Effect of butorphanol administration on cardiovascular parameters in isoflurane-anesthetized horses – a retrospective clinical evaluation

Sedation with dexmedetomidine-butorphanol or xylazine-butorphanol continuous intravenous infusions during unilateral ovariectomy in standing donkeys

BACKGROUND

Intravenous infusions of alpha-2 adrenoceptor sedatives and opioids can potentially facilitate surgery in donkeys while standing. Literature on this subject matter is scant.

OBJECTIVES

Evaluation of efficacy of sedation from α2 -adrenoceptors (dexmedetomidine or xylazine) and butorphanol during ovariectomy in standing donkeys.

STUDY DESIGN

Randomised, masked in vivo experiment.

METHODS

Thirteen female donkeys were sedated with butorphanol (0.05 mg/kg bwt followed by 0.05 mg/kg bwt/h) IV. Concomitantly, 6 of the 13 jennies were sedated with dexmedetomidine 2.5 mcg/kg bwt followed by 2.5 mcg/kg bwt/h (Dex-B group), while seven jennies were sedated with xylazine 0.5 mg/kg bwt followed by 0.5 mg/kg bwt/h (Xyl-B group). A line block of the left flank and an infiltration block around uterine ligament were performed with lidocaine. While the jennies underwent ovariectomies standing, sedation scores and head height above ground were assessed at 2 and 10 min after sedative boluses and every 10 min thereafter. If sedation was too light or too deep, the dose of dexmedetomidine or xylazine was increased or decreased by 25% of the original infusion rate, while butorphanol infusion rate was constant. Physiological parameters were measured. Normally distributed data were compared using the two-sample t test while repeatedly measured data were tested for differences between and within groups using repeated measures analysis of variance (ANOVA) by ranks followed by a Wilcoxon test with Tukey Honest Significant Difference for multiple testing. Statistical significance was set at p < 0.05.

RESULTS

Both Dex-B and Xyl-B caused moderate to marked sedation adequate for ovariectomy in donkeys. Evident sedation was absent by 60 min of termination of infusions. No adverse physiological effects were observed.

MAIN LIMITATIONS

Study on ovariectomy cases only, no pharmacokinetic profiling.

CONCLUSIONS

Dexmedetomidine or xylazine and butorphanol sedation is feasible for ovariectomy in standing donkeys.

A comparison of rectal versus fetlock temperatures in dorsally recumbent horses during general anesthesia

OBJECTIVE

To investigate the effect of isoflurane anesthesia on thermoregulation and peripheral heat loss in dorsally recumbent horses.

STUDY DESIGN

Prospective, clinical study.

ANIMALS

Seven adult horses (2.6 ± 1.5 years old, 455 ± 70.2 kg).

METHODS

Horses underwent elective surgical procedures in dorsal recumbency under general anesthesia (GA) maintained with isoflurane in oxygen. Rectal (TR), intranasal (TN) and fetlock surface temperatures (TF) were measured every 10 minutes for the first 80 minutes following induction of GA. Room temperature (TRO) was monitored during the study. Statistical analysis to determine differences between temperature measurement sites and techniques (TR, TN and TF), and differences over time were completed using a mixed-effects model with Tukey's multiple comparison or Dunnett's multiple comparison testing where appropriate. Significance was set at p < 0.05.

RESULTS

Following induction of anesthesia, TF was significantly increased compared with baseline (0 minutes) from 40 to 80 minutes (p < 0.01). No significant differences were detected in TR and TN at any time point compared with baseline (p > 0.05). TF was significantly lower than TN (p < 0.02) at all time points and TR from times 0 to 70 minutes (p < 0.04). There were no significant differences between TR and TN at any time (p > 0.05).

CONCLUSIONS

In horses undergoing isoflurane GA, TF increased, indicating peripheral heat loss likely because of vasodilation, whereas TR showed a clinically relevant decrease over time. These findings are suggestive of body heat redistribution during GA in horses in dorsal recumbency. Thermographic imaging of the peripheral limbs in combination with TR and TN monitoring allowed for recognition of peripheral heat redistribution in anesthetized horses.

CLINICAL RELEVANCE

Anesthetized horses experience peripheral heat loss through their extremities as a result of vasodilation. Mitigating peripheral heat loss may improve thermoregulation and reduce hypothermic complications in anesthetized horses.

