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Imboden TJ, Pownall WR, Rubin S, Spadavecchia C, Schöllhorn B, Rohrbach H. Determination of a safe sedative combination of dexmedetomidine, ketamine and butorphanol for minor procedures in dogs by use of a stepwise optimization method. Acta Vet Scand 2023; 65:41. [PMID: 37737188 PMCID: PMC10515426 DOI: 10.1186/s13028-023-00697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND In veterinary practice, most minor procedures such as radiographs, skin biopsies, and wound treatments require sedation. The combination of butorphanol, ketamine, and dexmedetomidine is commonly used, but the ideal dosages for this combination have not been defined. This randomized prospective clinical 3-phases trial initially tested eight clinically relevant combinations of intramuscular administration in 50 dogs (phase 1). The quality of each combination was rated using a purposefully developed negative score (NS; 0-21.5, the lower the NS the better the quality of sedation) to judge the quality of sedation, the occurrence of side effects, and the need for additional anaesthetics. Based on the results of the NS, the eight combinations were divided into "promising" and "unsatisfactory" subgroups. In phase 2, a new combination (N) was calculated and tested in six dogs replacing the worst of the eight initial combinations. This procedure was repeated until the NS could not be improved any further. In phase 3, the best combination was tested in 100 adult dogs undergoing diagnostic or therapeutic procedures. RESULTS The optimal combination established was dexmedetomidine 0.005 mg/kg, ketamine 1 mg/kg, and butorphanol 0.3 mg/kg with a median NS of 1.5 (interquartile range 1.5-2.4). In all 112 dogs receiving this combination, the quality of sedation was satisfactory and no severe side effects were detected. CONCLUSIONS The application of this optimization method allowed the calculation of an optimal drug combination to sedate cardiovascularly healthy dogs. After having being tested in 112 animals, this combination can consequently be considered safe. Therefore, this combination can now be used in daily clinical practice for cardiovascularly healthy adult dogs undergoing minor procedures.
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Affiliation(s)
- Tobias Jonas Imboden
- Border Veterinary Service, Postfach, Fracht West, Zurich Airport, 8058 Switzerland
| | - William Robert Pownall
- Surgery Department, Department of Veterinary Sciences, Vetsuisse Faculty, Small Animal Clinic, University of Bern, Laenggassstrasse 128, Bern, 3012 Switzerland
| | | | - Claudia Spadavecchia
- Anaesthesiology Section, Department of Veterinary Sciences, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, Bern, 3012 Switzerland
| | - Bernhard Schöllhorn
- Vet Zentrum Berchtesgadener Land, Weitwiesenring 4, 83435 Bad Reichenhall, Deutschland
| | - Helene Rohrbach
- Anaesthesiology Section, Department of Veterinary Sciences, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, Bern, 3012 Switzerland
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Schöndorfer B, Vogl C, Eberspächer-Schweda E. Sedative effects and changes in cardiac rhythm with intravenous premedication of medetomidine, butorphanol and ketamine in dogs. Vet Anaesth Analg 2023; 50:136-145. [PMID: 36754695 DOI: 10.1016/j.vaa.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the sedative effects and characteristics of cardiac rhythm with intravenous (IV) premedication of medetomidine, butorphanol and ketamine in dogs. STUDY DESIGN Prospective, blinded, randomized clinical trial. ANIMALS A total of 116 client-owned healthy dogs undergoing elective surgery. METHODS Dogs were randomly allocated one of four groups: group M, medetomidine 5 μg kg-1; group B, butorphanol 0.2 mg kg-1; group MB, medetomidine 5 μg kg-1 and butorphanol 0.2 mg kg-1; or group MBK, medetomidine 5 μg kg-1, butorphanol 0.2 mg kg-1 and ketamine 1 mg kg-1 IV. Sedation was assessed using a numerical descriptive scale. Heart rate (HR) and rhythm were monitored; propofol dose (mg kg-1 IV) to allow orotracheal intubation was documented. Data were analysed using anova, accounting for multiple testing with the Tukey honest significant difference test. RESULTS Sedation scores varied significantly between all groups at all time points, except between groups MB and MBK at four time points. HR decreased in all groups: most in groups M and MB, least in group B. HR was initially higher in group MBK than in groups M and MB. Arrhythmias occurred in all groups: group B showed second-degree atrioventricular blocks occasionally, all other groups showed additionally ventricular escape complexes and bundle branch blocks. Dose of propofol required for orotracheal intubation was significantly higher in group B (5.0 ± 2.0 mg kg-1) than in group M (2.6 ± 0.6 mg kg-1). Although no difference could be demonstrated between groups MB (1.4 ± 0.6 mg kg-1) and MBK (0.9 ± 0.8 mg kg-1), both groups required significantly less propofol than group M. CONCLUSION AND CLINICAL RELEVANCE Medetomidine-based premedication protocols led to various bradyarrhythmias. Addition of subanaesthetic doses of ketamine to medetomidine-based protocols resulted in higher HRs, fewer bradyarrhythmias and fewer animals that required propofol for intubation without causing side effects in healthy dogs.
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Affiliation(s)
- Benedikt Schöndorfer
- Clinic of Anaesthesiology and Perioperative Intensive Care, Department of Small Animals and Horses, Veterinary University Vienna, Vienna, Austria
| | - Claus Vogl
- Institute of Animal Breeding and Genetics, Veterinary University Vienna, Vienna, Austria
| | - Eva Eberspächer-Schweda
- Clinic of Anaesthesiology and Perioperative Intensive Care, Department of Small Animals and Horses, Veterinary University Vienna, Vienna, Austria.
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Immediate Postoperative Analgesia of Nalbuphine-Ketamine Combination Compared with Ketamine Alone in Xylazine-Sedated Goats Undergoing Left Flank Laparotomy. Animals (Basel) 2022; 12:ani12040509. [PMID: 35203217 PMCID: PMC8868226 DOI: 10.3390/ani12040509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
Goats have been used as animal models in research, and the need for achieving safer anesthesia for research or surgical intervention is gaining much attention. The objective of this study was to evaluate intraoperative effects and the immediate postoperative analgesia of nalbuphine–ketamine regimen in goats. Twenty clinically healthy adult female crossbred goats weighing 14 ± 2 kg were allocated randomly into each of two equally sized groups. All animals were sedated with intramuscular (IM) xylazine (0.07 mg/kg), then anesthesia was intravenously (IV) induced with ketamine alone (10 mg/kg) (XK group), or a combination of nalbuphine (0.5 mg/kg) and ketamine (5 mg/kg) (XNK group). Following induction, left flank laparotomy was performed and then sutured. The quality of anesthesia and immediate postoperative analgesia was evaluated. Immediate postoperative analgesia was assessed up to 5 h after standing, using a modified Unesp–Botucatu acute composite pain scale (USAPS). Serum cortisol, glucose, insulin, and C-reactive protein (CRP) were measured at ½, 1, 2, 4, 6, 12, and 24 h, postoperatively (PO). The USAPS pain scores were significantly lower in the XNK compared to the XK group (p < 0.05). The XNK group exhibited a statistically significant difference in the level of serum cortisol at ½ and 1 h PO (p = 0.018 and 0.045, respectively) compared to the XK group. At 2, 4, 6 h PO, CRP significantly decreased (p = 0.023, 0.040 and 0.005, respectively) in the XNK compared to the XK group. Nalbuphine–ketamine produced an acceptable induction of anesthesia and recovery compared to ketamine. Recovery with nalbuphine–ketamine was faster and better quality. The USAPS pain scores were lower in nalbuphine–ketamine, indicating that this novel combination produces better postoperative pain control than ketamine alone.
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Arenillas M, Canfrán S, Aguado D, Gómez de Segura IA. Sedative and analgesic effects of two subanaesthetic doses of ketamine in combination with methadone and a low dose of dexmedetomidine in healthy dogs. Vet Anaesth Analg 2021; 48:545-553. [PMID: 34083140 DOI: 10.1016/j.vaa.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 10/06/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the sedative, analgesic and recovery characteristics of two subanaesthetic ketamine doses in combination with dexmedetomidine and methadone for intramuscular sedation in healthy Beagles. STUDY DESIGN Randomized, blinded, crossover, experimental study. ANIMALS Six healthy adult Beagles. METHODS Dogs were randomly given three treatments: dexmedetomidine (3 μg kg-1) and methadone (0.3 mg kg-1) combined with ketamine at 1 and 2 mg kg-1 (K1 and K2, respectively) or saline (K0), intramuscularly. Sedation score, response to tail clamping and rectal temperature were recorded at baseline, 5, 15, 25, 35, and 45 minutes posttreatment. Pulse rate (PR), respiratory rate, oxygen haemoglobin saturation and noninvasive blood pressure were also recorded at baseline and every 5 minutes until 45 minutes posttreatment. Onset and duration of recumbency, response to venous catheterization and recovery quality were also assessed. Sedation and physiological variables were compared between treatments and within treatments compared to baseline (analysis of variance). Nonparametric data were analysed with the Friedman and Cochran's Q tests; p < 0.050. RESULTS Increased sedation was found at 15 (K0 and K1), 25 (all treatments) and 35 (K1) minutes compared with baseline. Sedation score, onset (3-12 minutes) and duration of recumbency (29-51 minutes) were similar between treatments. Recovery quality was considered acceptable in all cases. Response to tail clamping was inconsistent within treatments with no differences between them. None of the dogs responded to venous catheterization. There were no differences between treatments in physiological variables, except for PR which was higher in K2 than in K0. Oxygen supplementation was required in five and three dogs administered saline and ketamine, respectively. CONCLUSIONS AND CLINICAL RELEVANCE The addition of 1 or 2 mg kg-1 of ketamine to methadone and dexmedetomidine combination did not enhance sedation or antinociception in healthy dogs. Recovery quality was unaffected.
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Affiliation(s)
- Mario Arenillas
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain.
| | - Susana Canfrán
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Delia Aguado
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Ignacio A Gómez de Segura
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
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Tamura J, Ishizuka T, Fukui S, Oyama N, Kawase K, Miyoshi K, Sano T, Pasloske K, Yamashita K. The pharmacological effects of the anesthetic alfaxalone after intramuscular administration to dogs. J Vet Med Sci 2014; 77:289-96. [PMID: 25428797 PMCID: PMC4383774 DOI: 10.1292/jvms.14-0368] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The pharmacological effects of the anesthetic alfaxalone were evaluated after
intramuscular (IM) administration to 6 healthy beagle dogs. The dogs received three IM
doses each of alfaxalone at increasing dose rates of 5 mg/kg (IM5), 7.5 mg/kg (IM7.5) and
10 mg/kg (IM10) every other day. Anesthetic effect was subjectively
evaluated by using an ordinal scoring system to determine the degree of neuro-depression
and the quality of anesthetic induction and recovery from anesthesia. Cardiorespiratory
variables were measured using noninvasive methods. Alfaxalone administered IM produced
dose-dependent neuro-depression and lateral recumbency (i.e., 36 ± 28 min, 87 ± 26 min and
115 ± 29 min after the IM5, IM7.5 and IM10 treatments, respectively). The endotracheal
tube was tolerated in all dogs for 46 ± 20 and 58 ± 21 min after the IM7.5 and IM10
treatments, respectively. It was not possible to place endotracheal tubes in 5 of the
6 dogs after the IM5 treatment. Most cardiorespiratory variables remained
within clinically acceptable ranges, but hypoxemia was observed by pulse oximetry for 5 to
10 min in 2 dogs receiving the IM10 treatment. Dose-dependent decreases in rectal
temperature, respiratory rate and arterial blood pressure also occurred. The quality of
recovery was considered satisfactory in all dogs receiving each treatment; all the dog
exhibited transient muscular tremors and staggering gait. In conclusion, IM alfaxalone
produced a dose-dependent anesthetic effect with relatively mild cardiorespiratory
depression in dogs. However, hypoxemia may occur at higher IM doses of alfaxalone.
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Affiliation(s)
- Jun Tamura
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan
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Barletta M, Austin BR, Ko JC, Payton ME, Weil AB, Inoue T. Evaluation of dexmedetomidine and ketamine in combination with opioids as injectable anesthesia for castration in dogs. J Am Vet Med Assoc 2011; 238:1159-67. [DOI: 10.2460/javma.238.9.1159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ueyama Y, Ueyema Y, Waselau AC, Wiese AJ, Muir WW. Anesthetic and cardiopulmonary effects of intramuscular morphine, medetomidine, ketamine injection in dogs. Vet Anaesth Analg 2008; 35:480-7. [PMID: 18713225 DOI: 10.1111/j.1467-2995.2008.00415.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the quality and duration of anesthesia and the cardiopulmonary effects of a morphine, medetomidine, ketamine (MMK) combination administered intramuscularly (IM) to dogs. STUDY DESIGN Descriptive injectable anesthetic protocol evaluation. ANIMALS Eight intact adult Beagle dogs: five males, three females. METHODS The electrocardiogram, heart rate, direct arterial blood pressure, and core body temperature were monitored in eight chronically instrumented dogs. Each dog received 0.2 mg kg(-1) morphine sulfate, 20 microg kg(-1) medetomidine hydrochloride, and 5 mg kg(-1) ketamine hydrochloride IM. Anesthetic and analgesic effects (clamping the tail and metatarsus) were categorized, and the times to lateral recumbency, orotracheal intubation, extubation, and sternal recumbency were recorded. Respiratory, cardiovascular, temperature, and acid-base variables were recorded 5 minutes before, and 3, 10, 20, 30, 45, 50, and 60 minutes after MMK. Atipamezole, 100 microg kg(-1) IM, was administered 60 minutes after MMK administration and data recorded 10 minutes later. RESULTS The onset of anesthesia was uneventful and rapid. Time to lateral recumbency was 7.1 +/- 4.1 minutes. The tracheas of four dogs were orally intubated in 5.1 +/- 0.8 minutes. After MMK administration most dogs were unresponsive to noxious stimulation from 20 to 60 minutes and heart rate, cardiac index and venous blood pH were significantly decreased from baseline values. Arterial blood pressure increased initially and then returned to baseline values. Times to extubation (four dogs) and return to sternal recumbency after atipamezole administration were 2.8 +/- 1.8 and 4.3 +/- 4.4 minutes, respectively. CONCLUSION The IM administration of MMK produced anesthesia and analgesia in Beagle dogs. Hemodynamic data were within accepted normal values. Atipamezole administration produced rapid return to consciousness in all dogs. CLINICAL RELEVANCE Morphine/medetomidine/ketamine may be used for minor medical and surgical procedures requiring short-term anesthesia and analgesia but it is not recommended for medical procedures that are painful.
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Affiliation(s)
- Yukie Ueyama
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Silva FDC, Hatschbach E, Lima AFDM, Carvalho YKD, Massone F. Continuous infusion in adult females dogs submitted to ovariohysterectomy with midazolam-xylazine and/or medetomidine pre-treated with methotrimeprazine and buprenorphine. Acta Cir Bras 2007; 22:272-8. [PMID: 17625665 DOI: 10.1590/s0102-86502007000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 06/15/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To compare, by continuous infusion of ketamine or medetomidine combined to methotrimeprazine and buprenorphine, ketamine and midazolam, the degree of hypnosis, myorelaxation, anesthetic quality and surgical feasibility through evaluation of possible parametric alterations and recovery quality. METHODS: 20 healthy adult females dogs, aged 3 to 5 years, body weight between 7 and 15 kg, were assigned randomly and homogenously to 2 groups of 10 animals each (n=10), group 1 (G1) and group 2 (G2), respectively. Animals of G1 were subjected to a pre-treatment with intravenous 1.0 mg/kg methotrimeprazine and or 3ì/kg. After 15 minutes, a 5.0 mg/kg ketamine and 0.2 mg/kg midazolam were intravenously injected. Immediately after induction, an anesthetic combination of 0.4 mg/kg/h midazolam, 20 mg/kg/h ketamine and 1.0 mg/kg/h xylazine, was continuously and intravenously administered for 30 minutes. The same techniques were used in G2 except for the substitution of xylazine for 30ìg/kg/h medetomidine. RESULTS: In G1 there was a 1st and 2nd degree atrioventricular heart block, a longer recovery period and lower quality. In G2 a 1st degree atrioventricular heart block occurred but isolated and ephemeral. CONCLUSIONS: The continuous infusion method, besides reducing drugs utilization, prevented collateral effects allowing a more tranquil recovery with no excitations, both protocols permitted the surgical procedure (ovary-hysterectomy) bringing about a reduction in hypnosis and an accentuated myorelaxation. Xylazine and medetomidine showed a similar pharmacodynamic behavior but with different clinical aspects. The electrocardiographic alterations observed in G2 and in a lower degree in G1 must be well studied. Describers: dogs, ketamine, methotrimeprazine, medetomidine, midazolam and xylazine.
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Ko JC, Fox SM, Mandsager RE. Sedative and cardiorespiratory effects of medetomidine, medetomidine-butorphanol, and medetomidine-ketamine in dogs. J Am Vet Med Assoc 2000; 216:1578-83. [PMID: 10825944 DOI: 10.2460/javma.2000.216.1578] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine sedative and cardiorespiratory effects of i.m. administration of medetomidine alone and in combination with butorphanol or ketamine in dogs. DESIGN Randomized, crossover study. ANIMALS 6 healthy adult dogs. PROCEDURES Dogs were given medetomidine alone (30 micrograms/kg [13.6 micrograms/lb] of body weight, i.m.), a combination of medetomidine (30 micrograms/kg, i.m.) and butorphanol (0.2 mg/kg [0.09 mg/lb], i.m.), or a combination of medetomidine (30 micrograms/kg, i.m.) and ketamine (3 mg/kg [1.36 mg/lb], i.m.). Treatments were administered in random order with a minimum of 1 week between treatments. Glycopyrrolate was given at the same time. Atipamezole (150 micrograms/kg [68 micrograms/lb], i.m.) was given 40 minutes after administration of medetomidine. RESULTS All but 1 dog (given medetomidine alone) assumed lateral recumbency within 6 minutes after drug administration. Endotracheal intubation was significantly more difficult when dogs were given medetomidine alone than when given medetomidine and butorphanol. At all evaluation times, percentages of dogs with positive responses to tail clamping or to needle pricks in the cervical region, shoulder region, abdominal region, or hindquarters were not significantly different among drug treatments. The Paco2 was significantly higher and the arterial pH and Pao2 were significantly lower when dogs were given medetomidine and butorphanol or medetomidine and ketamine than when they were given medetomidine alone. Recovery quality following atipamezole administration was unsatisfactory in 1 dog when given medetomidine and ketamine. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that a combination of medetomidine with butorphanol or ketamine resulted in more reliable and uniform sedation in dogs than did medetomidine alone.
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Affiliation(s)
- J C Ko
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville 32608, USA
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