2College of veterinary medicine, Mekelle University, PO Box 231, Mekelle, Ethiopia
Key words: Diazepam; Ethiopia; General anesthesia; ketamine; Local breed of dogs; Mekelle
Abbreviations: AK-Acepromazine -Ketamine; ANOVA-Analysis of Variance; CSA-Central Statistical Agency; DK-Diazepam – Ketamine; DLDifferential Leukocyte Counts; EDTA-Ethylene Diamine Tetra acetic acid; GABAA-.Gamma-Amino Butyric Acid type A receptors; HbC-Hemoglobin Concentration; IM-Intramuscular; Kg-Kilo gram; mg-milligram; PCV-Packed Cell Volume; SD-Standard Deviation; SPSS-Statistical Package for Social Sciences; TEC-Total Erythrocyte count; TLC-Total Leukocyte count; XK-Xylazine - Ketamine
The combination of ketamine hydrochloride and xylazine HCl usually result in a smooth induction and recovery with cataleptic effects of ketamine HCl get ameliorated by the sedative and my relaxing effects of xylazine HCl[10, 15].
Diazepam is associated with occasional individual variability in response. Moreover, its solvent (propylene glycol) may produce hypotension. Acepromazine has prolonged duration of sedation effect and is associated with hypotension secondary to marked peripheral vasodilatation. The combination of diazepam and ketamine is commonly described protocol for induction of general anesthesia in healthy dogs of various ages. It may also be indicated in certain cases with cardiovascular compromises [7,12,16]. This combination has proved good in providing excitement-free induction of anesthesia in dogs [6,31].
Ketamine is poor in visceral analgesia. However, it can be used in combination with xylazine or diazepam to provide good visceral analgesia in case of abdominal surgery (including ovariohysterectomy) and thoracic surgery. Pain is an unpleasant sensory or emotional experience most commonly associated with potential tissue damage. The sensation of pain is a consequence of the activation of specialized receptors and neurological pathways after such pain stimuli [17,21].
Studies on acute pain in clinical cases have most often evaluated the effects of surgical trauma on animals, while prevention and pain management are the key issues in anesthesia [14,22,28]. When pain is not appropriately managed, it is not only an animal welfare issue, but it can also have many detrimental effects which can impact the patient recovery [26]. A variety of physiological changes also occur in response to pain such as increases in heart rate, respiratory rate, blood pressure and body temperature [3,5,14].
Ketamine is rarely used alone because of its association with poor muscle relaxation, tachycardia and catalepsy or muscle rigidity. Therefore, it is commonly used in combination with xylazine, diazepam and acepromazine to minimize the adverse effects. Moreover, there are different breed of dogs which require proper anesthetic medicament combination. However, there are limited or no experiments carried out to determine a specific anesthetic combination in relation to the local breed of dogs in the study area. Hence, determining the effects of the ketamine in combination with other sedative agents may help to come out with the safest combination for surgical procedures in local breed of dogs. Therefore, the purpose of this study is to evaluate the effects of xylazine-ketamine, diazepam-ketamine and acepromazine-ketamine on anesthetic, physiological and hematological parameters so as to choose a suitable general anesthetic combination for use in surgical procedures in local breed of dogs in Mekelle, Ethiopia.
The dogs were housed individually in a kennel, fed meat and bread. Prior to anesthesia, each dog was withheld of food and water for 12 and 6 hours respectively. These dogs were placed in a quiet kennel and left undisturbed. Heart rate, respiratory rate and temperature were recorded prior to premedication. Blood samples were taken prior to premedication. All dogs were premedicated with atropine sulphate at 0.04 mg/kg body weight subcutaneously for the reduction of salivary and bronchial secretions fifteen minutes before induction of anesthesia with xylazine - ketamine, diazepam - ketamine and acepromazine - ketamine.
Group 2: First all dogs were premedicated with atropine sulphate at 0.04 mg/kg body weight subcutaneously. After fifteen minutes of premedication, a combination of diazepam and ketamine at two different doses diazepam and ketamine at 0.1 mg/kg and 5 mg/kg respectively and again at 0.5 mg/kg and 10 mg/kg intramuscularly respectively with one week interval between trials.
