Recovery quality following a single post-anaesthetic dose of dexmedetomidine or romifidine in sevoflurane anaesthetised horses.
Authors: Hector Rachel C, Rezende Marlis L, Mama Khursheed R, Hess Ann M
Journal: Equine veterinary journal
Summary
# Recovery from Sevoflurane Anaesthesia: Dexmedetomidine vs Romifidine Post-anaesthetic sedation in horses serves a critical function—improving recovery quality and reducing injury risk during the vulnerable emergence phase from inhalant anaesthesia—yet dexmedetomidine's efficacy as a single-dose recovery agent had not been clinically evaluated. This prospective, randomised, masked trial compared dexmedetomidine (1 mcg/kg) against the established romifidine protocol (20 mcg/kg) in 99 adult horses anaesthetised with sevoflurane, with independent blinded assessors scoring overall recovery quality on a visual analogue scale and ataxia severity (1–4 scale), alongside objective recovery metrics. After accounting for differences in end-tidal sevoflurane concentration and additional ketamine administration, dexmedetomidine and romifidine produced no significant differences in VAS scores or time to standing, indicating clinically equivalent recovery profiles between the two agents. More compelling were the study's findings regarding factors influencing recovery quality: increased age, absence of regional nerve blocks, prolonged hypotensive episodes, and nervous temperament were significant predictors of poorer recovery scores, independent of which sedative was used. For clinical practitioners, this work provides reassurance that dexmedetomidine represents a viable alternative to romifidine for post-anaesthetic sedation, whilst highlighting that optimising recovery quality depends substantially on modifiable factors such as perioperative blood pressure management and regional analgesia—considerations that transcend the choice of recovery agent.
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Practical Takeaways
- •Either dexmedetomidine or romifidine can be used for post-anaesthetic sedation in horses with equivalent recovery outcomes; choice may be based on availability, cost, or clinician preference.
- •Focus on modifiable factors during anaesthesia (maintaining normotension, using regional analgesia) rather than sedative drug selection to improve recovery quality.
- •Individual horse temperament and age influence recovery quality more than the type of alpha-2 agonist used for post-operative sedation.
Key Findings
- •Dexmedetomidine 1 mcg/kg and romifidine 20 mcg/kg produced clinically similar recovery quality (VAS scores) and time to standing when given at first spontaneous breath in recovery.
- •After adjusting for end-tidal sevoflurane concentration and additional ketamine dosing, no significant differences in recovery parameters were found between treatment groups.
- •Increased age, absence of nerve blocks, prolonged hypotension duration, and nervous temperament were significant predictors of poorer recovery quality independent of sedative choice.