Publications by authors named "Lesley J Smith"

34 Publications

Retrospective analysis of complications associated with retrobulbar bupivacaine in dogs undergoing enucleation surgery.

Vet Anaesth Analg 2020 Sep 6;47(5):588-594. Epub 2020 May 6.

Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA.

Objective: To investigate complications associated with, and without, bupivacaine retrobulbar local anesthesia in dogs undergoing unilateral enucleation surgery.

Study Design: Retrospective, observational study.

Animals: A total of 167 dogs underwent unilateral enucleation surgery via a transpalpebral approach.

Methods: Records from 167 dogs that underwent unilateral enucleation surgery that did (RB) or did not (NB) include retrobulbar bupivacaine anesthesia were reviewed, including anesthetic record, daily physical examination records, surgery report, patient discharge report and patient notes within 14 days of the surgery. Specific complications and severity were compared between RB and NB using the Wilcoxon rank-sum test. A 'complication burden' (0-5) comprising five prespecified complications was assigned and tested using rank-sum procedures. Statistical significance was set to 0.05.

Results: Group RB included 97 dogs and group NB 70 dogs. Dogs in NB had a 17.0 percentage points (points) greater risk for a postoperative recovery complication (38.6% versus 21.6%; 95% confidence interval: 3.0-30.6 points; p = 0.017). There was inconclusive evidence that dogs in group RB had a lower risk of requiring perioperative anticholinergic administration (12.4% versus 22.9%; 10.5 points; p = 0.073). Other complications were similar between groups RB and NB with risks that differed by <10 points. The risk of hemorrhage was similar between groups RB (22.7%) and NB (20.0%) with no significant difference in the level of severity (p = 0.664).

Conclusions And Clinical Relevance: In this retrospective study, the use of retrobulbar bupivacaine for enucleation surgery in dogs was not associated with an increased risk of major or minor complications.
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http://dx.doi.org/10.1016/j.vaa.2020.04.007DOI Listing
September 2020

Effects of hetastarch 130/0.4 on plasma osmolality, colloid osmotic pressure and total protein in horses anaesthetised for elective surgical procedures.

Vet Rec 2018 07 31;183(4):127. Epub 2018 May 31.

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Effects of lactated Ringer's solution (LRS) and hetastarch 130/0.4 (HES) on colloid osmotic pressure (COP), plasma osmolality (OSM) and total protein (TP) were investigated in 18 inhalational-anaesthetised healthy horses. Horses received 4-6 ml/kg LRS (LRS; n=9) or HES (HES; n=9) from anaesthesia induction through 60 min, after which all were administered LRS. COP, TP and OSM were measured before premedication (baseline), postinduction and 30 (n=18), 60 (n=18), 90 (n=18) and 120 (n=12) minutes. Baseline COP, OSM and TP were not different between groups. TP decreased in both groups at all time points after induction. OSM increased from baseline in HES at 30, 60, 90 and 120 minutes. COP decreased at 30-120 minutes in LRS, and at 90 and 120 minutes in HES. Mean COP was higher in HES than LRS at 30 (18.8±0.5 vs 16.3±0.4 mmHg (P=0.001)), 60 (19.1±0.5 vs 15.9±0.4 mmHg (P<0.0001)) and 90 (17.4±0.5 vs 15.4±0.5 mmHg (P=0.005)) minutes. Sixty minutes of HES infusion increases OSM and transiently maintains COP compared with an equal volume of LRS in anaesthetised horses.
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http://dx.doi.org/10.1136/vr.104634DOI Listing
July 2018

Comparison of the effects of alfaxalone and propofol with acepromazine, butorphanol and/or doxapram on laryngeal motion and quality of examination in dogs.

Vet Anaesth Analg 2018 May 3;45(3):241-249. Epub 2018 Feb 3.

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA. Electronic address:

Objective: To compare the effects of alfaxalone and propofol, with and without acepromazine and butorphanol followed by doxapram, on laryngeal motion and quality of laryngeal examination in dogs.

Study Design: Randomized, crossover, blinded study.

Animals: Ten female Beagle dogs, aged 11-13 months and weighing 7.2-8.6 kg.

Methods: The dogs were administered four intravenous (IV) treatments: alfaxalone (ALF), alfaxalone+acepromazine and butorphanol (ALF-AB), propofol (PRO) and propofol+AB (PRO-AB). AB doses were standardized. Dogs were anesthetized 5 minutes later by administration of alfaxalone or propofol IV to effect. Arytenoid motion during maximal inspiration and expiration was captured on video before and after IV doxapram (0.25 mg kg). The change in rima glottidis surface area (RGSA) was calculated to measure arytenoid motion. An investigator blinded to the treatment scored laryngeal examination quality.

Results: A 20% increase in RGSA was the minimal arytenoid motion that was detectable. RGSA was significantly less in ALF before doxapram compared with all other treatments. A <20% increase in RGSA was measured in eight of 10 dogs in PRO and in all dogs in ALF before doxapram. After doxapram, RGSA was significantly increased for PRO and ALF; however, 20% of dogs in PRO and 50% of dogs in ALF still had <20% increase in RGSA. A <20% increase in RGSA was measured in five of 10 dogs in PRO-AB and ALF-AB before doxapram. All dogs in PRO-AB and ALF-AB with <20% increase in RGSA before doxapram had ≥20% increase in RGSA after doxapram. Examination quality was significantly better in PRO-AB and ALF-AB.

Conclusions And Clinical Relevance: The use of acepromazine and butorphanol improved the quality of laryngeal examination. Any negative impact on arytenoid motion caused by these premedications was overcome with doxapram. Using either propofol or alfaxalone alone is not recommended for the evaluation of arytenoid motion.
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http://dx.doi.org/10.1016/j.vaa.2017.08.014DOI Listing
May 2018

Evaluation of an intramuscular butorphanol and alfaxalone protocol for feline blood donation: a pilot study.

J Feline Med Surg 2018 08 26;20(8):793-798. Epub 2017 Sep 26.

2 Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.

