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Hoeberg E, Haga HA, Lervik A. Cardiovascular effects of intravenous morphine in anesthetized horse. Front Vet Sci 2022; 9:1007345. [PMID: 36225800 PMCID: PMC9549263 DOI: 10.3389/fvets.2022.1007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To investigate whether morphine causes a change in mean arterial blood pressure (MAP) heart rate (HR) and oxygen extraction (OE) rate in healthy horses anesthetized with isoflurane and a dexmedetomidine infusion. Material and methods The study design was prospective clinical, randomized, blinded two groups including 33 horses. All horses were sedated with romifidine IV, and anesthesia was induced with midazolam IV and ketamine IV and maintained with isoflurane in oxygen and medical air and a dexmedetomidine infusion. As a baseline venous and arterial blood, HR and MAP were sampled. Thereafter either morphine 0.1 mg kg−1 IV or an equivalent volume of NaCl 0.9% IV was administered. HR and MAP were then further sampled for 5 min before venous and arterial blood was again sampled. OE was calculated based upon arterial and venous blood gas analysis. To evaluate the change in minimum MAP, mean HR, and OE, the differences between baseline and observation period values were further termed delta MAP, delta HR, and delta OE. Individual delta MAPs were normalized to the minimum baseline value and are reported as a percentage. Alpha was set to 0.05. Confidence intervals 95% (CI) were calculated for delta MAP, delta HR, and delta OE within groups, and for the difference between groups. Results The 95% CIs for delta MAP (%), delta HR (min−1), and delta OE (mL/dL) in the morphine group were −20.5 to −9.0, 0.6 to 3.1, and −0.1 to 0.6 and in the placebo group were −17.4 to −10.1, 0.2 to 2.0, and −0.2 to 0.3, respectively. The 95% CI for the differences in delta MAP (%), delta HR (min−1), and delta OE (mL/dL) were −5.5 to 7.6, −2.3 to 0.7, and −0.7 to 0.2, respectively. The minimum MAP of one horse in the morphine group decreased around 50% between baseline and observation period with almost unchanged OE and HR. Conclusion and clinical relevance The effects of morphine 0.1 mg kg−1 IV on HR, MAP, and OE in healthy horses anesthetized with isoflurane and a CRI of dexmedetomidine are minimal.
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Rabbogliatti V, Amari M, Brioschi FA, Di Cesare F, Zani DD, De Zani D, Di Giancamillo M, Cagnardi P, Ravasio G. Use of dexmedetomidine repeated subcutaneous administration for balanced anaesthesia in horses. BMC Vet Res 2022; 18:269. [PMID: 35818051 PMCID: PMC9275161 DOI: 10.1186/s12917-022-03350-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background A balanced anaesthetic protocol is a common concept in modern veterinary anaesthesia and aims to maintain good intraoperative cardiopulmonary function. In horses, alpha-2-agonists produce sedation and analgesia and have been shown to reduce inhalational anaesthetic requirements when administered intravenously. Furthermore, these drugs can improve recovery quality. Preliminary investigations of subcutaneous dexmedetomidine administration in humans demonstrated a reduced haemodynamic impact if compared with the intravenous route suggesting that dexmedetomidine is adequately absorbed with both administration routes. The aim of the study was to compare two different dexmedetomidine (DEX) administration routes: intravenous constant rate infusion (CRI) versus repeated subcutaneous (SC) injections on cardiopulmonary function and recovery in anaesthetized horses. Results No significant differences between groups in heart rate and systolic arterial pressure were detected. A significantly higher mean and diastolic arterial pressure were detected in the SC group at T25 (p = 0.04; p = 0.02), T75 (p = 0.02; p = 0.009), and T85 (p = 0.001; p = 0.005). In SC group there was a significantly lower dobutamine infusion rate (p = 0.03) and a significantly higher urinary output (p = 0.02). Moreover, recovery quality was higher (p = 0.01). Conclusions Cardiopulmonary effects in both groups were comparable and within clinical ranges with less dobutamine requirement in the subcutaneous group. Recovery was of better quality with fewer attempts in horses receiving subcutaneous dexmedetomidine. The present study suggests that intravenous constant rate infusion and subcutaneous repeated administration of dexmedetomidine at indicated dosage can be useful in balanced anaesthesia without any systemic or local adverse effects; moreover, in healthy horses undergoing general anaesthesia, repeated subcutaneous dexmedetomidine administration may be a suitable alternative if constant rate infusion is not feasible.
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Affiliation(s)
- Vanessa Rabbogliatti
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Martina Amari
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | | | - Federica Di Cesare
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Davide Danilo Zani
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Donatella De Zani
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Mauro Di Giancamillo
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Petra Cagnardi
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Giuliano Ravasio
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy.
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Effects of detomidine or romifidine during maintenance and recovery from isoflurane anaesthesia in horses. Vet Anaesth Analg 2022; 49:624-633. [DOI: 10.1016/j.vaa.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/23/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
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Phillips V, Schauvliege S, Decloedt A, Van Steenkiste G, van Loon G. Anaesthetic management for cardiac 3D electro‐anatomical mapping and radiofrequency catheter ablation in a horse with sustained atrial tachycardia. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Phillips
- Willows Veterinary Centre and Referral Service Highlands Road Shirley UK
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Annelies Decloedt
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Gunther van Loon
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
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Loomes K, Louro LF. Recovery of horses from general anaesthesia: A systematic review (2000-2020) of the influence of anaesthetic protocol on recovery quality. Equine Vet J 2021; 54:219-261. [PMID: 34668220 DOI: 10.1111/evj.13524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The recovery phase after equine general anaesthesia (GA) is a time of considerable risk and therefore has been the subject of extensive research over the last 20 years. Various pharmacological interventions have been developed and studied with the objective of improving recovery quality and reducing anaesthetic-related mortality and morbidity. Nevertheless, some controversy remains regarding the influence of anaesthetic protocol choice on recovery quality from GA and its implications for recovery-related mortality and morbidity. A systematic review of the literature investigating the influence of anaesthetic protocol choice on recovery quality is currently lacking. OBJECTIVES To perform a detailed evaluation of the equine veterinary literature investigating the effect of anaesthetic protocol choice on equine recovery quality utilising the GRADE framework. STUDY DESIGN A systematic evaluation of the equine veterinary literature was performed using the GRADE framework. METHODS A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub-topic was assessed using the GRADE framework. RESULTS A total of 124 studies were identified which directly assessed the impact of anaesthetic protocol choice on recovery quality after GA in horses. Evaluation of the available evidence indicated that certain partial intravenous anaesthesia (PIVA) agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality. MAIN LIMITATIONS The validity of the results of some studies may have been compromised by missing data and small sample sizes. CONCLUSIONS There is evidence to indicate that certain PIVA agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.
