DOCSLIB.ORG

What's New in Veterinary Anesthesia and Analgesia?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
What's New in Veterinary Anesthesia and Analgesia? 1/3/2018 CREDIBILITY FACTOR? WHAT’S NEW IN Anesthesiology ANESTHESIA/ ANALGESIA? BS Biochemistry 8 yrs DVM Residency LYSA PAM POSNER, DVM, DACVAA DACVAA Faculty Faculty 2005 PROFESSOR OF ANESTHESIOLOGY 1-2018 PLAN? • Introduce new products • Introduce new ways to use established products ANALGESICS CLASSIC 3-NEURON CHAIN MODEL OF NOCICEPTIVE PROCESSING (SOMATIC) REVIEW OF PAIN PATHWAY 1 1/3/2018 PERIPHERAL SENSITIZATION Ganong; physiology CENTRAL SENSITIZATION / WIND-UP PERCEPTION • Dorsal horn of the spinal cord • Must reach cortex to be perceived as pain • Extreme or repeated activation • Mediated by glutamate • If patient is unconscious/ anesthetized, they won’t “feel” pain but the entire • Results in pathway may be activated – Decreased threshold – Expansion of receptive field – Increased spontaneous firing • When consciousness returns, pain – Hyperalgesia/allodynia pathway will be in full activation – Spontaneous pain – With less descending modulation LOCAL ANESTHETICS – Mechanism of action • Sodium channels propagate action potential • Local anesthetics block sodium channel – Routes of administration • Perineural • IV LOCAL ANESTHETICS • Dermal – Species Differences • Sensitivity to toxicity 2 1/3/2018 LOCAL ANESTHETIC UPDATES: LOCAL ANESTHETIC UPDATES: LIDOCAINE PATCHES LIDOCAINE CRI IN DOGS • IV lidocaine in DOGS • Lidocaine Patches • Systemic analgesia • Antiinflammatory – Little to no systemic absorption (dogs/cats) • GI Prokinetic – CAN be cut to size/area wanted – Should be replaced daily • Dose of IV lidocaine in dogs: – Potential uses – Loading: 1.0 mg/kg • IVDD, bone pain, inflammatory – CRI: 25 mcg/kg/min LOCAL ANESTHETIC UPDATE: NOCITA LOCAL ANESTHETIC UPDATE: NOCITA • Long acting local anesthetic • Off label use – Extended-release bupivacaine technology – Amputations – Multivesicular liposomes • 72 hr duration – Orthopedics (besided CCL) • Labeled for dogs following CCL surgery – Soft tissue procedures • Dosage –Cats – 5.3 mg/kg (0.4 mL/kg) – Infiltration injection into the tissue layers • No data on perineural administration • Caution? – At the time of incisional closure – Infected wounds • Very effective – Patients with immune disturbances • Expensive • Short shelf life once opened – Labeled for 4 hr once opened DISSOCIATIVE ANESTHETICS KETAMINE/TILETAMINE/PHENCYCLIDINE AMANTADINE •NMDA (N-methyl-D-aspartate) antagonists –NMDA receptors are excitatory receptors •Dissociative anesthetic –Thalamo-cortical and limbic systems NMDA –Altered consciousness (at anesthetic doses) –Catalepsy (at anesthetic doses) –Amnesia (at anesthetic doses) ANTAGONISTS –Analgesia –at subanesthetic doses •Ketamine –Approved for use in cats and primates •Tiletamine (part of the combination Telazol) –Telazol approved for cats and dogs 3 1/3/2018 NMDA RECEPTOR ANTAGONISTS PAIN PATHWAY DORSAL HORN OF SPINAL CORD • Dorsal horn of spinal cord – Opioid receptors – Alpha-2 receptors – NMDA receptors • Central sensitization – Wind-up pain NMDA ANTAGONISTS DISSOCIATIVES: WHAT’S NEW? •At least 24 hr CRI needed to “break” windup cycle (in humans) • Mechanism of action – Unclear how long dogs/cats – Antagonize activation of NMDA receptor – Induction dose unlikely enough