• 1. Johnston GM, Eastment JK, Wood JLN, et al. The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of phases 1 and 2. Vet Anaesth Analg 2002;29:159170.

    • Search Google Scholar
    • Export Citation
  • 2. Eger EI II. Partition coefficients of I-653 in human blood, saline, and olive oil. Anesth Analg 1987;66:971973.

  • 3. Eger EI II, Johnson BH. Rates of awakening from anesthesia with I-653, halothane, isoflurane, and sevoflurane: a test of the effect of anesthetic concentration and duration in rats. Anesth Analg 1987;66:977982.

    • Search Google Scholar
    • Export Citation
  • 4. Santos M, Lopez-Sanroman J, Garcia-Iturralde P, et al. Cardiopulmonary effects of desflurane in horses. Vet Anaesth Analg 2005;32:355359.

    • Search Google Scholar
    • Export Citation
  • 5. Marcilla MG, Schauvliege S, Segaert S, et al. Influence of a constant rate infusion of dexmedetomidine on cardiopulmonary function and recovery quality in isoflurane anaesthetized horses. Vet Anaesth Analg 2012;39:4958.

    • Search Google Scholar
    • Export Citation
  • 6. Mama KR, Steffey EP, Pascoe PJ. Evaluation of propofol for general anesthesia in premedicated horses. Am J Vet Res 1996;57:512516.

  • 7. Bettschart-Wolfensberger R, Freeman SL, Jaggin-Schmucker N, et al. Infusion of a combination of propofol and medetomidine for long-term anesthesia in ponies. Am J Vet Res 2001;62:500507.

    • Search Google Scholar
    • Export Citation
  • 8. Bettschart-Wolfensberger R, Freeman SL, Bowen IM, et al. Cardiopulmonary effects and pharmacokinetics of i.v. dexmedetomidine in ponies. Equine Vet J 2005;37:6064.

    • Search Google Scholar
    • Export Citation
  • 9. Gozalo-Marcilla M, Hopster K, Gasthuys F, et al. Effects of a constant-rate infusion of dexmedetomidine on the minimal alveolar concentration of sevoflurane in ponies. Equine Vet J 2013;45:204208.

    • Search Google Scholar
    • Export Citation
  • 10. Raisis AL. Skeletal muscle blood flow in anaesthetized horses. Part II: effects of anaesthetics and vasoactive agents. Vet Anaesth Analg 2005;32:331337.

    • Search Google Scholar
    • Export Citation
  • 11. Hopster K, Hopster-Iversen C, Geburek F, et al. Temporal and concentration effects of isoflurane anaesthesia on intestinal tissue oxygenation and perfusion in horses. Vet J 2015;205:6268.

    • Search Google Scholar
    • Export Citation
  • 12. Kowalczyk M, Fijałkowska A, Nestorowicz A. New generation pulse oximetry in the assessment of peripheral perfusion during general anaesthesia—a comparison between propofol and desflurane. Anaesthesiol Intensive Ther 2013;45:138144.

    • Search Google Scholar
    • Export Citation
  • 13. De Blasi RA, Palmisani S, Boezi M, et al. Effects of remifentanil-based general anaesthesia with propofol or sevoflurane on muscle microcirculation as assessed by near-infrared spectroscopy. Br J Anaesth 2008;101:171177.

    • Search Google Scholar
    • Export Citation
  • 14. Linton RA, Young LE, Marlin DJ, et al. Cardiac output measured by lithium dilution, thermodilution, and transesophageal Doppler echocardiography in anesthetized horses. Am J Vet Res 2000;61:731737.

    • Search Google Scholar
    • Export Citation
  • 15. Mama KR, Steffey EP, Pascoe PJ. Evaluation of propofol as a general anesthetic for horses. Vet Surg 1995;24:188194.

  • 16. Clark-Price SC, Posner LP, Gleed RD. Recovery of horses from general anesthesia in a darkened or illuminated recovery stall. Vet Anaesth Analg 2008;35:473479.

    • Search Google Scholar
    • Export Citation
  • 17. Levionnois OL, Spadavecchia C, Kronen PW, et al. Determination of the minimum alveolar concentration of isoflurane in Shetland ponies using constant current or constant voltage electrical stimulation. Vet Anaesth Analg 2009;36:917.

    • Search Google Scholar
    • Export Citation
  • 18. Quasha AL, Eger EI II, Tinker JH. Determination and applications of MAC. Anesthesiology 1980;53:315334.

  • 19. Sonner JM. Issues in the design and interpretation of minimum alveolar anesthetic concentration (MAC) studies. Anesth Analg 2002;95:609614.

    • Search Google Scholar
    • Export Citation
  • 20. Krug A. Mikrozirkulation und Sauerstoffversorgung des Gewebes—Methode des so genannten O2C (oxygen to see). Phlebologie 2006;35:300312.

