Cattle & Buffalo (Large Ruminants) | Anesthesia Protocol | Lecture 03

[00:00:10]Hi everyone. I'm Dr. Sagar Sah and welcome to Vet Surgery Tips. So today I welcome you to another lecture in the series or you can say the playlist field anesthetic protocol. I have already made two videos. They are very old actually.

[00:00:23]I had made around two three years back. I don't even remember. So one video is on pet animal anesthesia and other one is in the lab animal as well as birds. There are some updates regarding those. I will share it later. But I have not made any protocol video for large ruminants.

[00:00:41]Where most of the field veterinarians they face this large animal cases. So in those cases you have to you know uh if it is necessary you have to administer some degree of anesthesia.

[00:00:53]So I will discuss few of the protocols, not all. And most of the protocols which I'm I will be discussing in this lecture, I have personally used. And there are few protocols which I have not used but I am very much eager to use and I will discuss those also. Apart from that, there are some research protocols I have taken from different materials that I will also share. But they are really very brief and I will mostly discuss the protocols that I have used. Okay?

[00:01:23]Then let us go to our lecture. Before going to the lecture, some formalities.

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[00:01:39]First one, before going to anesthetic anesthesia or anesthetics, we should know that there are different stages of CNS depression. Why I'm discussing this one? You will know in subsequent slides.

[00:01:51]The first one is actually tranquilization. Okay? Tranquilization stage. Anesthesia simply loss of pain.

[00:01:57]but the serious depression starts from tranquilization.

[00:02:01]I have discussed this one vividly in the series anesthesiology veterinary anesthesiology playlist. There is a playlist where I have discussed all the lectures of anesthesiology. I have taken that screenshot from that one. I will be discussing little bit in brief. If you want a full disclosure, then you can go to the anesthesiology playlist. I will give the link in the description. So, you can check that out. The first one is the tranquilization state, which means simply the animal will calm down angiolysis, then sedation drowsy.

[00:02:30]Next stage is hypnosis where the animal will sleep, then next stage is narcosis, in which the animal will be in the deep sleep state. And the final one is the general anesthesia where the animal is completely unconscious. These are the stages of anesthesia. Okay. Not stages, the degree of uh CNS depression that anesthetic can cause.

[00:02:51]Now, coming to this slide, this is very, very important.

[00:02:57]Irrespective of any patient, whether large ruminant small ruminant pet animal lab animal anything, this is very, very important. Why? I will discuss. So, the American Society for Anesthesiology, it has described or categorized the patients coming to your ward into different categories. Okay. So, the first one, category one is the healthy patients where you are supposed to perform any elective surgeries. Category two, mild systemic disease. Category three, severe systemic disease. Category four, severe systemic disease that is a constant threat to life of the patient. That is category four. Category five, moribund patient, not expected to survive.

[00:03:37]Category six, brain dead patient. We do not have to deal with these two mostly from the anesthesiology point of view in large ruminant, but these four type of patients may come to you. Why I'm telling this this is important. Suppose let us take the most common drug or sedative drug that is used in veterinary clinics in large ruminant is xylazine.

[00:04:01]Xylazine.

[00:04:03]It is a sedative hypnotic which causes dose dependent sedation. Okay? So, xylazine it if you are administering IV, it has a dose rate ranging from 0.05 mg per kg body weight to 0.1 mg per kg body weight. Okay. Let us take that we have taken the 0.05 mg per kg body weight intravenously.

[00:04:28]Now, if we you will administer at this particular dose rate to a category one patient, it may cause tranquilization only.

[00:04:39]It may cause tranquilization.

[00:04:42]But the same dose if you'll go for category two, then it may cause some sedation.

[00:04:50]Some sedation.

[00:04:52]In category three, it may cause hypnosis.

[00:04:58]In category four, it may cause narcosis.

