Narkose, Analgesie, Euthanasie...Puncture of the retro-orbital sinus •only under anesthesia!!!!!...
Transcript of Narkose, Analgesie, Euthanasie...Puncture of the retro-orbital sinus •only under anesthesia!!!!!...
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Taking samples
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What samples?
• blood / plasma / serum
• body fluids: liquor, tears, urine, stomach/gut contents, stool,
• cells: smears, scratches, suspensions, lavages, biopsies
• tissues / organs ( fixation, perfusion)
• whole animals
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Metabolic cages
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Blood withdrawal
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Points to consider:
• volume to be withdrawn
• frequency of withdrawal
• site and method of withdrawal
• personal skills and experience
• (kind of) anesthesia
• species, age, gender, body condition and health status
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Puncture of the facial vein
• take the animal by the scruff
• puncture with an animal lancet dorsocaudal from
the mandible
• collect blood
• stopp sqeezing the vessel
• compress the puncture site
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Puncture of the retro-orbital sinus
• only under anesthesia!!!!!
• squeeze the vessels of the neck by scruffing theanimal
• introduce the capillary at the inner angle of theeye and move it towards the ear of the oppositeside
• under soft pressure and slight rotations penetratethe tissue
• collect the blood
• loose the grip around the neck
each eye can be used twice (maximum), with a
2-week-break in between
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Puncture of the retro-orbital sinus
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only under anesthesia!!!
Puncture of the retro-orbital sinus
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Puncture of the lateral tail vein
• same procedure as i.v. application
• puncture with a needle
• inzision should be avoided
• can lead to granuloma in rats
cutting the tip of the tail is only allowed in animalsyounger than 3 weeks
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Puncture of the lateral tail vein
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• terminal procedure• under anesthesia
Two methods:1. open chest: under visual control2. closed chest: through the lateral wall of the
thorax; on ellbow-level, vertical to the body axis
Cardiac puncture
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Only under anesthesia and only as a terminal procedure
NO waking up again!!!
Cardiac puncture
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Further sites for blood withdrawal
• Vena saphena
on the outside of the lower leg
sqeeze the vessel above the knee joint
flat insertion of the needle
• Vena sublingualis (rat)
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Vena saphena
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Amounts of blood to be withdrawn
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Sites for blood withdrawal
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Species-specific information
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Pathophysiology of blood withdrawal
up to 10 % of the total blood volume:compensatory reactions: vasoconstriction and increase in heart rate; no hemodynamic effects
15 to 20 % of the total blood volume:in spite of compensatory reactions: decrease in bloodpressure, tachycardia, tachypnoe
20 bis 30 % of the total blood volume:hypovolemia (standard-shock-model in experimentalresearch)
> 30 % of the total blood volume:decompensation
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Taking organs
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Abdominal cavity
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Abdominal cavity
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Abdominal cavity
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Genitals of a male rodent
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Genitals of a female rodent
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Anesthesia and Analgesia
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Legal provisions
§ 5 Animal Welfare Law
Vertebrates: no painfull intervention without anesthesiaAnesthesia has to be performed by a veterinarian(exception: local anesthesia)…No anesthesia is required,1. if there would be no anesthesia in the same procedurein a human being or if the intervention is less painfullcompared to the negative effect of the anesthesia itself2. if a veterinarian decides, that in this particular caseanesthesia is not applicable
Is no anesthesia required, all opportunities have to beexhausted, to minimize pain and suffering of the animals
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§ 17 Decree on laboratory animal welfare
(2) Experiments with vertebrates and cephalopodes areonly allowed under anesthesia or local analgesiaunless1. the procedure causes less pain than the anesthesia itself2. the aim of the experiment excludes anesthesia and doesnot lead to severe injuries
(1) When performing experiments in vertebrates andcephalopodes one has to make sure to reduce pain andsuffering to the least possible extend by applying painkilling substances and using least painful methods
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§ 17 Decree on laboratory animal welfare
Anesthesia is only to be performed by a person fulfillingthe requirements of §7Abs.1Satz3 TSchG (requiredknowledge and skills) and of §16Abs.1 Satz2 TSchVersV(person admitted to perform surgery)
If the anesthesia is performed for teaching purposesother people are allowed to perform it under supervisionof such a person mentioned above
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§ 17 Decree on laboratory animal welfare
(3) Is to expect, that in an anesthetized animal pain will occur when the animal wakes up, the aninal has to betreated in time with analgesics or pain relievingmethods.
