An investigation of the action and haemolytic effect of glyceryl guaiacolate in the horse

A review of equine anesthetic induction: Are all equine anesthetic inductions "crash" inductions?

Horses are the most challenging of the common companion animals to anesthetize. Induction of anesthesia in the horse is complicated by the fact that it is accompanied by a transition from a conscious standing position to uncconconscious recumbency. The purpose of this article is to review the literature on induction of anesthesia with a focus on the behavioral and physiologic/pharmacodynamic responses and the actions and interactions of the drugs administered to induce anesthesia in the healthy adult horse with the goal of increasing consistency and predictability.

Anaesthesia in horses using halothane and intravenous ketamine-guaiphenesin: a clinical study

OBJECTIVE

The aim of this study was to define and evaluate a combined inhalation-intravenous anaesthetic protocol for use in equine anaesthesia.

STUDY DESIGN

Prospective, randomized clinical trial.

ANIMALS

Twenty-eight horses (body mass 522 ± 82; 330-700 kg [mean ± SD; range]) with a mean age of 6 ± 4 years (range: 2-18 years) presented to the university hospital for various surgical procedures requiring general anaesthesia.

MATERIALS AND METHODS

Animals were randomly allocated to one of two treatment groups. Anaesthesia was maintained in 14 horses with halothane alone (H group). The mean end-tidal halothane concentration was 1.24%. In the second group (n = 14) anaesthesia was maintained with both halothane (end-tidal concentration 0.61%) and a continuous infusion of a ketamine-guaiphenesin mixture (HKG group). The two techniques were compared in terms of qualitative differences and cardiopulmonary effects.

RESULTS

The stability of anaesthesia was significantly greater in group HKG and the need for dobutamine to maintain blood pressure was significantly less. Recovery times and quality were acceptable in all cases. There were no significant differences between the groups.

CONCLUSIONS

The infusion of ketamine and guaiphenesin in horses receiving low inspired concentrations of halothane provides suitable surgical anaesthesia and lowers the risk of hypotension.

CLINICAL RELEVANCE

The anaesthetic technique described in this study is a useful and practical alternative to inhalation anaesthesia using halothane alone.

Evaluation of the clinical efficacy of two partial intravenous anesthetic protocols, compared with isoflurane alone, to maintain general anesthesia in horses

OBJECTIVE

To compare the ability of 2 partial IV anesthesia (PIVA) techniques to maintain anesthesia, compared with isoflurane alone, in horses.

ANIMALS

45 horses.

PROCEDURES

Client-owned horses requiring general anesthesia for a variety of procedures of at least 1 hour's duration were randomly allocated to 3 groups (n = 15/group) that differed for the maintenance protocol. Anesthesia was maintained with isoflurane with a starting end-tidal isoflurane concentration of 1.3% (isoflurane group) or a concentration of 1% supplemented with an adjustable continuous infusion of guaifenesin-ketamine (IGK group) or romifidine-ketamine (IRK group). A predefined scoring system was used to assess anesthetic depth and to adjust anesthetic delivery. The need for rescue anesthetics and recovery quality were compared.

RESULTS

A mean ± SD end-tidal isoflurane concentration of 1.36 ± 0.16% was necessary to maintain a surgical plane of anesthesia in the isoflurane group. Mean infusion rates of 5.0 ± 1.3 μL/kg/min and 5.1 ± 0.8 μL/kg/min were necessary to maintain a surgical plane of anesthesia in the IRK and IGK groups, respectively. A lower need for ketamine as a rescue anesthetic was observed in the IGK group, compared with the isoflurane group. Higher blood pressure and lower heart rates were found at selected time points for the IRK group, compared with the IGK and isoflurane groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Both PIVA protocols were satisfactory to maintain smooth and stable surgical anesthesia in horses. The present study supports previous findings in which PIVA has isoflurane-sparing effects. Furthermore, PIVA did not impair recovery quality.

Emergency analgesia and chemical restraint in the horse

Clinical examination of the equine patient with acute abdominal pain should identify the affected body system and yield a provisional diagnosis. Determination of signalment, history, physical examination, and basic laboratory tests should assist in classification of the gastrointestinal disorder and direct the therapeutic plan. Determination of the definitive diagnosis of abdominal pain based on clinical examination is not crucial. For a successful outcome, efforts should be directed toward early recognition of the need for surgery and treatment of cardiovascular compromise in horses with severe gastrointestinal disease.

