Effect of rate of administration of propofol or alfaxalone on induction dose requirements and occurrence of apnea in dogs

OBJECTIVE

To evaluate the effect of rate of administration of propofol or alfaxalone on induction dose requirements and incidence of postinduction apnea (PIA) in dogs following premedication with methadone and dexmedetomidine.

STUDY DESIGN

Prospective, randomized clinical trial.

ANIMALS

Thirty-two healthy American Society of Anesthesiologists class I client-owned dogs (seven females, 25 males), aged between 5 and 54 months, weighing between 2.0 and 48.2 kg.

METHODS

Dogs were premedicated intramuscularly with 0.5 mg kg^-1 methadone and 5 μg kg^-1 dexmedetomidine. Thirty minutes after premedication, dogs were preoxygenated for 5 minutes before the induction agent was administered intravenously via a syringe driver until orotracheal intubation was achieved. Dogs were randomized to receive alfaxalone 0.5 mg kg^-1 minute^-1 (A-Slow), alfaxalone 2 mg kg^-1 minute^-1 (A-Fast), propofol 1 mg kg^-1 minute^-1 (P-Slow), or propofol 4 mg kg^-1 minute^-1 (P-Fast). Oxygen saturation of hemoglobin (SpO₂), end-tidal carbon dioxide and respiratory rate were monitored. If PIA (≥30 seconds without a breath) occurred, the time to the first spontaneous breath was measured. If SpO₂ decreased below 90%, the experiment was stopped and manual ventilation initiated.

RESULTS

The mean±standard deviation induction doses of alfaxalone and propofol were lower in the A-Slow [A-Slow 0.9±0.3 mg kg^-1, A-Fast 2.2±0.5 mg kg^-1 (p≤0.001)] and P-Slow [P-Slow 1.8±0.6 mg kg^-1, P-Fast 4.1±0.7 mg kg^-1 (p≤0.001)] groups, respectively. The incidence of PIA was 25% for the A-Slow and P-Slow groups and 100% for the A-Fast and P-Fast groups (p = 0.007).

CONCLUSIONS AND CLINICAL RELEVANCE

Both propofol and alfaxalone following methadone and dexmedetomidine premedication caused PIA. Induction dose requirement and incidence of PIA were affected by the rate of administration of both drugs. When possible, propofol and alfaxalone doses should be reduced and administered slowly to reduce PIA.

Influence of two administration rates of alfaxalone at induction on its relative potency in cats: a pilot study

Objectives The aim of the study was to evaluate, in a controlled, randomised, masked clinical trial, the influence of administration rate of alfaxalone at induction on its relative potency in cats and to report the incidence of cardiorespiratory adverse effects. Methods Twelve healthy female domestic cats admitted for ovariohysterectomy were premedicated with buprenorphine 20 µg/kg intramuscularly and alfaxalone 3.0 mg/kg subcutaneously. Sedation scores were established (using a published scale ranging from 1 [no sedation] to 5 [profound sedation]) prior to anaesthesia induction with alfaxalone intravenously at 2 mg/kg/min (group A2; n = 6) or 0.5 mg/kg/min (group A0.5; n = 6) to effect until orotracheal intubation was achieved. Sedation scores and alfaxalone induction doses were compared between the groups, using a Mann-Whitney exact test. Results are reported as median and range. Presence of apnoea (no breathing for more than 30 s) or hypotension (mean arterial blood pressure <60 mmHg) within 5 mins postintubation was also reported. Results Although sedation scores (1.5 [range 1.0-3.0] and 2.5 [range 1.0-3.0] for A2 and A0.5, respectively) were not significantly different ( P = 0.32), cats in group A2 required significantly more alfaxalone (4.3 mg/kg [range 3.4-7.0 mg/kg]) than group A0.5 (2.1 mg/kg [range 1.5-2.5 mg/kg]) ( P = 0.002). Two cats in each group presented postinduction apnoea, and two cats in group A2 and three cats in group A0.5 presented postinduction hypotension. Conclusions and relevance The use of a slower induction infusion rate resulted in an increase in the alfaxalone relative potency without obvious cardiorespiratory benefit.

Combinations of dexmedetomidine and alfaxalone with butorphanol in cats: application of an innovative stepwise optimisation method to identify optimal clinical doses for intramuscular anaesthesia

OBJECTIVES

The aim of this study was to optimise dexmedetomidine and alfaxalone dosing, for intramuscular administration with butorphanol, to perform minor surgeries in cats.

