Adam Auckburally

An evaluation of anaesthetic induction in healthy dogs using rapid intravenous injection of propofol or alfaxalone

OBJECTIVE To evaluate quality of anaesthetic induction and cardiorespiratory effects following rapid intravenous (IV) injection of propofol or alfaxalone. STUDY DESIGN Prospective, randomised, blinded clinical study. ANIMALS Sixty healthy dogs (ASA I/II) anaesthetized for elective surgery or diagnostic procedures. METHODS Premedication was intramuscular acepromazine (0.03 mg kg(-1) ) and meperidine (pethidine) (3 mg kg(-1) ). For anaesthetic induction dogs received either 3 mg kg(-1) propofol (Group P) or 1.5 mg kg(-1) alfaxalone (Group A) by rapid IV injection. Heart rate (HR), respiratory rate (f(R) ) and oscillometric arterial pressures were recorded prior to induction, at endotracheal intubation and at 3 and 5 minutes post-intubation. The occurrence of post-induction apnoea or hypotension was recorded. Pre-induction sedation and aspects of induction quality were scored using 4 point scales. Data were analysed using Chi-squared tests, two sample t-tests and general linear model mixed effect anova (p < 0.05). RESULTS There were no significant differences between groups with respect to sex, age, body weight, f(R) , post-induction apnoea, arterial pressures, hypotension, SpO(2) , sedation score or quality of induction scores. Groups behaved differently over time with respect to HR. On induction HR decreased in Group P (-2 ± 28 beats minute(-1) ) but increased in Group A (14 ± 33 beats minute(-1) ) the difference being significant (p = 0.047). However HR change following premedication also differed between groups (p = 0.006). Arterial pressures decreased significantly over time in both groups and transient hypotension occurred in eight dogs (five in Group P, three in Group A). Post-induction apnoea occurred in 31 dogs (17 in Group P, 14 in Group A). Additional drug was required to achieve endotracheal intubation in two dogs. CONCLUSIONS AND CLINICAL RELEVANCE Rapid IV injection of propofol or alfaxalone provided suitable conditions for endotracheal intubation in healthy dogs but post-induction apnoea was observed commonly.

Two doses of dexmedetomidine in combination with buprenorphine for premedication in dogs; a comparison with acepromazine and buprenorphine.

OBJECTIVE To assess as premedicants, the sedative, cardiorespiratory and propofol-sparing effects in dogs of dexmedetomidine and buprenorphine compared to acepromazine and buprenorphine. STUDY DESIGN Prospective, randomised, blinded clinical study. ANIMALS Sixty healthy dogs (ASA grades I/II). Mean (SD) body mass 28.0 ± 9.1 kg, and mean age 3.4 ± 2.3 years. METHODS   Dogs were allocated randomly to receive 15 μg kg(-1) buprenorphine combined with either 30 μg kg(-1) acepromazine (group 1), 62.5 μg m(-2) dexmedetomidine (group 2), or 125 μg m(-2) dexmedetomidine (group 3) intramuscularly. After 30 minutes, anaesthesia was induced using a propofol target controlled infusion. Heart rate, respiratory rate, and oscillometric arterial blood pressure were recorded prior to induction, at endotracheal intubation and at 3 and 5 minutes post-intubation. Induction quality and pre-induction sedation were scored on 4 point scales. Propofol target required for endotracheal intubation was recorded. Data were analysed using Chi-squared tests, Kruskal-Wallis, one way and general linear model ANOVA (p<0.05). RESULTS Age was significantly lower in group 1 (1.0 (1.0-3.8) years) than group 2 (5.0 (2.0-7.0) years), (median, (IQR)). There were no significant differences in sedation or quality of induction between groups. After premedication, heart rate was significantly lower and arterial blood pressures higher in groups 2 and 3 than group 1, but there was no significant difference between groups 2 and 3. Propofol targets were significantly lower in group 3 (1.5 (1.0-2.5) μg mL(-1) ) than group 1 (2.5 (2.0-3.0) μg mL(-1) ); no significant differences existed between group 2 (2.0 (1.5-2.5) μg mL(-1) ) and the other groups (median, (interquartile range)). CONCLUSIONS AND CLINICAL RELEVANCE When administered with buprenorphine, at these doses, dexmedetomidine had no advantages in terms of sedation and induction quality over acepromazine. Both doses of dexmedetomidine produced characteristic cardiovascular and respiratory effects of a similar magnitude.

