Use of dexmedetomidine in continuous infusion during anesthesia in a dog with insulinoma
Case report
DOI:
https://doi.org/10.31533/pubvet.v18n05e1592Keywords:
Anesthesia, hyperinsulinemia, pancreatic neoplasiaAbstract
Insulinoma in dogs is a neoplasm that affects the endocrine pancreas, causing increased release of insulin into the bloodstream. As a result, the animals will experience hypoglycemia, convulsions and weakness. This report describes the case of a dog of approximately 10 years of age who had frequent seizures without improvement when phenobarbital was administered. After magnetic resonance imaging, a nodule was visualized in the pancreatic region, indicating insulinoma. The anesthetic protocol used for the surgical treatment of this condition consisted of an infusion of 5% glucose solution and dexmedetomidine at a rate of 1 mcg/kg/h, ensuring adequate blood glucose levels during nodule excision. For maintenance of anesthesia, the patient received sevoflurane associated with lumbosacral epidural anesthesia, as well as analgesic adjuvants such as lidocaine at a rate of 1 mg/kg/h, ketamine at 1mg/kg/h and refimentanil at 10 to 15 mcg/kg/h. During the postoperative period, the animal presented transient hyperglycemia, pancreatitis and anorexia.
References
Adams, J. G., Figueiredo, J. P. & Graves, T.K. (2017). Fisiologia, fisiopatologia e manejo anestésico de pacientes com doenças gastrointestinais e endócrinas. In: Grimm, K. A. et al. (ed.5) Anestesiologia e analgesia em veterinária: Lumb &Jones. Rio de Janeiro: Editora Roca, p. 633-672.
Afonso, J., & Reis, F. (2012). Dexmedetomidina: rol actual en anestesia y cuidados intensivos. Revista Brasileira de Anestesiologia, 62(1), 125–133. https://doi.org/10.1590/S0034-70942012000100015.
Andrade, S. A., & Borges, H. H. G. (2024). Anestesia multimodal com infusão de dexmedetomidina em cadela: Relato de caso. PUBVET, 18(1), e1527. https://doi.org/0.31533/pubvet.v18n01e1527.
Apodaca-Torrez, F. R., Triviño, T., Lobo, E. J., Goldenberg, A., & Figueira, A. (2003). Insulinomas do pâncreas: diagnóstico e tratamento. Arquivos de Gastroenterologia, 40, 73–79. https://doi.org/10.1590/s0004-28032003000200003.
Buishand, F. O. (2022). Current trends in diagnosis, treatment and prognosis of canine insulinoma. Veterinary Sciences, 9(10), 540. https://doi.org/10.3390/vetsci9100540.
Buishand, F. O., Grosso, F. R. V., Kirpensteijn, J., & van Nimwegen, S. A. (2018). Utility of contrast-enhanced computed tomography in the evaluation of canine insulinoma location. Veterinary Quarterly, 38(1), 53–62. https://doi.org/10.1080/01652176.2018.1481545.
Carvalho, L. S., Ribeiro, J. F. A., Rosa, L. R., & Pelegrini, E. M. (2023). Insulinoma em cão sem raça definida: Relato de caso. PUBVET, 17(12), e1499. https://doi.org/10.31533/pubvet.v17n12e1499.
Cleland, N. T., Morton, J., & Delisser, P. J. (2021). Outcome after surgical management of canine insulinoma in 49 cases. Veterinary and Comparative Oncology, 19(3). https://doi.org/10.1111/vco.12628.
Cury, L. P., & Gomes, D. E. (2020). Uso da dexmedetomdina na medicina veterinária. Revista Científica Unilago, 1(1), 1–8.
Del Busto, I., German, A. J., Treggiari, E., Romanelli, G., O’Connell, E. M., Batchelor, D. J., Silvestrini, P., & Murtagh, K. (2020). Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma. Journal of Veterinary Internal Medicine, 34(3), 1135–1143. https://doi.org/10.1111/jvim.15751.
