Sedation with dexmedetomidine-butorphanol or xylazine-butorphanol continuous intravenous infusions during unilateral ovariectomy in standing donkeys.

BACKGROUND: Intravenous infusions of alpha-2 adrenoceptor sedatives and opioids can potentially facilitate surgery in donkeys while standing. Literature on this subject matter is scant. OBJECTIVES: Evaluation of efficacy of sedation from α2 -adrenoceptors (dexmedetomidine or xylazine) and butorphanol during ovariectomy in standing donkeys. STUDY DESIGN: Randomised, masked in vivo experiment. METHODS: Thirteen female donkeys were sedated with butorphanol (0.05 mg/kg bwt followed by 0.05 mg/kg bwt/h) IV. Concomitantly, 6 of the 13 jennies were sedated with dexmedetomidine 2.5 mcg/kg bwt followed by 2.5 mcg/kg bwt/h (Dex-B group), while seven jennies were sedated with xylazine 0.5 mg/kg bwt followed by 0.5 mg/kg bwt/h (Xyl-B group). A line block of the left flank and an infiltration block around uterine ligament were performed with lidocaine. While the jennies underwent ovariectomies standing, sedation scores and head height above ground were assessed at 2 and 10 min after sedative boluses and every 10 min thereafter. If sedation was too light or too deep, the dose of dexmedetomidine or xylazine was increased or decreased by 25% of the original infusion rate, while butorphanol infusion rate was constant. Physiological parameters were measured. Normally distributed data were compared using the two-sample t test while repeatedly measured data were tested for differences between and within groups using repeated measures analysis of variance (ANOVA) by ranks followed by a Wilcoxon test with Tukey Honest Significant Difference for multiple testing. Statistical significance was set at p < 0.05. RESULTS: Both Dex-B and Xyl-B caused moderate to marked sedation adequate for ovariectomy in donkeys. Evident sedation was absent by 60 min of termination of infusions. No adverse physiological effects were observed. MAIN LIMITATIONS: Study on ovariectomy cases only, no pharmacokinetic profiling. CONCLUSIONS: Dexmedetomidine or xylazine and butorphanol sedation is feasible for ovariectomy in standing donkeys.

Morphine in donkeys: Antinociceptive effect and preliminary pharmacokinetics.

BACKGROUND: Morphine is the prototypical µ-opioid receptor agonist used to provide analgesia in veterinary species. Its effects are well-described in horses but not donkeys. OBJECTIVES: To determine the antinociceptive effects of two doses of morphine in donkeys. To describe preliminary pharmacokinetic parameters of morphine in donkeys. STUDY DESIGN: In vivo experiment. METHODS: Eight adult castrated male donkeys were given intravenous (IV) 0.9% saline, morphine 0.1 mg/kg bwt (LDM), or morphine 0.5 mg/kg bwt (HDM) in a randomised order with a minimum 1-week washout period. Mechanical nociceptive thresholds (MNTs) were determined by a blinded investigator pre-injection and 15, 30, 45, 60, 90, 120, 150, 180, 210, 240, 300, and 360 min post-injection. Venous blood samples were collected pre-injection and 2, 5, 10, 15, 30, 45, 60, 90, and 120 min post-injection. Data were analysed using Friedman's test with Dunn's post hoc test for multiple comparisons. Pharmacokinetic parameters were calculated for the HDM treatment. RESULTS: Baseline MNT was [median (interquartile range)] 8.9 (7.1-10.3) N and did not differ between treatments. Peak MNTs occurred at 60 min for both LDM (16.2 N) and HDM (25.0 N) treatments. MNTs after HDM treatment were higher than saline (p < 0.04) at 15, 60, 90, 120, 150, 180, 240, and 300 min post-injection. MNTs after LDM treatment were higher than baseline (p < 0.05) at 45 and 60 min post-injection. Terminal half-life for HDM was (mean ± SD) 51.0 ± 10.7 min, the volume of distribution at steady-state 2.07 ± 0.33 L/min and clearance 49.2 ± 4.16 ml * min/kg using noncompartmental analysis. The concentration of morphine-3-glucuronide (M3G) was higher than morphine-6-glucuronide (M6G) at all sampled time points. MAIN LIMITATIONS: Short duration of plasma sampling for pharmacokinetic analysis; lack of objective measure of gastrointestinal function. CONCLUSIONS: The HDM treatment provided mechanical antinociception in donkeys with no significant adverse effects.

Effects of two continuous infusion doses of lidocaine on isoflurane minimum anesthetic concentration in chickens.