with glutamate at dorsal horn of spinal cord – With extended inactivation can interrupt central sensitization •Injectable ketamine CRI • >24 hr (days? weeks?) – At least 24 hr is recommended to alter/ prevent windup •Oral amantadine – Ketamine, amantadine – At least 2-3 week trial – Can use with NSAIDs, gabapentin, opioids, etc – Chronic pain/ wounds/ burns – Amputations NMDA ANTAGONISTS • Ketamine: side effects – Anesthetic doses CALCIUM • 5mg/kg induction dose • Increased CV work • Hallucinations/ behavioral effects CHANNEL – Analgesic doses—few side effects • 5-10 mcg/kg/min (ketamine) BLOCKERS • Amantadine: side effects –Not reported • 3-5mg/kg PO SID 4 1/3/2018 CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS GABAPENTIN (GABAPENTIN) • Mechanism of action • Side effects –Binds α2δ subunit-voltage gated – Somnolence calcium channels • Decreases with time • Upregulated in pain states –Humans • Rapid withdrawal associated with seizure risk – May (?) interacts with NMDA receptors, protein kinase C, • Species Differences inflammatory cytokines – Administered in many species – Little adverse effects – Unknown dosing ideals TRPVI RECEPTOR AGONISTS • Mechanism of Action TRVP1 – Calcium channels – Activated by • Heat • H+ RECEPTOR • Capsaicin • Resiniferatoxin (RTX) AGONISTS – More on c-fibers (?) • “burning, itching, stinging” sensation – Activate then desensitize nerve TRPVI RECEPTOR AGONISTS • Side effects – First must “activate” then desensitize receptor – Tingling up to pain – Some treatments require anesthesia ANESTHETICS 5 1/3/2018 NEUROSTEROIDS: ALFAXALONE •GABA is the primary inhibitory neurotransmitter •Binds to specific site on GABA receptor NEUROSTEROIDS – GABA enhancer/ agonist ALFAXALONE •Structurally similar to steroids –Does not bind to sex hormone, glucocorticoid or mineralocorticoid receptors ALFAXALONE NEUROSTEROIDS & VETERINARY MEDICINE NEUROSTEROID STRUCTURE • Saffan PROGESTERONE ALFAXALONE – Alfaxalone and alfadolone (3:1) – Clinical trials and marketed in UK – Hard to dissolve in water-based solutions • Solubilized in Cremophor – Reports from 1974 & 1980 • Allergic reactions (69% of cats!) – Ear swelling to anaphylaxis • Many dogs died from anaphylaxis ALFAXAN® ALFAXALONE: DOSE AND SAFETY ALFAXALONE •Alfaxalone only DOGS CATS –Difficult to dissolve in water based solution •~2mg/kg IV •4-5 mg/kg IV •Cyclodextrin ring –Water soluble delivery •> 10 weeks age •> 4 weeks age •Approved in USA –Schedule IV controlled drug (USA) •C-sections –Labeled for dogs and cats, IV use •C-sections •Clear solution •Safety with 5x dose –< 6 hr once opened •Safety at 10 x dose 6 1/3/2018 ALFAXALONE: PHYSIOLOGIC EFFECTS ALFAXALONE: MISCELLANEOUS •CV • Induction and recovery not as smooth as propofol – CV depression similar or better than propofol – Particularly as a solo agent • Head bob, uncoordinated gait •Respiratory – Depression to apnea • Does not cause tissue reaction if administered outside of vein or SQ – Product literature and Heit 2004 •Analgesia – No analgesia • Can us as a CRI (constant rate infusion) •Metabolism • More expensive that propofol in USA – Liver metabolism ALFAXALONE: WHAT'S NEW? ALFAXALONE: WHAT'S NEW? • Off Label Use • Off label, published, use in other species – IM administration for sedation – Not labeled for in USA, but is in Australia –Ferrets – Volume is the limiting factor – Rabbits –Turtles –Dose – Dogs: ~ 1 mg/kg (with opioid or midazolam) – Reptiles – Cats: ~ 1-2 mg/kg (with opioid or midazolam) – Fish by immersion • Indication – e.g. Fractious animal with CV disease – e.g. Echo without dexmedetomidine/ketamine QUESTIONS ON ALFAXALONE? ETOMIDATE 7 1/3/2018 ETOMIDATE ETOMIDATE •Ultrashort non-barbiturate (imidazole compound) • CV – Introduced in human anesthesia 1972 – NO CV EFFECTS • Not approved for use in veterinary species • HR, BP, SVR, CO •Not scheduled in USA • CNS Effects – GABA enhancer • Respiratory •Propylene glycol vehicle (35%) – Moderate depression – Long shelf life • Metabolism – Pain on injection – Liver metabolism (+ propylene glycol) – Can cause hemolysis with CRI • Decreases adrenal gland hormones ETOMIDATE: ENDOCRINE EFFECTS ETOMIDATE: MISCELLANEOUS • Decreased adrenocortical activity • Poor muscle relaxation – lasts, 2 - 6 hr – Muscle rigidity, myoclonus, vocalization, opisthotonus •Inhibits 11-B hydroxylase – Administer with muscle relaxant (e.g. benzodiazepine) – cholesterol to cortisol • Emesis • Decreased adrenal stress response •Multiple doses / CRI • Expensive (2015) (~ $5/ml) – hypoadrenocorticism – 4kg cat ~ $12.00 – +/- death (dogs and humans) – 40kg dog ~ $100.00 WHAT’S NEW: ETOMIDATE? • Available • Non scheduled • Fills particular patient needs QUESTIONS? 8.
Load more

Recommended publications
  • Analgesia and Sedation in Hospitalized Children
    Analgesia and Sedation in Hospitalized Children By Elizabeth J. Beckman, Pharm.D., BCPS, BCCCP, BCPPS Reviewed by Julie Pingel, Pharm.D., BCPPS; and Brent A. Hall, Pharm.D., BCPPS LEARNING OBJECTIVES 1. Evaluate analgesics and sedative agents on the basis of drug mechanism of action, pharmacokinetic principles, adverse drug reactions, and administration considerations. 2. Design an evidence-based analgesic and/or sedative treatment and monitoring plan for the hospitalized child who is postoperative, acutely ill, or in need of prolonged sedation. 3. Design an analgesic and sedation treatment and monitoring plan to minimize hyperalgesia and delirium and optimize neurodevelopmental outcomes in children. INTRODUCTION ABBREVIATIONS IN THIS CHAPTER Pain, anxiety, fear, distress, and agitation are often experienced by GABA γ-Aminobutyric acid children undergoing medical treatment. Contributory factors may ICP Intracranial pressure include separation from parents, unfamiliar surroundings, sleep dis- PAD Pain, agitation, and delirium turbance, and invasive procedures. Children receive analgesia and PCA Patient-controlled analgesia sedatives to promote comfort, create a safe environment for patient PICU Pediatric ICU and caregiver, and increase patient tolerance to medical interven- PRIS Propofol-related infusion tions such as intravenous access placement or synchrony with syndrome mechanical ventilation. However, using these agents is not without Table of other common abbreviations. risk. Many of the agents used for analgesia and sedation are con- sidered high alert by the Institute for Safe Medication Practices because of their potential to cause significant patient harm, given their adverse effects and the development of tolerance, dependence, and withdrawal symptoms. Added layers of complexity include the ontogeny of the pediatric patient, ongoing disease processes, and presence of organ failure, which may alter the pharmacokinetics and pharmacodynamics of these medications.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 De Juan Et Al
