1
|
Bini G, Bailey KM, Voyvodic JT, Chiavaccini L, Munana KR, Keenihan EK. Effects of alfaxalone, propofol and isoflurane on cerebral blood flow and cerebrovascular reactivity to carbon dioxide in dogs: A pilot study. Vet J 2023; 291:105939. [PMID: 36509393 DOI: 10.1016/j.tvjl.2022.105939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Propofol total intravenous anesthesia is a common choice to anesthetize patients with increased intracranial pressure, reducing cerebral blood flow while maintaining cerebrovascular reactivity to CO2. Propofol and alfaxalone are commonly used for total intravenous anesthesia in dogs, but the effects of alfaxalone on cerebral blood flow and cerebrovascular reactivity to CO2 are unknown. Our hypothesis was that alfaxalone would not be significantly different to propofol, while isoflurane would increase cerebral blood flow and decrease cerebrovascular reactivity to CO2. Six healthy hound dogs were evaluated in this randomized crossover trial. Dogs were anesthetized with 7.5 mg/kg propofol, 3 mg/kg alfaxalone or 8 % sevoflurane, mechanically ventilated and maintained with propofol (400 µg/kg/min), alfaxalone (150 µg/kg/min) or 1.7 % end-tidal isoflurane, respectively, with one week washout between treatments. Cerebral blood flow and cerebrovascular reactivity to CO2 during hypercapnic and hypocapnic challenges were measured using arterial spin labelling and blood oxygen level-dependent magnetic resonance imaging sequences, respectively. Median (interquartile range, IQR) normocapnic cerebral blood flow was significantly lower (P = 0.016) with alfaxalone compared to isoflurane, in the whole brain 15.39 mL/min/100 g (14.90-19.90 mL/min/100 g) vs. 34.10 mL/min/100 g (33.35-43.17 mL/min/100 g), the grey matter 14.57 mL/min/100 g (13.66-18.72 mL/min/100 g) vs. 32.37 mL/min/100 g (31.03-42.99 mL/min/100 g), the caudal brain 15.47 mL/min/100 g (13.37-21.45 mL/min/100 g) vs. 36.85 mL/min/100 g (32.50-47.18 mL/min/100 g) and the temporal lobe grey matter 18.80 mL/min/100 g (15.89-20.84 mL/min/100 g) vs. 43.32 (36.07-43.58 mL/min/100 g). Median (IQR) hypocapnic cerebrovascular reactivity to CO2 was significantly higher (P = 0.016) for alfaxalone compared to isoflurane 8.85 %S/mm Hg (6.92-10.44 %S/mm Hg) vs. 3.90 %S/mm Hg (3.80-4.33 %S/mm Hg). Alfaxalone maintained lower cerebral blood flow and higher hypocapnic cerebrovascular reactivity to CO2 than isoflurane.
Collapse
Affiliation(s)
- G Bini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA.
| | - K M Bailey
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - J T Voyvodic
- Brain Imaging and Analysis Center, Radiology Department, Duke University, 40 Duke Medicine Circle, Durham, NC 27710, USA
| | - L Chiavaccini
- Department of Comparative, Diagnostic & Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL 32608, USA
| | - K R Munana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - E K Keenihan
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| |
Collapse
|
2
|
Mancini SL, Early PJ, Slater BM, Olby NJ, Mariani CL, Munana KR, Woelfel CW, Schacher JA, Zhong L, Messenger KM. Novel subcutaneous cytarabine infusion with the Omnipod system in dogs with meningoencephalomyelitis of unknown etiology. Am J Vet Res 2022; 83:ajvr.22.03.0046. [PMID: 35895763 DOI: 10.2460/ajvr.22.03.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the feasibility and pharmacokinetics of cytarabine delivery as a subcutaneous continuous-rate infusion with the Omnipod system. ANIMALS 6 client-owned dogs diagnosed with meningoencephalomyelitis of unknown etiology were enrolled through the North Carolina State University Veterinary Hospital. PROCEDURES Cytarabine was delivered at a rate of 50 mg/m2/hour as an SC continuous-rate infusion over 8 hours using the Omnipod system. Plasma samples were collected at 0, 4, 6, 8, 10, 12, and 14 hours after initiation of the infusion. Plasma cytarabine concentrations were measured by high-pressure liquid chromatography. A nonlinear mixed-effects approach generated population pharmacokinetic parameter estimates. RESULTS The mean peak plasma concentration (Cmax) was 7,510 ng/mL (range, 5,040 to 9,690 ng/mL; SD, 1,912.41 ng/mL), average time to Cmax was 7 hours (range, 4 to 8 hours; SD, 1.67 hours), terminal half-life was 1.13 hours (SD, 0.29 hour), and the mean area under the curve was 52,996.82 hours X μg/mL (range, 35,963.67 to 71,848.37 hours X μg/mL; SD, 12,960.90 hours X μg/mL). Cmax concentrations for all dogs were more than 1,000 ng/mL (1.0 μg/mL) at the 4-, 6-, 8-, and 10-hour time points. CLINICAL RELEVANCE An SC continuous-rate infusion of cytarabine via the Omnipod system is feasible in dogs and was able to achieve a steady-state concentration of more than 1 μg/mL 4 to 10 hours postinitiation of cytarabine and a Cmax of 7,510 ng/mL (range, 5,040 to 9,690 ng/mL; SD, 1,912.41 ng/mL). These are comparable to values reported previously with IV continuous-rate infusion administration in healthy research Beagles and dogs with meningoencephalomyelitis of unknown etiology.
