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Total Intravenous Anesthesia with Midazolam, Ketamine Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2010 Total invtravenous anesthesia with midazolam, ketamine, and xylazine or detomidine following induction with tiletamine, zolazepam, and xylazine in red deer (Cervus elaphus hippelaphus) undergoing surgery Auer, U ; Wenger, S ; Beigelböck, C ; Zenker, W ; Mosing, M Abstract: Sixteen captive female red deer were successfully anesthetized to surgically implant a telemetry system. The deer were immobilized with (mean±SD) 1.79±0.29 mg/kg xylazine and 1.79±0.29 mg/kg tiletamine/zolazepam given intramuscularly with a dart gun. Anesthesia was maintained for 69±2 min using a total intravenous protocol with a catheter placed in the jugular vein. Group X received xylazine (0.5±0.055 mg/kg/hr) and group D, detomidine (2±0.22 µg/kg/hr), both in combination with ketamine (2±0.02 mg/kg/hr) and midazolam (0.03±0.0033 mg/kg/hr), as a constant rate infusion. Anesthesia was reversed with 0.09±0.01 mg/kg atipamezole and 8.7±1.21 µg/kg sarmazenil given intravenously in both groups. These drug combinations provided smooth induction, stable anesthesia for surgery, and rapid recovery. Respiratory depression and mild hypoxemia were seen, and we, therefore, recommend using supplemental intranasal oxygen. DOI: https://doi.org/10.7589/0090-3558-46.4.1196 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-36361 Journal Article Originally published at: Auer, U; Wenger, S; Beigelböck, C; Zenker, W; Mosing, M (2010). Total invtravenous anesthesia with midazolam, ketamine, and xylazine or detomidine following induction with tiletamine, zolazepam, and xylazine in red deer (Cervus elaphus hippelaphus) undergoing surgery. Journal of Wildlife Diseases, 46(4):1196-1203. DOI: https://doi.org/10.7589/0090-3558-46.4.1196 Journal of Wildlife Diseases, 46(4), 2010, pp. 1196–1203 # Wildlife Disease Association 2010 TOTAL INTRAVENOUS ANESTHESIA WITH MIDAZOLAM, KETAMINE, AND XYLAZINE OR DETOMIDINE FOLLOWING INDUCTION WITH TILETAMINE, ZOLAZEPAM, AND XYLAZINE IN RED DEER (CERVUS ELAPHUS HIPPELAPHUS) UNDERGOING SURGERY Ulrike Auer,1,6 Sandra Wenger,2 Christoph Beigelbo¨ck,3 Wolfgang Zenker,4 and Martina Mosing5 1 Division of Anaesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Veterina¨ rplatz 1, 1210 Vienna, Austria 2 Clinicfor Zoo Animals, ExoticPets and Wildlife, Vetsuisse Faculty,Univ ersity of Zurich, Winterthurerstrasse 260, 8057 Zu¨ rich, Switzerland 3 Research Institute of Wildlife Ecology, University of Veterinary Medicine, Savoyenstrasse 1, 1160 Vienna, Austria 4 Praxis fu¨ r Zootiere und Exoten, Kleintierpraxis, Neuwiesenstr. 6, 8610 Uster, Switzerland 5 Equine Hospital, The University of Liverpool, Leahurst, Chester High Road, Neston, South Wirral CH64 7TE, UK 6 Corresponding author (email: [email protected]) ABSTRACT: Sixteen captive female red deer were successfully anesthetized to surgically implant a telemetry system. The deer were immobilized with (mean6SD) 1.7960.29 mg/kg xylazine and 1.7960.29 mg/kg tiletamine/zolazepam given intramuscularly with a dart gun. Anesthesia was maintained for 6962 min using a total intravenous protocol with a catheter placed in the jugular vein. Group X received xylazine (0.560.055 mg/kg/hr) and group D, detomidine (260.22 mg/kg/ hr), both in combination with ketamine (260.02 mg/kg/hr) and midazolam (0.0360.0033 mg/kg/ hr), as a constant rate infusion. Anesthesia was reversed with 0.0960.01 mg/kg atipamezole and 8.761.21 mg/kg sarmazenil given intravenously in both groups. These drug combinations provided smooth induction, stable anesthesia for surgery, and rapid recovery. Respiratory depression and mild hypoxemia were seen, and we, therefore, recommend using supplemental intranasal oxygen. Key words: Detomidine, ketamine, midazolam, red deer, total intravenous anesthesia, xylazine. INTRODUCTION et al., 2000). For prolonged or invasive procedures, inhalation anesthesia is rec- Approximately five million deer live in ommended (Caulkett, 1997). As inhalation captivity worldwide and interest in farmed anesthesia can be difficult to perform deer is growing exponentially (Hudson, under field conditions, a safe protocol 2001). Procedures such as hoof care, using total intravenous anesthesia (TIVA) treatment of dystocia or amputation of would be valuable. antlers are commonly performed in deer, The aims of this study were to evaluate and an in-depth knowledge about immo- a TIVA protocol using a combination of bilization and anesthesia is necessary. midazolam, ketamine, and xylazine or Many sedative and anesthetic protocols detomidine to maintain anesthesia in red have been evaluated in various deer deer and to investigate the effects of species during the past two decades. partial antagonization of this combination Numerous reports describe the use of with atipamezole and sarmazenil. injectable anesthetics alone or in combi- nation with local anesthesia for short MATERIALS AND METHODS surgical procedures. Potent opioids or cyclohexamines (tiletamine, ketamine) in Animals combination with benzodiazepines or al- Sixteen female free-ranging red deer (Cer- pha-2 adrenoceptor agonists are common- vus elaphus hippelaphus), living in a 45-ha, forested portion of the Research Institute ly used for immobilization and short-term of Wildlife Ecology in Vienna, Austria anesthesia in red deer (McKelvey and (48u12900N, 16u22900E), were immobilized. Simpson, 1985; Caulkett, 1997; Janovsky Animals had a mean6SD age of 4.161.3 yr 1196 AUER ET AL.