[00:05:03]If you're using beyond that, it may cause death also, severe depression because xylazine has a effect that is the suppression of a cardiopulmonary functions. Why I'm telling this? When the patient's condition worsens, naturally there will be some degree of CNS depression. Now, when you will administer xylazine, it will take further a step back because it causes dose dependent depression. If the animal is already depressed, it will take further. So, the same dose rate which causes in a healthy patient only a tranquilization, it may cause narcosis in a severely threatened cases. Okay? In large ruminants, I'm discussing about large ruminants. Not only large ruminant, in any species.

[00:05:46]There will be some dosage. If you will give to a different category of patient, it will respond differently. So, that is why this categorization is very, very important when whenever any large animal cases is coming to you, please recognize these classes.

[00:06:02]Okay. Accordingly, you have to select a dose. Suppose I have to give a dose where it will cause sedation, I may go on lower dose. But if I want sedation this in a healthy patient, I may go on higher dose and it will be not that detrimental. But if I will get a higher dose to category IV patients, then there is a problem. Okay. So, I hope you have understood the categorization of the patients and it has some significance in field, not only field in clinical settings also. All the settings it has some uh help.

[00:06:36]Next.

[00:06:37]The next some points you have to remember while dealing with the large animals, that is the cattle or buffalo.

[00:06:42]Mostly I will be discussing cattle and buffalo, not camel.

[00:06:47]Because the camel cases are not here. We have We have got uh only cattle and buffalo.

[00:06:52]So, first one is the site selection. So, we have to select a open field, preferably may may not get in every cases, grassy field, flat and even, not some inclined spaces.

[00:07:04]Avoid pucca or concrete flooring because it causes damages the radial nerve.

[00:07:10]Sometimes as and also it if uh you are putting the animal for longer duration, it may cause pressure sores also. Okay, so some wounds may develop, all those things. So, avoid pucca and concrete floor. If at all you are going to do on pucca and concrete floor, please um make a straw bed over which the animal can rest. Over the straw bed, apply some polythene, then the animal can rest.

[00:07:31]Okay, so that the operation will be slightly aseptic. It may It is not possible in field to do exactly aseptic surgery, but you can uh some make some arrangements. Okay. So, open grassy flat or even if at all it's not grassy field is not available you can go for some other floor. Okay, avoid pucca and concrete floor. Okay, and also not in inclined. What will happen if you especially you are giving epidural anesthetics, okay. So, suppose this is the animal.

[00:08:00]This is the tail.

[00:08:03]Suppose you have to give Suppose this is lumbar vertebrae, this is sacral, then coccygeal.

[00:08:09]So, if you have to give the sacrococcygeal sacrococcygeal block, it may migrate caudally and you may not get your desired level of anesthesia.

[00:08:19]Similarly, if you if you rotate this one, the anesthetic may migrate cranially and you may depress some other structures in line, okay. I hope you understood.

[00:08:31]What happens if you are giving large volumes, it may migrate, okay. Sometimes it may reach thoracic vertebrae which may cause thoracic paralysis. But it is in very large doses, okay. In clinical settings, in field settings, if at all some degree of inclination it is not a big problem, but you should avoid. As a veterinarian, you should avoid. If there is some inclination, make some straw bedding or some what sandbags, all those things to elevate that one and can perform your surgery.

[00:09:01]Next is the IV access. Always keep IV access. My preference is always ear vein catheterization. Ear vein you can use usually 20 gauge or 22 gauge venflon intra-IV cannula intravenous cannula that can be fixed to ear in case of any emergency. Okay, what actually the emergency happens?

[00:09:21]Sometimes the antidote is not available.

[00:09:23]In many parts of the India or I am from Odisha, in many parts you will not find the antidote. So, in that particular case, the IV fluids saves you. I will tell you incident what happened actually Um, in a some dispensary I was posted.

