Randomized clinical trial of the effects of a combination of acepromazine with morphine and midazolam on sedation, cardiovascular variables and the propofol dose requirements for induction of anesthesia in dogs

Simonsen

2020

Basic Clin Pharma Tox

Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-ago go channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.

Section: Pharmacodynamic Interactions Of Antipsychotics and Opioidssupporting

confidence: 64%

Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?

Simonsen

2020

Basic Clin Pharma Tox

“…As doses dos medicamentos de eleição foram midazolam 1 mg/kg/IM, acepromazina 0,5 mg/kg/IM e meperidina 15 mg/kg/IM. Fenotiazínicos, benzodiazepínicos e opióides são frequentemente utilizados em cães e gatos ao preparo cirúrgico (MONTEIRO et al, 2014). As doses dos medicamentos empregadas seguirão os padrões e recomendações para roedores (PANG, 2015).…”

Section: Resultsunclassified

UROLITÍASE EM CAVIA PORCELLUS SUBMETIDA À CISTOTOMIA: RELATO DE CASO/ Urolithiasis in Cavia porcellus submitted to cystotomy: case report

et al. 2021

Urolitíase é uma doença multifatorial e possui uma casuística elevada em Cavia porcellus. Os urólitos podem ser encontrados em múltiplas regiões do trato urinário desses animais. Dentre machos e fêmeas, as fêmeas apresentam maior incidência sendo a patofisiologia pouco compreendida. Sinais clínicos são importantes para o correto diagnóstico, no entanto, exames de imagem são mecanismos cruciais para a determinação de urólitos ao longo do sistema urinário. Dentre as opções para o tratamento, os procedimentos cirúrgicos são os mais utilizados. Diante disso, o presente relato discute o percurso clínico-cirúrgico de C. porcellus, fêmea, destacando o procedimento anestésico adotado durante cistotomia.

“…The sedative effect induced by acepromazine--opioid combinations has been extensively studied in dogs [2,4,7,9,10,13]. To the authors' knowledge, this is the first study to report the influence of dose of the phenothiazine on the sedating action of the combination.…”

Section: Discussionmentioning

confidence: 99%

“…Sedation was assessed by use of a numeric descriptive scale (NDS) and a simple numerical scale (SNS). The NDS ranged from 0 to 3, as follows: 0, no sedation; 1, mild sedation, less alert but still active; 2, moderate sedation, drowsy, recumbent but can walk; 3, intense sedation, very drowsy, unable to walk [9,14]. The SNS consisted of a scale ranging from 0 to 10 where 0 represents no sedation and 10 represents the most sedation possible [2].…”

Section: Phasementioning

confidence: 99%

See 1 more Smart Citation

Effects of Three Acepromazine Doses on the Incidence of Morphine-Induced Vomiting, Sedation and Some Physiological Variables in Dogs

Monteiro

Pinto

Nunes

et al. 2017

Acta Scientiae. Vet.

Background: Acepromazine was found to reduce the incidence of vomiting induced by opioids such as morphine, hydromorphone and oxymorphone in dogs. Despite the effectiveness of the phenothiazine in preventing opioid-induced vomiting in this species, a single dose of acepromazine (0.05 mg/kg) was tested and the influence of dose on the antiemetic effect of the drug is unknown. The primary objective of this study was to evaluate the effect of three acepromazine doses on the incidence of vomiting induced by morphine in dogs. A secondary aim was to assess the degree of sedation and effects on physiological variables following administration of the combinations tested.Materials, Methods & Results: All dogs received 0.5 mg/kg morphine (IM). Fifteen min before morphine, dogs in the Control, ACPLD, ACPMD and ACPHD groups were administered (IM) physiological saline or acepromazine at doses of 0.025, 0.05 and 0.1 mg/kg, respectively. In Phase 1, purpose-bred dogs (n = 8) underwent each of the four treatments in a randomized, crossover design; the incidence of vomiting, sedation, pulse rate (PR), systolic, mean and diastolic blood pressures (SAP, MAP and DAP) were investigated for 60 min. Sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 1-10). In Phase 2, client-owned dogs (n = 50) received a single treatment and only the incidence of vomiting was assessed. There was no significant difference between groups on the incidence of vomiting recorded in Phase 1, Phase 2 and the average of Phases 1 and 2. A significant decrease in PR was observed in most groups but no significant difference was detected between groups. Blood pressure decreased in all groups; during most of the evaluation period, SAP, MAP and DAP were significantly higher in the Control than in other treatments. Dogs in this study presented mild to intense sedation. A significant difference in NDS scores was observed between the Control and ACPMD groups whereas for SNS scores, significant differences were detected between the ACPMD and ACPHD groups compared with the Control group. The number of dogs presenting intense sedation as judged by the NDS (NDS score = 3) were: 1/8, 3/8, 3/8 and 4/8 dogs in the Control, ACPLD, ACPMD and ACPHD groups, respectively.Discussion: The hypothesis of the study was rejected. The acepromazine dose did not influence the frequency of morphineinduced vomiting, the degree of sedation or cardiovascular variables after administration of either treatment. The frequency of vomiting was high (≥ 75%) in dogs of the present study regardless of the treatment administered. There was no significant difference in the frequency of vomiting in ACPLD, ACPMD and ACPHD as compared to the Control group. This finding was unexpected because it has been reported in a previous study that acepromazine reduced the incidence of opioid-induced vomiting in dogs. ACPLD, ACPMD and ACPHD improved the quality of sedation compared to the Control treatment but no significant difference in sedation scores was observed among these groups. These findings suggest that, when combined to morphine, there is no improvement in sedation when the acepromazine dose is increased above 0.025 mg/kg in dogs. Despite a significant decrease, mean values of PR, SAP, MAP and DAP remained within the physiological range for conscious dogs. In summary, none of the acepromazine doses was effective in preventing morphine-induced vomiting in dogs. Sedation is greater after acepromazine-morphine combinations than after morphine alone and is not influenced by the acepromazine dose. Cardiovascular effects induced by combinations administered in this study were well tolerated and of little clinical relevance to healthy conscious dogs.