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Välimäki E, Leppänen H, Turunen H, Raekallio M, Honkavaara J. The impact of intravenous medetomidine and vatinoxan on echocardiographic evaluation of dogs with stage B1 mitral valve disease. J Vet Cardiol 2024; 54:7-17. [PMID: 38838577 DOI: 10.1016/j.jvc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION/OBJECTIVE The purpose of this study was to investigate the echocardiographic effects of intravenous medetomidine and vatinoxan in dogs with stage B1 mitral valve disease. We hypothesised medetomidine-vatinoxan would reduce the need for manual restraint during echocardiography without producing detrimental cardiovascular effects or echocardiographic changes. ANIMALS Twelve client-owned dogs with stage B1 mitral valve disease. METHODS A transthoracic echocardiographic examination was performed before and after sedation with intravenous medetomidine (10 μg/kg) and vatinoxan (200 μg/kg). Vital parameters were also recorded, and the level of sedation was assessed subjectively. The data were analysed with Student's t-tests with an alpha level of <0.05. RESULTS End-systolic volume and left ventricular systolic diameter increased (from 0.89 ± 0.19 mL/kg to 1.13 ± 0.29 mL/kg and 0.96 ± 0.12 cm to 1.10 ± 0.10 cm, respectively) and ejection fraction (from 66.33 ± 4.0% to 56.23 ± 9.54%) and fractional shortening (from 36.13 ± 5.42% to 27.24 ± 5.6%) decreased significantly after sedation. End diastolic volume, left ventricular diastolic diameter, and left atrial size remained statistically unchanged, while aortic (from 1.34 ± 0.2 m/s to 0.99 ± 0.14 m/s) and pulmonic (from 0.94 ± 0.16 m/s to 0.66 ± 0.15 m/s) velocities decreased significantly. No dogs had a mean arterial pressure below 65 mmHg. Sedation enabled echocardiographic examination without manual restraint. No adverse effects were observed with the dose studied. CONCLUSIONS Echocardiographic parameters were not completely comparable with the baseline values, which should be taken into consideration when evaluating dogs sedated with intravenous medetomidine-vatinoxan.
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Affiliation(s)
- E Välimäki
- Evidensia Animal Hospital Tammisto, Tammiston Kauppatie 29, 01510 Vantaa, Finland.
| | - H Leppänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Finland
| | - H Turunen
- Vetcare Ltd, Liedontie 45 (PL 26) 04601 Mäntsälä, Finland
| | - M Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Finland
| | - J Honkavaara
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Finland
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McKenzie SR, Chiavaccini L, Moura RA, Santoro D. Comparison between dexmedetomidine and a combination of medetomidine-vatinoxan on muscle tissue saturation in privately-owned adult dogs undergoing intradermal testing. Res Vet Sci 2024; 171:105207. [PMID: 38460204 DOI: 10.1016/j.rvsc.2024.105207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/02/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024]
Abstract
This double-blinded randomized cross-over study compared the muscle tissue oxygen saturation (StO2) measured at the sartorius muscle after intramuscular (IM) injection of dexmedetomidine hydrochloride (HCl) and co-administration of vatinoxan HCl, a peripheral α2-adrenoceptor antagonist, and medetomidine HCl in healthy privately-owned dogs undergoing intradermal testing (IDAT). After written owner consent, dogs received IM injections of either dexmedetomidine (0.5 mg/m2, DEX) or medetomidine (1 mg/m2) and vatinoxan (20 mg/m2) (MVX). Once sedated, intradermal injections were given on the lateral thorax of each dog, and the study was repeated with the alternative sedation on the opposite side one week later. At the end of the study, sedation was reversed with atipamezole (5 mg/m2). Depth of sedation, cardiopulmonary parameters, StO2, and rectal temperature were recorded and compared using mixed effect linear models (α ≤ 0.05). MVX achieved adequate sedation faster [median (interquartile range), 10 (8, 10) minutes] compared to DEX [18 (15, 22) minutes; hazard ratio = 7.44, p = 0.013), with higher scores at 10- and 15-min post-injection. StO2 was significantly reduced for 30 min after injection (p < 0.001), independently of the treatment (p = 0.68). Cardiopulmonary variables favored MVX. However, higher heart rate did not correlate with improved StO2. There was no difference in either subjective or objective assessment of the wheal size between sedations (p > 0.05). Both sedation protocols, MVX and DEX, were deemed suitable for IDAT in dogs, with mild reductions in StO2 measured at the sartorius muscle that were not significantly different between treatments.
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Affiliation(s)
- Stuart R McKenzie
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA.
| | - Raiane A Moura
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA
| | - Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA
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Honkavaara J, Grobelna A, Restitutti F, Kallio-Kujala I, Raekallio M, Spillmann T. Validity and Repeatability Characteristics of a Non-Invasive, Infrared-Based Method Estimating Plasma Indocyanine Green Decay in Healthy Dogs. Animals (Basel) 2023; 13:3455. [PMID: 38003073 PMCID: PMC10668645 DOI: 10.3390/ani13223455] [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: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Plasma clearance of indocyanine green (ICG-CL) is an invasive method to evaluate liver dysfunction. We aimed to investigate the practicality of a noninvasive, transcutaneous, infrared-based method estimating the disappearance rate of indocyanine green (ICG-PDR). In a randomized, cross-over study, both ICG-CL and ICG-PDR were determined in eight healthy dogs while conscious and when sedated with medetomidine and medetomidine-vatinoxan. ICG-PDR was further repeated in six of the dogs to assess its repeatability. Differences were tested with repeated-measures analysis of variance and post hoc t-tests with Bonferroni corrections, while associations were evaluated by both Spearman and Pearson correlation analyses. Furthermore, repeatability was assessed by examining calculated coefficients of variation (CV). A significant decrease in ICG-CL was observed in dogs sedated with medetomidine, while no difference between conscious and sedated states was detected with ICG-PDR. Overall, correlations between ICG-CL and ICG-PDR were poor, as was the intrasubject repeatability of ICG-PDR in conscious dogs with CV consistently above 20%. While some of the results may be explained by poor signal quality for the non-invasive method, we conclude that in healthy dogs ICG-PDR performed poorly.
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Affiliation(s)
- Juhana Honkavaara
- Faculty of Veterinary Medicine, University of Helsinki, FIN-00014 Helsinki, Finland (F.R.); (I.K.-K.); (M.R.); (T.S.)
