#Dexmedetomidine

[unayang]

Dexmedetomidine 113775-47-6

[mcatmemoranda]

Dexmedetomidine (Precedex) can be used to sedate people in the ICU. For people with alcohol withdrawal, it will mask the signs of EtOH withdrawal, so the pt would be at risk for seizures. Midazolam and other benzos actually treat seizures and sedate. So midazolam would be better for someone with EtOH withdrawal. We have a pt who is on a lot of sedating meds in the ICU that we are trying to wean. Benzos need to be carefully weaned because they work on the brain like EtOH does—withdraw them too quickly and you risk seizures. The pt has hx of EtOH use, but is luckily far out of the window where we would be worried about EtOH withdrawal seizures.

[neuromedical]

A cardiologist in our ICU writing a report today: Excuse me, what drug is Dexdor?

Me: Dexmedetomidine :)

Her, murmuring: ....okay, never heard of that, I'll just write down Dexdor.....

[allthingsvetmed]

WEEK FOUR

This week, I am going to be breaking down the ECG shown above from our patient from week three.

To jog your memory, we have a young small breed dog with no prior medical history presenting for a bilateral deciduous canine removal, as well as a bilateral maxillary third incisor removal. 

This patient was pre-medicated with Buprenorphine at a 0.02mg/kg IM dose, Dexmedetomidine 5mcg/kg IM and Meloxicam 0.95mg SQ. After we placed the intravenous catheter, she was induced with 4mg/kg of Propofol and maintained under general anesthesia at 1.5% Isoflurane inhalant. 

The deciduous canines were extracted with no issues, but once we began working on extracting the maxillary incisors we noticed that she was developing a heart block. 

A heart block, otherwise known as an “AV Block”, means that the impulse normally generated from the atria to the ventricles is being disrupted somehow. There can be many cause of AV block from ischemia to mitral valve insufficiency, excessive vagal tone, and drugs with parasympathomimetic effects. 

There are many different kinds of heart block, all requiring different methods of treatment. First degree AV block is seen by prolonged p-r intervals with a normal QRS complex. There are many things that are associated with first degree av block. Normally, we do not always have to treat first degree av block, it is best to find the underlying cause of the block to appropriately treat the issue. 

There are two types of second degree AV block. First is, 2nd degree AV block Mobitz type 1. This is classified on an ECG by progressive prolongation of P to QRS waves, then a dropped QRS complex. Some causes of 2nd degree av block mobitz type 1 is AV node disorders or increased vagal tone. Treatment of mobitz type 1 would be done only if the patient is hemodynamically unstable (decreased blood pressure and heart rate). The increased vagal tone is possibly caused by general anesthesia, so it may be helpful to lower the patient’s anesthetic depth if you are seeing this dysrhythmia. 

For second degree AV block mobitz type two, you will see many P waves with no corresponding QRS complexes. This can be a more serious dysthymia, because it has the possibility of becoming third degree AV block. The cause of this dysthymia is an abnormality within the bundle of HIS. Treatment is warranted, especially is the QRS complexes are becoming wider. We would treat with anticholinergics, isoproterenol, or a pacemaker. Sometimes this can also be due to increased vagal tone, which can be arising from many different issues.  

Finally for third degree AV block, on the ECG we would see P waves with escape QRS beats from ectopic foci. All the P and QRS waves are uncoordinated and random. This can be caused by a congenital deformity within the heart, an abnormality within the heart itself or an electrolyte imbalance. This rhythm should be treated as soon as possible with either isoproterenol, a pacemaker, or epinephrine if cardiac arrest is impending. 

In our patient, we took into account that we were in the middle of extracting her maxillary incisors and that she was under general anesthesia. We deemed that the patient was showing signs of seconds degree AV block mobitz type 1. After finding this block, we took into account that her blood pressure, mucous membranes and capillary refill time and heart rate were stable and that this block was most likely due to increased vagal tone. The vagal tone may have been increased from the increased ocular pressure that was occurring from the doctor while the maxillary teeth were being extracted. 