Collapse
Affiliation(s)
- Shelby L Mancini
- Veterinary Specialty Services-Neurology, Manchester, MO.,Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Peter J Early
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Bailey M Slater
- Cornell University Hospital for Animals Pharmacy, Ithaca, NY
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Christopher L Mariani
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Karen R Munana
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Christian W Woelfel
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Jordan A Schacher
- Department of Clinical Sciences, North Carolina State University Veterinary Hospital, Raleigh, NC
| | - Li Zhong
- Roy J. Carver Biotechnology Center, University of Illinois, Urbana, IL
| | - Kristen M Messenger
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| |
Collapse
|
3
|
Mancini SL, Early PJ, Pastina BO, Olby NJ, Mariani CL, Munana KR. The bioavailability of cytarabine in dogs with meningoencephalitis of unknown etiology through iontophoresis and rectal delivery. Open Vet J 2021; 11:36-38. [PMID: 33898281 PMCID: PMC8057209 DOI: 10.4314/ovj.v11i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cytarabine (CA) is used to treat dogs with meningoencephalitis of unknown etiology (MUE) by subcutaneous or intravenous administration. Aim: The objective was to investigate transdermal iontophoresis and rectal administration as alternative routes of CA delivery. Methods: Two client-owned dogs with MUE were studied. The ActivaPatch® IONTOGO™ 12.0 iontophoresis drug delivery system delivered 200 mg/m2 CA transdermally. Blood samples were collected by sparse sampling technique after initiation of the device. At another visit, 100 mg/m2 CA was administered rectally. Blood samples were collected by sparse sampling technique after administration. Plasma CA concentrations were measured by high-pressure liquid chromatography. Results: The concentration of plasma CA after transdermal and rectal administration was below the limits of quantification (0.1 μg/ml) in all samples suggesting inadequate bioavailability with transdermal and rectal administration. Conclusion: Transdermal and rectal CA administration are not reasonable alternative routes of delivery.
Collapse
Affiliation(s)
- Shelby L Mancini
- NC State University Veterinary Hospital, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| | - Peter J Early
- NC State University Veterinary Hospital, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| | - Bethany O Pastina
- Veterinary Medical Center of Long Island, 75 Sunrise Highway, West Islip, NY, 11795-2033, USA
| | - Natasha J Olby
- NC State University Veterinary Hospital, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| | - Christopher L Mariani
- NC State University Veterinary Hospital, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| | - Karen R Munana
- NC State University Veterinary Hospital, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| |
Collapse
|
4
|
Lewis MJ, Early PJ, Mariani CL, Munana KR, Olby NJ. Influence of Duration of Injury on Diffusion Tensor Imaging in Acute Canine Spinal Cord Injury. J Neurotrauma 2020; 37:2261-2267. [PMID: 32586187 DOI: 10.1089/neu.2019.6786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Diffusion tensor imaging (DTI) quantifies microstructural lesion characteristics, but impact of the interval between spinal cord injury (SCI) and examination on imaging characteristics is unclear. Our objective was to investigate the impact of duration of injury on DTI indices in dogs with acute, spontaneous SCI from thoracolumbar intervertebral disc herniation (IVDH) and explore associations with clinical severity. Twenty-six dogs with acute thoracolumbar IVDH of variable severity who underwent DTI were included. Neurological severity was graded using the modified Frankel Score (0-V). Fractional anisotropy (FA) and mean diffusivity (MD) were calculated on regions of interest within and adjacent to the lesion epicenter. Relationships between FA or MD and duration (injury to imaging interval) or neurological severity were determined using regression analysis and Wilcoxon rank sum. Median age was 6.8 years (1-13), median duration was 1.5 days (1-9), and neurological signs ranged from ambulatory paraparesis (MFS II) to paraplegia with absent pain perception (MFS V). Mean FA was 0.61 ± 0.09 cranial to the lesion, 0.57 ± 0.12 at the epicenter and 0.55 ± 0.10 caudally. Mean MD was 1.18 × 10-3 ± 0.0002 cranially, 1.09 × 10-3 ± 0.0002 at the epicenter, and 1.14 × 10-3 ± 0.0002 caudally. Accounting for neurological severity and age, FA caudal to the epicenter decreased with increasing duration of injury (p = 0.02). Lower MD within the lesion epicenter was associated with worse neurological severity (p = 0.01). Duration of injury should be considered when interpreting DTI results in dogs with acute thoracolumbar IVDH. The MD might differentiate injury severity in the acute setting and be worthy of development as an imaging biomarker.