Objectives The purpose of this pilot study was to evaluate the use of an intramuscular (IM) sedation protocol with butorphanol and alfaxalone in cats undergoing blood donation. We hypothesized that this drug combination would provide sufficient sedation to perform phlebotomy without causing hypotension or significant changes in heart rate. Methods Six purpose-bred, healthy adult cats were sedated using IM butorphanol (0.4 mg/kg) and alfaxalone (2-3 mg/kg). Pulse and Doppler blood pressure (BP) were recorded at baseline, after sedation and immediately following phlebotomy. Once laterally recumbent, 12 ml/kg blood was collected from the jugular vein. Sedation scores, duration of lateral recumbency and the ability to successfully perform phlebotomy were recorded. Results There was no significant change in heart rate post-sedation (median 190 beats per min [bpm], range 160-224 bpm) or post-phlebotomy (median 200 bpm, range 180-220 bpm) compared with baseline values (median 200 bpm, range 180-220 bpm) ( P = 0.395). A statistically significant change in BP was detected ( P = 0.029), attributed to a difference between post-sedation (median 113.3 mmHg, range 110.7-130.0) and baseline (median 133.3 mmHg, range 130.0-183.3) measurements. Hypotension was not observed in any cat. Collection of at least 80% of the target volume was achieved in 5/6 cats, although all were adequately sedated to allow jugular venous phlebotomy. Median recumbency time was 53 mins (range 43-83 mins). Phlebotomy duration lasted a median of 13 mins (range 5-21 mins). Conclusions and relevance The administration of IM alfaxalone and butorphanol provided sufficient restraint for blood donation without causing hypotension or significant changes in heart rate before or after phlebotomy.
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http://dx.doi.org/10.1177/1098612X17732484DOI Listing
August 2018

Involving ACVAA diplomates to decrease anesthetic risk.

Authors:
Lesley J Smith

J Am Vet Med Assoc 2016 Apr;248(8):875

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http://dx.doi.org/10.2460/javma.248.8.875DOI Listing
April 2016

Postoperative Analgesia Provided by Liposomal Hydromorphone in Client-Owned Dogs Undergoing Limb Amputation.

J Am Anim Hosp Assoc 2016 Jan-Feb;52(1):13-21. Epub 2015 Nov 25.

From the Department of Surgical Sciences, University of Wisconsin, Madison, Madison, WI (L.K-H., L.J.S, B.S., P.V.S., C.B.); and the Division of Pharmaceutical Sciences, School of Pharmacy, University of Wisconsin, Madison, Madison, WI (T.D.H.).

The analgesic efficacy of liposomal hydromorphone (LE-hydro) was tested in dogs undergoing limb amputation. The positive controls (n = 10) received subcutaneous (SQ) hydromorphone (0.2 mg/kg) and 1.5 mL of blank liposomes before surgery; fentanyl continuous rate infusion (CRI), 5-10 μg/kg/hr IV, during and for 24 hr after surgery; and a fentanyl patch at extubation. The negative controls (n = 7) received SQ hydromorphone (0.2 mg/kg) and 1.5 mLs of blank liposomes SQ before surgery, fentanyl CRI (5-10 μg/kg/hr IV) during surgery but stopped at extubation, and a fentanyl patch at extubation. The test group (n = 11) received 3 mg/kg of LE-hydro and 1.5 mL of saline SQ before surgery, 1.5 mL of saline SQ, and a saline CRI during surgery. All groups received a bupivacaine block in the limb prior to amputation and carprofen prior to surgery. Treatment failures, pain scores, opioid side effects, heart rate, respiratory rate, temperature, and client-reported pain and side effects were evaluated. There were three treatment failures in the positive control (3/10) and test groups (3/11). Negative controls had seven treatment failures (7/7). Side effects for all three groups were within expected limits. LE-hydro provides postoperative analgesia equivalent to fentanyl CRI in dogs undergoing limb amputation.
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http://dx.doi.org/10.5326/JAAHA-MS-6113DOI Listing
August 2016

ANESTHETIC INDUCTION AND RECOVERY PARAMETERS IN BEARDED DRAGONS (POGONA VITTICEPS): COMPARISON OF ISOFLURANE DELIVERED IN 100% OXYGEN VERSUS 21% OXYGEN.

J Zoo Wildl Med 2015 Sep;46(3):534-9

Inland bearded dragons (Pogona vitticeps, n=6) were anesthetized for 1 hr using isoflurane in either 100% oxygen or 21% oxygen (FI 21; medical-grade room air). Parameters of anesthetic depth were recorded throughout both induction and recovery by an observer blinded to the fraction of inspired oxygen (FiO2), including the loss and return of withdrawal and righting reflexes, muscle tone, ability to intubate or extubate, and return to spontaneous respiration. Physiologic data were recorded every 5 min throughout the anesthetic procedures, including heart rate, body temperature, end-tidal CO2, hemoglobin oxygen saturation (SpO2), and percent expired isoflurane. Lizards were subjected to application of a noxious stimulus (needle stick) at 0, 30, and 60 min, and responses recorded. Following a minimum 7-day washout period, the experiment was repeated with each lizard subjected to the other protocol in a randomized, complete crossover design. The only statistically significant difference was a lower mean SpO2 in the group inspiring 21% oxygen (P<0.0020). No statistically significant differences were detected in any parameters during induction or recovery; however, all values were uniformly shorter for the FI 21 group, indicating a possible clinically significant difference. A larger sample size may have detected statistically significant differences. Further studies are needed to evaluate these effects in other reptile species and with the concurrent use of injectable anesthetic and analgesic drugs.
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http://dx.doi.org/10.1638/2014-0193.1DOI Listing
September 2015

Comparison of carprofen and tramadol for postoperative analgesia in dogs undergoing enucleation.

J Am Vet Med Assoc 2014 Dec;245(12):1375-81

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706.

Objective: To compare analgesia provided by carprofen and tramadol in dogs after enucleation.

Design: Randomized, masked clinical trial.

Animals: 43 dogs.

Procedures: Client-owned dogs admitted for routine enucleation were randomly assigned to receive either carprofen or tramadol orally 2 hours prior to surgery and 12 hours after the first dose. Dogs were scored for signs of pain at baseline (ie, before carprofen or tramadol administration) and at 0.25, 0.5, 1, 2, 4, 6, 8, 24, and 30 hours after extubation. Dogs received identical premedication and inhalation anesthesia regimens, including premedication with hydromorphone. If the total pain score was ≥ 9 (maximum possible score of 20), there was a score ≥ 3 in any of 5 behavioral categories (highest score possible per category was 3 or 4), or the visual analog scale (VAS) score was ≥ 35 (maximum possible score of 100) combined with a palpation score > 0, rescue analgesia (hydromorphone) was administered and treatment failure was recorded.

