DEXMEDETOMIDINE ALONE OR COMBINED WITH MORPHINE FOR EPIDURAL ANESTHESIA IN BITCHES UNDERGOING ELECTIVE OVARIOHYSTERECTOMY

The purpose of this study was to assess perioperative analgesia provided by the combination of epidural dexmedetomidine and morphine in bitches undergoing elective ovariohysterectomy. Twenty-four bitches were included in the study and allocated into three groups: GM, morphine 0.1 mg/kg; GD, dexmedetomidine 2 µg/kg; and GDM, dexmedetomidine and morphine at the same doses. All solutions were diluted in saline to a total of 0.36 mL/kg. Heart rate (HR), respiratory rate (FR) and systolic blood pressure (SAP) were recorded prior to epidural analgesia (TB), immediately following epidural analgesia (TEA), at surgical incision (TSI), at the first ovarian pedicle clamping (TOP1), at the second pedicle clamping (TOP2), at uterine stump clamping (TUC), at the start of abdominal cavity closure (TSC) and at the end of skin closure (TEC). Rescue analgesia with fentanyl was administered at 2 µg/kg IV if nociception corresponding to a 20% increase of any cardiorespiratory variables was noted. Postoperative pain assessment was performed using a modified composite Glasgow pain scale along the first 6 hours following the end of surgery. Numeric data were compared using ANOVA for repeated measures followed by Tukey test and ovarian ligament relaxation was analyzed using chi-square test under 5% significance. No differences were found on FR among times or groups, although HR showed significant differences between GM and GD at TSI, TOP1, TOP2, TSC and TEC and between GM and GDM at TEA and TSI (significantly lower HR values recorded in dexmedetomidine groups). Differences among time points were found on HR between TB and TEA in GD and on PAS between TOP1 and TSC in GM and between TOP1 and TUC in GDM (p<0.05). Ovarian ligament relaxation was significantly more present in groups using dexmedetomidine, although the number of rescue analgesia administrations did not differ among groups. Kaplan-Meyer analysis failed to show significant differences on time of rescue analgesia administration among groups (p>0.05). In conclusion, the combination of epidural dexmedetomidine and morphine is a more interesting choice for elective ovariohysterectomy in bitches for producing analgesia comparable to that of each drug alone, with noticeable relaxation of ovarian ligaments and lesser cardiovascular consequences.

Analgesic, cardiorespiratory effects and motor block characteristics of epidural levobupivacaine alone or in combination with methadone or dexmedetomidine in bitches undergoing unilateral total mastectomy

The aim of this study was to evaluate the latency, extent of analgesia, and duration of motor block of levobupivacaine alone and combined with methadone or dexmedetomidine after epidural administration during and after mastectomy in dogs. Twenty-four mature, mixed-breed female dogs were randomly divided into three experimental groups with eight animals each, according to the agents used in lumbosacral epidural analgesia: levobupivacaine 0.75% alone (1.5mg/kg - control group), levobupivacaine 0.75% (1.5 mg/kg) + methadone 1% (0.3 mg/kg), or levobupivacaine 0.75% (1.5 mg/kg) + dexmedetomidine 0.05% (3 µg/kg). During surgery, cardiorespiratory parameters were evaluated. Rescue analgesia was given when there were signs of nociception and was necessary in all three treatment groups. Since all animals received rescue analgesia during the surgery and immediately post-surgery, the duration of the sensitive block were not evaluated. The extent of sensory block was between the 12º and 13º thoracic vertebrae for the control group, 7º thoracic vertebra to 5º lumbar vertebra (methadone group), and 8º thoracic vertebra to 4º lumbar vertebra for the dexmedetomidine group. Methadone or dexmedetomidine combined with levobupivacaine increased the extent of the sensory block and the duration of the motor block in bitches when administered via the epidural route.