Prolonged Recovery From General Anesthesia Possibly Related to Persistent Hypoxemia in a Draft Horse

Horses are susceptible to developing large areas of pulmonary atelectasis during recumbency and anesthesia. The subsequent pulmonary shunt is responsible for significant impairment of oxygenation. Since ventilation perfusion mismatch persists into the post-operative period, hypoxemia remains an important concern in the recovery stall. This case report describes the diagnosis and supportive therapy of persistent hypoxemia in a 914 kg draft horse after isoflurane anesthesia. It highlights how challenging it can be to deal with hypoxemia after disconnection from the anesthesia machine and how life-threatening it can become if refractory to treatment. Furthermore, it stresses the point on the interactions between hypoxemia and other factors, such as residual drug effects and hypothermia, that should also be considered in the case of delayed recovery from general anesthesia.

Pain Management in Horses

There has been great progress in the understanding of basic neurobiologic mechanisms of pain, but this body of knowledge has not yet translated into new and improved analgesics. Progress has been made regarding pain assessment in horses, but more work is needed until sensitive and accurate pain assessment tools are available for use in clinical practice. This review summarizes and updates the knowledge concerning the cornerstones of pain medicine (understand, assess, prevent, and treat). It highlights the importance of understanding pain mechanisms and expressions to enable a rational approach to pain assessment, prevention, and management in the equine patient.

Effects of a continuous rate infusion of butorphanol in isoflurane-anesthetized horses on cardiorespiratory parameters, recovery quality, gastrointestinal motility and serum cortisol concentrations

PURPOSE

To assess the cardiorespiratory parametes, recovery, gastrointestinal motility and serum cortisol concentrations in horses anesthetized with isoflurane with or without a continuous rate infusion (CRI) of butorphanol for orchiectomy.

METHODS

Twelve adult, intact, male horses weighing 332 ± 55 kg were included in the study. Xilazine was administered as premedication. Anesthesia was induced with ketamine and midazolam and maintained with isoflurane. Butorphanol (0.025 mg kg-1 bolus) or an equivalent volume of saline (0.9%) was given intravenously followed by a CRI of butorphanol (BG) (13 µg kg-1 hour-1) or saline (CG). Cardiorespiratory variables were recorded before (T0) and every 15 minutes for 75 minutes after the start of infusion. Serum cortisol concentration was measured at T0 and 60 minutes, and 30 minutes and 19 hours after the horse stood up. Recovery from anesthesia was evaluated using a scoring system. Gastrointestinal motility was evaluated before anesthesia and during 24 hours after recovery.

RESULTS

There were no significant differences between groups in cardiopulmonary variables, or recovery scores or serum cortisol concentrations. A reduction in gastrointestinal motility was recorded for 60 minutes in BG.

CONCLUSIONS

Continuous rate infusion of butorphanol in horses anesthetized with isoflurane did not adversely affect the cardiopulmonary variables monitored, or recovery scores. A small but statistically significant reduction in gastrointestinal motility occurred in the butorphanol group.

Effects of continuous rate infusion of butorphanol in isoflurane-anesthetized calves

PURPOSE

To assess the hemodynamic changes and bispectral index (BIS) following administration of a continuous rate infusion (CRI) of butorphanol in isoflurane-anesthetized calves.

METHODS

Eight calves weighing 110 ± 12 kg were included in the study. Anesthesia was induced with 5% isoflurane in O2 delivered via face mask and maintained with end-tidal concentration of 1.4%. IPPV was set to a peak inspiratory airway pressure of 15 cmH2O and respiratory rate of six breaths minute-1. Forty minutes after the start of anesthetic maintenance, 0.1 mg kg-1butorphanol was administered intravenously, followed by a CRI of 20 µg kg-1 minute-1. Hemodynamic variables and BIS were recorded before butorphanol administration (T0), and at 10, 20, 40 and 80 minutes following the CRI. Anesthesia was discontinued after the last recording and the calves were allowed to recover. The time to sternal recumbency (SRE) and standing (ST) were evaluated.

RESULTS

There were no significant differences between the moments in all hemodynamic variables and BIS. The time to SRE and ST was 9 ± 5 and 14 ± 7 minutes, respectively.

CONCLUSION

The continuous rate infusion did not produce clinically relevant changes in hemodynamic or bispectral index values compared to baseline in mechanically ventilated and unstimulated calves anesthetized at 1.4% isoflurane.