The vagus nerve is cranial nerve 10 and it originates in the medulla. It innervates many parts of the body and is mostly apart of the parasympathetic nervous system. The parasympathetic nervous system is the part of the autonomic nervous system which tells the body to “rest and digest”.  It innervates the heart, lungs, stomach, spleen, kidneys, small and large intestines. When the vagus nerve is stimulated, this induces the parasympathetic nervous system to kick on and bradycardia, increased gut motility, miosis, decreased blood pressure, increased secretions and more can be seen.

After identifying this arrhythmia, we chose to monitor for any decline in her hemodynamics. The procedure was smooth from here on out and her blocks resolved when the teeth were extracted. 

[taimoorkhan]

Tranquilizers, also known as anxiolytics or psychotropic drugs, are medications that are used to treat anxiety, insomnia, and other mental health disorders. In the emergency department (ED), tranquilizers are often used to manage agitated or distressed patients, or to sedate patients before procedures.

There are several different types of tranquilizers that are commonly used in the ED, each with its own unique set of characteristics and potential side effects.

• Benzodiazepines

Benzodiazepines are a class of tranquilizers that are widely used in the ED due to their fast-acting sedative effects and low risk of overdose. They work by enhancing the activity of a neurotransmitter called GABA, which slows down the activity of the brain and central nervous system.

Examples of benzodiazepines include lorazepam (Ativan), diazepam (Valium), and midazolam (Versed). These medications are typically given intravenously (IV) or intramuscularly (IM) in the ED and can be used to treat anxiety, insomnia, and alcohol withdrawal.

• Antipsychotics

Antipsychotics, also known as neuroleptics or major tranquilizers, are a class of medications that are used to treat psychosis, schizophrenia, and other mental health disorders. They work by blocking the action of dopamine, a neurotransmitter that is involved in the regulation of mood and behavior.

Examples of antipsychotics include haloperidol (Haldol), olanzapine (Zyprexa), and quetiapine (Seroquel). These medications are typically given orally or by injection in the ED and can be used to treat agitation, psychosis, and delirium.

• Beta blockers

Beta blockers are a class of medications that are commonly used to treat hypertension, angina, and other cardiovascular conditions. They work by blocking the action of the hormone adrenaline, which can help to reduce anxiety and heart rate.

Examples of beta blockers include propranolol (Inderal) and metoprolol (Lopressor). These medications are typically given orally or by injection in the ED and can be used to treat anxiety, hypertension, and tachycardia.

• Sedative-hypnotics

Sedative-hypnotics are a class of medications that are used to induce sleep or sedation. They work by slowing down the activity of the brain and central nervous system.

Examples of sedative-hypnotics include lorazepam (Ativan), zolpidem (Ambien), and eszopiclone (Lunesta). These medications are typically given orally or intravenously in the ED and can be used to treat insomnia and anxiety.

• Alpha-2 agonists

Alpha-2 agonists are a class of medications that are used to sedate patients and reduce anxiety. They work by activating alpha-2 receptors in the brain, which can help to reduce the activity of the sympathetic nervous system and lower blood pressure.

Examples of alpha-2 agonists include clonidine (Catapres) and dexmedetomidine (Precedex). These medications are typically given intravenously or intramuscularly in the ED and can be used to treat agitation and hypertension.

• Barbiturates

Barbiturates are a class of medications that are used to induce sleep or sedation. They work by enhancing the activity of GABA, a neurotransmitter that slows down the activity of the brain and central nervous system.

Examples of barbiturates include pentobarbital (Nembutal) and secobarbital (Seconal). These medications are typically given intravenously or intramuscularly in the ED and can be used to treat severe anxiety or to induce coma in cases of life-threatening conditions such as intracranial pressure or status epilepticus.

It's important to note that all tranquilizers have the potential for side effects and should be used with caution. Common side effects of tranquilizers include drowsiness, dizziness, dry mouth, and constipation. In rare cases, tranquilizers can also cause more serious side effects such as respiratory depression, hypotension, and paradoxical reactions (e.g., agitation or excitement instead of sedation).

