Comparison of Dexmedetomidine-Ketamine-Midazolam and Isoflurane for Anesthesia of Black-tailed Prairie Dogs (Cynomys ludovicianus)

Evaluation of dexmedetomidine anesthesia-related temperature changes: preliminary retrospective observational study

INTRODUCTION AND OBJECTIVE

Dexmedetomidine is a potent adrenergic alpha-2 agonist, and analgesic, sedative, anxiolytic and sympatholytic. Given there have been reports of dexmedetomidine associated temperature changes, in which these events have been associated with complications, our objective was to describe both temperature increase and decrease, during the intra and postoperative period (initial 24 hours), and factors associated, in patients who received dexmedetomidine for anesthesia/sedation in the surgical suite.

METHOD

Retrospective observational study, analyzing charts of patients ≥ 18 years submitted to anesthesia/sedation with dexmedetomidine, between 1/1/2017 and 31/12/2017. Upper temperature threshold was considered ≥ 37.8 °C, and lower, < 35 °C. The association with dexmedetomidine was assessed by the OMS/UMC causality system and by the Naranjo algorithm.

RESULTS

The sample included 42 patients who received dexmedetomidine and whose temperature data were available, with predominance of men 26 (62%), 49.4/16.5 years old (mean/standard deviation), and weight 65/35.8 kg. None of the patients presented intraoperative temperature equal to or above 37.8 °C or below 35 °C. During the postoperative period, one patient presented an increase ≥ 37.8 °C (2.4%) and three, temperature decrease < 35 °C (7%). Surgery/anesthesia time and exposure time to dexmedetomidine were not appropriate linear predictors of maximum temperature. Older age (p < 0.01), longer exposure to dexmedetomidine (p < 0.05) and shorter surgery time (p < 0.01) were significant linear predictors for lower minimum temperature.

CONCLUSIONS

Increase ≥ 37.8 °C/decrease < 35 °C of temperature possibly associated with dexmedetomidine did not occur in the intraoperative period and had a low frequency during the postoperative period.

ANESTHETIC EFFECT OF DEXMEDETOMIDINE-KETAMINEMIDAZOLAM COMBINATION ADMINISTERED INTRAMUSCULARLY TO ZOO-HOUSED NAKED MOLE-RATS (HETEROCEPHALUS GLABER)

In this study, adult intact male and female (n = 10) naked mole-rats (Heterocephalus glaber) were anesthetized using a combination of dexmedetomidine (0.06 mg/kg intramuscularly [IM]), ketamine (20 mg/kg IM), and midazolam (1.0 mg/kg IM). Atipamezole (1.0 mg/kg IM) and flumazenil (0.1 mg/kg IM) were administered 40 min after induction. Induction and recovery times were monitored and recorded. Vital parameters, including heart rate, respiratory rate, and SpO₂, and reflexes were monitored every 5 min during the anesthetic period. Anesthetic induction was smooth and rapid. All monitored reflexes were lost within a median time of 60 sec (interquartile range, 15 sec). Heart rate and respiratory rate were significantly decreased from baseline, whereas there was no difference in SpO₂ over the anesthetic period. The mean time to recovery was 15 ± 7 min (mean ± SD). One animal was found dead 40 min after apparent recovery, which is suspected to be an anesthetic-related death. Based on these findings, dexmedetomidine-ketamine-midazolam anesthesia is an effective anesthetic protocol in naked mole rats that provides a consistent anesthetic plane but should be used with caution in animals with underlying conditions.

Anesthetic Effects of Intramuscular Alfaxalone-Ketamine in Naked Mole Rats (Heterocephalus glaber)

In this study, adult intact male and female (n = 10) naked mole rats (Heterocephalus glaber) were anesthetized by using a combination of ketamine (20 mg/kg IM), and alfaxalone (4.0 mg/kg IM). Induction and recovery times were recorded. Vital parameters, including heart rate, respiratory rate, and reflexes, were monitored every 5 min during the anesthetic period. Anesthetic induction was smooth and rapid. Induction time was significantly longer in male rats (median, 325 s; range, 180 to 385 s) than in females (median, 145 s; range, 118 to 180 s). In addition, overall duration of loss of righting reflex was shorter in male mole rats (median, 50 min; range, 36 to 65 min) than females (median, 70 min; range, 60 to 85 min). Males largely had intact withdrawal reflexes, whereas females showed variable loss of both forelimb and hindlimb withdrawal reflexes. Neither recovery time (mean ± 1 SD, 16 ± 13 min) nor vital parameters differed between sexes. None of animals showed any anesthesia-related adverse responses. According to these findings, intramuscular AK is a safe and effective protocol that provides brief, light anesthesia in male naked mole rats and deeper anesthesia in females. We recommend adding analgesics when this AK protocol is used for pain-inducing or invasive procedures, and further studies evaluating higher doses and different combinations are indicated.

Anesthetic Effects of Alfaxalone-Ketamine, Alfaxalone-Ketamine-Dexmedetomidine, and Alfaxalone-Butorphanol-Midazolam Administered Intramuscularly in Five striped Palm Squirrels ( Funambulus pennantii)

Injectable anesthesia protocols for five striped palm squirrels (Funambulus pennantii) are poorly described in the literature. In this study, male intact squirrels received intramuscular injections of either alfaxalone (6 mg/kg) and ketamine (40 mg/ kg; AK group, n = 8); alfaxalone (6 mg/kg), ketamine (20 mg/kg), and dexmedetomidine (0.1 mg/kg; AKD group, n = 8); or alfaxalone (8 mg/kg), butorphanol (1 mg/kg), and midazolam (1 mg/kg; ABM group, n = 8). Atipamezole (0.15 mg/kg IM) and flumazenil (0.1 mg/kg IM) were administered 40 min after anesthesia induction (defined as loss of the righting reflex) with AKD and ABM, respectively. Heart rate, respiratory rate, rectal temperature, and reflexes were recorded every 5 min during anesthesia. Anesthetic induction was rapid in all groups (AK: median, 49 s; range, 33 to 60 s; AKD, 60 s; 54 to 70 s; and ABM, 15 s; 5 to 58 s). The anesthetic duration (from induction to full recovery) for the AK group was 62 ± 3 min (mean ± 1 SD). There was no statistically significant difference between the ABM and AKD groups regarding recovery time after partial antagonist administration and was 51 ± 5 and 48 ± 5 min, respectively. All AK animals showed twitching and abnormal vocalization during recovery. The righting reflex was absent in all squirrels for 20 min in the AK treatment group and throughout the 40 min anesthetic period in the AKD and ABM groups. The frontlimb withdrawal response was absent in all squirrels for the 40 min anesthetic period in the AKD and ABM groups, with variable responses for the AK treatment. All tested protocols in this study provided safe and effective immobilization in five striped palm squirrels, but oxygen and thermal support were indicated. Anesthetic depth must be determined before surgical procedures are performed in palm squirrels anesthetized by using these regimens.

Pharmacokinetic Profiles of Gabapentin after Oral and Subcutaneous Administration in Black-tailed Prairie Dogs (Cynomys ludovicianus)

In veterinary and human medicine, gabapentin (a chemical analog of γ-aminobutyric acid) is commonly prescribed to treat postoperative and chronic neuropathic pain. This study explored the pharmacokinetics of oral and subcutaneous administration of gabapentin at high (80 mg/kg) and low (30 mg/kg) doses as a potential analgesic in black-tailed prairie dogs (Cynomys ludovicianus; n = 24). The doses (30 and 80 mg/kg) and half maximal effective concentration (1.4 to 16.7 ng/mL) for this study were extrapolated from pharmacokinetic efficacy studies in rats, rabbits, and cats. Gabapentin in plasma was measured by using an immunoassay, and data were evaluated using noncompartmental analysis. The peak plasma concentrations (mean ±1 SD) were 42.6 ±14.8 and 115.5 ±15.2 ng/mL, respectively, after 30 and 80 mg/kg SC and 14.5 ±3.5 and 20.7 ±6.1 ng/mL after the low and high oral dosages, respectively. All peak plasma concentrations of gabapentin occurred within 5 h of administration. Disappearance half-lives for the low and high oral doses were 7.4 ± 6.0 h and 5.0 ± 0.8 h, respectively. The results of this study demonstrate that oral administration of gabapentin at low (30 mg/kg) doses likely would achieve and maintain plasma concentrations at half maximum effective concentration for 12 h, making it a viable option for an every 12-h treatment.

Comparison of intramuscular administration of alfaxalone-ketamine-dexmedetomidine and alfaxalone-butorphanol-midazolam in naked mole-rats (Heterocephalus glaber)

OBJECTIVE

To compare anesthetic effects of alfaxalone-ketamine-dexmedetomidine (AKD) and alfaxalone-butorphanol-midazolam (ABM) in naked mole-rats (Heterocephalus glaber).

ANIMALS

20 naked mole-rats.

PROCEDURES

Naked mole-rats received AKD (alfaxalone, 2 mg/kg; ketamine, 20 mg/kg; and dexmedetomidine, 0.02 mg/kg; n = 10) or ABM (alfaxalone, 2 mg/kg; butorphanol, 2 mg/kg; and midazolam, 1 mg/kg; 9) IM; 1 animal was removed from the study. Atipamezole (I mg/kg) and flumazenil (0.1 mg/kg) were administered 40 minutes after anesthetic induction (defined as loss of the righting reflex) with AKD and ABM, respectively. Heart rate, respiratory rate, oxygen saturation, and reflexes were recorded every 5 minutes.

