TUGAS MATAKULIAH

ILMU BEDAH UMUM VETERINER

“ANASTESI PADA KASUS FRAKTUR”

Disusun Oleh:

Kadek Apriyan Widiarta

1709514116

Kelas C

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

2020

i
 RINGKASAN

Anjing merupakan salah satu hewan kesayangan yang dijadikan peliharaan oleh
manusia. Dalam pemeliharaannya, anjing dapat mengalami kondisi trauma yang
menyebabkan patah tulang femur (fraktur femur). Fraktur femur merupakan salah satu
kasus fraktur tulang panjang yang paling sering pada anjing. Penanganan dilakukan
dengan proses operasi. Sebelum melakukan operasi pemasangan pin, anjing diinduksi
dengan anastesi berupa kombinasi ketamine dan diazepam secara intravena

ii
 KATA PENGANTAR

Puji dan syukur saya panjatkan kehadapan Tuhan Yang Maha Esa karena atas
berkat dan rahmat-Nya makalah yang berjudul ANASTESI PADA KASUS
FRAKTUR ini dapat diselesaikan tepat pada waktunya. Saya ingin mengucapkan
terima kasih untuk berbagai sumber yang telah saya pakai sebagai data dan fakta pada
makalah ini.

Saya menyadari bahwa makalah ini masih jauh dari sempurna dan perlu
pendalaman lebih lanjut, dan tidak semua hal dapat saya desksripsikan dengan
sempurna. Oleh karena itu, saya mengharapkan saran dari pembaca yang bersifat
konstruktif demi kesempurnaan makalah ini. Saya harap semoga pembahasan dalam
makalah ini dapat bermanfaat bagi dunia kesehatan hewan dan pendidikan serta
masyarakat umum, mengenai ANASTESI PADA KASUS FRAKTUR ini dengan
baik serta mengetahui pencegahan dan pengobatan jika nanti adanya kemunculan
penyakit ini.

Denpasar, 10 Maret 2020

Penulis

iii
 DAFTAR ISI

Halaman Judul................................................................................................................ i

Ringkasan ..................................................................................................................... ii

Kata Pengantar ............................................................................................................. iii

Daftar Isi....................................................................................................................... iv

Daftar Gambar ............................................................................................................... v

Daftar Lampiran ........................................................................................................... vi

BAB I PENDAHULUAN ............................................................................................. 1

1.1 Latar Belakang .................................................................................................. 1

1.2 Rumusan Masalah ............................................................................................. 2

BAB II TUJUAN DAN MANFAAT PENULISAAN .................................................. 3

BAB III PENUTUP. ..................................................................................................... 4

3.1 Anjing................................................................................................................ 4
3.2 Fraktur Femur. .................................................................................................. 5
3.3 Anastesi ............................................................................................................. 7

BAB IV PEMBAHASAAN .......................................................................................... 9

BAB V SIMPULAN DAN SARAN ........................................................................... 11

5.1 Simpulan ......................................................................................................... 12

5.2 Saran ................................................................................................................ 12

Daftar Pustaka ............................................................................................................ 13

Lampiran .................................................................................................................... 14

DAFTAR GAMBAR

iv
Gambar 1 Berbagai macam jenis anjing ....................................................................... 5

Gambar 2 Penampakan lateral radiografi fraktur bagian distal femoral ....................... 7

Gambar 3 Penampakan radiografi fraktur tuberositas tibial dan distal femoral ........... 7

v
 DAFTAR LAMPIRAN

1. Lampiran 1. Jurnal Krishna, H.N.V.V., Ayyappan, S., and Prasad,A. A. 2018.

Femur Fracture Tie-In Fixation in a Dog - A Case Report. Indian Vet. J., April
2018, 95 (04) : 57 - 59
2. Lampiran 2. Jurnal Nazhvani,D.S., Jahromi, R.A.R., Foroud, M., Vesal, N.1
and Hooman, F. 2013. Surgical Repair of Distal Femoral Fracture in a Wild
Gray Wolf (Canis lupus). Iranian Journal of Veterinary Research, Shiraz
University, 2013, Vol. 14, No. 2, Pages 165-16
3. Lampiran 3. Jurnal Ozkan, F., Ozkan, N.C., Eyibilen, A., Yener, T., and
Erkorkmaz, U. 2010. Comparison of ketamine-diazepam with ketamine-
xylazine anesthetic combinations in sheep spontaneously breathing and
undergoing maxillofacial surgery. Bosnian Journal of Basic Medical Sciences
2010; 10 (4): 297-302.
4. Lampiran 4. Jurnal Tembhurne R.D., Gahlod, B.M., Dhakate,M.S., Akhare,
S.B., Upadhye, S. V. and Bawaskar, S. S. 2010. Management of femoral
Fracture with the use of Horn Peg in Canine. Veterinary World, Vol.3(1):37-41

vi
 BAB I

PENDAHULUAN

1.1 Latar Belakang

Berbagai jenis hewan, binatang, maupun satwa, seperti satwa akuatik, satwa
liar, hewan kesayangan, hewan ternak, hewan eksotik, dan lain sebagainya sangat
sering kita jumpai dikeseharian. (Bryan dkk, 2010).

Hewan kesayangan merupakan salah satu jenis hewan yang banyak dipelihara
oleh masyarakat Indonesia karena bersifat sebagai companion animals. Seperti
misalnya anjing. Masyarakat cenderung memilih untuk menjadikan anjing sebagai
hewan peliharaan dikarenakan anjing dapat dijadikan sebagai penjaga rumah atau
sebagai sahabat manusia.

Pemilik anjing memiliki bebagai cara dalam memelihara anjingnya, seperti

dikandangkan, dilepas di halaman rumah, atau dilepas liarkan. Anjing yang
dilepasliarkan memiliki risiko tinggi tertular penyakit, berkelahi, atau mengalami
kecelakaan. Kecelakaan tersebut dapat berupa tertabrak kendaraan atau terjatuh dari
tempat yang tinggi, sehingga dapat menimbulkan patah tulang (fraktur) salah satunya
pada tulang paha (femur).

Fraktur pada anjing akibat tertabrak oleh kendaraan bermotor dapat dialami
anjing dari semua usia yang dilepas liarkan diluar rumah. Tulang pada daerah
extremitas kaki belakang merupakan tulang yang paling sering mengelami fraktur.
Penanganan anjing yang mengalami fraktur harus ditangani dengan cepat dan tepat bila
terlambat dilakukan penanganan, maka akan terbentuk callus yang akan menyelimuti
tulang yang mengalami fraktur, sehingga menyulitkan dalam proses penanganan
fraktur (Denny et al., 2008)

Penanganan terhadap patah tulang sebaiknya adalah dengan melakukan operasi

di klinik atau rumah sakit hewan. Operasi patah tulang memerlukan anastesi dalam
menghilangkan rasa sakit saat operasi. Makalah ini dibuat untuk membahas mengenai

1
anastesi yang digunakan saat akan melakukan operasi fraktur femur pada anjing
lengkap dengan dosis beserta cara pengaplikasiannya.

1.2 Rumusan Masalah

1.2.1 Apa saja anastesi yang digunakan saat akan melakukan operasi fraktur femur
pada anjing?
1.2.2 Berapa dosis anastesi yang digunakan saat akan melakukan operasi fraktur
femur pada anjing?
1.2.3 Bagaimana cara mengaplikasikan anastesi yang digunakan saat akan
melakukan operasi fraktur femur pada anjing ?

2
 BAB II

TUJUAN DAN MANFAAT TULISAN

Tujuan penulisan makalah ini adalah untuk memberikan informasi atau sumber
bacaan kepada penulis sendiri maupun pembaca mengenai anastesi yang digunakan
saat akan melakukan operasi fraktur femur pada anjing lengkap dengan dosis beserta
cara pengaplikasiannya.

Manfaat yang diharapkan dapat diperoleh dari penulisan makalah ini adalah
agar penulis dan pembaca mengetahui anastesi yang digunakan saat akan melakukan
operasi fraktur femur pada anjing lengkap dengan dosis beserta cara
pengaplikasiannya.

3
 BAB III

TINJAUAN PUSTAKA

3.1 Anjing

Anjing merupakan hewan yang sudah sejak lama didomestikasi oleh

manusia. Pada zaman dahulu hewan ini digunakan untuk membantu manusia
dalam berburu binatang liar, dan juga untuk menjaga hewan ternak dari
ancaman binatang buas. Ada ungkapan yang berbunyi “Dogs are men’s best
friends” (Anjing adalah sahabat terbaik manusia). Di masa kini, manusia tidak
hanya memelihara anjing untuk berburu dan mencari makan, tetapi juga sebagai
hewan kesayangan, penjaga rumah dan perkebunan, hiburan, pelacak, dan
bahkan menjadi aktor film, serta masih banyak kegunaan anjing lainnya dalam
kehidupan manusia.

Anjing merupakan salah satu hewan kesayangan yang dijadikan

peliharaan, hal ini dikarenakan anjing memiliki indra penciuman, pendengaran
dan pengelihatan yang sensitif serta merupakan hewan yang setia (Budiana,
2007).

Menurut Rumatiwi (2009), anjing diklasifikasikan sebagai berikut:

Kingdom : Animalia

Filum : Chordata
Subfilum : Vertebrata
Kelas : Mamalia
Ordo : Carnivora
Family : Canidae
Genus : Canis
Spesies : Canis familiaris

4
 Gambar 1. Berbagai jenis anjing (http://theconversation.com/why-dog-breeds-
arent-considered-separate-species-56113)

Anjing sangat bervariasi dalam ukuran, penampilan dan tingkah laku

dibandingkan dengan hewan peliharaan yang lain. Sebagian besar anjing masih
mempunyai ciri-ciri fisik yang diturunkan dari serigala. Anjing adalah hewan
pemangsa dan hewan pemakan bangkai, memiliki gigi tajam dan rahang yang
kuat untuk menyerang, menggigit, dan mencabik-cabik makanan. Ciri-ciri khas
dari moyang serigala masih bertahan pada anjing, walaupun penangkaran
secara selektif telah berhasil mengubah bentuk fisik berbagai jenis anjing.

Anjing memiliki otot yang kuat, tulang pergelangan kaki yang bersatu,
sistem kardiovaskuler yang mendukung ketahanan fisik serta kecepatan berlari,
dan gigi untuk menangkap dan mencabik mangsa. Bila dibandingkan dengan
struktur tulang kaki manusia, secara teknis anjing berjalan berjingkat dengan
jari-jari kaki.