Group 3: First all dogs were premedicated with atropine sulphate at 0.04 mg/kg body weight subcutaneously. After fifteen minutes of premedication, a combination of acepromazine and ketamine at two different doses acepromazine and ketamine at 0.01 mg/kg and 5 mg/kg respectively and again acepromazine and ketamine at 0.05 mg/kg and 10 mg/kg intramuscularly respectively with one week interval between trials.
The recorded onset of action, duration of action and recovery time of the anesthetic combination of diazepam – ketamine at 0.1 mg/kg and 5mg/kg body weight given intramuscular, respectively were 12 ± 2.12, 37.8 ± 1.92 and 47.8 ± 1.92 minutes, respectively. The recorded onset of action, duration of action and recovery time of the anesthetic combination of diazepam – ketamine at 0.5 mg/kg and 10 mg/kg body weight given IM, respectively were 10 ± 2.12, 44.8 ± 1.92 and 55.6 ± 3.85 minutes, respectively. In this study, onset of action was shorter whereas duration of action and recovery time were longer in the anesthetic combination of diazepam – ketamine at 0.5 mg/kg and 10 mg/kg, respectively when compared to the anesthetic combination of diazepam – ketamine at 0.1 mg/kg and 5 mg/kg, IM (Table 1).
Anesthetic combinations |
Doses (mg/kg) |
Onset of action (min) |
Duration of action (min) |
Recovery time (min) |
Group 1 |
1 mg/kg and 5mg/kg |
8 ± 2.12 |
68 ± 6.28 |
78.2 ±6.53 |
2 mg/kg and 10 mg/kg |
6± 2.12 |
91 ± 6.28 |
101.2 ±6.53 |
|
Group 2 |
0.1 mg/kg and 5 mg/kg |
12 ±2.12 |
37.8 ± 1.92 |
47.8 ±1.92 |
0.5 mg/kg and 10 mg/kg |
10 ± 2.12 |
44.8 ± 1.92 |
55.6 ± 3.85 |
|
Group 3 |
0.01 mg/kg and 5 mg/kg |
13 ± 2.12 |
62.8 ± 2.28 |
72.8 ±2.28 |
0.05 mg/kg and 10 mg/kg |
11 ± 2.12 |
78.6 ± 1.67 |
88.6 ± 1. 67 |
In group 1 the rightening reflex was lost at 8 ± 2.12 minutes in xylazine-ketamne at dose rate of 1 mg/kg and 5 mg/kg, respectively, 6 ± 2.12 minutes in xylazine-ketamne at 2 mg/kg and 10 mg/kg, respectively (Table 2). In group 2 this reflex was lost at 12 ± 2.12 minutes (Table 2). In group 3 this reflexes was lost at 13 ± 2.12 minutes (Table 2). In this study, the rightening reflex remained unchanged throughout the anesthesia in all groups.
In all groups the eyes remained opened, with a central and dilated pupil during the anesthesia. In this study, the corneal reflex remained unchanged throughout the anesthesia in all groups.