In conclusion, tranquilizers are a valuable tool in the management of agitated or distressed patients in the ED. However, it's important for healthcare providers to carefully consider the risks and benefits of these medications and to use them appropriately to minimize the risk of side effects.

[schlauemaus]

Sedativa

Benzodiazepine

Antagonist: Flumazenil (sehr teuer, Verwendung nur im Notfall)

von allen Sedativa die wenigsten Nebenwirkungen

oft verwendet zur Anästhesieeinleitung gemeinsam mit Ketamin

Grundsätzliche Wirkungen (variabel nach Individuum):

zentrales Muskelrelaxanz

antikonvulsiv

Sedierung bei alten/ schwachen Tieren und Neonaten (bei gesunden Tieren nicht)

wirken auf gesunde Tiere aufputschend

schneller Wirkungseintritt; Wirkungsdauer: 45 min

Nebenwirkungen

dämpft Atmung leicht -> kann Atemdämpfung des Anästhetikums verstärken (zB Ketamin)

Diazepam: i.v., löst sich in Plastik! Midazolam: i.v., s.c. oder i.m.

Neuroleptika

KEIN ANTAGONIST VERFÜGBAR

wirkt verstärkt auf Boxer -> niedrig dosieren

bewirkt Penisprolaps beim Pferd -> nicht bei Hengsten anwenden!

wirkt leicht sedierend/hypnotisch ohne Ataxie (nicht muskelrelaxierend) -> "Wurschtigkeitsspritze"

schützt Herz vor arrythmogener Wirkung anderer Medis

antiemetisch

selbst nicht analgetisch (potenziert aber Wirkung anderer Analgetika)

langsamer Wirkungseintritt: 20-30 min; sehr lange Wirkungsdauer: 6 Std

Nebenwirkungen

periphere Vasodilatation -> Blutdruckabfall (wg. Blockade v. α1-Rez.)

!Kann zu starken Blutdruckabfall bei Tieren im Schock/aufgeregten Tieren mit hohen Adrenalinspiegel führen, weil Adrenalin auch vasodilatatorisch wirkt!

Hämatokritabfall (wg. Ery-Sequestration in der Milz)

Hypothermie (wg. Ausfall der Thermoregulation und Vasodilatation)

Phenodiazine

Azepromazin

Butyrophenone

Azaperon: nur mehr beim Schw gebräuchlich

Alpha 2 Agonisten

Antagonisten: Atipamezol, Yohimbin, Tolazolin

starke Sedation

(viszerale) Analgesie

muskelrelaxierend

schneller Wirkungseintritt, Wirkungsdauer dosisabhängig

Nebenwirkungen

peripher: Vasokonstriktion (wg. Aktivierung v. α2-Rez.) -> Hypertension (-> je nach Agonist, kann daraufhin eine hypotensive Phase folgen od. Rückkehr zur ursprünglichen Druck)

zentral: Bradykardie (=Reaktion auf Hypertension), Bradyarrythmie (AV-Block)

ev. Atemdepression u. Bronchokonstriktion

Hypothermie

reduzierte Magendarmmotilität

Erbrechen bei i.m. Gabe v.a. bei Ktz

Xylazin: starke Atemdepression und sehr emetisch beim Kleintier; Verwendung va beim KolikerPfd (wg. kurzer Wirkdauer: 20-30min)aber Achtung: plötzliches "Aufwachen" durch schmerzhaften Reiz möglich! Detomidin: zugelassen f. Pfd, Rd u. Hd; Vergleich Xylazin: leichtere Administration da geringeres Volumen benötigt, wirkt weniger muskelrelaxierend (Eingriffe im Stehen), längere Wirkung (Achtung bei KolikPferd! Verschleiert Kolik!): bis 120min Medetomidin: f. Kleintiere; KEINE hypotensive Phase! Dexmedetomidin: f. Kleintiere; Vergleich Medetomidin: doppelt so starke Analgesie aber schwächere Sedierung Romifidin: zugelassen nur f. Pfd.; Analgesie verschwindet vor Sedation! + wenig muskelrelaxierend! -> Achtung vor Ausschlagen! Verwendung meist f. Feldsedation; starker Blutdruckanstieg, hypotensive Phase selten

[venovenous]

I have a healing deep cut on my thumb from a cooking incident and every time I spilled meds like dexmedetomidine or hydromorphone or versed or what have you while spiking the bags in an inexperienced manner I wondered if it was somehow going to get into my bloodstream and I was going to become slightly sedated at work. Honestly there are times where I could have used it.

