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American Journal of Veterinary Research Sep 2020To determine perioperative analgesia associated with oral administration of a novel methadone-fluconazole-naltrexone formulation in dogs undergoing routine...
OBJECTIVE
To determine perioperative analgesia associated with oral administration of a novel methadone-fluconazole-naltrexone formulation in dogs undergoing routine ovariohysterectomy.
ANIMALS
43 healthy female dogs.
PROCEDURES
Dogs were randomly assigned to receive the methadone-fluconazole-naltrexone formulation at 1 of 2 dosages (0.5 mg/kg, 2.5 mg/kg, and 0.125 mg/kg, respectively, or 1.0 mg/kg, 5.0 mg/kg, and 0.25 mg/kg, respectively, PO, q 12 h, starting the evening before surgery; n = 15 each) or methadone alone (0.5 mg/kg, SC, q 4 h starting the morning of surgery; 13). Dogs were sedated with acepromazine, and anesthesia was induced with propofol and maintained with isoflurane. A standard ovariohysterectomy was performed by experienced surgeons. Sedation and pain severity (determined with the Glasgow Composite Pain Scale-short form [GCPS-SF]) were scored for 48 hours after surgery. Rescue analgesia was to be provided if the GCPS-SF score was > 6. Dogs also received carprofen starting the day after surgery.
RESULTS
None of the dogs required rescue analgesia. The highest recorded GCPS-SF score was 4. A significant difference in GCPS-SF score among groups was identified at 6:30 am the day after surgery, but not at any other time. The most common adverse effect was perioperative vomiting, which occurred in 11 of the 43 dogs.
CONCLUSIONS AND CLINICAL RELEVANCE
Oral administration of a methadone-fluconazole-naltrexone formulation at either of 2 dosages every 12 hours (3 total doses) was as effective as SC administration of methadone alone every 4 hours (4 total doses) in dogs undergoing routine ovariohysterectomy. Incorporation of naltrexone in the novel formulation may provide a deterrent to human opioid abuse or misuse.
Topics: Administration, Oral; Analgesia; Analgesics, Opioid; Animals; Dog Diseases; Dogs; Female; Fluconazole; Humans; Hysterectomy; Methadone; Naltrexone; Ovariectomy; Pain, Postoperative
PubMed: 33112167
DOI: 10.2460/ajvr.81.9.699 -
Journal of Feline Medicine and Surgery Nov 2020Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part... (Review)
Review
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.
Topics: Analgesia; Anesthesia; Animals; Cats; Conscious Sedation; Risk Factors
PubMed: 33100168
DOI: 10.1177/1098612X20965830 -
Journal of Feline Medicine and Surgery Jun 2021The aim of this study was to compare the sedative effects in cats administered acepromazine-nalbuphine and acepromazine-butorphanol, intramuscularly (IM) and...
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-NAL and ACP-BUT groups, respectively) or IM (ACP-NAL and ACP-BUT 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 ( <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-NAL, 12 (10-12); ACP-NAL, 11 (6-16); ACP-BUT, 11 (7-14); and ACP-BUT, 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-NAL, 108 ± 13; ACP-NAL, 102 ± 10; ACP-BUT, 97 ± 13; and ACP-BUT, 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-NAL, ACP-NAL, ACP-BUT and ACP-BUT, 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.
Topics: Acepromazine; Animals; Butorphanol; Cats; Hypnotics and Sedatives; Nalbuphine; Propofol
PubMed: 33044122
DOI: 10.1177/1098612X20962754 -
Veterinary Sciences Sep 2020Gastroesophageal reflux (GER) is a common event during general anaesthesia but is often underdiagnosed in veterinary medicine. The oesophageal pH in anaesthetised dogs...
