and this recipe will be marked in your life if you watch it today talk like a quick easy recipe, write it down and now we will start with a good easy recipe to make nutritious and delicious against fillet with chimichurri sauce you there teething inside us and will learn a different way as I said and mix it in the pan mix and then you put it on the fire you can't stir it but our business is good look if not us and if you are watching this video lesson to get some tiva recipes So you
can stop that it won't happen now if you are here to know what is really important in this modality anesthetic continues watching Okay release the vignette What's up o Hello NAVE crew, all right in this video lesson of the Anesthesia course o basics we're going to talk a little bit about Total intravenous anesthesia Total intravenous anesthesia better known as motiva is a modality exclusively injectable anesthetic that has the characteristics of promoting hypnosis analgesia and a thousand relaxation suitable for performing Active surgical procedures have been receiving prominence since the 70's what was it when the evolution
of the synthesis of medicines began safer and also have faster biotransformation at the same time also the mechanisms of administration of these drugs became safer giving more security to anesthesiologists in this video class we’ll address the advantages and disadvantages of this anesthetic modality methods of administration and factors that influence Total anesthesia intravenous Ok let's go there is against us we speak of tiva to a totally unnecessary comparison with objective inhalation anesthesia responds up boy only here in Brazil to have this ridiculous discussion but as this comparison is inevitable we will see the advantages and disadvantages
of these modalities good as advantages of active in relation to inhalation anesthesia we have greater hemodynamic stability lower endocrine response to surgical stress zero environmental pollution pulmonary system independence in analgesia anesthesia and the need not of an inhalation anesthesia machine for the procedure on the other hand we we have some disadvantages such as changing the anesthetic plan more most medicines have a cumulative effect. Pharmacodynamic and pharmacokinetic information on medicines is guided by healthy animals the biotransformation and excretion systems are more required and the patient's logic can change completely the profile of anesthesia some of these
comparisons are half and founded, for example greater hemodynamic stability really active have greater hemodynamic stability But if we understand that the anesthetic protocol to be done will have two three to four drugs then we are using the lowest doses decreasing undesirable effects now if we did an active only with propofol hemodynamic depression maybe be the same as inhaled anesthetic or even greater analgesia comparison if we think propofol and inhaled anesthetics are not painkillers So in this case both one modality and the other we have to make combinations of drugs to achieve hypnosis analgesia and a
thousand adequate relaxation to perform the surgical procedure and decrease also the deleterious effects for the patient already today we're going to talk a little bit about the most used drugs in active propofol is the basis of active as we go there in the class of Agents propofol has rapid biotransformation so the effect cumulative is not so relevant as it is an excellent medicine for us we do total anesthesia intravenous and of short duration more or minus 60 is up to 90 minutes the same goes for the hello fax but we cannot use only these drugs
or propofol the fax Alone mainly that they do not promote analgesia so we make associations that are usually a opioids with alpha-2 adrenergic agonists ketamine lidocaine and others adjuvants already in large animals the business is a little different even though we have protocols based on propofol most of them are based on and fast in the dissociative and non-agonist Alpha 2 adrenergic although it is a Total intravenous anesthesia we have to remember anesthesia does not promote hypnosis it is basically dissociative anesthesia I decided here not to address anesthetic protocol that I can stay for hours days
here setting up anesthetic protocol for each different species for each different situation for each surgical procedure different thing that you can do yourself looking for published articles or textbooks on the topic Ok so at least in my opinion it is more important for us to talk on how to administer these drugs and also what are the factors that can influence Native and we have some possibilities to make active the simplest of them is the simple cake we make an administration and quickly we have a peak anesthetic concentration and then that peak drops dramatically and basically
we have anesthetic time according to the period of action of the medication we usually use this modality to rapid and outpatient procedures the other modality is the intermittent cakes may have understood attention huh the intermittent Bose looks like that joke of the undead or undead I didn't understand what he values because what happens is a succession of cakes one after the other that will promote peaks of concentration and concentration vouchers and this will basically leave the animal very deep in anesthesia at some very superficial moment usually the next cakes is done when the animal starts
to move ie it is a modality is terrible the correct way to administrative is by continuous infusion how do we do that we we administer an attack dose that will promote a plasma concentration well interesting and then we leave a fixed rate of infusion of that medicine or mixture to maintain adequate plasma concentration standards for this animal to be kept under anesthesia these rates are predetermined in scientific studies which standardize the drugs the doses and rates for that particular species and basically for that surgical situation it all involves pharmacokinetic standards and pharmacodynamics that in this
case in this video lesson we cannot approach but I suggest you consult here the material in the description because it is a very rich subject and whoever is going to work with Total intravenous anesthesia has to have a reasonable knowledge of half-life in volume of Distribution and Beltran the description of medicines for that understand better how this modality works Ok well I told you that we maintain a fixed rate of infusion but in practice this is not what it happens we work this rate according to the anesthetic plan of the patient if he has superficial
we increase the rate if he has profound we decrease a little something that we cannot forget is that basically all the drugs that we use have some effect cumulative So if anesthesia by infusion was generally prolonging the plasma concentration of these drugs tends to increase slightly Hence, we decrease this rate over time so that we can carry out a Total intravenous anesthesia safely It is essential that we we use infusion pumps that can be syringe or peristaltic pumps team usually on small animals we use syringe pumps because they are much more accurate and the volume
is very small already the more that the volume is higher then we end up using a team pump still the ideal is that we have an infusion pump for each medication that is important because we can change a speed rate of one and not changed the others, but we can also mix it, but we have to understand that the speed will be the same for everyone as I said to big animals we use our peristaltic team pumps because they accept larger volumes the Bible has changed to make counting the drops my old that given I've
