Veteriner Hekimliği Öğrencilerinin Cerrahi Becerilerinin Ovaryohisterektomi Yapılan Köpeklerde Postoperatif Stres, Oksidatif Stres ve Ağrı Üzerine Etkileri

Year 2021, , 149 - 158, 31.03.2021

Merve Can Oktay Yılmaz

https://doi.org/10.30607/kvj.844118

Abstract

SSunulan çalışmada, veteriner hekimliği eğitiminin son sınıfında olan öğrencilerin, toplam operasyon süresi ve deri ensizyonu uzunluğu ile ilişkili olan cerrahi becerilerinin operasyon sonrası stres, oksidatif stres ve ağrı üzerine etkilerinin aynı anestezi ve cerrahi prosedürler altında ortaya konulması amaçlandı. Tecrübeli bir hekimin opere ettiği köpekler kontrol grubunu (n=12) oluştururken, veteriner fakültesi son sınıfta eğitim gören öğrenciler tarafından opere edilen köpekler (n=12) deneme grubunu oluşturdu. Operasyondan 24 saat önce, premedikasyon sırasında, operasyon sonunda ve operasyondan 30 dakika, 1, 2, 4 ve 6 saat sonra kan örnekleri toplanarak kortizol, toplam oksidant durum (TOD), toplam antioksidant durum (TAD) ölçüldü ve oksidatif stress indeksi (OSI) hesaplandı. Modifiye edilmiş Melbourne Ağrı Skalası ağrı değerlendirilmesi için kullanıldı. Deneme grubundaki köpeklerde, toplam operasyon süresi ve deri ensizyon uzunluğunun kontrol grubundaki köpeklerden istatistiksel olarak (p<0.001) daha yüksek olduğu gözlendi. Deneme grubunda ölçülen kortizol düzeylerinin kontrol grubuna göre istatistiksel olarak yüksek (p<0.001) olduğu, ancak operasyondan 24 saat önceki değerlerde farklılık olmadığı belirlendi. TOD ve TAD düzeylerinin gruplar içinde ve arasında önemli farklılık oluşturmadığı izlendi. Benzer şekilde, OSI değerleri de gruplar içinde farklılık oluşturmadı. Bununla birlikte, deneme grubunda premedikasyon sırasındaki OSI değerlerinin kontrol grubuna göre istatistiksel olarak yüksek (p<0.05) olduğu gözlendi. Ağrı skorları ise gruplar içinde ve arasında farklılık oluşturmadı. Sonuç olarak, operasyon süresi ve deri ensizyonu uzunluğu ile ilişkili olarak kortizol düzeylerinin artış eğiliminde olduğu belirlendi. Diğer taraftan, veteriner hekimliği son sınıf öğrencilerinin de operasyon sonrası ağrıya neden olmadan güvenli bir şekilde kısırlaştırma operasyonları gerçekleştirebileceği düşünülmektedir.

Keywords

Kortizol, köpek, ağrı, TOD, TAD

Thanks

Muğla Sıtkı Koçman Üniversitesi Milas Veteriner Fakültesi Fizyoloji Anabilim Dalı öğretim üyesi Prof. Dr. Aziz BÜLBÜL'e teknik desteği için teşekkür ederiz.

Effects of Surgical Skills of Veterinary Medicine Students on Postoperative Stress, Oxidative Stress and Pain in Bitches Undergoing Ovariohysterectomy

