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Paper summaries: IM alfaxalone in dogs

The following paper summaries complement the article by Matt Gurney describing the intramuscular use of alfaxalone in dogs 

Kato, K., Itami, T., Nomoto, K., Endo, Y., Tamura, J., Oyama, N., Sano, T., & Yamashita, K. (2021). The anesthetic effects of intramuscular alfaxalone in dogs premedicated with low dose medetomidine and/or butorphanol. Journal of Veterinary Medical Science, 83(1): 53–61. https://doi.org/10.1292/jvms.20-0330

Objective

A canine study to evaluate the quality of anaesthetic induction and recovery, and the cardiorespiratory effects of intramuscular (IM) premedication with medetomidine, butorphanol, or medetomidine + butorphanol, followed by IM alfaxalone.

Method

A randomised, blinded, crossover study of 6 healthy, 1 year-old, intact (3 male, 3 female) beagles with a median bodyweight of 9.9kg (range 7.3-12.3kg). All dogs received all treatments with a 7-day wash-out between treatments.  Premedication protocols were: medetomidine 0.005mg/kg (M); butorphanol 0.3mg/kg (B); or medetomidine 0.005mg/kg + butorphanol 0.3mg/kg (MB).  15 minutes later alfaxalone was administered at 1, 2.5 or 5mg/kg (see Table 1).  All treatments were administered into the lumbar musculature.  

Quality of induction, and recovery were scored 1-4 (1 = poor - 4 = very smooth). Neurological depression was a composite score (maximum 19) of posture, effect of placement in lateral recumbency, response to noise, jaw tone, general attitude and response to toe pinch. Ease of endotracheal (ET) intubation was also evaluated. All assessments were performed by a single, blinded observer. Times for: alfaxalone administration to lateral recumbency and ET intubation; duration of intubation; duration of lateral recumbency to head lift; and head-lift to standing, were recorded. Heart rate (HR), respiratory rate (RR), arterial blood pressure (BP), rectal temperature (RT) and electrocardiography (ECG) were documented before premedication (baseline) then every 5 minutes until standing or 180 minutes after alfaxalone administration. End tidal carbon dioxide (ETCO2) was monitored following intubation, and haemoglobin oxygen saturation (SpO2) was recorded following alfaxalone administration.

Results

Marked sedation and spontaneous lateral recumbency occurred 15 minutes after the MB combination in 15/18 treatments. For medetomidine alone or butorphanol alone spontaneous lateral recumbency was not observed.  Neurological depression score was higher for MB (> 11.5/19) than medetomidine (<2.5) or butorphanol (<4). Discomfort during alfaxalone administration was observed in 2/6 dogs for each MA group and for BA-1, and 1/6 dogs from BA-5 and MBA-5.  All dogs except 2/6 in BA-1 could be positioned in lateral recumbency. Quality of induction, endotracheal intubation, time to intubation, duration of intubation and duration of lateral recumbency were dose and protocol-related:

Induction score was significantly higher for MA-5 versus MA-1 (p = 0.011) and for MBA-5 versus MBA-1 (p = 0.024). MBA-1 had a significantly higher score than MA-1 or BA-1 (p = 0.024). MBA-5 had a significantly higher induction score than BA-5 (p = 0.018). Endotracheal intubation was possible in all MBA groups and MA-5 dogs, and 4/6 MA-2.5, BA-2.5 and BA-5 dogs. Intubation was not possible in any dog from groups MA-1 and BA-1. Time to intubation was shorter, and durations of intubation and lateral recumbency longer for the MBA groups compared to MA or BA (see Table 2).

Hypotension was not observed following any treatment. Compared to baseline, HR decreased significantly (<60 beats/min) following medetomidine, and medetomidine + butorphanol (p = <0.001). The subsequent administration of alfaxalone did not have any additional effect on HR. Spontaneous respiration on room air was maintained for all dogs. Following premedication with medetomidine + butorphanol RR fell significantly to <18 breaths/min (p = 0.022). There was a further slight decrease in all treatment groups following alfaxalone administration. SpO2 was not measured after premedication or prior to alfaxalone administration therefore the contributions of medetomidine and/or butorphanol are unclear, but mild hypoxaemia was observed in all patients once all drugs had been administered. Two MBA-5 dogs developed transient hypoxaemia (86-89%) but there were no significant differences between groups. ETCO2 measurements were only possible in intubated dogs and were not significantly different between groups. All were maintained within normal limits except one MA-5 dog with transient hypercapnia (48mmHg). All recoveries were considered smooth with no significant difference between groups.

