Effects of ketamine or midazolam continuous rate infusions on alfaxalone total intravenous anaesthesia requirements and recovery quality in healthy dogs: a randomized clinical trial |
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| Institution: | 1. The University Veterinary Teaching Hospital, The School of Veterinary Science, The University of Sydney, New South Wales, Australia;2. Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain;3. Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina;1. Department of Veterinary Anaesthesia, Animal Health Trust, Newmarket, Suffolk, UK;2. Pride Veterinary Centre, Derby, UK;1. Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy;2. Anaesthesiology Section, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland;3. Epidemiology Section, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland;1. Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA;2. College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA;3. Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC, USA;4. Department of Biological and Diagnostic Sciences, University of Tennessee, Knoxville, TN, USA;5. Office of Information and Technology, University of Tennessee, Knoxville, TN, USA;6. Jurox Pty Ltd, Rutherford, NSW, Australia;7. Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA;1. University of Bristol School of Veterinary Sciences, Langford, Bristol, UK;2. Langford Vets, Langford, Bristol, UK |
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| Abstract: | ObjectiveTo determine the alfaxalone dose reduction during total intravenous anaesthesia (TIVA) when combined with ketamine or midazolam constant rate infusions and to assess recovery quality in healthy dogs.Study designProspective, blinded clinical study.AnimalsA group of 33 healthy, client-owned dogs subjected to dental procedures.MethodsAfter premedication with intramuscular acepromazine 0.05 mg kg-1 and methadone 0.3 mg kg-1, anaesthetic induction started with intravenous alfaxalone 0.5 mg kg-1 followed by either lactated Ringer’s solution (0.04 mL kg-1, group A), ketamine (2 mg kg-1, group AK) or midazolam (0.2 mg kg-1, group AM) and completed with alfaxalone until endotracheal intubation was achieved. Anaesthesia was maintained with alfaxalone (6 mg kg-1 hour-1), adjusted (±20%) every 5 minutes to maintain a suitable level of anaesthesia. Ketamine (0.6 mg kg-1 hour-1) or midazolam (0.4 mg kg-1 hour-1) were employed for anaesthetic maintenance in groups AK and AM, respectively. Physiological variables were monitored during anaesthesia. Times from alfaxalone discontinuation to extubation, sternal recumbency and standing position were calculated. Recovery quality and incidence of adverse events were recorded. Groups were compared using parametric analysis of variance and nonparametric (Kruskal-Wallis, Chi-square, Fisher’s exact) tests as appropriate, p < 0.05.ResultsMidazolam significantly reduced alfaxalone induction and maintenance doses (46%; p = 0.034 and 32%, p = 0.012, respectively), whereas ketamine only reduced the alfaxalone induction dose (30%; p = 0.010). Recovery quality was unacceptable in nine dogs in group A, three dogs in group AK and three dogs in group AM.Conclusions and clinical relevanceMidazolam, but not ketamine, reduced the alfaxalone infusion rate, and both co-adjuvant drugs reduced the alfaxalone induction dose. Alfaxalone TIVA allowed anaesthetic maintenance for dental procedures in dogs, but the quality of anaesthetic recovery remained unacceptable irrespective of its combination with ketamine or midazolam. |
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| Keywords: | alfaxalone dog recovery quality TIVA |
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