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minimal cardiovascular effect and good recovery. With the increased cost of compounded
guaifenesin and unwanted muscle relaxation (authors personal experience) in recovery, the
author does not use guaifenesin in PIVA. The published dose for PIVA is 25.0 mg/kg/hour.
Opioids: Opioids are not commonly used as part of CRI during anesthesia. Morphine is
inconsistent in reducing the minimum alveolar concentration (MAC) of inhalants in horses.
Fentanyl reduces the MAC in horses to a lesser degree compared with other species. Handling of
controlled drugs, especially CIIs, is another hindrance to the widespread use of these drugs as
CRI during anesthesia. There are no published data on the use of butorphanol CRI during
anesthesia. The author has used butorphanol (0.02 mg/kg/hour) together with lidocaine and
ketamine in horses with severe pain.
Technique
After deciding on the drugs that will be used for PIVA, the next step is making the
preparation for infusion. There are three main ways of administering the drugs for CRI: (1) using
a syringe pump, (2) a fluid bag administered using an infusion pump, and (3) a fluid bag
administered by determining the drops per second or seconds between drops.
When the syringe pump is used, the drugs should be given without dilution. Calculate the
amount (mg) of the drug needed for one hour. Convert the amount of the drug from mg to ml by
dividing the amount (mg) by the concentration (mg/ml) of the drug. Add up the volume of the
drugs and the syringe pump is set up to deliver in ml/hour.
Here is a sample calculation when using a single syringe pump and more than one drug
without dilution:
Drugs: Xylazine 1.0 mg/kg/hour; ketamine 2.0 mg/kg/hour
Body weight: 500-kg horse
Total dose/hour: Xylazine 500 mg and ketamine 1000 mg
Drug concentrations: Xylazine 100 mg/ml and ketamine 100 mg/ml
Total ml per hour (Total dose/hour concentration): Xylazine 5 ml and lidocaine 10 ml
Setting on the syringe pump: 5 ml + 10 ml = 15 ml per hour
When utilizing a fluid bag for administration, the drugs will be diluted. Using an infusion
pump, the solution can be administered accurately in ml/hour. When an infusion pump is not
available, the solution will be administered by determining the rate in drops per second or the
number of seconds between drops.
Using the same drugs in the example above and utilizing an infusion pump, it is
important that the amount of drugs to be added to a bag of crystalloid fluid is known. To figure
out the amount of drugs to be added to a bag of fluids, use this formula:
Amount of drug (mg) = [CRI dose (mg/kg/hour) Fluid rate (ml/kg/hour)] x Total vol of fluid
(ml)
Sample calculation:
The total volume of fluid is the bag size = 1000 ml (can be 500 ml). Normal saline can be used.
The fluid rate has to be determined knowing the body weight of the horse and the approximate
duration of the procedure. For adult horses, use fluid rates 1 ml/kg/hour. The lower fluid rate
leads to less number of times a solution has to be prepared. For example, if the procedure is
about 3 hours and the horse weighs 500 kg. If you use 1.0 ml/kg/hour, the volume administered
is 500 ml/hour. The 1,000 ml-bag will be finished in 2 hours and another bag has to be prepared
because it is a 3-hour procedure. For this example then, use 0.5 ml/kg/hour and the 500-kg horse
will get 250 ml/hour. The 1000-ml bag will be good for more than 3 hours.
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Dose
Inhalant
used
Sevoflurane
References
Guaifenesin
Ketamine
Xylazine
25.0 mg/kg/hr
1.2 mg/kg/hr
0.3 mg/kg/hr
Guaifenesin
Ketamine
Medetomidine
24.5 mg/kg/hr
0.98 mg/kg/hr
0.0012 mg/kg/hr
Sevoflurane
Yamashita et al,
2002
Lidocaine
Isoflurane
Enderle et al,
2008
Ketamine
3.6 mg/kg/hr
Reduce rate by 65%
after 50 mins. and
stop 15 mins before
end of anesthesia
2.0 mg/kg over 10
mins; 3.0 mg/kg/hr
Isoflurane
Valverde et al,
2010
Lidocaine
Medetomidine
Lidocaine
5 g/kg
2.0 mg kg over 10
mins; 3.0 mg/kg/hr
Isoflurane
Yamashita et al,
2009
Valverde et al,
2010
References
1. Enderle AK, Levionnois OL, Kuhn M: Clinical evaluation of ketamine and lidocaine intravenous
infusions to reduce isoflurane requirements in horses under general anaesthesia. Vet Anaest Analg
2008;35:297-305
2. Valverde A, Rickey E, Sinclair M, et al: Comparison of cardiovascular function and quality of
recovery in isoflurane-anaesthetised horses administered a constant rate infusion of lidocaine or
lidocaine and medetomidine during elective surgery. Equine Vet J 2010;42:192-199
3. Yamashita K, Muir III WW, Tsubakishita S, et al: Infusion of guaifenesin, ketamine, and
medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane
alone for anesthesia in horses. J Am Vet Med Assoc 2002;221:1150-1155
4. Yamashita K, Muir III WW: Intravenous anesthetic and analgesic adjuncts to inhalation
anesthesia, in Muir WW, Hubbell JAE (eds): Equine Anesthesia Monitoring and Emergency
Therapy. Missouri, MO, Saunders Elsevier, 2009, pp 260-276
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