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Joerger FB, Wieser ML, Steblaj B, Niemann L, Turunen H, Kutter AP. Evaluation of cardiovascular effects of intramuscular medetomidine and a medetomidine-vatinoxan combination in Beagle dogs: A randomized blinded crossover laboratory study. Vet Anaesth Analg 2023; 50:397-407. [PMID: 37481386 DOI: 10.1016/j.vaa.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/12/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To compare the cardiovascular effects of a combination of medetomidine and vatinoxan (MVX) versus medetomidine (MED) alone administered intramuscularly (IM) and to determine whether heart rate (HR) can be used as a surrogate for cardiac output (CO) after the use of medetomidine with or without vatinoxan. STUDY DESIGN A randomized, blinded, experimental, crossover study. ANIMALS A group of eight healthy Beagle dogs aged 4.6 (2.3-9.4) years and weighing 12.9 (9-14.7) kg, median (range). METHODS Each dog was injected with 1 mg m-2 medetomidine with or without 20 mg m-2 vatinoxan IM with a washout period of 7 days. Cardiovascular data and arterial and mixed venous blood gas samples were collected at baseline, 5, 10, 15, 20, 35, 45, 60, 90 and 120 minutes after treatment administration. CO was measured at all time points via thermodilution. Differences between treatments, period and sequence were evaluated with repeated measures analysis of covariance and the relationship between HR and CO was assessed with a repeated measures analysis of variance; p values < 0.05 were deemed significant. RESULTS The CO was 47-96% lower after MED than after MVX (p < 0.0001). Increases in systemic, pulmonary arterial and right atrial pressures and oxygen extraction ratio were significantly higher after MED than after MVX (all p < 0.0001). HR was significantly lower after MED and the linear relationship to CO was significant (p < 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE Overall, MED affected the cardiovascular system more negatively than MVX, and the difference in cardiovascular function between the treatments can be considered clinically relevant. HR was linearly related to CO, and decreases in HR reflected cardiac performance for dogs sedated with medetomidine with or without vatinoxan.
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Affiliation(s)
- Fabiola Binia Joerger
- Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland.
| | - Manuela L Wieser
- Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Barbara Steblaj
- Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Lisa Niemann
- Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | | | - Annette Pn Kutter
- Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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Effects of vatinoxan in dogs premedicated with medetomidine and butorphanol followed by sevoflurane anaesthesia: a randomized clinical study. Vet Anaesth Analg 2022; 49:563-571. [PMID: 36115767 DOI: 10.1016/j.vaa.2022.08.002] [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: 01/05/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate effects of vatinoxan in dogs, when administered as intravenous (IV) premedication with medetomidine and butorphanol before anaesthesia for surgical castration. STUDY DESIGN A randomized, controlled, blinded, clinical trial. ANIMALS A total of 28 client-owned dogs. METHODS Dogs were premedicated with medetomidine (0.125 mg m-2) and butorphanol (0.2 mg kg-1) (group MB; n = 14), or medetomidine (0.25 mg m-2), butorphanol (0.2 mg kg-1) and vatinoxan (5 mg m-2) (group MB-VATI; n = 14). Anaesthesia was induced 15 minutes later with propofol and maintained with sevoflurane in oxygen (targeting 1.3%). Before surgical incision, lidocaine (2 mg kg-1) was injected intratesticularly. At the end of the procedure, meloxicam (0.2 mg kg-1) was administered IV. The level of sedation, the qualities of induction, intubation and recovery, and Glasgow Composite Pain Scale short form (GCPS-SF) were assessed. Heart rate (HR), respiratory rate (fR), mean arterial pressure (MAP), end-tidal concentration of sevoflurane (Fe'Sevo) and carbon dioxide (Pe'CO2) were recorded. Blood samples were collected at 10 and 30 minutes after premedication for plasma medetomidine and butorphanol concentrations. RESULTS At the beginning of surgery, HR was 61 ± 16 and 93 ± 23 beats minute-1 (p = 0.001), and MAP was 78 ± 7 and 56 ± 7 mmHg (p = 0.001) in MB and MB-VATI groups, respectively. No differences were detected in fR, Pe'CO2, Fe'Sevo, the level of sedation, the qualities of induction, intubation and recovery, or in GCPS-SF. Plasma medetomidine concentrations were higher in group MB-VATI than in MB at 10 minutes (p = 0.002) and 30 minutes (p = 0.0001). Plasma butorphanol concentrations were not different between groups. CONCLUSIONS AND CLINICAL RELEVANCE In group MB, HR was significantly lower than in group MB-VATI. Hypotension detected in group MB-VATI during sevoflurane anaesthesia was clinically the most significant difference between groups.
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Niemann L, Kutter A, Joerger F, Wieser M, Hartnack S, Steblaj B. The impact of vatinoxan on microcirculation after intramuscular coadministration with medetomidine in Beagle dogs – a blinded cross-over study. Vet Anaesth Analg 2022; 49:336-343. [DOI: 10.1016/j.vaa.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/17/2021] [Accepted: 07/15/2021] [Indexed: 10/19/2022]
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Einwaller J, Meyer LCR, Auer U, Raekallio M, Nowack J, Haw A, Vetter S, Painer J, Stalder G. Cardiovascular effects of intravenous vatinoxan in wild boars (Sus scrofa) anaesthetised with intramuscular medetomidine-tiletamine-zolazepam. Vet Rec 2021; 190:e835. [PMID: 34472117 DOI: 10.1002/vetr.835] [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: 11/25/2020] [Revised: 05/18/2021] [Accepted: 07/29/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The potent sedative medetomidine is a commonly used adjunct for the immobilisation of non-domestic mammals. However, its use is associated with pronounced cardiovascular side effects, such as bradycardia, vasoconstriction and decreased cardiac output. We investigated the effects of the peripherally-acting alpha-2-adrenoceptor antagonist vatinoxan on cardiovascular properties in medetomidine-tiletamine-zolazepam anaesthetised wild boar (Sus scrofa). METHODS Twelve wild boars, anaesthetised twice with medetomidine (0.1 mg/kg) and tiletamine/zolazepam (2.5 mg/kg) IM in a randomised, crossover study, were administered (0.1 mg/kg) vatinoxan or an equivalent volume of saline IV (control). Cardiovascular variables, including heart rate (HR), mean arterial blood pressure (MAP), pulmonary artery pressure (PAP), pulmonary artery occlusion pressure (PAOP) and cardiac output (CO), were assessed 5 min prior to vatinoxan/saline administration until the end of anaesthesia 30 min later. RESULTS MAP (p < 0.0001), MPAP (p < 0.001) and MPAOP (p < 0.0001) significantly decreased from baseline after vatinoxan until the end of anaesthesia. HR increased significantly (p < 0.0001) from baseline after vatinoxan administration. However, the effect on HR subsided 3 min after vatinoxan. All variables remained constant after saline injection. There was no significant effect of vatinoxan or saline on CO. CONCLUSION Vatinoxan significantly reduced systemic and pulmonary artery hypertension, induced by medetomidine in wild boar.
