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Bustamante R, González-Pérez E, Caro-Vadillo A, Aguado D. Impact of preanaesthetic electrocardiogram on decision making and modification of anaesthetic protocols in dogs. Vet Rec 2024:e4266. [PMID: 38975620 DOI: 10.1002/vetr.4266] [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: 01/13/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND This retrospective observational study explored the impact of preanaesthetic electrocardiogram (ECG) assessment on preoperative echocardiography requests and modifications to a standardised anaesthetic protocol in healthy dogs. METHODS A total of 228 healthy dogs with no previously diagnosed heart disease that underwent general anaesthesia at Complutense Veterinary Teaching Hospital from December 2017 to June 2018 were included. Preanaesthetic ECGs were assessed for abnormalities, and the findings were documented. The number of dogs requiring echocardiography, based on ECG findings, and the echocardiography results were recorded. All anaesthesia-related decisions were documented. RESULTS Overall, 72 dogs (31.6%) exhibited ECG abnormalities. Echocardiography was requested for five dogs (2.2%). The anaesthetic protocol was changed in 11 dogs (15.3% of those with ECG abnormalities). P wave disturbances, ventricular premature complexes and impulse conduction issues were abnormalities that prompted echocardiography. Bradycardia and electrical impulse conduction abnormalities influenced protocol modifications. LIMITATIONS The limited sample size meant that it was not possible to investigate potential correlations between demographics and ECG alterations. CONCLUSIONS Preanaesthetic ECG screening was useful for promoting echocardiography and influencing anaesthesia plans in a subset of dogs. Despite this, further assessment of the impact of routine use of non-targeted preoperative ECG on anaesthesia-related outcomes is warranted.
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Affiliation(s)
- Rocío Bustamante
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Complutense University of Madrid, Madrid, Spain
| | - Eva González-Pérez
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alicia Caro-Vadillo
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Complutense University of Madrid, Madrid, Spain
| | - Delia Aguado
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Complutense University of Madrid, Madrid, Spain
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2
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Casoria V, Greet V, Auckburally A, Murphy S, Flaherty D. Comparison of the effects of propofol and alfaxalone on the electrocardiogram of dogs, with particular reference to QT interval. Front Vet Sci 2024; 10:1330111. [PMID: 38260194 PMCID: PMC10800659 DOI: 10.3389/fvets.2023.1330111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Cardiac electrical activity is often altered by administration of anesthetic drugs. While the effects of propofol in this regard have previously been described in dogs, to date, there are no reports of the effect of alfaxalone. This study investigated the impact of both propofol and alfaxalone on the ECG of 60 dogs, after premedication with acepromazine and methadone. Heart rate increased significantly in both groups. The PR and QRS intervals were significantly increased following propofol while with alfaxalone the QRS duration was significantly increased and ST segment depression was observed. The QT and JT interval were significantly shorter following induction with alfaxalone, but, when corrected (c) for heart rate, QTc and JTc in both groups were significantly greater following induction. When comparing the magnitude of change between groups, the change in RR interval was greater in the alfaxalone group. The change in both QT and JT intervals were significantly greater following alfaxalone, but when QTc and JTc intervals were compared, there were no significant differences between the two drugs. The similarly increased QTc produced by both drugs may suggest comparable proarrhythmic effects.
