Chloral Hydrate in Experiments with Rodents and Rabbits
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Veterinary Emergency & Anaesthesia Pfizer
AVA ECVA & AVEF Thank all their sponsors for this spring edition PARIS 2007 On VETERINARY EMERGENCY & ANAESTHESIA PFIZER MERIAL FORT DODGE BAYER BOEHRINGER MEDISUR COVETO OPTOMED HALLOWELL SCIL JANSSEN SOGEVAL KRUSSE TECHNIBELT MILA TEM The Organisatiors 7th AVEF European Meeting- 10th March 2007-ROISSY 2 AVA – ECVA Spring Meeting 2007 on Veterinary Emergency & Anesthesia 7 – 10 March 2007, Paris, France AVA PARIS 2007 — Wednesday March 7th RESIDENT DAY RUMINANT ANAESTHESIA Hyatt Regency Hotel, Roissy CDG, France K OTTO, D HOLOPHERNE, G TOUZOT 8.30 REGISTRATIONS 9.00-9.45 Specific anatomo-physiology to consider for ruminant peri-anaesthetic period K OTTO 10.00-10.30 COFFEE BREAK 10.30-11.15 Post-anaesthetic and pain management in ruminants K OTTO 11.30-12.15 Physical restraint and sedation of ruminants D HOLOPHERNE 12.30-1.30 LUNCH 1.30-2.15 Anaesthesia of Lamas & Alpagas G TOUZOT 2.30-3.15 Regional & local anaesthesia for ruminants D HOLOPHERNE 3.30-4.00 COFFEE BREAK 4.00-4.45 Pharmacology and protocols for ruminant anaesthesia G TOUZOT AVA-ECVA PARIS 2007, Veterinary Emergency & Anaesthesia, 7-10th March AVA-ECVA PARIS 2007, Veterinary Emergency & Anaesthesia, 7-10th March AVA – ECVA Spring Meeting 2007 on Veterinary Emergency & Anesthesia 7 – 10 March 2007, Paris, France Specific anatomo-physiology to consider for ruminants peri-anaesthetic period Klaus A. Otto Institut für Versuchstierkunde und Zentrales Tierlaboratorium, Medizinische Hochschule Hannover, D-30623 Hannover, Germany The suborder “ruminantia” includes members of the family “bovidae” such as cattle (bos taurus), sheep (ovis spp) and goats (capra spp). Members of the family “camelidae” (camelus spp, llama spp, vicugna spp) belong to the suborder “tylopodia” and therefore are not true ruminants. -
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. -
PENTOBARBITAL SODIUM- Pentobarbital Sodium Injection Akorn, Inc
PENTOBARBITAL SODIUM- pentobarbital sodium injection Akorn, Inc. ---------- Nembutal® Sodium Solution CII (pentobarbital sodium injection, USP) + novaplus TM Rx only Vials DO NOT USE IF MATERIAL HAS PRECIPITATED DESCRIPTION The barbiturates are nonselective central nervous system depressants which are primarily used as sedative hypnotics and also anticonvulsants in subhypnotic doses. The barbiturates and their sodium salts are subject to control under the Federal Controlled Substances Act (See “Drug Abuse and Dependence” section). The sodium salts of amobarbital, pentobarbital, phenobarbital, and secobarbital are available as sterile parenteral solutions. Barbiturates are substituted pyrimidine derivatives in which the basic structure common to these drugs is barbituric acid, a substance which has no central nervous system (CNS) activity. CNS activity is obtained by substituting alkyl, alkenyl, or aryl groups on the pyrimidine ring. NEMBUTAL Sodium Solution (pentobarbital sodium injection) is a sterile solution for intravenous or intramuscular injection. Each mL contains pentobarbital sodium 50 mg, in a vehicle of propylene glycol, 40%, alcohol, 10% and water for injection, to volume. The pH is adjusted to approximately 9.5 with hydrochloric acid and/or sodium hydroxide. NEMBUTAL Sodium is a short-acting barbiturate, chemically designated as sodium 5-ethyl-5-(1- methylbutyl) barbiturate. The structural formula for pentobarbital sodium is: The sodium salt occurs as a white, slightly bitter powder which is freely soluble in water and alcohol but practically insoluble in benzene and ether. CLINICAL PHARMACOLOGY Barbiturates are capable of producing all levels of CNS mood alteration from excitation to mild sedation, to hypnosis, and deep coma. Overdosage can produce death. In high enough therapeutic doses, barbiturates induce anesthesia. -
Evaluating the Translational Potential of Progesterone Treatment Following