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Affiliation(s)
- Joy Einwaller
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Leith C R Meyer
- Department of Paraclinical Sciences and Centre for Veterinary Wildlife Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Ulrike Auer
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Marja Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Julia Nowack
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria.,School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Anna Haw
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Sebastian Vetter
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Johanna Painer
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Gabrielle Stalder
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
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Huuskonen V, Restitutti F, Honkavaara JM, Raekallio MR, Männikkö S, Scheinin M, Vainio OM. Investigation of the effects of vatinoxan on somatic and visceral antinociceptive efficacy of medetomidine in dogs. Am J Vet Res 2020; 81:299-308. [PMID: 32228259 DOI: 10.2460/ajvr.81.4.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether concurrent vatinoxan administration affects the antinociceptive efficacy of medetomidine in dogs at doses that provide circulating dexmedetomidine concentrations similar to those produced by medetomidine alone. ANIMALS 8 healthy Beagles. PROCEDURES Dogs received 3 IV treatments in a randomized crossover-design trial with a 2-week washout period between experiments (medetomidine [20 μg/kg], medetomidine [20 μg/kg] and vatinoxan [400 μg/kg], and medetomidine [40 μg/kg] and vatinoxan [800 μg/kg]; M20, M20V400, and M40V800, respectively). Sedation, visceral and somatic nociception, and plasma drug concentrations were assessed. Somatic and visceral nociception measurements and sedation scores were compared among treatments and over time. Sedation, visceral antinociception, and somatic antinociception effects of M20V400 and M40V800 were analyzed for noninferiority to effects of M20, and plasma drug concentration data were assessed for equivalence between treatments. RESULTS Plasma dexmedetomidine concentrations after administration of M20 and M40V800 were equivalent. Sedation scores, visceral nociception measurements, and somatic nociception measurements did not differ significantly among treatments within time points. Overall sedative effects of M20V400 and M40V800 and visceral antinociceptive effects of M40V800 were noninferior to those produced by M20. Somatic antinociception effects of M20V400 at 10 minutes and M40V800 at 10 and 55 minutes after injection were noninferior to those produced by M20. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested coadministration with vatinoxan did not substantially diminish visceral antinociceptive effects of medetomidine when plasma dexmedetomidine concentrations were equivalent to those produced by medetomidine alone. For somatic antinociception, noninferiority of treatments was detected at some time points.
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Effects of intramuscular vatinoxan (MK-467), co-administered with medetomidine and butorphanol, on cardiopulmonary and anaesthetic effects of intravenous ketamine in dogs. Vet Anaesth Analg 2020; 47:604-613. [PMID: 32682664 DOI: 10.1016/j.vaa.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the impact of intramuscular (IM) co-administration of the peripheral α2-adrenoceptor agonist vatinoxan (MK-467) with medetomidine and butorphanol prior to intravenous (IV) ketamine on the cardiopulmonary and anaesthetic effects in dogs, followed by atipamezole reversal. STUDY DESIGN Randomized, masked crossover study. ANIMALS A total of eight purpose-bred Beagle dogs aged 3 years. METHODS Each dog was instrumented and administered two treatments 2 weeks apart: medetomidine (20 μg kg-1) and butorphanol (100 μg kg-1) premedication with vatinoxan (500 μg kg-1; treatment MVB) or without vatinoxan (treatment MB) IM 20 minutes before IV ketamine (4 mg kg-1). Atipamezole (100 μg kg-1) was administered IM 60 minutes after ketamine. Heart rate (HR), mean arterial (MAP) and central venous (CVP) pressures and cardiac output (CO) were measured; cardiac (CI) and systemic vascular resistance (SVRI) indices were calculated before and 10 minutes after MVB or MB, and 10, 25, 40, 55, 70 and 100 minutes after ketamine. Data were analysed with repeated measures analysis of covariance models. A p-value <0.05 was considered statistically significant. Sedation, induction, intubation and recovery scores were assessed. RESULTS At most time points, HR and CI were significantly higher, and SVRI and CVP significantly lower with MVB than with MB. With both treatments, SVRI and MAP decreased after ketamine, whereas HR and CI increased. MAP was significantly lower with MVB than with MB; mild hypotension (57-59 mmHg) was recorded in two dogs with MVB prior to atipamezole administration. Sedation, induction, intubation and recovery scores were not different between treatments, but intolerance to the endotracheal tube was observed earlier with MVB. CONCLUSIONS AND CLINICAL RELEVANCE Haemodynamic performance was improved by vatinoxan co-administration with medetomidine-butorphanol, before and after ketamine administration. However, vatinoxan was associated with mild hypotension after ketamine with the dose used in this study. Vatinoxan shortened the duration of anaesthesia.
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Turunen H, Raekallio MR, Honkavaara JM, Restitutti F, Kallio-Kujala IJ, Adam M, Nevanperä K, Scheinin M, Männikkö SK, Hautajärvi HJ, Larenza Menzies P, Vainio OM. Cardiovascular and sedation reversal effects of intramuscular administration of atipamezole in dogs treated with medetomidine hydrochloride with or without the peripheral α 2-adrenoceptor antagonist vatinoxan hydrochloride. Am J Vet Res 2019; 80:912-922. [PMID: 31556714 DOI: 10.2460/ajvr.80.10.912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the cardiovascular and sedation reversal effects of IM administration of atipamezole (AA) in dogs treated with medetomidine hydrochloride (MED) or MED and vatinoxan (MK-467). ANIMALS 8 purpose-bred, 2-year-old Beagles. PROCEDURES A randomized, blinded, crossover study was performed in which each dog received 2 IM treatments at a ≥ 2-week interval as follows: injection of MED (20 μg/kg) or MED mixed with 400 μg of vatinoxan/kg (MEDVAT) 30 minutes before AA (100 μg/kg). Sedation score, heart rate, mean arterial and central venous blood pressures, and cardiac output were recorded before and at various time points (up to 90 minutes) after AA. Cardiac and systemic vascular resistance indices were calculated. Venous blood samples were collected at intervals until 210 minutes after AA for drug concentration analysis. RESULTS Heart rate following MED administration was lower, compared with findings after MEDVAT administration, prior to and at ≥ 10 minutes after AA. Mean arterial blood pressure was lower with MEDVAT than with MED at 5 minutes after AA, when its nadir was detected. Overall, cardiac index was higher and systemic vascular resistance index lower, indicating better cardiovascular function, in MEDVAT-atipamezole-treated dogs. Plasma dexmedetomidine concentrations were lower and recoveries from sedation were faster and more complete after MEDVAT treatment with AA than after MED treatment with AA. CONCLUSIONS AND CLINICAL RELEVANCE Atipamezole failed to restore heart rate and cardiac index in medetomidine-sedated dogs, and relapses into sedation were observed. Coadministration of vatinoxan with MED helped to maintain hemodynamic function and hastened the recovery from sedation after AA in dogs.