Gastroesophageal reflux (GER) is a common event during general anaesthesia but is often underdiagnosed in veterinary medicine. The oesophageal pH in anaesthetised dogs undergoing endoscopic evaluation of the upper gastrointestinal tract (END group; = 12) or orthopaedic surgery (ORT group; = 12) was measured using an oesophageal probe. The dogs were sedated with acepromazine or with methadone or butorphanol, and anaesthesia was induced with propofol and maintained with isoflurane. Of the 24 dogs in this study, 21 (87.5%) had an episode of GER during anaesthesia. The incidence of GER, as well as the first, the minimum, and the maximum pH values, did not differ significantly between the groups. The mean maximum difference versus the first pH value was higher for dogs in the END group (-2.6 ± 3.5) as compared with those in the ORT group (-0.7 ± 2.5), although they were not statistically significant ( = 0.25). The administration of methadone or butorphanol had no significant effect on the development of acidic reflux or biliary reflux. In the acepromazine-sedated dogs, the incidence of GER did not differ significantly between patients undergoing an endoscopic procedure and those undergoing orthopaedic surgery; however, during endoscopy, fluctuations in the oesophageal pH can be expected, even without any clinical signs of GER.
PubMed: 32992677
DOI: 10.3390/vetsci7040144 -
International Journal of Veterinary... Jul 2020The dynamic variations of the Parasympathetic Tone Activity (PTA) index were evaluated to assess nociception in dogs undergoing anaesthetic protocols with different...
The dynamic variations of the Parasympathetic Tone Activity (PTA) index were evaluated to assess nociception in dogs undergoing anaesthetic protocols with different premedication drugs. Sixty-six dogs, divided into three groups of 22 dogs each, were given different premedication drugs "morphine" (0.2 mg/kg), "morphine + medetomidine (5 μg/kg)", "morphine + acepromazine (0.03 mg/kg)", then similarly induced and maintained under general anaesthesia. The PTA, HR (heart rate) and MAP (mean arterial pressure) were assessed at S (steady-state), Cut (cutaneous incision), PTA (PTA Event, assessed 1 min before a significant PTA decrease), HDR (Haemodynamic reaction, assessed 5 min before an increase of ≥ 20% in HR and/or MAP). For each group, the dynamic variation of PTA (ΔPTA) was calculated and a Receiver Operating Characteristics (ROC) curve was performed to detect if any of the premedication drugs may alter the performance of PTA index to predict intraoperative haemodynamic reactions. In all groups, a haemodynamic reaction was detected after Cut, PTA and HDR and was preceded with a significant decrease of PTA, except for "morphine + medetomidine" group which showed a significant drop of PTA only at PTA and HDR. The ΔPTA showed a fair performance in all groups (a mean [95% CI] AUC of 0.73 [0.62-0.82], 0.70 [0.59-0.79] and 0.71 [0.59-0.80] respectively in morphine, morphine + ACP and morphine + medetomidine). Although ΔPTA was rather altered by the premedication drug, it was able to predict, to a certain extent, haemodynamic reactions in all groups.
PubMed: 32953875
DOI: 10.1080/23144599.2020.1783090 -
Iranian Journal of Veterinary Research 2020Analgesic and hemodynamic effects of ketamine in subanesthetic doses during surgical anesthesia and postoperative, are due to the action on the N-methyl-D-aspartate...
BACKGROUND
Analgesic and hemodynamic effects of ketamine in subanesthetic doses during surgical anesthesia and postoperative, are due to the action on the N-methyl-D-aspartate receptors (NMDAR).
AIMS
To evaluate the intraoperative cardiorespiratory effects provided by ketamine compared to lidocaine, both administered epidurally, in bitches submitted to ovariohysterectomy.
METHODS
Thirty-six dogs of different breeds were used in a randomized, prospective, and blinded clinical trial. Two groups were formed: G (ketamine 3 mg/kg, n=18) and G (lidocaine 4 mg/kg, n=18). Animals were premedicated with acepromazine 0.05 mg/kg intravenous. Anesthesia was induced with propofol 5 mg/kg intravenous. Anesthetic maintenance was performed with isoflurane in 100% oxygen. Every 5 min during surgery, heart rate (HR), respiratory rate (RR), esophageal temperature (°C), oxygen saturation (SPO), end tidal carbon dioxide (ETCO) and mean arterial pressure (MAP) were monitored.
