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Fernandes NS, Passos YDB, Arcoverde KN, Mouta AN, Paiva TC, Oliveira KDS, Araujo-Silva G, de Paula VV. Clinical Effects and Pharmacokinetic Profile of Intramuscular Dexmedetomidine (10 μg/kg) in Cats. Animals (Basel) 2024; 14:2274. [PMID: 39123800 PMCID: PMC11310985 DOI: 10.3390/ani14152274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
This study investigated the pharmacokinetic profile of and pharmacodynamic response to dexmedetomidine administered intramuscularly (IM) at a dose of 10 μg/kg in healthy cats. Nine adult cats were evaluated before and after administration of the drug, with serial collections of plasma samples. Dexmedetomidine induced deep sedation, with a rapid onset of action and a duration of one hour, reaching a peak between 20 and 30 min after administration. The half-life (T½) was 70.2 ± 48 min, with a maximum concentration (Cmax) of 2.2 ± 1.9 ng/mL and time to reach maximum concentration (Tmax) of 26.4 ± 19.8 min. The area under the curve (AUC) was 167.1 ± 149.1 ng/mL*min, with a volume of distribution (Vd) of 2159.9 ± 3237.8 mL/kg and clearance (Cl) of 25.8 ± 33.0 mL/min/kg. There was a reduction in heart rate (HR) and respiratory rate (RR) in relation to the baseline, with a slight decrease in systolic (SBP), diastolic (DBP), and mean (MAP) blood pressure in the first hour. Blood glucose increased after 60 min. Dexmedetomidine proved to be effective and safe, with rapid absorption, metabolization, and elimination, promoting good sedation with minimal adverse effects after IM administration in healthy cats.
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Affiliation(s)
- Naftáli S. Fernandes
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
| | - Yanna D. B. Passos
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
| | - Kathryn N. Arcoverde
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
| | - Andressa N. Mouta
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
| | - Thainá C. Paiva
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
| | - Kalyne D. S. Oliveira
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
| | | | - Valéria Veras de Paula
- Department of Animal Sciences, Semi-Arid Federal University, Mossoró 59625-900, RN, Brazil; (N.S.F.); (Y.D.B.P.); (K.N.A.); (A.N.M.); (T.C.P.); (K.D.S.O.)
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Burbaitė E, Čechovičienė S, Sarapinienė I, Karvelienė B, Riškevičienė V, Daunoras G, Juodžentė D. Effects of Medetomidine-Butorphanol and Medetomidine-Buprenorphine on Oxidative Stress and Vital Parameters in Dogs Undergoing Ovariohysterectomy. Animals (Basel) 2024; 14:1349. [PMID: 38731353 PMCID: PMC11083284 DOI: 10.3390/ani14091349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Oxidative stress (OS) is caused by an imbalance between the production of oxygen-containing free radicals and their elimination. General anesthesia increases the production of reactive oxygen species (ROS) and therefore causes oxidative stress. Our objective was to determine the effects of medetomidine-butorphanol (MEDBUT) and medetomidine-buprenorphine (MEDBUP) on oxidative stress and cardiorespiratory parameters in dogs undergoing ovariohysterectomy (OHE). Ten healthy female dogs were randomly assigned to two groups: the MEDBUT group (n = 5) received medetomidine and butorphanol, while the MEDBUP group (n = 5) received medetomidine and buprenorphine. OS was evaluated by measuring total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) during five different time points (from the administration of anesthetic drugs to 2 h after surgery). The observed vital cardiorespiratory parameters included heart rate (HR), respiratory rate (fR), noninvasive systolic (SAP) and diastolic (DAP) arterial blood pressures, oxygen saturation (SpO2), end-tidal CO2 (EtCO2), and body temperature (BT). Cardiorespiratory parameters were altered at a significantly greater degree in animals sedated with MEDBUT (p < 0.05). The administration of medetomidine-butorphanol was more likely to increase OS parameters, while medetomidine-buprenorphine showed decreased levels of oxidative stress throughout the study.
