Pre-emptive epidural ketamine or S(+)-ketamine in post-incisional pain in dogs: a comparative study

OBJECTIVE: To compare the pre-emptive analgesic effects of epidural ketamine or S(+)-ketamine on post-incisional hyperalgesia. STUDY DESIGN: Prospective randomized study. ANIMALS: Twenty-four mongrel dogs (1-5 years, weighing 11.9+/-1.8 kg). METHODS: Dogs were anesthetized with propofol (5 mg/kg intravenously) and a lumbosacral epidural catheter was placed. Dogs were randomly allocated to 3 groups, each with 8 dogs. The control group (CG) was administered saline solution (0.3 mL/kg); the ketamine group (KG) ketamine (0.6 mg/kg); and the S(+)-ketamine group (SG) S(+)-ketamine (0.6 mg/kg). The final volume was adjusted to 0.3 mL/kg in all groups. Five minutes after the epidural injection a surgical incision was made in the common pad of the right hind limb and was immediately closed with simple interrupted nylon suture. Respiratory (RR) and heart (HR) rates, rectal temperature (T), sedation (S), lameness score, and mechanical nociceptive threshold by von Frey filaments were evaluated before the propofol anesthesia and at 15, 30, 45, 60, 75, and 90 minutes and then at 2, 4, 6, 8, 12, and 24 hours after epidural injection. RESULTS: There were no differences in RR, HR, T, or S between groups. Motor blockade of the hind limbs was observed during 20+/-3.6 minutes in KG and during 30.6+/-7.5 minutes in SG (mean+/-SD). Mechanical force applied to obtain an aversive response was higher from 45 minutes to 12 hours in KG and from 60 to 90 minutes in SG, when compared with CG. CONCLUSIONS: Pre-emptive epidural ketamine induced no alterations in RR and HR, and reduced post-incisional hyperalgesia for a longer time than did S(+) ketamine. CLINICAL RELEVANCE: Although anesthetic and analgesic potency of S(+) ketamine is twice that of ketamine, the racemic form is seemingly better for post-incisional hyperalgesia.     

Relative potency of ketamine and S(+)-ketamine in dogs

The aim of this study was to determine the relative potency of racemic ketamine and S(+)-ketamine for the hypnotic effect and to evaluate the clinical anesthesia produced by equianesthetic doses of these two substances in dogs. One hundred and eight dogs were allocated in groups R2, R2.5, R3, R6, R9, R12, S2, S2.5, S3, S6, S9, and S12, to receive by intravenous route 2, 2.5, 3, 6, 9, and 12 mg/kg of ketamine or S(+)-ketamine, respectively. A dose-effect curve was drawn with the dose logarithm and the percentage of dogs that presented hypnosis in each group. The curve was used to obtain a linear regression, to determine the effective doses 100 and the potency relationship. In another experimental phase, eight groups of five dogs received 3, 6, 9 and 12 mg/kg of ketamine or S(+)-ketamine to evaluate the periods of latency, hypnosis, and total recovery. The times in which the dogs reached the sternal position, attempted to stand up for the first time, recovered the standing position, and started to walk were also recorded. The hypnotic dose for ketamine was 9.82 +/- 3.02 (6.86-16.5) mg/kg and for S(+)-ketamine was 7.76 +/- 2.17 (5.86-11.5) mg/kg. The time of hypnosis was longer in R3 and the first attempt to stand up occurred early in R6 when compared with S3 and S6 respectively. When R9 (100% of hypnosis with ketamine) and S6 [100% of hypnosis with S(+)-ketamine] were compared (1:1.5 ratio), the time to sternal position (12 +/- 2.5 and 20.2 +/- 5.6 min respectively) and the total recovery time (45 +/- 5.5 and 60.2 +/- 5.2 min respectively) were significantly shorter with S(+)-ketamine. It was concluded that the potency ratio between ketamine and S(+)-ketamine in dogs is smaller than the one reported in other species, and that the dose obtained after a reduction of 50%, as usually performed in humans, would not be enough to obtain equianesthetic effects in dogs.     