Loss of body reflexes in minutes |
|||||
Anesthetic combinations |
Doses(mg/kg) |
Rightening reflex |
Palpebral reflex |
Corneal reflex |
Pedal reflex |
Group 1 |
1 mg/kg and 5mg/kg |
8 ± 2.12 |
8.1±2.02 |
8.1±2.02 |
8.6±2.42 |
2 mg/kg and 10 mg/kg |
6 ± 2.12 |
6.1±2.02 |
6.1±2.02 |
6.6±2.42 |
|
Group 2 |
0.1 mg/kg and 5 mg/kg |
12± 2.12 |
12.2±2.12 |
12.2±2.12 |
12.5±2.23 |
0.5 mg/kg and 10 mg/kg |
10± 2.12 |
10.2±2.12 |
10.2±2.12 |
10.5±2.23 |
|
Group 3 |
0.01 mg/kg and 5 mg/kg |
13± 2.12 |
13.2±2.12 |
13.2±2.12 |
13.7±2.22 |
0.05 mg/kg and 10 mg/kg |
11± 2.12 |
11.2±2.12 |
11.2±2.12 |
11.7±2.22 |
Parameters |
Time interval in minutes |
|
||||||||||||
BA |
5 |
10 |
15 |
20 |
25 |
30 |
35 |
40 |
45 |
50 |
55 |
60 |
||
HR (beat/min) |
80.1±2.2 |
79.8±2.23 |
79.5±2.24 |
79.3±2.34 |
78.2±2.26 |
77.4±2.28 |
74.2±2.34 |
73.4±2.35 |
72.5±2.41 |
72.3±2.47 |
79.3±2.35 |
79.5±2.24 |
79.8±2.23 |
|
RR(breath/min) |
23.7±0.7 |
23.1±0.78 |
18.6±0.8 |
17.4±0.91 |
17.4±0.92 |
16.6±1.13 |
15.7±1.24 |
15.4±1.36 |
15.0±1.34 |
20.2±0.77 |
23.2±0.77 |
23.2±0.64 |
23.5±0.53 |
|
RT(0c) |
37.8±0.77 |
37.76±0.79 |
37.68±0.80 |
37.64±0.85 |
37.45±0.87 |
37.42±0.89 |
37.4±0.912 |
37.35±0.93 |
37.29±0.95 |
37.182±1.02 |
37.68±0.84 |
37.69±0.79 |
37.78±0.69 |
In group 1 hemoglobin concentration (P = 0.066), packed cell volume (P = 0.073), total erythrocyte count (P = 0.069), total leukocyte count (P = 0.079), lymphocyte (P = 0.064), monocyte (P = 0.061), eosinophil (P = 0.074) and basophils (P= 0.084) were decreased non-significantly, Neutrophils (P = 1.000) were increased non-significantly from 58.8±0.39 to 64 ± 0.68 (Table 6).
In group 2 hemoglobin concentration (P = 0.062), packed cell volume (P = 0.065), total erythrocyte count (P = 0.067), total leukocyte count (P = 0.078), lymphocyte (P= 0.084), monocyte (P = 0.071), eosinophil (P = 0.0614) and basophils (P= 0.083) were decreased non-significantly, on the other hand, neutrophils (P = 1.0211) were increased non-significantly from 58.8 ± 0.39 to 66.5 ± 0.34 (Table 6).
In group 3 hemoglobin concentration (P = 0.076), packed cell volume (P = 0.073), total erythrocyte count (P = 0.069), total leukocyte count (P = 0.089), lymphocyte (P= 0.0714), monocyte (P = 0.0831), eosinophil (P = 0.0724) and basophils (P= 0.0806) were decreased non-significantly, on the other hand, neutrophils (P = 1.0221) were increased non-significantly from 58.8 ± 0.39 to 66.58 ± 0.34 (Table 6).
Parameters |
Time interval in minutes |
|||||||||
BA |
5 |
10 |
15 |
20 |
25 |
30 |
35 |
40 |
45 |
|
HR(beat/min) |
80.1±2.22 |
79.8±2.33 |
79.5±2.42 |
79.3±2.46 |
78.2±2.47 |
77.4±2.37 |
74.2±2.1 |
73.4±2.4 |
72.5±2.5 |
79.3±2.4 |
RR(breath/min) |
23.7±0.73 |
23.1±0.79 |
18.6±0.82 |
17.48±0.89 |
17.43±0.94 |
16.67±1.32 |
15.74±1. |
15.45±1 |
15.03±1 |
23.2±0.7 |
RT(0c) |
37.81±0.77 |
37.76±0.78 |
37.68±0.81 |
37.64±0.86 |
37.45±0.88 |
37.42±0.90 |
