Quad combo

RE: Quad combo

Martin Atkinson — Thu, 11 Jan 2018 08:51:56 GMT

[quote user="Gillian Mostyn"]In which case the opioid effect has certainly gone! Ouch![/quote]Last time I looked buprenorphine was effective for up to 6 hrs - how long do your surgical procedure take?!!

RE: Quad combo

Julie Innes — Thu, 11 Jan 2018 08:33:49 GMT

We tend to give at the same time as the reversal agent, so they still have some of the ketamine effect too.

RE: Quad combo

Gillian Mostyn — Wed, 10 Jan 2018 19:39:00 GMT

[quote user="Martin Atkinson"]We don't give NSAIDs until they are fully awake up and ambulatory[/quote]

In which case the opioid effect has certainly gone! Ouch!

RE: Quad combo

Gillian Mostyn — Wed, 10 Jan 2018 19:37:19 GMT

[quote user="Julie Innes"]They do have opioid on board[/quote]

OK. But butorphanol has questionable analgesic benefit, and certainly not for very long, and no antiinflammatory properties.

As Michael has just said, I am trying to avoid wind-up.

RE: Quad combo

Michael Woodhouse — Wed, 10 Jan 2018 19:34:45 GMT

2 words - wind up. We know analgesia works best if given before the pain is caused. We know multimodal analgesia is superior to relying on single agents. There is also published evidence showing cats in early renal failure are not worsened with long term meloxicam therapy.

My views are pretty simple (and I believe supported by evidence and collective experience):

1. NSAID always at pre-med

2. Judicious NSAIDs when cats need them (pain in cats badly underestimated IMO)

RE: Quad combo

David Mills — Wed, 10 Jan 2018 18:35:22 GMT

I do love veterinary logic sometimes.

If something goes wrong, blame either alpha 2s or NSAIDs.

One despairs.

RE: Quad combo

Martin Atkinson — Wed, 10 Jan 2018 14:42:00 GMT

[quote user="Julie Innes"]....when it happened we altered our protocol slightly. I felt if it happened again and we weren't so lucky, it wouldn't look good that we had ignored the previous incident.[/quote]That wasn't ironic applause by the way, just pleased someone else is listening.

RE: Quad combo

Julie Innes — Wed, 10 Jan 2018 14:17:22 GMT

[quote user="Gillian Mostyn"]

Doesn't this give a significant amount of time with no effective analgesia?

This is only my amateur musings, but I'd have thought that the immediate post op period would be the worst time to give it....the animal may have low BP, mild dehydration, mild hypothermia etc? No

[/quote]

They do have opioid on board. I know alpha agonists retain central pressure, but I thought perfusion was reduced (reduced heart rate etc, comes back up after reversal)? I'm definitely no expert! Our nurses are very good at monitoring temperature and keeping everything warm post op, so I don't worry about hypothermia, really, and as these are such short ops I don't really worry about dehydration (maybe I should )

I know it was just the one cat, but he was a very healthy 6 month old boy, and I had read about the possible issue with NSAIDs on here and elsewhere, so when it happened we altered our protocol slightly. I felt if it happened again and we weren't so lucky, it wouldn't look good that we had ignored the previous incident.

RE: Quad combo

Roland Bulkyn-Rackowe — Wed, 10 Jan 2018 13:58:40 GMT

I had a cat go into acute renal failure post castration about 15 years ago. He had pre op bloods which were normal and responded well to fluids. He hadn't had any perioperative NSAID as it wasn't in our protocol at the time.

RE: Quad combo

Martin Atkinson — Wed, 10 Jan 2018 13:58:08 GMT

[quote user="Gillian Mostyn"]Doesn't this give a significant amount of time with no effective analgesia? [/quote]One would assume it would have an opioid on board.

[quote user="Gillian Mostyn"] I'd have thought that the immediate post op period would be the worst time to give it....the animal may have low BP, mild dehydration, mild hypothermia etc? [/quote]Surely not as bad as peri-operatively when you have no idea how it will recover. At least a judgement call can be made in the post op period if these things are likely to be happening. We don't give NSAIDs until they are fully awake up and ambulatory (unless its an evil b******d we can't get near)! I'm sure that's what Julie was intimating.

RE: Quad combo

Gillian Mostyn — Wed, 10 Jan 2018 13:11:09 GMT

[quote user="Julie Innes"]we still give a dose of NSAID post-op, but I now give it once the alpha agonist has been reversed[/quote]

Doesn't this give a significant amount of time with no effective analgesia?

This is only my amateur musings, but I'd have thought that the immediate post op period would be the worst time to give it....the animal may have low BP, mild dehydration, mild hypothermia etc? No?

RE: Quad combo

Martin Atkinson — Wed, 10 Jan 2018 11:35:35 GMT

[quote user="David Mills"]

[quote user="Martin Atkinson"]. There is enough evidence to [/quote]

Is there? We're these mystical cats given anything else at the time?

[/quote]

RE: Quad combo

David Mills — Wed, 10 Jan 2018 11:22:26 GMT

[quote user="Martin Atkinson"]. There is enough evidence to [/quote]

Is there? We're these mystical cats given anything else at the time?

RE: Quad combo

David Mills — Wed, 10 Jan 2018 11:21:10 GMT

[quote user="Julie Innes"]but I now give it once the alpha agonist has been reversed, as my logic is that it causes reduced renal perfusion[/quote]

Alpha 2s increase or maintain renal perfusion. They don't reduce it. Acp, propofol, and almost every other anaesthetic agent does.

RE: Quad combo

Martin Atkinson — Wed, 10 Jan 2018 11:17:45 GMT

[quote user="Julie Innes"]Martin isn't the only one![/quote]Thank you!