METHODS

Initially, cats were assigned to one of five groups, each composed of six animals and receiving, in addition to 0.3 mg/kg butorphanol intramuscularly, one of the following: (A) 0.005 mg/kg dexmedetomidine, 2 mg/kg alfaxalone; (B) 0.008 mg/kg dexmedetomidine, 1.5 mg/kg alfaxalone; (C) 0.012 mg/kg dexmedetomidine, 1 mg/kg alfaxalone; (D) 0.005 mg/kg dexmedetomidine, 1 mg/kg alfaxalone; and (E) 0.012 mg/kg dexmedetomidine, 2 mg/kg alfaxalone. Thereafter, a modified 'direct search' method, conducted in a stepwise manner, was used to optimise drug dosing. The quality of anaesthesia was evaluated on the basis of composite scores (one for anaesthesia and one for recovery), visual analogue scales and the propofol requirement to suppress spontaneous movements. The medians or means of these variables were used to rank the treatments; 'unsatisfactory' and 'promising' combinations were identified to calculate, through the equation first described by Berenbaum in 1990, new dexmedetomidine and alfaxalone doses to be tested in the next step. At each step, five combinations (one new plus the best previous four) were tested.

RESULTS

None of the tested combinations resulted in adverse effects. Four steps and 120 animals were necessary to identify the optimal drug combination (0.014 mg/kg dexmedetomidine, 2.5 mg/kg alfaxalone and 0.3 mg/kg butorphanol).

CONCLUSIONS AND RELEVANCE

The investigated drug mixture, at the doses found with the optimisation method, is suitable for cats undergoing minor clinical procedures.

Self-administration of progesterone and synthetic neuroactive steroids by male rhesus monkeys

BACKGROUND

Progesterone-derived neuroactive steroids have shown promise clinically (e.g., anti-seizure medications) but, as with other GABAA receptor modulators (e.g., benzodiazepines), may have the potential for abuse.

METHODS

We evaluated the reinforcing effects of progesterone, a steroid precursor of endogenous neuroactive steroids, with and without pretreatments with the neuroactive steroid synthesis inhibitor, finasteride, in rhesus monkeys trained under a progressive-ratio (PR) schedule of i.v. midazolam injection. We also assessed reinforcing effects of the short-acting neuroactive steroid alphaxolone and the long-acting neuroactive steroid ganaxolone in comparison with the short-acting benzodiazepine triazolam and the long-acting benzodiazepine clonazepam.

RESULTS

At least one dose of progesterone, alphaxolone, and ganaxolone was self-administered significantly above vehicle levels in all monkeys tested (n=4 for progesterone, n=3 for alphaxolone and ganaxolone). The 5α-reductase inhibitor finasteride attenuated progesterone self-administration, consistent with the reinforcing effects of progesterone being mediated by the in vivo synthesis of neuroactive steroids. The comparison drugs, triazolam and clonazepam, were self-administered significantly above vehicle by all monkeys. Although the maximum number of injections/session maintained by the neuroactive steroids was below that maintained by the midazolam training dose, analysis of break points (i.e., highest response requirement achieved) suggested modest differences in relative reinforcing effectiveness for neuroactive steroids compared with benzodiazepines.

CONCLUSIONS

Our results are consistent with endogenous and synthetic neuroactive steroids having reinforcing effects similar to that of benzodiazepines, with reinforcing effectiveness possibly lower for the neuroactive steroids compared with benzodiazepines based on some measures.

Effects of ketamine and alfaxalone on application of a feline pain assessment scale

OBJECTIVES

The objective of this study was to compare the effects of ketamine and alfaxalone on the application of a validated feline-specific multidimensional composite pain scale (UNESP-Botucatu MCPS).

METHODS

In a prospective, randomized, blinded, crossover trial, 11 adult cats (weight 4.4 ± 0.6 kg) were given dexmedetomidine (15 μg/kg) and hydromorphone (0.05 mg/kg) with either alfaxalone (2 mg/kg) or ketamine (5 mg/kg) as a single intramuscular injection for the induction of general anesthesia. After orotracheal intubation, general anesthesia (without surgery) was maintained for 32 mins with isoflurane, followed by atipamezole. The following parameters were recorded at baseline, 1-8 h and 24 h post-extubation: pain (pain expression and psychomotor subscales) and sedation scale scores. Alfaxalone treatment injection sites were examined for inflammation at baseline, postinjection, and 8 h and 24 h post-extubation.

