Advertisement

Alfaxalone for total intravenous anaesthesia in bitches undergoing elective caesarean section and its effects on puppies: a randomized clinical trial

      Abstract

      Objective

      To evaluate the effects and reliability of alfaxalone constant rate infusion (CRI) in comparison to isoflurane to maintain anaesthesia in bitches undergoing elective caesarean section.

      Study design

      Prospective, randomized, ‘blinded’ clinical trial.

      Animals

      Twenty-two client-owned bitches and 94 puppies.

      Methods

      Bitches were randomly assigned to receive an alfaxalone CRI [0.2 mg kg-1 minute-1 intravenously (IV), and once the last puppy was delivered, the dose was halved; n = 11] or 2% (vaporizer dial setting) isoflurane (n = 11) for maintenance of anaesthesia. All dogs were induced with alfaxalone (3 mg kg-1) IV. Additional alfaxalone (0.3 mg kg-1 IV) was administered if the depth of anaesthesia was inadequate and the total dose was calculated. Bitches were mechanically ventilated. Analgesia was administered after the delivery of puppies. Physiological variables were recorded every 5 minutes. The bitches’ recovery times were also recorded. Quality of induction and recovery were evaluated. Puppies’ vigour was evaluated with a modified Apgar score at 5 and 60 minutes after birth. Puppies’ survival rates at 24 and 48 hours and at 15 days were recorded. Data were analysed using an anova, Student’s t-test or Wilcoxon rank-sum test.

      Results

      The rescue dose of alfaxalone was higher (p = 0.01); bitches’ recoveries were longer (p < 0.001) and puppies’ Apgar scores were significantly lower at 5 and 60 minutes (p < 0.001 and p = 0.003, respectively) with alfaxalone than with isoflurane. However, no significant differences were found for puppies’ survival between groups.

