Objective: To evaluate dose requirements of etomidate for endotracheal intubation, with or without midazolam co-induction, and to describe induction quality and associated cardiorespiratory variables in healthy cats.
Study design: Randomized prospective experimental study.
Animals: A group of 24 adult neutered cats (17 females, seven males).
Methods: Cats were premedicated with intramuscular butorphanol (0.4 mg kg-1) and alfaxalone (2 mg kg-1), and anesthesia was induced with etomidate following midazolam (0.3 mg kg-1) or physiologic saline (0.06 mL kg-1) intravenously. Heart rate, respiratory rate (fR) and arterial blood pressure were measured following premedication, at co-induction, after etomidate administration, and after orotracheal intubation and compared using repeated-measures anova. Pre- and post-etomidate blood samples were assessed for the presence of hemolysis. Etomidate dose requirements and prevalence of myoclonus were compared with Wilcoxon signed ranks test and Fisher's test. Values of p < 0.05 were considered significant.
Results: Mean ± standard deviation etomidate doses required for orotracheal intubation were 0.84 ± 0.26 and 1.39 ± 0.33 mg kg-1 for midazolam and saline co-induction, respectively (p = 0.001). The presence of myoclonus at sedated baseline, co-induction and etomidate was 6/12, 8/12 and 9/12 in the saline group, respectively, and 10/12, 2/12 and 0/12 in the midazolam group. The prevalence of myoclonus was lower in the midazolam group after co-induction and etomidate injection (p = 0.036 and p < 0.001, respectively). Cardiorespiratory variables did not differ between groups at any time point. Compared with baseline, fR decreased in both groups after etomidate injection and intubation. Hemolysis was observed in all post-etomidate plasma samples.
Conclusions and clinical relevance: Etomidate, with or without midazolam co-induction, provides acceptable cardiovascular function in premedicated healthy cats. Midazolam reduces etomidate requirements for orotracheal intubation and improves induction quality in cats premedicated with intramuscular butorphanol-alfaxalone.
Objective: To investigate the pharmacodynamics and pharmacokinetics of rocuronium administered by bolus injection to sevoflurane-anesthetized horses.
Study design: Prospective, experimental, crossover study.
Animals: Five healthy adult Thoroughbred horses (body mass 368-470 kg, three females and two males).
Methods: Each horse was anesthetized twice with sevoflurane and assigned to be administered rocuronium bromide intravenously: 0.2 mg kg-1 (R02) or 0.4 mg kg-1 (R04). There was a minimum 2 week washout period between experiments. During anesthesia, the peroneal nerve was stimulated (train-of-four) and neuromuscular function was assessed with acceleromyography. Plasma rocuronium concentrations were measured using liquid chromatography-tandem mass spectrometry. Pharmacodynamic and pharmacokinetic data are presented as mean ± standard deviation and were statistically compared between R02 and R04 with a Student's paired t-test. Significance was set at p < 0.05.
Results: Complete neuromuscular blockade was observed in all horses. The duration of action was significantly shorter for R02 (42.5 ± 11.2 minutes) than for R04 (67.0 ± 17.8 minutes, p = 0.003). Plasma concentrations of rocuronium showed a biphasic elimination pattern. Systemic clearance was significantly higher for R04 (2.12 ± 1.15 mL minute-1 kg-1) than for R02 (1.07 ± 0.46 mL minute-1 kg-1, p = 0.034). Mean residence time was significantly shorter for R04 (109 ± 73.1 minutes) than for R02 (183 ± 64.6 minutes, p = 0.015).
Conclusions and clinical relevance: Rocuronium induced complete neuromuscular blockade with both R02 and R04, and exhibited a dose-dependent duration of action. Significantly higher systemic clearance and shorter mean residence time for the high dose (R04) were observed compared with the low dose (R02). The prolonged clearance of rocuronium in horses contributed to its extended duration of action in this species.