AAHA Anesthesia Guidelines for Dogs and Cats*

Safe and effective anesthesia of dogs and cats rely on preanesthetic patient assessment and preparation. Patients should be premedicated with drugs that provide sedation and analgesia prior to anesthetic induction with drugs that allow endotracheal intubation. Maintenance is typically with a volatile anesthetic such as isoflurane or sevoflurane delivered via an endotracheal tube. In addition, local anesthetic nerve blocks; epidural administration of opioids; and constant rate infusions of lidocaine, ketamine, and opioids are useful to enhance analgesia. Cardiovascular, respiratory, and central nervous system functions are continuously monitored so that anesthetic depth can be modified as needed. Emergency drugs and equipment, as well as an action plan for their use, should be available throughout the perianesthetic period. Additionally, intravenous access and crystalloid or colloids are administered to maintain circulating blood volume. Someone trained in the detection of recovery abnormalities should monitor patients throughout recovery. Postoperatively attention is given to body temperature, level of sedation, and appropriate analgesia.

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Studies to Evaluate the Safety of Constant Rate Infusions of Dexmedetomidine, Ketamine and Lidocaine Alone or in Combination during Isoflurane Anesthesia in Horses

Indian Journal of Animal Research ◽

10.18805/ijar.b-4401 ◽

2021 ◽

Author(s):

Aswathy Gopinathan ◽

Kiranjeet Singh ◽

Sherin B. Sarangom ◽

V. Ramya ◽

P. Sangeetha ◽

...

Keyword(s):

Significant Decline ◽

Constant Rate Infusion ◽

Anesthetic Depth ◽

Isoflurane Anesthesia ◽

Anesthetic Agents ◽

Constant Rate ◽

Sparing Effect ◽

Rate Infusion ◽

Operative Quality

Background: Horses mount a huge stress response to anesthesia when compared to other animals, hence are risky candidates for anesthesia. Inhalant anesthetic agents offer more control to anesthetic depth and facilitate rapid recovery, hence are considered to be safer than intravenous agents for surgical procedures requiring more than an hour, however, newer drug combinations are being explored to minimize the undesired consequences and dose rate of inhalant agents. The present study explored the safety of dexmedetomidine, ketamine and lidocaine constant rate infusion alone or as a combination along with Isoflurane for safer anesthesia in horses.Methods: The study was conducted on 28 horses divided into S, D, DK and DKL groups having 7 animals in each. Xylazine (1 mg/kg) and butorphanol (0.05mg/kg) were given intravenously for premedication. Ketamine (2 mg/kg) and midazolam (0.2 mg/kg) were used for induction and anesthesia was maintained with isoflurane. Normal saline (1000ml/hour), Dexmedetomidine (2µg/kg/hr), Dexmedetomidine and ketamine (2 µg/kg/hr and 2 mg/kg/hr) and Dexmedetomidine, ketamine and lidocaine (2 µg/kg/hr, 2 mg/kg/hr and 2 mg/kg/h) were given as CRI in groups S, D, DK and DKL, respectively. Thiopentone sodium (250mg bolus, 5%) was given as a fast intravenous bolus whenever required. Anesthetic efficacy was evaluated based on clinical, haemato-biochemical, hemodynamic, and endocrine variables.Result: A significant decline in mean arterial pressure was noticed in group DKL but changes in CVP and SpO2 in different groups were non-significant. Higher Blood glucose and low Insulin levels were seen in group DK during 45-60 min. Constant rate infusions of Dexmedetomidine, Ketamine and Lidocaine alone or in combination produced a significant sparing effect on Isoflurane and thiopentone while they improved peri-operative quality of anesthesia in horses.

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Effects of oral atenolol on volatile anesthetic induction with sevoflurane in adults

Journal of Anesthesia ◽

10.1007/s00540-004-0246-4 ◽

2004 ◽

Vol 18 (3) ◽

Author(s):

Michiaki Yamakage ◽

Hideaki Sasaki ◽

Masahito Mizuuchi ◽

Sohshi Iwasaki ◽

Akiyoshi Namiki

Keyword(s):

Volatile Anesthetic ◽

Anesthetic Induction

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Opioid–Volatile Anesthetic Synergy

Anesthesiology ◽

10.1097/00000542-200608000-00009 ◽

2006 ◽

Vol 105 (2) ◽

pp. 267-278 ◽

Cited By ~ 72

Author(s):

Sandeep C. Manyam ◽

Dhanesh K. Gupta ◽

Ken B. Johnson ◽

Julia L. White ◽

Nathan L. Pace ◽

...

