Comparison of Plasma Fentanyl Concentrations by Using Three Transdermal Fentanyl Patch Sizes in Dogs

Objective—To compare plasma fentanyl concentrations attained after the application of three transdermal fentanyl patch sizes (50, 75, and 100 μg/hour) in dogs. Design—Repeated Latin square controlled study. Animals—Six intact, mixed-breed adult dogs (2 males, 4 females) weighing 19.9 ± 3.4 kg. Methods—Each dog was randomly assigned to receive each of three treatments: 50 (P50), 75 (P75), or 100 (P100) μg/hour transdermal patches. Patches were left in place for 72 hours. Jugular venous blood was collected at 1,2, 4, 8, 12, 24, 36, 48, 60, and 72 hours after patch application and for 1, 2, 4, 8, and 12 hours after patch removal. Plasma fentanyl concentrations were measured using a radioimmunoassay technique. After a 96-hour washout period, each dog was moved to another treatment group and received a different patch size. Results—The following results were obtained (mean ± SD): average plasma fentanyl concentration from 24 to 72 hours, 0.7 ± 0.2 ng/mL (P50), 1.4 ± 0.5 ng/mL (P75), 1.2 ± 0.5 ng/mL (P100); the total area under the concentration versus time curve (0 hours to infinity), 46 ± 12.2 ng/h/mL (P50), 101.2 ± 41.4 ng/h/mL (P75), 80.4 ± 38.3 ng/h/mL (P100); and the apparent elimination half-life, 3.6 ± 1.2 hours (P50), 3.4 ± 2.7 hours (P75), and 2.5 ± 2.0 hours (P100). There was a high degree of variability in plasma fentanyl concentrations achieved. Plasma fentanyl concentrations declined rapidly after patch removal. Conclusions—The attainment of steady-state plasma concentrations takes up to 24 hours, and there is a great deal of variability in the final concentrations reached in different individuals. In this study, the 100 μg/hour patches did not provide statistically increased plasma concentrations when compared with the 50 μg/hour patches. Clinical Relevance—Because of the interindividual and intraindividual variation in plasma fentanyl concentrations, patches should be applied 24 hours before the anticipated time that analgesia will be required. Adequacy of analgesia and potentially deleterious side effects, such as sedation and respiratory depression, should be monitored while the patches are in place. Skin reactions may occur, and the patches should be removed if such skin irritation is seen. After the patch is removed, it is expected that analgesia will wane rapidly because of the brief elimination half-life.     

SENSITIVITY OF LOW‐FIELD T2* IMAGES FOR DETECTING THE PRESENCE AND SEVERITY OF HISTOPATHOLOGIC MENISCAL LESIONS IN DOGS

The sensitivity of low‐field magnetic resonance (MR) T2^* images for predicting the presence of meniscal lesions was determined in 12 dogs with naturally‐occurring cranial cruciate ligament rupture and three control dogs, using histopathology as the reference standard. Previously published grading systems were used to grade the severity of meniscal lesions on MR images, gross inspection and histopathology. Focal areas of increased signal intensity were detected in 11/12 symptomatic dogs and 3/3 control dogs. Lesions mimicking meniscal tears (pseudotears) were identified at junctions between meniscal margins and adjacent connective tissue in control dogs and dogs with naturally occurring disease. Histopathologic lesions were present in all menisci of both symptomatic and control dogs, including the menisci from two affected dogs that appeared grossly normal but were removed and submitted based on MR imaging findings. Histopathologic lesions identified included hyaline cartilage metaplasia and changes in the amount of ground substance and cellularity. The sensitivity of MR imaging for detecting the presence of meniscal histopathologic lesions was 90% in symptomatic dogs and 91% in control dogs. However, agreement between severity scores for the different tests was poor. Low‐field MR imaging is a sensitive test for predicting the presence but not severity of meniscal histopathologic lesions in dogs with naturally‐occurring cranial cruciate ligament rupture. Findings also supported previous studies indicating that histopathologic lesions can be present in dogs with grossly normal menisci. An improved grading system for comparing MR images and histopathologic severity of meniscal lesions in dogs is needed.     