Clinical evaluation of an infusion of xylazine, guaifenesin and ketamine for maintenance of anaesthesia in horses

General anaesthesia was maintained in 40 horses by the continuous intravenous infusion of a mixture of 500 ml 10% guaifenesin solution, 1 g ketamine and 500 mg xylazine. The median duration of infusion was 65 mins (interquartile range 51-95 mins). Anaesthesia was characterised by active palpebral reflexes, variable degrees of nystagmus and occasional swallowing. Swallowing was considered to be undesirable in horses undergoing laryngeal surgery, but the infusion produced satisfactory conditions for all other surgical procedures performed. Arterial blood pressure was well maintained in all cases (median mean arterial blood pressure = 85 mmHg after 30 mins anaesthesia). Heart rate and PaCO2 were significantly lower, whilst PaO2 was significantly higher in the infusion group than in a group of paired control horses which were anaesthetised with halothane. Recovery from anaesthesia was good (Grades 1-2) in 33 horses. Median times to sternal recumbency and to standing were 24 and 38 mins respectively. The infusion caused a significant fall in packed cell volume, haemoglobin concentration and red blood cell count (P < 0.01) and a significant rise in plasma glucose concentration (P < 0.01). These variables returned to pre-infusion values within 24 h.

Effects of 5% and 10% guaifenesin infusion on equine vascular endothelium

Twelve horses of various breeds and either sex were anesthetized with xylazine and ketamine injected into a median or lateral thoracic vein. During anesthesia, with the horse in sternal recumbency, a 14-gauge, 8.9 cm catheter was inserted into each jugular vein by using aseptic technique. Guaifenesin in water (100 mg/kg or a maximum dose of 50 grams) was infused into one jugular vein and an equal volume of 0.9% saline solution was infused into the other jugular vein. Seven horses received 10% guaifenesin, and five horses received 5% guaifenesin. The catheters were removed before the horses recovered from anesthesia. The horses were euthanatized approximately 48 hours later, and the jugular veins were removed for histologic examination. Adherent thrombus material was observed in all veins exposed to 10% guaifenesin and in one vein exposed to 5% guaifenesin. No evidence of thrombus was observed in four veins infused with 5% guaifenesin or in those infused with saline solution. These findings are of particular significance with horses at increased risk for thrombosis or thrombophlebitis.

A comparison of xylazine-diazepam-ketamine and xylazine-guaifenesin-ketamine in equine anesthesia

After sedation with xylazine (0.3 mg/kg intravenously [IV]), anesthesia was induced in six healthy horses with ketamine (2.0 mg/kg IV) and guaifenesin (100 mg/kg IV), diazepam (0.05 mg/kg IV), or diazepam (0.10 mg/kg IV). Anesthesia was maintained with halothane for 30 minutes. Heart rate, respiratory rate, direct arterial blood pressure, arterial blood gas, and pH measurements were made before, and at set intervals after, induction of anesthesia. Quality and characteristics of induction and recovery were evaluated objectively by an independent observer unaware of the protocol used. There were no significant differences among the three protocols from pre-induction values for arterial blood pressure, blood gas values, and pH. There was significantly greater ataxia at induction with the use of guaifenesin. The nature of induction, transition to and recovery from general anesthesia were comparable between guaifenesin and the higher dose of diazepam. Because of movements and difficulty with intubation, the lower dose of diazepam was considered unsatisfactory. It was concluded that diazepam (0.10 mg/kg) could be substituted for guaifenesin (100 mg/kg) to produce comparable quality of anesthesia in horses.

Jugular thrombophlebitis resulting from an anaesthetic induction technique in the horse

Forty-eight hours after general anaesthesia was induced by glycerol guaiacolate and thiopentone sodium in 10 horses, the jugular veins were dissected out at post-mortem and examined visually and histologically. All veins showed a marked thrombophlebitis involving the media and intima at the site of injection. The influence of catheter composition, catheter placement and chemical composition on the occurrence of the thrombophlebitis is discussed. It is concluded that the thrombophlebitis was chemically induced.

