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OBJECTIVE To compare effects of tiletamine-zolazepam, alfaxalone, ketamine-diazepam, and propofol for anesthetic induction on cardiorespiratory and acid-base variables before and during isoflurane-maintained anesthesia in healthy dogs. ANIMALS 6 dogs. PROCEDURES Dogs were anesthetized with sevoflurane and instrumented. After dogs recovered from anesthesia, baseline values for cardiorespiratory variables and cardiac output were determined, and arterial and mixed-venous blood samples were obtained. Tiletamine-zolazepam (5 mg/kg), alfaxalone (4 mg/kg), propofol (6 mg/kg), or ketamine-diazepam (7 and 0.3 mg/kg) was administered IV in 25% increments to enable intubation. After induction (M0) and at 10, 20, 40, and 60 minutes of a light anesthetic plane maintained with isoflurane, measurements and sample collections were repeated. Cardiorespiratory and acid-base variables were compared with a repeated-measures ANOVA and post hoc t test and between time points with a pairwise Tukey test. RESULTS Mean ± SD intubation doses were 3.8 ± 0.8 mg/kg for tiletamine-zolazepam, 2.8 ± 0.3 mg/kg for alfaxalone, 6.1 ± 0.9 mg/kg and 0.26 ± 0.04 mg/kg for ketamine-diazepam, and 5.4 ± 1.1 mg/kg for propofol. Anesthetic depth was similar among regimens. At M0, heart rate increased by 94.9%, 74.7%, and 54.3% for tiletamine-zolazepam, ketamine-diazepam, and alfaxalone, respectively. Tiletamine-zolazepam caused higher oxygen delivery than propofol. Postinduction apnea occurred in 3 dogs when receiving alfaxalone. Acid-base variables remained within reference limits. CONCLUSIONS AND CLINICAL RELEVANCE In healthy dogs in which a light plane of anesthesia was maintained with isoflurane, cardiovascular and metabolic effects after induction with tiletamine-zolazepam were comparable to those after induction with alfaxalone and ketamine-diazepam.

OBJECTIVE To compare characteristics of recovery from isoflurane anesthesia in healthy nonpremedicated dogs after anesthetic induction by IV administration of tiletamine-zolazepam with those observed after induction by IV administration of alfaxalone, ketamine-diazepam, or propofol. DESIGN Prospective, randomized crossover study. ANIMALS 6 healthy adult hounds. PROCEDURES Each dog underwent the 4 treatments in random order with a ≥ 7-day washout period between anesthetic episodes. Anesthesia was induced by IV administration of the assigned induction drug or combination (each to effect in 25% increments of calculated dose) and maintained with isoflurane in oxygen for 60 minutes. Cardiorespiratory variables and end-tidal isoflurane concentration (ETISO) were measured just before isoflurane administration was discontinued. Dogs were observed and video recorded during recovery. Recovery characteristics were retrospectively scored from recordings by 3 raters. Interrater and intrarater reliability of scoring was assessed by intraclass correlation coefficient calculation. Linear and mixed ANOVAs were used to compare extubation times, recovery scores, and body temperature among treatments. RESULTS Most cardiorespiratory variables, body temperature, ETISO, and time to extubation did not differ between tiletamine-zolazepam and other induction treatments. Recovery scores were lower (indicating better recovery characteristics) with propofol or alfaxalone than with tiletamine-zolazepam but did not differ between tiletamine-zolazepam and ketamine-diazepam treatments. Anesthetic episode number and ETISO had no effect on extubation time or recovery score. Intrarater and interrater correlations for recovery scores were excellent. CONCLUSIONS AND CLINICAL RELEVANCE Recovery of healthy dogs from anesthesia with isoflurane after induction with tiletamine-zolazepam was uncomplicated and had characteristics comparable to those observed following induction with ketamine-diazepam. However, recovery characteristics were improved when anesthesia was induced with propofol or alfaxalone.

Objective To evaluate the effects of induction of anesthesia with alfaxalone in alpacas. Study design Prospective, randomized, crossover design. Animals Five healthy alpacas (96.7 ± 19.9 kg, 9.6 ± 3.1 years old). Methods The alpacas were anesthetized on three occasions with alfaxalone, propofol, or ketamine-diazepam by intravenous injection. Quality of induction and intubation was assessed using a simple descriptive scale, and quality of recovery was scored: 1 (very poor)–5 (excellent). The auricular artery was catheterized for measurement of systolic (SAP), mean (MAP), and diastolic (DAP) arterial pressures and collection of blood. Variables measured were hemoglobin oxygen saturation (SpO 2 ), respiratory rate, and end-tidal carbon dioxide partial pressure (P e ’CO 2 ), and ECG. Repeated measures anova was used to assess effects of drug and time. Significance was set at p Results Mean dose of alfaxalone sufficient to allow intubation was 2.1 mg kg −1 . Induction was excellent with all protocols. Heart rate (HR), SAP and MAP were significantly higher following alfaxalone compared to ketamine-diazepam. Blood lactate concentration when standing following alfaxalone was higher compared to minutes 1 and 6, and to propofol ( p 2 e ’CO 2 > 60 mmHg. Time from induction to standing was longer with alfaxalone (34.1 ± 3.2 minutes) than propofol (19.0 ±4.3 minutes) or ketamine-diazepam (24.9 ±1.7 minutes). Recovery quality median scores were clinically and statistically different: 2 (alfaxalone), 4 (ketamine-diazepam), and 5 (propofol). Tremors, paddling, rolling, seizure-like activity and thrashing characterized recovery from alfaxalone. Conclusion Recovery quality was worst with alfaxalone. HR, SAP, MAP were increased at minute 1 in all protocols. Transient hypercapnia and hypoxia was observed with all protocols. Clinical relevance All protocols were adequate for induction of anesthesia. Alfaxalone alone in unpremedicated alpacas is not recommended.