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Valverde A, Skelding AM. Alternatives to Opioid Analgesia in Small Animal Anesthesia: Alpha-2 Agonists. Vet Clin North Am Small Anim Pract 2019; 49:1013-1027. [PMID: 31481257 DOI: 10.1016/j.cvsm.2019.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Alpha-2 agonists have potent analgesic effects, in addition to their sedative actions. Alpha-2 agonists provide analgesia through any of several routes of administration, including parenteral, oral, epidural or intrathecal and intraarticular, because of spinal and supraspinal actions. Systemic doses are short acting, whereas local administration at the site of action result in longer analgesic effects. The potent cardiovascular and respiratory effects of alpha-2 agonists should be considered when used as analgesics.
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Affiliation(s)
- Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Alicia M Skelding
- Toronto Animal Health Partners Emergency and Specialty Hospital, Toronto, Ontario M3B 2R2, Canada
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Honkavaara JM, Raekallio MR, Syrja PM, Pypendop BH, Knych HK, Kallio-Kujala IJ, Vainio OM. Concentrations of medetomidine enantiomers and vatinoxan, an α 2-adrenoceptor antagonist, in plasma and central nervous tissue after intravenous coadministration in dogs. Vet Anaesth Analg 2019; 47:47-52. [PMID: 31761600 DOI: 10.1016/j.vaa.2019.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/19/2019] [Accepted: 07/27/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To quantify the peripheral selectivity of vatinoxan (L-659,066, MK-467) in dogs by comparing the concentrations of vatinoxan, dexmedetomidine and levomedetomidine in plasma and central nervous system (CNS) tissue after intravenous (IV) coadministration of vatinoxan and medetomidine. STUDY DESIGN Experimental, observational study. ANIMALS A group of six healthy, purpose-bred Beagle dogs (four females and two males) aged 6.5 ± 0.1 years (mean ± standard deviation). METHODS All dogs were administered a combination of medetomidine (40 μg kg-1) and vatinoxan (800 μg kg-1) as IV bolus. After 20 minutes, the dogs were euthanized with an IV overdose of pentobarbital (140 mg kg-1) and both venous plasma and CNS tissues (brain, cervical and lumbar spinal cord) were harvested. Concentrations of dexmedetomidine, levomedetomidine and vatinoxan in all samples were quantified by liquid chromatography-tandem mass spectrometry and data were analyzed with nonparametric tests with post hoc corrections where appropriate. RESULTS All dogs became deeply sedated after the treatment. The CNS-to-plasma ratio of vatinoxan concentration was approximately 1:50, whereas the concentrations of dexmedetomidine and levomedetomidine in the CNS were three- to seven-fold of those in plasma. CONCLUSIONS AND CLINICAL RELEVANCE With the doses studied, these results confirm the peripheral selectivity of vatinoxan in dogs, when coadministered IV with medetomidine. Thus, it is likely that vatinoxan preferentially antagonizes α2-adrenoceptors outside the CNS.
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Affiliation(s)
- Juhana M Honkavaara
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
| | - Marja R Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Pernilla M Syrja
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Bruno H Pypendop
- Department of Radiological and Surgical Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Heather K Knych
- Kenneth L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Ira J Kallio-Kujala
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Outi M Vainio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Kallio-Kujala I, Bennett R, Raekallio M, Yatkin E, Meierjohann A, Savontaus E, Scheinin M, Spillmann T, Vainio O. Effects of dexmedetomidine and MK-467 on plasma glucose, insulin and glucagon in a glibenclamide-induced canine hypoglycaemia model. Vet J 2018; 242:33-38. [DOI: 10.1016/j.tvjl.2018.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 07/02/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
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Peripherally acting α-adrenoceptor antagonist MK-467 with intramuscular medetomidine and butorphanol in dogs: A prospective, randomised, clinical trial. Vet J 2018; 240:22-26. [DOI: 10.1016/j.tvjl.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/28/2018] [Accepted: 08/12/2018] [Indexed: 11/21/2022]
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15
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Peripheral α 2 -adrenoceptor antagonism affects the absorption of intramuscularly coadministered drugs. Vet Anaesth Analg 2018; 45:405-413. [DOI: 10.1016/j.vaa.2018.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/18/2017] [Accepted: 01/20/2018] [Indexed: 12/14/2022]
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16
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Salla KM, Tuns CI, Bennett RC, Raekallio MR, Scheinin M, Kuusela E, Vainio OM. Cardiovascular effects of premedication with medetomidine alone and in combination with MK-467 or glycopyrrolate in dogs subsequently anesthetized with isoflurane. Am J Vet Res 2018; 78:1245-1254. [PMID: 29076369 DOI: 10.2460/ajvr.78.11.1245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare cardiovascular effects of premedication with medetomidine alone and with each of 3 doses of MK-467 or after glycopyrrolate in dogs subsequently anesthetized with isoflurane. ANIMALS 8 healthy purpose-bred 5-year-old Beagles. PROCEDURES In a randomized crossover study, each dog received 5 premedication protocols (medetomidine [10 μg/kg, IV] alone [MED] and in combination with MK-467 at doses of 50 [MMK50], 100 [MMK100], and 150 [MMK150] μg/kg and 15 minutes after glycopyrrolate [10 μg/kg, SC; MGP]), with at least 14 days between treatments. Twenty minutes after medetomidine administration, anesthesia was induced with ketamine (0.5 mg/kg, IV) and midazolam (0.1 mg/kg, IV) increments given to effect and maintained with isoflurane (1.2%) for 50 minutes. Cardiovascular variables were recorded, and blood samples for determination of plasma dexmedetomidine, levomedetomidine, and MK-467 concentrations were collected at predetermined times. Variables were compared among the 5 treatments. RESULTS The mean arterial pressure and systemic vascular resistance index increased following the MED treatment, and those increases were augmented and obtunded following the MGP and MMK150 treatments, respectively. Mean cardiac index for the MMK100 and MMK150 treatments was significantly greater than that for the MGP treatment. The area under the time-concentration curve to the last sampling point for dexmedetomidine for the MMK150 treatment was significantly lower than that for the MED treatment. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated concurrent administration of MK-467 with medetomidine alleviated medetomidine-induced hemodynamic changes in a dose-dependent manner prior to isoflurane anesthesia. Following MK-467 administration to healthy dogs, mean arterial pressure was sustained at acceptable levels during isoflurane anesthesia.