Comparison between S(+) ketamine–diazepam and S(+) ketamine–midazolam on anesthetic induction and recovery in dogs

S(+) ketamine, one of the two enantiomers of racemic ketamine, is a phencyclidine derivative that induces amnesia and analgesia. Its activity is related to blockade of NMDA receptors and some opioid action. We compared anesthetic induction and recovery quality with S(+) ketamine in combination with diazepam or midazolam in 10 dogs (ASA 1) admitted for elective surgery. After all clinical examinations, the dogs were separated into two groups (G I and G II). All animals received acepromazine (0.1 mg kg^?1) and fentanyl (5 µg kg^?1) IM, 20 minutes before induction with S(+) ketamine (6 mg kg^?1) and diazepam (0.5 mg kg^?1) IV (G I) or midazolam 0.2 mg kg^?1 (G II) IV. The doses of diazepam and midazolam were chosen according to the literature. All dogs were intubated and then maintained with halothane in oxygen at a vaporizer setting sufficient to maintain surgical anesthesia. Quality of induction, time needed for intubation, heart rate, respiratory rate, SpO₂, time to extubation, and quality of recovery were evaluated. The results were analyzed by Student's t‐test. Smooth induction and recovery were observed in all animals. The time to intubation was 45 ± 20 (GI) and 25 ± 6 seconds (GII), HR was 122 ± 12 (GI) and 125 ± 7 beats minute^?1 (GII), RR was 17 ± 2 (GI) and 21 ± 3 breaths minute^?1 (GII), SpO₂ was 96 ± 2 (GI) and 94 ± 1% (GII), time to extubation was 7 ± 3 (GI) and 4 ± 1 minutes (GII). No statistical differences were found in analyses, although time to intubation was less in GII. The results suggested that both combinations could be used safely for anesthetic induction in healthy dogs.     

Clinical evaluation of intranasal medetomidine–ketamine and medetomidine–S(+)-ketamine for induction of anaesthesia in rabbits in two centres with two different administration techniques

Objective

The aim was to compare efficacy and side effects of induction with medetomidine–ketamine or medetomidine–S(+)-ketamine by intranasal (IN) instillation in rabbits and to evaluate both protocols during subsequent isoflurane anaesthesia.

A comparison of romifidine and xylazine when used with diazepam/ketamine for short duration anesthesia in the horse.

The purpose of this study was to compare and evaluate sedation with intravenous xylazine (1.1 mg/kg bodyweight [BW]) versus intravenous romifidine (100 micrograms/kg BW) followed by induction of anesthesia with intravenous diazepam (0.04 mg/kg BW) and ketamine (2.2 mg/kg BW). Twelve healthy horses were used in a blinded, randomized, cross-over design. Heart rate, presence of 2nd degree atrioventricular heart blocks (2 degrees AVB), respiratory rate, arterial blood pressures, blood gases, packed cell volume, total serum proteins, and duration of anesthesia and recumbency were recorded. Induction and recovery quality was evaluated using a 0 to 4 score. Response to stimulation with noise, pressure, and cutaneous electrical stimulation was assessed at 5 minute intervals during recumbency to evaluate the depth of anesthesia. Heart rate was lower and 2 degrees AVB more frequent in the romifidine group, while blood pressure was lower in the xylazine group. Duration of anesthesia was longer in the romifidine group (mean 20.8, s mean 2.3 min) versus the xylazine group (mean 15.8, s mean 1.6 min), while induction and recovery were excellent in both groups. Respiratory rates, blood gas values, packed cell volumes, and total protein levels did not differ between groups. The results indicate that romifidine premedication followed by diazepam and ketamine is a very satisfactory regime for short duration intravenous anesthesia in horses.     

A comparison of two field chemical immobilization techniques for bobcats (Lynx rufus)