3.2 Fraktur Femur

Fraktur merupakan istilah dari hilangnya kontinuitas tulang, baik yang
bersifat total maupun sebagian, biasanya disebabkan oleh trauma. Terjadinya
suatu fraktur lengkap atau tidak lengkap ditentukan oleh kekuatan, sudut dan
tenaga, keadaan tulang, serta jaringan lunak di sekitar tulang. Secara umum,
keadaan patah tulang secara klinis dapat diklasifikasikan sebagai fraktur
terbuka, fraktur tertutup, dan fraktur dengan komplikasi. Fraktur tertutup adalah
fraktur dimana kulit tidak ditembus oleh fragmen tulang, sehingga tempat

5
fraktur tidak tercemar oleh lingkungan luar. Fraktur terbuka adalah fraktur yang
mempunyai hubungan dengan lingkungan luar melalui luka pada kulit dan
jaringan lunak, dapat terbentuk dari dalam maupun luar. Fraktur dengan
komplikasi adalah fraktur yang disertai dengan komplikasi seperti malunion,
delayed union, non union dan infeksi tulang (Mahartha et al., 2013)
Fraktur femur biasanya terjadi pada anjing dikarenakan adanya trauma.
Sebagian besar fraktur femur diobservasi sebagai fraktur tertutup karena otot-
otot yang terlalu tebal, kecuali apabila disebabkan oleh luka yang dalam seperti
luka tembak.
Ada dua hal penyebab terjadinya fraktur yakni akibat traumatik (fraktur
traumatik) dan akibat penyakit lainya (fraktur patologik). Fraktur traumatic
dapat terjadi bila tulang mendapatkan tekanan keras dari eksternal misalnya
fraktur akibat pukulan benda keras, tertabrak kendaraan bermotor, terjatuh dari
tempat tinggi, tersandungnya kaki hewan ketika bergerak cepat.
Fraktur akibat traumatik dapat terjadi secara langsung dan tidak
langsung. Secara langsung (Direct) merupakan patah tulang yang terjadi
langsung ditempat terjadinya trauma. Biasanya arah patahan dari fraktur akibat
traumatik langsung bersifat transversal. Sedangkan secara tidak langusng
(indirect), fraktur terjadi ditempat lain akibat kekuatan yang diantarkan lewat
tulang.
Fraktur patologik merupakan fraktur yang terjadi akibat penyakit
sehingga kerusakan minor dapat menyebabkan terjadinya fraktur. Adapun
penyakit yang dapat menyebabkan fraktur adalah osteoma, osteosarcoma,
osteomyelitis, dan rakhitis (Piermattei et al.,2006

6
3.3 Anastesi
Anastesi berasal dari bahasa Yunani (an=tidak, aesthesis=rasa atau
sensasi), sehingga memiliki arti suatu keadaan hilangnya rasa atau sensasi tanpa
atau disertai dengan hilangnya kesadaran. Anastesia adalah keadaan tanpa rasa
(without sensation) tapi hanya bersifat sementara dan dapat kembali pada
keadaan semula karena hanya merupakan penekanan pada fungsi atau aktifitas
jaringan saraf baik lokal maupun umum. Termasuk dalam keadaan without
sensation ini adalah keadaan tidak sadar (unconsciousness) dan keadaan tidak
ingat atau amnesia (inability to remember past experiences) (Sudisma, et al.
2016)
Tujuan penggunaan anastesi pada dasarnya adalah untuk membuat agar
pasien (hewan) tidak merasakan (insensible) terhadap rasa sakit dan atau tidak
sanggup bergerak. Penggunaan anastesi juga dimaksudkan sebagai bantuan
dalam melakukan diagnosa, dengan demikian banyak agen-agen kimia yang
bias digunakan dalam mencapai tujuan dari anastesi (Sudisma, et al. 2016)
Menurut Sudisma, et al (2016) anastesi dapat diklasifikasikan
berdasarkan luas wilayah yang teranastesi (menurut luas pengaruhnya) menjadi
3, yakni anastesi lokal, anastesi regional, dan anastesi umum :
a. Anastesi lokal adalah substansi yang dapat menghilangkan rasa sakit
secara lokal dengan cara penghambatan impuls saraf perifer secara
reversibel tanpa disertai hilangnya kesadaran. Anastesi lokal dapat
dilakukan dengan surface aflication, sub kutan, dan infiltrasi.
b. Anastesi regional adalah suatu substansi yang dapat menghilangkan
rasa sakit pada suatu daerah atau region tertentu secara reversibel tanpa
disertai hilangnya kesadaran. Anastesi regional dapat diaplikasikan
dengan cara anastesi epidural, spinal, dan para vertebral.
c. Anastesi umum adalah anastesi yang dapat menekan susunan sistem
saraf pusat secara reversibel sehingga hewan kehilangan rasa sakit di
seluruh tubuh, hilangnya reflek otot, dan hilangnya kesadaran.
Anastesi umum dapat diberikan dengan cara inhalasi atau injeksi.

7
 Menurut Warne, et al (2018) sebelum melakukan anastesi, penting
untuk melakukan evaluasi klinis terhadap hewan, seperti sinyalemen, sejarah
dan alasan menggunakan anastesi, pemeriksaan fisik, dan diagnosis klinik.
a. Sinyalemen terdiri dari informasi mengenai spesies, usia, ras, status
nutrisi, dan sikap atau perilaku hewan.
b. Sejarah dan alasan penggunaan anastesia. Sejarah pasien digunakan
untuk mengetahui informasi terapi obat yang pernah atau sedang
diberikan, ada atau tidaknya reaksi sensitif terhadap pengobatan atau
zat anastetik.
c. Pemeriksaan fisik harus dilakukan sebelum pemberian anastesi umum
dan sedasi.
d. Diagnosis klinik. Evaluasi terhadap kondisi pasien hendaknya
dilakukan minimal 1 hari sebelum prosedur anastesi.

8
 BAB IV
PEMBAHASAAN
Menurut Tembhurne, et al (20 10) sebelum melakukan operasi fraktur
femur, dilakukan pemberian pre anastesi seperti xylazine hydrochloride 1mg/kg
berat badan, atropine sulphate 0.04mg/kg berat badan, dan Betamethazone
sodium phosphate 2mg/kg berat badan secara intramuskular. Setelah 15 menit,
kembali diinjeksikan ketamine hydrochloride 5-10mg/kg berat badan dan
diazepam 1mg/kg berat badan secara intravena untuk induksi dan pemeliharaan
anastesi saat operasi berlangsung.
Menurut Krishna, et al (2018) anastesi yang diberikan sebelum
melakukan operasi fraktur femur adalah anastesi umum ketamine 5.0mg/kg
berat badan dan diazepam 0.3mg/kg berat badan secara intravena. Anastesi
umum ini dipelihara dengan pemberian 2% Isoflurane.
Menurut Nazhvani et al (2013), induksi anastesia yang diberikan
sebelum melakukan operasi fraktur femur adalah kombinasi diazepam
0,25mg/kg berat badan dan ketamine 5mg/kg berat badan dalam satu syringe
yang sama kemudian diinjeksikan secara intravena. Anastesia dipelihara
dengan pemberian halothane 0.8-1.0% disalurkan melalui oksigen.
Sebagian besar anastesia yang digunakan saat akan melakukan operasi
fraktur adalah kombinasi ketamine dan diazepam dengan pemberian injeksi
secara intravena. Ketamine adalah bahan anastesi yang digunakan sebagai
anastesi umum oleh dokter hewan sebagai tranquilizer. Tidak seperti anastesia
lainnya, ketamine tidak menyebabkan hilangnya kesadaran dan menimbulkan
halusinasi. Ketamine memiliki sifat onset cepat, telah terbukti aman, dan durasi
yang pendek (Young,et al. 2011).
Ketamine digunakan secara luas dengan dosis yang rendah untuk
perawatan pada pasien yang mengalami rasa sakit akut atau kronis, rasa sakit
akibat kelainan neuropati, iskemia pada kaki atau anggota tubuh lain, dan
kanker yang sulit disembuhkan, serta merupakan standar untuk terapi opioid.

9
Ketamine secara khusus digunakan secara intramuskular, intravena, peroral,
perrektal, atau dengan inhalasi (Young, et al. 2011)
Diazepam adalah bahan anastesi yang masuk ke dalam golongan
benzodiazepine, bias diaplikasikan secara intramuskular, intravena, oral, dan
rektal. Diazepam digunakan sebagai antikonvulsan dan penghilang rasa cemas,
sedasi, dan myorelaksasi (Griffin, et al. 2013)
Ketamine dapat meningkatkan detak jantung dan tekanan pada arteri,
menstimulasi fungsi kardiovaskular, dan apabila digunakan sebagai agen
tunggal dapat memicu efek samping yang tidak diinginkan seperti hipertonisitas
otot, myoclonus, dan konvulsi. Sehingga untuk meminimalkan efek samping
yang tidak diinginkan tersebut, pemberian ketamine dikombinasikan dengan
golongan benzodiazepine dan agonis alpha-2 (Ozkan, et al. 2010).
Diazepam adalah hipnotik-sedatif dan bersifat muscle relaxant. Obat ini
bersifat jangka panjang karena metabolismenya yang lambat dan relatif lebih
rendah efeknya pada kardiovaskular apabila dibandingkan dengan obat lainnya.
Saat dikombinasikan dengan ketamine, diazepam mengurangi efek yang tidak
diinginkan dari ketamine pada kardiovaskular, dan menunjukkan sifat
antikonvulsif, amnestic, relaksasi otot melalui mekanisme sentral (Ozkan, et al.
2010). Kombinasi ketamine dan diazepam bermanfaat karena induksi yang
cepat, durasi anastesi yang panjang, dan proses pemulihannya cepat. Oleh
karena itu, sebagian besar dalam kasus operasi fraktur femur digunakan
kombinasi ketaminediazepam untuk menghasilkan anastesia yang baik.