RESULTS

Psychomotor scores were higher with ketamine at hours 1 (3.5 [0-5.0], P <0.0001), 2 (2.5 [0-4.0], P <0.0001) and 3 (0.5 [0-4.0], P = 0.009) post-extubation compared with alfaxalone (hour 1, 0 [0-2]; hour 2, 0 [0-0]; hour 3, 0 [0-0]). Six cats in the ketamine group crossed the analgesic intervention threshold. In contrast, pain expression scores did not differ significantly between treatments at any time (P >0.05); one cat from each group crossed the analgesic intervention threshold. Sedation was greater with ketamine (1 [0-3], P = 0.02) than alfaxalone (0 [0-1]) 1 h post-extubation. No cats had visible inflammation at the injection sites at any time.

CONCLUSIONS AND RELEVANCE

Ketamine has a confounding effect on the psychomotor subscale of the pain scale studied, which may lead to erroneous administration of rescue analgesia. In contrast, alfaxalone was not associated with significant increases in either pain subscale. These effects of ketamine should be considered when evaluating acute postoperative pain in cats.

Alfaxalone Anaesthesia Facilitates Electrophysiological Recordings of Nociceptive Withdrawal Reflexes in Dogs (Canis familiaris)

Naturally occurring canine osteoarthritis represents a welfare issue for affected dogs (Canis familiaris), but is also considered very similar to human osteoarthritis and has therefore been proposed as a model of disease in humans. Central sensitisation is recognized in human osteoarthritis sufferers but identification in dogs is challenging. Electromyographic measurement of responses to nociceptive stimulation represents a potential means of investigating alterations in central nociceptive processing, and has been evaluated in conscious experimental dogs, but is likely to be aversive. Development of a suitable anaesthetic protocol in experimental dogs, which facilitated electrophysiological nociceptive withdrawal reflex assessment, may increase the acceptability of using the technique in owned dogs with naturally occurring osteoarthritis. Seven purpose bred male hound dogs underwent electromyographic recording sessions in each of three states: acepromazine sedation, alfaxalone sedation, and alfaxalone anaesthesia. Electromyographic responses to escalating mechanical and electrical, and repeated electrical, stimuli were recorded. Subsequently the integral of both early and late rectified responses was calculated. Natural logarithms of the integral values were analysed within and between the three states using multi level modeling. Alfaxalone increased nociceptive thresholds and decreased the magnitude of recorded responses, but characteristics of increasing responses with increasing stimulus magnitude were preserved. Behavioural signs of anxiety were noted in two out of seven dogs during recordings in the acepromazine sedated state. There were few significant differences in response magnitude or nociceptive threshold between the two alfaxalone states. Following acepromazine premedication, induction of anaesthesia with 1–2 mg kg^-1 alfaxalone, followed by a continuous rate infusion in the range 0.075–0.1 mg kg^-1 min^-1 produced suitable conditions to enable assessment of spinal nociceptive processing in dogs, without subjecting them to potentially aversive experiences. This methodology may be appropriate for obtaining electrophysiological nociceptive withdrawal reflex data in client-owned dogs with naturally occurring osteoarthritis.

Evaluation of a combination of alfaxalone with medetomidine and butorphanol for inducing surgical anesthesia in laboratory mice

The anesthetic effects of alfaxalone were investigated in mice. Mice were administered alfaxalone (100 mg/kg) alone or the combinations of 0.3 mg/kg of medetomidine and 5 mg/kg of butorphanol with alfaxalone at doses of 20 mg/kg (M/B/A20), 40 mg/kg (M/B/A40), 60 mg/kg (M/B/A60), or 80 mg/kg (M/B/A80). Control mice received 0.3 mg/kg of medetomidine, 4 mg/kg of midazolam, and 5 mg/kg of butorphanol (M/M/B). Each drug was administrated by intraperitoneal (IP) or subcutaneous (SC) routes. M/M/B IP did not achieve surgical anesthesia but M/M/B SC achieved surgical anesthesia within 10 min after administration and maintained anesthesia for 45 min. The anesthetic scores were very low after IP or SC administration of alfaxalone alone. M/B/A20 IP and SC did not achieve surgical anesthesia. M/B/A40 IP did not achieve surgical anesthesia but M/B/A40 SC achieved surgical anesthesia within 10 min after administration and maintained anesthesia for 35 min. M/B/A60 SC achieved surgical anesthesia within 5 min after administration and maintained anesthesia for 75 min. By contrast, M/B/A60 IP did not achieve surgical anesthesia. M/B/A80 SC achieved surgical anesthesia within 5 min after administration and maintained anesthesia for 85 min. By contrast, M/B/A80 IP did not achieve surgical anesthesia and one mouse died about 10 min after drug administration. Administration of atipamezole rapidly reversed anesthesia induced by M/B/A60 in mice. These results suggest that M/B/A60 SC, an alfaxalone-based combination, is suitable for inducing surgical anesthesia in laboratory mice.