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Affiliation(s)
- Vincenzo Casoria
- Department of Anaesthesia and Analgesia, Southern Counties Veterinary Specialists, Ringwood, United Kingdom
| | - Victoria Greet
- Department of Cardiology, Southern Counties Veterinary Specialists, Ringwood, United Kingdom
| | - Adam Auckburally
- Department of Anaesthesia and Analgesia, Southern Counties Veterinary Specialists, Ringwood, United Kingdom
| | - Steve Murphy
- Department of Anaesthesia and Analgesia, Southern Counties Veterinary Specialists, Ringwood, United Kingdom
| | - Derek Flaherty
- Department of Anaesthesia and Analgesia, Southern Counties Veterinary Specialists, Ringwood, United Kingdom
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3
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Bini G, Bailey KM, Voyvodic JT, Chiavaccini L, Munana KR, Keenihan EK. Effects of alfaxalone, propofol and isoflurane on cerebral blood flow and cerebrovascular reactivity to carbon dioxide in dogs: A pilot study. Vet J 2023; 291:105939. [PMID: 36509393 DOI: 10.1016/j.tvjl.2022.105939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Propofol total intravenous anesthesia is a common choice to anesthetize patients with increased intracranial pressure, reducing cerebral blood flow while maintaining cerebrovascular reactivity to CO2. Propofol and alfaxalone are commonly used for total intravenous anesthesia in dogs, but the effects of alfaxalone on cerebral blood flow and cerebrovascular reactivity to CO2 are unknown. Our hypothesis was that alfaxalone would not be significantly different to propofol, while isoflurane would increase cerebral blood flow and decrease cerebrovascular reactivity to CO2. Six healthy hound dogs were evaluated in this randomized crossover trial. Dogs were anesthetized with 7.5 mg/kg propofol, 3 mg/kg alfaxalone or 8 % sevoflurane, mechanically ventilated and maintained with propofol (400 µg/kg/min), alfaxalone (150 µg/kg/min) or 1.7 % end-tidal isoflurane, respectively, with one week washout between treatments. Cerebral blood flow and cerebrovascular reactivity to CO2 during hypercapnic and hypocapnic challenges were measured using arterial spin labelling and blood oxygen level-dependent magnetic resonance imaging sequences, respectively. Median (interquartile range, IQR) normocapnic cerebral blood flow was significantly lower (P = 0.016) with alfaxalone compared to isoflurane, in the whole brain 15.39 mL/min/100 g (14.90-19.90 mL/min/100 g) vs. 34.10 mL/min/100 g (33.35-43.17 mL/min/100 g), the grey matter 14.57 mL/min/100 g (13.66-18.72 mL/min/100 g) vs. 32.37 mL/min/100 g (31.03-42.99 mL/min/100 g), the caudal brain 15.47 mL/min/100 g (13.37-21.45 mL/min/100 g) vs. 36.85 mL/min/100 g (32.50-47.18 mL/min/100 g) and the temporal lobe grey matter 18.80 mL/min/100 g (15.89-20.84 mL/min/100 g) vs. 43.32 (36.07-43.58 mL/min/100 g). Median (IQR) hypocapnic cerebrovascular reactivity to CO2 was significantly higher (P = 0.016) for alfaxalone compared to isoflurane 8.85 %S/mm Hg (6.92-10.44 %S/mm Hg) vs. 3.90 %S/mm Hg (3.80-4.33 %S/mm Hg). Alfaxalone maintained lower cerebral blood flow and higher hypocapnic cerebrovascular reactivity to CO2 than isoflurane.
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Affiliation(s)
- G Bini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA.
| | - K M Bailey
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - J T Voyvodic
- Brain Imaging and Analysis Center, Radiology Department, Duke University, 40 Duke Medicine Circle, Durham, NC 27710, USA
| | - L Chiavaccini
- Department of Comparative, Diagnostic & Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL 32608, USA
| | - K R Munana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - E K Keenihan
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
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HANAZONO K, NAKAMOTO M, HORI A, MIYOSHI K, NAKADE T, ITAMI T, SANO T, KATO K, ITO A, TANAKA K, YAMASHITA K, ENDOH D. Evaluation of caudal vena cava size using computed tomography in dogs under general anesthesia. J Vet Med Sci 2022; 84:1556-1562. [PMID: 36244742 PMCID: PMC9791227 DOI: 10.1292/jvms.22-0122] [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] [Indexed: 11/18/2022] Open
Abstract
This study investigated the association between caudal vena cava (CVC) size and circulatory dynamics in dogs using computed tomography (CT) under general anesthesia. The subjects were 104 dogs who had undergone CT under general anesthesia in the past. The ratio of short diameter of the CVC to aortic diameter (CVCS/Ao) and the ratio of long to short diameter of the CVC (CVCL/CVCS) in the thorax and abdomen, respectively, were calculated using factors such as mean blood pressure (MBP), shock index (SI), anemia, hypoproteinemia, presence of intra-abdominal mass, and cardiac disease. There was a significant but negligible negative correlation between CVCS/Ao and MBP. In contrast, no significant correlation was found between CVC size and SI. The low MBP group had significantly higher CVCS/Ao of the thorax than the normal MBP group. The group with intra-abdominal mass had significantly lower CVCS/Ao of the abdomen than the group without intra-abdominal mass. The group with cardiac disease had significantly lower CVCL/CVCS of the thorax than the group without cardiac disease. In multiple regression analysis, low MBP, cardiac disease, intra-abdominal mass, and anemia were significant factors for CVCS/Ao of the thorax, CVCL/CVCS of the thorax, CVCS/Ao of the abdomen, and CVCL/CVCS of the abdomen, respectively. In conclusion, CVC size assessment using CT in dogs under general anesthesia is influenced by various factors.
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Affiliation(s)
- Kiwamu HANAZONO
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan,Correspondence to: Hanazono K: , School of
Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai-Midorimachi, Ebetsu, Hokkaido
069-8501, Japan
| | - Mako NAKAMOTO
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Ai HORI
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Kenjiro MIYOSHI
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Tetsuya NAKADE
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Takaharu ITAMI
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Tadashi SANO
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Keiko KATO
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Akifumi ITO
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Kakeru TANAKA
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Kazuto YAMASHITA
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
| | - Daiji ENDOH
- School of Veterinary Medicine, Rakuno Gakuen University,
Hokkaido, Japan
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5
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Comparison of blind and endoscopic-guided orotracheal intubation on laryngeal and tracheal damage in domestic rabbits (Oryctolagus cuniculus). Vet Anaesth Analg 2022; 49:398-406. [DOI: 10.1016/j.vaa.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 11/24/2022]
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6
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Martín Bellido V, Vettorato E. Clinical review of the pharmacological and anaesthetic effects of alfaxalone in dogs. J Small Anim Pract 2021; 63:341-361. [PMID: 34893985 DOI: 10.1111/jsap.13454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/11/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023]
Abstract
This clinical review summarises the pharmacological and anaesthetic properties of alfaxalone in the dog. Available pharmacokinetic-pharmacodynamic data and factors affecting the induction dose have been reported. Furthermore, quality of induction and recovery after alfaxalone administration, the use of alfaxalone for total intravenous anaesthesia, and its effects on the cardio-respiratory system, on laryngeal motion, on intraocular pressure and tear production have been evaluated. Finally, the use of alfaxalone in dogs undergoing caesarean section and the effect of intramuscular alfaxalone administration have been considered.
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Affiliation(s)
- V Martín Bellido
- Dick White Referrals, Station Farm - London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - E Vettorato
- Dick White Referrals, Station Farm - London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
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7
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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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8
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Vettorato E. Persistent hypotension resolved by neostigmine administration in a dog in which atracurium was used. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.59] [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]
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9
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Medina‐Serra R, Palacios C, McMillan M. Alternative anaesthetic management in a reintervention for correction of a left‐to‐right shunting patent ductus arteriosus (PDA) in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Roger Medina‐Serra
- Royal Veterinary College Department of Veterinary, Clinical Sciences Anaesthesia and Analgesia Hatfield UK
| | | | - Matthew McMillan
- Royal Veterinary College Queen Mother Hosptial for Animals Hatfield UK
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10
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Xu JJ, Yousuf Z, Ouyang Z, Kennedy E, Lester PA, Martin T, Bruns TM. Anesthetic agents affect urodynamic parameters and anesthetic depth at doses necessary to facilitate preclinical testing in felines. Sci Rep 2020; 10:11401. [PMID: 32647241 PMCID: PMC7347647 DOI: 10.1038/s41598-020-68395-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/22/2020] [Indexed: 01/23/2023] Open
Abstract
Urodynamic studies, used to understand bladder function, diagnose bladder disease, and develop treatments for dysfunctions, are ideally performed with awake subjects. However, in small and medium-sized animal models, anesthesia is often required for these procedures and can be a research confounder. This study compared the effects of select survival agents (dexmedetomidine, alfaxalone, and propofol) on urodynamic (Δpressure, bladder capacity, bladder compliance, non-voiding contractions, bladder pressure slopes) and anesthetic (change in heart rate [∆HR], average heart rate [HR], reflexes, induction/recovery times) parameters in repeated cystometrograms across five adult male cats. The urodynamic parameters under isoflurane and α-chloralose were also examined in terminal procedures for four cats. Δpressure was greatest with propofol, bladder capacity was highest with α-chloralose, non-voiding contractions were greatest with α-chloralose. Propofol and dexmedetomidine had the highest bladder pressure slopes during the initial and final portions of the cystometrograms respectively. Cats progressed to a deeper plane of anesthesia (lower HR, smaller ΔHR, decreased reflexes) under dexmedetomidine, compared to propofol and alfaxalone. Time to induction was shortest with propofol, and time to recovery was shortest with dexmedetomidine. These agent-specific differences in urodynamic and anesthetic parameters in cats will facilitate appropriate study-specific anesthetic choices.
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Affiliation(s)
- Jiajie Jessica Xu
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Zuha Yousuf
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Zhonghua Ouyang
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Eric Kennedy
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Patrick A Lester
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tara Martin
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA. .,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA.
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11
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Cazlan CE, Hay Kraus BL. Effects of 2% lidocaine hydrochloride solution as a coinduction agent with propofol on cardiopulmonary variables and administered propofol doses in healthy dogs premedicated with hydromorphone hydrochloride and acepromazine maleate. J Am Vet Med Assoc 2020; 256:93-101. [PMID: 31841086 DOI: 10.2460/javma.256.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of lidocaine as a coinduction agent with propofol on cardiopulmonary variables and administered propofol doses in healthy dogs premedicated with hydromorphone hydrochloride and acepromazine maleate and anesthetized with isoflurane. ANIMALS 40 client-owned dogs (American Society of Anesthesiologists physical status classification I or II and age ≥ 6 months) scheduled to undergo anesthesia for elective procedures. PROCEDURES In a randomized, blinded, controlled clinical trial, dogs received 2% lidocaine hydrochloride solution (2.0 mg/kg [0.9 mg/lb], IV; n = 20) or buffered crystalloid solution (0.1 mL/kg [0.05 mL/lb], IV; 20; control treatment) after premedication with acepromazine (0.005 mg/kg [0.002 mg/lb], IM) and hydromorphone (0.1 mg/kg, IM). Anesthesia was induced with propofol (1 mg/kg [0.45 mg/lb], IV, with additional doses administered as needed) and maintained with isoflurane. Sedation was assessed, and anesthetic and cardiopulmonary variables were measured at various points; values were compared between treatment groups. RESULTS Propofol doses, total sedation scores, and anesthetic and most cardiopulmonary measurements did not differ significantly between treatment groups over the monitoring period; only oxygen saturation as measured by pulse oximetry differed significantly (lower in the lidocaine group). Mean ± SD propofol dose required for endotracheal intubation was 1.30 ± 0.68 mg/kg (0.59 ± 0.31 mg/lb) and 1.41 ± 0.40 mg/kg (0.64 ± 0.18 mg/lb) for the lidocaine and control groups, respectively. CONCLUSIONS AND CLINICAL RELEVANCE No propofol-sparing effect was observed with administration of lidocaine as a coinduction agent for the premedicated dogs of this study. Mean propofol doses required for endotracheal intubation were considerably lower than currently recommended doses for premedicated dogs. (J Am Vet Med Assoc 2020;256:93-101).
