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Efficacy of Maropitant in Preventing Vomiting in Dogs Premedicated with Hydromorphone Bonnie L

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Efficacy of Maropitant in Preventing Vomiting in Dogs Premedicated with Hydromorphone Bonnie L Veterinary Clinical Sciences Publications Veterinary Clinical Sciences 1-2013 Efficacy of maropitant in preventing vomiting in dogs premedicated with hydromorphone Bonnie L. Hay Kraus Iowa State University, [email protected] Follow this and additional works at: https://lib.dr.iastate.edu/vcs_pubs Part of the Small or Companion Animal Medicine Commons, and the Veterinary Toxicology and Pharmacology Commons The ompc lete bibliographic information for this item can be found at https://lib.dr.iastate.edu/ vcs_pubs/29. For information on how to cite this item, please visit http://lib.dr.iastate.edu/ howtocite.html. This Article is brought to you for free and open access by the Veterinary Clinical Sciences at Iowa State University Digital Repository. It has been accepted for inclusion in Veterinary Clinical Sciences Publications by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. Efficacy of maropitant in preventing vomiting in dogs premedicated with hydromorphone Abstract Objective The og al of this study was to evaluate the effectiveness of maropitant (Cerenia®) in preventing vomiting after premedication with hydromorphone. Study design Randomized, blinded, prospective clinical study. Animals Eighteen dogs ASA I/II admitted for elective orthopedic surgical procedures. The dogs were a mixed population of males and females, purebreds and mixed breeds, 1.0–10.2 years of age, weighing 3–49.5 kg. Methods Dogs were admitted to the study if they were greater than 1 year of age, healthy and scheduled to undergo elective orthopedic surgery. Dogs were randomly selected to receive one of two treatments administered by subcutaneous injection. Group M received 1.0 mg kg−1 of maropitant, Group S received 0.1 mL kg−1 of saline 1 hour prior to anesthesia premedication. Dogs were premedicated with 0.1 mg kg−1 of hydromorphone intramuscularly. A blinded observer documented the presence of vomiting, retching and/or signs of nausea for 30 minutes after premedication. Results All dogs in S vomited (6/9), retched (1/9) or displayed signs of nausea (2/9). None (0/9) of the dogs in M vomited, retched or displayed signs of nausea. Dogs in M had significantly fewer incidences of vomiting (p=0.0090), vomiting and retching (p=0.0023) and vomiting, retching and nausea (p<0.0001) when compared to S. Conclusion and clinical relevance Maropitant prevents vomiting, retching and nausea associated with intramuscular hydromorphone administration in dogs. Keywords dogs, hydromorphone, maropitant, vomiting Disciplines Small or Companion Animal Medicine | Veterinary Toxicology and Pharmacology Comments This is the peer-reviewed version of the following article: Kraus, Bonnie L. Hay. "Efficacy of maropitant in preventing vomiting in dogs premedicated with hydromorphone." Veterinary Anaesthesia and Analgesia 40, no. 1 (2013): 28-34, which has been published in final form at DOI: 10.1111/j.1467-2995.2012.00788.x. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self- Archiving. Posted with permission. Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This article is available at Iowa State University Digital Repository: https://lib.dr.iastate.edu/vcs_pubs/29 Veterinary Anaesthesia and Analgesia, 2012 doi:10.1111/j.1467-2995.2012.00788.x 1 2 2 RESEARCH PAPER 3 4 Efficacy of maropitant in preventing vomiting in dogs 5 6 premedicated with hydromorphone 7 8 9 Bonnie L. Hay Kraus 10 Department of Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA 11 12 13 Correspondence: Bonnie L. Hay Kraus, Iowa State University-College of Veterinary Medicine, 1600 South 16th Street, Ames, IA 50011- 14 1250, USA. E-mail: [email protected] 15 16 17 18 19 Conclusion and clinical relevance Maropitant pre- Abstract 20 vents vomiting, retching and nausea associated 21 Objective The goal of this study was to evaluate the with intramuscular hydromorphone administration 22 effectiveness of maropitant (Cerenia) in preventing in dogs. 23 vomiting after pre-medication with hydromorphone. Keywords dogs, hydromorphone, maropitant, vomi- 24 ting. 25 Study design Randomized, blinded, prospective clin- 26 ical study. 27 Introduction 28 Animals Eighteen dogs ASA I/II admitted for elective 29 orthopedic surgical procedures. The dogs were a mixed Opioids are commonly used for chemical restraint 30 population of males and females, purebreds and mixed and as preanesthetic medications in veterinary 31 breeds, 1.0–10.2 years of age, weighing 3–49.5 kg. medicine. Full mu-agonists offer dose dependent 32 sedation and analgesia and are used to treat moder- 33 Methods Dogs were admitted to the study if they ate to severe pain. They may also be used as induction 34 were greater than 1 year of age, healthy and agents and as intra- and post-operative analgesics in 35 scheduled to undergo elective orthopedic surgery. veterinary patients. Adverse side effects may include 36 Dogs were randomly selected to receive one of two respiratory depression, bradycardia, behavioral 37 treatments administered by subcutaneous injection. changes including sedation, dysphoria or excite- ) 38 Group M received 1.0 mg kg 1 of maropitant, ment, urine retention and decreased urine produc- ) 39 Group S received 0.1 mL kg 1 of saline 1 hour tion and gastrointestinal effects including salivation, 40 prior to anesthesia premedication. Dogs were pre- nausea, vomiting and defecation (Wilson 1992; ) 41 medicated with 0.1 mg kg 1 of hydromorphone Branson & Gross 2001; Lamont & Mathews 2007). 