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Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021; 11:ani11061777. [PMID: 34198637 PMCID: PMC8232193 DOI: 10.3390/ani11061777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions. Abstract Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.
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Lervik A, Forr Toverud S, Bohlin J, Haga HA. Macrocirculatory Parameters and Oxygen Debt Indices in Pigs During Propofol Or Alfaxalone Anesthesia When Subjected to Experimental Stepwise Hemorrhage. Front Vet Sci 2021; 8:664112. [PMID: 34095276 PMCID: PMC8173164 DOI: 10.3389/fvets.2021.664112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pigs are anesthetized when used for emergency procedures live tissue training (LTT) of civilian and military medical personnel or for experimental purposes, but there is a paucity in the literature regarding anesthesia of pigs for this purpose. Objective(s): The main goals of the study were to compare oxygen debt, macrocirculatory parameters, and time to cardiac arrest between pigs in hemorrhagic shock and anesthetized with propofol-ketamine-dexmedetomidine or alfaxalone-ketamine-dexmedetomidine. Design: A prospective, non-blinded randomized study design was used. Sixteen pigs were randomized in blocks of four to be anesthetized with either propofol-ketamine-dexmedetomidine (n = 8) or alfaxalone-ketamine-dexmedetomidine (n = 8) as a continuous infusion. Interventions: Premedication with ketamine 15 mg kg-1 and midazolam 1 mg kg-1 was given i.m. Anesthesia was maintained with propofol 8 mg kg-1 h-1 or alfaxalone 5 mg kg-1 h-1 combined with ketamine 5 mg kg-1 h-1 and dexmedetomidine 4 μg kg-1 h-1 i.v. A stepwise, volume-controlled model for hemorrhage was created by exsanguination. Main Outcome Measures: Indices of oxygen debt (lactate, base excess, and oxygen extraction), macrocirculatory (PR, SAP, DAP, MAP, and CI, SVI, and TPR) variables, and time to death was compared between groups. Results: Pigs in the alfaxalone group had significantly higher SAP than pigs given propofol. No difference in other macrocirculatory variables or indices of oxygen debt could be found. A blood loss of 50% of the total blood volume or more was possible in most pigs with both anesthetic regimes. Conclusions: Pigs anesthetized with propofol or alfaxalone combined with ketamine and dexmedetomidine tolerated substantial blood loss.
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Affiliation(s)
- Andreas Lervik
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Simen Forr Toverud
- Animal Health and Welfare Branch, Veterinary Inspectorate, Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway
| | - Jon Bohlin
- Division of Infection Control and Environmental Health, Department for Method Development and Analysis, Norwegian Institute of Public Health, Oslo, Norway.,Center for Fertility and Health Analysis, Norwegian Institute of Public Health, Oslo, Norway
| | - Henning Andreas Haga
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
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Wiederkehr A, Barbarossa A, Ringer SK, Jörger FB, Bryner M, Bettschart-Wolfensberger R. Clinical Randomized Comparison of Medetomidine and Xylazine for Isoflurane Balanced Anesthesia in Horses. Front Vet Sci 2021; 8:603695. [PMID: 33959647 PMCID: PMC8093396 DOI: 10.3389/fvets.2021.603695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/22/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: To assess drug plasma levels, preanesthetic sedation, cardiopulmonary effects during anesthesia and recovery in horses anesthetized with isoflurane combined with medetomidine or xylazine. Study design: Prospective blinded randomized clinical study. Animals: Sixty horses undergoing elective surgery. Methods: Thirty minutes after administration of antibiotics, flunixine meglumine or phenylbutazone and acepromazine horses received medetomidine 7 μg kg−1 (group MED) or xylazine 1.1 mg kg−1 (group XYL) slowly intravenously (IV) and sedation was assessed 3 min later. Anesthesia was induced with ketamine/diazepam and maintained with isoflurane in oxygen/air and medetomidine 3.5 μg kg−1 h−1 or xylazine 0.69 mg kg−1 h−1. Ringer's acetate 10 mL kg−1 h−1 and dobutamine were administered to maintain normotension. All horses were mechanically ventilated to maintain end-tidal carbon dioxide pressures at 45 ± 5 mmHg (5.3–6.7 kPa). Heart rate (HR), invasive arterial blood pressures, inspired and expired gas compositions, pH, arterial blood gases, electrolytes, lactate and glucose were measured. For recovery all horses received intramuscular morphine 0.1 mg kg−1 and medetomidine 2 μg kg−1 or xylazine 0.3 mg kg−1 IV. Recovery was timed and scored using three different scoring systems. Plasma samples to measure medetomidine and xylazine concentrations were collected at predetermined timepoints. Repeatedly measured parameters were analyzed using a two-way repeated-measures analysis of variance for differences between groups and over time; p < 0.05 was considered statistically significant. Results: Mean arterial blood pressures (MAP) stayed within normal ranges but were higher (p = 0.011) in group XYL despite significant lower dobutamine doses (p = 0.0003). Other measured parameters were within clinically acceptable ranges. Plasma levels were at steady state during anesthesia (MED 2.194 ± 0.073; XYL 708 ± 18.791 ng mL−1). During recovery lateral recumbency (MED 42.7 ± 2.51; XYL 34.3 ± 2.63 min; p = 0.027) and time to standing (MED 62.0 ± 2.86; XYL 48.8 ± 3.01 min; p = 0.002) were significantly shorter in group XYL compared to group MED. Recovery scores did not differ significantly between groups. Conclusion and Clinical Relevance: In horses anesthetized with isoflurane and medetomidine or xylazine, xylazine maintained higher MAP, reduced the dobutamine consumption and recovery time, whilst overall recovery quality was unaffected.