Results: No differences were found in age, sex, or baseline pain scores between groups. Significantly more dogs receiving tramadol required rescue analgesia (6/21), compared with dogs receiving carprofen (1/22). Pain and VAS scores decreased linearly over time. No significant differences were found in pain or VAS scores between groups at any time point (dogs were excluded from analysis after rescue).

Conclusions And Clinical Relevance: Results of this study suggested that carprofen, with opioid premedication, may provide more effective postoperative analgesia than tramadol in dogs undergoing enucleation.
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http://dx.doi.org/10.2460/javma.245.12.1375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378264PMC
December 2014

Anesthesia case of the month. Accidental lidocaine overdose during surgery for vertebral fractures.

J Am Vet Med Assoc 2014 Nov;245(10):1098-101

Section of Anesthesia and Pain Management, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706.

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http://dx.doi.org/10.2460/javma.245.10.1098DOI Listing
November 2014

A comparison of cardiopulmonary function, recovery quality, and total dosages required for induction and total intravenous anesthesia with propofol versus a propofol-ketamine combination in healthy Beagle dogs.

Vet Anaesth Analg 2015 Jul 21;42(4):350-9. Epub 2014 Jul 21.

Section of Anesthesia and Pain Management, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA.

Objective: To compare cardiopulmonary function, recovery quality, and total dosages required for induction and 60 minutes of total intravenous anesthesia (TIVA) with propofol (P) or a 1:1 mg mL(-1) combination of propofol and ketamine (KP).

Study Design: Randomized crossover study.

Animals: Ten female Beagles weighing 9.4 ± 1.8 kg.

Methods: Dogs were randomized for administration of P or KP in a 1:1 mg mL(-1) ratio for induction and maintenance of TIVA. Baseline temperature, pulse, respiratory rate (fR), noninvasive mean blood pressure (MAP), and hemoglobin oxygen saturation (SpO2) were recorded. Dogs were intubated and spontaneously breathed room air. Heart rate (HR), fR, MAP, SpO2, end tidal carbon dioxide tension (Pe'CO2), temperature, and salivation score were recorded every 5 minutes. Arterial blood gas analysis was performed at 10, 30, and 60 minutes, and after recovery. At 60 minutes the infusion was discontinued and total drug administered, time to extubation, and recovery score were recorded. The other treatment was performed 1 week later.

Results: KP required significantly less propofol for induction (4.0 ± 1.0 mg kg(-1) KP versus 5.3 ±1.1 mg kg(-1) P, p = 0.0285) and maintenance (0.3 ± 0.1 mg kg(-1) minute(-1) KP versus 0.6 ±0.1 mg kg(-1) minute(-1) P, p = 0.0018). Significantly higher HR occurred with KP. Both P and KP caused significantly lower MAP compared to baseline. MAP was significantly higher with KP at several time points. P had minimal effects on respiratory variables, while KP resulted in significant respiratory depression. There were no significant differences in salivation scores, time to extubation, or recovery scores.

Conclusions And Clinical Relevance: Total intravenous anesthesia in healthy dogs with ketamine and propofol in a 1:1 mg mL(-1) combination resulted in significant propofol dose reduction, higher HR, improved MAP, no difference in recovery quality, but more significant respiratory depression compared to propofol alone.
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http://dx.doi.org/10.1111/vaa.12218DOI Listing
July 2015

A comparison of epidural analgesia provided by bupivacaine alone, bupivacaine + morphine, or bupivacaine + dexmedetomidine for pelvic orthopedic surgery in dogs.

Vet Anaesth Analg 2013 Sep 7;40(5):527-36. Epub 2013 Jun 7.

Section of Anesthesiology and Pain Management, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.

Objective: To compare the analgesic efficacy of bupivacaine, bupivacaine + morphine, or bupivacaine + dexmedetomidine administered epidurally in dogs undergoing pelvic limb orthopedic surgery.

Study Design: Prospective, randomized, double blinded clinical trial.

Animals: Sixty dogs weighing (mean ± SD) 35 ± 15.7 kg, aged 5 ± 3 years.

Methods: Dogs were assigned to receive a lumbosacral epidural containing bupivacaine (B) 0.5%, 1 mg kg(-1) ; B, bupivacaine 0.5%, 1 mg kg(-1)  + morphine 1%, 0.1 mg kg(-1) ; B + M, or bupivacaine 0.5%, 1 mg kg(-1)  + dexmedetomidine 0.05%, 4 μg kg(-1) ; B + D. The anesthetic protocol was standardized. The median expired isoflurane concentration (E'Iso) and requirement for additional induction agent preventing purposeful movement were recorded. Pain was scored using visual analog (VAS) and modified University of Melbourne (UMPS) pain scales. Sedation was assessed using a 0-4 scale. All parameters were recorded preoperatively, and at extubation (t = 0), then at 1, 2, 4, 8, 12, 16, and 20-24 hours. Hydromorphone was administered postoperatively to patients with a VAS ≥ 35 and/or UMPS ≥ 9. Time to first voluntary urination and first motor activity were recorded.

Results: Postoperatively, B + D had a lower UMPS pain score than B at t = 1 hour (p = 0.013), but not compared to B + M. The B + D group had a shorter time to urination (p = 0.0131) and a longer time for return of motor function (p = 0.0068). There were no other differences between the treatments.

Conclusion And Clinical Relevance: Epidurally administered B, B + M, or B + D in dogs all provided acceptable analgesia to manage post-operative orthopedic pelvic limb pain. Epidural administration of B + D is an effective alternative to the analgesia provided by B or B + M, but is associated with increased time to return of motor function. The direct neurotoxic effects of epidural dexmedetomidine have not been fully tested.
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http://dx.doi.org/10.1111/vaa.12050DOI Listing
September 2013

Pharmacokinetics of ammonium sulfate gradient loaded liposome-encapsulated oxymorphone and hydromorphone in healthy dogs.

Vet Anaesth Analg 2013 Sep 20;40(5):537-45. Epub 2013 Apr 20.

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison WI 53706, USA.