10
 BAB V
PENUTUP

5.1 KESIMPULAN

Fraktur femur adalah hilangnya kontinuitas tulang femur, yang

merupakan kasus fraktur yang paling sering terjadi pada anjing karena trauma.
Penanganan fraktur femur dapat dilakukan dengan tindakan operasi
pemasangan pin pada tulang. Anastesi yang digunakan saat akan melakukan
operasi fraktur femur adalah kombinasi ketamine dan diazepam secara
intravena karena dapat menghasilkan anastesia yang baik

5.2 SARAN

Saran yang dapat diberikan adalah agar pembaca dapat memahami

dengan baik penanganan fraktur femur pada anjing beserta penggunaan anastesi
yang baik sebelum operasi

11
 DAFTAR PUSTAKA

Bryan K., Green J., Hunt S., Martin J. 2010. Materi Biologi Volume 6, Hewan.
Bandung. Penerbit Pakar Raya
Budiana, N.S. 2007. Anjing. Depok. Penerbit Penebar Swadaya
Denny, H. R ., dan S. J. Butterworth. 2008. A Guide to Canine and Feline
Orthophaedic Surgery. 4th ed. Jhon Wiley and Sons.
Griffin, C.E., Kaye, A.M., Pharm, D., Bueno, F.R., and Alan, D. 2013.
Benzodiazepine Pharmacology and Central Nervous System-
Mediated effects. The Ochsner Journal 13:214-223
Krishna, H.N.V.V., Ayyappan, S., and Prasad,A. A. 2018. Femur Fracture Tie-
In Fixation in a Dog - A Case Report. Indian Vet. J., April 2018,
95 (04) : 57 - 59
Tembhurne R.D., Gahlod, B.M., Dhakate,M.S., Akhare, S.B., Upadhye, S. V.
and Bawaskar, S. S. 2010. Management of femoral Fracture with
the use of Horn Peg in Canine. Veterinary World, Vol.3(1):37-41
Mahartha, G.R.A., Maliawan, S., and Kawiyana, K. 2013. Manajemen Fraktur
pada Trauma Muskuloskeletal. Denpasar: Fakultas Kedokteran
Universitas Udayana
Nazhvani,D.S., Jahromi, R.A.R., Foroud, M., Vesal, N.1 and Hooman, F. 2013.
Surgical Repair of Distal Femoral Fracture in a Wild Gray Wolf
(Canis lupus). Iranian Journal of Veterinary Research, Shiraz
University, 2013, Vol. 14, No. 2, Pages 165-168
Ozkan, F., Ozkan, N.C., Eyibilen, A., Yener, T., and Erkorkmaz, U. 2010.
Comparison of ketamine-diazepam with ketamine-xylazine
anesthetic combinations in sheep spontaneously breathing and
undergoing maxillofacial surgery. Bosnian Journal of Basic
Medical Sciences 2010; 10 (4): 297-302

12
Piermattei, D; Flo, G and DeCamp, C (2006). Brinker, Piermattei, and Flo’s
handbook of small animal orthopedics and fracture repair. 4th
Edn., St. Louis, Missouri, Saunders/ Elsevier. PP: 549-553.
Sharma, M.D.K. Sarma, and Boro, P.K. 2018. Fixation of Distal End Femoral
Fracture in a Dog with Arrow Pinning: A Case Report.
International Journal of Current Microbiology and Applied
Sciences ISSN: 2319-7706 Volume 7 Number 03 (2018)
Sudisma, I.G.N., Pemayun, I.G.A.G.P., Wardhita, A.A.G.J., Gorda, I.W. 2016.
Denpasar: Penerbit Plawa Sari
Young, M.S., Kolp, E., and Friedman H.L. 2011. Ketamine.
https://www.researchgate.net/publication/261697361 (diakses
pada Selasa, 27 Februari 2019)
Warne, L.N., Bauquier, S.H., Pengelly, J., Neckd, D., and Swinneye, G. 2018.
Standards of Care Anaesthesia Guidelines for Dogs and Cats. Aust
Vet J 2018;96:413–427

13
Veterinary World, Vol.3(1):37-41 RESEARCH

Management of femoral fracture with

the use of horn peg in canine
Tembhurne R.D. B.M Gahlod, M.S. Dhakate, S.B.Akhare S. V. Upadhye and S. S. Bawaskar

Department of veterinary Surgery and Radiology,

Nagpur Veterinary College, Nagpur.

Abstract
The present investigation was carried on six clinical cases of femur fracture presented to the
N.V.C. Hospital. Immobilization of femur fracture was done with the use of horn -peg prepared
from bovine horn. The healing of femur fracture was evaluated on the basis of clinical, radiographic,
hematological & biochemical observation. The clinical observations such as rectal temperature,
heart rate and respiration rate recorded for 7 consequent days were within normal range in all
dogs. The surgical wound healed by primary intention in all the dogs. The partial weight bearing
by operated limb was seen in 7.66 ± 0.84 post-operative days and the complete weight bearing
was seen in 37.00 ± 2.94 post-operative days.The radiograph taken on 45th post-operative days
showed a well organized external bridging of fracture gap by a firm callus in all dogs. The
hematological studies revealed lymphocytopenia on 10th day. The haemoglobin level, total
erythrocyte count, total leucocyte count, PCV, eosinophils, monocytes and basophils count were
within normal range. Biochemical studies revealed significant increase in the serum alkaline
phosphatase activity, however serum calcium, serum creatinine, SGOT and SGPT levels were
within normal ranges. The horn-peg did not elicit any untoward reaction at the site of fracture
during period of healing process.
Keywords: Horn peg, Immobilization, Femur, Fracture, Canine.

Introduction in bovines respectively (Sakate et al. 1993). Horn is

The femur fracture in canine was more frequently
recorded as compare to other long bone fractures.
Steinmann-pin, Kirschner-wire, Rush-pin and
Kuntscher nail are same of the devices which we
generally used in veterinary orthopaedics surgery. But
prolonged use of such devices may resulted in
osteopenia and weakening of bone rendering it liable
to re-fracture (Paavolainen et al., 1978).
The ideal immobilization of fracture is one which
offers security to the extent that the normal use of the
limb is possible and sufficient flexibility to allow same
degree of movement at fracture site and provides rapid
bony union by the development of external bridging
callus (Mickibbin, 1978). There are suggestions to
explore the possibilities of using heterogeneous
biological implants for repair of fractures in canines
(Singh et al. 1987).
Biological implants such as horn plate and horn
pegs, prepared from buffalo horn have been used for
the repair of femoral fracture (Singh and Singh 1990
(b), Dubey, 1991) in canines and metatarsal fractures
www.veterinaryworld.org Veterinary World Vol.3, No.1, January 2010
an inert, economical, cheap and easily available
material for fixation of femoral fracture. The present
study was undertaken to evaluate the horn-peg for
the treatment of femoral fracture in dogs.
Materials and Methods
The study was undertaken on six dogs of either
sex about 2 months to 7 years of age weighing 9-12
kg. All the dogs were hold to food and water for 12
hours and 6 hours respectively before operation. The
site of operation was prepared aseptically. Pre-
anesthetic medicines like inj. xylazine hydrochloride,
atropine sulphate and Betamethazone sodium
phosphate were administer intra muscularly @ 1mg/
kg, 0.04mg/kg and 2mg/kg body weight respectively.
After 15 minutes, inj ketamine hydrochloride @ 5-10mg/
kg body weight and Dizepam @ 1 mg/kg body weight
were given intravenously for induction and maintenance
anesthesia during the surgical procedure.
The dogs were placed in lateral recumbence
with the affected leg upward. A long skin incision was
made along the line extending from the greater
37
 Management of femoral fracture with the use of horn peg in canine
trochanter to the lateral surface of the patella over the
midshaft of femur to exteriorize the femoral shaft. The
horn-peg prepared from the bovine horn was used for
the internal immobilization of femoral fracture.
Sterilization of the horn pegs were done in autoclave
for 15 minutes at 120oC under 15 lbs pressure before
use. After correct reduction and alignment of fracture
fragment the horn peg of appropriate size and shape
was inserted in a retrograde fashion. The surgical
wound was closed in a routine manner and sealed
with Tincture Benzoin and the affected limb was
covered using soft cotton rolled bandage.
Postoperatively, all the dogs were given
injections Reflin-250mg intramuscularly daily for five
consecutive days, injection Diclofenac Sodium was
given @ 2mg/kg body weight intramuscular daily for 3
days and the surgical wound was dressed with
betadine solution. The skin sutures were removed on
10th postoperative day.
The plane latero-medial radiographs of the
affected limb were taken immediately after internal
immobilization and subsequently on 10th, 20th and
45th postoperative day to note the status of horn-peg,
status of alignment, progress of healing process and
reaction of horn peg to host bone.
The clinical observations viz. rectal temperature,
heart rate and respiration rate were recorded daily for
the first seven consecutive days. Walking and weight
bearing by the operated leg and wound healing was
also recorded in each dog.
The hematological parameters viz. Hb%, TEC,
TLC, PCV% and DLC were recorded on 0 day and on
1st, 10th, 20th and 45th post operative day. The
biochemical parameters viz. creatinine, serum SGOT
and serum SGPT were recorded on 0 day and on 1st,
10th, 20th and 45th day of observation. The data
recorded during the present study was analyzed as
described by Snedecor and Conchron(1967).
Results and Discussion
The present study was conducted on six clinical
cases of dog with history of femur fracture. Evaluation
of the horn peg in the treatment of the femoral fracture
was done on the basis of clinical, hematological,
biochemical alterations and radiographic
observations during the healing period.
The surgery was under taken under dissociative
anaesthesia with ketamine and diazepam
combination. The duration of anaesthesia was found
satisfactory and the muscle relaxation was excellent
hence the entire orthopedic procedure was performed
smoothly in all the dogs.
A conventional method of sterilization with
autoclave seems to be effective way of sterilization of
www.veterinaryworld.org Veterinary World Vol.3, No.1, January 2010
horn pegs and did not affect the physical nature and
properties of the horn peg. These findings are in
agreement with Singh and Singh (1990) and Dubey
et al. (1993). The intramedullary fixation technique
was found easy and no difficulty was encountered
during retrograde fixation of horn peg in all the dogs.
The observations of present findings are in
concurrence with Dubey (1991) and Shinde (1994)
during the repair of femoral fracture with horn peg in
canines.
Clinical observations
The clinical observations such as rectal
temperature, heart rate and respiratory rate recorded
for 7 post-operative days were within normal range
and did not show any significant change at different
interval. It indicated that internal implant horn peg used
for the repair of femoral fracture did not affect the
physiological function of the body. These observation
confirms the findings reported by Dubey (1991),
Shinde (1994) and Pawar (1999) following repair of
the fractures in canines.
The surgical wound healed in 8-10 days by
primary intention. Clinically the dogs did not show any
sign of infection at the operative site except two dogs,
where in D2 seroma developed at the level of
trochanteric fossa on 8th post-operative day and in
D6 wound was distracted due to self mutilation. Local
dressing with betadine solution and administration of
antibiotics daily for five days resulted in satisfactory
recovery.
The partial weight bearing on the affected limb
during standing was seen from 5th -8th post-operative
day (mean value 7.66 ± 0.84 days) except in two dogs
which show partial weight bearing on 10th day
onwards.
The complete weight bearing on the limb during
standing was seen from 30th-45th post-operative day
(37.00 ± 2.94 days) except in two dogs which started
complete weight bearing from 45th and 40th post-
operative day respectively. The delay in weight
bearing by these dogs could be due to the pain and
presence of sepsis at the upper third of peg at
trochanteric fossa. Dubey et al. (1992) reported weight
bearing by operated limb on 7-10 post-operative day
days, which suggested desired degree of movement
of fragments permitted by the implanted horn plate
and proper securing of fractured fragments in position.
Radiographic Observations
The horn pegs used for fracture fixation being
radiolucent could not be visualized on radiographs
and allowed good visualization of fracture site hence
the evaluation of fracture healing was easy. These
findings are in agreement Wandhare (1989), Dubey,
(1991) Shinde, (1994) and Pawar (1999). The
38
 Management of femoral fracture with the use of horn peg in canine

