Comparison of Two Different Alfaxalone Concentrations Combined with Midazolam to Anesthetize Cynomolgus Macaques (Macaca fascicularis) for Plethysmography

Plethysmography is employed in nonhuman primates (NHPs) to calculate respiratory minute volume and determine the exposure time required to deliver an aerosol at the target dose. Anesthetic drugs can impact breathing parameters like steady-state minute volume (SSMV) central to aerosol dosing. Alfaxalone-midazolam mixtures (AM) provide superior parameters for plethysmography in cynomolgus macaques. An obstacle to the use of AM is the volume required to anesthetize via intramuscular injection. A more concentrated formulation of alfaxalone will reduce injection volumes and refine AM protocols. The purpose of this study was to compare AM using the Indexed 10-mg/mL (AM10) formulation compared with an investigational 40-mg/mL (AM40) formulation for IM administration in cynomolgus macaques undergoing plethysmography. We hypothesized that AM10 and AM40 would show no difference in quality of anesthesia (QA), duration of anesthesia, SSMV, accumulated minute volume (AMV), and side effects. We also hypothesized that female macaques would have a longer duration of anesthesia compared with males using both formulations. The study used 15 cynomolgus macaques comprised of 8 females and 7 males. NHPs were compared between 2 separate and randomized anesthetic events no less than one week apart. Each animal served as its own control and animals were randomized by random number generation. Anesthetized NHPs were placed in a sealed plethysmography chamber, and minute volume measurements were calculated every 10 s to determine SSMV. Once SSMV was achieved for 20 min, the trial ended. There were no statistically significant differences between AM10 and AM40 for duration of anesthesia, SSMV, AMV, side effects, or QA. AM40 had a significantly smaller injection volume. Females did not show a significantly longer median duration of anesthesia using either of the alfaxalone formulations. Overall, AM40 offers a more humane anesthetic than AM10 for plethysmography in cynomolgus macaques.

A Comparison of Three Anesthetic Drug Combinations for Use in Inducing Surgical Anesthesia in Female Guinea Pigs (Cavia porcellus)

Guinea pigs are often used in translational research, but providing them with safe and effective anesthesia is a challenge. Common methods like inhalant anesthesia and injectable ketamine/xylazine induce surgical anesthesia but can negatively affect cardiovascular, respiratory, and thermoregulatory systems and complicate the interpretation of research outcomes. Several alternative anesthetic regimens have been investigated, but none have consistently achieved a surgical plane of anesthesia. Therefore, identifying an anesthetic regimen that achieves a stable state of the surgical plane of anesthesia while preserving cardiorespiratory function would be a valuable contribution. To address this issue, we compared the efficacy of 3 anesthetic combinations in female Dunkin-Hartley guinea pigs: 1) alfaxalone, dexmedetomidine, and fentanyl (ADF); 2) alfaxalone, midazolam, and fentanyl (AMF); and 3) alfaxalone, midazolam, fentanyl, and isoflurane (AMFIso). We monitored anesthetic depth, heart rate, oxygenation, respiratory rate, respiratory effort, blood pressure, and body temperature every 15 min from injection to recovery. We also recorded the time to loss of righting reflex, duration of anesthesia, and time to achieve a surgical plane. The results showed no statistically significant differences in induction and recovery times among the groups. In the AMFIso group, 100% of the animals achieved a surgical plane of anesthesia, whereas only 10% of the animals in the AMF group reached that level. None of the animals in ADF group reached a surgical plane of anesthesia. Respiratory rate was significantly lower in the AMFIso as compared with the ADF group (P < 0.001) but was not different between the AMF and ADF groups. Temperature was significantly lower in the AMFIso group as compared with both the ADF and AMF groups (P < 0.001). In conclusion, both combinations of solely injectable anesthetics assessed in this study can be used for short, nonpainful procedures without significant cardiorespiratory depression. However, for mildly to moderately painful surgical procedures, the addition of an inhalant anesthetic like isoflurane is necessary for female guinea pigs.

Intramuscular alfaxalone and methadone with or without ketamine in healthy cats: effects on sedation and echocardiographic measurements

OBJECTIVE

To evaluate the effect of alfaxalone and methadone administered intramuscularly (IM), with or without ketamine, on sedation and echocardiographic measurements in healthy cats.

STUDY DESIGN

A randomized, blinded, clinical study.

ANIMALS

A group of 24 client-owned cats.

METHODS

Baseline echocardiographic evaluation (bEchoCG) was performed. Cats were given IM alfaxalone (2 mg kg^-1) and methadone (0.3 mg kg^-1) with (AMK group) or without (AM group) ketamine (1 mg kg^-1). A sedation score (0-5, indicating none to good sedation) was assigned at 5 (T5), 10 (T10) and 15 (T15) minutes after IM injection. At T15, a second echocardiographic evaluation (sEchoCG) was performed. Data are shown as median (range). Significance was p < 0.05.

