Effects of dexmedetomidine combined with commonly administered opioids on clinical variables in dogs
What did the research find?
The objective of the study was to evaluate the effects of dexmedetomidine combined with commonly administered opioids in dogs. The research found:
- Similar cardiorespiratory depression when dexmedetomidine was combined with any of the opioids included in the study.
- Monitoring of ventilation and oxygenation is recommended, particularly when a combination of dexmedetomidine and meperidine or methadone is used.
- Superior sedation was achieved when dexmedetomidine was combined with meperidine or methadone compared to dexmedetomidine alone or in combination with the rest of opioids included in the study.
- Antinociceptive effects were difficult to interpret because of sedation, but they appeared to be better when dexmedetomi¬dine was combined with butorphanol, methadone, morphine, or nalbuphine.
How was it conducted?
Eight healthy, 24-month-old beagles, habituated to both environment and research team, where used in the study. Water and food were withheld for 6 hours before the start of the investigation.
Dogs were randomly assigned to receive the 7 predefined treatments with a minimum washout interval of 7 days between treatments. The treatments consisted of:
- dexmedetomidine (0.01 mg/kg)
And the same dose of dexmedetomidine combined with:
- butorphanol (0.15 mg/kg)
- meperidine (5 mg/kg)
- methadone (0.5 mg/kg)
- morphine (0.5 mg/kg)
- nalbuphine (0.5 mg/kg)
- tramadol (5 mg/kg)
Opioid doses were selected based on equipotent analgesic doses used in other studies (Mastrocinque and Fantoni, 2003; Mainte et al. 2009).
Variables were measured before drug administration (time 0; baseline) and every 15 minutes after drug administration for 120 minutes. Measured variables included:
- Cardiopulmonary, blood gas, and electrolyte values - heart rate, cardiac rhythm, blood pressure, respiratory rate, blood pH, PaCO2, PaO2, arterial oxygen saturation, base excess and electrolyte concentrations.
- Sedative effects - evaluated and scored separately by 3 examiners blinded to the treatments administered.
- Antinociceptive effects – withdrawal reflex to heat stimulation (60oC metallic probe in interdigital space for a maximum 5 of seconds).
Why is this study important?
Dexmedetomidine has more potent sedative and analgesic effects than the racemate medetomidine but can cause dose-dependent cardiopulmonary depression. Combinations of opioids and alpha2-adrenoerceptor agonists are often used in veterinary medicine and can lead to supra-additive or synergic antinociceptive and sedative effects. This study is relevant because opioids form the basis of pain management in dogs and are commonly used in veterinary practice, but information on efficacy of certain opioids, such as nalbuphine and tramadol, have been less evaluated. The authors of the study hypothesised that dexmedetomidine in combination with any of the opioids would result in superior antinociception and sedation but would cause similar cardiopulmonary depression, compared with results for administration of dexmedetomidine alone. The results of the study confirmed the authors hypothesis.
In the paper, previous studies are compared with the current study. We have provided a summary of the parameter comparison in this table:
|Measured Parameter||Previous studies suggest…||Current study suggests…|
|Arterial blood pressure||Reduction (dexmedetomidine + buprenorphine, methadone, morphine, or tramadol)||Not detected|
|Heart rate||Vagally mediated bradycardia (opioids)
Reduction (opioids + alpha2-adrenorecptor agonists)
|No difference in heart rate or AMP among treatments|
|Arrythmia||Not reported (dexmedetomidine + meperidine, methadone, morphine, or tramadol||Some cardiac arrhythmias were detected (all treatments), but not clinically relevant. There were no differences among treatments|
|Hypoxemia||Effects of opioids on oxygenation in dogs differ among reports. High doses of methadone (1.0 mg/kg) administered IV to conscious dogs can cause hypoxemia result of ventilation-perfusion impairment||Significant but not clinically relevant reductions in PaO2, particularly when dogs received dexmedetomidine with methadone or mepivacaine. Due to impaired alveolar ventilation and ventilation-perfusion.|
|Sedation||Improved when dexmedetomidine is administered with methadone or morphine (compared with dexmedetomidine given alone or in combination with tramadol)|
Improved when a combination of dexmedetomidine and meperidine is administered (compared with dexmedetomidine administered alone)
Adding butorphanol (0.2 mg/kg) to medetomidine improves sedation in dogs
|Sedation was observed for all treatments for up to 60 minutes after injection. Superior sedation observed in dogs administered dexmedetomidine + mepivacaine or dexmedetomidine + methadone|
Link to the full article: http://eprints.gla.ac.uk/14155...
Want to know more about opioids? Read Persperctives on Premeds - Opioids by Karen Heskin.
Originally published: Thursday, 31st May 2018
Last updated: Thursday, 14th June 2018
Maiante, A.A., Teixeira Neto, F.J., Beier, S.L., Corrente, J.E. and Pedroso, C.E.B.P. 2009. Comparison of the cardio‐respiratory effects of methadone and morphine in conscious dogs. Journal of veterinary pharmacology and therapeutics. 32(4): 317-328.
Mastrocinque, S. and Fantoni, D.T. 2003. A comparison of preoperative tramadol and morphine for the control of early postoperative pain in canine ovariohysterectomy. Veterinary anaesthesia and analgesia. 30(4): 220-228.
The effects of hypothermia are very far reaching throughout the peri-anaesthetic process. In this article, James takes us through the interesting mechanisms of body cooling and warming, the clinical relevance of hypothermia and what we can do to prevent it.Read On...
All patients are exposed to the risks associated with general anaesthesia. Continuously monitoring anaesthetised patients maximises patients safety and wellbeing. In this article, Dan takes us through the common monitoring techniques that provide information about the cardiovascular status of your patient.Read On...
Despite being widely recognized in humans, postoperative nausea and vomiting (PONV), and the role of maropitant in reducing inhalational anaesthetic requirements have been poorly documented in dogs. This recent study evaluates PONV and isoflurane requirements after maropitant administration during routine ovariectomy in bitches.Read On...
Little information is available about the effect that different doses of medetomidine and butorphanol may have when using sevoflurane for maintenance of anaesthesia in dogs. This recent study evaluates heart rate and median sevoflurane concentration required at different dose rates.Read On...
In this second article of the capnography series, James provides a guide to a few of the most common traces that you will encounter during surgery. Scroll to the end of the article to download a printable capnography cheatsheet.Read On...
Pain, what a Pain! (Part 2) – Practical Tips On How To Perform Dental Nerve Blocks In Companion Animal Practice
In this second article of the Pain, what a Pain! series, Dan takes us through the LRA techniques associated with dental and oral surgery. In this article, you will find practical tips and pictures on common dental nerve blocks as well as safety concerns to consider.Read On...
This recent retrospective study looks at the cases of 185 pet rabbits admitted for sedation or general anaesthetic and evaluates the incidence and risk factors contributing to peri-anaesthetic mortality and gastrointestinal complications.Read On...
Pain, what a Pain! How Locoregional Anaesthesia can Improve the Outcome and Welfare of Veterinary Patients (Part 1)
In this first article out of a series of two, Dan takes us through an introduction and practical tips for appropriate local anaesthesia delivery. Find out why these anaesthesia techniques, that are well recognised in human medicine, have seen an increase in popularity in veterinary medicine over the recent yearsRead On...
This study evaluates the effectiveness of two methods of preoxygenation in healthy yet sedated dogs and the impact of these methods on time taken to reach a predetermined haemoglobin desaturation point (haemoglobin saturation (SpO2) of 90%) during an experimentally induced period of apnoea.Read On...