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Adam M, Raekallio MR, Keskitalo T, Honkavaara JM, Scheinin M, Kajula M, Mölsä S, Vainio OM. The impact of MK-467 on plasma drug concentrations, sedation and cardiopulmonary changes in sheep treated with intramuscular medetomidine and atipamezole for reversal. J Vet Pharmacol Ther 2018; 41:447-456. [DOI: 10.1111/jvp.12486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. Adam
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
- Pharmacology Department; Faculty of Veterinary Medicine; Beni-Suef University; Beni-Suef Egypt
| | - M. R. Raekallio
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
| | - T. Keskitalo
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
| | - J. M. Honkavaara
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
| | - M. Scheinin
- Department of Pharmacology; Drug Development and Therapeutics; University of Turku; Turku Finland
- Unit of Clinical Pharmacology; Turku University Hospital; Turku Finland
| | | | - S. Mölsä
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
| | - O. M. Vainio
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
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Siao KT, Pypendop BH, Honkavaara J, Ilkiw JE. Hemodynamic effects of dexmedetomidine, with and without MK-467, following intramuscular administration in cats anesthetized with isoflurane. Vet Anaesth Analg 2017; 44:1101-1115. [DOI: 10.1016/j.vaa.2017.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 12/16/2022]
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19
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Bennett RC, Salla KM, Raekallio MR, Scheinin M, Vainio OM. Effects of the α2-adrenoceptor agonist medetomidine on the distribution and clearance of alfaxalone during coadministration by constant rate infusion in dogs. Am J Vet Res 2017; 78:956-964. [DOI: 10.2460/ajvr.78.8.956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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The impact of MK-467 on sedation, heart rate and arterial blood pressure after intramuscular coadministration with dexmedetomidine in conscious cats. Vet Anaesth Analg 2017; 44:811-822. [DOI: 10.1016/j.vaa.2016.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/30/2016] [Accepted: 08/24/2016] [Indexed: 12/28/2022]
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21
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Plasma concentration and cardiovascular effects of intramuscular medetomidine combined with three doses of the peripheral alpha2-antagonist MK-467 in dogs. Vet Anaesth Analg 2017; 44:417-426. [DOI: 10.1016/j.vaa.2016.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/21/2016] [Accepted: 04/08/2016] [Indexed: 11/18/2022]
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22
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Honkavaara J, Pypendop B, Turunen H, Ilkiw J. The effect of MK-467, a peripheral α2-adrenoceptor antagonist, on dexmedetomidine-induced sedation and bradycardia after intravenous administration in conscious cats. Vet Anaesth Analg 2017; 44:42-51. [DOI: 10.1111/vaa.12385] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/15/2016] [Indexed: 12/16/2022]
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23
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de Vries A, Pakkanen SAE, Raekallio MR, Ekiri A, Scheinin M, Taylor PM, Vainio OM. Clinical effects and pharmacokinetic variables of romifidine and the peripheral α 2 ‐adrenoceptor antagonist MK‐467 in horses. Vet Anaesth Analg 2016; 43:599-610. [DOI: 10.1111/vaa.12354] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
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24
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Pypendop BH, Honkavaara J, Ilkiw JE. Pharmacokinetics of dexmedetomidine, MK-467, and their combination following intravenous administration in male cats. J Vet Pharmacol Ther 2016; 39:460-8. [DOI: 10.1111/jvp.12302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/29/2016] [Indexed: 01/11/2023]
Affiliation(s)
- B. H. Pypendop
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis CA USA
| | - J. Honkavaara
- Department of Equine and Small Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Helsinki Finland
| | - J. E. Ilkiw
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis CA USA
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25
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Bennett RC, Hokkanen J, Raekallio MR, Vainio OM. The impact of medetomidine on the protein-binding characteristics of MK-467 in canine plasma. J Vet Pharmacol Ther 2016; 39:405-7. [PMID: 26763140 DOI: 10.1111/jvp.12291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
This study determined the unbound fraction of the peripheral α2 -adrenoceptor antagonist MK-467 alone and combined with medetomidine. MK-467 (0.1, 1 and 10 μm) was incubated in canine plasma with and without medetomidine (molar ratio 20:1), with human serum albumin (HSA) and with α1-acid glycoprotein (AGP). Rapid equilibrium dialysis was used for the measurement of protein binding. All samples were analysed by liquid chromatography and tandem mass spectrometry to obtain the unbound fraction (fu ) of MK-467. Unbound fractions (fu ) of MK-467 in canine plasma (mean ± standard deviation) were 27.6 ± 3.5%, 26.6 ± 0.9% and 42.4 ± 1.2% at 0.1, 1.0 and 10 μm concentrations, respectively. In the presence of medetomidine, fu were 27.5 ± 0.4%, 26.6 ± 0.9% and 41.0 ± 2.4%. The fu of MK-467 in HSA were 50.1 ± 2.5% at 0.1 μm, 49.4 ± 1.2% at 1.0 μm and 56.7 ± 0.5% at 10 μm. fu of MK-467 in AGP was 56.3 ± 3.7% at 0.1 μm, 54.6 ± 5.6% at 1.0 μm and 65.3 ± 0.4% at 10 μm. Protein binding of MK-467 was approximately 70% between 0.1 and 1.0 μm. Medetomidine had no apparent effect on the protein binding of MK-467.
