• 1. Alkabes SB, Adams SB, Moore GE, et al. Comparison of two tourniquets and determination of amikacin sulfate concentrations after metacarpophalangeal joint lavage performed simultaneously with intravenous regional limb perfusion in horses. Am J Vet Res 2011; 72: 613619.

    • Search Google Scholar
    • Export Citation
  • 2. Kelmer G, Bell G, Martin-Jimenez T, et al. Evaluation of regional limb perfusion with amikacin using the saphenous, cephalic, and palmar digital veins in standing horses. J Vet Pharmacol Ther 2013; 36: 236240.

    • Search Google Scholar
    • Export Citation
  • 3. Levine DG, Epstein KL, Ahern BJ, et al. Efficacy of three tourniquet types for intravenous antimicrobial regional limb perfusion in standing horses. Vet Surg 2010; 39: 10211024.

    • Search Google Scholar
    • Export Citation
  • 4. Rubio-Martínez LM, Cruz AM. Antimicrobial regional limb perfusion in horses. J Am Vet Med Assoc 2006; 228: 706712.

  • 5. Rubio-Martínez LM, Elmas CR, Black B, et al. Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999–2009). J Am Vet Med Assoc 2012; 241: 16501658.

    • Search Google Scholar
    • Export Citation
  • 6. Butt TD, Bailey JV, Dowling PM, et al. Comparison of 2 techniques for regional antibiotic delivery to the equine forelimb: intraosseous perfusion vs intravenous perfusion. Can Vet J 2001; 42: 617622.

    • Search Google Scholar
    • Export Citation
  • 7. Lacy MK, Nicolau DP, Nightingale CH, et al. The pharmacodynamics of aminoglycosides. Clin Infect Dis 1998; 27: 2327.

  • 8. Langer K, Seidler C, Partsch H. Ultrastructural study of the dermal microvasculature in patients undergoing retrograde intravenous pressure infusions. Dermatology 1996; 192: 103109.

    • Search Google Scholar
    • Export Citation
  • 9. Grice SC, Morell RC, Balestrieri FJ, et al. Intravenous regional anesthesia: evaluation and prevention of leakage under the tourniquet. Anesthesiology 1986; 65: 316320.

    • Search Google Scholar
    • Export Citation
  • 10. Parra-Sanchez A, Lugo J, Boothe DM, et al. Pharmacokinetics and pharmacodynamics of enrofloxacin and a low dose of amikacin administered via regional intravenous limb perfusion in standing horses. Am J Vet Res 2006; 67: 16871695.

    • Search Google Scholar
    • Export Citation
  • 11. Mattson S, Bouré L, Pearce S, et al. Intraosseous gentamicin perfusion of the distal metacarpus in standing horses. Vet Surg 2004; 33: 180186.

    • Search Google Scholar
    • Export Citation
  • 12. Rubio-Martínez LM, López-Sanromán J, Cruz AM, et al. Evaluation of safety and pharmacokinetics of vancomycin after intravenous regional limb perfusion in horses. Am J Vet Res 2005; 66: 21072113.

    • Search Google Scholar
    • Export Citation
  • 13. Werner LA, Hardy J, Bertone AL. Bone gentamicin concentration after intra-articular injection or regional intravenous perfusion in the horse. Vet Surg 2003; 32: 559565.

    • Search Google Scholar
    • Export Citation
  • 14. Baetge CL, Matthews NS, Carroll GL. Comparison of 3 total intravenous anesthetic infusion combinations in adult horses. Int J Appl Res Vet Med 2007; 5: 18.

    • Search Google Scholar
    • Export Citation
  • 15. Hyde RM, Lynch TM, Clark CK, et al. The influence of perfusate volume on antimicrobial concentration in synovial fluid following intravenous regional limb perfusion in the standing horse. Can Vet J 2013; 54: 363367.

    • Search Google Scholar
    • Export Citation
  • 16. Beccar-Varela AM, Epstein KL, White CL. Effect of experimentally induced synovitis on amikacin concentrations after intravenous regional limb perfusion. Vet Surg 2011; 40: 891897.