done it a lot now and then I still do it but there are risk even if we know that one ml in the macro drops team corresponds to 20 drops and in the microgroplet corresponds to 60 drops this is not precise so the infusion rate she sure will be totally different from what we are thinking very bagual scheme by the way As the gauchos say right we still have the modality of administration of controlled target infusion it is the best of worlds but basically it's made teaches me still that there are some jobs at the
vet with this because we have to feed a software with patient information like race weight age exams laboratories And these pumps will work accelerating or decreasing the medication infusion speed according to all this information this in the veterinary still impractical because we have a variation of very large breed species so now we are working with a 2 kg animal suddenly in the afternoon I can be with another species of 400 500 Kg So the information that we will have to feed this soft they are extremely comprehensive far greater than in medicine e Tiva protocols determined
by studies are generally carried out in accordance with healthy animals in standard procedures elective procedures there we take this cake recipe and go out and play in our routine there bitch with pyometra hypotensive animal liver disease this to give a problem is very easy it occurs because these protocols were determined with strict standards of pharmacokinetics and pharmacodynamics ie they work well for that situation but from the moment we have a new situation different the quantities of pharmacokinetics and pharmacodynamics change a lot and that's it the Grand Bid of Total intravenous anesthesia we will highlight here
some factors that can influence this anesthesia the species the first factor that we have because we have patients of 50 grams or even a This completely changes the dynamics of medications, we can see for example that in rats the average fusion of propofol is around 06 to 08 MG that minute and already equine it is 01 to 02 MG that minute or well different if we think of birds then the reptiles then the section changes race is another fundamental component we will see that if we focus only on dogs we will have animals that are
more obese leaner animals that tend to be sedentary the other more athletes this everything will also change the dynamics of the drugs we can see in this work here that the enzymatic activity of beagle dogs is much higher than that of the greyhound breed making the biotransformation of propofol very faster by beagle than by greyhound Sex also has a difference we have a different hormonal component between males and females that can change the dynamics of drugs in this same work, the authors enzymatic activity in male and female crossbreed dogs and realizing that the enzyme activity
in males was higher than in females age is also importantly we must not forget that newborns do not yet have the system of fully mature biotransformation and they also retain more water than the adults and the elderly on the other hand the elderly already have a disability biotransformation and excretion and less water in the body this review here Bença shows the difference we can see in this figure that the rates of propofol infusion for anesthetic maintenance in humans decreases with advancing age reaching up to fifty percent less elderly compared to young patients in that one
we can see that the concentration serum creatinine tends to increase over time Creatinine in humans tends to decrease over time physiological condition is very important for de and are of this rate of infusion patients for example who have metabolic acidosis tend to potentiate acidic anesthetics like propofol jane's thesis the basics like lidocaine tend to r & d the potency pictures of hypotension they can also change the pattern of the active because there will certainly be a decrease in the hepatic and renal flow compromising biotransformation and excretion depending on of the medicine being used patience for
all paws can also present any problem in this modality depending on the medication that we will approach we can see in this work here that patients humans who underwent liver surgery had the concentration of morphine maintained longer and less metabolite formation compared for example with patients who underwent colon surgery making it evident that medicines they need and exclusively from the liver may have commitment to biotransformation and patience paws already in the film that evaluated the pharmacokinetics and pharmacodynamics of remifentanil in Severe liver injury patients detected no difference between patients healthy and liver disease obviously because
the biotransformation of remifentanil is independent of health is practical drug interaction is very important for two reasons. The first is that antagonism can occur chemical when we combine the two drugs in the same solution then a there that the other to the point of inactivating that he medicates the other is that it is continuous infusion of two, three or four medications can promote side effects synergistic or even antagonistic additives completely changing the dynamics of what medicine when it is done alone these two works bring important information about the drug interaction of some medicines, as we
already said, time is also a key part of this anesthesia usually over time plasma concentrations of drugs are increasing due to the cumulative effect that can be greater or less depending on the medication and this will influence the dynamics of anesthesia so my old man in the face of all this you be very careful with these cake recipes that are going on the internet because we don't know which patient she was made for What is the procedure surgical it was done and if it worked not actually to give problem in your hand is two toothpicks
And there is no one to help you in that situation, right? Obviously, over time with the experience gained. they will mount the anesthetic and active protocols for each patient for each situation but I recommend starting with the simple procedure standard and healthy patients to gain experience and then and testing something different Ok conclusion of this video lesson we have to main advantages of Total intravenous anesthesia is greater stability the absence of environmental pollution as the main disadvantages we have that kinetic alterations of the drugs occur according to the physiology of the patient and this modality
requires much more from the liver and kidneys than active inhalation should always be carried out in continuous infusion and using infusion pumps so that anesthesia has the highest precision to the patient's physiological condition and anesthetic time are fundamental in process of choosing medications and infusion rates Native good staff certainly this subject is 56 video lessons, he is very rich and well extensive but I hope that with this time that we talked here we have in focused on some interesting points about active Okay I invite you to read the material here from the description that has
pharmacokinetic concepts and interesting pharmacodynamics so that you have more basis for begin to do Total intravenous anesthesia, thank you that you are following video lessons over time and also comment here put suggestions like critical comments well like dislike that It is very interesting for people that we tend to improve our our video lessons ok A big hug and see you soon What's up What's up [Music] What's up [Music]
