Comparison of alfaxalone versus propofol as anaesthetic induction agents in increasing the rate of survival and vigour of neonates

Published:

2021-06-30

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DOI

https://doi.org/10.18849/ve.v6i2.344

Abstract

PICO question

In routine canine caesareans, is alfaxalone a superior anaesthetic induction agent than propofol in increasing the rate of survival and vigour of neonates?

 

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Three randomised positive clinical trials have compared the efficacy between alfaxalone and propofol in routine canine caesarean sections for increased neonatal survival and vigour

Strength of evidence

Weak

Outcomes reported

Although two studies found alfaxalone to be associated with higher Apgar scores for neonates than propofol, each study nonetheless revealed positive vigour and high survival rates from the use of either alfaxalone or propofol. The evidence is too weak to suggest that one induction agent is superior to another. The selection between the two induction agents may not be the main concern in regard to neonatal depression and 24 hour survival post-delivery, provided that the entire canine caesarean protocol is thoroughly and carefully studied

Conclusion

The evidence is too weak to suggest that alfaxolone or propofol is superior to another during canine cesareans. There is no signifcant difference seen in neonatal survival rate and vigour when using either alfaxolone or propofol

 

How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

 

Open Access Peer Reviewed

References

Onclin, K.J. & Verstegen, J.P. (2008). Cesarean Section in the Dog. Clinician’s brief. 72–78.

Pascoe, P.J. & Moon, P.F. (2001). Periparturient and neonatal anaesthesia. Veterinary Clinics of North America: Small Animal Practice. 31(2), 315–341. DOI: https://doi.org/10.1016/S0195-5616(01)50208-9

World Small Animal Veterinary Association Global Veterinary Community. Cesarean section.

Paddleford, R.R. (2016). Anesthesia for Ceserean Section in the Dog. Veterinary Clinics of North America: Small Animal Practice. 22(2), 481–484. DOI: https://doi.org/10.1016/S0195-5616(92)50678-7

Sams, L., Braun, C., Allman, D. & Hofmeister, E. (2008). A comparison of the effects of propofol and etomidate on the induction of anaesthesia and on cardiopulmonary parameters in dogs. Veterinary Anaesthesisa and Analgesia. 35(6), 488–494.DOI: http://doi.org/ 1111/j.1467-2995.2008.00417.x

Luna, S.P.L., Cassu, R.N., Castro, G.B., Teixeira Neto, F.J., Silva Júnior, J.R. & Lopes, M.D. (2004). Effects of four anaesthetic protocols on the neurological and cardiorespiratory variable of puppies born by caesarean section. Veterinary Record. 154(13), 387–389. DOI: https://doi.org/10.1136/vr.154.13.387

Moon, P.F., Erb, H.N., Ludders, J.W., Gleed, R.D & Pascoe, P.J. (2000). Perioperative risk factors for puppies delivered by cesarean section in the United States and Canada. Journal of the American Animal Hospital Association. 36(4), 359–68. DOI: https://doi.org/10.5326/15473317-36-4-359

Jurox Animal Health. (2013). What is Alfaxan®? Alfaxan (alfaxalone 10 mg/mL). Available at: https://jurox.com/sites/default/files/resources/juroxinc_alfaxan_whatisalfaxan_ipad.pdf [Accessed May 2019].

Brewster, M.E., Estes, K.S. & Bodor, N. (1989). Development of a non-surfactant formulation for alfaxalone through use of chemically-modified cyclodextrins. Journal of Parenteral Science and Technology. 43(6), 262–265.

Maney, J.K., Shepard, M.K., Braun, C., Cremer, J. & Hofmeister, E.H. (2013). A comparison of cardiopulmonary and anesthetic effects of an induction dose of alfaxalone or propofol in dogs. Veterinary Anaesthesia and Analgesia. 40(3), 237–244. DOI: https://doi.org/10.1111/vaa.1200

Kanto, J.H. (1988). Propofol, the newest induction agent of anesthesia. International Journal of Clinical Pharmacology, Therapy and Toxicology. 26(1), 41–57.