Wong et al. BMC Neuroscience 2014, 15:131 http://www.biomedcentral.com/1471-2202/15/131 RESEARCH ARTICLE Open Access Evaluating the translational potential of progesterone treatment following transient cerebral ischaemia in male mice Raymond Wong1, Claire L Gibson2*, David A Kendall3 and Philip MW Bath1 Abstract Background: Progesterone is neuroprotective in numerous preclinical CNS injury models including cerebral ischaemia. The aim of this study was two-fold; firstly, we aimed to determine whether progesterone delivery via osmotic mini-pump would confer neuroprotective effects and whether such neuroprotection could be produced in co-morbid animals. Results: Animals underwent transient middle cerebral artery occlusion. At the onset of reperfusion, mice were injected intraperitoneally with progesterone (8 mg/kg in dimethylsulfoxide). Adult and aged C57 Bl/6 mice were dosed additionally with subcutaneous infusion (1.0 μl/h of a 50 mg/ml progesterone solution) via implanted osmotic minipumps. Mice were allowed to survive for up to 7 days post-ischaemia and assessed for general well-being (mass loss and survival), neurological score, foot fault and t-maze performance. Progesterone reduced neurological deficit [F(1,2) = 5.38, P = 0.027] and number of contralateral foot-faults [F(1,2) = 7.36, P = 0.0108] in adult, but not aged animals, following ischaemia. In hypertensive animals, progesterone treatment lowered neurological deficit [F(1,6) = 18.31, P = 0.0001], reduced contralateral/ipsilateral alternation ratio % [F(1,2) = 17.05, P = 0.0006] and time taken to complete trials [F(1,2) = 15.92, P = 0.0009] for t-maze. Conclusion: Post-ischemic progesterone administration via mini-pump delivery is effective in conferring functional improvement in a transient MCAO model in adult mice. -
Deliberate Self-Poisoning with a Lethal Dose of Pentobarbital: Survival with Supportive Care
Deliberate self-poisoning with a lethal dose of pentobarbital: Survival with supportive care. (1) (1,2) Santosh Gone , Andis Graudins (1) Clinical Toxicology Service, Program of Emergency Medicine, Monash Health (2) Monash Emergency Research Collaboration, Clinical Sciences at Monash Health, Monash University Abstract 84 INTRODUCTION CASE REPORT (continued) DISCUSSION Pentobarbital (Nembutal) is short acting In the ED: Pentobarbital has been a banned substance for barbiturate sedative-hypnotic, currently widely GCS: 3/15, fixed dilated pupils, apnoeic and human use in Australia since 1998. However, it can used in veterinary practice for anesthesia and ventilated. be procured overseas or bought on the internet. euthanasia. Pulse: 116 bpm sinus tachycardia BP: 115/60 on epinephrine infusion. Pentobarbital is recommended as an effective It is also commonly recommended as a VBG: pH 7.03 pCO2 77 mmHg Bicarb 19 mmol/L agent for use in euthanasia due to its apparently euthanasia drug for assisted suicide and it is Lactate 8.8 mmol/L peaceful transition to death. unlikely that any resuscitative measures will be Activated charcoal (50g) given via an NG tube. attempted in such cases. Course in the Intensive Care Department: In a case series of 150 assisted suicides in Day-1 post-OD: Sweden, a 100% success rate was seen with Intentional overdose results in depression of - Absent brain stem reflexes and fixed dilated pupils for ingestion of 9 grams. Cardiovascular collapse was brain stem function and rapid onset respiratory five days. seen within 15 minutes in 30% of patients. It is rare depression and apnoea. Hypotension also - Diabetes insipidus developed with urine output of to see survival after intentional ingestion for develops, followed by cardiovascular collapse 300ml/hour. -
Pentobarbital Sodium