37.4±0.9 |
37.35±0.94 |
37.29±0.96 |
37.62±1.02 |
Parameter |
Time interval in minutes |
||||||||||||
BA |
5 |
10 |
15 |
20 |
25 |
30 |
35 |
40 |
45 |
50 |
55 |
60 |
|
HR(beat/min) |
80.1±2.22 |
79.7±2.23 |
79.4±2.24 |
79.3±2.35 |
78.1±2.26 |
77.3±2.28 |
74.1±2.31 |
73.3±2.35 |
72.4±2.41 |
72.2±2.47 |
79.2±2.35 |
79.4±2.24 |
79.7±2.23 |
RR(breath/min) |
23.7±0.73 |
23.4±0.78 |
18.5±0.8 |
17.4±0.88 |
17.3±0.91 |
16.6±1.12 |
15.6±1.22 |
15.4±1.3 |
15.1±1.3 |
19.3±0.77 |
23.3±0.77 |
235±0.64 |
23.6±0.53 |
RT(0c) |
37.81±0.77 |
37.676±0.78 |
37.588±0.80 |
37.54±0.85 |
37.35±0.87 |
37.32±0.89 |
37.3±0.912 |
37.25±0.93 |
37.39±0.95 |
37.282±1.02 |
37.77±0.84 |
37.78±0.79 |
37.79±0.69 |
Anesthetics |
|
|||||||||
HBC |
PCV |
TEC |
TLC |
NTP |
LYM |
MN |
EOS |
BAS |
||
Group 1 |
Before anesthesia |
14.2±0.25 |
42.2±0.25 |
6.2±0.25 |
10.2±0.25 |
58.8±0.39 |
29.8±0.53 |
7.2±0.25 |
3.4±0.27 |
0.8±0.13 |
During anesthesia |
13.81±0.29 |
41.62±0.29 |
5.68±0.25 |
9.19±0.33 |
64±0.68 |
27.1±0.67 |
6.4±0.16 |
2.5±0.16 |
0.4±0.1632 |
|
Group 2 |
Before anesthesia |
14.2±0.25 |
42.2±0.25 |
6.2±0.25 |
10.2±0.25 |
10.2±0.25 |
29.8±0.53 |
7.2±0.25 |
3.4±0.27 |
0.8±0.133 |
During anesthesia |
12.61±0.29 |
40.59±0.27 |
4.78±0.20 |
7.78±0.19 |
66.5±0.34 |
26.1±0.38 |
5.6±0.16 |
2±0.21 |
0.2±0.13 |
|
Group 3 |
Before anesthesia |
14.2±0.25 |
42.2±0.25 |
6.2±0.25 |
10.2±0.25 |
10.2±0.25 |
29.8±0.53 |
7.2±0.25 |
3.4±0.27 |
0.8±0.13 |
During anesthesia |
12.63±0.29 |
40.69±0.27 |
4.76±0.20 |
7.79±0.19 |
66.58±0.34 |
26.4±0.38 |
5.7±0.16 |
2.1±0.2108 |
0.22±0.13 |
In this study, the onset of action of xylazine and ketamine combination was relatively 6 minutes rapid when compared to the studies by Emami, et al.(2014) who found 12 minutes after administration of xylazine at dose rate of 1mg/kg and ketamine at dose rate of 15 mg/kg body weight intramuscularly [11]. The duration of action of xylazine and ketamine combination was relatively 35.75 minutes longer when compared to the studies by Sindak, et al.(2010) reported 55.25 minutes[27]. The duration of action of xylazine and ketamine combination was relatively 19.4 minutes longer when compared to the studies by Emami, et al.(2010) found 71.60 ± 3.07 minutes [11]. The recovery time of xylazine and ketamine combination in the present finding was relatively 27.85 minutes longer when compared to the study by Sindak, et al.(2010) reported 73.15 minutes [27]. This finding difference in the present study from previous studies might be due to difference in breed and physiological status of the dogs or might be due to difference in dose of the anesthetic agents.
In this study, heart rate was decreased non- significantly at 30-45 minutes, respiratory rate was decreased non-significantly at 10-45 minutes and rectal temperature was decreased nonsignificantly at 20-45 minutes after administration of xylazine and ketamine combination.