Abstract

This study was designed to demonstrate the effects of surgical skills of final-year veterinary medicine students relating to total surgery time and skin incision length on postoperative stress, oxidative stress and pain in bitches undergoing ovariohysterectomy under identical anaesthesia and surgical procedures. The control group (n=12) consisted of bitches that were operated on by an experienced surgeon, while the ovariohysterectomies in the experiment group (n=12) were performed by final-year veterinary medicine students. Blood samples were taken 24 hours before the surgery, during premedication, at the end of surgery and 30 minutes, 1, 2, 4 and 6 hours after surgery for the analysis of cortisol, total oxidant status (TOS), total antioxidant status (TAS) and for the calculation of the oxidative stress index (OSI). Modified Melbourne Pain Scale was used for pain assessment. It was observed that the total surgery time and length of skin incision in the experiment group were significantly higher (p<0.001) than those detected in the control group. The concentrations of cortisol were statistically higher (p<0.001) in the experiment group than those measured in the control group, apart from the concentrations measured at 24 hours before surgery. The concentrations of TOS and TAS did not show any significant differences within and between groups. Similarly, OSI did not differ within groups. However, OSI values at premedication time in the experiment group were statistically higher (p<0.05) than those calculated in the control group. Pain scores did not differ within and between groups. In conclusion, it is indicated that the blood cortisol concentrations tend to increase due to the surgery time or the length of skin incision. Moreover, ovariohysterectomies may be safely performed by final-year veterinary medicine students without any postoperative pain.

