Effects of the morphine-lidocaine-ketamine combination on cardiopulmonary function and isoflurane sparing in sheep

Abstract

The aims of this study were to evaluate the isoflurane sparing and clinical effects of a constant rate infusion of morphine -lidocaine -ketamine (MLK) in healthy sheep undergoing experimental gastrointestinal surgery. Twelve adult female sheep (Texel breed) were used, weighing 36.5 ± 8.1 kg. The sheep were anesthetized for the implantation of duodenal cannulas. The sheep were premedicated with 0.3 mg kg -1 intramuscular (IM) morphine and 20 µg kg -1 intravenous (IV) detomidine. After premedication, anesthesia was induced using 5 mg kg -1 ketamine and 0.5 mg kg -1 diazepam IV and maintained using isoflurane in 100% oxygen. After the induction of anesthesia, the animals were allocated into two groups (each n=6); the GMLK (MLK group -10 mg morphine, 150 mg lidocaine, 30 mg de ketamine were added in 500 mL saline) received a 10 mL kg -1 h -1 MLK infusion during the maintenance of anesthesia, and GCON (control group) received 10 mL kg -1 h -1 of 0.9% sodium chloride. The animals were mechanically ventilated. Cardiopulmonary variables and end-tidal isoflurane concentration (FE´Iso) were measured at baseline (immediately before the surgery) and 15, 30 and 45 minutes after initiation of surgery. In GMLK, there was a decrease in the FE´Iso at 15, 30 and 45 minutes, a reduction of up to 75.6% during the surgery. The HR was lower in GMLK compared with GCON at 30 minutes, and the MAP was at during baseline in GCON compared with GMLK. The standing time was less in GMLK than in GCON. The use of intravenous MLK was demonstrated to offer great efficiency as part of a balanced anesthesia protocol in sheep, with a 75.6% reduction in the need for isoflurane, providing stability of the cardiovascular parameters and blood gases with a shortened recovery period. Key words: Sheep, morphine, lidocaine, ketamine, isoflurane ResumoOs objetivos deste estudo foram avaliar a redução na concentração expirada de isoflurano, bem como os efeitos clínicos de uma infusão constante de morfina -lidocaína -cetamina (MLK) em ovinos saudáveis submetidos a cirurgia gastrointestinal experimental. Foram utilizados doze ovinos adultos da raça Texel, fêmeas, pesando 36,5 ± 8,1 kg. Os animais foram anestesiados para implantação de cânulas no duodeno, sendo pré-medicados com morfina 0,3 mg kg -1 , pela via intramuscular (IM), e detomidina 20 ug kg -1 pela via intravenosa (IV). Após a pré-medicação, a anestesia foi induzida com cetamina 5 mg kg -1 e diazepam 0,5 mg kg -1 IV, sendo mantidos com isoflurano em oxigênio a 100%. Após a indução da anestesia os animais foram divididos em dois grupos (n = 6): GMLK (grupo MLK -10 mg de morfina, 150 mg de lidocaína e 30 mg de cetamina foram adicionados em 500 ml de solução salina) que recebeu infusão contínua de MLK na taxa de 10 mL kg

Analgesia for Sheep in Commercial Production: Where to Next?

“…In human surgery, a patient may receive: pre-operative NSAID, pre-anaesthetic opioid and benzodiazepine; general anaesthesia induced using an injectable agent and maintained using a combination of inhalational agents (e.g., isoflurane plus nitrous oxide); intraoperative regional anaesthesia via an epidural spinal block or peripheral nerve block; intraoperative local anaesthesia, or application of another analgesic agent at the surgical site; post-operative analgesia using opioids and/or NSAIDs. The use of multiple analgesic approaches in this case both improves the overall post-operative pain levels for the patient and reduces the dose of each agent required, thus reducing the risk of toxicity [ 475 , 476 , 477 , 478 ]. Although this level of multi-modal analgesia is achievable and to be recommended for livestock undergoing surgery in a biomedical research context, it would be both practically and economically unachievable in routine livestock production.…”

Lidocaína Intravenosa Como Alternativa Analgésica Em Ovino: Estudo De Caso

“…A administração intravenosa da lidocaína no período perioperatório sucede alívio da dor pós-cirúrgica e redução no consumo de opiodes (VENTHAM et al 2015). No intra-operatório, o uso intravenoso guarda evidências na redução do consumo de anestésicos inalatórios e opioides na espécie canina (ORTEGA & CRUZ, 2011;MATSUBARA et al, 2009), na espécie equina (NANNARONE et al, 2015) e em bezerros (ARAUJO et al, 2014), bem como em caprinos anestesiados com isofluorano, quando associada à cetamina (DOHERTY et al, 2007) e em ovelhas, quando associada à morfina e à cetamina (BEIER et al 2014).…”