[00:09:38]So, I had the xylazine as well as the xylocaine. You know, xylocaine is the local anesthetic. That is the brand name xylocaine, but xylazine is the um main drug name. So, I had kept So, some uh senior told me that uh I want to do the horn amput- I think horn dressing. There was a case in horn was fractured. The pulp cavity was not exposed. So, you have to do some bandaging around the wound. I told you give xylocaine 2 ml or uh in a small heifer 2 ml cornual nerve block to do the cornual nerve block.

[00:10:11]So, instead of 2 ml xylocaine, by mistake the senior not deliberately, by mistake administered xylazine subcutaneously.

[00:10:20]Okay. We don't have antidote in small uh heifer actually. So, what we did, we had placed uh ear vein catheter in both the ear, and in both the ear we started giving fluids, normal saline. So, after 1 and 1/2 hour, animal recovered. So, that will be very helpful if you will keep a ear vein all the time. Jugular vein may not be accessible, especially when the xylazine in higher doses. It causes some degree of the collapse of the jugular vein. Many a times it will go subcort- uh the needle will come out.

[00:10:51]There are some problems. It will not always happen, but you know that each life is essential. Each life is valuable. So, never make any mistake. If at all, then don't be in a guilt, but learn and then improve.

[00:11:07]So, you have to give the ear vein catheterization, otherwise you can go for jugular vein. Jugular vein is easily accessible compared to the ear vein because of larger size not easily accessible. Large volumes can be given through the jug- jugular vein very in a quick period of time. So, keep sufficient quantity of fluids. As I told you some incident, so you have to keep sufficient amount of RL and NS that can be kept. Recumbency, you can perform surgeries on lateral and dorsal.

[00:11:34]Dorsal is very very difficult in large animals. Most of the surgeries will be done on lateral recumbency, lateral recumbency. So, when you will be putting the animal lateral recumbency in some drugs like xylazine, you will find hypersalivation. So, in lateral recumbency, place a pad at the head and neck junction. This image you can I have created using AI. I'm not that good in AI, but I had created this one. So, what will happen if you'll put a pillow between the This is the head.

[00:12:00]This is the head and this is the neck junction. What will happen? Whatever the saliva will be produced, it will come out like this. It will not go Here will be the esophagus like this.

[00:12:11]It will be like this. So, whatever the saliva saliva will be produced, it will come out. It will not enter the trachea or esophagus. Esophagus is not a problem, but in trachea, it will be a problem. So, it will not enter. First, second, what happens, the advantage of placing this one is in especially in xylazine, you will find the gastroesophageal sphincter relaxes. So, the ruminal fluid may come.

[00:12:34]Okay. And it may enter the trachea. So, in this particular setting, it will not come up to the pharynx level. If at all it comes, it will come out immediately.

[00:12:42]So, this setting helps or this is a practical setting guide while dealing with especially xylazine. Okay.

[00:12:50]Otherwise, it is a normal setting you have to do in every cases, not in xylazine, but it is very important when you are using any protocol having xylazine.

[00:12:59]Okay. Next, eye protection for the uh contralateral side. This one the upper uh the side which is on towards the sky and the the uh side which is towards the earth, the eye may get injured, so you can give uh gauze pack, all those things to protect the eye. Okay.

[00:13:18]Next is the very important one that is the fasting. Fasting is very very important whenever giving you are giving administering anesthesia. Food and water withdrawal minimum is 12 to 8 hours. It is not recommended one, but in field settings, whatever I have surgery performed, I have tried to maintain this 12 to 18 hours at a minimum. Okay? Good one is 24 hours, very good. 48 hours is the best, but for 48 hours you have to give fluids mon- morning and evening two times you have to give fluids.

[00:13:51]So, 48 hours is the best one especially for GI surgeries. If you're going for rumenotomy or all those things or intussusception surgery or any TRP cases you are handling, it is better go for 48 hour um fasting. In case of small nursing ruminants like calves 2 months or below, there you don't need any fasting, okay?

[00:14:12]Because they are kind of monogastric animals.