Conclusion

When administered with medetomidine alone or butorphanol alone the dose of alfaxalone required to achieve neuro-depression adequate to permit endotracheal intubation was 2.5mg/kg or greater.  Therefore, the authors concluded that in healthy dogs the IM protocol of medetomidine 0.005mg/kg + butorphanol 0.3mg/kg followed by IM alfaxalone 1-2.5mg/kg provides a better quality of induction than MA or BA, and produces clinically useful & effective anaesthesia and a smooth recovery, without causing severe cardiovascular or respiratory depression.

 

Tamura, J., Hatakeyama, N., Ishizuka, T., Itami, T., Fukui, S., Miyoshi, K., Sano, T., Pasloske, K., & Yamashita, K. (2016). The pharmacological effects of intramuscular administration of alfaxalone combined with medetomidine and butorphanol in dogs. Journal of Veterinary Medical Science, 78(6): 929–936. https://doi.org/10.1292/jvms.1...

Objective

A canine study to evaluate the quality and duration of anaesthetic induction and recovery, and the cardiorespiratory effects of intramuscular (IM) alfaxalone alone, medetomidine + butorphanol, and alfaxalone + medetomidine + butorphanol.

Method

A crossover study of 6 healthy, 1-5 year-old (mean 2.9 +/- 1.5 years), intact (3 male, 3 female) beagles with a mean bodyweight of 11.5kg +/- 3.2kg. All dogs received all treatments with a 10-day wash-out between treatments.  Dogs were administered alfaxalone 2.5mg/kg IM (ALFX), medetomidine 0.0025mg/kg + butorphanol 0.25mg/kg IM (MB) or medetomidine 0.0025mg/kg + butorphanol 0.25mg/kg + alfaxalone 2.5mg/kg IM (MBA). Drugs were mixed in the same syringe and administered into the dorsal lumbar musculature. Dogs were intubated when possible and breathed room air. Extubation was performed once laryngeal reflexes had been regained. Response to IM injection was recorded and the quality of induction and recovery were scored 1-4 (poor – very smooth); neurological depression was a composite score (maximum 19) of posture, effect of placement in lateral recumbency, response to noise, jaw tone, general attitude and response to toe pinch; ease of ET intubation was evaluated; time from drug administration to lateral recumbency, intubation, first spontaneous movement, and time to standing together with duration of intubation and lateral recumbency were recorded. HR, RR, RT, ECG, systolic, diastolic, mean BP (SAP, DAP and SAP respectively), and central venous pressure (CVP) were recorded at 2, 5, 10, 15, 20, 30, 45, 60, 90 and 120 minutes after drug administration together with partial pressure of arterial oxygen (PaO2) and carbon dioxide (PaCO2).

Results

No animal reacted to IM administration and there were no soft tissue reactions at the injection site. Nausea was observed in two MB dogs and 3 MBA dogs although vomiting did not occur. All ALFX and MBA dogs attained lateral recumbency with no significant difference between the 2 groups (3.7 +/- 1.8 minutes & 6.5 +/- 4.4 minutes respectively) (p = 0.239). Only 4/6 MB dogs attained lateral recumbency in 14.2 minutes +/- 9.4.  There was no significant difference in quality of induction between groups (p = 0.130) although a single dog received score = 1 (poor) for all three treatments.  Time to ET intubation, and duration of intubation and lateral recumbency are described in Table 3.

Peak neuro-depression occurred at 10-30 minutes for MBA, 30-45 minutes for MB and 10-20 minutes for ALFX.  The total neuro-depression score was significantly higher for MBA (score 17/19) than MB (12.5/19) or ALFX (15/19) (p=0.001).   

