ANESTHETIC EFFECTS OF KETAMINE-MEDETOMIDINE-

HYDROMORPHONE IN DOGS AS PART OF A HIGH-VOLUME

STERILIZATION PROGRAM IN BELIZE
SYLVESTRE-ROBERGE F1, MONTEIRO B2,3, SIMARD MJ4, STEAGALL PV2,3
1Hôpital
Vétérinaire des Laurentides, Québec, QC.
2Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal
3Groupe de recherche en pharmacologie animale du Québec, Département de biomédecine vétérinaire, Université de Montréal
4Fondation Aide Vétérinaire Internationale, Beloeil, QC.

INTRODUCTION Table 1. Chart used for the calculation of total anesthetic volume of the “Doggy magic”.
Anesthesia for high-volume sterilization programs presents unique The patient’s body weight (kg) is represented in bold whereas the respective volume of
administration (mL) is in italics.†
challenges. Injectable anesthesia is often used, however limited information
1 0.12 3 0.40 5 0.68 7 0.95 12-13 1.5 21-23 2.3
is available on the prevalence of adverse effects.
1.5 0.17 3.5 0.46 5.5 0.74 7.5-8.0 1.0 14-15 1.7 24-25 2.5
The aim of this study was to describe the anesthetic effects of an injectable
2 0.25 4 0.52 6 0.80 8.5-9.5 1.2 16-17 2.0 26-27 2.7
anesthetic protocol in dogs included in a high-volume sterilization
program in Belize. 2.5 0.34 4.5 0.61 6.5 0.89 10-11 1.3 18-20 2.2
†The "Doggy magic" mixture has a total volume of 9.9 mL including 3.3 mL of ketamine (100
The hypothesis was that this protocol would offer effective anesthesia with mg/mL), 3.3 mL of medetomidine (1 mg/mL), 0.66 mL of hydromorphone (10 mg/mL) and
low prevalence of adverse effects in this specific context. 2.64 mL of sterile saline.

MATERIAL & METHODS RESULTS

Ethics committee protocol number: 18-Rech-1920
Study design: Prospective, cohort study
Animals: Thirty-five client-owned, free-ranging dogs (8 males and 27
females; 13.7 ± 7.6 kg; ≥ 8 weeks-old) from two mobile clinics in rural Belize
were included. Dogs could be pregnant or in estrus.
Anesthesia and surgery: A volume-based protocol entitled “Doggy magic”
was administered using a pre-established chart according to the patient’s
body weight (Table 1). Dogs received approximately 4.5 mg/kg of ketamine,
0.04 mg/kg of medetomidine and 0.09 mg/kg of hydromorphone IM.
Anesthetic monitoring: Following physical examination and anesthetic
induction, dogs were intubated with a cuffed endotracheal tube and
allowed spontaneous breathing in room air. Monitoring included SpO2,
MAP, SAP, DAP, HR, fR, rectal body temperature and FE’CO2. Meloxicam
(0.2 mg/kg SC) was administered at the end of surgery. Adverse effects
were monitored throughout the procedure (Figure 1a,b,c,d).
Pain assessment: The Glasgow canine pain score (CMPS)1 was used for the
assessment of postoperative pain up to 4 hours after the end of surgery.
Statistical analysis: Data were analyzed with linear models and chi-square
tests (p < 0.05).
Rapid onset of lateral recumbency (3.2 ± 1.9 minutes) was recorded.
Four dogs required additional administration of anesthetics during
surgery.
Return of swallowing reflex and time to standing were 71.9 ± 23.6 and
152.8 ± 52.3 minutes after injection, respectively.
Return of swallowing reflex was significantly longer in heavier dogs.
Mean ± SD were 110 ± 18 mmHg for MAP, 85 ± 19 bpm for HR and 19 ± 8
rpm for RR throughout the procedure.
Hypoxemia (SpO2 < 90%)2 was observed at least once in 65.7% of dogs
and was significantly more frequent in heavier dogs.
Hypoventilation (FE’CO2 ≥ 50 mmHg)2 was observed in 45.7% of dogs.
Hypertension (MAP ≥ 120 mmHg)2, bradycardia (HR ≤ 60 bpm),
tachycardia (HR ≥ 140 bpm) and hypothermia (≤ 36.5°C)3 were observed
in 40%, 14%, 2% and 2%, respectively.
Sex was not significantly associated with any complication.
Mean CMPS scores were 2.7 ± 2.1. Four dogs (11.8%) had scores ≥ 6. It is
not known if they were actually painful or if scores were influenced by
demeanor and/or residual anesthetic effects.

FIGURES CONCLUSIONS
The combination of ketamine, medetomidine and hydromorphone was
effective for the majority of dogs undergoing sterilization.
Hypoventilation, hypoxemia and prolonged recovery were commonly
observed.
Oxygen supplementation, assisted ventilation, intraperitoneal and
intratesticular blocks and drug antagonism should be considered as part
of high-volume sterilization programs using similar anesthetic protocols.
Further studies are warranted to assess perioperative pain management
using injectable anesthesia.

ACKNOWLEDGMENTS
The authors would like to thank the Fondation Aide
Vétérinaire Internationale for their support

REFERENCES
1. Reid J, Nolan AM, Hughes JML, et al. Development of the short-form Glasgow Composite Measure Pain Scale
Figure 1. Anesthesia in a high-volume sterilization program in Belize. (CMPS-SF) and derivation of an analgesic intervention score. Animal Welfare 2007; 16:97-104.
a. Anesthetic monitoring used in the study 2. Ramos RV, Monteiro-Steagall BP, Steagall PV. Management and complications of anaesthesia during balloon
b. Set-up for anesthesia and surgery valvuloplasty for pulmonic stenosis in dogs: 39 cases (2000 to 2012). Journal of Small Animal Practice 2014; 55:207–212
c. A dog is undergoing general anesthesia for ovariohysterectomy 3. Redondo JI, Suesta P, Serra I, et al. Retrospective study of the prevalence of postanaesthetic hypothermia in dogs.
Veterinary Record 2012; 171:374
d. Anesthetic recovery in dogs