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12
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Bravo VR, Palomba N, Corletto F, Willis R, Vettorato E. Comparison between intravenous lidocaine and fentanyl on cough reflex and sympathetic response during endotracheal intubation in dogs. Vet Anaesth Analg 2020; 47:481-489. [PMID: 32439239 DOI: 10.1016/j.vaa.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/26/2019] [Accepted: 11/11/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the effects of intravenous (IV) lidocaine and fentanyl on the cough reflex and autonomic response during endotracheal intubation in dogs. STUDY DESIGN Randomized, blinded, superiority clinical trial. ANIMALS A total of 46 client-owned dogs undergoing magnetic resonance imaging. METHODS After intramuscular methadone (0.2 mg kg-1), dogs were randomized to be administered either IV lidocaine (2 mg kg-1; group L) or fentanyl (7 μg kg-1; group F). After 5 minutes, alfaxalone was administered until endotracheal intubation was possible (1 mg kg-1 IV over 40 seconds followed by 0.4 mg kg-1 increments to effect). Total dose of alfaxalone was recorded and cough reflex at endotracheal intubation was scored. Heart rate (HR) was continuously recorded, Doppler systolic arterial blood pressure (SAP) was measured every 20 seconds. Vasovagal tonus index (VVTI) and changes (Δ) in HR, SAP and VVTI between pre-intubation and intubation were calculated. Groups were compared using univariate and multivariate analysis. Statistical significance was set as p < 0.05. RESULTS Group F included 22 dogs and group L 24 dogs. The mean (± standard deviation) alfaxalone dose was 1.1 (± 0.2) and 1.35 (± 0.3) mg kg-1 in groups F and L, respectively (p = 0.0008). At intubation, cough was more likely in group L (odds ratio = 11.3; 95% confidence intervals, 2.1 - 94.2; p = 0.01) and HR increased in 87.5% and 54.5% of groups L and F, respectively (p = 0.02). The median (range) ΔHR between pre-intubation and intubation was higher (13.1%; - 4.3 to + 55.1) in group L (p = 0.0021). Between groups, SAP and VVTI were similar. CONCLUSION AND CLINICAL RELEVANCE At the stated doses, whilst reducing the alfaxalone dose, fentanyl is superior to lidocaine in suppressing the cough reflex and blunting the increase in HR at endotracheal intubation in dogs premedicated with methadone.
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Affiliation(s)
| | - Nunzia Palomba
- Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK
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13
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Bennett KJ, Seddighi R, Moorhead KA, Messenger K, Cox SK, Sun X, Pasloske K, Pypendop BH, Doherty TJ. Effect of fentanyl on the induction dose and minimum infusion rate of alfaxalone preventing movement in dogs. Vet Anaesth Analg 2019; 46:173-181. [DOI: 10.1016/j.vaa.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022]
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14
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Hampton CE, Riebold TW, LeBlanc NL, Scollan KF, Mandsager RE, Sisson DD. Effects of intravenous administration of tiletamine-zolazepam, alfaxalone, ketamine-diazepam, and propofol for induction of anesthesia on cardiorespiratory and metabolic variables in healthy dogs before and during anesthesia maintained with isoflurane. Am J Vet Res 2019; 80:33-44. [PMID: 30605029 DOI: 10.2460/ajvr.80.1.33] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare effects of tiletamine-zolazepam, alfaxalone, ketamine-diazepam, and propofol for anesthetic induction on cardiorespiratory and acid-base variables before and during isoflurane-maintained anesthesia in healthy dogs. ANIMALS 6 dogs. PROCEDURES Dogs were anesthetized with sevoflurane and instrumented. After dogs recovered from anesthesia, baseline values for cardiorespiratory variables and cardiac output were determined, and arterial and mixed-venous blood samples were obtained. Tiletamine-zolazepam (5 mg/kg), alfaxalone (4 mg/kg), propofol (6 mg/kg), or ketamine-diazepam (7 and 0.3 mg/kg) was administered IV in 25% increments to enable intubation. After induction (M0) and at 10, 20, 40, and 60 minutes of a light anesthetic plane maintained with isoflurane, measurements and sample collections were repeated. Cardiorespiratory and acid-base variables were compared with a repeated-measures ANOVA and post hoc t test and between time points with a pairwise Tukey test. RESULTS Mean ± SD intubation doses were 3.8 ± 0.8 mg/kg for tiletamine-zolazepam, 2.8 ± 0.3 mg/kg for alfaxalone, 6.1 ± 0.9 mg/kg and 0.26 ± 0.04 mg/kg for ketamine-diazepam, and 5.4 ± 1.1 mg/kg for propofol. Anesthetic depth was similar among regimens. At M0, heart rate increased by 94.9%, 74.7%, and 54.3% for tiletamine-zolazepam, ketamine-diazepam, and alfaxalone, respectively. Tiletamine-zolazepam caused higher oxygen delivery than propofol. Postinduction apnea occurred in 3 dogs when receiving alfaxalone. Acid-base variables remained within reference limits. CONCLUSIONS AND CLINICAL RELEVANCE In healthy dogs in which a light plane of anesthesia was maintained with isoflurane, cardiovascular and metabolic effects after induction with tiletamine-zolazepam were comparable to those after induction with alfaxalone and ketamine-diazepam.