PENTobarbital Sodium Brand names Nembutal Sodium Medication error Look-alike, sound-alike drug names. Tall man letters (not FDA approved) are recommended potential to decrease confusion between PENTobarbital and PHENobarbital.(1,2) ISMP recommends the following tall man letters (not FDA approved): PENTobarbital.(30) Contraindications Contraindications: In patients with known hypersensitivity to barbiturates or any com- and warnings ponent of the formulation.(2) If an allergic or hypersensitivity reaction or a life-threatening adverse event occurs, rapid substitution of an alternative agent may be necessary. If pentobarbital is discontinued due to development of a rash, an anticonvulsant that is structurally dissimilar should be used (i.e., nonaromatic). (See Rare Adverse Effects in the Comments section.) Also contraindicated in patients with a history of manifest or latent porphyria.(2) Warnings: Rapid administration may cause respiratory depression, apnea, laryngospasm, or vasodilation with hypotension.(2) Should be withdrawn gradually if large doses have been used for prolonged periods.(2) Paradoxical excitement may occur or important symptoms could be masked when given to patients with acute or chronic pain.(2) May be habit forming. Infusion-related Respiratory depression and arrest requiring mechanical ventilation may occur. Monitor cautions oxygen saturation. If hypotension occurs, the infusion rate should be decreased and/or the patient should be treated with IV fluids and/or vasopressors. Pentobarbital is an alkaline solution (pH = 9–10.5); therefore, extravasation may cause tissue necrosis.(2) (See Appendix E for management.) Gangrene may occur following inadvertent intra-arterial injection.(2) Dosage Medically induced coma (for persistently elevated intracranial pressure (ICP) or refractory status epilepticus): Patient should be intubated and mechanically ventilated. -
Toxicological Review of Chloral Hydrate (CAS No. 302-17-0) (PDF)
EPA/635/R-00/006 TOXICOLOGICAL REVIEW OF CHLORAL HYDRATE (CAS No. 302-17-0) In Support of Summary Information on the Integrated Risk Information System (IRIS) August 2000 U.S. Environmental Protection Agency Washington, DC DISCLAIMER This document has been reviewed in accordance with U.S. Environmental Protection Agency policy and approved for publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use. Note: This document may undergo revisions in the future. The most up-to-date version will be made available electronically via the IRIS Home Page at http://www.epa.gov/iris. ii CONTENTS—TOXICOLOGICAL REVIEW for CHLORAL HYDRATE (CAS No. 302-17-0) FOREWORD .................................................................v AUTHORS, CONTRIBUTORS, AND REVIEWERS ................................ vi 1. INTRODUCTION ..........................................................1 2. CHEMICAL AND PHYSICAL INFORMATION RELEVANT TO ASSESSMENTS ..... 2 3. TOXICOKINETICS RELEVANT TO ASSESSMENTS ............................3 4. HAZARD IDENTIFICATION ................................................6 4.1. STUDIES IN HUMANS - EPIDEMIOLOGY AND CASE REPORTS .................................................6 4.2. PRECHRONIC AND CHRONIC STUDIES AND CANCER BIOASSAYS IN ANIMALS ................................8 4.2.1. Oral ..........................................................8 4.2.2. Inhalation .....................................................12 4.3. REPRODUCTIVE/DEVELOPMENTAL STUDIES ..........................13 -
Pharmacology – Inhalant Anesthetics
Pharmacology- Inhalant Anesthetics Lyon Lee DVM PhD DACVA Introduction • Maintenance of general anesthesia is primarily carried out using inhalation anesthetics, although intravenous anesthetics may be used for short procedures. • Inhalation anesthetics provide quicker changes of anesthetic depth than injectable anesthetics, and reversal of central nervous depression is more readily achieved, explaining for its popularity in prolonged anesthesia (less risk of overdosing, less accumulation and quicker recovery) (see table 1) Table 1. Comparison of inhalant and injectable anesthetics Inhalant Technique Injectable Technique Expensive Equipment Cheap (needles, syringes) Patent Airway and high O2 Not necessarily Better control