The effects of intravenous alfaxalone with and without premedication on intraocular pressure in healthy dogs

The objective of this study was to investigate the effects of intravenous alfaxalone with and without premedication on intraocular pressure (IOP) in healthy dogs. Thirty-three dogs were randomized to receive 1 of 3 treatments: acepromazine [0.03 mg/kg body weight (BW)] with butorphanol (0.2 mg/kg BW) intramuscularly (IM), followed by intravenous (IV) alfaxalone (1.5 mg/kg BW); dexmedetomidine (0.002 mg/kg BW) with hydromorphone (0.1 mg/kg BW) IM, followed by alfaxalone (1 mg/kg BW) IV; and saline 0.9% (0.02 mL/kg BW) IM, followed by alfaxalone (3 mg/kg BW) IV. Intraocular pressure (IOP) was measured at baseline, 15 min, and 30 min after premedication, after pre-oxygenation, after administration of alfaxalone, and after intubation. After induction and after intubation, the IOP was significantly increased in all groups compared to baseline. While premedication with acepromazine/butorphanol or dexmedetomidine/hydromorphone did not cause a significant increase in IOP, the risk of vomiting and the associated peak in IOP after dexmedetomidine/hydromorphone should be considered when selecting an anesthetic protocol for dogs with poor tolerance for transient increases in IOP.

Effects of intramuscular sedation with alfaxalone and butorphanol on echocardiographic measurements in healthy cats

OBJECTIVES

The aim of the study was to evaluate the effects of intramuscular (IM) injections of alfaxalone combined with butorphanol on echocardiographic (ECG) measurements in cats.

METHODS

Client-owned adult domestic shorthair cats younger than 5 years of age were recruited. All cats that were considered healthy on the basis of physical examination, blood work, urinalysis, blood pressure measurement and baseline ECG underwent a second ECG under sedation. Cats were sedated with two separate IM injections of butorphanol at 0.2 mg/kg and alfaxalone at 2 mg/kg. ECG variables were analysed using a linear mixed model, and sedation scores were analysed using an ordinal mixed logistic model. The significance level was set at α = 0.05 and adjusted at α = 0.0017 for multiple comparisons of the ECG measurements.

RESULTS

Ten healthy cats were included. Sedation was uneventful, and recovery was smooth and quick for all cats. The mean duration of lateral recumbency was 36.3 ± 4.37 mins. Reduction in heart rate following sedation approached statistical significance (P = 0.002). The thickness of the interventricular septum, the thickness of the left ventricular free wall, and the left ventricular internal dimensions in diastole and systole were not affected by the sedation. The changes in left atrium/aortic ratio and shortening fraction were statistically significant. Although the peak velocity of early diastolic transmitral flow (E) and late diastolic transmitral flow (A), the peak early diastolic (Ea) mitral valve annulus velocity, and the peak late diastolic (Aa) mitral valve annulus velocity changed after sedation, the ratios E/A, E/Ea and Ea/Aa were not significantly different after sedation.

CONCLUSIONS AND RELEVANCE

IM injections of alfaxalone and butorphanol induced rapid, deep and short-lasting sedation. The mean differences after sedation were not clinically significant for most echocardiographic measurements.

Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions

The aim of this study was to evaluate the analgesic effects of maxillary and/or inferior alveolar nerve blocks with lidocaine and bupivacaine in cats undergoing dental extractions. Twenty-nine cats were enrolled. Using an adapted composite pain scale, cats were pain scored before the dental procedure and 30 mins, and 1, 2 and 4 h after isoflurane disconnection. Cats were sedated with buprenorphine (20 µg/kg), medetomidine (10 µg/kg) and acepromazine (20 µg/kg) intramuscularly. Anaesthesia was induced using alfaxalone (1-2 mg/kg) intravenously and maintained with isoflurane in oxygen. Each cat was randomly assigned to receive maxillary and/or inferior alveolar nerve blocks or no nerve blocks prior to dental extractions. Each nerve block was performed using lidocaine (0.25 mg/kg) and bupivacaine (0.25 mg/kg). Heart rate, systolic arterial blood pressure, respiratory rate, end tidal carbon dioxide and isoflurane vaporiser settings were recorded 5 mins before and after the dental extractions, and the difference calculated. Group mean differences (mean ± SD) for heart rate (-9.7 ± 10.6 vs 7.6 ± 9.5 beats/min [nerve block vs control group, respectively], P <0.0001), systolic arterial blood pressure (-10.33 ± 18.44 vs 5.21 ± 15.23 mmHg, P = 0.02) and vaporiser settings (-0.2 ± 0.2 vs 0.1 ± 0.4, P = 0.023) were significantly different between groups. The control group had higher postoperative pain scores (median [interquartile range]) at 2 h (3 [1.75-4.00] vs 1 [0-2], P = 0.008) and 4 h (4 [2-6] vs 2 [1-2], P = 0.006) after the dental extractions. Maxillary and inferior alveolar nerve blocks with lidocaine and bupivacaine administered prior to dental extractions resulted in a reduction in heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks.

The use of alfaxalone and remifentanil total intravenous anesthesia in a dog undergoing a craniectomy for tumor resection

A 7-year-old castrated border collie dog was anesthetised for surgical resection of a hippocampal mass. Anesthesia was maintained using a previously unreported TIVA protocol for craniectomy consisting of alfaxalone and remifentanil. Recovery was uneventful, and the patient was discharged from hospital. We describe the anesthetic management of this case.

Clinical evaluation of alfaxalone to induce and maintain anaesthesia in cats undergoing neutering procedures

This study looked at the use and efficacy of alfaxalone for total intravenous anaesthesia (TIVA) in cats. Following intramuscular medetomidine (20 μg/kg) and morphine (0.3 mg/kg) premedication, anaesthesia was induced and maintained with intravenous alfaxalone. Patients were breathing 100% oxygen. Heart rate (HR), respiratory rate (RR), end-tidal carbon dioxide, oxygen saturation of haemoglobin and indirect arterial blood pressure via Doppler (DAP) were recorded every 5 mins. Thirty-four cats (10 males and 24 females), between the age of 6 and 18 months, and weighing between 1.8 and 5.3 kg, and undergoing neutering procedures were included in this study. The results are presented as median (min, max) values. The time to first spontaneous movement (TS) was >30 mins in 19 cats, of which 12 received atipamezole for reversal of the effects of medetomidine. The TS was 53 (43, 130) mins in these 12 cats and 50 (40, 72) mins in the other seven cats. The body temperature in those 19 cats was significantly lower than the other cats (P = 0.05). The alfaxalone induction dose and maintenance infusion rate were1.7 (0.7, 3.0) mg/kg and 0.18 (0.06, 0.25) mg/kg/min, respectively. The HR, RR and DAP were 145 (68, 235) beats/min, 17 (5, 40) breaths/min and 110 (58, 210) mmHg, respectively. Apnoea was not observed in any cat. In conclusion, alfaxalone TIVA in combination with medetomidine and morphine premedication was effective in feral and domestic cats for the performance of neutering surgery; low body temperature might have resulted in longer recoveries in some cats.

Cardiovascular and respiratory effects, and quality of anesthesia produced by alfaxalone administered intramuscularly to cats sedated with dexmedetomidine and hydromorphone

The cardiovascular and respiratory effects, and the quality of anesthesia of alfaxalone administered intramuscularly (IM) to cats sedated with dexmedetomidine and hydromorphone were evaluated. Twelve healthy adult cats were anesthetized, with six cats receiving dexmedetomidine (0.01 mg/kg IM) followed by alfaxalone (5 mg/kg IM; group DA) and six receiving dexmedetomidine (0.01 mg/kg IM) plus hydromorphone (0.1 mg/kg IM) followed by alfaxalone (5 mg/kg IM; group DHA). Cardiorespiratory (pulse rate, blood pressure, respiratory rate, saturation of oxygen with hemoglobin, end tidal carbon dioxide partial pressure) and bispectral index (BIS) data were collected every 10 mins for 90 mins starting immediately after intubation. The quality of anesthesia was scored by a blinded researcher at induction and at 5 and 60 mins after extubation. Recovery scores ranged from 1 (prolonged struggling) to 4 (no struggling). There were no clinically significant (P >0.05) differences in any data between groups or over time. Physiologic parameters were within normal limits for cats at all times. BIS values were consistent with light anesthesia in both groups. However, recovery was prolonged and marked with excitement, ataxia and hyper-reactivity in all cats. Thus, although cardiovascular and respiratory parameters are stable following IM injection of alfaxalone to cats sedated with dexmedetomidine and hydromorphone, recovery is extremely poor and this route of administration is not recommended for anesthesia in cats.

