The effects of xylazine or detomidine when used as a pre-anesthetic sedative on recovery quality and duration in horses undergoing elective equine castration.

The purpose of this prospective, blinded, randomized clinical trial was to compare the effects of low dose detomidine to xylazine on recovery quality and duration in a castration procedure. Horses were administered either detomidine [0.015 mg/kg body weight (BW)] or xylazine (1.1 mg/kg BW) intravenously (IV) before IV induction with ketamine (2.2 mg/kg BW) and diazepam (0.05 mg/kg BW). Two anesthesiologists who were unaware of treatment allocation scored the recoveries using a simple descriptive scale (with a low number representing the most desirable recovery) and recoveries were timed. Horses in the detomidine group (n = 16) had a median recovery score of 16 (range: 11 to 26), whereas horses in the xylazine group (n = 12) had a median recovery score of 12 (range: 10 to 16) (P = 0.001). There was no difference in surgery time (P = 0.52), time from the end of surgery to standing (P = 0.45), or time from induction to standing (P = 0.48) between the groups.

Les effets de la xylazine ou de la détomidine lors d'utilisation comme sédatif pré-anesthésique sur la qualité et la durée de la récupération chez les chevaux soumis à une castration équine élective. Le but de cet essai clinique prospectif, en aveugle et randomisé était de comparer les effets de la détomidine à faible dose à la xylazine sur la qualité et la durée de la récupération dans une procédure de castration. Les chevaux ont reçu soit de la détomidine [0,015 mg/kg de poids corporel (PC)] soit de la xylazine (1,1 mg/kg de PC) par voie intraveineuse (IV) avant l'induction IV avec de la kétamine (2,2 mg/kg de PC) et du diazépam (0,05 mg/kg de PC). Deux anesthésistes qui ignoraient l'attribution du traitement ont noté les récupérations à l'aide d'une échelle descriptive simple (avec un petit nombre représentant la récupération la plus souhaitable) et les récupérations ont été chronométrées. Les chevaux du groupe détomidine (n = 16) avaient un score de récupération médian de 16 (éventail de valeurs : 11 à 26), tandis que les chevaux du groupe xylazine (n = 12) avaient un score de récupération médian de 12 (éventail de valeurs : 10 à 16) (P = 0,001). Il n'y avait aucune différence dans le temps de chirurgie (P = 0,52), le temps entre la fin de la chirurgie et la position debout (P = 0,45) ou le temps entre l'induction et la position debout (P = 0,48) entre les groupes.(Traduit par Dr Serge Messier).

Anesthesia, Sedation, and Pain Management of Donkeys and Mules.

The number of donkeys in the world may not be increasing but awareness of their use and concern for welfare and pain recognition and treatment are receiving increasing veterinary interest. Therefore, accurate information about anesthesia and analgesia in donkeys and mules is important to more equine practitioners. This review highlights the current knowledge on various anesthetic and analgesic approaches in donkey and mules. The authors emphasize that there is still much information that is not available about donkeys and mules; in many circumstances, the clinician must use available equine information to treat the patient, while monitoring for differences in response.

Effect of preoperative administration of tepoxalin on induction dose of injectable anesthetics in dogs.

Medications given preoperatively have the potential to affect the induction dose of injectable anesthetics, which could result in an anesthetic overdose. Tepoxalin is an NSAID approved for the treatment of arthritis in dogs in the United States and hence could be administered in patients requiring anesthesia. In this study, administration of a single dose or a 10-day course of tepoxalin did not affect the induction dose (dose that allowed intubation) of propofol, thiopental, or ketamine-diazepam and also did not affect the time required for dogs to recover from anesthesia.

Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals.