Mechanical Comparison of 3.5 mm Broad Dynamic Compression Plate,Broad Limited‐Contact Dynamic Compression Plate,and Narrow Locking Compression Plate Systems Using Interfragmentary Gap Models

Objectives— To compare (1) pullout properties between 3.5 mm cortical and locking screws, and (2) mechanical properties and gap displacements between the 3.5 mm broad limited‐contact dynamic compression plate (LC‐DCP), broad dynamic compression plate (DCP), and narrow locking compression plate (LCP), during axial loading of plate‐stabilized diaphyseal fragments with an interfragmentary gap. Study Design— In vitro mechanical testing of implanted polyurethane foam (PUF) hollow cylinders that simulated compact or osteopenic diaphyseal bone. Sample Population— (1) Five cortical and locking screws and (2) 4 PUF‐plate constructs for each plate type; using high‐ and low‐density (0.8 and 0.32 g/cm³) cylinders. Methods— (1) Screws were completely extracted at 5 mm/min. (2) Plated constructs were axially compressed at 300 N/s for 10 cycles from 5 to 355 N to determine gap displacement during physiologic loading, followed by single cycle increasing load to failure. Results— Pullout properties were not different between screw types. All plate constructs had yield loads over 3 times trotting loads. Gap closure occurred with LC‐DCP and DCP constructs, but not LCP constructs. LCP construct properties were most similar to LC‐DCP and DCP construct properties in the low‐density model. Conclusion— All plate systems sustained physiologic limb loads. Only LCP constructs maintained some gap integrity, although LC‐DCP and DCP screws were placed in neutral position. Clinical Relevance— The LCP system is more likely than LC‐DCP and DCP systems, with neutrally positioned screws, to maintain a planned interfragmentary gap, although gap strains range from 0% to 15% across the 2 mm gap during a trot load.     

The Analgesic Effects of Administering Fentanyl or Medetomidine in the Lumbosacral Epidural Space of Cats

The analgesic effects of fentanyl (4 μg/kg) and medetomidine (10 μg/kg) in 1 mL saline injected epidurally were measured in 15 cats. The response to an electrical cutaneous stimulus from a constant current generator was used as the index of analgesia. The stimulus was applied to a forelimb before epidural injection, and at 15, 30, 60, 90, 120, 180, 240, and 300 minutes post-injection (PI). The hindlimb was tested 5 minutes later. One mL saline only was used to control for volume of injection and saline. Medetomidine significantly increased the pain threshold for the hindlimb at 20 to 245 minutes PI compared with the preinjection level. Fentanyl significantly increased the pain threshold at 20 minutes PI only compared with preinjection levels. Medetomidine significantly increased the pain threshold of the forelimb at 15 to 120 minutes PI compared with the preinjection levels. Fentanyl did not significantly increase the pain threshold of the forelimb. Administration of medetomidine produced emesis in 12 of 15 cats in an average of 6.4 minutes PI (range, 3 to 11 minutes) and mild sedation in all cats. Injection of fentanyl produced no visible side effects in any of the cats.     

Comparison of Three Clinical Techniques for the Diagnosis of Laryngeal Paralysis in Dogs

