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UNIPLANAR BILATERAL ACRYLIC EXTERNAL SKELETAL FIXATION FOR THE TREATMENT OF LONG BONE FRACTURE IN GOATS
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES-MANNUTHY,THRISSUR, 2018) ATHIRA V. P.; C. B. Devanand
The study was conducted in six goats affected with fracture of metatarsus during the period from August 2017 to April 2018. The objectives of the study were to assess healing of fracture by uniplanar bilateral external skeletal fixation using acrylic connecting bar and evaluate the efficacy of acrylic external skeletal fixator for the treatment of long bone fracture in goats. The goats were selected irrespective of age, sex, breed and bodyweight. They were subjected to clinical examination and radiography of affected limb for confirmation of fracture of the bone. After confirming the fitness of the animal for surgical correction, and obtaining the consent of owner all the goats were treated by uniplanar bilateral external skeletal fixation using acrylic connecting bar and centrally threaded transfixation pins under general anaesthesia. Clinical, radiographic, haematological and serum biochemical evaluations were conducted preoperatively, on the day of surgery, postoperatively on second, fourth, and eighth week. The body weight of animals ranged from 5 to 14 kg. Among the six animals five (83.33 per cent) of them were female and one (16.7 per cent) was male. Hindlimb of the goats was affected in all the cases with fracture of metatarsus. Physiological and haematological parameters showed variations and they were within the normal range throughout the observation period. Postoperative radiograph of all the goats showed good alignment and apposition between the fracture fragments and adequate implant stability throughout the observation period. Postoperative radiograph of goat 3 showed a mild degree of angulation on day of surgery. All the goats showed periosteal callus formation by second postoperative week. Endosteal callus formation commenced by fourth postoperative week in majority of cases whereas in goat 3 and 6 in which it started by second postoperative week. The serum calcium level on fourth postoperative week was elevated when compared to preoperative day of surgery. However, serum calcium level on eighth week was within the normal physiological limit. The serum phosphorus level was elevated on the day of surgery and variations was noticed upto eighth postoperative week. The serum alkaline phosphatase level was high at the time of presentation and continued to increase significantly (P<0.01) on the day of surgery and second postoperative week. Thereafter it decreased significantly (P<0.01) on fourth and eighth postoperative week and within normal physiological range. All the animals had good functional outcome and normal weight bearing on all the limbs. The animals regained weight bearing on eighth postoperative week. In all the cases implant was removed by eighth week except for goat 3 where the implant was removed by fourth postoperative week when early usage of the limb was observed. Mild pin tract drainage, angular deformity and mild degree of osteolysis were the complications noticed during the study. The results of the study revealed that use of uniplanar bilateral external skeletal fixator using acrylic connecting bar provided excellent implant stability during the period of fracture healing. Use of centrally threaded pins could achieve pin - bone interface stability with no pin loosening. Acrylic external skeletal fixator was proved to be an economical, technically feasible and reliable alternative over stainless steel external fixator for treatment of long bone fracture in small ruminants.