Reduction of greenhouse gases emission through the use of tiletamine and zolazepam

Isoflurane is an anaesthetic gas widely used in both human and veterinary medicine. All currently used volatile anaesthetics are ozone-depleting halogenated compounds. The use of total intravenous anaesthesia (TIVA) allows to induce the effect of general anaesthesia by administering drugs only intravenously without the use of anaesthetic gases. This allows you to create a protocol that is safe not only for the patient, but also for doctors and the environment. However, so far, no anaesthetic protocol based on induction of anaesthesia with tiletamine-zolazepam without the need to maintain anaesthesia with anaesthetic gas has been developed. Our study showed that the use of this combination of drugs for induction does not require the use of additional isoflurane to maintain anaesthesia. Thanks to Dixon's up-and-down method we proved that with the induction of anaesthesia with tiletamine-zolazepam at a dose of 5 mg/kg the use of isoflurane is not needed to maintain anaesthesia in minimally invasive surgical procedures. Until now, this dose has been recommended by the producer for more diagnostic than surgical procedures or for induction of general anaesthesia. The maintenance was required with anaesthetic gas or administration of another dose of the tiletamine-zolazepam. The results obtained in this study will allow for a significant reduction in the consumption of isoflurane, a gas co-responsible for the deepening of the greenhouse effect, having a negative impact on patients and surgeons. These results are certainly the first step to achieving a well-balanced and safe TIVA-based anaesthetic protocol using tiletamine-zolazepam, the obvious goal of which will be to maximize both the safety of the patient, people involved in surgical procedures, and the environment itself. Being aware of the problem of the greenhouse effect, we are committed to reducing the consumption of anaesthetic gases by replacing them with infusion agents.

Comparative study on epidural administration of dexmedetomidine, dexmedetomidine-lidocaine or lidocaine in conscious rabbits

The aim of this study was to compare the cardiorespiratory, arterial blood gas and antinociceptive effects of dexmedetomidine (D), dexmedetomidine-lidocaine (DL) or lidocaine (L) administered epidurally on conscious rabbits. Eight six-month-old male New Zealand rabbits were randomly distributed into three treatments: D (2.5 μg/kg); DL (2.5 μg/kg; 2 mg/kg); and L (2 mg/kg). The drugs were injected epidurally via a catheter. Cardiorespiratory, arterial blood gas and antinociceptive variables were recorded before administration, 5 and 10 min after drug administration, then every 10 min until the animals presented a positive response to nociceptive stimulation of perineal dermatomes. Two animals had permanent paralysis after DL treatment due to hemorrhage and congestion with neuron necrosis in spinal cord segments. There was a reduction in mean arterial pressure in treatment L at 5 and 10 min, compared with the baseline, and in treatment DL at 10-30 min. Increases in pH were observed in treatment D at 5 and 10 min, and in DL at all the times evaluated, compared with the baseline. No alterations were observed in other blood gas or electrolyte variables. Antinociceptive effects were evaluated in the perineal, sacral and lumbar regions, and were restricted to the perineal region following D and L treatment. The antinociceptive effects following DL were greater than D and L alone in all of the regions. L and D promotes short-term antinociceptive effects for up to 15 min and, when used in combination with D, increased the duration and extent of sensory block by up to 45 min.

Clinical effects of epidurally administered dexmedetomidine with or without lidocaine in sheep

BACKGROUND

The aims of this study were evaluate cardiopulmonary, sedative and antinociceptive effects of dexmedetomidine-lidocaine combination via lumbosacral epidural injection in sheep.

METHODS

Six Santa Inês breed sheep, 16±6 months old and weighing 42.2 ± 5.7 kg were used. Sheep were subjected to epidural anaesthesia with three treatments: L, lidocaine (1.2 mg/kg), D, dexmedetomidine (2.5 μg/kg) or DL, dexmedetomidine plus lidocaine (2.5 μg/kg + 1.2 mg/kg). Drugs were injected via pre-placed lumbosacral epidural catheters. Cardiopulmonary, arterial blood gases, electrolytes, degree of sedation and antinociceptive aspects were measured before drug administration (T0) and then at 15, 30, 60 and 120 min after drug injection (T15-T120) in all treatments and at T0 to T240 in DL.