RESULTS

Finally, 21 cats were included. Sedation score was significantly higher in the AMK (11 cats) than in the AM group (10 cats): 4 (1-5) versus 0.5 (0-4) at T5 (p = 0.003); 4 (1-5) versus 1.5 (0-5) at T10 (p = 0.043); and 4 (1-5) versus 2 (0-5) at T15 (p = 0.024). All echocardiographic measurements obtained were within reference ranges. Between the groups, aortic root area (p = 0.009) and end-diastolic aortic dimension (p = 0.011) were significantly higher in the AM group at bEchoCG and sEchoCG, respectively. Within each group, values at bEchoCG and sEchoCG showed no significant differences, except for pulmonary peak velocity (0.85 m second^-1; p = 0.028) in the AMK group and ejection time (154 m second; p = 0.03) in the AM group; both variables decreased after sedation.

CONCLUSIONS AND CLINICAL RELEVANCE

In this population of healthy cats, neither protocol produced clinically meaningful effects on the echocardiographic variables evaluated. Alfaxalone with methadone produced mild sedation, whereas the addition of 1 mg kg^-1 ketamine induced adequate sedation for diagnostic procedures.

Sedative and cardiorespiratory effects of intramuscular administration of alfaxalone and butorphanol combined with acepromazine, midazolam, or dexmedetomidine in dogs

OBJECTIVE

To evaluate the sedative and cardiorespiratory effects of IM administration of alfaxalone and butorphanol combined with acepromazine, midazolam, or dexmedetomidine in dogs.

ANIMALS

6 young healthy mixed-breed hounds.

PROCEDURES

Dogs received each of 3 treatments (alfaxalone [2 mg/kg] and butorphanol [0.4 mg/kg] combined with acepromazine [0.02 mg/kg; AB-ace], midazolam [0.2 mg/kg; AB-mid], or dexmedetomidine [0.005 mg/kg; AB-dex], IM) in a blinded, randomized crossover-design study with a 1-week washout period between treatments. Sedation scores and cardiorespiratory variables were recorded at predetermined time points. Data were analyzed by use of mixed-model ANOVA and linear generalized estimating equations with post hoc adjustments.

RESULTS

All treatments resulted in moderate to deep sedation (median score, ≥ 15/21) ≤ 5 minutes after injection. Sedation scores did not differ among treatments until the 40-minute time point, when the score was higher for AB-dex than for other treatments. Administration of AB-dex resulted in median scores reflecting deep sedation until 130 minutes, versus 80 and 60 minutes for AB-ace and AB-mid, respectively, after injection. Heart rate, cardiac output, and oxygen delivery decreased significantly after AB-dex, but not AB-ace or AB-mid administration. Respiratory variables remained within clinically acceptable ranges after all treatments. Undesirable recovery characteristics were observed in 4 dogs after AB-mid treatment. Four dogs required atipamezole administration 180 minutes after AB-dex injection.

CONCLUSIONS AND CLINICAL RELEVANCE

All protocols produced reliable sedation. The results indicated that in young, healthy dogs, AB-mid may produce undesirable recovery characteristics; AB-dex treatment caused cardiovascular depression and should be used with caution.

Comparison of intramuscular administration of alfaxalone-ketamine-dexmedetomidine and alfaxalone-butorphanol-midazolam in naked mole-rats (Heterocephalus glaber)

OBJECTIVE

To compare anesthetic effects of alfaxalone-ketamine-dexmedetomidine (AKD) and alfaxalone-butorphanol-midazolam (ABM) in naked mole-rats (Heterocephalus glaber).

ANIMALS

20 naked mole-rats.

PROCEDURES

Naked mole-rats received AKD (alfaxalone, 2 mg/kg; ketamine, 20 mg/kg; and dexmedetomidine, 0.02 mg/kg; n = 10) or ABM (alfaxalone, 2 mg/kg; butorphanol, 2 mg/kg; and midazolam, 1 mg/kg; 9) IM; 1 animal was removed from the study. Atipamezole (I mg/kg) and flumazenil (0.1 mg/kg) were administered 40 minutes after anesthetic induction (defined as loss of the righting reflex) with AKD and ABM, respectively. Heart rate, respiratory rate, oxygen saturation, and reflexes were recorded every 5 minutes.