OBJECTIVE To identify risk factors for anesthetic-related death in pet dogs and cats. DESIGN Matched case-control study. ANIMALS 237 dogs and 181 cats. PROCEDURES Electronic medical records from 822 hospitals were examined to identify dogs and cats that underwent general anesthesia (including sedation) or sedation alone and had death attributable to the anesthetic episode ≤ 7 days later (case animals; 115 dogs and 89 cats) or survived > 7 days afterward (control animals [matched by species and hospital]; 122 dogs and 92 cats). Information on patient characteristics and data related to the anesthesia session were extracted. Conditional multivariable logistic regression was performed to identify factors associated with anesthetic-related death for each species. RESULTS The anesthetic-related death rate was higher for cats (11/10,000 anesthetic episodes [0.11%]) than for dogs (5/10,000 anesthetic episodes [0.05%]). Increasing age was associated with increased odds of death for both species, as was undergoing nonelective (vs elective) procedures. Odds of death for dogs were significantly greater when preanesthetic physical examination results were not recorded (vs recorded) or when preanesthetic Hct was outside (vs within) the reference range. Odds of death for cats were greater when intra-anesthesia records for oxygen saturation as measured by pulse oximetry were absent. Underweight dogs had almost 15 times the odds of death as nonunderweight dogs; for cats, odds of death increased with increasing body weight (but not with overweight body condition). CONCLUSIONS AND CLINICAL RELEVANCE Several factors were associated with anesthetic-related death in cats and dogs. This information may be useful for development of strategies to reduce anesthetic-related risks when possible and for education of pet owners about anesthetic risks.

Pharmacokinetics and clinical effects of a subanesthetic continuous rate infusion of ketamine in awake horses.

OBJECTIVE: To determine the pharmacokinetics and clinical effects of a subanesthetic, continuous rate infusion of ketamine administered to healthy awake horses. ANIMALS: 8 adult horses. PROCEDURES: Ketamine hydrochloride was administered to 2 horses, in a pilot study, at rates ranging from 0.4 to 1.6 mg/kg/h for 6 hours to determine an appropriate dose that did not cause adverse effects. Ketamine was then administered to 6 horses for a total of 12 hours (3 horses at 0.4 mg/kg/h for 6 hours followed by 0.8 mg/kg/h for 6 hours and 3 horses at 0.8 mg/kg/h for 6 hours followed by 0.4 mg/kg/h for 6 hours). Concentration of ketamine in plasma, heart rate, respiratory rate, blood pressure, physical activity, and analgesia were measured prior to, during, and following infusion. Analgesic testing was performed with a modified hoof tester applied at a measured force to the withers and radius. RESULTS: No signs of excitement and no significant changes in the measured physiologic variables during infusion rates of 0.4 and 0.8 mg of ketamine/kg/h were found. At 6 hours following infusions, heart rate and mean arterial pressure were decreased, compared with preinfusion measurements. An analgesic effect could not be demonstrated during or after infusion. Pharmacokinetic variables for 0.4 and 0.8 mg/kg/h infusions were not significantly different. CONCLUSIONS AND CLINICAL RELEVANCE: Ketamine can be administered to awake horses at 0.4 or 0.8 mg/kg/h without adverse behavioral effects. The observed pharmacokinetic values are different than those reported for single-dose IV bolus administration of this drug.

Comparative pharmacokinetics of meloxicam in clinically normal horses and donkeys.