RESULTS

There were significantly increases in PaCO₂ at times T60 and T120 in D, and at T30-T120 in DL, compared to baseline. The antinociceptive effects were observed up to 240 min in DL and 60 min in L, and were more intense in DL. Treatment D provided analgesia only in the perineal region, and only at T15.

CONCLUSION

The combination of DEX with lidocaine produced similar cardiopulmonary changes compared with either drug alone, but with greater and more prolonged antinociceptive effects.

Alternatives to Opioid Analgesia in Small Animal Anesthesia: Alpha-2 Agonists

Alpha-2 agonists have potent analgesic effects, in addition to their sedative actions. Alpha-2 agonists provide analgesia through any of several routes of administration, including parenteral, oral, epidural or intrathecal and intraarticular, because of spinal and supraspinal actions. Systemic doses are short acting, whereas local administration at the site of action result in longer analgesic effects. The potent cardiovascular and respiratory effects of alpha-2 agonists should be considered when used as analgesics.

Experimental study on the effects of isoflurane with and without remifentanil or dexmedetomidine on heart rate variability before and after nociceptive stimulation at different MAC multiples in cats

BACKGROUND

Heart rate variability (HRV) provides information about autonomic nervous system (ANS) activity and is therefore a possible tool with which to assess anaesthetic depth. The aim of the present study was to evaluate the effects of isoflurane, remifentanil and dexmedetomidine on HRV before and after nociceptive stimulation at different anaesthetic depths. Seven healthy domestic short-hair cats were used, and each cat was anaesthetized three times - group I with isoflurane alone, group IR with isoflurane and a constant rate infusion (CRI) of remifentanil (18 μg/kg/h), and group ID with isoflurane and a CRI of dexmedetomidine (3 μg/kg/h). Minimum alveolar concentration (MAC) values were determined via electrical supramaximal nociceptive stimulation for each treatment group. Nociceptive stimulation was repeated at 3 different MAC multiples (0.75, 1.0 and 1.5 MAC), and electrocardiographic recordings were performed for 3 min before and after stimulation. Only the 1 min epochs were used for further statistical analysis. Electrocardiographic data were exported for offline HRV analysis.

RESULTS

The mean isoflurane MAC ± standard deviation (SD) was 1.83 ± 0.22 vol% in group I, 1.65 ± 0.13 vol% in group IR and 0.82 ± 0.20 vol% in group ID. Nociception was indicated by several HRV parameters, however, with high variability between treatments. The best correlation with MAC was found for the SD of heart rate (STD HR) in group I (r_s = - 0.76, p = 0.0001, r² = 0.46). STD HR was also able to distinguish 0.75 MAC from 1.5 MAC and 1.0 MAC from 1.5 MAC in group I, as well as 0.75 MAC from 1.5 MAC in group ID.

CONCLUSIONS

The choice of anaesthetic protocol influences the HRV parameters in cats. Frequency domain parameters respond to nociception at lower MAC levels. The STD HR has the potential to provide additional information for the assessment of anaesthetic depth in isoflurane-anaesthetized cats. The utility of HRV analysis for the assessment of anaesthetic depth in cats is still questionable.

Epidural anesthesia and analgesia in small animal practice: An update

Epidural anesthesia is a commonly performed technique in both human and veterinary medicine. The technique is relatively simple following appropriate training and provides anesthesia and analgesia for acute and chronic pain. Several drug combinations have been administered by this route with variable success and duration. Multiple techniques to guide or confirm correct epidural needle placement are discussed in this article, as well as anatomical features of the epidural space, effect of drug volume and concentration, and adverse effects of the technique in small animal practice. This article is not an exhaustive review of the literature, but an update of some new findings over the last decade.