Open Access
EVALUATION AND MANAGEMENT OF ORAL AND MAXILLOFACIAL DISORDERS IN CANINES
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES-MANNUTHY,THRISSUR, 2018) ASWATHY P.; M. K. Narayanan
Veterinary dentistry is receiving more attention in general practice. Small animal dentistry has gained significant and tremendous momentum owing to its pivotal role in providing a comprehensive preventive health care plan for pet dogs. The dietary changes and eating habits in companion animals have been influenced by lifestyle leading to an increase in acquired periodontal and endodontic diseases. The present study was conducted to identify the etiopathological factors affecting oral and maxillofacial disorders and diagnosis and treatment of specific oral pathologies and maxillofacial affections in canines The study was conducted in dogs with oral and maxillofacial disorders belonging to different age group, breed and sex presented at University Veterinary Hospitals Mannuthy and Kokkalai from June 2017 to June 2018. The study involved evaluation and management of oral and maxillofacial disorders and its diagnosis as well as treatment adopted for specific oral pathologies and maxillofacial affections. A total of 11,691 cases of dogs presented with various surgical problems were evaluated and from that 87 cases of oral and maxillofacial disorders were identified. Out of 87 cases of oral and maxillofacial disorders, a total of 24 dogs were selected for the present study irrespective of breed, sex and age. All dogs were subjected to detailed clinical, haematological, biochemical, histopathology and radiographic examination relevant to each case. Various medical and surgical protocol was applied to each case based on the severity of the condition and tissues involved. Each cases were evaluated on the day of presentation and subsequently for review on day 14th and in required cases a further review was carried out to access the progress of treatment. Among the dogs, the incidence of dental tartar was high constituting 19.54 per cent followed by oral neoplasm (18.39 per cent), enamel hypoplasia (12.64 per cent), laceration (8.05 per cent), dental attrition and mandibular fracture (each constituting 5.75 per cent). A total of 31.05 per cent constituted other condition like oral ulcer, pulpitis, malalignment of teeth in dental arcade, persistent deciduous teeth, pus in antrum, cleft palate, glossoplegia, mandibular abscess, supernumerary teeth and halitosis. The incidence of various type of oral and maxillofacial disorders together constituted almost 0.74 per cent of clinical cases in dogs presented requiring immediate intervention. Out of 87 cases of oral and maxillofacial affections, seventeen cases were affected with dental tartar, eleven dogs had enamel hypoplasia, five dogs had dental attrition, four dogs had persistent deciduous teeth, three dogs had pulpitis, four dogs had malalignment of teeth and one dog had supernumerary teeth. In the present study, furcation involvement noticed mostly in the 4th premolar of upper arcade irrespective of sides and class III furcation was noticed most frequently in the 3rd premolar irrespective of sides. All the physiological and haematological parameters were found to be within the normal range except a statistically significant difference noticed in the total leukocyte count between the day of presentation and 14th day of presentation in dogs affected with periodontitis. The bacterial organism identified were Klebsiella spp., Enterococcus spp., Acinetobacter spp., Staphylococcus aureus (22.22 per cent) and Escherichia coli (11.11 per cent). All the dogs with accumulation of tartar and enamel hypoplasia in this group were subjected to ultrasonic dental scaling when the teeth were healthy whereas exodontia was performed in one dog due to the excessive mobility of the tooth. The antibiotic therapy, parenterally on the day of scaling and oral medication with oral metronidazole gel therapy found to be effective in reducing halitosis and treatment of periodontal disease. The trauma was observed more in male (four cases) and one case in female. In the present study, a total of 16 out of 87 cases were reported as neoplasms and the present study could correlate metastasis with the help of thoracic radiograph and clinical signs associated with neoplasm such as lymph node. All the animals affected with neoplasm were subjected to surgical excision of tumor with thermocautery and bleeding was controlled using electrocautery, topical haemostat application and ligatures. Major neoplasm identified by histopathology were melanoma, squamous cell carcinoma, fibromyoma, gingival acanthomatous ameloblastoma, basal cell carcinoma and osteochondrosarcoma. The result of the present study indicate that the major dental disorders encountered during the period include dental tartar, neoplasms, enamel hypoplasia, lacerations, dental attrition, mandibular fractures, oral ulcers, malalignment of teeth in dental arcade, persistent deciduous teeth, pus in natrum, cleft palate, mandibular abscess, supernumerary teeth, glossoplegia and halitosis. The study revealed that proper care, management, feeding and timely diagnosis using appropriate diagnostic procedures could reduce the chance of disorders involving the teeth and oral cavity. Oral examination with the special reference to dental affections has to be made mandatory as part of general health checkup. It was also suggested the need for a detailed epidemiological study regarding neoplasms in dogs and its association with the environmental factors.
