Pre‐operative management of paroxysmal ventricular tachycardia in a stallion scheduled for castration

A 15-year-old, fractious, weighing 470 kg, Achal-Tekkiner stallion was referred for elective castration. Pre-anaesthetic clinical evaluation revealed tachycardia with a heart rate (HR) of 66 bpm and diastolic left side heart murmur II/VI grade. Lung auscultation was unremarkable. Acepromazine (0.03 mg/kg) was administered intramuscularly to calm the horse for reassessment. Thirty minutes later, HR was 120 bpm. An electrocardiogram (ECG) showed monomorphic ventricular tachycardia. A bolus of Ringer lactate, 10 ml/kg over 30 minutes, and magnesium, 27 g diluted in 1 L 0.9% sodium chloride (NaCl), was administered intravenously. As arrhythmia persisted, a constant-rate infusion of lidocaine, 50 mcg/kg/h, was started. The horse was monitored with telemetry ECG. The arrhythmia resolved after 24 hours and echocardiography showed mild tricuspid, aortic and pulmonary insufficiency. Anaesthetic risk was considered to be acceptable and the procedure was performed without complications. The horse was discharged after another 24 hours without detectable ECG abnormalities

Analgesic Efficacy of Non-Steroidal Anti-Inflammatory Drug Therapy in Horses with Abdominal Pain: A Systematic Review

This systematic review aimed to identify the evidence concerning the analgesic efficacy of non-steroidal anti-inflammatory drugs to treat abdominal pain in horses, and to establish whether one non-steroidal anti-inflammatory drug could provide better analgesia compared to others. This systematic review was conducted following the “Systematic Review Protocol for Animal Intervention Studies”. Research published between 1985 and the end of May 2023 was searched, using three databases, namely, PubMed, Embase, and Scopus, using the words equine OR horse AND colic OR abdominal pain AND non-steroidal anti-inflammatory drug AND meloxicam OR flunixin meglumine OR phenylbutazone OR firocoxib OR ketoprofen. Risk of bias was assessed with the SYRCLE risk of bias tool, and level of evidence scored according to the Oxford Centre for Evidence-based Medicine. A total of 10 studies met the inclusion criteria. From those only one study judged pain with a validated pain score, and a high risk of bias was identified due to the presence of selection, performance, and “other” types of bias. Therefore, caution is required in the interpretation of results from individual studies. To date, the evidence on analgesic efficacy to determine whether one drug is more potent than another regarding the treatment of abdominal pain in horses is sparse

Antinociceptive and Cardiorespiratory Effects of a Single Dose of Dexmedetomidine in Laboratory Mice Subjected to Craniotomy under General Anaesthesia with Isoflurane and Carprofen or Meloxicam

Pain refinement represents an important aspect of animal welfare in laboratory animals. Refining analgesia regimens in mice undergoing craniotomy has been sparsely investigated. Here, we sought to investigate the effect of dexmedetomidine in combination with other analgesic drugs on intraoperative anti-nociceptive effects and cardiorespiratory stability. All mice were anaesthetised with isoflurane and received local lidocaine infiltration at the surgical site. Mice were randomised into treatment groups consisting of either carprofen 5 mg kg−1 or meloxicam 5 mg kg−1 with or without dexmedetomidine 0.1 mg kg−1 administered subcutaneously. Intra-anaesthetic heart rates, breathing rates, isoflurane requirements, and arterial oxygen saturations were continuously monitored. We found that administration of dexmedetomidine significantly improved heart and breathing rate stability during two of four noxious stimuli (skin incision and whisker stimulation) compared to non-dexmedetomidine-treated mice and lowered isoflurane requirements throughout anaesthesia by 5–6%. No significant differences were found between carprofen and meloxicam. These results demonstrate that dexmedetomidine reduces nociception and provides intra-anaesthetic haemodynamic and respiratory stability in mice. In conclusion, the addition of dexmedetomidine to anaesthetic regimes for craniotomy offers a refinement over current practice for laboratory mice

Systematic Review: Anesthetic Protocols and Management as Confounders in Rodent Blood Oxygen Level Dependent Functional Magnetic Resonance Imaging (BOLD fMRI)—Part B: Effects of Anesthetic Agents, Doses and Timing

In rodent models the use of functional magnetic resonance imaging (fMRI) under anesthesia is common. The anesthetic protocol might influence fMRI readouts either directly or via changes in physiological parameters. As long as those factors cannot be objectively quantified, the scientific validity of fMRI in rodents is impaired. In the present systematic review, literature analyzing in rats and mice the influence of anesthesia regimes and concurrent physiological functions on blood oxygen level dependent (BOLD) fMRI results was investigated. Studies from four databases that were searched were selected following pre-defined criteria. Two separate articles publish the results; the herewith presented article includes the analyses of 83 studies. Most studies found differences in BOLD fMRI readouts with different anesthesia drugs and dose rates, time points of imaging or when awake status was compared to anesthetized animals. To obtain scientifically valid, reproducible results from rodent fMRI studies, stable levels of anesthesia with agents suitable for the model under investigation as well as known and objectively quantifiable effects on readouts are, thus, mandatory. Further studies should establish dose ranges for standardized anesthetic protocols and determine time windows for imaging during which influence of anesthesia on readout is objectively quantifiable

Data Collection for the Fourth Multicentre Confidential Enquiry into Perioperative Equine Fatalities (CEPEF4) Study:New Technology and Preliminary Results