Arterial blood PO2 and PCO2 in horses during early halothane-oxygen anaesthesia

Arterial blood was collected from 25 clinically normal horses immediately before and serially throughout the first hour of halothane oxygen anaesthesia. Blood was analysed for oxygen and carbon dioxide partial pressure (PaO2, PaCO2). Measurements of inspired oxygen concentration during anaesthesia permitted direct correlation with blood gases. Horses were divided arbitrarily into two groups based on their age: two to seven years, n = 15; over seven years, n = 10. Average (+/- sd) PaO2 and PaCO2 was 14.1 +/- 1.5 kPa (106 +/- 11 mmHg) and 5.9 +/- 0.6 kPa (44.4 +/- 4.4 mmHg) respectively in conscious, young horses and 14.0 +/- 0.7 and 5.8 +/- 0.5 kPa (105 +/- 5 and 43.3 +/- 3.8 mmHg) respectively in conscious older horses. Arterial oxygen tension decreased to 9.3 +/- 1.0 and 8.5 +/- 1.4 kPa (69.6 +/- 7.8 and 63.7 +/- 10.4 mmHg) in young and older air breathing horses respectively immediately following intravenous anaesthetic induction, recumbency and orotracheal intubation. At this time, PaCO2 was 6.5 +/- 0.5 and 6.0 +/- 0.7 kPa (48.7 +/- 3.5 and 45.1 +/- 4.9 mmHg) respectively. By 30 mins after the start of halothane in oxygen (6 litres/min) anaesthesia PaO2 increased to a maximum in both study groups. Arterial PCO2 increased steadily during anaesthesia and 60 mins after induction PaCO2 was 10.5 +/- 2.4 kPa (78.5 +/- 17.8 mmHg) in the younger horses and 9.2 +/- 1.6 kPa (68.8 +/- 11.8 mmHg) in the older horses. During inhalation anaesthesia PaO2 tended to be greater at comparable time periods in the younger horses despite a slightly greater degree of hypoventilation.

Some metabolic and hormonal changes associated with general anaesthesia and surgery in the horse

Three different anaesthetic techniques were studied in normal, healthy Thoroughbred or Thoroughbred type horses. These were (a) acepromazine, thiopentone and suxamethonium; (b) acepromazine, glyceryl guaiacolate and a 'half-dose' of thiopentone; and (c) xylazine and ketamine. Anaesthesia was maintained with halothane vaporized in oxygen and nitrous oxide. All horses underwent either laryngeal or body surface surgery. Heart rate, packed cell volume, blood glucose and lactate, plasma non-esterified fatty acids, insulin and cortisol were measured before, during and after surgery. The greatest metabolic and hormonal changes occurred immediately after anaesthetic induction and were different in each group. The combination of acepromazine, glyceryl guaiacolate and a 'half-dose' of thiopentone was associated with the least change in the physiological and metabolic variables measured.

Use of guaiacol glycerine ether in clinical anaesthesia in the horse

A total of 103 anaesthetic inductions were performed in horses for a variety of elective procedures. All cases were premedicated with acepromazine maleate (0.02 to 0.05 mg/kg body weight [bwt] intramuscularly [im]). In 50 cases (Group A) anaesthesia was induced by a single intravenous (iv) bolus of thiopentone sodium (11.1 mg/kg bwt or 1 g/90 kg bwt) followed immediately by a bolus of suxamethonium chloride (0.1 mg/kg bwt). In 53 cases (Group B) anaesthesia was induced using iv guaiacol glycerine ether (GGE) (approximately 50 mg/kg bwt) followed by a bolus of thiopentone at half the usual dose rate (5.6 mg/kg bwt or 1 g/180 kg bwt). Induction of anaesthesia was uneventful in both groups although in Group B it was particularly smooth. Following endotracheal intubation anaesthesia was maintained with halothane in oxygen administered via a circle system. The duration of anaesthesia was comparable between the two groups; however, the mean (+/- sd) time to standing in Group B, 35 +/- 22 mins, was significantly shorter than in Group A, 48 +/- 25 mins. The use of the GGE/thiopentone technique is discussed.

Observations on the use of glyceryl guaiacolate as an adjunct to general anaesthesia in horses

Twenty-one horses undergoing clinical surgery and diagnostic procedures received 15% glyceryl guaiacolate followed by a rapid intravenous injection of a thiobarbiturate for induction of anaesthesia. Premedication was with atropine and acepromazine. Induction was smooth and free from problems apart from transient apnoea in some horses. Maintenance of anaesthesia was with oxygen and halothane administered by means of a closed circle system with soda-lime absorber and with the vaporiser out of circuit. During the period immediately following induction, the heart rate increased and the respiratory rate fell. Blood gas estimations were carried out on 6 horses during anaesthesia. These horses showed respiratory acidosis. Arterial blood oxygen tension values were above those reported in conscious horses. Use of glyceryl guaiacolate in this way provides a safe induction and enables transition to a stable maintenance period which is followed by a quiet and uneventful recovery.