—TOTAL INTRAVENOUS ANESTHESIA IN RED DEER 1197 (range,1.5–6 yr) and a body weight of tance, approximately 600 m), where endotra- 120615 kg (range, 90–135 kg). Body weight cheal intubation was performed. Time from was estimated by one person before darting; darting to intubation (intubation time) was after induction, the exact weight was deter- recorded. mined by weighing with an electronic balance. A catheter (Intraflon2, 12 G, Vycon, Surgery was performed to implant a self- Ecoune, France) was placed in the left jugular constructed telemetry system as part of an vein for intravenous (IV) administration of etho-ecologic project. A ventral midline neck 10 ml/kg/hr lactated Ringer’s solution (Ringer incision was made through the skin, and the Lactat ‘‘Fresenius,’’ Fresenius Kabi Austria subcutaneous tissue was separated by blunt GmbH, Graz, Austria) and anesthesia mainte- dissection to form a pouch on the left ventro- nance using CRI. After endotracheal intuba- lateral aspect of the neck. Two incisions were tion, the tube was connected to a circle system made along the caudal ventral midline of the delivering an oxygen/air mixture with an pouch for placement of the electrocardiogram inspiratory oxygen concentration (FIO2)of (ECG) electrodes. Electrodes were pulled 30–50%. Animals breathed spontaneously. from the transmitter pouch through a subcu- The animals were positioned in right lateral taneous tunnel prepared with a sterile cathe- recumbency with the left foreleg pulled ter. The transmitter and electrodes were fixed forward. to the subcutis, and the skin incisions were To prepare the CRI solution, 250 mg closed with absorbable suture material (Gia- xylazine (Xylasol, Dr. E. Gra¨ub AG, Berne, cometti et al., 2001). This study was approved Switzerland) for group X, or 1.4 mg detomi- by the Institutional Ethics Committee of dine (Domosedan, Pfizer, Vienna, Austria) for the Veterinary University of Vienna and group D, plus the 1,000 mg ketamine (10% had governmental approval (reference, GZ Narketan, Vetoquinol Austria GmbH, Vienna, 68.205/88-BvGt/2002). Austria) and 15 mg midazolam (Midazolam Mayrhofer Pharmazeutika, Vienna, Austria) Study design were mixed in 500 ml saline (0.9% NaCl A parallel study design was used, and ‘‘Fresenius,’’ Fresenius Kabi). This resulted in animals were randomly divided into two a concentration of 0.5 mg/ml xylazine or 2.0 mg/ groups. Group X received a TIVA protocol ml detomidine, 2 mg/ml ketamine, and using midazolam, ketamine, and xylazine given 0.03 mg/ml midazolam. For the first 20 min, an infusion rate of 1.2 ml/kg/hr was adminis- as a continuous rate infusion (CRI) after initial TM immobilization with tiletamine, zolazepam, tered via an infusion pump (Asena , Alaris and xylazine. In group D, anesthesia was Medical UK Ltd, Basingstoke, Hampshire, maintained using a CRI with midazolam, UK). Thereafter, CRI rate was reduced ketamine, and detomidine. stepwise in 10% increments every 10 min. The duration of CRI administration and the Anesthesia total volume given were noted. After surgery, the animals were brought back Two days before surgery the deer were to the restricted area. Twenty minutes after the brought into a 1-ha, restricted area. Food, but end of anesthesia, a combination of 10 mg not water, was withheld for 24 hr. Lyophilized atipamezole (Antisedan, Pfizer) and 1 mg sar- powder of 500 mg tiletamine-zolazepam (Zo- mazenil (Sarmasol, Dr. E. Gra¨ub AG, Bern, letil, Virbac, Carros, France) and 500 mg of Switzerland) was administered by IV. The lyophilized xylazine powder (Rompun TS, catheter and endotracheal tube were removed. Bayer, Leverkusen, Germany) were dissolved Time from administration of the antagonists to in 5 ml water for injection. This resulted in a sternal recumbency (sternal time) and standing concentration of 50 mg tiletamine, 50 mg (up time) were recorded. Quality of recovery zolazepam, and 100 mg xylazine per milliliter was evaluated as excellent (standing on first of solution. The body weight of the animal was attempt, normal gait without ataxia), good estimated, and a 3-ml, plastic dart (Telinject (standing on first attempt with minimal ataxia, G.U.T., Roemerberg, Germany) was prepared. moving with unsteady gait) or poor (requiring The animal was darted with 2 to 2.5 ml of the more than one attempt to standing, moderate to solution intramuscularly in the upper hind leg severe ataxia, and falling over). Animals were or shoulder area using a CO2-pressurized dart observed for 4 hr after surgery.
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