评估芬太尼、利多卡因、氯胺酮、右美托咪定或利多卡因-氯胺酮-右美托咪定联合用药在犬卵巢子宫切除术中对异氟烷的节省作用。

Evaluation of the isoflurane-sparing effects of fentanyl, lidocaine, ketamine, dexmedetomidine, or the combination lidocaine-ketamine-dexmedetomidine during ovariohysterectomy in dogs.

作者信息

Gutierrez-Blanco Eduardo, Victoria-Mora José M, Ibancovichi-Camarillo Jose A, Sauri-Arceo Carlos H, Bolio-González Manuel E, Acevedo-Arcique Carlos M, Marin-Cano Gabriela, Steagall Paulo V M

机构信息

Department of Animal Health and Preventive Medicine, Faculty of Veterinary Medicine, Yucatan Autonomous University, Merida, Mexico; Department of Veterinary Anesthesiology, Faculty of Veterinary Medicine, Mexico State Autonomous University, Toluca, Mexico.

出版信息

Vet Anaesth Analg. 2013 Nov;40(6):599-609. doi: 10.1111/vaa.12079. Epub 2013 Aug 2.

OBJECTIVE

To evaluate the isoflurane-sparing effects of an intravenous (IV) constant rate infusion (CRI) of fentanyl, lidocaine, ketamine, dexmedetomidine, or lidocaine-ketamine-dexmedetomidine (LKD) in dogs undergoing ovariohysterectomy.

STUDY DESIGN

Randomized, prospective, blinded, clinical study.

ANIMALS

Fifty four dogs.

METHODS

Anesthesia was induced with propofol and maintained with isoflurane with one of the following IV treatments: butorphanol/saline (butorphanol 0.4 mg kg(-1), saline 0.9% CRI, CONTROL/BUT); fentanyl (5 μg kg(-1), 10 μg kg(-1) hour(-1), FENT); ketamine (1 mg kg(-1), 40 μg kg(-1) minute(-1), KET), lidocaine (2 mg kg(-1), 100 μg kg(-1) minute(-1), LIDO); dexmedetomidine (1 μg kg(-1), 3 μg kg(-1) hour(-1), DEX); or a LKD combination. Positive pressure ventilation maintained eucapnia. An anesthetist unaware of treatment and end-tidal isoflurane concentration (Fe'Iso) adjusted vaporizer settings to maintain surgical anesthetic depth. Cardiopulmonary variables and Fe'Iso concentrations were monitored. Data were analyzed using anova (p < 0.05).

RESULTS

At most time points, heart rate (HR) was lower in FENT than in other groups, except for DEX and LKD. Mean arterial blood pressure (MAP) was lower in FENT and CONTROL/BUT than in DEX. Overall mean ± SD Fe'Iso and % reduced isoflurane requirements were 1.01 ± 0.31/41.6% (range, 0.75 ± 0.31/56.6% to 1.12 ± 0.80/35.3%, FENT), 1.37 ± 0.19/20.8% (1.23 ± 0.14/28.9% to 1.51 ± 0.22/12.7%, KET), 1.34 ± 0.19/22.5% (1.24 ± 0.19/28.3% to 1.44 ± 0.21/16.8%, LIDO), 1.30 ± 0.28/24.8% (1.16 ± 0.18/32.9% to 1.43 ± 0.32/17.3%, DEX), 0.95 ± 0.19/54.9% (0.7 ± 0.16/59.5% to 1.12 ± 0.16/35.3%, LKD) and 1.73 ± 0.18/0.0% (1.64 ± 0.21 to 1.82 ± 0.14, CONTROL/BUT) during surgery. FENT and LKD significantly reduced Fe'Iso.

CONCLUSIONS AND CLINICAL RELEVANCE

At the doses administered, FENT and LKD had greater isoflurane-sparing effect than LIDO, KET or CONTROL/BUT, but not at all times. Low HR during FENT may limit improvement in MAP expected with reduced Fe'Iso.

目的

评估静脉持续输注（CRI）芬太尼、利多卡因、氯胺酮、右美托咪定或利多卡因 - 氯胺酮 - 右美托咪定（LKD）对接受卵巢子宫切除术的犬的异氟烷节省效应。

研究设计

随机、前瞻性、盲法临床研究。

动物

54只犬。

方法

用丙泊酚诱导麻醉，并用异氟烷维持麻醉，同时给予以下静脉治疗之一：布托啡诺/生理盐水（布托啡诺0.4 mg kg⁻¹，0.9%生理盐水CRI，对照组/布托啡诺）；芬太尼（5 μg kg⁻¹，10 μg kg⁻¹小时⁻¹，芬太尼组）；氯胺酮（1 mg kg⁻¹，40 μg kg⁻¹分钟⁻¹，氯胺酮组），利多卡因（2 mg kg⁻¹，100 μg kg⁻¹分钟⁻¹，利多卡因组）；右美托咪定（1 μg kg⁻¹，3 μg kg⁻¹小时⁻¹，右美托咪定组）；或LKD组合。通过正压通气维持正常碳酸血症。一名不知道治疗情况的麻醉师根据呼气末异氟烷浓度（Fe'Iso）调整蒸发器设置以维持手术麻醉深度。监测心肺变量和Fe'Iso浓度。使用方差分析（p < 0.05）分析数据。

结果

在大多数时间点，芬太尼组的心率（HR）低于其他组，但右美托咪定组和LKD组除外。芬太尼组和对照组/布托啡诺组的平均动脉血压（MAP）低于右美托咪定组。手术期间，总体平均±标准差Fe'Iso和异氟烷需求降低百分比分别为：芬太尼组1.01±0.31/41.6%（范围，0.75±0.31/56.6%至1.12±0.80/35.3%），氯胺酮组1.37±0.19/20.8%（1.23±0.14/28.9%至1.51±0.22/12.7%），利多卡因组1.34±0.19/22.5%（1.24±0.19/28.3%至1.44±0.21/16.8%），右美托咪定组1.30±0.28/24.8%（1.16±0.18/32.9%至1.43±0.32/17.3%），LKD组0.95±0.19/54.9%（0.7±0.16/59.5%至1.12±0.16/35.3%），对照组/布托啡诺组1.73±0.18/0.0%（1.64±0.21至1.82±0.14）。芬太尼组和LKD组显著降低了Fe'Iso。

结论及临床意义

在所给剂量下，芬太尼组和LKD组比利多卡因组、氯胺酮组或对照组/布托啡诺组具有更大的异氟烷节省效应，但并非在所有时间。芬太尼组HR较低可能会限制随着Fe'Iso降低预期的MAP改善。