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Affiliation(s)
- Evelina Burbaitė
- Dr. L. Kriaučeliūnas Small Animal Clinic, Faculty of Veterinary, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės str 18, 44307 Kaunas, Lithuania
- Neurology and Neurosurgery Division, San Marco Veterinary Clinic, 35030 Veggiano, Italy
| | - Sandra Čechovičienė
- Dr. L. Kriaučeliūnas Small Animal Clinic, Faculty of Veterinary, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės str 18, 44307 Kaunas, Lithuania
| | - Ieva Sarapinienė
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukilėlių Ave 15, 44307 Kaunas, Lithuania
| | - Birutė Karvelienė
- Dr. L. Kriaučeliūnas Small Animal Clinic, Faculty of Veterinary, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės str 18, 44307 Kaunas, Lithuania
| | - Vita Riškevičienė
- Department of Veterinary Pathobiology, Faculty of Veterinary, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės str 18, 44307 Kaunas, Lithuania;
| | - Gintaras Daunoras
- Dr. L. Kriaučeliūnas Small Animal Clinic, Faculty of Veterinary, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės str 18, 44307 Kaunas, Lithuania
| | - Dalia Juodžentė
- Dr. L. Kriaučeliūnas Small Animal Clinic, Faculty of Veterinary, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės str 18, 44307 Kaunas, Lithuania
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Margeti C, Kazakos G, Skampardonis V, Galatos AD, Zacharopoulou T, Tsioli V, Loukopoulos E, Tyrnenopoulou P, Papatsiros VG, Flouraki E. The Effect of a Subsequent Dose of Dexmedetomidine or Other Sedatives following an Initial Dose of Dexmedetomidine on Sedation and Quality of Recovery in Cats: Part I. Vet Sci 2024; 11:186. [PMID: 38787158 PMCID: PMC11126131 DOI: 10.3390/vetsci11050186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
Dexmedetomidine is an a2-agonist commonly used in veterinary practice. Occasionally, the administered dose of dexmedetomidine may result in insufficient sedation, and an additional dose or drug may be required. The sedative effects of seven different drugs administered at subsequent time points after an initial, insufficient dose of dexmedetomidine were evaluated. Seven adult cats participated in this crossover, blind, randomised study. The groups consisted of two consecutive doses of dexmedetomidine (15 + 10 μg/kg) (DD) or a dose of dexmedetomidine (15 μg/kg) followed by either NS 0.9% (DC-control group), tramadol 2 mg/kg (DT), butorphanol 0.2 mg/kg (DBT), buprenorphine 20 μg/kg (DBP), ketamine 2 mg/kg (DK), or midazolam 0.1 mg/kg (DM). Sedation was evaluated using the Grint sedation scale. In all groups, atipamezole was administered at the end of the evaluation, and recovery was assessed using the Lozano and Sams recovery scales. The DC and DM groups exhibited minimal sedative effects. The maximum sedative effect was observed in the DD and DK groups, while sedation in the DD and DK groups was significantly higher compared to the DC group. Recovery in all groups was uneventful, except in the DM group, where it was prolonged and difficult, although no statistically significant difference was detected. Therefore, insufficient sedation with dexmedetomidine can be enhanced by a subsequent dose of dexmedetomidine, ketamine, or butorphanol, whereas the addition of midazolam reduces sedation and prolongs recovery.
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Affiliation(s)
- Chrysoula Margeti
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
| | - Georgios Kazakos
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece;
| | - Vassilis Skampardonis
- Department of Epidemiology, Biostatistics and Animal Health Economics, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece;
| | - Apostolos D. Galatos
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
| | - Theodora Zacharopoulou
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
| | - Vassiliki Tsioli
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
| | - Epameinondas Loukopoulos
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
| | - Panagiota Tyrnenopoulou
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
| | - Vasileios G. Papatsiros
- Clinic of Medicine, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece
| | - Eugenia Flouraki
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (E.L.); (P.T.)
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Short E, Chagas J, Kurihara M, Ishikawa Y, Chambers JP, Bridges J, Sano H. Effect of common sedation agents on feline splenic size determined via ultrasonography. N Z Vet J 2023; 71:244-250. [PMID: 37345417 DOI: 10.1080/00480169.2023.2223177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
AIMS To evaluate the effect of IM administration of three sedative drugs, acepromazine, alfaxalone and dexmedetomidine, in combination with morphine, on the size of the feline spleen using ultrasonography. METHODS Twenty-four client-owned cats undergoing elective de-sexing or minor procedures were recruited for a focused ultrasonographic examination of the spleen prior to and at 10, 20 and 30 minutes following administration of one of three randomly assigned IM sedation protocols: 0.05 mg/kg acepromazine (ACE group), 3 mg/kg alfaxalone (ALF group), or 10 μg/kg dexmedetomidine (DEX group), in combination with 0.5 mg/kg morphine. B-mode images of the spleen were collected and measured following a standardised protocol. Cardiorespiratory parameters and sedation score were also recorded. Mean thickness of the head, body and tail of the spleen for each group at 10, 20 and 30 minutes after drug administration was compared to baseline. RESULTS Mean splenic thickness increased over time in the ACE group (thickness of body at T0 = 8.9 (SE 2.1) mm and at T30 = 10.5 (SE 2.0) mm; p = 0.001) and the ALF group (thickness of body at T0 = 8.8 (SE 1.0) mm and at T30 = 10.3 (SE 1.7) mm; p = 0.022) but not in the DEX group (thickness of body at T0 = 8.6 mm (1.2) and at T30 = 8.9 mm (0.6); p = 0.67). Mean arterial blood pressure in the DEX group was significantly higher than in the other groups (p = 0.002). Sedation scores in the DEX group were consistently high for the entire period. However, the sedation score in the ACE group increased over 30 minutes (p = 0.007). Sedation score in the ALF group was highest at 10 minutes but gradually decreased over the following 20 minutes (p = 0.003). CONCLUSIONS Sedation with IM dexmedetomidine and morphine did not change splenic size, whereas acepromazine or alfaxalone and morphine increased it regardless of the degree of sedation. CLINICAL RELEVANCE Where splenomegaly is identified in a cat sedated with acepromazine or alfaxalone, the effects of the sedation protocol could be considered as a possible cause.
