Short CommunicationThe incidence of spontaneous movements (myoclonus) in dogs undergoing total intravenous anaesthesia with propofol
Introduction
Propofol (2,6-diisopropylphenol) is one of the most widely used injectable anaesthetic agents for the induction and maintenance of general anaesthesia, both in humans and veterinary practice. In humans, a number of cases of spontaneous involuntary excitatory movements, presumably induced by the drug, have been reported. The occurrence of these phenomena has also been reported in dogs (Hall & Chambers 1987; Davies 1991; Robertson et al. 1992). The incidence in dogs of involuntary spontaneous movements during propofol based total intravenous anaesthesia (TIVA) reported by Hall & Chambers (1987) was five cases out of 23 (21.7%). Davies (1991) reported 12 cases of excitatory spontaneous involuntary movements out of 159 dogs (7.5%). In her report propofol had been administered for induction and, in some cases, also for maintenance of anaesthesia, and in most of the cases the involuntary movements occurred upon induction or recovery of anaesthesia. Robertson et al. (1992), in an experimental study, reported spontaneous involuntary movements in six of 13 (46.1%) dogs in which anaesthesia had been induced and maintained with propofol for one hour. In this study, unlike the previous, almost all of the phenomena occurred several minutes after the administration of propofol and then continued for the duration of anaesthesia.
In human medicine many authors have pointed to the difficulty in accepting that a drug with strong evidence of anti-convulsant activity, in certain circumstances, could be pro-convulsant. However, propofol can induce seizure-like phenomena (SLP), excitatory phenomena, and/or disorder of muscle tone during induction and maintenance of, or emergence from anaesthesia in epileptic and non-epileptic patients (San-juan et al. 2010). Reports refer to qualitatively different effects and it is difficult to quantify the incidence of these complications.
The incidence of spontaneous movements in dogs anaesthetized with propofol appears to vary significantly from study to study. However, our impression is that the incidence of such phenomena, in clinical practice, is lower than previously reported. The objective of this retrospective study is to assess the incidence of involuntary spontaneous movements, of such severity as to interfere with the procedure, associated with the use of propofol in healthy anaesthetized dogs undergoing TIVA with propofol, and to define them in relation to the characteristics of their onset.
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Materials and methods
A retrospective analysis was performed reviewing the medical and anaesthetic records of all dogs anaesthetized with a TIVA including propofol at the ‘Clinica Veterinaria dell’Adriatico’, Vasto, Italy, or at the Department of Animal Medicine, Production and Health of the University of Padua Italy, in a period between January 2012 and January 2013. In this study, subjects that presented with current, existing or potential (as a side effect of other disease processes) neurological or neuromuscular
Results
The anaesthesia records of 509 dogs subject to various procedures were included in the study. Of these dogs, 17 then were excluded, as they were incomplete. Thus 492 dogs remained in the study. Overall, 202 (41.1%) of dogs were male and 290 (58.9%) female. The mean ± standard deviation age was 29 ± 9 months, and body weight was 16.9 ± 10.5 Kg. The most common breeds represented were mixed breed [122 (24.8%)]. Only 58 of 492 (11.8%) cases included in this study received premedication, and of
Discussion
In this study, the incidence of involuntary movements was 1.2% (one case out of 82), far lower than that previously reported in veterinary literature (Hall & Chambers 1987; Davies 1991; Robertson et al. 1992). Various factors may explain this finding. Our definition of myoclonus may have played an important role. It was deliberately restrictive, in order to consider only those cases that were based on characteristics of onset and lack of response to dosing increase, so that it could (most
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2023, Veterinary Anaesthesia and AnalgesiaCitation Excerpt :The administration of a propofol bolus or an increase in propofol Cp (as per our algorithm) did not result in resolution of the myoclonus. This agrees with Cattai et al. (2015), who stated that true myoclonus is not related to a superficial anaesthetic plane during propofol TIVA, and it is erroneous to increase propofol administration in an attempt to counteract it. In our study, inhalation of isoflurane suppressed myoclonus in all dogs.
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2022, Research in Veterinary ScienceCitation Excerpt :This increased respiratory depressant effect of ketamine strongly suggests the provision of mechanical ventilation. Myoclonus is a common adverse effect of propofol TIVA (Cattai et al., 2015; Robertson et al., 1992) and we found an overall incidence of forelimb myoclonus (20%). However, these episodes resolved spontaneously without intervention.
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2021, Topics in Companion Animal MedicineCitation Excerpt :This reaction has been reported by other studies in dogs. Cattai et al.14 reported six occurrences of muscular reactions among 492 (1.2%) dogs undergoing propofol anesthesia and proposed an antagonistic effect of propofol on glycine receptors at the spinal cord and brainstem as a possible explanation. The authors discussed that many motor centers (red nucleus, vestibular nucleus, reticular formation and cerebellar nucleus) project to those areas and modulate abnormal movement when stimulated.
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2019, Veterinary Anaesthesia and AnalgesiaCitation Excerpt :PE values show a slight tendency to be higher at higher target Cp (Fig. 1), which may be related to incomplete mixing at greater rates of drug delivery (Swinhoe et al. 1998). In this study, neither apnoea nor involuntary movements or other anaesthetic-related adverse effects were observed during induction and maintenance of anaesthesia despite having been reported to be possible after propofol administration in dogs (Smith et al. 1993; Cattai et al. 2015). The setting of a maximum rate based on weight to reduce the risk of respiratory depression potentially related to rapid infusions, and the selection of the induction target in accordance with the level of sedation, may have contributed to this result.
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2017, Veterinary Anaesthesia and AnalgesiaCitation Excerpt :The induction and recovery phases were considered smooth in all dogs on all occasions, despite the presence of myoclonus in two dogs in the recovery period. Myoclonus has been reported in association with propofol administration in dogs (Robertson et al. 1992; Ferreira et al. 2015; Reed et al. 2015; Davis et al. 2017) with an incidence of 1.2% (Cattai et al. 2015). All episodes of myoclonus resolved spontaneously within 20 minutes after extubation.
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