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Comparison between continuous rate infusion and target-controlled infusion of propofol in dogs: a randomized clinical trial

Published:November 02, 2021DOI:https://doi.org/10.1016/j.vaa.2021.08.048

      Abstract

      Objective

      To compare a propofol continuous rate infusion (CRI) with a target-controlled infusion (TCI) in dogs.

      Study design

      Randomized prospective double-blinded clinical study.

      Animals

      A total of 38 healthy client-owned dogs.

      Methods

      Dogs premedicated intramuscularly with acepromazine (0.03 mg kg–1) and an opioid (pethidine 3 mg kg–1, morphine 0.2 mg kg–1 or methadone 0.2 mg kg–1) were allocated to P-CRI group (propofol 4 mg kg–1 intravenously followed by CRI at 0.2 mg kg–1 minute–1), or P-TCI group [propofol predicted plasma concentration (Cp) of 3.5 μg mL–1 for induction and maintenance of anaesthesia via TCI]. Plane of anaesthesia, heart rate, respiratory rate, invasive blood pressure, oxygen haemoglobin saturation, end-tidal carbon dioxide and body temperature were monitored by an anaesthetist blinded to the group. Numerical data were analysed by unpaired t test or Mann–Whitney U test, one-way analysis of variance and Dunnett’s post hoc test. Categorical data were analysed with Fisher’s exact test. Significance was set for p < 0.005.

      Results

      Overall, propofol induced a significant incidence of relative hypotension (mean arterial pressure 20% below baseline, 45%), apnoea (71%) and haemoglobin desaturation (65%) at induction of anaesthesia, with a higher incidence of hypotension and apnoea in the P-CRI than P-TCI group (68% versus 21%, p = 0.008; 84% versus 58%, p = 0.0151, respectively). Propofol Cp was significantly higher at intubation in the P-CRI than P-TCI group (4.83 versus 3.5 μg mL–1, p < 0.0001), but decreased during infusion, while Cp remained steady in the P-TCI group. Total propofol administered was similar between groups.

      Conclusions and clinical relevance

      Both techniques provided a smooth induction of anaesthesia but caused a high incidence of side effects. Titration of anaesthesia with TCI caused fewer fluctuations in Cp and lower risk of hypotension compared with CRI.