OBJECTIVE: To determine the disposition of a bolus of meloxicam (administered IV) in horses and donkeys (Equus asinus) and compare the relative pharmacokinetic variables between the species. ANIMALS: 5 clinically normal horses and 5 clinically normal donkeys. PROCEDURES: Blood samples were collected before and after IV administration of a bolus of meloxicam (0.6 mg/kg). Serum meloxicam concentrations were determined in triplicate via high-performance liquid chromatography. The serum concentration-time curve for each horse and donkey was analyzed separately to estimate standard noncompartmental pharmacokinetic variables. RESULTS: In horses and donkeys, mean +/- SD area under the curve was 18.8 +/- 7.31 microg/mL/h and 4.6 +/- 2.55 microg/mL/h, respectively; mean residence time (MRT) was 9.6 +/- 9.24 hours and 0.6 +/- 0.36 hours, respectively. Total body clearance (CL(T)) was 34.7 +/- 9.21 mL/kg/h in horses and 187.9 +/- 147.26 mL/kg/h in donkeys. Volume of distribution at steady state (VD(SS)) was 270 +/- 160.5 mL/kg in horses and 93.2 +/- 33.74 mL/kg in donkeys. All values, except VD(SS), were significantly different between donkeys and horses. CONCLUSIONS AND CLINICAL RELEVANCE: The small VD(SS) of meloxicam in horses and donkeys (attributed to high protein binding) was similar to values determined for other nonsteroidal anti-inflammatory drugs. Compared with other species, horses had a much shorter MRT and greater CL(T) for meloxicam, indicating a rapid elimination of the drug from plasma; the even shorter MRT and greater CL(T) of meloxicam in donkeys, compared with horses, may make the use of the drug in this species impractical.

Pharmacokinetics of sulfamethoxazole and trimethoprim in donkeys, mules, and horses.

OBJECTIVE: To compare serum disposition of sulfamethoxazole and trimethoprim after IV administration to donkeys, mules, and horses. ANIMALS: 5 donkeys, 5 mules, and 3 horses. PROCEDURE: Blood samples were collected before (time 0) and 5, 15, 30, and 45 minutes and 1, 1.25, 1.5, 1.75, 2, 2.5, 3, 3.5, 4, 4.5, 5, 6, 8, 10, and 24 hours after IV administration of sulfamethoxazole (12.5 mg/kg) and trimethoprim (2.5 mg/kg). Serum was analyzed in triplicate with high-performance liquid chromatography for determination of sulfamethoxazole and trimethoprim concentrations. Serum concentration-time curve for each animal was analyzed separately to estimate noncompartmental pharmacokinetic variables. RESULTS: Clearance of trimethoprim and sulfamethoxazole in donkeys was significantly faster than in mules or horses. In donkeys, mean residence time (MRT) of sulfamethoxazole (2.5 hours) was less than half the MRT in mules (6.2 hours); MRT of trimethoprim in donkeys (0.8 hours) was half that in horses (1.5 hours). Volume of distribution at steady state (Vdss) for sulfamethoxazole did not differ, but Vdss of trimethoprim was significantly greater in horses than mules or donkeys. Area under the curve for sulfamethoxazole and trimethoprim was higher in mules than in horses or donkeys. CONCLUSIONS AND CLINICAL RELEVANCE: Dosing intervals for IV administration of trimethoprim-sulfamethoxazole in horses may not be appropriate for use in donkeys or mules. Donkeys eliminate the drugs rapidly, compared with horses. Ratios of trimethoprim and sulfamethoxazole optimum for antibacterial activity are maintained for only a short duration in horses, donkeys, and mules.

Pharmacokinetics of R(-) and S(+) carprofen after administration of racemic carprofen in donkeys and horses.

OBJECTIVE: To compare plasma disposition of the R(-) and S(+) enantiomers of carprofen after IV administration of a bolus dose to donkeys and horses. ANIMALS: 5 clinically normal donkeys and 3 clinically normal horses. PROCEDURE: Blood samples were collected from all animals at time 0 (before) and at 10, 15, 20, 30, and 45 minutes and 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 10, 24, 28, 32, and 48 hours after IV administration of a bolus of carprofen (0.7 mg/kg). Plasma was analyzed in triplicate via high-performance liquid chromatography to determine the concentrations of the carprofen enantiomers. A plasma concentrationtime curve for each donkey and horse was analyzed separately to estimate noncompartmental pharmacokinetic variables. RESULTS: In donkeys and horses, the area under the plasma concentration versus time curve (AUC) was greater for the R(-) carprofen enantiomer than it was for the S(+) carprofen enantiomer. For the R(-) carprofen enantiomer, the AUC and mean residence time (MRT) were significantly less and total body clearance (CIT) was significantly greater in horses, compared with donkeys. For the S(+) carprofen enantiomer, AUC and MRT were significantly less and CIT and apparent volume of distribution at steady state were significantly greater in horses, compared with donkeys. CONCLUSIONS AND CLINICAL RELEVANCE: Results have suggested that the dosing intervals for carprofen that are used in horses may not be appropriate for use in donkeys.