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Affiliation(s)
- Alexandra Wiederkehr
- Section Anesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Andrea Barbarossa
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Simone K Ringer
- Section Anesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Fabiola B Jörger
- Section Anesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Marco Bryner
- Clinic for Equine Surgery, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Regula Bettschart-Wolfensberger
- Section Anesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Fujiyama M, Jones T, Duke-Novakovski T. Evaluation of the perioperative stress response from dexmedetomidine infusion alone, with butorphanol bolus or remifentanil infusion compared with ketamine and morphine infusions in isoflurane-anesthetized horses. Vet Anaesth Analg 2021; 48:344-355. [PMID: 33741263 DOI: 10.1016/j.vaa.2021.01.006] [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: 10/12/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate perioperative stress-related hormones in isoflurane-anesthetized horses administered infusions of dexmedetomidine alone or with butorphanol or remifentanil, compared with ketamine-morphine. STUDY DESIGN Randomized, prospective, nonblinded clinical study. ANIMALS A total of 51 horses undergoing elective surgical procedures. METHODS Horses were premedicated with xylazine, anesthesia induced with ketamine-diazepam and maintained with isoflurane and one of four intravenous infusions. Partial intravenous anesthesia (PIVA) was achieved with dexmedetomidine (1.0 μg kg-1 hour-1; group D; 12 horses); dexmedetomidine (1.0 μg kg-1 hour-1) and butorphanol bolus (0.05 mg kg-1; group DB; 13 horses); dexmedetomidine (1.0 μg kg-1 hour-1) and remifentanil (3.0 μg kg-1 hour-1; group DR; 13 horses); or ketamine (0.6 mg kg-1 hour-1) and morphine (0.15 mg kg-1, 0.1 mg kg-1 hour-1; group KM; 13 horses). Infusions were started postinduction; butorphanol bolus was administered 10 minutes before starting surgery. Blood was collected before drugs were administered (baseline), 10 minutes after ketamine-diazepam, every 30 minutes during surgery and 1 hour after standing. Mean arterial pressure (MAP), pulse rate, end-tidal isoflurane concentration, cortisol, nonesterified fatty acids (NEFA), glucose and insulin concentrations were compared using linear mixed models. Significance was assumed when p < 0.05. RESULTS Within D, cortisol was lower at 120-180 minutes from starting surgery compared with baseline. Cortisol was higher in KM than in D at 60 minutes from starting surgery. Within all groups, glucose was higher postinduction (except DR) and 60 minutes from starting surgery, and insulin was lower during anesthesia and higher after standing compared with baseline. After standing, NEFA were higher in KM than in DB. In KM, MAP increased at 40-60 minutes from starting surgery compared with 30 minutes postinduction. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine suppressed cortisol release more than dexmedetomidine-opioid and ketamine-morphine infusions. Ketamine-morphine PIVA might increase catecholamine activity.
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Affiliation(s)
- Masako Fujiyama
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Teela Jones
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tanya Duke-Novakovski
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Alonso BB, La Rosa L, Carregaro AB, Gasthuys F, Schauvliege S. Recovery Quality After Romifidine Versus Detomidine Infusion During Isoflurane Anesthesia in Horses. J Equine Vet Sci 2020; 94:103243. [PMID: 33077077 DOI: 10.1016/j.jevs.2020.103243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/07/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022]
Abstract
To examine the influence of detomidine or romifidine on recovery quality from isoflurane anesthesia, 78 anesthetic records were reviewed, from horses that had received romifidine (group R) during premedication [80-120 μg kg-1 IV], anesthetic maintenance (40 μg kg-1 hour-1 IV), and recovery (20 μg kg-1 IV) or detomidine (group D), at doses of 10-20 μg kg-1 IV, 5 μg kg-1 hour-1 IV, and 2.5 μg kg-1 IV, respectively. Duration of the different recovery phases, the number of attempts to sternal and standing, scores for transition to standing (TrSta), balance and coordination once standing (BC), and final recovery score (FS) were compared between groups using a Mann-Whitney U-test, independent t-test, or chi-squared test, as appropriate (alpha 0.05). Parametric data are represented as the mean ± standard deviation, and nonparametric data as the median (interquartile range). Compared with group D (25 horses), horses in group R (53 horses) needed significantly fewer attempts to achieve sternal recumbency [R 1 (1-1) vs. D 1 (1-2)], remained significantly longer in sternal recumbency [R 10 (3-14,5) vs. D 5 (1-9,5) minutes], needed significantly less attempts to stand [R 1 (1-1) vs. D 2 (1-4)], and a significantly shorter time to stand after making their first attempt [R 0 (0-0) vs. D 3 (0-6) minutes], with significantly better scores for TrSta, BC, and FS in group R. The results suggest that, at the doses used, romifidine provides a better recovery quality.
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Affiliation(s)
- Bruna Bodini Alonso
- Faculty of Veterinary Medicine, Department of Surgery and Anaesthesia of Domestic Animals, University of Ghent, Merelbeke, Belgium.
| | - Lavínia La Rosa
- Faculty of Veterinary Medicine, Department of Surgery and Anaesthesia of Domestic Animals, University of Ghent, Merelbeke, Belgium
| | - Adriano Bonfim Carregaro
- School of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo, Pirassununga, São Paulo, Brazil
| | - Frank Gasthuys
- Faculty of Veterinary Medicine, Department of Surgery and Anaesthesia of Domestic Animals, University of Ghent, Merelbeke, Belgium
| | - Stijn Schauvliege
- Faculty of Veterinary Medicine, Department of Surgery and Anaesthesia of Domestic Animals, University of Ghent, Merelbeke, Belgium
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11
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Guedes A, Knych H, Tucker L, Almeida DC, Baldo CF, Wendt-Hornickle E, Allweiler S. Pharmacokinetics and clinical effects of xylazine and dexmedetomidine in horses recovering from isoflurane anesthesia. J Vet Pharmacol Ther 2020; 43:369-376. [PMID: 32166760 DOI: 10.1111/jvp.12855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/29/2020] [Accepted: 02/23/2020] [Indexed: 12/01/2022]
Abstract
This study determined the pharmacokinetics and compared the clinical effects of xylazine and dexmedetomidine in horses recovering from isoflurane anesthesia. Six healthy horses aged 8.5 ± 3 years and weighing 462 ± 50 kg were anesthetized with isoflurane for 2 hr under standard conditions on two occasions one-week apart. In recovery, horses received 200 μg/kg xylazine or 0.875 μg/kg dexmedetomidine intravenously and were allowed to recover without assistance. These doses were selected because they have been used for postanesthetic sedation in clinical and research studies. Serial venous blood samples were collected for quantification of xylazine and dexmedetomidine, and the pharmacokinetic parameters were calculated. Two individuals blinded to treatment identity evaluated recovery quality with a visual analog scale. Times to stand were recorded. Results (mean ± SD) were compared using paired t tests or Wilcoxon signed-ranked test with p < .05 considered significant. Elimination half-lives (62.7 ± 21.8 and 30.1 ± 8 min for xylazine and dexmedetomidine, respectively) and steady-state volumes of distribution (215 ± 123 and 744 ± 403 ml/kg) were significantly different between xylazine and dexmedetomidine, whereas clearances (21.1 ± 17.3 and 48.6 ± 28.1 ml/minute/kg), times to stand (47 ± 24 and 53 ± 12 min) and recovery quality (51 ± 24 and 61 ± 22 mm VAS) were not significantly different. When used for postanesthetic sedation following isoflurane anesthesia in healthy horses, dexmedetomidine displays faster plasma kinetics but is not associated with faster recoveries compared to xylazine.
