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KANDA T, AKASHI N, KAWAMURA N, NEKI Y, OSUMI M, SUGINO R, IWASAKI H, KADOWAKI Y, ITOI T. Effect of fentanyl constant-rate infusions with or without medetomidine on the minimum infusion rate of propofol required to prevent motor movement in dogs. J Vet Med Sci 2024; 86:266-271. [PMID: 38267038 PMCID: PMC10963098 DOI: 10.1292/jvms.23-0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
Propofol is a potential injectable anesthetic agent used in total intravenous anesthesia. However, the sparing effect of fentanyl and medetomidine on the required propofol dose in dogs remains unclear. We aimed to investigate the effect of fentanyl constant-rate infusion (CRI) with or without medetomidine on the minimum infusion rate of propofol required to prevent motor movement (MIRNM) in dogs. Six healthy purpose-bred dogs were anesthetized on three occasions with propofol alone (loading dose [LD], 8 mg/kg to effect; initial infusion rate [IR], 0.70 mg/kg/min); propofol (LD, 6 mg/kg to effect; IR, 0.35 mg/kg/min) and fentanyl (LD, 2 µg/kg; IR, 0.10 µg/kg/min); or propofol (LD, 4 mg/kg to effect; IR, 0.25 mg/kg/min), fentanyl (LD, 2 µg/kg; IR, 0.10 µg/kg/min), and medetomidine (LD, 2 µg/kg; IR, 0.5 µg/kg/hr) under controlled ventilation. The MIRNM was determined by observing the response to a noxious electrical stimulus. Heart rate, blood pressure, and blood gas analyses were performed at 1, 2, 3, and 4 hr after initiating CRI. The MIRNM (mean [range]) was significantly lower in the propofol-fentanyl-medetomidine group (0.16 [0.10-0.27] mg/kg/min) than that in the propofol-alone group (0.63 [0.47-0.82] mg/kg/min) (P=0.0004). Fentanyl combined with medetomidine did not significantly decrease the mean arterial pressure in dogs receiving propofol CRI 1-3 hr after initiating CRI compared with propofol CRI alone (P>0.9999, P=0.1536, and P=0.0596, respectively), despite inducing a significantly lower heart rate.
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Affiliation(s)
- Teppei KANDA
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Natsuki AKASHI
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
| | - Nanako KAWAMURA
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Yuna NEKI
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Miho OSUMI
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Reina SUGINO
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Hana IWASAKI
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Yumi KADOWAKI
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
| | - Takamasa ITOI
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
- Department of Comparative Animal Science, College of Life Science, Kurashiki University of Science and the Arts, Okayama, Japan
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Zavataro AL, Bonatto N, Julião GH, Costa IM, Moreira TF, Zamboni V, Floriano BP. COMPARISON OF COINDUCTION ADJUVANTS TO PROPOFOL IN HEALTHY CATS SEDATED WITH DEXMEDETOMIDINE. Top Companion Anim Med 2022; 48:100634. [PMID: 35045356 DOI: 10.1016/j.tcam.2022.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to compare the effects of different coinduction agents on the duration and dose of propofol in healthy cats. Six cats aged 4.8 ± 1.0 years and weighing 4.4 ± 1.1 kg participated in four treatment groups of propofol combined with: saline or control group (TC); ketamine 2 mg/kg (Tket); fentanyl 1 µg/kg (Tfen); or midazolam 0.3 mg/kg (Tmid). Twenty minutes following premedication with dexmedetomidine at 10 µg/kg, induction followed the same protocol in all groups, starting with a propofol bolus of 1 mg/kg over 1 minute followed by an adjuvant, then propofol again at 1 mg/kg/minute for orotracheal intubation. Variables recorded were (in minutes): time of extubation, time to return of palpebral reflex, eye recentralization, recovery of consciousness, quadrupedal position and total propofol dose used (mg/kg). A comparison between the four groups was performed by analysis of variance followed by Dunnett test under 5% significance. There was no significant difference in any of the times evaluated during anesthetic recovery between the groups. The propofol dose used to allow orotracheal intubation was significantly lower in all groups compared to TC (p<0.05). Ketamine, midazolam and fentanyl are indicated as suitable choices for coinduction with propofol in cats.
