Isofourane으로 마취된 개에 medetomidine, medetomidine-buprenorphine, medetomidine-fentanyl의 경막외 투여 시 심혈관계 반응과 진통효과의 비교

Comparision of cardiovascular and analgesic effects of epidural administration of medetomidine, medetomidine-buprenorphine and medetomidine-fentanyl in dogs anesthetized with isoflurane

  • Chang, Hwa-Seok (College of Veterinary Medicine, Konkuk University) ;
  • Kim, Hye-Jin (College of Veterinary Medicine, Konkuk University) ;
  • Choi, Chi-Bong (College of Veterinary Medicine, Konkuk University) ;
  • Lee, Jung-Sun (College of Veterinary Medicine, Konkuk University) ;
  • Kim, Hwi-Yool (College of Veterinary Medicine, Konkuk University)
  • 심사 : 2007.03.21
  • 발행 : 2007.03.30

초록

The aim of this study was to compare the reaction of the cardiovascular system, and the anesthetic effect among 3 experimental groups, epidural administration of medetomidine as a single agent, the combination of buprenorphine and medetomidine, and the combination of fentanyl and medetomidine. Twenty one dogs were anesthetized with isoflurane and allowed to breathe spontaneously. Epidural, arterial, and venous catheters were inserted. The tip of epidural catheter was positioned at the level of the space between the sixth and seventh lumbar vertebra. After a stable plane of anesthesia was achieved, these dogs were each administered one of the following treatments epidurally : medetomidine $10{\mu}g/kg$ (Group M), a combination of medetomidine $5{\mu}g/kg$ and buprenorphine $10{\mu}g/kg$ (Group M/B), and a combination of medetomidine $5{\mu}g/kg$ and fentanyl $10{\mu}g/kg$ (Group M/F). Heart rate (HR), Respiratory rate (RR), End-tidal carbon dioxide (EtCO2), and arterial blood pressure were measured before drug administration (base line) and 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min postinjection. Blood gas analysis was performed before injection and 5, 15, 25, 35, 45, 60 min postinjection. Isoflurane was discontinued 80 min postinjection and pain/motor function were evaluated up to 260 min postinjection every 15 min. At the early stage of drug introduction (until 5 min), the HR was decreased significantly in all 3 groups compared with base line. In Group M, HR was significantly decreased compared with the other 2 groups. With time (starting 20 min after drug introduction), the HR was decreased significantly in Group M/B in respect to base line. However, no significant difference was seen number-wise in all 3 groups. During 60 min after drug introduction, the systolic, diastolic and mean arterial pressures were highest in Group M and lowest in Group M/F. Among 3 groups, drug action and motor loss duration were longest in Group M/F. Analgesic effect observed in the M/F group was the most prominent and long-lasting, compared to those seen in the other 2 groups. Given the fact that the recovery of motor function takes place in a short period of time after analgesic effects disappeared, additional use of M/F depending on the patient's condition would be a good way to achieve effective pain management. However, proper care should be taken to ensure the function of cardiovascular system in the patient because the administration of M/F under isoflurane anesthesia results in a significant decline in arterial blood pressure ($65{\pm}10mmHg$).