[healthcarehubhh]

General Anesthesia Drugs Market will grow at highest pace owing to growing number of surgeries

General anesthesia drugs are widely used to induce a state of controlled sleep or unconsciousness during surgical procedures and other medical interventions. These drugs work by depressing the central nervous system, which allows patients to undergo painful medical procedures without the sensation of pain. Some key advantages of general anesthesia include inducing amnesia, blocking pain signals to the brain, and causing partial or complete muscle relaxation. There has been a steady rise in the number of surgeries performed worldwide each year owing to the growing global geriatric population, increasing incidence of chronic diseases, and technological advancements in the field of medicine. The growing number of surgeries is expected to drive significantly higher demand for general anesthesia drugs over the forecast period. The Global General Anesthesia Drugs Market is estimated to be valued at US$ 4.95 Bn in 2024 and is expected to exhibit a CAGR of 4.1% over the forecast period 2023 to 2030. Key Takeaways Key players operating in the general anesthesia drugs are Baxter Healthcare, Dr. Reddy's Laboratories, Novartis International AG, Hospira, Maruishi, Hengrui, Lunan, Fresenius Kabi, Pfizer Inc., Hikma Pharmaceuticals, Sagent Pharmaceuticals, Teva Pharmaceuticals, Par Pharmaceutical, Viatris Inc., AbbVie, Piramal Critical Care, Aspen Global Incorporated, B. Braun SE, Abbott and Cosmo pharmaceuticals. The general anesthesia drugs market is witnessing high demand due to the increasing number of surgical procedures performed globally each year. Technological advancements in anesthesia delivery methods and monitoring devices are also fueling the growth of this market. Market trends: The general anesthesia drugs market is witnessing growing adoption of specialty anesthetic drugs such as dexmedetomidine and ketamine. These drugs offer advantages like less interference with respiration and provide sedative effects during surgical procedures. Another key trend is the increasing popularity of targeted drug delivery methods using techniques like nanocarriers to deliver anesthetic drugs directly to surgical sites for localized pain management. Market Opportunities: The development of anesthetic drugs with advanced safety profiles and reduced recovery time offers lucrative growth opportunities. Growing investment in R&D for customized anesthesia based on patient profiles also presents new avenues for market expansion. Emerging areas like ambulatory anesthesia centers and pain management are expected to generate increased demand for safer and targeted general anesthesia formulations. General Anesthesia Drugs Market Impact of COVID-19 The COVID-19 pandemic has significantly impacted the growth of the general anesthesia drugs market. With the increasing number of COVID-19 cases globally, there has been a rise in demand for general anesthesia during surgical procedures involving critically ill COVID-19 patients. General anesthesia allows doctors to safely perform surgeries on patients who require ventilator support or extracorporeal membrane oxygenation. During the initial months of the pandemic in 2020, several elective surgeries were postponed to avoid resource crunch and reduce risks of virus transmission in hospitals. This led to declines in the consumption of general anesthesia drugs temporarily. However, with resumption of surgeries since mid-2020 and vaccination drives, the market is recovering steadily. Another factor fueling the market growth is wider usage of anesthesia drugs in COVID-19 patients undergoing intubation procedures and those in intensive care units on ventilator support. Manufacturers are enhancing production capacities to meet the rising requirements. The future strategies for market players include developing drugs with improved safety profiles, conducting clinical trials on usage in COVID-19 affected patients, and ensuring adequate supplies through supply chain management.

