Evaluation of Ketamine Hydrochloride in Combination with Midazolam, Dexmedetomidine and Butorphanol as Balanced Anaesthesia in Cats

Background: As cats undergo stress at the time of presentation before surgery and therefore sedation is required often. It is very difficult to choose a balanced anaesthetic protocol during the surgical intervention in the case of a cat. Therefore, the present study was undertaken to evaluate the effect of ketamine hydrochloride in combination with midazolam, dexmedetomidine and butorphanol as balanced anaesthesia on clinico-physiological, haematological, serum biochemical profile in the surgical management of cats undergoing neutering. Methods: The study was performed on 18 clinical cases of cats which were brought to the Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry (CVSc and AH), Central Agricultural University (CAU), Selesih, Aizawl, Mizoram for elective surgery such as neutering. Cats were randomly divided into 3 equal groups, i.e. Gr. A, Gr. B and Gr. C. Animals were premedicated with glycopyrrolate @ 0.01 mg/kg, i/m. After 10 minutes of premedication, in Gr. A ketamine hydrochloride @15 mg/kg and midazolam @ 0.5 mg/kg, in Gr. B ketamine hydrochloride @10 mg/ kg and dexmedetomidine@ 5 mcg /kg and in Gr. C ketamine hydrochloride @ 5 mg/kg, dexmedetomidine@ 5 mcg/kg and butorphanol @ 0.2 mg/kg was administered intramuscularly. Clinico-physiological and haemato-biochemical profiles were evaluated at 0 minute (baseline), then at 15, 30 and 60 minutes after administration of anaesthetic agents to evaluate their anaesthetic effect. Result: In the case of time for induction, the quality of induction, assessment of peri-operative analgesia, depth of anaesthesia and quality of recovery there was no significant difference among all three groups. In Gr. B, animals showed significantly higher duration of recumbency (DOE) and recovery. The assessment of peri-operative analgesic effect among the groups revealed that analgesia during the perioperative period appeared best in Gr. C protocol. In regards to depth of anaesthesia, ketamine hydrochloride in combination with dexmedetomidine and butorphanol group showed a better result. Rectal temperature decreased significantly (P greater than 0.05) up to 60th minutes in Gr. A, but it remained within the physiological range. Heart rate raised significantly (p less than 0.05) from the baseline (0 minutes) onwards and decreased significantly (p less than 0.05) till the end (60 minutes) of the study in Gr. C. The respiration rate was significantly (p less than 0.01) different in between time intervals for all three groups. No significant difference was observed on haemato-biochemical observation except glucose level which significantly increased after induction of anaesthesia. In conclusion, treatment with ketamine hydrochloride in combination with dexmedetomidine and butorphanol led to acceptable sedation and mild changes in clinico-physiological, haematological, serum biochemical profile in comparison to the other two groups.

Intra Venous Butorphanol versus Intravenous Nalbuphine for (Intra Operative) Balanced Anaesthesia and Post Operative Analgesic Effect in Patients Undergoing Laparoscopic Surgery

Laparoscopic surgery has replaced many of the open surgeries because of its advantages. Both the groups of drugs have hemodynamic stability, analgesia, sedation and decrease the requirement of other anesthetic drugs. So we have chosen Butorphanol and Nalbuphine to study the analgesia and hemodynamic changes in both groups. In our study mean heart rate was lower in Butorphanol group compare to Nalbuphine group. Similarly fifty patients of ASA I&II scheduled for elective laparoscopic surgery, were randomized in to butorphanol group and nalbuphine group. It was observed that there was significant rise in systolic blood pressure & Diastolic Blood pressure after intubation in fentanyl group compare to Butorphanol. This study finds that suppression of sympathetic response to laryngoscopy and intubation was better with Butorphanol than Fentanyl. This study analysis indicates that both Butorphanol and Nalbuphine help in maintaining a steady haemodynamic state all throughout the procedure.

Comparative Evaluation of the Isoflurane-sparing Effects of Butorphanol and Pentazocine in Buffaloes Undergoing Diaphragmatic Herniorrhaphy

Background: Isoflurane is commonly used as an inhalant anaesthesia in animals. Foreign body syndrome ultimately results into diaphragmatic hernia which is common in buffaloes. Diaphragmatic herniorrhaphy is generally performed under isoflurane anaesthesia. But there are adverse effects of isoflurane like respiratory depression, hypotension, reduced cardiac output and its metabolites cause atmospheric pollution. So, the present study was planned with the hypothesis that inclusion of opioid analgesic in the balanced anaesthesia might have isoflurane sparing effect. Methods: The present study was conducted in 15 female buffaloes which were suffering from diaphragmatic hernia which was diagnosed by radiography and later confirmed on rumenotomy. Animals were randomly divided in three groups - group I (Atropine (0.04 mg/kg) - xylazine (0.05 mg/kg) - propofol (till effect) - isoflurane; AXPI), group II (Atropine - xylazine - butorphanol (0.03 mg/kg) - propofol - isoflurane; AXBPI) and group III (Atropine - xylazine - pentazocine (0.75 mg/kg) - propofol - isoflurane; AXPPI) having five animals in each. Group I was taken as control as no analgesic was used in anaesthetic combination for animals of this group. The total isoflurane vapour delivered (mL) for the total duration of anaesthesia was calculated and the values so obtained were equated to 400 kg body weight and 40 minute duration for each animal for statistical comparison.Result: The Mean volume of isoflurane (ml) utilized for group I (65.58±8.8) was significantly higher than in Group II (38.54±5.7) and Group III (41.01±4.8). There were no significant changes in the haematological and biochemical profile of these buffaloes among three groups.