Objective To determine the minimum alveolar concentration (MAC) of desflurane in llamas and alpacas. Design Prospective study. Animals Six healthy adult llamas and six healthy adult alpacas. Procedure Anesthesia was induced with desflurane delivered with oxygen through a mask. An endotracheal tube was inserted, and a port for continuous measurement of end-tidal and inspired desflurane concentrations was placed between the endotracheal tube and the breathing circuit. After equilibration at an end-tidal-to-inspired desflurane concentration ratio >0.90 for 15 minutes, a 50-Hz, 80-mA electrical stimulus was applied to the antebrachium until a response was obtained (i.e. gross purposeful movement) or for up to 1 minute. The vaporizer setting was increased or decreased to effect a 10–20% change in end-tidal desflurane concentration, and equilibration and stimulus were repeated. The MAC was defined as the average of the lowest end-tidal desflurane concentration that prevented a positive response and the highest concentration that allowed a positive response. Results Mean ± SD MAC of desflurane was 7.99 ± 0.58% in llamas and 7.83 ± 0.51% in alpacas. Conclusions and clinical relevance The MAC of desflurane in llamas and alpacas was in the range of that reported for other species.

Objective—To determine the serum concentrations and sedative effects of fentanyl after transdermal administration at 3 dosages in llamas. Animals—9 healthy adult female llamas (mean age, 8 ± 3 years; mean weight, 150 ± 18 kg). Procedure—Llamas were allocated to 1 of 3 groups (3 llamas/group). Fentanyl patches (each providing transdermal delivery of 75 µg of fentanyl/h) were placed on shaved areas of the antebrachium of all llamas. In group 1, llamas were treated with 1 patch (anticipated fentanyl dosage, 75 µg/h). In group 2, llamas were treated with 2 patches (anticipated fentanyl dosage, 150 µg/h). In group 3, llamas were treated with 4 patches (anticipated fentanyl dosage, 300 µg/h). For each llama, the degree of sedation was assessed by use of a subjective scoring system and a blood sample was collected for determination of serum fentanyl concentration at 12, 24, 36, 48, 60, and 72 hours after patch placement. Results—Following the placement of 4 patches, mean ± SD serum fentanyl concentration in group 3 llamas reached 0.3 ± 0.08 ng/mL within 12 hours. This concentration was sustained for 72 hours. In group 2, application of 2 patches provided inconsistent results; in group 1, application of 1 patch rarely provided measurable serum fentanyl concentrations. No llamas became sedated at any time. Conclusions and Clinical Relevance—Results suggest that application of four 75 µg/h fentanyl patches provides consistent, sustained serum fentanyl concentrations without sedation in llamas. However, the serum concentration of fentanyl that provides analgesia in llamas is not known. (Am J Vet Res 2005;66:907–909)

Objective—To determine the minimum alveolar concentration (MAC) of sevoflurane in spontaneously breathing llamas and alpacas. Design—Prospective study. Animals—6 healthy adult llamas and 6 healthy adult alpacas. Procedure—Anesthesia was induced with sevoflurane delivered with oxygen through a mask. An endotracheal tube was inserted, and a port for continuous measurement of end-tidal and inspired sevoflurane concentrations was placed between the endotracheal tube and the breathing circuit. After equilibration at an end-tidal-to-inspired sevoflurane concentration ratio > 0.90 for 15 minutes, a 50-Hz, 80-mA electrical stimulus was applied to the antebrachium until a response was obtained (ie, gross purposeful movement) or for up to 1 minute. The vaporizer setting was increased or decreased to effect a 10 to 20% change in end-tidal sevoflurane concentration, and equilibration and stimulus were repeated. The MAC was defined as the mean of the lowest end-tidal sevoflurane concentration that prevented a positive response and the highest concentration that allowed a positive response. Results—Mean ± SD MAC of sevoflurane was 2.29 ± 0.14% in llamas and 2.33 ± 0.09% in alpacas. Conclusions and Clinical Relevance—The MAC of sevoflurane in llamas and alpacas was similar to that reported for other species. (J Am Vet Med Assoc 2003;223:1167–1169)

