Objective—To evaluate the degree of postoperative pain in dogs undergoing elective castration or ovariohysterectomy (OHE); determine whether an association exists between surgeon experience, incision length, or surgery duration and degree of postoperative pain; and determine whether analgesic treatment decreases expression of postoperative pain behaviors.
Design—Randomized controlled clinical trial.
Animals—426 client-owned dogs undergoing OHE or castration.
Procedures—Dogs underwent OHE or castration performed by an experienced veterinarian or a fourth-year veterinary student. Dogs were randomly assigned to 1 of 4 treatment groups: no perioperative analgesic treatment (n = 44), preoperative administration of morphine (144), preoperative administration of nalbuphine (119), and postoperative administration of ketoprofen (119). Dogs were evaluated while in the hospital before anesthesia and for 4 hours after surgery and once a day at home for 3 days after surgery.
Results—Dogs in all 4 groups had significant increases in overall pain scores after surgery, compared with baseline scores. There were significant differences among groups, with control dogs having significantly higher increases in overall pain scores than dogs in the other groups. Factors that did not influence the frequency or severity of pain-related behaviors included breed, individual hospital, anesthetic induction protocol, surgeon experience, and duration of surgery.
Conclusions and Clinical Relevance—Results suggested that dogs expressed behaviors suggestive of pain following OHE and castration, that analgesic treatment mitigated the expression of pain-related behaviors, and that surgeon experience and surgery duration did not have any effect on expression of pain-related behaviors.
Procedure—Lidocaine hydrochloride (loading infusion, 1.3 mg/kg during a 15-minute period [87.5 μg/kg/min]; maintenance infusion, 50 μg/kg/min for 60 to 90 minutes) was administered IV to dorsally recumbent anesthetized horses. Blood samples were collected before and at fixed time points during and after lidocaine infusion for analysis of serum drug concentrations by use of liquid chromatography-mass spectrometry. Serum lidocaine concentrations were evaluated by use of standard noncompartmental analysis. Selected cardiopulmonary variables, including heart rate (HR), mean arterial pressure (MAP), arterial pH, PaCO2, and PaO2, were recorded. Recovery quality was assessed and recorded.
Results—Serum lidocaine concentrations paralleled administration, increasing rapidly with the initiation of the loading infusion and decreasing rapidly following discontinuation of the maintenance infusion. Mean ± SD volume of distribution at steady state, total body clearance, and terminal half-life were 0.70 ± 0.39 L/kg, 25 ± 3 mL/kg/min, and 65 ± 33 minutes, respectively. Cardiopulmonary variables were within reference ranges for horses anesthetized with inhalation anesthetics. Mean HR ranged from 36 ± 1 beats/min to 43 ± 9 beats/min, and mean MAP ranged from 74 ± 18 mm Hg to 89 ± 10 mm Hg. Recovery quality ranged from poor to excellent.
Conclusions and Clinical Relevance—Availability of pharmacokinetic data for horses with gastrointestinal tract disease will facilitate appropriate clinical dosing of lidocaine.
Objective—To determine effects of a continuous rate infusion of lidocaine on the minimum alveolar concentration (MAC) of sevoflurane in horses.
Animals—8 healthy adult horses.
Procedures—Horses were anesthetized via IV administration of xylazine, ketamine, and diazepam; anesthesia was maintained with sevoflurane in oxygen. Approximately 1 hour after induction, sevoflurane MAC determination was initiated via standard techniques. Following sevoflurane MAC determination, lidocaine was administered as a bolus (1.3 mg/kg, IV, over 15 minutes), followed by constant rate infusion at 50 μg/kg/min. Determination of MAC for the lidocaine-sevoflurane combination was started 30 minutes after lidocaine infusion was initiated. Arterial blood samples were collected after the lidocaine bolus, at 30-minute intervals, and at the end of the infusion for measurement of plasma lidocaine concentrations.
Results—IV administration of lidocaine decreased mean ± SD sevoflurane MAC from 2.42 ± 0.24% to 1.78 ± 0.38% (mean MAC reduction, 26.7 ± 12%). Plasma lidocaine concentrations were 2,589 ± 811 ng/mL at the end of the bolus; 2,065 ± 441 ng/mL, 2,243 ± 699 ng/mL, 2,168 ± 339 ng/mL, and 2,254 ± 215 ng/mL at 30, 60, 90, and 120 minutes of infusion, respectively; and 2,206 ± 329 ng/mL at the end of the infusion. Plasma concentrations did not differ significantly among time points.
Conclusions and Clinical Relevance—Lidocaine could be useful for providing a more balanced anesthetic technique in horses. A detailed cardiovascular study on the effects of IV infusion of lidocaine during anesthesia with sevoflurane is required before this combination can be recommended.