RE: Quad combo

Julie Innes — Wed, 10 Jan 2018 10:52:21 GMT

I had one cat castrate come in the day after (having had meloxicam at time of surgery) not eating and poorly- Did bloods, urea and creatinine through the roof! Onto fluids for a couple of days and recovered, but gave me a scare, so Martin isn't the only one!

we still give a dose of NSAID post-op, but I now give it once the alpha agonist has been reversed, as my logic is that it causes reduced renal perfusion, so more likely to have issues with NSAID?

RE: Quad combo

Martin Atkinson — Wed, 10 Jan 2018 10:37:07 GMT

[quote user="Thomas Johnson"]But no one else seems to be having the same experience as you, a lot of other posters have written about how safe they find Metacam in cats, should you be learning from our experience rather than the other way round?.[/quote]I have said that I use meloxican routinely in cats and 99% of the time it is safe so not suggesting anyone stops just that you're not blase about it like Mr Mills. NSAIDs are not benign drugs, especially in cats, and need to be treated with respect especially peri-operatively and in cats with renal disease. There is enough evidence to suggest that one day you turn will come. As you have said, just be aware.

RE: Quad combo

Thomas Johnson — Wed, 10 Jan 2018 10:07:50 GMT

[quote user="Martin Atkinson"]Well what a surprise that you'd be along with these comments - the only surprise was that you hadn't been on sooner. Choose yourself if you don't want to listen to my experience, quite frankly my dear............[/quote]

But no one else seems to be having the same experience as you, a lot of other posters have written about how safe they find Metacam in cats, should you be learning from our experience rather than the other way round?. We give it routinely at induction to cats, and have a lot of older cats on it long-term for arthritis, and I have yet to see a cat develop an acute renal injury because of it, though I am of course aware that it is possible.

RE: Quad combo

Martin Atkinson — Wed, 10 Jan 2018 09:56:52 GMT

[quote user="David Mills"]

We've been here before ad nauseum. Atko always over exaggerates.

[/quote]Well what a surprise that you'd be along with these comments - the only surprise was that you hadn't been on sooner. Choose yourself if you don't want to listen to my experience, quite frankly my dear............

RE: Quad combo

David Mills — Tue, 09 Jan 2018 20:47:22 GMT

We've been here before ad nauseum.

Atko always over exaggerates. The published evidence contradicts him. He scaremongers some more, and his figures get bigger each time. Funny thing is, it would make an interesting case series if he could be bothered to look at them, and it would be interesting to see what else they had at the time.

In humans, most ARF following NSAID use is an idiosyncratic reaction, and at the moment we have no reason to believe the same isn't true in cats (and dogs).

I have never knowingly had one happen. And I use it preop at the one-off higher dosage in what must now be 1000s of cats. It kinda dwarfs one man's crusade, and I'm just one person. C'est la vie.

RE: Quad combo

Gillian Mostyn — Tue, 09 Jan 2018 18:15:31 GMT

[quote user="Martin Atkinson"]Don't be Ostrich like with this, it will happen to you one day and all the one stars you want to give me won't change that.[/quote]

I'm not an ostrich. I don't doubt that one day I'll have a cat go into ARF. It is one of the accepted side effects of meloxicam. I just choose, on balance, to use it. My own opinion is that unsatisfactory analgesia will also cause problems, both medically immediately post op and behaviourally in the longer term. No other currently available product offers the same analgesic cover as meloxicam. We all make decisions based on the balance of risk vs benefit...this is one of mine. (All spays and significant 'dentals' also go home with oral meloxicam. The boxes are well labelled...only for use if eating well and never if vomitting etc.)

RE: Quad combo

Martin Atkinson — Tue, 09 Jan 2018 17:40:55 GMT

[quote user="Robin Grimmer"]Never had any problems with metacam in cats pre-op, post-op or for long term tx eg arthritis. Only NSAID I ever had a problem with was in the bad old days with ketofen - a non COX-2 selective nsaid - and cat developed ARF.[/quote]

[quote user="Gillian Mostyn"]Snap. [/quote]And long may it continue. The last cat I had with ARF from one injection of meloxicam ended up at the QMH in intensive care. It got better but they said it is one of the more common things cats are admitted for. Don't be Ostrich like with this, it will happen to you one day and all the one stars you want to give me won't change that.

RE: Quad combo

Gillian Mostyn — Tue, 09 Jan 2018 14:58:45 GMT

[quote user="Robin Grimmer"]Never had any problems with metacam in cats pre-op, post-op or for long term tx eg arthritis. [/quote]

Snap. All our cat ops get it at the same time as their premed ... from 4 month old kittens to 16 year old cats for dental treatment. The only difference is the older cats also get IV fluids.

RE: Quad combo

Robin Grimmer — Tue, 09 Jan 2018 14:45:43 GMT

Never had any problems with metacam in cats pre-op, post-op or for long term tx eg arthritis. Only NSAID I ever had a problem with was in the bad old days with ketofen - a non COX-2 selective nsaid - and cat developed ARF.

RE: Quad combo

Martin Atkinson — Tue, 09 Jan 2018 12:34:10 GMT

[quote user="Anthony Dennison"]I've used Onsior a few times in cats, and a couple have become azotaemic. What sort of pulse dosing do you use?[/quote]As with all NSAIDs I use it only as absolutely necessary in cats so that may be for just 2-3 days. I'm aware the data sheet says not to give for more than 6 days and I've not found the need to do so continually yet, but if I felt there was a need I'd give a break of a week between courses.

Incidentally, just had a dog that's on long-term meloxicam for severe OA come in this morning with HGE. The owner had the sense to stop (surprising as she's not usually very sensible!) and our dispensing labels say to 'stop if not eating, vomiting or has severe diarrhoea especially with blood'.