This does not have to be thecase, when it is ethicallyjustified and scientificallywell founded that applyingthese methods or substancesis incompatible with the aimof the experiment.
In vertebrates and cephalopodes it is not allowed to useor apply substances, that hinder or impede the expressionof pain!!
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§ 16 Decree on laboratory animal welfareRequirements concerning expert knowledge
…animal experiments including surgery are only allowed to beperformed by … 1. people with completed studies (degree) of veterinary orhuman medicine2. people with completed studies in natural science (degree) plus the adequat knowledgeand skills (verifiable)
The authority can approve andadmit exceptions if the proofof the required knowledge andskills has been given otherwise
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General remarks concerning anesthesia
Principles of anesthesia:• hypnosis (unconsciousness, dormancy)• analgesia• relaxation
is reached by certain substances causing a reversibleintoxication of the central nervous system
Anesthesia has to protect each individual animal fromunnecessary suffering and distress
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local anesthesia / regional anesthesia
blockade of afferent (sensory) neurons
no transmission of pain
no loss of consciousness
in animals usually problem of acceptance
general anesthesia
reversible blockade of the CNS
1. injectable anesthesia
2. inhalational anesthesia
General remarks concerning anesthesia
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depending on the kind of (surgical) intervention weightis shifted on either hypnosis, analgesia and / or musclerelaxation (example: local anesthesia)
perfect anesthesia is usually not achievable with onesingle substance
combination of substances:• synergistic effects (less dosing, less side effects)• supplement of missing properties• antagonism (contrary properties neutralise each
other; convulsive / anti-convulsive)
General remarks concerning anesthesia
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The perfect anesthetic substance...
• would lead to the desired state of hypnosis, analgesiaand relaxation without any side effects
• would allow a fast induction without excitations• would reach the state of surgical tolerance quickly• would allow quick and smooth recovery• would have no irritating properties
• would be cheap, stable, non explosiv and non-flamable
• would not require specific equipment
... is non-existent !
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Choice of suitable methods of anesthesia
Selection criteria:• condition / status of the patient / laboratory
animal• goal of anesthesia / planned intervention• equipment• personal skills• costs
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Premedication
Sedative or sedative-analgetic premedications canbe indicated:
- to calm down the animals and thereby preventfear and movements of defense during theinduction phase
- to exclude potential pain in the presurgical phase
- as a supplement to local or regional anesthesia to
control / restrict spontaneous movements
- to reduce the necessary dosage of general
anesthetics
- to prepare a smooth recovery
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Stages of anesthesia
I. stage of analgesia:
reduced sense of pain, cloudiness of concsiousness
II. stage of excitation:
elevated restlessness, unconsciousness, movements ofdefense, possibly vomiting, quiet surrounding necessary!
III. stage of tolerance:
reduced or missing reflexes, reduced muscle tonus, surgery
possible
1. light (hypnosis)
2. medium (tolerance)
3. deep (depression)
IV. stage of paralysis (after overdose):
cessation of breathing and break-down of the cardiovascular
system without adequat measurements: death
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Zw
ischenze
henre
flex
Stages of anesthesia
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Reflexes to estimate depth of anesthesia:
• (righting reflex)• eye lid closing reflex• pupillary reflex / light reflex• swallowing reflex• tonus of the jaw muscles• toe pinch reflex (in rodents!!!!)
strong species-specific differences!