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Affiliation(s)
- Alonso Guedes
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Heather Knych
- K. L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Laura Tucker
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel C Almeida
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Caroline F Baldo
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Erin Wendt-Hornickle
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sandra Allweiler
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
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12
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Hector RC, Rezende ML, Mama KR, Hess AM. Recovery quality following a single post-anaesthetic dose of dexmedetomidine or romifidine in sevoflurane anaesthetised horses. Equine Vet J 2020; 52:685-691. [PMID: 31975413 DOI: 10.1111/evj.13238] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/13/2019] [Accepted: 01/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Post-anaesthetic sedation is administered to horses to improve recovery quality from inhalant anaesthesia and reduce the risk of catastrophic injury. A single dose of dexmedetomidine for this purpose has not been evaluated clinically. OBJECTIVES To determine whether dexmedetomidine improves recovery quality from sevoflurane anaesthesia compared to a previously studied dose of romifidine. STUDY DESIGN Prospective, randomised, masked clinical trial. METHODS Ninety-nine, adult, client-owned horses anaesthetised for elective procedures completed the trial. Anaesthetic protocol was standardised. Horses were randomly assigned to receive either dexmedetomidine 1 mcg/kg bwt (D) or romifidine 20 mcg/kg bwt (R) intravenously at their first spontaneous breath in recovery. Recoveries were reviewed and independently assigned subjective visual analogue scale (VAS) scores (0-100 mm, worst to best) for overall quality and standing ataxia scores (1-4, none to severe) by two anaesthesiologists blinded to treatment group. Objective anaesthesia and recovery data were also recorded. Comparisons were made using the Chi-square, Wilcoxon rank sum, linear models or Welch-Satterthwaite two-sample t-test (P ≤ .05). Predictors of VAS score were analysed independent of treatment group. RESULTS There were no significant differences between groups except end-tidal sevoflurane (FE´Sevo) concentration and post-induction extra ketamine dosing. Including FE´Sevo and additional ketamine in the analysis as covariates, VAS scores and time to standing were not significantly different between groups. Increased age, not receiving a nerve block, increased duration of hypotension, and having a nervous temperament were significant predictors of VAS score. MAIN LIMITATIONS No universal recovery scale exists for inter-study comparisons. CONCLUSIONS After sevoflurane anaesthesia, sedation with dexmedetomidine or romifidine provides clinically similar recovery time and quality.
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Affiliation(s)
- Rachel C Hector
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Marlis L Rezende
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Khursheed R Mama
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ann M Hess
- Department of Statistics, College of Natural Sciences, Colorado State University, Fort Collins, CO, USA
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Louro LF, Fernández‐Flores FF, Bautista OD, Senior M. Postanaesthetic brachial compartmental syndrome in a horse. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Luís Filipe Louro
- Equine Clinical ScienceUniversity of Liverpool Institute of Veterinary ScienceLiverpoolUK
| | | | | | - Mark Senior
- Equine Clinical ScienceUniversity of Liverpool Institute of Veterinary ScienceLiverpoolUK
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Hollis AR, Pascal M, Van Dijk J, Jolliffe C, Kaartinen J. Behavioural and cardiovascular effects of medetomidine constant rate infusion compared with detomidine for standing sedation in horses. Vet Anaesth Analg 2019; 47:76-81. [PMID: 31619335 DOI: 10.1016/j.vaa.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the efficacy of a medetomidine constant rate infusion (CRI) with a detomidine CRI for standing sedation in horses undergoing high dose rate brachytherapy. STUDY DESIGN Randomized, controlled, crossover, blinded clinical trial. ANIMALS A total of 50 horses with owner consent, excluding stallions. METHODS Each horse was sedated with intravenous acepromazine (0.02 mg kg-1), followed by an α2-adrenoceptor agonist 30 minutes later and then by butorphanol (0.1 mg kg-1) 5 minutes later. A CRI of the same α2-adrenoceptor agonist was started 10 minutes after butorphanol administration and maintained for the treatment duration. Treatments were given 1 week apart. Each horse was sedated with detomidine (bolus dose, 10 μg kg-1; CRI, 6 μg kg-1 hour-1) or medetomidine (bolus dose, 5 μg kg-1; CRI, 3.5 μg kg-1 hour-1). If sedation was inadequate, a quarter of the initial bolus of the α2-adrenoceptor agonist was administered. Heart rate (HR) was measured via electrocardiography, and sedation and behaviour evaluated using a previously published scale. Between treatments, behaviour scores were compared using a Wilcoxon signed-rank test, frequencies of arrhythmias with chi-square tests, and HR with two-tailed paired t tests. A p value <0.05 indicated statistical significance. RESULTS Total treatment time for medetomidine was longer than that for detomidine (p = 0.04), and ear movements during medetomidine sedation were more numerous than those during detomidine sedation (p = 0.03), suggesting there may be a subtle difference in the depth of sedation. No significant differences in HR were found between treatments (p ≥ 0.09). Several horses had arrhythmias, with no difference in their frequency between the two infusions. CONCLUSIONS AND CLINICAL RELEVANCE Medetomidine at this dose rate may produce less sedation than detomidine. Further studies are required to evaluate any clinical advantages to either drug, or whether a different CRI may be more appropriate.
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Affiliation(s)
| | | | - Jan Van Dijk
- Animal Health Trust, Lanwades Park, Kentford, UK
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Tapio HA, Raekallio MR, Mykkänen AK, Al-Ramahi D, Scheinin M, Hautajärvi HJ, Männikkö S, Vainio O. Effects of vatinoxan on cardiorespiratory function, fecal output and plasma drug concentrations in horses anesthetized with isoflurane and infusion of medetomidine. Vet J 2019; 251:105345. [PMID: 31492389 DOI: 10.1016/j.tvjl.2019.105345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022]
Abstract
A constant rate infusion (CRI) of medetomidine is used to balance equine inhalation anesthesia, but its cardiovascular side effects are a concern. This experimental crossover study aimed to evaluate the effects of vatinoxan (a peripheral α2-adrenoceptor antagonist) on cardiorespiratory and gastrointestinal function in anesthetized healthy horses. Six horses received medetomidine hydrochloride 7μg/kg IV alone (MED) or with vatinoxan hydrochloride 140μg/kg IV (MED+V). Anesthesia was induced with midazolam and ketamine and maintained with isoflurane and medetomidine CRI for 60min. Heart rate, carotid and pulmonary arterial pressures, central venous pressure, cardiac output and arterial and mixed venous blood gases were measured. Selected cardiopulmonary parameters were calculated. Plasma drug concentrations were determined. Fecal output was measured over 24h. For statistical comparisons, repeated measures analysis of covariance and paired t-tests were applied. Heart rate decreased slightly from baseline in the MED group. Arterial blood pressures decreased with both treatments, but significantly more dobutamine was needed to maintain normotension with MED+V (P=0.018). Cardiac index (CI) and oxygen delivery index (DO2I) decreased significantly more with MED, with the largest difference observed at 20min: CI was 39±2 and 73±18 (P=0.009) and DO2I 7.4±1.2 and 15.3±4.8 (P=0.014)mL/min/kg with MED and MED+V, respectively. Fecal output or plasma concentrations of dexmedetomidine did not differ between the treatments. In conclusion, premedication with vatinoxan induced hypotension, thus its use in anesthetized horses warrants further studies. Even though heart rate and arterial blood pressures remained clinically acceptable with MED, cardiac performance and oxygen delivery were lower than with MED+V.