Open Access
COMPARATIVE EVALUATION OF CLINICAL SIGNIFICANCE OF CRANIAL AND CAUDAL INTRAMUSCULAR SITES OF INJECTION IN INDIAN SNAKES USING BUTORPHANOL - KETAMINE ANAESTHESIA
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES, POOKODE WAYANAD, 2018) KOUNDINYA U.; George Chandy
The clinical significance of cranial and caudal intramuscular sites of injection in Indian snakes using butorphanol-ketamine anaesthesia was evaluated in 12 Indian Spectacled Cobras (Naja naja) which underwent routine health screening at the State Zoological Gardens, Thiruvananthapuram. The animals were randomly allocated into two groups of six each. Group I animals were anaesthetized using a combination of butorphanol and ketamine at the rate of 1.5 mg/kg and 40 mg/kg body weight, respectively, intramuscularly at cranial one third of body (cranial to the heart). Group II animals were anaesthetized using combination of butorphanol and ketamine at the rate of 1.5 mg/kg and 40 mg/kg body weight, respectively, intramuscularly at caudal one third of body. The mean±SE time taken for induction of anaesthesia in Group I snakes was 9.06±0.11 minutes and in Group II was 8.59±0.57 minutes. The mean±SE time taken for recovery from anaesthesia in Group I and Group II snakes was 18.47±0.41 and 18.54±0.46 hours, respectively. Increased heart rate was observed in snakes of both groups immediately after induction and respiratory rates were uniform throughout the period of anaesthesia. Increase in pH, glucose and lactate, and decrease in level of carbon dioxide were observed at the onset of anaesthetic phase, and the values were returning to normal towards the end of recovery. Creatinine and blood urea nitrogen values before anaesthesia and after recovery were found to be unaltered. All the haematological parameters were within normal range and did not differ significantly between groups. No complications were observed during the study. No difference was seen in the quality of induction, maintenance of anaesthesia or recovery periods in snakes of both groups. The study suggests that the renal portal system does not have any clinical significance and that both cranial and caudal sites for intramuscular injection of anaesthetic drugs can be recommended for snakes.
Open Access
COMPARATIVE STUDY ON LAPAROSCOPIC OVARIECTOMY WITH INTRACORPOREAL LIGATION AND HAEMOCLIP APPLICATION IN DOGS
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES, POOKODE WAYANAD, 2018) SARATH K.S.; Sooryadas S.
The study was conducted on fourteen adult non-pregnant female dogs of different age and body weight brought for laparoscopic birth control surgery at Teaching Veterinary Clinical Complex, Pookode. They were randomly divided into two groups of seven animals each - Group I (laparoscopic ovariectomy by intracorporeal ligation) and Group II (laparoscopic ovariectomy by haemoclip application). The study was carried out with an objective to compare the clinical efficacy of intracorporeal ligation and haemoclip application for laparoscopic ovariectomy in dogs subjected to ventral midline 3-port-laparoscopic ovariectomy. The ovary was anchored to the abdominal wall in an elevated position using suspension sutures, to facilitate ligation and resection. Laparoscopic ovariectomy by intracorporeal ligation required three ports. Two needle holders were introduced – one through the cranial and the other through the caudal instrumental ports for knot tying. Twelve centimetres long braided silk was found sufficient for applying intracorporeal flat surgeon’s knot and provided hazzle free ligation. The procedure of intracorporeal ligation was graded difficult in all the animals of Group I but provided excellent haemosatsis for ovariectomy. Hemoclip application with ventral midline three port technique was easy compared to intracorporeal ligation. The procedure of haemoclip application was graded moderately difficult in animals with considerable fat deposition around ovary and multiple clips had to be applied in the pedicle and ovarian end so as to ensure incorporation of all vessels. Haemoclip applied on ovarian pedicle with minimal fat and connective tissues were not secure. The total surgical time was 76.93±3.38 min for laparoscopic ovariectomy with intracorporeal ligation while that for hemoclip application was 61.21±2.14 min. The difference in time is attributed to difficulty in formation of knots and long learning curve, increase in number of instrument changes and surgical movements, and difficulty of intracorporeal ligation procedure compared to the procedure of haemoclip application. Intracorporeal ligation ensured more haemostatic competency inspite of its complexity. All animals returned to normal appetite within 8 to 10 h after recovery from anaesthesia. The post surgical tolerance was good and comparable between the groups with no postoperative complications. To conclude intracorporeal ligation may be preferred for ovarian pedicle haemostasis prior to ovarietomy in animals with considerable fat deposition around ovary, while hemoclip application may be limited to animals with minimal to moderate ovarian pedicle fat. Keywords: Laparoscpic ovariectomy, intracorporeal ligation, endoclip application
