Cardiorespiratory effects of epidurally administered ketamine or lidocaine in dogs undergoing ovariohysterectomy surgery: a comparative study

Document Type: Full paper (Original article)

Authors

1 1Section of Pharmacology and Veterinary Therapeutics, Department of Clinical Pharmacology and Veterinary Anesthesia, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, Cuautitlan Izcalli, Mexico State, 54714, Mexico

2 Department of Surgery, Faculty of Veterinary Medicine, National Autonomous University of Mexico, Mexico City, 04510, Mexico

3 Department of Canine Clinic, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, Mexico State, 54714, Mexico

4 Department of Biological Sciences, and Clinical Pharmacology and Veterinary Anesthesia, Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, Cuautitlan Izcalli, Mexico State, 54714, Mexico

5 MSc Student in Neurology Area, Research Unit of Pediatric Hospital Century XXI, Mexican Social Security Institute, Mexico City, 06725, Mexico

Abstract

Background: Analgesic and hemodynamic effects of ketamine in subanesthetic doses during surgical anesthesia and postoperative, are due to the action on the N-methyl-D-aspartate receptors (NMDAR). Aims: To evaluate the intraoperative cardiorespiratory effects provided by ketamine compared to lidocaine, both administered epidurally, in bitches submitted to ovariohysterectomy. Methods: Thirty-six dogs of different breeds were used in a randomized, prospective, and blinded clinical trial. Two groups were formed: GKET (ketamine 3 mg/kg, n=18) and GLIDO (lidocaine 4 mg/kg, n=18). Animals were premedicated with acepromazine 0.05 mg/kg intravenous. Anesthesia was induced with propofol 5 mg/kg intravenous. Anesthetic maintenance was performed with isoflurane in 100% oxygen. Every 5 min during surgery, heart rate (HR), respiratory rate (RR), esophageal temperature (°C), oxygen saturation (SPO2), end tidal carbon dioxide (ETCO2) and mean arterial pressure (MAP) were monitored. Results: Cardiorespiratory variables during anesthesia were within normal ranges. Heart rate was significantly higher at 5 (108 ± 12 vs 95 ± 11) and 10 (110 ± 11 vs 97 ± 11) min in GKET compared to GLIDO after the start of surgery (P=0.03 and P=0.01, respectively). Mean arterial pressure was higher in GKET, (100 ± 23, 105 ± 35, and 103 ± 35 mmHg) in comparison with GLIDO (66 ± 7, 74 ± 10, and 67 ± 9 mmHg) at 20, 25 and 30 min (P=0.01, P=0.004, and P=0.002, respectively). Mild hypothermia at 25 (36.5 ± 1.3°C) and 30 (36.5 ± 1.4°C) min in the GKET was recorded. Conclusion: Epidural administration of ketamine provides better hemodynamic stability, compared to the use of epidural lidocaine.

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Ahmad, RA; Amarpal, P; Kinjavdekar, HP; Aithal, AM; Pawde, D and Kumar (2013). Potential use of dexmedetomidine for different levels of sedation, analgesia and anaesthesia in dogs. Vet. Med., 58: 87-95.

Aida, S; Yamakura, T; Baba, H; Taga, K; Fukuda, S and Shimoji, K (2000). Preemptive analgesia by intravenous low-doses ketamine and epidural morphine in gastrectomy: a randomized double-blind study. Anesthesiology. 92: 1624-1630.

Amarpall, HP; Aithal, P; Kinjavdekar, P and Singh, GR (2003). Interaction between epidurally administered Ketamine and Pethidine in dogs. J. Vet. Med. A. Physiol. Pathol. Clin. Med., 50: 254-8.

Annetta, MG; Iemma, D; Garisto, C; Tafani, C and Proietti, R (2005). Ketamine: new indications for an old drug. Curr. Drug Targets. 6: 789-794.

Armstrong, SR; Roberts, BK and Aronsohn, M (2005). Perioperative hypothermia. J. Vet. Emerg. Crit. Care. 15: 32-37.

