d. score=1.95) and normal-weight (n=15; BMI s.d. score=−0.14) Swiss children aged 8–14 years. Composition and diversity of gut microbiota were analyzed by qPCR and temperature gradient gel electrophoresis (TGGE).

Results:

No significant quantitative differences in gut microbiota communities of obese and normal-weight children were identified. Microbial community profiling by TGGE revealed a high degree of both intra- and intergroup variation. Intergroup comparison of TGGE profiles failed to identify any distinct populations exclusive to either obese or normal-weight children. High-pressure liquid chromatography analysis identified significantly higher (P<0.05) concentrations of short-chain fatty acids (SCFA) butyrate and propionate in obese versus normal-weight children. Significantly lower concentrations of intermediate metabolites were detected in obese children, suggesting exhaustive substrate utilization by obese gut microbiota.

Conclusions:

Our results indicate that a dysbiosis may be involved in the etiology of childhood obesity. In turn, aberrant and overactive metabolic activity within the intestine could dictate survival or loss of individual microbial communities, leading to the altered population ratios previously identified in adult obesity.

[Open surgical versus laparoscopic treatment of iatrogenic colon perforation - results of a 13-year experience]

BACKGROUND

Iatrogenic colon perforation is a rare but life-threatening complication of colonscopy. As in other diseases, laparoscopic treatment has increasingly been propagated for the treatment of colonic disorders in the last years. The aim of this comparative study was to answer the question of whether laparoscopic surgical treatment may serve as a suitable treatment for the acute colon perforation comparable to open surgery.

PATIENTS AND METHODS

The data of all patients who underwent surgery for iatrogenic colon perforation within a 13-year time period (1997-2009) were recorded prospectively and analysed retrospectively with regard to different perioperative parameters. In the following analysis the laparoscopically and open surgically treated patients were compared.

RESULTS

In the observation period 24 patients with iatrogenic colon perforation were treated laparoscopically and 12 patients with open surgery. There were no significant differences concerning age in both groups. In both groups resection of the affected region was preferred [open surgically: 58 % (n = 7), laparoscopically: 80 % (n = 19)]. The median operation time was 105 min (range: 35 - 180) for the open surgically treated patients and 165 min (90 - 420) for laparoscopic procedures (p = 0.006). In 4 cases of the laparoscopic group a conversion via laparotomy was -necessary. There was no significant difference concerning the hospital stay between both groups with 14.5 days (7-40) for the open surgical and 11 days (7-25) for the laparoscopic group. Concerning the postoperative morbidity a significantly higher incidence could be seen in the open surgical group (p < 0.0001).

CONCLUSION

An iatrogenic colon perforation mostly leeds to the immediate indication for a surgical treatment. The morbidity and mortality is -primarily determined through the appearance of postoperative complications due to delays in diagnostics and treatment. In this study the feasibility of a laparoscopic treatment could be shown. The laparoscopy with its minimal access trauma offers an enlargement of the diagnostics as well as a safe treatment of the perforation in most patients. However, the laparoscopic treatment especially in emergancy situations requires -advanced experience of the surgeon and always needs a critical benefit-risk consideration in the individual situation.

Management and results of complications after anterior resection with colonic pouch reconstruction for rectal cancer

AIM

Colonic J-pouch reconstruction is widely carried out during low anterior resection. The aim of this observational study was to describe the complications and evaluate the results of adverse event management.

METHOD

A total of 128 patients underwent an elective anterior resection with colorectal or coloanal J-pouch reconstruction for primary rectal cancer between January 1997 and December 2008.

RESULTS

The overall mortality was 1.6%. Three (2.3%) patients developed pouch necrosis, one of whom died. The rate of anastomotic leakage was 11.7%. Other major complications included intra-abdominal abscess (3.1%), haemorrhage (0.8%) and abdominal dihiscence (0.8%). In all cases of anastomotic leakage, the pouch was salvaged, with 80% of patients undergoing surgical revision with relaparotomy and transanal suture. Patients with pouch necrosis underwent relaparotomy with removal of the pouch and a terminal colostomy. In all cases of intra-abdominal abscess without anastomotic leakage, radiologically controlled percutaneous drainage was carried out.