There was no significant difference in quality of recovery between groups (p=0.747) although ataxia was observed in 33%, 17% and 50% dogs, and muscle tremors in 33%, 33% and 88% dogs, for ALFX, MB and MBA respectively.  Limb extension was observed in one (17%) ALFX dog. Clinically relevant and significant bradycardia (<60bpm) was observed in the MBA and MB groups but not in the ALFX dogs (p=<0.001). There was no clinically significant hypotension in any group.  The authors suggest the bradycardia may have been the result of a baroreceptor-mediated response to the dose-dependent CV depression, peripheral vasoconstriction and transient hypertension following medetomidine administration.

Spontaneous respiration was maintained for all groups. Compared to baseline RR fell significantly in the MBA (p=0.026) and MB (p=<0.001) groups possibly related to the depressive effects of medetomidine and butorphanol.  No clinically relevant hypoxaemia was observed in any group and PaCO2 remained within normal clinical ranges.

For the MBA group there was a significant fall in rectal temperature compared to baseline (p=<0.001). 

Conclusion

Simultaneous IM administration of alfaxalone (2.5mg/kg), medetomidine (0.0025mg/kg) and butorphanol (0.25mg/kg) produced anaesthesia adequate to permit endotracheal intubation without severe cardiorespiratory depression in healthy dogs.

 

Micieli, F., Chiavaccini, L., Pare, M. D., Chagas, J. B., Vesce, G., & Gianotti, G. (2019). Comparison of the sedative effects of alfaxalone and methadone with or without midazolam in dogs. Canadian Veterinary Journal, 60(10): 1060–1064.

Objective

To evaluate the sedative and physiological effects of intramuscular alfaxalone and methadone, with or without midazolam, in healthy adult dogs.

Method

A blinded, randomised, prospective study of 16 client-owned healthy adult dogs of various breeds weighing a mean of 7.72 +/- 2.4kg. Dogs were randomly allocated to receive either methadone 0.5mg/kg + midazolam 0.5mg/kg + alfaxalone 1mg/kg (MMA), or methadone 0.5mg/kg + alfaxalone1mg/kg (MA) intramuscularly into the epaxial musculature. HR, RR, Doppler SAP, RT and SpO2 were assessed prior to administration of the drug combinations and at 10, 15, 20 and 25 minutes post-injection.  Sedation was assessed via a composite score of posture, and response to sound, clipping, and IV cannulation at 10, 15, 20 and 25 minutes post-injection. Other signs (leg withdrawal, shivering, rigidity, twitching, struggling, vocalisation, biting, facial expression) were recorded. Anaesthesia was then induced with incremental doses of alfaxalone 1mg/kg until endotracheal intubation was possible following the loss of palpebral, gag and swallowing reflexes. The total dose of IV alfaxalone was recorded.

Results

Dogs administered intramuscular MMA were significantly less sedated than MA at 15, 20 and 25 minutes (p = 0.02, 0.02 and 0.01 respectively). There were no statistical differences between groups for HR, SAP, RR, SpO2, or RT over time. Compared to baseline HR and SAP decreased for both groups but did not fall more than 15% or to less than 120mmHg respectively and remained within clinically acceptable parameters. Significantly more MMA dogs (5/8) versus MA (1/8) dogs demonstrated excitement (p = 0.03). The excitement persisted until administration of IV alfaxalone for 3 of the affected MMA dogs. There was no difference between groups for the volume of IV alfaxalone required to induce anaesthesia (p = 0.92).

Conclusion

In healthy adult dogs the IM combination of methadone 0.5 mg/kg and alfaxalone 1 mg/kg produced moderate to deep sedation without significant changes to HR, RR, or SAP. The addition of midazolam to an IM combination of methadone and alfaxalone resulted in high prevalence of behavioural changes and variability in sedation scores and therefore cannot be recommended for sedation in healthy adult dogs.

 

Lee, J., Suh, S., Choi, R., & Hyun, C. (2016). Cardiorespiratory and anesthetic effects produced by the combination of butorphanol, medetomidine and alfaxalone administered intramuscularly in Beagle dogs. Journal of Veterinary Medical Science, 77(12), 1677–1680. https://doi.org/10.1292/jvms.1...

Objective

To assess the quality of anaesthesia and cardiorespiratory effects of an intramuscular combination of medetomidine, butorphanol and alfaxalone.