OBJECTIVE: To assess the effect of two intravenous (IV) doses of lidocaine on the minimum anesthetic concentration (MAC) of isoflurane in chickens. STUDY DESIGN: Blinded, prospective, randomized, experimental crossover study. ANIMALS: A total of six adult female chickens weighing 1.90 ± 0.15 kg. METHODS: Chickens were anesthetized with isoflurane and mechanically ventilated. Isoflurane MAC values were determined (T0) in duplicate using an electrical noxious stimulus and the bracketing method. After MAC determination, a low dose (LD; 3 mg kg-1 followed by 3 mg kg-1 hour-1) or high dose (HD; 6 mg kg-1 followed by 6 mg kg-1 hour-1) of lidocaine was administered IV. MAC determination was repeated at 1.5 (T1.5) and 3 (T3) hours of lidocaine administration and blood was collected for analysis of plasma lidocaine and monoethylglycinexylidide (MEGX) concentrations. Pulse rate, peripheral hemoglobin oxygen saturation, noninvasive systolic arterial pressure and cloacal temperature were recorded at T0, T1.5 and T3. Treatments were separated by 1 week. Data were analyzed using mixed-effects model for repeated measures. RESULTS: MAC of isoflurane (mean ± standard deviation) at T0 was 1.47 ± 0.18%. MAC at T1.5 and T3 was 1.32 ± 0.27% and 1.26 ± 0.09% (treatment LD); and 1.28 ± 0.06% and 1.30 ± 0.06% (treatment HD). There were no significant differences between treatments or times. Maximum plasma lidocaine concentrations at T3 were 496 ± 98 and 1200 ± 286 ng mL-1 for treatments LD and HD, respectively, and were not significantly different from T1.5. With treatment HD, plasma concentration of MEGX was significantly higher at T3 than at T1.5. Physiological variables were not significantly different among times with either treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of lidocaine did not significantly change isoflurane MAC in chickens. Within treatments, plasma lidocaine concentrations were not significantly different at 1.5 and 3 hours.

Determination of the minimum alveolar concentration of isoflurane in donkeys.

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of isoflurane in donkeys and characterize recovery from anesthesia. ANIMALS: 7 healthy castrated male adult donkeys. PROCEDURES: Anesthesia was induced with propofol and maintained under mechanical ventilation with 1.3% isoflurane end-tidal concentration (ETiso). The MAC of isoflurane was determined after a 60-minute propofol washout period using the bracketing method. A continuous noxious electrical stimulation was applied to the oral mucosa for 1 minute or until the donkey moved. The ETiso was increased or decreased by 10% depending on the response, and MAC was defined as the average of 2 ETiso values allowing and preventing movement in response to stimulation. Arterial blood gases were measured during anesthesia and the recovery period. Unassisted recovery was timed, and a quality score was assigned from 1 (very poor) to 5 (excellent). RESULTS: The mean dose of propofol required for induction was 3.0 ± 0.6 mg/kg. The MAC of isoflurane was 1.44 ± 0.13%. One donkey was excluded from the study because it was still responsive when stimulated at ETiso of 2.8%. Immediately after extubation, the median (range) partial pressure of oxygen in the arterial blood was 63 (minimum to maximum, 46 to 72) mm Hg and 3 donkeys were hypoxemic (partial pressure of arterial oxygen < 60 mm Hg). The median time to standing was 13 (7 to 38) minutes, while the recovery score was 3 (2 to 5). CLINICAL RELEVANCE: The MAC of isoflurane in donkeys is similar to that reported in other species. Oxygen support should be provided to donkeys during recovery from isoflurane anesthesia to prevent hypoxemia.

Oxygen reserve index as a noninvasive indicator of arterial partial pressure of oxygen in anaesthetized donkeys: a preliminary study.