Stages of anesthesia
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Injectable anesthetics
none of the injectable anesthetics alone – in a
therapeutic dosage - fulfills all the
requirements of a good general anesthesia
differentiation into:
• hypnotics
• analgesics
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Ketamin / Xylazin
mouse rat rabbit guinea pig
Ketamin 80 – 120 80 – 100 40 – 50 40
Xylazin 10 – 15 5 – 10 4 – 6 5
dosage in mg/kg body weight:
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Inhalational anesthetics
Nitrous oxide (laughing gas) and liquid substances with a low boiling point, whose inhaled vapors evoke anesthetic conditions:
• Diethyl-Ether (strongly irritating, today obsolete)• Methoxyfluran (today obsolete, toxic to the kidneys)• Halothane• Isoflurane• Enflurane• Sevoflurane• Desflurane
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Inhalational anesthetics
Differences in:
• spectrum of effects• strength of effects• accumulation• elimination• metabolism• effects on the cardiovascular system, respiratory
system, liver, kidneys
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• are absorbed by the respiratory system exclusively• absorption and elimination depend on , the blood-gas-
solubility coefficient• the smaller , the faster absorption and elimination• very little metabolism in the body• chemically stable and non-flamable• compatible with other substances• gentle application in whole-body chambers possible
without restraint
Routes of application:• inhalation chamber• inhalation mask• intubation
Inhalational anesthetics
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Isoflurane:• strong relaxation• no analgesia• 1,4 (very good to regulate / manage)• depressive on the respiratory system• less cardiotoxic than other inhalational anesthetics• strong reduction of the blood pressure
Inhalational anesthetics
N2O (laughing gas)• 0,47• only in combination with other anesthetics• >> 80 Vol% would be necessary if used as a singlesubstance (and thereby induce hypoxia)
• hardly any side effects
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Comparison
Injectable anesthesiaKetamin / Xylazin
• hard to control
• difficult to give multiple doses
• long hangover withhypothermia
• instable blood pressure
• cheap
• easy to administer
Inhalational anesthesiaIsoflurane
• easy to control
• fast recovery
• low blood pressure
• quick recovery of bloodpressure
• expensive
• technically moredemanding
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Key data concerning anesthesia in mice:
• high metabolic rates lead to a high relative O2-consumption (3500 ml O2 /kg/body weight/hour 155 ml in an elephant)
• mean art. blood pressure is about 90 mm Hg
• about 530 heartbeats / minute
• in relation to the body weight mice have a very large bodysurface and are therefor prone to hypothermia
• tidal volume (in all species) is about 10 ml / kg bodyweight, about 0,3 ml in a 30g mouse
• under anesthesia about 140 – 150 breaths /minute• eyes stay open, danger of drying up, protection
necessary!!!!! (Bepanthen, artificial tears etc.)
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• Hypothermia
missing muscle activity, cold surfaces, disturbance of
thermoregulation through anesthetics, loss of body
warmth through open body cavities
shear and shave as little as possible, heat pads,
red light, temperature control!!
Possible complications during anesthesia:
• Respiratory and cardiac depression
for example in animals with precursory problems, airway
obstruction, depressiv action of certain anesthetics
oxygen supply, ventilation
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Possible complications during anesthesia:
• Dehydration
diuretic action of some anesthetics, blood loss, evaporation
through open body cavities, breathing
substitution of liquids (body-warm!!!)
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Prophylaxis of critical incidents duringanesthesia
• preanesthetic examination / applicability of anesthesia
• exact weighing
• possibilities to warm the animals
• monitoring
• substitution of oxygen
• ventilation
• i.v. access
• substitution of fluids
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(minimal) monitoring during anesthesia
• bodytemperature
• reflexes
• mucosa
rosy: ok
red: hypercapnia
pale: anemia, peripheral
vasoconstriction
blue: cyanosis, hypoxia
• frequency of breathing
• heart beats
• time of capillary refilling (< 2 sec.)