Table-1. Showing mean values of haemogram in canines

Parameters Days of interval

N 0 Day 1st Day 10th Day 20th Day 45th Day
Hb gm/100ml 6 11.41±0.68 11.33±0.66 11.38 ±0.48 11.53±0.59 12.05±0.59
TEC 106 /mm3 6 6.76±0.13 6.62±0.04 6.69±0.09 6.82±0.07 6.96±0.09
TLC 106 /mm3 6 14±0.49 14.74±1.70 14.34±2.21 14.65±2.27 15.25 ±2.17
PCV % 6 32.33 ±2.73 31.5 ±2.49 33.93±2.01 36.22 ±2.33 37.22±2.32
Neutrophils % 6 74.33±0.88 80.33±1.90 82.33±1.05 82.33±1.56 84.33±2.06
Lymphocytes % 6 23 ± 0.73 17.33 ±2.04 15.16 ±0.87 16.16 ±1.90 13.33 ±1.97
Eosinophils % 6 1.33 ±0.33 0.5 ±0.33 0.83 ±0.16 0.6 ±0.49 1.16 ±0.3
Monocytes % 6 0.83 ±0.40 1.33±0.33 1.16 ±0.30 0.83 ±0.65 0.83 ±.037
Basophils % 6 0.5 ±0.33 0.5 ±0.28 0.5 ±0.22 0.00 0.3±0.21

radiograph taken soon after surgery showed excellent
reduction and good alignment of fractured fragments
and the fracture line was clearly visible on radiograph.
Soon after surgery radiographs revealed excellent
alignment. Singh and Singh (1990b) and Dubey et
al.(1993) observed perfect alignment of fracture ends
by using horn plates for femoral fracture. On 45th day
radiographs revealed complete bridging of fracture
gap by a well organized and distinct callus. Singh and
Singh (1990)observed of gap by periosteal callus on
day 45th.Dubey et al. (1993) observed bridging callus
at 6th week while at 9th week Radio graph revealed
complete obliteration of fracture line with well
organized osseous callus. The intramedullary horn
peg fixation did not show any untoward reaction at the
site of contact with endosteal surface during healing
of femoral fracture. These findings are in agreement
with Singh and Singh (1990), Ashtekar and
Deshpande(1981) ,Dubey et al.(1992) and Dubey et
al.(1993) reduction and good alignment of fractured
fragments and the fracture line was clearly visible on
radiograph. Soon after surgery radiographs revealed
excellent alignment. Singh and Singh (1990b) and
Dubey et al.(1993) observed perfect alignment of
fracture ends by using horn plates for femoral fracture.
On 45th day radiographs revealed complete bridging
of fracture gap by a well organized and distinct
callus.Singh and Singh (1990)observed of gap by
periosteal callus on day 45th.Dubey et al. (1993)
observed bridging callus at 6th week while at 9th week
Radio graph revealed complete obliteration of fracture
line with well organized osseous callus. The
intramedullary horn peg fixation did not show any
untoward reaction at the site of contact with endosteal
surface during healing of femoral fracture. These
findings are in agreement with Singh and Singh (1990)
Ashtekar and Deshpande(1981),Dubey et al.(1992)
and Dubey et al.(1993).
Haematological Observations
www.veterinaryworld.org Veterinary World Vol.3, No.1, January 2010
The Hematological parameter viz Hb%, TEC,
TLC, PCV, eosinophils, monocytes and basophils
were within normal physiological range. However the
mean values of neutrophil percentage on ‘0’ day was
74 ± 0.88 while on 1st , 10th , 20th and 45th day it was
80.33 ± 1.90, 82.33 ± 1.05, 82.33 ±1.56 and 84.33 ±
2.06 % respectively. There was constant and
increasing trend of neutrophil and the values were
not statistically significant. The rise in neutrophil
percentage might be due to the response to
inflammatory condition during healing of surgical
wound and stress during post-operative period.
Neutrophil are the first line of defense and therefore
there number got increased after the onset of
inflammation (Sastry, 1983). Aithal (1996) observed
significant increase in neutrophil count on 1st and 3rd
post-operative day. Marked increase in neutrophil was
reported following traumatic and post surgical wound
(Mahajan, 1992). The mean lymphocyte percentage
decreased from 23 ± 0.73 on “0” day to 15.16 ± 0.87
on 10th day and it was found highly statistically
significant. The decrease in lymphocyte count was
due to tissue injury during surgery or inflammation
elicited production of immuno-regulatory cytokines.
These cytokines activate the pituitary adrenal axes
and increase in glucocorticoid concentration. It results
to increased level of lymphoid tissue and reduction in
circulating lymphocytes (Kaneko et al.. 1997).
Biochemical Observations
The Biochemical studies revealed significant
increase in the concentration of alkaline phosphatase
from 3.15± 0.53 KA unit on 0 day to 6.94 ± 0.38 KA
unit on 20th day while on 45th day, level reached
toward normal range. The increased level level of
alkaline phosphatase on 1st, 10th and 20th post
operative day were highly statistically significant.
Similar observations were noticed by Shifrin (1970)
and Pawar (1999). Singh et al. (1976) reported a
significant increase in the serum alkaline phosphate
39
 Management of femoral fracture with the use of horn peg in canine

Table-2. Showing mean values of biochemical in canines

Parameters No. Days in interval

0 Day 1st Day 10th Day 20th Day 45th Day
Serum calcium
(mg/dl) 6 6.96± 0.29 6.83± 0.31 6.92± 0.34 6.95± 0.37 6.91± 0.3
Serum Alkaline
Phosphatase 6 3.15 ± 0.53 4.79± 0..53 7.52± 0.48 6.94± 0.38 5.74± 0.89
(KA unit)
Serum Creatinine
(mg/dl) 6 0.95± 0.14 1.11± 0.2 1.05± 0.2 1.13± 0.16 1.25 ± 0.21
SGOT
(units/litre) 6 22.82 ±2.45 23.62 ±2.83 24.57 ±2.52 26.67±2.06 27.21±2.96
SGPT
(units/ litre) 6 24.26 ±2.40 23.34 ±2.18 24.10 ±2.31 24.81±2.28 25.39± 2.43

concentration at 7th and 14th post-operative day in
experimentally created gap in right ulnae and filled
with ceramic implants held in position by an
intramedullary pin. Uma Rani and Ganesh (2003)
observed significant elevation of serum alkaline
phosphatase levels up to 15th post operative day
during femoral fracture healing in goats. However,
Aithal et al. (1998) reported a significant increase in
serum alkaline phosphatase activity from 7thday
onward in dogs treated with cross-intramedullary pin
fixation technique. In the present study the increase
level of serum alkaline phosphatase could be due to
an enzyme phosphatase secreted by proliferating
cartilage cells and increased osteoblasts in the fracture
haematoma. These findings are in accordance
Amresh Kumar (1996). The significant increase in the
level of alkaline phosphatase during fracture healing
could be attributed to the accelerated osteoblastic
activity at the fracture site as stated by Guyton (1986).
The mean values of serum calcium on 0 day
was 6.96 ± 0.29 mg/dl while on 1st ,20th ,and 45th day
it was 6.83 ± 0.31, 6.92 ± 0.34 , 6.95 ± 0.37 and 6.91
± 0.3 mg/dl respectively. This observation showed the
declining trend up to 20th day was statistically non-
significant. The observations revealed a non-
significant variation in the level of calcium as also
observed by Singh et al. (1976) and Sahkar et al.
(1998). The decline in the serum calcium was possibly
due to increased urinary excretion after traumatic bone
injury as stated by Kumar et al. (1992). The serum
creatinine, SGOT and SGPT values did not show any
significant change during the period of fractur.
Conclusion
The following conclusions could be drawn from the
present investigations,
1. The horn peg of appropriate shape and size
could be easily prepared for the intramedullary
fixation of femoral fracture in canines.
2. The radiological assessment of fracture healing
www.veterinaryworld.org Veterinary World Vol.3, No.1, January 2010
was quite easy due to the radiolucency of the
horn peg.
3. Fracture immobilized with horn peg revealed
good healing supported by distinct periosteal
callus.
4. The horn peg did not ellicit any reaction at the
site of contact with host bone throughout the
period of observation which indicated that horn
has very poor antigenic potential.
References
1. Aithal, H. P (1996): A Study on incidence of fractures in
animals and management of Supracondylar femoral
fracture in Dog. Ph. D. Thesis submitted to I.V.R.I;
Izatnagar (U.P.) India.
2. Amresh Kumar (1996): Fracture and their management
Vet. Surg, techniques Ist edi. Vikas Publishing House
Pvt. Ltd New Delhi pp. 184-194.
3. Ashtekar, V.R. and Deshpande K.S.(1981):
Experimental studies on heterogeneous bone grafting
in small animals. Indian J. Vet. Surg. 2 (1):14-20.
4. Dubey, I.K. (1991): An experimental study on use of
buffalo horn plates and intramedullary nails in fracture
repair of canine femur. M.V.Sc. Thesis submitted to
P.D.K.V. Akola. (M.S.)
5. Dubey, I.K.; Patil S.N.; Marudwar S.S.; Dhakate M.S.
and Pawde A. M. (1992): A note on experiment
evaluation of repair of femoral fractures in canine with
bovine horn plates. Indian J. Vet. Surg. 13 (1): 39-41.
6. Dubey, I.K.; Patil S.N.; Marudwar S.S. and Dhakate
M.S. (1993): Repair of transverse femoral fracture in
canines using intramedullary nails prepared from
bovine horn- an experimental study. Ind. Vet. J. 5 (70):
445-448.
7. Ganesh, T.N.; Jayaprakash R.; Ayyappan S.;
Archibald W.P. David and Balasubramanian N.N.
(1994): Repair of femoral fracture by intramedullary
nailing – A clinical study of 6 cases. Paper presented
in XVIIth Annual congress of I.S.V.S. and National
Symposium at Mathura. (U.P.).
8. Guyton, A.C. (1986): A textbook of medical physiology,
(7th edn;) W.B. Saunder’s Company, Philadelphia, p.
943.
9. Kaneko, J.J.; Harvey J.W. and Bruss M.L. (1997):
40
 Management of femoral fracture with the use of horn peg in canine
Adrenocortical functions, Clinical Biochemistry of
Domastic Animals. 5th edn. Academic Press, New
York pp: 560.
10. Kumar, R.; Gill P.S.; Rajvir Singh; Setia M. S. and
Rattan P. J. S. (1992): Indian Vet. J. 69: 476.
11. Mahajan, D.N. (1992): Studies on Diclofenac sodium in
the treatment of inflammatory and rheumatic affections
in bovine. M.V.Sc. Thesis submitted to M.A.U.
Parbhani. (M.S.).
12. McKibbin, B. (1978): The biology of fracture healing in
long bones. J. Bone. Jt. Surg. 60 : 150-162.
13. Muller, M.E.; Allgower M. and Willenegger H. (1965):
Mannual of internal fixation. Springer Verlag, Berlin.
Cited by Singh, G. and G.R. Singh (1990).
14. Paavolainan, P.; Karaharju E.; Slatis P.; Ahonen J. and
Holstrom T. (1978): Effects of rigid plate fixation on
structure and mineral content of cortical bone. Clin.
Orthop. 136: 287-293.
15. Pawar, V.K (1999): Studies on repair of fracture of tibia
with reference to bone plating, pinning and horn pegging
in canines. M.V.Sc. Thesis submitted to M.A.U.
Parbhani, (M.S.).
16. Salunke, V.M. (1993): Studies on wound healing (A
clinical and experimental study). M.V.Sc. Thesis
submitted to M.A.U. Parbhani. (M.S.).
17. Sarkate, L.B.; Aher V.D. and Bhokre A.P. (1993):
Intramedullary horn pegs fixation for the repair of
metatarsal fracture in buffalo calves and goat. Paper
th
presented at XVI I.S.V.S. and N.S. held at Parbhani.
Abst. pp :23.
18. Shifrin, L.Z (1970): Serum calcium, phosphorus, and
alkaline phosphatase level in dogs during repair of
experimental ulnar defects. Clin. Orthop. 70:212
********
www.veterinaryworld.org Veterinary World Vol.3, No.1, January 2010
19. Sastry, G.A. (1983): Veterinary Pathology, 6th edn.CBS
Publishers and distributers, Delhi.
20. Shinde, S.R. (1994): Comparative study on healing of
femoral fracture by intramedullary Stainless Steel
pinning and intramedullary horn peg fixation in canine.
M.V.Sc. Thesis submitted to M.A.U. Parbhani, (M.S.).
21. Singh, G (1988): Studies on the use of horn plates for
internal fixation of femoral frature in dogs. M.V.Sc.
Thesis. i.V.R.I., Izatnagar, (U.P.)
22. Singh G.R (1986): Experimental evaluation of horn
plates in the treatment of metacarpal and radial
fractures in bovines. Ph. D. Thesis. G.B. Pant University
of Agriculture and Technology, Pantnagar, (U.P.)
23. Singh G.R.; I.V. Mogha and Chattopadhaya (1984):
Xenogenous bone plate for treatment of femoral fracture
in sheep Indian J. Anim. Sci. 54(4): 339-344.
24. Singh, G.R.; Bhargava A.K. and Mogha I.V.. (1987):Use
of bone plates prepared from bovine horn for the fixation
of femoral fracture in goats. Indian J. Anim. Sci. 57(11):
1166-1169.
25. Singh, G.N. and Singh G.R. (1990): Use of horn plates
as internal fixation devise for femoral fracture in dog: A
radiographic evaluation. Indian J. Anim. Sci. 60 (12):
1408-1411.
26. Uma Rani, R. and Ganesh T.N. (2003): Study of serum
calcium, phosphorus and alkaline phosphatase during
fracture healing of femur in goats. Indian Vet. J.; 80:
377-378.
27. Wandhare, P.N. (1989): Studies on use of buffalo horn
plates for internsl fixation of femoral fracture and its
evaluation in dogs. M.V.Sc. Thesis. Submitted to P.K.V.
Akola. (M.S.).
41
 M.Venkatesan et al.
Franz, S., M.Flock and M. H.Parisot (2009) Ultrasonography anatomy and its relationship with quarter and udder milk ow
of the bovine udder and teat. Vet. Clin. North. Am. Food. characteristics in dairy cows, J. Dairy Sci., 87:3280 -3289.
Anim. Pract., 25: 669-685.
Venkatesan, M., D.Sumathi, P.Selvaraj, K.Vijayarani and
Trostle, S. S and R. T. О’Brien (1998) Ultrasonography of the A.P.Nambi (2016) Comparison of clinical and ultrasonograph-
bovine mammary gland. Compendium on Continuing Educa- ic diagnosis of milk ow disorders in hand milking dairy cows,
tion for the Practicing Veterinarian, 20:64–71. Indian Vet. J., 93 (08): 72 – 74
Weis, D., M. Weinfurther and R. M. Bruckmaier (2004) Teat