A comparison of three combinations of injectable anesthetics in miniature donkeys.

OBJECTIVE: To compare three combinations of injectable anesthetics in miniature donkeys for quality of induction, recovery, muscle relaxation, cardiopulmonary changes during anesthesia and duration of recumbency. Design Prospective, randomized experimental study. ANIMALS: Six miniature donkeys (< 90 cm in height at the withers) weighing 92-127 kg were used. MATERIALS AND METHODS: The drug combinations were: xylazine-butorphanol-ketamine (XBK), xylazine-butorphanol-tiletamine-zolazepam (XBT) and xylazine-propofol (XP). Each miniature donkey was anesthetized with each combination at 1-week intervals in random order. Heart and respiratory rates, indirect blood pressure and temperature were measured before and at 5-minute intervals during recumbency. Arterial blood samples were drawn for blood-gas analysis before and at 5, 15 and 30 minutes of anesthesia when samples could be collected. Recumbency time to sternal and time to standing were recorded and a subjective evaluation of induction, muscle relaxation and recovery were made. RESULTS: Mean recumbency time ± SD was 14.7 ± 9.4, 33.8 ± 6.3 and 14.6 ± 1.9 minutes with XBK, XBT and XP, respectively. Mean time to standing ± SD was 28.4 ± 11.3, 43.7 ± 7.2 and 26.3 ± 2.9 minutes with XBK, XBT and XP, respectively. Heart and respiratory rates and blood pressures varied from baseline but were always within normal ranges. Hemoglobin saturation, pH and PaO2 tended to be lower with these doses of XBT and XP. CONCLUSIONS AND CLINICAL RELEVANCE: Overall quality of anesthesia was poor with XBK. At the doses used this combination did not provide sufficient anesthesia compared with the combinations of XBT and XP, which appeared to provide acceptable anesthesia of short duration in miniature donkeys.

Repetitive propofol administration in dogs and cats.

A bolus of propofol was administered to 10 dogs (6 mg/kg intravenously [IV]) and 10 cats (10 mg/kg IV) on three consecutive days. The occurrence of apnea, heart and respiratory rates, blood pressure, time to movement, and changes in a complete blood count and biochemical profile were recorded. Apnea was not seen in the dogs but was seen in three cats. Slight increases in the number of Heinz bodies were seen in six cats, but the increases were not considered clinically significant. No apparent cumulative adverse effects were seen from a bolus of bisulfite-containing propofol, administered on three consecutive days.

Anesthesia and analgesia for geriatric veterinary patients.

The number of geriatric veterinary patients presented for anesthesia appears to be increasing. This article summarizes physiologic changes that occur in geriatric patients that are relevant to anesthesia. Proper patient preparation and vigilant monitoring are the best defense against anesthetic problems in the geriatric animal. The authors also discuss particular anesthetic problems as they relate to geriatric patients and seek to present solutions to these problems.

Effect of ketamine hydrochloride on the analgesic effects of tramadol hydrochloride in horses with signs of chronic laminitis-associated pain.