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Zapata A, Laredo FG, Escobar M, Agut A, Soler M, Belda E. Effects of midazolam before or after alfaxalone for co-induction of anaesthesia in healthy dogs. Vet Anaesth Analg 2018; 45:609-617. [DOI: 10.1016/j.vaa.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/02/2018] [Accepted: 04/06/2018] [Indexed: 11/16/2022]
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Bigby SE, Beths T, Bauquier S, Carter JE. Postinduction apnoea in dogs premedicated with acepromazine or dexmedetomidine and anaesthetized with alfaxalone or propofol. Vet Anaesth Analg 2017; 44:1007-1015. [PMID: 28927811 DOI: 10.1016/j.vaa.2016.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare incidence and duration of postinduction apnoea in dogs after premedication with methadone and acepromazine (MA) or methadone and dexmedetomidine (MD) followed by induction with propofol (P) or alfaxalone (A). STUDY DESIGN Prospective, randomized clinical trial. ANIMALS A total of 32 American Society of Anesthesiologists class I dogs (15 females, 17 males), aged between 4 months and 4 years, weighing between 3 and 46 kg. METHODS Dogs were randomly allocated to be administered MA+P, MA+A, MD+P or MD+A (methadone 0.5 mg kg-1 and acepromazine 0.05 mg kg-1 or dexmedetomidine 5 μg kg-1). Induction agents were administered intravenously via syringe driver (P at 4 mg kg-1 minute-1 or A at 2 mg kg-1 minute-1) until successful endotracheal intubation and the endotracheal tube connected to a circle system with oxygen flow at 2 L minute-1. Oxygen saturation of haemoglobin (SpO2), end tidal partial pressure of carbon dioxide and respiratory rate were monitored continuously. If apnoea (≥ 30 seconds without breathing) occurred, the duration until first spontaneous breath was measured. If SpO2 decreased below 90% the experiment was stopped and manual ventilation initiated. Data were analysed with general linear models with significance set at p ≤ 0.05. RESULTS There was no statistical difference in the incidence (11 of 16 dogs in A groups and 12 of 16 dogs in P groups), or mean ± standard deviation duration (A groups 125 ± 113 seconds, P groups 119 ± 109 seconds) of apnoea. The SpO2 of one dog in the MD+P group decreased below 90% during the apnoeic period. CONCLUSIONS AND CLINICAL RELEVANCE Propofol and alfaxalone both cause postinduction apnoea and the incidence and duration of apnoea is not influenced by the use of acepromazine or dexmedetomidine in premedication. Monitoring of respiration is recommended when using these premedication and induction agent combinations.