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Affiliation(s)
- H A Tapio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Finland.
| | - M R Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Finland
| | - A K Mykkänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Finland
| | - D Al-Ramahi
- Bioanalytical Laboratory, Institute of Biomedicine, Kiinamyllynkatu 10, 20520 Turku, Finland; Unit of Clinical Pharmacology, Turku University Hospital, P.O. Box 52, 20521 Turku, Finland
| | - M Scheinin
- Bioanalytical Laboratory, Institute of Biomedicine, Kiinamyllynkatu 10, 20520 Turku, Finland; Unit of Clinical Pharmacology, Turku University Hospital, P.O. Box 52, 20521 Turku, Finland
| | | | - S Männikkö
- 4Pharma Ltd., Tykistökatu 4D, 20520 Turku, Finland
| | - O Vainio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Finland
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Bettembourg V, Dulgheriu D, Haga HA. Plasma concentrations at two dexmedetomidine constant rate infusions in isoflurane anaesthetized horses: a clinical study. Vet Anaesth Analg 2019; 46:627-635. [PMID: 31395482 DOI: 10.1016/j.vaa.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 03/18/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine dexmedetomidine plasma concentrations at two infusion rates in isoflurane anaesthetized horses and compare cardiovascular effects and anaesthetic recovery between treatments. STUDY DESIGN Prospective, randomized, masked clinical study. ANIMALS Healthy, adult, client-owned, non-food producing horses presented for castration. METHODS Premedication consisted of acepromazine, romifidine and morphine, and anaesthesia was induced with ketamine and midazolam. The horses were randomized to receive dexmedetomidine 0.5 μg kg-1 hour-1 (treatment DL, n = 7) or 1.75 μg kg-1 hour-1 (treatment DH, n = 7) for 90 minutes of isoflurane anaesthesia at an end-tidal concentration of 1.2%. Venous plasma concentrations were determined with liquid chromatography-electrospray-ionization-tandem mass spectrometry. Jugular venous and arterial blood was sampled for blood gas analysis at the start and end of the infusion. Changes in cardiovascular variables from the start to the end of the infusion, and recovery parameters were statistically compared between treatments. RESULTS Fourteen male horses, 2-6 years old, 325-536 kg were included. Mean ± standard deviation dexmedetomidine plasma concentrations at 30, 60 and 90 minutes with treatment DL were 0.22 ± 0.05, 0.29 ± 0.07 and 0.33 ± 0.08 ng mL-1, and with treatment DH were 0.65 ± 0.11, 0.89 ± 0.10 and 1.01 ± 0.10 ng mL-1. The 95% confidence interval for change minute-1 in dexmedetomidine plasma concentrations between 75 and 90 minutes was 0-1% for both treatments. With treatment DH, the heart rate decreased significantly more from the beginning to the end of the infusion compared to DL (p = 0.043). No other significant differences were found between treatments in cardiovascular or recovery parameters. CONCLUSIONS AND CLINICAL RELEVANCE Infusion of dexmedetomidine in isoflurane anaesthetized horses resulted in plasma concentrations with low variation at both infusion rates, approaching stable levels after 75 minutes of infusion. No differences of clinical importance were found when comparing cardiovascular variables and quality of recovery between treatments.
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Affiliation(s)
- Vanessa Bettembourg
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway.
| | - Daniela Dulgheriu
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
| | - Henning Andreas Haga
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
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Neudeck S, Kästner SBR, Wittenberg-Voges L, Rohn K, Hopster K. Comparison of desflurane and propofol at equipotent doses in combination with a constant rate infusion of dexmedetomidine on global and peripheral perfusion and oxygenation in horses. Am J Vet Res 2018; 79:487-495. [DOI: 10.2460/ajvr.79.5.487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
| | - E. J. Love
- School of Veterinary Sciences University of Bristol Bristol UK
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Gozalo-Marcilla M, Gasthuys F, Luna SPL, Schauvliege S. Is there a place for dexmedetomidine in equine anaesthesia and analgesia? A systematic review (2005-2017). J Vet Pharmacol Ther 2017; 41:205-217. [PMID: 29226340 DOI: 10.1111/jvp.12474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
The objective of this review was to perform a literature compilation of all the equine publications that used dexmedetomidine as the first article on this topic was published, in 2005. We also aimed to answer the question whether the use of dexmedetomidine can currently be justified. For that, we compiled information from databases, such as PubMed, Google Scholar and Web of Science and the proceedings of the last veterinary anaesthesiology meetings. Dexmedetomidine is an attractive drug to be used in horses, mainly due to its pharmacokinetic profile and pharmacodynamics that favour its use as intravenous constant rate infusion (CRI). Nowadays, its clinical use is popular for sedation in prolonged standing procedures and during partial intravenous anaesthesia (PIVA) and total intravenous anaesthesia (TIVA). However, legal requirements for its use should be taken into account.