Effects of the ultra-short-acting beta-blocker Esmolol infusion on cardiovascular parameters and quality of postoperative recovery in patients scheduled for elective plastic surgery

Background/Aim: Esmolol is an ultra-short-acting, easily titratable b-adrenergic receptor antagonist used for urgent treatment of hypertension and tachycardia in non-surgical and surgical settings. Aim of this clinical study was to investigate its cardiovascular effects and quality of the emergence from anaesthesia in patients scheduled for elective plastic surgery under general balanced anaesthesia. Methods: A total of 30 ASA I/II patients were randomised in two groups of similar demographic characteristics and baseline values of cardiovascular parameters. Esmolol group received esmolol dissolved in glucose 5 % as an intravenous infusion, 0.3 mg/kg/min during the first 5 min and at a rate of 0.1 mg/kg/ min thereafter. Control patients received the solvent only, at the same rate and volume. General balanced anaesthesia was induced with thiopentone sodium and fentanyl and maintained with nitrous oxide and oxygen. Neuromuscular relaxation was assured with pancuronium bromide and was antagonised at the end of operation with atropine and neostigmine. Systolic and diastolic blood pressure and heart rate were registered at all critical phases: (1) immediately prior to the induction (baseline value), (2) induction to anaesthesia, (3) tracheal intubation, (4) first skin incision, (5) surgical manipulation with organs, (6) suture of the surgical wound and (7) tracheal extubation. Drug consumption and quality of postoperative recovery were monitored. Results: In most of the critical phases of anaesthesia and operation, patients from the Esmolol group had significantly lower values of cardiovascular parameters than the patients from the Control group. Esmolol-treated patients needed less fentanyl, droperidol and pancuronium and had faster and smoother emergence from anaesthesia than the control patients. Conclusion: Esmolol improved haemodynamics and post-anaesthesia recovery in patients undergoing elective plastic surgery under general balanced anaesthesia.

Esmolol as an adjunct to general balanced anaesthesia in neurosurgery

Background/Aim: In surgery, and especially in the neurosurgical operations, maintenance of cardiovascular stability during and in the phase of the immediate postoperative recovery is of vital importance. The aim of this study was to investigate the effects of continuous esmolol infusion on the values of cardiovascular parameters and quality of the emergence from anaesthesia in neurosurgical patients. Methods: A total of 40 patients of both sexes scheduled for elective supratentorial surgery were randomly assigned to two groups. Esmolol group received intravenous (iv) infusion of esmolol dissolved in 5 % glucose solution (during the first 5 min at a rate of 0.3 mg/kg/min and thereafter at a rate of 0.1 mg/kg/min), while the ones from the control group received a 5 % glucose solution without esmolol at the same volume and rate. Cardiovascular parameters were registered at critical phases of anaesthesia and operation (induction, intubation, placement of Mayfield frame, craniotomy, skull closure, extubation). Recovery after anaesthesia was assessed based on times of eye opening on command, spontaneous eye opening and regaining of full orientation. Results: Values of systolic blood pressure and heart rate were significantly lower in the esmolol than in the control group of patients. Although the durations of anaesthesia did not differ, patients from the esmolol group required significantly less opioids and isoflurane and recovered after the anaesthesia significantly faster than the patients in the control group. Conclusion: Ultrashort-acting beta-adrenergic receptor antagonist esmolol, administered as a continuous iv infusion, assures better cardiovascular stability and smoother emergence from the balanced inhalation general anaesthesia than the control glucose infusion in elective neurosurgical patients.

Fast-track cardiac anaesthesia and early extubation

‘Fast-track’ cardiac anaesthesia and recovery is the term given to a multicomponent intervention during cardiac surgery and postoperatively, with the ultimate goal of early extubation (within 1–6 hours) in order to reduce duration of mechanical ventilation, length of stay in the intensive care unit, and overall resource utilization. Key components of fast-track cardiac care include balanced anaesthesia (low-dose opioids together with inhaled or intravenous anaesthetics) and a time-directed extubation protocol. Fast-track cardiac care requires an interdisciplinary approach to anaesthesia during surgery, as well as a coordinated approach after surgery, in order to achieve early extubation and an overall streamlined approach to recovery and hospital discharge.