Minimum alveolar concentration: Key concepts and a review of its pharmacological reduction in dogs. Part 1

OBJECTIVE

To outline the major components of the minimum alveolar concentration (MAC) and review the literature in regard to pharmacological manipulation of the MAC of halothane, isoflurane, sevoflurane, enflurane, and desflurane in dogs. The pharmacologic agents included are alpha-2 agonists, benzodiazepines, propofol, maropitant, opioids, lidocaine, acepromazine, non-steroidal anti-inflammatory agents, and NMDA antagonists. Part 1 will focus on summarizing the relevance, measurement, and mechanisms of MAC and review the effects of alpha-2 agonists, benzodiazepines, and propofol on MAC.

DATABASES USED

PubMed, Google Scholar, CAB Abstracts. Search terms used: minimum alveolar concentration, MAC, dog, canine, inhaled anesthetic potency, isoflurane, sevoflurane, desflurane, enflurane, and halothane.

CONCLUSIONS

Many drugs reduce the MAC of inhaled anesthetics in dogs, and allow for a clinically important decrease in inhalant anesthetic use. A decrease in MAC may decrease the adverse cardiovascular and pulmonary effects associated with the use of high concentrations of inhaled anesthetics.

An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha₂ agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect), perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique.

Psoas compartment and sacral plexus block via electrostimulation for pelvic limb amputation in dogs

OBJECTIVE

To assess the efficacy of psoas compartment and sacral plexus block for pelvic limb amputation in dogs.

STUDY DESIGN

Prospective clinical study.

ANIMALS

A total of 16 dogs aged 8±3 years and weighing 35±14 kg (mean±standard deviation).

METHODS

Dogs were administered morphine (0.5 mg kg^-1) and atropine (0.02 mg kg^-1); anesthesia was induced with propofol and maintained with isoflurane. Regional blocks were performed before surgery in eight dogs with bupivacaine (2.2 mg kg^-1) and eight dogs were administered an equivalent volume of saline. The lumbar plexus within the psoas compartment was identified using electrolocation lateral to the lumbar vertebrae at the fourth-fifth, fifth-sixth and sixth-seventh vertebral interspaces. The sacral plexus, ventrolateral to the sacrum, was identified using electrolocation. Anesthesia was monitored using heart rate (HR), invasive blood pressure, electrocardiography, expired gases, respiratory frequency and esophageal temperature by an investigator unaware of the group allocation. Pelvic limb amputation by coxofemoral disarticulation was performed. Dogs that responded to surgical stimulation (>10% increase in HR or arterial pressure) were administered fentanyl (2 μg kg^-1) intravenously for rescue analgesia. Postoperative pain was assessed at extubation; 30, 60 and 120 minutes; and the morning after surgery using a visual analog scale (VAS).

RESULTS

The number of intraoperative fentanyl doses was fewer in the bupivacaine group (2.7±1.1 versus 6.0±2.2; p<0.01). Differences in physiologic variables were not clinically significant. VAS scores were lower in bupivacaine dogs at extubation (0.8±1.9 versus 3.8±2.5) and at 30 minutes (1.0±1.4 versus 4.3±2.1; p<0.05).

CONCLUSIONS AND CLINICAL RELEVANCE

Psoas compartment (lumbar plexus) and sacral plexus block provided analgesia during pelvic limb amputation in dogs.