Keyword(s):

Response Surface ◽

Volatile Anesthetic ◽

Experimental Pain ◽

Sedation Score ◽

Target Concentration ◽

Pharmacodynamic Interaction ◽

Interaction Models ◽

Pooled Data ◽

Sedation And Analgesia ◽

Clinical Anesthesia

Background Combining a hypnotic and an analgesic to produce sedation, analgesia, and surgical immobility required for clinical anesthesia is more common than administration of a volatile anesthetic alone. The aim of this study was to apply response surface methods to characterize the interactions between remifentanil and sevoflurane. Methods Sixteen adult volunteers received a target-controlled infusion of remifentanil (0-15 ng/ml) and inhaled sevoflurane (0-6 vol%) at various target concentration pairs. After reaching pseudo-steady state drug levels, the Observer's Assessment of Alertness/Sedation score and response to a series of randomly applied experimental pain stimuli (pressure algometry, electrical tetany, and thermal stimulation) were observed for each target concentration pair. Response surface pharmacodynamic interaction models were built using the pooled data for sedation and analgesic endpoints. Using computer simulation, the pharmacodynamic interaction models were combined with previously reported pharmacokinetic models to identify the combination of remifentanil and sevoflurane that yielded the fastest recovery (Observer's Assessment of Alertness/Sedation score > or = 4) for anesthetics lasting 30-900 min. Results Remifentanil synergistically decreased the amount of sevoflurane necessary to produce sedation and analgesia. Simulations revealed that as the duration of the procedure increased, faster recovery was produced by concentration target pairs containing higher amounts of remifentanil. This trend plateaued at a combination of 0.75 vol% sevoflurane and 6.2 ng/ml remifentanil. Conclusion Response surface analyses demonstrate a synergistic interaction between remifentanil and sevoflurane for sedation and all analgesic endpoints.

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Analgesic and Sedative Effects of Epidural Lidocaine-Xylazine in Elective Bilateral Laparoscopic Ovariectomy in Standing Mule Mares

Animals ◽

10.3390/ani11082419 ◽

2021 ◽

Vol 11 (8) ◽

pp. 2419

Author(s):

Cecilia Vullo ◽

Adolfo Maria Tambella ◽

Marina Meligrana ◽

Giuseppe Catone

Keyword(s):

Analgesic Efficacy ◽

Epidural Block ◽

Efficacy And Safety ◽

Constant Rate Infusion ◽

Arterial Blood ◽

Constant Rate ◽

Sedative Effects ◽

Caudal Epidural Block ◽

Sedation And Analgesia ◽

Rate Infusion

The purpose of this study was to determine the analgesic efficacy and safety of epidural lidocaine-xylazine administration in standing mules undergoing elective bilateral laparoscopic ovariectomy in order to suppress unwanted behaviour. Eight mule mares were sedated with intramuscular 0.05 mg/kg acepromazine followed by 1.3 mg/kg of xylazine and 0.02 mg/kg of butorphanol intravenously. Sedation was maintained by a constant rate infusion of 0.6 mg/kg/h of xylazine. The paralumbar fossae were infiltrated with 30 mL of 2% lidocaine. Epidural anaesthesia was performed at the first intercoccygeal space with 0.2 mg/kg of lidocaine and 0.17 mg/kg of xylazine. After 15 min, bilateral laparoscopic ovariectomy was performed. Heart rate, respiratory rate, rectal temperature, invasive arterial blood pressure, degree of analgesia, sedation and ataxia were evaluated during surgery. The laparoscopic ovariectomy was successfully completed in all animals. Sedation and analgesia were considered satisfactory in six out of the eight mules. In conclusion, caudal epidural block allowed surgery to be easily completed in six out of eight. The animals did not show any signs of discomfort associated with nociception and were mostly calm during the procedures, however additional studies are needed to establish epidural doses of xylazine and lidocaine that result in reliable abdominal pain control in mules for standing ovariectomy.

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Anesthetic Effects of Alfaxalone–Ketamine, Alfaxalone–Ketamine–Dexmedetomidine, and Alfaxalone–Butorphanol–Midazolam Administered Intramuscularly in Five‑striped Palm Squirrels (Funambulus pennantii)

Journal of the American Association for Laboratory Animal Science ◽

10.30802/aalas-jaalas-19-000146 ◽

2020 ◽

Author(s):

David Eshar ◽

Hugues Beaufrère

Keyword(s):

