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Alfaxalone

Grade

CRI - TIVA

Alfaxalone Continuous Rate Infusion   

  • 6-9 mg/kg/h CRI following induction 

Induction

  • 1-4 mg/kg by slow IV injection (Dependent upon premedication).

Suitability

  • ASA Status:  Recommendations apply to ASA1 and 2 patients.

  • Intubation: In clinical settings, animals are usually intubated, or a supraglottic device is placed to allow oxygen support and supportive ventilation.

Patient Preparation

  • Induction Preparation: Rabbits benefit from premedication, IV access and preoxygenation before Alfaxan induction.

  • Suitable Handling: Ensure rabbits are kept away from predator contact, smell and excessive noise

  • Intubation: In clinical settings, animals are usually intubated, or a supraglottic device is placed to allow volatile agents to be employed for anaesthetic maintenance.

  • Analgesia: Where painful procedures are anticipated, clinicians must employ suitable analgesia agents and monitor the patient for pain.

Therapeutics

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Therapeutic Principles

  1. Multimodal Use: Multimodal use achieves balanced narcosis, analgesia, and muscle relaxation, improves anaesthetic safety, and avoids deep levels of central brain depression. The dosing schedules elsewhere in this monograph cover the use of opiates, midazolam and α2 adrenergic agonists.

  2. Adverse Effects Profile: Respiratory depression and apnea may occur with rapid IV injection or excessive dose. Cardiodepressant and vasodilatory effects of inhalant anaesthetics may result in hypotension.

  3. 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.

  4. Treatment Goals: Stable unpremedicated anaesthesia.

  5. Treatment Endpoints: Completion of any planned procedure.

  6. Efficacy Profile:  Comparative risk of death or other adverse outcomes, such as inadequate depth or duration of surgical anaesthesia or sedation, remain poorly investigated.

  7. 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.

  8. 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.

Evidence

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  1. 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

  2. Bradley, M.P., Doerning, C.M., Nowland, M.H., Pasloske, K., Lester, P.A., 2022. Evaluation of alfaxalone total intravenous anesthesia in rabbits (Oryctolagus cuniculus) premedicated with dexmedetomidine or dexmedetomidine and buprenorphine. Vet Anaesth Analg S1467-2987(22)00013–7. https://doi.org/10.1016/j.vaa.2022.01.006

  3. Calero Rodriguez, A., van Zeeland, Y.R., Schoemaker, N.J., de Grauw, J.C., 2021. Agreement between invasive and oscillometric arterial blood pressure measurement using a high-definition oscillometric device in normotensive New Zealand White rabbits using two different anaesthetic protocols. Vet Anaesth Analg 48, 679–687. https://doi.org/10.1016/j.vaa.2021.03.016

  4. Engbers, S., Larkin, A., Rousset, N., Prebble, M., Jonnalagadda, M., Knight, C.G., Pang, D.S.J., 2017. Comparison of a Supraglottic Airway Device (v-gel®) with Blind Orotracheal Intubation in Rabbits. Front Vet Sci 4, 49. https://doi.org/10.3389/fvets.2017.00049

  5. Gil, A.G., Silván, G., Villa, A., Illera, J.C., 2012. Heart and respiratory rates and adrenal response to propofol or alfaxalone in rabbits. Vet Rec 170, 444. https://doi.org/10.1136/vr.100573

  6. Grint, N.J., Smith, H.E., Senior, J.M., 2008. Clinical evaluation of alfaxalone in cyclodextrin for the induction of anaesthesia in rabbits. Vet Rec 163, 395–396. https://doi.org/10.1136/vr.163.13.395

  7. 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

  8. Marsh, M.K., McLeod, S.R., Hansen, A., Maloney, S.K., 2009. Induction of anaesthesia in wild rabbits using a new alfaxalone formulation. Vet Rec 164, 122–123. https://doi.org/10.1136/vr.164.4.122

  9. Navarrete-Calvo, R., Gómez-Villamandos, R.J., Morgaz, J., Manuel Domínguez, J., Fernández-Sarmiento, A., Muñoz-Rascón, P., López Villalba, I., Del Mar Granados, M., 2014. Cardiorespiratory, anaesthetic and recovery effects of morphine combined with medetomidine and alfaxalone in rabbits. Vet Rec 174, 95. https://doi.org/10.1136/vr.101293

  10. Raulic, J., Leung, V.S., Doss, G.A., Graham, J.E., Keller, K.A., Mans, C., Sadar, M.J., Vergneau-Grosset, C., Pang, D.S., 2021. Development and Testing of a Sedation Scale for Use in Rabbits (Oryctolagus cuniculus). J Am Assoc Lab Anim Sci 60, 549–555. https://doi.org/10.30802/AALAS-JAALAS-21-000002

  11. 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

  12. Roan, R., 2009. Use of alfaxalone in rabbits. Vet Rec 164, 188. https://doi.org/10.1136/vr.164.6.188-a

  13. Rousseau-Blass, F., Pang, D.S., 2020. Hypoventilation following oxygen administration associated with alfaxalone-dexmedetomidine-midazolam anesthesia in New Zealand White rabbits. Vet Anaesth Analg 47, 637–646. https://doi.org/10.1016/j.vaa.2020.04.012

  14. Tutunaru, A.C., Sonea, A., Drion, P., Serteyn, D., Sandersen, C., 2013. Anaesthetic induction with alfaxalone may produce hypoxemia in rabbits premedicated with fentanyl/droperidol. Vet Anaesth Analg 40, 657–659. https://doi.org/10.1111/vaa.12071


Unpremedicated Anaesthesia

  1. 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

  2. Gil, A.G., Silván, G., Villa, A., Illera, J.C., 2012. Heart and respiratory rates and adrenal response to propofol or alfaxalone in rabbits. Vet Rec 170, 444. https://doi.org/10.1136/vr.100573

  3. 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


Expert Opinion

  1. 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.


Monograph Details

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