Open Access
HEALING OF BONE DEFECTS TREATED WITH TRI - PHASIC COMPOSITE BIO - CERAMIC IN RAT MODELS
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES, POOKODE WAYANAD, 2018) Dinesh P. T.; Syam K. Venugopal
The study was conducted to assess the efficacy of tri-phasic silica containing ceramic coated hydroxyapatite (HASi) as a bone graft substitute for fractures with segmental loss in rat models and to evaluate regeneration of bones treated with HASi, before this new material is put to clinical use. A six millimeter mid diaphyseal defect was created in the right femur of 80 adult male Wistar rats aged 16 weeks. The procedure was done under general anaesthesia using xylazine hydrochloride and ketamine hydrochloride at the dose rate of 9.0 mg/kg and 90 mg/kg body weight given intraperitoneal. The defect was bridged with presized HASi graft and immobilized with 1.5 mm microplates and screws. Healing was evaluated by radiography, histology, haematology, assessment of bone turnover markers activity in serum and by assessment of biomechanical strength. All the animals showed undisturbed wound healing without any complication. Serial radiographic evaluation fortnightly revealed that the fragments were in alignment and apposition. The graft had integrated with the host bone radiographically by four weeks and showed both proximal and distal union. By 16 weeks time, new bone formation was evident. Healing was assessed by scoring the radiographs and the total score observed was 0.57 ± 0.15 at two weeks, 3.25 ± 0.25 at four weeks, 6.83 ± 0.28 at eight weeks, 8.94 ± 0.15 at twelve weeks and 9.54 ± 0.16 at sixteen weeks in a scorecard of maximum 10 points. New bone formation was observed in the peripheral region of the defect, while the mid region was identifiable with a portion of the material. Grossly, the graft material was incorporated with newly regenerated bone. At 16 weeks, new bone substitution in par with the degradation of the graft material was almost achieved throughout the defect. The total leukocyte count showed an initial increase during the second week of observation, which was with in the normal range. There after, it was reduced and was maintained with in the normal range. Hematologic evaluation results suggested no signs of inflammation or infection during the entire period of fracture healing. Assessment of activity of bone turn markers showed that ALP levels regained to near normal levels indicating completion of osteoblastic activity in time. ACP values were found significantly higher in comparison with normal values suggestive of ongoing osteoclast activity. These two enzyme levels were suggestive of normal fracture healing processes and bone remodeling, respectively. Histological examination revealed complete healing of the defect without any signs of inflammation or fibrous proliferation. New bone deposition and material degradation were more significant in periphery as compared to the centre of the defect at eight weeks. At 16 weeks, new bone deposition and material degradation were achieved throughout the defect. The material was not completely resorbed, but existed as small islands embedded in newly formed bone. Histological evaluation has proved adequate levels of osteoconduction and osteointegration between bone substitution graft and the host bone. The fractured limb had regained 83 per cent of its flexural strength, 92.82 per cent of compressive strength and 78.99 per cent of torsional strength when compared to that of the normal limb by 16 weeks. Therefore, the present study has proved the successful use of HASi bone substitute graft material for the treatment of critical sized segmental defects in the rat femur on the basis clinical results.
Open Access
CLINICO-PHYSIOLOGICAL EVALUATION OF KETAMINE AND LIGNOCAINE AS CONTINUOUS RATE INFUSION (CRI) FOR PROPOFOL ANAESTHESIA IN DOGS.