RESULTS

The ABM group had significantly longer median times for induction and recovery than the AKD group. Administration of ABM resulted in significantly lower respiratory rates than administration of AKD from time of anesthetic induction to 10 minutes after induction. Respiratory rate significantly decreased in the AKD group from I0 minutes after induction through the end of the anesthetic period but did not change over time in the ABM group. Males had higher respiratory rates in both groups. Loss of the righting reflex was still evident 40 minutes after induction in both groups. In the AKD group, all tested reflexes were absent from I0 to 40 minutes after induction; the ABM group had variable reflexes that recovered within individual animals over time.

CONCLUSIONS AND CLINICAL RELEVANCE

Both AKD and ABM provided effective immobilization in naked mole-rats, but AKD appeared to provide more consistent and deeper anesthesia, compared with administration of ABM.

Field immobilization using alfaxalone and alfaxalone-medetomidine in free-ranging koalas (Phascolarctos cinereus): a randomized comparative study

OBJECTIVE

To characterize and compare two intramuscular drug protocols using alfaxalone and alfaxalone-medetomidine combination for the field immobilization of free-ranging koalas.

STUDY DESIGN

Blinded, randomized, comparative field study.

ANIMALS

A total of 66 free-ranging koalas from the Mount Lofty Ranges, South Australia.

METHODS

Koalas were randomly allocated into two groups. Group A animals were given alfaxalone alone at 3.5 mg kg^-1. Group AM animals were given alfaxalone 2 mg kg^-1 and medetomidine 40 μg kg^-1, reversed with atipamezole at 0.16 mg kg^-1. Blinded operators recorded heart rate (HR), respiratory rate (f_R), cloacal temperature, depth of sedation and times to: first effect, sedation suitable for clinical interventions, first arousal and full recovery. Data were analysed using independent t test, Mann-Whitney U test, chi-square analysis and log-rank test at 5% level of significance.

RESULTS

Suitable immobilization for clinical examination and sample collection was achieved in all animals. In groups A and AM, median time to working depth was 6.5 minutes (range: 3.4-15) and 8.1 minutes (range: 4.3-24) and time to complete recovery was 66 minutes (range: 12-138) and 34 minutes (range: 4-84), respectively, following reversal. Time to first effect was significantly shorter in group A (p = 0.013), whereas time to full arousal was significantly shorter in group AM (p = 0.007) probably due to the administration of atipamezole. Maximum HR was 117 ± 28 beats minute^-1 in group A, which was a significant increase from baseline values (p < 0.0001), whereas group AM showed a significant tachypnoea of 67 ± 25 (normal f_R 10-15; p < 0.0001).

CONCLUSIONS AND CLINICAL RELEVANCE

Both the protocols produced immobilization, enabling clinical examination and sample collection; however, protocol AM was more suitable for field work due to shorter recovery times.

Comparison of intravenous anesthetic induction doses and physiologic effects of ketamine or alfaxalone in goats undergoing surgery with isoflurane anesthesia

OBJECTIVE

To compare IV doses of alfaxalone and ketamine needed to facilitate orotracheal intubation and assess effects of each treatment on selected physiologic variables in goats undergoing orthopedic surgery with isoflurane anesthesia.

ANIMALS

18 healthy adult goats.

PROCEDURES

Behavior was assessed before and after sedation with midazolam (0.1 mg/kg, IV) for IV catheter placement. Anesthesia was induced with additional midazolam (0.1 mg/kg, IV) and alfaxalone (n = 9) or ketamine (9) at 2 mg/kg, IV, over 30 seconds. An additional dose of alfaxalone or ketamine (1 mg/kg) was given IV if needed for intubation; anesthesia was maintained with isoflurane in oxygen and IV fluids with ketamine (0.5 to 1 mg/kg/h). Direct systolic (SAP), diastolic (DAP), and mean (MAP) arterial blood pressures; heart rate; and respiratory rate were recorded before induction, immediately after intubation, and during surgery. Qualitative anesthetic induction and recovery characteristics were assessed. Variables were compared within and between groups by statistical methods.

RESULTS

No preinduction variables differed significantly between groups. Postintubation and 30-minute intraoperative SAP, DAP, and MAP were higher for the ketamine group than for the alfaxalone group; within the alfaxalone group, postintubation SAP, MAP, and respiratory rate prior to mechanical ventilation were lower than respective preinduction values. All alfaxalone-group goats were intubated after 1 dose of the induction agent; 5 of 9 ketamine-group goats required an additional (1-mg/kg) dose. Postoperative recovery was good to excellent for all animals.

CONCLUSIONS AND CLINICAL RELEVANCE

Both drugs were suitable for induction of anesthesia after sedation with midazolam, but most goats required higher doses of ketamine to allow intubation. For situations in which alfaxalone administration is appropriate, the potential for decreased arterial blood pressures and respiratory rate should be considered.