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Affiliation(s)
- E Short
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - J Chagas
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - M Kurihara
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Y Ishikawa
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - J P Chambers
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - J Bridges
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - H Sano
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Hommuang K, Koatsang N, Srikullabutr S, Sattasathuchana P, Thengchaisri N. Intranasal dexmedetomidine with morphine or tramadol: A comparative study of effects on alfaxalone requirements for anesthesia in cats. Vet World 2023; 16:1201-1208. [PMID: 37577209 PMCID: PMC10421539 DOI: 10.14202/vetworld.2023.1201-1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/08/2023] [Indexed: 08/15/2023] Open
Abstract
Background and Aim Intranasal (IN) sedatives provide a non-invasive route for premedication drug administration. This study compared the cardiorespiratory and sparing effects of IN dexmedetomidine combined with morphine (DM) or tramadol (DT) on alfaxalone requirements for anesthesia induction in cats. Materials and Methods Twenty-four cats were randomly assigned to three groups: Dexmedetomidine combined morphine (IN dexmedetomidine 20 μg/kg plus 0.2 mg/kg morphine), DT (IN dexmedetomidine 20 μg/kg plus 1 mg/kg tramadol), or control (no premedication). The intravenous dose of 1% alfaxalone for endotracheal intubation was recorded with sedation scores, cardiorespiratory parameters (heart rate and respiration rate), and side effects. Results Both DM and DT were associated with significantly higher sedation scores than baseline, and sedation scores were found to be highest 20 min after premedication. Sedation scores were comparable between DM and DT groups. Side effects, including hypersalivation, vomiting, and pupillary dilation, were observed in the DM and DT groups. The dosage of alfaxalone required in the DM group (1.5 ± 0.3 mg/kg) was comparable to that of the DT group (2.0 ± 0.6 mg/kg, p = 0.0861), and both groups required significantly less alfaxalone than the control group (3.0 ± 0.6 mg/kg; p < 0.01). Heart and respiratory rates were comparable between the DM and DT groups. Duration of anesthesia in the control group (11 ± 4 min) was significantly shorter than in the DM (29 ± 5 min, p = 0.0016) and DT (38 ± 14 min, p < 0.001) groups. Conclusion Intranasal administration of DM or DT produces good sedation and offers an alternative, non-invasive route for cats undergoing general anesthesia.
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Affiliation(s)
- Kewvaree Hommuang
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Sciences, Mahidol University, Salaya, Phutthamonthon District, Nakhon Pathom, 73170, Thailand
| | - Nattika Koatsang
- Surgery Unit, Kasetsart University Veterinary Teaching Hospital, Bangkok, 10900, Thailand
| | - Suttiporn Srikullabutr
- Department of Companion Animal Clinical Science, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Panpicha Sattasathuchana
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
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Bagardi M, Locatelli C, Brambilla PG, Ghilardi S, Rabbogliatti V, Amari M, Casiraghi S, Ravasio G, Galimberti L, Brioschi FA. Comparison of two multimodal intramuscular anaesthetic protocols in uncooperative feline patients: effects on sedation and echocardiographic measurements. J Feline Med Surg 2023; 25:1098612X231153069. [PMID: 36820491 PMCID: PMC10812084 DOI: 10.1177/1098612x231153069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES The aims of this study were to compare the sedative effect, feasibility of venous angiocatheter placement and influence on heart rate (HR), systemic blood pressure (SBP) and echocardiographic variables of two multimodal anaesthetic protocols in uncooperative cats; and to compare their influence on HR, SBP and echocardiographic variables 20 mins after sedation and after elective ovariectomy. METHODS Eighteen stray female cats randomly received intramuscular (IM) ketamine (2 mg/kg) and methadone (0.3 mg/kg) plus dexmedetomidine (7 µg/kg; group D, n = 9) or alfaxalone (2 mg/kg; group A, n = 9). A sedation score (0-15 [from none to good sedation]) was assigned at 5 mins, 10 mins, 15 mins and 20 mins after IM injection. Venous angiocatheter placement and echocardiographic examination feasibility scores (both from 0 to 3 [from very difficult to very easy]) were recorded at 20 mins. Echocardiography, HR and blood pressure measurements (Doppler and oscillometric methods) were performed at 20 mins and at the end of surgery. RESULTS Sedation and angiocatheter feasibility scores did not differ significantly between groups (P >0.05); the feasibility score of echocardiographic examination was higher in cats in group D (P = 0.01). HR was higher in group A at 20 mins and after surgery (P <0.05). The systolic arterial pressure obtained with the Doppler method was statistically significantly higher in cats in group D than in group A at 20 mins (P = 0.01), while postoperatively there were no differences between groups. Cats in group D showed significantly higher atrial diameters (P <0.05) and slower atrial flows (P = 0.04) compared with group A; ventricular thickness and atrial function did not differ between groups (P >0.05). Most echocardiographic variables were not different at 20 mins vs postoperatively. CONCLUSIONS AND RELEVANCE Both protocols allowed for effective sedation; however, cats in group D presented alterations in some echocardiographic measurements; the use of alfaxalone, combined with ketamine and methadone, is recommended to obtain a reliable echocardiographic evaluation in uncooperative cats.
