Induction of anesthesia and recovery in donkeys sedated with xylazine: a comparison of midazolam–alfaxalone and midazolam–ketamine

Objective

To compare the induction and recovery characteristics and selected cardiopulmonary variables of midazolam–alfaxalone or midazolam–ketamine in donkeys sedated with xylazine.

Evaluation of the nociception–antinociception balance using the Parasympathetic Tone Activity index in dogs anaesthetized for castration

ObjectiveTo evaluate the performance of the Parasympathetic Tone Activity (PTA) index in assessing the nociception–antinociception balance in anaesthetized dogs undergoing castration.Study designProspective clinical study.AnimalsA group of 22 healthy client-owned dogs.MethodsThe dogs underwent general anaesthesia, with continuous monitoring of mean and instantaneous PTA (PTAm, PTAi), mean arterial pressure and heart rate. The values of these variables were divided according to the occurrence or absence of a haemodynamic reaction (HDR) at different time points: during surgical preparation, cutaneous incision, testicles extraction, cutaneous suture, after fentanyl administration, and after dexmedetomidine administration during recovery. Data were collected initially and 1, 3 and 5 minutes after each time point. The performance of the dynamic variation of the PTA (ΔPTA) to predict HDR or its resolution within 3 or 5 minutes was assessed using receiver operating characteristic (ROC) curves analysis. A p value < 0.05 was considered significant.ResultsDuring HDR, a decrease in PTAi (–34% and –31%) and PTAm (–26% and –30%) occurred at 3 (p = 0.005; p = 0.004) and 5 minutes (p = 0.001), respectively. After fentanyl administration, a decrease in haemodynamic variables occurred with a 45% increase in PTAi (p = 0.004). The ROC curve analysis of pooled data of the ΔPTAi for the prediction of HDR within 3 minutes indicated an area under the curve (AUC) of 0.70 (p = 0.0016) (threshold value: –16%). After fentanyl administration, the ROC curve analysis of ΔPTAi for the prediction of resolution of HDR within 3 minutes indicated an AUC of 0.69 (threshold value: +12%).Conclusions and clinical relevanceThe PTAi appears to be an interesting tool to assess the nociception–antinociception balance. However, further studies with a variety of clinical scenarios and anaesthesia protocols are required to conclude on its performance.     

Hypoventilation following oxygen administration associated with alfaxalone–dexmedetomidine–midazolam anesthesia in New Zealand White rabbits

ObjectiveTo investigate the relationship between oxygen administration and ventilation in rabbits administered intramuscular alfaxalone–dexmedetomidine–midazolam.Study designProspective, randomized, blinded study.AnimalsA total of 25 New Zealand White rabbits, weighing 3.1–5.9 kg and aged 1 year.MethodsRabbits were anesthetized with intramuscular alfaxalone (4 mg kg^–1), dexmedetomidine (0.1 mg kg^–1) and midazolam (0.2 mg kg^–1) and randomized to wait 5 (n = 8) or 10 (n = 8) minutes between drug injection and oxygen (100%) administration (facemask, 1 L minute^–1). A control group (n = 9) was administered medical air 10 minutes after drug injection. Immediately before (PRE_oxy/air5/10) and 2 minutes after oxygen or medical air (POST_oxy/air5/10), respiratory rate (f_R), pH, PaCO₂, PaO₂, bicarbonate and base excess were recorded by an investigator blinded to treatment allocation. Data [median (range)] were analyzed with Wilcoxon, Mann–Whitney U and Kruskal–Wallis tests and p < 0.05 considered significant.ResultsHypoxemia (PaO₂ < 88 mmHg, 11.7 kPa) was observed at all PRE times: PRE_oxy5 [71 (61–81) mmHg, 9.5 (8.1–10.8) kPa], PRE_oxy10 [58 (36–80) mmHg, 7.7 (4.8–10.7) kPa] and PRE_air10 [48 (32–64) mmHg, 6.4 (4.3–8.5) kPa]. Hypoxemia persisted when breathing air: POST_air10 [49 (33–66) mmHg, 6.5 (4.4–8.8) kPa]. Oxygen administration corrected hypoxemia but was associated with decreased f_R (>70%; p = 0.016, both groups) and hypercapnia (p = 0.016, both groups). Two rabbits (one per oxygen treatment group) were apneic (no thoracic movements for 2.0–2.5 minutes) following oxygen administration. f_R was unchanged when breathing air (p = 0.5). PaCO₂ was higher when breathing oxygen than air (p < 0.001).Conclusions and clinical relevanceEarly oxygen administration resolved anesthesia-induced hypoxemia; however, f_R decreased and PaCO₂ increased indicating that hypoxemic respiratory drive is an important contributor to ventilation using the studied drug combination.     

Hyaluronidase administered with xylazine–tiletamine–zolazepam into adipose tissue shortens recovery from anesthesia in pigs

Objective

To evaluate the effect of hyaluronidase on uptake, duration and speed of elimination of xylazine–tiletamine–zolazepam administered in the subcutaneous fat over the dorsal lumbar region of swine.

A comparison of the pharmacodynamic effects of intravenous ketamine–xylazine with alfaxalone in mute swans (Cygnus olor) presenting at a wildlife veterinary hospital

ObjectiveTo compare effects of intravenous (IV) alfaxalone with ketamine–xylazine combination on anaesthetic induction, recovery and cardiopulmonary variables in mute swans.Study designRandomized, controlled, clinical study.AnimalsA group of 58 mute swans.MethodsSwans were given either alfaxalone (10 mg kg^–1; group A) or a combination of ketamine (12.5 mg kg^–1) and xylazine (0.28 mg kg^–1) (group KX) IV. Heart and respiratory rates, end-tidal carbon dioxide and peripheral haemoglobin oxygen saturation were recorded at 5 minute intervals during anaesthesia. Time from anaesthetic induction to intubation, from cessation of isoflurane to extubation, to lifting head, sternal recumbency and absence of head/neck ataxia were recorded. Anaesthetic and recovery quality were scored (1 = very poor; 5 = excellent). Data are presented as median (interquartile range). Significance was set at p < 0.05.ResultsIn group A, 44% (12/27) of swans required mechanical ventilation for 2–14 minutes versus 3.2% (1/31) of swans in group KX (p = 0.0002). Heart rate was higher in group A than in group KX [146 (127–168) versus 65.5 (56–78) beats minute^–1, respectively; p < 0.0001]. The isoflurane concentration required to maintain anaesthesia was higher in group A than in group KX [2.5% (2.0–3.0%) versus 1.5% (1.0–2.0%), respectively; p = 0.0001]. Time from cessation of isoflurane administration to lifting head was significantly longer in group A than in group KX [12 (9–17) versus 6 (4–7.75) minutes, respectively; p < 0.0001]. Anaesthesia quality scores were significantly better in group KX than in group A [4 (4–5) versus 4 (3–4), respectively; p = 0.0011], as were recovery scores [4 (3–5) versus 2 (2–3), respectively; p = 0.0005].Conclusions and clinical relevanceAlfaxalone is a suitable anaesthetic induction agent for use in mute swans. There is a greater incidence of postinduction apnoea and a higher incidence of agitation on recovery with alfaxalone than with ketamine–xylazine.     

Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis secondary to gastro-duodenal ulcer disease in three foals

The objective of the study was to describe a modified Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis in foals due to gastric ulceration and assess the short- and long-term outcome of foals receiving the pyloroplasty. Medical records of foals undergoing a modified Heineke–Mikulicz pyloroplasty due to gastric outflow obstruction secondary to a pyloric stenosis were included in this retrospective case series. The pyloroplasty consisted of an oral to aboral full thickness longitudinal incision on the ventral aspect of the pylorus and proximal duodenum, which was sutured closed with 0 polydioxanone in a transverse orientation, thereby, enlarging the pyloric lumen diameter. Long-term outcome was obtained from medical and race records. The pyloroplasty was successfully performed in three foals with a surgical time of 95–121 min, with immediate return to nursing and hospital stay of 4–14 days. Complications included a small intestinal volvulus and intra-abdominal adhesions in a foal that did not survive. Another foal had an incisional infection. Two of the three foals went on to race. It was concluded that the pyloroplasty procedure is an acceptable option for the treatment of pyloric stenosis and secondary gastric outflow obstruction due to gastric ulceration. The limited amount of bowel manipulation with no change in intestinal flow, along with the successful outcomes achieved, make this another surgical option available for the correction of pyloric stenosis in foals.     

Intratesticular and incisional line infiltration with ropivacaine for castration in medetomidine–butorphanol–midazolam sedated dogs

Objective

To evaluate whether intratesticular and incisional ropivacaine infiltration produces sufficient intra- and postoperative analgesia for castrating dogs under sedation.