RESULTS
Cardiorespiratory variables during anesthesia were within normal ranges. Heart rate was significantly higher at 5 (108 ± 12 95 ± 11) and 10 (110 ± 11 97 ± 11) min in G compared to G after the start of surgery (P=0.03 and P=0.01, respectively). Mean arterial pressure was higher in G, (100 ± 23, 105 ± 35, and 103 ± 35 mmHg) in comparison with G (66 ± 7, 74 ± 10, and 67 ± 9 mmHg) at 20, 25 and 30 min (P=0.01, P=0.004, and P=0.002, respectively). Mild hypothermia at 25 (36.5 1.3C) and 30 (36.5 1.4C) min in the G was recorded.
CONCLUSION
Epidural administration of ketamine provides better hemodynamic stability, compared to the use of epidural lidocaine.
PubMed: 32849886
DOI: No ID Found -
BMC Veterinary Research Jul 2020To evaluate the effect on arterial blood pressure (ABP) of labetalol infusion as treatment for perioperative non nociceptive acute hypertension in dogs. The clinical...
BACKGROUND
To evaluate the effect on arterial blood pressure (ABP) of labetalol infusion as treatment for perioperative non nociceptive acute hypertension in dogs. The clinical records of dogs receiving intra or postoperative labetalol infusion were retrospectively reviewed. Invasive systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressure and heart rate (HR) before labetalol infusion (T0) and 15, 30, 45 and 60 min (T1, T2, T3 and T4 respectively) after infusion were retrieved. The dose rate of labetalol infusion and use of concurrently administered drugs that could have potentially affected ABP and/or HR were also recorded. ANOVA for repeated measures and Dunnett's multiple comparison test were used to determine the effect of labetalol on ABP and HR. Differences were considered significant when p < 0.05.
RESULTS
A total of 20 dogs met the inclusion criteria, and hypertension was documented after craniotomy (12/20), adrenalectomy (4/20) and other procedures (4/20). Five dogs received labetalol intraoperatively, 14 postoperatively, and 1 during the surgical procedure and recovery. Median infusion duration and rate were 463 (60-2120) minutes and 1.1 (0.2-3.4) mg/kg/h respectively. Median loading dose was 0.2 (0.2-0.4) mg/kg. Labetalol produced a significant decrease in SAP and DAP at all time points compared to T0 (p < 0.05), while the effect was not significant at T1 for MAP (p = 0.0519). Median maximum MAP decrease was 31 (20-90) mmHg. Heart rate did not increase significantly during treatment (p = 0.2454). Acepromazine given before or during labetalol treatment did not reduce significantly ABP (p = 0.735).
CONCLUSIONS
Labetalol produced a reliable and titratable decrease in ABP with non significant increase in HR.
Topics: Adrenalectomy; Animals; Antihypertensive Agents; Craniotomy; Dogs; Heart Rate; Hypertension; Intraoperative Complications; Labetalol; Retrospective Studies
PubMed: 32709242
DOI: 10.1186/s12917-020-02475-4 -
Veterinary Sciences Jul 2020This prospective, randomised and blind study investigated the efficacy of laserpuncture for postoperative pain management in dogs.
BACKGROUND
This prospective, randomised and blind study investigated the efficacy of laserpuncture for postoperative pain management in dogs.
METHOD
Sixteen bitches were sedated with acepromazine and randomly treated before ovariohysterectomy with meloxicam 0.2 mg·kg intramuscular or laserpuncture (wavelength 904 mm, frequency 124 Hz, potency 10 Joules, 100 s in each acupoint). Anaesthesia was performed with propofol, isoflurane/O, and fentanyl. The Glasgow Composite Measure Pain Scale (GCMPS) and Dynamic Interactive Visual Analog Scale (DIVAS) were used to evaluate postoperative pain before and for 24 h after surgery. Morphine was administrated as rescue analgesia when pain scores were ≥3.33 (GCMPS). Differences between treatments, time points, and amount of rescue analgesia between groups were investigated by the Mann-Whitney test and the area under the curve (AUC) for GCMPS, Friedman, and Chi-squared tests, respectively ( < 0.05).
