MLK Infusion

RE: MLK Infusion

Neil Wheadon — Mon, 09 Nov 2015 13:16:05 GMT

It is light sensitive but you don't need to wrap the fluid it's in as it's stable for 24 hours

Neil

RE: MLK Infusion

Silvia Maldonado — Mon, 09 Nov 2015 04:07:32 GMT

Hi, all. Does anyone know if there is any contraindication for using emeprid in CRI with some fluids? Apart from being light sensitive, is there any reaction or precipitation because of emeprid's preservative?

Re: MLK Infusion

Silvia Maldonado — Mon, 08 Jun 2015 03:16:36 GMT

Yes, you are right, morphine dose is the same I should try posting comments at a "human being" hour of day, I guess

Re: MLK Infusion

Neil Wheadon — Sun, 07 Jun 2015 19:05:58 GMT

HI Silvia Can you quantify this post? You're saying that Vets Now uses higher doses of Lidocaine and Ketamine but lower doses of Morphine, yet you have said that you add Lidocaine 750mg as apposed to 500mg Ketamine 75mg as apposed to 60mg And the morphine doses are the same 60mg. The rate I quoted was 1-2ml/kg/hour which is the dose of the analgesia. any fluid losses or requirements need to be added in addition to this. Just goes to show there are differences and that the advise you sometimes see of having to remove the amount of hartmanns/saline you are adding in terms of these drugs doesn't mean a lot Neil

Re: MLK Infusion

Silvia Maldonado — Sat, 06 Jun 2015 21:36:06 GMT

I take note of your "recipe" because Vets Now uses a higher dose of lidocaine and ketamine, but lower dose of morphine. However, in a GDV they can spend up to 3 litres of IV fluids the half hour prior to surgery, to avoid death for hypovolemia, or potassium levels problems (good reason to use lidocaine, as someone has already mention).

In any case, here is the protocol used in some practices, for a 500ml of fluid bag as well:

lidocaine (20mg/ml): 750mg into 500ml bag, which is 37.5ml of lidocaine 2%.
ketamine (100mg/ml): 75mg into a 500ml bag, or 0.75ml of ketalar 1000.
morphine (10mg/ml): 60mg into a 500ml bag, or 6ml of morphine 1%

Hope it helps. ;)

Re: MLK Infusion

Stephen Courtney — Fri, 05 Jun 2015 22:19:23 GMT

I would almost always use a lignocaine CRI perioperatively for a GDV - but tend not to use the morphine and ketamine. the lignocaine infusion provides excellent analgesia and protects against the arrhythmias that can occur post operatively

We also use lignocaine infusions for pancreatitis cases that need it. The morphine and ketamine seem less necessary now that we are more used to methadone, but I can't really remember if that is why we use them less these days or not. The lignocaine infusions are simpler, and cheaper, and have less record keeping requirements. job gets done just as good as far as i can see.

Re: MLK Infusion

Neil Wheadon — Fri, 05 Jun 2015 19:35:34 GMT

Yes and quite frequently

Are you using this recipe

Into a 500ml Hartmanns

Morphine 60mg

Lidocaine 500mg

Ketamine 60mg

Then 1-2ml/kg/hour

This is Ava Firths recipe and she is certainly one to respect

I did a review of doses used at various Vets Now Clinics and some used 150mg Ketamine which might help, all used 60mg Morphine

Neil

Re: MLK Infusion

Tom Ward — Fri, 05 Jun 2015 19:19:26 GMT

Ressurecting an old thread here! Had a young dog today with a non displaced cervical 2 fracture which was very painful and non ambulatory though had no obvious neuro deficits. After discussion with a specialist, we opted to treat conservatively. To try to manage his pain we started a MLK infusion, but he spent most of the afternoon crying repeatedly even after application of a neck splint. He seemed reasonably alert and would temporarily calm down when he received some attention. I was concerned that despite the infusion we were not effectively managing his pain. One of my colleagues mentioned that she'd seen the occasional dog become quite dissociative on MLK and though it could be this - has anyone else seen this?

Re: MLK Infusion

vetbl.locum — Mon, 17 Nov 2014 21:00:12 GMT

Thanks

Does anyone use MLK infusions for orthopaedic ops?

or possibly TECA?

Re: MLK Infusion

Niall Taylor — Mon, 17 Nov 2014 13:58:29 GMT

[quote user="Evelyn Barbour-Hill"]For a moment I thought you'd written milk infusion.[/quote]

There used to be an old treatment for gastric ulcers called a milk drip where milk was administered via naso-gastric tube. I believe there were one or two tragic misunderstandings involving it being given i/v, before the practice became out-dated.

Apologies for the derail,

Niall

Re: MLK Infusion

Neil Wheadon — Fri, 14 Nov 2014 09:56:10 GMT

In answer to the saline question. You're always safer using sodium chloride and would continue to do this with an MLK as there are 3 drugs in the bag. The question is weither the subsequent acidosis is an issue and if it needs correcting with the alkalinising solution. My thought in a GDV is once you correct the twist the resulting respiratory component to acid base balance will be gone so it's not such an issue Neil

Re: MLK Infusion

Neil Wheadon — Fri, 14 Nov 2014 09:51:50 GMT

I asked this same question at Vets Now conference a few years ago as the use of lidocaine seems sensible given that a proportion of GDV's suffer with runs of tachycardia post op. The answer was no reason not too. MLK infusions are very good and great for controlling pain. I have read though that Confortam can't be substituted for Morphine, unless someone knows better Neil

Re: MLK Infusion

vetbl.locum — Fri, 14 Nov 2014 08:47:33 GMT

Never heard of milk combination being put into joints!

Does ketamine work locally?

Regards

Re: MLK Infusion

vetbl.locum — Fri, 14 Nov 2014 00:17:50 GMT

Yes sorry

Mlk is morphine lignocaine ketamine

Re: MLK Infusion

Anthony Dennison — Fri, 14 Nov 2014 00:06:04 GMT

morphine/lidocaine/ketamine I think. Often gets infused into joints after orthopaedic procedures

Re: MLK Infusion

Evelyn Barbour-Hill — Fri, 14 Nov 2014 00:03:19 GMT

For a moment I thought you'd written milk infusion. Yeah, it could work!

What is mlk?