Heart Rate ◽

Treatment Group ◽

Rectal Temperature ◽

Recovery Time ◽

Anesthesia Induction ◽

Anesthetic Induction ◽

Anesthetic Depth ◽

Significant Difference ◽

Righting Reflex ◽

Withdrawal Response

Injectable anesthesia protocols for five-striped palm squirrels (Funambulus pennantii) are poorly described in the literature.In this study, male intact squirrels received intramuscular injections of either alfaxalone (6 mg/kg) and ketamine (40 mg/kg; AK group, n = 8); alfaxalone (6 mg/kg), ketamine (20 mg/kg), and dexmedetomidine (0.1 mg/kg; AKD group, n = 8); or alfaxalone (8 mg/kg), butorphanol (1 mg/kg), and midazolam (1 mg/kg; ABM group, n = 8). Atipamezole (0.15 mg/kg IM) and flumazenil (0.1 mg/kg IM) were administered 40 min after anesthesia induction (defined as loss of the righting reflex) with AKD and ABM, respectively. Heart rate, respiratory rate, rectal temperature, and reflexes were recorded every 5 min during anesthesia. Anesthetic induction was rapid in all groups (AK: median, 49 s; range, 33 to 60 s; AKD, 60 s; 54 to 70 s; and ABM, 15 s; 5 to 58 s). The anesthetic duration (from induction to full recovery) for the AK group was 62 ± 3 min (mean ± 1 SD). Therewas no statistically significant difference between the ABM and AKD groups regarding recovery time after partial antagonist administration and was 51 ± 5 and 48 ± 5 min, respectively. All AK animals showed twitching and abnormal vocalization during recovery. The righting reflex was absent in all squirrels for 20 min in the AK treatment group and throughout the 40-min anesthetic period in the AKD and ABM groups. The frontlimb withdrawal response was absent in all squirrels for the 40-min anesthetic period in the AKD and ABM groups, with variable responses for the AK treatment. All tested protocols in this study provided safe and effective immobilization in five-striped palm squirrels, but oxygen and thermal support wereindicated. Anesthetic depth must be determined before surgical procedures are performed in palm squirrels anesthetized by using these regimens.

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ESTIMATING ANESTHETIC DEPTH FROM COMPUTERIZED ELECTROENCEPHALOGRAM DURING ANESTHETIC INDUCTION AND INTUBATION IN CARDIAC SURGERY PATIENTS

Anesthesiology ◽

10.1097/00000542-198909001-00394 ◽

1989 ◽

Vol 71 (Supplement) ◽

pp. A394

Author(s):

A. Sidi ◽

P. Halimi ◽

S. Cotev

Keyword(s):

Cardiac Surgery ◽

Anesthetic Induction ◽

Anesthetic Depth

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Estimating anesthetic depth by electroencephalography during anesthetic induction and intubation in patients undergoing cardiac surgery

Journal of Clinical Anesthesia ◽

10.1016/0952-8180(90)90062-8 ◽

1990 ◽

Vol 2 (2) ◽

pp. 101-107 ◽

Cited By ~ 29

Author(s):

Avner Sidi ◽

Patrick Halimi ◽

Shamay Cotev

Keyword(s):

Cardiac Surgery ◽

Anesthetic Induction ◽

Anesthetic Depth

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Limited usefulness of the observation of eye bulb rotation and neuro-ophthalmic responses for assessing the depth of equine anesthesia: an observational study comparing three protocols

Medycyna Weterynaryjna ◽

10.21521/mw.6586 ◽

2021 ◽

Vol 77 (10) ◽

pp. 6586-2021

Author(s):

OLGA DREWNOWSKA ◽

BERNARD TUREK ◽

BARBARA LISOWSKA ◽

CHARLES E. SHORT ◽

MAKSYMILIAN BIELECKI

Keyword(s):

Observational Study ◽

Depth Of Anesthesia ◽

Constant Rate Infusion ◽

Anesthetic Depth ◽

Group 12 ◽

Constant Rate ◽

Balanced Anesthesia ◽

Corneal Reflex ◽

Limited Usefulness ◽

Rate Infusion

The observation of the neuro-ophthalmic responses is an established basic tool for monitoring the depth of anesthesia in horses. However, their usefulness during balanced anesthesia in the clinic is questionable. The aim of this study was to compare the usefulness of neuro-ophthalmic responses during 3 commonly used anesthetic protocols. An observational study was performed on 22 horses, 5 maintained only with isoflurane (ISO group), 12 maintained with isoflurane and a constant rate infusion of ketamine (ISO+KET group), and 5 maintained with isoflurane and a constant rate infusion of detomidine (ISO+DET group). The occurrence of all five responses was noted: spontaneous palpebral and provoked palpebral response, corneal response, nystagmus and eye bulb rotation. The most consistent with the literature and most useful for anesthetic depth assessment was the observation of spontaneous palpebral reflex in all of the groups (p = 0.788) and the most significant differences were visible for the observation of the provoked palpebral reflex (p = 0.015) for all groups. The reflexes in the group ISO+DET were less consistent with the literature than in other groups, making them least useful. The group ISO seemed to have the reflexes’ observations most consistent with the literature expectations. The corneal reflex was always present and nystagmus always absent which confirmed the observations from literature. The above results suggest that neuro-ophthalmic responses, especially eye bulb rotation and provoked palpebral reflexes, should not be the only indicators in assessing the depth of anesthesia during maintenance with ketamine or detomidine with concurrent isoflurane.

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