Kedilerde Medetomidin–Butorfanol–Ketamin Kombinasyonunun (Kitty Magic) Anestezik Etkinliğinin Değerlendirilmesi

Öz

Bu çalışma, rutin orşiektomi operasyonu geçiren kedilerde medetomidin–butorfanol–ketamin kombinasyonunun (Kitty Magic) anestezik etkinliğini, fizyolojik stabilite üzerindeki etkilerini ve postoperatif analjezik etkinliğini değerlendirmek amacıyla gerçekleştirildi. Farklı ırk, yaş ve vücut ağırlıklarına sahip, klinik olarak sağlıklı 20 erkek kediye 0,02–0,08 mL/kg dozunda tek intramüsküler enjeksiyon uygulandı. Ortalama sedasyon süresi 4,15 ± 2,13 dakika, cerrahi anestezi süresi 43,85 ± 8,78 dakika ve toplam anestezi süresi 59,65 ± 9,03 dakika olarak belirlendi. Kedilerin sternal pozisyona gelme süresi 57,25 ± 10,89 dakika, ayağa kalkma süresi ise 60,85 ± 16,80 dakika olarak kaydedildi. Kalp atım hızı, solunum sayısı ve vücut ısısında istatistiksel olarak anlamlı ancak klinik olarak tolere edilebilir düşüşler gözlendi. Kusma, ürinasyon veya eksitasyon gibi komplikasyonlara rastlanmadı. Postoperatif ağrı değerlendirmesi, Basit Tanımlayıcı Ölçek (Simple Descriptive Scale) kullanılarak yapıldı ve olguların %90’ında ağrı skoru “0” olarak belirlendi. Operasyon sonunda uygulanan atipamezol enjeksiyonu, ortalama 12,11 ± 5,47 dakika içinde tam uyanma sağladı. Elde edilen bulgular, Kitty Magic kombinasyonunun kedilerde güvenilir bir anestezi sağladığını, yeterli kas gevşemesi ve analjezi oluşturduğunu, kardiyorespiratuar stabiliteyi koruduğunu göstermektedir. Basit uygulama şekli, ekonomik oluşu ve atipamezol ile kolaylıkla geri döndürülebilmesi nedeniyle, bu protokolün barınak ve klinik koşullarda kısa süreli cerrahi girişimler için pratik ve güvenli bir alternatif olduğu sonucuna varılmıştır.

Anahtar Kelimeler

• İmidazoller
• Kediler
• Morfinanlar
• Siklohekzanlar
• Analjezikler

Evaluation of the Anesthetic Efficacy of the Medetomidine–Butorphanol–Ketamine Combination (Kitty Magic) in Cats

Öz

This study aimed to evaluate the anesthetic efficacy, physiological stability, and postoperative analgesia of the medetomidine–butorphanol–ketamine combination (Kitty Magic) in cats undergoing routine castration. Twenty clinically healthy male cats of different breeds and weights were anesthetized using a single intramuscular injection of the combination at a dose of 0.02–0.08 mL/kg. Sedation occurred within 4.15 ± 2.13 minutes, and surgical anesthesia lasted 43.85 ± 8.78 minutes, with total anesthesia time averaging 59.65 ± 9.03 minutes. Mean times to sternal recumbency and standing were 57.25 ± 10.89 and 60.85 ± 16.80 minutes, respectively. The protocol produced significant but clinically acceptable decreases in heart rate, respiratory rate, and body temperature, remaining within physiological limits. No complications such as vomiting, urination, or excitation were observed. Postoperative pain scores, assessed using a simple descriptive scale, indicated minimal discomfort, with 90% of cats scoring 0. Atipamezole administered at the end of surgery reversed anesthesia within 12.11 ± 5.47 minutes, ensuring smooth recovery. The findings demonstrate that the Kitty Magic combination provides reliable anesthesia with adequate depth, muscle relaxation, and analgesia while maintaining cardiovascular stability. Owing to its simplicity, cost-effectiveness, and reversibility, this protocol represents a safe and practical alternative for feline castration and similar short-duration surgical procedures, particularly in shelters and clinical settings lacking inhalation anesthesia equipment.