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES, POOKODE WAYANAD, 2018) AVINASH E.M; Dinesh P. T
General anaesthesia with sustained analgesia is inevitable for most of the surgical procedures performed. Additional analgesia without deepening anaesthesia, could be attained by administering analgesic drugs as continuous rate infusion (CRI). A CRI with analgesics will also help in reducing the total anaesthetic requirement during a surgical procedure. Accordingly, the study was conducted to find out the clinico-physiological effects of ketamine and lignocaine as continuous rate infusion for propofol anaesthesia in dogs. The study was carried out in twelve dogs presented for neutering at the surgery out-patient unit of Kerala Veterinary and Animal Sciences University. Female dogs presented for spaying, were selected and randomly divided into group I and group II with six animals each. All the animals were premedicated with injection of tramadol @ 4 mg/kg body weight and xylazine @ 1 mg/kg body weight mixed together in a single syringe and given as intramuscular injection. General anaesthesia was induced in all the animals using injection of diazepam @ 0.2 mg/kg body weight intravenous, immediately followed by propofol injection given intravenously “to effect”. In group I animals, anaesthesia was maintained using propofol given intravenously as bolus injection as and when required “to effect”. In group II animals, anaesthesia was maintained using ketamine @ 10 µg/kg/min and lignocaine @ 30 µg/kg/min mixed in 100 ml normal saline and administered intravenously as continuous rate infusion (CRI) throughout the period of surgery using a flow regulator set at 100 ml per hour speed. Propofol, if required was administered intravenously. The quality of anaesthetic induction was excellent in all the animals studied. There was profound sedation in all the twelve animals studied, following intravenous administration of diazepam and propofol. Transition to anaesthesia was calm and smooth in all animals with profound jaw muscle relaxation, which facilitated an easy endotracheal intubation. Time taken for induction had no significant variations between group I and group II. Rectal temperature, rate of respiration and capillary refill time recorded were within normal limits in all the animals. Heart rate and pulse rate were found to be elevated in group I and group II throughout the anaesthetic period. Blood pressure was observed to be enhanced and stabilised in group II than in group I. The values were observed within the normal range. Electrocardiogram recordings did not reveal any kind of cardiac abnormalities throughout the study period instead a tachycardia could be observed in animals of both the groups. The EtCO2 values were higher with non-significant difference between the groups. An improvement in the saturation of oxygen in peripheral blood could be observed in group II animals which was not observed in group I animals during the period of study. All the animals had a calm recovery except for two animals of group II, where a short period of paddling have been observed prior to the attempts to stand. The time taken for recovery was prolonged in animals of group II as compared to the animals of group I. The dogs which received CRI required less amount of propofol top up for the maintenance of anaesthesia, which proves the sparing effect of ketamine-lignocaine CRI on the requirement of propofol and hence the protocol is proven to be economic. It could be thus concluded that the dogs sedated with intramuscular injection of xylazine-tramadol, followed by an induction with diazepam-propofol and maintained with a continuous rate infusion of ketamine and lignocaine provided excellent analgesia, adequate muscle relaxation, improvement in the saturation of oxygen in peripheral blood, smooth quality of induction and recovery and an enhanced hemodynamics with minimal adverse effects on cardiovascular and respiratory systems. The protocol is also proven to be economic due to the sparing effect of ketamine-lignocaine CRI on the requirement of propofol.
Open Access
MULTIMODAL ANALGESIA AND BALANCED ANAESTHESIA WITH MELOXICAM- BUTORPHANOLMIDAZOLAM- KETAMINE COMBINATION IN INDIAN PIGEON (Columba livia)
(COLLEGE OF VETERINARY AND ANIMAL SCIENCES, POOKODE WAYANAD, 2018) RASHMI S. GOKHALE; Sooryadas S.
of the surgical procedures performed in avian practice. Practitioners often perform general anaesthesia by giving an injectable or inhalant agent, with or without a sedative. Intraoperative response to pain is often misunderstood as lightening of anaesthesia and managed by administration of incremental doses of the anaesthetic agent, resulting in alarmingly deeper planes of anaesthesia. Instead, balanced anaesthesia with multimodal analgesia would be a better anaesthetic practice to follow for surgical interventions involving deep pain in birds. Keeping this in view, the present study was undertaken to evaluate the analgesic and anaesthetic effects of meloxicam- butorphanol- midazolamketamine combination for balanced anaesthesia in Indian pigeon (Columba livia) and compare it with that of the existent diazepam-ketamine anaesthetic protocol in practice. Twelve adult pigeons presented for surgical correction of pategium ligament injuries were randomly assigned to two groups – group I and group II, of six birds each. In Group I, thirty minutes following pre-emptive analgesia with meloxicam at the rate of 0.5 mg/kg, anaesthesia was induced with butorphanol, midazolam and ketamine at the dose rate of 1 mg/kg, 1 mg/kg and 30 mg/kg respectively as a single intramuscular injection. Birds of Group II were anaesthetised with a drug combination of diazepam and ketamine at the rate of 2 mg/kg and 50 mg/kg body weight respectively as a single intramuscular injection. Physiological, anaesthetic and analgesic parameters were recorded immediately after induction and every 10 minutes thereafter, throughout the anaesthetic period. All the birds were observed till complete recovery from anaesthesia. Loss of righting reflex, loss of wing fluttering, loss of voluntary head movement, eyelid closure, reduced spontaneous blinking and loss of palpebral reflex, successively, were noted as the signs of induction in all the twelve birds. Induction of anaesthesia was significantly quick for birds anaesthetised with meloxicam- butorphanol- midazolam- ketamine combination when compared to birds anaesthetised with diazepam-ketamine. The balanced anaesthetic combination provided excellent analgesia. Cardiorespiratory functions were well preserved. The balanced anaesthetic combination provided significantly quick recovery when compared to that in practice. To conclude, the anaesthetic protocol of pre-emptive analgesia with meloxicam at the rate of 0.5 mg/kg intramuscularly, followed by combination of butorphanol-midazolam-ketamine at the dose rate of 1 mg/kg, 1 mg/kg and 30 mg/kg as a single intramuscular injection, provides quick anaesthesia, excellent analgesia and speedy recovery in Indian pigeons (Columba livia) for surgical correction of pategium ligament injuries.