Objective: To evaluate the pharmacokinetics, in dogs, of liposome-encapsulated oxymorphone and hydromorphone made by the ammonium sulfate gradient loading technique (ASG).

Animals: Four healthy purpose-bred Beagles aged 9.5 ± 3.2 months and weighing 13.4 ± 2.3 kg.

Study Design: Randomized cross-over design.

Methods: Each dog was given either 4.0 mg kg(-1) of ASG-oxymorphone or 8.0 mg kg(-1) of ASG-hydromorphone SC on separate occasions with a 3-month washout period. Blood was collected at baseline and at serial time points up to 1032 hours (43 days) after injection for determination of serum opioid concentrations. Serum opioid concentrations were measured with HPLC-MS and pharmacokinetic parameters were calculated using commercial software and non-compartmental methods.

Results: Serum concentrations of oxymorphone remained above the limit of quantification for 21 days, while those for hydromorphone remained above the limit of quantification for 29 days. Cmax for ASG-oxymorphone was 7.5 ng mL(-1) ; Cmax for ASG-hydromorphone was 5.7 ng mL(-1) .

Conclusions And Clinical Relevance: Oxymorphone and hydromorphone, when encapsulated into liposomes using the ammonium sulfate gradient loading technique, result in measureable serum concentrations for between 3 to 4 weeks. This formulation may have promise in the convenient use of opioids for clinical treatment of chronically painful conditions in dogs.
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http://dx.doi.org/10.1111/vaa.12042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740050PMC
September 2013

Evaluation of topical nalbuphine or oral tramadol as analgesics for corneal pain in dogs: a pilot study.

Vet Ophthalmol 2011 Nov 19;14(6):358-64. Epub 2011 Apr 19.

Eye Care for Animals, Wheeling, IL 60090, USA.

Objective: To evaluate the effectiveness of topical nalbuphine or oral tramadol in the treatment of corneal pain in dogs.

Animals Studied: Fourteen male Beagle dogs.

Procedures: Dogs were divided into three treatment groups and sedated with dexmedetomidine (5 μ/kg IV). A 4 mm corneal epithelial wound was created in the right eye (OD) of all dogs. Sedation was reversed with atipamazole IM. All dogs received pre/post ophthalmic examinations. Post operatively, Group NB (n = 5) received topical 1% preservative-free nalbuphine OD q8 h and an oral placebo PO q8 h. Group TR (n = 5) received tramadol (4 mg/kg) PO q8 h and topical sterile saline OD q8 h. Group CNTRL (n = 4) received topical sterile saline OD q8 h and an oral placebo q8 h. All dogs received topical 0.3% gentamicin OD TID until healed. Dogs were pain scored using a pain scoring system modified from the University of Melbourne pain scale at 0, 1, 2, 4, and 6 h, then every 6 h by observers masked to treatment, until corneal wounds were healed. Treatment failure was recorded if cumulative pain scores were above a minimum threshold of acceptable pain and rescue analgesia of morphine (1.0 mg/kg IM) was administered subsequently.

Result: Four dogs in Group NB, one dog in Group TR, and two dogs in Group CNTRL required rescue analgesia. There was no significant difference in the incidence of treatment failure between groups (P = 0.184). Mean time to rescue was 9.16 h. All corneal wounds were healed by 84 h.

Conclusions: The results of this study suggest tramadol rather than nalbuphine should be further investigated for the treatment of corneal pain.
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http://dx.doi.org/10.1111/j.1463-5224.2011.00883.xDOI Listing
November 2011

Epidural administration of liposome-encapsulated hydromorphone provides extended analgesia in a rodent model of stifle arthritis.

J Am Assoc Lab Anim Sci 2011 Jul;50(4):507-12

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Liposome encapsulation of opioids by using an ammonium-sulfate-gradient loading technique significantly slows the release time of the drug. This study evaluated the duration of analgesia in a rodent model of monoarthritis after epidural administration of liposome-encapsulated hydromorphone (LE-hydromorphone; prepared by ammonium-sulfate-gradient loading) compared with standard hydromorphone and a negative control of blank liposomes. Analgesia was assessed by changes in thermal withdrawal latency, relative weight-bearing, and subjective behavioral scoring. Analgesia in arthritic rats was short-lived after epidural hydromorphone; increases in pain threshold were observed only at 2 h after administration. In contrast, thermal pain thresholds after epidural LE-hydromorphone were increased for as long as 72 h, and subjective lameness scores were lower for as long as 96 h after epidural administration. Injection of LE-hydromorphone epidurally was associated with various mild changes in CNS behavior, and 2 rats succumbed to respiratory depression and death. In conclusion, LE-hydromorphone prolonged the duration of epidural analgesia compared with the standard formulation of hydromorphone, but CNS side effects warrant careful administration of this LE-hydromorphone in future studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148635PMC
July 2011

Respiratory rates and arterial blood-gas tensions in healthy rabbits given buprenorphine, butorphanol, midazolam, or their combinations.

J Am Assoc Lab Anim Sci 2011 Mar;50(2):205-11

Department of Surgical Sciences, Section of Anesthesia and Pain Management, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA.

The objective of this study was to evaluate the respiratory effects of buprenorphine, butorphanol, midazolam, and their combinations in healthy conscious rabbits. Six adult female New Zealand white rabbits were anesthetized briefly with isoflurane by mask to allow placement of a catheter into the central ear artery. After a 60-min recovery period, a baseline arterial sample was obtained. Animals then were injected intramuscularly with either 0.9% NaCl (1 mL), buprenorphine (0.03 mg/kg), butorphanol (0.3 mg/kg), midazolam (2 mg/kg), buprenorphine + midazolam (0.03 mg/kg, 2 mg/kg), or butorphanol + midazolam (0.3 mg/kg, 2 mg/kg). Arterial blood gases were evaluated at 30, 60, 90, 120, 180, 240, and 360 min after drug administration. All drug treatments caused significant decreases in respiratory rate, compared with saline. Buprenorphine and the combinations of midazolam-butorphanol and midazolam-buprenorphine resulted in statistically significant decreases in pO(2). No significant changes in pCO(2) pressure were recorded for any treatment. Increases in blood pH were associated with administration of butorphanol, midazolam, and the combinations of midazolam-butorphanol and midazolam-buprenorphine. In light of these results, buprenorphine and the combinations of midazolam-buprenorphine and midazolam-butorphanol result in statistically significant hypoxemia in rabbits that breathe room air. The degree of hypoxemia is of questionable clinical importance in these healthy subjects. Hypoxemia resulting from these drug combinations may be amplified in rabbits with underlying pulmonary or systemic disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061421PMC
March 2011

Peginterferon with or without ribavirin has minimal effect on quality of life, behavioral/emotional, and cognitive outcomes in children.

