Attenuation of ischaemic injury in the equine jejunum by administration of systemic lidocaine

Cook, Vanessa L.; Shults, Jennifer Jones; McDowell, Marsha R.; Campbell, Nigel; Davis, Jennifer L.; Blikslager, Anthony T.

doi:10.2746/042516408x293574

Cited by 91 publications

(65 citation statements)

References 31 publications

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“…This likely reflects an awareness of the increasing body of published evidence supporting a pivotal role for inflammation in equine POI pathogenesis 3,13,14,15,16 . Similarly, it is likely that the reported anti-inflammatory effects of lidocaine 17,18,19 , in addition to its perceived prokinetic effects 2 , also contributed to the high frequency with which this drug was used, both intra-and postoperatively. Furthermore, in addition to inflammation, pain is recognised as an important risk factor for POI in both humans and horses 1,2,6,9,12,19 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in addition to inflammation, pain is recognised as an important risk factor for POI in both humans and horses 1,2,6,9,12,19 . The specific reasons why flunixin was the preferred nonsteroidal anti-inflammatory drug (NSAIDs) remain uncertain; however, its reportedly greater potency against the systemic effects of endotoxaemia 17 , compared with other NSAIDs, may be a contributing factor in light of the respondents perception that endotoxaemia was "quite important" as a risk factor for the development of POI.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features and management of equine post operative ileus (POI):Survey ofDiplomates of theAmericanColleges ofVeterinaryInternalMedicine (ACVIM),VeterinarySurgeons (ACVS) andVeterinaryEmergency andCriticalCare (ACVECC)

Lefebvre

Hudson

Elce

et al. 2015

Equine Veterinary Journal

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Summary Reasons for performing study A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale. Objectives To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery. Study design Cross‐sectional survey. Methods Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC). Results The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0–20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti‐inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation. Conclusions There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical features and management of equine post operative ileus (POI):Survey ofDiplomates of theAmericanColleges ofVeterinaryInternalMedicine (ACVIM),VeterinarySurgeons (ACVS) andVeterinaryEmergency andCriticalCare (ACVECC)

Lefebvre

Hudson

Elce

et al. 2015

Equine Veterinary Journal

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“…This conclusion is also supported by a later study that found that lidocaine was an unsuitable choice as a sole analgesic in management of post operative colic cases, as horses treated with lidocaine alone showed an increase in pain score post operatively in comparison to flunixin meglumine. (Cook et al 2008) In addition to its potential role in analgesia lidocaine has been shown in humans, dogs, goats and horses to reduce the minimum alveolar concentration (MAC) of inhaled anesthetic agents (Doherty et al 2007;Doherty and Frazier 1998;Himes et al 1977) and therefore lidocaine infusions are widely used in standard anesthetic protocols. One study investigated the effect of intravenous lidocaine on halothane MAC in ponies.…”

Section: )mentioning

confidence: 99%

Serum concentrations of lidocaine and its metabolites after prolonged infusion in healthy horses

Dickey

McKenzie

Brown

et al. 2008

Equine Veterinary Journal

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Summary Reasons for performing study: Continuous‐rate infusions (CRI) of lidocaine are often used for prolonged duration but, to date, only limited time/concentration relationships administered as a short term (24 h) CRI have been reported. Objective: To determine the time/concentration profile of lidocaine and its active metabolites glycinexylidide (GX) and monoethylglycinexylidide (MEGX) during a 96 h lidocaine infusion. Methods: Lidocaine was administered to 8 mature healthy horses as a continuous rate infusion (0.05 mg/kg bwt/min) for 96 h. Blood concentrations of lidocaine, GX and MEGX were determined using high performance liquid chromatography during and after discontinuation of the infusion. Results: Serum lidocaine concentrations reached steady state by 3 h and did not accumulate thereafter. Concentrations were above the target therapeutic concentration (980 ng/ml) only at 6 and 48 h, and did not reach the range described as potentially causing toxicity (>1850 ng/ml) at any time. MEGX did not accumulate over time, while the GX accumulated significantly up to 48 h and then remained constant. The serum concentrations of lidocaine, MEGX and GX were below the limit of detection within 24 h of discontinuation of the infusion. None of the horses developed any signs of lidocaine toxicity during the study. Conclusions: The metabolism of lidocaine was not significantly impaired by prolonged infusion and no adverse effects were observed. Prolonged infusions appear to be safe in normal horses but the accumulation of GX, a potentially toxic active metabolite, is cause for concern. Clinical relevance: Although the toxic level of GX has not yet been determined, such accumulation could lead potentially to adverse side effects and it is important to consider this potential for accumulation when utilising prolonged lidocaine infusions.

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“…42,43 Segmental mesenteric ischemia, as noted in volvulus or trauma, has been induced in the pig, dog, and cat, as well as the horse. 44–47 In each of these models, the choice of animal species has a substantial impact on the pathology and clinical outcome. 48 For instance, the porcine small intestinal tract has low levels of the key oxidant-generating enzyme xanthine oxidase, which has been shown to be largely responsible for reperfusion injury in feline and rodent models that have relatively high levels of intestinal xanthine oxidase.…”

Section: Examples Of Large Animal Models In Digestive Diseasementioning

confidence: 99%

Large Animal Models: The Key to Translational Discovery in Digestive Disease Research

Ziegler

Gonzalez

Blikslager

2016

Cellular and Molecular Gastroenterology and Hepatology

160

142

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Gastrointestinal disease is a prevalent cause of morbidity and mortality and the use of animal models have been instrumental in studying mechanisms of digestive pathophysiology. As investigators attempt to translate the wealth of basic science information developed from rodent, models, large animal models provide a number of translational advantages. The pig, in particular, is arguably one of the most powerful models of human organ systems, including the gastrointestinal tract. The pig has provided important tools and insight into intestinal ischemia/reperfusion injury, intestinal mucosal repair, as well as new insights into esophageal injury and repair. Porcine model development has taken advantage of the size of the animal, allowing increased surgical and endoscopic access. In addition, cellular tools such as the intestinal porcine epithelial cell line and porcine enteroids are providing the methodology to translate basic science findings using in-depth mechanistic analyses. Further opportunities in porcine digestive disease modeling include developing additional transgenic pig strains. Collectively, porcine models hold great promise for the future of clinically relevant digestive disease research.

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Attenuation of ischaemic injury in the equine jejunum by administration of systemic lidocaine

Abstract: Treatment with systemic lidocaine ameliorated the inhibitory effects of flunixin meglumine on recovery of the mucosal barrier from ischaemic injury, when the 2 treatments were combined. The mechanism of lidocaine in improving mucosal repair has not yet been elucidated.

Cited by 91 publications

References 31 publications

Clinical features and management of equine post operative ileus (POI):Survey ofDiplomates of theAmericanColleges ofVeterinaryInternalMedicine (ACVIM),VeterinarySurgeons (ACVS) andVeterinaryEmergency andCriticalCare (ACVECC)

Clinical features and management of equine post operative ileus (POI):Survey ofDiplomates of theAmericanColleges ofVeterinaryInternalMedicine (ACVIM),VeterinarySurgeons (ACVS) andVeterinaryEmergency andCriticalCare (ACVECC)

Serum concentrations of lidocaine and its metabolites after prolonged infusion in healthy horses

Large Animal Models: The Key to Translational Discovery in Digestive Disease Research

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