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Influence of Ketamine Or Xylazine Constant Rate Infusion on Quality Of University of Veterinary Medicine Hannover Influence of ketamine or xylazine constant rate infusion on quality of anaesthesia, cardiopulmonary function and recovery in isoflurane anaesthetised horses- a clinical trial Thesis Submitted in partial fulfilment of the requirements for the degree -Doctor of Veterinary Medicine- Doctor medicinae veterinariae (Dr. med. vet.) by Nina Franziska Pöppel Rheda Hannover 2012 Academic supervision: Prof. Dr. S. Kästner Clinic for small animals 1. Referee: Prof. Dr. S. Kästner 2. Referee: Prof. Dr. M. Kietzmann Day of oral examination: 15th November 2012 For my beloved and patient parents This study has been published in part previously: Pöppel NF, Hopster K, Kästner SBR (2012): Influence of ketamine or xylazine constant rate infusion on quality of anaesthesia, cardiopulmonary function and recovery in isoflurane anaesthetised horses- a clinical trial AVA Spring Meeting 21st March – 23rd March 2012, Davos, Switzerland Congress Proceedings, page 35. Contents 1 Introduction...........................................................................................................11 2 Review of literature...............................................................................................13 2.1 General anaesthesia in horses ......................................................................13 2.1.1 Balanced anaesthesia in horses .............................................................14 2.2 Influence of general anaesthesia on cardiopulmonary function and recovery in horses .................................................................................................................15 2.2.1 Isoflurane.................................................................................................16 2.2.2 Xylazine...................................................................................................18 2.2.3 Ketamine .................................................................................................20 2.2.4 Midazolam ...............................................................................................23 2.2.5 Acepromazine .........................................................................................24 2.2.6 Butorphanol .............................................................................................25 2.2.7 Dobutamine .............................................................................................27 2.2.8 Thiopental................................................................................................28 2.3 Monitoring anaesthesia..................................................................................30 2.3.1 Respiratory function ................................................................................30 2.3.2 Circulation ...............................................................................................31 2.3.2.1 Cardiac output measurement ...........................................................31 2.3.2.1.1 The Fick principle .......................................................................33 2.3.2.1.2 Indicator Dilution Methods..........................................................34 2.3.2.1.2.1 Dye dilution..........................................................................34 2.3.2.1.2.2 Thermodilution.....................................................................35 2.3.2.1.2.3 Lithium dilution.....................................................................35 2.3.2.1.3 Pulse contour analysis (PulseCO) .............................................37 2.3.2.1.4 Other cardiac output measurement methods.............................39 2.3.3 Determination of anaesthetic depths.......................................................40 3 Material and Methods ...........................................................................................41 3.1 Animals ..........................................................................................................41 3.2 Assignment of animals to groups...................................................................41 3.3 Experimental setup ........................................................................................45 3.3.1 Preoperative examination and preparations............................................45 Contents 3.3.2 Premedication and induction of general anaesthesia..............................45 3.3.3 Anaesthetic protocol and ventilation........................................................46 3.3.4 Cardiovascular support ...........................................................................46 3.3.5 Recovery .................................................................................................47 3.4 Determination of anaesthetic depth ...............................................................48 3.5 Intraoperative monitoring ...............................................................................49 3.5.1 Heart rate ................................................................................................49 3.5.2 Respiratory rate and end-expiratory concentration of isoflurane.............49 3.5.3 Mean arterial pressure ............................................................................50 3.5.4 Arterial blood gas analysis ......................................................................50 3.5.5 Cardiac output .........................................................................................51 3.5.6 Dobutamine amount ................................................................................55 3.6 Postoperative monitoring ...............................................................................56 3.6.1 Duration of recovery ................................................................................56 3.6.2 Recovery quality......................................................................................56 3.7 Calculated parameters after anaesthesia ......................................................60 3.8 Statistical analysis..........................................................................................61 4 Manuscript ............................................................................................................62 5 Discussion ............................................................................................................87 5.1 Discussion of Materials and Methods ............................................................87 5.1.1 Animals....................................................................................................87 5.1.2 Premedication, induction and maintenance of anaesthesia ....................87 5.1.3 Cardiovascular support ...........................................................................89 5.1.4 Determination of anaesthetic depth.........................................................89 5.1.5 Intraoperative monitoring.........................................................................90 5.1.6 Recovery .................................................................................................92 5.2 Discussion of results ......................................................................................94 5.2.1 Heart rate ................................................................................................94 5.2.2 Mean arterial pressure ............................................................................95 5.2.3 Cardiac output .........................................................................................95 5.2.4 Other cardiopulmonary parameters.........................................................98 Contents 5.2.5 Isoflurane requirements and adaption of anaesthetic depth ...................99 5.2.6 Recovery ...............................................................................................100 5.3 Conclusion ...................................................................................................101 6 Zusammenfassung .............................................................................................103 7 Summary ............................................................................................................106 8 References .........................................................................................................109 9 Appendix.............................................................................................................132 List of abbreviations Abbreviation Meaning ANOVA analysis of variance bwt body weight CaO2 arterial oxygen content CB crossbred horse CI cardiac index CO cardiac output CRI constant rate infusion CRT capillary refill time CVP central venous pressure DO2 oxygen delivery ECG electrocardiogram EDTA ethylenediaminetetraacetic acid ETCO2 end-expiratory concentration of carbon dioxide ETISO end-expiratory concentration of isoflurane F Frisian GABA gamma-aminobutyric acid GP German riding pony h hour hb haemoglobin HES hydroxyethyl starch HR heart rate HTC haematocrit IK group isoflurane-ketamine IM intramuscularly IPPV intermittent positive pressure ventilation I group isoflurane IU international unit IV intravenously IX group isoflurane-xylazine List of abbreviations kg kilogram kPa kilopascal l litre MAC minimal alveolar concentration MAP mean arterial pressure ml millilitre mmHg millimetre of mercury mmol millimol NFP Nina Franziska Pöppel NICO non-invasive cardiac output monitoring system NMDA N-methyl-D-aspartate PaCO2 arterial pressure of carbon dioxide PAM post-anaesthetic myopathy PaO2
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