of anesthetic depth Once given, suffer the consequences Ease of elimination (ventilation) Only through metabolism & Excretion Pollution No • Commonly administered inhalant anesthetics include volatile liquids such as isoflurane, halothane, sevoflurane and desflurane, and inorganic gas, nitrous oxide (N2O). Except N2O, these volatile anesthetics are chemically ‘halogenated hydrocarbons’ and all are closely related. • Physical characteristics of volatile anesthetics govern their clinical effects and practicality associated with their use. Table 2. Physical characteristics of some volatile anesthetic agents. (MAC is for man) Name partition coefficient. boiling point MAC % blood /gas oil/gas (deg=C) Nitrous oxide 0.47 1.4 -89 105 Cyclopropane 0.55 11.5 -34 9.2 Halothane 2.4 220 50.2 0.75 Methoxyflurane 11.0 950 104.7 0.2 Enflurane 1.9 98 56.5 1.68 Isoflurane 1.4 97 48.5 1.15 Sevoflurane 0.6 53 58.5 2.5 Desflurane 0.42 18.7 25 5.72 Diethyl ether 12 65 34.6 1.92 Chloroform 8 400 61.2 0.77 Trichloroethylene 9 714 86.7 0.23 • The volatile anesthetics are administered as vapors after their evaporization in devices known as vaporizers. -
Chloral Hydrate and Paraldehyde As Drugs of Addiction
Sept., 1932J CHLORAL HYDRATE DRUG HABIT : CHOPRA & SINGH CHOPRA 481 certain parts of the Punjab. This is not the outcome of the use of the drug in the treatment Original Articles of insomnia, but is due to entirely different causes. Until a few years ago in that province potable country-made spirits were allowed to CHLORAL HYDRATE AND PARALDE' be sold to retail dealers in bulk and the vendors HYDE AS DRUGS OF ADDICTION bottled the liquor themselves. Some of these ingenious people conceived the idea of diluting R. N. m.d. By CHOPRA, m.a., (Cantab.) the spirit and adding small quantities of chloral I.M.S. LIEUTENANT-COLONEL, hydrate to make up for the loss in its potency and which would result from dilution. The know- GURBAKHSH SINGH CHOPRA, m.b., b.s. ledge that the drug had hypnotic and narcotic was obtained from the (Drug Addiction Inquiry, Indian Research Fund effects undoubtedly Association) medical profession and compounders work- in It was further learnt that Series No. 15 ing dispensaries. the effects chloral hydrate in many Chloral produced by hydrate and paraldehyde belong to resemble those by alcohol, the of ways produced group drugs known as soporifics or especially when the latter is taken in large The chief use of hypnotics. this class of drugs quantities. When the two articles are taken is in the treatment of one insomnia, of the together they act in a manner synergistic to worst evils of modern times from which man- each other and in this way the effect of either kind can suffer. -
Halogenated Ether, Alcohol, and Alkane Anesthetics Activate TASK-3 Tandem Pore Potassium Channels Likely Through a Common Mechanism S
Supplemental material to this article can be found at: http://molpharm.aspetjournals.org/content/suppl/2017/03/21/mol.117.108290.DC1 1521-0111/91/6/620–629$25.00 https://doi.org/10.1124/mol.117.108290 MOLECULAR PHARMACOLOGY Mol Pharmacol 91:620–629, June 2017 Copyright ª 2017 by The American Society for Pharmacology and Experimental Therapeutics Halogenated Ether, Alcohol, and Alkane Anesthetics Activate TASK-3 Tandem Pore Potassium Channels Likely through a Common Mechanism s Anita Luethy, James D. Boghosian, Rithu Srikantha, and Joseph F. Cotten Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.L., J.D.B., and J.F.C.); Department of Anesthesia, Kantonsspital Aarau, Aarau, Switzerland (A.L.); Carver College of Medicine, University of Iowa, Iowa City, Iowa (R.S.) Received January 7, 2017; accepted March 20, 2017 Downloaded from ABSTRACT The TWIK-related acid-sensitive potassium channel 3 (TASK-3; hydrate (165% [161–176]) . 2,2-dichloro- . 2-chloro 2,2,2- KCNK9) tandem pore potassium channel function is activated by trifluoroethanol . ethanol. Similarly, carbon tetrabromide (296% halogenated anesthetics through binding at a putative anesthetic- [245–346]), carbon tetrachloride (180% [163–196]), and 1,1,1,3,3,3- binding cavity. To understand the pharmacologic requirements for hexafluoropropanol (200% [194–206]) activate TASK-3, whereas molpharm.aspetjournals.org TASK-3 activation, we studied the concentration–response of the larger carbon tetraiodide and a-chloralose inhibit. Clinical TASK-3 to several anesthetics (isoflurane, desflurane, sevoflurane, agents activate TASK-3 with the following rank order efficacy: halothane, a-chloralose, 2,2,2-trichloroethanol [TCE], and chloral halothane (207% [202–212]) . -