키워드

참고문헌

  1. Benson GJ, Tranquilli WJ. Advantages and guidelines for using opioid agonist-antagonist analgesics. Vet Clin North Am Small Anim Pract 1992, 22, 363-365 https://doi.org/10.1016/S0195-5616(92)50637-4
  2. Bilsback P, Rolly G, Tampubolon O. Efficacy of the extradural administration of lofentanil, buprenorphine or saline in the management of postoperative pain. Br J Anaesth 1985, 57, 943-948 https://doi.org/10.1093/bja/57.10.943
  3. Branson KR, Ko JCH, Tranquilli WJ, Benson J, Thurmon JC. Duration of analgesia induced by epidurally administered morphine and medetomidine in dogs. J Vet Pharmacol Ther 1993, 16, 369-372 https://doi.org/10.1111/j.1365-2885.1993.tb00184.x
  4. Cedarbaum JM, Aghajanian GK. Catecholamine receptors on locus coeruleus neurons: pharmacological characterization. Eur J Pharmacol 1977, 44, 375-385 https://doi.org/10.1016/0014-2999(77)90312-0
  5. Dyce KM, Sack WO, Wensing CJG. Textbook of Veterinary Anatomy. 1st ed. pp. 225-327, Saunders, Philadelphia, 1987
  6. Fletcher TF. Spinal cord and meninges. In: Evans HE (ed.). Miller's Anatomy of the Dog. 3rd ed. pp. 804-805, Saunders, Philadelphia, 1993
  7. Grimm KA, Tranquilli WJ, Gross DR, Sisson DD, Bulmer BJ, Benson GJ, Greene SA, Martin-Jimenez T. Cardiopulmonary effects of fentanyl in conscious dogs and dogs sedated with a continuous rate infusion of medetomidine. Am J Vet Res 2005, 66, 1222-1226 https://doi.org/10.2460/ajvr.2005.66.1222
  8. Inagaki Y, Mashimo T, Yoshiya I. Mode and site of analgesic action of epidural buprenorphine in humans. Anesth Analg 1996, 83, 530-536 https://doi.org/10.1097/00000539-199609000-00016
  9. Ko JCH, Thurmon JC, Benson JG, Tranquilli WJ, Olson WA. Evaluation of analgesia induced by epidural injection of detomidine or xylazine in swine. J Vet Anaesth 1992, 9, 56-60
  10. Lin HC, Trachte EA, DeGraves FJ, Rodgerson DH, Steiss JE, Carson RL. Evaluation of analgesia induced by epidural administration of medetomidine to cows. Am J Vet Res 1998, 59, 162-167
  11. McMurphy RM. Postoperative epidural analgesia. Vet Clin North Am Small Anim Pract 1993, 23, 703-716 https://doi.org/10.1016/S0195-5616(93)50077-3
  12. Mpanduji DG, Bittegeco SBP, Mgasa MN, Batamuzi EK. Analgesic, behavioural and cardiopulmonary effect of epidurally injected medetomidine ($Domitor^{\circledR}$) in goats. J Vet Med A Physiol Pathol Clin Med 2000, 47, 65-72 https://doi.org/10.1046/j.1439-0442.2000.00254.x
  13. Murphy DF, MacEvilly M. Pain relief with epidural buprenorphine after spinal fusion: a comparison with intramuscular morphine. Acta Anaesthesiol Scand 1984, 28, 144-146 https://doi.org/10.1111/j.1399-6576.1984.tb02030.x
  14. Naganobu K, Maeda N, Miyamoto T, Hagio M, Nakamura T, Takasaki M. Cardiorespiratory effects of epidural administration of morphine and fentanyl in dogs anesthetized with sevoflurane. J Am Vet Med Assoc 2004, 224, 67-70 https://doi.org/10.2460/javma.2004.224.67
  15. Oliver JE, Lorenz MD, Kornegay JN. Neurologic history and examination. In: Handbook of Veterinary Neurology. 3rd ed. pp. 9-31, Saunders, Philadelphia, 1997
  16. Pacharinsak C, Greene SA, Keegan RD, Kalivas PW. Postoperative analgesia in dogs receiving epidural morphine plus medetomidine. J Vet Pharmacol Ther 2003, 26, 71-77 https://doi.org/10.1046/j.1365-2885.2003.00452.x
  17. Paddleford RR. Analgesia and pain management. In: Manual of Small Animal Anesthesia. 2nd ed. pp. 12-13, Saunders, Philadelphia, 1999
