Cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane and low-dose S-ketamine or medetomidine infusions

Menzies, M Paula Larenza; Ringer, Simone K; Conrot, Aude; Theurillat, Regula; Kluge, Katharina; Kutter, Annette Pn; Jackson, Michelle; Thormann, Wolfgang; Bettschart-Wolfensberger, Regula (2016). Cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane and low-dose S-ketamine or medetomidine infusions. Veterinary anaesthesia and analgesia, 43(6), pp. 623-634. Blackwell Science 10.1111/vaa.12359

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OBJECTIVES

To evaluate cardiopulmonary effects and anaesthesia recovery quality in horses anaesthetized with isoflurane receiving medetomidine or S-ketamine infusions.

STUDY DESIGN

Randomized, blinded, prospective clinical trial.

ANIMALS

Fifty horses undergoing elective surgery.

METHODS

After acepromazine and flunixin meglumine premedication, horses received medetomidine (7 μg kg(-1) ) intravenously (IV). Anaesthesia was induced with midazolam and racemic ketamine (Med treatment group; 2.2 mg kg(-1) ; n = 25) or S-ketamine (S-ket treatment group; 1.1 mg kg(-1) ; n = 25) IV and maintained with isoflurane in oxygen/air and medetomidine (Med; 3.5 μg kg(-1) hour(-1) ) or S-ketamine (S-ket; 0.5 mg kg(-1) hour(-1) ). All horses were mechanically ventilated. Cardiopulmonary variables were evaluated. Isoflurane end-tidal concentrations (Fe'Iso), dobutamine requirements and thiopental boli were recorded. Plasma samples were collected in six horses to evaluate S-ketamine and S-norketamine concentrations. After surgery, medetomidine 2 μg kg(-1) was administered IV. Four independent observers scored recovery using a visual analogue scale and a numerical rating scale.

RESULTS

Both groups required similar mean Fe'Iso (1%). However, S-ket horses needed more thiopental boli. Median intraoperative cardiac index values were higher with S-ket (4.5 L minute(-1)  m(-2) ) than Med (3.9 L minute(-1)  m(-2) ). Overall, there were no differences in heart rate, blood pressure or dobutamine requirements; however, horses in S-ket showed higher heart rate values at 30 minutes after anaesthesia induction. Compared with Med horses, S-ket horses showed decreased PaO2 and increased pulmonary venous admixture values estimated with the Fshunt calculation. Recoveries were shorter and of poorer quality with S-ket. During infusion, S-ketamine and S-norketamine plasma concentrations lay in the ranges of 0.209-0.917 μg mL(-1) and 0.250-0.723 μg mL(-1) , respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Despite the higher intraoperative cardiac index with S-ket, both protocols were considered to provide acceptable cardiovascular function. However, recovery quality was significantly better in the Med group.

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5 Citations in Web of Science ®
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