OBJECTIVE: To evaluate the oxygen reserve index (ORI) as a noninvasive estimate of the PaO2 during moderate hyperoxaemia [100-200 mmHg (13.3-26.6 kPa)], and to determine ORI values identifying PaO2 > 100, > 150 (20.0 kPa) and > 200 mmHg in anaesthetized donkeys with an inspired fraction of oxygen (FiO2) > 0.95. STUDY DESIGN: Prospective observational study. ANIMALS: A group of 28 adult standard donkeys aged (mean ± standard deviation) 4 ± 2 years and weighing 135 ± 15 kg. METHODS: Donkeys were sedated intramuscularly with xylazine and butorphanol; anaesthesia was induced with ketamine and diazepam and maintained with isoflurane in oxygen. An adhesive sensor probe was applied to the donkey's tongue and connected to a Masimo pulse co-oximeter to determine ORI values. An arterial catheter was inserted into an auricular artery. After ORI signal stabilization, the value was noted and PaO2 determined by blood gas analysis. The Pearson correlation coefficient was used to assess the relationship between ORI and PaO2 for oxygen tension < 200 mmHg (< 26.6 kPa). The Youden index was used to identify the value of ORI that detected PaO2 > 150 and 200 mmHg (20.0 and 26.6 kPa) with the highest sensitivity and specificity. RESULTS: A total of 106 paired measurements were collected. A mild positive correlation was observed between ORI and PaO2 for values < 200 mmHg (26.6 kPa; r = 0.52). An ORI > 0.0, > 0.1 and > 0.3 indicated a PaO2 > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) with negative predictive values > 94%. CONCLUSIONS AND CLINICAL RELEVANCE: ORI may provide a noninvasive indication of PaO2 > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) in anaesthetized donkeys with an FiO2 > 0.95, although it does not replace blood gas analysis for assessment of oxygenation.

Evaluation of xylazine-alfaxalone anesthesia for field castration in donkey foals.

OBJECTIVE: To evaluate the anesthetic and cardiopulmonary effects of xylazine-alfaxalone anesthesia in donkey foals undergoing field castration. STUDY DESIGN: Prospective clinical study. ANIMALS: A group of seven standard donkeys aged [median (range)] 12 (10-26) weeks, weighing 47.3 (37.3-68.2) kg. METHODS: Donkeys were anesthetized with xylazine (1 mg kg-1) intravenously (IV) followed 3 minutes later by alfaxalone (1 mg kg-1) IV. Additional doses of xylazine (0.5 mg kg-1) and alfaxalone (0.5 mg kg-1) IV were administered as needed to maintain surgical anesthesia. Intranasal oxygen was supplemented at 3 L minute-1. Heart rate (HR), respiratory rate (fR) and mean arterial pressure (MAP) by oscillometry were recorded before drug administration and every 5 minutes after induction of anesthesia. Peripheral oxygen saturation (SpO2) was recorded every 5 minutes after induction. Time to recumbency after alfaxalone administration, time to anesthetic re-dose, time to first movement, sternal and standing after last anesthetic dose and surgery time were recorded. Induction and recovery quality were scored (1, very poor; 5, excellent). RESULTS: Median (range) induction score was 5 (1-5), and recovery score 4 (1-5). Overall, two donkeys were assigned a score of 1 (excitement) during induction or recovery. HR and MAP during the procedure did not differ from baseline. fR was decreased at 5 and 10 minutes but was not considered clinically significant. SpO2 was <90% at one time point in two animals. CONCLUSIONS AND CLINICAL RELEVANCE: Xylazine-alfaxalone anesthesia resulted in adequate conditions for castration in 12 week old donkeys. While the majority of inductions and recoveries were good to excellent, significant excitement occurred in two animals and may limit the utility of this protocol for larger donkeys. Hypoxemia occurred despite intranasal oxygen supplementation.

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. STUDY DESIGN: Randomized, blinded, crossover experimental trial. ANIMALS: A group of seven adult male castrated donkeys weighing 164 ± 14 kg. METHODS: Donkeys were randomly administered midazolam (0.05 mg kg-1) and alfaxalone (1 mg kg-1) or midazolam (0.05 mg kg-1) and ketamine (2.2 mg kg-1) intravenously following sedation with xylazine, with ≥ 7 days between treatments. Donkeys were not endotracheally intubated and breathed room air. Time to lateral recumbency, first movement, sternal recumbency and standing were recorded. Induction and recovery were assigned scores between 1 (very poor) and 5 (excellent). Heart rate (HR), respiratory rate (fR), invasive arterial blood pressures and arterial blood gases were measured before induction and every 5 minutes following induction until first movement. RESULTS: Time to lateral recumbency (mean ± standard deviation) was shorter after alfaxalone (29 ± 10 seconds) compared with ketamine (51 ± 9 seconds; p = 0.01). Time to first movement was the same between treatments (27 versus 23 minutes). Time to standing was longer with alfaxalone (58 ± 15 minutes) compared with ketamine (33 ± 8 minutes; p = 0.01). Recovery score [median (range)] was of lower quality with alfaxalone [3 (2-5)] compared with ketamine [5 (3-5); p = 0.03]. There were no differences in HR, fR or arterial pressures between treatments. No clinically important differences in blood gases were identified between treatments. Five of seven donkeys administered alfaxalone became hypoxemic (PaO2 <60 mmHg; 8.0 kPa) and all donkeys administered ketamine became hypoxemic (p = 0.13). CONCLUSIONS AND CLINICAL RELEVANCE: Both midazolam-alfaxalone and midazolam-ketamine produced acceptable anesthetic induction and recovery in donkeys after xylazine sedation. Hypoxemia occurred with both treatments.

