Determination of the minimum infusion rate of alfaxalone during its co-administration with fentanyl at three different doses by constant rate infusion intravenously in goats

Dzikiti, Brighton T.; Ndawana, Patience S.; Zeiler, Gareth Edward; Ferreira, Jacques; Dzikiti, Loveness Nyaradzo

doi:10.1111/vaa.12300

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…Anesthetics can suppress consciousness by inhibiting arousal nuclei in the brainstem and diencephalon (e.g., locus coeruleus and pons reticular formation) or by activating sleeppromoting nuclei (e.g., preventral optic nucleus) (Mashour and Hudetz, 2017). However, opioids, which are the most commonly used analgesics, cause a central excitatory effect during anesthesia recovery (Dzikiti et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Opioid-induced short-term consciousness improvement in patients with disorders of consciousness

Wang²,

Zhuang³

et al. 2023

Front. Neurosci.

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IntroductionEffective treatment to facilitate recovery from prolonged disorders of consciousness is a complex topic for the medical community. In clinical practice, we have found that a subset of patients has a short-term improvement of consciousness after general anesthesia.MethodsTo determine the clinical factors responsible for the consciousness improvement, we enrolled 50 patients with disorders of consciousness who underwent surgery from October 2021 to June 2022. Their states of consciousness were evaluated before surgery, within 48 h after surgery, and 3 months after surgery. Clinical-related factors and intraoperative anesthetic drug doses were collected and compared between patients with and without consciousness improvement. Independent associations between selected factors and postoperative improvement were assessed using multivariate logistical regression analyses.ResultsPostoperative short-term consciousness improvement was found in 44% (22/50) of patients, with significantly increased scores of auditory and visual subscales. Patients with traumatic etiology, a preoperative diagnosis of minimally conscious state, and higher scores in the auditory, visual, and motor subscales were more likely to have postoperative improvement. This short-term increase in consciousness after surgery correlated with patients’ abilities to communicate in the long term. Furthermore, the amount of opioid analgesic used was significantly different between the improved and non-improved groups. Finally, analgesic dose, etiology, and preoperative diagnosis were independently associated with postoperative consciousness improvement.DiscussionIn conclusion, postoperative consciousness improvement is related to the residual consciousness of the patient and can be used to evaluate prognosis. Administration of opioids may be responsible for this short-term improvement in consciousness, providing a potential therapeutic approach for disorders of consciousness.

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Section: Introductionmentioning

confidence: 99%

Opioid-induced short-term consciousness improvement in patients with disorders of consciousness

Wang²,

Zhuang³

et al. 2023

Front. Neurosci.

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“…However, the alfaxalone MIR required to prevent purposeful movement in response to noxious stimuli decreased significantly in the EA-ALF group in comparison with the ALF group (9 (4.8-9.6) and 12 (11.4-18), respectively; p = 0.0035), indicating the dose sparing effect of EA on alfaxalone anesthesia in goats. In prior reports, the effects of fentanyl or midazolam on MIR of alfaxalone were investigated in goats [26,30]. CRI of fentanyl (0.005 mg/kg/h) and midazolam (0.1 and 0.3 mg/kg/h) reduced the alfaxalone MIR by 30% in comparison to MIR for alfaxalone alone in goats.…”

Section: Discussionmentioning

confidence: 99%

“…The goats were then positioned on the right lateral recumbency and allowed to breathe room air. Immediately after the induction, alfaxalone was initially infused at a dose rate of 0.2 mg kg/min [26] for the maintenance using an IV infusion pump (Volumetric infusion pump/controller, IMED Gemini PC-1 v8.13). The initial infusion rate was kept for an equilibration period of 10 min before testing nociception in response to noxious stimulation.…”

Section: General Anesthesia and Mir Determinationmentioning

confidence: 99%

Determination of the Minimum Infusion Rate of Alfaxalone Combined with Electroacupuncture in Goats