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Affiliation(s)
- Sarah E Bigby
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Australia.
| | - Thierry Beths
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Australia
| | - Sébastien Bauquier
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Australia
| | - Jennifer E Carter
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Australia
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Bennett RC, Salla KM, Raekallio MR, Scheinin M, Vainio OM. Effects of the α2-adrenoceptor agonist medetomidine on the distribution and clearance of alfaxalone during coadministration by constant rate infusion in dogs. Am J Vet Res 2017; 78:956-964. [DOI: 10.2460/ajvr.78.8.956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bigby SE, Beths T, Bauquier S, Carter JE. Effect of rate of administration of propofol or alfaxalone on induction dose requirements and occurrence of apnea in dogs. Vet Anaesth Analg 2017; 44:1267-1275. [PMID: 29146451 DOI: 10.1016/j.vaa.2017.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of rate of administration of propofol or alfaxalone on induction dose requirements and incidence of postinduction apnea (PIA) in dogs following premedication with methadone and dexmedetomidine. STUDY DESIGN Prospective, randomized clinical trial. ANIMALS Thirty-two healthy American Society of Anesthesiologists class I client-owned dogs (seven females, 25 males), aged between 5 and 54 months, weighing between 2.0 and 48.2 kg. METHODS Dogs were premedicated intramuscularly with 0.5 mg kg-1 methadone and 5 μg kg-1 dexmedetomidine. Thirty minutes after premedication, dogs were preoxygenated for 5 minutes before the induction agent was administered intravenously via a syringe driver until orotracheal intubation was achieved. Dogs were randomized to receive alfaxalone 0.5 mg kg-1 minute-1 (A-Slow), alfaxalone 2 mg kg-1 minute-1 (A-Fast), propofol 1 mg kg-1 minute-1 (P-Slow), or propofol 4 mg kg-1 minute-1 (P-Fast). Oxygen saturation of hemoglobin (SpO2), end-tidal carbon dioxide and respiratory rate were monitored. If PIA (≥30 seconds without a breath) occurred, the time to the first spontaneous breath was measured. If SpO2 decreased below 90%, the experiment was stopped and manual ventilation initiated. RESULTS The mean±standard deviation induction doses of alfaxalone and propofol were lower in the A-Slow [A-Slow 0.9±0.3 mg kg-1, A-Fast 2.2±0.5 mg kg-1 (p≤0.001)] and P-Slow [P-Slow 1.8±0.6 mg kg-1, P-Fast 4.1±0.7 mg kg-1 (p≤0.001)] groups, respectively. The incidence of PIA was 25% for the A-Slow and P-Slow groups and 100% for the A-Fast and P-Fast groups (p = 0.007). CONCLUSIONS AND CLINICAL RELEVANCE Both propofol and alfaxalone following methadone and dexmedetomidine premedication caused PIA. Induction dose requirement and incidence of PIA were affected by the rate of administration of both drugs. When possible, propofol and alfaxalone doses should be reduced and administered slowly to reduce PIA.
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Affiliation(s)
- Sarah E Bigby
- Department of Veterinary Medicine, University of Cambridge, Cambridge, England, UK.
| | - Thierry Beths
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, VIC, Australia
| | - Sébastien Bauquier
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, VIC, Australia
| | - Jennifer E Carter
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, VIC, Australia
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Iizuka T, Masui K, Miyabe-Nishiwaki T, Kanazawa H, Nishimura R. Propofol-fentanyl interaction in Beagles - Apnea, response to mechanical ventilation, endotracheal tube, and tetanic stimulation. Res Vet Sci 2017; 115:34-42. [PMID: 28152385 DOI: 10.1016/j.rvsc.2017.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/28/2016] [Accepted: 01/20/2017] [Indexed: 12/25/2022]
Abstract
The objective of this study was to characterize the propofol-fentanyl interaction in Beagles for four pharmacodynamic endpoints: apnea, response to mechanical ventilation, endotracheal tube, and tetanic stimulation. After anesthesia was induced with varying combinations of propofol and fentanyl, the pharmacodynamic endpoints were assessed in intubated dogs (n=6) using the cross-over design. Effective concentrations of propofol plasma concentration (Cp) and fentanyl Cp were assessed using additive, reduced Greco, Minto, and hierarchical interaction models. The interaction was best described as synergistic by the hierarchical model. A 1ng/mL fentanyl Cp reduced the effective propofol Cp to half or less of that without fentanyl for all endpoints. An additional increment of fentanyl Cp to 5ng/mL or higher hardly reduced effective propofol Cp for all endpoints except response to tetanic stimulation. Additionally, the effective propofol Cp in 50% dogs for response to tetanic stimulation (15% increase of heart rate) was lower than that for the other endpoints at fentanyl Cp >7ng/mL. Peripheral oxygen saturation decreased below 90% after extubation in five treatments in which fentanyl Cps were ≥5ng/mL. Propofol and fentanyl interacted synergistically. To avoid patient-ventilator dyssynchrony and hypoxemia after extubation, fentanyl Cp at 1-5ng/mL may be appropriate in intubated dogs. When a dog responds to mechanical ventilation or endotracheal tube at a high fentanyl Cp >5ng/mL under propofol anesthesia even if the dog tolerate to tetanic stimulation, it may be necessary to increase propofol Cp to eliminate the responses because an additional fentanyl may be little impact.
