Effect of Experimentally Induced Synovitis on Amikacin Concentrations after Intravenous Regional Limb Perfusion

Abstract

Synovitis of the radiocarpal joint resulted in an earlier observed T(max) and higher observed C(max) of intra-articular amikacin after IVRLP compared with normal joints.

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

“…1,2,4,9,10,15 Injection of a large volume in standing, sedated horses results in pain, leading to limb movement that leads to loss of tourniquet integrity, hematoma formation, and vasculitis. 1,3,4,16,17 Therefore, a greater degree of sedation than that used for small-volume perfusion is recommended for largevolume IVRLP. Repeated IVRLP becomes increasingly difficult to perform when complications such as hematoma and cellulitis develop.…”

“…The lack of horse movement was likely important to maintaining tourniquet integrity. 1,3,16 An anesthetized horse positioned in lateral recumbency could be reasonably expected to have a lower blood pressure throughout the distal portion of the limb than would a standing horse because its systemic blood pressure would be lower and because partial exsanguination of the limb might occur prior to tourniquet placement. 9 Baseline venous blood pressures (85 to 125 mm Hg) identified in standing horses in a study 19 involving various IVRLP procedures were 3 to 4 times the baseline venous blood pressures (20 to 50 mm Hg) identified in anesthetized horses in the present study.…”

“…Patient movement can result in leakage of perfusate under the tourniquet, leading to a decrease in the amount of antimicrobial available for diffusion into extravascular spaces. 1,3,16,17 In the other study, 15 serum samples were not obtained to determine whether the administered antimicrobial had entered systemic circulation. Because of the possible effects of leakage under the tourniquet, it is difficult to interpret the results of that study.…”

“…This tourniquet pressure was considerably greater than the minimum recommended tourniquet pressure of at least 100 mm Hg greater than arterial pressure. 1,6,16 Serum samples in the present study were obtained prior to IVRLP and again 30 minutes after the procedure began, before the tourniquet was released. All serum samples were free of detectable amikacin concentrations, suggesting adequate tourniquet function.…”

Drug delivery to equine digital lamellar tissue

“…This technique has been validated for antimicrobial delivery to distal limb synovial structures, bone and subcutaneous tissues, and is in frequent clinical use (Parra-Sanchez et al 2006;Rubio-Martinez et al 2006;Levine et al 2010;Beccar-Varela et al 2011;Lallemand et al 2013;Mahne et al 2013). Previously reported complications of RLP include phlebitis, perivasculitis (Parra-Sanchez et al 2006), cellulitis, mild limb swelling and hematoma formation (Beccar-Varela et al 2011), occurring at rates of 12-27% in horses receiving multiple RLPs (Kelmer et al 2012;Rubio-Martinez et al 2012). The efficacy of RLP for targeted delivery to the lamellar tissue is unknown, but is worthwhile to investigate as it has potential as a simple technique for lamellar delivery.…”