Keywords

Cortisol, dog, pain, TOS, TAS

References

• Annandale A, Scheepers E, Fosgate GT. The effect of an ovariohysterectomy model practice on surgical times for final-year veterinary students’ first live-animal ovariohysterectomies. J Vet Med Edu. 2020; 47(1): 44-55.
• Anup R, Balasubramanian KA. Surgical stress and the gastrointestinal tract. J Surgical Res. 2000; 92: 291-300.
• Anup R, Aparna V, Pulimood A, Balasubramanian KA. Surgical stress and the small intestine: role of oxygen free radicals. Surgery. 1999; 125: 560-569.
• Benson GJ, Grubb TL, Neff-Davis C, Olson WA, Thurmon JC, Lindner DL, Tranquilli WJ, Vanio O. Perioperative stress response in the dog: effect of pre-emptive administration of medetomidine. Vet Surgery. 2000; 29: 85-91.
• Blacklock KLB, Langer P, Halfacree Z, Yool DA, Corr S, Owen L, Friend ED, Ekiri A. Canine Ovariohysterectomy: A Survey of Surgeon Concerns and Surgical Complications Encountered by Newly Graduated Veterinarians. J Vet Med Edu. 2016; 43(2): 184-189.
• Bowlt KL, Murray JK, Herbert GL, Delisser P, Ford-Fennah V, Murrell J, Friend EJ. Evaluation of the expectations, learning and competencies of surgical skills by undergraduate veterinary students performing canine ovariohysterectomies. J Small Anim Pract. 2011; 52: 587-594.
• Brown DC, Conzemius MG, Schofer F, Swann H. Epidemiological evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc. 1997; 210: 1302-1306.
• Campagnol D, Teixeira‐Neto FJ, Monteiro ER, Restitutti F, Minto BW. Effect of intraperitoneal or incisional bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs. Vet Anaesth Analg. 2012; 39(4): 426-430.
• Carpenter RE, Wilson DV, Evans AT. Evaluation of intraperitoneal and incisional lidocaine or bupivacaine for analgesia following ovariohysterectomy in the dog. Vet Anaesth Analg. 2004; 31(1): 46-52.
• Church DB, Nicholson AI, Ilkiw JE, Emslie DR. Effect of non-adrenal illness, anaesthesia and surgery on plasma cortisol concentrations in dogs. Res Vet Sci. 1994; 56: 129-131.
• Çolak E, Yilmaz O. Sprayed intraperitoneal and incisional lidocaine reduces early postoperative pain after ovariohysterectomy in dogs. Kocatepe Vet J. 2020; 13(4):396-405.
• Devitt CM, Cox RE, Hailey JJ. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. J Am Vet Med Assoc. 2005; 227(6): 921-927.
• Distel M, Mueller C, Bluhmki E, Fries J. Safety of meloxicam: a global analysis of clinical trials. British J Rheumatol. 1996; 35(Suppl 1): 68-77.
• Dow SW, Rosychuk RA, McChesney AE, Curtis CR. Effects of flunixin and flunixin plus prednisone on the gastrointestinal tract of dogs. Am J Vet Res. 1990; 51: 1131-1138.
• Erel O. A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation. Clinical Biochem. 2004; 37: 277-285.
• Erel O. A new automated colorimetric method for measuring total oxidant status. Clinical Biochem. 2005; 38: 1103-1111.
• European Coordination Committee for Veterinary Training (2015). Day One Competencies. Brussels, Belgium: European Coordination Committee for Veterinary Training, https://www. eaeve. org/fileadmin/downloads/eccvt/2015_2_D1C_ Adopted_ Annex_5.4.1.pdf
• Firth AM, Haldane SL. Development of a scale to evaluate postoperative pain in dogs. J Am Vet Med Assoc. 1999; 214: 651-659.
• Fossum TW. Small Animal Surgery. 3rd ed. St Louis: Mosby Elsevier, 2007: 709-713.
• Fox SM, Mellor DJ, Firth EC, Hodge H, Lawoko CR. Changes in plasma cortisol concentrations before, during and after analgesia, anaesthesia and anaesthesia plus ovariohysterectomy in bitches. Res Vet Sci. 1994; 57: 110-118.
• Freeman LJ, Huse D, Lee R, Inoue T, Weil AB, Constable PD. Teaching veterinary anesthesia and surgery: the impact of instructor availability on anesthesia, operative, and recovery times in dogs undergoing ovariohysterectomy or castration. J Vet Med Edu. 2014; 41(4): 390-399.
• Freeman LJ, Ferguson N, Fellenstein C, Johnson R, Constable PD. Evaluation of learning curves for ovariohysterectomy of dogs and cats and castration of dogs. J Am Vet Med Assoc. 2017; 251: 322-332.
• Gates MC, Odom TF, Sawicki RK. Experience and confidence of final year veterinary students in performing desexing surgeries. New Zealand Vet J. 2018; 66(4): 210-215.
• Harris KP, Adams VJ, Fordyce P, Ladlow J. Comparison of surgical duration of canine ovariectomy and ovariohysterectomy in a veterinary teaching hospital. J Small Anim Pract. 2013; 54: 579-583.
• Hellyer PW, Frederick C, Lacy M, Salman MD, Wagner AE. Attitudes of veterinary medical students, house officers, clinical faculty, and staff toward pain management in animals. J Am Vet Med Assoc. 1999; 214: 238-244.
• Hewson CJ, Dohoo IR, Lemke KA. Factors affecting the use of postincisional analgesics in dogs and cats by Canadian veterinarians in 2001. Can Vet J. 2006; 47: 453-459.