Anahtar Kelimeler

• imidazoles
• feline
• morphinans
• cyclohexanes
• analgesic

Kaynakça

1. Baetge, C. L., & Matthews, N. S. (2012). Anesthesia and analgesia for geriatric veterinary patient. Veterinary Clinics of North America: Small Animal Practice, 42, 643–653.
2. Biermann, K., Hungerbühler, S., Mischke, R., & Kastner, S. (2012). Sedative, cardiovascular, haematologic and biochemical effects of four different drug combinations administered intramuscularly in cats. Veterinary Anaesthesia and Analgesia, 39, 137–150.
3. Bruniges, N., Taylor, M. P., & Yates, D. (2016). Injectable anaesthesia for adult cat and kitten castration: Effects of medetomidine, dexmedetomidine and atipamezole on recovery. Journal of Feline Medicine and Surgery, 18(11), 860–867.
4. Corona, D., Ranninger, E., Jörger, F. B., Goldinger, E., Stefan, A., Torgerson, P. R., & Bettschart-Wolfensberger, R. (2020). Cats undergoing spay with medetomidine, ketamine and butorphanol develop arterial oxygen desaturation independent of surgical positioning and increased intraocular pressure in Trendelenburg position. Schweizer Archiv für Tierheilkunde, 162(9), 539–550. https://doi.org/10.17236/sat00271
5. Cremer, J., & Riccó, C. H. (2017). Cardiovascular, respiratory, and sedative effects of intramuscular alfaxalone–butorphanol–dexmedetomidine compared with ketamine–butorphanol–dexmedetomidine in healthy cats. Journal of Feline Medicine and Surgery, 20(10), 973– 979. https://doi.org/10.1177/1098612X17742289
6. Fernandez-Parra, R., Adami, C., Dresco, T., Donnelly, T. M., & Zilberstein, L. (2017). Dexmedetomidine–methadone–ketamine versus dexmedetomidine–methadone–alfaxalone for cats undergoing ovariectomy. Veterinary Anaesthesia and Analgesia, 44, 1332– 1340.
7. Granholm, M., McKusick, B. C., Westerholm, F. C., & Aspegren, J. (2006). Evaluation of the clinical efficacy and safety of dexmedetomidine or medetomidine in cats and their reversal with atipamezole. Veterinary Anaesthesia and Analgesia, 33, 214–223.
8. Harrison, A. K., Robertson, S. A., Levy, J. K., & Isaza, N. M. (2011). Evaluation of medetomidine, ketamine and buprenorphine for neutering feral cats. Journal of Feline Medicine and Surgery, 13, 896–902.