CONCLUSION

Anal function can usually be saved after anastomotic leakage by salvage surgery without increase in mortality.

A diminished serotonin level influences the performance in a modified AX-continuous performance task in adult ADHD

Introduction

Attention deficit disorder (ADHD) is a psychiatric disorder, which is characterized by deficits of executive functions (EF) and impulsivity. Whereas a variety of studies on the involvement of the dopaminergic system in ADHD exists, the impact of the serotonergic system to EF in ADHD in adults is underinvestigated.

Aims

To ascertain the effects of rapid tryptophan depletion (RTD) and the resultant reduction of the central nervous levels of serotonin on the EF of male adult patients with ADHD.

Methods

20 ADHD patients and 20 healthy controls completed the RTD test on one day and a placebo on another day in a double-blind within subject crossover design.- In addition, the subtest alertness of the TAP and a modified Version of the Continuous performance test (AX-CPT) with three stimulus conditions (AX, AY, BX) were administered.

Results

Statistical analysis revealed significant shorter reaction times, more errors and more omission errors in the ADHD group in the AX-CPT. The omissions error rate increased in both groups in the RTD condition but not in the placebo condition. Statistical analyses did not yield any significant differences between groups in the subtest alertness and no significant interaction of group and effect of the RTD condition could be observed.

Conclusions

In addition to higher impulsivity of patients with ADHD as reflected by shorter reaction times and higher error rates, the results of the present study imply an involvement of the serotonergic system as reflected by RTD in sustained and selective attention.

Growth of byssochlamys nivea in pineapple juice under the effect of water activity and ascospore age

The study of thermal resistant mould, including Byssochlamys nivea, is of extreme importance since it has been associated with fruit and fruit products. The aim of this work is to analyze the influence of water activity (aw) and ascospore age (I) on the growth of Byssochlamys nivea in pineapple juice. Mold growth was carried out under different conditions of water activity (aw) (0.99, 0.96, 0.95, 0.93, 0.90) and ascospore age (I) (30, 51, 60, 69, 90 days). Growth parameters as length of adaptation phase (λ), maximum specific growth rate (µmax) and maximum diameter reached by the colony (A) were obtained through the fit of the Modified Gompertz model to experimental data (measuring radial colony diameter). Statistica 6.0 was used for statistical analyses (significance level α = 0.05). The results obtained clearly showed that water activity is statistically significant and that it influences all growth parameters, while ascospore age does not have any statistically significant influence on growth parameters. Also, these data showed that by increasing aw from 0.90 to 0.99, the λ value substantially decreased, while µmax and A values rose. The data contributed for the understanding of the behavior of B. nivea in pineapple juice. Therefore, it provided mathematical models that can well predict growth parameters, also helping on microbiological control and products' shelf life determination.

Non-Hodgkin's lymphoma in adolescents: experiences in 378 adolescent NHL patients treated according to pediatric NHL-BFM protocols

Age-related differences in the distribution, biology and treatment response of non-Hodgkin's lymphoma (NHL) in adolescents remain to be elucidated. The current analyses present clinical parameters and outcomes of adolescents treated in pediatric NHL-BFM trials. Patients were stratified by histological subtype: lymphoblastic lymphoma (LBL); mature B-NHL, including Burkitt's lymphoma/leukemia (BL/B-AL), diffuse B-cell lymphoma (DLBCL-CB) and mediastinal B-cell lymphoma (PMLBL); and anaplastic large cell lymphoma (ALCL). Between October 1986 and December 2007, 2915 patients were registered, including 378 (13%) adolescents (15-18 years) with BL/B-AL (n=101), ALCL (n=74), DLBCL-CB (n=55), T-LBL (n=45), PMLBL (n=24), pB-LBL (n=13) and rare or not-specified NHL subtypes (n=66). The 5-year event-free survival (EFS) was 79±2% for adolescents compared with 85±1% for patients aged <15 years (P=0.014). EFS was 83±7% for adolescents with T-LBL, 82±4% with BL/B-AL, 85±5% with DLBCL-CB, 57±10% with PMLBL and 70±6% with ALCL. According to sex, the 5-year EFS in females versus males, respectively, was 70±5 versus 83±2% overall (P=0.004), 57±17 versus 92±6% (P=0.0036) for T-LBL patients and 71±9 versus 97±3% (P=0.0067) for DLBCL-CB patients. Adolescents with NHL treated according to pediatric NHL-BFM protocols had an EFS of 79±2%, which is marginally inferior to that of children. In adolescents with T-LBL and DLBCL-CB, female sex was associated with a worse prognosis.