Collapse
Affiliation(s)
- Melissa J Lewis
- Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Peter J Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Christopher L Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Karen R Munana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| |
Collapse
|
5
|
Zidan N, Sims C, Fenn J, Williams K, Griffith E, Early PJ, Mariani CL, Munana KR, Guevar J, Olby NJ. A randomized, blinded, prospective clinical trial of postoperative rehabilitation in dogs after surgical decompression of acute thoracolumbar intervertebral disc herniation. J Vet Intern Med 2018; 32:1133-1144. [PMID: 29635872 PMCID: PMC5980307 DOI: 10.1111/jvim.15086] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Experimental evidence shows benefit of rehabilitation after spinal cord injury (SCI) but there are limited objective data on the effect of rehabilitation on recovery of dogs after surgery for acute thoracolumbar intervertebral disc herniations (TL-IVDH). OBJECTIVE Compare the effect of basic and intensive post-operative rehabilitation programs on recovery of locomotion in dogs with acute TL-IVDH in a randomized, blinded, prospective clinical trial. ANIMALS Thirty non-ambulatory paraparetic or paraplegic (with pain perception) dogs after decompressive surgery for TL-IVDH. METHODS Blinded, prospective clinical trial. Dogs were randomized (1:1) to a basic or intensive 14-day in-house rehabilitation protocol. Fourteen-day open field gait score (OFS) and coordination (regulatory index, RI) were primary outcomes. Secondary measures of gait, post-operative pain, and weight were compared at 14 and 42 days. RESULTS Of 50 dogs assessed, 32 met inclusion criteria and 30 completed the protocol. There were no adverse events associated with rehabilitation. Median time to walking was 7.5 (2 - 37) days. Mean change in OFS by day 14 was 6.13 (confidence intervals: 4.88, 7.39, basic) versus 5.73 (4.94, 6.53, intensive) representing a treatment effect of -0.4 (-1.82, 1.02) which was not significant, P=.57. RI on day 14 was 55.13 (36.88, 73.38, basic) versus 51.65 (30.98, 72.33, intensive), a non-significant treatment effect of -3.47 (-29.81, 22.87), P = .79. There were no differences in secondary outcomes between groups. CONCLUSIONS Early postoperative rehabilitation after surgery for TL-IVDH is safe but doesn't improve rate or level of recovery in dogs with incomplete SCI.
Collapse
Affiliation(s)
- Natalia Zidan
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
| | - Cory Sims
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
| | - Joe Fenn
- Department of Clinical Science and ServicesRoyal Veterinary College, Hawkshead Lane, HatfieldLondonUnited Kingdom
| | - Kim Williams
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
| | - Emily Griffith
- Department of StatisticsNorth Carolina State UniversityRaleighNorth Carolina
| | - Peter J. Early
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
| | - Chris L. Mariani
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
- Comparative Medicine Institute, North Carolina State UniversityRaleighNorth Carolina
| | - Karen R. Munana
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
- Comparative Medicine Institute, North Carolina State UniversityRaleighNorth Carolina
| | - Julien Guevar
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
| | - Natasha J. Olby
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State University, 1060 William Moore DriveRaleighNorth Carolina
- Comparative Medicine Institute, North Carolina State UniversityRaleighNorth Carolina
| |
Collapse
|
6
|
Royal KD, Neel JA, Munana KR, Flammer K. Using a Modified Bookmark Procedure to Help Identify Reasonable Consequences for Academic Integrity Violations. J Vet Med Educ 2017; 45:43-50. [PMID: 28745546 DOI: 10.3138/jvme.0816-126r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
It is recommended that institutions develop academic conduct policies to help preserve academic integrity, enforce compliance, and aid in legal defensibility. These policies should also articulate reasonable consequences for persons found in violation. The problem, however, is that all academic misconduct offenses are not created equal, and determining reasonable consequences for these violations can be particularly challenging due to their subjective nature. Thus, the purpose of this study was to introduce a novel method for more objectively determining reasonable sanctions for several academic misconduct offenses of varying degrees of severity. We utilized a variation of the Bookmark procedure, a popular standard-setting technique used primarily by psychometricians in high-stakes testing environments, to investigate empirical survey data and develop policy recommendations. We encourage others to use this procedure, where appropriate, to identify appropriate cut scores and ranges to aid in policy development across a variety of contexts.