A comparison of induction of anaesthesia using a target-controlled infusion device in dogs with propofol or a propofol and alfentanil admixture

OBJECTIVE To compare induction targets, and the haemodynamic and respiratory effects, of propofol, or as an admixture with two different concentrations of alfentanil, delivered via a propofol target-controlled infusion (TCI) system. STUDY DESIGN Prospective blinded randomized clinical study. ANIMALS Sixty client-owned dogs scheduled for elective surgery under general anaesthesia. Mean body mass (SD) 28.5 kg (8.7) and mean age (SD) 3.5 years (2.4). METHODS Dogs received pre-anaesthetic medication of acepromazine (0.03 mg kg(-1)) and morphine (0.2 mg kg(-1)) administered intramuscularly. Animals were randomly assigned to receive one of three induction protocols: propofol alone (group 1), a propofol/alfentanil (11.9 microg mL(-1)) admixture (group 2), or a propofol/alfentanil (23.8 microg mL(-1)) admixture (group 3), via a TCI system. Blood target concentrations were increased until endotracheal intubation was achieved, and induction targets were recorded. Heart rate (HR), respiratory rate (f(r)) and non-invasive arterial blood pressure were recorded pre-induction, at endotracheal intubation (time 0) and at 3 and 5 minutes post-intubation (times 3 and 5, respectively). Data were analysed using anova for normally distributed data or Kruskal-Wallis test, with significance assumed at p < 0.05. RESULTS There were no significant differences between groups with respect to age, body mass, HR, f(r), systolic and diastolic blood pressure. The blood propofol targets to achieve endotracheal intubation were significantly higher in group 1 compared with groups 2 and 3. Mean arterial blood pressure (MAP) was significantly higher in group 1 at time 0 when compared with groups 2 and 3. CONCLUSIONS AND CLINICAL RELEVANCE Induction of anaesthesia with a TCI system can be achieved at lower blood propofol targets when using a propofol/alfentanil admixture compared with using propofol alone. However, despite reduced targets with both propofol/alfentanil admixture groups, MAP was lower immediately following endotracheal intubation than when using propofol alone.

Avian reflex and electroencephalogram responses in different states of consciousness.

Defining states of clinical consciousness in animals is important in veterinary anaesthesia and in studies of euthanasia and welfare assessment at slaughter. The aim of this study was to validate readily observable reflex responses in relation to different conscious states, as confirmed by EEG analysis, in two species of birds under laboratory conditions (35-week-old layer hens (n=12) and 11-week-old turkeys (n=10)). We evaluated clinical reflexes and characterised electroencephalograph (EEG) activity (as a measure of brain function) using spectral analyses in four different clinical states of consciousness: conscious (fully awake), semi-conscious (sedated), unconscious-optimal (general anaesthesia), unconscious-sub optimal (deep hypnotic state), as well as assessment immediately following euthanasia. Jaw or neck muscle tone was the most reliable reflex measure distinguishing between conscious and unconscious states. Pupillary reflex was consistently observed until respiratory arrest. Nictitating membrane reflex persisted for a short time (<1 min) after respiratory arrest and brain death (isoelectric EEG). The results confirm that the nictitating membrane reflex is a conservative measure of death in poultry. Using spectral analyses of the EEG waveforms it was possible to readily distinguish between the different states of clinical consciousness. In all cases, when birds progressed from a conscious to unconscious state; total spectral power (PTOT) significantly increased, whereas median (F50) and spectral edge (F95) frequencies significantly decreased. This study demonstrates that EEG analysis can differentiate between clinical states (and loss of brain function at death) in birds and provides a unique integration of reflex responses and EEG activity.

