MKBM™ (Medetomidine HCl 20 mg/mL + Ketamine HCl 100 mg/mL + Butorphanol Tartrate 30 mg/mL + Midazolam HCl 20 mg/mL), Injectable Solution, 10mL
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- Product Type:
- Controlled Substance:
- Schedule CIII
Wildlife practice is a specialized area of veterinary medicine, particularly in the realm of large and exotic hoofstock. Restraining individual animals of these species nearly always requires the use of anesthetic drugs to provide safe, effective immobilization before veterinarians and/or wildlife managers engage in any number of invasive or noninvasive procedures.1,2 Thus, anesthesia plays a critical role in wildlife veterinary medicine. Relocation and other management procedures, preventive medicine, imaging and surgery are among the key interventions typically carried out on wildlife species.
While the study of chemical immobilization has been traced to the South American tribes who used curare-coated arrows to immobilize food animals, the modern chemical immobilization techniques in place today were pioneered beginning in the late 1950s by wildlife managers in South Africa. Many of the species encountered during this period (from the late 1950s through the late 1970s) underscored the vast differences between chemical immobilization requirements across large exotic species.
In the early days of modern chemical immobilization, there was a great deal of trial-and-error as veterinarians and wildlife managers sought the optimal drug combinations to effectively anesthetize wildlife species. Some drugs worked well on certain species, but not on other closely-related species. Other drugs worked very well, but had unforgiving safety margins which could easily lead to the death of an animal. It quickly became apparent that there was no single drug that was ideal for large wildlife species, or even for individual species, since age size, sex, overall health and environmental factors typically play roles in any immobilization scenario.
In recent years, and especially given concerns in the area of conservation and humane treatment, great care has been taken with chemical immobilization protocols and drug development to keep these within safety margins through the use of novel anesthetics, including combinations of true anesthetics, neuromuscular blockers and tranquilizers.2 Thus, modern chemical immobilization techniques have dramatically reduced the side-effects of drugs and mortalities. Additionally, the use of antagonists to anesthetics is now widely employed, as this avoids the undesirable and potentially harmful effects of drugs and facilitates speedy recovery from chemical immobilization events.1,2
Nominal guidelines for chemical immobilization agents to be used in wildlife species generally include the following:
Versatility (able to be used in as wide a range of species as is practical)
High potency in small volume
Wide safety margin
Calm induction and recovery
Minimal side effects
Minimal handling risk for humans
The MKBM™ Formulation for Exotic Wildlife Species
MKBM™ is an original formulation by NexGen Pharmaceuticals, containing
Medetomidine hcl 20 mg/ml
Ketamine hcl 100 mg/ml
Butorphanol 30 mg/ml
MKBM™ is indicated for the chemical immobilization of numerous large exotic hoofstock species, and is especially efficacious when anesthetizing bongo, kudu, gazelle, eland, as well as other African hoofstock and certain domestic wildlife species.
Medetomidine (medetomidine hydrochloride) is an α-2-adrenoreceptor agonist with sedative and analgesic properties. It is used by veterinarians as both a surgical anesthetic and analgesic. The pharmacological restraint and pain relief provided by medetomidine facilitates handling and aids in the conduct of diagnostic or therapeutic procedures. Used alone and in combination with other drugs, medetomidine has been shown to be useful for anesthesia and immobilization in zoo animals and exotic species.3
The pharmacologic effects of medetomidine include: depression of CNS (sedation, anxiolysis), GI (decreased secretions, varying effects on intestinal muscle tone) and endocrine functions, peripheral and cardiac vasoconstriction, bradycardia, respiratory depression, diuresis, hypothermia, analgesia (somatic and visceral), muscle relaxation (but not enough for intubation), and blanched or cyanotic mucous membranes. Effects on blood pressure are variable, but medetomidine can cause hypertension for longer periods than xylazine. Medetomidine also induces sedation for a longer period than does xylazine. Sedative effects persist longer than analgesic effects.3
Ketamine is a dissociative general anesthetic and an NMDA-receptor antagonist. It has been FDA-approved for use in humans, sub-human primates, and cats, although it has been used in many other species. Ketamine is used to induce general anesthesia and as a constant rate infusion to provide analgesia and decrease the amount of inhalant used to maintain a surgical plane of anesthesia.3
Ketamine has significant analgesic activity and a relative lack of cardiopulmonary depressant effects. It is thought to induce both anesthesia and amnesia by functionally disrupting the CNS through over-stimulating the CNS or inducing a cataleptic state. Ketamine also interacts with opioid and monoaminergic receptors, which contributes to the antinociceptive effects of this drug.2,3
Butorphanol (butorphanol tartrate) is a synthetically derived opioid agonist-antagonist analgesic of the phenanthrene series, with a potency of about four to seven times that of morphine. In the United States, it is a U.S. Drug Enforcement Administration (DEA) class IV controlled substance. Butorphanol is a mixed agonist-antagonist with low intrinsic antagonist activity at receptors of the mu1 (µ1) and mu2 (µ2) opioid type (morphine-like), which are responsible for the significant opioid side effects and also an agonist with a high affinity for kappa (κ) opioid receptors.3
General anesthesia poses increased risks for larger exotic species, such as cardiorespiratory depression, myopathy, and hyperthermia. In ruminants, ruminal bloat and regurgitation of rumen contents with potential aspiration pneumonia are added risks. Thus, the use of heavy sedation such as is provided by butorphanol is justified for these species.4 Generally, there is minimal cardiopulmonary depression with its use compared with other opioids and, at lower doses, there is a dose-dependent effect on respiratory depression but then a ceiling is reached and no further respiratory depression occurs.
Midazolam is a benzodiazepine that is often used primarily as a preoperative medication. In veterinary patients, midazolam is principally used for its sedative, anxiolytic, and muscle relaxant properties prior to induction of general anesthesia. When midazolam is used alone, sedation may be adequate in ruminants, camelids and several other species. When used in combination with other drugs (e.g., opioids, ketamine, acepromazine, dexmedetomidine), midazolam provides more reliable sedation.3
Midazolam exhibits similar pharmacologic actions as other benzodiazepines, depressing subcortical levels of the CNS; this produces anxiolytic, sedative, skeletal muscle relaxant, and anticonvulsant effects. Midazolam has unique solubility characteristics that provide a rapid onset of action after injection. Compared to diazepam, midazolam has ≈2 times the affinity for benzodiazepine receptors, is nearly 3 times as potent, and has a faster onset of action and a shorter duration of effect.3
Where to buy MKBM™
The MKBM™ is an original formulation available exclusively through NexGen Pharmaceuticals. It is indicated for the chemical immobilization of large exotic hoofstock and other exotic species.
MKBM™ carries numerous potential drug interactions. Please consult your veterinarian prior to beginning any treatment regimen.
FOR RX ONLY: A valid prescription from a licensed veterinarian is required for dispensing this medication.
1Arnemo, Jon & Kreeger, Terry. (2018). Handbook of Wildlife Chemical Immobilization 5th Ed. Sunquest Publishing, 2007, 432 pages.
2Nielsen, L. Chemical Immobilization of Wild and Exotic Animals. (1999) Ames, Iowa, Iowa State University Press.
3Plumb’s Veterinary Drugs.
4Bouts T., et. al. Detomidine and Butorphanol for Standing Sedation in a Range Of Zoo-Kept Ungulate Species. J Zoo Wildlife Medicine. 2017 Sep; 48 (3):616-626.