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Affiliation(s)
- M Gozalo-Marcilla
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - F Gasthuys
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - S P L Luna
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - S Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Medeiros LQ, Gozalo-Marcilla M, Taylor PM, Campagnol D, de Oliveira FA, Watanabe MJ, de Araujo Aguiar AJ. Sedative and cardiopulmonary effects of dexmedetomidine infusions randomly receiving, or not, butorphanol in standing horses. Vet Rec 2017; 181:402. [PMID: 28822974 DOI: 10.1136/vr.104359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/22/2017] [Accepted: 07/24/2017] [Indexed: 11/04/2022]
Abstract
Dexmedetomidine (DEX) alone, or combined with butorphanol (BUT), may be administered by constant rate infusions (CRIs) in standing horses. This blinded, randomised, crossover study in six healthy adult horses aimed to determine the sedative and cardiopulmonary effects of DEX (dexmedetomidine (3.5 µg/kg+5 µg/kg/hour CRI) and DEX/BUT (dexmedetomidine (3.5 µg/kg+3.5 µg/kg/hour CRI) and butorphanol (20 µg/kg+24 µg/kg/hour CRI)). Head height above ground (HHAG), ataxia, responses to tactile/auditory stimuli and cardiopulmonary variables were recorded before, at 5/15/30/60/90 minutes and after CRIs terminated (15/30/60 minutes). Repeated measures analysis of variance with Tukey-Kramer test were used for cardiopulmonary values (mean±SD) and HHAG reduction (per cent), and Friedman's and Dunn's for non-parametric data (P<0.05). Maximum HHAG reductions of 54 per cent (DEX) and 58 per cent (DEX/BUT) occurred at 15 minutes, with ataxia for 15 minutes in both treatments. Responses to stimuli were reduced for 30 minutes in both treatments, and auditory up to 60 minutes in DEX. Cardiopulmonary effects typical of α2-agonists were observed, with no differences between treatments. At the doses and rates reported here, both regimens provided clinically sufficient sedation for only 30 minutes.
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Affiliation(s)
- Luíza Quintão Medeiros
- Graduate Program in Anaesthesiology, Medical School of Botucatu, UNESP-Univ Estadual Paulista, Botucatu-SP, Brazil
| | - Miguel Gozalo-Marcilla
- Department of Veterinary Surgery and Anaestesiology, Faculty of Veterinary Medicine and Animal Science, UNESP - Univ Estadual Paulista, Botucatu-SP, Brazil
| | | | - Daniela Campagnol
- Graduate Program in Anaesthesiology, Medical School of Botucatu, UNESP-Univ Estadual Paulista, Botucatu-SP, Brazil
| | - Flávia Augusta de Oliveira
- Graduate Program in Anaesthesiology, Medical School of Botucatu, UNESP-Univ Estadual Paulista, Botucatu-SP, Brazil
| | - Marcos Jun Watanabe
- Department of Veterinary Surgery and Anaestesiology, Faculty of Veterinary Medicine and Animal Science, UNESP - Univ Estadual Paulista, Botucatu-SP, Brazil
| | - Antonio José de Araujo Aguiar
- Department of Veterinary Surgery and Anaestesiology, Faculty of Veterinary Medicine and Animal Science, UNESP - Univ Estadual Paulista, Botucatu-SP, Brazil
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Comparison of sedation and mechanical antinociception induced by intravenous administration of acepromazine and four dose rates of dexmedetomidine in donkeys. Vet Anaesth Analg 2017; 44:509-517. [DOI: 10.1016/j.vaa.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
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Sacks M, Ringer SK, Bischofberger AS, Berchtold SM, Bettschart-Wolfensberger R. Clinical comparison of dexmedetomidine and medetomidine for isoflurane balanced anaesthesia in horses. Vet Anaesth Analg 2017; 44:1128-1138. [PMID: 29037800 DOI: 10.1016/j.vaa.2016.12.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effects of two balanced anaesthetic protocols (isoflurane-dexmedetomidine versus medetomidine) on sedation, cardiopulmonary function and recovery in horses. STUDY DESIGN Prospective, blinded, randomized clinical study. ANIMALS Sixty healthy adult warm blood horses undergoing elective surgery. METHODS Thirty horses each were sedated with dexmedetomidine 3.5 μg kg-1 (group DEX) or medetomidine 7 μg kg-1 (group MED) intravenously. After assessing and supplementing sedation if necessary, anaesthesia was induced with ketamine/diazepam and maintained with isoflurane in oxygen/air and dexmedetomidine 1.75 μg kg-1 hour-1 or medetomidine 3.5 μg kg-1 hour-1. Ringer's lactate (7-10 mL kg-1 hour-1) and dobutamine were administered to maintain normotension. Controlled mechanical ventilation maintained end-tidal expired carbon dioxide pressures at 40-50 mmHg (5.3-6.7 kPa). Heart rate, invasive arterial blood pressure, inspired and expired gas composition and arterial blood gases were measured. Dexmedetomidine 1 μg kg-1 or medetomidine 2 μg kg-1 was administered for timed and scored recovery phase. Data were analysed using two-way repeated-measures analysis of variance and chi-square test. Significance was considered when p≤0.05. RESULTS In group DEX, significantly more horses (n=18) did not fulfil the sedation criteria prior to induction and received one or more supplemental doses, whereas in group MED only two horses needed one additional bolus. Median (range) total sedation doses were dexmedetomidine 4 (4-9) μg kg-1 or medetomidine 7 (7-9) μg kg-1. During general anaesthesia, cardiopulmonary parameters did not differ significantly between groups. Recovery scores in group DEX were significantly better than in group MED. CONCLUSIONS AND CLINICAL RELEVANCE Horses administered dexmedetomidine required more than 50% of the medetomidine dose to reach equivalent sedation. During isoflurane anaesthesia, cardiopulmonary function was comparable between the two groups. Recovery scores following dexmedetomidine were better compared to medetomidine.