[00:14:15]And there is a very acute chance of developing the hypoglycemia, okay? And in case of these this nursing ruminants, if you're performing in surgery like more than 15-20 minutes, you have to give dextrose solutions 10 ml per kg per hour intravenously for long procedures.

[00:14:34]These are the basic things you have to keep in mind while administering the sedation or anesthesia, okay? Some protocols are sedative, some protocols are anesthetics.

[00:14:46]Let us go to the protocols. Before going to the protocols, important thing is this one.

[00:14:51]Though these protocols will be discussed, but none of the protocols will be like a general anesthetic protocol. There are a few protocols, but they are not that routinely used, okay?

[00:15:02]So, whenever you are using these protocols which I am going to discuss, you have to combine these protocols along with local or regional anesthesia.

[00:15:12]Always combine these protocols with local regional anesthesia for better outcome.

[00:15:18]For example, suppose in a case you have to perform a rumenotomy.

[00:15:24]Okay. Suppose you have to perform a rumenotomy.

[00:15:28]So, for sedation or anesthetic protocol, sedation actually mostly anesthetic protocols are not that used in rumenotomy at field level. In a situation level in colleges, it may be.

[00:15:38]So, what you have to do for sedation protocol, you may use butorphanol, xylazine, ketamine. This is this known as ketamine stone technique. Okay, I will discuss, don't worry. So, first BXK protocol you can use for some degree of then you can use the paravertebral This is regional anesthesia.

[00:15:57]Paravertebral nerve block along with you can go for line infiltration where you are supposed to give the line infiltration. Supposed to give the incision. Okay. So, when you will combine all this, it will be very good analysis. Now, remember why these anesthetic protocols. Okay. You see it is an obligation of a veterinarian to their patient that it should be how it should have minimal pain. We know that that large ruminants, they don't vocalize their pain lot. Okay. Like sheep and goat, they also vocalize when they are in pain.

[00:16:36]Dog and cat, you know that how emotionally attached their patient only is, but for large animals, not so not they don't vocalize and they can easily be manually restrained, but it does not mean that they feel don't feel pain.

[00:16:50]They do feel pain. So, it is our responsibility. I personally feel it it is our responsibility that we should whenever possible, we can use these anesthetic protocols to reduce their pain and suffering during the procedure.

[00:17:05]Okay. And also this procedure will help that so much suppose to restrain a 400 kg cow, you may need five, six people. But if you will give these protocols, according to the your situation, situation, it may reduce number of people handling the cases. Okay? So, but more importantly, it reduces the pain of the animal. Okay?

[00:17:28]Up to great degree. It reduces the stress hormone, stress response. All those things can be reduced by simple adopting these sedation protocols. Okay?

[00:17:37]Let us go to the protocols. First one is the benzodiazepines.

[00:17:41]Diazepam or midazolam.

[00:17:44]You can use any of them. Dosage is 0.1 to 0.2 mg per kg body weight intravenously. I've not written mg per kg body weight. You can understood You can understand that it is mg per kg body weight. 0.1 to 0.2 mg per kg body weight. It is mostly given to comfort or calm the patient. Okay? There are many procedures like suppose you have to do some abscess lancing. Okay? Cyst opening. Atresia ani surgery. In atresia ani, you are also have to give epidural.

[00:18:11]Small wound stitching, local infiltration can be given along with diazepam or midazolam. Lower end simple like metatarsal or metacarpal fractures.

[00:18:19]All those fractures can be simple fractures and transverse fractures.

[00:18:23]Those fractures can be managed with midazolam and or diazepam given intravenously at a dosage rate of 0.1 to 0.2 mg mg per kg body weight. Okay? I have used few this one in many of the metatarsal or metacarpal fractures.

