Genel Anestezi, Sedasyon, Analjezi ve Premedikasyon
Özet
Evcil hayvanlarda (kedi, köpek, at, sığır) genel anestezi, sedasyon, analjezi ve premedikasyon, cerrahi ve tanısal işlemler sırasında hem hayvanın konforunu sağlamak hem de veteriner hekimin güvenli müdahalesine olanak tanımak amacıyla kullanılır. Genel anestezi, bilincin tamamen kaybolduğu, reflekslerin baskılandığı kontrollü bir durumdur. Sedasyon, hayvanın çevresel uyarılara karşı tepkisini azaltarak sakinleşmesini sağlar. Analjezi, ağrının giderilmesi veya azaltılmasıdır; sıklıkla multimodal yaklaşımla (farklı mekanizmalarla etki eden ilaçların kombinasyonu) uygulanır. Premedikasyon ise anestezi öncesinde uygulanan ilaçlarla stresin, ağrının ve ilaç gereksiniminin azaltılmasını hedefler. Türler arası fizyolojik farklar nedeniyle ilaç seçimleri ve dozlamalar dikkatle belirlenmelidir. Örneğin, atlar sedasyona daha dirençliyken, ruminantlarda regürjitasyon riski göz önünde bulundurulmalıdır. Etkili ve güvenli bir anestezi yönetimi için hastanın yaşı, genel durumu, işlem tipi ve süresi gibi faktörler dikkate alınarak bireyselleştirilmiş bir yaklaşım benimsenmelidir. Sonuç olarak, kedi, köpek, at ve sığırlarda anestezi ve analjezi uygulamalarının başarısı, bireysel hayvan özelliklerinin, uygun ilaç seçiminin, doz ayarlamalarının ve perioperatif bakımın titizlikle yürütülmesine bağlıdır.
General anesthesia, sedation, analgesia and premedication are used in domestic animals (cats, dogs, horses, cattle) to ensure the comfort of the animal and to enable the veterinarian to perform safe intervention during surgical and diagnostic procedures. General anesthesia is a controlled state in which consciousness is completely lost and reflexes are suppressed. Sedation calms the animal by reducing its response to environmental stimuli. Analgesia is the relief or reduction of pain, often applied with a multimodal approach (combination of drugs acting through different mechanisms). Premedication aims to reduce stress, pain and the need for medication with medications administered before anesthesia. Due to physiological differences between species, drug selection and dosing should be determined carefully. For example, while horses are more resistant to sedation, the risk of regurgitation in ruminants must be considered. For effective and safe anesthesia management, an individualized approach should be adopted, taking into account factors such as the patient's age, general condition, type of procedure, and duration. In conclusion, the success of anesthesia and analgesia in cats, dogs, horses and cattle depends on the meticulous execution of individual animal characteristics, appropriate drug selection, dose adjustments and perioperative care.
Referanslar
Cornick-Seahorn JL, Shawn PM. Veterinary Anesthesia. 1 st ed. Woburn: Butterworth-Heinemann; 2001
Smith R. Introduction to Anesthesia. In: William WM, John AE, Richard B, Phillip L (eds.) Handbook Of Veterinary Anesthesia. 5th ed. Riverport Lane: Elsevier; 2013 p. 1-12
William JT, Kurt AG, Leigh AL. Overview, History, and Current Issuesin Veterinary Anesthesia and Analgesia. In: Lamont L, Grimm K, Robertson S, Love L, Schroeder C (eds.) Veterinary Anesthesia and Analgesia. 6th ed. New Jersey: John Wiley & Sons; 2024
Boztok Özgermen B. Anestezinin temel prensipleri. Nisbet HÖ (Ed). Evcil Hayvanlarda Anestezi ve Analjeziye Güncel Yaklaşımlar. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.1-6.
Nesgash A, Yaregal B, Kindu T, Hailu E. Evalution of General Anesthesia Using Xylazine-Ketamine Combination with and without Diazipam for Ovariohysterectomy in Bitches. Journal of Veterinary Science and Technology 2016;07(06). doi:10.4172/2157-7579.1000376.
Önyay T, Doğmuş T. Premedikasyon ve temel ilkeleri. Nisbet HÖ (Ed). Evcil Hayvanlarda Anestezi ve Analjeziye Güncel Yaklaşımlar. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.25-30.