RESULTS
Dogs treated with laserpuncture presented lower GCMPS AUC for 24 h and lower GCMPS scores at 2 and 4 h postoperatively ( = 0.04). Three dogs treated with meloxicam required postoperatively rescue analgesia against none treated with laserpuncture.
CONCLUSIONS
In this preliminary study, laserpuncture mitigated postoperative pain in dogs following ovariohysterectomy, and the technique is a promising adjunct to perioperative pain management in dogs undergoing soft tissue surgery.
PubMed: 32708066
DOI: 10.3390/vetsci7030094 -
Frontiers in Veterinary Science 2020This study aimed to evaluate the inter-rater reliability of the Feline Grimace Scale (FGS) in cats undergoing dental extractions and the effects of the caregiver's...
This study aimed to evaluate the inter-rater reliability of the Feline Grimace Scale (FGS) in cats undergoing dental extractions and the effects of the caregiver's presence on the FGS scores. Twenty-four cats (6 ± 3.3 years old; 4.9 ± 1.7 kg) undergoing oral treatment were included in a prospective, blinded, randomized, clinical study. They underwent treatment under general anesthesia (acepromazine-hydromorphone-propofol-isoflurane-meloxicam-local anesthetic blocks) at day 1 and were discharged at day 6. Images of cat faces were captured from video recordings with or without the caregiver's presence at 6 h postoperatively (day 1), day 6, and before and after rescue analgesia. Images were randomized and independently evaluated by four raters using the FGS [five action units (AU): ear position, orbital tightening, muzzle tension, whiskers change, and head position; score 0-2 for each]. Inter-rater reliability and the effects of the caregiver's presence were analyzed with intraclass correlation coefficient [single measures (95% confidence interval)] and the Wilcoxon signed-rank test, respectively ( < 0.05). A total of 91 images were scored. Total FGS scores showed good inter-rater reliability [0.84 (0.77-0.89)]. Reliability for each AU was: ears [0.68 (0.55-0.78)], orbital tightening [0.76 (0.65-0.84)], muzzle [0.56 (0.43-0.69)], whiskers [0.64 (0.50-0.76)], and head position [0.74 (0.63-0.82)]. The FGS scores were not different with [0.075 (0-0.325)] or without [0.088 (0-0.525)] the caregivers' presence ( = 0.12). The FGS is a reliable tool for pain assessment in cats undergoing dental extractions. The caregiver's presence did not affect FGS scores.
PubMed: 32548134
DOI: 10.3389/fvets.2020.00302 -
Heliyon Apr 2020Tranquilization of horses with acepromazine has been used to suppress erratic head movements and increase the accuracy of a lameness examination. Some equine clinicians...
Tranquilization of horses with acepromazine has been used to suppress erratic head movements and increase the accuracy of a lameness examination. Some equine clinicians believe that tranquilization with acepromazine will make lameness more evident by causing the horse to focus on adjusting its gait to avoid limb pain rather than its surroundings. The aim of this study was to investigate the effect of acepromazine on the Lyapunov exponents of lame horses. Ten lame horses were trotted in a straight line for a minimum of 25 strides. Kinematic data created by head movement were analyzed. Nonlinear analysis methods were applied to lame horse locomotion. The effect of acepromazine on the largest Lyapunov exponents of the lame horses were investigated. There was no statistically significant effect of acepromazine on the maximum value of Lyapunov exponents. The nonlinear dynamic methods can be used to analyze the gait in horses. Local stability of horse gait remains unchanged after the administration of acepromazine.
PubMed: 32322720
DOI: 10.1016/j.heliyon.2020.e03726