Method

Ten healthy adult (mean 4.2 +/- 1 years) beagle dogs (5 male, 5 female) weighing 8.6 +/- 1kg were assigned to receive butorphanol 0.1mg/kg + medetomidine 0.01mg/kg + alfaxalone 1.5mg/kg intramuscularly. Drugs were mixed in the same syringe and administered into the dorsal lumbar musculature. Endotracheal intubation was performed, and dogs breathed room air. Time from IM administration to lateral recumbency, endotracheal intubation, recovery and standing were recorded together with duration of anaesthesia (lateral recumbency to extubation) and recovery (extubation to standing).  Quality of induction (0 = smooth, to 3 = rough) and recovery (0 = perfect, to 3 = rough, significant ataxia or crawling) were recorded. BP, HR, RR, RT, blood gas analysis and left ventricular dimensions (via echocardiography) were obtained prior to drug administration (baseline) and every 10 minutes until extubation. Analgesia was determined by response to needle prick every 5 minutes until a positive response.

Results

Induction quality was smooth (score = 0) and recovery good (score – 1) i.e. minimal ataxia and uncomplicated, although mild agitation was observed in 3/10 dogs during recovery. Mean time to lateral recumbency was 319 +/- 106 seconds (5.3 +/- 1.8 minutes) and time to intubation was 359 +/- 107 seconds (6 +/- 1.8 minutes). Intubation was uncomplicated.

Duration of anaesthesia was 89 +/- 17 minutes, recovery was 6 +/- 1 minute from extubation and analgesia 80 +/- 12 minutes. No apnoea or hypoxia was observed in any dog. The cardiovascular effects observed in the study were considered to be related to medetomidine administration: mean arterial blood pressure was maintained at >83mmHg throughout the study although it did fall compared to baseline (p = 0.05). HR, RR, PaO2 and SaO2 decreased significantly from 10 minutes until recovery (p = <0.05 for all). PaCO2 remained within normal limits but did increase significantly from 10 minutes until recovery (p = <0.05). Nausea or vomiting was observed in 3 dogs and was considered to be due to medetomidine administration.

Conclusion

The combination of butorphanol 0.1mg/kg + medetomidine 10mcg/kg and alfaxalone 1.5mg/kg administered intramuscularly provided acceptable anaesthesia but monitoring of vital signs, including respiratory rate, oxyhaemoglobin saturation and end tidal carbon dioxide, are recommended.

 

Murdock M.A., Ricco Pereira C., Aarnes T.K., Lerche P. & Bednarski R.M. (2020). Sedative and cardiorespiratory effects of intramuscular administration of alfaxalone and butorphanol combined with acepromazine, midazolam, or dexmedetomidine in dogs. AJVR, 1: 65-76

Objective

To assess the sedative and cardiorespiratory effects of intramuscularly administered alfaxalone and butorphanol when combined with acepromazine, midazolam or dexmedetomidine.

Method

A prospective, blinded, randomised crossover study of 6 adult (11-15 months) intact dogs (3 female, 3 male) weighing 25.4 +/- 2.2kg. All dogs received all treatments with a 1-week wash-out period between treatments.  The protocols were: alfaxalone 2mg/kg with butorphanol 0.4mg/kg plus either acepromazine 0.02mg/kg (AB-ace), midazolam 0.2mg/kg (AB-mid) or dexmedetomidine 0.005mg/kg (AB-dex). Each combination was mixed in the same syringe and administered at two sites in the epaxial musculature. Endotracheal intubation was not performed. Baseline measurements of HR, RR, RT and oscillometric SAP, DAP and MAP were recorded. Cardiac output and blood gas analysis was performed at 5, 10, 20 and 30 minutes. Sedation scores ranged from 0-21 (no - deep sedation) and were recorded at 5, 10, 20, 30 and then every 10 minutes up to 180 minutes post injection or until the score was equal to or less than baseline. Peak sedation was calculated to be the time of highest median sedation score.