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Affiliation(s)
- A L Zavataro
- University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil
| | - Ncm Bonatto
- University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil
| | - G H Julião
- Roque Quagliato Veterinary Teaching Hospital, University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil
| | - I M Costa
- Roque Quagliato Veterinary Teaching Hospital, University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil
| | - T F Moreira
- Roque Quagliato Veterinary Teaching Hospital, University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil
| | - Vag Zamboni
- Roque Quagliato Veterinary Teaching Hospital, University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil
| | - B P Floriano
- University Center of the Integrated Faculties of Ourinhos, São Paulo State, Brazil.
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Bustamante R, Canfrán S, Gómez de Segura IA, Aguado D. Intraoperative effect of low doses of ketamine or dexmedetomidine continuous rate infusions in healthy dogs receiving propofol total intravenous anaesthesia and epidural anaesthesia: A prospective, randomised clinical study. Res Vet Sci 2021; 143:4-12. [PMID: 34953409 DOI: 10.1016/j.rvsc.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
The present study aimed to determine the effect of either ketamine or dexmedetomidine constant rate infusion (CRI) on intraoperative propofol anaesthetic requirements during total intravenous anaesthesia (TIVA) in healthy dogs undergoing hindlimbs orthopaedic procedures receiving epidural anaesthesia. In this randomised, blinded clinical study, thirty-nine healthy client-owned dogs were premedicated intramuscularly (dexmedetomidine 4 μg/kg and methadone 0.3 mg/kg). General anaesthesia was induced to effect with propofol administered as intravenous bolus, and maintained with propofol TIVA (18 mg/kg/h), adjusted to meet the suitable clinical anaesthetic depth (indicatively±20%) based on clinical judgement. Lumbosacral epidural anaesthesia was performed using bupivacaine (1 mg/kg) and morphine preservative free (0.1 mg/kg). Dogs randomly received either saline (SP; loading dose 1 mL/kg, CRI 1 mL/kg/h), or ketamine (KP; loading dose 1.5 mg/kg, CRI 1.5 mg/kg/h), or dexmedetomidine (DP; loading dose 1 μg/kg/, CRI 1 μg/kg/h). Physiological variables were recorded intraoperatively at 5-min intervals using standard-of-care monitoring. Recovery quality and duration were recorded. Treatment groups were compared with parametric and non-parametric tests as appropriate, p < 0.05. Propofol rates and recovery scores were similar between groups. Overall mean and diastolic blood pressures were higher in group DP compared to group KP (12-14 mmHg, p = 0.016 and p = 0.015, respectively). More dogs required mechanical ventilation in group KP (12 dogs) than in either group SP or DP (7 dogs per group, p = 0.037). Ketamine or dexmedetomidine CRIs, at the studied rates, did not reduce propofol TIVA requirements in dogs undergoing orthopaedic surgery with epidural anaesthesia.
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Affiliation(s)
- Rocío Bustamante
- Anaesthesiology Service, Vetsia Veterinary Hospital, Calle Galileo 3, 28914, Leganés, Madrid, Spain.
| | - Susana Canfrán
- Anaesthesiology Service, Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
| | - Ignacio A Gómez de Segura
- Anaesthesiology Service, Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
| | - Delia Aguado
- Anaesthesiology Service, Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
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Bustamante R, Gómez de Segura IA, Canfrán S, Aguado D. Effects of ketamine or midazolam continuous rate infusions on alfaxalone total intravenous anaesthesia requirements and recovery quality in healthy dogs: a randomized clinical trial. Vet Anaesth Analg 2020; 47:437-446. [PMID: 32340894 DOI: 10.1016/j.vaa.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/18/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To 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 DESIGN Prospective, blinded clinical study. ANIMALS A group of 33 healthy, client-owned dogs subjected to dental procedures. METHODS After 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. RESULTS Midazolam 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 RELEVANCE Midazolam, 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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Affiliation(s)
- Rocío Bustamante
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Ignacio A Gómez de Segura
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Susana Canfrán
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Delia Aguado
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain.
