Effect of a Constant Rate Infusion of Ketamine on a Variable Rate Infusion of Xylazine in Standing Horses Undergoing Ventriculocordectomy and Laryngoplasty

Standing sedation in horses provides immobilization and analgesia for surgery while avoiding the high risks of general anesthesia. Ketamine at subanesthetic doses may enhance sedation and reduce xylazine requirements, but evidence in clinical settings is limited. In a randomized blinded trial, we evaluated whether adding a low-dose ketamine infusion could reduce the xylazine dose required for effective sedation during standing ventriculocordectomy and laryngoplasty. Fifty-one horses were randomly assigned to sedation with xylazine alone (SX group) or xylazine plus ketamine (KX group) in a continuous rate infusion. The ketamine group received ketamine (0.25 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg/h infusion), while xylazine was administered in both groups via a titrated infusion to effect according to the Ghent Sedation Algorithm. Sedation depth, ataxia, surgical condition scores, and cardiorespiratory parameters were recorded. Data are presented as median (25th–75th percentiles) and estimated effect with 95% confidence intervals (CI). Statistical significance was set at p < 0.05 and at 95% CIs excluding zero. The addition of ketamine did not significantly reduce xylazine requirements (0.9 (0.7–1.3) vs. 0.8 (0.5–1.1) mg/kg/h for SX and KX, respectively; p = 0.139). However, horses receiving ketamine (KX) achieved deeper sedation (Estimate = 2.74; 95% CI: 0.95 to 4.63) with no differences in ataxia or surgical conditions. Cardiorespiratory variables remained stable in both groups, and no adverse events occurred. In conclusion, adding a subanesthetic ketamine infusion improved sedation depth without adverse effects but did not significantly reduce the xylazine requirement.