Vilar, J.M., Batista, M., Perez, R., Zagorskaia, A., Jouanisson, E., Díaz-Bertrana, & Rosales, S. (2018). Comparison of 3 anesthestic protocols for the elective cesarean-section in the dog: Effects on the bitch and the newborn puppies. Animal Reproduction Science. 190, 53–62. DOI: https://doi.org/10.1016/j.anireprosci.2018.01.007

Ruiz, C.C., Del Carro, A.P., Rosset, E., Guyot, E., Maroiller, L., Buff, S. & Portier, K. (2016). Alfaxalone for total intravenous anaesthesia in bitches undergoing elective caesarean section and its effects on puppies: a randomized clinical trial. Veterinary Anaesthesia and Analgesia. 43(3), 281–290. DOI: https://doi.org/10.1111/vaa.12298

Metcalfe, S., Hulands-Nave, A., Bell, M., Kidd, C., Pasloske, K., O’Hagan, B., Perkins, N. & Whittem, T. (2014). Multicentre, randomised clinical trial evaluating the efficacy and safety of alfaxalone administered to bitches for induction of anaesthesia prior to caesarean section. Australian Veterinary Journal. 92(9), 333–338. DOI: https://doi.org/10.1111/avj.12223

Doebeli, A., Michel, E., Bettschart, R. Hartnack, S. & Reichler, I.M. (2013). Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol. 80(8), 850–854. DOI: https://doi.org/10.1016/j.theriogenology.2013.07.006

Callander,, Antsey, A.V., Ingram, J.R., Limpens, J., Flohr, C. & Spuls, P.I. (2017). How to write a Critically Appraised Topic: evidence to underpin routine clinical practice. British Journal of Dermatology. 177(4), 1007–1013. DOI: https://doi.org/10.1111/bjd.15873

Bang, H., Ni, L. & Clarence, E.D. (2004). Assessment of blinding in clinical trials. Control Clinical Trials. 25(2), 143–156. DOI: https://doi.org/10.1016/j.cct.2003.10.016

Juni, P., Altman, D.G. & Egger, M. (2001). Assessing the quality of controlled clinical trials. 323, 42–46. DOI: https://doi.org/10.1136/bmj.323.7303.42

Nayak, B.K. (2010).Understanding the relevance of sample size calculation. Indian Journal of Opthalmology. 58(6) , 469–470. DOI: https://doi.org/ 4103/0301-4738.71673

Mila, H., Grellet, A., Delebarre, M., Mariani, C., Feugier, A. & Chastant-Maillard, S. (2017). Monitoring of the newborn dog and prediction of neonatal mortality. Preventive Veterinary Medicine. 143, 11–20. DOI: https://doi.org/10.1016/j.prevetmed.2017.05.005

Veronesi, M.C. (2016). Assessment of canine neonatal viability – the Apgar score. Reproduction in Domestic Animals. 51(S1), 46–50. DOI: https://doi.org/10.1111/rda.12787

Groppetti, D., Pecile, A., Del Carro, A.P., Copley, K., Minero, M. & Cremonesi, F. (2010). Evaluation of newborn canine viability by means of umbilical vein lactate measurement, apgar score and uterine tocodynamometry. 74(7), 1187–1196. DOI: https://doi.org/10.1016/j.theriogenology.2010.05.020

WSAVA Global Pain Council Pain Management Protocol. (2014). Caesarean section. Journal of Small Animal Practice. I55, E10–E68.

Bolis, B., Prandi, A., Rota, A., Faustini, M. & Veronesi, M.C. (2017). Cortisol fetal fluid concentrations in term pregnancy of small-sized purebred dogs and its preliminary relation to first 24 hours survival of newborns. 88, 264–269. DOI: http://doi.org/10.1016/j.theriogenology.2016.09.037

Melandri, M., Alonge, S., Peric, T., Bolis, B. & Veronesi, M.C. (2019). Effects of Alfaxalone or Propofol on Giant-Breed Dog Neonates Viability During Elective Caesarean Section. 9(11), 962. DOI: https://doi.org/10.3390/ani9110962

De Cramer, K.G.M., Joubert, K.E. & Nöthling, J.O. (2017). Puppy survival and vigor associated with the use of low dose medetomidine premedication, propofol induction and maintenance of anesthesia using sevoflurane gas-inhalation for cesarean section in the bitch. Theriogenology. 96, 10–15. DOI: https://doi.org/10.1016/j.theriogenology.2017.03.021

Vol. 6 No. 2 (2021): The second issue of 2021

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  / 

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