Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration
Abstract
:1. Introduction
2. Materials and Methods
2.1. Horses
2.2. Anaesthesia
2.3. Anaesthesia Monitoring
2.4. Surgery
2.5. Recovery from Anaesthesia
2.6. Statistical Analysis
3. Results
3.1. Anaesthesia and Surgery
3.2. Physiological Data
3.3. Anaesthesia Recovery
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Category | Description | Score |
---|---|---|
A: Activity in recumbency | No obvious activity | 1 |
Quiet, occasional stretch, head lift | 2 | |
Tense, trembling, sweating, waiting to explode | 3 | |
Failing and galloping | 5 | |
B: Move to sternal | Smooth, methodical | 1 |
Slightly uncontrolled, fighting | 5 | |
Forceful head impact with ground, flopping over, violent struggle | 10 | |
C: Number of attempts to sternal | Count number of attempts: | |
One | 1 | |
Two | 3 | |
Three | 5 | |
Four | 7 | |
Five | 8 | |
More than five | 10 | |
D: Sternal phase | Non-existent | 1 |
Organised, relaxed | 3 | |
Prolonged * | 5 | |
Multiple phases *, non-traumatic | 7 | |
Multiple phases *, traumatic | 10 | |
E: Move to stand | Methodical | 1 |
An organised scramble * | 3 | |
Used walls for support, disorganised scramble * | 6 | |
Ricocheting off walls, violently | 10 | |
F: Strength | Near full | 1 |
Mildly weak | 3 | |
Dog sitting before standing | 6 | |
Repeated attempts due to weakness | 10 | |
G: Number of attempts to stand | Count number of attempts: | |
One | 1 | |
Two | 3 | |
Three | 5 | |
Four | 7 | |
Five | 8 | |
More than five | 10 | |
H: Balance and coordination | No ataxia, solid | 1 |
Moderate swaying/dancing throughout | 2 | |
Modest number of reflex saves | 3 | |
Severe swaying, constant reflex saves | 5 | |
Careering around walls, falls once | 8 | |
Careering, falls back down >1, violent | 10 | |
I: Knuckling | None | 1 |
Hindlimbs only—mild | 2 | |
Hindlimbs only—marked | 3 | |
All four limbs | 4 | |
Excessive and prolonged | 5 | |
J: Overall attitude | Calm | 1 |
Calm/determined | 3 | |
Anxious, excited | 5 | |
Confused, unaware | 7 | |
Frantic, angry | 10 | |
K: Overall recovery | Excellent | 1 |
Good | 3 | |
Fair | 5 | |
Poor | 7 | |
Unacceptable | 10 | |
Total Score: |
- Minimum score: 13
- Maximum score: 122.5
- Head lift: Head raised from lateral without obvious contraction of abdominal musculature, no leg movement and lack of any other activity deemed by the assessors to represent an attempt to attain sternal.
- Attempt to sternal: Head lift with contraction of abdominal musculature, obvious leg movement or attempted movement, or any other activity deemed by the assessors to represent an attempt to attain sternal.
- Prolonged sternal phase: Assessors deem the animal making no visual attempt to stand or fails to achieve a position that would allow a standing attempt to occur—forelimb protraction, hindlimb tucked under abdomen.
- Multiple phases: Struggles to maintain sternal. Lack of appropriate limb movement or positioning to attain and hold sternal without full reliance on constant abdominal musculature contraction.
- Organised scramble: Obvious attempt to stand. There is no appreciable risk of injury, and the animal remains aware and in control of the location of its limbs.
- Disorganised scramble: As per organised, except the animal is no longer aware of the location of its limbs, it has lost full limb control and there is an appreciable risk of injury to the animal.