Evaluation of the sedative and physiological effects of intramuscular lidocaine in bearded dragons (Pogona vitticeps) sedated with alfaxalone

OBJECTIVE

To evaluate if intramuscular (IM) lidocaine potentiates the sedative effects of alfaxalone and results in cardiopulmonary changes in sedated bearded dragons.

STUDY DESIGN

Prospective experimental crossover study.

ANIMALS

A group of eight adult bearded dragons (Pogona vitticeps) weighing 334 ± 46 g.

METHODS

Animals were administered alfaxalone (10 mg kg^-1 subcutaneously) and 15 minutes later either lidocaine 2% (4 mg kg^-1) or 0.9% sodium chloride (0.2 mL kg^-1) was administered IM in the thoracic limb. The treatments were randomized and separated by 7 days. Sedation was scored based on body position, eye closure, jaw tone, swallowing, pick up response, righting reflex and pelvic limb withdrawal reflex. Heart rate (HR) and respiratory rate (f_R) were recorded every 5 minutes until recovery from sedation.

RESULTS

Lidocaine had no significant effect on duration or depth of alfaxalone sedation. HR increased significantly for <10 minutes following lidocaine administration by a median (interquartile range) of 33% (28-37%; p = 0.024). No clinically significant effects on f_R occurred following lidocaine injection.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of lidocaine 2% (4 mg kg^-1) IM did not potentiate alfaxalone sedation but resulted in a transient clinically relevant increase in HR.

Effects of intravenous administration of tiletamine-zolazepam, alfaxalone, ketamine-diazepam, and propofol for induction of anesthesia on cardiorespiratory and metabolic variables in healthy dogs before and during anesthesia maintained with isoflurane

OBJECTIVE To compare effects of tiletamine-zolazepam, alfaxalone, ketamine-diazepam, and propofol for anesthetic induction on cardiorespiratory and acid-base variables before and during isoflurane-maintained anesthesia in healthy dogs. ANIMALS 6 dogs. PROCEDURES Dogs were anesthetized with sevoflurane and instrumented. After dogs recovered from anesthesia, baseline values for cardiorespiratory variables and cardiac output were determined, and arterial and mixed-venous blood samples were obtained. Tiletamine-zolazepam (5 mg/kg), alfaxalone (4 mg/kg), propofol (6 mg/kg), or ketamine-diazepam (7 and 0.3 mg/kg) was administered IV in 25% increments to enable intubation. After induction (M₀) and at 10, 20, 40, and 60 minutes of a light anesthetic plane maintained with isoflurane, measurements and sample collections were repeated. Cardiorespiratory and acid-base variables were compared with a repeated-measures ANOVA and post hoc t test and between time points with a pairwise Tukey test. RESULTS Mean ± SD intubation doses were 3.8 ± 0.8 mg/kg for tiletamine-zolazepam, 2.8 ± 0.3 mg/kg for alfaxalone, 6.1 ± 0.9 mg/kg and 0.26 ± 0.04 mg/kg for ketamine-diazepam, and 5.4 ± 1.1 mg/kg for propofol. Anesthetic depth was similar among regimens. At M₀, heart rate increased by 94.9%, 74.7%, and 54.3% for tiletamine-zolazepam, ketamine-diazepam, and alfaxalone, respectively. Tiletamine-zolazepam caused higher oxygen delivery than propofol. Postinduction apnea occurred in 3 dogs when receiving alfaxalone. Acid-base variables remained within reference limits. CONCLUSIONS AND CLINICAL RELEVANCE In healthy dogs in which a light plane of anesthesia was maintained with isoflurane, cardiovascular and metabolic effects after induction with tiletamine-zolazepam were comparable to those after induction with alfaxalone and ketamine-diazepam.

Effects of the fraction of inspired oxygen on alfaxalone-sedated inland bearded dragons (Pogona vitticeps)

OBJECTIVE To evaluate the effects of providing 100% O₂, compared with provision of room air, in sedated spontaneously breathing inland bearded dragons (Pogona vitticeps). ANIMALS 8 adult bearded dragons. PROCEDURES Animals were sedated with alfaxalone (20 mg/kg, SC) and received 21% O₂ (equivalent to room air) or 100% O₂ via face mask (flow rate, 1 L/min) in a randomized, blinded, complete crossover study (2-week interval between treatments). Sedation variables, cardiopulmonary variables, venous blood gas values, and postsedation food intake were evaluated. RESULTS Respiratory rate, heart rate, oxygen saturation, and sedation quality were comparable between treatments. Venous blood gas analysis revealed a higher total Pco₂ and HCO₃^- concentration for the 21% O₂ treatment. Postsedation food intake was not affected by the inspired oxygen fraction provided during sedation. CONCLUSIONS AND CLINICAL RELEVANCE The fraction of inspired oxygen did not appear to have clinically relevant effects on physiologic variables of bearded dragons during and after sedation. Therefore, provision of 100% O₂ can be considered for use in sedated bearded dragons without the risk of inducing hypoventilation. Similarly, failure to provide 100% O₂ would be unlikely to result in clinically relevant consequences in healthy sedated bearded dragons.