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Affiliation(s)
- Muriel Sacks
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Simone K Ringer
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Andrea S Bischofberger
- Clinic for Equine Surgery, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Sabrina M Berchtold
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Cerasoli I, Melis S, Loon G, De Clercq D, Brunsting J, Schauvliege S. Horse: anaesthetic management for open castration of a Belgian draught horse with interventricular septum defect, aortic regurgitation and ventricular premature depolarisations. VETERINARY RECORD CASE REPORTS 2017. [DOI: 10.1136/vetreccr-2016-000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ilaria Cerasoli
- Department of Surgery and AneasthesiologyGhent UniversityMerelbekeBelgium
| | - Sanne Melis
- Pride Veterinary CentreRiverside RdDerbyDE24 8HXUK
| | - Gunther Loon
- Department of Internal MedicineGhent UniversityMerelbekeBelgium
| | | | - Julie Brunsting
- Department of Surgery and AneasthesiologyGhent UniversityMerelbekeBelgium
| | - Stijn Schauvliege
- Department of Surgery and AneasthesiologyGhent UniversityMerelbekeBelgium
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Guedes AGP, Tearney CC, Cenani A, Aristizabal F, Nieto J. Comparison between the effects of postanesthetic xylazine and dexmedetomidine on characteristics of recovery from sevoflurane anesthesia in horses. Vet Anaesth Analg 2017; 44:273-280. [PMID: 28258815 DOI: 10.1016/j.vaa.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare postanesthetic xylazine and dexmedetomidine on recovery characteristics from sevoflurane anesthesia in horses. STUDY DESIGN Randomized, crossover study. ANIMALS Six geldings, mean±standard deviation (SD) (range), 17±4 (11-24) years and 527±80 (420-660) kg. METHODS Horses were anesthetized with sevoflurane for 60 minutes under standardized conditions for a regional limb perfusion study. In recovery, horses were administered either xylazine (200 μg kg-1) or dexmedetomidine (0.875 μg kg-1) intravenously. Recoveries were unassisted and were video-recorded for later evaluation of recovery events and quality by two individuals unaware of treatment allocation. Recovery quality was assessed using a 100 mm visual analog scale (VAS) (0=poor recovery, 100=excellent recovery), the Edinburgh Scoring System (ESS) (0-100; 100=excellent recovery) and the mean attempt interval (MAI) (longer=better). Data are mean±SD. RESULTS All recovery quality assessments (xylazine and dexmedetomidine, respectively: VAS: 71±21 mm, 84±13 mm; ESS: 65±22, 67±30; MAI: 52±24 minutes, 60±32 minutes) and events (first limb movement: 37±8 minutes, 42±10 minutes; first attempt to lift head: 44±12 minutes, 48±9 minutes; first attempt to sternal posture: 57±28 minutes, 50±7 minutes; number of head bangs: 2.0±3.0, 0.5±0.5; time to first attempt to stand: 72±6 minutes, 78±13 minutes; time to standing: 79±14 minutes, 84±13 minutes) did not differ significantly between treatments (p>0.05). CONCLUSIONS AND CLINICAL RELEVANCE Recovery characteristics did not differ significantly between postanesthetic xylazine and dexmedetomidine following 1 hour of sevoflurane anesthesia in horses in this study. Further evaluations in more horses and in younger horses are required to confirm these results.
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Affiliation(s)
- Alonso G P Guedes
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, MN, USA.
| | - Caitlin C Tearney
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Alessia Cenani
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Fabio Aristizabal
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Jorge Nieto
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
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Cagnardi P, Villa R, Ravasio G, Lucatello L, Di Cesare F, Capolongo F, Boccardo A, Pravettoni D. Pharmacokinetics and sedative effects of dexmedetomidine in dairy calves. N Z Vet J 2016; 65:14-18. [DOI: 10.1080/00480169.2016.1237313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- P Cagnardi
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milan 20133, Italy
| | - R Villa
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milan 20133, Italy
| | - G Ravasio
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan 20133, Italy
| | - L Lucatello
- Department of Comparative Biomedicine and Food Science, Università degli Studi di Padova, Legnaro (Padua) 35020, Italy
| | - F Di Cesare
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milan 20133, Italy
| | - F Capolongo
- Department of Comparative Biomedicine and Food Science, Università degli Studi di Padova, Legnaro (Padua) 35020, Italy
| | - A Boccardo
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan 20133, Italy
| | - D Pravettoni
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan 20133, Italy
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Risberg ÅI, Ranheim B, Krontveit RI, Lervik A, Haga HA. The cardiovascular status of isoflurane-anaesthetized horses with and without dexmedetomidine constant rate infusion evaluated at equivalent depths of anaesthesia. Vet Anaesth Analg 2016; 43:412-23. [DOI: 10.1111/vaa.12315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
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Sleiman M, Dinev D, Simeonovа G. The Effects of Dexmedetomidine Continuous Rate Infusion (CRI) on Isoflurane Anaesthesia in Healthy Horses. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijcm.2016.76040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lamuraglia R, Kirkby P, Funcia JP. Cardiopulmonary Effects and Recovery Quality of Remifentanil–Isoflurane Anesthesia in Horses. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gozalo-Marcilla M, Gasthuys F, Schauvliege S. Partial intravenous anaesthesia in the horse: a review of intravenous agents used to supplement equine inhalation anaesthesia. Part 2: opioids and alpha-2 adrenoceptor agonists. Vet Anaesth Analg 2015; 42:1-16. [DOI: 10.1111/vaa.12196] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/13/2013] [Indexed: 01/04/2023]
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Tokushige H, Ohta M, Okano A, Kuroda T, Kakizaki M, Ode H, Aoki M, Wakuno A, Kawasaki K. Effects of Medetomidine Constant Rate Infusion on Sevoflurane Requirement, Cardiopulmonary Function, and Recovery Quality in Thoroughbred Racehorses Undergoing Arthroscopic Surgery. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2014.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pöppel N, Hopster K, Geburek F, Kästner S. Influence of ketamine or xylazine supplementation on isoflurane anaesthetized horses- a controlled clinical trial. Vet Anaesth Analg 2015; 42:30-8. [DOI: 10.1111/vaa.12176] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/06/2013] [Indexed: 11/26/2022]
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Zeiler GE. A review of clinical approaches to antagonism of alpha2-adrenoreceptor agonists in the horse. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G. E. Zeiler
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Onderstepoort South Africa
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Ranheim B, Risberg ÅI, Spadavecchia C, Landsem R, Haga HA. The pharmacokinetics of dexmedetomidine administered as a constant rate infusion in horses. J Vet Pharmacol Ther 2014; 38:93-6. [PMID: 25229603 DOI: 10.1111/jvp.12157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/17/2014] [Indexed: 12/26/2022]
Abstract
Dexmedetomidine, the most selective α2-adrenoceptor agonist in clinical use, is increasingly being used in both conscious and anaesthetized horses; however, the pharmacokinetics and sedative effects of this drug administered alone as an infusion are not previously described in horses. Seven horses received an infusion of 8 μg dexmedetomidine/kg/h for 150 min, venous blood samples were collected, and dexmedetomidine concentrations were assayed using liquid chromatography-mass spectrometry (LC/MS) and analyzed using noncompartmental pharmacokinetic analysis. Sedation was scored as the distance from the lower lip of the horse to the ground measured in centimetre. The harmonic mean (SD) plasma elimination half-life (Lambda z half-life) for dexmedetomidine was 20.9 (5.1) min, clearance (Cl) was 0.3 (0.20) L/min/kg, and volume of distribution at steady-state (Vdss ) was 13.7 (7.9) L/kg. There was a considerable individual variation in the concentration of dexmedetomidine vs. time profile. The level of sedation covaried with the plasma concentration of dexmedetomidine. This implies that for clinical use of dexmedetomidine constant rate infusion in conscious horses, infusion rates can be easily adjusted to effect, and this is preferable to an infusion at a predetermined value.