It is almost 20 years since the largest observational, multicentre study evaluating the risks of mortality associated with general anaesthesia in horses. We proposed an internet-based method to collect data (cleaned and analysed with R) in a multicentre, cohort, observational, analytical, longitudinal and prospective study to evaluate peri-operative equine mortality. The objective was to report the usefulness of the method, illustrated with the preliminary data, including outcomes for horses seven days after undergoing general anaesthesia and certain procedures using standing sedation. Within six months, data from 6701 procedures under general anaesthesia and 1955 standing sedations from 69 centres were collected. The results showed (i) the utility of the method; also, that (ii) the overall mortality rate for general anaesthesia within the seven-day outcome period was 1.0%. In horses undergoing procedures other than exploratory laparotomy for colic (“noncolics”), the rate was lower, 0.6%, and in “colics” it was higher, at 3.4%. For standing sedations, the overall mortality rate was 0.2%. Finally, (iii) we present some descriptive data that demonstrate new developments since the previous CEPEF2. In conclusion, horses clearly still die unexpectedly when undergoing procedures under general anaesthesia or standing sedation. Our method is suitable for case collection for future studies

Comparison of recovery quality following Medetomidine versus Xylazine balanced isoflurane anaesthesia in horses: a retrospective analysis

Medetomidine partial intravenous anaesthesia (PIVA) has not been compared to xylazine PIVA regarding quality of recovery. This clinical retrospective study compared recoveries following isoflurane anaesthesia balanced with medetomidine or xylazine. The following standard protocol was used: sedation with 7 µg·kg−1 medetomidine or 1.1 mg·kg−1 xylazine, anaesthesia induction with ketamine/diazepam, maintenance with isoflurane and 3.5 µg·kg−1·h−1 medetomidine or 0.7 mg·kg−1·h−1 xylazine, and sedation after anaesthesia with 2 µg·kg−1 medetomidine or 0.3 mg·kg−1 xylazine. Recovery was timed and, using video recordings, numerically scored by two blinded observers. Influence of demographics, procedure, peri-anaesthetic drugs, and intraoperative complications (hypotension, hypoxemia, and tachycardia) on recovery were analysed using regression analysis (p < 0.05). A total of 470 recoveries (medetomidine 279, xylazine 191) were finally included. Following medetomidine, recoveries were significantly longer (median (interquartile range): 57 (43–71) min) than xylazine (43 (32–59) min) (p < 0.001). However, the number of attempts to stand was similar (medetomidine and xylazine: 2 (1–3)). Poorer scores were seen with increased pre-anaesthetic dose of xylazine, intraoperative tetrastarch, or salbutamol. However, use of medetomidine or xylazine did not influence recovery score, concluding that, following medetomidine–isoflurane PIVA, recovery is longer, but of similar quality compared to xylazine

Evaluation of accuracy of invasive and non-invasive blood pressure monitoring in relation to carotid artery pressure in anaesthetised ponies

Invasive blood pressure measurement (IBP) using peripheral arteries is a commonly used technique in equine anaesthesia, although the accuracy has not been demonstrated. Non-invasive blood pressure monitoring (NIBP) may be indicated for field anesthesia, short procedures and foal anaesthesia. In the present report, the agreement of various IBP and NIBP measuring sites compared to carotid artery pressure was tested in anaesthetised experimental ponies. Six ponies were anaesthetised in lateral recumbency with sevoflurane and received either saline or dexmedetomidine boli followed by constant rate infusion (CRI). Invasive blood pressure measurements were obtained simultaneously from the carotid, facial and metatarsal arteries. NIBP measurements over both median arteries, metatarsal and middle coccygeal arteries were performed in random order. All blood pressure readings obtained were compared to carotid pressure by Bland-Altman analysis. Non-invasive blood pressure measurements had larger bias and poorer limits of agreement compared to IBP measurements. NIBP measurement from the coccygeal artery had the best repeatability and best limits of agreement of all NIBP positions and was not affected by the use of dexmedetomidine. The facial artery had smaller limits of agreement with dexmedetomidine treatment. There was no difference between the facial and metatarsal arteries during dexmedetomidine treatment in MAP and DAP. Systolic arterial pressures from the metatarsal artery showed larger bias and larger limits of agreement compared to facial artery. In conclusion, NIBP measurement from the tail artery is a reliable alternative to direct arterial blood pressure measurement. Both the metatarsal and facial arteries have acceptable agreement with carotid artery pressure so the choice can be based on the logistics of the procedure

Case Report Balanced Anaesthetic Approach in a Late-Term Gravid Cow Undergoing Metacarpal Fracture Repair

An 800 kg Swiss cow, eighth months gravid, was presented for anaesthesia to repair metacarpal fracture. The cow was premedicated with intravenous isoxsuprine, butorphanol, ketoprofen, and xylazine IM and induced with ketamine and diazepam IV. In lateral recumbency, the trachea was intubated, and isoflurane in oxygen and air was administered. Despite a ring block with lidocaine, purposeful movement happened, and xylazine 0.02 mg kg −1 h −1 and ketamine 0.6 mg kg −1 h −1 constant rate infusion was started. During anaesthesia, slight hypercapnia and hypoxaemia developed. Total time of xylazine and ketamine infusion was 3.5 hours. Total anaesthesia time was 4.5 hours. For recovery of anaesthesia, isoflurane was discontinued, and in sternal recumbency, the trachea was extubated when the cow swallowed. Paralysis of the left radial nerve occurred, and the cow was supported to stand up after 2 hours. The radial nerve paralysis resolved within three days. A healthy calf was born at term. This is the first paper that describes the successful use of adjunctive xylazine and ketamine infusion to isoflurane anaesthesia in a late-term gravid cow undergoing fracture repair during 4.5 hours