  18. Paddleford RR. Analgesia and pain management. In: Manual of Small Animal Anesthesia. 2nd ed. pp. 244-246, Saunders, Philadelphia, 1999
  19. Robinson KJ, Jones RS, Cripps PJ. Effects of medetomidine and buprenorphine administered for sedation in dogs. J Small Anim Pract 2001, 42, 444-447 https://doi.org/10.1111/j.1748-5827.2001.tb02498.x
  20. Skarda RT. Local and regional anesthetic and analgesic techniques. In: Lumb and Jone's Veterinary Anesthesia. 3rd ed. pp. 437-598, Wolters Kluwer, Baltimore, 1996
  21. Skarda RT, Muir WW 3rd. Caudal analgesia induced by epidural or subarachnoid administration of detomidine hydrochloride solution in mares. Am J Vet Res 1994, 55, 670-680
  22. Skarda RT, Muir WW 3rd. Analgesic, hemodynamic, and respiratory effects of caudal epidurally administered xylazine hydrochloride solution in mares. Am J Vet Res 1996, 57, 193-200
  23. Skarda RT, Muir WW 3rd. Comparison of antinociceptive, cardiovascular, and respiratory effects, head ptosis, and position of pelvic limbs in mares after caudal epidural administration of xylazine and detomidinehydrochloride solution. Am J Vet Res 1996, 57, 1338-1345
  24. Smith LJ, Yu JK. A comparison of epidural buprenorphine with epidural morphine for postoperative analgesia following stifle surgery in dogs. Vet Anaesth Analg 2001, 28, 87-96 https://doi.org/10.1046/j.1467-2987.2000.00038.x
  25. Steffey EP, Howland D Jr. Isoflurane potency in the dog and cat. Am J Vet Res 1977, 38, 1833-1836
  26. Thomas WB, Dewey CW. Performing the neurologic examination. In: Dewey CW (ed.). A Practical Guide to Canine and Feline Neurology. 1st ed. pp. 31-55, Iowa State Press, Ames, 2003
  27. Thurmon JC, Tranquilli WJ, Benson GJ. Local anesthetic and analgesia techniques. In: Essentials of Small Animal Anesthesia and Analgesia. 1st ed. pp. 48-51, Willams & Wikins, Baltimore, 1999
  28. Thurmon JC, Tranquilli WJ, Benson GJ. Local anesthetic and analgesia techniques. In: Essentials of Small Animal Anesthesia and Analgesia. 1st ed. pp. 213-224, Willams & Wikins, Baltimore, 1999
  29. Tiwari SK, Kumar A, Vainio O. Reversal of sedative and clinicophysiological effects of epidural xylazine and detomidine with atipamezole and yohimbine in buffaloes(Bubalus bubalis). Vet Rec 1998, 143, 529-532 https://doi.org/10.1136/vr.143.19.529
  30. Vesal N, Cribb PH, Frketic M. Postoperative analgesic and cardiopulmonary effects in dogs of oxymorphone administered epidurally and intramuscularly, and medetomidine administered epidurally: a comparative clinical study. Vet Surg 1996, 25, 361-369 https://doi.org/10.1111/j.1532-950X.1996.tb01428.x
  31. Virtanen R. Pharmacological profiles of medetomidine and its antagonist, atipamezole. Acta Vet Scand Suppl 1989, 85, 29-37
  32. Waterman AE, Kalthum W. Use of opioids in providing postoperative analgesia in the dog: A doubleblind trial of pethidine, pentazocine, buprenorphine, and butorphanol. In: Short CE, Van Poznak A (eds.). Animal Pain. 1st ed. pp. 466-476, Churchill Livingstone, New York, 1992
  33. Wilde GP, Whitaker AJ, Moulton A. Epidural buprenorphine for pain relief after spinal decompression. J Bone Joint Surg Br 1988, 70, 448-450 https://doi.org/10.2106/00004623-198870030-00020
  34. Wittern C, Hendrickson DA, Trumble T, Wagner A. Complications associated with administration of detomidine into the caudal epidural space in horse. J Am Vet Med Assoc 1998, 213, 516-518
  35. Wolff J, Carl P, Crawford ME. Epidural buprenorphine for postoperative analgesia. A controlled comparison with epidural morphine. Anaesthesia 1986, 41, 76-79