    US 200601 10428A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 de Juan et al. (43) Pub. Date: May 25, 2006 (54) METHODS AND DEVICES FOR THE Publication Classification TREATMENT OF OCULAR CONDITIONS (51) Int. Cl. (76) Inventors: Eugene de Juan, LaCanada, CA (US); A6F 2/00 (2006.01) Signe E. Varner, Los Angeles, CA (52) U.S. Cl. .............................................................. 424/427 (US); Laurie R. Lawin, New Brighton, MN (US) (57) ABSTRACT Correspondence Address: Featured is a method for instilling one or more bioactive SCOTT PRIBNOW agents into ocular tissue within an eye of a patient for the Kagan Binder, PLLC treatment of an ocular condition, the method comprising Suite 200 concurrently using at least two of the following bioactive 221 Main Street North agent delivery methods (A)-(C): Stillwater, MN 55082 (US) (A) implanting a Sustained release delivery device com (21) Appl. No.: 11/175,850 prising one or more bioactive agents in a posterior region of the eye so that it delivers the one or more (22) Filed: Jul. 5, 2005 bioactive agents into the vitreous humor of the eye; (B) instilling (e.g., injecting or implanting) one or more Related U.S. Application Data bioactive agents Subretinally; and (60) Provisional application No. 60/585,236, filed on Jul. (C) instilling (e.g., injecting or delivering by ocular ion 2, 2004. Provisional application No. 60/669,701, filed tophoresis) one or more bioactive agents into the Vit on Apr. 8, 2005. reous humor of the eye. Patent Application Publication May 25, 2006 Sheet 1 of 22 US 2006/0110428A1 R 2 2 C.6 Fig.
    [Show full text]
  • 268 Part 522—Implantation Or Injectable Dosage Form
    § 520.2645 21 CFR Ch. I (4–1–18 Edition) (ii) Indications for use. For the control 522.82 Aminopropazine. of American foulbrood (Paenibacillus 522.84 Beta-aminopropionitrile. larvae). 522.88 Amoxicillin. 522.90 Ampicillin injectable dosage forms. (iii) Limitations. The drug should be 522.90a Ampicillin trihydrate suspension. fed early in the spring or fall and con- 522.90b Ampicillin trihydrate powder for in- sumed by the bees before the main jection. honey flow begins, to avoid contamina- 522.90c Ampicillin sodium. tion of production honey. Complete 522.144 Arsenamide. treatments at least 4 weeks before 522.147 Atipamezole. main honey flow. 522.150 Azaperone. 522.161 Betamethasone. [40 FR 13838, Mar. 27, 1975, as amended at 50 522.163 Betamethasone dipropionate and FR 49841, Dec. 5, 1985; 59 FR 14365, Mar. 28, betamethasone sodium phosphate aque- 1994; 62 FR 39443, July 23, 1997; 68 FR 24879, ous suspension. May 9, 2003; 70 FR 69439, Nov. 16, 2005; 73 FR 522.167 Betamethasone sodium phosphate 76946, Dec. 18, 2008; 75 FR 76259, Dec. 8, 2010; and betamethasone acetate. 76 FR 59024, Sept. 23, 2011; 77 FR 29217, May 522.204 Boldenone. 17, 2012; 79 FR 37620, July 2, 2014; 79 FR 53136, 522.224 Bupivacaine. Sept. 8, 2014; 79 FR 64116, Oct. 28, 2014; 80 FR 522.230 Buprenorphine. 34278, June 16, 2015; 81 FR 48702, July 26, 2016] 522.234 Butamisole. 522.246 Butorphanol. § 520.2645 Tylvalosin. 522.275 N-Butylscopolammonium. 522.300 Carfentanil. (a) Specifications. Granules containing 522.304 Carprofen. 62.5 percent tylvalosin (w/w) as 522.311 Cefovecin.
