Mental Health and Addiction Services: Brief/Social Detox Unit OPIOID WITHDRAWAL PROTOCOL Clinical Features of Opioid Withdrawal - detected & monitored using the Opioid Withdrawal Scale (OWS) Physical signs/symptoms Lacrimation, rhinorrhea, yawning Dilated pupils, nausea/vomiting Diaphoresis, chills, piloerection, mild tachycardia and/or hypertension Myalgias, abdominal cra
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DIRECTIONS FOR USE
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methadone, morphine sulfate, butorphanol DESCRIPTION
1CTIVE INGREDIENT A
CH OF CHILDREN
KEEP OUT OF REA
PRESCRIPTION ANIMAL REMEDY
The dosing syringe should be prepared to contain the above dose. The rate of Alfaxan® should be given by slow continuous injection and NOT as a rapid
intravenous injection should be such that the total dose, if required, would be dose. Some patients, especially dogs, may undergo a short period of apnoea
administered over the first 60 seconds. If, 60 seconds after complete delivery of on induction using Alfaxan® by the intravenous route. This can be avoided by this first induction dose, intubation is still not possible, one further similar dose inducing anaesthesia by slow continuous intravenous injection over 60 seconds, may be administered to effect. The necessary injection rate can be achieved while assessing the degree of anaesthesia achieved.
by administration of one quarter (¼) of the calculated dose every 15 seconds. Appropriate analgesia should be provided in cases where procedures are Administration should continue until the clinician is satisfied that the depth of anaesthesia is sufficient for endotracheal intubation, or until the entire dose has • It is advisable to ensure that the patient has been fasted before receiving the The dose is calculated at 5 mg to 10 mg per kg bodyweight (0.5 mL to 1.0 mL • Additional monitoring is advised and particular attention should be paid to per kg bodyweight). Some degree of variability may be experienced when using respiratory parameters in aged animals, or in cases where there may be Alfaxan® by the intramuscular route, but this can be minimised by ensuring the additional physiological stress imposed by pre-existing pathology or shock.
injection is given by deep intramuscular injection. A dosage of 10 mg per kg • Following induction of anaesthesia, the use of an endotracheal tube is (1 mL per kg bodyweight) is expected to induce deep sedation or light recommended to maintain airway patency.
anaesthesia sufficient to allow venepuncture or the practice of some minor • It is advisable to administer supplemental oxygen during maintenance of surgical techniques such as the drainage of an abcess or the repair of small • Respiratory embarrassment may occur – ventilation of the lungs with oxygen The suitability of a combined technique of anaesthesia involving both the should be considered if haemoglobin saturation with oxygen (SpO %) falls intramuscular and intravenous routes of administration is a question of personal below 90% or if apnoea persists for longer than 60 seconds.
choice. Sedation is induced using an intramuscular dose of approximately 10 mg • If cardiac arrhythmias are detected, attention to respiratory ventilation per kg (1 mL per kg bodyweight) and maintained by supplementary intravenous with oxygen is the first priority followed by appropriate cardiac therapy or During recovery, it is preferable that animals are not handled or disturbed. This The intramuscular route in dogs and subcutaneous route of administration in may lead to paddling, minor muscle twitching or movements that are more both dogs and cats are not recommended.
violent. While better avoided, such reactions are clinically insignificant.
Maintenance of Anaesthesia
Psychomotor excitement may be encountered in a minority of dogs and cats Maintenance doses of Alfaxan® may be given as supplemental intravenous recovering from Alfaxan® anaesthesia. Post-anaesthetic recovery should boluses or as constant rate infusion. Alfaxan® has been used safely and thus take place in appropriate facilities and under sufficient supervision. Use effectively in both dogs and cats for procedures lasting for up to one hour. The of a benzodiazepine as the sole premedicant may increase the probability of following doses suggested for maintenance of anaesthesia are based on data taken from controlled laboratory and field studies and represent the average In both dogs and cats, the dose interval for maintenance of anaesthesia by amount of drug required to provide maintenance anaesthesia for a dog or cat. intermittent bolus administration may require lengthening by more than 20%, or However the actual dose will be based on the response of the individual patient.
the maintenance dose by intravenous infusion may require reduction by more Alfaxan® doses suggested for maintanance of anaesthesia are as follows: than 20%, when hepatic blood flow is severely diminished or hepatocellular Dosage and Administration
Alfaxan® contains no preservatives. Solution should be removed from the vial
using aseptic technique. Contents of broached vials should preferably be used premedicated Premedicated
within 24 hours, but may be stored if necessary at 4°C for up to 7 days provided Dose for constant rate infusion
contamination is avoided. Do not use broached vials if the solution is not clear, colourless and free from particulate matter.
Induction of Anaesthesia:
Dosing recommendations for induction of anaesthesia are as follows: mL/kg/minute 0.013 - 0.015 0.010 - 0.012 0.016 - 0.018 0.011 - 0.013 Bolus dose for each 10 minutes maintenance
In most cases the average duration of recovery when using Alfaxan® Anaesthetic Injection for Dogs and Cats for maintenance will be longer than if using a volatile
ParlamentarierInnen-Initiative: Abzug der US-Atomwaffen in Europa „Hiermit fordere ich die Regierungen von Belgien, Deutschland, Italien, den Niederlande, der Türkei und Großbritannien auf: a.) Verhandlungen über den Abzug der US-Atomwaffen in Europa aufzunehmen, b.) die nukleare Teilhabe zu beenden.“ ErstunterzeichnerInnen: Belgien Jean Cornil, senate PS Rudi Daems, Flemish