Anesthesia Infusion Drops Ketamine and Propofol as Alternative General Anesthesia Inhalation on Pig

The use of pigs as surgical model animals especially for laparoscopic surgery is growing and has been used in various countries. The use of pigs as model animals for various surgical methods began to be actively implemented in Indonesia. Pig animals are an ideal model for various laparoscopic surgical techniques training. The anatomy of pigs in general has similarities with human anatomy. Training using pig animals can refine techniques and improve efficiency and expertise.

Surgery cannot be performed if anesthesia has not been performed, so anestesi is a very important and strategic stage in the surgical action. History shows surgical science underwent a rapid revolution after ether was discovered as an anesthetic by William Thomas Green Morton in 1846. Anesthesia has a much greater risk than surgical procedures because the lives of patients who are anaesthetized can be threatened. Therefore the ideal selection of anesthesia is necessary in producing analgesia, sedation, relaxation, unconsciousness,, safety and comfort for the vital system of the body, economical and easy to apply. To date anesthesia that meets these ideal criteria does not yet exist.

A common anesthetic that is often used and declared safe enough in animals is inhalation anesthesia. But inhalation anesthesia requires a device that is complicated, expensive, and has a relatively slow induction time and is impractical in handling surgical cases in the field. Inhalation anesthesia such as halotan causes poisoning of the organs and causes pollution to individuals in the operating room. Individuals exposed to subclinical halothan cause impairment of liver function. Inhalation anesthesia, such as nitrogen oxide  and halogen anesthesia result in environmental pollution and depletion of the ozone layer.

General anesthesia of injection and inhalation in pigs has several disadvantages such as the occurrence of hypersalivation, limited peripheral blood vessels, anatomical form of the larynx that become difficult in the intubation of the trachea, and tend to the occurrence of laringospasmus. Pigs are also difficult to tighten so intramuscular or intravenous injection is difficult to do. With such difficulty, a rapid and precise intramuscular and intravenous combination anaesthesia method is one of the anaesthetic solutions. The intramuscular anesthetic compound used must have a rapid onset and a small volume of administration in order for the administration of anesthetics to be quickly performed. The character of the rapid onset of the drug should also have a wide safety limit, directly providing a hypnotic effect, as well as analgesia.

Alternative anesthesia methods are necessary to overcome the affection in addition to the use of general anesthesia inhalation. General anesthesia with total intravenous injection anesthesia method (TIVA) is similar to the inhalation anesthesia method, but the infusion pump used in the TIVA method is very expensive. The cheaper, practical and most likely method for achieving the duration and maintenance of the long-term status of anaesthesia as inhalation anesthesia is the method of repeated injection of intravenous infusion drops (gravimetric method). Intravenous infusion allows longer distribution of the drug so that it can maintain anesthetic status for longer. The gravimetric infusion method uses parenteral anesthetics through continuous intravenous infusion drops. Anesthetics are mixed in bags of infusion fluid and anesthetic fluid is flowed through intravenous infusion drops based on gravitational forces with a certain dose and drip speed.

Anesthetic parenteral that can be administered via intravenous infusion drops is propofol. Propofol is a parenteral substance as an induction agent in general anesthesia especially inhalation anesthesia. Propofol has a short recovery time, but results in bradycardia and high doses of life-threatening treatment of patients. Ketamine can be combined with propofol to lower the hypnotic dose of propofol and reduce the influence of cardiovascular depression due to propofol.

Ketamine is an anesthetic dissociative of the nonbarbiturat group with strong pain relief properties and anesthetic reaction does not cause sleepiness. Inhibition of NMDA receptors with low doses of ketamine produces good analgesics, but ketamine causes muscle spasmus and increased heart rate.

Overcoming ketamine side effects, the compound is often combined with hypnotic premedication of the α2-adrenoceptor (xylazine) or benzodiazepines (diazepam, midazolam). Midazolam is more potential than diazepam. Midazolam can prevent muscle hypertones, increase the effects of sedation and have a hypnotic effect. The use of premeditation of xylazine in pigs causes vomiting, hypersalivation, and bradycardia. The administration of atrophine simultaneously as a premeditation, can decrease the influence of hypersalivation and bradycardiaa of xylazine.

Thus, the combination of atrophine-xylazine with ketamine and propofol gravimetrically through intravenous infusion drops has the potential to be an alternative to general anesthesia inhalation. Therefore, anaesthesia quality data is required when used as an anesthetic for a long duration of anesthesia in pigs. Many studies have been conducted to study the influences and physiological responses to the use of ketamine-propofol combinations that are administered repeatedly through intravenous infusion drops. It is necessary to research to obtain the induction time and duration of maintenance of ketamine-propofol anesthesia on pigs and a safe dose of ketamine-propofol combination on pigs as a cheap and practical general anesthetic method mainly used in the field as an alternative to complex and expensive inhalation general anesthesia.