Objective—To compare cardiovascular effects of sevoflurane alone and sevoflurane plus an IV infusion of lidocaine in horses.
Animals—8 adult horses.
Procedures—Each horse was anesthetized twice via IV administration of xylazine, diazepam, and ketamine. During 1 anesthetic episode, anesthesia was maintained by administration of sevoflurane in oxygen at 1.0 and 1.5 times the minimum alveolar concentration (MAC). During the other episode, anesthesia was maintained at the same MAC multiples via a reduced concentration of sevoflurane plus an IV infusion of lidocaine. Heart rate, arterial blood pressures, blood gas analyses, and cardiac output were measured during mechanical (controlled) ventilation at both 1.0 and 1.5 MAC for each anesthetic protocol and during spontaneous ventilation at 1 of the 2 MAC multiples.
Results—Cardiorespiratory variables did not differ significantly between anesthetic protocols. Blood pressures were highest at 1.0 MAC during spontaneous ventilation and lowest at 1.5 MAC during controlled ventilation for either anesthetic protocol. Cardiac output was significantly higher during 1.0 MAC than during 1.5 MAC for sevoflurane plus lidocaine but was not affected by anesthetic protocol or mode of ventilation. Clinically important hypotension was detected at 1.5 MAC for both anesthetic protocols.
Conclusions and Clinical Relevance—Lidocaine infusion did not alter cardiorespiratory variables during anesthesia in horses, provided anesthetic depth was maintained constant. The IV administration of lidocaine to anesthetized nonstimulated horses should be used for reasons other than to improve cardiovascular performance. Severe hypotension can be expected in nonstimulated horses at 1.5 MAC sevoflurane, regardless of whether lidocaine is administered.
Objective—To evaluate perioperative administration of gabapentin as an adjunct for analgesia in dogs undergoing amputation of a forelimb.
Design—Randomized, controlled trial.
Animals—30 client-owned dogs.
Procedures—On the day before surgery, a baseline pain evaluation was performed in each dog by use of multiple pain assessment methods. Dogs then received gabapentin (10 mg/kg [4.5 mg/lb], PO, once, followed by 5 mg/kg [2.3 mg/lb], PO, q 12 h for 3 additional days) or a placebo. On the day of surgery, dogs were anesthetized and forelimb amputation was performed. Fentanyl was infused after surgery for 18 to 24 hours; use of other analgesics was allowed. In-hospital pain evaluations were repeated at intervals for 18 hours after surgery, and owners were asked to evaluate daily their dog's activity, appetite, and wound soreness for the first 3 days after discharge from the hospital. Results were analyzed by use of a repeated-measures ANOVA.
Results—Pain evaluation scores did not differ significantly between gabapentin and placebo groups in the hospital or at home after discharge.
Conclusions and Clinical Relevance—As an adjunct to other analgesics and anesthetics, gabapentin, at the dose and frequency used in this study, did not provide a significant benefit for the management of acute perioperative pain in dogs undergoing forelimb amputation. The small sample size and number of other confounding factors, such as aggressive use of other analgesics, limited the likelihood of detecting a benefit of gabapentin. Other gabapentin doses or dosing regimens warrant further study.
Procedure—Dogs were anesthetized with glycopyrrolate,
morphine, propofol, and isoflurane. Thirteen
dogs were treated with ketamine IV, as follows: 0.5
mg/kg (0.23 mg/lb) as a bolus before surgery, 10
µg/kg/min (4.5 µg/lb/min) during surgery, and 2
µg/kg/min (0.9 µg/lb/min) for 18 hours after surgery.
Fourteen dogs received the same volume of saline
(0.9% NaCl) solution. All dogs received an infusion of
fentanyl (1 to 5 µg/kg/h [0.45 to 2.27 µg/lb/h]) for the
first 18 hours after surgery. Dogs were evaluated for
signs of pain before surgery, at the time of extubation,
and 1, 2, 3, 4, 12, and 18 hours after extubation.
Owners evaluated their dogs' appetite, activity, and
wound soreness on postoperative days 2, 3, and 4.
Results—Dogs that received ketamine infusions had
significantly lower pain scores 12 and 18 hours after
surgery and were significantly more active on postoperative
day 3 than dogs that received saline solution
Conclusions and Clinical Relevance—Results suggest
that perioperative administration of low doses of
ketamine to dogs may augment analgesia and comfort
in the postoperative surgical period. (J Am Vet
Med Assoc 2002;221:72–75)
Objective—To evaluate the use of xylazine and ketamine
for total IV anesthesia in horses.
