Abstract

BackgroundThis study assessed the effects of sedation using a combination of fentanyl, midazolam and medetomidine in comparison to ketamine. Rhesus Macaques (Macaca mulatta), (n = 16, 5 males and 3 females randomly allocated to each treatment group) received either ketamine (KET) (10 mg.kg−1) or fentanyl-midazolam-medetomidine (FMM) (10 μg/kg−1; 0.5 mg.kg−1; 20 μg.kg−1) both IM. Oxygen (100 %) was provided by mask and heart rate, blood pressure, respiratory rate, EtCO2 and depth of sedation were assessed every 5 min for 20 min. After the last time point, FMM monkeys were reversed with atipamezole-naloxone (0.2 mg.kg−1; 10 μg.kg−1). Recovery was scored using clinical scoring scheme. Differences in physiological parameters and quality of sedation were compared using Area Under the Curve (AUC) method and either Mann-Witney or t-student tests.ResultsHeart rate (beats/min) (Ket = 119 ± 18; FMM = 89 ± 17; p = 0.0066), systolic blood pressure (mmHg) (Ket = 109 ± 10; FMM = 97 ± 10; p = 0.0313), and respiratory rate (breaths/min) (Ket = 39 ± 9; FMM = 29 ± 10; p = 0.0416) were significantly lower in the FMM group. End-tidal CO2 (mmHg) did not differ between the groups (KET = 33 ± 8; FMM = 42 ± 11; p = 0.0462). Although some depression of physiological parameters was seen with FMM, the variables all remained within the normal ranges in both groups. Onset of a sufficient degree of sedation for safe handling was more rapid with ketamine (KET = 2.9 ± 1.4 min; FMM = 7.9 ± 1.2 min; p = 0.0009), but FMM recovery was faster (KET = 21.4 ± 13.4 min; FMM = 9.1 ± 3.6 min; p = 0.0379) and of better quality (KET = 1.3 ± 0.9; FMM = 7.4 ± 1.9; p = 0.0009) most probably because of the effectiveness of the reversal agents used.ConclusionFMM provides an easily reversible immobilization with a rapid and good recovery quality and may prove a useful alternative to ketamine.

Highlights

  • This study assessed the effects of sedation using a combination of fentanyl, midazolam and medetomidine in comparison to ketamine

  • Some depression of physiological parameters was seen with FMM, the variables all remained within the normal ranges in both groups

  • Onset of a sufficient degree of sedation for safe handling was more rapid with ketamine (KET = 2.9 ± 1.4 min; FMM = 7.9 ± 1.2 min; p = 0.0009), but FMM recovery was faster (KET = 21.4 ± 13.4 min; FMM = 9.1 ± 3.6 min; p = 0.0379) and of better quality (KET = 1.3 ± 0.9; FMM = 7.4 ± 1.9; p = 0.0009) most probably because of the effectiveness of the reversal agents used

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Summary

Results

Sedation procedure One female from the KET group started to recover 10 min after administration of the anaesthetic and was placed in a recovery cage. The heart rate (HR) (p = 0.0066), Respiration rate (RR) (p = 0.0416), systolic blood pressure (BPsyst) (p = 0.0313) and the end-tidal CO2 (EtCO2) (p = 0.0462) AUCs were significantly lower in the FMM group. The Shapiro-wilk test showed a normal distribution for Heart Rate (HR), the Respiration Rate (RR), the Systolic Blood Pressure (BPsyst) and the end-tidal CO2 (EtCO2). These AUCs parameters were compared with Student t test. The Bland-Altman plots demonstrated a non-significant bias of 0.1437 and a reasonably good level of agreement between the two tests (Fig. 3) It showed a non-homogeneous distribution of the plots that was probably due to the scale difference between the VAS and the RCS.

Background
Discussion
Twitching Delayed blinking Minimal Only digits fingers movements
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