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Affiliation(s)
- Mara Bagardi
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Chiara Locatelli
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Paola G Brambilla
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Sara Ghilardi
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Vanessa Rabbogliatti
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Martina Amari
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Silvia Casiraghi
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Giuliano Ravasio
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
| | - Luigi Galimberti
- Health Protection Agency (ATS), Milan Metropolitan City, Lodi, Italy
| | - Federica A Brioschi
- University of Milan, Department of Veterinary Medicine and Animal Science, Lodi, Italy
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Martín Bellido V, Martínez i Ferré B, McDonald H, Vettorato E. Effect of intravenous fentanyl on cough reflex and quality of endotracheal intubation in cats. Vet Anaesth Analg 2023; 50:230-237. [PMID: 37076353 DOI: 10.1016/j.vaa.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/11/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the effects of intravenous (IV) fentanyl on cough reflex and quality of endotracheal intubation (ETI) in cats. STUDY DESIGN Randomized, blinded, negative controlled clinical trial. ANIMALS A total of 30 client-owned cats undergoing general anaesthesia for diagnostic or surgical procedures. METHODS Cats were sedated with dexmedetomidine (2 μg kg-1 IV), and 5 minutes later either fentanyl (3 μg kg-1, group F) or saline (group C) was administered IV. After alfaxalone (1.5 mg kg-1 IV) administration and 2% lidocaine application to the larynx, ETI was attempted. If unsuccessful, alfaxalone (1 mg kg-1 IV) was administered and ETI re-attempted. This process was repeated until successful ETI. Sedation scores, total number of ETI attempts, cough reflex, laryngeal response and quality of ETI were scored. Postinduction apnoea was recorded. Heart rate (HR) was continuously recorded and oscillometric arterial blood pressure (ABP) was measured every minute. Changes (Δ) in HR and ABP between pre-intubation and intubation were calculated. Groups were compared using univariate analysis. Statistical significance was set as p < 0.05. RESULTS The median and 95% confidence interval of alfaxalone dose was 1.5 (1.5-1.5) and 2.5 (1.5-2.5) mg kg-1 in groups F and C, respectively (p = 0.001). The cough reflex was 2.10 (1.10-4.41) times more likely to occur in group C. The overall quality of ETI was superior in group F (p = 0.001), with lower laryngeal response to ETI (p < 0.0001) and ETI attempts (p = 0.045). No differences in HR, ABP and postinduction apnoea were found. CONCLUSIONS AND CLINICAL RELEVANCE In cats sedated with dexmedetomidine, fentanyl could be considered to reduce the alfaxalone induction dose, cough reflex and laryngeal response to ETI and to improve the overall quality of ETI.
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Skelding AM, Valverde A. Comparison of the effect of three intramuscular sedation protocols on packed cell volume and total protein in cats. J Feline Med Surg 2022; 24:1173-1180. [PMID: 34904480 PMCID: PMC10812377 DOI: 10.1177/1098612x211064702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the change in packed cell volume (PCV) and total protein following intramuscular preanesthetic sedation with one of three drug combinations in cats. METHODS Thirty client-owned cats were enrolled in this prospective, randomized, blinded, clinical study. A venous blood sample was obtained prior to administration of any sedation and PCV, total protein, electrolytes (Na+, K+, Cl-, iCa2+), glucose and lactate were measured. Cats were randomly assigned to receive one of three intramuscular sedation protocols (n = 10 cats/protocol): methadone 0.2 mg/kg + acepromazine 0.02 mg/kg (MA), methadone 0.2 mg/kg + dexmedetomidine 5 µg/kg (MD) or methadone 0.2 mg/kg + midazolam 0.2 mg/kg + alfaxalone 2 mg/kg (MMA). Twenty-five minutes later, cats were assessed for level of sedation followed by another venous blood sampling to evaluate the same variables as above. RESULTS There were no significant differences in demographics (age, weight, sex) between groups. Level of sedation was significantly higher in MMA cats. Within groups, after premedication, PCV and hemoglobin significantly decreased in all groups, total protein significantly decreased in the MA and MMA groups and glucose significantly increased in the MD group. For electrolytes, statistical changes were not clinically relevant; Cl- mean difference was significantly different between MA and MD; in the MD group Na+ and Cl- significantly decreased and in the MMA group Cl- significantly increased. CONCLUSIONS AND RELEVANCE All three sedation protocols caused significant decreases in PCV and hemoglobin in healthy cats.
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Affiliation(s)
- Alicia M Skelding
- Toronto Animal Health Partners Emergency and Specialty Hospital, Toronto, ON, Canada
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Wolfran L, Debiage RR, Lopes DM, Fukushima FB. Ophthalmic effects of dexmedetomidine, methadone and dexmedetomidine-methadone in healthy cats and their reversal with atipamezole. J Feline Med Surg 2022; 24:1253-1259. [PMID: 35616047 PMCID: PMC10812348 DOI: 10.1177/1098612x221077023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate and compare the effects that dexmedetomidine and methadone, either alone or in combination, have on the ocular variables of healthy adult cats when administered intramuscularly, as well as their reversal with atipamezole. METHODS A randomized crossover blinded study of 10 healthy cats was used to assess the effect of 0.2 mg/kg methadone (MET), 7.5 μg/kg dexmedetomidine (D7), 10 μg/kg dexmedetomidine (D10), 7.5 μg/kg dexmedetomidine and 0.2 mg/kg methadone (DM7) and 10 μg/kg dexmedetomidine and 0.2 mg/kg methadone (DM10) on intraocular pressure (IOP), tear production and pupil diameter (PD). The animals were evaluated for 30 mins. Afterwards, atipamezole was administered and ocular variables were evaluated for 30 mins. RESULTS D10, DM7 and DM10 significantly decreased mean IOP but MET or D7 did not. Tear production decreased significantly in all treatments, corresponding to 18%, 59%, 63%, 86% and 98% in MET, D7, D10, DM7 and DM10, respectively. PD increased in all treatments, but MET showed the highest PD. Thirty minutes after atipamezole (RT30), IOP returned to baseline with no difference between groups, and there was a significant increase in tear production, but the means were still different from baseline. CONCLUSIONS AND RELEVANCE Dexmedetomidine decreases IOP and tear production but increases PD in healthy cats. Atipamezole can partly reverse those alterations. Low-dose dexmedetomidine (7.5 µg/kg) promotes sedation without changing the IOP. All protocols significantly decrease tear production, and Schirmer tear test after sedation is not representative of non-sedated values. Methadone induces quick onset mydriasis without changing the IOP.
