Dissociative anesthetics, especially ketamine, are widely used in veterinary medicine because they are very versatile . However, they are often used incorrectly and this raises a lot of doubt about what can or cannot be done in the patient under this anesthesia. Let's ask some common questions about dissociative anesthesia.
Hello Nave crew, how are you? I'm Adriano Carregaro, from NAVE. vet.
br and in this video we are going to answer three questions about dissociative anesthesia. and I would like to take this opportunity to thank Fernando Murta, Filipa P and Salgado Louro for posting these doubts, ok? and in this video we will have a special participation, check it out?
And if you haven't subscribed to the nave channel, do it there now to always know when there's a new video on the channel, ok? so go there. The first question was asked by Fernando Murta Professor, I would like to know your opinion about the infamous "Ketapum".
even though many anesthesiologists hate this combination , it is still used a lot because of its practicality and safety . So what do you say? "Ketapum" is anesthesia?
and if combined with some block or more elaborate analgesic protocol, do you think there is a feasibility do you think there is a greater feasibility for more invasive surgeries in places with little support? (wild, farms or small towns)? Hi Fernando, come on.
taí. . .
infamous. . .
the guy spared me a curse. I liked that adjective. So, let's go there just to guide everyone on this subject the infamous "ketapum" was the name formerly for the combination between ketamine that the correct name is ketamine and xylazine that was formerly only sold under the trade name of Rompun.
oh the jabá there. . .
Well, now let's go by parts, there Jack No, no. . .
it's Jack the Ripper. Well, part one: Is it anesthesia? IT IS!
By definition it is anesthesia. It is dissociative anesthesia. it is of poor quality even when dealing with dissociative anesthesia, because there is no pre-anesthetic medication or anything.
If you do the pre-anesthetic medication, it already improves. If you use opioids in this combination, it gets better too. But we cannot forget that this is a dissociative anesthesia and it is one of the worst combinations in this modality, ok?
However, Fernando, your question is only about "Ketapum" so I will disregard any other combination that we can do with these two drugs. Can it operate? It depends.
. . It depends on what you're talking about operating.
. . In fact, this anesthetic combination is basically used for chemical containment or also for very simple outpatient procedures, such as removing a hedgehog spine that the animal sometimes bites, draining an abscess, things like that.
even though I don't use this anesthetic protocol for these procedures, ok? Well, as we talked about in this video class here on dissociative anesthesia, this modality allows for very simple , basically outpatient procedures, as I said earlier. So, medium or high complexity surgeries do not have the slightest possibility of doing it with dissociative anesthesia.
We need to submit the animal to general anesthesia, either inhalational or intravenous, or even locoregional block so that we can abolish any physiological response to surgical stimuli, OK? So this anesthetic modality is not suitable for us to perform cavitary, orthopedic or more invasive surgeries. For those who saw the comments on the dissociative anesthesia video class, you must have read the comment of our late friend Professor Flávio Massone, who said: I believe that the use of the commonly called "ketapum" is the pseudo-anesthesia of those who stopped in time and space because the ketamine from somatic anesthesia and xylazine not from visceral anesthesia, but colleagues misuse it in laparotomies, causing the patient to feel pain but unable to react.
Veio Massone was short and thick. That's it! Now you asked me if I use it?
I wear. But basically to induce anesthesia in large animals and then maintain with inhalational or intravenous general anesthesia. On small animals I can't remember the last time I used it, ok?
Basically, we have so many other anesthetic protocols, in dogs and cats, which are much cheaper and better for us to use. There is absolutely no need to use "Ketapum" on cats and dogs today. Another situation that can also be used is in the chemical containment of wild animals.
because we are going to make a dart, administer it remotely, so we need to do something that is administered intramuscularly. But even so, I prefer to administer dexmedetomidine, because it has a much smaller volume, has better analgesia than xylazine, has a longer period of action, and in theory it alters the physiological parameters less than xylazine, although both change a lot. but, remembering that this is a chemical restraint, we are not going to use this anesthesia to operate on a wild animal, ok?
Finally, I left your comment about using these anesthetics in places that have little support. Let's go Fernando. .
. until when are we going to listen to this spiel of saying "Oh Adriano, I live in the countryside, in the countryside, in the countryside, I can't buy these innovative things to do anesthesia! " Old man, let's stop this.