    [Show full text]
  • Euthanasia of Experimental Animals
    EUTHANASIA OF EXPERIMENTAL ANIMALS • *• • • • • • • *•* EUROPEAN 1COMMISSIO N This document has been prepared for use within the Commission. It does not necessarily represent the Commission's official position. A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int) Cataloguing data can be found at the end of this publication Luxembourg: Office for Official Publications of the European Communities, 1997 ISBN 92-827-9694-9 © European Communities, 1997 Reproduction is authorized, except for commercial purposes, provided the source is acknowledged Printed in Belgium European Commission EUTHANASIA OF EXPERIMENTAL ANIMALS Document EUTHANASIA OF EXPERIMENTAL ANIMALS Report prepared for the European Commission by Mrs Bryony Close Dr Keith Banister Dr Vera Baumans Dr Eva-Maria Bernoth Dr Niall Bromage Dr John Bunyan Professor Dr Wolff Erhardt Professor Paul Flecknell Dr Neville Gregory Professor Dr Hansjoachim Hackbarth Professor David Morton Mr Clifford Warwick EUTHANASIA OF EXPERIMENTAL ANIMALS CONTENTS Page Preface 1 Acknowledgements 2 1. Introduction 3 1.1 Objectives of euthanasia 3 1.2 Definition of terms 3 1.3 Signs of pain and distress 4 1.4 Recognition and confirmation of death 5 1.5 Personnel and training 5 1.6 Handling and restraint 6 1.7 Equipment 6 1.8 Carcass and waste disposal 6 2. General comments on methods of euthanasia 7 2.1 Acceptable methods of euthanasia 7 2.2 Methods acceptable for unconscious animals 15 2.3 Methods that are not acceptable for euthanasia 16 3. Methods of euthanasia for each species group 21 3.1 Fish 21 3.2 Amphibians 27 3.3 Reptiles 31 3.4 Birds 35 3.5 Rodents 41 3.6 Rabbits 47 3.7 Carnivores - dogs, cats, ferrets 53 3.8 Large mammals - pigs, sheep, goats, cattle, horses 57 3.9 Non-human primates 61 3.10 Other animals not commonly used for experiments 62 4.
    [Show full text]
  • Alfadolone Acetate (BANM, Rinnm) 362: 1749–57
    1780 General Anaesthetics blood, then to the brain; recovery is a function of the zolam, and other anaesthetics such as etomidate, propofol, ful if the patient’s cooperation is required, as conscious- removal of the anaesthetic from the brain. With inject- or ketamine. Small doses of short-acting opioids, for ex- ness soon returns once the nitrous oxide is stopped. The able anaesthetics their activity is similarly dependent ample alfentanil, fentanyl, or remifentanil, given before or neuroleptic most commonly employed was droperidol and on their ability to penetrate the blood/brain barrier and at induction allow the use of smaller induction doses of it was usually used with fentanyl although other opioids recovery in turn is governed by their redistribution and some drugs used for anaesthesia, and this technique is par- have also been used. These procedures have since evolved ticularly suitable for poor-risk patients. into conscious sedation and monitored anaesthetic care excretion. The potency of inhalational anaesthetics is After induction, muscle relaxation with a rapidly acting techniques employing newer drugs. often expressed in terms of minimum alveolar concen- depolarising neuromuscular blocker such as suxamethoni- Ketamine used alone can produce a state of dissociative trations, known as MAC values. The MAC of an um aids intubation of the patient. Longer acting, compet- anaesthesia similar to that of neuroleptanalgesia in which anaesthetic is the concentration at 1 atmosphere that itive neuromuscular blockers may then be given to allow the patient may appear to be awake but is unconscious. will produce immobility in 50% of subjects exposed to procedures such as abdominal surgery to be carried out un- Marked analgesia and amnesia are produced, but there a noxious stimulus.