Results

Mild vocalisation and resistance to restraint was observed in up to 50% of dogs for all treatments. All combinations resulted in moderate to deep sedation (median score >15) beginning at 5 minutes post-injection. Peak sedation occurred at 10 minutes for AB-ace and AB-dex, and 20 minutes for AB-mid. AB-mid resulted in less sedation than AB-ace, and AB-ace produced less sedation than AB-dex. Signs of sedation were still evident at 180 minutes for all groups. Gag reflex was lost between 5 and 20 minutes for all groups although some AB-ace and AB-mid dogs retained jaw tone. Mean PaCO2 and SpO2 remained within normal limits for all groups and there were no major effects on alveolar ventilation or oxygenation. Bradycardia (<50bpm) was observed following AB-dex (p = <0.044) but not AB-ace or AB-mid. DAP declined for AB-ace (p = <0.028) but not AB-dex or AB-mid at 5, 20 and 30 minutes. MAP was maintained for all treatments, although systolic arterial pressure increased compared to baseline for AB-dex (p = 0.045) at 5 minutes after injection and was significantly higher than AB-ace (p = <0.039) and AB-mid (p = <0.018) between 5 and 30 minutes. Recoveries were smooth for AB-ace and AB-dex but 2/6 (33%) AB-mid dogs experienced nystagmus, paddling, head thrashing and dysphoria. By 180 minutes 4/6 (66%) AB-dex dogs were still unresponsive to verbal stimulation and were administered atipamezole.

Conclusion

All protocols resulted in reliable sedation from approximately 5 minutes post IM administration. However, the study indicated that in young, healthy dogs the AB-mid (alfaxalone, butorphanol, midazolam) protocol resulted in undesirable recovery characteristics. The AB-dex (alfaxalone, butorphanol, dexmedetomidine) combination resulted in physiological changes suggestive of cardiovascular depression and should be used with caution.

 

Cruz-Benedetti, I. C., Bublot, I., Ribas, T., Fourel, I., Vogl, C., Dubois, C., Milani, M., Ida, K. K., & Portier, K. (2018). Pharmacokinetics of intramuscular alfaxalone and its echocardiographic, cardiopulmonary and sedative effects in healthy dogs. PLoS ONE, 13(9): 1–16. https://doi.org/10.1371/journa...

Objective

A study in healthy dogs to determine the pharmacokinetics and pharmacodynamics of a single intramuscular dose of alfaxalone and the impact on sedation, cardiorespiratory parameters and echocardiographic measurements.

Method

A prospective cross-over study of 12 healthy adult (2 +/- 0.6 years) beagle dogs (9 male, 3 female) weighing 9.3 +/- 1.7kg.

Baseline echocardiographic measurements were recorded without sedation. Alfaxalone 4mg/kg was then administered at two sites in the caudal lumbar musculature. Sedation was scored 0-19 (0 = no sedation, >15 = deep sedation) at baseline then every 5 minutes until standing. Time to lateral recumbency, first movement, head lift and standing were recorded together with behaviours such as paddling, vocalisation. HR, RR, SpO2, oscillometric BP, and rectal temperature were recorded at baseline and then every 5 minutes until standing. Arterial blood gas analysis was performed at 5, 20 and 35 minutes.

Venous blood was sampled for alfaxalone plasma concentration at baseline and 5, 10, 15, 25, 35 and 50 minutes. Following a one-week wash-out alfaxalone 4mg/kg was again administered IM. Echocardiography was performed starting 5 minutes after alfaxalone administration.  HR, RR, SpO2 and MAP were also recorded.

Results

The mean time to lateral recumbency was 5.4 +/- 3.6 minutes with a duration of sedation to first voluntary movement of 23.5 +/- 12.2 minutes with patients standing by 42.8 +/- 14.1 minutes post injection. Moderate sedation peaked at 15 minutes post alfaxalone administration although stimulation resulted in trembling or paddling in 91% of dogs. 50% of dogs demonstrated paddling, trembling or nystagmus during echocardiography with increased sensitivity to sound in 2 of these dogs.  Cardiac output was maintained, and hypotension was not observed although there was a baroreceptor facilitated increase in HR. Respiratory rate declined but SpO2 and blood gas parameters remained unchanged. Only minor changes to echocardiographic variables were recorded with no clinical significance to the decreased end diastolic volume (EDV) and early diastolic septal mitral valve annulus velocity (as a result of the increased HR). The mean half-life following IM administration was 29 +/- 8 minutes. Plasma alfaxalone concentration positively influenced sedation score and HR and negatively influenced RR (p = 0.001 for all). No apnoea was observed, and plasma alfaxalone concentration had no effect on SpO2 or mean arterial pressure.