9. Hedenqvist, P., Kälin, N., & Bettschart-Wolfensberger, R. (2021). Injectable anesthetic combinations for cats: Physiologic stability and safety considerations. In J. C. Ko (Ed.), Small Animal Anesthesia and Pain Management: A Color Handbook (2nd ed., pp. 185–190). Boca Raton, FL: CRC Press. https://doi.org/10.1201/9781003353799-10
10. Horn, C. (2017). Anestezi ve perioperatif multimodal sağaltım. In D. Seyrek (Ed.), Küçük Hayvan Cerrahisi (4th ed., pp. 131–153). Medipres.
11. Imboden, I., Kälin, N., Käser, S., Hilbe, M., Bollerhey, M., & BettschartWolfensberger, R. (2023). Optimization of dexmedetomidine– ketamine–butorphanol doses for canine sedation using a stepwise titration method. Acta Veterinaria Scandinavica, 65(1), 17. https:// doi.org/10.1186/s13028-023-00697-8
12. Khenissi, L., Topie, N. O., Broussaud, S., & Jourde, G. T. (2017). Comparison of intramuscular alfaxalone and ketamine combined with dexmedetomidine and butorphanol for castration in cats. Journal of Feline Medicine and Surgery, 19(8), 791–797.
13. Kim, Y. W., Suh, S., Choi, R., & Hyun, C. (2015). Evaluation of quality of anesthesia and analgesia and of vital signs after intramuscular administration of a combination of butorphanol, medetomidine and alfaxalone in cats. Journal of Veterinary Medical Science, 78(3), 431–433.
14. Koç, B., & Sarıtaş, Z. K. (2004). Veteriner Anesteziyolojisi ve Reanimasyon (p. 266). Malatya: Medipress Matbaacılık Yayıncılık.
15. Lee, J., Suh, S., Choi, R., & Hyun, C. (2015). Cardiorespiratory and anesthetic effects produced by the combination of butorphanol, medetomidine, and alfaxalone administered intramuscularly in Beagle dogs. Journal of Veterinary Medical Science.
16. Lemke, K. A. (2004). Perioperative use of selective alpha-2 agonists and antagonists in small animals. The Canadian Veterinary Journal, 45, 475–480.
17. Miller, R. D., Eriksson, L. I., Fleisher, L. A., Wiener-Kronish, J. P., Cohen, N. H., & Young, W. L. (2014). Miller’s anesthesia e-book. Elsevier Health Sciences.
18. Moser, K., Hasiuk, M., Armstrong, T., Gunn, M., & Pang, D. (2020). A randomized clinical trial comparing butorphanol and buprenorphine within a multimodal analgesic protocol in cats undergoing orchiectomy. Journal of Feline Medicine and Surgery, 22(8), 760–767.
19. Nussbaumer, I., Zimmermann, W., & Peterbauer, C. (2008). Anaesthesia of pigs with a combination of romifidine, butorphanol and ketamine. Veterinary Record, 163, 720–721.
20. Polson, S., Taylor, P. M., & Yates, D. (2012). Analgesia after feline ovariohysterectomy under midazolam–medetomidine–ketamine anaesthesia with buprenorphine or butorphanol, and carprofen or meloxicam: A prospective, randomised clinical trial. Journal of Feline Medicine and Surgery, 14, 553–559.
21. Robertson, S. A., Gleerup, K. B., Marx, R., & O’Hagan, B. (2018). 2018 AAFP anesthesia guidelines for dogs and cats. Journal of Feline Medicine and Surgery, 20(7), 602–634. https://doi. org/10.1177/1098612X18781391
22. Schroeder, C. A., & Smith, L. J. (2011). Advances in anesthesia. In T. M. McLoughlin (Ed.), Advances in Anesthesia (pp. 59–84). Philadelphia, PA: Elsevier.
23. Slingsby, L. S., Bortolami, E., & Murrell, J. C. (2015). Methadone in combination with medetomidine as premedication prior to ovariohysterectomy and castration in the cat. Journal of Feline Medicine and Surgery, 17(10), 864–872.
24. Steagall, P. V. M., Taylor, P. M., Rodrigues, L. C. C., Ferreira, T. H., Minto, B. W., & Aguiar, A. J. A. (2009). Analgesia for cats after ovariohysterectomy with either buprenorphine or carprofen alone or in combination. Veterinary Record, 164, 359–363.
25. Taylor, P. M., Kirby, J. J., Robinson, C., Watkins, E. A., Clarke, D. D., Ford, M. A., & Church, K. E. (2010). A prospective multi-centre clinical trial to compare buprenorphine and butorphanol for postoperative analgesia in cats.
26. Topal, A. (2005). Veteriner Anestezi. Bursa: Nobel & Güneş Yayınları. Ünsaldı, S. (2011). Genel anestezide kullanılan ilaçlar. In Veteriner Anestezi (pp. 35–43). İstanbul: Nobel Tıp Kitabevleri.
27. Van Nimwegen, S. A., Kamp, V. M., Kroese, A. B. A., & Hedenqvist, P. (2019). Medetomidine–ketamine–butorphanol anesthesia in cats: Evaluation of arterial oxygen saturation and intraocular pressure during Trendelenburg positioning. Schweizer Archiv für Tierheilkunde, 162(9), 539–550.
28. Wiese, A. J., & Muir, W. W. (2006). Anaesthetic and cardiopulmonary effects of intramuscular morphine, medetomidine and ketamine administered to telemetered cats. Journal of Feline Medicine and Surgery, 9, 150–156.