title: Effect of Regional Intravenous Limb Perfusate Volume on Synovial Fluid Concentration of Amikacin and Local Venous Blood Pressure in the Horse.
abstract: OBJECTIVE
  To determine the effect of volume of amikacin perfusate for intravenous regional limb perfusion (IVRLP) via the cephalic vein in standing, sedated horses on (1) amikacin concentrations in the synovial fluid of the radiocarpal joint (RCJ) and distal interphalangeal joint (DIPJ) and, (2) amikacin concentration in the systemic circulation, and (3) regional intravenous pressure.
  
  
  METHODS
  Randomized cross-over design.
  
  
  METHODS
  Six adult horses.
  
  
  METHODS
  Each horse received IVRLP using 4 perfusate volumes (10, 30, 60 & 120 ml) in random order, after a minimum of 1 week washout. After application of a pneumatic tourniquet, IVRLP with 1 g of amikacin in 0.9% NaCl was performed. Synovial fluid from the RCJ and DIPJ, and systemic and regional venous blood were sampled, and regional blood pressure was measured, immediately before perfusion (time 0), and 15 and 30 minutes after perfusion but before tourniquet release.
  
  
  RESULTS
  No difference was observed in the mean amikacin concentration of synovial fluid for the 4 perfusate volumes (P>.09). For all volumes, mean amikacin concentration for DIPJ synovial fluid was higher than for RCJ (P<.0001). The mean amikacin concentration in DIPJ synovial fluid was therapeutic for resistant pathogens using the 10, 60, and 120 mL volumes but the mean amikacin concentration for RCJ synovial fluid was not therapeutic for resistant pathogens with any perfusate volume. All volumes resulted in an immediate increase in mean regional intravascular pressure after perfusion (P<.0001) but was not different across the 4 perfusate volumes.
  
  
  CONCLUSIONS
  Cephalic IVRLP of 1 g of amikacin diluted to a volume of 10-120 mL with 0.9% NaCl will achieve amikacin concentrations therapeutic for resistant pathogens in the synovial fluid from the DIPJ. Concentrations below therapeutic levels for resistant pathogens are reached in the synovial fluid from the RCJ.
authors: Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma. darlakmoser@gmail.com.
authors: Darla K
authors: DK
authors: Moser
authors: Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma.
authors: Mike J
authors: MJ
authors: Schoonover
authors: Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma.
authors: Todd C
authors: TC
authors: Holbrook
authors: Department of Statistics, Oklahoma State University, Stillwater, Oklahoma.
authors: Mark E
authors: ME
authors: Payton
mesh_terms: D061605:Administration, Intravenous / Q000379:methods / Q000662:veterinary*; D000583:Amikacin / Q000378:metabolism*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000378:metabolism*; D050824:Carpal Joints / Q000502:physiology; D018592:Cross-Over Studies; D005260:Female; D005552:Forelimb / Q000098:blood supply*; D006736:Horses; D008297:Male; D011897:Random Allocation; D013582:Synovial Fluid / Q000737:chemistry; D014033:Toe Joint / Q000502:physiology; D014690:Venous Pressure
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin