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Anggoro D, Purba MS, Nishida N, Itoh H, Itamoto K, Nemoto Y, Nakaichi M, Sunahara H, Tani K. Quantitative evaluation of the biomechanical and viscoelastic properties of the dog patellar tendon in response to neuromuscular blockade at different stifle angles. PLoS One 2024; 19:e0292453. [PMID: 38166027 PMCID: PMC10760779 DOI: 10.1371/journal.pone.0292453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/14/2023] [Indexed: 01/04/2024] Open
Abstract
The patellar tendon (PT) is crucial for maintaining stability and facilitating movement in the stifle joint. Elastography has been recognized as a prominent method for evaluating PT properties in humans and dogs. The utilization of oscillation methods in canine studies remains limited despite their extensive documentation in human studies. Our study represents the first effort to quantitatively assess and compare the effects of muscle relaxant on the biomechanical and viscoelastic characteristics of the PT at varying stifle angles in living dogs. Five healthy female beagles were used in this study. Biomechanical (tone, stiffness, and decrement) and viscoelastic (relaxation time and creep) properties of the PT were measured using MyotonPRO (Myoton Ltd, Estonia) prior to and following administration of rocuronium (0.5 mg/kg/body weight) at normal, extended, and flexed positions. Rocuronium was selected for its safety, controllability, and widespread clinical use in veterinary anesthesia. Two-way analysis of variance showed that tone, stiffness, and decrement were significantly higher (P < 0.001) in the control group than in the muscle relaxation group. At the same time, relaxation time and creep were significantly lower (P < 0.001) in the control group than in the muscle relaxation group. The findings indicate that stifle angle position and muscle rexalant administration fundamentally alter the biomechanical loading conditions of the PT, leading to changes in its viscoelastic properties. Therefore, this novel quantitative data could benefit clinical settings that necessitate accurate and objective methods for risk identification and monitoring PT biomechanics in dogs.
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Affiliation(s)
- Dito Anggoro
- Laboratory of Veterinary Surgery, Joint Graduate School of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Melpa Susanti Purba
- Laboratory of Veterinary Surgery, Joint Graduate School of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Harumichi Itoh
- Laboratory of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuhito Itamoto
- Laboratory of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yuki Nemoto
- Laboratory of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Munekazu Nakaichi
- Laboratory of Veterinary Radiology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Hiroshi Sunahara
- Laboratory of Veterinary Surgery, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kenji Tani
- Laboratory of Veterinary Surgery, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
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Martin-Flores M, Hackman MC, Araos JD, Campoy L, Gleed RD. Duration of neuromuscular block is more variable and recovery time is shorter with rocuronium than cisatracurium in anesthetized dogs. Vet Ophthalmol 2023; 26:407-413. [PMID: 36799561 DOI: 10.1111/vop.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To compare the variability in the duration of action of a single dose of rocuronium or cisatracurium, and duration of subsequent top-up doses in anesthetized dogs. ANIMALS Thirty dogs requiring ophthalmic surgery with neuromuscular block. PROCEDURES Neuromuscular function was monitored with train-of-four (TOF) and acceleromyography. Dogs received an initial dose of rocuronium 0.6 mg/kg, or cisatracurium 0.15 mg/kg IV, which produced complete neuromuscular block. Upon return of the first response (T1) of TOF, a third of the initial dose was repeated. The duration of the initial dose and its variability were compared between agents. Duration of subsequent top-up doses was assessed with mixed effect models. Spontaneous (from last return of T1) or neostigmine-enhanced (from administration to complete recovery) recovery times were measured for each agent. RESULTS Duration of action of the initial dose was [median (range)] 25 (10-60) min with rocuronium and 35 (15-45) min with cisatracurium (p = .231). The variability of rocuronium was 3.25 times larger than cisatracurium (p = .034). Duration of top-up doses did not vary for either agent. Spontaneous recovery was shorter for rocuronium [15 (10-20) min] than cisatracurium [25 (15-45) min] (p = .02). Neostigmine-enhanced recovery times were 5 (5-25) for rocuronium and 10 (5-10) for cisatracurium (p = .491). CONCLUSIONS Duration of action for a single dose is significantly more variable with rocuronium than cisatracurium. Time to spontaneous recovery was longer for cisatracurium, and cases of unexpectedly long recovery times were observed with both agents. Objective monitoring is recommended.
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Affiliation(s)
- Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Megan C Hackman
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Joaquin D Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Robin D Gleed
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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ED50 and ED95 of rocuronium during alfaxalone anesthesia in dogs. Vet Anaesth Analg 2023; 50:204-210. [PMID: 36967325 DOI: 10.1016/j.vaa.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To determine the median effective dose (ED50) and effective dose required to depress the twitch value by 95% (ED95) of rocuronium during alfaxalone anesthesia in dogs. STUDY DESIGN A randomized, prospective, crossover experimental study. ANIMALS A total of eight adult Beagle dogs (four female, four male), weighing 10.3-14.6 kg and aged 6-8 years. METHODS The dogs were anesthetized three times with 1.25-fold the individual minimum infusion rate of alfaxalone at intervals of ≥ 14 days. Neuromuscular function was monitored with train-of-four (TOF) stimulation of the peroneal nerve by acceleromyography. After recording the control TOF ratio (TOFRC) and first twitch of TOF (T1C), a single bolus dose of rocuronium 100, 175 or 250 μg kg-1 (treatments R100, R175 or R250) was administered intravenously. The maximum suppression of the first twitch of TOF (T1) was recorded and calibrated with T1C to construct the dose-response curve, from which ED50 and ED95 were calculated. Time from rocuronium administration to TOF ratio/TOFRC > 0.9 (duration TOFR0.9) was recorded. RESULTS ED50 and ED95 of rocuronium during alfaxalone anesthesia were 175 and 232 μg kg-1, respectively. The median (range) duration TOFR0.9 was longer in treatment R250 [10.1 (9.2-10.9) minutes] than in treatments R100 [3.1 (2.9-4.4) minutes; p < 0.0001] and R175 [7.7 (6.9-8.1) minutes; p < 0.0001]; and longer in treatment R175 than in treatment R100 (p < 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE The duration of TOFR0.9 correlated positively with the dosage of rocuronium, indicating that recovery time of rocuronium was also dose-dependent in dogs anesthetized with alfaxalone. The duration TOFR0.9 of rocuronium 250 μg kg-1 was 10 minutes during alfaxalone anesthesia in dogs.
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Gomez AG, Auckburally A, Flaherty D. Extremely prolonged neuromuscular blockade following a single dose of rocuronium in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Effects of sevoflurane, propofol or alfaxalone on neuromuscular blockade produced by a single intravenous bolus of rocuronium in dogs. Vet Anaesth Analg 2021; 49:36-44. [PMID: 34893432 DOI: 10.1016/j.vaa.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the effects of sevoflurane, propofol and alfaxalone on the neuromuscular blockade induced by a single intravenous bolus of rocuronium in dogs. STUDY DESIGN A randomized, prospective, crossover experimental study. ANIMALS A total of eight adult Beagle dogs (four female, four male), weighing 8.9-15.3 kg and aged 5-7 years. METHODS The dogs were anesthetized three times with 1.25× minimum alveolar concentration of sevoflurane (SEVO treatment) and 1.25× minimum infusion rate of propofol (PROP treatment) or alfaxalone (ALFX treatment) at intervals of ≥14 days. Neuromuscular function was monitored with train-of-four (TOF) stimulation of the peroneal nerve by acceleromyography. After recording the control TOF ratio (TOFRC), a single bolus dose of rocuronium (1 mg kg-1) was administered intravenously. The times from rocuronium administration to achieving TOF count 0 (onset time), from achieving TOF count 0 to the reappearance of TOF count 4 (clinical blockade period), from 25% to 75% of TOFRC (recovery index) and from achieving TOF count 0 to TOF ratio/TOFRC >0.9 (total neuromuscular blockade duration) were recorded. RESULTS The onset time and recovery index did not differ among the treatments. The median clinical blockade period was longer in the SEVO treatment [27.3 (26.0-30.3) minutes] than in PROP [16.6 (15.4-18.0) minutes; p = 0.002] and ALFX [22.4 (18.6-23.1) minutes; p = 0.017] treatments; and longer in the ALFX treatment than in the PROP treatment (p = 0.020). The mean total neuromuscular blockade duration was longer in the SEVO treatment (43.7 ± 9.9 minutes) than in PROP (25.1 ± 2.7 minutes; p < 0.001) and ALFX (32.5 ± 8.4 minutes; p = 0.036) treatments. CONCLUSIONS AND CLINICAL RELEVANCE Compared with alfaxalone and propofol, sevoflurane prolonged rocuronium-induced neuromuscular blockade by a significantly greater extent in dogs.
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Sakata H, Ishikawa Y, Ishihara G, Oyama N, Itami T, Umar MA, Sano T, Yamashita K. Effect of sevoflurane anesthesia on neuromuscular blockade produced by rocuronium infusion in dogs. J Vet Med Sci 2019; 81:425-433. [PMID: 30700651 PMCID: PMC6451902 DOI: 10.1292/jvms.18-0479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the effect of sevoflurane anesthesia on neuromuscular blockade with rocuronium in dogs. Six healthy beagle dogs were anesthetized four times with a minimum 14-day
washout period. On each occasion, the dogs were administered 1.25-, 1.5-, 1.75-, or 2.0-fold of the individualized minimum alveolar concentration (MAC) of sevoflurane and received an
infusion of rocuronium (0.5 mg/kg followed by 0.2 mg/kg/hr) for 120 min. Neuromuscular function was monitored with acceleromyography and train-of-four (TOF) stimulation of the left hind
limb. Time to achieve TOF count 0 (onset time), time from the onset of neuromuscular blockade to the reappearance of TOF count 4 (blockade period), and time from the onset of rocuronium
infusion to attaining a 70 or 90% TOF ratio (TOFR70 or TOFR90) were recorded. There were no significant differences in the onset time, blockade period, and plasma
rocuronium concentration between the sevoflurane MAC multiples. The TOFR70 and TOFR90 were dose-dependently prolonged with the sevoflurane MAC multiples. There were
significant differences in the TOFR70 and TOFR90 between the 1.25 sevoflurane MAC (median: 55 and 77.5 min, respectively) and 1.75 sevoflurane MAC (122.0 and 122.6 min;
P=0.020 and P=0.020, respectively), 1.25 sevoflurane MAC and 2.0 sevoflurane MAC (126.0 and 131.4 min; P=0.020 and
P=0.020), and 1.5 sevoflurane MAC (97.5 and 121.3 min) and 2.0 sevoflurane MAC (P=0.033 and P=0.032). In dogs, sevoflurane anesthesia
produced dose-dependent prolongation of recovery from neuromuscular blockade produced by rocuronium.
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Affiliation(s)
- Hisashi Sakata
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Yushun Ishikawa
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Genki Ishihara
- Anicom Specialty Medical Institute, Inc., Nishi-Shinjuku, Tokyo 160-0023, Japan
| | - Norihiko Oyama
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Takaharu Itami
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Mohammed Ahmed Umar
- Department of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Tadashi Sano
- Department of Veterinary Nursing Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
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Haga HA, Bettembourg V, Lervik A. Rocuronium infusion: A higher rate is needed in diabetic than nondiabetic dogs. Vet Anaesth Analg 2019; 46:28-35. [DOI: 10.1016/j.vaa.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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Küls N, Rocchi A, Larenza PM. Suspected anaphylaxis after intravenous injection of rocuronium in a dog. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2016-000343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nina Küls
- Veterinarmedizinische Universitat WienWienAustria
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Martin-Flores M, Sakai DM, Campoy L, Gleed RD. Recovery from neuromuscular block in dogs: restoration of spontaneous ventilation does not exclude residual blockade. Vet Anaesth Analg 2014; 41:269-77. [DOI: 10.1111/vaa.12109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 02/19/2013] [Indexed: 12/01/2022]
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Madsen MV, Donatsky AM, Jensen BR, Rosenberg J, Hammelev KP, Gätke MR. Monitoring of intense neuromuscular blockade in a pig model. J Clin Monit Comput 2013; 28:351-5. [PMID: 24306323 DOI: 10.1007/s10877-013-9539-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 11/30/2013] [Indexed: 12/19/2022]
Abstract
Intense neuromuscular blockade (NMB) measured by post tetanic count (PTC) was monitored, reversed and verified in this pig model. In a cross-over assessor blinded design six pigs were randomized to either no NMB followed by intense NMB, or intense NMB followed by no NMB. Neuromuscular measurements were performed with acceleromyography [train-of-four (TOF) Watch SX]. In all pigs, the response to TOF nerve stimulation was stable and intense NMB (PTC 0-1) was established with rocuronium 3 mg/kg. For reversal, the pigs received sugammadex 20-35 mg/kg and returned to TOF-ratio above 0.90 within 2.15 min after injection. We established a pig model for monitoring intense NMB with surface stimulation electrodes and acceleromyography. We verified total relaxation of the diaphragm and the abdominal muscles at the PTC 0-1 by suction test and with surface electromyography. This pig model is suitable for studies with experimental abdominal surgery with monitoring of intense NMB, and where relaxation of the diaphragm and the abdominal muscles are required.
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Affiliation(s)
- Matias V Madsen
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark,
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Briganti A, Barsotti G, Portela DA, Di Nieri C, Breghi G. Effects of rocuronium bromide on globe position and respiratory function in isoflurane-anesthetized dogs: a comparison between three different dosages. Vet Ophthalmol 2013; 18:89-94. [PMID: 24131770 DOI: 10.1111/vop.12108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect on globe position and respiration of three dosages of intravenous rocuronium in isoflurane-anesthetized dogs. ANIMAL STUDIED Thirty-two dogs anesthetized for ophthalmic procedures. PROCEDURES The dogs were divided into four groups, each of eight animals (G1-G4). G1, G2, G3 received 0.075, 0.05, 0.03 mg/kg of IV rocuronium, respectively; G4 received 0.9% NaCl IV; all the treatments were administered when an end-tidal isoflurane of 1.1-1.2% was reached. Anesthesia was obtained with dexmedetomidine (2.5 mcg/kg IV), methadone (0.1 mg/kg IV), propofol (2 mg/kg IV), and isoflurane in oxygen. Neuromuscular function was assessed with acceleromyography by stimulation of the peroneal nerve using the train-of-four (ToF) and the ToF ratio (ToFR). Monitoring of cardiovascular and respiratory functions was performed. Changes in globe position were recorded. RESULTS All three dosages of rocuronium produced centralization of the globe. Duration was 24.3 ± 4.2, 23.4 ± 3.6, and 8.7 ± 2.8 min, for G1, G2, and G3, respectively. The control group did not show globe centralization. No significant differences were found among the four groups in cardiovascular and respiratory parameters. Minute volume and ToFR were significantly lower in G1 compared with baseline values. CONCLUSIONS All doses of rocuronium resulted in globe centralization. The higher dose provoked a transient respiratory depression and some degree of skeletal muscular blockade detectable with ToFR. No alterations in respiratory activity were present when 0.05 mg/kg was used. The 0.03 mg/kg dosage could be useful for very short ophthalmic procedures.
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Affiliation(s)
- Angela Briganti
- Department of Veterinary Science, University of Pisa, Via Livornese, lato monte, 56122, San Piero a Grado, Pisa, Italy
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Barsotti G, Briganti A, Spratte JR, Ceccherelli R, Breghi G. Mydriatic effect of topically applied rocuronium bromide in tawny owls (Strix aluco): comparison between two protocols. Vet Ophthalmol 2010; 13 Suppl:9-13. [DOI: 10.1111/j.1463-5224.2010.00773.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sarrafzadeh-Rezaei F, Eddie Clutton R. The post-tetanic count during vecuronium-induced neuromuscular blockade in halothane-anaesthetized dogs. Vet Anaesth Analg 2009; 36:246-54. [PMID: 19397776 DOI: 10.1111/j.1467-2995.2009.00457.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the post-tetanic count (PTC) for predicting the return of reversible neuromuscular blockade at the n. facialis-m. nasolabialis (nF-mNL) and n. ulnaris-mm. carpi flexorii (nU-mCF) nerve-muscle units (NMUs) during profound vecuronium neuromuscular blockade in halothane-anaesthetized dogs. STUDY DESIGN Randomized, prospective, experimental study. ANIMALS Twenty-five dogs (seven male 18 female) undergoing surgery; mean age: 4.8 years; mean body weight 22 kg. METHODS Thirty minutes after acepromazine (0.05 mg kg(-1)) and morphine (0.5 mg kg(-1)) pre-medication, anaesthesia was induced with intravenous (IV) thiopental and maintained with halothane, N(2)O and O(2). The lungs were mechanically ventilated and end-tidal halothane concentration (Fe'(HAL)) maintained at 1.04%. Neuromuscular transmission was monitored using the train-of-four count (TOFC) at one nF-mNL and both nU-mCF units. Vecuronium (50 microg kg(-1) IV) was injected after 15 minutes constant Fe'(HAL). When the first twitch (T1) at both nU-mCF units had disappeared (t = 0) one (randomly allocated) ulnar nerve was stimulated every 5 minutes using PTC; TOF stimulation continued at the other sites. The PTC was plotted against the interval between recording time and T1's reappearance at the other NMUs. RESULTS At t = 0, the mean PTC in the contralateral nU-mCF unit was 18 (range 0-20). Mean PTC was a minimum at t = 5, rising to the maximum (20) at 25 minutes. Six dogs were vecuronium-resistant as monitored by PTC. Excluding data from these revealed a strong negative relationship between ulnar PTC and the time taken for T1's return at the facial (r = -0.7018; p < 0.00001) and contralateral ulnar (r = -0.8409; p < 0.00001) NMUs. CONCLUSION AND CLINICAL RELEVANCE Post-tetanic count monitoring beginning >5 minutes after the TOFC at nU-mCF = 0 provided a reliable estimate of T1's return at ulnar and facial NMUs.
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Martin-Flores M, Campoy L, Ludders JW, Erb HN, Gleed RD. Comparison between acceleromyography and visual assessment of train-of-four for monitoring neuromuscular blockade in horses undergoing surgery. Vet Anaesth Analg 2008; 35:220-7. [DOI: 10.1111/j.1467-2995.2007.00380.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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