Microbial integrity of preservative-free alfaxalone in a multiple-use system for two storage conditions and three handling techniques

OBJECTIVE To evaluate the microbial integrity of preservative-free cyclodextrin-based alfaxalone in a multiple-use system. SAMPLE 22 vials of preservative-free alfaxalone. PROCEDURES 2 storage conditions (room temperature, 22°C; refrigerated temperature, 4°C) and 3 handling techniques (closed system transfer device, nonclosed dispensing pin, and manufacturer-supplied vial stopper) comprised 6 treatment groups (3 replicates/group). An aliquot (0.5 mL) was withdrawn from each vial daily for 14 days. Samples were immediately inoculated into tryptic soy broth and incubated at 36°C for 24 hours; samples were subcultured onto 5% Columbia sheep blood agar and incubated for 48 hours. Isolated colonies were evaluated for identification. RESULTS There was no evidence of microbial contamination of vials stored for 7 days in refrigeration and handled with a protected port (closed system transfer device or nonclosed dispensing pin). CONCLUSIONS AND CLINICAL RELEVANCE The US FDA prohibits the use of alfaxalone beyond 6 hours after the vial stopper is broached (punctured), as mandated for a preservative-free injectable medication. Findings for the study reported here supported the use of alfaxalone for 7 days when refrigerated and handled with a single puncture of the stopper by use of a protected port (closed system transfer device or nonclosed dispensing pin). This would appear to be a practical alternative for an injectable anesthetic. It would minimize drug waste and the subsequent environmental impact for disposal of unused drug and allow standardization of storage and handling protocols for alfaxalone use in veterinary practices across the United States.

Effects of a single intravenous bolus injection of alfaxalone on canine splenic volume as determined by computed tomography

The purpose of this study was to evaluate the effects of a single intravenous dose of alfaxalone on canine splenic volume. In 6 adult beagle dogs the splenic volume [mean ± standard error (SE)] was determined by computed tomography to be 0.17 ± 0.02 L before alfaxalone administration and 0.24 ± 0.02 L (P = 0.0091) and 0.23 ± 0.02 L (P = 0.0268) 15 and 30 min, respectively, after alfaxalone administration. Hematocrits (mean ± SE) obtained at the same times were, respectively, 46.3% ± 1.3%, 40.6% ± 1.3% (P = 0.0015), and 41.7% ± 1.3% (P = 0.0057). In conclusion, alfaxalone caused relaxation of the canine splenic capsule and an increase in the splenic volume, along with a decrease in the hematocrit in these dogs.

Effects of alfaxalone, thiopental, or propofol and diazepam on laryngeal motion in healthy dogs

Laryngeal function is assessed by direct visualization of the larynx under a light plane of anesthesia. This study compared the effects of 3 anesthetic protocols on arytenoid motion in healthy dogs. Eight dogs were randomly assigned to receive alfaxalone, propofol and diazepam, or thiopental. Videolaryngoscopy was performed and still images at maximum inspiration and expiration were used to measure the area and height of the glottal gap. The normalized glottal gap area (NGGA = area in pixels/height²) was calculated. The NGAA change was defined as the difference between NGAA during inspiration and exhalation. Data were analyzed using Mann-Whitney and Kruskal-Wallis tests, P-values < 0.05 were considered statistically significant. No significant difference among induction protocols was found when comparing NGGA change after induction or before recovery. Alfaxalone and propofol/diazepam are useful for evaluation of laryngeal function when administered to effect and a light plane of anesthesia is maintained.

Effect of blood collection by the push-pull technique from an indwelling catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol in dogs

OBJECTIVE To compare the effect of blood collection by a push-pull technique from an indwelling IV catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol to dogs. DESIGN Prospective randomized clinical study. ANIMALS 30 healthy client-owned dogs that weighed ≥ 10 kg (22 lb) and were anesthetized for elective surgical procedures. PROCEDURES All dogs were premedicated with methadone (0.5 mg/kg [0.2 mg/lb], IM), and 20 to 30 minutes later, anesthesia was induced with either alfaxalone (1 to 3 mg/kg [0.5 to 1.4 mg/lb], IV to effect; n = 15) or propofol (2 to 6 mg/kg [0.9 to 2.7 mg/lb], IV to effect; 15). Immediately prior to premedication and after anesthesia induction, paired blood samples were collected from the cephalic veins; 1 by direct venipuncture and 1 by use of a push-pull technique from a 20-gauge catheter. All blood samples underwent venous blood gas analysis immediately after collection. Results were compared between sample collection techniques before and after anesthesia induction and between anesthesia induction protocols. RESULTS All results were within established reference ranges. For many variables, statistically significant but clinically irrelevant differences were detected between samples collected by direct venipuncture and those collected by the push-pull technique but not between the 2 anesthesia induction protocols. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated the push-pull technique was an acceptable method for collection of blood samples from dogs for venous blood gas analysis that could be used instead of direct venipuncture for patients with patent IV catheters.

