Abstract
ObjectiveTo compare the duration, quality of anaesthesia and analgesia, and quality of recovery of dexmedetomidine and methadone combined with either ketamine or alfaxalone. Study designRandomized, prospective clinical trial. AnimalsA group of 44 healthy client-owned cats presenting for ovariectomy. MethodsCats were randomly assigned to one of the two treatment groups: DAM (n=22), which was administered intramuscularly (IM) dexmedetomidine (15 μg kg−1), methadone (0.3 mg kg−1) and alfaxalone (3 mg kg−1), and DKM (n=22), which was administered IM dexmedetomidine (15 μg kg−1), methadone (0.3 mg kg−1) and ketamine (3 mg kg−1). During anaesthesia, heart rate, respiratory rate and systolic arterial pressure were measured every 5 minutes. Cats that moved or had poor muscle relaxation were administered an additional 1 mg kg−1 of either alfaxalone (DAM) or ketamine (DKM) intravenously (IV). In cases of increased autonomic responses to surgical stimulation, fentanyl (2 μg kg−1) was administered IV. At the end of the surgery, atipamezole (75 μg kg−1) was administered IM, and the times to both sternal recumbency and active interaction were recorded. Quality of recovery was evaluated with a simple descriptive scale. The UNESP-Botucatu multidimensional composite pain scale and a visual analogue scale were used to evaluate postoperative analgesia at the return of active interaction and 1, 2 and 3 hours later. ResultsThe additional anaesthesia and rescue fentanyl requirements were similar between groups. The quality of recovery was better in the DAM group than in the DKM group [simple descriptive scale scores: 0 (0–1) and 1 (0–3), respectively; p=0.002]. Postoperative pain scores decreased progressively over time in both groups, with no significant differences (p=0.08) between them. Conclusions and clinical relevanceBoth protocols provided comparable quality of anaesthesia and analgesia and were suitable for cats undergoing ovariectomy. In combination with methadone and dexmedetomidine, alfaxalone and ketamine showed comfortable and reliable recoveries.
Highlights
Ovariectomy is one of the most common reasons for anaesthesia in young female cats in Europe
Conclusions and clinical relevance Both protocols provided comparable quality of anaesthesia and analgesia that were suitable for cats undergoing ovariectomy
Repeated dosing of ketamine during anaesthesia has been associated with drug accumulation and delayed recovery in cats (Baggot et al 1976; Liu et al 2006)
Summary
Ovariectomy is one of the most common reasons for anaesthesia in young female cats in Europe. The anaesthetic drugs should be safe, well-absorbed by IM route and provide reliable unconsciousness, muscle relaxation and analgesia. Alpha-2 agonists are commonly used anaesthetic agents because they provide reliable sedation and short-term analgesia (Cullen et al 1996; Murrell et al.2005; Nagore et al 2013). Opioid and alpha-2 agonist combinations have a synergistic analgesic effect (Meert et al 1994; Slingsby et al 2014) and provide deeper sedation compared with the effect of either agent alone (Girard et al 2010). Ketamine is often used in combination with opioids and alpha-2 agonists because it is inexpensive and offers the advantage of producing predictable dissociative and analgesic effects (Ko et al 2011; Harrison et al 2011; Carbone 2012). Repeated dosing of ketamine during anaesthesia has been associated with drug accumulation and delayed recovery in cats (Baggot et al 1976; Liu et al 2006)
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