Indian Vet. J., April 2018, 95 (04) : 57 - 59

Femur Fracture Tie-In Fixation in a Dog - A Case Report

N.V.V.Hari Krishna1, S.Ayyappan and A.Arun Prasad

Department of Veterinary Surgery and Radiology, Madras Veterinary College, Chennai – 600 007.
(Received : 05-09-2017 298/17 Accepted : 10-10-2017)

Abstarct Clinical examination revealed the presence

A two year old male Mongrel dog weighing 14
Kg was presented with a history of non-weight
bearing lameness following dog bite. Clini-
cal and radiological examination revealed a
complete transverse fracture of left femur.
Successful surgical treatment of the fracture by
tie-in external xation was reported.
Key words: Dog, femur, tie-in xation
Pelvic limb fractures were more common
in dogs. Among pelvic limb fractures, femur
fractures occupy 47.48% (Aithal et al., 1999 and
Simon et al., 2010) of which 60% were diaphyseal
(Unger et al. 1990). Most of the femur fractures
were closed and require some sort of internal
xation (Beale, 2004). But internal xation like
intramedullary pinning alone cannot counteract
rotational and compressive forces as effective
as it does to bending forces. The present paper
reports about the surgical treatment of femur
fracture in a dog using tie-in xation.
Case History and Observations
A 2 year old male Mongrel dog weighing 14 kg
was presented with a history of dog bite and non-
weight bearing lameness of the left hind limb.
1
Corresponding author : Email : drharikrishnavet@gmail.com
The Indian Veterinary Journal (April, 2018)
of swelling of the thigh along with crepitus in
the mid femoral region. A bite wound was seen
on the caudo-lateral aspect of the thigh which
did not communicate with the fracture (Fig. 1).
Orthogonal radiographs of the femur revealed a
complete transverse mid- shaft fracture of the
left femur (Fig. 2) and it was decided to reduce
the fracture by tie-in xation. The wound was
cleaned and dressed with povidone iodine and
the fractured limb was stabilized with a modied
Robert Jones bandage till the day of surgery.
Advised the pet owner for post bite antirabies
vaccination.
Treatment and Discussion
Surgical site was prepared aseptically. The dog
was pre-medicated with Inj. Atropine @ 0.04 mg/
kg. i.m. followed by Inj. Xylazine @ 1mg/kg. i.m.
10 minutes later. Inj. tramadol @ 2.0 mg/kg and
Inj. Cefotaxime @ 22 mg/Kg b.wt. i.v. were given
15 minutes before start of surgery. General
anaesthesia was induced by Inj. Ketamine and
Inj. Diazepam mixture at the dose rates of 5.0
mg/kg and 0.3 mg/kg body weight respectively.
General anesthesia was maintained by 2%
Isoourane. The femur was approached through
a cranio-lateral incision (Piermattei, 2004). The
tensor fascia lata was incised and the muscles
57
 Femur Fracture Tie-In Fixation in a Dog ...
Fig. 1 Photograph showing dog bite wound with non-weight
bearing lameness.
Fig. 3 Skiagram showing tie-in xation - Immediate postop.
separated by blunt dissection and the fracture
ends were debrided and reduced with the help of
bone holding forceps. A 3 mm Steinmann intra-
medullary pin was placed in retrograde fashion
and a counter pin of same length was used to
assess the level of the distal pin tip in the distal
metaphysis of the femur. Proximal end of the
intramedullary pin was left uncut.
The Kirschner-Ehmer (K-E) splint was
constructed on the lateral aspect of the thigh.
Transxation pins of 25% transcortical thick-
ness (Ayyappan et al., 2009) were placed from
the lateral femoral cortex till the trocar tip just
emerges the far cortex. Predrilling was done
with a smaller Steinmann pin. Most proximal
and distal pins were placed rst. Two transx-
ation pins per fragment were used. All the four
transxation pins were connected to a 4.0 mm
connecting rod using single pin small clamps.
The intramedullary pin was tied-in or connected
58 The Indian Veterinary Journal (April, 2018)
Fig. 2 Skiagram showing complete transverse mid shaft frac-
ture of femur.
to unilateral external skeletal xator with a
small piece of connecting rod which was xed
between the proximal extremity of the intra-
medullary pin and the proximal extremity of the
connecting rod using two clamps, one on either
end and the surgical incision closed in routine
manner. Protective bandage was applied cover-
ing the entire splint to prevent interference with
furniture (Ayyappan et al., loc. cit). Postopera-
tively Tab. Cefalexin @ 22 mg/kg b.i.d was given
orally for 7 days and Tab. Carprofen @ 2.2 mg/kg
b.i.d was given orally for ve days. Skin sutures
were removed on 12th postoperative day.
The ESF to the IM pin signicantly
increased the rigidity. Immediate post-operative
radiographs showed excellent alignment and
apposition of the fracture fragments (Fig. 3).
Postoperative weight bearing was noticed on 7th
postoperative day following tie-in xation. The
external xator was removed on 45th postopera-
tive day and IMP was removed two weeks later
(George et al., 2007 and Vedpathak et al., 2011).
In the present case early mobility of the limb
and weight bearing of the affected limb could be
due to increased rigidity of the tie-in xator. The
fracture healed by callus formation.
External skeletal xation of long bones
is useful to treat to a wide variety of fractures
like open fractures, infected fractures, commi-
nuted fractures, certain osteotomies and cases
with delayed healing or when supplementation
with other internal xation methods is required.
Thus, when these two methods are combined
they help in reducing almost all disadvantages
 N.V.V.Hari Krishna et al.
of both the techniques individually. The tie-in
conguration approximately doubles the stabil-
ity of the repair and prevents migration or the
IM pin (Beale, loc. cit).
Summary
A complete transverse mid femur fracture in
a two year old male Mongrel dog was treated
successfully using tie-in xation without any
complications.
References
Aithal, H.P., Singh, G.R. and Bisht, G.S. (1999) Fractures in
dogs: a survey of 402 cases. Indian J. Vet. Surg., 20: 15-21.
Ayyappan, S., Shauzama, Md., Ganesh, T.N., Das, B.C. and
Sureshkumar, R. (2009) A Clinical Study on External Fixators
for Long Bone Fracture Management in Dogs. Indian J. of
Vet. Surg., 30(2): 90-92.
Beale, B. (2004) Orthopaedic clinical techniques femur frac-
ture repair. Clin. Tech. in Small Anim. Pract., 19(3): 134-150.
Indian Vet. J., April 2018, 95 (04) : 59 - 61
Fetal Maceration in a Crossbred Cow
H. Hemalatha, K. Murugavel1, S. Kantharaj, D. Antoine and M.S. Raju
Department of Veterinary Gynaecology and Obstetrics, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry- 605 009.
(Received : 03-08-2017 250/17
Abstract
A crossbred Jersey cow aged four years at full
term was reported with history of intermit-
tent unproductive straining with foul smelling
discharge from the vaginal passage for the past
one week. Rectal examination revealed that the
uterus was hard on palpation with crepitating
bony structures. Vaginal examination revealed
that the cervix was three nger dilated with
fetal bones protruding through the partially
dilated cervix. Cervix was dilated manually by
fanning the cervix with hand along with warm
saline solution. Under epidural anesthesia and
sufcient cervical dilation, macerated fetal mass
1
Corresponding author : Email : dr.murugavel@gmail.com
The Indian Veterinary Journal (April, 2018)
George, C., Nagarajan, L. and Manohar, B. M. (2007) Stain-
less steel and acrylic external skeletal xators as adjuncts
to intramedullary pinning for femoral fracture repair in dogs.
Indian J. of Vet. Surg., 28(1): 37-38.
Piermattei, D.L. and Johnson, K.A. (2004) Approach to the
femur through a lateral incision. In: An Atlas of Surgical
Approaches to the Bones and Joints of the Dog and Cat, 4 th
edn. W. B. Saunders, Philadelphia. pp. 337.
Simon, S. M., Ganesh, R., Ayyappan, S., Rao, G. D., Suresh-
kumar, R., Kundeve, V. R. and Das, B.C. (2010) Incidence
of pelvic limb fractures in dogs: A survey of 478 cases. Vet.
World., 3(3): 120-121.
Unger, M., Montavon, P. M. and Heim, U. F. A. (1990) Clas-
sication of femur fractures and long bones in the dog and
cat: Introduction and Clinical application. Vet. Comp. Orth.
and Traumatol., 3: 41-50.
Vedpathak, H. S., Tank, P. H., Karle, A. S., Bhatia, A. and
Desai, B. D. (2011) Clinical evaluation of tie-in conguration
and intramedullary pinning for stabilization of femoral frac-
tures in dogs. Indian J. of Vet. Surg., 32(2): 111-113.
Accepted : 05-09-2017)
was removed per-vaginum by applying traction.
Key words: Fetal maceration, Bovine.
In cattle, retained macerated fetus follow-
ing fetal death, regression of corpus luteum and
failure of the fetus to expel from the uterus
occur at any stage of gestation (Roberts, 1971).
Failure of the expulsion of the fetus results in
bacterial invasion through the dilated cervix
and resulting in digestion of soft fetal tissues
by a combination of putrication and autolysis
(Noakes et al., 2001) leaving a mass of fetal
bones within the uterus. These fetal bones may
be embedded within the uterine wall resulting in
a chronic endometritis and severe damage to the
59
 Comparison of ketamine-diazepam with ketamine-
xylazine anesthetic combinations in sheep spontaneously
breathing and undergoing maxillofacial surgery
Fatih Özkan1*, Nilüfer Çakır-Özkan2, Ahmet Eyibilen3, Tamer Yener4, Ünal Erkorkmaz5
1
Department of Anesthesiology, Faculty of Medicine, Gaziosmanpaşa University, Health Research Center, 60100, Tokat, Turkey. 2 Clinic of
Oral and Maxillofacial Surgery, Faculty of Medicine, Gaziosmanpaşa University, Health Research Center, 60100, Tokat, Turkey. 3 Department
of Otorhinolaryngology, Faculty of Medicine, Gaziosmanpaşa University, Health Research Center, 60100, Tokat, Turkey. 4 Experimental
Animal Labaratory, Faculty of Medicine, Gaziosmanpaşa University, Health Research Center, 60100, Tokat, Turkey. 5 Department of
Biostatistics , Gaziosmanpaşa University, Faculty of Medicine, Health Research Center, 60100, Tokat, Turkey