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Bradbrook C, Clark L. State of the art analgesia-Recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2. Vet J 2018; 236:62-67. [PMID: 29871752 DOI: 10.1016/j.tvjl.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
There has been considerable interest in the area of acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is ever increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The second part of this review will consider the non-traditional analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.
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Affiliation(s)
| | - L Clark
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, SG5 3HR, UK
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Smith CK, Seddighi R, Cox SK, Sun X, Knych HK, Doherty TJ. Effect of dexmedetomidine on the minimum infusion rate of propofol preventing movement in dogs. Vet Anaesth Analg 2017; 44:1287-1295. [PMID: 29074303 DOI: 10.1016/j.vaa.2017.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effect of dexmedetomidine on induction dose and minimum infusion rate of propofol preventing movement (MIRNM). STUDY DESIGN Randomized crossover, unmasked, experimental design. ANIMALS Three male and three female healthy Beagle dogs weighing 10.2 ± 2.8 kg. METHODS Dogs were studied on three occasions at weekly intervals. Premedications were 0.9% saline (treatment P) or dexmedetomidine (1 μg kg-1, treatment PLD; 2 μg kg-1, treatment PHD) intravenously. Anesthesia was induced with propofol (2 mg kg-1 and then 1 mg kg-1 every 15 seconds) until intubation. Anesthesia was maintained for 90 minutes in P with propofol (0.5 mg kg-1 minute-1) and saline, in PLD with propofol (0.35 mg kg-1 minute-1) and dexmedetomidine (1 μg kg-1 hour-1), and in PHD with propofol (0.3 mg kg-1 minute-1) and dexmedetomidine (2 μg kg-1 hour-1). The stimulus (50 V, 50 Hz, 10 ms) was applied to the antebrachium, and propofol infusion was increased or decreased by 0.025 mg kg-1 minute-1 based on a positive or negative response, respectively. Data were analyzed using a mixed-model anova and presented as mean ± standard error. RESULTS Propofol induction doses were 8.68 ± 0.57 (P), 6.13 ± 0.67 (PLD) and 4.78 ± 0.39 (PHD) mg kg-1 and differed among treatments (p < 0.05). Propofol MIRNM values were 0.68 ± 0.13, 0.49 ± 0.16 and 0.26 ± 0.05 mg kg-1 minute-1 for P, PLD and PHD, respectively. Propofol MIRNM decreased 59% in PHD (p < 0.05). Plasma propofol concentrations were 14.04 ± 2.30 (P), 11.30 ± 4.30 (PLD) and 7.96 ± 0.72 (PHD) μg mL-1 and dexmedetomidine concentrations were 0.68 ± 0.12 (PLD) and 0.89 ± 0.08 (PHD) ng mL-1 at MIRNM determination. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine (1 and 2 μg kg-1) decreased propofol induction dose. Dexmedetomidine (2 μg kg-1 hour-1) resulted in a significant decrease in propofol MIRNM.
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Affiliation(s)
- Christopher K Smith
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA.
