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Which ketamine combination is the best?
Ketamine is used in anesthetic induction protocols in many species for many years. Especially ketamine plus diazepam and ketamine plus midazolam are widely used in dogs. Which of the 2 combinations do the authors recommend?

S(+) ketamine, one of the two enantiomers of racemic ketamine, is a phencyclidine derivative that induces amnesia and analgesia. Its activity is related to blockade of NMDA receptors and some opioid action.

We compared anesthetic induction and recovery quality with S(+) ketamine in combination with diazepam or midazolam in 10 dogs (ASA 1) admitted for elective surgery. After all clinical examinations, the dogs were separated into two groups (G I and G II). All animals received acepromazine (0.1 mg kg-1) and fentanyl (5 µg kg-1) IM, 20 minutes before induction with S(+) ketamine (6 mg kg-1) and diazepam (0.5 mg kg-1) IV (G I) or midazolam 0.2 mg kg-1 (G II) IV. The doses of diazepam and midazolam were chosen according to the literature. All dogs were intubated and then maintained with halothane in oxygen at a vaporizer setting sufficient to maintain surgical anesthesia. Quality of induction, time needed for intubation, heart rate, respiratory rate, SpO2, time to extubation, and quality of recovery were evaluated. The results were analyzed by Student`s t-test.
Smooth induction and recovery were observed in all animals. The time to intubation was 45 ± 20 (GI) and 25 ± 6 seconds (GII), HR was 122 ± 12 (GI) and 125 ± 7 beats minute-1 (GII), RR was 17 ± 2 (GI) and 21 ± 3 breaths minute-1 (GII), SpO2 was 96 ± 2 (GI) and 94 ± 1% (GII), time to extubation was 7 ± 3 (GI) and 4 ± 1 minutes (GII). No statistical differences were found in analyses, although time to intubation was less in GII.
The results suggested that both combinations could be used safely for anesthetic induction in healthy dogs.

Source: Riviera, FB, Pires, JS (2003): Comparison between S(+) ketamine–diazepam and S(+) ketamine–midazolam on anesthetic induction and recovery in dogs, In: Veterinary Anaesthesia and Analgesia Volume 30: Issue 2 p 101-101




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