[00:18:40]Next protocol is diazepam and xylazine. This combination they are the lower doses of both. Xylazine The midazolam is 0.1 mg per kg body weight intravenously. Then xylazine 0.025 mg per kg body weight intravenously. Both can be used in a combination, especially for fracture management. Okay? In oblique fractures, yet simple fracture, not compound. Simple fractures with oblique fractures. That When there will be oblique fracture, there will be pain.

[00:19:09]Well, when you will manipulate those limbs for alignment, you will the animal will feel pain, but with these protocols, they will feel less pain.

[00:19:17]Okay, also you can use suppose you have metatarsal fracture, you can also go for lumbosacral. Okay, but it is not recommended for simple oblique fractures. If you are going for a surgery like ESF like that, then you can go for lumbosacral. But with these xylazine and diazepam given intravenously, first diazepam then xylazine, separate syringes not in a single series, you can give for so simple oblique fractures. Okay? You see, you have to use according to your conscious, your understanding. Does not necessarily mean that simple oblique fractures means I will give this one. Suppose the animal has some other issue, two fractures are there, you may need some stronger protocol. Okay?

[00:20:02]Next protocol is xylazine. You know this one very well.

[00:20:05]More many of the veterinarians are using xylazine and it is also good, but it has disadvantages like cardiopulmonary suppression. Okay, and also hypersalivation will be there in case of cattle.

[00:20:17]So, the dosage if you are giving intravenously 0.05 mg/kg body weight to 0.1 mg/kg body weight. And intramuscular, simply double, 0.1 to 0.2 mg/kg body weight. When you will give intravenously, the cardiopulmonary effect will be much greater compared to the intramuscular injections in case of xylazine in ruminants. It is suitable for all procedures, most of the procedures you can do along with xylazine. But I told you in category one and category two, maximum.

[00:20:46]Category three and four, it may cause some depression, severe depression.

[00:20:51]It has side effect, I told you, reduced GI motility, cardiopulmonary. Important is cardiopulmonary function and also hypersalivation. Hypersalivation in case of cattle.

[00:21:04]Hypersalivation.

[00:21:06]The antidote is yohimbine and The dosage rate is mentioned here, but you have to take into consideration how much time has passed. You may reduce this dose further. It's maximum dose 0.125 mg per kg per kg body weight yohimbine. This is maximum dosage. Suppose you have given xylazine now and after 5 minutes you have to go for the maximum for maximum dose. But if it's 20 minutes, 30 minutes have passed, you may reduce it to half.

[00:21:30]Accordingly, this is that is how the antidote is calculated. And you can go for tolazoline 2 mg per kg body weight.

[00:21:37]That is the maximum dosage. But these two may not be available in field, so keep the fluids ready and IV cannula fixed. You fix the IV cannula in ear vein.

[00:21:46]Simply go for normal saline pushing blood. There will be urine formation.

[00:21:50]Drug will excrete out. Okay? But not necessarily you have to keep yohimbine many parts in I am from where I told you many parts it is not available. Okay? All veterinarians cannot have the access to yohimbine or tolazoline. Okay? But that in case I told you fluids. Very good.

[00:22:09]This technique I want to highlight.

[00:22:12]Currently, I am using this protocol for all my surgeries involving the large animals. Very good protocol.

[00:22:20]This is known as ketamine stun technique.

[00:22:23]Okay? This is known as ketamine stun technique.

[00:22:33]Ketamine stun technique. What happens actually? Here we use sub anesthetic dose dose of ketamine.

[00:22:41]Sub anesthetic dose of ketamine.

[00:22:44]What happens actually when the ketamine is used sub at a sub anesthetic dose, its analgesic property increases.

[00:22:53]Okay?

[00:22:54]Its analgesic property increases. So this is used in combination with xylazine and butorphanol for effective analgesia in ruminants.

[00:23:04]So, the combination is butorphanol, xylazine, ketamine, BXK.

[00:23:09]Some surgeons may prefer XBK, xylazine, butorphanol, and ketamine.

[00:23:14]But, fundamentally, they are butorphanol, xylazine, and ketamine. So, the dose rate is there are two type of technique, the standing stone technique and recommend stone technique.

[00:23:25]The standing for standing stone, butorphanol 0.01 mg per kg body weight, xylazine 0.02 mg per kg body weight, ketamine 0.04 mg per per kg body weight. You can give intramuscular and intravenous. For if you will give intravenous, it will be the effect will be like 15 to 20 minutes, but if you will give intramuscular, it may go up to 30 minutes. But, the onset of action is faster in IV compared to the IM.

[00:23:51]Next, for recommend stone, butorphanol, xylazine, ketamine. Butorphanol is 0.025 mg per per kg body weight, xylazine 0.05 mg per mg per kg body weight, ketamine 0.1 mg per kg body weight. Okay? So, these two techniques, one is for standing standing sedation, another for recommend sedation. Both can be used. It is suitable for all procedure. I'm currently using this one for all my surgeries mostly.

[00:24:17]And it produces chemical hypnosis, drug-induced hypnosis. Very good. Well, I have I have got good result with this one, especially when comes is to come to pain management large animals intraoperative.

[00:24:30]Okay? So, you can use this protocol. My suggestion will be please adopt this protocol. Uh this is very good compared to the only xylazine. Okay?

[00:24:41]Next, this is a general anesthetic protocol. I have not used one this one, but I am planning. Uh and with time, we evolve. Our confidence also evolves. All those things evolve. So, I hope I will adopt this one and the next one also. So, diazepam and ketamine uh that can be used to induce anesthesia.

[00:25:02]Diazepam at the point 0.05 to 0.1 mg per kg body weight. Ketamine 1.5 to 2 mg per kg body weight intravenously.

[00:25:11]It can be performed for major major surgeries like C-section, large hernia, or ESF application before supposed to you have to combine it with also local anesthetics or regional anesthetics.

[00:25:23]Suppose you have to go for metatarsal MTD metatarsal fracture.

[00:25:29]You can give this protocol as well as the lumbosacral. Okay. So, you can give for if you are performing ESF. Very good. Okay.

[00:25:38]Always I told I will keep reporting repeating this one that whenever you are using sedation anesthetic protocol, always use along with the local or regional anesthesia in case of large animals, cattle or buffalo.

[00:25:52]Maintenance is 30 to 50% of induction dose, but the literature says that only one to two supplementary doses are allowed, not beyond that. Okay.

[00:26:03]Better to maintain with double drip or triple drip. I will discuss this one.

[00:26:07]Okay, this is very I found this one very fascinating because many of the surgeries are for induction, only single dose, not for maintenance. Except this one where ketamine, but still one to two doses only. But this is the drip which is for maintenance. Although it in you can induce this this one, but this is for maintenance also. Okay. So, I will discuss double drip and triple drip. Don't worry. Next protocol is xylazine and ketamine.

[00:26:33]You know that xylazine ketamine is for every species. Okay, you will find the lumbar zones pattern in anesthesia and this is xylazine protocol you will find for every species. Okay.

[00:26:43]So, xylazine ketamine xylazine is 0.05 mg per kg body weight. Ketamine 2 mg per kg body weight intravenously. Major surgeries, simply induction dose 30 to 50% maintenance but only one to two dose not beyond that. Okay. May double or triple drip, it can be used for maintenance and this for only for induction. What is double drip or triple drip?

[00:27:05]So, this is basically double drip.

[00:27:07]Double drip is guafenisin and ketamine combination. So, guafenisin comes with 1 L bottle uh or this polythene bag.

[00:27:15]You have to add 20 ml of ketamine which has 50 mg per ml concentration. There is a ketamine which is 100 mg per ml not that one. Okay, you have to add 20 ml 50 mg per ml. That is the basically 100 mg. Okay.

[00:27:31]Uh 1,000 mg I'm sorry, 1,000 mg of ketamine. If you're using 100 mg then it will be reduced 10 ml you have to add.