Hepatology 2011 May;53(5):1468-75

Beth Israel Deaconess Medical Center, Boston, MA.

Unlabelled: The aim of this study was to prospectively assess the quality of life (QOL), behavioral/emotional functioning, and cognitive status of children undergoing treatment for hepatitis C virus (HCV) infection. In all, 114 children (5 to 18 years old) enrolled in a multisite randomized clinical trial (Peds-C) to evaluate peginterferon alpha 2a (PEG 2a) with ribavirin (RV) or with placebo (PL) completed several standardized measures prior to treatment and at 24 weeks, 48 weeks, 6 months following treatment, and at two annual follow-up visits. After 24 weeks of treatment, mean physical QOL scores declined significantly for both groups from baseline to 24 weeks of treatment (F = 5.8, P = 0.004), although scores remained in the average range. There were no significant time or group effects for behavioral/emotional or cognitive functioning. Three children (5%) in the PEG 2a + RV group and no children in the PEG 2a + PL group had a clinically significant increase in depression symptoms. For those children who received 48 weeks of treatment, there were no significant time or group effects on any of the outcome measures (P > 0.05). A majority of children in both the PEG 2a + RV and PEG 2a + PL groups experienced no clinically significant change in physical QOL, behavioral adjustment, depression, or cognitive functioning during or after treatment.

Conclusion: Overall QOL and psychosocial functioning are not deleteriously impacted by PEG 2a + RV or PL treatment of children with HCV.
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http://dx.doi.org/10.1002/hep.24248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082614PMC
May 2011

Antithrombin-heparin covalent complex reduces microemboli during cardiopulmonary bypass in a pig model.

Blood 2010 Dec 3;116(25):5716-23. Epub 2010 Sep 3.

McMaster University, Hamilton, ON, Canada.

Transcranial Doppler-detected high-intensity transient signals (HITS) during cardiopulmonary bypass (CPB) surgery have been associated with postoperative neurocognitive dysfunction, suggesting microemboli in the brain could be a contributing factor. HITS occur despite administration of unfractionated heparin (UFH). This study was done to determine whether antithrombin-heparin covalent complex (ATH), a more potent anticoagulant than heparin, can reduce HITS during CPB. In a pig CPB model, ATH, UFH, or UFH + antithrombin (AT) was intravenously administered to female Yorkshire pigs after sternotomy. Twenty minutes later, hypothermic CPB was initiated and continued for 1.25 hours, then normothermia was re-established for 45 minutes. Protamine sulfate was given to neutralize the anticoagulants, and pigs were allowed to recover. HITS were monitored using an arterial flow probe placed over the carotid artery. Compared with UFH (300 or 1000 U/kg), ATH reduced the number of HITS during CPB in a dose-dependent manner. AT (3 mg/kg) + UFH (300 U/kg) resulted in an intermediate HITS rate between UFH and ATH (2 mg/kg in terms of AT). Examination of brain sections for emboli formation confirmed that, similar to HITS, number of thrombi decreased in direct proportion to ATH dosage. These results support the hypotheses that the majority of HITS represent thromboemboli and that ATH reduces emboli formation during CPB.
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http://dx.doi.org/10.1182/blood-2010-05-284448DOI Listing
December 2010

Effectiveness of injection of local anesthetic into the retrobulbar space for postoperative analgesia following eye enucleation in dogs.

J Am Vet Med Assoc 2010 Jul;237(2):174-7

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.

Objective: To assess the efficacy of a retrobulbar bupivacaine nerve block for postoperative analgesia following eye enucleation in dogs.

Design: Randomized controlled trial.

Animals: 22 dogs.

Procedures: Client-owned dogs admitted to the hospital for routine eye enucleation were enrolled with owner consent and randomly assigned to a treatment (bupivacaine hydrochloride) or control (saline [0.9% NaCl] solution) group. Baseline subjective pain scores were recorded. Anesthesia consisted of hydromorphone and midazolam preoperatively, thiopental or propofol for induction, and isoflurane in oxygen for maintenance. An inferior-temporal palpebral retrobulbar injection of either saline solution or bupivacaine was administered. Transpalpebral eye enucleation was performed. Pain scores were recorded at 0.25, 0.5, 1, 2, 4, 6, 8, and 24 hours after extubation (time 0) by observers masked to treatment groups. Dogs were given hydromorphone (0.2 mg/kg [0.09 mg/lb], IM or IV) as a rescue analgesic if the subjective pain score totaled >or= 9 (out of a maximum total score of 18) or >or= 3 in any 1 category.

Results: 9 of 11 control dogs required a rescue dose of hydromorphone, but only 2 of 11 dogs in the bupivacaine treatment group required rescue analgesia. Mean time to treatment failure (ie, administration of rescue analgesia following extubation) was 0.56 hours (95% confidence interval, 0.029 to 1.095 hours) for the 11 dogs that received hydromorphone.

Conclusions And Clinical Relevance: Retrobulbar administration of bupivacaine in dogs in conjunction with traditional premedication prior to eye enucleation was an effective form of adjunctive analgesia and reduced the need for additional postoperative analgesics.
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http://dx.doi.org/10.2460/javma.237.2.174DOI Listing
July 2010

Pharmacokinetics and behavioral effects of an extended-release, liposome-encapsulated preparation of oxymorphone in rhesus macaques.

J Pharmacol Exp Ther 2009 Jul 7;330(1):135-41. Epub 2009 Apr 7.

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.