In those places that say there are few resources, little support , people use iPhone 30s, old man? I said 30 not to beat the video soon. So let's stop, anywhere today anything arrives , we can buy anything on the internet, it arrives anywhere in Brazil, medicines, anesthesia machines, monitoring, So we have to stop this business of always saying that we you are doing a bad quality anesthesia Because this is a bad quality anesthesia Because we live in the countryside of the countryside, ok?
let's stop it. . .
So, here's the thing: Do you want to have a decent anesthetic? It does something besides dissociative anesthesia, okay? Today we have several techniques, all accessible to any anesthesiologist, and we don't need to keep doing "Ketapum" there to anesthetize an animal.
Filipa asked: - Very good channel content! Congratulations! What is your opinion regarding the use of zolethyl alone as an anesthetic agent in surgeries?
example, orchiectomies, ovariohysterectomy etc. . .
I've seen some surgeries with this procedure and especially in orchiectomy I noticed that cats react to stimuli, shaving, disinfection and the surgical procedure itself. Hi Filipa! Thank you for the compliments.
Your question was kind of getting ahead of my answer, right? Zoletil, which is the combination of tiletamine and zolazepam, is a dissociative anesthesia. But these two drugs alone do not provide quality anesthesia.
So the first thing I'm going to tell you is: we have to do the pre-anesthetic medication, use drugs that are used in premedication, so that the effects of MPA favor anesthesia. So, potentiate the inducing agents, reduce the patient's stress, promote sedation and so on. So, I'll tell you that with Zoletil alone, we can't operate on an animal, ok!
? Well, as we mentioned in Fernando's answer, dissociative anesthesia, whether with the combination of ketamine and alpha-2 agonist or benzodiazepine, or Zoletil itself, right? that tiletamine is the dissociative and zolazepam is the benzodiazepine, it allows very simple surgeries or outpatient procedures, as I said, right?
abscess drainage, a dressing a little more complex there. . .
but no surgery of medium complexity and above. Even if we go to see it, orchiectomy is a very easy surgery to do. However, this anesthetic technique is also not adequate.
If you get an intratesticular block you can even help the procedure, although I don't do this anesthesia even for orchiectomy. I prefer to do general anesthesia, and then subject the animal to a better anesthetic quality, ok? you even said that you saw some procedures there and were even bothered by the situation you saw.
So, you've already realized that this business is not interesting. But I also don't use dissociative anesthesia , I think it's too expensive, we can't buy tiletamine and zolazepam separately. So, there are two brands on the market that put the price up there, it has a very high price.
I prefer to use ketamine with some other myorelaxant, whether it's a benzodiazepine or an alpha-2 adrenergic agonist. We use a lot of dissociative anesthesia in small animals, but basically combined with a benzodiazepine, such as midazolam for example, or in large animals, it doesn't matter if we use an alpha-2 agonist or a benzodiazepine, but I really prefer to use the drugs separately, to be better cheaper. Besides, in the dissociative anesthesia video class, we talk about recovery from Zoletil or Telazol, right?
She is very troubled, very complex. The animal is very upset. So, that's also why I don't like to use this combination, ok?
Salgado Louro asked: Is it advantageous to apply benzodiazepine and ketamine in the same syringe? What's the correct way to do it? What?
are you upside down? I read the same too. .
. Let's go Salgado. If we put practicality, latency period, period of action, kinetics of the drugs on the scale, even when they are combined in the same syringe, we will have good and bad things.
But it doesn't matter to me. For example, in small animals I always do combined and in this case I add ketamine with a benzodiazepine, or for example with dexmedetomidine, and do it intramuscularly. The dissociative anesthetic administration hurts, so I basically just do one injection and the anesthetic induction is done.
In large animals I do it separately. Because? The latency period for ketamine is slightly shorter than the latency period for alpha-2 adrenergic agonists and even benzodiazepines.
So, if we do it together , the animal will have a somewhat rigid anesthetic induction, this is not very good at that moment of anesthesia. But I also did it for a long time together and I had no problems. So you'll see people saying that they do it together, people saying that they do it separately, in practice everything will go the same way, okay?
But it is quite possible for someone to comment here on this video saying that the combination of these two drugs in the same syringe can be bad. . .
But then we can discuss later, ok? Well folks, as I said, this subject was already a lot of doubt, a lot of confusion, especially about what can or cannot be done in dissociative anesthesia. I hope I have adequately answered these questions.
I invite you to post comments, suggestions, criticisms, praises here, we'll read and respond there, ok? Don't forget to watch other NAVE videos, like the ones here, and see you in the next video. A big hug and see you soon!