OBJECTIVE: To investigate the effects of ketamine hydrochloride on the analgesic effects of tramadol hydrochloride in horses with signs of pain associated with naturally occurring chronic laminitis. ANIMALS: 15 client-owned adult horses with chronic laminitis. PROCEDURES: Each horse received tramadol alone or tramadol and ketamine in a randomized, crossover study (≥ 2 months between treatments). Tramadol (5 mg/kg) was administered orally every 12 hours for 1 week. When appropriate, ketamine (0.6 mg/kg/h) was administered IV for 6 hours on each of the first 3 days of tramadol administration. Noninvasive systemic blood pressure values, heart and respiratory rates, intestinal sounds, forelimb load and off-loading frequency (determined via force plate system), and plasma tumor necrosis factor-α and thromboxane B(2) concentrations were assessed before (baseline) during (7 days) and after (3 days) each treatment. RESULTS: Compared with baseline data, arterial blood pressure decreased significantly both during and after tramadol-ketamine treatment but not with tramadol alone. Forelimb off-loading frequency significantly decreased during the first 3 days of treatment with tramadol only, returning to baseline frequency thereafter. The addition of ketamine to tramadol treatment reduced off-loading frequency both during and after treatment. Forelimb load did not change with tramadol alone but increased with tramadol-ketamine treatment. Plasma concentrations of tumor necrosis factor-α and thromboxane B(2) were significantly reduced with tramadol-ketamine treatment but not with tramadol alone. CONCLUSIONS AND CLINICAL RELEVANCE: In horses with chronic laminitis, tramadol administration induced limited analgesia, but this effect was significantly enhanced by administration of subanesthetic doses of ketamine.

Anesthetic considerations of the older equine.

This article briefly reviews physiologic changes that may occur with aging in equine patients. It summarizes anesthetic protocols and problems encountered in a group of older horses (> 20 years old) anesthetized over the previous 10 years in the teaching hospital and makes recommendations for appropriate management of these patients.

An evaluation of pulse oximeters in dogs, cats and horses.

OBJECTIVE: Evaluation of five pulse oximeters in dogs, cats and horses with sensors placed at five sites and hemoglobin saturation at three plateaus. STUDY DESIGN: Prospective randomized multispecies experimental trial. ANIMALS: Five healthy dogs, cats and horses. METHODS: Animals were anesthetized and instrumented with ECG leads and arterial catheters. Five pulse oximeters (Nellcor Puritan Bennett-395, NPB-190, NPB-290, NPB-40 and Surgi-Vet V3304) with sensors at five sites were studied in a 5 x 5 Latin square design. Ten readings (SpO2) were taken at each of three hemoglobin saturation plateaus (98, 85 and 72%) in each animal. Arterial samples were drawn concurrently and hemoglobin saturation was measured with a co-oximeter. Accuracy of saturation measurements was calculated as the root mean squared difference (RMSD), a composite of bias and precision, for each model tested in each species. RESULTS: Accuracy varied widely. In dogs, the RMSD for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 2.7, 2.2, 2.4, 1.7 and 2.7% respectively. Failure to produce readings for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 0, 0, 0.7, 0, and 20%, respectively. The Pearson correlation coefficients for the tongue, toe, ear, lip and prepuce or vulva were 0.95, 0.97, 0.69, 0.87 and 0.95, respectively. In horses, the RMSD for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 3.1, 3.0, 4.7, 3.3 and 2.1%, respectively while rates of failure to produce readings were 10, 21, 0, 17 and 60%, respectively. The Pearson correlation coefficients for the tongue, nostril, ear, lip and prepuce or vulva were 0.98, 0.94, 0.88, 0.93 and 0.94, respectively. In cats, the RMSD for all data for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 5.9, 5.6, 7.9, 7.9 and 10.7%, respectively while failure rates were 0, 0.7, 0, 20 and 32%, respectively. The correlation coefficients for the tongue, rear paw, ear, lip and front paw were 0.54, 0.79,.0.64, 0.49 and 0.57, respectively. For saturations above 90% in cats, the RMSD for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 2.6, 4.4, 4.0, 3.5 and 4.8%, respectively, while failure rates were 0, 1.7, 0, 25 and 43%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Accuracy and failure rates (failure to produce a reading) varied widely from model to model and from species to species. Generally, among the models tested in the clinically relevant range (90-100%) RMSD ranged from 2-5% while failure rates were highest in the V3304.