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Affiliation(s)
- T Iizuka
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - K Masui
- Department of Anesthesiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
| | - T Miyabe-Nishiwaki
- Center of Human Evolution Modeling Research, Primate Research Institute, Kyoto University, Inuyama, Aichi 484-8506, Japan
| | - H Kanazawa
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - R Nishimura
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Davis CA, Seddighi R, Cox SK, Sun X, Egger CM, Doherty TJ. Effect of fentanyl on the induction dose and minimum infusion rate of propofol preventing movement in dogs. Vet Anaesth Analg 2017. [PMID: 28624496 DOI: 10.1016/j.vaa.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the effect of fentanyl on the induction dose of propofol and minimum infusion rate required to prevent movement in response to noxious stimulation (MIRNM) in dogs. STUDY DESIGN Crossover experimental design. ANIMALS Six healthy, adult intact male Beagle dogs, mean±standard deviation 12.6±0.4 kg. METHODS Dogs were administered 0.9% saline (treatment P), fentanyl (5 μg kg-1) (treatment PLDF) or fentanyl (10 μg kg-1) (treatment PHDF) intravenously over 5 minutes. Five minutes later, anesthesia was induced with propofol (2 mg kg-1, followed by 1 mg kg-1 every 15 seconds to achieve intubation) and maintained for 90 minutes by constant rate infusions (CRIs) of propofol alone or with fentanyl: P, propofol (0.5 mg kg-1 minute-1); PLDF, propofol (0.35 mg kg-1 minute-1) and fentanyl (0.1 μg kg-1 minute-1); PHDF, propofol (0.3 mg kg-1 minute-1) and fentanyl (0.2 μg kg-1 minute-1). Propofol CRI was increased or decreased based on the response to stimulation (50 V, 50 Hz, 10 mA), with 20 minutes between adjustments. Data were analyzed using a mixed-model anova and presented as mean±standard error. RESULTS ropofol induction doses were 6.16±0.31, 3.67±0.21 and 3.33±0.42 mg kg-1 for P, PLDF and PHDF, respectively. Doses for PLDF and PHDF were significantly decreased from P (p<0.05) but not different between treatments. Propofol MIRNM was 0.60±0.04, 0.29±0.02 and 0.22±0.02 mg kg-1 minute-1 for P, PLDF and PHDF, respectively. MIRNM in PLDF and PHDF was significantly decreased from P. MIRNM in PLDF and PHDF were not different, but their respective percent decreases of 51±3 and 63±2% differed (p=0.035). CONCLUSIONS AND CLINICAL RELEVANCE Fentanyl, at the doses studied, caused statistically significant and clinically important decreases in the propofol induction dose and MIRNM.
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Affiliation(s)
- Carrie A Davis
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA.
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Sherry K Cox
- Department of Biological and Diagnostic Sciences, University of Tennessee, Knoxville, TN, USA
| | - Xiaocun Sun
- Office of Information and Technology, University of Tennessee, Knoxville, TN, USA
| | - Christine M Egger
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
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