[riyasworkplaceexperience]

Week 9 at The Clinic

This week was very different from other weeks. This week there was no power for most of the day. This meant that we were very limited in what we could do. For the firs half of the day half of the clinic had power and so we worked with the little power that we did have. After a few hours power shut off in the entire clinic. We had to stop appointments for about 2 hours. After the power came back on the servers to the hospital software was not working so we had to work without patient records for a while. We conducted appointments by writing notes on hand and we relied on what the client knew about their patient. Some patients had to reschedule for vaccines and a few were able to get vaccines.

Despite our lack of power, we still saw a few interesting patients and sadly we did have a euthanasia. The euthanasia was done on a black domestic short-hair who was around 15 years old. The owners had the cat for 11 years. The cat had a large cancerous tumor on its right hind limb. It seemed to be in a lot of pain and since the cat was so feral it many treatment options were not viable. This euthanasia was different than the first one I experienced because I was actually able to see the family interact with the patient before the procedure and I really saw how some of the techniques that were talked about in Veterinary Management were used.

When speaking to the clients we had to approach the topic very carefully. The team made sure to handle the clients with empathy and did things like made sure they were in a private and comfortable space they made sure to empathize with the clients and speak in a calming voice and offered comfort where it was appropriate. These are some of the things that I learned about in Veterinary Management and it was very eye opening to see how it was applied in real life.

To euthanize the patient, we used a solution called Euthasol. Euthasol is a commercial solution for euthanasia and it consists of a barbiturate known as pentobarbital. Pentobarbital is a fast-acting barbiturate. It achieves euthanasia because barbiturates can achieve all forms of CNS depression rapidly. This allows the patient to have a quick and peaceful passing. Before euthanizing this patient, we sedated the patient using something called “Kitty Magic” This is a combination of drugs that uses Ketamine, Dexmedetomidine and Butorphanol. These are sedative-hypnotic agents that allow the patient to be unconscious, relaxed and alleviates some of the pain the patient may be experiencing.

[nursingscience]

John Korsah

Q: List of emergency drugs to patients, purpose, procedure and risks

Some commonly used emergency drugs that healthcare providers may use in different situations:

▪️Epinephrine: used to treat severe allergic reactions, anaphylaxis, and cardiac arrest

▪️Aspirin: used to reduce the risk of heart attack and stroke

▪️Nitroglycerin: used to treat angina and heart attack

▪️Albuterol: used to treat asthma and other respiratory conditions

▪️Glucose: used to treat low blood sugar in diabetic patients

▪️Naloxone: used to reverse the effects of opioid overdose

▪️Atropine: used to treat bradycardia and some types of poisoning

▪️Diazepam: used to treat seizures and anxiety

▪️Lidocaine: used to treat ventricular arrhythmias and local anesthesia

▪️Dopamine: used to treat shock and low blood pressure.

▪️Adenosine: used to treat supraventricular tachycardia

▪️Calcium chloride: used to treat calcium channel blocker toxicity, hyperkalemia, and hypocalcemia

▪️Sodium bicarbonate: used to treat acidosis and some types of poisoning

▪️Ketamine: used for procedural sedation and analgesia, as well as for rapid sequence intubation in critically ill patients

▪️Heparin: used to prevent and treat blood clots

▪️Furosemide: used to treat congestive heart failure and fluid overload

▪️Morphine: used to treat severe pain, such as in the case of myocardial infarction or trauma

▪️Dextrose: used to treat hypoglycemia and to provide calories and fluids in critically ill patients.

▪️Amiodarone: used to treat ventricular arrhythmias and to stabilize the heart's rhythm during cardiac arrest

▪️Sodium nitroprusside: used to treat hypertensive crisis and congestive heart failure

▪️Epinephrine autoinjector: a self-administered injection used to treat anaphylaxis in patients with known allergies

▪️Activated charcoal: used to treat certain types of poisoning by absorbing toxins in the digestive tract

▪️Dexamethasone: used to treat severe allergic reactions, as well as some types of inflammation and swelling

▪️Magnesium sulfate: used to treat certain types of arrhythmias, as well as eclampsia and pre-eclampsia in pregnant women

Propranolol: used to treat high blood pressure, angina, and certain types of arrhythmias

▪️Rocuronium: used as a muscle relaxant during intubation and other medical procedures.