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10
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Watanabe R, Monteiro BP, Ruel HLM, Cheng A, Marangoni S, Steagall PV. The Effects of Sedation with Dexmedetomidine-Butorphanol and Anesthesia with Propofol-Isoflurane on Feline Grimace Scale © Scores. Animals (Basel) 2022; 12:ani12212914. [PMID: 36359038 PMCID: PMC9656706 DOI: 10.3390/ani12212914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the effects of sedation and anesthesia on Feline Grimace Scale© (FGS) scores. Twelve healthy cats were included in a prospective, blinded and randomized, cross-over study with a 14 day wash-out. Saline or dexmedetomidine-butorphanol (Dex-But) was administered intramuscularly before an anesthetic induction with propofol and maintenance with isoflurane. Saline or atipamezole (Dex-But) was administered at the end of the general anesthesia. Video-filming/image capturing was performed before and up to 24 h post-anesthesia. A total of 125 images were evaluated by four raters blinded to the treatment groups using the FGS (ear position/orbital tightening/muzzle tension/whiskers change/head position; action units (AU); scores 0−2 for each AU). The effects of the sedation/anesthesia were analyzed (p < 0.05). The total FGS and each AU scores were significantly higher with Dex-But than with saline 20 min post-sedation. In the saline group, the total FGS, orbital tightening, and whiskers and head position scores were significantly higher than baseline at 0.5 h post-anesthesia. In the Dex-But group, the total FGS and each AU scores were significantly higher after sedation, whereas the orbital tightening scores were significantly higher at 0.5 h post-anesthesia when compared with the baseline. None of the other comparisons between or within the groups was significantly different. The sedation with dexmedetomidine-butorphanol and anesthesia with propofol-isoflurane changed the FGS scores on a short-term basis; consequently, they may bias acute pain assessment.
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Affiliation(s)
- Ryota Watanabe
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Beatriz P. Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Hélène L. M. Ruel
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Alice Cheng
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Sabrine Marangoni
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Paulo V. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
- Department of Veterinary Clinical Sciences, Centre for Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
- Correspondence:
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11
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Hommuang K, Sattasathuchana P, Thengchaisri N. Effects of intranasal and intramuscular dexmedetomidine in cats receiving total intravenous propofol anesthesia. Vet World 2022; 15:1706-1713. [PMID: 36185505 PMCID: PMC9394123 DOI: 10.14202/vetworld.2022.1706-1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: The efficacy of intranasal (IN) dexmedetomidine in cats as a premedication remains elusive. Thus, this study aimed to compare the perioperative and sparing effects of IN and intramuscular (IM) dexmedetomidine administration on propofol requirements for anesthetic induction in cats. Materials and Methods: This study randomly assigned 16 cats into two groups of IN or IM dexmedetomidine at 20 μg/kg. Sedation scores and side effects were recorded at time points of 0, 5, 10, 15, and 20 min after the dexmedetomidine administration. Anesthesia was induced with intravenous (IV) 1% propofol by titrating a bolus of 2 mg every 45 s and the total dose of the administered IV propofol to achieve endotracheal intubation was recorded. Results: Cats receiving IM dexmedetomidine were significantly associated with higher sedation scores. All cats were sedated at 20 min after premedication; however, the average composite sedation scores in the IN group were significantly lower than those in the IM group during premedication. Pre-operative side effects, including vomiting, were more frequently observed in the IN group (5 cats, 62.5%) than in the IM group (3 cats, 37.5%; p < 0.05). Higher body temperature (>1°F compared to baseline) was more frequently observed in the IN group (6 cats, 75.0%) than in the IM group (1 cat, 12.5%; p < 0.05). The dosage of required propofol in the IN group was significantly higher (1.1 ± 0.3 mg/kg) than that in the IM group (0.7 ± 0.2 mg/kg; p < 0.05). The duration of general anesthesia was comparable between the groups. Conclusion: IN dexmedetomidine produces moderate sedation and cats may have side effects, including vomiting and higher body temperature. Higher sparing effects of propofol were identified in the IM group compared with the IN group. Nonetheless, IN administration of dexmedetomidine provides a noninvasive alternative to the IM route.