Procedure—Anesthetic induction was performed on
4 occasions in each horse with xylazine (0.75 mg/kg,
IV), guaifenesin (75 mg/kg, IV), and ketamine
(2 mg/kg, IV). Intravenous infusions of xylazine and
ketamine were then started by use of 1 of 6 treatments
as follows for which 35, 90, 120, and 150 represent
infusion dosages (µg/kg/min) and X and K represent
xylazine and ketamine, respectively: X35+K90
with 100% inspired oxygen (O2), X35+K120-O2,
X35+K150-O2, X70+K90-O2, K150-O2, and X35+K120
with a 21% fraction of inspired oxygen (ie, air).
Cardiopulmonary measurements were performed.
Response to a noxious electrical stimulus was
observed at 20, 40, and 60 minutes after induction.
Times to achieve sternal recumbency and standing
were recorded. Quality of sedation, induction, and
recovery to sternal recumbency and standing were
Results—Heart rate and cardiac index were higher
and total peripheral resistance lower in K150-O2 and
X35+K120-air groups. The mean arterial pressure was
highest in the X35+K120-air group and lowest in the
K150-O2 group (125 ± 6 vs 85 ± 8 at 20 minutes,
respectively). Mean PaO2 was lowest in the
X35+K120-air group. Times to sternal recumbency
and standing were shortest for horses receiving
K150-O2 (23 ± 6 minutes and 33 ± 8 minutes, respectively)
and longest for those receiving X70+K90-O2
(58 ± 28 minutes and 69 ± 27 minutes, respectively).
Conclusions and Clinical Relevance—Infusions of
xylazine and ketamine may be used with oxygen supplementation
to maintain 60 minutes of anesthesia in
healthy adult horses. (Am J Vet Res 2005;66:1002–1007)
Objective—To assess the pharmacokinetics and pharmacodynamics of morphine in llamas.
Animals—6 healthy adult llamas.
Procedures—Llamas received morphine sulfate in a randomized crossover design. In phase 1, they received IV or IM administration of morphine at 0.05 or 0.5 mg/kg, respectively; in phase 2, they received IV administration of morphine at 0.05, 0.25, or 0.5 mg/kg. Plasma morphine and morphine-6-glucuronide concentrations were determined by validated methods. Body temperature, heart rate, respiratory rate, sedation, and analgesia were assessed and compared with plasma concentrations by regression analysis.
Results—Total body clearance was similar between IV administration of morphine sulfate at 0.25 and 0.5 mg/kg (mean ± SD, 25.3 ± 6.9 mL/min/kg and 27.3 ± 5.9 mL/min/kg, respectively), and linearity was demonstrated between these doses. Bioavailability of morphine following IM administration at 0.5 mg/kg was 120 ± 30%. Body temperature and sedation increased as the dose of morphine administered increased. Heart rate was unaffected by varying doses. Respiratory rate decreased as dose increased. Analgesia was difficult to assess as a result of high individual variability. Intravenous administration of morphine at 0.25 mg/kg provided the most consistent increase in tolerance to electric stimulation. Pharmacodynamic modeling revealed a sigmoidal relationship between plasma concentration and sedation score.
Conclusions and Clinical Relevance—Morphine was characterized by a large apparent volume of distribution and high systemic clearance in llamas. A prolonged half-life was observed with IM injection. Intravenous administration of morphine sulfate at 0.25 mg/kg every 4 hours is suggested for further study.
Objective—To evaluate herd-level risk factors for
seropositive status of cattle to 1 or more bluetongue
Animals—110 herds of cattle in Nebraska, North
Dakota, and South Dakota.
Procedure—Blood samples were collected before
and after the vector season. Samples were tested
for antibodies against bluetongue virus by use of a
commercially available competitive ELISA. Factors
evaluated included descriptors of geographic location
and management practices. Trapping of insect
vectors was conducted to evaluate vector status on
a subset of 57 operations. A multivariable logistic
regression model was constructed to evaluate associations.
Results—For the full data set, altitude and latitude
were associated with risk of having seropositive cattle
(an increase in altitude was associated with an
increase in risk, and a more northerly location was
associated with a decrease in risk of a premise having
seropositive cattle). Import of cattle from selected
states was associated with an increase in risk of having
seropositive cattle. From the subset of herds with
data on vector trapping, altitude and latitude were
associated with risk of having seropositive cattle, similar
to that for the full model. However, commingling
with cattle from other herds was associated with a
decrease in risk of seropositivity.
Conclusions and Clinical Relevance—Findings
reported here may be useful in generating additional
hypotheses regarding the ecologic characteristics of
bluetongue viruses and other vector-borne diseases
of livestock. Sentinel surveillance programs are useful
for documenting regionalization zones for diseases,
which can be beneficial when securing international
markets for animals and animal products. (Am J Vet