▪️Atropine sulfate: used to treat bradycardia and as a pre-medication prior to anesthesia

▪️Midazolam: used to treat seizures and anxiety, as well as for procedural sedation and analgesia

▪️Dexmedetomidine: used for sedation and analgesia in critically ill patients

▪️Propofol: used for anesthesia induction and maintenance, as well as for procedural sedation and analgesia

▪️Ketorolac: used to treat moderate to severe pain, such as in the case of post-operative pain or renal colic

▪️Ondansetron: used to treat nausea and vomiting, such as in the case of chemotherapy-induced nausea and vomiting

▪️N-acetylcysteine: used to treat acetaminophen toxicity and prevent liver damage

▪️Tranexamic acid: used to treat or prevent excessive bleeding, such as in the case of traumatic injury or surgery.

It is important to note that the use of these drugs should be guided by a healthcare professional who has training and experience in emergency medicine.

➡️ Purpose

The purpose of emergency drugs is to provide immediate medical intervention to address life-threatening or time-sensitive medical emergencies. These drugs are designed to quickly alleviate symptoms, stabilize vital signs, and prevent further complications until the patient can receive definitive treatment.

The use of emergency drugs is often necessary in situations such as cardiac arrest, severe allergic reactions, respiratory distress, trauma, and overdose. In these situations, the prompt administration of appropriate medications can be critical to saving the patient's life or preventing long-term damage.

Emergency drugs are typically administered by trained healthcare professionals who have the knowledge and skills to safely and effectively use these medications in emergency situations. However, in some cases, patients may be instructed to self-administer emergency drugs, such as in the case of an epinephrine autoinjector for severe allergic reactions.

It is important to note that emergency drugs should only be used when medically necessary and under the guidance of a qualified healthcare provider. The inappropriate use of emergency drugs can lead to serious complications and should be avoided.

➡️ Procedure

The procedure for administering emergency drugs varies depending on the drug and the specific medical emergency being treated. In general, the administration of emergency drugs involves the following steps:

▪️Assessment and diagnosis: The healthcare provider will assess the patient's condition and diagnose the medical emergency. This involves evaluating the patient's vital signs, medical history, and current symptoms.

▪️Drug selection: Based on the patient's diagnosis and medical history, the healthcare provider will select the appropriate emergency drug and dose.

▪️Preparation: The healthcare provider will prepare the emergency drug for administration, following the manufacturer's instructions for reconstitution and dilution if necessary.

▪️Administration: The healthcare provider will administer the emergency drug using the appropriate route of administration, which may include intravenous (IV), intramuscular (IM), subcutaneous (SC), or inhalation. The provider will monitor the patient's response to the medication and adjust the dose or route of administration if necessary.

▪️Monitoring: The healthcare provider will continue to monitor the patient's vital signs, symptoms, and response to treatment. They will also monitor for potential side effects or adverse reactions to the medication.

▪️Follow-up: After the administration of the emergency drug, the healthcare provider will continue to monitor the patient's condition and provide further treatment as needed. They may also provide instructions for follow-up care or referral to a specialist if necessary.

It is important to note that the administration of emergency drugs should only be performed by trained healthcare professionals who have the knowledge and skills to safely and effectively use these medications in emergency situations.

➡️ Risks

Like all medications, emergency drugs carry potential risks and side effects. Some of the risks associated with the use of emergency drugs include:

▪️Adverse reactions: Emergency drugs can cause adverse reactions such as allergic reactions, anaphylaxis, respiratory depression, and hypotension.

▪️Drug interactions: Emergency drugs may interact with other medications the patient is taking, potentially leading to adverse effects or decreased efficacy.

▪️Administration errors: Misuse or incorrect dosing of emergency drugs can lead to adverse effects, including severe side effects or treatment failure.