Review of hypoxaemia in anaesthetized horses: predisposing factors, consequences and management

OBJECTIVE To discuss how hypoxaemia might be harmful and why horses are particularly predisposed to developing it, to review the strategies that are used to manage hypoxaemia in anaesthetized horses, and to describe how successful these strategies are and the adverse effects associated with them. DATABASES USED Google Scholar and PubMed, using the search terms horse, pony, exercise, anaesthesia, hypoxaemia, oxygen, mortality, morbidity and ventilation perfusion mismatch. CONCLUSIONS Although there is no evidence that hypoxaemia is associated with increased morbidity and mortality in anaesthetized horses, most anaesthetists would agree that it is important to recognise and prevent or treat it. Favourable anatomical and physiological adaptations of a horse for exercise adversely affect gas exchange once the animal is recumbent. Hypoxaemia is recognised more frequently in horses than in other domestic species during general anaesthesia, although its incidence in healthy horses remains unreported. Management of hypoxaemia in anaesthetized horses is challenging and often unsuccessful. Positive pressure ventilation strategies to address alveolar atelectasis in humans have been modified for implementation in recumbent anaesthetized horses, but are often accompanied by unpredictable and unacceptable cardiopulmonary adverse effects, and some strategies are difficult or impossible to achieve in adult horses. Furthermore, anticipated beneficial effects of these techniques are inconsistent. Increasing the inspired fraction of oxygen during anaesthesia is often unsuccessful since much of the impairment in gas exchange is a direct result of shunt. Alternative approaches to the problem involve manipulation of pulmonary blood away from atelectatic regions of the lung to better ventilated areas. However, further work is essential, with particular focus on survival associated with general anaesthesia in horses, before any technique can be accepted into widespread clinical use.

Evoked otoacoustic emissions: An alternative test of auditory function in horses

REASONS FOR PERFORMING STUDY Deafness has been reported in horses due to a variety of causes and objective auditory assessment has been performed with brainstem auditory evoked potential testing. Evoked otoacoustic emission (OAE) tests are widely used in human patients for hearing screening, detecting partial hearing loss (including frequency-specific hearing loss) and monitoring cochlear outer hair cell function over time. OAE tests are noninvasive, quick and affordable. Two types of OAE are commonly used clinically: transient evoked OAEs (TEOAEs) and distortion product OAEs (DPOAEs). Detection of OAEs has not been reported and OAE testing has not been evaluated for auditory assessment in horses. OBJECTIVES To investigate whether TEOAEs and DPOAEs can be recorded in horses, and to evaluate the use of human OAE screening protocols in horses with apparently normal hearing. METHODS Sixteen systemically healthy horses with normal behavioural responses to sound were included. OAE testing was performed during general anaesthesia using commercially available equipment and the final outcome for each ear for the TEOAE test (after a maximum of 3 runs) and the DPOAE test (after one run) were compared. RESULTS TEOAEs and DPOAEs can be recorded in horses. Using the chosen TEOAE protocol, 96% of ears achieved a pass. Seventy percent of ears passed DPOAE testing, despite all of these ears passing TEOAE testing. CONCLUSIONS Using the chosen stimulus and analysis protocols, TEOAEs were recorded from most ears; however, a smaller proportion of ears passed the DPOAE protocol, suggesting that this may be overly stringent and require further optimisation in horses. POTENTIAL RELEVANCE OAE testing is rapid and easily performed in anaesthetised horses. It provides frequency-specific information about outer hair cell function, and is a promising tool for audiological assessment in the horse; however, it has not been assessed in conscious or sedated animals.

Sedative and cardiopulmonary effects of xylazine alone or in combination with methadone, morphine or tramadol in sheep.

