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Butorphanol–Azaperone–Medetomidine (BAM) is a relatively new drug mixture compounded for the past decade to immobilize mammals, particularly ungulates. 1‐3% inhalant to effect (up to 5% for induction). It is relatively expensive and rabbits require comparatively larger doses than other species. Ketamine/medetomidine produces restraint for minor procedures in mice, such as retroorbital bleeding, which can be reversed rapidly by atipamezole (Cruz et al., 1998; Taylor et al., 2000). Survival surgery requires concurrent preemptive analgesia. Medetomidine Hydrochloride (medetomidine hydrochloride) is a synthetic alpha 2-adrenoreceptor agonist with sedative and analgesic properties. Medetomidine provides better sedation and analgesia than xylazine and has a longer duration of action (Tyner et al., 1997). The IM dose rates given to induce profound sedation are up to 750–1000 µg/m2. Despite its increased use in recent years, scant research has quantified the physiologic responses of immobilized animals or assessed its relative efficacy using different trapping methods. The most common effect noted is an initial hypertension (due to peripheral postsynaptic adrenoreceptors causing vasoconstriction), which results in a baroreceptor-mediated reflex bradycardia. The use of blindfolds and hobbles is advocated to limit the possibility of injury to people working with the lions. Jeffery R. Zuba, Mark Greenberg, in Fowler's Zoo and Wild Animal Medicine Current Therapy, Volume 9, 2019, Medetomidine is considered the most selective of all the α-2 agonists and is currently prepared only in formulations intended for zoo and wildlife species.6,19 It is available in highly concentrated injectable solutions (20 and 40 mg/mL, Wildlife Pharmaceuticals, Inc.); therefore it may be combined in darts with UPOs and other drugs intended for nondomestic ungulate and megavertebrate species. Reverse with atipamezole at a dose of 25-300 mcg/kg (equal to volume of medetomidine used) IM. Sedation is achieved at 2 µg/kg IV and increasing the dose rate increases the intensity and duration of sedation, from 60 minutes after 5 µg/kg to 120 minutes after 20 µg/kg. Medetomidine causes peripheral vasoconstriction, which gives mucous membranes a slight mauve appearance that may be mistaken for cyanosis. The analgesia associated with medetomidine only lasts 15 to 30 minutes but sedation can last 1 to 2 hours. It is a sedative that provides pain relief as well as muscle relaxation. Side-effects: Due to the mode of action of medetomidine, heart rate and body temperature decrease. Ketamine in combination with medetomidine (MK) has been widely used as an anaesthetic for laboratory rats and mice [1, 7, 21–24]. Vasoconstriction can prevent satisfactory pulse oximetry and venepuncture for blood collection or intravenous fluid therapy. Mark G. Papich DVM, MS, DACVCP, in Saunders Handbook of Veterinary Drugs (Fourth Edition), 2016. The atipamezole dose for the reversal of IM dexmedetomidine or medetomidine is 5000 mcg/m 2. Due to the large doses used in zoo and wildlife species, this drug must be considered dangerous in case of a significant accidental human exposure. 3; Dexdomitor is the purified version of medetomidine 3,4 Results from the third dose rate combination included times to sternal and lateral recumbency on average 8 and 13 minutes, respectively, and an excellent rated quality of induction. Leigh Lamont, in Handbook of Veterinary Pain Management (Second Edition), 2009. Some common side effects like period of surgical anaesthesia (Grant et al, salivation, frequent urination, defaecation, 1996). See package insert for full information on side effects, precautions, warnings and contraindications. In case of accidental eye exposure, flush with water for 15 minutes. Medetomidine and detomidine are metabolized similarly, by hepatic monooxygenases. The product information sheet contains detailed tables on volume of drug to administer for different weights of dogs. If irritation or other adverse reaction occurs (e.g., sedation, hypotension, bradycardia), seek medical attention. Medetomidine hydrochloride can be absorbed and may cause irritation following direct exposure to skin, eyes, or mouth. Medication should never be administered without first consulting your veterinarian. Analgesic DrugsAutonomic Nervous System Drugs; Anesthetics; Analgesics, ©Copyright 1999 - 2021. The atipamezole dose for the reversal of IV dexmedetomidine or medetomidine is 3750 mcg/m 2. Dexmedetomidine has recently been approved by the FDA for use in humans (Precedex) and dogs (Dexdomitor; http://www.fda.gov/cvm/Green_Book/200702.pdf, accessed 24 July 2007). A main advantage to the use of these two combinations is their reversibility with nalbuphine or butorphanol and atipamazole. Medetomidine can cause hypothermia and diuresis. Medetomidine is a racemic mixture of two stereoisomers, dextro-medetomidine and