what are the optimal dosing ratios for a dexmedetomidine-ketamine-opioid TIVA protocol?

Question

Accepted Answer

The sources do not describe a dexmedetomidine-ketamine-opioid TIVA (total intravenous anesthesia) protocol with defined dosing ratios — the available evidence covers IM induction combinations and CRI adjuncts to propofol-based TIVA, not a standalone dexmedetomidine-ketamine-opioid infusion regimen. What the sources do provide are two distinct clinical contexts that partially address this question: For IM induction in cats, ketamine 7 mg/kg combined with dexmedetomidine 10 µg/kg IM provides an adequate anesthetic plane for orchiectomy when supplemented with local anesthesia (intratesticular and subcutaneous lidocaine 2 mg/kg); a rescue dose of ketamine may be required in some patients.2 The 2020 AAHA guidelines describe a volume-based IM combination of dexmedetomidine 0.005–0.01 mg/kg plus ketamine 3–10 mg/kg plus an opioid of choice, dosed at approximately 0.1–0.2 mL per 4.5 kg body weight of each drug, with the low end used for moderate sedation and the high end for deep sedation or light anesthesia.1 For CRI adjuncts to propofol TIVA in dogs, dexmedetomidine at 1 µg/kg/h and ketamine at 1.5 mg/kg/h have been evaluated as separate infusions alongside epidural anesthesia; neither produced a propofol-sparing effect at these rates, and ketamine CRI was associated with respiratory depression requiring mechanical ventilation in most patients.3 The WSAVA pain guidelines describe a ketamine CRI of 5–10 µg/kg/min following a bolus of 0.2–0.3 mg/kg IV for analgesia in dogs and cats, but this is framed as an analgesic adjunct rather than a primary anesthetic protocol.5 No source in the available veterinary literature defines an optimized dosing ratio for a three-drug dexmedetomidine-ketamine-opioid TIVA regimen — the IM protocols above are induction-only, and the CRI data addresses two-drug adjunct combinations without opioid integration or ratio optimization. --- Would you like the specific atipamezole reversal doses for dexmedetomidine following these protocols?