DeBusk S, Silberstein N, Jensen E, O’Keefe L (eds.) Introduction to Anesthesia. 3rd ed. Portland: Banfield Pet Hospital; 2010.
Warne L, Bauquier S, Pengelly J, Neck D, Swinney G. STANDARDS OF CARE Anaesthesia guidelines for dogs and cats. Australian Veterinary Journal 2018;96(11):413-427.
Can P, Uslu E. K(Ed)i ve köpeklerde genel anestezi. Nisbet HÖ (Ed). Evcil Hayvanlarda Anestezi ve Analjeziye Güncel Yaklaşımlar. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.38-43.
Kushnir Y, mcKune Cm. Anesthetic process. ın: Shelby AA, mcKune Cm, eds. Small Animal Anesthesia Technique. 2nd ed. NY, USA: Wiley-Blacwell. 2023. p. 3-27.
Alkan İ, Atasoy N, Taş A, Aslan L, Sancak T, Kuşcu Y, Kayıkcı C. Yenidoğan buzağılarda anestezi protokolü: Buzağılarda cerrahi vakalarda anestezi uygulamaları. Baran V (Ed). Ruminantlarda Neonatal Cerrahi. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.24-8.
Bednarski RM. Dogs and cats. In: Grimm KA, Lamont LA, Tranquilli Wj, Greene SA, robertson SA, (eds.) Veterinary Anesthesia and Analgesia. 5th ed. Ames, Iowa: Wiley Blackwell; 2015. p. 819-26.
Ermutlu CŞ. Köpeklerde sevofloran ile oluşturulan inhalasyon anestezi öncesinde ksilazin-ketamin ya da propofol kullanımının postoperatif ağrı üzerine etkinliklerinin karşılaştırılması. Veterinary Journal of Mehmet Akif Ersoy University. 2018;3(1): 43-54. 2018 https://doi.org/10.24880/maeuvfd.401245
Yımaz A, Ertmutlu CŞ: Kastrasyon yapılan atlarda fluniksin meglumin, tramadol hcı ve lidokain hcı ile oluşturulan multimodal analjezinin bazı biyobelirteçler ve grimace skala ile değerlendirilmesi.Kafkas Üniv, Sağlık Bilimleri Enstitüsü, Doktora Tezi, Kars, 2008.
Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362–379.
Grubb T, Sager j, Gaynor jS, montgomery E, Parker jA, Shafford H, et al. AAHA anesthesia and monitoring guidelines for dogs and cats. j Am Anim Hosp Assoc. 2020;56(2):59-82.
Schroeder CA, Smith LJ. Veterinary Anesthesia. Advances in Anesthesia 2011;29(1):59-84.
Gozalo-Marcilla M, Ringer SK. Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals 2021;11(6):1777.
Murray MJ, Eichorn ES. Effects of intermittent feed deprivation, intermittent feed deprivation with ranitidine administration, and stall confinement with ad libitum access to hay on gastric ulceration in horses. Am J Vet Res 1996; 57(11): 1599–1603.
Senior JM, Pinchbeck GL, Allister R, et al. Post anaesthetic colic in horses: a preventable complication? Equine Vet J 2006; 38(5): 479–484.
Hospes R, Bleul U. The effect of extended preoperative fasting in mares undergoing surgery of the perineal region. J Equine Vet Sci 2007; 27(12): 542–545.
Bailey PA, Hague BA, Davis M, et al. Incidence of post-anesthetic colic in non-fasted adult equine patients. Can Vet J 2016; 57(12): 1263–1266.
Wohlfender, F.D. Doherr, MG.; Driessen, B.; Hartnack, S.; Johnston, G.M.; Bettschart-Wolfensberger, R. International online survey to assess current practice in equine anaesthesia. Equine Vet. J. 2015, 47, 65–71.
Johnston, G.M.; Eastment, J.K.; Wood, J.; Taylor, P.M. The confidential enquiry into perioperative equine fatalities (CEPEF): Mortality results of Phases 1 and 2. Vet. Anaesth. Analg. 2002, 29, 159–170.