The decrease in heart rate, respiratory rate and rectal temperature in this study were in agreement with the studies by Sindak, et al.(2010) reported decreased heart rate at 30- 45 minutes after administration of xylazine and ketamine combination, decrease in respiratory rate and decrease in rectal temperature at 20-45 minutes after administration of xylazine and ketamine; Mwangi, et al.(2014) reported decreased rectal temperature at 30 minutes and Emami, et al.(2010) reported decreased respiratory rate at 5-55 minutes following administration of xylazine and ketamine combination. On the other hand, Afshar, et al.(2005) reported significant decrease in heart rate at 15-60 minutes after administration of xylazine and ketamine combination; Kul, et al.(2000) reported significant decreased in respiratory rate at 15 - 60 minutes after administration of xylazine and ketamine combination; Demirkan, et al.(2002) reported significantly remained lower respiratory rate than the baseline throughout the xylazine and ketamine anesthesia and rectal temperature remained significantly decreased at 30-60 minutes after administration of xylazine and ketamine combination [1,9,11,19,23,27].
The decreases in rectal temperature after administration of xylazine and ketamine combination found in the present study were in contrary with the findings of Wyatt, et al.(2001) reported unchanged in rectal temperature after administration of xylazine at 1 mg/kg and ketamine at 10 mg/kg body weight intramuscularly in dogs [33].
The decrease in body temperature after the administration of the xylazine-ketamine, diazepam-ketamine and acepromazineketamine could be explained by blocking of the hypothalamic thermoregulatory center. The decrease in heart rate could be attributed to inhibition of the release of the neurotransmitter noradrenalin or depression of the sympathetic activity.
The decrease in respiratory rate could be attributed to depression of the respiratory center by the xylazine-ketamine, diazepam-ketamine and acepromazine-ketamine [30]. The non significant decrease in heart rate, respiratory rate and rectal temperature in the present study when compared to other studies might be due to difference in breed and physiological status of the dogs or might be due to difference in dose of the sedative agents.
In the present study, the average duration of anesthetic induction after administration of diazepam and ketamine at 0.1 mg/kg and 5 mg/kg, respectively were 12 ± 2.12 and 37.8 ± 1.92 minutes, respectively. This finding is in agreement with the studies by Ferreira, et al.(2015) reported 35.7 minutes of the average duration of anesthesia after administration of diazepam and ketamine combination, but the onset of action was slower in the present finding when compared to observations separated by Ferreira, et al.(2015) he had reported average 4.2 minutes after administration of diazepam and ketamine combination [13]. The slower onset of action in the present finding when compared to the other studies might be due to difference in breed of the dog or due to difference in physiological status of the dog.
In this study, heart rate was decreased non-significantly at 30-40 minutes, respiratory rate was decreased non-significantly at 10-40 and rectal temperature was decreased non-significantly at 20-40 minutes after administration of diazepam at 0.5 mg/ kg and ketamine at 10 mg/kg body weight intramuscularly. Relatively similar finding were reported by White, et al.(2001) who found decreased respiratory rate at the first 30 minutes after administration of the diazepam at 0.3 mg/kg and ketamine at 5 mg/kg body weight intramuscularly on ten healthy dogs [31].
After administration of xylazine –ketamine, Diazepam – ketamine and acepromazine - ketamine combinations the hemoglobin concentration, packed cell volume, total erythrocyte count, total leukocyte count, lymphocyte, monocyte, eosinophil and basophils were decreased non-significantly, but neutrophils were increased non-significantly.
Pooling of circulating blood cells in the spleen and other reservoirs secondary to decreased sympathetic activity could be the reason for a decrease in hemoglobin concentration, packed cell volume, total erythrocyte count, total leukocyte count, lymphocyte, monocyte, eosinophil and basophils [18]. The decrease in hemoglobin concentration, packed cell volume, total erythrocyte count, total leukocyte count, lymphocyte, monocyte, eosinophil and basophils after administration of the diazepam and ketamine combination might be attributed to the shifting of fluid from extra vascular compartment to intravascular compartment in order to maintain normal cardiac output in the dogs [29].
This finding is in agreement with the findings of Mahmud, et al.(2014) who had reported decreased the hemoglobin concentration, packed cell volume, total erythrocyte count, total leukocyte count, lymphocyte, monocyte, eosinophil and basophils and increased neutrophils after administration of diazepam at 0.4 mg/kg and ketamine at 10mg/kg combination in dogs [20].