      Conclusions and clinical relevance

      Alfaxalone CRI seems to be a possible protocol for puppies and bitches undergoing elective caesarean sections. However, bitches recovered more slowly and puppy Apgar scores were lower in comparison to isoflurane.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ambros B
        • Duke-Novakovski T
        • Pasloske KS
        Comparison of the anesthetic efficacy and cardiopul-monary effects of continous rate infusions of alfaxalone-2-hydroxypropil–cyclodextrin and propofol in dogs.
        Am J Vet Res. 2008; 69: 1391-1398
        • Andaluz A
        • Santos S
        • García F
        • et al.
        Maternal and foetal cardiovascular effects of the anaesthetic alfaxalone in 2-hydroxypropyl-β-cyclodextrin in the pregnant ewe.
        Sci World J. 2013; (Article ID 18943, 6,)
        • Clarke KW
        • Trim CM
        • Hall LW
        • et al.
        Anaesthesia for obstetrics.
        in: Veterinary Anaesthesia. 11th edn. Saunders Elsevier, UK2014: 587-598
        • Doebeli A
        • Michel E
        • Bettschart R
        • et al.
        Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol.
        Theriogenology. 2013; 80: 850-854
        • Ferré P
        • Pasloske K
        • Whittem T
        • et al.
        Plasma pharmacokinetics of alfaxalone in dogs after an intravenous bolus of Alfaxan-CD RTU.
        Vet Anaesth Analg. 2006; 33: 229-236
        • Greer ML
        Neonatal and pediatric care.
        in: Greer ML Canine Reproduction and Neonatology. Teton NewMedia, USA2014: 140-212
        • Groppetti D
        • Pecile A
        • Del Carro AP
        • et al.
        Evaluation of newborn canine viability by means of umbilical vein lactate measurement, apgar score and uterine tocodynamometry.
        Theriogenology. 2010; 74: 1187-1196
        • Gulotta T
        • Castello T
        • Angelo F
        Use of althesin as a drug to induce and maintain anesthesia for cesarean section.
        Minerva Anestesiol. 1980; 46 (Abstract): 293-296
        • Herbert GL
        • Bowlt K
        • For-Fennah V
        • et al.
        Alfaxalone for total intravenous anaesthesia in dogs undergoing ovariohysterectomy: a comparison of premedication with acepromazine or dexmedetomidine.
        Vet Anaesth Analg. 2013; 40: 124-133
        • Jiménez CP
        • Mathis A
        • Mora SS
        • et al.
        Evaluation of the quality of the recovery after administration of propofol or alfaxalone for induction of anaesthesia in dogs anaesthetized for magnetic resonance imaging.
        Vet Anaesth Analg. 2012; 39: 151-159
        • Luna SPL
        • Cassu RN
        • Castro GB
        • et al.
        Effects of four anaesthetic protocols on the neurological and cardiorespiratory variables of puppies born by caesarean section.
        Vet Rec. 2004; 27: 387-390
        • Maney JK
        • Shepard M
        • Braun C
        • et al.
        A comparison of cardiopulmonary and anesthetic effects of an induction dose of alfaxalone or propofol in dogs.
        Vet Anaesth Analg. 2013; 40: 237-244
        • Metcalfe S
        • Hons B
        • Applecross M
        • et al.
        A multi-centre clinical trial evaluating the efficacy and safety of Alfaxan administered to bitches for induction of anaesthesia prior to Caesarean section.
        in: Proceedings of the 6th International Symposium on Canine and Feline Reproduction & 6th Bianual European Veterinary Society for Small Animal Reproduction Congress, Viena, Austria. (Abstract). 2008
        • Moon-massat P
        • Erb H
        Perioperative factors associated with puppy vigor after delivery by cesarean section.
        J Am Anim Hosp Assoc. 2002; 38: 90-96
        • Morgaz Rodríguez J
        • Muñoz-Rascón P
        • Navarrete-Calvo R
        • et al.
        Comparison of the cardiopulmonary parameters after induction of anaesthesia with alphaxalone or etomidate in dogs.
        Vet Anaesth Analg. 2012; 39: 357-365
        • Okutomi T
        • Whittington R
        • Stein D
        • et al.
        Comparison of the effects of sevoflurane and isoflurane anesthesia on the maternal-fetal unit in sheep.
        J Anesth. 2009; 23: 392-398
        • Palahniuk RJ
        • Schnider SM
        Maternal and fetal cardiovascular and acid-base changes during halotane and isoflurane anesthesia in the pregnant ewe.
        Anesthesiology. 1974; 41: 462-472
        • Pasloske K
        • Sauer B
        • Perkins N
        • et al.
        Plasma pharmacokinetics of alfaxalone in both premedicated and unpremedicated Greyhound dogs after single, intravenous administration of Alfaxan at a clinical dose.
        J Vet Pharmacol Ther. 2009; 32: 510-513
        • Raffe MR
        • Carpenter RE
        Anesthesic management of cesarean section patients.
        in: Tranquilli WJ Thurmon JC Grimm KA Lumbs and Jones’ Veterinary Anesthesia. 4th edn. Blackwell, UK2007: 955-968
        • Schwarz A
        • Kalchofner K
        • Palm J
        • et al.
        Minimum infusion rate of alfaxalone for total intravenous anaesthesia after sedation with acepromazine or medetomidine in cats undergoing ovariohysterectomy.
        Vet Anaesth Analg. 2014; 41: 1-11
        • Shirangi A
        • Fritschi L
        • Holman C
        Maternal occupational exposures and risk of spontaneous absorption in veterinary practice.
        Occup Environ Med. 2008; 65: 719-726
        • Suarez M
        • Dzikiti BT
        • Stegmann FG
        • et al.
        Comparison of alfaxalone and propofol administered as total intravenous anaesthesia for ovariohysterectomy in dogs.
        Vet Anaesth Analg. 2012; 39: 236-244
        • Veronesi M
        • Panzani S
        • Faustini M
        • et al.
        An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis.
        Theriogenology. 2009; 72: 401-407
        • Zuccherelli L
        “Killing me softly ?” The long-term effects of anaesthesia.
        Southern Afr J Anaesth Analg. 2007; 13: 5-10