RESEARCH PAPERThe effect of aquapuncture at Pericardium 6 (PC-6) on dexmedetomidine-induced nausea and vomiting in cats
Introduction
Perianesthetic drug-induced nausea and vomiting can lead to anesthetic complications such as aspiration pneumonia and increased intraocular and intracranial pressure. Furthermore, humans report postoperative nausea and vomiting (PONV) to be a highly distressing part of their surgical experience (Kerger et al. 2007).
Acupuncture at point Pericardium-6 (PC-6) significantly reduces vomiting and nausea in humans and dogs following anesthesia and opioid administration (Lee et al., 2015, Scallan and Simon, 2016). In humans, PC-6 stimulation has shown similar efficacy to ondansetron, a 5HT3 antagonist, at preventing PONV (Ravi et al. 2010). To date, there is no published study on the use of this acupuncture point in cats.
Dexmedetomidine is an α2-adrenergic receptor agonist routinely used in veterinary medicine to provide analgesia and sedation (Mendes et al. 2003). When administered as a single agent to cats, either intramuscularly (IM) or intravenously (IV), dexmedetomidine causes vomiting with an incidence rate as high as 81% (Thawley & Drobatz 2015).
Acupuncture points can be stimulated in a variety of ways beyond traditional needle placement, such as acupressure. Aquapuncture, a type of acupressure, is the subcutaneous injection of slowly resorbed fluid at the acupuncture point. Liquid vitamin B12 is often used for this purpose (Altman 2001). The pressure applied by the subcutaneous fluid stimulates the acupuncture point and is useful in animals that do not tolerate prolonged acupuncture needle placement. Because cats are less likely to tolerate prolonged needle placement, aquapuncture was utilized for point stimulation in this study.
The purpose of this study was to evaluate the effects of stimulation of PC-6 on the incidence of dexmedetomidine-induced vomiting and nausea in cats. We hypothesized that aquapuncture at PC-6 30 minutes prior to the administration of dexmedetomidine (10 μg kg–1) IM would reduce the incidence of vomiting and severity of nausea in cats.
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Ethical approval, animals and housing
The study was approved by the North Carolina State University Institutional Animal Care and Use Committee (no. 17-083-O). Cats were client-owned by individuals affiliated with this institution, and informed consent was obtained from all owners. Adult cats aged 1–12 years were recruited for the study; however, the exact age of some cats was unknown. Exclusion criteria included a history of gastrointestinal disease (including undiagnosed disease if there was a history of vomiting more than once
Results
A total of 22 client-owned cats, 14 females and eight males, weighing 4.9 ± 1.1 kg, were enrolled in the study. One cat was excluded from the study because pulse deficits and multifocal premature ventricular depolarizations on the ECG were noted following administration of dexmedetomidine. This cat was administered atipamezole IM and it recovered without further complication. All other cats recovered from the study without complications. Nausea scoring from two cats was not included because of
Discussion
Stimulation of acupuncture point PC-6 did not reduce the incidence of vomiting in dexmedetomidine-treated cats. Vomiting incidence was 76–85%, which agrees with a previous retrospective study in which 81% of cats vomited after administration of dexmedetomidine (Thawley & Drobatz 2015).
The cause of vomiting in cats is multifactorial. The nucleus tractus solitarius (NTS), which contains the vomiting center, receives and integrates emetogenic inputs from multiple sites including the cerebral
Conclusion
Aquapuncture at point PC-6 using 0.25 mL (25 μg) of vitamin B12 did not reduce the incidence of vomiting or nausea induced by dexmedetomidine (10 μg kg–1) IM in cats.
Acknowledgements
The authors thank Dr Emily Griffith for the statistical analysis, Dr Jody Gookin for expertise on feline nausea and vomiting and Dr Julie Balko for input into the nausea score (College of Veterinary Medicine, North Carolina State University).
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