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

OBJECTIVE

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

STUDY DESIGN

Prospective, randomized clinical trial.

ANIMALS

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

METHODS

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

RESULTS

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

CONCLUSIONS AND CLINICAL RELEVANCE

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

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

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

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

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

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION AND CLINICAL RELEVANCE

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

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

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

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

RATIONALE

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

Effects of intravenous anaesthetics on nerve axons

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

Incorporation of alphaxalone into different types of liposomes

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

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

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

Responses of laboratory animals to some injectable anaesthetics

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

Effects in vitro of progesterone and two 5 alpha-reduced progestins, 5 alpha-pregnane-3,20-dione and 5 alpha-pregnane-3 alpha-ol-20-one, on contracting human myometrium at term

Progesterone is known to prevent labour at term in domestic animals, but its effect in primates is uncertain. 5 alpha-reduced progesterone metabolites are more potent central nervous system depressants than progesterone is itself. Progesterone and its 5 alpha-reduced metabolites also relax pregnant rat myometrium in vitro. The serum concentration of the initial 5 alpha-reduced metabolite, 5 alpha-pregnane-3,20-dione, is high during pregnancy, but decreases significantly prior to parturition. The next metabolite, 5 alpha-pregnane-3 alpha-ol-20-one, has anaesthetic properties in human beings. The purpose of this study was to ascertain whether these progesterone metabolites also suppress contracting human uterine muscle at term. An in vitro model was devised. Strips of human myometrial muscle were mounted in organ chambers and after regular contractions had become established, the strips were superfused with progestin solutions. The progestins were dissolved in the buffer using an ultrasound bath. Progesterone, used as reference substance, slightly reduced the measured amount of muscular work performed per contraction, recordable after 18 min of exposure (p less than 0.05). Similar results have been reported previously in the literature; 5 alpha-pregnane-3 alpha-ol-20-one showed the same tendency though not significant at the 5% level. 5 alpha-pregnane-3,20-dione evidently reduced the contraction frequency after 10 min of exposure (p less than 0.05). None of the substances affected the duration of the contraction. These 5 alpha-reduced progesterone metabolites are thus not potent inhibitors of contracting human term myometrium in vitro.

Preparative surgery enhances the direct spinal actions of three injectable anaesthetics in the anaesthetized rat

In this study we have investigated the influence of preparative surgery on the potency with which a range of injectable anaesthetics depressed nociceptive withdrawal reflexes in anaesthetized, spinalized rats. Drug effects were compared on 2 different preparations, each requiring differing degrees of preparatory surgery. Recordings were made in each case of unitary motoneurone responses to controlled noxious stimuli. The dose-dependent effects of the general anaesthetics alpha-chloralose (20-80 mg/kg i.v.) and alphaxalone/alphadolone (0.5-2 mg/kg) and of the dissociative anaesthetic ketamine (0.5-16 mg/kg) were studied. When the degree of surgical intervention was increased, the reflex response to a uniform mechanical pinch stimulus was facilitated. This enhanced response was more susceptible to the reflex depressant actions of all the compounds studied.

Intrahypothalamic injection of RU486 antagonizes the lordosis induced by ring A-reduced progestins

We explored the possibility that ring A-reduced progestins facilitate lordosis in estrogen primed rats through their interaction with an intracellular progestin receptor (PR) by using RU486. This drug binds with high affinity to the PR, thus preventing the action of progesterone (P). Ovariectomized estrogen-primed rats (2 micrograms estradiol benzoate 40 hr earlier) were bilaterally injected into the ventromedial hypothalamic nucleus (VMHN) with 1 microgram of: P, 5 alpha-pregnanedione or 3 beta,5 beta-pregnanolone in 1 microliter oil. All three progestins effectively facilitated lordosis, tested at four and eight hours after intrahypothalamic injections. The ability of RU486 to counteract progestin-induced lordosis was assessed by infusing 10 micrograms of this agent into the VMHN along with any of the progestins. RU486 antagonized the lordosis induced not only by P (67% reduction) but also that induced by 5 alpha-pregnanedione and by 3 beta,5 beta-pregnanolone (47% and 93% reductions, respectively). Results suggest that ring A-reduced progestins may act through the PR mechanism to facilitate lordosis, i.e., in a fashion similar to P.