[Clinical usability and practicability of Alfaxalone for short-term anaesthesia in the cat after premedication with Buprenorphine]

Objective of this clinical study was to assess the anaesthetic quality (induction and recovery) and utility of short term alfaxalone anaesthesia in healthy and diseased cats. Cardiopulmonary effects and the influence on haematological and biochemical blood parameters were evaluated.

MATERIAL AND METHODS

Twenty feline patients (ASA1-4) were anaesthetized with alfaxalone for various short surgical or diagnostic procedures. Heart rate, breathing rate, end-tidal CO2 partial pressure, arterial oxygen saturation, mean arterial blood pressure and the body temperature were measured and recorded every 10 minutes. Before, after and 6 hours after anaesthesia venous blood samples were taken and haematologic and blood chemistry parameters were determined. Recovery time and quality were assessed by a numerical rating scale.

RESULTS

Anaesthetic induction was rapid and smooth in all cats. Spontaneous respiration was maintained in all cats. Cardiopulmonary parameters mostly remained within a clinically tolerable range. Noticeable was a high heart rate (mean >190 bpm) at the beginning of anaesthesia lasting up to 10 minutes. Statistically significant changes (p<0.05) occurred in some haematologic parameters (RBC, haemoglobin, haematocrit and MCV decreased), electrolytes and venous acid-base-status (bicarbonate, chloride and base excess increased, sodium and potassium decreased) and blood chemistry parameters (alanine aminotransferase, glutamate dehydrogenase and creatinine decreased). None of these changes appeared to have clinical relevance. Recovery was smooth in the majority of cats. Mild signs of hyperexcitability (muscle tremor, short term opisthotonus and hyperacusis) occurred in individual animals. The duration of recovery varied between 21 and 93 minutes.

CONCLUSION AND CLINICAL RELEVANCE

Alfaxalone by repeated intravenous injection is suitable for short-term diagnostic and surgical procedures in cats. Because of its minor cardiovascular effects and slight respiratory depression, it is also well tolerated by patients with increased anaesthetic risk (ASA 3 and 4).

Neurosteroid analogues. 16. A new explanation for the lack of anesthetic effects of δ(16)-alphaxalone and identification of a δ(17(20)) analogue with potent anesthetic activity

This study addresses the hypothesis that the lack of anesthetic activity for (3α,5α)-3-hydroxypregn-16-ene-11,20-dione (Δ(16)-alphaxalone) is explained by the steroid Δ(16) double bond constraining the steroid 20-carbonyl group to a position that prevents it from favorably interacting with γ-aminobutyric acid type A (GABA(A)) receptors. A series of Δ(16) and Δ(17(20)) analogues of Δ(16)-alphaxalone was prepared to evaluate this hypothesis in binding, electrophysiological, and tadpole anesthesia experiments. The results obtained failed to support the hypothesis. Instead, the results indicate that it is the presence of the C-21 methyl group in Δ(16)-alphaxalone, not the location of the constrained C-20 carbonyl group, that prevents Δ(16)-alphaxalone from interacting strongly with the GABA(A) receptor and having anesthetic activity. Consistent with this conclusion, a Δ(17(20)) analogue of Δ(16)-alphaxalone without a C-21 methyl group was found to be very similar to the anesthetic steroid (3α,5α)-3-hydroxypregnane-11,20-dione (alphaxalone) with regard to time of onset and rate of recovery from anesthesia when administered to mice by tail vein injection.

Changes in relative potency among positive GABA(A) receptor modulators upon discontinuation of chronic benzodiazepine treatment in rhesus monkeys

RATIONALE

Benzodiazepine treatment can result in dependence as evidenced by signs of withdrawal upon discontinuation of use.

OBJECTIVE

Positive GABA(A) receptor modulators were examined for their capacity to attenuate flumazenil-like discriminative stimulus effects (i.e., withdrawal) that emerge upon discontinuation of chronic benzodiazepine treatment.

METHODS

Rhesus monkeys receiving chronic diazepam (5.6 mg(-1) kg(-1) 24 h(-1) p.o.) discriminated flumazenil (0.1 mg/kg s.c.) from vehicle.

