Descriptive assessment of adverse events associated with midazolam-etomidate versus saline-etomidate in healthy hydromorphone premedicated dogs.

OBJECTIVES: To determine the frequency, severity and duration of adverse events including myoclonus, pain on injection, hypersalivation, regurgitation and apnoea after administration of midazolam or saline followed by etomidate in hydromorphone premedicated dogs. MATERIALS AND METHODS: Dogs undergoing elective dental prophylaxis or soft tissue surgeries were enrolled in this randomised trial. Dogs were premedicated with hydromorphone 0.1 mg/kg IV. Sixty seconds later, midazolam 0.3 mg/kg or saline at an equivalent volume was administered IV. Sixty seconds after that, etomidate 1.5 mg/kg IV was administered over 60 seconds. Additional doses of 0.5 mg/kg etomidate were administered until endotracheal intubation was successful. Observers were blinded to the treatment. Frequency, duration and a severity score of 0 to 3 were recorded for myoclonus, pain on injection, hypersalivation and regurgitation. Duration of apnoea and frequency of any additional complications was recorded. RESULTS: Forty variable breed healthy dogs were enrolled in the study. Myoclonus, pain on injection, regurgitation, hypersalivation, gagging, tachypnoea and pigmenturia occurred, respectively, in 10%, 40%, 0%, 15%, 35%, 25% and 5% of dogs in the saline group and 0%, 65%, 0%, 10%, 45%, 15% and 5% of dogs in the midazolam group. Apnoea occurred for 115 seconds (range 0 to 660 seconds) and 160 seconds (range 0 to 600 seconds) in the saline and midazolam groups, respectively. Two dogs developed pigmenturia. The trial was stopped early due to the occurrence of pigmenturia. CLINICAL SIGNIFICANCE: Due to early stopping of the trial, the predefined sample size was not reached. Further investigation is needed to determine if midazolam reduced the incidence of adverse events or improved the induction quality when combined with hydromorphone and etomidate.

The effect of induction with propofol or ketamine and diazepam on quality of anaesthetic recovery in dogs.

OBJECTIVE: To evaluate the quality of recovery in dogs undergoing elective orthopaedic surgery induced with either propofol or a combination of ketamine and diazepam. MATERIALS AND METHODS: Sixty client-owned dogs undergoing single-limb elective orthopaedic procedures were enrolled. Dogs were randomly assigned to receive induction with propofol (4 mg/kg) (group P) or ketamine (5 mg/kg) with diazepam (0.25 mg/kg) (group KD) to which all scorers were blinded. The recovery monitoring period lasted for 1 hour following extubation. The recovery period was video-recorded for blinded scoring at a later time. Scoring for quality of recovery was carried out using three different systems (lower numbers=better quality): a simple descriptive scale (1 to 5), a visual analogue scale (0 to 10 cm) and a numeric rating scale (0 to 10). Videos were reviewed by three ACVAA board-certified anaesthesiologist raters. RESULTS: Five dogs were deemed to be ineligible. The mean (±SD) duration of anaesthesia was 260.4 ±57.84 minutes in group KD and 261.1 ±51.83 minutes in group P. There was no difference between groups for time to extubation, head lift or sternal recumbency. The number of dogs having a recovery that was scored overall as bad (mean simple descriptive scale > 4, mean visual analogue scale or numeric rating scale > 5) was not different between groups. Dogs in group KD had significantly lower scores than group P dogs (simple descriptive scale P=0.01, numeric rating scale P=0.03, visual analogue scale P=0.03). CLINICAL SIGNIFICANCE: Induction with ketamine and diazepam resulted in a smoother recovery from anaesthesia than induction with propofol.

The effect of midazolam on the recovery quality, recovery time and the minimum alveolar concentration for extubation in the isoflurane-anesthetized pig.

There are no reported studies evaluating the effect of midazolam on recovery quality, recovery time or minimum alveolar concentration (MAC) at which extubation occurs (MAC extubation). Our hypotheses were that midazolam administered prior to recovery would decrease MAC extubation, prolong recovery time but provide a smoother recovery. Sixteen Yorkshire pigs were anesthetized with isoflurane for approximately 5 h. The end-tidal isoflurane concentration was then stabilized at 1.4% for 20 min. Pigs were randomly assigned to receive midazolam or saline. The vaporizer was decreased by 10% every 10 min until extubation. Pigs were declared awake by a blinded observer and were assigned a recovery score by the same observer. Mean MAC extubation was not significantly different for pigs receiving saline prior to recovery compared with those pigs receiving midazolam. The overall mean MAC extubation for both groups was 0.6 ± 0.4 vol%. Time to extubation was not significantly longer with midazolam (124 ± 36 min) compared with the saline group (96 ± 61 min; P = 0.09). Recovery score was not significantly different between groups (midazolam, 0.86 ± 1.1; saline 0.5 ± 0.5; P = 0.26). In conclusion, midazolam did not affect MAC extubation. There was no advantage of administering midazolam in the recovery period when performing step-down titration of isoflurane anesthesia.

Refinement of the dose of doxapram to counteract the sedative effects of acepromazine in dogs.

OBJECTIVES: To evaluate the effectiveness of two doses of doxapram in reversing acepromazine sedation in dogs. METHODS: Using a crossover design, 10 adult mixed-breed dogs received 0·05 mg/kg acepromazine, intramuscularly (im) followed 30 minutes later by one of the three randomly determined treatments: 0·0625 mL/kg saline, intravenously (iv), 1·25 mg/kg doxapram, iv or 2·5 mg/kg doxapram, iv. Sedation scores were obtained by a single, blinded observer at 0, 15 and 30 minutes after acepromazine administration and at 5, 15 and 30 minutes after the treatment administration. RESULTS: The mean baseline sedation score of all the treatments was not different among treatments. All the dogs had a significant increase in sedation score at 30 minutes after acepromazine administration. Both the low and high doses of doxapram showed a significant decrease in sedation score compared to saline, but there was no significant difference between the two doses. Five dogs in the high dose group panted after treatment injection, and this was significantly more than in the low dose group. CLINICAL SIGNIFICANCE: Doxapram is effective in reducing the sedative effects of acepromazine over a short period of time. A dose of 1·25 mg/kg effectively decreases acepromazine sedation without causing panting.

Sample size and statistical power in the small-animal analgesia literature.

OBJECTIVE: To document the power and required sample sizes to achieve certain treatment objectives in the veterinary analgesia literature. METHODS: Pubmed's MEDLINE database and selected journals were searched. Only publications produced between 1994 and 2004 that reported 'no difference' between experimental groups in the abstract, results or conclusion sections and those that were randomised, prospective and blinded were reviewed. The data reported in the publications were then subjected to power analyses to determine the power and necessary sample size (to achieve a power of 0.8) to allow detection of 20 per cent, 50 per cent and 80 per cent treatment effects. RESULTS: Twenty-two studies provided sufficient data for analysis. Five out of 22 (23 per cent) had sufficient power to detect a 20 per cent treatment effect, 12 of 22 (54 per cent) had sufficient power to detect a 50 per cent treatment effect and 18 of 22 (82 per cent) had sufficient power to detect an 80 per cent treatment effect. The mean number of animals required per group to document a 20 per cent, 50 per cent and 80 per cent treatment effect were 90, 15 and 7, respectively. CLINICAL SIGNIFICANCE: Publications that report no significant difference between analgesic regimens may have committed a Type II error. The reader may inappropriately conclude that there is no difference between treatments when there may, in fact, be a superior analgesic regimen. Clinical practice based on the principles of evidence-based medicine could therefore result in suboptimal care for patients.