Minimum alveolar concentration: Key concepts and a review of its pharmacological reduction in dogs. Part 1

The effect of oral pregabalin on the minimum alveolar concentration of isoflurane in cats

OBJECTIVE

To investigate the effect of three different doses of oral pregabalin on minimum alveolar concentration of isoflurane (MACISO) in cats.

STUDY DESIGN

Prospective, randomized, placebo-controlled, blinded, crossover trial.

ANIMALS

A group of eight healthy adult cats aged 24-48 months.

METHODS

Cats were randomly assigned to three oral doses of pregabalin (low dose: 2.5 mg kg-1, medium dose: 5 mg kg-1, high dose: 10 mg kg-1) or placebo 2 hours before MACISO determination, with the multiple treatments administered with a minimum 7 day washout period. Anesthesia was induced and maintained with isoflurane in oxygen until endotracheal intubation was achieved, and maintained with isoflurane with volume-controlled ventilation. MACISO was determined in triplicate using the bracketing technique and tail clamp method 120 minutes after pregabalin or placebo administration. Physiologic variables (including heart rate and blood pressure) recorded during MACISO determination were averaged and compared between the pregabalin and placebo treatments. One-way analysis of variance and the Friedman test were used to assess the difference for normally and non-normally distributed data, respectively. The Tukey test was used as a post hoc analysis. Values of p < 0.05 were considered significant.

RESULTS

The MACISO with the medium- and high-dose pregabalin treatments were 1.33 ± 0.21% and 1.23 ± 0.17%, respectively. These were significantly lower than MACISO after placebo treatment (1.62 ± 0.13%; p = 0.014, p < 0.001, respectively), representing a decrease of 18 ± 9% and 24 ± 6%. The mean plasma pregabalin concentration was negatively correlated with MACISO values. Physiologic variables did not differ significantly between treatments.

CONCLUSIONS AND CLINICAL RELEVANCE

Doses of 5 or 10 mg kg-1 pregabalin, administered orally 2 hours before determining MACISO, had a significant isoflurane-sparing effect in cats.

Minimum anesthetic concentration of isoflurane and sevoflurane and cardiorespiratory effects of varying inspired oxygen fractions in Magellanic penguins (Spheniscus magellanicus)

The aim of this study was to determine the minimum anesthetic concentration of isoflurane (MACISO) and sevoflurane (MACSEVO) and evaluate the cardiorespiratory changes induced by varying fractions of inspired oxygen (FiO2) in Magellanic penguins (Spheniscus magellanicus). Twenty adult penguins (3.53 ± 0.44 kg) of undetermined sex were used. Both MACISO (n = 9) and MACSEVO (n = 13) were established using an up-and-down design. Next, twelve mechanically ventilated penguins were maintained at 1 MACISO or 1 MACSEVO (n = 6 per group) with the FiO2 initially set at 1.0. Three FiO2 values (0.6, 0.4 and 0.2) were then held constant during anesthesia for 20 minutes each. Arterial blood samples were collected for gas analysis after the 20-minute period for each FiO2. Mean ± SD MACISO was 1.93 ± 0.10% and MACSEVO was 3.53 ± 0.13%. Other than heart rate at 0.6 FiO2 (86 ± 11 beats/minute in MACISO and 132 ± 37 beats/minute in MACSEVO; p = 0.041), no significant cardiorespiratory differences were detected between groups. In both groups, decreasing the FiO2 produced increased pH values and reduced partial pressures of carbon dioxide and bicarbonate. Partial pressures of oxygen (PaO2) gradually lowered from 1.0 FiO2 through 0.2 FiO2, though hypoxemia (PaO2 < 80 mmHg) occurred only with the latter FiO2. The MACISO and the MACSEVO for the Magellanic penguin fell within the upper range of reported avian MAC estimates. To prevent hypoxemia in healthy, mechanically ventilated, either isoflurane- or sevoflurane-anesthetized Magellanic penguins, a minimum FiO2 of 0.4 should be used.

Determination of the minimum alveolar concentration of sevoflurane in Holstein steers

OBJECTIVE

To determine the minimum alveolar concentration (MAC) of sevoflurane in Holstein steers using electric stimulation.

STUDY DESIGN

Prospective experimental study.

ANIMALS

A total of 15 Holstein steers aged 7.3 ± 1.2 months and weighing 121 ± 25 kg.

METHODS

Animals were anesthetized with sevoflurane at 8% in oxygen at 5 L minute-1 via facemask and were intubated with an orotracheal tube of a compatible size. After 15 minutes of stabilization of the initial expired concentration of sevoflurane (Fe'Sevo) at 2.6%, electrical stimulation on the thoracic limb was initiated with a sequence of 2 × 10 ms followed by 2 × 3 second electrical currents of 50 V and 50 Hz, 5 seconds apart. Following each stimulus with a negative response, the Fe'Sevo was decreased by 0.2% and a 15 minute interval was awaited before the next stimulus. The procedure was repeated until the first Fe'Sevo value with a positive motor response was obtained. The Fe'Sevo was then increased by 0.1%, followed by a new stimulus, until a negative response was obtained. The value of MAC was calculated as the arithmetic mean between the lowest Fe'Sevo associated with a negative motor response and the highest Fe'Sevo associated with a positive response.