42 intramuscularly. A blinded observer documented Hydromorphone is approximately five to seven 43 the presence of vomiting, retching and/or signs of times more potent than morphine, exhibits similar 44 nausea for 30 minutes after premedication. efficacy, and at equianalgesic doses, produces a 45 similar adverse effect profile as morphine (Mahler & 46 Results All dogs in S vomited (6/9), retched (1/9) or Forrest 1975; Coda et al.1997). However, neither 47 displayed signs of nausea (2/9). None (0/9) of the hydromorphone nor oxymorphone were found to 48 dogs in M vomited, retched or displayed signs of increase plasma histamine concentrations after 49 nausea. Dogs in M had significantly fewer inci- intra-venous administration (Smith et al. 2001) as 50 dences of vomiting (p = 0.0090), vomiting and is seen with morphine (Doenicke et al. 1995). 51 retching (p = 0.0023) and vomiting, retching and Oxymorphone also causes less vomiting than either 52 nausea (p < 0.0001) when compared to S. morphine or hydromorphone in dogs (Valverde 1 VAA 788 Dispatch: 26.9.12 Journal: VAA CE: Sindhuja R. Journal Name Manuscript No. B Author Received: No. of pages: 7 PE: Priyadharshini Maropitant prevents hydromorphone induced vomiting BL Hay Kraus 1 et al. 2004) however, it is significantly more Materials and methods 2 expensive (Pettifer & Dyson 2000). The ability to 3 give hydromorphone intravenously (IV), without Study population 4 the risk of histamine release, and the decreased cost, 5 contribute to its widespread use as an analgesic This study was approved by the Iowa State Uni- 6 drug in veterinary medicine. versity Institutional Animal Care and Use Commit- 7 The incidence of vomiting in dogs given opioids as tee. Dogs presented to the Lloyd Veterinary Medical 8 anesthetic pre-medications is 50–75% with mor- Center at Iowa State University College of Veteri- 9 phine (Valverde et al. 2004; Wilson et al. 2007), nary Medicine for elective orthopedic surgery were 10 44–100% with hydromorphone (Valverde et al. included in the study. The owners’ gave consent for 11 2004; KuKanich et al. 2008) and 33% with each animal to be included in the study. The study 12 oxymorphone (Valverde et al. 2004). The incidence population included 18 dogs, classified as ASA sta- 13 of vomiting is affected by the specific drug and its tus 1 or 2 based on complete physical examination 14 lipid solubility profile, the dose and route of admin- and normal routine blood chemistry and complete 15 istration and concomitant drug administration. blood count. There were 13 spayed females, 4 cas- 16 Decreasing incidence of vomiting is observed with trated males and one intact male, aged 1– 17 higher opioid doses, higher lipid solubility and prior 11.2 years and weighing 3.0–49.5 kg. Ten different 18 administration of acepromazine (Blancquaert et al. breeds of dog were represented in the study 19 1986; Hersom & Mackenzie 1987; Gross 2001; including two mixed breed dogs, four Labrador 20 Valverde et al. 2004; KuKanich et al. 2008). Retrievers, four Golden Retrievers, and single rep- 21 Vomiting and regurgitation, especially when asso- resentatives of Boxer, Mastiff, Pomeranian, Brussells 22 ciated with anesthesia have been documented as risk Griffon, Newfoundland, Blue Heeler, German Shep- 23 factors for development of aspiration pneumonia herd, Miniature Pinscher. 24 (Fransson et al. 2001; Alwood et al. 2006; Tart et al. 25 2010). Additional risk factors for aspiration include Study protocol 26 underlying esophageal, laryngeal and neurological 27 disease, prolonged anesthesia, cervical disc lesions On entry into the study, dogs were randomly 28 and the use of hydromorphone as an intra-operative assigned to receive one of two treatments prior to 29 analgesic; all of which can be commonly encountered preanesthetic medication. Group M received 1.0 mg ) ) 30 in clinical anesthesia practice (Fransson et al. 2001; kg 1 (0.1 mL kg 1) of maropitant and Group S ) 31 Alwood et al. 2006; Kogan et al. 2008; Tart et al. received saline 0.1 mL kg 1 subcutaneously 1 hour 32 2010). In addition, vomiting may be particularly prior to anesthesia premedication. The dose of saline 33 undesirable in certain cases such as penetrating eye was selected to parallel the volume of maropitant ) 34 wounds, intra-ocular surgery and patients with head needed to deliver a 1.0 mg kg 1 dose.
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