Evaluation of Xylazine, Acepromazine and Medetomidine with Ketamine for General Anaesthesia in Rabbits

A randomized, prospective, blinded experimental study was conducted in 32 rabbits of either sex to compare  the anaesthetic and physiological effects of ketamine with different pre-anaesthetics. Rabbits were  randomly divided into 4 equal groups. Xylazine 6 mg/kg in animals of group xylazine-ketamine (XK), acepromazine  2 mg/kg in animals of group acepromazine-ketamine (AK), medetomidine 125 μg/kg in group  medetomidine-ketamine 1 (MK1) or medetomidine 250 μg/kg in group medetomidine-ketamine 2 (MK2)  were administered by intramuscular injection (IM). Five minutes later, ketamine 60 mg/kg was administered  intramuscularly to all the groups. The rabbits were observed for the onset of weak time, down time,  the time to loss of righting reflex, pedal reflexes and response to surgical stimuli. Heart rate, respiratory  rate and rectal temperature and arterial oxygen saturation of haemoglobin (SpO2) were recorded up to 60  min. Weak time, down time and time to loss of righting reflex were the shortest in animals of group MK2  as compared to the other groups. Pedal reflexes remained intact in all the animals of XK group, but were  abolished in 50% of the AK group, 75% of the MK1 group and 100% of animals in the MK2 group. Pain  was evinced during surgery by all the animals in group XK, 5 animals in group AK and 4 animals in group  MK1. The best analgesia was achieved in the animals of group MK2, where none of the animals showed  pain on surgical stimulation. Heart rate and SpO2 decreased significantly (P<0.01) in the animals of groups  XK, MK1 and MK2 but respiratory rate and rectal temperature decreased significantly (P<0.01) in all the  groups. However, all the animals recovered from anaesthesia without complications. It was concluded that  medetomidine 250 µg/kg and ketamine 60 mg/kg produced excellent anaesthesia to allow pain free surgery  and may be considered suitable for anaesthesia in New Zealand White rabbits.

High acceptability, convenience and reduced carbon emissions of tele-neurology outpatient services at a regional referral centre in Kenya

Background: There is severe shortage of neurologists in sub-Saharan Africa. Tele-neurology consultations (TNC) can bridge this service gap, but there is very little published evidence on TNC in our setting, which we addressed through our study. Methods: We prospectively enrolled patients at our neurology outpatients from October 2020 to October 2021. We administered a post-TNC questionnaire which captured satisfaction/acceptability using Likert scales. A sub-group of participants who also did in-person consultations (IPC) were additionally administered post-IPC questionnaires. Statistical comparisons were made using the paired student t-test, and descriptive data expressed as median (inter-quartile range). Results: From 219 enrolled patients, 66.7% participants responded: 74.0% had both IPC and TNC; 63.0% were female; age was 40.9 (30.6–55.2) years; and 2.7% were from neighbouring countries. The commonest presentations were headache (30.8%), seizures (26.0%) and neurodegenerative disorders (15.1%). For TNC, >90% found it: (i) as comfortable as IPC (p = 0.35); (ii) didn't violate their privacy; (iii) saved time [3.0 (2.0–4.0) hours], travel [11.0 (7.2–21.1) km] and cost [$9.09 (4.55–18.18)]; and (iv) addressed their concerns satisfactorily such that they would use TNC again. Conversely, 15.1$6167, 1143 h, and 25,506 km of travel, translating to 3.5 t (equivalent to 21 newly-planted trees) of carbon dioxide emissions. Conclusions: Our study demonstrates that TNC is an acceptable, efficient, effective, and environmentally-sustainable care delivery model

Intracranial neurenteric cyst traversing the brainstem

Neurenteric cysts (NECs), also called enterogenous cysts, are rare benign endodermal lesions of the central nervous system that probably result from separation failure of the notochord and upper gastrointestinal tract. Most frequently they are found in the lower cervical spine or the upper thoracic spine. Intracranial occurrence is rare and mostly confined to infratentorial compartment, in prepontine region [51%]. Other common locations are fourth ventricle and cerebellopontine angle. There are few reports of NEC in medulla or the cerebellum. Because of the rarity of the disease and common radiological findings, they are misinterpreted as arachnoid or simple cysts until the histopathological confirmation, unless suspected preoperatively. We herein report a rare yet interesting case of intracranial NEC traversing across the brainstem