Open Access
CLINICAL EVALUATION OF DEXMEDETOMIDINE-MIDAZOLAMKETAMINE WITH ATRACURIUM FOR ISOFLURANE ANAESTHESIA IN DOGS
(2018-01-11) JOSELIN, Binu S; S, Sooryadas
8. ABSTRACT General anaesthesia with sustained muscle relaxation is inevitable for most of the surgical procedures performed. Additional muscle relaxation, without deepening anaesthesia, could be attained by administering a peripheral acting muscle relaxant like atracurium. Accordingly the study was conducted to find out the clinico-physiological and haemodynamic effects of atracurium on animals induced with dexmedetomidine-midazolam-ketamine combination and maintained on isoflurane for various surgical procedures. The study was conducted in twelve dogs which underwent various surgical procedures, in the Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Pookode, Wayanad. These dogs were randomly allocated into two groups – Group I and Group II, of six animals each. Animals of Group I were anaesthetised with a drug combination of dexmedetomidine, midazolam and ketamine at the rate of 5 μg/kg, 0.2 mg/kg and 5 mg/kg body weight respectively as a single intramuscular injection. Following endotracheal intubation, isoflurane was administered in oxygen to maintain anaesthesia. In Group II, following induction with the same injectable drug combination and maintenance with isoflurane, a loading dose of atracurium at the dose rate of 0.1 mg/kg body weight was administered intravenously, immediately followed by a continuous rate infusion of atracurium at a dose rate of 0.1 mg/kg/hour. The quality of anaesthetic induction, produced by the dexmedetomidinemidazolam- ketamine combination was excellent in all the animals. There was profound sedation in all the twelve animals following the intramuscular administration of the injectable anaesthetic combination, and the transition to anaesthesia was calm and smooth. Eyeball rolled ventrally and medially. There was profound relaxation of jaw muscle and laryngeal tone which permitted easy intubation. Respiratory rate reduced in all the animals following induction with the injectable anaesthetic combination. Administration of atracurium in the animals of Group II produced pronounced reduction in the rate and depth of respiration which necessitated manual assisted ventilation for every spontaneous breath. All four muscle twitches were present in the animals of Group I, after induction and during maintenance of anaesthesia. But the twitches, assessed visually, were not as strong as those before administration of the injectable anaesthetic drug combination. The eye ball was positioned ventrally and medially in all the animals of Group I, after induction and during maintenance. There was disappearance of two muscle twitches and central positioning of the eyeballs within five to eight minutes after administration of atracurium. The eyeballs maintained the central position and the third and fourth muscle twitches remained absent up to 20th minute, after which the eyeballs rolled down and the twitches reappeared and remained so throughout the period of anaesthesia. There were no significant variations in the haematological, serum biochemical, blood gas and electrolyte values in both the groups. Time taken for recovery, time to regain sternal recumbency and time to assume standing posture unassisted, following weaning from anaesthesia did not vary significantly in the animals administered with atracurium when compared to the animals of Group I. It could be thus concluded that dogs anaesthetised with intramuscular injection of dexmedetomidine-midazolam-ketamine combination and maintained on isoflurane when administered atracurium intravenously followed immediately by a continuous rate infusion, provided profound muscle relaxation without compromising the haemodynamic functions, but the marked reduction in the rate and depth of respiration necessitated assisted ventilation.

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