      Keywords

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      References

        • Amengual M.
        • Flaherty D.
        • Auckburally A.
        • et al.
        An evaluation of anaesthetic induction in healthy dogs using rapid intravenous injection of propofol or alfaxalone.
        Vet Anaesth Analg. 2013; 40: 115-123
        • Andreoni V.
        • Hughes J.M.L.
        Propofol and fentanyl infusions in dogs of various breeds undergoing surgery.
        Vet Anaesth Analg. 2009; 36: 523-531
        • Auckburally A.
        • Pawson P.
        • Flaherty D.
        A comparison of induction of anaesthesia using a target-controlled infusion device in dogs with propofol or a propofol and alfentanil admixture.
        Vet Anaesth Analg. 2008; 35: 319-325
        • Beths T.
        • Glen J.B.
        • Reid J.
        • et al.
        Evaluation and optimisation of a target-controlled infusion system for administering propofol to dogs as part of a total intravenous anaesthetic technique during dental surgery.
        Vet Rec. 2001; 148: 198-203
        • Bijker J.B.
        • van Klei W.A.
        • Kappen T.H.
        • et al.
        Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection.
        Anesthesiology. 2007; 107: 213-220
        • Boscan P.
        • Rezende M.L.
        • Grimsrud K.
        • et al.
        Pharmacokinetic profile in relation to anaesthesia characteristics after a 5% micellar microemulsion of propofol in the horse.
        Br J Anaesth. 2010; 104: 330-337
        • Breslin D.S.
        • Mirakhur R.K.
        • Reid J.E.
        • Kyle A.
        Manual versus target-controlled infusions of propofol.
        Anaesth. 2004; 59: 1059-1063
        • Brooks D.
        • Churchill J.
        • Fein K.
        • et al.
        2014 AAHA weight management guidelines for dogs and cats.
        J Am Anim Hosp Assoc. 2014; 50: 1-11
        • Cattai A.
        • Rabozzi R.
        • Natale V.
        • Franci P.
        The incidence of spontaneous movements (myoclonus) in dogs undergoing total intravenous anaesthesia with propofol.
        Vet Anaesth Analg. 2015; 42: 93-98
        • Claeys M.A.
        • Gepts E.
        • Camu F.
        Haemodynamic changes during anaesthesia induced and maintained with propofol.
        Br J Anaesth. 1988; 60: 3-9
        • Cuniberti B.
        • Huuskonen V.
        • Hughes J.M.L.
        In vitro delivery accuracy of Computer Controlled Infusion Pump software linked to an Alaris® GH syringe pump for propofol target-controlled infusion in dogs.
        Med Weter. 2018; 74: 466-472
        • Davies C.
        Excitatory phenomena following the use of propofol in dogs.
        Vet Anaesth Analg. 1991; 18: 48-51
        • Dolin S.J.
        • Smith M.B.
        • Soar J.
        • Morris P.J.
        Does glycine antagonism underlie the excitatory effects of methohexitone and propofol?.
        Br J Anaesth. 1992; 68: 523-526
        • Egan T.D.
        • Kern S.E.
        • Johnson K.B.
        • Pace N.L.
        The pharmacokinetics and pharmacodynamics of propofol in a modified cyclodextrin formulation (Captisol®) versus propofol in a lipid formulation (Diprivan®): an electroencephalographic and hemodynamic study in a porcine model.
        Anesth Analg. 2003; 97: 72-79
        • Gadawski J.E.
        Respiratory depression and apnea induced by propofol in dogs.
        Am J Vet Res. 1998; 59: 157-161
        • Gepts E.
        • Camu F.
        • Cockshott I.D.
        • Douglas E.J.
        Disposition of propofol administered as constant rate intravenous infusions in humans.
        Anesth Analg. 1987; 66: 1256-1263
        • Glowaski M.M.
        • Wetmore L.A.
        Propofol: application in veterinary sedation and anesthesia.
        Clin Tech Small Anim Pract. 1999; 14: 1-9
        • Griffenhagen G.M.
        • Rezende M.L.
        • Gustafson D.L.
        • et al.
        Pharmacokinetics and pharmacodynamics of propofol with or without 2% benzyl alcohol following a single induction dose administered intravenously in cats.
        Vet Anaesth Analg. 2015; 42: 472-483
        • Hall L.W.
        • Chambers J.P.
        A clinical trial of propofol infusion anaesthesia in dogs.
        J Small Anim Pract. 1987; 28: 623-637
        • Herbert G.L.
        • Bowlt K.L.
        • Ford-Fennah V.
        • et al.
        Alfaxalone for total intravenous anaesthesia in dogs undergoing ovariohysterectomy: a comparison of premedication with acepromazine or dexmedetomidine.
        Vet Anaesth Analg. 2013; 40: 124-133
        • Hopkins C.S.
        Recurrent opisthotonus associated with anaesthesia.
        Anaesth. 1988; 43 (904): 904
        • Hunt-Smith J.
        • Donaghy A.
        • Leslie K.
        • Kluger M.
        Safety and efficacy of target controlled infusion (Diprifusor) vs manually controlled infusion of propofol for anaesthesia.
        Anaesth Intens Care. 1999; 27: 260-264
        • Hug Jr., C.C.
        • McLeskey C.H.
        • Nahrwold M.L.
        • et al.
        Hemodynamic effects of propofol: data from over 25,000 patients.
        Anesth Analg. 1993; 77: 21-29
        • Kuusela E.
        • Vainio O.
        • Short C.E.
        • et al.
        A comparison of propofol infusion and propofol/isoflurane anaesthesia in dexmedetomidine premedicated dogs.