In the current study, heart rate was decreased nonsignificantly at 30-45 minutes, respiratory rate decreased non-significantly at 10-45 minutes after administration of the xylazine-ketamine, diazepam-ketamine and acepromazineketamine intramuscularly and rectal temperature decreased non-significantly at 20-45 minutes after administration of the xylazine-ketamine, diazepam-ketamine and acepromazineketamine combinations intramuscularly.
This finding is relatively similar with the findings of Amarpal, et al.(2010) who had reported decreased heart rate at 60 minutes after administration of the acepromazine and ketamine combination, decrease in respiratory rate at 10-60 minutes after administration of the acepromazine and ketamine combination and decrease in rectal temperature at 10-60 minutes intramuscularly after administration of the acepromazine and ketamine combination in dogs [2].
- Afshar S, Baniadam A, Marashipour P.Effect of xylazine –ketamine on arterial blood pressure, arterial blood pH, blood gases, rectal temperature, heart rate and respiratory rate in goat. Bulletin of the Veterinary Institute in Pulawy.2005;49: 481-484.
- Amarpal P, Kinjavdekar P, Aithal A, Pawde K, Singh J,Rahul U. Evaluation of Xylazine, Acepromazine and Medetomidine + Ketamine for general anesthesia in rabbits. Scandinavian Journal of Laboratory Animal Sciences.2017;37(3): 223-229.
- Atalan H, Gunes V, Cihan M, Celebi F, Citil M. Comparisons of xylazine + ketamine-HCl anaesthetic agents with acepromazine + butorphanol + ketamine combinations for their clinical,cardiovascular and respiratory effects in dogs.2002;8:35-40.
- Azizpour A, Hassani Y. Clinical evaluation of general anaesthesia with a combination of Ketamine HCL and Diazepam in pigeons. Journal of Agriculture. 2012;7(2):101-105. doi: 10.3923/aj.2012.101.105
- Bergamasco L, Osella C, Savarino P, Larosa G, Ozella L, Manassero M, et al. Heart rate variability assessment in shelter dog. Application animal Science. 2010;125(1-2): 56-68.
- Beteg F, Muste A, Mates N, Donisa A, Scurtu L, Bota A, et al. Observations concerning the effects of medetomidine on diazepam-ketamine induced anesthesia in dogs. Indian Journal of Veterinary Research. 2010; 43(10): 95-99.
- Boutureira J, Trim C, Cornell K. Acute pulmonary edema after diazepam–ketamine in a dog. Journal of Veterinary Anesthesia and Analgesia.2007; 34(5): 371-376.
- CSA. Central Statistical Agency: Report on monthly average retail prices of goods and services. Statistics Bulletn. 2008;416.
- Demirkan G, Gokce I, Ozaydin D, Celebi F. Comparative study of butorphanol-ketamine and xylazine –ketamine combinations for their clinical, cardiovascular and respiratory effects in healthy dogs. Turkey journal of veterinary and animal science. 2002;26:1073-1079.
- Durrani F, Ashraf M, Khan A. A comparison of the clinical effects associated with xylazine, ketamine and a xylazine–ketamine cocktail in pigeons (Columba Livia). Turkish Journal of Veterinary and Animal Science. 2009 ;33: 413-417.
- Emami R, Sedighi R, Sarhaddi S. Cardiovascular and respiratory effects of romfidine or xylazine in ketamine anesthesia in dogs. Iranian journal of veterinary surgery. 2007;2(2):59-64.
- Fayyaz S, Kerr C, Dyson H, Mirakhur K. The cardiovascular and pulmonary effects of anesthetic induction with isoflurane, diazepam‐ketamine or diazepam‐propofol in the hypovolemic dogs. Journal of Veterinary Anesthesia and Analgesia. 2009;36(2): 110-123.
- Ferreira P, Dzikiti B, Zeiler E, Buck R, Nevill B, Gummow B. Anesthetic induction and recovery characteristics of a diazepam-ketamine combination compared with propofol in dogs, Journal of the South African Veterinary Association. 2015;86(1):1258.