Fukazawa, K., Kayanuma, H., Kanai, E., Sakata, M., Shida, T., & Suganuma, T. (2009). Insulinoma with basal ganglion involvement detected by magnetic resonance imaging in a dog. Journal of Veterinary Medical Science, 71(5). https://doi.org/10.1292/jvms.71.689.
Garcia, C., Renosto, W., Meira, J., Saccaro, R. O., & Weege, K. (2022). Insulinoma em canino sem raça definida: Relato de caso. PUBVET, 16(2), 1–5. https://doi.org/10.31533/pubvet.v16n02a1047.1-5.
Gavet, M., & Conde Ruiz, C. (2023). Partial intravenous anaesthesia and opioid-sparing analgesia in a dog undergoing surgical management of insulinoma. Veterinary Record Case Reports, 11(1). https://doi.org/10.1002/vrc2.541.
Goutal, C. M., Brugmann, B. L., & Ryan, K. A. (2012). Insulinoma in dogs: a review. Journal of the American Animal Hospital Association, 48(3), 151–163.
Green, R., Musulin, S E., Baja, A. J., Hansen B. D. (2023). Case report: Low dose dexmedetomidine infusion for the management of hypoglycemia in a dog with an insulinoma
Grimm, K. A., Lamont, L. A., Tranquilli, W. J., Greene, S. A., & Robertson, S. A. (2015). Veterinary anesthesia and analgesia. John Wiley & Sons.
Grubb, T., Sager, J., Gaynor, J. S., Montgomery, E., Parker, J. A., Shafford, H., & Tearney, C. (2020). 2020 AAHA anesthesia and monitoring guidelines for dogs and cats. Journal of the American Animal Hospital Association, 56(2), 59–82. https://doi.org/10.5326/JAAHA-MS-7055.
Guedes, A. G., & Rude, E. P. (2013). Effects of pre-operative administration of medetomidine on plasma insulin and glucose concentrations in healthy dogs and dogs with insulinoma. Veterinary Anaesthesia and Analgesia, 40(5). https://doi.org/10.1111/vaa.12047.
Gutierrez-Blanco, E., Victoria-Mora, J. M., Ibancovichi-Camarillo, J. A., Sauri-Arceo, C. H., Bolio-Gonzalez, M. E., Acevedo-Arcique, C. M., Marin-Cano, G., & Steagell, P. V. (2013). Evaluation of the isoflurane-sparing effects of fentanyl, lidocaine, ketamine, dexmedetomidina, or the combination lidocaine-ketamine-dexmedetomidine during ovariohysterectomy in dogs. Veterinary Anaesthesia and Analgesia, 40, 599–609.
Hess, R. S. (2013). Insulinoma. In J. Rand, E. N. Behrend, D. Gunn-Moore, & M. L. Campbell-Ward (Eds.), Clinical endocrinology of companion animals (pp. 229–239). Wiley Blackwell.
Hixon, L. P., Grimes, J. A., Wallace, M. L., & Schmiedt, C. W. (2019). Risk factors for gastrointestinal upset and evaluation of outcome following surgical resection of canine pancreatic p-cell tumors. Canadian Veterinary Journal, 60(12).
Junqueira, J. V. S., & Tognoli, G. K. (2017). Dexmedetomidina em cães. Revista Científica de Medicina Veterinária do UNICEPLAC, 4(2), 1–15.
Martins, M. M. L., Soares, T. J., Alves, F. G. F., Silva, C. V., Garcez, C. M., Costa, B. N., Laskoski, L. M., & Perotta, J. H. (2023). Metaraminol in reverting hypotension in equine anesthesia with isoflurane and dexmedetomidine: Case report. PUBVET, 17(8), e1428. https://doi.org/10.31533/pubvet.v17n8e1428.
Nelson, R. (2011). Medicina interna de pequenos animais. Elsevier Brasil.
Nelson, R., & Couto, C. G. (2015). Medicina interna de pequenos animais (3.ed.). Elsevier Brasil.
Oliveira, L. C. C., Comassetto, F., Costa, Á., & Kaneko, V. M. (2022). Influência da administração de dexmedetomidina no requerimento de propofol para a indução da anestesia. PUBVET, 16(10), 1–7. https://doi.org/10.31533/pubvet.v16n10a1244.1-7.