Mechanism of action of a structural analog of alphaxalone on myelinated nerve fibre

The action of alphadolone acetate (0.05-5 mM), a steroid anaesthetic and structural analog of alphaxalone, was investigated on frog myelinated axons under voltage-clamp conditions. When applied externally, alphadolone acetate reduced K and Na currents, with apparent dissociation constants of 0.70 and 1.74 mM, respectively, and without noticeable modification in their time course. In addition, Na conductance-voltage and steady-state inactivation-voltage curves were shifted towards negative voltages. This effect was more pronounced on the steady-state inactivation-voltage relationship. These results suggest that alphadolone acetate blocked K channels indifferently in their resting or open state, and Na channels preferentially in their inactivated state. Alphaxalone has been shown to preferentially block open K and inactivated Na channels (Benoit et al., 1988, Br. J. Pharmacol. 94, 635). Thus, a structural change of a steroid molecule can lead to differences in its mechanism of action. This supports the hypothesis of direct interactions between steroid molecules and target membrane proteins with resulting anaesthetic activity.

Remote intramuscular injection of immobilising drugs into fish using a laser-aimed underwater dart gun

Sixty coldwater and warmwater fish ranging in weight from 2 to 35 kg were injected intramuscularly with the hypnotics alphaxalone-alphadolone and metomidate hydrochloride and the non-depolarising muscle relaxant gallamine triethiodide using a laser-aimed underwater dart gun. Alphaxalone-alphadolone produced sufficient sedation for easy netting within five to 20 minutes at doses between 0.3 and 0.5 ml/kg, with induction being somewhat faster in warmwater species. The pattern of induction was similar with metomidate but required doses of 40 to 60 mg/kg. The muscle relaxant gallamine triethiodide showed promise as a practical agent for the capture and handling of large fish by virtue of its smooth induction of paralysis at doses between 1 and 3 mg/kg and its reversible supplementation with orally administered metomidate hydrochloride.

Contrasting effects of 5 alpha- and 5 beta-pregnane-3,20-dione on the motor activity of ovariectomized rats

While progesterone metabolites have long been known to be potent anesthetics in pharmacological doses, there is no available information as to their effects on behaviour at physiological levels. In this study, 5 alpha- and 5 beta-pregnanediones in silastic capsules were implanted in ovariectomized rats. Approximately 4 mg/kg/day was absorbed over a 24-day period. Rats receiving 5 beta-pregnanedione had decreased motor activity (58% control, P less than or equal to 0.001) while those receiving the 5 alpha-isomer had increased activity (143% control, P = 0.01). These studies suggest that these progesterone metabolites may be responsible for some behavioural changes.

Comparative studies of the use of some injectable anaesthetic agents in birds

The effect of three injectable drugs and a combination of two of them was compared in birds. The agents were ketamine hydrochloride, xylazine hydrochloride and the steroid mixture alphaxalone-alphadolone. Ketamine and xylazine were used in combination. One hundred and fifty-four species, all maintained by major zoos in the United Kingdom, were involved in the study. The results indicate that the drugs used produced more widely differing effects in the range of species studied than have previously been reported.

Role of sex steroid hormones in relative refractoriness to angiotensin II during pregnancy

Normal human pregnancy is associated with significant vascular refractoriness to the pressor effects of infused angiotensin II, and in women destined to develop pregnancy-induced hypertension, this refractoriness is lost several weeks before the onset of hypertension. The plasma concentrations of sex steroid hormones gradually increase throughout pregnancy. In the present study, the effect of infusion of 17 beta-estradiol (E2), progesterone, or 5 alpha-dihydroprogesterone on the pressor response to infused angiotensin II (0.002 to 0.1 micrograms X min-1 X kg-1) was evaluated in eight unanesthetized and chronically instrumented nonpregnant ewes. Pressor response to infused angiotensin II (0.02 to 0.1 micrograms X min-1 X kg-1) was significantly suppressed by a 60-minute infusion of E2 (0.8 micrograms X kg-1), whereas infusion of progesterone (4 micrograms X min-1 X kg-1) or 5 alpha-dihydroprogesterone (0.8 micrograms X min-1 X kg-1) did not affect the pressor response. Neither the acid-base status, plasma renin activity, nor serum electrolytes were altered by the administration of E2 or progesterone. These results indicate that E2 may play an important role in the refractoriness to infused angiotensin II during pregnancy, and that this refractoriness by E2 is not mediated by changes in chemoreceptor reflex, renin-angiotensin system, or serum electrolytes, but more likely by the changes in the characteristics of the vascular wall.

