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      Intravenous sufentanil-midazolam versus sevoflurane anaesthesia in medetomidine pre-medicated Himalayan rabbits undergoing ovariohysterectomy

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          Abstract

          Objective

          To compare physiological effects of sufentanil-midazolam with sevoflurane for surgical anaesthesia in medetomidine premedicated rabbits.

          Study design

          Prospective, randomized controlled experimental study.

          Animals

          Eighteen female Himalayan rabbits, weight 2.1 ± 0.1 kg.

          Methods

          Premedication with 0.1 mg kg −1 medetomidine and 5 mg kg −1 carprofen subcutaneously, was followed by intravenous anaesthetic induction with sufentanil (2.3 μg mL −1) and midazolam (0.45 mg mL −1). After endotracheal intubation, anaesthesia was maintained with sufentanil-midazolam ( n = 9) or sevoflurane ( n = 9). Ovariohysterectomy was performed. Intermittent positive pressure ventilation was performed as required. Physiological variables were studied perioperatively. Group means of physiologic data were generated for different anaesthetic periods. Data were compared for changes from sedation, and between groups by anova. Post-operatively, 0.05 mg kg −1 buprenorphine was administered once and 5 mg kg −1 carprofen once daily for 2–3 days. Rabbits were examined and weighed daily until one week after surgery.

          Results

          Smooth induction of anaesthesia was achieved within 5 minutes. Sufentanil and midazolam doses were 0.5 μg kg −1 and 0.1 mg kg −1, during induction and 3.9 μg kg −1 hour −1 and 0.8 mg kg −1 hour −1 during surgery, respectively. End-tidal sevoflurane concentration was 2.1% during surgery. Assisted ventilation was required in nine rabbits receiving sufentanil-midazolam and four receiving sevoflurane. There were no differences between groups in physiologic data other than arterial carbon dioxide. In rabbits receiving sevoflurane, mean arterial pressure decreased pre-surgical intervention, heart rate increased 25% during and after surgery and body weight decreased 4% post-operatively. Post-operative problems sometimes resulted from catheterization of the ear artery.

          Conclusion

          Sevoflurane and sufentanil-midazolam provided surgical anaesthesia of similar quality. Arterial blood pressure was sustained during sufentanil-midazolam anaesthesia and rabbits receiving sevoflurane lost body weight following ovariohysterectomy. Mechanical ventilation was required with both anaesthetic regimens.

          Clinical relevance

          Anaesthesia with sufentanil-midazolam in medetomidine premedicated healthy rabbits is useful in the clinical and the research setting, as an alternative to sevoflurane.

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          Most cited references23

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          • Article: not found

          Recommendations for the health monitoring of rodent and rabbit colonies in breeding and experimental units.

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            The risk of death: the confidential enquiry into perioperative small animal fatalities.

            To estimate the risks of anaesthetic and sedation-related mortality in companion animals in the UK. (The Confidential Enquiry into Perioperative Small Animal Fatalities, CEPSAF). A prospective cohort study with nested case-control study. All small animals anaesthetized and sedated at participating centres between June 2002 and June 2004. Patient outcomes at 48 hours (alive, dead and killed) were recorded. Anaesthetic and sedation-related death was defined as death where surgical or pre-existing medical causes did not solely cause death. Species-specific risks of anaesthetic-related death and 95% confidence intervals (95% CI) were calculated. Risks were also estimated in the sub-sets of dogs, cats and rabbits that were either healthy or sick (ASA 1-2 and 3-5, respectively). One hundred and seventeen veterinary practices participated in the study and 98 036 dogs, 79 178 cats and 8209 rabbits were anaesthetized and sedated. Overall risks of anaesthetic and sedation-related death in dogs were 0.17% (1 in 601, 95% CI 0.14-0.19%), in cats 0.24% (1 in 419, 95% CI 0.20-0.27%) and in rabbits 1.39% (1 in 72, 95% CI 1.14-1.64%) within 48 hours of the procedure. In healthy dogs, cats and rabbits, the risks were estimated to be 0.05% (1 in 1849, 95% CI 0.04-0.07%), 0.11%, (1 in 895, 95% CI 0.09-0.14%) and 0.73% (1 in 137, 95% CI 0.54-0.93%), respectively. In sick dogs, cats and rabbits, the risks were 1.33%, (1 in 75, 95% CI 1.07-1.60%), 1.40% (1 in 71, 95% CI 1.12-1.68%) and 7.37% (1 in 14, 95% CI 5.20-9.54%), respectively. Postoperative deaths accounted for 47% of deaths in dogs, 61% in cats and 64% in rabbits. Most other small animal species had higher mortality risks. Small animal anaesthesia appears to be increasingly safe. Greater patient care in the postoperative period could reduce fatalities.
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              Opioid analgesics in anesthesia: with special reference to their use in cardiovascular anesthesia.

