Select Species Dataset
Alfaxalone
Sedation
Alfaxalone: 4-6 mg/kg IM (once) produced smooth and consistent sedation with minimal side effects (Bradley et al., 2019; Gardhouse and Sanchez, 2022; Huynh et al., 2015).
Multimodal
Medetomidine 0.25 mg/kg and Alfaxalone 3-5 mg/kg, together, IM (Marsh et al., 2009)
Dexmedetomidine 0.1 mg/kg and Alfaxalone 3-5 mg/kg, together, IM (Rousseau-Blass and Pang, 2020).
Dexmedetomidine 0.1 mg/kg + Midazolam 0.2 mg/kg + Alfaxalone 4 mg/kg, together, IM (Rousseau-Blass and Pang, 2020 / Engbers et al., 2017).
Technique
Sedation occurs a few minutes after Alfaxalone is administered at 2.5 -6.0 mg/kg IM in adult healthy rabbits.
More profound sedation is available through combined use alongside Dexmedetomidine or Medetomidine, IV or IM. Suitable multimodal dosing options are given below and elsewhere in this Alfaxalone monograph or the monographs of the partner drugs.
Additional Medications and Support
Premedication and Patient Preparation: Preoxygenation, thermal support, sedation, and analgesic agents reduce the Alfaxalone induction dose and improve patient welfare and anaesthetic safety.
Multimodal Sedation: This monograph's dosing schedules detail the use of opiates, midazolam, and α2 adrenergic agonists before or alongside Alfaxalone.
Reversal: Optional. *α2 adrenergic agonist reversal can be actioned using Atipamezole.
Intubation: Subsequent intubation and maintenance using a volatile agent (e.g. Isoflurane) with supplementary oxygen and additional analgesia is recommended for all painful or significant procedures.
Oxygen: As with other species, dose-dependent respiratory depression is expected, and supplemental oxygen is recommended.
Suitability
Consider the patient's ASA status: Most standard protocols apply only to ASA 1 and 2 patients.
High-risk patients: Clinicians are encouraged to tailor their practices to suit the issues encountered in ASA 3 & 4 and address them throughout the peri-anaesthetic period. Ensure that ASA 3 & 4 patients are managed differently and that clients know additional risks.
Multimodal use alongside additional agents is RECOMMENDED. For details, see specific indication recommendations in the expandable indication boxes below.
Sole agent use as an induction agent is NOT RECOMMENDED.
Adverse Effects Profile: Respiratory depression and apnea may occur with excessive doses.
Reproductive Safety: Studies and rabbits have not been performed. However, alfaxalone is used during cesarean sections in dogs and cats and, therefore, is belived to have a fair reproductive safety profile. Clinicians must perform a risk-benefit analysis.
Treatment Goals: Stable sedation.
Treatment Endpoints: Completing any planned procedure, such as radiography or IV cannulation.
Efficacy Profile: Comparative risk of death or other adverse outcomes, such as inadequate depth or duration of sedation, remain poorly investigated.
Alternative Products: A range of options are presented in this formulary. These include multimodal use of medetomidine, dexmedetomidine, propofol and alfaxalone. Additional options, such as buprenorphine and butorphanol, are located in opiate monographs.
Alternative Products: A range of options are presented in this formulary. These include multimodal use of medetomidine, dexmedetomidine, and propofol alongside alfaxalone. Additional options are located in these monographs and also the monographs associated with the additional agent, such as buprenorphine and butorphanol.
Suitability
Sole agent use as a sedation agent is RECOMMENDED.
Multimodal use alongside additional agents is RECOMMENDED.
Patient Preparation
Consider the patient ASA status: Ensure that ASA 3 & 4 patients are managed differently, and clients are aware of additional risks. Most standard protocols listed apply only to ASA 1 and 2 patients. Clinicians are encouraged to tailor their practices to suit the issues encountered in ASA 3 & 4 and address them throughout the peri-anaesthetic period.
Preparation: Rabbits benefit from premedication, IV access and preoxygenation before Alfaxan sedation.
Suitable Handling: Ensure rabbits are kept away from predator contact, smell and excessive noise
Intubation: In clinical settings, if prolonged sedation or anaesthesia is anticipated, animals are usually intubated, or a supraglottic device is placed to allow volatile agents to be employed for anaesthetic maintenance and oxygen support.
Sedation/Deep Sedation
Bradley, M.P., Doerning, C.M., Nowland, M.H., Lester, P.A., 2019. Intramuscular Administration of Alfaxalone Alone and in Combination for Sedation and Anesthesia of Rabbits (Oryctolagus cuniculus). J Am Assoc Lab Anim Sci 58, 216–222. https://doi.org/10.30802/AALAS-JAALAS-18-000078
Gardhouse, S., Sanchez, A., 2022. Rabbit Sedation and Anesthesia. Veterinary Clinics of North America: Exotic Animal Practice 25, 181–210. https://doi.org/10.1016/j.cvex.2021.08.012
Huynh, M., Poumeyrol, S., Pignon, C., Le Teuff, G., Zilberstein, L., 2015. Intramuscular administration of alfaxalone for sedation in rabbits. Vet Rec 176, 255. https://doi.org/10.1136/vr.102522
Ishikawa, Y., Sakata, H., Tachibana, Y., Itami, T., Oyama, N., Umar, M.A., Sano, T., Yamashita, K., 2019. Sedative and physiological effects of low-dose intramuscular alfaxalone in rabbits. J Vet Med Sci 81, 851–856. https://doi.org/10.1292/jvms.18-0618
Marín, P., Belda, E., Laredo, F.G., Torres, C.A., Hernandis, V., Escudero, E., 2020. Pharmacokinetics and sedative effects of alfaxalone with or without dexmedetomidine in rabbits. Res Vet Sci 129, 6–12. https://doi.org/10.1016/j.rvsc.2019.12.015
Reabel, S.N., Queiroz-Williams, P., Cremer, J., Hampton, C.E., Liu, C.-C., da Cunha, A., Nevarez, J.G., 2021. Assessment of intramuscular administration of three doses of alfaxalone combined with hydromorphone and dexmedetomidine for endoscopic-guided orotracheal intubation in domestic rabbits (Oryctolagus cuniculus). J Am Vet Med Assoc 259, 1148–1153. https://doi.org/10.2460/javma.20.07.0402
Expert Opinion
1317822* | 220805 Extrapolation of pharmacological properties in man and veterinary species. Some material employed in collating the data displayed here was taken from veterinary product datasheets or extrapolated from pharmacology texts.