Anesthetic protocols that allow quick induction, short processing time, and rapid reversal are necessary for researchers performing minimally invasive procedures (including morphometric measurements or attachment of radiocollars). The objective of this study was to evaluate the effectiveness of medetomidine and butorphanol as a substitute for xylazine in ketamine-based field immobilization protocols for bobcats (Lynx rufus) to reduce recovery and total field times. During 2008 and 2009, 11 bobcats were immobilized with an intramuscular combination of ketamine (10 mg/kg)-xylazine (0.75 mg/kg) (KX) or ketamine (4 mg/kg)-medetomidine (40 mcg/kg)-butorphanol (0.4 mg/kg) (KMB). Time to initial sedation, recumbency, and full anesthesia were recorded postinjection. Time to head up, sternal, standing, full recovery, and total processing times were recorded post-reversal. Throughout anesthesia, heart rate (HR), respiratory rate (RR), rectal temperature (RT), and noninvasive hemoglobin-oxygen saturation (SpO2) were recorded at 5-min intervals. The KX combination had a median time to full anesthesia of 10 min, a median recovery time of 46 min, and a median total processing time of 83 min. Alternatively, the KMB combination had a median time to full anesthesia of 21 min, a median recovery time of 18 min, and a median total processing time of 64 min. The KX protocol produced a median HR of 129 beats/min, RR of 25 breaths/min, RT of 38.3 degrees C, and SpO2 of 93%. The KMB protocol produced a median HR of 97 beats/min, RR of 33 breaths/min, RT of 38.4 degrees C, and SpO2 of 92%. Though both protocols provided safe and reliable sedation, the benefits of using medetomidine and butorphanol to lower ketamine doses and decrease processing time for brief nonsurgical sedation of bobcats in the field are presented.     

Analgesic effects of epidurally administered levogyral ketamine alone or in combination with morphine on intraoperative and postoperative pain in dogs undergoing ovariohysterectomy

OBJECTIVE: To evaluate the analgesic and adverse effects of epidurally administered levogyral (S[+]) ketamine alone or in combination with morphine on intraoperative and postoperative pain in dogs undergoing ovariohysterectomy. ANIMALS: 30 dogs scheduled for ovariohysterectomy. PROCEDURE: Dogs were randomly allocated to 1 of 3 groups. Dogs in group 1 received S(+) ketamine (1 mg/kg), dogs in group 2 received S(+) ketamine (0.5 mg/kg) and morphine (0.05 mg/kg), and dogs in group 3 received S(+) ketamine (1 mg/kg) and morphine (0.025 mg/kg). The skin was incised 15 minutes after epidural administration of analgesics. Heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation as measured by pulse oximetry, and arterial blood gases were obtained before anesthesia, 15 minutes after epidural administration of analgesics, 15 and 30 minutes after initiation of surgery, and at the end of surgery. During the intraoperative period, an increase of > or =20% in baseline values for HR, RR, and SBP was considered a sign of intraoperative pain. Signs of pain and adverse effects were assessed at 2, 4, and 8 hours postoperatively. RESULTS: There were no significant differences in intraoperative or postoperative measurements among the 3 groups. No dogs had intraoperative signs of pain. Mean postoperative pain assessment scores were <3.5 in all 3 groups. Salivation was the most frequent adverse effect in dogs in groups 1 and 3, and sedation occurred more frequently in dogs in groups 2 and 3. CONCLUSIONS AND CLINICAL RELEVANCE: All 3 analgesic regimens provided good respiratory and cardiovascular stability intraoperatively and adequate postoperative analgesia with minimal adverse effects.     

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.     

Anesthetic, cardiorespiratory, and metabolic effects of four intravenous anesthetic regimens induced in horses immediately after maximal exercise

OBJECTIVE: To determine the anesthetic, cardiorespiratory, and metabolic effects of 4 IV anesthetic regimens in Thoroughbred horses recuperating from a brief period of maximal exercise. ANIMALS: 6 adult Thoroughbreds. PROCEDURE: Horses were preconditioned by exercising them on a treadmill. Each horse ran 4 simulated races, with a minimum of 14 days between races. Races were run at a treadmill speed that caused horses to exercise at 120% of their maximal oxygen consumption. Horses ran until fatigued or for a maximum of 2 minutes. Two minutes after exercise, horses received a combination of xylazine hydrochloride (2.2 mg/kg of body weight) and acepromazine maleate (0.04 mg/kg) IV. Five minutes after exercise, horses received 1 of the following 4 IV anesthetic regimens: ketamine hydrochloride (2.2 mg/kg); ketamine (2.2 mg/kg) and diazepam (0.1 mg/kg); tiletamine hydrochloride-zolazepam hydrochloride (1 mg/kg); and guaifenesin (50 mg/kg) and thiopental sodium (5 mg/kg). Treatments were randomized. Cardiopulmonary indices were measured, and samples of blood were collected before and at specific times for 90 minutes after each race. RESULTS: Each regimen induced lateral recumbency. The quality of induction and anesthesia after ketamine administration was significantly worse than after other regimens, and the duration of anesthesia was significantly shorter. Time to lateral recumbency was significantly longer after ketamine or guaifenesin-thiopental administration than after ketaminediazepam or tilet-amine-zolazepam administration. Arterial blood pressures after guaifenesin-thiopental administration were significantly lower than after the other regimens. CONCLUSIONS AND CLINICAL RELEVANCE: Anesthesia can be safely induced in sedated horses immediately after maximal exercise. Ketamine-diazepam and tilet-amine-zolazepam induced good quality anesthesia with acceptable perturbations in cardiopulmonary and metabolic indices. Ketamine alone and guaifenesin-thiopental regimens are not recommended.     

Recovery from desflurane anesthesia in horses with and without post-anesthetic xylazine

The objective of this study was to compare recovery from desflurane anesthesia in horses with or without post-anesthetic xylazine. Six adult horses were anesthetized on 2 occasions, 14 d apart using a prospective, randomized crossover design. Horses were sedated with xylazine, induced to lateral recumbency with ketamine and diazepam, and anesthesia was maintained with desflurane. One of 2 treatments was administered intravenously at the end of anesthesia: xylazine [0.2 mg/kg body weight (BW)] or an equivalent volume of saline. Recovery parameters were recorded and assessed by 2 blinded observers. A Wilcoxon signed-rank test was used to analyze recovery data. Heart rate, arterial blood pressures, and arterial blood gas data were analyzed using 2-way analysis of variance (ANOVA) for repeated measures. Values of P < 0.05 were considered significant. Duration of anesthesia was not different between groups. Administration of xylazine at the end of desflurane anesthesia was associated with significantly longer times to first movement, endotracheal tube removal, first attempt to achieve sternal recumbency, sternal recumbency, first attempt to stand, and standing. Number of attempts to stand and quality of recovery scores were not different between groups. Administering xylazine after desflurane anesthesia resulted in longer recovery times. Recovery scores were not significantly different between groups.     

Anesthetic and physiologic effects of tiletamine, zolazepam, ketamine, and xylazine combination (TKX) in feral cats undergoing surgical sterilization

Tiletamine (12.5 mg), zolazepam (12.5 mg), ketamine (20 mg), and xylazine (5 mg) (TKX; 0.25 ml, IM) combination was evaluated as an anesthetic in 22 male and 67 female adult feral cats undergoing sterilization at high-volume sterilization clinics. Cats were not intubated and breathed room air. Oxygen saturation (SpO(2)), mean blood pressure (MBP), heart rate (HR), respiration rate (RR), and core body temperature were recorded. Yohimbine (0.25 ml, 0.5 mg, IV) was administered at the completion of surgery. TKX produced rapid onset of lateral recumbency (4+/-1 min) and surgical anesthesia of sufficient duration to complete surgical procedures in 92% of cats. SpO(2) measured via a lingual pulse oximeter probe averaged 92+/-3% in male cats and 90+/-4% in females. SpO(2) fell below 90% at least once in most cats. MBP measured by oscillometry averaged 136+/-30 mm Hg in males and 113+/-29 mm Hg in females. MBP increased at the onset of surgical stimulation suggesting incomplete anti-nociceptive properties. HR averaged 156+/-19 bpm, and RR averaged 18+/-8 bpm. Neither parameter varied between males and females or over time. Body temperature decreased significantly over time, declining to 38.0+/-0.8 degrees C at the time of reversal in males and 36.6+/-0.8 degrees C at the time of reversal in females. Time from anesthetic reversal to sternal recumbency was prolonged (72+/-42 min). Seven cats (8%) required an additional dose of TKX to maintain an adequate plane of anesthesia at the onset of surgery, and this was associated with significantly longer recovery times (108+/-24 min).     