▪️Delayed definitive treatment: While emergency drugs can provide immediate relief and stabilize the patient's condition, they are not a substitute for definitive treatment. Delaying definitive treatment can lead to complications and worsen the patient's outcome.

▪️Masking underlying conditions: In some cases, the use of emergency drugs can mask underlying conditions, making it more difficult to diagnose and treat the underlying cause of the emergency.

It is important to note that the potential risks associated with the use of emergency drugs should always be weighed against the potential benefits of their use. Emergency drugs should only be used when medically necessary and under the guidance of a qualified healthcare provider with training and experience in emergency medicine.

[the-graveyard-sys]

rabbits are rabbits are rabbits are rabbits are rabbits are rabbits are rabbits are rabbits are blood vessel contraction agent tetrahydrozoline hydrochloride added

inaba is inaba is inaba is inaba is inaba is inaba is inaba is inaba is stops at the affected area and immediately dissolves and eases symptoms such as high fever

udonge udonge udonge udonge udonge udonge udonge udonge eight different ingredients, including lidocaine which relieves pain, will heal the affected area

stops at the affected area and immediately dissolves and eases symptoms such as high fever blood vessel contraction agent tetrahydrozoline hydrochloride added

fun aesop nerd fact: lidocaine is a painkiller, tetrahydrozoline hydrochloride is used in eyedrops. some versions of the song mention dexmedetomidine which is a sedative and xylocaine which is also a painkiller. tetrahydrozoline hydrochloride relieves eye redness by causing blood vessels in the eye to contract, its also not used very much anymore due to the pretty high side effects

[allthingsvetmed]

WEEK TEN

This week, we are discussing pharmacology. A few days ago we sedated an 8yr MN Large Breed dog for a small mass removal on his hind leg. We placed an 18G 1.5” IVC in his left cephalic vein, then  he was premedicated with Maropitant 1mg/kg IV and sedated with Dexmedetomidine 5mcg/kg and Butorphanol 0.2mg/kg IV. I had propofol drawn up to his 4mg/kg dose, just in case the two pre-medications were not enough. Thankfully, this brought him to an adequate plane of sedation. The mass was blocked with local Lidocaine and removed via scalpel blade excision. After the mass removal was finished, I reversed his Dexmedetomidine with Atipamezole 100mcg/kg IM into his right epaxial muscle. He took a little bit to wake up and required some continuous stimuli, but overall did very well. 

Let’s go over the drugs we used for this procedure. 

What is Maropitant?

Maropitant citrate, other wise known as cerenia is an anti-emetic agent that is very commonly used in veterinary medicine. Its method of action is to antagonize neurokinin-1 receptors which blocks substance P from binding. This occurs in the chemoreceptor trigger zone within the central nervous system. The dose for maropitant is usually 1mg/kg IV or SQ but can go up to 2mg/kg for enteral route. When giving an injection of cerenia, it is important to know that it can sting, no matter what route you give it. To reduce the level of sting, it is recommended to refrigerate the vial instead of keeping it at room temperature. It is unknown as to why it causes a stinging sensation. 

What is Dexmedetomidine? 

Dexmedetomidine, also known as Dexdomitor, is an alpha 2 agonist that is known for it’s potent sedative effects. It does have some analgesic effects as well, but not very strong. The dose is measured in micrograms and it can be given IV or IM. It has a biphasic effect on the cardiovascular system. In phase 1, you can see vasoconstriction which will result in pale pink mucous membranes. This increase in blood pressure will cause the baroreceptor reflex to kick in and will cause the heart rate to decrease as a reflex bradycardia. This leads into phase 2, where you can see vasodilation and a persistent bradycardia. 

What is Butorphanol?

Butorphanol is a partial mu opioid receptor agonist and a full kappa opioid agonist. It is used as a mild analgesic with very weak sedative effects. It is also called Torbugesic. It is also used as an antitussive agent. Butorphanol is commonly used in combinations with other drugs for pre-medications. 

What is Atipamezole? 