RESULTS

Upon discontinuation of diazepam treatment, responding switched from the vehicle to the flumazenil lever, although at different times among monkeys. The shorter-acting benzodiazepine lorazepam (3.2 mg(-1) kg(-1) 8 h(-1)) was substituted for diazepam and, 11 h after lorazepam, monkeys consistently responded on the flumazenil lever. Flumazenil-lever responding after acute lorazepam deprivation was attenuated not only by benzodiazepines (lorazepam and midazolam) but also by positive GABA(A) receptor modulators acting at neuroactive steroid (pregnanolone and alfaxalone) and barbiturate sites (pentobarbital). Deprivation-induced responding on the flumazenil lever was not attenuated by low efficacy positive GABA(A) modulators (bretazenil and L-838,417) or non-GABA(A) receptor ligands (ketamine and cocaine). Neuroactive steroids were relatively more potent than other positive GABA(A) receptor modulators in attenuating deprivation-induced flumazenil-lever responding, as compared to their relative potency in monkeys discriminating midazolam and otherwise not receiving benzodiazepine treatment.

CONCLUSIONS

These results suggest that positive GABA(A) receptor modulators acting at different sites attenuate withdrawal induced by discontinuation of benzodiazepine treatment, consistent with previous studies suggesting that the same compounds attenuate flumazenil-precipitated withdrawal. Differences in the relative potency of positive modulators as a function of acute versus chronic benzodiazepine treatment suggest that neuroactive steroids, in particular, are especially potent in benzodiazepine-dependent animals.

Antinociceptive properties of neurosteroids: a comparison of alphadolone and alphaxalone in potentiation of opioid antinociception

In this study, we investigated the antinociceptive and sedative effects of the opioids fentanyl, morphine, and oxycodone given alone and in combination with two neurosteroids: alphadolone and alphaxalone. An open-field activity monitor and rotarod apparatus were used to define the sedative effects caused by opioid and neurosteroid compounds given alone intraperitoneally to male Wistar rats. Dose-response curves for antinociception were constructed using only nonsedative doses of these drugs. At nonsedating doses, fentanyl, morphine, and oxycodone all caused dose-dependent tail flick latency (TFL) antinociceptive effects. Because neither neurosteroid altered TFL, electrical current was used as the test to determine doses of neurosteroid that caused antinociceptive effects at nonsedative doses. Alphadolone 10 mg/kg intraperitoneally caused significant antinociceptive effects in the electrical test but alphaxalone did not. All three opioid dose-response curves for TFL antinociception were shifted to the left by coadministration of alphadolone even though alphadolone alone had no effect on TFL. Alphaxalone given alone had no antinociceptive effects at nonsedative doses and it had no effect on opioid antinociception. Neither neurosteroid caused sedative effects when combined with opioids. We conclude that coadministration of alphadolone, but not alphaxalone, with morphine, fentanyl, or oxycodone potentiates antinociception and that this effect is not caused by an increase in sedation.

Antinociceptive properties of neurosteroids III: experiments with alphadolone given intravenously, intraperitoneally, and intragastrically

The veterinary neurosteroid anaesthetic Saffan has the same formulation as Althesin now withdrawn from human use and is a mixture of two neurosteroids, alphadolone, and alphaxalone. The molecular structures of these two pregnanes and their properties as i.v. anaesthetics were reported to be similar. Preliminary experiments showed that alphadolone caused powerful antinociceptive effects without sedation when given i.p. In this study, alphadolone was given to rats (weight 100-200 g) i.v., i.p., and intragastrically. I.v. injections of alphadolone (25 mg kg(-1)) caused anaesthesia and sedation, whereas i.p. (0.1-100 mg kg(-1)) and intragastric administration (750 mg kg(-1)) produced no such effects. Intragastric alphadolone caused antinociceptive effects assessed with the electrical current threshold test (response 2.2 x pre-drug control values) without sedation. These effects were reversed at the level of the spinal cord by intrathecally-administered bicuculline (10 pmol). We conclude that a metabolite of alphadolone acetate produced in the liver leads to antinociceptive effects after i.p. and intragastric administration of the parent compound. This antinociception involves spinal cord GABA(A) receptors, even though the drug was administered via a non-spinal route.

