Professional Documents
Culture Documents
doi:10.1111/vaa.12176
RESEARCH PAPER
Correspondence: Klaus Hopster, Equine Clinic, University of Veterinary Medicine Hanover, Foundation, B
unteweg 9, 30559 Hanover,
Germany. Email: klaus.hopster@tiho-hannover.de
Abstract
Objectives To determine the influence of ketamine
or xylazine constant rate infusions on isoflurane
requirements, cardiovascular parameters and quality
of anaesthesia in horses undergoing elective surgery.
Study design Prospective, matched paired clinical
trial.
Animals Fifty four adult Warmblood horses.
Methods After premedication with acepromazine,
xylazine and butorphanol, anaesthesia was induced
with ketamine-midazolam and maintained with
isoflurane alone (I), isoflurane with either
1 mg kg 1 hour 1 ketamine (IK) or same dose of
xylazine (IX). End tidal concentration of isoflurane
(FEIso) was adjusted by the same anaesthetist in all
horses according to a scoring system. Dobutamine was
infused to maintain mean arterial pressure (MAP)
70 mmHg. Arterial blood gases, heart rate (HR),
respiratory rate, MAP and cardiac output (lithium
dilution) were measured. Groups I and IK received
xylazine before recovery. Recovery quality was scored.
Results Mean SD averaged FEIso (volume%) was
significantly lower in IX (0.95 0.07) and IK
(0.97 0.08) than in I (1.16 0.13). In group
IX, HR was significantly lower and averaged MAP
(90 13 mmHg) significantly higher than in
groups I (71 7 mmHg) and IK (76 7 mm
Hg). Differences in other cardiopulmonary variables
Introduction
Anaesthesia in horses carries a much higher risk of
mortality than in humans and small animals (Johnston et al. 2002; Bidwell et al. 2007; Brodbelt
2009;). In Johnston et al. (2002)s survey, 30.4%
of deaths occurred in the recovery period, mainly
due to fractures, and to myopathies. A major risk
factor for post-anaesthetic myopathy is reduced
muscle perfusion during anaesthesia (Weaver et al.
1984; Lindsay et al. 1989), which is closely related
to mean arterial blood pressure (MAP) and cardiac
_ (Richey et al. 1990; Lee et al. 1998;
output(Qt)
Edner et al. 2002). Therefore, to reduce periopera30
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Table 1 Mean cardiovascular variables and median dose of dobutamine in horses during maintenance
of anaesthesia with isoflurane (I) or
isoflurane supplemented with a
constant rate infusion (CRI) of
either ketamine (IK) at 1 mg
kg 1 hour 1 or xylazine (IX) at
1 mg kg 1 hour 1
Non-parametric data were analysed by the KruskalWallis test, followed by the Wilcoxon-Mann
Whitney test, if significance level had been reached.
For non-parametric data influences by time
were detected using Wilcoxon signed-rank test.
Categorical data were analysed by the Fishers exact
test.
Significance level was set at p < 0.05. Normally
distributed data are presented as mean SD and
non-parametric data are shown as median [range].
Results
There were no significant differences between groups
in age, body weight, timepoint at which surgery
started and duration of anaesthesia (Table S1). All
groups required a mean dose of xylazine of
0.6 0.1 mg kg 1 before induction of anaesthesia.
Additional boli of thiopental to deepen anaesthesia
were required in nine and seven horses in group I
and group IK, respectively. Both groups were significantly different to group IX in which none of the
horses required additional thiopental. Horses
received thiopental at a maximum of three times
per anaesthesia and never in quick succession.
Median [range] total additional doses of thiopental
in groups I and IK were 0.831 [02.99] mg kg 1
and 0 [02.77] mg kg 1, respectively.
Group IX had significantly (p = 0.0022) lower
values for mean HR (Table 1) and significantly
(p < 0.0001) higher values for mean MAP compared to groups I and IK, respectively (Fig. 1).
Groups IX and IK required significantly (p < 0.001)
less isoflurane than group I (Fig. 2). Horses in group
IX also required significantly less (p < 0.0001)
dobutamine than in groups I and IK (Table 1). No
_ and arterial blood gases
significant differences in Qt,
occurred between groups (Table 2).