Consequent and intensified relapse therapy improved survival in pediatric AML: results of relapse treatment in 379 patients of three consecutive AML-BFM trials

Relapse remains the major cause of treatment failure in pediatric acute myeloid leukemia (AML). We analyzed the clinical characteristics, treatment response to relapse treatment and overall survival (OS) of 379 children with AML relapse treated according to three consecutive frontline protocols of the AML-Berlin/Frankfurt/Muenster study group (AML-BFM-87/-93/-98). Of 313 treated patients with data on remission status, 198 children (63%) achieved a second complete remission (CR2). There were no significant differences in remission rates and OS for the intensive reinduction treatment schedules used. The 5-year OS rate was 23% for the total group and 29% for patients treated with curative intent. OS rates increased with study periods from 18 to 34% (P(log rank)=0.012), whereas the proportion of patients receiving only palliative treatment decreased from 23 to 11% (P(CMH)=0.005). Late relapse, no allogeneic stem cell transplantation (SCT) in CR1, age <10 years and favorable cytogenetics were independent favorable prognostic factors for survival. Achievement of CR2 was the most important prognostic factor (OS 44 vs 3%; P(log rank)<0.0001). Overall, one-third of children with relapsed AML can be cured today. SCT in CR2 is recommended for most patients, although its impact on CR2 is discussed.

Subtype-specific changes in 5-HT receptor-mediated modulation of C fibre-evoked spinal field potentials are triggered by peripheral nerve injury

Neurotransmitter serotonin (5-HT) released from descending pain modulation pathways to the dorsal horn is crucial to spinal nociception processing. This study sought to gain insight into the modulatory roles of specific serotonin receptor subtypes in experimentally induced neuropathic pain. In rats subjected to spinal nerve ligation (SNL) surgery, we recorded field potentials evoked in the spinal dorsal horn by C fibre-input, during spinal superfusion with subtype-selective drugs. In neuropathic rats, subtype 5-HT1A agonist 8-OH-DPAT (100 nM) was found to potently depress evoked field potentials, as opposed to 5-HT2A or 5-HT2B subtype agonists TCB-2 (100 nM) or BW 723C86 (1 microM), respectively, which consistently enhanced evoked potentials. All three failed to alter spinal field potentials in sham operated rats. CP 94253 (1 microM), WAY 161503 (1 mM) or SR 57227 (at 1 microM in SNL rats, and 100 microM in sham rats), selective agonists for 5-HT1B, 5-HT2C and 5-HT3 receptors, respectively, significantly depressed evoked field potentials in both animal groups. The 5-HT4 agonist RS 67333 (1 microM) was depressant only in sham operated animals. Only after SNL, spinal superfusion with 5-HT1A- or 5-HT1B receptor-antagonists (S)-WAY 100135 (100 microM) or SB 224289 (100 microM), respectively, disinhibited C fibre-evoked potentials, whereas 5-HT2A or 5-HT2B receptor-antagonists 4F 4PP (100 microM) or SB 204741 (100 microM) depressed evoked potentials, suggesting tonic activity of all four subtypes as a consequence of experimental nerve injury. The present findings reveal profound subtype-specific changes in the functional modulatory activities of spinal serotonin receptors following peripheral nerve injury. In particular, spinal hyperexcitation promoted by receptors 5-HT2A and 5-HT2B is suggested as a novel pathogenic pathway contributing to neuropathic pain.