Appendix B
Score | Description |
---|---|
1: Excellent smooth recovery | No struggling from lateral to sternal position. Stands without difficulty on first attempt, with no ataxia after standing. |
2: Good smooth recovery | 1 to 2 attempts to sternal recumbency and standing, with mild ataxia and staggering after standing. |
3: Average to fair recovery | Multiple attempts to stand, with moderate ataxia after standing, no falls. |
4: Poor recovery | Multiple attempts to stand. Severe ataxia and falls once, aimless walking. Moderate risk of self-inflicted injury. |
5: Very poor to unacceptable recovery | Multiple, violent attempts to stand. Severe ataxia resulting in multiple falls. High risk of self-inflicted injury. |
Appendix C
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Variable | Time (Minutes) after Induction of Anaesthesia | |||||||
---|---|---|---|---|---|---|---|---|
Baseline | 10 | 15 | 20 | 25 | 30 | 35 | 40 | |
HR (beats/min) | 44 (40–80) | 39 (32–39) | 44 (34–60) | 43 (34–60) | 43 (35–59) | 38 (34–43) | 37 (30–44) | 36 (30–43) |
fR (breaths/min) | 20 (16–24) | 6 (4–29) | 7 (5–17) | 13 (5–21) | 12 (6–15) | 10 (5–15) | 11 (5–15) | 11 (5–15) |
SAP (mmHg) | - | 140 (124–150) | 145 (128–158) | 136 (129–156) | 134 (127–138) | 132 (126–142) | 131 (123–141) | 131 (123–143) |
DAP (mmHg) | - | 104 (84–109) | 104 (86–113) | 105 (87–110) | 96 (91–103) | 98 (90–104) | 93 (85–103) | 95 (83–103) |
MAP (mmHg) | - | 116 (101–126) | 118 (102–127) | 119 (102–126) | 112 (106–117) | 110 (106–117) | 110 (104–119) | 107 (100–117) |
SpO2 (%) | - | 96 (95–97) | 96 (95–98) | 96 (95–98) | 96 (95–98) | 97 (85–97) | 98 (97–98) | 97 (97–98) |
Variable | Time (Minutes) after the Start of IV Infusion | |||
---|---|---|---|---|
10 | 20 | 30 | 40 | |
pH | 7.36 (7.33–7.38) | 7.38 (7.35–7.39) | 7.38 (7.35–7.40) | 7.39 (7.35–7.40) |
PaCO2 (mmHg) | 54 (51–60) | 52 (50–57) | 54 (51–58) | 57 (54–57) |
PaO2 (mmHg) | 88 (76–145) | 97 (77–127) | 122 (81–245) | 126 a (117–261) |
HCO3− (mmol/L) | 30.0 (28.5–33.9) | 30.9 (28.2–33.5) | 31.6 (29.5–35.1) | 33.2 (31.5–34.7) |
Lactate (mmol/L) | 1.6 (1.5–1.9) | 1.9 (1.8–2.0) | 1.8 (1.8–2.5) | 1.6 (1.5–1.8) |
Median Score | |
---|---|
Composite Score System | |
A. activity in recumbency (score 1–5) | 2 (1–2) |
B. move to sternal (score 1–10) | 1 (1–5) |
C. attempts to sternal (score 1–10) | 3 (1–7.5) |
D. sternal phase (score 1–10) | 3 (1–3) |
E. move to stand (score 1–10) | 3 (1–4.5) |
F. strength (score 1–10) | 3 (1–4.5) |
G. attempts to stand (score 1–10) | 2 (1–5) |
H. balance and coordination (score 1–10) | 2 (2–3) |
I. knuckling (score 1–5) | 1 (1–2) |
J. overall attitude (score 1–10) | 2 (1–5) |
K. overall recovery (score 1–10) | 3 (2–4) |
Overall calculated score | 30.5 (24.8–40.5) |
Simple descriptive scale (score 1–5) | 2 (2–2.5) |
Visual Analogue Scale (0–100 mm) | 85 (76.5–91) |
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Cunneen, A.; Pratt, S.; Perkins, N.; McEwen, M.; Truchetti, G.; Rainger, J.; Farry, T.; Kidd, L.; Goodwin, W. Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration. Vet. Sci. 2021, 8, 142. https://doi.org/10.3390/vetsci8080142
Cunneen A, Pratt S, Perkins N, McEwen M, Truchetti G, Rainger J, Farry T, Kidd L, Goodwin W. Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration. Veterinary Sciences. 2021; 8(8):142. https://doi.org/10.3390/vetsci8080142
Chicago/Turabian StyleCunneen, Alexandra, Shaun Pratt, Nigel Perkins, Margaret McEwen, Geoffrey Truchetti, Joanne Rainger, Trish Farry, Lisa Kidd, and Wendy Goodwin. 2021. "Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration" Veterinary Sciences 8, no. 8: 142. https://doi.org/10.3390/vetsci8080142