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Affiliation(s)
- R C Bennett
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki, Finland.,University Veterinary Hospital, University College Dublin, Dublin, Ireland
| | | | - M R Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki, Finland
| | - O M Vainio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki, Finland
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26
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Bennett RC, Salla KM, Raekallio MR, Hänninen L, Rinne VM, Scheinin M, Vainio OM. Effects of MK-467 on the antinociceptive and sedative actions and pharmacokinetics of medetomidine in dogs. J Vet Pharmacol Ther 2016; 39:336-43. [DOI: 10.1111/jvp.12292] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- R. C. Bennett
- University Veterinary Hospital; UCD; Dublin Ireland
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
| | - K. M. Salla
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
| | - M. R. Raekallio
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
| | - L. Hänninen
- Department of Production Animal Medicine; University of Helsinki; Helsinki Finland
| | - V. M. Rinne
- Department of Pharmacology; Drug Development and Therapeutics; University of Turku and Unit of Clinical Pharmacology; Turku University Hospital; Turku Finland
| | - M. Scheinin
- Department of Pharmacology; Drug Development and Therapeutics; University of Turku and Unit of Clinical Pharmacology; Turku University Hospital; Turku Finland
| | - O. M. Vainio
- Department of Equine and Small Animal Medicine; University of Helsinki; Helsinki Finland
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27
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Pakkanen SA, Raekallio MR, Mykkänen AK, Salla KM, de Vries A, Vuorilehto L, Scheinin M, Vainio OM. Detomidine and the combination of detomidine and MK-467, a peripheral alpha-2 adrenoceptor antagonist, as premedication in horses anaesthetized with isoflurane. Vet Anaesth Analg 2014; 42:527-36. [PMID: 25529045 DOI: 10.1111/vaa.12238] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/09/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate MK-467 as part of premedication in horses anaesthetized with isoflurane. STUDY DESIGN Experimental, crossover study with a 14 day wash-out period. ANIMALS Seven healthy horses. METHODS The horses received either detomidine (20 μg kg(-1) IV) and butorphanol (20 μg kg(-1) IV) alone (DET) or with MK-467 (200 μg kg(-1) IV; DET + MK) as premedication. Anaesthesia was induced with ketamine (2.2 mg kg(-1) ) and midazolam (0.06 mg kg(-1) ) IV and maintained with isoflurane. Heart rate (HR), mean arterial pressure (MAP), end-tidal isoflurane concentration, end-tidal carbon dioxide tension, central venous pressure, fraction of inspired oxygen (FiO2 ) and cardiac output were recorded. Blood samples were taken for blood gas analysis and to determine plasma drug concentrations. The cardiac index (CI), systemic vascular resistance (SVR), ratio of arterial oxygen tension to inspired oxygen (Pa O2 /FiO2 ) and tissue oxygen delivery (DO2 ) were calculated. Repeated measures anova was applied for HR, CI, MAP, SVR, lactate and blood gas variables. The Student's t-test was used for pairwise comparisons of drug concentrations, induction times and the amount of dobutamine administered. Significance was set at p < 0.05. RESULTS The induction time was shorter, reduction in MAP was detected, more dobutamine was given and HR and CI were higher after DET+MK, while SVR was higher with DET. Arterial oxygen tension and Pa O2 /FiO2 (40 minutes after induction), DO2 and venous partial pressure of oxygen (40 and 60 minutes after induction) were higher with DET+MK. Plasma detomidine concentrations were reduced in the group receiving MK-467. After DET+MK, the area under the plasma concentration time curve of butorphanol was smaller. CONCLUSIONS AND CLINICAL RELEVANCE MK-467 enhances cardiac function and tissue oxygen delivery in horses sedated with detomidine before isoflurane anaesthesia. This finding could improve patient safety in the perioperative period. The dosage of MK-467 needs to be investigated to minimise the effect of MK-467 on MAP.
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Affiliation(s)
- Soile Ae Pakkanen
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - Marja R Raekallio
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - Anna K Mykkänen
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - Kati M Salla
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | | | - Lauri Vuorilehto
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Mika Scheinin
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Outi M Vainio
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
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28
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Kaartinen J, del Castillo JRE, Salla K, Troncy E, Raekallio MR, Vainio OM. Haemodynamic interactions of medetomidine and the peripheral alpha-2 antagonist MK-467 during step infusions in isoflurane-anaesthetised dogs. Vet J 2014; 202:353-60. [PMID: 25201249 DOI: 10.1016/j.tvjl.2014.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022]
Abstract
The haemodynamic interactions of a step infusion with medetomidine (MED) and the peripherally acting alpha-2 antagonist MK-467 (MK) were compared with MED infused alone in isoflurane-anaesthetised dogs. Eight purposely-bred Beagles were used in a randomised crossover study. Anaesthesia was induced with propofol intravenously (IV) and maintained with isoflurane in oxygen. Dogs received 1.25 µg/kg MED as a 1 min loading dose IV, along with a step-down MED infusion at rates of 8.0 µg/kg/h (step 1: 0-20 min), 5.5 µg/kg/h (step 2: 20-40 min) and 4.0 µg/kg/h (step 3: 40-95 min). Five minutes after starting the MED infusion, the dogs received MK-467 in a step-up infusion at rates of 100 µg/kg/h (step 1: 5-35 min), 200 µg/kg/h (step 2: 35-65 min) and 500 µg/kg/h (step 3: 65-95 min). Heart rate (HR), systolic (SAP) and mean arterial (MAP) blood pressures and arteriovenous oxygen content differences (a-vO2 diff) were calculated. Plasma drug concentrations were analysed. Repeated-measures general linear mixed models with Bonferroni correction were used for statistical analyses. MED infusion alone increased SAP maximally by 24.9%, MAP by 34.7% and a-vO2 diff by 222.5%, and reduced HR by 32.3%, but these changes were significantly attenuated by MK-467. Most MED effects returned to baseline during step 2 of MK-467 infusion and step 3 of MED infusion (MED/MK-467 ratio 1:18 to 1:50). Plasma concentrations of MED tended to be lower with the addition of MK-467. The use of step infusions helped to narrow down the therapeutic range for the MED/MK-467 infusion dose ratio during isoflurane anaesthesia in dogs.
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Affiliation(s)
- Johanna Kaartinen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Finland.
| | - Jérôme R E del Castillo
- GREPAQ, Department of Veterinary Biomedical Sciences, Université de Montréal, St. Hyacinthe, Quebec, Canada
| | - Kati Salla
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Finland
| | - Eric Troncy
- GREPAQ, Department of Veterinary Biomedical Sciences, Université de Montréal, St. Hyacinthe, Quebec, Canada
| | - Marja R Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Finland
| | - Outi M Vainio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Finland
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29
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Salla K, Restitutti F, Vainionpää M, Junnila J, Honkavaara J, Kuusela E, Raekallio M, Vainio O. The cardiopulmonary effects of a peripheral alpha-2-adrenoceptor antagonist, MK-467, in dogs sedated with a combination of medetomidine and butorphanol. Vet Anaesth Analg 2014; 41:567-74. [PMID: 24674053 DOI: 10.1111/vaa.12158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/23/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the cardiopulmonary effects of intravenous (IV) and intramuscular (IM) medetomidine and butorphanol with or without MK-467. STUDY DESIGN Prospective, randomized experimental cross-over. ANIMALS Eight purpose-bred beagles (two females, six males), 3-4 years old and weighing 14.5 ±1.6 kg (mean ± SD). METHODS All dogs received four different treatments as follows: medetomidine 20 μg kg(-1) and butorphanol tartrate 0.1 mg kg(-1) IV and IM (MB), and MB combined with MK-467,500 μg kg(-1) (MBMK) IV and IM. Heart rate (HR), arterial blood pressures (SAP, MAP, DAP), central venous pressure (CVP), cardiac output, respiratory rate (fR ), rectal temperature (RT) were measured and arterial blood samples were obtained for gas analysis at baseline and at 3, 10, 20, 30, 45 and 60 minutes after drug administration. The cardiac index (CI), systemic vascular resistance index (SVRI) and oxygen delivery index (DO2 I) were calculated. After the follow-up period atipamezole 50 μg kg(-1) IM was given to reverse sedation. RESULTS HR, CI and DO2 I were significantly higher with MBMK after both IV and IM administration. Similarly, SAP, MAP, DAP, CVP, SVRI and RT were significantly lower after MBMK than with MB. There were no differences in fR between treatments, but arterial partial pressure of oxygen decreased transiently after all treatments. Recoveries were uneventful following atipamezole administration after all treatments. CONCLUSIONS AND CLINICAL RELEVANCE MK-467 attenuated the cardiovascular effects of a medetomidine-butorphanol combination after IV and IM administration.