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Sherry K Cox
- Department of Biological and Diagnostic Sciences, University of Tennessee, Knoxville, TN, USA
| | - Xiaocun Sun
- Office of Information and Technology, University of Tennessee, Knoxville, TN, USA
| | - Heather K Knych
- KL Maddy Equine Analytical Chemistry Laboratory, University of California Davis, Davis, CA, USA
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
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Cox S, Bailey J, Okafor C, Seddighi R, Doherty T. The influence of storage time and temperature on propofol concentrations in canine blood and plasma. PeerJ 2017; 5:e3476. [PMID: 28674652 PMCID: PMC5494168 DOI: 10.7717/peerj.3476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/30/2017] [Indexed: 11/29/2022] Open
Abstract
Propofol is an intravenous anesthetic commonly used due to its favorable pharmacokinetic and pharmacodynamic profile. There are discrepancies in the literature about the most appropriate sample for determining propofol concentrations. Although plasma has been used for determining propofol concentrations, whole blood has been the preferred sample. There is also a lack of consistency in the literature on the effect of storage time and temperature on propofol concentrations and this may lead to errors in the design of pharmacokinetic/pharmacodynamics studies. The purpose of this study was to determine the difference in propofol concentrations in whole blood versus plasma and to evaluate the influence of storage time (56 days) and temperature (4 °C, −20 °C, −80 °C) on the stability of propofol concentrations in blood and plasma samples. Results from the study indicate that whole blood and plasma samples containing propofol stored at −80 °C have concentrations as high as or higher than those stored at 4 °C or −20 °C for 56 days; thus, −80 °C is an appropriate temperature for propofol sample storage. Plasma propofol concentrations were consistently higher than whole blood for all three storage temperatures. Consequently, plasma is the most appropriate sample for propofol analysis due to its consistent determinations.
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Affiliation(s)
- Sherry Cox
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | - Joan Bailey
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | - Chika Okafor
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States of America
| | - Tom Doherty
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States of America
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Davis CA, Seddighi R, Cox SK, Sun X, Egger CM, Doherty TJ. Effect of fentanyl on the induction dose and minimum infusion rate of propofol preventing movement in dogs. Vet Anaesth Analg 2017. [PMID: 28624496 DOI: 10.1016/j.vaa.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the effect of fentanyl on the induction dose of propofol and minimum infusion rate required to prevent movement in response to noxious stimulation (MIRNM) in dogs. STUDY DESIGN Crossover experimental design. ANIMALS Six healthy, adult intact male Beagle dogs, mean±standard deviation 12.6±0.4 kg. METHODS Dogs were administered 0.9% saline (treatment P), fentanyl (5 μg kg-1) (treatment PLDF) or fentanyl (10 μg kg-1) (treatment PHDF) intravenously over 5 minutes. Five minutes later, anesthesia was induced with propofol (2 mg kg-1, followed by 1 mg kg-1 every 15 seconds to achieve intubation) and maintained for 90 minutes by constant rate infusions (CRIs) of propofol alone or with fentanyl: P, propofol (0.5 mg kg-1 minute-1); PLDF, propofol (0.35 mg kg-1 minute-1) and fentanyl (0.1 μg kg-1 minute-1); PHDF, propofol (0.3 mg kg-1 minute-1) and fentanyl (0.2 μg kg-1 minute-1). Propofol CRI was increased or decreased based on the response to stimulation (50 V, 50 Hz, 10 mA), with 20 minutes between adjustments. Data were analyzed using a mixed-model anova and presented as mean±standard error. RESULTS ropofol induction doses were 6.16±0.31, 3.67±0.21 and 3.33±0.42 mg kg-1 for P, PLDF and PHDF, respectively. Doses for PLDF and PHDF were significantly decreased from P (p<0.05) but not different between treatments. Propofol MIRNM was 0.60±0.04, 0.29±0.02 and 0.22±0.02 mg kg-1 minute-1 for P, PLDF and PHDF, respectively. MIRNM in PLDF and PHDF was significantly decreased from P. MIRNM in PLDF and PHDF were not different, but their respective percent decreases of 51±3 and 63±2% differed (p=0.035). CONCLUSIONS AND CLINICAL RELEVANCE Fentanyl, at the doses studied, caused statistically significant and clinically important decreases in the propofol induction dose and MIRNM.
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Affiliation(s)
- Carrie A Davis
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA.
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Sherry K Cox
- Department of Biological and Diagnostic Sciences, University of Tennessee, Knoxville, TN, USA
| | - Xiaocun Sun
- Office of Information and Technology, University of Tennessee, Knoxville, TN, USA
| | - Christine M Egger
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
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