Collapse
|
7
|
Abstract
Epilepsy is a common problem in dogs, and management of this chronic disorder requires a substantial commitment on the part of the pet owner. The aim of this study was to evaluate the impact of epilepsy in dogs on their owners, utilizing an online survey tool. A questionnaire was developed to explore a variety of factors, including seizure history, treatment, outcome, quality of life, costs associated with therapy, and sources of support. A total of 225 responses were obtained. The majority of respondents reported positive scores for overall quality of life, although scores were significantly lower for dogs with poorly controlled epilepsy and medication-related adverse effects. The median monthly expenditure for antiepileptic medication was $51-75. Despite the considerable financial burden placed on the dog owner, monthly medication cost was not associated with quality of life score. Few published reports follow dogs with epilepsy after diagnosis, and there is a growing need to understand the issues associated with long-term management of this population. The results of this study provide useful information that can help veterinary professionals educate owners and set expectations regarding treatment of seizures and quality of life for dogs with epilepsy.
Collapse
Affiliation(s)
- Julie A. Nettifee
- From the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Karen R. Munana
- From the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Emily H. Griffith
- From the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| |
Collapse
|
8
|
Royal KD, Munana KR, Neel JA. Prohibiting Students from Asking Questions during Exams: A Guideline for Promoting Fairness and Preserving Score Validity. J Vet Med Educ 2016; 44:343-345. [PMID: 27487114 DOI: 10.3138/jvme.0316-054r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many medical and professional programs implement policies that prohibit students from asking questions during examinations. The reasoning behind these policies remains unclear to some, as there is a lack of literature addressing this topic. The purpose of this article is to present the rationale behind such policies and to discuss why these policies may help promote fairness and preserve score validity.
Collapse
|
9
|
Affiliation(s)
- Edward MacKillop
- Department of Clinical Sciences North Carolina State University College of Veterinary Medicine, Raleigh, NC, USA
| | | | | | | | | |
Collapse
|
10
|
Lappin MR, Chavkin MJ, Munana KR, Cooper CM. Feline ocular and cerebrospinal fluid Toxoplasma gondii-specific humoral immune responses following specific and nonspecific immune stimulation. Vet Immunol Immunopathol 1996; 55:23-31. [PMID: 9014303 DOI: 10.1016/s0165-2427(96)05633-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Toxoplasma gondii-naive cats and cats previously infected orally with T. gondii tissue cysts were inoculated with soluble tachyzoite antigens plus adjuvant or adjuvant alone. Toxoplasma gondii-specific IgM and IgG were measured in serum, aqueous humor, and cerebrospinal fluid (CSF). The Goldman-Witmer coefficient (C value) for ocular or central nervous system (CNS) antibody production was calculated for aqueous humor or CSF samples positive for T. gondii-specific antibodies. Following inoculation with adjuvant plus soluble tachyzoite antigens, ocular and CNS T. gondii-specific IgG C values increased in the three previously infected cats. Following inoculation with adjuvant, the two previously infected cats had increases in ocular and CNS T. gondii-specific IgG C values. Ocular (2/3 cats) or CNS (1/3 cats) T. gondii-specific IgG C values of over 1 were detected in some T. gondii-naive cats following inoculation with adjuvant plus soluble tachyzoite antigens. The results of this study suggest that T. gondii-specific IgG C values of over 1 in aqueous humor or CSF do not prove active ocular or CNS infection in all cats.
Collapse
Affiliation(s)
- M R Lappin
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins 80523, USA
| | | | | | | |
Collapse
|