There is an erratum to this paper published in Veterinary Evidence Vol 7, Issue 2 (2022): https://doi.org/10.18849/ve.v7i2.588
In horses undergoing volatile anaesthesia with isoflurane or sevoflurane, does administration of an alpha-2 agonist as a CRI compared to anaesthetic maintenance with volatile alone improve recovery quality?
Clinical bottom line
Category of research question
The number and type of study designs reviewed
Eight papers were critically appraised. All prospective, randomised clinical trials. 7/8 papers were blinded and 4/8 were crossover design
Strength of evidence
One paper investigating detomidine and one on romifidine showed no improvement in recovery quality. 3/3 medetomidine papers and 2/3 dexmedetomidine papers showed a significant improvement in recovery quality in the alpha-2 agonist CRI group
In a healthy horse undergoing general anaesthesia with isoflurane or sevoflurane maintenance, an intra-operative constant rate of infusion (CRI) of medetomidine and dexmedetomidine can lead to better recovery quality when compared to horses who are maintained on isoflurane or sevoflurane alone
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
Bidwell, L.A., Bramlage, L.R. & Rood, W.A. (2007). Equine perioperative fatalities associated with general anaesthesia at a private practice--a retrospective case series. Veterinary Anaesthesia and Analgesia. 34(1), 23–30. DOI: http://dx.doi.org/10.1111/j.1467-2995.2005.00283.x
Creighton, C.M., Lemke, K.A., Lamont, L.A., Horney, B.S. & Doyle, A.J. (2012). Comparison of the effects of xylazine bolus versus medetomidine constant rate infusion on the stress response, urine production, and anesthetic recovery characteristics in horses anesthetized with isoflurane. Journal of the American Veterinary Medical Association. 240(8), 998–1002. DOI: http://dx.doi.org/10.2460/javma.240.8.998
Devisscher, L., Schauvliege, S., Dewulf, J. & Gasthuys, F. (2010). Romifidine as a constant rate infusion in isoflurane anaesthetized horses: a clinical study. Veterinary Anaesthesia and Analgesia. 37(5), 425–433. DOI: http://dx.doi.org/10.1111/j.1467-2995.2010.00556.x
Dugdale, A.H.A., Obhrai, J. & Cripps, P.J. (2016). Twenty years later: a single-centre, repeat retrospective analysis of equine perioperative mortality and investigation of recovery quality. Veterinary Anaesthesia and Analgesia. 43(2), 171–178. DOI: http://dx.doi.org/10.1111/vaa.12285
Gozalo-Marcilla, M., Hopster, K., Gasthuys, F., Hatz, L., Krajewski, A.E. & Schauvliege, S. (2013). Effects of a constant-rate infusion of dexemedtomidine on the minimal alveolar concentration of sevoflurane in ponies. Equine Veterinary Journal. 45(2), 204–208. DOI: https://doi.org/10.1111/j.2042-3306.2012.00613.x
Johnston, G.M., Eastment, J.K., Wood, J.L.N. & Taylor, P.M. (2002). The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of phases 1 and 2. Veterinary Anaesthesia and Analgesia. 29(4), 159–170. DOI: http://dx.doi.org/10.1046/j.1467-2995.2002.00106.x
Kempchen, S., Kuhn, M., Spadavecchia, C. & Levionnois, O.L. (2012). Medetomidine continuous rate infusion in horses which surgical anaesthesia is maintained with isoflurane and intravenous infusions of lidocaine and ketamine. Veterinary Anaesthesia and Analgesia. 39(3), 245–255. DOI: http://dx.doi.org/10.1111/j.1467-2995.2011.00701.x
Marcilla, M.G., Schauvliege, S., Duchateau, L. & Gasthuys, F. (2010). Cardiopulmonary effects of two constant rate infusions of dexmedetomidine in isoflurane anesthetized ponies. Veterinary Anaesthesia and Analgesia. 37(4), 311–321. DOI: https://doi.org/10.1111/j.1467-2995.2010.00537.x
Marcilla, M.G., Schauvliege, S., Segaert, S., Duchateau, L. & Gasthuys, F. (2012). Influence of a constant rate infusion of dexmedetomidine on cardiopulmonary function and recovery quality in isoflurane anaesthetized horses. Veterinary Anaesthesia and Analgesia. 39(1), 49–58. DOI: http://dx.doi.org/10.1111/j.1467-2995.2011.00672.x