Conclusion

The mean alfaxalone half-life of 29 minutes demonstrates a large volume of distribution and rapid elimination. The moderate to deep sedation following alfaxalone 4mg/kg IM had a sufficient duration of action to permit echocardiography with limited changes to measurements and no significant change to cardiac output or oxyhaemoglobin saturation although trembling, paddling and nystagmus were observed in some animals. The changes to HR and other cardiovascular parameters warrant further investigation.

Article by
Dr. Karen Heskin
BVSc CertSAO MRCVS

Originally published: Wednesday, 17th March 2021

References

Sinclair, M. D. (2003). A review of the physiological effects of α2-agonists related to the clinical use of medetomidine in small animal practice. Canadian Veterinary Journal, 44(11): 885–897.

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Paper summary: Pre-anaesthetic screening of geriatric dogs

In this summary of a paper by Joubert (2007) we examine the value of pre-anaesthetic screening in geriatric dogs and how the results influence the anaesthetic process.

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Anaesthesia for Canine Cushing's disease: What should we assess and what should we monitor?

Cushing's disease (hyperadrenocorticism) is relatively common in the dog and this article discusses the appropriate pre-anaesthetic assessment we should perform and why careful monitoring is essential.

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Paper summary: How frequently are intravenous catheters removed as a result of complications due to bacterial contamination?

In this summary of a paper by Ramos (2018) we examine the incidence of bacterial colonisation of intravenous catheters removed as a result of cannula complication

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What's the Point? Peripheral Intravenous Cannulation.

Peripheral venous cannulation is a common invasive procedure in small animals, but what are the best-practice insertion techniques and what can we do to avoid complications?

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Rabbit Anaesthesia – Understanding Your Patient.

How does the anatomy, physiology, behaviour and response to drugs affect your decision making when anaesthetising the rabbit patient?

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Paper summary: Heated intravenous fluids alone fail to prevent hypothermia in cats under general anaesthesia.

In this summary of a paper by Jourdan et al (2017) we examine the common practice of warming intravenous fluids and the effect on patient temperature.

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​Considerations for anaesthesia of the brachycephalic dog.

In this article Matt Gurney discusses the induction of anaesthesia and intubation of the brachycephalic patient.

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Watch the induction and intubation of a brachycephalic.

Induction of anaesthesia and intubation of a brachycephalic dog with Matt Gurney.

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Paper summary: The effect of omeprazole on oesophageal pH in dogs during anaesthesia

This summary of a publication by Panti et al., examines the effect of orally administered omeprazole on gastro-oesophageal reflux in the anaesthetised dog.

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How does a syringe driver benefit your patients?

Syringe drivers are becoming increasingly commonplace in modern veterinary practice and are a useful tool for multiple applications. This article looks at the science behind constant rate infusions and the basics of syringe driver use.

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Paper summary: Pet owner opinions about anaesthesia, pain and surgery in small animals

In this paper we explore perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals.

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Achieving Safer Anaesthesia with ASA and Joanne Michou MA VetMB DipECVAA MRCVS

How can a Veterinary version of the ASA Physical Status Classification help you achieve safer anaesthesia? To find out how watch our webinar.

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Paper summary: ASA classification and risk of anaesthetic related death in dogs and cats.

This scientific paper assessed whether the American Society of Anesthesiologists (ASA) Physical Status Classification correlated with the risk of anaesthetic death in dogs and cats.

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New! Methadyne, Our New Methadone Now Available

This is our third product launch this year, and the latest addition to our anaesthesia and analgesia portfolio, Methadyne, contains 10mg/ml methadone as its active ingredient. It can be administered for analgesia of moderate to severe pain in dogs and cats, to provide neuroleptanalgesia, and as part of a patient’s premedication protocol prior to general anaesthesia.

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A retrospective comparison of two analgesic strategies after uncomplicated tibial plateau levelling osteotomy in dogs.

In this review we summarise a publication by Bini (2018) examining two protocols for the administration of methadone following TPLO surgery in dogs.