- Gaynor S, Muir W. Handbook of Veterinary Pain Management. Drugs acting on the central nervous system. 2nd edition. St. Louis: Mosby. 2008;78-109.
- Gulanber E, Baştan A, Tasal I, Aktas M, Arikan N. Ketamine as general anesthesia. Journal of the faculty of veterinary medicine, Istanbul University. 2001;27(2):401-409.
- Hazra S, De D, Roy B. Use of ketamine, xylazine, and diazepam anesthesia with retrobulbar block for phacoemulsification in dogs. Veterinary Ophthalmology. 2008;11(4): 255-259.
- Junior E, Santos J, Russo C, Elsensaut P, Headley A. Evaluation of cortisol levels of dogs anesthetized with sevoflurane and premedicated with butorphanol. 2009;30(2): 425-433.
- Kilic N. Physiological and hematological changes in ketamine and diazepam anesthesia in horse. Indian Journal of Veterinary. 2004;81:396-398.
- Kul M, Koc Y, Alkand F, Ogurtan Z. The effects of xylazine-ketamine and diazepam-ketamine on arterial blood pressure and blood gases in dogs. Journal of Veterinary Research. 2000;4:123-132.
- Mahmud A, Shaba P, Yisa H, Gana J, Ndagimba R, Ndagi S. Comparative efficacy of Diazepam, Ketamine and Diazepam-Ketamine combination for sedation or anesthesia. Journal of advances Veterinary Animal Research. 2014;1(3):107-113.
- Mathews A. Pain assessment and general approach to management. Veterinary Clinical. North America Small Animal Practice. 2000;30(4): 729-755.
- Muir W. Cylohexamine drug mixtures: The pharmacology of ketamine and ketamine combination drugs. Proceedings of second International Congress of Veterinary Anesthesia.Veterinary Publishing Co, Santa Barbara. 2008;4: 5-14.
- Mwangi E, Mogoa M, Nguhiu J, Mulei M. Effects of epidural Ketamine, Xylazine and their combinations on body temperature in acepromazine-sedated dogs. International Journal of Advanced Research. 2014;2(4):336-340.
- Naqialbayati T. A comparative study between of effect of tramadol and xylazine as premedication those followed by ketamine anesthesia in dogs. Kufa journal for veterinary medical sciences. 2015;6:2.
- Orpet H, Welsh P. Handbook of Veterinary Nursing. Implementation a patient care plan. 1st edition, Blackwell Science Ltd., USA. 2002;10: 244-251.
- Orskov T. Pain assessment in cats and dogs. Irish Journal of Veterinary science. 2010; 63(6): 362-364.
- Sindak N, Camekerten I, Ceylan C. clinical evaluation of xylazine-ketamine anesthesia in bozova greyhounds. Journal of animal and veterinary advances. 2010;9(15): 2025-2029.
- Tranquilli J, Thurmon C, Grimm A. Lumb and Jones' Veterinary Anesthesia and Analgesia. 4th edition. Oxford: Blackwell. 2007;80-105.
- Wagner A, Muir W, Hinchclif K W. Cardiovascular effects of xylazine and detomidine in horse. American Journal of Veterinary Research. 1991; 52(5): 651–657.
- Walter H. Handbook of Veterinary Pharmacology: Drugs Acting on the Central Nervous System. Wiley-Blackwell. IOWA. 2008;81-107.
- White K, Shelton K, Taylor P. Comparisons of diazepam–ketamine and thiopentone for induction of anaesthesia in healthy dogs. Journal of Veterinary Anaesthesia and Analgesia.2001; 28(1): 42-48.
- Winer J, Brown R, Michels K. Statistical principles in experimental designs. 3rd edition, Mcgraw hill series. 2001;1057.
- Wyatt D, Scott W, Richardson E. The effects of prolonged ketamine-xylazine intravenous infusion on arterial blood pH, blood gases, mean arterial blood pressure, heart and respiratory rates, rectal temperature and reflexes in the rabbit. Journal of Veterinary Science. 1989;39(5):411-416.