HR (beats minute 1)
MAP (mmHg)
dob (lg kg 1 minute 1)
dob_p1 (lg kg 1 minute 1)
dob_p2 (lg kg 1 minute 1)
Group I
Group IK
Group IX
37 5
71 8
0.38 [0.161.00]
0.50 [0.231.35]*
0.42 [0.001.21]
35 4
76 7
0.22 [0.071.20]
0.35 [0.151.03]*
0.00 [0.001.62]
31 3*
91 13*
0.07 [0.020.32]*
0.10 [0.050.30]*
0.00 [0.000.30]*
HR, heart rate; MAP, mean arterial pressure; dob, dose of dobutamine; dob_p1, dose of
dobutamine during p1 (=T0 - T60); dob_p2, dose of dobutamine during p2 (=T65 - T90);
Normally distributed data are presented as mean SD. Non-parametric data are
presented as median [range]. *Significantly different from other groups (p < 0.05).
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T30
PaO2 (mmHg)
I
354 95
IK
396 104
IX
394 97
PaO2 (kPa)
I
47 13
IK
53 14
IX
52 13
PaCO2 (mmHg)
I
44 4
IK
44 7
IX
43 5
PaCO2 (kPa)
I
5.9 0.5
IK
5.9 0.9
IX
5.7 0.6
CI (mL kg 1 minute 1)
I
74 [3598]
IK
78 [4396]
IX
66 [54125]
T60
T90
350 94
403 118
364 90**
326 114**
366 112*, **
359 95**
46 13
54 16
48 12**
43 15**
49 15*, **
48 13**
46 5
44 6
45 5
46 6
45 5
47 6**
6.2 0.7
5.9 0.8
5.9 0.7
6.1 0.8
6.0 0.7
6.3 0.8**
78 [51121]
78 [5893]
60 [43170]
66 [5489]*
65 [5074]*
79 [54149]
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First movement
(minutes)
Sternal recumbency
(minutes)
Standing Position
(minutes)
Score
Group I
Group IK
Group IX
20 [734]
16 [536]
20 [740]
25 [1739]
26 [1050]
30 [1560]
37 [1755]
40 [2058]
42 [17100]
20 [1330]
22 [1345]*
15 [1142]
35
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result of low isoflurane requirements at the beginning of anaesthesia, the mean averaged FEIso
(1.16 0.13) measurements were much lower
than published data for MAC (1.31.6) in isoflurane-anaesthetized horses (Steffey et al. 1977, 2000).
However, these MAC studies were performed in
animals that were administered inhalants alone.
The quality of unassisted recovery was good and
unremarkable for all tested protocols, but sedation
with a xylazine bolus in horses of groups I and IK
before recovery might have minimised differences
between groups. As sedation for recovery has
become general practice (Clark-Price et al. 2008)
we decided to include xylazine for recovery in the
client-owned horses. The slightly better recovery
quality of IX compared to IK seems not to be
clinically relevant as all horses recovered well and a
median score of 22 in IK was still low on a scale from
11 to 100 points.
In conclusion, it was possible to maintain the
(successfully) measured cardiopulmonary variables
within clinical acceptable ranges with all three
protocols without clinically relevant differences in
recovery quality, but with pronounced differences in
blood pressure support. Both xylazine and ketamine
supplementations resulted in a pronounced reduction of anaesthetic requirements to maintain an
adequate anaesthetic level with less blood pressure
support being required.
References
Ambrisko TD, Moens Y (2013b) Voltage changes in the
lithium dilution cardiac output sensor after exposure to
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367369.
Ambrisko TD, Coppens P, Kabes R et al. (2012) Lithium
dilution, pulse power analysis, and continuous
thermodilution cardiac output measurements compared
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Anaesth 109, 864869.
Ambrisko TD, Kabes R, Moens Y (2013a) Influence of drugs
on the response characteristics of the LiDCO sensor: an in
vitro study. Br J Anaesth 110, 305310.
Bettschart-Wolfensberger R, Larenza MP (2007) Balanced
Anesthesia in the Equine. Clin Tech Equine Pract 6, 104
110.
Bidwell LA, Bramlage LR, Rood WA (2007) Equine
perioperative fatalities associated with general
anaesthesia at a private practicea retrospective case
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Brodbelt D (2009) Perioperative mortality in small animal
anaesthesia. Vet J 182, 152161.
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Supporting Information
Additional Supporting Information may be found in
the online version of this article:
Table S1. Demographic data and information
about recumbency, type of surgery and anaesthetic
duration in horses during maintenance of anaesthesia with isoflurane (I) or isoflurane supplemented
with a constant rate infusion (CRI) of either
ketamine (IK) or xylazine (IX).
Appendix S1. Scoring system used to score
recovery.
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