• Hill LN, Smeak DD, Lord LK. Frequency of use and proficiency in performance of surgical skills expected of entry-level veterinarians by general practitioners. J Vet Med Edu. 2012; 240(11): 1345-1354.
• Hugonnard M, Leblond A, Keroack S, Cadore JL. Attitudes and concerns of French veterinarians towards pain and analgesia in dogs and cats. Vet Anaesth Analg. 2004; 31: 154-163.
• Hunt JA, Heydenburg M, Anderson SL, Thompson RR. Does virtual reality training improve veterinary students’ first canine surgical performance? Vet Rec. 2020; doi: 10.1136/vr.105749
• Kim YK, Lee SS, Suh EH, Lee L, Lee HC, Lee HJ, Yeon SC. Sprayed intraperitoneal bupivacaine reduces early postoperative pain behavior and biochemical stress response after laparoscopic ovariohysterectomy in dogs. Vet J. 2012; 191: 188-192.
• Koksal H, Kurban S. Total oxidant status, total antioxidant status, and paraoxonase and arylesterase activities during laparoscopic cholecystectomy. Clinics. 2010; 65: 285-290.
• Korkmaz M, Yilmaz O, Saritas ZK, Demirkan I, Jaroszewski JJ. Evaluation of intraperitoneal and incisional bupivacaine or levobupivacaine for postoperative analgesia in ovariohysterectomized dogs. Acta Sci Vet. 2019; 47: 1666.
• Kozlik J, Przybylowska J, Mikrut K, Zukiewicz-Sobczak WA, Zwolinski J, Piatek J, Sobczak P. Selected oxidative stress markers in gynecological laparoscopy. Videosurgery Miniinv. 2015; 10: 92-100.
• Langebæk R, Eika B, Tanggaard L, Jensen, AL, Berendt M. Emotions in veterinary surgical students: a qualitative study. J Vet Med Edu. 2012; 39: 312-321.
• Lee JY, Kim MC. Comparison of oxidative stress status in dogs undergoing laparoscopic and open ovariectomy. J Vet Med Sci. 2014; 76(2): 273-276.
• Lemke KA, Runyon CL, Horney BS. Effects of preoperative administration of ketoprofen on anesthetic requirements and signs of postoperative pain in dogs undergoing elective ovariohysterectomy. J Am Vet Med Assoc. 2002; 221(9): 1268-1275.
• Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PV, Yamashita K. Guidelines for recognition, assessment and treatment of pain. J Small Anim Pract. 2014; 55(6): E10-E68.
• Michelsen J, Heller J, Wills F, Noble GK. Effect of surgeon experience on postoperative plasma cortisol and C‐reactive protein concentrations after ovariohysterectomy in the dog: a randomised trial. Aust Vet J. 2012; 90(12): 474-478.
• Odette O, Lesley JS. A comparison of epidural analgesia provided by bupivacaine alone, bupivacaine + morphine or bupivacaine + dexmedetomidine for pelvic orthopedic surgery in dogs. Vet Anaesth Analg. 2013; 40: 527-536.
• Raekallio M, Heinonen KM, Kuussaari J, Vainio O. Pain alleviation in animals: attitudes and practices of Finnish veterinarians. Vet J. 2003; 165: 131-136.
• Read EK, Vallevand A, Farrell RM. Evaluation of veterinary student surgical skills preparation for ovariohysterectomy using simulators: a pilot study. J Vet Med Edu, 2016; 43(2): 190-213.
• Shaver SL, Larrosa M, Hofmeister EH. Factors affecting the duration of anesthesia and surgery of canine and feline gonadectomies performed by veterinary students in a year-long preclinical surgery laboratory. Vet Surgery. 2019; 48: 352-359.
• Sies H. Oxidative stress: oxidants and antioxidants. Exp Physiol. 1997; 82: 291-295.
• Szymczyk G, Beltowski J, Marciniak A, Kotarski J. Assessment of serum lipid peroxide levels and antioxidant status in females who had undergone total abdominal hysterectomy without closing of the peritoneum. Ginekologia Polska. 2003; 74: 1397-1403.
• Tsai TY, Chang SK, Chou PY, Yeh LS. Comparison of postoperative effects between lidocaine infusion, meloxicam, and their combination in dogs undergoing ovariohysterectomy. Vet Anaesth Analg. 2013; 40(6): 615-622.
• Van Goethem BV, Okkens AS, Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: A discussion of the benefits of either technique. Vet Surgery. 2006; 35: 136-143.
• Wetzel CM, Kneebone RL, Woloshynowych M, Moorthy K, Kidd J, Darzi A. The effects of stress on surgical performance. Am J Surgery. 2006; 191(1): 5-10.
• Williams VM, Lascelles BDX, Robson MC. Current attitudes of peri-operative analgesia in dogs and cats by veterinarians in New Zealand. New Zealand Vet J. 2005; 53: 193-202.
• Yilmaz O, Korkmaz M, Jaroszewski JJ, Yazici E, Ulutas E, Saritas ZK. Comparison of flunixin meglumine and meloxicam influence on postoperative and oxidative stress in ovariohysterectomized bitches. Polish J Vet Sci. 2014; 17(3): 493-499.
• Zeugschmidt EL, Farnsworth CH, Carroll HS, Lucia TA, Hinckley MM, Gay JM, Cary JA. Effects of an optional clinical skills laboratory on surgical performance of third-year veterinary students. J Am Vet Med Assoc. 2016; 248: 630-635.