Lidocaine, dexmedetomidine and their combination reduce isoflurane minimum alveolar concentration in dogs

The effects of intravenous (IV) lidocaine, dexmedetomidine and their combination delivered as a bolus followed by a constant rate infusion (CRI) on the minimum alveolar concentration of isoflurane (MAC_ISO) in dogs were evaluated. Seven healthy adult dogs were included. Anaesthesia was induced with propofol and maintained with isoflurane. For each dog, baseline MAC (MAC_ISO/BASAL) was determined after a 90-minute equilibration period. Thereafter, each dog received one of the following treatments (loading dose, CRI): lidocaine 2 mg kg⁻¹, 100 µg kg⁻¹ minute⁻¹; dexmedetomidine 2 µg kg⁻¹, 2 µg kg⁻¹ hour⁻¹; or their combination. MAC was then determined again after 45- minutes of treatment by CRI. At the doses administered, lidocaine, dexmedetomidine and their combination significantly reduced MAC_ISO by 27.3% (range: 12.5–39.2%), 43.4% (33.3–53.3%) and 60.9% (46.1–78.1%), respectively, when compared to MAC_ISO/_BASAL. The combination resulted in a greater MAC_ISO reduction than the two drugs alone. Their use, at the doses studied, provides a clinically important reduction in the concentration of ISO during anaesthesia in dogs.

Effects of lidocaine, dexmedetomidine or their combination on the minimum alveolar concentration of sevoflurane in dogs

The aim of this study was to determine the effects of lidocaine (LIDO) and dexmedetomidine (DEX) or their combination (LIDO-DEX), administered by constant-rate infusion (CRI), on the minimum alveolar concentration (MAC) of sevoflurane in dogs. Seven healthy mongrel dogs were used with a 2-week washout interval between treatments in this study. Anesthesia was induced with propofol and maintained with sevoflurane in oxygen, and MAC of sevoflurane was determined after 90 min equilibration period in the dogs (SEV-MACBASAL). Then, sevoflurane MAC was determined again in the dogs after 45 min equilibration period of one of the following treatments: an intravenous loading dose of lidocaine 2 mg/kg followed by 6 mg/kg/hr CRI (SEV-MACLIDO); an intravenous loading dose of dexmedetomidine 2 µg/kg followed by 2 µg/kg/hr CRI (SEV-MACDEX); or their combination (SEV-MACLIDO-DEX). These SEV-MACs were determined in duplicate. Data were analyzed using ANOVA and post hoc Tuckey test when appropriate. The SEV-MACBASAL was 1.82 ± 0.06%, SEV-MACLIDO was 1.38 ± 0.08%, SEV-MACDEX was 1.22 ± 0.10%, and SEV-MACLIDO-DEX was 0.78 ± 0.06%. The CRI administration of lidocaine, dexmedetomidine and their combination produced a significant reduction in the MAC of sevoflurane by 26.1 ± 9.0% (P<0.0001), 43.7 ± 11.8% (P<0.0002) and 54.4 ± 9.8% (P<0.0001), respectively. The MAC reduction was significantly greater after the CRI combination of lidocaine and dexmedetomidine when compared with lidocaine CRI (P<0.0001) or dexmedetomidine CRI treatments (P<0.025).

Effects of isoflurane with and without dexmedetomidine or remifentanil on heart rate variability before and after nociceptive stimulation at different multiples of minimum alveolar concentration in dogs

OBJECTIVE

To evaluate the influence of 3 anesthetic protocols and multiples of minimum alveolar concentration (MAC) on heart rate variability (HRV) with and without nociceptive stimulation in dogs.

ANIMALS

6 healthy adult Beagles.

PROCEDURES

Each dog was anesthetized 3 times: with isoflurane alone, with isoflurane and a constant rate infusion of dexmedetomidine (IsoD; 3 μg/kg/h, IV), and with isoflurane and a constant rate infusion of remifentanil (IsoR; 18 μg/kg/h, IV). Individual MAC was determined via supramaximal electrical stimulation. Sinus rhythm-derived intervals between 2 adjacent R-R intervals were exported from ECG recordings. Selected HRV time and frequency domain variables were obtained (at 2-minute intervals) and analyzed offline with signed rank tests before and after stimulation at 0.75, 1.0, and 1. 5 MAC for each anesthetic session.

