SAEVA Proceedings 2014 | Page 110

110   46TH  ANNUAL  CONGRESS  OF  THE  SAEVA        SKUKUZA      16-­‐20  FEBRUARY  2014     Examples of various combinations used in clinical practice for prolonged standing sedation Drug Loading Constant dose rate infusion dose Combo Medetomidine 0.005 0.018 May cause severe ataxia in 1 mg/kg mg/kg/hr some horses Butorphanol 0.02 mg/kg 0.012 mg/kg/hr Combo Romifidine 0.04 to 0.03 mg/kg/hr Initial bolus based on 2 0.08 mg/kg temperament of horse. Drafts horses require a lower dose. Butorphanol 0.018 0.025 Visceral pain, minor skin mg/kg mg/kg/hr lesions OR Morphine 0.1 mg/kg 0.05 mg/kg/hr For moderate to severe somatic or visceral pain Combo Detomidine 0.01 to 0.005 to 0.01 Dose depending on 3 0.02 mg/kg mg/kg/hr temperament and breed of horse as with Romifidine (above) Buprenorphine 0.005 to Not Buprenorphine has a long 0.01 mg/kg indicated duration of action. Consider rebolusing after 60 minutes if analgesia seems inadequate OR Butorphanol 0.018 0.025 Visceral pain, minor skin mg/kg mg/kg/hr lesions OR Morphine 0.1 mg/kg 0.05 mg/kg/hr For moderate to severe somatic or visceral pain Table 1: Various combinations used to achieve predictable standing sedation in horses. Worked example on how to prepare a constant rate infusion cocktail Administration set influences how long an infusion can last. Always best to use an easy drip rate to manage. Usually 1 drop/second is preferred. Admin set (drops/mL) Drops/secon Volume How long infusion will d (mL) last 10 1 200 33 min ≈ 0.5 hours 20 1 200 66 min ≈ 1 hour 60 1 200 200 min ≈ 3 hours Now that you know how long a bag will last; you now spike the bag with how much drug you need per hour. For example: CRI of Romifidine (0.03 mg/hr) and Morphine (0.05 mg/kg) in a 500 kg horse. Romifidine formulation is 10 mg/mL and Morphine is 10 mg/mL. You can mix your cocktail in one 200 mL bag. To be absolutely correct you should withdrawal   110