Advertisement

Total intravenous anesthesia with alfaxalone, dexmedetomidine and remifentanil in healthy foals undergoing abdominal surgery

  • Teela Jones
    Correspondence
    Correspondence: Teela Jones, Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada.
    Affiliations
    Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
    Search for articles by this author
  • José L. Bracamonte
    Affiliations
    Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
    Search for articles by this author
  • Barbara Ambros
    Affiliations
    Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
    Search for articles by this author
  • Tanya Duke-Novakovski
    Affiliations
    Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
    Search for articles by this author
Published:January 21, 2019DOI:https://doi.org/10.1016/j.vaa.2019.01.003

      Abstract

      Objective

      To evaluate effects of anesthesia induced with alfaxalone and maintained with alfaxalone, dexmedetomidine and remifentanil infusions in foals.

      Study design

      Prospective, experimental study.

      Animals

      A group of six healthy foals [median (range) 11 (8–33) days] undergoing abdominal surgery.

      Methods

      Intravenous (IV) dexmedetomidine (3–7 μg kg−1) provided sedation for insertion of a pulmonary artery catheter. IV anesthesia was induced with alfaxalone (2 mg kg−1) and maintained with alfaxalone (6 mg kg−1 hour−1), dexmedetomidine (1 μg kg−1 hour−1) and remifentanil (3 μg kg−1 hour−1). Foals were endotracheally intubated and lungs were mechanically ventilated with oxygen. Cardiac output (thermodilution), heart rate and systemic arterial pressure were measured. Arterial and mixed venous blood was analyzed for PO2 and PCO2, and glucose, lactate and electrolyte concentrations. Anesthetic depth was subjectively assessed. Systemic vascular resistance (SVR), oxygen utilization and intrapulmonary shunt were calculated. Preinduction (PB) or 10 minutes postinduction (+10B) data were used as baselines with one-way analysis of variance for repeated measures. Data are mean ± standard deviation; significance was p ≤ 0.05.

      Results

      Duration of anesthesia was 129 ± 22 minutes. One foal was administered additional alfaxalone (0.5 mg kg−1) following induction. Cardiac index decreased to 107 ± 31 and 87 ± 21 mL kg−1 minute−1 at 60 and 80 minutes, respectively, compared with PB (157 ± 33 mL kg−1 minute−1). SVR increased to 1223 ± 166 dynes second−1 cm−5 at 80 minutes compared with +10B (704 ± 247 dynes second−1 cm−5). Mean arterial pressures were 63–128 mmHg. Time from stopping infusions to standing was 46–106 minutes. All foals were hypothermic (<36 °C) and three foals were administered atipamezole (0.05 mg kg−1) intramuscularly during recovery.