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Affiliation(s)
- Kati Salla
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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30
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Salla K, Bennett RC, Restitutti F, Junnila J, Raekallio M, Vainio O. A comparison in dogs of medetomidine, with or without MK-467, and the combination acepromazine-butorphanol as premedication prior to anaesthesia induced by propofol and maintained with isoflurane. Vet Anaesth Analg 2014; 41:163-73. [DOI: 10.1111/vaa.12094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/13/2013] [Indexed: 12/12/2022]
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Restitutti F, Laitinen MR, Raekallio MR, Vainionpää M, O’Brien RT, Kuusela E, Vainio OM. Effect of MK‐467 on organ blood flow parameters detected by contrast‐enhanced ultrasound in dogs treated with dexmedetomidine. Vet Anaesth Analg 2013; 40:e48-56. [DOI: 10.1111/vaa.12058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
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32
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Vainionpää MH, Raekallio MR, Pakkanen SAE, Ranta-Panula V, Rinne VM, Scheinin M, Vainio OM. Plasma drug concentrations and clinical effects of a peripheral alpha-2-adrenoceptor antagonist, MK-467, in horses sedated with detomidine. Vet Anaesth Analg 2013; 40:257-64. [DOI: 10.1111/vaa.12012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/13/2012] [Indexed: 12/12/2022]
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Vainionpää M, Salla K, Restitutti F, Raekallio M, Junnila J, Snellman M, Vainio O. Thermographic imaging of superficial temperature in dogs sedated with medetomidine and butorphanol with and without MK-467 (L-659’066). Vet Anaesth Analg 2013; 40:142-8. [DOI: 10.1111/j.1467-2995.2012.00768.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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34
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Rolfe NG, Kerr CL, McDonell WN. Cardiopulmonary and sedative effects of the peripheral α2-adrenoceptor antagonist MK 0467 administered intravenously or intramuscularly concurrently with medetomidine in dogs. Am J Vet Res 2012; 73:587-94. [DOI: 10.2460/ajvr.73.5.587] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Restitutti F, Raekallio M, Vainionpää M, Kuusela E, Vainio O. Plasma glucose, insulin, free fatty acids, lactate and cortisol concentrations in dexmedetomidine-sedated dogs with or without MK-467: a peripheral α-2 adrenoceptor antagonist. Vet J 2012; 193:481-5. [PMID: 22277719 DOI: 10.1016/j.tvjl.2011.12.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 11/29/2022]
Abstract
Six healthy laboratory Beagles were treated IV with 10 μg/kg dexmedetomidine (DEX) or 10 μg/kg dexmedetomidine combined with 500 μg/kg MK-467 in the same syringe (DMK) in a randomised cross-over design with a 14 day washout. Blood was collected immediately before treatment and 35, 60 and 120 min post-injection through a central venous catheter. The plasma concentrations of glucose, insulin, non-esterified free fatty acids (NEFAs), lactate and cortisol were determined. A repeated-measures ANOVA test was used to compare treatments and effects for each sample time point. Significant differences between treatments were found for plasma glucose (P=0.037) and insulin (P=0.009). DEX significantly increased plasma glucose at 120 min, but reduced plasma insulin at 35 and 60 min. NEFA decreased for both treatments at 35 min. This reduction was transient for DMK, whereas it persisted during the follow up period for DEX. Plasma lactate concentrations increased at 35 and 60 min with DEX. Neither treatment altered plasma cortisol concentrations. The addition of MK-467 to dexmedetomidine prevented or abolished most metabolic changes in healthy Beagles.
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Affiliation(s)
- F Restitutti
- Veterinary Pharmacology and Toxicology, Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Koetilantie 7, PO Box 57, FI-00014 Helsinki, Finland.
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Honkavaara J, Restitutti F, Raekallio M, Salla K, Kuusela E, Ranta-Panula V, Rinne V, Vainio O, Scheinin M. Influence of MK-467, a Peripherally Acting α2-Adrenoceptor Antagonist on the Disposition of Intravenous Dexmedetomidine in Dogs. Drug Metab Dispos 2011; 40:445-9. [DOI: 10.1124/dmd.111.042671] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Alef M. [α2-agonists in veterinary medicine]. PHARMAZIE IN UNSERER ZEIT 2011; 40:489-495. [PMID: 22028134 DOI: 10.1002/pauz.201100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Michaele Alef
- Klinik für Kleintiere, Veterinärmedizinische Fakultät der Universität Leipzig, Leipzig.
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Musk GC, Netto JD, Maker GL, Trengove RD. Transplacental transfer of medetomidine and ketamine in pregnant ewes. Lab Anim 2011; 46:46-50. [PMID: 22008849 DOI: 10.1258/la.2011.010179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The extent of placental transfer of medetomidine and ketamine is unknown in pregnant ewes. Date-mated singleton (n = 8) and twin (n = 8) pregnant merino cross ewes were anaesthetized for Caesarean delivery of preterm lamb fetuses. A combination of medetomidine (20 μg/kg) and ketamine (10 mg/kg) was administered by intravenous injection and surgery performed immediately thereafter. Blood samples were collected from the ewe at one, five and 10 min after intravenous injection and from the umbilical vein of the fetus at delivery. Non-pregnant ewes were also anaesthetized (n = 8). There was no difference in the plasma concentration of medetomidine or ketamine when comparing singleton and twin ewes or pregnant and non-pregnant ewes for the short duration of the study. Fetal plasma concentrations of each drug were comparable to the maternal concentrations at the same time. We conclude that both drugs cross the placenta readily and provide anaesthesia and analgesia for the fetus when it is delivered.
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Affiliation(s)
- G C Musk
- School of Veterinary and Biomedical Sciences, Murdoch University, Western Australia 6150, Australia.
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Xylazine-/diazepam-ketamine and isoflurane differentially affect hemodynamics and organ injury under hemorrhagic/traumatic shock and resuscitation in rats. Shock 2011; 35:573-8. [PMID: 21330949 DOI: 10.1097/shk.0b013e318212266b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most experimental studies on hemorrhage and trauma are performed under anesthesia. We determined the effects of three commonly used anesthetic regimens on hemodynamics and organ damage under normal and hemorrhagic/traumatic shock (HTS) conditions in rats. Animals were anesthetized with ketamine/diazepam (K/D), ketamine/xylazine (K/X), or isoflurane (ISO). Hemorrhagic/traumatic shock was induced by a midline laparotomy, bleeding to a mean arterial pressure of 30 to 35 mmHg until decompensation, followed by restrictive and adequate phases of resuscitation. The experiment was terminated 120 min after the completion of resuscitation. Under normal conditions, K/D anesthesia resulted in higher mean arterial pressure and heart rate than K/X and higher systemic vascular resistance index (SVRI) than ISO. Stroke volume was significantly lower in K/D group than in K/X and ISO groups. Under normal conditions, ISO anesthesia was accompanied by the highest cardiac index. During shock and resuscitation, heart rate remained higher in the K/D than K/X. During shock, SVRI decreased in the K/D group but increased in K/X and ISO groups. After resuscitation, SVRI was lower, and cardiac index was higher in the ISO group than in the K/D group. Despite higher shed blood volume, the rats anesthetized with ISO did not decompensate within the time frame compared with other groups. Cellular damage (plasma creatine kinase, lactate dehydrogenase, uric acid) was more pronounced with K/D compared with ISO. Histological examinations revealed frequent HTS-induced damage to adrenals, kidney, and liver of animals anesthetized with K/D and K/X but not with ISO. Anesthetics differentially affect HTS-induced hemodynamic alterations and organ injury. Thus, when interpreting data from HTS models, the individual effect of anesthetics should be considered.