    • Search Google Scholar
    • Export Citation
  • 21. Reichert C, Kästner SBR, Hopster K, et al. Use of micro-lightguide spectrophotometry for evaluation of microcirculation in the small and large intestines of horses without gastrointestinal disease. Am J Vet Res 2014;75:990996.

    • Search Google Scholar
    • Export Citation
  • 22. Skimming JW, Cassin S, Nichols WW. Calculating vascular resistances. Clin Cardiol 1997;20:805808.

  • 23. Steffey EP. Methodology for determining minimum alveolar concentration: a critical appraisal. Vet Anaesth Analg 2017;44:26.

  • 24. Clarke KW, Song DY, Lee YH, et al. Desflurane anaesthesia in the horse: minimum alveolar concentration following induction of anaesthesia with xylazine and ketamine. Vet Anaesth Analg 1996;23:5659.

    • Search Google Scholar
    • Export Citation
  • 25. Steffey EP, Woliner MJ, Puschner B, et al. Effects of desflurane and mode of ventilation on cardiovascular and respiratory functions and clinicopathologic variables in horses. Am J Vet Res 2005;66:669677.

    • Search Google Scholar
    • Export Citation
  • 26. Oku K, Ohta M, Yamanaka T, et al. The minimum infusion rate (MIR) of propofol for total intravenous anesthesia after premedication with xylazine in horses. J Vet Med Sci 2005;67:569575.

    • Search Google Scholar
    • Export Citation
  • 27. Müller C, Hopster K, Hopster-Iversen C, et al. Elaboration of a xylazine and dexmedetomidine infusion regime which provides a constant level of sedation in horses. Pferdeheilkunde 2012;28:668674.

    • Search Google Scholar
    • Export Citation
  • 28. Pöppel N, Hopster K, Geburek F, et al. Influence of ketamine or xylazine supplementation on isoflurane anaesthetized horses—a controlled clinical trial. Vet Anaesth Analg 2015;42:3038.

    • Search Google Scholar
    • Export Citation
  • 29. Bettschart-Wolfensberger R, Jaggin-Schmucker N, Lendl C, et al. Minimal alveolar concentration of desflurane in combination with an infusion of medetomidine for the anaesthesia of ponies. Vet Rec 2001;148:264267.

    • Search Google Scholar
    • Export Citation
  • 30. Valente AC, Brosnan RJ, Guedes AG. Desflurane and sevoflurane elimination kinetics and recovery quality in horses. Am J Vet Res 2015;76:201207.

    • Search Google Scholar
    • Export Citation
  • 31. Nolan A, Reid J, Welsh E, et al. Simultaneous infusions of propofol and ketamine in ponies premedicated with detomidine: a pharmacokinetic study. Res Vet Sci 1996;60:262266.

    • Search Google Scholar
    • Export Citation
  • 32. Waterman AE, Robertson SA, Lane JG. Pharmacokinetics of intravenously administered ketamine in the horse. Res Vet Sci 1987;42:162166.

  • 33. Muir WW III, Sams R. Effects of ketamine infusion on halothane minimal alveolar concentration in horses. Am J Vet Res 1992;53:18021806.

    • Search Google Scholar
    • Export Citation
  • 34. Villalba M, Santiago I, Gómez de Segura IA. Effects of a constant rate infusion of medetomidine-propofol on isoflurane minimum alveolar concentrations in horses. Vet J 2014;202:329333.

    • Search Google Scholar
    • Export Citation
  • 35. Edner A, Nyman G, Essen-Gustavsson B. The relationship of muscle perfusion and metabolism with cardiovascular variables before and after detomidine injection during propofol-ketamine anaesthesia in horses. Vet Anaesth Analg 2002;29:182199.

    • Search Google Scholar
    • Export Citation
  • 36. Risberg ÅI, Ranheim B, Krontveit RI, et al. The cardiovascular status of isoflurane-anaesthetized horses with and without dexmedetomidine constant rate infusion evaluated at equivalent depths of anaesthesia. Vet Anaesth Analg 2016;43:412423.

    • Search Google Scholar
    • Export Citation
  • 37. Grum CM. Tissue oxygenation in low flow states and during hypoxemia. Crit Care Med 1993;21:S44S49.

  • 38. Muir WW, Wellman ML. Hemoglobin solutions and tissue oxygenation. J Vet Intern Med 2003;17:127135.

  • 39. Fijałkowska A, Kowalczyk M. Peripheral blood perfusion during desflurane anaesthesia [in Polish]. Anestezjol Intens Ter 2010;42:1114.

    • Search Google Scholar
    • Export Citation
  • 40. Karzai W, Haberstroh J, Priebe HJ. Effects of desflurane and propofol on arterial oxygenation during one-lung ventilation in the pig. Acta Anaesthesiol Scand 1998;42:648652.

    • Search Google Scholar
    • Export Citation
  • 41. Rezende ML, Grimsrud KN, Stanley SD, et al. Pharmacokinetics and pharmacodynamics of intravenous dexmedetomidine in the horse. J Vet Pharmacol Ther 2015;38:1523.

    • Search Google Scholar
    • Export Citation
  • 42. Ambrisko TD, Moens Y. Voltage changes in the lithium dilution cardiac output sensor after exposure to blood from horses given xylazine. Br J Anaesth 2014;112:367369.

    • Search Google Scholar
    • Export Citation
  • 43. Hopster K, Ambrisko TD, Stahl J, et al. Influence of xylazine on the function of the LiDCO sensor in isoflurane anaesthetized horses. Vet Anaesth Analg 2015;42:142149.

    • Search Google Scholar
    • Export Citation
  • 44. Ambrisko TD, Kabes R, Moens Y. Influence of drugs on the response characteristics of the LiDCO sensor: an in vitro study. Br J Anaesth 2013;110:305310.

    • Search Google Scholar
    • Export Citation

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Comparison of desflurane and propofol at equipotent doses in combination with a constant rate infusion of dexmedetomidine on global and peripheral perfusion and oxygenation in horses

Stephan Neudeck Dr Med Vet1, Sabine B. R. Kästner Prof Dr Med Vet2, Liza Wittenberg-Voges Dr Med Vet3, Karl Rohn Dr Med Vet4, and Klaus Hopster Dr Med Vet5
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  • 1 Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany.
  • | 2 Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany.
  • | 3 Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany.
  • | 4 Institute for Biometry, Epidemiology and Data Processing, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany.
  • | 5 Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany.

Abstract

OBJECTIVE To determine global and peripheral perfusion and oxygenation during anesthesia with equipotent doses of desflurane and propofol combined with a constant rate infusion of dexmedetomidine in horses.

ANIMALS 6 warmblood horses.

PROCEDURES Horses were premedicated with dexmedetomidine (3.5 μg•kg−1, IV). Anesthesia was induced with propofol or ketamine and maintained with desflurane or propofol (complete crossover design) combined with a constant rate infusion of dexmedetomidine (7 μg•kg−1 •h−1). Microperfusion and oxygenation of the rectal, oral, and esophageal mucosa were measured before and after sedation and during anesthesia at the minimal alveolar concentration and minimal infusion rate. Heart rate, mean arterial blood pressure, respiratory rate, cardiac output, and blood gas pressures were recorded during anesthesia.

RESULTS Mean ± SD minimal alveolar concentration and minimal infusion rate were 2.6 ± 0.9% and 0.04 ± 0.01 mg•kg−1 •min−1, respectively. Peripheral microperfusion and oxygenation decreased significantly after dexmedetomidine administration for both treatments. Oxygenation returned to baseline values, whereas tissue microperfusion remained low during anesthesia. There were no differences in peripheral tissue microperfusion and oxygenation between treatments. Cardiac index was significantly higher and systemic vascular resistance was significantly lower for desflurane treatment than for propofol treatment. For the propofol treatment, Pao2 was significantly higher and there was less dead space and venous admixture than for the desflurane treatment.

CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine decreased blood flow and oxygen saturation in peripheral tissues. Peripheral tissues were well oxygenated during anesthesia with desflurane and propofol combined with dexmedetomidine, whereas blood flow was reduced.

Abstract

OBJECTIVE To determine global and peripheral perfusion and oxygenation during anesthesia with equipotent doses of desflurane and propofol combined with a constant rate infusion of dexmedetomidine in horses.

ANIMALS 6 warmblood horses.

PROCEDURES Horses were premedicated with dexmedetomidine (3.5 μg•kg−1, IV). Anesthesia was induced with propofol or ketamine and maintained with desflurane or propofol (complete crossover design) combined with a constant rate infusion of dexmedetomidine (7 μg•kg−1 •h−1). Microperfusion and oxygenation of the rectal, oral, and esophageal mucosa were measured before and after sedation and during anesthesia at the minimal alveolar concentration and minimal infusion rate. Heart rate, mean arterial blood pressure, respiratory rate, cardiac output, and blood gas pressures were recorded during anesthesia.

RESULTS Mean ± SD minimal alveolar concentration and minimal infusion rate were 2.6 ± 0.9% and 0.04 ± 0.01 mg•kg−1 •min−1, respectively. Peripheral microperfusion and oxygenation decreased significantly after dexmedetomidine administration for both treatments. Oxygenation returned to baseline values, whereas tissue microperfusion remained low during anesthesia. There were no differences in peripheral tissue microperfusion and oxygenation between treatments. Cardiac index was significantly higher and systemic vascular resistance was significantly lower for desflurane treatment than for propofol treatment. For the propofol treatment, Pao2 was significantly higher and there was less dead space and venous admixture than for the desflurane treatment.

CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine decreased blood flow and oxygen saturation in peripheral tissues. Peripheral tissues were well oxygenated during anesthesia with desflurane and propofol combined with dexmedetomidine, whereas blood flow was reduced.

Contributor Notes

Dr. Hopster's present address is Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348.

Address correspondence to Dr. Neudeck (stephan.neudeck@tiho-hannover.de).