      Conclusion

      and clinical relevance Combined alfaxalone–dexmedetomidine–remifentanil provided suitable anesthesia to permit laparotomy in foals. At the doses evaluated, prolonged recovery may occur.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Aoki M.
        • Wakuno A.
        • Kushiro A.
        • et al.
        Evaluation of total intravenous anesthesia with propofol-guaifenesin-medetomidine and alfaxalone-guaifenesin-medetomidine in thoroughbred horses undergoing castration.
        J Vet Med Sci. 2017; 79: 2011-2018
        • Auckburally A.
        • Nyman G.
        Review of hypoxaemia in anaesthetized horses: predisposing factors, consequences and management.
        Vet Anaesth Analg. 2017; 44: 397-408
        • Baggot J.D.
        • Short C.R.
        Drug disposition in the neonatal animal, with particular reference to the foal.
        Equine Vet J. 1984; 16: 364-367
        • Benmansour P.
        • Duke-Novakovski T.
        Prolonged anesthesia using sevoflurane, remifentanil and dexmedetomidine in a horse.
        Vet Anaesth Analg. 2013; 40: 521-526
        • Benmansour P.
        • Billinsky J.
        • Duke-Novakovski T.
        • Alcorn J.
        Blood concentrations of remifentanil during and after infusion in horses anesthetized with isoflurane and dexmedetomidine.
        Res Vet Sci. 2016; 107: 202-206
        • Benmansour P.
        • Husulak M.L.
        • Bracamonte J.L.
        • et al.
        Cardiopulmonary effects of an infusion of remifentanil or morphine in horses anesthetized with isoflurane and dexmedetomidine.
        Vet Anaesth Analg. 2014; 41: 346-356
        • Corley K.T.T.
        • Donaldson L.L.
        • Furr M.O.
        Comparison of lithium dilution and thermodilution cardiac output measurements in anaesthetised neonatal foals.
        Equine Vet J. 2002; 34: 598-601
        • Deutsch J.
        • Ekiri A.
        • de Vries A.
        Alfaxalone for maintenance of anesthesia in ponies undergoing field castration: continuous infusion compared with intravenous boluses.
        Vet Anaesth Analg. 2017; 44: 832-840
        • Fischer B.
        • Clark-Price S.
        Anesthesia of the equine neonate in health and disease.
        Vet Clin North Am Equine Pract. 2015; 31: 567-585
        • Goodwin W.A.
        • Keates H.L.
        • Pearson M.
        • Pasloske K.
        Alfaxalone and medetomidine intravenous infusion to maintain anaesthesia in colts undergoing field castration.
        Equine Vet J. 2013; 45: 315-319
        • Goodwin W.A.
        • Keates H.L.
        • Pasloske K.
        • et al.
        The pharmacokinetics and pharmacodynamics of the injectable anaesthetic alfaxalone in the horse.
        Vet Anaesth Analg. 2011; 38: 431-438
        • Goodwin W.
        • Keates H.
        • Pasloske K.
        • et al.
        Plasma pharmacokinetics and pharmacodynamics of alfaxalone in neonatal foals after an intravenous bolus of alfaxalone following premedication with butorphanol tartrate.
        Vet Anaesth Analg. 2012; 39: 503-510
        • Goodwin W.A.
        • Pasloske K.
        • Keates H.L.
        • et al.
        Alfaxalone for total intravenous anesthesia in horses.
        Vet Anaesth Analg. 2019; 46: 188-199
        • Gozalo-Marcilla M.
        • Steblaj B.
        • Schauvliege S.
        • et al.
        Comparison of the influence of two different constant-rate infusions (dexmedetomidine versus morphine) on anesthetic requirements, cardiopulmonary function and recovery quality in isoflurane anesthetized horses.
        Res Vet Sci. 2013; 95: 1186-1194
        • Hollis A.R.
        • Furr M.O.
        • Magdesian K.G.
        • et al.
        Blood glucose concentrations in critically ill neonatal foals.
        J Vet Intern Med. 2008; 22: 1223-1227
        • Kerr C.L.
        • Bouré L.P.
        • Pearce S.G.
        • McDonell W.N.
        Cardiopulmonary effects of diazepam-ketamine-isoflurane or xylazine-ketamine-isoflurane during abdominal surgery in foals.
        Am J Vet Res. 2009; 70: 574-580
        • Lawrence C.J.
        • Prinzen F.W.
        • de Lange S.
        The effect of dexmedetomidine on nutrient organ blood flow.
        Anesth Analg. 1996; 83: 1160-1165
        • Lehner A.F.
        • Almeida P.
        • Jacobs J.
        • et al.
        Remifentanil in the horse: identification and detection of its major urinary metabolite.
        J Anal Toxicol. 2000; 24: 309-315
        • Maddern K.
        • Adams V.J.
        • Hill N.A.
        • Leece E.A.
        Alfaxalone induction dose following administration of medetomidine and butorphanol in the dog.
        Vet Anaesth Analg. 2010; 37: 7-13
        • Marcilla M.G.
        • Schauvliege S.
        • Duchateau L.
        • Gasthuys F.
        Cardiopulmonary effects of two constant rate infusions of dexmedetomidine in isoflurane anaesthetized ponies.
        Vet Anaesth Analg. 2010; 37: 311-321
        • Mathis A.
        • Pinelas R.
        • Brodbelt D.C.
        • Alibhai H.I.
        Comparison of quality of recovery from anaesthesia in cats induced with propofol or alfaxalone.
        Vet Anaesth Analg. 2012; 39: 282-290
        • Medeiros L.Q.
        • Gozalo-Marcilla M.
        • Taylor P.M.
        • et al.
        Sedative and cardiopulmonary effects of dexmedetomidine infusions randomly receiving, or not, butorphanol in standing horses.
        Vet Rec. 2017; 181: 402
        • Ohmura H.
        • Okano A.
        • Mukai K.
        • et al.
        Cardiorespiratory and anesthetic effects of combined alfaxalone, butorphanol, and medetomidine in Thoroughbred horses.
        J Equine Sci. 2016; 27: 7-11
        • Panzer O.
        • Moitra V.
        • Sladen R.N.
        Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists.
        Crit Care Clin. 2009; 25: 451-469
        • Read M.R.
        • Read E.K.
        • Duke T.
        • Wilson D.G.
        Cardiopulmonary effects and induction and recovery characteristics of isoflurane and sevoflurane in foals.
        J Am Vet Med Assoc. 2002; 221: 393-398
        • Robertson S.A.
        Sedation and general anaesthesia of the foal.
        Equine Vet Educ. 2005; 15: 94-101
        • Smale K.
        • Anderson L.S.
        • Butler P.J.
        An algorithm to describe the oxygen equilibrium curve for the Thoroughbred racehorse.
        Equine Vet J. 1994; 26: 500-502
        • Thomas W.P.
        • Madigan J.E.
        • Backus K.Q.
        • Powell W.E.
        Systemic and pulmonary haemodynamics in normal neonatal foals.
        J Reprod Fertil Suppl. 1987; 35: 623-628
        • Wagner A.E.
        • Dunlop C.I.
        • Wertz E.M.
        • Chapman P.L.
        Evaluation of five common induction protocols by comparison of hemodynamic responses to surgical manipulation in halothane-anesthetized horses.
        J Am Vet Med Assoc. 1996; 208: 252-257
        • Wagner A.E.
        • Dunlop C.I.
        • Heath R.B.
        • et al.
        Hemodynamic function during neurectomy in halothane-anesthetized horses with or without constant dose detomidine infusion.
        Vet Surg. 1992; 21: 248-255