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Alfaxalone

Grade

Midazolam + Alfaxalone


Midazolam

  • Midazolam: 1 mg/kg, IM | (Citation)

  • Alfaxalone to effect (1-4 mg/kg) [Slow IV]


Midazolam-Buprenorphine

  • Midazolam (0.7 mg/kg) and Buprenorphine (0.03 mg/kg) together subcutaneously or IV | (Citation)

  • Alfaxalone to effect (1-4 mg/kg) [Slow IV]


Midazolam-Butorphanol

  1. Butorphanol 0.5 mg/kg and midazolam 0.5 mg/kg  | (Citation)

  2. Alfaxalone to effect (1-4 mg/kg) [Slow IV]


Midazolam-Methadone+Alfaxalone

  1. Midazolam (0.5 mg/kg) and Methadone (0.2 mg/kg) together subcutaneous  or IV

  2. Alfaxalone to effect (1-4 mg/kg) [Slow IV]


Therapeutics

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  1. Administration Advice: Animals should have IV access and be preoxygenated before induction. This can be before or after premedication with medetomidine and additional agents. Ensure rabbits are kept away from predator contact, smell and excessive noise. In clinical settings, animals are usually intubated, or a supraglottic device is placed to allow volatile agents to be employed for anaesthetic maintenance.

  2. Multimodal Use: The protocols provided are all multimodal use.

  3. Adverse Effects Profile: Post-induction apnoea, defined as the cessation of breathing for 30 seconds, is possible if alfaxalone is administered intravenously. This appears more likely with rapid administration or high doses. Anxiolytic premedication and sensitive patient handling will reduce induction tachycardia associated with catecholamine release. Preoxygenation will extend the period where patients showing post-induction issues can be safely supported. Neurological signs (convulsions, myoclonus, tremor, prolonged anaesthesia), cardiorespiratory signs (cardiac arrests, bradycardia, bradypnea) and behavioural signs (hyperactivity, vocalisation) are reported as very rare adverse effects on product datasheets.

  4. Reproductive Safety: According to a product datasheet, studies using alfaxalone in pregnant mice, rats and rabbits have demonstrated no harmful effects on the treated animals' gestation or on their offspring's reproductive performance.

  5. Treatment Goals: Profound sedation or surgical anaesthesia.

  6. Treatment Endpoints: Surgical anaesthesia and positive surgical outcomes.

  7. Efficacy Profile: The comparative risk of death or other adverse outcomes, such as inadequate depth or duration of surgical anaesthesia or sedation, remain poorly investigated and therefore, most information located is regarded as expert opinion only. 

  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.

  9. Alternative Protocols: 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.

  10. Clinical Review: Medetomidine and alfaxalone are readily available in most developed countries.


Evidence

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  1. 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

  2. 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

  3. 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

  4. Reabel, S.N., Queiroz-Williams, P., Cremer, J., Langohr, I.M., da Cunha, A.F., Hampton, C.E., Carossino, M., Liu, C.-C., Nevarez, J.G., 2022. Comparison of blind and endoscopic-guided orotracheal intubation on laryngeal and tracheal damage in domestic rabbits (Oryctolagus cuniculus). Veterinary Anaesthesia and Analgesia 49, 398–406. https://doi.org/10.1016/j.vaa.2022.04.003

  5. 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


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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