Calcium Current Block by (-)-Pentobarbital, Phenobarbital
The Journal of Neuroscience, August 1993, 13(E): 321 l-3221 Calcium Current Block by (-)-Pentobarbital, Phenobarbital, and CHEB but not (+)-Pentobarbital in Acutely Isolated Hippocampal CA1 Neurons: Comparison with Effects on GABA-activated Cl- Current Jarlath M. H. ffrench-Mullen,’ Jeffery L. Barker,* and Michael A. Rogawski3 ‘Department of Pharmacology, Zeneca Pharmaceuticals Group, Zeneca Inc., Wilmington, Delaware 19897 and *Laboratory of Neurophysiology, and 3Neuronal Excitability Section, Epilepsy Research Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892 Block of a voltage-activated Ca*+ channel current by pheno- Ca*+ current, whereas the sedative effects that occur at high- barbital (PHB), 5-(2-cyclohexylideneethyl)-5-ethyl barbituric er concentrations could reflect stronger Ca2+ current block- acid (CHEB), and the optical R(-)- and S(+)-enantiomers of ade. The powerful sedative-hypnotic action of (-)-PB may pentobarbital (PB) was examined in freshly dissociated adult reflect greater maximal enhancement of GABA responses guinea pig hippocampal CA1 neurons; the effects of the in conjunction with strong inhibition of Ca2+ current. The barbiturates on GABA-activated Cl- current were also char- convulsant action of CHEB is unlikely to be related to its acterized in the same preparation. (-)-PB, PHB, and CHEB effects on the Ca*+ current. produced a reversible, concentration-dependent block of the [Key words: calcium channel, GABA receptor, (-)-pen- peak Ca*+ channel current (3 mM Ba2+ as the charge carrier) tobarbital, (+)-pentobarbital, phenobarbital, CHEB [S-(2-cy- evoked by depolarization from -80 to - 10 mV (I&,, values, clohexylideneethyl)-S-ethyl barbituric acid], CA 1 hippocam- 3.5, 72, and 118 PM, respectively). -
Oral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial
85 Emergency (2014); 2 (2): 85‐89 ORIGINAL RESEARCH Oral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial Reza Azizkhani1, Soheila Kanani1*, Ali Sharifi2, Keihan Golshani1, Babak Masoumi1, Omid Ahmadi1 1. Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2. Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran Abstract Introduction: The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia (PSA) to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced till now. The aim of the present study was comparison of oral chloral hydrate (OCH) and rectal sodium thiopental (RST) in pediatric PSA. Methods: In the present randomized clinical trial, 2‐6 years old pediatrics who referred for performing brain computed tomography scan was enrolled and were randomly divided in to two groups. OCH (50mg/kg) and RST (25mg/kg) were prescribed and a trained nurse recorded the time from drug prescription to receiving the con‐ scious sedation (onset of action), the total time period which the patient has the Ramsay score≥4 (duration of action), and adverse effect of agents. Mann‐Whitney U test and chi‐squared test, and Non‐parametric analysis of covariance (ANCOVA) were used for comparisons. Results: One hundred and forty children were entered to two groups of OCH and RST, randomly. The patients of two groups had similar age, sex, weight, and baseline vital signs except for diastolic blood pressure (p<0.001). The onset of action in OCH and RST groups were 24.5±6.1and 28.7±5.2 minutes, respectively (p<0.001).