[00:27:39]So, 20 ml of commercially available ketamine to 1 L of 5% guafenisin, it will make a double drip. You can use for induction also 1.5 to 2 ml per kg body weight. Maintenance is 2.5 ml to per kg per hour. In that way you can maintain.

[00:27:56]You have to calculate how much ml per hour then you have to calculate per second. How many drops? Drops per second it will be set.

[00:28:04]Similarly, there is a triple drip in which the xylazine is added. Whenever xylazine will be added is not suitable for category three or category four patients. But the BXK protocol can be used up to category three. I have used for category three and I have never used to any anesthetic protocols or sedation protocol for category four patients.

[00:28:23]Mostly have done with local one or regional one. Okay. For up to category three I have used BXK not that I have not found any death cases immediately after giving the drugs.

[00:28:34]Okay.

[00:28:36]So, triple drip is guafenisin, xylazine and ketamine.

[00:28:39]Avoid xylazine in category three and four patients. Category three and four is Add 20 ml of ketamine 15 mg per ml, 5 ml of xylazine, 20 mg per ml concentration.

[00:28:50]There is a xylazine also for wild animal, which is 100 mg per ml.

[00:28:54]Avoid that one. So, this 5 ml of commercially available xylazine for surgery, 20 mg per ml, to 1 L of 5% guaifenesin.

[00:29:02]Induction is same, 1.15 ml per kg, but maintenance is 2.5 ml per kg per hour.

[00:29:09]Okay? So, this is basically double drip and triple drip. I hope someday I will use this one, and also I will share the feedback to you.

[00:29:19]There's some research I have taken this uh research from the uh you know, there is a conference known as Indian Society for Veterinary Surgery. They arrange um arranges conference in every year organization, not arranges, organizes conference every year. Most of the time I go because it is a very good platform to see different parts of the India veterinarians of different parts of India, of different institutions, veterinary institutions, colleges, okay?

[00:29:47]And they discuss different surgeries, progresses. It feels good, okay? If you are um some student or some faculty >> [laughter] >> or any field veterinarian, do attend that if you are willing to do something in surgery. So, there are I have taken that from last year's the ISBS conference. Um there will be booklet. Most of the uh researches and most of the what uh work that is conducted in India in veterinary surgery, they mostly present in the Indian Society for Veterinary Surgery conferences. So, most of the things you may find the abstracts which they have submitted. From that you can find. So, these are the things which I have found from that booklet. Some research is going on combination of acepromazine, butorphanol, and ketamine.

[00:30:35]There's another one where pre-medication with butorphanol and ketamine, induction with midazolam and ketamine. There is also tell us what little mean logical combination that can be used in ruminants. Propofol also automated and it before that is a combination of propofol and automated they all this can be used in ruminants but it may come very in very late stage to field. Okay, whatever happens in the situation takes few years few maybe decades coming to the field. There is a huge gap between the field and uh institution. I try to my best this gap is minimized. So, this is all about this lecture.

[00:31:17]So, mostly the first protocols up to the BXK the benzodiazepines and the diazepam xylazine xylazine and BXK the ketamine stone. In these protocols I have confidently used and you can use them in the field confidently also. They have lesser side effects compared to the general anesthetic protocols. If at all you do not have any antidote especially in xylazine when you are using xylazine you can give sufficient amount of fluid therapy to the animal or a recovery.

[00:31:48]Okay, so this is the basic moral of this particular lecture and I also urge you to be empathetic towards the large ruminants especially avoid doing surgeries only manual restraint where the animals especially large ruminants they can express their pain through vocalization.

[00:32:08]Okay, so this is all about today. So, before that please do subscribe to the channel and like this video and you can also share among your friends, colleagues and juniors all those things.

[00:32:20]So, [snorts] we'll meet in the next class till then tata bye-bye. Take care.