Evaluation of the perioperative stress response from dexmedetomidine infusion alone, with butorphanol bolus or remifentanil infusion compared with ketamine and morphine infusions in isoflurane-anesthetized horses.
Abstract: To evaluate perioperative stress-related hormones in isoflurane-anesthetized horses administered infusions of dexmedetomidine alone or with butorphanol or remifentanil, compared with ketamine-morphine. Methods: Randomized, prospective, nonblinded clinical study. Methods: A total of 51 horses undergoing elective surgical procedures. Methods: Horses were premedicated with xylazine, anesthesia induced with ketamine-diazepam and maintained with isoflurane and one of four intravenous infusions. Partial intravenous anesthesia (PIVA) was achieved with dexmedetomidine (1.0 μg kg hour; group D; 12 horses); dexmedetomidine (1.0 μg kg hour) and butorphanol bolus (0.05 mg kg; group DB; 13 horses); dexmedetomidine (1.0 μg kg hour) and remifentanil (3.0 μg kg hour; group DR; 13 horses); or ketamine (0.6 mg kg hour) and morphine (0.15 mg kg, 0.1 mg kg hour; group KM; 13 horses). Infusions were started postinduction; butorphanol bolus was administered 10 minutes before starting surgery. Blood was collected before drugs were administered (baseline), 10 minutes after ketamine-diazepam, every 30 minutes during surgery and 1 hour after standing. Mean arterial pressure (MAP), pulse rate, end-tidal isoflurane concentration, cortisol, nonesterified fatty acids (NEFA), glucose and insulin concentrations were compared using linear mixed models. Significance was assumed when p < 0.05. Results: Within D, cortisol was lower at 120-180 minutes from starting surgery compared with baseline. Cortisol was higher in KM than in D at 60 minutes from starting surgery. Within all groups, glucose was higher postinduction (except DR) and 60 minutes from starting surgery, and insulin was lower during anesthesia and higher after standing compared with baseline. After standing, NEFA were higher in KM than in DB. In KM, MAP increased at 40-60 minutes from starting surgery compared with 30 minutes postinduction. Conclusions: Dexmedetomidine suppressed cortisol release more than dexmedetomidine-opioid and ketamine-morphine infusions. Ketamine-morphine PIVA might increase catecholamine activity.
Copyright © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
Publication Date: 2021-02-15 PubMed ID: 33741263DOI: 10.1016/j.vaa.2021.01.006Google Scholar: Lookup
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Summary
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The research article examines the variation in stress hormonal responses in horses under isoflurane anesthesia given different drug infusions, namely dexmedetomidine alone or in combination with butorphanol or remifentanil, in comparison to a ketamine and morphine mix.
Study Design
- The experiment was conducted as a randomized, prospective, nonblinded clinical study involving a total of 51 horses scheduled for elective surgical procedures.
- Horses were first premedicated with xylazine, then anesthetized with a ketamine-diazepam compound. The main study anesthesia was maintained using isoflurane in combination with one of four different intravenous infusions.
- The experimental groups considered dexmedetomidine alone (group D); dexmedetomidine with a butorphanol bolus (group DB); dexmedetomidine with remifentanil (group DR); and a mixture of ketamine and morphine (group KM).
- Relevant physiological and biochemical parameters, such as Mean Arterial Pressure, pulse rate, end-tidal isoflurane concentration, cortisol, glucose, nonesterified fatty acids (NEFA) and insulin concentrations, were regularly measured and compared across all groups.
Key Findings
- The dexmedetomidine group (group D) exhibited a reduction in cortisol levels from 120 to 180 minutes into the surgical procedure, indicating a strong inhibitory effect on cortisol release.
- Increased cortisol levels were observed in the ketamine-morphine group (group KM) compared to group D, 60 minutes post-surgery commencement, hinting at a discrepancy in stress responses conditioned by the two drug formulations.
- All experimental groups showed higher glucose levels post-induction, except for group DR, and enhanced insulin levels post-anaesthesia in comparison to baseline measurements, indicating the possible metabolic strain presented by the anaesthetic process.
- Post-anaesthesia, NEFA was found to be highest in group KM, followed by group DB, suggesting a differential metabolic response depending on the medicinal compound utilized.
- In group KM, Mean Arterial Pressure saw an uptick at about 40 to 60 minutes into the surgery when compared to measures taken 30 minutes post-induction.
- The article concludes that dexmedetomidine suppresses cortisol release more effectively than either the dexmedetomidine-opioid or ketamine-morphine infusions. In contrast, the ketamine-morphine anesthesia seems to upregulate catecholamine activity, implying an increase in metabolic stress.
Cite This Article
APA
Fujiyama M, Jones T, Duke-Novakovski T.
(2021).
Evaluation of the perioperative stress response from dexmedetomidine infusion alone, with butorphanol bolus or remifentanil infusion compared with ketamine and morphine infusions in isoflurane-anesthetized horses.
Vet Anaesth Analg, 48(3), 344-355.
https://doi.org/10.1016/j.vaa.2021.01.006 Publication
Researcher Affiliations
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada. Electronic address: maf939@mail.usask.ca.
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
MeSH Terms
- Anesthesia Recovery Period
- Animals
- Butorphanol
- Dexmedetomidine
- Horses
- Isoflurane
- Ketamine
- Morphine
- Prospective Studies
- Remifentanil
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