Comparison of diazepam–ketamine and thiopentone for induction of anaesthesia in healthy dogs

Objective To compare the anaesthetic and cardiopulmonary effects of a diazepam–ketamine combination with thiopentone for induction of anaesthesia in dogs. Animal population Twenty healthy dogs of various breeds weighing between 3.8 and 42.6 kg undergoing major orthopaedic or soft tissue surgery. Materials and methods Pre‐anaesthetic medication in all cases was intramuscular acepromazine and methadone given 30 minutes before induction of anaesthesia. Each animal was then randomly assigned to receive either thiopentone or diazepam and ketamine. Quality of conditions for, and time to tracheal intubation were recorded. Anaesthesia was maintained with halothane in oxygen and nitrous oxide. Heart rate, respiratory rate, systolic blood pressure, end tidal carbon dioxide tensions and oxygen saturation were recorded at 10 minute intervals throughout surgery. The quality of recovery from anaesthesia was assessed. Results The quality of induction in both groups was satisfactory. The total mean time (± SD) to tracheal intubation (162 ± 84 seconds) was significantly longer in dogs receiving diazepam and ketamine compared to dogs receiving thiopentone (62 ± 28 seconds). Heart rate, systolic blood pressure and end tidal carbon dioxide concentration were not significantly different between groups. Respiratory rate was significantly higher in the diazepam–ketamine group between 0 and 30 minutes. The quality of recovery was similar in each group. Conclusions There appear to be fewer differences between the induction agents examined in this study than was previously believed. No pressor, or other cardiovascular stimulating effects were detected in the dogs that received diazepam and ketamine. Clinical relevance The absence of obvious differences between groups suggests that pre‐anaesthetic medication, inhaled anaesthetics and the physiological effects of surgery itself probably had a greater effect on the variables studied than the induction agent used. Further studies are required to determine whether diazepam and ketamine offers significant advantages over other induction agents in the unhealthy dog.     

A comparison of two intramuscular doses of xylazine-ketamine combination and tolazoline reversal in llamas

OBJECTIVE: To evaluate the anesthetic and cardiorespiratory effects of two doses of intramuscular xylazine/ketamine in llamas, and to determine if an intramuscular injection of tolazoline would shorten the anesthesia recovery time. STUDY DESIGN: Prospective randomized study. ANIMALS: Six castrated male llamas. METHODS: Each llama received a low dose (LD) (0.4 mg kg(-1) xylazine and 4 mg kg(-1) ketamine) and high dose (HD) (0.8 mg kg(-1) xylazine and 8 mg kg(-1) ketamine). Time to sedation, duration of lateral recumbency and analgesia, pulse, respiratory rate, hemoglobin oxygen saturation, arterial blood pressure, blood gases, and the electrocardiogram were monitored and recorded during anesthesia. Three llamas in each treatment were randomized to receive intramuscular tolazoline (2 mg kg(-1)) after 30 minutes of lateral recumbency. RESULTS: Onset of sedation, lateral recumbency, and analgesia was rapid with both treatments. The HD was able to provide at least 30 minutes of anesthesia in all six llamas. The LD provided only 30 minutes of anesthesia in two out of six llamas. Respiratory depression and hypoxemia were seen in the HD treatment during the first 10 minutes of lateral recumbency. Two llamas were severely hypoxemic during this period and were given nasal oxygen for five minutes. Heart rate decreased, but there were no significant changes in blood pressure. Tolazoline significantly shortened the duration of recumbency in the HD treatment. CONCLUSIONS: The HD provided more consistent clinical effects in llamas than did the LD. Intramuscular tolazoline shortens the duration of lateral recumbency in llamas anesthetized with this combination. CLINICAL RELEVANCE: Both doses appear to be very effective in providing restraint in llamas. The LD may be used for procedures requiring a short period of anesthesia or restraint. The HD could be used when a longer duration of anesthesia is desired. Supplemental oxygen should be available if using the HD. Tolazoline (IM) shortened the recovery time with this combination in llamas.     

Comparison of four drug combinations for total intravenous anesthesia of horses undergoing surgical removal of an abdominal testis

OBJECTIVE: To evaluate anesthetic effects of 4 drug combinations used for total intravenous anesthesia of horses undergoing surgical removal of an abdominal testis. DESIGN: Clinical trial. ANIMALS: 32 healthy cryptorchid horses. PROCEDURE: Horses were sedated with xylazine and butorphanol and were randomly assigned to 1 of 4 groups: induction of anesthesia with ketamine and diazepam and maintenance with bolus administration of ketamine and xylazine (KD/KX); induction and maintenance of anesthesia with bolus administration of tiletamine-zolazepam, ketamine, and detomidine (TKD); induction and maintenance of anesthesia with continuous infusion of xylazine, guaifenesin, and ketamine; and induction and maintenance of anesthesia with continuous infusion of guaifenesin and thiopental. Horses that moved 3 consecutive times in response to surgical stimulation or for which surgery time was > 60 minutes were administered an inhalant anesthetic, and data from these horses were excluded from analysis. RESULTS: Quality of induction was not significantly different among groups. Muscle relaxation and analgesia scores were lowest for horses given KD/KX, but significant differences among groups were not detected. Horses anesthetized with TKD had a significantly greater number of attempts to stand, compared with the other groups, and mean quality of recovery from anesthesia for horses in the TKD group was significantly worse than for the other groups. Anesthesia, surgery, and recovery times were not significantly different among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that all 4 drug combinations can be used to induce short-term anesthesia for abdominal cryptorchidectomy in horses. However, horses receiving TKD had a poorer recovery from anesthesia, often requiring assistance to stand.     

Cardiopulmonary and anesthetic effects of ketamine and its enantiomers in dogs

Dogs were used to determine cardiopulmonary and chemical restraining effects of racemic ketamine and its enantiomers. Levorotatory ketamine induced the shortest duration of unconsciousness and recumbency when compared with effects of dextrorotatory and racemic ketamine. Administration of racemic ketamine or either of its enantiomers (30 mg/kg of body weight, IV) to dogs recovering from isoflurane anesthesia induced transient, but significant (P less than 0.05), decreases in arterial blood pressure, left ventricular contractility, cardiac output, and total peripheral vascular resistance. Arterial blood pressure and left ventricular contractility significantly (P less than 0.05) increased at later times after ketamine administration. Arterial pH and the PO2 values decreased after IV administration of racemic ketamine or its enantiomers. Significant differences in cardiopulmonary variables were not observed between groups given ketamine or its enantiomers.     

Cardiopulmonary effects of anesthetic induction with thiopental, propofol, or a combination of ketamine hydrochloride and diazepam in dogs sedated with a combination of medetomidine and hydromorphone

OBJECTIVE: To evaluate the cardiopulmonary effects of anesthetic induction with thiopental, propofol, or ketamine hydrochloride and diazepam in dogs sedated with medetomidine and hydromorphone. ANIMALS: 6 healthy adult dogs. PROCEDURES: Dogs received 3 induction regimens in a randomized crossover study. Twenty minutes after sedation with medetomidine (10 microg/kg, IV) and hydromorphone (0.05 mg/kg, IV), anesthesia was induced with ketamine-diazepam, propofol, or thiopental and then maintained with isoflurane in oxygen. Measurements were obtained prior to sedation (baseline), 10 minutes after administration of preanesthetic medications, after induction before receiving oxygen, and after the start of isoflurane-oxygen administration. RESULTS: Doses required for induction were 1.25 mg of ketamine/kg with 0.0625 mg of diazepam/kg, 1 mg of propofol/kg, and 2.5 mg of thiopental/kg. After administration of preanesthetic medications, heart rate (HR), cardiac index, and PaO(2) values were significantly lower and mean arterial blood pressure, central venous pressure, and PaCO(2) values were significantly higher than baseline values for all regimens. After induction of anesthesia, compared with postsedation values, HR was greater for ketamine-diazepam and thiopental regimens, whereas PaCO(2) tension was greater and stroke index values were lower for all regimens. After induction, PaO(2) values were significantly lower and HR and cardiac index values significantly higher for the ketamine-diazepam regimen, compared with values for the propofol and thiopental regimens. CONCLUSIONS AND CLINICAL RELEVANCE: Medetomidine and hydromorphone caused dramatic hemodynamic alterations, and at the doses used, the 3 induction regimens did not induce important additional cardiovascular alterations. However, administration of supplemental oxygen is recommended.     