RESULTS

The isoflurane session had the overall lowest prestimulation SDNN (SD of all R-R intervals) values. Prestimulation SDNN values decreased significantly with increasing MAC in all sessions. For the IsoD session, SDNN (milliseconds) or high-frequency power (milliseconds(2)) was inversely correlated with MAC (Spearman rank correlation coefficient for both variables, -0.77). In the isoflurane and IsoR sessions, heart rate increased significantly after stimulation. In the IsoD session, poststimulation SDNN was increased significantly, compared with prestimulation values, at 0.75 and 1.0 MAC.

CONCLUSIONS AND CLINICAL RELEVANCE

On the basis of SDNN and high-frequency power values, anesthetic levels between 0.75 and 1.5 MAC within the same anesthetic protocol could be differentiated, but with a large overlap among protocols. Usefulness of standard HRV variables for assessment of anesthetic depth and nociception in dogs is questionable.

Evaluation of the isoflurane-sparing effects of fentanyl, lidocaine, ketamine, dexmedetomidine, or the combination lidocaine-ketamine-dexmedetomidine during ovariohysterectomy in dogs

OBJECTIVE

To evaluate the isoflurane-sparing effects of an intravenous (IV) constant rate infusion (CRI) of fentanyl, lidocaine, ketamine, dexmedetomidine, or lidocaine-ketamine-dexmedetomidine (LKD) in dogs undergoing ovariohysterectomy.

STUDY DESIGN

Randomized, prospective, blinded, clinical study.

ANIMALS

Fifty four dogs.

METHODS

Anesthesia was induced with propofol and maintained with isoflurane with one of the following IV treatments: butorphanol/saline (butorphanol 0.4 mg kg(-1), saline 0.9% CRI, CONTROL/BUT); fentanyl (5 μg kg(-1), 10 μg kg(-1) hour(-1), FENT); ketamine (1 mg kg(-1), 40 μg kg(-1) minute(-1), KET), lidocaine (2 mg kg(-1), 100 μg kg(-1) minute(-1), LIDO); dexmedetomidine (1 μg kg(-1), 3 μg kg(-1) hour(-1), DEX); or a LKD combination. Positive pressure ventilation maintained eucapnia. An anesthetist unaware of treatment and end-tidal isoflurane concentration (Fe'Iso) adjusted vaporizer settings to maintain surgical anesthetic depth. Cardiopulmonary variables and Fe'Iso concentrations were monitored. Data were analyzed using anova (p < 0.05).

RESULTS

At most time points, heart rate (HR) was lower in FENT than in other groups, except for DEX and LKD. Mean arterial blood pressure (MAP) was lower in FENT and CONTROL/BUT than in DEX. Overall mean ± SD Fe'Iso and % reduced isoflurane requirements were 1.01 ± 0.31/41.6% (range, 0.75 ± 0.31/56.6% to 1.12 ± 0.80/35.3%, FENT), 1.37 ± 0.19/20.8% (1.23 ± 0.14/28.9% to 1.51 ± 0.22/12.7%, KET), 1.34 ± 0.19/22.5% (1.24 ± 0.19/28.3% to 1.44 ± 0.21/16.8%, LIDO), 1.30 ± 0.28/24.8% (1.16 ± 0.18/32.9% to 1.43 ± 0.32/17.3%, DEX), 0.95 ± 0.19/54.9% (0.7 ± 0.16/59.5% to 1.12 ± 0.16/35.3%, LKD) and 1.73 ± 0.18/0.0% (1.64 ± 0.21 to 1.82 ± 0.14, CONTROL/BUT) during surgery. FENT and LKD significantly reduced Fe'Iso.

CONCLUSIONS AND CLINICAL RELEVANCE

At the doses administered, FENT and LKD had greater isoflurane-sparing effect than LIDO, KET or CONTROL/BUT, but not at all times. Low HR during FENT may limit improvement in MAP expected with reduced Fe'Iso.