Sedative and physiologic effects of low-dose intramuscular alfaxalone in dogs.

OBJECTIVE: To describe the sedative and physiologic effects of two doses of alfaxalone administered intramuscularly in dogs. STUDY DESIGN: Randomized, blinded, crossover experimental trial. ANIMALS: Ten adult mixed-breed dogs. METHODS: Dogs were assigned randomly to be administered one of three intramuscular injections [saline 0.1 mL kg-1 (S), alfaxalone 1 mg kg-1 (A1) or alfaxalone 2 mg kg-1 (A2)] on three occasions. Heart rate (HR), respiratory rate (fR) and sedation score were assessed before injection (T0) and at 5 (T5), 10 (T10), 15 (T15), 20 (T20), 30 (T30), 45 (T45) and 60 (T60) minutes postinjection. Rectal temperature was determined at T0 and T60. Adverse events occurring between the time of injection and T60 were recorded. RESULTS: Sedation scores were higher in group A2 at T15 and T30 compared with group S. There were no additional differences between groups in sedation score. The A2 group had higher sedation scores at T15, T20 and T30 compared with T0. The A1 group had higher sedation scores at T10 and T30 compared with T0. Temperature was lower in groups A1 and A2 compared with S at T60, but was not clinically significant. There were no differences between or within groups in HR or fR. Adverse effects were observed in both A1 and A2 groups. These included ataxia (17/20), auditory hyperesthesia (5/20), visual disturbance (5/20), pacing (4/20) and tremor (3/20). CONCLUSIONS AND CLINICAL RELEVANCE: While alfaxalone at 2 mg kg-1 intramuscularly resulted in greater median sedation scores compared with saline, the range was high and adverse effects frequent. Neither protocol alone can be recommended for providing sedation in healthy dogs.

A comparison of cardiopulmonary and anesthetic effects of an induction dose of alfaxalone or propofol in dogs.

OBJECTIVE: To compare the physiological parameters, arterial blood gas values, induction quality, and recovery quality after IV injection of alfaxalone or propofol in dogs. STUDY DESIGN: Prospective, randomized, blinded crossover. ANIMALS: Eight random-source adult female mixed-breed dogs weighing 18.7 ± 4.5 kg. METHODS: Dogs were assigned to receive up to 8 mg kg(-1) propofol or 4 mg kg(-1) alfaxalone, administered to effect, at 10% of the calculated dose every 10 seconds. They then received the alternate drug after a 6-day washout. Temperature, pulse rate, respiratory rate, direct blood pressure, and arterial blood gases were measured before induction, immediately post-induction, and at 5-minute intervals until extubation. Quality of induction, recovery, and ataxia were scored by a single blinded investigator. Duration of anesthesia and recovery, and adverse events were recorded. RESULTS: The mean doses required for induction were 2.6 ± 0.4 mg kg(-1) alfaxalone and 5.2 ± 0.8 mg kg(-1) propofol. After alfaxalone, temperature, respiration, and pH were significantly lower, and PaCO2 significantly higher post-induction compared to baseline (p < 0.03). After propofol, pH, PaO2 , and SaO2 were significantly lower, and PaCO2 , HCO3 , and PA-aO2 gradient significantly higher post-induction compared to baseline (p < 0.03). Post-induction and 5-minute physiologic and blood gas values were not significantly different between alfaxalone and propofol. Alfaxalone resulted in significantly longer times to achieve sternal recumbency (p = 0.0003) and standing (p = 0.0004) compared to propofol. Subjective scores for induction, recovery, and ataxia were not significantly different between treatments; however, dogs undergoing alfaxalone anesthesia were more likely to have ≥ 1 adverse event (p = 0.041). There were no serious adverse events in either treatment. CONCLUSIONS AND CLINICAL RELEVANCE: There were no clinically significant differences in cardiopulmonary effects between propofol and alfaxalone. A single bolus of propofol resulted in shorter recovery times and fewer adverse events than a single bolus of alfaxalone.