Objectives— To evaluate laryngeal function using 3 diagnostic techniques: echolaryngography (EL), transnasal laryngoscopy (TNL), and laryngoscopy per os (LPO).
Study Design— Prospective clinical study.
Animals— Dogs with laryngeal paralysis (n=5) and control dogs (n=10); 5 age- and breed-matched dogs and 5 young, breed-matched dogs.
Methods— Laryngeal function was evaluated in conscious dogs using EL. All examinations were recorded and evaluated by separate, blinded observers upon completion of the study. The methods were compared with a standard evaluation incorporating all clinical knowledge of the case (STD) using sensitivity, specificity, positive, and negative predictive values.
Results— Three dogs with bilateral laryngeal paralysis requiring surgery were diagnosed as unilaterally affected or normal on EL. Three dogs had paradoxic motion on TNL and LPO, 2 of those were considered normal on EL, and 1 had no motion on EL. Paralysis was diagnosed in 1 age-matched and 3 young control dogs on EL. LPO and TNL falsely diagnosed lack of arytenoid movement in 2 age-matched controls and 1 young control. Two age-matched and 1 young control dog were misdiagnosed as paralyzed with TNL and LPO.
Discussion— Direct observation of the larynx allowed better evaluation of laryngeal function compared with EL. TNL did not require induction of anesthesia, but did not improve the ability to assess laryngeal function compared with LPO.
Conclusions— EL was not as effective as direct observation of the larynx. TNL did not improve the evaluation of laryngeal function compared with LPO.
Clinical Relevance— We use LPO combined with knowledge of the clinical history and physical examination to diagnose laryngeal paralysis in preference to EL and TNL.     

The Cardiopulmonary Effects of Placing Fentanyl or Medetomidine in the Lumbosacral Epidural Space of Isoflurane-Anesthetized Cats

The cardiopulmonary effects of fentanyl (4 μg/kg) or medetomidine (10 μg/kg) in saline injected epidurally were measured for 2 hours in 15 isoflurane (2.4%)-anesthetized cats. One milliliter of saline without drug was used to control for saline and volume of injection. Baseline was taken as preinjection time 0. Medetomidine significantly increased ( P < .05) mean arterial blood pressure (MAP) 5 to 20 minutes postinjection (PI) compared with baseline. MAP significantly decreased 30 to 120 minutes PI compared with baseline. Fentanyl significantly decreased MAP 5 to 120 minutes PI compared with baseline. Heart rate and respiratory rates significantly decreased in the medetomidine and fentanyl groups 5 to 120 minutes PI compared with baseline. Arterial pCO₂ significantly increased while arterial pH significantly decreased 15 to 120 minutes PI in the fentanyl and medetomidine groups compared with baseline. Blood bicarbonate concentration significantly increased 90 to 120 minutes PI in the medetomidine group compared with baseline.     

Cardiopulmonary Effects of Using Carbon Dioxide for Laparoscopic Surgery in Dogs

Cardiopulmonary effects of laparoscopic surgery were investigated in five crossbred dogs (21 ± 1.9 kg). Premedicated dogs were anesthetized with thiopental and maintained with halothane at 1.5 times minimum alveolar concentration in oxygen. Controlled ventilation maintained partial pressure of end-tidal co₂ at 40 ± 2 mm Hg. Vecuronium was used for skeletal muscle relaxation. After instrumentation and stabilization, baseline measurements were made of cardiac output (thermodilution technique), mean systemic, mean pulmonary arterial and pulmonary wedge pressures, heart rate, saphenous vein and central venous pressures, and minute ventilation. Baseline arterial and mixed venous blood samples were drawn for analysis of pH, Pao₂, Paco₂, Pvo₂, Pvco₂, and bicarbonate concentrations. Systemic and pulmonary vascular resistances, oxygen delivery and consumption, shunt fraction, and dead space ventilation were calculated using standard formulas. Abdominal insufflation using co₂ to a pressure of 15 mm Hg for 180 minutes resulted in significant ( P <.05) increases in heart rate (15 to 180 minutes), minute ventilation (75 to 135 minutes), and saphenous vein pressure (15 to 180 minutes), and decreases in pH (60 to 180 minutes) and Pao₂ (60 to 180 minutes). For 30 minutes after desufflation, there was a significant decrease in Pao₂, and increases in cardiac output, o₂ delivery, and heart rate, compared with baseline. There was a significant increase in shunt fraction and decrease in pH at 15 minutes after desufflation only. The changes were within physiologically acceptable limits in these healthy, ventilated dogs.