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Practical Acute Pain Assessment

In this summary of acute pain assessment, Carl Bradbrook examines why we should be monitoring patients for pain and looks at the commonly used scoring systems.

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Alfaxan for the maintenance of anaesthesia: Peer reviewed clinical papers.

In this article we have identified the key clinical peer reviewed papers to support the use of Alfaxan for maintenance of Anaesthesia in Cats and Dogs.

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TIVA or not? (Total intravenous anaesthesia).

In this article the Jurox UK Technical Team discuss the use of intravenous agents to maintain anaesthesia in the dog and cat.

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Benzodiazepines - can they help reduce anaesthesia related side effects?

In part 4 of this series on premedicant agents we examine the pros and cons of benzodiazepines.

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Paper summary: Effect of benzodiazepines on the dose of alfaxalone needed for endotracheal intubation in healthy dogs

This paper examined whether a benzodiazepine, administered as a co-induction agent with alfaxalone, improved endotracheal intubation, and reduced the dose of alfaxalone, in the dog

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Putting methadone in its place in your pain management.

In this article we examine why methadone could be considered the analgesic of choice for many of our patients and understand its importance in modern veterinary medicine. The article includes a link to a downloadable summary sheet.

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Food for Thought: Pre-anaesthetic Fasting

In this article Karen examines why we fast our canine and feline patients prior to anaesthesia and what the current recommendations are. Karen also investigates why rabbits are different and should not be starved before anaesthesia.

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​Purr-fecting Pain Management

In this article summary we examine which of the two opioids, buprenorphine or butorphanol, provides the most appropriate analgesia following ovariohysterectomy in the cat.

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Perspectives on Premeds - Phenothiazines: from Mental Health to Premedication

In this article from the Perspectives on Premeds series, Karen takes us through the properties and uses of phenothiazines in modern veterinary practice.

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Methadone with Acepromazine - when is enough, enough?

This study looks at the effects of three methadone doses combined with acepromazine on sedation and some cardiopulmonary variables in dogs.

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AceSedate®, Our New Acepromazine, Available Now.

We have extended our anaesthesia and analgesia portfolio with the launch of AceSedate®. Containing the tried and trusted, long-acting sedative agent acepromazine as its active ingredient, AceSedate can be used for the premedication, sedation and tranquilisation of cats and dogs.

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Time: is 30 minutes long enough?

This recent study examined whether the application of EMLA cream, for 30 or 60 minutes, would be a useful tool to improve patient compliance prior to intravenous cannula placement in the veterinary clinical practice setting.

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Caesarean Section Survival Guide. Part 2: Anaesthetic Protocol Selection & Peri-operative Considerations.

In this second instalment of the 2-part article, we explore premedication, induction, maintenance & monitoring, recovery and analgesia for the Caesarean section patient.

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Buprenorphine: it’s not all static in rabbits

Opioids are well known for causing gastrointestinal stasis in mammalian species. This recent paper examined the effects of a single high dose of buprenorphine on the rabbit gastrointestinal tract using non-invasive imaging techniques.

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Caesarean Section Survival Guide. Part 1: Physiology & Pre-anaesthetic Considerations.

In the first instalment of this 2-part review Karen examines the physiological changes that occur during pregnancy and how those adjustments can affect the selection of anaesthetic protocols for the increasingly common Caesarean section.

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No leeway for the spay: A comparison between methadone and buprenorphine for perioperative analgesia in dogs undergoing ovariohysterectomy.

This recent paper compares post-operative pain scores and requirement for rescue analgesia following premedication with methadone or buprenorphine, in combination with acepromazine or medetomidine, in 80 bitches undergoing ovariohysterectomy.

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Cardiac arrest - the human factor

Cardiac arrest in dogs and cats is, thankfully, relatively rare. However, when it does happen it can have devastating consequences for the animal, owner and the veterinary team. This study examined the common causalities leading up to a cardiac arrest with the aim of changing protocols to improve outcomes.

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Are you Using Safety Checklists in your Practice?

In this article, Carl focuses on the benefits of introducing a safety checklist in practice to reduce patient morbidity, mortality and to improve communication between members of the veterinary team. The article contains links to the AVA safety checklist as well as a link to a customisable list that you can adapt to your practice needs. 

