Bart Gazendam, [14 Nov 2022 at 18:24:56]: Hi everyone, anyone experienced rough wake up after ketamine (2.5mg/kg) and medetomidine (0.03 mg/kg) in cheetah reversed with 4 times atipamezole dose IM? (yes slightly higher than the usual 3 times, but that shouldn’t be the problem I think?) Had two younger animals today (5 months) hallucinating and trashing around (one anaesthesia 40 minutes, one 1h20min, maintained with isoflurane) post recovery, had to give them midazolam to calm down unfortunately. Clinically healthy (apart one with lameness) Erik Verryne, [14 Nov 2022 at 18:33:24]: Hi Bart. How long after darting did you reverse the medetomidine? You typically see that when you reverse the medetomidine within 20-30 mins after induction. And you can get away with lower ketamine. Bart Gazendam, [14 Nov 2022 at 18:36:30]: 40 min for the one cat and 1 hour and 20 for the other So you would expect the ketamine to be worn off I guess, even with a slightly higher dose? Erik Verryne, [14 Nov 2022 at 18:40:25]: Ok. Sorry. You did mention it. Yes. Half-life is much shorter unless they had issues. And unlikely for both cats. Did you reverse IM? Bossie Boshoff, [14 Nov 2022 at 18:47:43]: Did you use atipamezole or yohimbine/atipamezole mix to reverse? Bart Gazendam,[14 Nov 2022 at 19:09:00]: Pure atipamezole, Intramuscular Willem Burger, [14 Nov 2022 at 19:11:17]: I suggest you go down to 3x atipamezole when crating. Bart Gazendam, [14 Nov 2022 at 19:20:02]: Same litter, so perhaps a heritable problem / genetics involved? Richard Burroughs [14 November 2022] Interesting. I wonder if there is not something else at play. I have used the doses and antagonists as Bart describes in many many cheetah, and have never seen this. My doses in practice (some years ago, agreed!) were around 5 mg/kg ketamine and 5:1 atipamezole to medetomidine. I would expect this at shorter durations as discussed, but not at 40 minutes and longer. I don’t think dropping the dose of ketamine or atipamezole will reduce these effects. Adrian Tordiffe, [15 Nov 2022 at 14:09:44]: Richard, over the years I have become more careful with atipamezole in cheetahs. I think higher doses contribute significantly to the recovery dysphoria and stress-related mortalities (especially in very wild individuals). I don't go higher than 2:1 (atipamezole: medetomidine) and always give it strictly IM Just out of interest we now routinely use the water-based perphenazine (0.3mg/kg) IM for the transport of wild cheetahs. Adrian Tordiffe, [15 Nov 2022 at 14:30:17]: Wild cheetah immobilization and clinical management protocol for translocation.pdf Here is the protocol we are using at the moment. Please feel free to comment 👆🏻 Henry Labuschagne, [15 Nov 2022 at 16:41:37]: 👍 I also give a cold ringers enema if temp is high. Richard Burroughs [16 Nov 2022] Morning Adrian. Thanks for the comment and for sharing your protocol. The reduction in atipamezole dose that you need to apply in current protocols is perplexing and interesting. What has changed over the years? I was using Domitor and Antisedan, and my total doses of Domitor may have come down to reduce costs, but I always used 5 x Antisedan doses as antagonist to the Domitor. Most of the cheetah that I did (? many 100s) were in a captive environment, some of which were captive bred, others were wild caught and in 'rehabilitation' facilities, so I cannot ascribe differences between wild vs captive bred. I never saw any complications to this (then standard) protocol over a 25 year period. I would be interested to hear comments from colleagues who currently work in captive breeding/rehabilitation facilities, and to try to figure out what the changes that have necessitated this reduction in dose may be. Adrian Tordiffe, [16 Nov 2022 at 09:25:33]: Richard, I don't think the atipamezole dose matters that much in captive cheetahs. Higher doses are very unlikely to cause any serious problems. The issue is with very wild cheetahs where the capture-related mortality rate was around 20% (Braud et al 2019). 30% of those deaths occurred AFTER antidote administration. It is my view that higher doses of atipamezole play at least some role in those deaths. Richard Burroughs [16 Nov 2022] Ok, thanks Adrian. Why then only in wild caught cheetah? That does not make any pharmacological sense, unless there were factors other than 'high' atipamezole dose per se. In wild caught cheetah, I would suspect that running, stress, and ambient temperature would be classical features that led to the development of for example hyperthermia, that to my mind, would be a much more likely event than the symptoms seen being the consequence of a high atipamezole dose. I have not read that paper, so possibly I need to check the rationale for this described there. Henry Labuschagne, [16 Nov 2022 at 09:51:27]: I think the adrenal response in wild cheetah is more pronounced and leads to negative response. Richard Burroughs [16 NOV 2022] Henry, agreed. No doubt. But that then talks to the management of the anaesthetic process, and not necessarily to the pharmacological antagonism of the A-2, and dose. Adrian Tordiffe, [16 Nov 2022 at 10:39:55]: Atipamezole causes CNS excitation. If you add some level of CNS stimulation to a high baseline stress level (from the capture), then in my view, you would get a more profound adrenal response. That would have several knock-on effects, including hyperthermia, increased metabolic rate, higher cardiac workload etc. Richard Burroughs [16 Nov, 2022] OK, thanks Adrian & Henry. I am persuaded. Adrian Tordiffe, [16 Nov 2022 at 10:50:50]: It's a theory 😉... which I admit is difficult to test scientifically. Hopefully we will see a dramatic decline in mortality rates and then we can perhaps tease apart the various factors that may have contributed to the problem. Erik Verrynne, [16 Nov 2022 at 12:14:56]: Richard and Adrian. This is worth investigating. I cannot explain it. However, I had cases in wild lions and sable where I saw hyper-excitability after reversal with higher dosages of atipamezole. It happened sporadically and not frequent enough for me to establish a pattern. But enough to make a mental note not to go over 1:5 medetomidine: atipamezole Henry Labuschagne, [16 Nov 2022 at 13:49:46]: In feline I use 1: 2.5 without issues Johan Wessels, [16 Nov 2022 at 13:55:54]: In domestic felines we do 1: 1 Henry Labuschagne, [16 Nov 2022 at 14:07:35]: How long after reversal are they able to walk without being disorientated? Hendrik Hansen, [16 Nov 2022 at 14:20:47]: All I can say that is 1:1 in antelope or even less wakes them up well enough. Chuma, [16 Nov 2022 at 20:25:50]: I also have used 1:1 medetomidine: atipamezole in free ranging lions with no problems, i.e. Zoletil 90-120 mg plus 2-3 med for females and males (lower Vs higher doses) Reversed 40-60min post darting. Leith Meyer, [16 Nov 2022 at 20:39:56]: Like the opioid antagonists, very small doses of atipamezole likely will antagonise the effects of medetomidine, but the risk of resedation, like renarcotisation, increase the lower you go, and often occur hours later when you are not around. Rob Jackson, [16 Nov 2022 at 22:54:31]: On wild lion, cheetah and leopard sedation, I once had a visiting vet who over at least 5 years used to use 10x atipamezole of medetomidine. He never had any negative results as far as I know. He was using the older higher doses of medetomidine, ketamine and included Zoletil in the mixes. Jacques ODell, [18 Nov 2022 at 08:14:32]: Morning colleagues. Interesting discussion regarding the cheetah. I’ve boxed a few wild free ranging cheetah. I always antagonise with 5:1 atipamezole:med and I have never lost a cheetah during or after capture. Maybe I have been lucky? Or an numbers game… That said, I only use zoletil+med in free ranging cheetah (ket+med for captive ones). I always feel that zolazepam plays a vital role in keeping them relaxed during the initial transport. Have not used WBP in them. Adrian Tordiffe, [18 Nov 2022 at 08:26:38]: Believe me, it is just a numbers game. There is also tremendous variation in the temperament of individual cheetahs. Some cheetahs are just highly strung. If you catch a large enough number, you will eventually encounter one or more of them. The zolazepam does not provide enough tranquilisation for those individuals (I don't think any off the benzodiazepines do) Andy Fraser, [18 Nov 2022 at 08:26:56]: Jacques be patient your opportunity will come. With combinations such as Zoletil/medetomidine, butorphanol/midazolam/medetomidine, butorphanol/medetomidine/ketamine or ketamine/medetomidine, veterinarains have lost cheetah on every drug combination imaginable...atipamezole at 1:1 or 5:1. On that unfortunate day with a very stressed cat when things don't go to plan, it just happens despite your best intentions. Our job is to make the pressured decision that we think is correct at the time for that specific situation. I like Adrian's approach of lower atipamezole when capture has been stressful, addition of a benzodiazepine or water-based perphenazine also helps the cat wake up gradually and gives time for the temp and hypercapnoea to correct itself. IV fluids, supplementary oxygen and slow wake up really make all the difference Jennifer Lawrence, [18 Nov 2022 at 09:59:21]: I agree with you Adrian regarding those highly strung individuals. Especially those captured from helicopters and relocated. Regardless of what is used at recovery and the time lapsed before recovering these individuals, they still have very erratic and unpleasant recoveries. Jacques ODell, [18 Nov 2022 at 10:02:40]: Haha, maybe. l pray not. Agree, I bolus all cheetah with iv Ringer’s Lactate and for those that were stressed or are hyperthermic, supply oxygen. Agree, one of the most difficult decisions is to know when to say NO, and not continue with the capture.