    [Show full text]
  • G Genito Urinary System and Sex Hormones
    WHO/EMP/RHT/TSN/2018.2 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Learning clinical pharmacology with the use of INNs and their stems. Geneva: World Health Organization; 2018 (WHO/EMP/RHT/TSN/2018.2). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 6,264,917 B1 Klaveness Et Al
    USOO6264,917B1 (12) United States Patent (10) Patent No.: US 6,264,917 B1 Klaveness et al. (45) Date of Patent: Jul. 24, 2001 (54) TARGETED ULTRASOUND CONTRAST 5,733,572 3/1998 Unger et al.. AGENTS 5,780,010 7/1998 Lanza et al. 5,846,517 12/1998 Unger .................................. 424/9.52 (75) Inventors: Jo Klaveness; Pál Rongved; Dagfinn 5,849,727 12/1998 Porter et al. ......................... 514/156 Lovhaug, all of Oslo (NO) 5,910,300 6/1999 Tournier et al. .................... 424/9.34 FOREIGN PATENT DOCUMENTS (73) Assignee: Nycomed Imaging AS, Oslo (NO) 2 145 SOS 4/1994 (CA). (*) Notice: Subject to any disclaimer, the term of this 19 626 530 1/1998 (DE). patent is extended or adjusted under 35 O 727 225 8/1996 (EP). U.S.C. 154(b) by 0 days. WO91/15244 10/1991 (WO). WO 93/20802 10/1993 (WO). WO 94/07539 4/1994 (WO). (21) Appl. No.: 08/958,993 WO 94/28873 12/1994 (WO). WO 94/28874 12/1994 (WO). (22) Filed: Oct. 28, 1997 WO95/03356 2/1995 (WO). WO95/03357 2/1995 (WO). Related U.S. Application Data WO95/07072 3/1995 (WO). (60) Provisional application No. 60/049.264, filed on Jun. 7, WO95/15118 6/1995 (WO). 1997, provisional application No. 60/049,265, filed on Jun. WO 96/39149 12/1996 (WO). 7, 1997, and provisional application No. 60/049.268, filed WO 96/40277 12/1996 (WO). on Jun. 7, 1997. WO 96/40285 12/1996 (WO). (30) Foreign Application Priority Data WO 96/41647 12/1996 (WO).
    [Show full text]
  • Effects of Alfaxalone Or Propofol on Giant-Breed Dog Neonates Viability
    animals Article Effects of Alfaxalone or Propofol on Giant-Breed Dog Neonates Viability During Elective Caesarean Sections Monica Melandri 1, Salvatore Alonge 1,* , Tanja Peric 2, Barbara Bolis 3 and Maria C Veronesi 3 1 Società Veterinaria “Il Melograno” Srl, 21018 Sesto Calende, Varese, Italy; [email protected] 2 Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy; [email protected] 3 Department of Veterinary Medicine, Università degli Studi di Milano, 20100 Milan, Italy; [email protected] (B.B.); [email protected] (M.C.V.) * Correspondence: [email protected]; Tel.: +39-392-805-8524 Received: 20 September 2019; Accepted: 7 November 2019; Published: 13 November 2019 Simple Summary: Nowadays, thanks to the increased awareness of owners and breeders and to the most recent techniques available to veterinarians, the management of parturition, especially of C-sections, has become a topic of greater importance. Anesthesia is crucial and must be targeted to both the mother and neonates. The present study aimed to evaluate the effect of the induction agent alfaxalone on the vitality of puppies born from elective C-section, in comparison to propofol. After inducing general anesthesia for elective C-section, puppies from the mothers induced with alfaxalone had higher 5-min Apgar scores than those induced with propofol. The concentration of cortisol in fetal fluids collected at birth is neither influenced by the anesthetic protocol used, nor does it differ between amniotic and allantoic fluids. Nevertheless, the cortisol concentration in fetal fluids affects the relationship between anesthesia and the Apgar score: the present study highlights a significant relationship between the anesthetic protocol used and Apgar score in puppies, and fetal fluids cortisol concentration acts as a covariate of this relationship.
