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      Use of butorphanol and diprenorphine to counter respiratory impairment in the immobilised white rhinoceros ( Ceratotherium simum)

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          Abstract

          Opioid-induced immobilisation results in severe respiratory impairment in the white rhinoceros. It has therefore been attempted in the field to reverse this impairment with the use of opioid agonist-antagonists, such as nalorphine, nalbuphine, butorphanol and diprenorphine; however, the efficacy of some of these treatments has yet to be determined. The efficacy of butorphanol, either alone or in combination with diprenorphine both with and without oxygen insufflation, in alleviating opioid-induced respiratory impairment was evaluated. The study was performed in two parts: a boma trial and a field trial. Rhinoceroses were immobilised specifically for the study, according to a strict protocol to minimise confounding variables. A two-way analysis of variance was used to compare the physiological responses of the rhinoceroses to the different treatments and their effects over time. The intravenous administration of butorphanol (at 3.3 mg per mg etorphine) plus diprenorphine (at 0.4 mg per mg etorphine) did not offer any advantage over butorphanol (at 15 mg per mg etorphine) alone with regard to improving P aO 2, P aCO 2 and respiratory rates in etorphine-immobilised white rhinoceroses. Both butorphanol + diprenorphine + oxygen and butorphanol + oxygen, at the doses used, significantly improved the etorphine-induced hypoxaemia in both boma- and field-immobilised white rhinoceroses. Clinically acceptable oxygenation in field-immobilised white rhinoceroses can be achieved by using either treatment regimen, provided that it is combined with oxygen insufflation.

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          Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma.

          The effect on Paco2 of high concentration oxygen therapy when administered to patients with severe exacerbations of asthma is uncertain.
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            Hypoxia following etorphine administration in goats (Capra hircus) results more from pulmonary hypertension than from hypoventilation

            Background Etorphine, a potent opioid agonist, causes pulmonary hypertension and respiratory depression. Whether etorphine-induced pulmonary hypertension negatively influences pulmonary gas exchange and exacerbates the effects of ventilator depression and the resultant hypoxemia is unknown. To determine if these effects occurred we instrumented twelve goats with peripheral and pulmonary arterial catheters to measure systemic and pulmonary pressures before and after etorphine administration. Concurrent cardiopulmonary and arterial blood gas variables were also measured. Results Etorphine induced hypoventilation (55% reduction to 7.6 ± 2.7 L.min−1, F(11,44) = 15.2 P  40 mmHg, F(11,44) = 5.6 P < 0.0001) and pulmonary hypertension (mean 23 ± 6 mmHg, F(11,44) = 8.2 P < 0.0001). Within 6 min of etorphine administration hypoxia was twice (F(11,22) = 3.0 P < 0.05) as poor than that expected from etorphine-induced hypoventilation alone. This disparity appeared to result from a decrease in the movement of oxygen (gas exchange) across the alveoli membrane, as revealed by an increase in the P(A-a)O2 gradient (F(11,44) = 7.9 P < 0.0001). The P(A-a)O2 gradient was not correlated with global changes in the ventilation perfusion ratio (P = 0.28) but was correlated positively with the mean pulmonary artery pressure (P = 0.017, r2 = 0.97), indicating that pulmonary pressure played a significant role in altering pulmonary gas exchange. Conclusion Attempts to alleviate etorphine-induced hypoxia therefore should focus not only on reversing the opioid-induced respiratory depression, but also on improving gas exchange by preventing etorphine-induced pulmonary hypertension.
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              Use of butorphanol during immobilization of free-ranging white rhinoceros (Ceratotherium simum).

              Forty free-ranging white rhinoceros (Ceratotherium simum) were anesthetized with etorphine, azaperone, and hyaluronidase in Kruger National Park, South Africa, between February and August 2009. Eighteen rhinoceros received butorphanol in the dart combination, and 22 rhinoceros had butorphanol administered intravenously within 15 min of darting. Body position, blood gas values, heart rate, respiratory rate, and temperature were measured at two time points after darting, approximately 10 min apart (sample 1 mean collection time after darting, 9.4 +/- 2.7 min; sample 2 mean collection time, 18.6 +/- 2.8 min). A significant number of field-captured rhinoceros remained standing at the first sample period when butorphanol was administered in the dart. Higher median values for arterial partial pressure of oxygen (PaO2) in combination with lower arterial partial pressure of carbon dioxide (PaCO2) in standing versus recumbent rhinoceros suggested improved ventilation in this posture (P < 0.05). When the effect of time, body position, and age was controlled, median values for respiratory rate, lactate, and pH were better in rhinoceros that received butorphanol in the dart (P < 0.05). There was also a trend toward higher median values for SO2 and bicarbonate in rhinoceros receiving butorphanol in the dart. Intravenous administration of butorphanol resulted in significantly decreased median PaCO2 and heart rate in recumbent rhinoceros (P < 0.05) without changes in PaO2 between sample periods 1 and 2. However, rhinoceros remained hypoxemic during the short anesthetic procedure despite butorphanol administration. Preliminary results suggest that administration of butorphanol (either in the dart or intravenously) improves some metabolic parameters in free-ranging recumbent white rhinoceros without significantly affecting ventilation. It is hypothesized that this may be due to a lighter state of immobilization. Addition of butorphanol to the dart provides handling and physiologic advantages because the majority of rhinoceros remain standing.
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                Author and article information

                Journal
                J S Afr Vet Assoc
                J S Afr Vet Assoc
                JSAVA
                Journal of the South African Veterinary Association
                AOSIS
                1019-9128
                2224-9435
                18 October 2018
                2018
                : 89
                : 1683
                Affiliations
                [1 ]Department of Paraclinical Sciences, University of Pretoria, South Africa
                [2 ]School of Physiology, University of the Witwatersrand, South Africa
                [3 ]Great Plains Conservation and Rhino without Borders, Maun, Botswana
                [4 ]Veterinary Wildlife Services, South African National Parks, South Africa
                [5 ]Department of Production Animal Studies, University of Pretoria, South Africa
                [6 ]Division of Molecular Biology and Human Genetics, Stellenbosch University, South Africa
                Author notes
                Corresponding author: Leith Meyer, leith.meyer@ 123456up.ac.za
                Author information
                https://orcid.org/0000-0002-5122-2469
                https://orcid.org/0000-0001-6370-8151
                https://orcid.org/0000-0003-4473-3671
                https://orcid.org/0000-0001-5614-0975
                https://orcid.org/0000-0002-5883-6076
                https://orcid.org/0000-0002-5904-2753
                Article
                JSAVA-89-1683
                10.4102/jsava.v89i0.1683
                6244275
                30456980
                8a4be439-e402-4d4d-bcb0-99cf68bf72bc
                © 2018. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 11 April 2018
                : 04 September 2018
                Categories
                Original Research

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