[Intravenous monoanesthesia and antianesthetics in emergency surgery]

Profiles of using the intravenous mononarcosis (sodium hydroxybutyrate, viadryl , ketamin , sombrevin, seduxen) in urgent surgery and traumatology are analyzed. Choice of certain narcotics is motivated for patients with blood loss and shock, intoxication, insufficiency of kidneys, adrenals and liver, cardio-vascular and respiratory disorders. The problem of antinarcotics is considered with reference to the efficiency of specific (bemegride, gutimine , amtizol , cytochrome "C") and nonspecific ( osmodiuretics , infusion media containing thawing water) antinarcotics . A preliminary assessment of the efficiency of different drugs of antinarcotic action is given.

Continuous infusion anaesthesia in baboons with alphaxolone-alphadolone

39 experiments were carried out in baboons using continuous intravenous infusion of alphaxalone-alphadolone as an anaesthetic for periods of up to 6 h. This steroid anaesthetic was found to be safe and reliable, with smooth, rapid induction, uneventful recovery, and no evidence of cumulative effect.

Clinical trial of continuous infusion of alphaxalone/alphadolone in intensive care patients

The safety and efficacy of prolonged infusion of alphaxalone/alphadolone (Alfathesin: Glaxo) was assessed in 20 critically ill patients needing sedation during intermittent positive pressure ventilation in a general intensive care unit. The mean dose of Alfathesin infused was 1542 ml (range: 225 to 4820 ml) over 6.9 days (3 to 16 days) at rates between 5 and 15 ml/hour. Significant increases in plasma urea, creatinine, bilirubin, alkaline phosphatase and white cell count occurred during the infusion, but these were expected from each patient's clinical course. Lipoprotein electrophoresis invariably showed loss of the alpha band and appearance of a densely staining pre-beta band. Four patients had involuntary movements during the infusion and two patients fitted when the infusion stopped. Both had cerebral injuries. Subjective assessment of the quality of sedation was "very good" or "good" in 15 patients and "fair" in five.

[Experiences with the steroid narcotic alfaxalone/alfadolone (Aurantex) in emergency patients in rescue service]

Prehospital emergency patients, especially with polytrauma and/or severe head injury need sedation for intubation and transportation. The use of relaxant drugs is dangerous under these circumstances. The "ideal drug" for this indication should not have any harmful effects on respiration, circulation, intracranial pressure, and should facilitate intubation. Short action without cumulation is desirable to make an early neurological diagnosis possible. Althesin was studied in our rescue service (ambulance and helicopter) in 133 cases (trauma n = 91, neurologic n = 18, cardiologic n = 12, intoxication n = 12), Althesin facilitated intubation in 129 cases, and was generally sufficient for sedation. Negative side effects were not seen provided althesin was correctly used. The necessity of the preceding use of an antihistaminic drug is emphasized. Althesin should not be used in patients suffering from severe cardiac disease because of its possible negative influence on cardiocirculatory function.

[CT 1341 programmed anesthesia]

The authors report on a method of planned anaesthesia which allows an optimal stability of the narcosis plan and of the cardiocirculatory parameters during the operation. The plan is a result of two equations which represent the plasmatic concentration of the drug as against time factor.

Evaluation of the actions and use of alphaxolone/alphadolone (CT1341) in sheep

CT1341 (alphaxolone/alphadolone) (Saffan; Glaxo) at various dose rates was investigated for use as an intravenous anaesthetic agent in sheep and it was found that at least 1.65 mg/kg was required to induce anaesthesia. In an experimental group of animals the effect of CT1341 2.2 mg/kg, on PaO2, PaCO2, paH and mean arterial blood pressure was measured. The drug caused a mild respiratory acidosis accompanied by a slight decrease in PaCO2 tensions. Mean arterial blood pressure decreased by 50 per cent, 30 seconds after injection but this fall lasted for only 10 minutes. Prior administration of either atropine sulphate or mepyramine maleate failed to modify this hypotensive effect. Injection of the vehicle, Cremophor EL, alone had no effect on mean arterial blood pressure. Intracerebroventricular administration of CT1341 while producing anaesthesia failed to produce any hypotension. The drug was used for the induction of anaesthesia in 19 sheep. A mean dose of 3.0 mg/kg was found to be most useful clinically. In a further three sheep an infusion of a dilute solution (0.234 mg/kg per minute) was used to maintain anaesthesia. The most notable clinical feature in sheep was the fast, complete recovery. It is concluded that this agent is an extremely useful drug for the induction and maintenance of anaesthesia in sheep.