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持续输注美托咪定和吗啡对马站立式腹腔镜检查镇静时行为和心肺功能的影响

Behavioural and cardiorespiratory effects of a constant rate infusion of medetomidine and morphine for sedation during standing laparoscopy in horses.

作者信息

Solano A M, Valverde A, Desrochers A, Nykamp S, Boure L P

机构信息

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario N1G 2W1, Canada.

出版信息

Equine Vet J. 2009 Feb;41(2):153-9. doi: 10.2746/042516408x342984.

Abstract

REASONS FOR PERFORMING STUDY

Standing surgical procedures are performed commonly in horses under sedation. This approach minimises the morbidity/mortality risks associated with general anaesthesia. The use of a medetomidine and morphine combination has not been investigated in horses despite the usefulness of each drug individually.

OBJECTIVE

To determine the efficacy of a medetomidine and morphine combination to produce standing sedation with minimal cardiorespiratory changes and adequate analgesia for exploratory laparascopy in mature horses.

HYPOTHESIS

The combination of medetomidine and morphine will induce reliable sedation with minimal cardiorespiratory changes.

METHODS

Medetomidine (5 microg/kg bwt i.v.) followed in 10 min by morphine (50 microg/kg bwt i.v.) and 10 min later by a constant rate infusion (CRI) of medetomidine and morphine (5 and 30 microg/kg bwt/h, respectively) was administered in 7 horses undergoing standing exploratory laparoscopy. Quality of sedation and cardiorespiratory function were assessed.

RESULTS

Sedation was satisfactory after the medetomidine and morphine bolus. The CRI of both drugs enhanced sedation and ataxia. Mean visual analogue scores on a scale of 10 varied between 7.8 and 8.8 and were similar between anaesthesiologists and surgeons. Heart rate, respiratory rate and packed cell volume (PCV) decreased significantly after medetomidine and, at some periods, during the CRI. Blood pressure only increased significantly at 5 min and arterial O2 decreased significantly at 10 min post medetomidine. PCV remained significantly lower and total protein decreased post morphine and CRI administration. Arterial CO2 increased towards the end of the CRI. Cardiac output did not change significantly over time.

CONCLUSION AND CLINICAL RELEVANCE

The combination of medetomidine and morphine results in reliable sedation and stable cardiorespiratory function in horses undergoing exploratory laparascopy.

摘要

开展本研究的原因

站立式外科手术通常在给马匹使用镇静剂的情况下进行。这种方法可将与全身麻醉相关的发病/死亡风险降至最低。尽管美托咪定和吗啡各自都有一定作用,但尚未对两者联合使用在马匹中的情况进行研究。

目的

确定美托咪定和吗啡联合使用在成年马匹中产生站立镇静效果的有效性,同时使心肺变化最小,并为探索性腹腔镜检查提供充分镇痛。

假设

美托咪定和吗啡联合使用将诱导出可靠的镇静效果,且心肺变化最小。

方法

对7匹接受站立式探索性腹腔镜检查的马匹,先静脉注射美托咪定(5微克/千克体重),10分钟后静脉注射吗啡(50微克/千克体重),再过10分钟后开始持续输注(CRI)美托咪定和吗啡(分别为5和30微克/千克体重/小时)。评估镇静质量和心肺功能。

结果

注射美托咪定和吗啡推注后镇静效果令人满意。两种药物的持续输注增强了镇静和共济失调。以10分为量表的平均视觉模拟评分在7.8至8.8之间变化,麻醉医生和外科医生的评分相似。注射美托咪定后心率、呼吸频率和红细胞压积(PCV)显著下降,在某些时间段,持续输注期间也有下降。注射美托咪定后5分钟血压仅显著升高,10分钟时动脉血氧显著下降。注射吗啡和持续输注后,红细胞压积仍显著降低,总蛋白下降。持续输注接近尾声时动脉二氧化碳升高。心输出量随时间无显著变化。

结论及临床意义

美托咪定和吗啡联合使用可使接受探索性腹腔镜检查的马匹产生可靠镇静效果和稳定的心肺功能。

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