        J Vet Pharmacol Therap. 2003; 26: 199-204
        • Leslie K.
        • Sessler D.I.
        • Bjorksten A.R.
        • Moayeri A.
        Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium.
        Anesth Analg. 1995; 80: 1007-1014
        • Mair A.R.
        • Pawson P.
        • Courcier E.
        • Flaherty D.
        A comparison of the effects of two different doses of ketamine used for co-induction of anaesthesia with a target-controlled infusion of propofol in dogs.
        Vet Anaesth Analg. 2009; 36: 532-538
        • McNally E.M.
        • Robertson S.A.
        • Pablo L.S.
        Comparison of time to desaturation between preoxygenated and nonpreoxygenated dogs following sedation with acepromazine maleate and morphine and induction of anesthesia with propofol.
        Am J Vet Res. 2009; 70: 1333-1338
        • Michou J.N.
        • Leece E.A.
        • Brearley J.C.
        Comparison of pain on injection during induction of anaesthesia with alfaxalone and two formulations of propofol in dogs.
        Vet Anaesth Analg. 2012; 39: 275-281
        • Minghella E.
        • Auckburally A.
        • Pawson P.
        • et al.
        Clinical effects of midazolam or lidocaine co-induction with a propofol target-controlled infusion (TCI) in dogs.
        Vet Anaesth Analg. 2016; 43: 472-481
        • Morgan D.W.
        • Legge K.
        Clinical evaluation of propofol as an intravenous anaesthetic agent in cats and dogs.
        Vet Rec. 1989; 124: 31-33
        • Morgan D.J.
        • Campbell G.A.
        • Crankshaw D.P.
        Pharmacokinetics of propofol when given by intravenous infusion.
        Br J Clin Pharmacol. 1990; 30: 144-148
        • Musk G.C.
        • Pang D.S.
        • Beths T.
        • Flaherty D.A.
        Target-controlled infusion of propofol in dogs – evaluation of four targets for induction of anaesthesia.
        Vet Rec. 2005; 157: 766-770
        • Nolan A.
        • Reid J.
        Pharmacokinetics of propofol administered by infusion in dogs undergoing surgery.
        Br J Anaesth. 1993; 70: 546-551
        • Passot S.
        • Servin F.
        • Allary R.
        • et al.
        Target-controlled versus manually-controlled infusion of propofol for direct laryngoscopy and bronchoscopy.
        Anesth Analg. 2002; 94: 1212-1216
        • Peacock J.E.
        • Lewis R.P.
        • Reilly C.S.
        • Nimmo W.S.
        Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients.
        Br J Anaesth. 1990; 65: 346-352
        • Pei Z.
        • Mao Y.
        • Wang S.
        • Tang X.
        Continuous infusion of remifentanil combined with target-controlled infusion of propofol for tracheal intubation in dogs.
        Vet Rec. 2014; 175: 119-123
        • Rabozzi R.
        • Novello L.
        Time course of propofol effect site depression in dogs using the bispectral index (abstract).
        Vet Anaesth Analg. 2007; 34: 3
        • Roberts F.L.
        • Dixon J.
        • Lewis G.T.R.
        • et al.
        Induction and maintenance of propofol anaesthesia: a manual infusion scheme.
        Anaesth. 1988; 43: 14-17
        • Robertson S.A.
        • Johnston S.
        • Beemsterboer J.
        Cardiopulmonary, anesthetic, and postanesthetic effects of intravenous infusions of propofol in greyhounds and non-greyhounds.
        Am J Vet Res. 1992; 53: 1027-1032
        • Ruffato M.
        • Novello L.
        • Clark L.
        What is the definition of intraoperative hypotension in dogs? Results from a survey of diplomates of the ACVAA and ECVAA.
        Vet Anaesth Analg. 2015; 42: 55-64
        • Russell D.
        • Wilkes M.P.
        • Hunter S.C.
        • et al.
        Manual compared with target-controlled infusion of propofol.
        Br J Anaesth. 1995; 75: 562-566
        • Silva A.
        • Ribeiro L.M.
        • Bressan N.
        • et al.
        Dogs mean arterial pressure and heart rate responses during high propofol plasma concentrations estimated by a pharmacokinetic model.
        Res Vet Sci. 2011; 91: 278-280
        • Smith J.A.
        • Gaynor J.S.
        • Bednarski R.M.
        • Muir W.W.
        Adverse effects of administration of propofol with various preanesthetic regimens in dogs.
        J Am Vet Med A. 1993; 202: 1111-1115
        • Tan C.H.
        • Onsiong M.K.
        Pain on injection of propofol.
        Anaesth. 1998; 53: 468-476
        • Väisänen M.A.M.
        • Valros A.E.
        • Hakaoja E.
        • et al.
        Pre-operative stress in dogs – a preliminary investigation of behavior and heart rate variability in healthy hospitalized dogs.
        Vet Anaesth Analg. 2005; 32: 158-167
        • Waelbers T.
        • Vermoere P.
        • Polis I.
        Total intravenous anesthesia in dogs.
        Vlaams Diergen Tijds. 2009; 78: 160-169
        • Wang Y.
        • Yu T.
        • Yuan C.
        • et al.
        Effects of propofol on the dopamine, metabolites and GABAA receptors in media prefrontal cortex in freely moving rats.
        Am J Transl Res. 2016; 8: 2301-2308
        • Waterman A.E.
        • Kalthum W.
        Pharmacokinetics of intramuscularly administered pethidine in dogs and the influence of anaesthesia and surgery.
        Vet Rec. 1989; 124: 293-296