• 1.

    Wilson DV, Walshaw R. Postanesthetic esophageal dysfunction in 13 dogs. J Am Anim Hosp Assoc 2004;40:455460.

  • 2.

    Ovbey DH, Wilson DV, Bednarski RM, et al. Prevalence and risk factors for canine post-anesthetic aspiration pneumonia (1999– 2009): a multicenter study. Vet Anaesth Analg 2014;41:127136.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Lamata C, Loughton V, Jones M, et al. The risk of passive regurgitation during general anaesthesia in a population of referred dogs in the UK. Vet Anaesth Analg 2012;39:266274.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    De Miguel Garcia C, Pinchbeck GL, Dugdale A, et al. Retrospective study of the risk factors and prevalence of regurgitation in dogs undergoing general anaesthesia. Open Vet Sc J 2013;7:611.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Wilson DV, Evans AT, Miller R. Effects of preanesthetic administration of morphine on gastroesophageal reflux and regurgitation during anesthesia in dogs. Am J Vet Res 2005;66:386390.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Galatos AD, Raptopoulos D. Gastro-oesophageal reflux during anaesthesia in the dog: the effect of age, positioning and type of surgical procedure. Vet Rec 1995;137:513516.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Savas I, Raptopoulos D. Incidence of gastro-oesophageal reflux during anaesthesia, following two different fasting times in dogs. Vet Anaesth Analg 2000;27:5960.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Adams JG, Figueiredo JP, Graves TK. Physiology, pathophysiology, and anesthetic management of patients with gastrointestinal and endocrine disease. In: Grimm KA, Lamont LA, Tranquilli WJ, et al., eds. Veterinary anesthesia and analgesia: the fifth edition of Lumb and Jones. Ames, Iowa: John Wiley & Sons Inc, 2015;659.

    • Search Google Scholar
    • Export Citation
  • 9.

    Wilson GP. Ulcerative esophagitis and esophageal stricture. J Am Anim Hosp Assoc 1977;13:180185.

  • 10.

    Pearson H, Darke PG, Gibbs C, et al. Reflux oesophagitis and stricture formation after anaesthesia: a review of seven cases in dogs and cats. J Small Anim Pract 1978;19:507519.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Kogan DA, Johnson LR, Sturges BK, et al. Etiology and clinical outcome in dogs with aspiration pneumonia: 88 cases (2004–2006). J Am Vet Med Assoc 2008;233:17481755.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Turan A, Wo J, Kasuya Y, et al. Effects of dexmedetomidine and propofol on lower esophageal sphincter and gastroesophageal pressure gradient in healthy volunteers. Anesthesiology 2010;112:1924.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Valverde A, Cantwell S, Hernández J, et al. Effects of acepromazine on the incidence of vomiting associated with opioid administration in dogs. Vet Anaesth Analg 2004;31:4045.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Hofmeister EH, Chandler MJ, Read MR. Effects of acepromazine, hydromorphone, or an acepromazine-hydromor-phone combination on the degree of sedation in clinically normal dogs (Erratum published in J Am Vet Med Assoc 2011;238:182). J Am Vet Med Assoc 2010;237:11551159.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Wilson DV, Boruta DT, Evans AT. Influence of halothane, isoflurane, and sevoflurane on gastroesophageal reflux during anesthesia in dogs. Am J Vet Res 2006;67:18211825.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Viskjer S, Sjöström L. Effect of the duration of food withholding prior to anesthesia on gastroesophageal reflux and regurgitation in healthy dogs undergoing elective orthopedic surgery. Am J Vet Res 2017;78:144150.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Strombeck DR, Harrold D. Effects of atropine, acepromazine, meperidine, and xylazine on gastroesophageal sphincter pressure in the dog. Am J Vet Res 1985;46:963965.

    • Search Google Scholar
    • Export Citation
  • 18.