RESULTS

The mean MAC for the 15 steers was 2.0 ± 0.3%, which corresponds to 2.1 ± 0.3% at sea level.

CONCLUSIONS

Based on the proposed methodology, the MAC of sevoflurane for healthy Holstein steers is 2.1 ± 0.3% at sea level.

CLINICAL RELEVANCE

This Fe'Sevo value can be used to guide depth of anesthesia in steers weighing approximately 120 kg in clinical practice.

Effect of oral administration of gabapentin on the minimum alveolar concentration of isoflurane in cats

Objective

To determine if oral gabapentin decreases the minimum alveolar concentration (MAC) of isoflurane in cats.

Study design

Prospective, randomized, blinded, crossover, and experimental study.

Animals

A total of six healthy adult cats (three male, three female) aged 18-42 months, weighing 3.31 ± 0.26 kg.

Methods

Cats were randomly given oral gabapentin (100 mg cat^-1) or placebo 2 h before starting MAC determination, with the crossover treatment given at least 7 days apart. Anesthesia was induced and maintained with isoflurane in oxygen. Isoflurane MAC was determined in duplicate using an iterative bracketing technique and tail clamp method. Hemodynamic and other vital variables were recorded at each stable isoflurane concentration and were compared between gabapentin and placebo treatments at lowest end-tidal isoflurane concentration when cats did not respond to tail clamping. A paired t-test was used to compare normally distributed data, and a Wilcoxon signed-rank test was applied for non-normally distributed data. Significance was set at p < 0.05. Data are mean ± standard deviation.

Results

Isoflurane MAC in the gabapentin treatment was 1.02 ± 0.11%, which was significantly lower than that in the placebo treatment (1.49 ± 0.12%; p < 0.001), decreasing by 31.58 ± 6.94%. No significant differences were found in cardiovascular and other vital variables between treatments.

Conclusion and clinical relevance

Oral administration of gabapentin 2 h before starting MAC determination had a significant isoflurane MAC-sparing effect in cats with no observed hemodynamic benefit.

Comparison of two injectable anaesthetic protocols in Egyptian fruit bats (Rousettus aegyptiacus) undergoing gonadectomy

Egyptian fruit bats have gained increasing interest being a natural reservoir for emerging zoonotic viruses. Anaesthesia is often required to allow safe handling of bats. We aimed to compare the sedative and cardiopulmonary effects of two balanced anaesthetic protocols in bats undergoing gonadectomy. Group DK (n = 10) received intramuscular dexmedetomidine (40 µg/kg) and ketamine (7 mg/kg), whereas group DBM (n = 10) received intramuscular dexmedetomidine (40 µg/kg), butorphanol (0.3 mg/kg) and midazolam (0.3 mg/kg). Induction time and cardiopulmonary parameters were recorded. If anaesthetic plan was inadequate, isoflurane was titrated-to-effect. At the end of surgery venous blood gas analysis was performed and atipamezole or atipamezole-flumazenil was administered for timed and scored recovery. In DBM group heart rate and peripheral oxygen saturation were significantly higher (p = 0.001; p = 0.003 respectively), while respiratory rate was significantly lower (p = 0.001). All bats required isoflurane supplementation with no significant differences between groups. Induction and recovery times showed no significant differences. In group DK a better recovery was scored (p = 0.034). Sodium and chloride were significantly higher in DBM group (p = 0.001; p = 0.002 respectively). Both anaesthetic protocols were comparable and can be recommended for minor procedures in bats.

Ferret Sedation and Anesthesia

Providing safe anesthetic events in ferrets can be achieved if fundamental principles in anesthesia are followed. Each phase of the anesthetic, event including preanesthetic, maintenance, and postanesthetic phase, have certain considerations. The anesthetic supervisor or veterinarian providing management should have a firm understanding of the species-specific anatomy, physiology, and common indications of general anesthesia along with perspective of their own experience with ferrets. Ensuring these guidelines are followed will facilitate safe administration of general anesthesia in this species.

Sedation and Anesthesia in Rodents

Sedation and anesthesia in rodent species are complex due to their wide species variation, small size, and metabolism. This review article covers recent advances in sedation and anesthesia as well as an updated drug formulary for sedation protocols. Setup, equipment, monitoring, maintenance, and recovery are reviewed as well as species-specific anatomy.