The objectives of the study were to determine the pharmacokinetics of oxymorphone (oxy) and of ammonium sulfate-loaded, liposome-encapsulated oxymorphone (LE-ASG oxy) and to evaluate the behavioral effects of both opioid preparations by using ethographic evaluation specific to rhesus monkeys. Rhesus monkeys (n = 8) were injected with 2.0 mg/kg LE-ASG oxy s.c.. Blood samples were collected at serial time points up to 144 h in six monkeys and up to 456 h in two monkeys. Separate groups of monkeys were injected with 0.1 mg/kg oxy s.c. (n = 4) or i.v. (n = 5). Blood samples were collected at serial time points up to 24 h after injection. Pharmacokinetic parameters were calculated by using commercially available software. Behavior was recorded in a different group of 10 monkeys administered LE-ASG oxy (2.0 mg/kg s.c.) or oxy (0.1 mg/kg s.c.) on separate occasions. Behavioral evaluations were made at serial time points while monkeys were in an extended cage with a compatible stimulus animal. Oxymorphone was rapidly eliminated from the serum in the oxy group. Measurable drug was present in serum for up to 4 h after oxy was administered subcutaneously or intravenously. LE-ASG oxy was present in serum in measurable concentrations for more than 2 weeks. Neither oxy nor LE-ASG oxy produced observable sedation. LE-ASG oxy decreased some environmentally directed behaviors, but this drug formulation increased watchfulness, decreased self-directed and elimination behaviors, increased nonspecific social contact, and decreased threat behaviors. LE-ASG oxy persisted for an extended period in rhesus monkey serum and produced behavioral changes consistent with this opioid.
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http://dx.doi.org/10.1124/jpet.108.150052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700165PMC
July 2009

Impact of hepatitis C virus infection on children and their caregivers: quality of life, cognitive, and emotional outcomes.

J Pediatr Gastroenterol Nutr 2009 Mar;48(3):341-7

The Transplant Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

Objective: Hepatitis C virus (HCV) infection is associated with decreased quality of life (QOL) and neurocognitive dysfunction in adults, but little is known about its impact on children and their caregivers.

Patients And Methods: We studied the QOL, behavioral, emotional, and cognitive functioning of 114 treatment-naïve children with HCV enrolled in a placebo-controlled, randomized, multisite clinical trial evaluating peginterferon alpha-2a alone or with ribavirin. Baseline assessment included measures of children's QOL, cognitive functioning, behavioral adaptation, and depression. Caregivers' QOL also was assessed.

Results: Relative to published normative data, caregivers were more likely to believe that their children's health was poor and would likely worsen (t = 3.93; P < 0.0001), and reported higher concern about their children's health status (t = 6.63; P < 0.0001) and that this concern limited family activities (t = 2.45; P < 0.01); they also viewed their children as having more internalizing behavioral problems (t = 1.98; P < 0.05). Only 2 (2%) children had a score in the clinically depressed range. Children with HCV had worse cognitive functioning than the normative sample but significantly better functioning than children with attention-deficit/hyperactivity disorder. Caregivers' QOL scores did not differ significantly from the normative sample, but infected mothers had lower QOL than noninfected caregivers. Caregivers were highly distressed about their children's medical circumstances.

Conclusions: Although HCV infection, in its early stages, does not lead to global impairment in QOL, cognitive, behavioral, or emotional functioning in children, it is associated with higher caregiver stress and strain on the family system, and it may be associated with some cognitive changes in children.
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http://dx.doi.org/10.1097/MPG.0b013e318185998fDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649743PMC
March 2009

Successful treatment with bortezomib of a refractory humoral rejection of the intestine after multivisceral transplantation.

Clin Transpl 2009 :465-9

Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA.

Graft rejection is a serious complication after intestinal and multivisceral transplantation. Classic anti-rejection strategies often focus on addressing the cellular component, however mounting evidence suggests that antibody mediated rejection may also play an important role in patient and graft survival. Bortezomib, a proteasome inhibitor used in the treatment of multiple myeloma, has been found to be useful in treating antibody mediated rejection in kidney transplant recipients. The following case illustrates how bortezomib was used to successfully reverse refractory rejection in a patient following multivisceral transplantation. While the rejection was able to be controlled, this patient's course was complicated by an aggressive viral infection after bortezomib therapy. Bortezomib may be a useful agent in the treatment of rejection after intestinal and multivisceral transplantation; however more data is needed to assess its impact on infectious complications in this complex group of patients.
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July 2010

Midazolam administration reverses thermal hyperalgesia and prevents gamma-aminobutyric acid transporter loss in a rodent model of neuropathic pain.

Anesth Analg 2008 Apr;106(4):1296-302, table of contents

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.

Background: Loss of gamma-aminobutyric acid (GABA) inhibition in the spinal dorsal horn may contribute to neuropathic pain. Here we examined whether systemic administration of the benzodiazepine midazolam would alleviate thermal hyperalgesia due to chronic constriction injury (CCI) of the sciatic nerve.

Methods: Hyperalgesia was evaluated with the thermal paw withdrawal latency test before, and 3 and 7 days after CCI. Animals randomly received, via osmotic minipump infusion, midazolam (2.0 mg x kg(-1) x h(-1)), flumazenil (0.004 mg x kg(-1) x h(-1)), midazolam plus flumazenil at the same doses, or saline (0.01 mg x kg(-1) x h(-1)). Four groups of sham-operated rats (surgery without nerve ligation) received matched treatments. Levels of the GABA transporter 1 (GAT-1) in the lumbar spinal dorsal horn were estimated using western immunoblots 7 days after surgery.

Results: Saline-treated CCI rats developed thermal hyperalgesia on Day 3 with a more pronounced effect on Day 7. Continuous midazolam infusion prevented thermal hyperalgesia on both days. The antihyperalgesic effect of midazolam was reversed by the coadministration of flumazenil. Infusion of flumazenil alone had no effect on the thermal hyperalgesia in CCI rats. Sham-operated rats treated with saline, midazolam, or midazolam plus flumazenil exhibited no thermal hyperalgesia. Unexpectedly, thermal paw withdrawal latency in sham animals treated with flumazenil alone was significantly decreased. Changes in GAT-1 levels paralleled the behavior. Midazolam prevented the CCI-associated decreases, and flumazenil reversed midazolam's effect. Flumazenil alone did not modify GAT-1 levels in CCI animals but in sham animals the transporter levels were significantly reduced.

Conclusions: GABA inhibition plays an important role in neuropathic pain. Continuous systemic benzodiazepine administration may prove effective in alleviating neuropathic pain.
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http://dx.doi.org/10.1213/ane.0b013e318164f1e9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2583451PMC
April 2008

Pharmacokinetics of hydromorphone hydrochloride in healthy dogs.