EVI1 overexpression in distinct subtypes of pediatric acute myeloid leukemia

Overexpression of the ecotropic virus integration-1 (EVI1) gene (EVI1+), localized at chromosome 3q26, is associated with adverse outcome in adult acute myeloid leukemia (AML). In pediatric AML, 3q26 abnormalities are rare, and the role of EVI1 is unknown. We studied 228 pediatric AML samples for EVI1+ using gene expression profiling and RQ-PCR. EVI1+ was found in 20/213 (9%) of children with de novo AML, and in 4/8 with secondary AML. It was predominantly found in MLL-rearranged AML (13/47), monosomy 7 (2/3), or FAB M6/7 (6/10), and mutually exclusive with core-binding factor AML, t(15;17), and NPM1 mutations. Fluorescent in situ hybridization (FISH) was performed to detect cryptic 3q26 abnormalities. However, none of the EVI1+ patients harbored structural 3q26 alterations. Although significant differences in 4 years pEFS for EVI1+ and EVI1- pediatric AML were observed (28%+/-11 vs 44%+/-4, P=0.04), multivariate analysis did not identify EVI1+ as an independent prognostic factor. We conclude that EVI1+ can be found in approximately 10% of pediatric AML. Although EVI1+ was not an independent prognostic factor, it was predominantly found in subtypes of pediatric AML that are related with an intermediate to unfavorable prognosis. Further research should explain the role of EVI1+ in disease biology in these cases. Remarkably, no 3q26 abnormalities were identified in EVI1+ pediatric AML.

[Scalp blocks. A useful technique for neurosurgery, dermatology, plastic surgery and pain therapy]

Safe and effective cranial analgesia can be achieved by blocking the sensitive nerves of that region. These include the supraorbital nerve, the supratrochlear nerve, the zygomaticotemporal nerve, the auriculotemporal nerve and the greater and lesser occipital nerves which are accessible at typical and most proximal points. Preferably long acting local anesthetics such as ropivacaine 0.75% or levobupivacaine 0.5% are used supplemented with 5 microg/ml epinephrine to reduce systemic resorption and to elongate the duration. Scalp blocks are useful for intraoperative neurologic testing of the patient during awake craniotomy or for supplementation of general anesthesia for other forms of craniotomy. Other applications are minimally invasive and stereotactic neurosurgery including deep brain stimulation, photodynamic therapy of actinic ceratosis, cranial plastic surgery and pain therapy.

Phase II window study on rituximab in newly diagnosed pediatric mature B-cell non-Hodgkin lymphoma (NHL)

10000

Background: Pediatric mature B-cell NHL differ from aggressive B-NHL of adults in terms of biology and treatment outcome. In contrast to adults, rituximab (Rx) is not established in the treatment of pediatric B-NHL has not be determined yet. Even the activity of Rx in pediatric B-NHL is not determined. We conducted a phase II window study to examine the activity of Rx in newly diagnosed pediatric B-NHL. Methods: Eligibility: age < 19 y, CD20 + B-NHL, ≥ 1 measurable lesion/s, informed consent. Exclusion: Lansky performance scale 5, pre-treatment, impaired renal-, heart-, liver-function, hepatitis B, pre-existing disease, pregnancy. Treatment: Rx 375 mg/m2 IV at day 1; concomitant therapy: Rasburicase, steroids only for anaphylaxis, intrathecal (IT) triple drug at days 1, 3 for CNS+ pts only. Begin of chemotherapy at day 5. Response evaluation: product of 2 perpendicular diameters of 1 - 3 index lesions/% blasts in BM/PB within 24 h prior to Rx and at day 5: responder (RP): at least 1 lesion with at least objective effect (decrease of ≥25%) and no progress (increase of ≥25 %) at other sites. Study plan: Simon 2-stage phase II with α and β = 5%. Response rate (RR) for poor activity was set to 45%, for good activity 65%. 33 pts entered the first stage, final evaluation after 79 pts. Results: One hundred thirty-six pts were enrolled from 04/04–08/08. NTC °3/4 toxicities: general condition 16%, fatigue 13%, anaphylaxis (chill/fever/bronchospasm) 6 (1/2/4)%, infection 3%, S-GOT/GPT 10%, acute tumor lysis (ATL) 7%, capillary leakage (0), toxic death (0). Forty-nine pts were not evaluable for response: Withdrawal (anaphylaxis 8, ATL 2, suspected progression, not verified 4, other 2), IT therapy in CNS- pts (8), corticosteroids (3), technical inadequacy of response evaluation (21), no index lesion (1). Of the 87 evaluable pts 37 were RPs (42.5%, 95%-CI 32% - 54%). RR by histology: BL/B-ALL 29/68, DLBCL 6/14, juvenile follicular lymphoma 1/2, PMBCL 1/1, B-NHL nfs 0/2. Fifty pts were non-RPs. Conclusions: Although the RR was lower than requested Rx as single agent is active in pediatric B-NHL.