    Wilson DV, Evans AT, Mauer WA. Pre-anaesthetic meperi-dine: associated vomiting and gastroesophageal reflux during the subsequent anesthetic in dogs. Vet Anaesth Analg 2007;34:1522.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Johnson RA. Maropitant prevented vomiting but not gastroesophageal reflux in anesthetized dogs premedicated with acepromazine-hydromorphone. Vet Anaesth Analg 2014;41:406410.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Raptopoulos D, Galatos AD. Gastro-oesophageal reflux during anaesthesia induced with either thiopentone or propofol in the dog. J Vet Anaesth 1997;24:2022.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement

Randomized, blinded, controlled clinical trial to assess gastroesophageal reflux and regurgitation in dogs undergoing general anesthesia after hydromorphone premedication with or without acepromazine or dexmedetomidine

Renata S. Costa DVM MPhil1, Lois A. Wetmore DVM, SCD1, and Amy Stein PhD2
View More View Less
  • 1 From the Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536;
  • | 2 From the From the Office of Research and Sponsors Program, Midwestern University, Glendale, AZ 85308.

Abstract

OBJECTIVE

To investigate whether premedication with hydromorphone alone or combined with acepromazine or dexmedetomidine affects the incidence of gastroesophageal reflux (GER) and regurgitation in dogs undergoing general anesthesia for elective orthopedic surgery.

ANIMALS

39 healthy client-owned dogs undergoing general anesthesia for elective orthopedic surgery between November 2016 and November 2018.

PROCEDURES

For this prospective, randomized, controlled, blinded clinical trial, dogs were randomly assigned to be premedicated with hydromorphone (0.1 mg/kg, IM) alone (group H [control group]) or with either acepromazine (0.05 mg/kg, IM; group AH) or dexmedetomidine (6 μg/kg, IM; group DH) before undergoing general anesthesia induced with propofol and maintained with isoflurane. A pH sensor–tipped probe was used to identify episodes of GER (esophageal pH < 4 or > 7.5 for ≥ 30 seconds). Results for GER, regurgitation, vomiting, propofol dose, and durations of food withholding and anesthesia were compiled and compared across groups.

RESULTS

There were 13 dogs in each group, and no meaningful differences were detected in age, body weight, sex, breed, or durations of anesthesia or food withholding across groups. Overall, 16 of the 39 (41%) dogs developed GER: 9 in group H, 6 in group AH, and 1 in group DH. The incidence of GER was significantly lower for group DH versus group H. Six of the 39 (15%) dogs regurgitated: 4 in group H and 2 in group AH.

CONCLUSIONS AND CLINICAL RELEVANCE

The combined use of dexmedetomidine and hydromorphone as premedication may be a better choice to reduce GER in healthy dogs undergoing orthopedic surgery than would the use of hydromorphone with or without acepromazine. Additional research is warranted. (Am J Vet Res 2021;82:695–700)

Abstract

OBJECTIVE

To investigate whether premedication with hydromorphone alone or combined with acepromazine or dexmedetomidine affects the incidence of gastroesophageal reflux (GER) and regurgitation in dogs undergoing general anesthesia for elective orthopedic surgery.

ANIMALS

39 healthy client-owned dogs undergoing general anesthesia for elective orthopedic surgery between November 2016 and November 2018.

PROCEDURES

For this prospective, randomized, controlled, blinded clinical trial, dogs were randomly assigned to be premedicated with hydromorphone (0.1 mg/kg, IM) alone (group H [control group]) or with either acepromazine (0.05 mg/kg, IM; group AH) or dexmedetomidine (6 μg/kg, IM; group DH) before undergoing general anesthesia induced with propofol and maintained with isoflurane. A pH sensor–tipped probe was used to identify episodes of GER (esophageal pH < 4 or > 7.5 for ≥ 30 seconds). Results for GER, regurgitation, vomiting, propofol dose, and durations of food withholding and anesthesia were compiled and compared across groups.

RESULTS

There were 13 dogs in each group, and no meaningful differences were detected in age, body weight, sex, breed, or durations of anesthesia or food withholding across groups. Overall, 16 of the 39 (41%) dogs developed GER: 9 in group H, 6 in group AH, and 1 in group DH. The incidence of GER was significantly lower for group DH versus group H. Six of the 39 (15%) dogs regurgitated: 4 in group H and 2 in group AH.

CONCLUSIONS AND CLINICAL RELEVANCE

The combined use of dexmedetomidine and hydromorphone as premedication may be a better choice to reduce GER in healthy dogs undergoing orthopedic surgery than would the use of hydromorphone with or without acepromazine. Additional research is warranted. (Am J Vet Res 2021;82:695–700)

Contributor Notes

Address correspondence to Dr. Costa (Rcosta@midwestern.edu).