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Evaluation of the perioperative stress response from dexmedetomidine infusion alone, with butorphanol bolus or remifentanil infusion compared with ketamine and morphine infusions in isoflurane-anesthetized horses
Veterinary Anaesthesia and Analgesia ( IF 1.7 ) Pub Date : 2021-02-15 , DOI: 10.1016/j.vaa.2021.01.006
Masako Fujiyama 1 , Teela Jones 1 , Tanya Duke-Novakovski 1
Affiliation  

Objective

To evaluate perioperative stress-related hormones in isoflurane-anesthetized horses administered infusions of dexmedetomidine alone or with butorphanol or remifentanil, compared with ketamine–morphine.

Study design

Randomized, prospective, nonblinded clinical study.

Animals

A total of 51 horses undergoing elective surgical procedures.

Methods

Horses were premedicated with xylazine, anesthesia induced with ketamine–diazepam and maintained with isoflurane and one of four intravenous infusions. Partial intravenous anesthesia (PIVA) was achieved with dexmedetomidine (1.0 μg kg–1 hour–1; group D; 12 horses); dexmedetomidine (1.0 μg kg–1 hour–1) and butorphanol bolus (0.05 mg kg–1; group DB; 13 horses); dexmedetomidine (1.0 μg kg–1 hour–1) and remifentanil (3.0 μg kg–1 hour–1; group DR; 13 horses); or ketamine (0.6 mg kg–1 hour–1) and morphine (0.15 mg kg–1, 0.1 mg kg–1 hour–1; group KM; 13 horses). Infusions were started postinduction; butorphanol bolus was administered 10 minutes before starting surgery. Blood was collected before drugs were administered (baseline), 10 minutes after ketamine–diazepam, every 30 minutes during surgery and 1 hour after standing. Mean arterial pressure (MAP), pulse rate, end-tidal isoflurane concentration, cortisol, nonesterified fatty acids (NEFA), glucose and insulin concentrations were compared using linear mixed models. Significance was assumed when p < 0.05.

Results

Within D, cortisol was lower at 120–180 minutes from starting surgery compared with baseline. Cortisol was higher in KM than in D at 60 minutes from starting surgery. Within all groups, glucose was higher postinduction (except DR) and 60 minutes from starting surgery, and insulin was lower during anesthesia and higher after standing compared with baseline. After standing, NEFA were higher in KM than in DB. In KM, MAP increased at 40–60 minutes from starting surgery compared with 30 minutes postinduction.

Conclusions and clinical relevance

Dexmedetomidine suppressed cortisol release more than dexmedetomidine–opioid and ketamine–morphine infusions. Ketamine–morphine PIVA might increase catecholamine activity.



中文翻译:

在异氟醚麻醉的马中,评价单独右美托咪定输注、布托啡诺推注或瑞芬太尼输注与氯胺酮和吗啡输注的围手术期应激反应

客观的

与氯胺酮-吗啡相比,评估单独输注右美托咪定或与布托啡诺或瑞芬太尼的异氟醚麻醉马的围手术期应激相关激素。

学习规划

随机、前瞻性、非盲临床研究。

动物

共有 51 匹马正在接受选择性外科手术。

方法

马用赛拉嗪预先给药,用氯胺酮-地西泮诱导麻醉,并用异氟醚和四次静脉输注之一维持。使用右美托咪定(1.0 μg kg –1小时–1;D 组;12 匹马)实现部分静脉麻醉 (PIVA );右美托咪定(1.0 μg kg –1小时–1)和布托啡诺大丸剂(0.05 mg kg –1;DB 组;13 匹马);右美托咪定(1.0 μg kg –1小时–1)和瑞芬太尼(3.0 μg kg –1小时–1;DR 组;13 匹马);或氯胺酮(0.6 mg kg –1小时–1)和吗啡(0.15 mg kg –1 , 0.1 mg kg–1小时–1 ; KM 组;13 匹马)。诱导后开始输注;在开始手术前 10 分钟注射布托啡诺。在给药前(基线)、氯胺酮-地西泮后 10 分钟、手术期间每 30 分钟和站立后 1 小时收集血液。使用线性混合模型比较平均动脉压 (MAP)、脉搏率、呼气末异氟醚浓度、皮质醇、非酯化脂肪酸 (NEFA)、葡萄糖和胰岛素浓度。当p < 0.05时假设显着。

结果

在 D 内,与基线相比,皮质醇在手术开始后 120-180 分钟时较低。手术开始后 60 分钟,KM 的皮质醇高于 D。在所有组中,与基线相比,诱导后(DR 除外)和手术开始 60 分钟后血糖较高,麻醉期间胰岛素较低,站立后胰岛素较高。站立后,KM的NEFA高于DB。在 KM 中,与诱导后 30 分钟相比,MAP 在手术开始后 40-60 分钟时增加。

结论和临床相关性

右美托咪定比右美托咪定-阿片类药物和氯胺酮-吗啡输注更能抑制皮质醇释放。氯胺酮-吗啡 PIVA 可能会增加儿茶酚胺的活性。

更新日期:2021-02-15
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