levo-medetomidine. Adverse effects of medetomidine include slowed heart rate with partial heart block, low body temperature and slowed breathing rate. The side effects of medetomidine were bradycardia, respiratory depression, stasis of the rumen with tympany, salivation and polyuria. Currently, there is little information available regarding the use of medetomidine in cats so caution should be used. It has been replaced by dexmedetomidine in domestic dog and cat anesthesia, because medetomidine is currently no longer available in a small animal formulation. Its side effects include tachycardia, dysphoria, and muscle rigidity. For sedation in dogs, medetomidine is dosed at 0.75 mg/square meter of body surface area intravenous or 1 mg/square meter body surface area intramuscular. A formula for calculating BSA using kg bodyweight is BSA m2 = (Bwt kg2/3 × 10.1)100 (Pypendop & Verstegen, 2000; Hill & Scott, 2004). The IHC Group. See chart to the right. During this time it is very important to keep the dog in a quiet environment to get maximum sedative effect. For example, lower doses are sometimes used for short-term sedation and analgesia, particularly when combined with other drugs such as opiates. The hypnotic/analgesic actions are due to the D-enantiomer dexmedetomidine; levomedetomidine is considered to be pharmacologically inactive (MacDonald and Virtanen, 1992). In cats, IM medetomidine had a tendency to produce higher sedation scores and a greater level of analgesia. Hypoxia occurs during anaesthesia with medetomidine and oxygen should be administered throughout the anaesthetic period (Flecknell, 2000). Immobilized lions should be administered one-third of the initial BMM dose IM at 45 minutes after induction and every subsequent 30 minutes. If experienced, these tend to have a Severe expression 1. Profound sedation and ... Medetomidine is a potent non-narcotic alpha 2-adrenoreceptor agonist which produces sedation and analgesia. These effects are dose dependent in depth and duration. Medetomidine can be used on its own as a premedicant or it can be combined with ketamine to provide surgical anaesthesia. It is a white, or almost white, crystalline, water soluble substance having a molecular weight of 236.7. Medetomidine belongs to a class of drugs known as alpha 2 adrenergic agonists and is similar to clonidine and xylazine. Medetomidine is used to produce sedation for short procedures and provides a short period of analgesia. It is often used as the hydrochloride salt, medetomidine hydrochloride, a crystalline white solid. Vomiting can occur following medetomidine administration and may result in aspiration pneumonia. An advantage of this combination is that reversal agents can be administered at any time point following induction.8. Medetomidine is available in 1 mg/ml concentration in 10 ml vials. Bruno H. Pypendop, in Handbook of Veterinary Pain Management (Third Edition), 2015, Dexmedetomidine is the active component, whereas levomedetomidine is considered pharmacologically inactive (although it may play a role in drug interactions).23, Racemic medetomidine is lipophilic, facilitating rapid absorption after intramuscular administration; peak plasma concentrations are reached in approximately ½ hour.25, Medetomidine and dexmedetomidine are the most specific α2-agonists available clinically, with an α2:α1 binding ratio of 1620:1.22. All Rights Reserved. Excretion of 3H-labeled medetomidine is mainly in the urine: 41% over 72 hours compared with 18% in the feces. Approximately 85% of the drug in plasma is protein-bound. In case of accidental oral exposure or injection, seek medical attention. No analgesic effect was produced by xylazine, however moderate analgesia was obtained by medetomidine. Must use precision vaporizer Reversal agents (Mice and Rats) Atipamezole 1‐2.5 mg/kg SC, IP, or IV For reversal of Medetomidine or Xylazine effects More specific for medetomidine than for Immobilization was reversed with naltrexone, tolazoline, and atipamezole. This can significantly reduce the amount of time needed for recovery. The vasoconstriction is not dangerous but the poor colour of the mucous membranes could mask a true cyanosis should it occur. Atipamezole is the recommended antagonist for medetomidine in veterinary species.19, Robert E. Meyer, Richard E. Fish, in Anesthesia and Analgesia in Laboratory Animals (Second Edition), 2008. zolazepam drug combination tiletamine Medicine & Life Sciences Together they form a unique fingerprint. Racemic medetomidine is quickly absorbed after IM administration, with peak plasma levels occurring in approximately 30 minutes. In the rat, absorption of medetomidine following SQ administration is rapid, with peak plasma concentrations reached within 10 minutes. The sedative effect is increased in senior dogs and frequently half the dose rate will have the same effect as the full dose in a younger dog. Nasal oxygen supplementation of 3–8 L/min was recommended for