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Table 1 Medications for the protocol

From: Novel 24-h ovine model of brain death to study the profile of the endothelin axis during cardiopulmonary injury

Drug

Bolus

Initial infusion rate

Notes

Anaesthetic induction

 

Lignocaine 1 %

3–5 mL subcutaneously

 

Over central venous access insertion sites

 

Buprenorphine

300 mcg

 

Administered six hourly during protocol

 

Midazolam

0.5 mg/kg

  
 

Alfaxalone

3 mg/kg

 

If further boluses needed, dosed at 0.5 mg/kg

Anaesthetic maintenance

 

Alfaxalone

 

6 mg/kg/h

Adjusted to surgical plane

 

Ketamine

 

3 mg/kg/h

Adjusted to surgical plane

 

Midazolam

 

0.25 mg/kg/h

Used only if required (if alfaxalone exceeded 250 mg/h)

Antimicrobial prophylaxis

 

Cefalotin

1000 mg

  
 

Gentamicin

40 mg

  

Fluid management

 

Hartmann’s solution

10–20 mL/kg

2 mL/kg/h

Titrated to CVP 8–12 mmHg. Boluses if needed for low urine output (<0.5 mL/kg/h) or hypotension (MAP < 60 mmHg). Initial fluid of choice

 

Normal saline 0.9 %

10–20 mL/kg

1–2 mL/kg/h

Boluses if needed for low urine output (UO < 0.5 mL/kg/h) or hypotension (MAP < 60 mmHg)

 

Dextrose 5 % or dextrose 4 % in saline 0.18 %

10–20 mL/kg

1–2 mL/kg/h

Utilised for hypoglycaemia (BSL < 6 mmol/L)

Vasopressors, inotropes and cardiovascular support

 

Metaraminol

0.5–1 mg

 

Utilised in emergency situations for hypotension only

 

Atropine

600 mcg

 

Utilised in emergency situations for bradycardia (HR < 60 bpm) only

 

Noradrenaline

 

0.05 mcg/kg/min

Adjusted to MAP > 60 mmHg

 

Dopamine

 

5 mcg/kg/min

Adjusted to MAP > 60 mmHg

 

Isoprenaline

 

0.5 mcg/min

Adjusted to MAP > 60 and HR > 60 bpm. Utilised only if considered bradycardia as cause of hypotension

 

Glyceryl trinitrate

 

0.1 mg/h

For hypertension (SBP > 180 mmHg) if necessary

 

Amiodarone

 

5 mg/kg over 2 h

Infusion for appropriate dysrhythmias (e.g. atrial fibrillation) if necessary. Could be repeated

Hormonal management

 

Insulin

10–20 U

0.5 U/h

Bolus for BSL > 16 mmol/L. Infusion adjusted to BSL 6–10 mmol/L, tested hourly once infusion commenced

 

Dextrose 50 %

25 mL

 

For management of hypoglycaemia (BSL < 3.5 mmol/L). Please also note that dextrose 5 % could be used for ongoing maintenance per above

 

Desmopressin

4 mcg

 

If urine output >300 mL/h for two consecutive hours

Hormone resuscitation at 12 h

 

Vasopressin

1 U

0.5–4.0 U/h (initial dose 2.0 U/h)

Adjusted to SVR 800–1200 dyn.s.cm−5

 

Liothyronine

4 mcg

3 mcg/h

 
 

Methylprednisolone

15 mg/kg

  

Electrolyte management

 

Potassium chloride

 

10–40 mmol/h

Adjusted to potassium 3.5–5.0 mmol/L

 

Calcium chloride 10 %

6.8 mmol

 

Administered to keep ionised calcium > 1.05 mmol/L

 

Magnesium sulphate

10–20 mmol

 

Allowed for management of dysrhythmias (e.g. atrial fibrillation)

Euthanasia

 

Sodium pentobarbitone

100 mg/kg

  
  1. Not all agents were used. Agents listed include medications that were able to be used in the case of predetermined outcomes or complications