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Affiliation(s)
- Kewvaree Hommuang
- Department of Companion Animal Clinical Science, Graduate Student in Veterinary Clinical Studies, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Panpicha Sattasathuchana
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand; Tippimarn Veterinary Hospital, Chulabhorn Royal Academy, Nakhon Ratchasima, Thailand
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12
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Clark TP. The history and pharmacology of buprenorphine: New advances in cats. J Vet Pharmacol Ther 2022; 45 Suppl 1:S1-S30. [DOI: 10.1111/jvp.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
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13
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Guo X, Li H, Zhang H, Su J, Hu M, Sun Y, He X, Wang G. Significant Anesthetic Effects of Butorphanol Combined with Propofol on Ultrasonic Bronchoscopy for the Elderly. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.562.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Comparative Multimodal Palliative efficacy of gabapentin and tramadol By Using Two Pain Scoring Systems in Cats Undergoing Ovariohysterectomy. ACTA VET-BEOGRAD 2021. [DOI: 10.2478/acve-2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The analgesic efficacy of the gabapentin-tramadol combination was compared with meloxicam-tramadol and tramadol perioperative analgesic regimens in cats brought to the clinic for ovariohysterectomy. Thirty adult cats belonging to comparable demographics (age, body weight), were enrolled into a randomized, blinded study after due consent from their owners into four treatment groups. A Gabapentin-Tramadol group (GT-group, n = 10), Meloxicam-Tramadol group (MT-group, n = 10), and a Tramadol group (T-group, n = 10) were formed. Gabapentin capsules at 50 mg were administered orally 2 hours before surgery while the rest received a placebo dose. Tramadol (2 mg/kg, IM) and meloxicam at (0.2 mg/kg, SC) were injected immediately prior to anesthetic premedication. Anesthetic protocol involved premedication with ketamine and xylazine, while anesthesia was induced using propofol. Inhalant isoflurane anesthesia was used to maintain a surgical plane. GT group scored lower on IVAS as well as CPS than MT group, and T group for up to 8 hours after surgery. The mechanical nociceptive threshold remained higher (98±0) for up to 12 hours postoperatively a nd serum cortisol concentrations remained significantly lower during the 24hr period. The addition of gabapentin to the tramadol regimen significantly improved analgesia and mechanical nociceptive threshold than when used on its own.
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15
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Wheeler EP, Abelson AL, Lindsey JC, Wetmore LA. Sedative effects of alfaxalone and hydromorphone with or without midazolam in cats: a pilot study. J Feline Med Surg 2021; 23:1109-1116. [PMID: 33655781 PMCID: PMC10812152 DOI: 10.1177/1098612x21996155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this pilot study was to compare the quality of sedation and ease of intravenous (IV) catheter placement following sedation using two intramuscular (IM) sedation protocols in cats: hydromorphone, alfaxalone and midazolam vs hydromorphone and alfaxalone. METHODS This was a prospective, randomized and blinded study. Cats were randomly assigned to receive an IM injection of hydromorphone (0.1 mg/kg), alfaxalone (1.5 mg/kg) and midazolam (0.2 mg/kg; HAM group), or hydromorphone (0.1 mg/kg) and alfaxalone (1.5 mg/kg; HA group). Sedation scoring (0-9, where 9 indicated maximum sedation) was performed at 0, 5, 10, 15 and 20 mins from the time of injection. At 20 mins, an IV catheter placement score (0-10, where 10 indicated least resistance) was performed. RESULTS Twenty-one client-owned adult cats were included in this study. Sedation and IV catheter placement scores were compared between groups using Wilcoxon rank sum tests. Peak sedation was significantly higher (P = 0.002) in the HAM group (median 9; range 7-9) than in the HA group (median 7; range 3-9), and IV catheter placement scores were significantly higher (P = 0.001) in the HAM group (median 9.5; range 7-10) compared with the HA group (median 7; range 4-9). Spearman correlations were calculated between IV catheter placement score and sedation scores. There was a significant positive correlation of average sedation over time (correlation 0.83; P <0.001) and sedation at 20 mins (correlation 0.76; P <0.001) with a higher, more favorable IV catheter placement score. CONCLUSIONS AND RELEVANCE These preliminary results suggest that the addition of midazolam to IM alfaxalone and hydromorphone produced more profound sedation and greater ease of IV catheter placement than IM alfaxalone and hydromorphone alone.
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Affiliation(s)
- Emily P Wheeler
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Amanda L Abelson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Jane C Lindsey
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lois A Wetmore
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
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16
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Costa GP, Monteiro ER, Marques ÉJ, Beck RC, Carneiro RK, da Costa FVA, Valle SF. Sedative effects of acepromazine in combination with nalbuphine or butorphanol, intramuscularly or intravenously, in healthy cats: a randomized, blinded clinical trial. J Feline Med Surg 2021; 23:540-548. [PMID: 33044122 PMCID: PMC10741301 DOI: 10.1177/1098612x20962754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to compare the sedative effects in cats administered acepromazine-nalbuphine and acepromazine-butorphanol, intramuscularly (IM) and intravenously (IV), and the occurrence of adverse cardiorespiratory effects. METHODS Forty-six cats were randomly divided into four groups and administered acepromazine (0.05 mg/kg) combined with nalbuphine (0.5 mg/kg) or butorphanol (0.4 mg/kg), IV (ACP-NALIV and ACP-BUTIV groups, respectively) or IM (ACP-NALIM and ACP-BUTIM groups, respectively). Sedation scores, ease of intravenous catheter placement (simple descriptive scale [SDS] scores), physiologic variables, venous blood gases and the propofol dose required for anesthetic induction were recorded. RESULTS Mild sedation was observed in all groups approximately 30 mins after treatment administration (timepoint T1, prior to propofol administration). Sedation scores at T1 increased above baseline in all groups (P <0.05), but no significant difference was observed among groups. Dynamic interactive visual analogue scale sedation scores (range 0-100 mm) recorded at T1 were (median [interquartile range]): ACP-NALIM, 12 (10-12); ACP-NALIV, 11 (6-16); ACP-BUTIM, 11 (7-14); and ACP-BUTIV, 12 (7-19). Overall, SDS scores did not change from baseline at T1 and there was no significant difference among groups. The propofol dose did not differ among groups. Blood gases remained within the reference intervals for cats. Significant decreases from baseline were detected for all groups in systolic arterial pressure (SAP). Mean ± SD values at T1 were (mmHg): ACP-NALIM, 108 ± 13; ACP-NALIV, 102 ± 10; ACP-BUTIM, 97 ± 13; and ACP-BUTIV, 98 ± 21. Arterial hypotension (SAP <90 mmHg) was recorded at T1 in 0/11, 1/13, 4/11 and 5/11 cats in groups ACP-NALIM, ACP-NALIV, ACP-BUTIM and ACP-BUTIV, respectively, and was further exacerbated after the induction of anesthesia with propofol. CONCLUSIONS AND RELEVANCE In healthy cats administered acepromazine-nalbuphine and acepromazine-butorphanol, IM and IV, the degree of sedation was mild regardless of the protocol and the route of administration. The main adverse effect observed was a reduction in arterial blood pressure.
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Affiliation(s)
- Gabriela P Costa
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
| | - Eduardo R Monteiro
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
| | - Éder J Marques
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
| | - Rafael C Beck
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
| | - Rafael K Carneiro
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
| | - Fernanda VA da Costa
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
| | - Stella F Valle
- Department of Animal Medicine, Faculty of Veterinary
Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS,
Brazil
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Abstract
PRACTICAL RELEVANCE Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA. CLINICAL CHALLENGES Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat's health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized. AIMS This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.
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Affiliation(s)
- Bradley T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Paulo V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Universite de Montreal, Saint-Hyacinthe, Canada
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18
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Moser KLM, Hasiuk MMM, Armstrong T, Gunn M, Pang DSJ. A randomized clinical trial comparing butorphanol and buprenorphine within a multimodal analgesic protocol in cats undergoing orchiectomy. J Feline Med Surg 2020; 22:760-767. [PMID: 31697181 PMCID: PMC10814498 DOI: 10.1177/1098612x19886132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of butorphanol and buprenorphine, as part of a multimodal analgesic protocol, on recovery and analgesia in cats undergoing orchiectomy. METHODS In a prospective, randomized, blind clinical trial, 47 adult male cats were randomly assigned to receive either butorphanol (0.3 mg/kg, n = 24) or buprenorphine (0.02 mg/kg, n = 23) in combination with dexmedetomidine (25 μg/kg) and alfaxalone (2 mg/kg) as a single intramuscular injection for the induction of general anesthesia. Isoflurane carried in oxygen was supplemented as needed during orchiectomy. All cats received lidocaine (2 mg/kg intratesticular), meloxicam (0.3 mg/kg SC) and atipamezole (125 μg/kg IM) postoperatively. Pain and sedation scales were applied at baseline, and 2, 4 and 6 h postoperatively. Time to achieve sternal recumbency and to begin eating were also recorded. RESULTS Pain scale scores were low and showed no difference between the treatment groups at all time points (P ⩾0.99, all time points). Four cats exceeded the analgesia intervention threshold for rescue analgesia (butorphanol, n = 3; buprenorphine, n = 1). There was no difference in sedation scores between groups at any time point (P >0.99, all time points). Significantly more cats in the buprenorphine group (n = 12) required isoflurane than in the butorphanol group (n = 2) (P = 0.0013; relative risk 6.3, 95% confidence interval [CI] 1.8-23.5). There was no significant difference in time to achieve sternal recumbency (P = 0.96, 95% CI -20 to 20) between groups or in return to eating (P = 0.48, 95% CI -92.0 to 113.5), with most cats eating within 1 h of surgery (butorphanol, 79%; buprenorphine, 83%). CONCLUSIONS AND RELEVANCE There were no significant differences in analgesia or recovery between butorphanol and buprenorphine treatment groups as part of a multimodal injectable anesthetic protocol. Butorphanol is associated with superior depth of anesthesia, facilitating injectable anesthesia.