animals with respiratory rates <15 breaths/min or SpO2 <90% at sea level; a lower value at higher altitudes. Medetomidine has some advantages. Medetomidine hydrochloride can be absorbed and may cause irritation following direct exposure to skin, eyes, or mouth. In practice, this means that large dogs require relatively lower doses than smaller dogs. Simple hepatic hydroxylation can explain the rapid removal of the drug; metabolism is regulated primarily by hepatic blood flow (Salonen, 1992). In rats, there is a dose-dependent sedation and loss of righting reflexes, but deep sedation is not produced in mice or rabbits. Other side effects include reduction in gut motility, hyperglycaemia, sweating and an increase in urination. Veterinary formulations: Domitor® (Pfizer). Treated animals should be kept in a warm and even temperature during the procedure and for 12 hours after sedation. Despite appearing completely sedated, animals can still move, even kick, bite or scratch, in response to sharp auditory stimulation. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Vomiting occurs in about 20% of dogs receiving medetomidine, which is less than xylazine. With this combination, induction occurred within 1 minute (Hahn et al., 2005). Medetomidine has a steep dose–response curve and doses should, ideally, be calculated on a body surface area (BSA) rather than on body weight. The chemical name is (±)-4-[1-(2,3-dimethylphenyl)ethyl]-1H-imidazole monohydrochloride. •medetomidine 5 g/kg + methadone 0.5 mg/kg IM •medetomidine 5 g/kg + methadone 0.5 mg/kg + ketamine 0.5 mg/kg IM •medetomidine 10 g/kg + methadone 0.5 mg/kg ketamine 0.5-1 mg/kg IM •or dexmedetomidine at half the above medetomidine doses ketamine … Extreme caution must be used if medetomidine is given to animals with heart disease, low blood pressure, shock, breathing problems, severe liver or kidney disease, a known seizure disorder or if the animal is severely debilitated. Following intramuscular (IM) administration, medetomidine was faster in onset and the magnitude of effect was also greater than that obtained with dexmedetomidine. Medetomidine Hydrochloride should be administered at the rate of 750 µg IV or 1,000 µg IM per square meter of body surface. Side effects occur frequently with alpha-2 agonists. It was developed by Orion Pharma. Medetomidine can be used on its own as a premedicant or it can be combined with ketamine to provide surgical anaesthesia. The authors have not observed adverse central nervous system or cardiorespiratory effects following intravenous atipamezole administration in cases of anesthetic emergencies. Consult with your veterinarian to determine if other drugs your pet is receiving could interact with medetomidine. The condition appears self-limiting and does not require treatment. Medetomidine, dexmedetomidine, and detomidine are more specific for the alpha2 receptor than xylazine. Such drugs include fentanyl, butorphanol, atropine, propofol and meperidine. Both medetomidine and detomidine can induce loss of the righting reflex in young chicks (MacDonald and Virtanen, 1992). The use of medetomidine in combination with ketamine is described in Box 4.5. The effects of medetomidine can be reversed with the use of atipamezole. Profound sedation and recumbency, with reduced sensitivity to environmental stimuli (sounds, etc. Therefore these drugs should not be used interchangeably without consulting the dose recommendations. Remove contaminated clothing. At the suggested midazolam dose rates, the omission of flumazenil does not significantly change the quality or time to recovery. Acepromazine provides some protection against histamine release. Mule deer and mule deer hybrids were immobilized by medetomidine, 0.1 mg/kg, and ketamine, 2.5 mg/kg, IM for 60 minutes followed by reversal with atipamezole, 0.5 mg/kg, injected half IV and half IM (Caulkett et al., 2000). In mice, very low doses of medetomidine are anxiolytic without obvious signs of sedation (MacDonald et al., 1989). Adverse effects of medetomidine include slowed heart rate with partial heart block, low body temperature and slowed breathing rate. Medetomidine is a synthetic compound used as a surgical anesthetic and analgesic. Medetomidine may interact with other medications. Vomiting can occur following medetomidine administration and may result in aspiration pneumonia. This drug is registered for use in animals only. ), are seen with medetomidine. Medetomidine is a commonly used supplemental drug combined with ketamine and other injectable anesthetic agents for use in great apes,22–24 nonhuman primates, and carnivores. Medetomidine is a synthetic drug used as both a surgical anesthetic and analgesic. Medetomidine, 0.01–0.02 mg/kg (10–20 µg/kg), IV significantly decreases serum insulin concentration but plasma glucose concentration remains within the normal physiological range (Burton et al., 1997).

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