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Cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane and low‐dose S‐ketamine or medetomidine infusions - Zurich Open Repository and Archive


Larenza Menzies, M Paula; Ringer, Simone K; Conrot, Aude; Theurillat, Regula; Kluge, Katharina; Kutter, Annette P N; Jackson, Michelle Amanada; Thormann, Wolfgang; Bettschart-Wolfensberger, Regula (2016). Cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane and low‐dose S‐ketamine or medetomidine infusions. Veterinary Anaesthesia and Analgesia, 43(6):623-634.

Abstract

OBJECTIVES: To evaluate cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane receiving medetomidine or S-ketamine infusions.
STUDY DESIGN: Randomized, blinded, prospective clinical trial.
ANIMALS: Fifty horses undergoing elective surgery.
METHODS: After acepromazine and flunixin meglumine premedication, horses received medetomidine (7 μg kg-1 ) intravenously (IV). Anaesthesia was induced with midazolam and racemic ketamine (Med treatment group; 2.2 mg kg-1 ; n = 25) or S-ketamine (S-ket treatment group; 1.1 mg kg-1 ; n = 25) IV and maintained with isoflurane in oxygen/air and medetomidine (Med; 3.5 μg kg-1 hour-1 ) or S-ketamine (S-ket; 0.5 mg kg-1 hour-1 ). All horses were mechanically ventilated. Cardiopulmonary variables were evaluated. Isoflurane end-tidal concentrations (Fe'Iso), dobutamine requirements and thiopental boli were recorded. Plasma samples were collected in six horses to evaluate S-ketamine and S-norketamine concentrations. After surgery, medetomidine 2 μg kg-1 was administered IV. Four independent observers scored recovery using a visual analogue scale and a numerical rating scale.
RESULTS: Both groups required similar mean Fe'Iso (1%). However, S-ket horses needed more thiopental boli. Median intraoperative cardiac index values were higher with S-ket (4.5 L minute-1 m-2 ) than Med (3.9 L minute-1 m-2 ). Overall, there were no differences in heart rate, blood pressure or dobutamine requirements; however, horses in S-ket showed higher heart rate values at 30 minutes after anaesthesia induction. Compared with Med horses, S-ket horses showed decreased PaO2 and increased pulmonary venous admixture values estimated with the Fshunt calculation. Recoveries were shorter and of poorer quality with S-ket. During infusion, S-ketamine and S-norketamine plasma concentrations lay in the ranges of 0.209-0.917 μg mL-1 and 0.250-0.723 μg mL-1 , respectively.
CONCLUSIONS AND CLINICAL RELEVANCE: Despite the higher intraoperative cardiac index with S-ket, both protocols were considered to provide acceptable cardiovascular function. However, recovery quality was significantly better in the Med group.

Abstract

OBJECTIVES: To evaluate cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane receiving medetomidine or S-ketamine infusions.
STUDY DESIGN: Randomized, blinded, prospective clinical trial.
ANIMALS: Fifty horses undergoing elective surgery.
METHODS: After acepromazine and flunixin meglumine premedication, horses received medetomidine (7 μg kg-1 ) intravenously (IV). Anaesthesia was induced with midazolam and racemic ketamine (Med treatment group; 2.2 mg kg-1 ; n = 25) or S-ketamine (S-ket treatment group; 1.1 mg kg-1 ; n = 25) IV and maintained with isoflurane in oxygen/air and medetomidine (Med; 3.5 μg kg-1 hour-1 ) or S-ketamine (S-ket; 0.5 mg kg-1 hour-1 ). All horses were mechanically ventilated. Cardiopulmonary variables were evaluated. Isoflurane end-tidal concentrations (Fe'Iso), dobutamine requirements and thiopental boli were recorded. Plasma samples were collected in six horses to evaluate S-ketamine and S-norketamine concentrations. After surgery, medetomidine 2 μg kg-1 was administered IV. Four independent observers scored recovery using a visual analogue scale and a numerical rating scale.
RESULTS: Both groups required similar mean Fe'Iso (1%). However, S-ket horses needed more thiopental boli. Median intraoperative cardiac index values were higher with S-ket (4.5 L minute-1 m-2 ) than Med (3.9 L minute-1 m-2 ). Overall, there were no differences in heart rate, blood pressure or dobutamine requirements; however, horses in S-ket showed higher heart rate values at 30 minutes after anaesthesia induction. Compared with Med horses, S-ket horses showed decreased PaO2 and increased pulmonary venous admixture values estimated with the Fshunt calculation. Recoveries were shorter and of poorer quality with S-ket. During infusion, S-ketamine and S-norketamine plasma concentrations lay in the ranges of 0.209-0.917 μg mL-1 and 0.250-0.723 μg mL-1 , respectively.
CONCLUSIONS AND CLINICAL RELEVANCE: Despite the higher intraoperative cardiac index with S-ket, both protocols were considered to provide acceptable cardiovascular function. However, recovery quality was significantly better in the Med group.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:05 Vetsuisse Faculty > Veterinary Clinic > Equine Department
Dewey Decimal Classification:570 Life sciences; biology
630 Agriculture
Uncontrolled Keywords:S-ketamine; S-norketamine; anaesthesia; horse; isoflurane; medetomidine
Language:English
Date:2016
Deposited On:15 Feb 2017 11:43
Last Modified:15 Feb 2017 11:43
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1467-2987
Publisher DOI:https://doi.org/10.1111/vaa.12359
PubMed ID:26915545

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