Effects of intravenous anaesthetics on nerve axons

The effects of ketamine, etomidate, alphaxalone and alphadolone acetate on nodal sodium and potassium currents of frog myelinated nerve fibre have been examined. The four general anaesthetics reversibly depressed ionic currents, although they tended to be more effective in blocking potassium than sodium current. The potassium current was reduced by etomidate and alphaxalone in a time-dependent manner. This was not found for ketamine and alphadolone acetate. In addition to blocking effects on sodium current, etomidate, alphaxalone and alphadolone acetate, but not ketamine, induced a negative shift of steady-state sodium inactivation-voltage curves. Collectively, the general anaesthetics appeared to alter specifically and differentially sodium and potassium channel-gating systems. The simplest interpretation of these results suggests that the compounds produce state-dependent blocks of ionic channels, and that there are general anaesthetic receptor sites located on the channel proteins themselves. Furthermore, potassium and sodium channels may contain several types of receptor sites, through which anaesthetics could exert their different actions.

Incorporation of alphaxalone into different types of liposomes

The poor solubility of steroid anaesthetics in water has been a serious drawback in the development of clinically acceptable intravenous formulations. The use of Cremophor EL to solubilize steroids such as alphaxalone led to unacceptable hypersensitivity reactions and consequent withdrawal of this anaesthetic. In principle, liposomes can act as a safe solvent for the intravenous administration of alphaxalone. We report the incorporation of [14C]acetylated alphaxalone in both multilamellar vesicles and stable plurilamellar vesicles prepared from a range of amphiphiles including synthetic polyhydroxyl lipids. For both types of preparations, addition of cholesterol to phosphatidylcholine-based lipids caused an increase in encapsulation efficiency. Maximum encapsulation was achieved with the stable plurilamellar vesicle preparation of 1-stearyl-2-myristylglycerate-3, N-methylglucamine:cholesterol:egg phosphatidylcholine (78%). The rate of efflux of this anaesthetic from a range of liposomes was measured in serum. The highest rate (85% after 30 min) was observed with an equimolar egg phosphatidylcholine:cholesterol stable plurilamellar vesicle preparation. From these studies it can be concluded that liposomes offer a suitable alternative for intravenous delivery of steroidal anaesthetics.

The metabolic disposition of plasma 5 alpha-dihydroprogesterone (5 alpha-pregnane-3,20-dione) in women and men

This study was conducted 1) to ascertain whether the high levels of plasma 5 alpha-dihydroprogesterone (5 alpha DHP) during the luteal phase of the human ovarian cycle and pregnancy are attributable to high rates of production or, alternatively, low rates of clearance, and 2) to estimate the relative distribution of the irreversible metabolism of 5 alpha DHP, i.e. hepatic compared with extrahepatic clearance of plasma 5 alpha DHP. The concentration of 5 alpha DHP in plasma of women during the luteal phase of the ovarian cycle and pregnancy is very high, viz. 12-40% that of progesterone. Thus, a potentially large source of steroid precursor is available for the formation of bioactive 5 alpha-pregnanolone metabolites. We found that the MCR of 5 alpha DHP in women and men is 4187 +/- 312 L plasma/24 h (range, 3181-5506; n = 6). The MCR of 5 alpha DHP as a function of body surface area was 2406 +/- 240 L/24 h.m2. The MCR of 5 alpha DHP, therefore, is the greatest of any steroid reported, except for that of the catechol estrogens, which are metabolized intravascularly by erythrocyte catechol-O-methyltransferase. Based on estimated rates of liver plasma flow (1500 L/24 h) and hepatic extraction (75-85%) of lipophilic steroids that are not specifically bound in plasma with high affinity to binding proteins as determined by other investigators (e.g. 5 alpha DHP), we estimate that approximately 1200 L plasma/24 h are cleared of 5 alpha DHP by liver and approximately 2800 L plasma/24 h are cleared of 5 alpha DHP (70%) by metabolism in extrahepatic tissues. Thus, 5 alpha DHP can serve as a precursor for bioactive 5 alpha-pregnanolone(s).

Responses of laboratory animals to some injectable anaesthetics

Xylazine, ketamine, methohexitone and alphadalone/alphaxalone, were administered intraperitoneally, intramuscularly or intravenously to mice, rats, guinea pigs and rabbits. Times for disappearance and reappearance of reflexes were recorded, and duration of loss of reflex. Delivering a predetermined dose gave a varying individual response, ranging from inadequate anaesthesia to death. Using reflexes to assess depth of anaesthesia was of limited value. Reflex movements to noxious stimuli generally persisted even at dose rates that caused prolonged recovery times and death. Conversely, in rats there was no response to a cutaneous stimulus in some animals even though recumbency was almost restored.