    • Search Google Scholar
    • Export Citation
  • 17. Mattson SE, Pearce SG, Bouré LP, et al. Comparison of intraosseous and intravenous infusion of technetium Tc 99m pertechnate in the distal portion of forelimbs in standing horses by use of scintigraphic imaging. Am J Vet Res 2005; 66: 12671272.

    • Search Google Scholar
    • Export Citation
  • 18. Mahne AT, Rioja E, Marais HJ, et al. Clinical and pharmacokinetic effects of regional or general anaesthesia on intravenous regional limb perfusion with amikacin in horses. Equine Vet J 2014; 46: 375379.

    • Search Google Scholar
    • Export Citation
  • 19. Errico JA, Trumble TN, Bueno AC, et al. Comparison of two indirect techniques for local delivery of a high dose of an antimicrobial in the distal portion of forelimbs of horses. Am J Vet Res 2008; 69: 334342.

    • Search Google Scholar
    • Export Citation
  • 20. Bidgood TL, Papich MG. Comparison of plasma and interstitial fluid concentrations of doxycycline and meropenem following constant rate intravenous infusion in dogs. Am J Vet Res 2003; 64: 10401046.

    • Search Google Scholar
    • Export Citation
  • 21. Linhares MC, Kissinger PT. Capillary ultrafiltration: in vivo sampling probes for small molecules. Anal Chem 1992; 64: 28312835.

  • 22. Linhares MC, Kissinger PT. Pharmacokinetic monitoring in subcutaneous tissue using in vivo capillary ultrafiltration probes. Pharm Res 1993; 10: 598602.

    • Search Google Scholar
    • Export Citation
  • 23. Whithair KJ, Bowersock TL, Blevins WE, et al. Regional limb perfusion for antibiotic treatment of experimentally induced septic arthritis. Vet Surg 1992; 21: 367373.

    • Search Google Scholar
    • Export Citation

Advertisement

Effects of regional limb perfusion volume on concentrations of amikacin sulfate in synovial and interstitial fluid samples from anesthetized horses

Jennifer L. Godfrey DVM1, Joanne Hardy DVM, PhD2, and Noah D. Cohen DVM, MPH, PhD3
View More View Less
  • 1 Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.
  • | 2 Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.
  • | 3 Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.

Abstract

OBJECTIVE To evaluate the effect of volume of IV regional limb perfusion (IVRLP) on amikacin concentrations in synovial and interstitial fluid of horses.

ANIMALS 8 healthy adult horses.

PROCEDURES Each forelimb was randomly assigned to receive IVRLP with 4 mL of amikacin sulfate solution (250 mg/mL) plus 56 mL (total volume, 60 mL) or 6 mL (total volume, 10 mL) of lactated Ringer solution. Horses were anesthetized, and baseline synovial and interstitial fluid samples were collected. A tourniquet was placed, and the assigned treatment was administered via the lateral palmar digital vein. Venous blood pressure in the distal portion of the limb was recorded. Additional synovial fluid samples were collected 30 minutes (just before tourniquet removal) and 24 hours after IVRLP began; additional interstitial fluid samples were collected 6 and 24 hours after IVRLP began.

RESULTS 30 minutes after IVRLP began, mean amikacin concentration in synovial fluid was significantly greater for the large-volume (459 μg/mL) versus small-volume (70 μg/mL) treatment. Six hours after IVRLP, mean concentration in interstitial fluid was greater for the large-volume (723 μg/mL) versus small-volume (21 μg/mL) treatment. Peak venous blood pressure after large-volume IVRLP was significantly higher than after small-volume IVRLP, with no difference between treatments in time required for pressure to return to baseline.

CONCLUSIONS AND CLINICAL RELEVANCE Study findings suggested that large-volume IVRLP would deliver more amikacin to metacarpophalangeal joints of horses than would small-volume IVRLP, without a clinically relevant effect on local venous blood pressure, potentially increasing treatment efficacy.

Contributor Notes

Address correspondence to Dr. Hardy (jhardy@cvm.tamu.edu).