Vet Anaesth Analg 2008 May 18;35(3):256-64. Epub 2008 Feb 18.

PharmCATS and the Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA.

Objective: To assess the pharmacokinetics of hydromorphone administered intravenously (IV) or subcutaneously (SC) to dogs.

Study Design: Randomized experimental trial.

Animals: Seven healthy male neutered Beagles aged 12.13 +/- 1.2 months and weighing 11.72 +/- 1.10 kg.

Methods: The study was a randomized Latin square block design. Dogs were randomly assigned to receive hydromorphone hydrochloride 0.1 mg kg(-1) or 0.5 mg kg(-1) IV (n = 4 dogs) or 0.1 mg kg(-1) (n = 6) or 0.5 mg kg(-1) (n = 5) SC on separate occasions with a minimum 14-day washout between experiments. Blood was sampled via a vascular access port at serial intervals after drug administration. Serum was analyzed by mass spectrometry. Pharmacokinetic parameters were determined with computer software.

Results: Serum concentrations of hydromorphone decreased quickly after both routes of administration of either dose. The serum half-life, clearance, and volume of distribution after IV hydromorphone at 0.1 mg kg(-1) were 0.57 hours (geometric mean), 106.28 mL minute(-1) kg(-1), and 5.35 L kg(-1), and at 0.5 mg kg(-1) were 1.00 hour, 60.30 mL minute(-1) kg(-1), and 5.23 L kg(-1), respectively. The serum half-life after SC hydromorphone at 0.1 mg kg(-1) and 0.5 mg kg(-1) was 0.66 hours and 1.11 hours, respectively.

Conclusions And Clinical Relevance: Hydromorphone has a short half-life, suggesting that frequent dosing intervals are needed. Based on pharmacokinetic parameters calculated in this study, 0.1 mg kg(-1) IV or SC q 2 hours or a constant rate infusion of hydromorphone at 0.03 mg kg(-1) hour(-1) are suggested for future studies to assess the analgesic effect of hydromorphone.
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http://dx.doi.org/10.1111/j.1467-2995.2007.00379.xDOI Listing
May 2008

Pathology of chronic hepatitis C in children: liver biopsy findings in the Peds-C Trial.

Hepatology 2008 Mar;47(3):836-43

Armed Forces Institute of Pathology and Veterans Administration Special Reference Laboratory for Pathology, Washington, DC, USA.

There is relatively little information in the literature on the histopathology of chronic hepatitis C in children. The Peds-C Trial, designed to test the efficacy and safety of peginterferon alfa-2a and ribavirin in children, provided an opportunity to examine liver biopsies from 121 treatment-naïve children, ages 2 to 16 (mean, 9.8 years) infected with the hepatitis C virus (HCV) and with no other identifiable cause for liver disease, signs of hepatic decompensation, or another significant nonhepatic disease. Liver biopsies were scored for inflammation, fibrosis, steatosis, and other histological features. Inflammation in the biopsy was minimal in 42%, mild in 17%, moderate in 38%, and severe in only 3%. Five had bridging fibrosis, and 2 had cirrhosis. Steatosis was absent in 56%, minimal in 34%, and mild in 10%. Inflammation scores correlated with fibrosis scores, serum alanine aminotransferase levels, and duration of infection, but not with age, body mass index z score, or HCV genotype. Fibrosis scores correlated with inflammation but not with age, HCV genotype, body mass index z score, or steatosis parameters. Steatosis correlated with serum alanine aminotransferase levels and body mass index z scores; overweight children had more fibrosis than the non-overweight. In conclusion, in this cohort of HCV-infected children, inflammation, fibrosis, and steatosis were milder than reported for treatment-naïve adults with chronic hepatitis C, but there were several with bridging fibrosis or cirrhosis. The positive correlation of inflammation with duration of infection and fibrosis and of obesity with fibrosis suggest that children with chronic hepatitis C will be at risk for progressive liver disease as they age and possibly acquire other comorbid risk factors.
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http://dx.doi.org/10.1002/hep.22094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3755275PMC
March 2008

An antithrombin-heparin complex increases the anticoagulant activity of fibrin clots.

Res Lett Biochem 2008 14;2008:639829. Epub 2008 Apr 14.

Henderson Research Centre, McMaster University, 711 Concession Street, Hamilton, L8V 1C3 Ontario, Canada.

Clotting blood contains fibrin-bound thrombin, which is a major source of procoagulant activity leading to clot extension and further activation of coagulation. When bound to fibrin, thrombin is protected from inhibition by antithrombin (AT) + heparin but is neutralized when AT and heparin are covalently linked (ATH). Here, we report the surprising observation that, rather than yielding an inert complex, thrombin-ATH formation converts clots into anticoagulant surfaces that effectively catalyze inhibition of thrombin in the surrounding environment.
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http://dx.doi.org/10.1155/2008/639829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005802PMC
October 2012

Serial transverse enteroplasty in a newborn patient.

J Pediatr Gastroenterol Nutr 2007 Aug;45(2):257-60

Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University College of Physicians and Surgeons, New York 10023, USA.

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http://dx.doi.org/10.1097/MPG.0b013e31803b9564DOI Listing
August 2007

A single dose of liposome-encapsulated hydromorphone provides extended analgesia in a rat model of neuropathic pain.

Comp Med 2006 Dec;56(6):487-92

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Opioids have been shown to relieve thermal hyperalgesia associated with neuropathic pain. We used a novel technique to produce liposome-encapsulated hydromorphone (LEH), which we then tested in a chronic constriction injury (CCI) thermal hyperalgesia model of neuropathic pain. Rats were divided into sham-operated and CCI groups. Treatments consisted of LEH or standard hydromorphone, administered at surgery or 3 d after surgery, when thermal hyperalgesia had developed in the CCI rats. We measured thermal withdrawal latencies on days 0, 3, and 5. CCI rats given liposome-encapsulated vehicle or standard hydromorphone at surgery developed full thermal hyperalgesia. CCI rats given LEH at surgery exhibited no significant change compared with baseline values in thermal withdrawal latency, indicating that this preparation prevented hyperalgesia after a single injection. CCI rats given LEH on day 3 (that is, after they had developed hyperalgesia) showed reversal of hyperalgesia that persisted to day 5, whereas CCI rats given standard hydromorphone on day 3 showed only brief (approximately 90 min) reversal of hyperalgesia. Preemptive injection of LEH prevented hyperalgesia in this model for as long as 5 d. In addition, hyperalgesia was alleviated for at least 2 d after injection of a single dose of LEH. These results suggest that liposome-encapsulation of hydromorphone offers a convenient and effective means to provide relief from neuropathic pain in this rodent model.
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December 2006

Development of a retrobulbar injection technique for ocular surgery and analgesia in dogs.