Objective To directly compare the time to onset and duration of analgesia produced by a lidocaine/xylazine combination with that produced by lidocaine and xylazine administered alone in the caudal epidural space of dairy cattle. Design Prospective randomized experimental study. Animals Nine adult (> 4 years of age) dairy cows (520–613 kg). Methods Caudal epidural analgesia was produced in all cows with 2% lidocaine (0.22 mg kg −1 ; 5.5 mL 500 kg −1 ), 10% xylazine (0.05 mg kg −1 diluted to 5.5 mL 500 kg −1 with sterile water), and 2% lidocaine/10% xylazine (0.22 mg kg −1 /0.05 mg kg −1 ; total volume of 5.7 mL 500 kg −1 ), at no earlier than weekly intervals in a Latin square design. Time to onset, duration and cranial spread of analgesia were recorded, as were degree of sedation, ataxia and ptyalism. Results No significant difference ( p > 0.05) was noted for time (mean ± SEM) of onset of analgesia between lidocaine (4.8 ± 1.0 minutes) and the lidocaine/xylazine combination (5.1 ± 0.9 minutes) but onset of analgesia following xylazine was significantly longer (11.7 ± 1.0 minutes) than either of the other two treatments. Lidocaine/xylazine (302.8 ± 11.0 minutes) produced analgesia of significantly longer duration than that of xylazine (252.9 ± 18.9 minutes) and both the lidocaine/xylazine combination and xylazine alone produced analgesia of significantly longer duration than that produced by lidocaine (81.8 ± 11.8 minutes). In all cattle, xylazine, administered either alone or with lidocaine, induced mild to moderate sedation and ataxia and cutaneous analgesia from the coccyx to T13. Mild ataxia was also present in those cattle receiving lidocaine alone. Conclusion The combination of xylazine and lidocaine produces analgesia of quicker onset and longer duration than xylazine administered alone and of longer duration than lidocaine administered alone. Clinical relevance Utilizing this combination, long–duration obstetrical and surgical procedures could commence relatively soon after epidural injection and could be completed without re–administration of anesthetic agents.

Ketamine is a rapid acting, potent, nonspecific, noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist commonly used for inducing general anesthesia and for providing post-operative pain management and may possibly lessen the need for other potentially harmful or contraindicated analgesics in camelids, such as nonsteroidal anti-inflammatory drugs. Prior to determining the effectiveness of CRI ketamine for analgesia, a safe, sub-anesthetic dose was established that did not produce untoward side effects, sedation or alter normal behavior. Six healthy male alpacas (40–90 kg) were used for the trial and each acted as its own control. Each alpaca was randomly assigned to receive ketamine at 20 and 40 μg kg–1 minute–1 in 500 mL saline. A blinded observer recorded heart rate, respiratory rate, and body temperature hourly, and behavior for 8 hours. There was a 72-hour washout period between each dosing regime. An equal volume saline CRI without ketamine was used as a control. Each alpaca was allowed a one-week washout prior to being anesthetized with isoflurane using mask induction. After achieving a stable plane of anesthesia, the MAC value for isoflurane was determined. Ketamine was infused at 40 μg kg–1pre-existing pain is unknown, but for elective procedures, preemptive analgesia using ketamine CRI in alpacas may be beneficial.

The efficacy of eliminating parotid salivary secretions by retrograde infusion of 10% formalin, 2% chlorhexidine, or 2% or 3% silver nitrate solutions was evaluated in 10 horses. Solutions were kept within the parotid salivary gland for 90 seconds after infusion through parotid duct cannulae and then allowed to drain freely. Severed parotid ducts and surgical incisions were left to heal by second intention. All agents eliminated glandular secretions. There was less necrosis and suppurative inflammation after formalin infusion than after chlorhexidine and silver nitrate. Silver nitrate (2% and 3%) caused the most necrosis and inflammation.

In conclusion, monitoring the depth of anesthesia plays an integral role in the anesthetic regimen. Although the use of sophisticated monitoring equipment has replaced some of the art of anesthesia and made assessment of depth of anesthesia more precise, a vigilant clinician still needs to serve as the animal's advocate. He or she must gather the data that are generated by machines, acquire data that monitoring equipment cannot obtain, assimilate all the facts, and make appropriate changes in anesthetic management.

Anesthesia for llamas is similar to other domestic species, although adjustments in technique are required to allow for species variations. Xylazine (0.4-0.6 mg/kg) is well tolerated for sedation. The thiobarbiturates (8-10 mg/kg), ketamine (2.5-5.0 mg/kg), or combinations of guaifenesin and thiobarbiturates or guaifenesin and ketamine (to effect) can be used for induction of anesthesia. In juvenile or debilitated animals, anesthesia can be induced with halothane or isoflurane administered by mask. After tracheal intubation, anesthesia can be maintained with the inhalation agents, usually halothane or isoflurane. Supportive therapy and many anesthetic monitoring techniques used in domestic animals can be used in llamas. While under marginal planes of anesthesia, llamas can have more active physiologic responses to pain, including bradycardia and vasoconstriction, than domestic animals. Llamas are more prone to airway obstruction after tracheal extubation than domestic ruminants but otherwise recover as well from general anesthesia as domestic ruminants.