Bornkamp, JL; Robertson, S; Isaza, NM; Harrison, K; DiGangi, BA and Pablo, L (2016). Effects of anesthetic induction with a benzodiazepine plus ketamine hydrochloride or propofol on hypothermia in dogs undergoing ovariohysterectomy. Am. J. Vet. Res., 77: 351-357.

Boscan, P; Pypendop, BH; Solano, AM and Ilkiw, JE (2005). Cardiovascular and respiratory effects of ketamine infusions in isoflurane-anesthetized dogs before and during noxios stimulation. Am. J. Vet. Res., 66: 2122-2129.

Bressan, TF; Monteiro, ER; Coelho, K; Monteiro, BS and Campagnol, D (2017). Minimum alveolar concentration of isoflurane in dogs administered a single intramuscular injection of racemic or S (+)-ketamine after premedication with acepromazine-morphine. Cienc. Rural. 47: 1: e20160027, https://doi.org/10.1590/0103-8478cr20160027.

Chizh, BA; Headley, PM and Tzschentke, TM (2001). NMDA receptor antagonist as analgesics: focus on the NR2B Subtype. Trends Pharmacol. Sci., 22: 636-642.

Dalla-Porta, AA; Gomar, C; Correa-Natalini, C; Bopp, S; Polydoro, A and Sala-Blanch, X (2005). Analgesic effects of epidurally administered levogyral ketamine alone or in combination with morphine on intraoperative and postoperative pain in dogs undergoing ovariohysterectomy. Am. J. Vet. Res., 66: 54-61.

DeRossi, R; Frazilio, FO; Jardim, PH; Martins, AR; Schmidt, R and Negrini-Neto, JM (2011). Evaluation of thoracic epidural analgesia induced by lidocaine, ketamine, or both administered via a lumbosacral approach in dogs. Am. J. Vet. Res., 72: 1580-1585.

Duque, JC; Valadao, CAA; Farias, A; De Almeida, RM and Oleskovicz, N (2004). Pre-emptive epidural ketamine or S(1)-ketamine in post-incisional pain in dogs: a comparative study. Vet. Surg., 33: 361-367.

Fajardo, MA; Lesmes, MA and Cardona, LA (2012). Evaluation of postoperative analgesic effect of intraoperative infusions of tramadol and tramadol/ lidocaine/ketamine compared with morphine/lidocaine/ ketamine in female dogs undergoing ovariohysterectomy. Arch. Med. Vet., 44: 145-153.

Firth, AM and Haldane, SL (1999). Development of a scale to evaluated postoperative pain in dogs. J. Am. Vet. Med. Assoc., 214: 651-659.

Franco, LG; Wilges, CHM; Junior, DP; Cerejo, SA; Nishimura, LT and Bittar, IP (2018). Effects of ketamine constant rate infusions on cardiac biomarkers and cardiac function in dogs. Vet. Anaesth. Analg., 45: 250-259.

Gutierrez, BE; Victoria, MJM; Ibancovichi, CJA; Sauri, ACH; Bolio, GME; Acevedo, CM; Marin, CG and Steagall, PVM (2015). Postoperative analgesic effects of either a constant rate infusion of fentanyl, lidocaine, ketamine, dexmedetomidine, or the combination lidocaine-ketamine-dexmedetomidine after ovariohysterectomy in dogs. Vet. Anaesth. Analg., 42: 309-318.

Hamilton, SM; Johnston, SA and Broadstone, RV (2005). Evaluation of analgesia provided by the administration of epidural ketamine in dogs with a chemically induced synovitis. Vet. Anaesth. Analg., 32: 30-39.

Hellyer, P; Rodan, I; Brunt, J; Downing, R; Hagedorn, JE and Robertson, SA (2007). AAHA/AAFP pain management guidelines for dogs and cats. J. Feline Med. and Surg., 9: 466-480.

Jones, RS (2001). Epidural analgesia in the dog and cat. Vet. J., 161: 123-131.