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Affiliation(s)
- B Ranheim
- Faculty of Veterinary Medicine and Biosciences, The Norwegian University of Life Sciences, Oslo, Norway
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Duke-Novakovski T, Palacios-Jimenez C, Wetzel T, Rymes L, Sanchez-Teran AF. Cardiopulmonary effects of dexmedetomidine and ketamine infusions with either propofol infusion or isoflurane for anesthesia in horses. Vet Anaesth Analg 2014; 42:39-49. [PMID: 24984762 DOI: 10.1111/vaa.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/17/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the cardiopulmonary effects of two anesthetic protocols for dorsally recumbent horses undergoing carpal arthroscopy. STUDY DESIGN Prospective, randomized, crossover study. ANIMALS Six horses weighing 488.3 ± 29.1 kg. METHODS Horses were sedated with intravenous (IV) xylazine and pulmonary artery balloon and right atrial catheters inserted. More xylazine was administered prior to anesthetic induction with ketamine and propofol IV. Anesthesia was maintained for 60 minutes (or until surgery was complete) using either propofol IV infusion or isoflurane to effect. All horses were administered dexmedetomidine and ketamine infusions IV, and IV butorphanol. The endotracheal tube was attached to a large animal circle system and the lungs were ventilated with oxygen to maintain end-tidal CO2 40 ± 5 mmHg. Measurements of cardiac output, heart rate, pulmonary arterial and right atrial pressures, and body temperature were made under xylazine sedation. These, arterial and venous blood gas analyses were repeated 10, 30 and 60 minutes after induction. Systemic arterial blood pressures, expired and inspired gas concentrations were measured at 10, 20, 30, 40, 50 and 60 minutes after induction. Horses were recovered from anesthesia with IV romifidine. Times to extubation, sternal recumbency and standing were recorded. Data were analyzed using one and two-way anovas for repeated measures and paired t-tests. Significance was taken at p ≤ 0.05. RESULTS Pulmonary arterial and right atrial pressures, and body temperature decreased from pre-induction values in both groups. PaO2 and arterial pH were lower in propofol-anesthetized horses compared to isoflurane-anesthetized horses. The lowest PaO2 values (70-80 mmHg) occurred 10 minutes after induction in two propofol-anesthetized horses. Cardiac output decreased in isoflurane-anesthetized horses 10 minutes after induction. End-tidal isoflurane concentration ranged 0.5%-1.3%. CONCLUSION AND CLINICAL RELEVANCE Both anesthetic protocols were suitable for arthroscopy. Administration of oxygen and ability to ventilate lungs is necessary for propofol-based anesthesia.
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Affiliation(s)
- Tanya Duke-Novakovski
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Benmansour P, Husulak ML, Bracamonte JL, Beazley SG, Withnall E, Duke-Novakovski T. Cardiopulmonary effects of an infusion of remifentanil or morphine in horses anesthetized with isoflurane and dexmedetomidine. Vet Anaesth Analg 2014; 41:346-56. [DOI: 10.1111/vaa.12149] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
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Gozalo-Marcilla M, Hopster K, Gasthuys F, Krajewski AE, Schwarz A, Schauvliege S. Minimum end-tidal sevoflurane concentration necessary to prevent movement during a constant rate infusion of morphine, or morphine plus dexmedetomidine in ponies. Vet Anaesth Analg 2014; 41:212-9. [DOI: 10.1111/vaa.12090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/25/2013] [Indexed: 12/01/2022]
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Hunt JR, Slingsby LS, Murrell JC. The effects of an intravenous bolus of dexmedetomidine following extubation in a mixed population of dogs undergoing general anaesthesia and surgery. Vet J 2014; 200:133-9. [PMID: 24582423 DOI: 10.1016/j.tvjl.2014.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 11/25/2022]
Abstract
An observer blinded, placebo controlled study evaluated the effects of 62.5 μg/m(2) dexmedetomidine administered IV on recovery from isoflurane anaesthesia in dogs. Forty-four healthy dogs, weighing 1.8-19.95 kg, presented for surgery that was expected to cause mild to moderate pain were studied. All were premedicated with 125 μg/m(2) dexmedetomidine and 20 μg/kg buprenorphine IM. Anaesthesia was induced with propofol and maintained with isoflurane. Non-steroidal anti-inflammatory drugs and local anaesthetics were administered as appropriate. Immediately prior to extubation dogs were treated with dexmedetomidine 62.5 μg/m(2) (group D) or an equivalent volume of heparinised saline (S). Assessments of heart rate, respiratory rate, pain (short form Glasgow composite pain scale [SF-GCPS], dynamic interactive visual analogue scale [DIVAS]), sedation (simple descriptive scale [SDS], DIVAS) and mechanical nociceptive threshold (MNT) were performed immediately before premedication, 20 min later, at the time of test drug administration (T0) and at 15-30 min intervals for four hours (T240 min). Recovery quality was scored 0 - 3 (SDS). Data were analysed with Student's t and Mann-Whitney U tests, two-way ANOVA and Fisher's exact test. Significantly fewer poor quality recoveries were observed in group D (D 2 [1-3]; S 2 [0-3]; P=0.02), however, sedation was increased in group D compared to group S from T15 to T150 min (P=0.0001). Pain scores were lower in group D compared to group S from T15 to T120 min (P=0.001), but the requirement for additional analgesia in the first 4h following extubation was not different between groups. Dexmedetomidine may decrease the incidence of poor quality anaesthetic recoveries in dogs.
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Affiliation(s)
- James R Hunt
- University of Bristol, Department of Clinical Veterinary Sciences, Langford House BS40 5DU, UK.
| | - Louisa S Slingsby
- University of Bristol, Department of Clinical Veterinary Sciences, Langford House BS40 5DU, UK
| | - Joanna C Murrell
- University of Bristol, Department of Clinical Veterinary Sciences, Langford House BS40 5DU, UK
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Gozalo-Marcilla M, Steblaj B, Schauvliege S, Duchateau L, Gasthuys F. Comparison of the influence of two different constant-rate infusions (dexmedetomidine versus morphine) on anaesthetic requirements, cardiopulmonary function and recovery quality in isoflurane anaesthetized horses. Res Vet Sci 2013; 95:1186-94. [DOI: 10.1016/j.rvsc.2013.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/28/2013] [Accepted: 09/26/2013] [Indexed: 11/16/2022]
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Valverde A. Balanced Anesthesia and Constant-Rate Infusions in Horses. Vet Clin North Am Equine Pract 2013; 29:89-122. [DOI: 10.1016/j.cveq.2012.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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GOZALO-MARCILLA M, HOPSTER K, GASTHUYS F, HATZ L, KRAJEWSKI AE, SCHAUVLIEGE S. Effects of a constant-rate infusion of dexmedetomidine on the minimal alveolar concentration of sevoflurane in ponies. Equine Vet J 2012; 45:204-8. [DOI: 10.1111/j.2042-3306.2012.00613.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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