Abstract

The objective of this study was to choose a suitable anesthetic combination for use in experimental surgical models by comparing the anesthet-
ic and cardio-respiratory changes. Fourteen healthy male sheep were randomly assigned to two different drug regimens. In Group  the sheep
were anesthetized with ketamine + xylazine ( mg/kg im. + . mg/kg i.m., respectively). Anesthetic combination of ketamine + diazepam (
mg/kg im. + . mg/kg i.m., respectively) was used in Group . Heart rate, respiratory rate and mean arterial pressures were evaluated before
anesthesia, after induction of anesthesia up to  minutes in  minute intervals and during recovery. In all sheep, duration of anesthesia induc-
tion, duration of anesthesia and duration of recovery were recorded. Quality of induction, anesthesia, analgesia and recovery were evaluated.
Cardio-respiratory parameters decreased below baseline values after anesthesia induction in both groups. However, no profound effects on
cardio-respiratory functions were observed during study. In Group , it was observed that; anesthesia induction time was longer, the depth
of anesthesia was inadequate during the osteotomy stage of the surgical procedure and recovery time was longer in comparison to Group .
Otherwise the quality of anesthesia induction, anesthesia, analgesia and recovery was better in Group  than Group . These findings indicate
that both drug combinations can provide short time anesthesia for minor surgical procedures. Ketamine+xylazine combination can be used as
a more suitable anesthetic combination in experimental surgical procedures such as maxillofacial surgery than ketamine+diazepam combina-
tion, in sheep. ©  Association of Basic Medical Sciences of FBIH. All rights reserved

KEY WORDS: anesthesia, general, oral surgical procedures, xylazine

Introduction muscular hypertonicity, myoclonus, and convulsions []. To

In the practice of anesthesia, drug combinations are fre-
quently used when optimal conditions for anesthesia are
generated. Since drugs manifest different effects when
used separately or in combination, changes that might oc-
cur during combined drug usage should be understood and
recognized. In humans, the addition of a sedative-hypnotic
drug to ketamine, an anesthetic drug which is also used
commonly in animal studies, is a frequent anesthetic ap-
plication to augment ketamine’s anesthetic effects, decrease
its side effects and also to provide necessary depth of anes-
thesia and surgical comfort []. In contrast to the majority
of anesthetics, ketamine increases heart rate and mean arte-
rial pressure, stimulates cardiovascular functions and when
used as a single agent it can induce undesired effects such as
* Corresponding author: Fatih Özkan, Department of Anesthesiology,
Faculty of Medicine, Gaziosmanpaşa University, Health Research Center,
60100, Tokat, Turkey. Tel:+90 3623121919/2536, Fax: +90 3624576041
e-mail: dr.fat.oz@hotmail.com
Submitted 27 June 2010/ Accepted 8 November 2010
minimize these unwanted and restricting effects, ketamine
is administered in combination with drug groups such as
benzodiazepines, and alpha- agonists. Diazepam is a po-
tent hypnotic- sedative and produces muscle relaxation; it
is a long-acting drug due to its slow metabolism and it has
relatively weaker cardiovascular effects when compared
with other sedative drugs []. In combination with ket-
amine, diazepam alleviates unwanted cardiovascular effects
of ketamine and demonstrates anticonvulsive, amnestic and
muscle relaxant effects via central mechanisms []. Xylazine,
an alpha- agonist used in animal experiments, stimulates
alpha- adrenergic receptor in cerebral presynaptic nerve
ends, inhibits release of cathecolamines and dopamine re-
sulting in analgesic and sedative effects, and hinders nerve
conduction in the central nervous system leading to relax-
ation of striated muscles []. Xylazine is usually used in com-
bination with ketamine during anesthetic applications [].
In veterinary medicine as well as in scientific investiga-
tions sheep are preferred as experimental animals because

BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2010; 10 (4): 297-302 

 FATIH ÖZKAN ET AL.: COMPARISON OF KETAMINEDIAZEPAM WITH KETAMINEXYLAZINE ANESTHETIC COMBINATIONS
IN SHEEP SPONTANEOUSLY BREATHING AND UNDERGOING MAXILLOFACIAL SURGERY

TABLE 1. Scoring criteria used for assessing quality of induction, anesthesia and analgesia, and recovery.
GOOD
The sheep immediately and quietly
entered into anesthetic state with
INDUCTION scarce number of to-and-fro move-
ments
Lack of response to painful stimuli,
ANESTHESIA AND and absence of tremor of leg muscles
ANALGESIA
MODERATE
Induction period prolonged a little. In-
coordinaton despite at a lesser extent
with conspicuous to-and-fro move-
ments. The animal struggled a while
on the ground.
Very faint movements as a response
to painful stimuli; muscular tremors
though at a lesser extent
WORSE
Induction period prolonged much
more than its normal duration. Incoor-
dination is very pronounced with very
prominent to-and-fro movements, and
excessive muscular tremors.
A marked response to painful stimuli; it
drew its legs back, and shuddered ; very
marked tremor of its legs

Lack of excitation, but with coordi- With lesser degrees of excitation and The animal floundered and struggled on
nation the animal stood up on its legs coordination, the animal could stand the ground to stand up. It made more
RECOVERY quietly and at one attempt without up only at 2-3 attempts with marked than 3 attempts to stand on its legs.
any conspicuous ataxia of its legs. ataxia of its legs.

of their unique characteristic features. Among these char-
acteristics their easy and perfect adaptations to laboratory
conditions with their body weights and sizes similar to
those of human beings can be enumerated []. Although
the effects of most of anesthetics in humans have been
investigated, and elucidated, studies in literature investi-
gating anesthetic effects of drug combinations in sheep
undergoing major surgery for research or treatment are
scarce in number. In this study, comparison of anes-
thetic drug combinations as diazepam-ketamine and as
xylazine-ketamine in spontaneously breathing sheep ex-
posed to experimental maxillofacial surgery was targeted.
Materials and Methods
After obtaining approval from the local ethics committee,
- month old  male sheep, weighing between - kg,
bred and raised under similar conditions, were random-
ized into  groups. In xylazine group (Group , n=) after
 hours of fasting and  hours of thirst, ketamine ( mg/
kg, i.m.) was administered  minutes after atropine (.
mg/kg, i.m.) + xylazine (. mg/kg, i.m.) premedication. For
diazepam group (Group, n=),  minutes after premedi-
cation with atropine (. mg/kg, i.m.) + diazepam (. mg/
kg, i.m.), ketamine ( mg/kg, i.m.) was injected. Induction
of anesthesia was performed after observation of findings
of sedation in all sheep which were head drop and palpe-
bral ptosis. The animals were maintained in spontaneous
respiration and as an analgesic flunixine meglumine ( mg/
kg, i.m.) was introduced just before surgical intervention.
During surgery, when animals started to move, additional
 mg/kg intravenous ketamine was given to Groups  and
 through external jugular vein to achieve rapid onset of ef-
fect. Heart rates, respiratory rates and blood pressures of
animals were assessed. Induction of anesthesia, anesthesia
and analgesia, and recovery from anesthesia were qualita-
tively evaluated as good, moderate and worse in accordance
with Aydilek and co-workers study [] (Table ). Besides,
duration of induction, anesthesia, surgery and postoperative
recovery period were recorded. The induction period was
assessed as the time for the sheep to lie sideways, and the
presence and absence of response to painful stimuli after
administration of ketamine. The duration of anesthesia was
determined as the period between the first injection and the
moment of the first spontaneous elevation of the sheep’s
head. The recovery period was the time passed from the
last injection up to the time the animal stands up on its legs,
and maintains its erect posture. The heart rates per minute
were determined by auscultation with a stethoscope, and
respiratory rates per minute were assessed by observation
of chest and abdomen movements, and auscultation with
a stethoscope. Systolic and diastolic blood pressures were
measured by placing a cuff around the tail root in a non-
invasive oscillometric method and mean arterial pressures
were calculated with the diastolic blood pressure + / (sys-
tolic –diastolic blood pressure) formula. Hemodynamic pa-
rameters were measured before premedication, at -minute
intervals for  minutes starting from the onset of the in-
duction of anesthesia, and also during the recovery period.
Surgical methods
Distraction Group; In all  sheep, submandibular incision
was made to expose the right mandibular body. After the
mucoperiosteal flap was reflected, vertical corticotomies
were performed from mesial to the decidious first pre-
molar tooth mesial to the first molar under saline irriga-
tion. The  mm mandibular bone segment was removed.
To create a transport segment, vertical corticotomy was
performed approximately  cm posterior to the distal
edge of the defect. The distraction device (LOGIC distrac-
tor system, straight, right, TX, USA), was oriented per-
pendicular to the corticotomy line and was fixed in place.
Graft group; The recipient site, the right mandible was
prepared by making  mm segmental resection be-
tween the canine and first molar. Block grafts mea-
suring  mm long,  mm high,  mm wide were
harvested from the right iliac crest. The block graft
was then placed into the defect and fixed in place.

 BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2010; 10 (4): 298-302

 FATIH ÖZKAN ET AL.: COMPARISON OF KETAMINEDIAZEPAM WITH KETAMINEXYLAZINE ANESTHETIC COMBINATIONS
IN SHEEP SPONTANEOUSLY BREATHING AND UNDERGOING MAXILLOFACIAL SURGERY

TABLE 2. Mean values of heart rate, respiratory rate and mean blood pressures in two groups
Group1 (n=7) Group2 (n=7)
T p
Mean±SD (Min-Max) Mean±SD (Min-Max)
Baseline 98.86±4.91 (90-105) 95.00±7.07 (85-105) 1.19 0.259
Premedication 89.86±3.63 (85-97) 84.14±3.53 (80-90) 2.98 0.011
Induction 90.00±4.08 (85-95) 84.29±6.08 (75-90) 2.07 0.061
5 89.14±9.74 (80-105) 80.29±4.27 (75-89) 2.20 0.058
10 101.57±12.90 (80-117) 83.43±10.06 (75-105) 2.94 0.012
15 106.14±3.67 (100-111) 111.00±18.82 (80-130) -0.67 0.526
Heart rate
20 110.29±10.05(100-127) 127.29±6.82 (120-137) -3.70 0.003
25 108.00±6.98 (99-117) 127.71±8.77 (115-141) -4.66 0.001
30 106.86±4.88 (100-115) 126.00±5.80 (115-133) -6.68 <0.001
Recovery 88.00±11.71 (70-105) 92.57±7.61 (78-100) -0.87 0.403
*F=8.55, p=0,001 *F=32.94, p<0.001
*F=3.97, p=0.070
Baseline 23.14±4.91 (20-29) 23.00±2.31 (19-26) 0.10 0.924
Premedication 18.29±2.22 (15-21) 18.86±1.57 (17-21) -0.56 0.588
Induction 17.43±2.70 (15-21) 18.86±1.57 (17-21) -1.21 0.250
5 17.57±2.15 (16-22) 19.00±2.24 (16-22) -1.22 0.246
10 19.29±3.64 (15-24) 18.43±2.30 (16-22) 0.53 0.608
15 21.71±1.80 (20-25) 22.14±4.02 (15-27) -0.26 0.801
Respiratory rate
20 20.29±1.80 (17-22) 24.57±0.98 (23-26) -5.54 <0.001
25 20.14±2.04 (16-22) 23.00±1.73 (21-26) -2.83 0.015
30 18.00±1.92 (15-20) 24.43±1.81 (22-26) -6.45 <0.001
Recovery 17.57±1.40 (16-20) 20.29±1.70 (18-22) -3.26 0.007
*F=4.73, p=0.013 *F=8.52, p=0.002
*F=31.97, p<0.001
Baseline 76.57±3.87 (70-82) 77.29±5.85 (69-85) -0.27 0.792
Premedication 72.57±6.29 (65-80) 68.43±7.55 (56-81) 1.12 0.287
Induction 65.00±5.00 (60-70) 63.14±3.85 (59-70) 0.78 0.451
5 67.43±4.16 (60-72) 64.14±5.08 (55-70) 1.32 0.210
10 72.86±9.42 (61-85) 64.14±4.30 (60-70) 2.23 0.055
15 79.86±7.80 (66-90) 72.71±12.43 (58-90) 1.29 0.222
Mean arterial pressure
20 79.57±2.23 (76-83) 86.57±5.68 (79-95) -3.04 0.017
25 82.71±4.15 (77-88) 87.86±5.67 (80-95) -1.94 0.077
30 73.29±7.78 (60-80) 86.86±7.20 (80-97) -3.39 0.005
Recovery 73.86±4.41 (69-81) 76.43±4.65 (68-82) -1.06 0.309
*F=5.89, p=0.004 *F=15.04, p<0.001
*F=0.18, p=0.683
*F= Repeated measures One Way Anova test value, Group 1 = ketamine+ xylazine group, Group 2 = ketamine+diazepam group

Statistical analysis Results

Because of the distribution of continuous variables were
normal, according to Klomogorov Smirnov normality test;
two independent sample t tests were used to compare vi-
tal findings, and durations of surgeries, inductions, recovery
periods, heart rates, respiratory rates and blood pressures
between two groups. One way repeated measures ANOVA
was used to compare the heart rates, respiratory rates and
blood pressures among  follow-up periods separately, for
each group (for multiple comparison Bonferroni test was
used). Two way repeated measures ANOVA was used to
compare the alteration of heart rates, respiratory rates and
blood pressures between two groups. Variables were pre-
sented as mean ± standard deviation and minimum and
maximum values. A p values <. were considered as statis-
tically significant. Analyses were performed using commer-
cial statistical software (SPSS, ver. . demo, Chicago, IL).
During the study period, animals remained hemody-
namically stable and any problem requiring medical
support was not seen. In both groups heart rates, respi-
ratory rates and mean arterial pressures during the sur-
gical procedure were rated within physiological limits.
There was statistically significant difference between the
groups (p<.) in heart rates, which were measured
soon after premedication, and at minute , ,  and
. In with-in group assessments, there was statistically
significant difference among  measures of heart rate
separately for two groups (for Groups  and , p=.,
p<. respectively) (Table ). There was no statistically
significant difference between Group  and Group  in
alteration of heart rates during the procedure (p=.).
In both groups heart rates increased with the start of

BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2010; 10 (4): 299-302 

 FATIH ÖZKAN ET AL.: COMPARISON OF KETAMINEDIAZEPAM WITH KETAMINEXYLAZINE ANESTHETIC COMBINATIONS
IN SHEEP SPONTANEOUSLY BREATHING AND UNDERGOING MAXILLOFACIAL SURGERY
surgical procedure after the induction period (p<.).
The mean arterial pressures measured at minute  and
 were significantly higher in Group . In within group
assessments, there was statistically significant difference
among  measures of mean arterial pressure separately
for two groups (for Groups  and , p=., p<. re-
spectively) (Table ). There was no statistically significant
difference between Group  and Group  in alteration of
mean arterial pressures during the procedure (p=.).
In both groups the mean arterial pressures increased with
the start of surgical procedure after the induction period.
The respiratory rates at minute ,  and  and recov-
ery were significantly higher in Group  (p<.). With-in
group assessments, there was statistically significant differ-
ence among  measures of respiratory rate in two groups
(for Groups  and , p=., p=. respectively) (Table
). There was statistically significant difference between
Group  and Group  when alteration of respiratory rates
was concerned during the procedure (p<.). In both
groups, respiratory rates increased with the start of surgi-
cal procedure after the induction period. Especially, in
Group  the respiratory rate was in a trend to increase
after the  th minute, meanwhile decrease in respira-
tory rates was observed in Group  after the th minute.
TABLE 3. Mean values of duration of anesthetic and surgical pro-
cedures in two groups
1 (n=7) 2 (n=7)
Mean±SD Mean±SD t p
(Min-Max) (Min-Max)
8.43±2.57 13.00±2.58
Duration of induction -3.32
(4-12) (9-17)
52.14±15.77 70.71±22.81
Duration of surgery -1.77
(40-75) (45-115)
86.43±9.88 146.43±20.35
Duration of recovery -7.02
(75-105) (120-180)
40.14±7.31
Duration of anesthesia
(26-45)
- -
The duration of anesthetic and surgical procedures was
shown in Table . Sufficient depth in anesthesia was
achieved after . minutes in Group  and  minutes in
Group  after ketamine administration. Time to the induc-
tion of anesthesia was found to be significantly shorter in
Group  (p= .). The quality of induction was deemed
to be good in both groups. In Group , the duration of
anesthesia ranged between  and  minutes (mean
.±. minutes) after administration of ketamine. In
Group , upon the initiation of the osteotomy phase of
the operation, involuntary movements in animals were
observed, and additional doses were instituted. Anesthe-
sia and analgesia in all phases of surgery in Group  were
of good quality. In this group, -shot additional dose was
administered to three animals dependent on the opera-