OBJECTIVE To evaluate the cardiopulmonary and sedative effects of xylazine alone or in combination with methadone, morphine or tramadol in sheep. STUDY DESIGN Experimental, prospective, crossover, randomized, blinded study. ANIMALS Six Santa Inês breed sheep (females) aged 12 ± 8 months and weighing 39.5 ± 7.4 kg. METHODS Sheep were sedated with each of four treatments in a randomized, crossover design, with a minimum washout period of 7 days between treatments. Treatments were: X [xylazine (0.1 mg kg(-1))]; XM [xylazine (0.1 mg kg(-1)) and methadone (0.5 mg kg(-1))]; XMO [xylazine (0.1 mg kg(-1)) and morphine (0.5 mg kg(-1))], and XT [xylazine (0.1 mg kg(-1)) and tramadol (5 mg kg(-1))]. Each drug combination was mixed in the syringe and injected intravenously. Sedation, heart rate (HR), mean arterial blood pressure (MAP), rectal temperature (RT°C), respiratory rate (fR), arterial blood gases and electrolytes were measured before drug administration (T0) and then at 15 minute intervals for 120 minutes (T15-T120). RESULTS Heart rate significantly decreased in all treatments compared with T0. PaCO2 values in XM and XMO were higher at all time points compared with T0. In treatments X and XM, pH, bicarbonate (HCO3-) and base excess were increased at all time points compared with T0. PaO2 was significantly decreased at T15-T75 in XM, at all time points in XMO, and at T15 and T30 in XT. Sedation at T15 and T30 in XM and XMO was greater than in the other treatments. CONCLUSIONS AND CLINICAL RELEVANCE The combinations of methadone, morphine or tramadol with xylazine resulted in cardiopulmonary changes similar to those induced by xylazine alone in sheep. The combinations provided better sedation, principally at 15 minutes and 30 minutes following administration.

An evaluation of a target-controlled infusion of propofol or propofol-alfentanil admixture for sedation in dogs.

OBJECTIVES To evaluate sedation quality and cardiorespiratory variables in dogs sedated using a target-controlled infusion of propofol or propofol-alfentanil admixture. METHODS A total of 60 dogs undergoing diagnostic imaging were randomly assigned to one of three sedation protocols: propofol alone; propofol with a low concentration of 12 µg of alfentanil per mL of propofol; or propofol with a higher concentration of 24 µg of alfentanil per mL of propofol. Target-controlled infusion was initiated at a propofol target concentration of 1·5 µg/mL and increased until lateral recumbency was achieved. Times to adopt lateral recumbency and recover, pulse rate, respiratory rate, oscillometric mean arterial pressure and oxygen saturation were recorded. Quality of sedation onset and recovery were scored. RESULTS Propofol target at lateral recumbency differed significantly (P=0·01) between groups with median (range) values of 3·0 (1·5 to 5·5), 2·0 (2 to 4·5) and 2·25 (1·5 to 3·5) µg/mL for propofol alone, propofol with the lower concentration of alfentanil and propofol with the higher concentration of alfentanil groups, respectively. Time to lateral recumbency was longer and quality of onset less smooth for the propofol group. Pulse rate change differed significantly (P<0·001) between groups (mean pulse rate change at onset of sedation: propofol group +2 ±24 bpm, low concentration alfentanil group -30 ±24 bpm, higher concentration alfentanil group -26 ±23 bpm). Hypoxaemia (SpO2 <90%) occurred in 1, 3 and 13 dogs, in the propofol group, the low concentration alfentanil group and the higher concentration of alfentanil group, respectively (P<0·001). CLINICAL SIGNIFICANCE Addition of alfentanil to propofol target-controlled infusion did not confer cardiovascular benefits and, at the higher concentration, alfentanil increased the incidence of hypoxaemia.

Use of supplemental intravenous anaesthesia/analgesia in horses

General anaesthesia in horses is associated with a significant risk of both morbidity and mortality. One major factor contributing to this is the marked cardiopulmonary depression that occurs in this species in association with the use of volatile anaesthetic agents. Attempts to minimise the required volatile concentration for the maintenance of unconsciousness by administering additional injectable agents may have beneficial effects on the outcome for the animal. This article describes the characteristics of the agents commonly used for supplemental intravenous anaesthesia/analgesia (SIVA), and highlights the key points that must be taken into consideration when undertaking the concurrent administration of these drugs.

Recovery from anaesthesia in horses 1: what can go wrong?

GENERAL anaesthesia of horses carries a significant risk, with the recovery period being a time of particular concern. Over the years, a number of different drugs and techniques have been suggested in order to make the transition from unconsciousness to standing as smooth as possible. However, as yet, there is no single generally accepted method of ensuring that the recovery period will proceed uneventfully. This article, the first of two, will review the factors implicated in potentially poor-quality recovery from anaesthesia in horses, and discuss the complications that may arise, together with how to manage them. The second article, to be published in the next issue of In Practice, will highlight some of the techniques that have been suggested in order to minimise the complications.