Kaka, U; Saifullah, B; Abubakar, AA; Goh, YM; Fakurazi, S; Kaka, A; Behan, AA; Ebrahimi, M and Chen, HC (2016). Serum concentration of ketamine and antinociceptive effects of ketamine and ketamine-lidocaine infusions in conscious dogs. BMC Vet. Res., 12: 198.

Kalchofner, GKS; Campagna, I; Bruhl-Day, R; Hegamin-Younger, C and Guerrero, TG (2016). Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy. Vet. Anaesth. Analg., 43: 571-578.

Katoh, T; Kobayashi, S; Suzuki, A; Iwamoto, T; Bito, H and Ikeda, K (1999). The effect of fentanyl on sevoflurane requirements for somatic and sympathethic responses to surgical incision. Anesthesiology. 90: 398-405.

Klepstad, P; Maurset, A; Moberg, ER and Oye, I (1990). Evidence of a role for NMDA receptors in pain perception. Eur. J. Pharmacol., 187: 513-518.

Martin, DD; Tranquilli, WJ; Olson, WA; Thurmon, JC and Benson, GJ (1997). Hemodynamic effects of epidural ketamine in isoflurane-anesthetized dogs. Vet. Surg., 26: 505-509.

Mion, G and Villevieille, T (2013). Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings). CNS Neurosci. Ther., 19: 370-380.

Mwangi, WE; Mogoa, EM; Nguhiu-Mwangi, J and Mulei, CM (2014). Effects of epidural Ketamine, Xylazine and their combination on body temperature in acepromazine-sedated dogs. Int. J. Adv. Res., 2: 336-340.

Niesters, M; Martini, C and Dahan, A (2014). Ketamine for chronic pain: risks and benefits. Br. J. Clin. Pharmacol., 77: 357-367.

Odette, O and Smith, LJ (2013). A comparison of epidural analgesia provided by bupivacaine alone, bupivacaine + morphine, or bupivacaine + dexmedetomidine for pelvic orthopedic surgery in dogs. Vet. Anaesth. Analg., 40: 527-536.

Pérez, T and Castañeda, J (2012). Pathophysiology of acute pain: cardiovascular, respiratory alterations and of other systems and organs. Rev. Cuba. Anestesiol. Reanim., 11: 19-26.

Pozzi, A; Muir, W and Trverso, F (2006). Prevention of central sensitization and pain by N-methyl-D-aspartate receptor antagonists. J. Am. Vet. Med. Assoc., 228: 53-60.

Prommer, EE (2012). Ketamine for pain: an update of uses in palliative care. J. Palliat. Med., 15: 474-483.

Ram, RP; Dass, LL and Sharma, AK (2014). Clinic-anaesthetic changes in dogs following epidural administration of ketamine and buprenorphine. Indian J. Anim. Res., 48: 182-187.

Romagnoli, N; Bektas, RN; Kutter, AP; Barbarossa, A; Roncada, P; Hartnack, S; Bettschart, WR (2017). Pharmacokinetics of ketamine and norketamine enantiomers after racemic or S-ketamine IV bolus administration in dogs during sevoflurane anaesthesia. Res. Vet. Sci. 112: 208-213.

Saritas, ZK; Saritas, TB; Pamuk, K; Korkmaz, M; Yaprakci, MV; Yilmaz, O and Demirkan, I (2015). Evaluation of preemptive dexketoprofen trometamol effect on blood chemistry, vital signs and postoperative pain in dogs undergoing ovariohysterectomy. Bratisl. Lek. Listy., 116: 191-195.

Sarotti, D; Rabozzi, R and Franci, P (2015). Comparison of epidural versus intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery. Vet. Anaesth. Analg., 42: 405-413.

Valverde, A (2008). Epidural analgesia and anesthesia in dogs and cats. Vet. Clin. Small Anim., 38: 1205-1230.

Wagner, A; Walton, J; Hellyer, P; Gaynor, J and Mama, K (2002). Use of low doses of ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs. J. Am. Vet. Med. Asoc., 221: 72-75.