Drug class effects on respiratory mechanics in animal models: access and applications

Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human models, it is desirable and sometimes mandatory to study non-human animals first. To acquire further precise and controlled signals and parameters, the animals studied must be further distant from their spontaneous ventilation. The majority of respiratory mechanics studies use positive pressure ventilation to model the respiratory system. In this scenario, a few drug categories become relevant: anesthetics, muscle blockers, bronchoconstrictors, and bronchodilators. Hence, the main objective of this study is to briefly review and discuss each drug category, and the impact of a drug on the assessment of respiratory mechanics. Before and during the positive pressure ventilation, the experimental animal must be appropriately sedated and anesthetized. The sedation will lower the pain and distress of the studied animal and the plane of anesthesia will prevent the pain. With those drugs, a more controlled procedure is carried out; further, because many anesthetics depress the respiratory system activity, a minimum interference of the animal's respiration efforts are achieved. The latter phenomenon is related to muscle blockers, which aim to minimize respiratory artifacts that may interfere with forced oscillation techniques. Generally, the respiratory mechanics are studied under appropriate anesthesia and muscle blockage. The application of bronchoconstrictors is prevalent in respiratory mechanics studies. To verify the differences among studied groups, it is often necessary to challenge the respiratory system, for example, by pharmacologically inducing bronchoconstriction. However, the selected bronchoconstrictor, doses, and administration can affect the evaluation of respiratory mechanics. Although not prevalent, studies have applied bronchodilators to return (airway resistance) to the basal state after bronchoconstriction. The drug categories can influence the mathematical modeling of the respiratory system, systemic conditions, and respiratory mechanics outcomes.

The Determination of the Minimum Anaesthetic Concentration of Halothane in the Rock Dove (Columba livia) Using an Electrical Stimulus

This study aims to determine the minimum anaesthetic concentration (MAC) of halothane in the Rock Dove using electrical stimulus. Seven Rock Doves are anaesthetised with halothane, and the MAC is determined using the bracketing method. An electrical stimulus (two single pulses and two five-second stimuli, all separated by five-second pauses; 30 Hz, 30 V, 7.5 ms) is applied to the legs via subcutaneous electrodes. A maximum of eight periods of electrical stimulation, each with a preceding 15 min stable phase, is applied to each bird. If the non-reflexive movement occurred following stimulation, the end-tidal halothane (Fe’Hal) is increased by 10% before the next stimulus delivery. If no movement occurred, Fe’Hal is decreased by 10%. The MAC is the average of the highest concentration that allowed movement and the lowest that prevented movement. Physiological variables and ventilatory settings are recorded every five minutes. The current delivered is calculated offline. The mean ± SD MAC of halothane is 1.62 ± 0.29%, calculated from five birds. During the entire anaesthesia, all birds had cardiac arrhythmias —with three having sporadic recurrent periods of prolonged ventricular standstill followed by marked sinus tachycardia. The mean recorded voltage and calculated current and resistance are 27.6 ± 2.7 V, 20.3 ± 7.3 mAmp and 1.6 ± 0.9 kΩ, respectively. The advantage of halothane for prolonged anaesthesia in Rock Doves may be limited when noxious stimulation is used, due to the development of severe ventricular arrhythmias.

2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats

Risk for complications and even death is inherent to anesthesia. However, the use of guidelines, checklists, and training can decrease the risk of anesthesia-related adverse events. These tools should be used not only during the time the patient is unconscious but also before and after this phase. The framework for safe anesthesia delivered as a continuum of care from home to hospital and back to home is presented in these guidelines. The critical importance of client communication and staff training have been highlighted. The role of perioperative analgesia, anxiolytics, and proper handling of fractious/fearful/aggressive patients as components of anesthetic safety are stressed. Anesthesia equipment selection and care is detailed. The objective of these guidelines is to make the anesthesia period as safe as possible for dogs and cats while providing a practical framework for delivering anesthesia care. To meet this goal, tables, algorithms, figures, and "tip" boxes with critical information are included in the manuscript and an in-depth online resource center is available at aaha.org/anesthesia.

Evaluating the anti-inflammatory and analgesic properties of maropitant: A systematic review and meta-analysis

The neurotransmitter Substance P, and its neurokinin-1 receptor (NK-1R) are involved in the regulation of many pathophysiological processes including emesis, inflammation and nociceptive processing. This review provides a brief summary of the anti-inflammatory and analgesic properties of experimental NK-1R antagonists followed by a systematic review and meta-analysis on maropitant, the only NK-1R antagonist with a label indication for emesis in veterinary patients. There is very limited evidence based information on the putative clinical utilisation of maropitant for pain and inflammation. The aim of this systematic review and meta-analysis was to evaluate published reports on anti-inflammatory, analgesic and anaesthesia-sparing effects of maropitant. Medline, Pubmed, Science direct and Web of Science were searched to identify all published studies on maropitant, followed by a meta-analysis. Fourteen studies with 128 animals receiving maropitant and 127 controls met the inclusion criteria. Overall, maropitant had a significant inhalation anaesthetic-sparing effect (SMD -0.92, 95% CI -1.30, -0.54; P < 0.00001). However, treatment with maropitant had no effect on pain (SMD 0.06, 95% CI -0.37, 0.48; P = 0.80), or leukocyte cell infiltration in different inflammatory conditions (SMD -0.60, 95% CI -1.31, 0.11; P = 0.10). Based on all eligible studies for this review, it can be deduced that maropitant significantly reduced the minimum alveolar concentrations for isoflurane and sevoflurane for many different surgical procedures but it had no clearly proven effect on inflammation and pain.