Determination of the effective dosage of tiletamine–zolazepam–ketamine–xylazine,with or without methadone,in dogs

ObjectiveTo determine the effective dosage of the combination tiletamine–zolazepam–ketamine–xylazine (TKX), with or without methadone, in dogs.Study designProspective, randomized, experimental study.AnimalsA total of 29 dogs.MethodsDogs were randomly administered TKX (group TKX, n = 13) or combined with 0.3 mg kg^–1 of methadone (group TKXM, n = 16) intramuscularly. The TKX solution contained tiletamine (50 mg mL^–1), zolazepam (50 mg mL^–1), ketamine (80 mg mL^–1) and xylazine (20 mg mL^–1). The effective dosages for immobility in 50% and 95% of the population (ED₅₀ and ED₉₅) were estimated using the up-and-down method. Approximately 20 minutes after drug administration, a skin incision was performed and the response was judged as positive or negative if the dogs moved or did not move, respectively. The TKX volume for the subsequent dog in the same group was increased or decreased by 0.005 mL kg^–1 if the response of the previous dog was positive or negative, respectively. Heart and respiratory rates, and sedation/anesthesia scores (range 0–21) were recorded before and 15 minutes after drug administration.ResultsEstimated ED₅₀ and ED₉₅ (95% confidence intervals) were: TKX, 0.025 (0.020–0.029) and 0.026 (0.010–0.042) mL kg^–1; TKXM, 0.022 (0.018–0.025) and 0.033 (0.017–0.049) mL kg^–1. Median (interquartile range) scores for sedation/anesthesia were 17 (16–18) and 17 (15–20), and times until lateral recumbency were 5 (4–6) and 6 (4–10) minutes in TKX and TKXM, respectively (p > 0.05). In both groups heart and respiratory rates decreased, but values remained acceptable for anesthetized dogs.Conclusions and clinical relevanceThe results provide a guide for volumes of TKX and TKXM in dogs requiring restraint for minimally invasive procedures. Inclusion of methadone in the TKX combination did not influence ED₅₀.     

Comparison of subcutaneous dexmedetomidine–midazolam versus alfaxalone–midazolam sedation in leopard geckos (Eublepharis macularius)

Objective

To compare dexmedetomidine–midazolam with alfaxalone–midazolam for sedation in leopard geckos (Eublepharis macularius).

Evaluation of Three Enzyme Immunoassays for Diagnosis of Clostridium difficile–Associated Diarrhea in Foals

The aim of the present study was to compare the test performances of three commercial enzyme immunoassays (EIAs) against the toxigenic culture using the cytotoxicity assay as the gold standard. All EIAs showed >78% sensitivity, and the lowest specificity was 92.6%. These results suggest that EIAs could be useful for the diagnosis of Clostridium difficile infection in foals.     

Physiologic and blood gas effects of xylazine–ketamine versus xylazine–tiletamine–zolazepam immobilization of white-tailed deer before and after oxygen supplementation: a preliminary study

ObjectiveTo compare oxygenation and ventilation in white-tailed deer (Odocoileus virginianus) anesthetized with two treatments with and without oxygen supplementation.Study designRandomized, blinded, crossover study.AnimalsA total of eight healthy adult white-tailed deer weighing 49–62 kg.MethodsEach deer was anesthetized twice intramuscularly: 1) treatment XK, xylazine (2 mg kg^–1) and ketamine (6 mg kg^–1) and 2) treatment XTZ, xylazine (2 mg kg^–1) and tiletamine–zolazepam (4 mg kg^–1). With the deer in sternal position, arterial and venous blood was collected before and at 30 minutes during administration of oxygen at 1 L minute^–1 through a face mask. PaO₂ and heart rate (HR) were compared using two-way repeated measures anova. pH, PaCO₂ and lactate concentration were analyzed using mixed-effects linear models, p < 0.05.ResultsWhen breathing air, PaO₂ was < 80 mmHg (10.7 kPa) in six and seven deer with XK and XTZ, respectively, and of these, PaO₂ was < 60 mmHg (8.0 kPa) in three and five deer, respectively. With oxygen supplementation, PaO₂ increased to 128 ± 4 and 140 ± 5 mmHg (17.1 ± 0.5 and 18.7 ± 0.7 kPa), mean ± standard error, with XK and XTZ, respectively (p < 0.001). PaO₂ was not significantly different between treatments at either time point. HR decreased during oxygen supplementation in both treatments (p < 0.001). Lactate was significantly lower (p = 0.047) with XTZ than with XK (2.2 ± 0.6 versus 3.5 ± 0.6 mmol L^–1) and decreased (p < 0.001) with oxygen supplementation (4.1 ± 0.6 versus 1.6 ± 0.6 mmol L^–1). PaCO₂ increased in XTZ during oxygen breathing.Conclusions and clinical relevanceTreatments XK and XTZ resulted in hypoxemia, which responded to oxygen supplementation. Both treatments are suitable for immobilization of white-tailed deer under the study circumstances.     