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Affiliation(s)
- Kira LM Moser
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
| | - Michelle MM Hasiuk
- Department of Small Animal Clinical Sciences, Faculty of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Tatum Armstrong
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
| | - Marta Gunn
- City of Calgary Animal Services Centre Clinic, Calgary, Canada
| | - Daniel SJ Pang
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Canada
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Clark L, Kavanagh JA, Pang DSJ, Gurney MA, Bradbrook CA, Gibson SM, Oliveira P. Impact of preanaesthetic echocardiography on the planned anaesthetic management of cats. Vet Anaesth Analg 2020; 47:614-620. [PMID: 32518026 DOI: 10.1016/j.vaa.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 03/26/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of preanaesthetic echocardiography on the subsequent intended anaesthetic management plan in cats with incidental clinical findings that may indicate cardiac disease. STUDY DESIGN Clinical study involving cats undergoing echocardiography and subsequent anaesthesia. ANIMALS A total of 40 client-owned cats. METHODS Echocardiography was performed in conscious cats and the information was used to plan anaesthesia or sedation. An information sheet including relevant history, temperament, body condition score, clinical examination findings, current medication and results of any relevant tests such as haematology, biochemistry or Doppler blood pressure measurement was sent to three specialist anaesthetists and virtual case management plans were designed for each cat in two steps: step 1) anaesthetists were unaware of echocardiography results; and step 2) anaesthetists were aware of echocardiography results. In the second step the anaesthetists documented any changes to their original management plan, as either 'step-up' or 'step-down'. RESULTS Of the 40 cats, 26 had murmurs, four had a gallop rhythm, four had both findings and six had other findings. Pathology of potential haemodynamic significance was found on echocardiography in 23 cats, 17 of which anaesthetists had correctly identified as having disease before echocardiography. A proportion of cats with murmurs were subsequently deemed to have no significant pathology after echocardiography. Echocardiography findings in these cases were: dynamic left ventricular outflow tract obstruction (DLVOTO) without hypertrophy; DLVOTO without hypertrophy + dynamic right ventricular outflow tract obstruction (DRVOTO); DRVOTO; valvular dysplasia; normal. In a median of 26/40 (range 16-38) of cases, the anaesthetic plan was changed after provision of further information; in 15/40 (8-20) cases, this was a 'step-up' in care and in eight/40 (6-23) it was a 'step-down' in care. In cases with atrial enlargement (left atrium to aortic ratio of >1.6) and deemed at risk of cardiac failure, alpha-2 agonist use changed considerably with availability of echocardiography findings. CONCLUSION and clinical relevance Where there are abnormal cardiac findings on clinical examination in cats, echocardiography is required to accurately assess anaesthetic risk . The availability of echocardiographic information positively influences anaesthetic management.
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Affiliation(s)
- Louise Clark
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, UK.
| | - Julie A Kavanagh
- Royal Veterinary College, Department of Veterinary Clinical Sciences, London, UK
| | - Daniel S J Pang
- Universite de Montreal Faculte de medicine, Montreal, QC, Canada
| | - Matt A Gurney
- Anderson Moores Veterinary Specialists, Winchester, UK
| | | | - Sarah M Gibson
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, UK
| | - Pedro Oliveira
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, UK
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Kreisler RE, Cornell HN, Smith VA, Kelsey SE, Hofmeister EH. Use of nalbuphine as a substitute for butorphanol in combination with dexmedetomidine and tiletamine/zolazepam: a randomized non-inferiority trial. J Feline Med Surg 2020; 22:100-107. [PMID: 30735096 PMCID: PMC10814574 DOI: 10.1177/1098612x19826715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The goal of this study was to determine whether a drug combination using nalbuphine with dexmedetomidine and tiletamine/zolazepam is non-inferior to one that uses butorphanol. METHODS All healthy cats presenting solely for gonadectomy to two trap-neuter-return mobile clinic days were randomly assigned to induction with a combination of tiletamine/zolazepam 3 mg/kg, dexmedetomidine 7.5 µg/kg and either butorphanol or nalbuphine at 0.15 mg/kg. All participants were blinded to the identity of the combinations. The primary endpoint was clinician satisfaction, comprised of the mean of four satisfaction ratings on a 7-point Likert scale (highly dissatisfied through to highly satisfied) recorded for induction, maintenance of anesthesia, surgery and recovery. Exploratory endpoints included each individual score, number of injections, duration of induction, duration of recovery and need for reversal agent. To assess non-inferiority for the primary endpoint and individual scores, the difference and 95% confidence intervals (CIs) of the difference between the mean clinical scores for the nalbuphine and butorphanol-based combinations were calculated and compared with a prespecified non-inferiority margin of 20% (1.4 points). RESULTS Seventy-two cats were enrolled, 36 in each group. The mean ± SD composite score for the combination with nalbuphine was 6.06 ± 0.59 (95% CI 5.86-6.25) points, while the combination with butorphanol was 6.22 ± 0.62 (95% CI 6.01-6.43). The difference between mean scores was 0.17 (-0.12 to 0.45), which did not exceed the prespecified boundary of 1.4, establishing the non-inferiority of nalbuphine. No individual clinical score for nalbuphine was inferior to butorphanol, and there were no significant differences for any secondary endpoints. CONCLUSIONS AND RELEVANCE The clinical experience of the nalbuphine-based combination was non-inferior to the butorphanol-based combination. Nalbuphine is an effective substitute for butorphanol, providing another option if butorphanol is unavailable due to shortage, controlled status or cost, without requiring a change in anesthetic workflow.
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Affiliation(s)
- Rachael E Kreisler
- Department of Pathology and Population Medicine, Animal Health Institute, College of Veterinary Medicine, Midwestern University, Glendale, AZ, USA
| | - Heather N Cornell
- Department of Pathology and Population Medicine, Animal Health Institute, College of Veterinary Medicine, Midwestern University, Glendale, AZ, USA
| | - Veronica A Smith
- College of Veterinary Medicine, Midwestern University, Glendale, AZ, USA
| | - Samantha E Kelsey
- College of Veterinary Medicine, Midwestern University, Glendale, AZ, USA
| | - Erik H Hofmeister
- Department of Surgery, Animal Health Institute, College of Veterinary Medicine, Midwestern University, Glendale, AZ, USA
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