Platt, J.P., Simon, B.T., Coleman, M., Martinez, E.A., Lepiz, M.A. & Watts, A.E. (2017). The effects of multiple anaesthetic episodes on equine recovery quality. Equine Veterinary Journal. 50(1), 111–116. DOI: http://dx.doi.org/10.1111/evj.12728
Ringer, S. K., Kalchofner, K., Boller, J. & Fürst, A. (2007). A clinical comparison of two anaesthetic protocols using lidocaine or medetomidine in horses. Veterinary Anaesthesia and Analgesia. 34(4), 257–268. DOI: http://dx.doi.org/10.1111/j.1467-2995.2006.00321.x
Risberg, A.I., Ranheim, B., Krontveit, R.I., Lervik, A. & Haga, H.A. (2016). The cardiovascular status of isoflurane-anaesthetized horses with and without dexmedetomidine constant rate infusion evaluated at equivalent depths of anaesthesia. Veterinary Anaesthesia and Analgesia. 43(4), 412–423. DOI: http://dx.doi.org/10.1111/vaa.12315
Sacks, M., Ringer, S.K., Bischofberger, A.S., Berchtold, S.M. & Bettschart-Wolfensberger, R. (2017). Clinical comparison of dexmedetomidine and medetomidine for isoflurane balanced anaesthesia in horses. Veterinary Anaesthesia and Analgesia. 44(5), 1128–1138. DOI: http://dx.doi.org/10.1016/j.vaa.2016.12.061
Santos, M., Fuente, M., Carcia-Iturralde, P., Herran, R., Lopez-Sanroman, J. & Tendillo, F.J. (2003). Effects of alpha-2 adrenoceptor agonists during recovery from isoflurane anaesthesia in horses. Equine Veterinary Journal. 35(2), 170–175. DOI: http://dx.doi.org/10.2746/042516403776114117
Schauvliege, S., Marcilla, M.G., Verryken, K., Duchateau, L., Devisscher, L. & Gasthuys, F. (2011). Effects of a constant rate infusion of detomidine on cardiovascular function, isoflurane requirements and recovery quality in horses. Veterinary Anaesthesia and Analgesia. 38(6), 544–554. DOI: http://dx.doi.org/10.1111/j.1467-2995.2011.00659.x
Simeonova, G.P., Dinev, D.N. & Sleiman, M.U. (2017). Comparative Study on Sevoflurane Anesthesia Alone and Combined with Partial Intravenous Anesthesia using Dexmedetomidine in Healthy Horses. Pakistan Veterinary Journal. 37(2), 155–159.
Tokushige, H., Ohta, M., Okano, A., Kuroda, T., Kakizaki, M., Ode, H., Aoki, M., Wakuno, A. & Kawasaki, K. (2015). Effects of Medetomidine Constant Rate Infusion on Sevoflurane Requirement, Cardiopulmonary Function, and Recovery Quality in Thoroughbred Racehorses Undergoing Arthroscopic Surgery. Journal of Equine Veterinary Science. 35(1), 83–87. DOI: http://dx.doi.org/10.1016/j.jevs.2014.11.004
Valverde, A., Rickey, E., Sinclair, M., Rioja, E., Pedernera, J., Hathway, A. & Cruz, A. (2010). Comparison of cardiovascular function and quality of recovery in isoflurane-anaesthetised horses administered a constant rate infusion of lidocaine or lidocaine and medetomidine during elective surgery. Equine Veterinary Journal. 42(3), 192–199. DOI: https://doi.org/10.1111/j.2042-3306.2010.00027.x
Valverde, A., Black, B., Cribb, N.C., Hathaway, A. & Daw, A. (2013). Assessment of unassisted recovery from repeated general isoflurane anesthesia in horses following post-anesthetic administration of xylazine or acepromazine or a combination of xylazine and ketamine. Veterinary Anaesthesia and Analgesia. 40(1), 3–12. DOI: https://doi.org/10.1111/j.1467-2995.2012.00782.x
Vetoratto, E., Chase-Topping, M.E. & Clutton, R.E. (2010). A comparison of four systems for scoring recovery quality after general anaesthesia in horses. Equine Veterinary Journal. 42(5), 400–406. DOI: https://doi.org/10.1111/j.2042-3306.2010.00093.x
Young, S.S. & Taylor, P.M. (1993). Factors influencing the outcome of equine anaesthesia: a review of 1,314 cases. Equine Veterinary Journal. 25(2), 147–151. DOI: https://doi.org/10.1111/j.2042-3306.1993.tb02926.x
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- Alison Bennell, Erratum to: In horses undergoing volatile anaesthesia, does intraoperative alpha-2-agonist infusion improve recovery? , Veterinary Evidence: Vol. 7 No. 2 (2022): The second issue of 2022