tive times, and degree of surgical comfort and satisfaction
were assessed to be good after additional doses. In Group ,
the quality of anesthesia and analgesia up to the osteotomy
phase of the surgery was of moderate degree, while during
the osteotomy phase it was evaluated as “worse” in qual-
ity. In this Group, during the osteotomy phase all animals
received additional doses. Two animals were administered
second, and one animal was administered third additional
doses. After administration of dosages surgical satisfac-
tion and comfort were evaluated as of moderate degree.
In Group  total duration of surgery, and postoperative
recovery time ranged between -, and - minutes,
respectively. In Group , operative time, and postopera-
tive recovery times varied between -, and -
minutes, respectively. In Group  postoperative recovery
time was detected to be significantly shorter than Group 
(p<.). The quality of recovery was evaluated as “good” in
Group  and “moderate” in Group . Although any statisti-
cally significant difference between operative times was not
found, relatively longer durations were observed in Group .
Discussion
Ketamine can be used singly or in combination for pre- and
intraoperative sedation, induction, and maintenance of
anesthesia, balanced anesthetic applications, regional and
spinal anesthesia, and postoperative analgesia [-]. The
pharmacodynamic and clinical effects of ketamine which
has been used since the s on bodily systems, have been
0.006 determined in experimental and clinical studies. Ketamine
had come into the foreground especially during the last
0.102
decade due to prevention of its side effects by using drug
combinations and thus expansion of its area of usage [-].
<0.001
Sedative preanesthetic drugs like diazepam and xylazine
- can possess hypotensive and hypoxic effects by depress-
ing cardiovascular and respiratory activities. In contrast to
most of the anesthetic drugs, ketamine has been shown to
possess incremental effects on the heart rate, blood pres-
sure and respiratory rate due to increase in sympathetic ac-
tivation [-]. Ketamine has desired effects such as main-
tenance and stimulation of respiration, bronchodilation,
maintenance of functional residual capacity and achieve-
ment of equivalent minute ventilation rates both in sponta-
neously breathing individuals and in those wide awake [].
It had also unwanted respiratory effects such as increase
in respiratory secretions [,]. It has been demonstrated
that anti-muscarinic drugs like atropine have decreasing ef-
fect on hypersecretion induced with ketamine []. In our
study, atropine incorporated in premedication decreased
hypersecretion which was induced during spontaneous
breathing. Benzodiazepines decrease cardiovascular effects
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2010; 10 (4): 300-302
 FATIH ÖZKAN ET AL.: COMPARISON OF KETAMINEDIAZEPAM WITH KETAMINEXYLAZINE ANESTHETIC COMBINATIONS
IN SHEEP SPONTANEOUSLY BREATHING AND UNDERGOING MAXILLOFACIAL SURGERY
of ketamine [-]. Similarly, xylazine decreases the effects
of ketamine by lowering blood pressure and depressing the
cardiovascular system. In these studies, dependent on the
stage of anesthesia, it was demonstrated that the drugs used
in combinations can cause fluctuations in heart rate, blood
pressure, respiratory rate and catecholamine levels varying
with the degree of stress [,,,]. Similar to the results of
other studies, our study demonstrated that hemodynamic
findings such as heart rates, respiratory rates and mean
blood pressures fell under baseline values after premedica-
tion phase and climbed over baseline values after induction
and during surgical intervention. We suggest that in addi-
tion to sympathetic effects of ketamine, higher values of the
three hemodynamic parameters in the ketamine-diazepam
Group can be attributed to relatively lesser contribution of
diazepam to the induction of anesthesia compared to xyla-
zine. Mouallem et al. [] in a study conducted in sheep em-
phasized that ketamine-diazepam combination significantly
reduced heart rates and respiratory rates, however Coulson
et al. [] investigated cardiovascular effects of ketamine-di-
azepam and ketamine-xylazine combinations in sheep and
stressed lack of any meaningful effects on heart rates and re-
spiratory hemodynamics. In our study incremental or dec-
remental alterations in hemodynamic variables caused by
both drug combinations remained within physiologic limits.
Ketamine anesthesia which demonstrates its main impact
via central nervous system, has anesthesic, analgesic, and
amnesic effects as well as unwanted effects such as delirium,
hallucination and nightmares during the recovery period
[]. In combination with benzodiazepines and an alpha-
agonist xylazine, an increase in the quality of analgesia, se-
dation, anesthesia and recovery, alleviation of anxiety and
a decrease in the unwanted ketamine have been demon-
strated [,, ,] . In our study prolongation of anes-
thetic induction and recovery period, inadequate depth of
intraoperative anesthesia were observed in premedication
with diazepam in ketamine-diazepam group. Xylazine pre-
medication in ketamine-xylazine Group was found to be ad-
equate. Compared with ketamine-diazepam combination,
faster anesthetic induction, an anticipated duration of anes-
thesia, improved surgical comfort and satisfaction at every
stage of anesthesia have been observed by using ketamine-
xylazine combination. On the other hand postoperative re-
covery period was shorter and requirement for additional
dosages was less compared to -ketamine-diazepam combi-
nation. In a study investigating the effects of both combina-
tions in sheep for minor surgeries of shorter duration both
combinations were emphasized to be appropriate []. In
our study both drug combinations have provided adequate
anesthesia up to the osteotomy stage, however anesthesia
achieved in ketamine-diazepam Group during osteotomy
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2010; 10 (4): 301-302
stage was not sufficient. Sumitra et al. [] emphasized that
ketamine-diazepam combination affected respiratory and
cardiac functions relatively at a lesser extent than ketamine-
xylazine combination, and ketamine-diazepam combina-
tion can be a suitable anesthetic regimen for surgical models
in rats. Lin et al. [] investigated the effects of two different
anesthetic regimens, namely ketamine-diazepam and ket-
amine-diazepam-xylazine combinations in sheep and found
that the latter combination resulted in a prolonged duration
of anesthesia. They finally emphasized that both combina-
tions can be used to anaesthetize sheep. In the same study
Lin et al. [] stated that intravenous ketamine and xylazine
infusions provide an improved anesthesia with subsequent
satisfactory recovery period lasting for  minutes after ces-
sation of infusion. In an investigation performed in children
with a benzodiazepine-ketamine combination unconscious
state was achieved within  minutes and stressed that an-
esthesia and analgesia was maintained with intravenous ket-
amine boluses without any side effects excluding delay in re-
covery []. Also in our study, anesthetic states was reached
within  minutes and with repeated doses were observed
delay in awakening and prolonged recovery times in ket-
amine-diazepam group. On the other hand in ketamine-
xylazine group anesthesia was achieved within approxi-
mately  minutes. With repeated doses delayed awakening
and longer recovery times were seen in this group, too.
Conclusion
Though ketamine-xylazine and ketamine-diazepam combi-
nations are frequently used anesthetic methods in clinical
and experimental studies, both methods can be preferred
in painful minor surgeries. However in major surgical inter-
ventions involving bone tissue as maxillofacial surgery, ket-
amine-xylazine anesthesia can be preferred over ketamine-
diazepam anesthesia in that it achieves more rapid anesthetic
induction, better surgical comfort, maintenance of physio-
logical parameters within optimal limits and faster recovery.
Declaration of Interest
No authors have affiliations or financial involvement with
any organization or entity with a direct financial interest in
the subject matter or materials discussed in the manuscript.
The authors declare that they have no competing interests.
References
[] Muir WW. rd, Lerche P, Robertson JT. et al. Comparison of four
drug combinations for total intravenous anesthesia of horses un-
dergoing surgical removal of an abdominal testis. J Am Vet Med
Assoc ; : -.

 FATIH ÖZKAN ET AL.: COMPARISON OF KETAMINEDIAZEPAM WITH KETAMINEXYLAZINE ANESTHETIC COMBINATIONS
IN SHEEP SPONTANEOUSLY BREATHING AND UNDERGOING MAXILLOFACIAL SURGERY
[] Haskins SC, Farver TB, Patz JD. Ketamine in dogs. Am J Vet Res
; : -.
[] Koshy TA, Mahabala TH, Srikantu J, Sanmathi S. Thiopentone-
midazolam mixture as an induction agent for general anesthesia on
‘in-patients’. Ind J Anesth ; : –.
[] Takeshita H, Okuda Y, Sari A. The effects of ketamine on cerebral
circulation and metabolism in man. Anesthesiology ; : -.
[] Bosanquet A, Goss AN. The sheep as a model for temporoman-
dibular joint surgery. Int J Oral Maxillofac Surg ; : -
[] Aydilek N, Ceylan C, Ipek H, Gundogdu U. Effects of xylazine-diaz-
epam-ketamine and xylazine-tiletamine-zolazepam anesthesia on
some coagulation parameters in horses. YYÜ Vet Fak Derg ;
: -
[] Akeson J, Björkman S, Messeter K, Rosén I, Helfer M. Cerebral
pharmacodynamics of anesthetic and subanesthetic doses of ket-
amine in the normoventilated pig. Acta Anaesthesiol Scand ;
: -
[] Annetta MG, Iemma D, Garisto C, Tafani C, Proietti R. Ketamine:
new indications for an old drug. Curr Drug Targets ; : -

[] Wyatt JD, Scott RA, Richardson ME. The effects of prolonged ket-
amine-xylazine intravenous infusion on arterial blood pH, blood
gases, mean arterial blood pressure, heart and respiratory rates, rec-
tal temperature and reflexes in the rabbit. Lab Anim Sci ; :
-.
[] Muir WW, Sharda RT, Milne DW. Evaluation of xylazine and ket-
amine hydrochloride for anesthesia in horses. J Am Vet Med Assoc
; : -.
[] Clarke KW, Taylor PM, Watkins SB. Detomidine/ketamine anes-
thesia in the horse. Acta Vet Scand ; : -.
[] Lin HC, Branson KR, Thurmon JC. et al. Ketamine, telazol, xylazine
and detomidine. A comparative anesthetic drug combinations
study in ponies. Acta Vet Scand ; : -.
[] Dzikiti TB, Chanaiwa S, Mponda P, Sigauke C, Dzikiti LN. Com-
parison of quality of induction of anesthesia between intramuscu-
larly administered ketamine, intravenously administered ketamine
and intravenously administered propofol in xylazine premedicated
cats. J S Afr Vet Assoc ; : -.

[] Lin HC, Tyler JW, Welles EG, Spano JS, Thurmon JC, Wolfe DF.
Effects of anesthesia induced and maintained by continuous intra-
venous administration of guaifenesin, ketamine, and xylazine in
spontaneously breathing sheep. Am J Vet Res.; :-.
[] Tokics L, Strandberg A, Brismar B, Lundquist H, Hedenstierna G.
Computerized tomography of the chest and gas exchange mea-
surements during ketamine anesthesia. Acta Anaesthesiol Scand
;:-
[] von Ungern-Sternberg BS, Regli A, Frei FJ. et al. A deeper level of
ketamine anesthesia does not affect functional residual capacity
and ventilation distribution in healthy preschool children. Paediatr
Anaesth ; : -.
[] Mogensen F, Mueller D, Valentin N. Glycopyrrolate during ket-
amine/diazepam anesthesia. Acta Anaesthesiol Scand.; :
-.
[] Jackson APF, Dhadphale PR, Callaghan ML. Haemodynamic stud-
ies during induction of anesthesia for open-heart surgery using di-
azepam and ketamine. Br J Anaesth ; : -.
[] Morse Z, Sano K, Kanri T. Effects of a midazolam-ketamine admix-
ture in human volunteers. Anesth Prog ; : -.
[] Sumitra M, Manikandan P, Rao KV, Nayeem M, Manohar BM, Pu-
vanakrishnan R. Cardiorespiratory effects of diazepam-ketamine,
xylazine-ketamine and thiopentone anesthesia in male Wistar rats-
a comparative analysis. Life Sci ; : -.
[] Mouallem H. Comparative studies of general anesthesia of sheep
with ketamine and Etomidate. Pol Arch Weter ; : -
[] Coulson NM, Januszkiewicz AJ, Dodd KT, Ripple GR. The cardio-
respiratory effects of diazepam-ketamine and xylazine-ketamine
anesthetic combinations in sheep. Lab Anim Sci ; : -.
[] Lin HC, Wallace SS, Tyler JW, Robbins RL, Thurmon JC, Wolfe DF.
Comparison of tiletamine-zolazepam-ketamine and tiletamine-
zolazepam-ketamine-xylazine anesthesia in sheep. Aust Vet J.
;: -.
[] Holm-Knudsen R, Sjorgren P, Laub M. Midazolam and ketamin for
rectal premedication and induction of anesthesia in children. An-
aesthesist ; : -.
BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2010; 10 (4): 302-302