Liu

Abouelfetouh

Salah

et al. 2021

Animals

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Total intravenous anesthesia (TIVA) is increasingly used in companion animals. The effect of electroacupuncture (EA) on alfaxalone-based TIVA has not been previously reported in goats. Therefore, the objective of this study was to determine the minimum infusion rate (MIR) of alfaxalone required to prevent purposeful movement of the extremities in response to standardized noxious stimulation during its combination with EA in goats. Twelve clinically healthy goats weighing 18.5 ± 2 kg were randomly assigned to two groups (six goats/group). Alfaxalone alone (ALF group) and alfaxalone combined with EA (EA-ALF group). In the EA-ALF, alfaxalone was administered 30 min after EA stimulation. For induction of anesthesia, a bolus of alfaxalone was given at 3 mg/kg IV, and an infusion dose of 9.6 mg/kg/h was initially set for maintenance. The MIR of alfaxalone in both groups was determined by testing for responses to stimulation (clamping on a digit with Vulsellum forceps) at 10-min intervals after induction of anesthesia till the entire period of the experiment. Cardiopulmonary parameters and nociceptive threshold were measured throughout anesthesia. The median alfaxalone MIR was significantly lower in the EA-ALF group than the ALF group [9 (4.8–9.6) and 12 (11.4–18)], respectively; p = 0.0035). In the ALF group, goats anesthetized with MIR showed a significant increase in heart rate and cardiac output (p < 0.0001 and 0.0312, respectively), and decrease in respiratory rate (p < 0.0001), hemoglobin oxygen saturation (p = 0.0081), and rectal temperature (p = 0.0046) compared with those in the EA-ALF. Additionally, goats in the EA-ALF showed a higher nociceptive threshold than those in the ALF group (p < 0.0001). EA provided analgesia, reduced the MIR of alfaxalone-based IV anesthesia and thereby alleviated the adverse cardiorespiratory effects associated with alfaxalone anesthesia in goats.

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“…Also, co-administration of a fentanyl CRI (10 µg/kg/h) results in a significant decrease of the alfaxalone infusion rate in dogs (Dehuisser et al, 2017), while combinations with medetomidine (3 -5 µg/kg/h) alone or with either butorphanol (30 µg/kg/h) or guaifenesin (80 mg/kg/h) have been demonstrated to reduce the alfaxalone dose regimen (1.5 -2 mg/kg/h or 0.025 -0.033 mg/kg/min) for TIVA in horses (Goodwin et al, 2013;Ohmura et al, 2016;Aoki et al, 2017). In goats, a significant reduction of the alfaxalone CRI down to 0.02 mg/kg/min has been observed after a combination with either midazolam (0.1 -0.9 mg/ kg/h) or fentanyl (5 -30 µg/kg/h) (Dzikiti et al, 2015;Dzikiti et al, 2016). The results of the present report suggest that an alfaxalone CRI at 0.05 mg/kg/min, possibly in combination with other drugs, may reduce the required dose of inhalant anesthetics delivered to the patient, which warrants further research.…”

Section: Figure 2 Graphical Representation (From Top Left To Bottom mentioning

confidence: 99%

“…Similarly, Moll et al, (2013) showed that the same rate infusion of alfaxalone in unpremedicated sheep maintained clinically acceptable hemodynamic stability, with mild respiratory depression. The use in combination with co-adjuvants midazolam or fentanyl has shown an eight-fold reduction for the alfaxalone constant rate infusion in goats (Dzikiti et al, 2015;Dzikiti et al, 2016). Furthermore, in desflurane-anesthetized sheep, a low alfaxalone CRI rate (0.07 mg/kg/min) reduces the desflurane requirements to maintain a suitable anesthetic depth (Granados et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Clinical effect of a constant rate infusion of alfaxalone in isoflurane-anesthetized goats undergoing an experimental procedure: a pilot study

Rodrigo-Mocholí¹,

Gasthuys²,

Vlaminck³

et al. 2020

VDT

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Determination of the minimum infusion rate of alfaxalone during its co-administration with fentanyl at three different doses by constant rate infusion intravenously in goats

Cited by 10 publications

References 19 publications

Opioid-induced short-term consciousness improvement in patients with disorders of consciousness

Opioid-induced short-term consciousness improvement in patients with disorders of consciousness

Determination of the Minimum Infusion Rate of Alfaxalone Combined with Electroacupuncture in Goats

Clinical effect of a constant rate infusion of alfaxalone in isoflurane-anesthetized goats undergoing an experimental procedure: a pilot study

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