              In this article, an attempt has been made to review the use of receptor stimulating pure agonist opioids in anesthesia, especially in patients with cardiovascular disease. Particular emphasis has been placed on the use of opioids in high doses to produce anesthesia, techniques that recently have become popular in cardiovascular anesthesia. A major benefit of opioid anesthesia is the cardiovascular stability obtained during induction and throughout operation, even in patients with severely impaired cardiac function. There is a considerable body of evidence to support this claim when fentanyl is used. Anesthetic doses of morphine are associated with a higher incidence of cardiovascular disturbances and other problems, and, therefore, more attention to detail is required in order to achieve adequate anesthesia and hemodynamic stability. Although other opioids have been used as sole or principal agents in anesthesia for cardiovascular surgery, none have gained widespread acceptance. Meperidine, for example, which is widely used in lower (nonanesthetic) doses as a supplement to nitrous oxide in cardiac and noncardiac surgery, has proved unsuitable because of severe hemodynamic disturbances when high doses are given. However, initial reports concerning two of the newer agonist opioids, sufentanil and alfentanil, suggest that they may prove to be suitable alternatives and perhaps provide advantages over morphine and fentanyl in patients with or without cardiovascular disease. Although cardiovascular stability usually can be assured in the chronically sick cardiac patient with opioid anesthesia, this is not always so with the healthier patient, particularly those presenting for coronary artery surgery. A frequently occurring problem in these patients is hypertension during or after sternotomy, which can result in myocardial ischemia and infarction. The incidence of severe hypertension (increases in systolic blood pressure greater than 20% of control values) can be reduced drastically by increasing the dose of opioid, e.g., up to 140 micrograms/kg of fentanyl. However, despite such large doses, some patients will continue to need treatment with vasodilators, inhalation anesthetics, or other supplements at certain periods during cardiovascular operations. The use of very large doses of opioids also will prolong postoperative respiratory depression. High doses of opioids can reduce or prevent the hormonal and metabolic responses to the stress of surgery. However, even very large doses of fentanyl or its newer analogues do not prevent marked increases in plasma catecholamine concentrations in response to cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 400 WORDS)
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                Author and article information

                Contributors
                Journal
                Vet Anaesth Analg
                Vet Anaesth Analg
                Veterinary Anaesthesia and Analgesia
                Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd.
                1467-2987
                1467-2995
                16 November 2016
                July 2015
                16 November 2016
                : 42
                : 4
                : 377-385
                Affiliations
                [a ]Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
                Author notes
                [* ] Correspondence: Patricia Hedenqvist, Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden patricia.hedenqvist@ 123456slu.se
                Article
                S1467-2987(16)30203-3
                10.1111/vaa.12207
                7185500
                25041686
                151c8147-7bcf-4428-bb16-9b21126688b6
                Copyright © 2015 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 3 December 2013
                : 20 May 2014
                Categories
                Article

                ovariohysterectomy,rabbit anaesthesia,sevoflurane,total intravenous anaesthesia sufentanil-midazolam

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