    [Show full text]
  • The Cardiorespiratory and Anesthetic Effects of Clinical and Supraclinical
    THE CARDIORESPIRATORY AND ANESTHETIC EFFECTS OF CLINICAL AND SUPRA CLINICAL DOSES OF ALF AXALONE IN CYCLODEXTRAN IN CATS AND DOGS DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Laura L. Nelson, B.S., D.V.M. * * * * * The Ohio State University 2007 Dissertation Committee: Professor Jonathan Dyce, Adviser Professor William W. Muir III Professor Shane Bateman If I have seen further, it is by standing on the shoulders of giants. lmac Ne1vton (1642-1727) Copyright by Laura L. Nelson 2007 11 ABSTRACT The anesthetic properties of steroid hormones were first identified in 1941, leading to the development of neurosteroids as clinical anesthetics. CT-1341 was developed in the early 1970’s, featuring a combination of two neurosteroids (alfaxalone and alphadolone) solubilized in Cremophor EL®, a polyethylated castor oil derivative that allows hydrophobic compounds to be carried in aqueous solution as micelles. Though also possessing anesthetic properties, alphadolone was included principally to improve the solubility of alfaxalone. CT-1341, marketed as Althesin® and Saffan®, was characterized by smooth anesthetic induction and recovery in many species, a wide therapeutic range, and no cumulative effects with repeated administration. Its cardiorespiratory effects in humans and cats were generally mild. However, it induced severe hypersensitivity reactions in dogs, with similar reactions occasionally occurring in cats and humans. The hypersensitivity reactions associated with this formulation were linked to Cremophor EL®, leading to the discontinuation of Althesin® and some other Cremophor®-containing anesthetics. More recently, alternate vehicles for hydrophobic drugs have been developed, including cyclodextrins.
    [Show full text]
  • Intravenous Alfaxalone Anaesthesia in Two Squamate Species: Eublepharis Macularius and Morelia Spilota Cheynei
    INTRAVENOUS ALFAXALONE ANAESTHESIA IN TWO SQUAMATE SPECIES: EUBLEPHARIS MACULARIUS AND MORELIA SPILOTA CHEYNEI Tesi per il XXIX Ciclo del Dottorato in Scienze Veterinarie, Curriculum Scienze Cliniche Veterinarie Dipartimento di Scienze Veterinarie, Universita’ degli Studi di Messina Tutor: Prof. Filippo Spadola Cotutor: Prof. Zdenek Knotek Dr. Manuel Morici Sommario L’anestesia negli Squamati è una costante sfida della medicina e chirurgia dei rettili. Le differenze morfo-fisiologiche di questi taxa, rendono difficilmente applicabile i comuni concetti di anestesiologia veterinaria usati con successo negli altri animali da compagnia. Diversi protocolli anestetici sono stati utilizzati, sia per l’induzione che per il mantenimento, sia negli ofidi che nei sauri, ma con risultati variabili. Di fatti la maggior parte dei protocolli risultano in induzione o recuperi troppo brevi o troppo lunghi. L’obbiettivo di questa tesi dottorale è di valutare l’efficacia di un anestetico steroideo (alfaxalone), somministrato per via endovenosa in due specie di squamati usati come modello: il geco leopardo (Eublepharis macularius) e il pitone tappeto (Morelia spilota cheynei). Due metodi di somministrazione endovenosa (vena giugulare nei gechi e vena caudale nei serpenti) sono stati analizzati e descritti, usando un dosaggio di anestetico di 5 mg/kg in 20 gechi leopardo, e di 10 mg/kg in 10 pitoni tappeto. Nei gechi il tempo di induzione, il tempo di perdita del tono mandibolare, l’intervallo di anestesia chirurgica e il recupero completo sono stati rispettivamente di 27.5 ± 30.7 secondi, 1.3 ± 1.4 minuti, 12.5 ± 2.2 minuti and 18.8 ± 12.1 minuti. Nei pitoni tappeto, il tempo di induzione, la perdita di sensazione, il tempo di inserimento del tubo endotracheale, l’intervallo di anestesia chirurgica e il recupero sono stati rispettivamente di 3.1±0.8 minuti, 5.6±0.7 minuti, 6.9±0.9 minuti, 18.8±4.7 minuti, e 36.7±11.4 minuti.