Field immobilization using alfaxalone and alfaxalone–medetomidine in free-ranging koalas (Phascolarctos cinereus): a randomized comparative study

ObjectiveTo characterize and compare two intramuscular drug protocols using alfaxalone and alfaxalone–medetomidine combination for the field immobilization of free-ranging koalas.Study designBlinded, randomized, comparative field study.AnimalsA total of 66 free-ranging koalas from the Mount Lofty Ranges, South Australia.MethodsKoalas were randomly allocated into two groups. Group A animals were given alfaxalone alone at 3.5 mg kg^–1. Group AM animals were given alfaxalone 2 mg kg^–1 and medetomidine 40 μg kg^–1, reversed with atipamezole at 0.16 mg kg^–1. Blinded operators recorded heart rate (HR), respiratory rate (f_R), cloacal temperature, depth of sedation and times to: first effect, sedation suitable for clinical interventions, first arousal and full recovery. Data were analysed using independent t test, Mann–Whitney U test, chi-square analysis and log-rank test at 5% level of significance.ResultsSuitable immobilization for clinical examination and sample collection was achieved in all animals. In groups A and AM, median time to working depth was 6.5 minutes (range: 3.4–15) and 8.1 minutes (range: 4.3–24) and time to complete recovery was 66 minutes (range: 12–138) and 34 minutes (range: 4–84), respectively, following reversal. Time to first effect was significantly shorter in group A (p = 0.013), whereas time to full arousal was significantly shorter in group AM (p = 0.007) probably due to the administration of atipamezole. Maximum HR was 117 ± 28 beats minute^–1 in group A, which was a significant increase from baseline values (p < 0.0001), whereas group AM showed a significant tachypnoea of 67 ± 25 (normal f_R 10–15; p < 0.0001).Conclusions and clinical relevanceBoth the protocols produced immobilization, enabling clinical examination and sample collection; however, protocol AM was more suitable for field work due to shorter recovery times.     

Cecal rupture in foals — 7 cases (1996–2006)

The objective of this study was to identify risk factors and describe clinical signs in 7 foals with cecal rupture; none of the foals survived. Six foals had undergone general anesthesia; 5 for orthopedic procedures. Six of the foals were receiving nonsteriod anti-inflammatory drugs. Most foals started showing colic signs on day 2 after surgery, preceded in 3 cases by dullness. Cecal rupture occurred between 4 hours and 2 days after the first signs of colic were noticed. Intestinal motility was decreased or absent in all foals for which it was recorded.Foals undergoing general anesthesia should be closely monitored for any sign of dullness, prolonged recumbency, reduced fecal output, and signs of abdominal discomfort for 3 days postoperatively, especially in cases following orthopedic surgery. If any of the above occurs, cecal impaction should be considered as a differential diagnosis. A prompt exploratory laparotomy may be a reasonable diagnostic option before the cecum ruptures with fatal consequences.     

Effects of xylazine and dexmedetomidine on equine articular chondrocytes in vitro

Objective

To assess the effects of xylazine and dexmedetomidine on equine chondrocytes, in vitro.

Comparison between three dosages of intramuscular alfaxalone and a ketamine–dexmedetomidine–midazolam–tramadol combination in golden-headed lion tamarins (Leontopithecus chrysomelas)

ObjectivesTo characterize the cardiopulmonary and anesthetic effects of alfaxalone at three dose rates in comparison with a ketamine–dexmedetomidine–midazolam–tramadol combination (KDMT) for immobilization of golden-headed lion tamarins (GHLTs) (Leontopithecus chrysomelas) undergoing vasectomy.Study designProspective clinical trial.AnimalsA total of 19 healthy, male, wild-caught GHLTs.MethodsTamarins were administered alfaxalone intramuscularly (IM) at 6, 12 or 15 mg kg^–1, or KDMT, ketamine (15 mg kg^–1), dexmedetomidine (0.015 mg kg^–1), midazolam (0.5 mg kg^–1) and tramadol (4 mg kg^–1) IM. Immediately after immobilization, lidocaine (8 mg kg^–1) was infiltrated subcutaneously (SC) at the incision site in all animals. Physiologic variables, anesthetic depth and quality of immobilization were assessed. At the end of the procedure, atipamezole (0.15 mg kg^–1) was administered IM to group KDMT and tramadol (4 mg kg^–1) SC to the other groups; all animals were injected with ketoprofen (2 mg kg^–1) SC.ResultsA dose-dependent increase in sedation, muscle relaxation and immobilization time was noted in the alfaxalone groups. Despite the administration of atipamezole, the recovery time was longer for KDMT than all other groups. Muscle tremors were noted in some animals during induction and recovery with alfaxalone. No significant differences were observed for cardiovascular variables among the alfaxalone groups, whereas an initial decrease in heart rate and systolic arterial blood pressure was recorded in KDMT, which increased after atipamezole administration.Conclusions and clinical relevanceAlfaxalone dose rates of 12 or 15 mg kg^–1 IM with local anesthesia provided good sedation and subjectively adequate pain control for vasectomies in GHLTs. KDMT induced a deeper plane of anesthesia and should be considered for more invasive or painful procedures. All study groups experienced mild to moderate hypothermia and hypoxemia; therefore, the use of more efficient heating devices and oxygen supplementation is strongly recommended when using these protocols.     

Evaluation of ultrasonography for measuring solar soft tissue thickness as a predictor of sole ulcer formation in Holstein–Friesian dairy cows

The aim of this research was to investigate the correlation between the thickness of solar soft tissue (SST; i.e. the corium and subcutaneous tissue) in early lactation and sole ulcer formation in late lactation. Fifty Holstein–Friesian cows were examined three times: (1) 30 days after calving (locomotion scoring, trimming, claw examination, measurement of SST); (2) 70 days after calving (locomotion scoring); and (3) 180 days after calving (locomotion scoring, trimming, claw examination).SST thickness was measured using an 8 MHz linear probe, at two points (SST1 below the apex of the pedal bone, and SST2 below the flexor tubercle). Mean values for SST1 and SST2 were 3.26 ± 0.43 mm and 4.35 ± 0.46 mm, respectively; the two measures were positively correlated (r = 0.95, P < 0.001). At 180 days after calving, a sole ulcer was diagnosed in 12/50 cows (24%). Cows with a thinner SST had a higher risk of developing sole ulcers than those with a thicker SST. The optimal cut-off values of SST1 and SST2 in predicting cows with sole ulcers (as calculated by ROC analysis) was ?3 mm for SST1 and ?3.9 mm for SST2. The relative risk of a sole ulcer developing, based on those cut-off values was 4.25 (95 CI, 1.77–24.88) for SST1 ? 3 mm and 3.63 (95 CI, 1.18–10.8) for SST2 ? 3.9 mm.     

Effects of intracoelomic alfaxalone–dexmedetomidine on righting reflex in common garter snakes (Thamnophis sirtalis): preliminary data

ObjectiveTo evaluate the effect of dexmedetomidine on alfaxalone immobilization in snakes.Study designNonblinded, crossover study.AnimalsA total of eight mature common garter snakes (Thamnophis sirtalis).MethodsSnakes were administered each of three treatments intracoelomically: alfaxalone (30 mg kg^–1; treatment A), alfaxalone (30 mg kg^–1) combined with dexmedetomidine (0.05 mg kg^–1; treatment AD0.05); and alfaxalone (30 mg kg^–1) combined with dexmedetomidine (0.10 mg kg^–1; treatment AD0.10). A minimum of 10 days elapsed between experimental trials. Times to loss of righting reflex (LRR) and return of righting reflex (RRR) were recorded. Heart rate (HR) was recorded every 5 minutes throughout the period of LRR and averaged for each snake. Times to LRR and RRR, and mean HR in snakes that achieved LRR were reported.ResultsLRR occurred in eight (100%), five (63%) and three (38%) snakes in treatments A, AD0.05 and AD0.10, respectively. For all treatments, time to LRR ranged 3–20 minutes. Median (range) times to RRR were 39 (30–46), 89 (62–128) and 77 (30–185) minutes for treatments A, AD0.05 and AD0.10, respectively. In animals where righting reflex was lost, mean HR was lower in all dexmedetomidine treatments compared with treatment A.Conclusions and clinical relevanceIn this pilot study, alfaxalone resulted in reliable immobilization, whereas dexmedetomidine and alfaxalone combinations resulted in highly variable durations of immobilization with low HR in immobilized animals. For snakes that achieved LRR, the addition of dexmedetomidine (0.05 mg kg^–1) to alfaxalone appeared to extend the period of immobilization compared with alfaxalone alone.