Driessen, B.; Zarucco, L.; Kalir, B.; Bertolotti, L. Contemporary use of acepromazine in the anaesthetic management of male horses and ponies: A retrospective study and opinion poll. Equine Vet. J. 2011, 43, 88–98
Ballard, S.; Shults, T.; Kownacki, A.A.; Blake, J.W.; Tobin, T. The pharmacokinetics, pharmacological responses and behavioral effects of acepromazine in the horse. J. Vet. Pharmacol. Ther. 1982, 5, 21–31.
Marroum, P.J.;Webb, A.I.; Aeschbacher, G.; Curry, S.H. Pharmacokinetics and pharmacodynamics of acepromazine in horses. Am. J. Vet. Res. 1994, 55, 1428–1433.
Matthews, N.S.; Hartsfield, S.M.; Cornick, J.L.;Williams, J.D.; Beasley, A. A comparison of injectable anesthetic combinations in horses. Vet. Surg. 1991, 20, 268–273.
Gozalo-Marcilla M, Bettschart-Wolfensberger R, Johnston M, et al. Data collection for the fourth multicentre Confidential Enquiry into Perioperative Equine Fatalities (CEPEF4) study: new technology and preliminary results. Animals 2021; 11(9): 2549.
Altan S, Ersöz Kanay B, Ruminantlarda Genel Anestezi. Turkiye Klinikleri Journal of Veterinary Sciences-Surgery-Special Topics. 2015;1(3):36-44
Yakan S, Aksoy Ö, Ermutlu CŞ, Comparison of Use of Isoflurane or Sevofluranefor Anaesthesia Induced by Mask in Calves. Acta Scientiae Veterinariae. 2020;48:1776
Cebra C, Sisson D. Diseases of the cardiovascular and hemolymphatic systems. In: Cebra C, Anderson DE, Tibary A, et al., eds. Llama and Alpaca Care: Medicine, Surgery, Reproduction, Nutrition, and Herd Health. St. Louis, MO: WB Saunders, 2014: 393–421.
Rabaza A, Banchero G, Cajarville C, et al. Effects of feed withdrawal duration on animal behaviour, rumen microbiota and blood chemistry in feedlot cattle: implications for rumen acidosis. Animal 2020; 14: 66–77.
Clariget J, Banchero G, Luzardo S, et al. Effect of pre-slaughter fasting duration on physiology, carcass and meat quality in beef cattle finished on pastures or feedlot. Res Vet Sci 2021; 136: 158–165.
Clabough DL, Swanson CR. Heart rate spectral analysis of fasting-induced bradycardia of cattle. Am J Physiol 1989; 257: R1303–R1306.
McGuirk S, Bednarski R, Clayton M. Bradycardia in cattle deprived of food. J Am Vet Med Assoc 1990; 196: 894–896.
Williams M, Caulkett N, Neuhaus P, et al. Comparison of the efficacy and safety of medetomidine-ketamine versus medetomidine-azaperone- alfaxalone combination in free-ranging rocky mountain bighorn sheep (Ovis canadensis). J Zoo Wildl Med 2018; 49: 662–670.
Cihan M. Kritik Hastalarda Sinir Sisteminin Muayenesi. Özaydın İ (ed.) Veteriner Acil Klinik içinde. 1. Baskı Erzurum: Eser Ofset Matbaacılık; 2004. p. 85-92.
Wagner AE, Walton JA, Hellyer PW, et al. Use of low doses of ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs. J Am Vet Med Assoc 2002; 221: 72–75.
Valverde A, Doherty TJ, Hernández J, et al. Effect of lidocaine on the minimum alveolar concentration of isoflurane in dogs. Vet Anaesth Analg 2004; 31: 264–271.
Redua M, Doherty T, Castro-Queiroz P, et al. Effect of intravenous lidocaine and ketamine on isoflurane minimum alveolar concentration in goats. Vet Anaesth Analg 2005; 32: 6–7.
Araújo MA, Dias BP, Bovino F, et al. Cardiovascular effects of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane. Vet Anaesth Analg 2014; 41: 145–152.
Hartnack AK, Niehaus AJ, Lakritz J, et al. Analgesic efficacy of an intravenous constant rate infusion of a morphine-lidocaine- ketamine combination in Holstein calves undergoing umbilical herniorrhaphy. Am J Vet Res 2020; 81: 25–32.