    [Show full text]
  • Pharmacology/Therapeutics II Block III Lectures 2013-14
    Pharmacology/Therapeutics II Block III Lectures 2013‐14 66. Hypothalamic/pituitary Hormones ‐ Rana 67. Estrogens and Progesterone I ‐ Rana 68. Estrogens and Progesterone II ‐ Rana 69. Androgens ‐ Rana 70. Thyroid/Anti‐Thyroid Drugs – Patel 71. Calcium Metabolism – Patel 72. Adrenocorticosterioids and Antagonists – Clipstone 73. Diabetes Drugs I – Clipstone 74. Diabetes Drugs II ‐ Clipstone Pharmacology & Therapeutics Neuroendocrine Pharmacology: Hypothalamic and Pituitary Hormones, March 20, 2014 Lecture Ajay Rana, Ph.D. Neuroendocrine Pharmacology: Hypothalamic and Pituitary Hormones Date: Thursday, March 20, 2014-8:30 AM Reading Assignment: Katzung, Chapter 37 Key Concepts and Learning Objectives To review the physiology of neuroendocrine regulation To discuss the use neuroendocrine agents for the treatment of representative neuroendocrine disorders: growth hormone deficiency/excess, infertility, hyperprolactinemia Drugs discussed Growth Hormone Deficiency: . Recombinant hGH . Synthetic GHRH, Recombinant IGF-1 Growth Hormone Excess: . Somatostatin analogue . GH receptor antagonist . Dopamine receptor agonist Infertility and other endocrine related disorders: . Human menopausal and recombinant gonadotropins . GnRH agonists as activators . GnRH agonists as inhibitors . GnRH receptor antagonists Hyperprolactinemia: . Dopamine receptor agonists 1 Pharmacology & Therapeutics Neuroendocrine Pharmacology: Hypothalamic and Pituitary Hormones, March 20, 2014 Lecture Ajay Rana, Ph.D. 1. Overview of Neuroendocrine Systems The neuroendocrine
    [Show full text]
  • 240 Part 522—Implantation Or Injectable Dosage Form
    § 520.2645 21 CFR Ch. I (4–1–14 Edition) feed; and for the control of porcine pro- (3) Limitations. Federal law restricts liferative enteropathies (PPE, ileitis) this drug to use by or on the order of a associated with Lawsonia intracellularis licensed veterinarian. when followed immediately by tylosin [77 FR 55415, Sept. 10, 2012] phosphate medicated feed. (B) For the treatment and control of PART 522—IMPLANTATION OR swine dysentery associated with Brachyspira hyodysenteriae. INJECTABLE DOSAGE FORM NEW (iii) Limitations. Prepare a fresh solu- ANIMAL DRUGS tion daily. Do not administer within 48 Sec. hours of slaughter. As indicated in 522.23 Acepromazine. paragraph (d)(3)(ii)(A) of this section, 522.52 Alfaxalone. follow with tylosin phosphate medi- 522.56 Amikacin. cated feed as in § 558.625(f)(1)(vi)(c) of 522.62 Aminopentamide. this chapter. 522.82 Aminopropazine. (4) Honey bees—(i) Amount. Mix 200 522.84 Beta-aminopropionitrile. milligrams tylosin in 20 grams confec- 522.88 Amoxicillin. 522.90 Ampicillin injectable dosage forms. tioners’/powdered sugar. Use imme- 522.90a Ampicillin trihydrate suspension. diately. Apply (dust) this mixture over 522.90b Ampicillin trihydrate powder for in- the top bars of the brood chamber once jection. weekly for 3 weeks. 522.90c Ampicillin sodium. (ii) Indications for use. For the control 522.144 Arsenamide. of American foulbrood (Paenibacillus 522.147 Atipamezole. 522.150 Azaperone. larvae). 522.161 Betamethasone. (iii) Limitations. The drug should be 522.163 Betamethasone dipropionate and fed early in the spring or fall and con- betamethasone sodium phosphate aque- sumed by the bees before the main ous suspension.
    [Show full text]