Infusion of guaifenesin,ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses

OBJECTIVE: To evaluate effects of infusion of guaifenesin, ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses. DESIGN: Randomized clinical trial. ANIMALS: 40 horses. PROCEDURE: Horses were premedicated with xylazine and anesthetized with diazepam and ketamine. Anesthesia was maintained by infusion of guaifenesin, ketamine, and medetomidine and inhalation of sevoflurane (20 horses) or by inhalation of sevoflurane (20 horses). A surgical plane of anesthesia was maintained by controlling the inhaled concentration of sevoflurane. Sodium pentothal was administered as necessary to prevent movement in response to surgical stimulation. Hypotension was treated with dobutamine; hypoxemia and hypercarbia were treated with intermittent positive-pressure ventilation. The quality of anesthetic induction, maintenance, and recovery and the quality of the transition to inhalation anesthesia were scored. RESULTS: The delivered concentration of sevoflurane (ie, the vaporizer dial setting) was significantly lower and the quality of transition to inhalation anesthesia and of anesthetic maintenance were significantly better in horses that received the guaifenesin-ketamine-medetomidine infusion than in horses that did not. Five horses, all of which received sevoflurane alone, required administration of pentothal. Recovery time and quality of recovery were not significantly different between groups, but horses that received the guaifenesin-ketamine-medetomidine infusion required fewer attempts to stand. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in horses, the combination of a guaifenesin-ketamine-medetomidine infusion and inhalation of sevoflurane resulted in better transition and maintenance phases while improving cardiovascular function and reducing the number of attempts needed to stand after the completion of anesthesia, compared with inhalation of sevoflurane.     

Anesthesia by injection of xylazine, ketamine and the benzodiazepine derivative climazolam and the use of the benzodiazepine antagonist Ro 15-3505

25 horses which entered the clinic for minor surgery, received ketamine (2.2 mg/kg i.v.) for induction of anesthesia after previous sedation with xylazine (1.1 mg/kg i.v.). As soon as the horses were in the lateral recumbency, the benzodiazepine derivate climazolam was administered at a dose of 0.1 mg/kg i.v. (10 horses) or 0.2 mg/kg i.v. (15 horses). The anesthesia was maintained with repeated injections of ketamine (1.1 mg/kg i.v. every 9-12 minutes). At the end of the surgery, 20 minutes after the last ketamine injection, Ro 15-3505, a benzodiazepine antagonist, was injected at a dose of 0.01 mg/kg i.v. or 0.02 mg/kg i.v. Climazolam successfully suppressed the adverse reactions of ketamine, such as poor muscle relaxation, hyperacusis and convulsions. The benzodiazepine antagonist Ro 15-3505 allowed good control of the duration of anesthesia and--in most cases--a smooth, predictable recovery period was the result.     

Effects of dissociative anesthesia opioid-free protocols combined with local anesthesia,with or without flumazenil or atipamezole postoperatively,for orchiectomy in cats

ObjectiveTo evaluate the anesthetic effects of two drug combinations with local anesthesia, with or without postoperative antagonists, for orchiectomy in cats.Study designProspective, randomized blinded clinical study.AnimalsA total of 64 healthy cats.MethodsCats were assigned to four equal groups: ketamine (5 mg kg^–1) and dexmedetomidine (10 μg kg^–1) were administered intramuscularly (IM), followed postoperatively with intravenous (IV) saline (5 mL; group KDS) or atipamezole (50 μg kg^–1; group KDA); and ketamine (14 mg kg^–1) with midazolam (0.5 mg kg^–1) and acepromazine (0.1 mg kg^–1) IM, with postoperative IV saline (5 mL; group KMAS) or flumazenil (0.1 mg kg^–1; group KMAF). Lidocaine (2 mg kg^–1) was divided between subcutaneous and intratesticular injection. Physiologic variables were recorded at time points during anesthesia. Ketamine rescue dose was recorded. The degree of sedation and the quality of recovery were evaluated postoperatively.ResultsTime to loss of pedal reflex was longer in groups KMAS and KMAF than in groups KDS and KDA (p = 0.010). Total rescue dose of ketamine was higher in KMAS and KMAF than in KDS and KDA (p = 0.003). Heart rate (HR) during anesthesia was higher in KMAS and KMAF than in KDS and KDA (p = 0.001). Times to head up (p = 0.0005) and to sternal recumbency (p = 0.0003) were shorter in KDA than in KDS, KMAS and KMAF. Lower sedation scores were assigned sooner to KDA than KDS, KMAS and KMAF (p < 0.001). Recovery quality scores were good in all groups.Conclusions and clinical relevanceBoth anesthetic protocols allowed the performance of orchiectomy. Groups KMAS and KMAF required higher rescue doses of ketamine before injecting lidocaine. HR and oscillometric systolic pressure were minimally changed in groups KD and tachycardia was recorded in groups KMA. Only atipamezole shortened the anesthetic recovery.