J Am Vet Med Assoc 2006 Jul;229(2):220-5

Veterinary Emergency Service, Middleton, WI 53562, USA.

Objective: To develop and compare 3 techniques for retrobulbar injection of local anesthetic agents for ocular surgery and analgesia in dogs.

Design: Prospective study.

Animals: 17 dogs (including 9 cadavers).

Procedures: Inferior-temporal palpebral (ITP), perimandibular, and combined superior-inferior peribulbar injection techniques were compared by assessing the distribution of latex after injection into the orbits of 5 canine cadavers; magnetic resonance imaging (MRI) evaluation of the distribution of contrast agent after injection in the retrobulbar space of 4 canine cadavers; and assessment of the efficacy and MRI evaluation of the anatomic distribution of injections of a lidocainecontrast agent mixture in 4 anesthetized, nonrecovery dogs. By use of the preferred technique (ITP), the ocular effects of lidocaine anesthesia were evaluated in 4 dogs; during a 2-week period after treatment, dogs underwent ophthalmic examination, Schirmer tear testing (STT), intraocular pressure (IOP) measurement, and Cochet-Bonnet esthesiometry.

Results: Of the 3 techniques, the ITP technique was the preferred method for retrobulbar administration of anesthetic agent in dogs because it was efficacious (pupil dilation and central rotation of the globe achieved in all eyes), easiest to perform, and provided thorough coverage of the intraconal retrobulbar space without complication. During the 2-week follow-up period, the ITP injection did not significantly affect STT, IOP, or Cochet-Bonnet esthesiometry values in dogs.

Conclusions And Clinical Relevance: In dogs, retrobulbar administration of anesthetic agents via the ITP technique is a potential alternative to systemic administration of neuromuscular blocking agents for ophthalmic surgery and provides the additional benefit of local ocular analgesia.
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http://dx.doi.org/10.2460/javma.229.2.220DOI Listing
July 2006

Evaluation of liposome-encapsulated oxymorphone hydrochloride in mice after splenectomy.

Comp Med 2004 Oct;54(5):558-63

Laboratory Animal Services, 414 E. Clark St., Lee Medical Bldg., University of South Dakota, Vermillion, South Dakota 57069, USA.

The use of mice in biomedical research is increasing, largely due to the production and use of genetically engineered animals. Providing postoperative pain control in mice presents many challenges, and long-acting analgesic preparations would be advantageous for this species. A single subcutaneous injection of a liposome-encapsulated (LE) preparation of oxymorphone was compared with multiple injections of buprenorphine or saline in outbred mice undergoing splenectomy. Control groups were given isoflurane alone or isoflurane and an injection of LE oxymorphone but did not undergo surgery. The following parameters were evaluated for 5 days after surgery and were compared with presurgical baseline data for each group: food and water consumption, body weight, ethographic score, and voluntary exercise on a running wheel. Ethographic scores indicated less postsurgical pain in both groups of mice that received either analgesic preparation compared with mice that received only saline. However, mice given LE oxymorphone had superior postoperative recovery, as measured by wheel-running distance and body weight gain, compared with mice given buprenorphine or saline. Mice undergoing splenectomy had significant decreases in body weight, food and water consumption, voluntary exercise, and other normal behaviors. Administration of liposomal oxymorphone at the time of surgery improved postsurgical recovery as measured by these parameters compared with multiple injections of buprenorphine or saline alone. Administration of LE oxymorphone at the time of surgery improved postsurgical recovery, as measured by these parameters.
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October 2004

Systemic lidocaine infusion as an analgesic for intraocular surgery in dogs: a pilot study.

Vet Anaesth Analg 2004 Jan;31(1):53-63

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.

Objective: To determine if systemic administration of lidocaine during intraocular surgery reduces post-operative ocular pain.

Study Design: Randomized, masked, controlled experimental trial.

Animals: Twelve dogs weighing 15.5 +/- 1.7 kg (mean +/- SD) and aged 2.5 +/- 0.6 years.

Methods: All dogs underwent a baseline ophthalmic examination and subjective pain score. Anesthesia consisted of acepromazine (0.1 mg kg(-1), i.m.), propofol (4-6 mg kg(-1), i.v.), and isoflurane in oxygen. There were three groups each receiving a bolus followed by an infusion (n=4): saline (0.3 mL kg(-1) i.v. + 0.2 mL kg(-1) hour(-1) i.v.); morphine (0.15 mg kg(-1) i.v. + 0.1 mg kg(-1) hour(-1) i.v.); and lidocaine (1.0 mg kg(-1) i.v. + 0.025 mg kg(-1) minute(-1) i.v.). All treatments began 15 minutes prior to starting of phacoemulsification and lens removal from the right eye. Pain scores were recorded at 0.5, 1, 2, 3, 4, 6, 8, 16, and 24 hours after t=0 (extubation). Rescue morphine was administered (1.0 mg kg(-1) i.m.) if the subjective pain score > or =9 (maximum=24), and the dog was excluded from further data analysis. Differences in pain scores and time-to-treatment failure (TTF) were analyzed using the Wilcoxon's rank sum test. Differences in incidence of treatment failure were analyzed using Fisher's exact test. Physiologic data were analyzed using repeated measures ANOVA. Significance was defined as P<0.05.

Results: Incidence of treatment failure was 100% in saline-treated dogs and 50% in morphine- or lidocaine-treated dogs. There was no difference in intraocular pressure, aqueous flare, cell count (or protein) between groups in the operated eye at any time following extubation.

Conclusion And Clinical Relevance: This pilot study suggests that intraoperative lidocaine may provide analgesic benefits similar to morphine for intraocular surgery in dogs, but more definitive research is needed. This model appears to be appropriate for pain assessment studies as the negative control group demonstrated 100% failure rate.
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http://dx.doi.org/10.1111/j.1467-2995.2004.00142.xDOI Listing
January 2004