Atipamezole, also known as Antisedan, is a competitive alpha 2 antagonist that is used to reverse the effects of dexmedetomidine or medetomidine. By blocking the alpha 2 receptor channels, it prevents the agonist from binding, therefore ceasing the effects of the alpha 2 agonists. Atipamezole is only recommended to be given IM. If it were to be given IV it could cause rapid vascular relaxation and in combination with the bradycardia from the dexmedetomidine, can cause cardiac arrest. 

[allthingsvetmed]

WEEK TWO

This week we are focused on my own dog, Shadow!

I normally brush Shadow and Beans’ teeth at home, at least once a week. This time I noticed that Shadow had a bit more halitosis than normal. While looking around in her mouth for the origin of the odor, I found that her pulp cavity was partially exposed on tooth 109. (Right maxillary carnassial) She normally loves to chew on sticks and hard toys at home, so I suspected this is what caused the fracture. 

This type of fracture is called a partial slab fracture. 

Since her pulp cavity was exposed, she was “chattering” every time I touched her fractured tooth. This was a good indicator that the tooth needed to be extracted because it was causing her a good amount of pain. I promptly removed dry food from her diet and removed all the hard chew toys from her box, to prevent her from further damaging her tooth. 

I wouldn't have known that she had fractured her tooth if I hadn’t looked. She wasn’t favoring any side of her mouth when she ate, nor was she avoiding playtime. The only vague indicator she gave me was that she was sleeping a little more than normal. Animals are masters at hiding their pain. 

When I was able to get her into the clinic, we ran pre-anesthetic bloodwork on her, since she’s 6 years old and she hasn’t had bloodwork done in a little bit. Her chemistry was within normal limits, besides her creatinine being on the high end of normal, which I will be keeping an eye on in the future. Her complete blood count was also within normal limits besides her hematocrit being slightly elevated, which could be due to her fasting overnight. Her mean corpuscular hemoglobin concentration was also elevated indicating a hypochromasia. You can calculate MCHC by dividing hemoglobin by hematocrit and multiplying by 100. (MCHC=(Hgb/HCT)x100). A hypochromasia means that the central pallor in the erythrocytes is increased, giving the cells a lighter and less dense appearance. Her MCHC and RBC were not extremely elevated so I was not concerned with these values, however if they were very elevated I would be considering an Iron deficiency. 

Since her bloodwork was clean, her ECG was normal sinus rate and rhythm, and she was fasted the night before, we moved forwards with her dental procedure. We began by placing an intravenous catheter and premedicated her with Maropitant 1mg/kg and Meloxicam 0.2mg/kg IV. Her induction medications consisted of Hydromorphone 0.075mg/kg IV and Dexmedetomidine 5mcg/kg IV. She was fully induced with Propofol 4mg/kg IV, using a total of 8mL. I intubated her with a 51Fr endotracheal tube. Her anesthesia was maintained with Isoflurane at 2% with oxygen gas flow rate at 2L/min. 

The tooth was first cut into 3 parts since it is a large two rooted tooth and then extracted piece by piece. The new hole created by the extracted tooth stretched into the attached gingiva and alveolar mucosa. The hole was then closed with 5-0 monocryl suture material which takes approximately 1-2 weeks to fully dissolve. 

The anesthetic portion of the procedure was relatively uneventful and her ECG, BP, ETCO2 and SPO2 were all within normal limits. I turned off her Isoflurane and kept her on fresh oxygen gas flow at 2L/min post-operatively for about 5 minutes. When she began coming-to, I disconnected her breathing circuit and untied her endotracheal tube from her head. She woke up slowly and when she began making full swallows, I then deflated her endotracheal tube cuff and extubated her. General rule of thumb is to wait for three full swallows before extubating animals. 

Before we went home, she was given another dose of Hydromorphone 0.075mg/kg IV to keep her pain under control for the night. She was sent home on Meloxicam PO and Gabapentin PO for 2 weeks. She was only allowed a soft food diet for the next 14 days and no hard toys/sticks were allowed.  

Overall, she did very good pre and post-operatively and I was very pleased that her source of pain was removed. The last photo of her is when we got home that day (: