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Serpieri M, Ottino C, Bonaffini G, Banchi P, Quaranta G, Mauthe von Degerfeld M. Comparison between Carprofen and Meloxicam for Post-Neutering Pain Management in Pet Rabbits. Vet Sci 2024; 11:257. [PMID: 38922004 PMCID: PMC11209068 DOI: 10.3390/vetsci11060257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Surgical neutering in pet rabbits is common practice to prevent reproduction and associated health issues. Adequate postoperative pain management is crucial for recovery, yet effective methods in clinical settings remain underexplored. This study compared the analgesic effects of carprofen and meloxicam in pet rabbits undergoing surgical neutering. Fifty rabbits of varied demographics were included, with pain assessed using the Centro Animali Non Convenzionali Rabbit Scale (CANCRS). Rabbits were allocated to receive postoperative 2 mg kg-1 carprofen or 1 mg kg-1 meloxicam by subcutaneous injection. Anesthesia was induced with an intramuscular combination of ketamine (20 mg kg-1), medetomidine (0.4 mg kg-1), and butorphanol (0.2 mg kg-1), and ovariectomy or orchiectomy were performed. The CANCRS scale was used to assess pain by evaluating the rabbit preoperatively, 6 h postoperatively, and at three time points the following day. Times of return to spontaneous feeding and fecal production were also recorded. No statistically significant difference was found between treatment groups based on CANCRS scores and resumption of food intake and fecal output. No clinically detectable adverse effects were noted. While limitations include the use of a single pain assessment scale and the absence of a placebo control group, the results suggest that both carprofen and meloxicam can be viable options in clinical practice. Further research utilizing diverse pain assessment methods is warranted to enhance understanding and optimize pain management strategies for rabbits undergoing surgical procedures.
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Affiliation(s)
- Matteo Serpieri
- Centro Animali Non Convenzionali (CANC)—Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (M.S.); (C.O.); (G.B.); (G.Q.)
| | - Chiara Ottino
- Centro Animali Non Convenzionali (CANC)—Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (M.S.); (C.O.); (G.B.); (G.Q.)
| | - Giuseppe Bonaffini
- Centro Animali Non Convenzionali (CANC)—Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (M.S.); (C.O.); (G.B.); (G.Q.)
| | - Penelope Banchi
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy;
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Giuseppe Quaranta
- Centro Animali Non Convenzionali (CANC)—Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (M.S.); (C.O.); (G.B.); (G.Q.)
| | - Mitzy Mauthe von Degerfeld
- Centro Animali Non Convenzionali (CANC)—Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (M.S.); (C.O.); (G.B.); (G.Q.)
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Mauthe von Degerfeld M, Serpieri M, Bonaffini G, Ottino C, Quaranta G. Intranasal Atomization of Ketamine, Medetomidine and Butorphanol in Pet Rabbits Using a Mucosal Atomization Device. Animals (Basel) 2023; 13:2076. [PMID: 37443874 DOI: 10.3390/ani13132076] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
A non-invasive method of drug delivery, intranasal atomization, has shown positive results in human medicine and in some animal species. The objective of this study was to evaluate the effects of intranasal atomization, compared to intramuscular administration, of a mix of anesthetic drugs in pet rabbits. In total, 104 mixed-breed pet rabbits, undergoing various types of surgery, received a combination of ketamine, medetomidine, and butorphanol (20, 0.4, and 0.2 mg/kg) by intranasal atomization using a Mucosal Atomization Device (Group MAD) or intramuscular administration (Group IM). When required, isoflurane was dispensed through a face mask. At the end of the procedures, atipamezole was administered using the same routes in the respective Groups. There were no differences in time to loss of righting reflex between the groups, while differences were found for the need for isoflurane (higher in Group MAD) and recovery time, occurring earlier in Group MAD. The results suggest that intranasal atomization of a combination of ketamine, medetomidine, and butorphanol produces a lighter depth of anesthesia in pet rabbits, compared to intramuscular administration. Intranasal atomization can be performed to administer sedative and anesthetic drugs, avoiding the algic stimulus related to the intramuscular inoculation of drugs.
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Affiliation(s)
- Mitzy Mauthe von Degerfeld
- Centro Animali Non Convenzionali, Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Largo Paolo Braccini 2, 10095 Grugliasco, Italy
| | - Matteo Serpieri
- Centro Animali Non Convenzionali, Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Largo Paolo Braccini 2, 10095 Grugliasco, Italy
| | - Giuseppe Bonaffini
- Centro Animali Non Convenzionali, Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Largo Paolo Braccini 2, 10095 Grugliasco, Italy
| | - Chiara Ottino
- Centro Animali Non Convenzionali, Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Largo Paolo Braccini 2, 10095 Grugliasco, Italy
| | - Giuseppe Quaranta
- Centro Animali Non Convenzionali, Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Largo Paolo Braccini 2, 10095 Grugliasco, Italy
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Abstract
Rabbits occupy facets of veterinary medicine spanning from companion mammals, wildlife medicine, zoologic species, and research models. Therefore, analgesia is required for a variety of conditions in rabbits and is a critical component of patient care. Considerations when selecting an analgesic protocol in rabbits include timing of administration, route of administration, degree or anticipated pain, ability to access or use controlled drugs, systemic health, and any potential side effects. This review focuses on pharmacologic and locoregional management of pain in rabbits and emphasizes the need for further studies on pain management in this species.
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Affiliation(s)
- Sarah Ozawa
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 Williams Moore Dr, Raleigh, NC 27606, USA.
| | - Alessia Cenani
- Department of Surgical and Radiographical Sciences, School of Veterinary Medicine University of California Davis, One Shields Avenue, Davis, CA 95616, USA
| | - David Sanchez-Migallon Guzman Lv
- Department of Medicine and Epidemiology, School of Veterinary Medicine University of California Davis, One Shields Avenue, Davis, CA 95616, USA
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Abstract
With the increasing frequency of rabbits as veterinary patients, the expectation for high-quality, intensive veterinary care, and resultantly an understanding of anesthesia has been increasing. Sedation and general anesthesia are commonly required for many routine and emergency procedures in rabbits, and this results in the need for a strong awareness of anesthetic principles, knowledge of limitations of anesthesia, and maintenance of high standards of anesthesia.
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Xueyuan H, Li L, Yujie Y, Wenshuai Y, Huayun Z, Wei G, Honggang F. Comparison of behavioral and cardiopulmonary parameters during immobilization using dexmedetomidine, tiletamine and zolazepam with or without buprenorphine in Siberian tigers (Panthera tigris). J Vet Behav 2021. [DOI: 10.1016/j.jveb.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raillard M, Detotto C, Grepper S, Beslac O, Fujioka-Kobayashi M, Schaller B, Saulacic N. Anaesthetic and Perioperative Management of 14 Male New Zealand White Rabbits for Calvarial Bone Surgery. Animals (Basel) 2019; 9:ani9110896. [PMID: 31683852 PMCID: PMC6912242 DOI: 10.3390/ani9110896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Bone substitutes are commonly used when bone grafts are necessary in human craniofacial surgery. To study the properties and biologic behaviour of those substitutes, they can be implanted in experimental animals. A frequently used model involves the creation of critical-sized defects (defects that are too large to heal by themselves) in the rabbits calvaria (the top part of the skull). The procedure was initially described in 1989 and the authors considered and reported that post-operative analgesia was not necessary. In our experience, this procedure is invasive and can result in severe postoperative pain. The anaesthetic management of rabbits undergoing this procedure is challenging. Most of the recent publications using this model fail to provide sufficient information on perioperative animal management. With this report we have aimed to document a possible practical and simple anaesthetic and postoperative management of rabbits undergoing this procedure. Particular emphasis has been placed on postoperative pain assessment, duration and treatment. Abstract Calvarial bone surgery on rabbits is frequently performed. This report aims to document a simple and practical anaesthetic and perioperative management for this procedure. Fourteen male New Zealand white rabbits were included in the study. Subcutaneous (SC) dexmedetomidine, ketamine and buprenorphine ± isoflurane vaporized in oxygen administered through a supraglottic airway device (V-gel®) provided clinically suitable anaesthesia. Supplemental oxygen was administered throughout recovery. Monitoring was clinical and instrumental (pulse-oximetry, capnography, invasive blood pressure, temperature, arterial blood gas analysis). Lidocaine was infiltrated at the surgical site and meloxicam was injected subcutaneously as perioperative analgesia. After surgery, pain was assessed five times daily (composite behavioural pain scale and grimace scale). Postoperative analgesia included SC meloxicam once daily for four days and buprenorphine every 8 h for three days (unless both pain scores were at the lowest possible levels). Rescue analgesia (buprenorphine) was administered in case of the score > 3/8 in the composite pain scale, >4/10 on the grimace scale or if determined necessary by the caregivers. Airway management with a V-gel® was possible but resulted in respiratory obstruction during the surgery in two cases. Hypoventilation was observed in all rabbits. All rabbits experienced pain after the procedure. Monitoring, pain assessments and administration of postoperative analgesia were recommended for 48 h.
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Affiliation(s)
- Mathieu Raillard
- Experimental Surgery Facility (ESF), Department of BioMedical Research, University of Bern, 3008 Bern, Switzerland.
- Vetsuisse Faculty, Department of Clinical Veterinary Medicine, Institute of Anaesthesiology and Pain Therapy, University of Bern, 3012 Bern, Switzerland.
- School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney 2006, Australia.
| | - Carlotta Detotto
- Experimental Surgery Facility (ESF), Department of BioMedical Research, University of Bern, 3008 Bern, Switzerland.
- Central Animal Facilities, Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland.
| | - Sandro Grepper
- Central Animal Facilities, Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland.
| | - Olgica Beslac
- Experimental Surgery Facility (ESF), Department of BioMedical Research, University of Bern, 3008 Bern, Switzerland.
| | - Masako Fujioka-Kobayashi
- Department of Cranio-Maxillofacial Surgery, Inselspital Bern, University Hospital, University of Bern, 3008 Bern, Switzerland.
| | - Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, Inselspital Bern, University Hospital, University of Bern, 3008 Bern, Switzerland.
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital Bern, University Hospital, University of Bern, 3008 Bern, Switzerland.
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Abstract
Managing pain effectively in any species is challenging, but small mammals present particular problems. Methods of pain assessment are still under development in these species, so the efficacy of analgesic therapy cannot be evaluated fully. Methods of assessing abdominal pain are established; however, applying these can be challenging. Alternative methods, using assessment of facial expression, may be more applicable to a range of painful procedures and across species. Multimodal and preventive analgesic strategies are most likely to be effective. Although data on analgesic dose rates are limited, sufficient information is available to enable analgesia to be provided safely.
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Affiliation(s)
- Paul Flecknell
- Comparative Biology Centre, Medical School, Newcastle University, Framlington Place, Newcastle NE24RU, UK; Flaire Consultants.
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Speer BL, Hennigh M, Muntz B, van Zeeland YRA. Low-Stress Medication Techniques in Birds and Small Mammals. Vet Clin North Am Exot Anim Pract 2018; 21:261-285. [PMID: 29655469 DOI: 10.1016/j.cvex.2018.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Low-stress medication principles and techniques are key aspects of optimal health care delivery for birds and small mammals. When paired with the medical details of patient management, by balancing medication techniques, the probability of clinical success on the highest ethical and welfare criteria can be greatly enhanced. This review addresses both the effects and the disadvantages of using forceful, coercive, and fear-evoking methods as well as the benefits, principles, and possible applications of low-stress medication in the veterinary setting.
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Affiliation(s)
- Brian L Speer
- Medical Center for Birds, 3805 Main Street, Oakley, CA 94561, USA.
| | - Melody Hennigh
- Medical Center for Birds, 3805 Main Street, Oakley, CA 94561, USA
| | - Bernice Muntz
- Dierentrainer, Mauvelaan 13, Leidschendam 2264 AJ, The Netherlands
| | - Yvonne R A van Zeeland
- Division of Zoological Medicine, Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584 CM, The Netherlands
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Weiland LC, Kluge K, Kutter APN, Kronen PW. Clinical evaluation of intranasal medetomidine-ketamine and medetomidine-S(+)-ketamine for induction of anaesthesia in rabbits in two centres with two different administration techniques. Vet Anaesth Analg 2017; 44:98-105. [PMID: 27374385 DOI: 10.1111/vaa.12408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to compare efficacy and side effects of induction with medetomidine-ketamine or medetomidine-S(+)-ketamine by intranasal (IN) instillation in rabbits and to evaluate both protocols during subsequent isoflurane anaesthesia. STUDY DESIGN Prospective, blinded, randomized experimental study in two centres. ANIMALS Eighty-three healthy New Zealand White rabbits undergoing tibial or ulnar osteotomy. METHODS Medetomidine (0.2 mg kg-1) with 10 mg kg-1 ketamine (MK) or 5 mg kg-1 S(+)-ketamine (MS) was administered IN to each rabbit in a randomized fashion. In Centre 1 (n = 42) rabbits were held in sternal recumbency, and in Centre 2 (n = 41) in dorsal recumbency, during drug instillation. Adverse reactions were recorded. If a rabbit swallowed during endotracheal intubation, half of the initial IN dose was repeated and intubation was re-attempted after 5 minutes. Anaesthesia was maintained with isoflurane. Heart rate, blood pressure, endtidal carbon dioxide concentration and blood gases were recorded. Data were analysed using Student's t-test, Mann-Whitney test and Fisher's exact test. RESULTS In all, 39 animals were assigned to the MK group and 44 to the MS group. Two rabbits in the MS group held in dorsal recumbency died after instillation of the drug. Eight (MK) and 11 rabbits (MS) were insufficiently anaesthetized and received a second IN dose. One rabbit in MK and three in MS required an isoflurane mask induction after the second IN dose. There were no significant differences between treatments for induction, intraoperative data, blood gas values and recovery data. CONCLUSION AND CLINICAL RELEVANCE This study indicated that medetomidine-ketamine and medetomidine-S(+)-ketamine were effective shortly after IN delivery, but in dorsal recumbency IN administration of S(+)-ketamine led to two fatalities. Nasal haemorrhage was noted in both cases; however, the factors leading to death have not been fully elucidated.
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Affiliation(s)
- Linda C Weiland
- VAS, Veterinary Anaesthesia Services-International, Winterthur, Switzerland
| | - Katharina Kluge
- Preclinical Surgery, AO Research Institute, Davos Platz, Switzerland
| | - Annette P N Kutter
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Peter W Kronen
- VAS, Veterinary Anaesthesia Services-International, Winterthur, Switzerland; Centre for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland.
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Santangelo B, Micieli F, Mozzillo T, Reynaud F, Marino F, Auletta L, Vesce G. Transnasal administration of a combination of dexmedetomidine, midazolam and butorphanol produces deep sedation in New Zealand White rabbits. Vet Anaesth Analg 2016; 43:209-14. [DOI: 10.1111/vaa.12278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/03/2015] [Indexed: 11/30/2022]
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Fuentes Hernandez VO, Castro CL, Hernandez RO, Canseco AB. The effect of small doses of naloxone on sexual exhaustion, plasma prolactin and testosterone levels in male rabbits. ITALIAN JOURNAL OF ANIMAL SCIENCE 2016. [DOI: 10.4081/ijas.2012.e23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Santangelo B, Micieli F, Marino F, Reynaud F, Cassandro P, Carfora A, Petrella R, Borriello R, Cataldi M, Vesce G. Plasma concentrations and sedative effects of a dexmedetomidine, midazolam, and butorphanol combination after transnasal administration in healthy rabbits. J Vet Pharmacol Ther 2015; 39:408-11. [PMID: 26687556 DOI: 10.1111/jvp.12282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 11/10/2015] [Indexed: 11/26/2022]
Abstract
Plasma concentrations of dexmedetomidine (D = 0.1 mg/kg), midazolam (M = 2 mg/kg), and butorphanol (B = 0.4 mg/kg) were analyzed by liquid chromatography-mass spectrometry (LC-MS/MS) after their simultaneous (DMB) transnasal (TN) administration to healthy rabbits. Time-dependent changes in sedation and antinociception were evaluated by measuring a sedation score based on rabbit's posture, loss of the righting, palpebral and pedal withdrawal reflexes and by instrumental monitoring of rectal temperature, heart rate, arterial blood pressure, pulse-oximetry, and capnometry. The peak plasma concentration (Cmax ) of each drug was reached within 5 min (Tmax ) from DMB-TN administration along with deep sedation and analgesia. Such effects subsided after 45 min into a moderate sedation and analgesia lasting for additional 15 min. All rabbits awakened spontaneously and uneventfully 90 min after DMB-TN administration. During the anesthetic procedure, arterial blood pressure markedly decreased and respiratory depression ensued requiring oxygen supplementation. The results of this study show that all three molecules of the DMB combination were absorbed through the TN route, inducing deep sedation and analgesia suitable for minor surgical procedures. Such combination should be used with caution in rabbits bearing cardiovascular or respiratory diseases because of its ability to induce hypotension and respiratory depression.
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Affiliation(s)
- B Santangelo
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Napoli, Italy
| | - F Micieli
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Napoli, Italy
| | - F Marino
- Clinica veterinaria Animalia srls, Aversa, Caserta, Italy
| | - F Reynaud
- Clinica veterinaria Sannio, Sant'Angelo a Cupolo, Benevento, Italy
| | - P Cassandro
- Department of Experimental Medicine, Laboratory of Forensic Toxicology, School of Medicine, Second University of Napoli, Napoli, Italy
| | - A Carfora
- Department of Experimental Medicine, Laboratory of Forensic Toxicology, School of Medicine, Second University of Napoli, Napoli, Italy
| | - R Petrella
- Department of Experimental Medicine, Laboratory of Forensic Toxicology, School of Medicine, Second University of Napoli, Napoli, Italy
| | - R Borriello
- Department of Experimental Medicine, Laboratory of Forensic Toxicology, School of Medicine, Second University of Napoli, Napoli, Italy
| | - M Cataldi
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Napoli Federico II, Napoli, Italy
| | - G Vesce
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Napoli, Italy
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Navarrete-Calvo R, Gómez-Villamandos RJ, Morgaz J, Manuel Domínguez J, Fernández-Sarmiento A, Muñoz-Rascón P, López Villalba I, Del Mar Granados M. Cardiorespiratory, anaesthetic and recovery effects of morphine combined with medetomidine and alfaxalone in rabbits. Vet Rec 2014; 174:95. [DOI: 10.1136/vr.101293] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- R. Navarrete-Calvo
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - R. J. Gómez-Villamandos
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - J. Morgaz
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - J. Manuel Domínguez
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - A. Fernández-Sarmiento
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - P. Muñoz-Rascón
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - I. López Villalba
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
| | - M. Del Mar Granados
- Department of Animal Medicine and Surgery; Scholl of Veterinary Medicine; University of Córdoba; Córdoba Spain
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Hedenqvist P, Edner A, Fahlman Å, Jensen-Waern M. Continuous intravenous anaesthesia with sufentanil and midazolam in medetomidine premedicated New Zealand White rabbits. BMC Vet Res 2013; 9:21. [PMID: 23351150 PMCID: PMC3568725 DOI: 10.1186/1746-6148-9-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaesthesia in rabbits is associated with a high mortality rate, compared to that in cats and dogs. Total intravenous anaesthesia (TIVA) with drugs that provide cardiovascular stability and are rapidly metabolised could be of benefit for use in rabbits. The aim was to evaluate cardiorespiratory effects of TIVA with sufentanil-midazolam in eight New Zealand White rabbits. Subcutaneous premedication with medetomidine (0.1 mg/kg BW) was followed by IV administration of a mixture of 2.5 μg/mL sufentanil and 0.45 mg/mL midazolam at a rate of 0.3 mL/kg BW/h for anaesthetic induction. Additionally, intravenous boluses of 0.1 mL of the mixture were administered every 20 s until the righting reflex was lost. Following endotracheal intubation, anaesthesia was maintained for 60 min with an infusion rate adjusted to supress the pedal withdrawal reflex. Air and oxygen (1:2) were delivered at 3 L/min. Physiological variables were recorded before induction and at predefined time points during and after anaesthesia. RESULTS Righting and pedal withdrawal reflexes were lost within 3 and 5 min, respectively. Doses of sufentanil and midazolam were 0.48 μg/kg BW and 0.09 mg/kg BW for induction, and 0.72 μg/kg BW/h and 0.13 mg/kg BW/h for maintenance. Apnoea occurred in two rabbits. Induction of anaesthesia caused a significant increase in heart rate, cardiac output and arterial CO2 partial pressure and a decrease in mean arterial pressure, respiratory rate and pH. Mean time from stopping the infusion to endotracheal extubation was 5 min, and to return of the righting reflex 7 min. Anaesthesia was characterized by induction and recovery without excitation, with muscle relaxation, and absence of the pedal withdrawal reflex. CONCLUSIONS TIVA with sufentanil-midazolam provided smooth induction and recovery of anaesthesia in rabbits but with marked hypotension and respiratory depression, requiring mechanical ventilation. Further evaluation is needed to establish if the protocol is useful for rabbits undergoing surgery.
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Affiliation(s)
- Patricia Hedenqvist
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, P.O. Box 7054, SE, 750 07, Uppsala, Sweden
| | - Anna Edner
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, P.O. Box 7054, SE, 750 07, Uppsala, Sweden
| | - Åsa Fahlman
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, P.O. Box 7054, SE, 750 07, Uppsala, Sweden
| | - Marianne Jensen-Waern
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, P.O. Box 7054, SE, 750 07, Uppsala, Sweden
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Murphy KL, Roughan JV, Baxter MG, Flecknell PA. Anaesthesia with a combination of ketamine and medetomidine in the rabbit: effect of premedication with buprenorphine. Vet Anaesth Analg 2010; 37:222-9. [PMID: 20230555 DOI: 10.1111/j.1467-2995.2009.00525.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effects of premedication with buprenorphine on the characteristics of anaesthesia induced with ketamine/medetomidine. STUDY DESIGN Prospective crossover laboratory study. ANIMALS Six female New Zealand White rabbits. METHODS Rabbits received, on occasions separated by 7 days, either buprenorphine (0.03 mg kg(-1)) or saline subcutaneously (SC) as premedication, followed 1 hour later by SC ketamine (15 mg kg(-1)) and medetomidine (0.25 mg kg(-1)) (K/M). At pre-determined time points reflex responses and cardiopulmonary parameters were recorded and arterial blood samples taken for analysis. Total sleep time was the duration of loss of the righting reflex. Duration of surgical anaesthesia was the time of suppression of the ear pinch and pedal withdrawal reflexes. Wilcoxon signed-ranks tests were used to compare data before (T(0)) and 10 minutes after (T(10)) injection with K/M. RESULTS All animals lost all three reflex responses within 10 minutes of injection of K/M. The duration of loss of these reflexes significantly increased in animals that received buprenorphine. At induction, animals that had received buprenorphine tended to have a lower respiration rate but there were no significant differences in arterial PCO(2), PO(2) or pH between treatments. Hypoxaemia [median PaO(2) < 6.0 kPa (45 mmHg)] developed in both treatments at T(10) but there was no significant difference between treatments. Mean arterial pressure (MAP) was lower at T(10) in animals that had received buprenorphine. CONCLUSION AND CLINICAL RELEVANCE Premedication with buprenorphine significantly increased the duration of anaesthesia induced by K/M, with no significant depression of respiration further to the control treatment within the first 10 minutes of anaesthesia. The MAP decreased but this was not reflected in a difference in other physiological parameters. These data show that premedication with buprenorphine, before K/M anaesthesia in the rabbit, has few negative effects and may provide beneficial analgesia.
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Affiliation(s)
- Kathy L Murphy
- Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford, UK.
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Marsh MK, McLeod SR, Hansen A, Maloney SK. Induction of anaesthesia in wild rabbits using a new alfaxalone formulation. Vet Rec 2009; 164:122-3. [DOI: 10.1136/vr.164.4.122] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M. K. Marsh
- Vertebrate Pest Research Unit; New South Wales Department of Primary Industries; Forest Road Orange NSW 2800 Australia
| | - S. R. McLeod
- Vertebrate Pest Research Unit; New South Wales Department of Primary Industries; Forest Road Orange NSW 2800 Australia
| | - A. Hansen
- Vertebrate Pest Research Unit; New South Wales Department of Primary Industries; Forest Road Orange NSW 2800 Australia
| | - S. K. Maloney
- School of Biomedical, Biomolecular and Chemical Science; University of Western Australia; Crawley WA 6009 Australia
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Grint NJ, Murison PJ. A comparison of ketamine-midazolam and ketamine-medetomidine combinations for induction of anaesthesia in rabbits. Vet Anaesth Analg 2008; 35:113-21. [PMID: 18179655 DOI: 10.1111/j.1467-2995.2007.00362.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare ketamine-midazolam (KMZ) and ketamine-medetomidine (KMT) anaesthesia in rabbits using anaesthetic induction, maintenance and recovery data. STUDY DESIGN Randomized, prospective, blinded clinical trial. ANIMALS Fifty rabbits (25 male, 25 female) of different breeds undergoing ovariohysterectomy or castration. Rabbits were 12.7 +/- 9.8 months old with body mass 2.24 +/- 0.61 kg. STUDY DESIGN Randomized, prospective, blinded clinical trial. METHODS Ketamine (15 mg kg(-1)) and midazolam (3 mg kg(-1)) or medetomidine (0.25 mg kg(-1)) were administered by intramuscular (IM) injection. Ten minutes after IM injection, blind intubation of the trachea was attempted. The time taken, the number of attempts and a subjective score of the ease of intubation were recorded. Isoflurane (range 0-3.6%) in 100% oxygen was delivered via a Jackson Rees modification of an Ayre's T-piece non-rebreathing system. Carprofen (3 mg kg(-1)) and dextrose saline (5 mL kg(-1) hour(-1)) were administered intravenously (IV). During surgery heart rate (HR), respiratory rate (RR) and arterial oxygen saturation of haemoglobin (SpO(2)) were monitored. Times to extubation and first head lift were recorded. Group KMT received atipamezole (0.5 mg kg(-1)) IM 30 minutes after discontinuation of isoflurane. Activity was scored at 30, 60 and 120 minutes after volatile agent discontinuation. Mean time to loss of righting reflex (LRR), body mass, RR and vaporizer setting were compared using a two-tailed t-test. Median values for all other data were compared using a Mann-Whitney test. RESULTS Mean time to LRR (+/-SD) was significantly shorter with KMT (1.64 +/- 0.55 minutes) compared with KMZ (2.28 +/- 0.66 minutes). Intubation was not possible in seven rabbits (three with KMT, four with KMZ) and three with KMT developed laryngospasm. Mean HR, SpO(2) and vaporizer settings were all significantly lower in group KMT. CONCLUSION AND CLINICAL RELEVANCE KMT has a faster onset of action and a greater isoflurane-sparing effect when compared with KMZ. Rabbits with KMT were more prone to laryngospasm and had significantly lower HR.
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Affiliation(s)
- Nicola J Grint
- Department of Clinical Veterinary Science, University of Bristol, Bristol, UK.
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Grint NJ, Murison PJ. Peri-operative body temperatures in isoflurane-anaesthetized rabbits following ketamine-midazolam or ketamine-medetomidine. Vet Anaesth Analg 2007; 34:181-9. [PMID: 17444931 DOI: 10.1111/j.1467-2995.2006.00319.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate alterations in peri-operative body temperatures and oesophageal-skin temperatures in isoflurane-anaesthetized rabbits following either ketamine-midazolam or ketamine-medetomidine induction of anaesthesia. ANIMAL POPULATION Fifty client-owned rabbits, (25 male, 25 female) of different breeds anaesthetized for elective neutering (age range: 3-42 months; mass range: 1.15-4.3 kg). STUDY DESIGN Randomized, blinded clinical study. METHODS Pre-anaesthetic rectal temperature was measured. A 24 SWG catheter was placed in a marginal ear vein after local anaesthesia. Ketamine (15 mg kg(-1)) with medetomidine (0.25 mg kg(-1)) (group KMT) or with midazolam (3 mg kg(-1)) (group KMZ) was injected intramuscularly (IM). Following endotracheal intubation anaesthesia was maintained with isoflurane in oxygen. Carprofen (3 mg kg(-1)) and glucose saline (5 mL kg(-1) hour(-1)) were administered through the intravenous catheter. Room temperature and humidity, skin temperature (from tip of pinna) and oesophageal temperature were measured during anaesthesia. Ovariohysterectomy or castration was performed. Rectal temperature was taken when isoflurane was discontinued (time zero) and 30, 60 and 120 minutes thereafter. Atipamezole (0.5 mg kg(-1)) was administered IM to rabbits in group KMT at zero plus 30 minutes. Mass, averaged room temperature and duration of anaesthesia data were compared using a two-tailed t-test. Age, averaged room humidity, rectal temperature decrease, oesophageal temperature decrease and oesophageal-skin difference data were compared using a Kruskal-Wallis test. p < 0.05 was considered significant. RESULTS The averaged oesophageal-skin temperature difference was significantly greater in group KMT [median 9.85 degrees C (range 6.42-13.85 degrees C)] than in group KMZ [4.38 degrees C (2.83-10.43 degrees C)]. Rectal temperature decreased over the anaesthetic period was not significantly different between the two groups; however, oesophageal temperature decrease was significantly less in group KMT [1.1 degrees C (-0.1-+2.7 degrees C)] than in group KMZ [1.4 degrees C (0.6-3.1 degrees C)]. CONCLUSIONS Oesophageal-skin temperature difference is larger in rabbits anaesthetized with ketamine-medetomidine combination than ketamine-midazolam. CLINICAL RELEVANCE The oesophageal temperature in rabbits anaesthetized with ketamine-medetomidine and isoflurane decreases significantly less than in animals anaesthetized with ketamine-midazolam and isoflurane, during anaesthesia.
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Affiliation(s)
- Nicola J Grint
- Department of Clinical Veterinary Science, University of Bristol, Bristol, UK.
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Partially antagonisable anaesthesia of the small hedgehog tenrec (Echinops telfairi) with medetomidine, midazolam and ketamine. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.jeas.2006.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fontes-Sousa APN, Brás-Silva C, Moura C, Areias JC, Leite-Moreira AF. M-mode and Doppler echocardiographic reference values for male New Zealand white rabbits. Am J Vet Res 2006; 67:1725-9. [PMID: 17014323 DOI: 10.2460/ajvr.67.10.1725] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine M-mode and Doppler echocardiographic reference values in healthy New Zealand white rabbits. ANIMALS 52 healthy male rabbits. PROCEDURES The rabbits were anesthetized and M-mode measurements of the left ventricle, left atrium, and aorta and Doppler measurements of pulmonary and aortic outflow and mitral inflow were recorded. RESULTS Mean +/- SD heart rate during echocardiographic examination was 155 +/- 29 beats/min. Mean +/- SD measurements in diastole and systole for the interventricular septum thickness, left ventricular internal diameter, and left ventricular free wall thickness were 2.03 +/- 0.37 mm and 3.05 +/- 0.45 mm; 14.37 +/- 1.49 mm and 10.25 +/- 1.22 mm; and 2.16 +/- 0.25 and 3.48 +/- 0.55 mm, respectively. Mean +/- SD left atrial-to-aortic diameter ratio was 1.17 +/- 0.14, and mean +/- SD mitral valve E-point-to-septal separation interval was 1.71 +/- 0.29 mm. Mean +/- SD for fractional shortening and ejection fraction were 30.13 +/- 2.98% and 61.29 +/- 4.66%, respectively. Mean +/- SD maximal aortic and pulmonary artery outflow velocities were 0.85 +/- 0.11 m/s and 0.59 +/- 0.10 m/s, respectively, and the peak E-to-peak A wave velocity ratio of the mitral valve was 2.19 +/- 0.46. CONCLUSIONS AND CLINICAL RELEVANCE Results provide echocardiographic reference values for young adult male New Zealand white rabbits anesthetized with ketamine and medetomidine. Values obtained from unanesthetized rabbits, rabbits sedated with other agents, or rabbits of different size may differ from those reported here.
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Henke J, Astner S, Brill T, Eissner B, Busch R, Erhardt W. Comparative study of three intramuscular anaesthetic combinations (medetomidine/ketamine, medetomidine/fentanyl/midazolam and xylazine/ketamine) in rabbits. Vet Anaesth Analg 2005; 32:261-70. [PMID: 16135207 DOI: 10.1111/j.1467-2995.2005.00242.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the quality of surgical anaesthesia and cardiorespiratory effects of three intramuscular (IM) anaesthetic combinations in rabbits. STUDY DESIGN Prospective randomized cross-over experimental study. ANIMALS Nineteen adult female chinchilla mixed-bred rabbits weighing 3.9 +/- 0.8 kg. METHODS Rabbits were given one of three IM anaesthetic combinations: 0.25 mg kg(-1) medetomidine and 35.0 mg kg(-1) ketamine (M-K), 0.20 mg kg(-1) medetomidine and 0.02 mg kg(-1) fentanyl and 1.0 mg kg(-1) midazolam (M-F-Mz) and 4.0 mg kg(-1) xylazine and 50 mg kg(-1) ketamine (X-K). The effects of anaesthesia on nociceptive reflexes, circulatory and respiratory function were recorded. Statistical analyses involved repeated measures anova with paired Student's t-test applied post hoc. P-values <0.05 were considered as significant. RESULTS Reflex loss was most rapid and complete in M-K recipients, whereas animals receiving M-F-Mz showed the longest tolerance of endotracheal intubation (78.1 +/- 36.5 minutes). Loss of righting reflex was significantly most rapid (p < 0.05) in the X-K group (114.7 +/- 24.0 minutes). Surgical anaesthesia was achieved in 16 of 19 animals receiving M-K, in 14 animals receiving M-F-Mz, and in seven animals with X-K, but only for a short period (7.1 +/- 11.6 minutes). This was significantly (p < 0.001) shorter than with M-K (38.7 +/- 30.0 minutes) and M-F-Mz (31.6 +/- 26.6 minutes). Heart rates were greatest in X-K recipients; lowest HR were seen in animals receiving M-F-Mz. Mean arterial blood pressure was significantly higher (about 88 mmHg) during the first hour in the M-K group. During recovery, the greatest hypotension was encountered in the X-K group; minimum values were 53 +/- 12 mmHg. Six of 19 animals in the M-F-Mz group showed a short period of apnoea (30 seconds) immediately after endotracheal intubation. Respiratory frequency was significantly lower in this group (p < 0.001). Highest values for arterial carbon dioxide partial pressures (PaCO(2)) (6.90 +/- 0.87 kPa; 52.5 +/- 6.5 mmHg) occurred after induction of anaesthesia in group M-F-Mz animals. There was a marked decrease in PaO(2) in all three groups (the minimum value 5.28 +/- 0.65 kPa [39.7 +/- 4.9 mmHg] was observed with M-K immediately after injection). Arterial PO(2) was between 26.0 and 43.0 kPa (196 and 324 mmHg) in all groups during O(2) delivery and decreased - but not <7.98 kPa - on its withdrawal. Immediately after drug injection, pH(a) values fell in all groups, with lowest values after 30 minutes (7.23 +/- 0.03 with M-K, 7.28 +/- 0.05 with M-F-Mz, and 7.36 +/- 0.04 with X-K). The X-K animals showed significantly (p < 0.001) higher pH values than medetomidine recipients. During 1 hour of anaesthesia pH values in the medetomidine groups remained below those of the X-K group. CONCLUSIONS Surgical anaesthesia was induced in most animals receiving medetomidine-based combinations. Arterial blood pressure was maintained at baseline values for about 1 hour after M-K. Transient apnoea occurred with M-F-Mz and mandates respiratory function monitoring. Oxygen enrichment of inspired gases is necessary with all three combinations. Endotracheal intubation is essential in rabbits receiving M-F-Mz. CLINICAL RELEVANCE The quality of surgical anaesthesia was greatest with M-K. All combinations allowed recoveries of similar duration. It is theoretically possible to antagonize each component of the M-F-Mz combination.
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Affiliation(s)
- Julia Henke
- Institute for Experimental Oncology and Therapeutic Research, Working Group Experimental Surgery, Munich, Germany.
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Ugarte CE, O'Flaherty K. The use of a medetomidine, butorphanol and atropine combination to enable blood sampling in young pigs. N Z Vet J 2005; 53:249-52. [PMID: 16044185 DOI: 10.1080/00480169.2005.36554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To determine the suitability of a reversible, injectable anaesthetic combination including medetomidine, butorphanol and atropine to produce the degree of immobilisation required to allow blood sampling in young pigs. METHODS Twenty 6-week-old crossbred, intact male pigs were sedated with an intramuscular (I/M) injection of 80 microg/kg medetomidine, 200 microg/kg butorphanol and 25 microg/kg atropine. Heart and respiratory rates and rectal temperatures were monitored. Excessive salivation, gagging, laryngeal reflex, presence of pedal reflex and deep and surface analgesia were noted. Time of injection and the time when pigs reached mild and full sedation were also recorded. RESULTS Mild sedation was produced in 90% of pigs after 5.6 (SEM 0.96) min (n = 18; median 5, range 2-16 min), and full sedation (lateral recumbency and loss of jaw tone) in 60% of pigs after 12.5 (SEM 2.14) min (n = 12; median 10, range 5-28 min). The depth and duration of sedation were very variable and most animals were easily aroused. Ninety percent of the animals required the administration of halothane by mask to allow blood sampling, but the amount of halothane required was small. Heart and respiratory rates decreased (p < 0.001) but remained within the normal range. Rectal temperature was above normal at the time of sedation and at the time of blood sampling when the ambient temperature was 29 degrees C but not when the ambient temperature was reduced to 25 degrees C. CONCLUSIONS The combination of medetomidine, butorphanol and atropine at these doses produced sedation of variable depth and duration that was insufficient on its own to allow blood sampling in the majority of pigs. Hyperthermia can occur in temperature-controlled environments when using medetomidine, butorphanol and atropine in pigs. Reduction of stress and a quieter environment may improve the effects of the anaesthetic combination.
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Affiliation(s)
- C E Ugarte
- Institute of Food, Nutrition and Human Health, Massey University, Private Bag 11222, Palmerston North, New Zealand.
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Henke J, Baumgartner C, Röltgen I, Eberspächer E, Erhardt W. Anaesthesia with Midazolam/Medetomidine/Fentanyl in Chinchillas (Chinchilla lanigera) Compared to Anaesthesia with Xylazine/Ketamine and Medetomidine/Ketamine. ACTA ACUST UNITED AC 2004; 51:259-64. [PMID: 15315707 DOI: 10.1111/j.1439-0442.2004.00632.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We studied four different drug regimes for anaesthetic management in chinchillas and evaluated and compared their cardiovascular and respiratory effects. In this randomized, cross-over experimental study, seven adult chinchillas, five females, two males [515 +/- 70 (SD) g] were randomly assigned to one of the following groups: group 1 [midazolam, medetomidine and fentanyl (MMF), flumazenil, atipamezole and naloxone (FAN); MMF-FAN] received 1.0 mg/kg midazolam, 0.05 mg/kg medetomidine and 0.02 mg/kg fentanyl i.m., and for reversal 0.1 mg/kg flumazenil, 0.5 mg/kg atipamezole and 0.05 mg/kg naloxone s.c. after 45 min; group 2 (MMF) 1.0 mg/kg midazolam, 0.05 mg/kg medetomidine and 0.02 mg/kg fentanyl i.m.; group 3 [xylazine/ketamine (X/K)] 2.0 mg/kg xylazine and 40.0 mg/kg ketamine i.m.; and group 4 [medetomidine/ketamine (M/K)] 0.06 mg/kg medetomidine and 5.0 mg/kg ketamine i.m. Reflexes were judged to determine anaesthetic stages and planes. Anaesthesia with X/K and M/K was associated with a prolonged surgical tolerance and recovery period. By reversing MMF, recovery period was significantly shortened (5 +/- 1.3 min versus 40 +/- 10.3 min in MMF without FAN, 73 +/- 15.0 min in X/K, and 31 +/- 8.5 min in M/K). Without reversal, MMF produced anaesthesia lasting 109 +/- 16.3 min. All combinations decreased respiratory and heart rate but compared with X/K and M/K, respiratory and cardiovascular complications were less in the MMF groups. Focussing on the clinical relevance of the tested combinations, completely reversible anaesthesia showed two major advantages: anaesthesia can be antagonized in case of emergency and routinely shortens recovery. In small animals particularly these advantages lead to less complications and discomfort and thus often can be lifesaving. As all analgesic components (medetomidine and fentanyl) are reversed, postoperative analgesia should be provided before reversal of anaesthesia.
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Affiliation(s)
- J Henke
- Institut für Experimentelle Onkologie und Therapieforschung, Arbeitsgruppe Experimentelle Chirurgie, München, Germany.
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