A comparison of epidural analgesia provided by bupivacaine alone, bupivacaine + morphine, or bupivacaine + dexmedetomidine for pelvic orthopedic surgery in dogs

OBJECTIVE

To compare the analgesic efficacy of bupivacaine, bupivacaine + morphine, or bupivacaine + dexmedetomidine administered epidurally in dogs undergoing pelvic limb orthopedic surgery.

STUDY DESIGN

Prospective, randomized, double blinded clinical trial.

ANIMALS

Sixty dogs weighing (mean ± SD) 35 ± 15.7 kg, aged 5 ± 3 years.

METHODS

Dogs were assigned to receive a lumbosacral epidural containing bupivacaine (B) 0.5%, 1 mg kg(-1) ; B, bupivacaine 0.5%, 1 mg kg(-1)  + morphine 1%, 0.1 mg kg(-1) ; B + M, or bupivacaine 0.5%, 1 mg kg(-1)  + dexmedetomidine 0.05%, 4 μg kg(-1) ; B + D. The anesthetic protocol was standardized. The median expired isoflurane concentration (E'Iso) and requirement for additional induction agent preventing purposeful movement were recorded. Pain was scored using visual analog (VAS) and modified University of Melbourne (UMPS) pain scales. Sedation was assessed using a 0-4 scale. All parameters were recorded preoperatively, and at extubation (t = 0), then at 1, 2, 4, 8, 12, 16, and 20-24 hours. Hydromorphone was administered postoperatively to patients with a VAS ≥ 35 and/or UMPS ≥ 9. Time to first voluntary urination and first motor activity were recorded.

RESULTS

Postoperatively, B + D had a lower UMPS pain score than B at t = 1 hour (p = 0.013), but not compared to B + M. The B + D group had a shorter time to urination (p = 0.0131) and a longer time for return of motor function (p = 0.0068). There were no other differences between the treatments.

CONCLUSION AND CLINICAL RELEVANCE

Epidurally administered B, B + M, or B + D in dogs all provided acceptable analgesia to manage post-operative orthopedic pelvic limb pain. Epidural administration of B + D is an effective alternative to the analgesia provided by B or B + M, but is associated with increased time to return of motor function. The direct neurotoxic effects of epidural dexmedetomidine have not been fully tested.

The influence of a continuous rate infusion of dexmedetomidine on the nociceptive withdrawal reflex and temporal summation during isoflurane anaesthesia in dogs

OBJECTIVE

To examine the influence of a low dose dexmedetomidine infusion on the nociceptive withdrawal reflex and temporal summation in dogs during isoflurane anaesthesia.

STUDY DESIGN

Prospective experimental blinded cross-over study.

ANIMALS

Eight healthy mixed breed dogs, body weight Mean ± SD 26.5 ± 8.4 kg and age 25 ± 16 months.

METHODS

Anaesthesia was induced with propofol and maintained with isoflurane (Fe'ISO 1.3%) delivered in oxygen and air. After stabilization, baseline recordings (time 0) were obtained, then a dexmedetomidine bolus (1 μg kg(-1) IV) followed by a continuous rate infusion (1 μg kg(-1) hour(-1)) or saline placebo were administered. At times 10, 30 and 60 minutes after the initial bolus, electrical stimulations of increasing intensity were applied over the lateral plantar digital nerve, and administered both as single and as repeated stimuli. The resulting reflex responses were recorded using electromyography. Data were analysed using a multivariable linear regression model and a Kruskal Wallis test for single stimulation data, and repeated measures anova and paired t-test for repeated stimulation data.

RESULTS

The AUC for the stimulus-response curves after single stimulation were similar for both treatments at time 0. At times 10, 30 and 60 the AUCs for the stimulus-response curves were significantly lower with dexmedetomidine treatment than with placebo. Temporal summation was evident in both treatments at times 0, 10, 30 and 60 starting from a stimulation intensity of 10 mA. The magnitude of temporal summation was smaller in dexmedetomidine than in placebo treated dogs at time 10, 30 and 60, but not at time 0.