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Restitutti F, Honkavaara JM, Raekallio MR, Kuusela EK, Vainio OM. Effects of different doses of L-659’066 on the bispectral index and clinical sedation in dogs treated with dexmedetomidine. Vet Anaesth Analg 2011; 38:415-22. [DOI: 10.1111/j.1467-2995.2011.00630.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Honkavaara JM, Restitutti F, Raekallio MR, Kuusela EK, Vainio OM. The effects of increasing doses of MK-467, a peripheral alpha(2)-adrenergic receptor antagonist, on the cardiopulmonary effects of intravenous dexmedetomidine in conscious dogs. J Vet Pharmacol Ther 2010; 34:332-7. [PMID: 20969603 DOI: 10.1111/j.1365-2885.2010.01242.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Different doses of MK-467, a peripheral alpha(2)-adrenergic receptor antagonist, with or without dexmedetomidine were compared in conscious dogs. Eight animals received either dexmedetomidine (10 μg/kg [D]), MK-467 (250 μg/kg [M250] or dexmedetomidine (10 μg/kg) with increasing doses of MK-467 (250 μg/kg [DM250], 500 μg/kg [DM500] and 750 μg/kg [DM750], respectively). Treatments were given intravenously (i.v.) in a randomized, crossover design with a 14-day washout period. Systemic hemodynamics and arterial blood gas analyses were recorded at baseline and at intervals up to 90 min after drugs administration. Dexmedetomidine alone decreased heart rate, cardiac index and tissue oxygen delivery and increased mean arterial pressure and systemic vascular resistance 5 min after administration. DM250 did not completely prevent these early effects, while DM750 induced a decrease in mean arterial pressure. With DM500, systemic hemodynamics remained stable throughout the observational period. MK-467 alone increased cardiac index and tissue oxygen delivery and had no deleterious adverse effects. No differences in arterial blood gases were observed between treatments that included dexmedetomidine. It was concluded that MK-467 attenuated or prevented dexmedetomidine's systemic hemodynamic effects in a dose-dependent manner when given simultaneously i.v. but had no effect on the pulmonary outcome in conscious dogs. A 50:1 dose ratio (MK-467:dexmedetomidine) induced the least alterations in cardiovascular function.
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Affiliation(s)
- J M Honkavaara
- Department of Equine and Small Animal Medicine, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
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RAEKALLIO MR, HONKAVAARA JM, VAINIO OM. The effects of L-659,066, a peripheral α2-adrenoceptor antagonist, and verapamil on the cardiovascular influences of dexmedetomidine in conscious sheep. J Vet Pharmacol Ther 2010; 33:434-8. [DOI: 10.1111/j.1365-2885.2009.01156.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marcilla MG, Schauvliege S, Duchateau L, Gasthuys F. Cardiopulmonary effects of two constant rate infusions of dexmedetomidine in isoflurane anaesthetized ponies. Vet Anaesth Analg 2010; 37:311-21. [DOI: 10.1111/j.1467-2995.2010.00537.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Carter JE, Campbell NB, Posner LP, Swanson C. The hemodynamic effects of medetomidine continuous rate infusions in the dog. Vet Anaesth Analg 2010; 37:197-206. [DOI: 10.1111/j.1467-2995.2009.00522.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Fayyaz S, Kerr CL, Dyson DH, Mirakhur KK. The cardiopulmonary effects of anesthetic induction with isoflurane, ketamine-diazepam or propofol-diazepam in the hypovolemic dog. Vet Anaesth Analg 2009; 36:110-23. [PMID: 19239649 DOI: 10.1111/j.1467-2995.2008.00437.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate and compare the cardiopulmonary effects of induction of anesthesia with isoflurane (Iso), ketamine-diazepam (KD), or propofol-diazepam (PD) in hypovolemic dogs. Study design Prospective randomized cross-over trial. ANIMALS Six healthy intact, mixed breed, female dogs weighing 20.7 +/- 4.2 kg and aged 22 +/- 2 months. Methods Dogs had 30 mL kg(-1) of blood removed at a rate of 1.5 mL kg(-1) minute(-1) under isoflurane anesthesia. Following a 30-minute recovery period, anesthesia was reinduced. Dogs were assigned to one of three treatments: isoflurane via facemask using 0.5% incremental increases in the delivered concentration every 30 seconds, 1.25 mg kg(-1) ketamine and 0.0625 mg kg(-1) diazepam intravenously (IV) with doses repeated every 30 seconds as required, and 2 mg kg(-1) propofol and 0.2 mg kg(-1) diazepam IV followed by 1 mg kg(-1) propofol increments IV every 30 seconds as required. Following endotracheal intubation all dogs received 1.7% end-tidal isoflurane in oxygen. Cardiopulmonary variables were recorded at baseline (before induction) and at 5 or 10 minute intervals following endotracheal intubation. RESULTS Induction time was longer in Iso (4.98 +/- 0.47 minutes) compared to KD (3.10 +/- 0.47 minutes) or PD (3.22 +/- 0.45 minutes). To produce anesthesia, KD received 4.9 +/- 2.3 mg kg(-1) ketamine and 0.24 +/- 0.1 mg kg(-1) diazepam, while PD received 2.2 +/- 0.4 mg kg(-1) propofol and 0.2 mg kg(-1) diazepam. End-tidal isoflurane concentration immediately following intubation was 1.7 +/- 0.4% in Iso. Arterial blood pressure and heart rate were significantly higher in KD and PD compared to Iso and in KD compared to PD. Arterial carbon dioxide partial pressure was significantly higher in PD compared to KD and Iso immediately after induction. CONCLUSIONS AND CLINICAL RELEVANCE In hypovolemic dogs, KD or PD, as used in this study to induce anesthesia, resulted in less hemodynamic depression compared to isoflurane.
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Affiliation(s)
- Sima Fayyaz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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