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The Big Chill - Temperature Management in Sedated and Anaesthetised Patients

The effects of hypothermia are very far reaching throughout the peri-anaesthetic process. In this article, James takes us through the interesting mechanisms of body cooling and warming, the clinical relevance of hypothermia and what we can do to prevent it.

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Keeping the Finger on the Pulse -  Nuances in CV Monitoring

All patients are exposed to the risks associated with general anaesthesia. Continuously monitoring anaesthetised patients maximises patients safety and wellbeing. In this article, Dan takes us through the common monitoring techniques that provide information about the cardiovascular status of your patient. 

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Effect of Maropitant on Isoflurane Requirements & Postoperative Nausea & Vomiting

Despite being widely recognized in humans, postoperative nausea and vomiting (PONV), and the role of maropitant in reducing inhalational anaesthetic requirements have been poorly documented in dogs. This recent study evaluates PONV and isoflurane requirements after maropitant administration during routine ovariectomy in bitches.

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New! Alfaxan® Multidose Now Available

We are happy to announce we have enhanced our anaesthesia and analgesia portfolio with the introduction of Alfaxan®Multidose for dogs, cats and pet rabbits.

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Sevoflurane requirement in dogs premedicated with medetomidine and butorphanol

Little information is available about the effect that different doses of medetomidine and butorphanol may have when using sevoflurane for maintenance of anaesthesia in dogs. This recent study evaluates heart rate and median sevoflurane concentration required at different dose rates.

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Capnography II - What happened to the elephants? A summary of abnormal traces

In this second article of the capnography series, James provides a guide to a few of the most common traces that you will encounter during surgery. Scroll to the end of the article to download a printable capnography cheatsheet. 

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Pain, what a Pain! (Part 2) – Practical Tips On How To Perform Dental Nerve Blocks In Companion Animal Practice

In this second article of the Pain, what a Pain! series, Dan takes us through the LRA techniques associated with dental and oral surgery. In this article, you will find practical tips and pictures on common dental nerve blocks as well as safety concerns to consider.

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​Peri-anaesthetic mortality and nonfatal gastrointestinal complications in pet rabbits

This recent retrospective study looks at the cases of 185 pet rabbits admitted for sedation or general anaesthetic and evaluates the incidence and risk factors contributing to peri-anaesthetic mortality and gastrointestinal complications.

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Pain, what a Pain! How Locoregional Anaesthesia can Improve the Outcome and Welfare of Veterinary Patients (Part 1)

In this first article out of a series of two, Dan takes us through an introduction and practical tips for appropriate local anaesthesia delivery. Find out why these anaesthesia techniques, that are well recognised in human medicine, have seen an increase in popularity in veterinary medicine over the recent years

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Perspectives on Premeds – Opioids

Perspectives on Premeds is a series of articles touching on different pharmacological, physiological and clinical aspects of pre-anaesthetic medication. This second article aims to provide a refresher on opioids.

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Effects of Dexmedetomidine with Different Opioid Combinations in Dogs

Read the highlights of a recently published research paper that evaluates cardiorespiratory, sedative and antinociceptive effects of dexmedetomidine alone and in combination with morphine, methadone, meperidine, butorphanol, nalbuphine and tramadol. 

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Preoxygenation Study Highlights

This study evaluates the effectiveness of two methods of preoxygenation in healthy yet sedated dogs and the impact of these methods on time taken to reach a predetermined haemoglobin desaturation point (haemoglobin saturation (SpO2) of 90%) during an experimentally induced period of apnoea.

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Capnography – Not Just a Load of Hot Air

Capnography is the measurement of inhaled and exhaled carbon dioxide (CO2) concentration. The graphical illustration of CO2 within respired gases versus times is known as the capnogram.

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Perspectives on Premeds – Alpha-2 Agonists

Perspectives on Premeds is a series of articles touching on different pharmacological, physiological and clinical aspects of pre-anaesthetic medication. This first article aims to provide a refresher on α2 agonists.

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Alfaxan - now licensed for use in pet rabbits

Jurox Animal Health is delighted to announce that Alfaxan is now licensed for cats, dogs and pet rabbits. This is an exciting advance and could change the way rabbits are anaesthetised in the U.K.

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