No significant financial relationships to disclose.

[Atrial fibrillation and adherence to guidelines in the real world: myth or reality?]

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with a prevalence increasing with the aging of the population. AF has become a public health problem in general clinical practice. Despite the conclusive evidence of numerous randomized trials and publication of unified guidelines, their application in the real-world is often sub-optimal, in particular concerning the anticoagulation prescription. Most of these reports have focused on hospitalized patients or were performed by generalists, whereas in the real-world AF is managed in an out-of-hospital setting with growing implication of cardiologists. The purpose of this presentation is to demonstrate that a strict adherence to international guidelines can be obtained in the real-world of AF management. However, some improvements are needed to get an optimal use of anticoagulation.

Pumpless extracorporeal removal of carbon dioxide combined with ventilation using low tidal volume and high positive end-expiratory pressure in a patient with severe acute respiratory distress syndrome

The effects of the combination of a 'lowest' lung ventilation with extracorporeal elimination of carbon dioxide by interventional lung assist are described in a patient presenting with severe acute respiratory distress syndrome due to fulminant pneumonia. Reducing tidal volume to 3 ml.kg(-1) together with interventional lung assist resulted in a decrease in severe hypercapnia without alveolar collapse or hypoxaemia but with a decrease in serum levels of interleukin-6. This approach was applied for 12 days with recovery of the patient, without complications. Extracorporeal removal of carbon dioxide by interventional lung assist may be a useful tool to enable 'ultraprotective' ventilation in severe acute respiratory distress syndrome.

Membranas de látex natural na herniorrafia diafragmática experimental em cães

Utilizaram-se membranas de látex para o reparo de defeitos diafragmáticos em 12 cães, distribuídos em três grupos: no G1 utilizou-se membrana comercial e no G2, membrana experimental. O G3 foi usado como controle. Foi feito um defeito retangular no músculo diafragma, com 4cm de comprimento por 3cm de largura, que nos grupos G1 e G2 foi substituído pelo implante da membrana de látex correspondente. Os animais foram avaliados por estudo radiográfico, hemograma, videocirurgia e análise histológica. Os resultados mostraram que a membrana de látex do grupo 2 foi eficiente na correção de defeito no diafragma, promovendo a reparação e neovascularização tecidual local, sem causar rejeição durante o período de avaliação.

Propofol-cetamina racêmica e propofol-cetamina levógira em cadelas: parâmetros eletrocardiográficos e outras variáveis fisiológicas

Estudaram-se os efeitos da infusão contínua da associação propofol e cetamina sobre variáveis fisiológicas e eletrocardiográficas e sua possível analgesia em 12 cadelas. Após indução com propofol, os animais receberam 0,4mg/kg/min de propofol + 0,2mg/kg/min de cetamina racêmica (n = 6, grupo PC) ou 0,4mg/kg/min de propofol + 0,1mg/kg/min de cetamina S+ (n = 6, grupo PCS). Avaliaram-se: teste álgico, freqüência cardíaca (FC), parâmetros eletrocardiográficos, freqüência respiratória (FR), pressão arterial sistólica, média e diastólica (PAS, PAM, PAD), saturação da oxiemoglobina (SpO2) e temperatura retal (TR). Houve elevação da FC sem alterações eletrocardiográficas, com exceção de aumento na amplitude da onda T em um animal de cada grupo. A FR diminuiu, e os valores de SpO2 ficaram abaixo de 90% em alguns momentos nos dois grupos. PAS, PAM e PAD diminuíram, mas não houve diferença entre os protocolos. Não se observou analgesia em sete animais, três cadelas apresentaram analgesia discreta, e apenas duas demonstraram analgesia favorável. Conclui-se que os protocolos são seguros em cadelas, contudo não há analgesia suficiente para procedimento cirúrgico. As alterações eletrocardiográficas foram relacionadas à FC e à amplitude de onda T, sendo esta sugestiva de hipóxia do miocárdio.