Pöppl, A. G. (2015). Insulinoma. In M. M. Jericó, J. P. Andrade Neto, & M. M. Kogika (Eds.), Tratado de medicina interna de cães e gatos (1a ed., pp. 5233–5268). Roca, São Paulo.
Ryan, D., Pérez-Accino, J., Gonçalves, R., Czopowicz, M., Bertolani, C., Tabar, M. D., Puig, J., Ros, C., & Suñol, A. (2021). Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020). Journal of Small Animal Practice, 62(7). https://doi.org/10.1111/jsap.13318.
Sheppard‐Olivares, S., Bello, N. M., Johannes, C. M., Hocker, S. E., Biller, B., Husbands, B., Snyder, E., McMillan, M., McKee, T., & Wouda, R. M. (2022). Toceranib phosphate in the management of canine insulinoma: A retrospective multicentre study of 30 cases (2009–2019). Veterinary Record Open, 9(1), e27. https://doi.org/10.1002/vro2.27.
Spinosa, H. S. S., Górniak, S. L., & Bernardi, M. M. (2017). Farmacologia aplicada à medicina veterinária. Koogan Guanabara.
Shuey, N. (2021) Sweet dreams: Use of low-dose dexmedetomidine for perioperative management of canine insulinoma. Firstline.18(2), 22-24.
Tranquilli, W. J., Thurmon, J. C., & Grimm, K. A. (2013). Lumb and Jones’ veterinary anesthesia and analgesia. John Wiley & Sons.
Trifonidou, M. A., Kirpensteijn, J., & Robben, J. H. (1998). A retrospective evaluation of 51 dogs with insulinoma. Veterinary Quarterly, 20(sup1), S114–S115. https://doi.org/10.1080/01652176.1998.10807459.
Vatnikov, Y., Vilkovysky, I., Kulikov, E., Popova, I., Khairova, N., Gazin, A., Zharov, A., & Lukina, D. (2020). Size of canine hepatocellular carcinoma as an adverse prognostic factor for surgery. Journal of Advanced Veterinary and Animal Research, 7(1), 127–132. https://doi.org/10.5455/javar.2020.g401.
Walczak, R., Paek, M., Uzzle, M., Taylor, J., & Specchi, S. (2019). Canine insulinomas appear hyperintense on MRI T2-weighted images and isointense on T1-weighted images. Veterinary Radiology and Ultrasound, 60(3). https://doi.org/10.1111/vru.12715.
Zhou, W., Wang, J., Yang, D., Tian, S., Tan, C., Yang, Y., Sui, W., Sun, J., & Zhang, Z. (2022). Effects of dexmedetomidine on glucose-related hormones and lactate in non-diabetic patients under general anesthesia: a randomized controlled trial. Minerva Anestesiologica, 88(1–2). https://doi.org/10.23736/S0375-9393.21.15734-7.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Fernanda Meireles dos Reis, Michele Andrade de Barros, Lívia Aparecida DAvila Bitencourt Pascoal, Bruna Maria Sarri, Gabriela Barbosa de Almeida, Tainá Rodrigues de Oliveira Zamiant, João Vitor Fraianella Teixeira Godoy, Michele Andrade de Barros
This work is licensed under a Creative Commons Attribution 4.0 International License.
Você tem o direito de:
Compartilhar — copiar e redistribuir o material em qualquer suporte ou formato
Adaptar — remixar, transformar, e criar a partir do material para qualquer fim, mesmo que comercial.
O licenciante não pode revogar estes direitos desde que você respeite os termos da licença. De acordo com os termos seguintes:
Atribuição
— Você deve dar o crédito apropriado, prover um link para a licença e indicar se mudanças foram feitas. Você deve fazê-lo em qualquer circunstância razoável, mas de nenhuma maneira que sugira que o licenciante apoia você ou o seu uso. Sem restrições adicionais
— Você não pode aplicar termos jurídicos ou medidas de caráter tecnológico que restrinjam legalmente outros de fazerem algo que a licença permita.