• urination
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Monitoring systems
• esophagus tube
bodytemperature, respiratory rate
• capnography (in exhalation air, animalintubated)
O2 / CO2-concentration, concentration of
anestehtic gas, tidal volume
• pulsoxymeter
heart rate
O2- saturation
• ECG
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Monitoring systems
• esophagus tube
bodytemperature, respiratory rate
• capnography (in exhalation air, animalintubated)
O2 / CO2-concentration, concentration of
anestehtic gas, tidal volume
• pulsoxymeter
heart rate
O2- saturation
• ECG
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• pain is an unpleasant sensory and emotional experience with actual or potential tissue damage
• in animals it is usually associated in a complextogether with fear and distress.
• reduction of one of the three components canreduce the other ones also
Inflicting pain upon an animal during a procedure or a
treatment obligates to take all possible measurements
to alleviate this pain
Pain therapy
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Pain has a lot of physical consequences:
Cardiac circuit:
stimulation of the sympathic nervous system
(Adrenaline, Noradrenaline) and thereby tachycardia,
vasoconstriction (cold extremities), increase in blood
pressure
Breathing:
painfull breathing leads to hypoventilation and hypoxia;
longlasting hypoventilation can lead to damage of the lung
and predisposition for pneumonia
Pain therapy
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Gastro-intestinal-tract:
diminished appetite, reduced motility, delayed emptying of
the stomach, salivation, vomiting
Pain therapy
Hormones:
release of -endorphines (intrinsic alleviation of pain)
increase in catecholamines (cardiac circuit)
release of ADH (antidiuretic hormone) stimulates water
resorption in the kidneys and leads to imbalances in the
homeostasis of body fluids
Pain has a lot of physical consequences:
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Pain therapy
Pain has a lot of physical consequences:
Nerves and muscles:
twitches, cramps, hyperesthesia, paralysis
In addition to all this pain can lead to depression,
aggression, states of excitement and automutilation
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Intensity of pain depends on the body region
• severe pain occurs in wounds around the thoracic region, cranial abdomen, eyes, nasal cavity, perineum
• moderate pain occurs in wounds around the caudalabdomen and the largerjoints
• mild pain occurs withtraumata or surgeriesalong the extremities andthe body surface
Pain therapy
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Pain therapyspecific pain symtoms can be:
dog: hardening of ventral and /or dorsal mucles, restlessness or no movements at all, yowling, whining, aggresssion, apathy, diminished appetite
cat: hardening of ventral and / or dorsal muscles, flight, holing up, hiss, growl, panting, diminished appetite
rabbit: inactivity, apathy, fear of contact, allotriophagy,diminished appetite, in acute pain sharp screams
rodents: decreased activity, untended coat, dirty eyes, piloerection, stiff and atactic way of walking, screams, allotriophagy, diminished appetite, attacked by cage mates
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The „mousegrimace scale“
www.nc3rs.org.uk
National center forthe replacement, refinement andreduction of animals in research
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IMPORTANT: newborns can perceive pain as well
There is no anatomic or physiologic proof or reason tobelieve that perception of pain would be less developed in
mammals and other animals compared to human beings
How much sense of pain we admit a certain species, is oftendepending on the sympathy we have for that particular
species (ethical ranking)
primates similarity to humans
cat and dog cuddling animals
small pets stroke animals
farm animals „food“
level ofemotions
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Goals of pain relief
• avoid suffering according to the animal welfare law
• normalize the general condition
• prevent neurogenic shock
• ease the handling of the animal by reducing pain-disstress
avoidance of fear and distress can elevate the paintreshold remarkably!
preoperative conditioning minimizes fear and distress
calm, secure and friendly handling creates trust
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Analgesics
application of analgesics best still during anesthesia, before the recovery (if necessary together with a sedative)
• strong pain killer:act at their receptors in the CNS(opioids; can prolong the sleeping phase remarkably, may bedepressiv on the respiratory system)Tramadol, Buprenorphin
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Analgesics
application of analgesics best still during anesthesia, before the recovery (if necessary together with a sedative)
• weak pain killer (group of NSAIDs)
a) substances with a clear central analgetic and antipyretic
action, only mildly antiinflammatory (Aspirin, Paracetamol,
Metamizol)
b) substances acting in the periphery, strong anti-
inflammatory, mild antipyretic action (Phenylbutazon,
Indomethacin, Diclofenac)