CONCLUSIONS

During isoflurane anaesthesia, low dose dexmedetomidine suppresses the nociceptive reflex responses after single and repeated electrical stimulation.

CLINICAL RELEVANCE

This experimental study confirms previous reports on its peri-operative efficacy under clinical conditions, and further indicates that dexmedetomidine might reduce the risk of post-operative chronic pain development.

Hemodynamics and bispectral index (BIS) of dogs anesthetized with midazolam and ketamine associated with medetomidine or dexmedetomidine and submitted to ovariohysterectomy

PURPOSE: To evaluate hemodynamics and bispectral index (BIS) in bitches anesthetized with ketamine and midazolam in combination with dexmedetomidine or medetomidine and submitted to ovariohysterectomy. METHODS: Twenty bitches pretreated with levomedetomidine and buprenorphine were anesthetized with 5 mg.kg-1 ketamine and 0.2 mg.kg-1 midazolam i.v. Continuous infusion of 0.4 mg.kg-1.h-1 midazolam and 20 mg.kg-1.h-1 ketamine was initiated in combination with DEX (n=10): 20 µg.kg-1.h-1 dexmedetomidine or MED (n=10): 30 µg.kg-1.h-1 medetomidine over 30 minutes. A pharmacokinetic study provided dexmedetomidine plasma concentration, set to be 3.0 ng.mL-1. RESULTS: BIS decreased in both groups (P<0.05), but it was lower in DEX (P<0.05) as compared to MED. No differences were found in hemodynamic parameters (heart rate, systolic, diastolic and mean arterial pressure) between groups (P>0.05), but heart rate decreased in both groups, as compared to control values (P<0.05). Respiratory rate decreased (P<0.05) and expired end tidal CO2 increased progressively (P<0.05) and similarly in both groups. Anesthetic recovery period was similar between groups (P<0.05) with no adverse effects. CONCLUSION: Continuous administration of dexmedetomidine with calculated plasma concentration equal to 3 ng.mL-1 in combination with midazolam and ketamine provides suitable anesthesia for spay surgery in bitches, hemodynamic stability and calm awakening with no adverse effects.

Effect of inhalation of isoflurane at end-tidal concentrations greater than, equal to, and less than the minimum anesthetic concentration on bispectral index in chickens

OBJECTIVE

To determine the effect of inhalation of isoflurane at end-tidal concentrations greater than, equal to, and less than the minimum anesthetic concentration (MAC) on bispectral index (BIS) in chickens. Animals-10 chickens.

PROCEDURES

For each chicken, the individual MAC of isoflurane was determined by use of the toe-pinch method. After a 1-week interval, chickens were anesthetized with isoflurane at concentrations 1.75, 1.50, 1.25, 1.00, and 0.75 times their individual MAC (administered from higher to lower concentrations). At each MAC multiple, a toe pinch was performed and BIS was assessed and correlated with heart rate, blood pressure, and an awareness score (derived by use of a visual analogue scale).

RESULTS

Among the chickens, mean +/- SD MAC of isoflurane was 1.15 +/- 0.20%. Burst suppression was detected at every MAC multiple. The BIS and awareness score were correlated directly with each other and changed inversely with increasing isoflurane concentration. Median (range) BIS values during anesthesia at 1.75, 1.50, 1.25, 1.00, and 0.75 MAC of isoflurane were 25 (15 to 35), 35 (25 to 45), 35 (20 to 50), 40 (25 to 55), and 50 (35 to 65), respectively. Median BIS value at extubation was 70 +/- 9. Values of BIS correlated with blood pressure, but not with heart rate. Blood pressure changed with end-tidal isoflurane concentrations, whereas heart rate did not.

CONCLUSIONS AND CLINICAL RELEVANCE

Assessment of BIS can be used to monitor the electrical activity of the brain and the degree of unconsciousness in chickens during isoflurane anesthesia.