RESULTS

The ABM group had significantly longer median times for induction and recovery than the AKD group. Administration of ABM resulted in significantly lower respiratory rates than administration of AKD from time of anesthetic induction to 10 minutes after induction. Respiratory rate significantly decreased in the AKD group from I0 minutes after induction through the end of the anesthetic period but did not change over time in the ABM group. Males had higher respiratory rates in both groups. Loss of the righting reflex was still evident 40 minutes after induction in both groups. In the AKD group, all tested reflexes were absent from I0 to 40 minutes after induction; the ABM group had variable reflexes that recovered within individual animals over time.

CONCLUSIONS AND CLINICAL RELEVANCE

Both AKD and ABM provided effective immobilization in naked mole-rats, but AKD appeared to provide more consistent and deeper anesthesia, compared with administration of ABM.

Comparison of the effects of a dexmedetomidine-ketamine-midazolam anesthetic protocol versus isoflurane inhalation anesthesia on echocardiography variables and plasma cardiac troponin I concentration in black-tailed prairie dogs (Cynomys ludovicianus)

OBJECTIVE

To compare the effects of a dexmedetomidine-ketamine-midazolam (DKM) anesthetic protocol versus isoflurane inhalation anesthesia on echocardiographic variables and plasma cardiac troponin 1 (cTnI) concentration in black-tailed prairie dogs (BTPDs; Cynomys ludovicianus).

ANIMALS

Nine 6-month-old sexually intact male captive BTPDs.

PROCEDURES

Each BTPD was randomly assigned to be anesthetized by IM administration of dexmedetomidine (0.25 mg/kg), ketamine (40 mg/kg), and midazolam (1.5 mg/kg) or via inhalation of isoflurane and oxygen. Three days later, each BTPD underwent the alternative anesthetic protocol. Echocardiographic data and a blood sample were collected within 5 minutes after initiation and just prior to cessation of each 45-minute-long anesthetic episode.

RESULTS

Time or anesthetic protocol had no significant effect on echocardiographic variables. For either protocol, plasma cTnI concentration did not differ with time. When administered as the first treatment, neither anesthetic protocol significantly affected plasma cTnI concentration. However, with regard to findings for the second treatments, plasma cTnI concentrations in isoflurane-treated BTPDs (n = 4; data for 1 animal were not analyzed because of procedural problems) were higher than values in DKM-treated BTPDs (4), which was suspected to be a carryover effect from prior DKM treatment.

CONCLUSIONS AND CLINICAL RELEVANCE

The DKM and isoflurane anesthetic protocols did not have any significant effect on echocardiographic measurements in the BTPDs. Increases in plasma cTnI concentration during the second anesthetic episode were evident when BTPDs underwent the DKM anesthetic protocol as the first of the 2 treatments, suggestive of potential myocardial injury associated with that anesthetic protocol. Clinicians should consider these findings, especially when evaluating BTPDs with known or suspected cardiac disease.

Anesthetic effects of dexmedetomidine-ketamine-midazolam administered intramuscularly in five-striped palm squirrels (Funambulus pennantii)

OBJECTIVE

To evaluate efficacy and safety of anesthesia with dexmedetomidine-ketamine-midazolam (DKM) in five-striped palm squirrels (Funambulus pennantii).

ANIMALS

8 male squirrels.

PROCEDURES

Squirrels were anesthetized with DKM (dexmedetomidine, 0.1 mg/kg; ketamine hydrochloride, 30 mg/kg; and midazolam, 0.75 mg/kg) administered IM. Atipamezole (0.15 mg/kg) and flumazenil (0.1 mg/kg) were administered IM 40 minutes after induction of anesthesia. Vital signs and responses were recorded every 5 minutes during anesthesia.

RESULTS

Anesthetic induction and recovery from anesthesia were rapid and without complications in all squirrels. Median anesthetic induction time was 67.5 seconds (interquartile [25th to 75th percentile] range, 5.5 seconds), and mean ± SD recovery time after drug reversal was 147 ± 79 seconds. Heart rate, respiratory rate, and rectal temperature significantly decreased during the anesthetic period. All squirrels became hypothermic by 40 minutes after induction. The righting reflex was absent during the 40-minute anesthetic period in all squirrels, with variable responses for the palpebral reflex, jaw tone, forelimb withdrawal reflex, and hind limb withdrawal reflex. Only 2 of 8 squirrels had loss of the limb withdrawal reflex in both the forelimbs and hind limbs from anesthetic induction to 25 minutes after induction.

CONCLUSIONS AND CLINICAL RELEVANCE

DKM appeared to provide safe and effective anesthesia in five-striped palm squirrels, but oxygen and thermal support were indicated. At the doses administered, deep surgical anesthesia was not consistently achieved, and anesthetic depth of individual squirrels must be determined before surgical procedures are performed in palm squirrels anesthetized with this drug combination.