Veterinary Anaesthesia and Analgesia, 2012 doi:10.1111/j.1467-2995.2012.00768.

RESEARCH PAPER

Thermographic imaging of superficial temperature in dogs

sedated with medetomidine and butorphanol with and
without MK-467 (L-659’066)

Mari Vainionpää*, Kati Salla*, Flávia Restitutti*, Marja Raekallio*, Jouni Junnila , Marjatta Snellman* &
Outi Vainio*
*Department of Equine and Small Animal Medicine, Pharmacology and Toxicology, Faculty of Veterinary Medicine,
University of Helsinki, Finland
  4Pharma Ltd, Espoo, Finland

Correspondence: Mari Vainionpää, Department of Equine and Small Animal Medicine, Pharmacology and Toxicology, Faculty of Veterinary
Medicine, Koetilantie 7, FI-00014 University of Helsinki, Finland. E-mail: mari.vainionpaa@helsinki.fi

(34.5 ± 1.1 IV, 34.8 ± 0.5 IM) than MB (31.1 ±

Abstract
Objective To record, with a thermal camera, periph-
eral temperature changes during different sedation
protocols and to relate the results to changes in the
rectal temperature.
Study design Randomized crossover part-blinded
experimental study.
2.9 IV, 30.5 ± 3.6 IM), DFT was higher (p < 0.001)
after MB+MK (33.6 ± 1.4 IV, 34.0 ± 0.6 IM) than
MB (26.7 ± 1.4 IV, 26.7 ± 2.5 IM), and RT was
lower (p < 0.001) after MB+MK (36.7 ± 0.8 IV,
36.9 ± 0.3 IM) than MB (37.5 ± 0.3 IV,
37.4 ± 0.4 IM), with both routes. The change from
baseline was greater with MB+MK than MB in all
variables.

Animals Eight healthy purpose-bred neutered Bea-
gles (two females and six males) weight
14.5 ± 1.6 kg (mean ± SD) and aged 3–4 years.
Methods Each dog was sedated four times. Treat-
ments were medetomidine 20 lg kg)1 and butorph-
anol 0.1 mg kg)1 (MB) with or without MK-467
500 lg kg)1 (MK). Both drug combinations were
administered IV and IM as separate treatments. A
thermal camera (T425, FLIR) with a resolution of
320 by 240 was used for imaging.
The dogs were placed in lateral recumbency on
an insulated mattress. Digital (DFT) and metatarsal
footpad temperatures (MFT) were measured with
thermography. Thermograms and rectal tempera-
ture (RT) were taken before and at 3, 10, 20, 30, 45
and 60 minutes after treatment.
Results At 60 minutes after drug administration,
MFT was higher (p < 0.001) after MB+MK
Conclusions Superficial temperature changes can be
seen and detected with thermography. MK-467
used with MB resulted in increased superficial
temperatures and a decline in rectal temperature
compared to MB alone.
Clinical relevance The sedation protocol may influ-
ence core temperature loss, and may also have an
effect on thermographic images.
Keywords butorphanol, dog, medetomidine, MK-467,
sedation, thermography.
Introduction
Medetomidine is an alpha-2-adrenergic agonist,
which is used widely in small animal practice. In
addition to its beneficial sedative and analgesic
effects on the central nervous system, medetomidine
also causes some unwanted cardiovascular side

1
Thermographic imaging in sedated dogs Mari Vainionpää et al.
effects, such as vasoconstriction and bradycardia.
The medetomidine-induced vasoconstriction is
mediated via post-synaptic alpha-2-adrenoceptors
located in vascular smooth muscle, and it results in
an increased systemic vascular resistance and car-
diac afterload (Pypendop & Verstegen 1998). Cen-
tral alpha-2-adrenoceptors mediate cardiovascular
depression, such as a decrease in blood pressure,
heart rate and cardiac output, by means of central
sympathetic inhibition and vagal activation
(Kobinger 1983).
In dogs, butorphanol is used frequently in com-
bination with medetomidine in order to improve the
sedative and analgesic (Ko et al. 2000; Kuo &
Keegan 2004).
The peripherally acting alpha-2-adrenergic
antagonist MK-467 (also termed L-659’066) selec-
tively blocks the alpha-2-adrenoceptors outside the
blood-brain barrier (Clineschmidt et al. 1988). It
has been shown to attenuate the peripherally
mediated cardiovascular effects of medetomidine
(Enouri et al. 2008) and dexmedetomidine (Pagel
et al. 1998; Honkavaara et al. 2011) in dogs, and
also in sheep (Bryant et al. 1998; Raekallio et al.
2010). However, the effects of MK-467 on dex-
medetomidine-induced sedation in dogs are minimal
(Honkavaara et al. 2008; Restitutti et al. 2011).
Hypothermia is a well known problem in sedated
and anaesthetized animals. It can occur in animals
sedated with medetomidine (Vainio 1989) when no
active attempts have been made to maintain the
body temperature. However, it has been suggested
that the peripheral vasoconstriction and the central
redistribution of blood induced by alpha-2-agonists
may enhance the maintenance of body temperature
by reducing cutaneous heat loss (Sinclair 2003).
Therefore, preventing the medetomidine-induced
peripheral vasoconstriction by MK-467, although
reducing peripheral resistance, may further impair
thermoregulation.
Thermography is a non-invasive and safe method
of detecting and visualizing changes in superficial
temperature in animals (Schweinitz von 1999;
Turner 2001; Kı́zková & Kunc 2007; Levet et al.
2009). The temperature of an area of the body is a
product of cell metabolism and local blood flow
(Head & Dyson 2001). If the superficial blood flow is
enhanced, the skin temperature increases due to
warmer blood coming to the surface from larger
vessels. Whilst the human hand and fingers are
sensitive enough to detect only a ‡2 C difference in
temperature on the animal’s skin (Holmes et al.
2  2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists
2003), modern infrared cameras are 10 times more
sensitive. Thus thermography will detect changes in
peripheral blood flow from the resulting changes in
heat loss (Varjú et al. 2004; Vianna & Carrive
2005; Stewart et al. 2007).
The aim of this study was to record superficial and
rectal (for core) temperature changes in dogs during
sedation with medetomidine and butorphanol with
and without MK-467. The superficial temperature
was recorded with a thermal camera as an indicator
of potential peripheral heat loss in dogs.
Materials and methods
Animals
Eight healthy purpose-bred neutered Beagle dogs (two
females and six males) were used for this study. The
dogs weighed (mean ± SD) 14.5 ± 1.6 kg, and were
aged between 3 and 4 years old. They were consid-
ered healthy based on a thorough clinical examina-
tion, complete blood count and serum chemistry.
The study protocol was approved by the National
Animal Experimentation Board of Finland (ESAVI-
2010-07734/Ym-23) and the Ethical Committee of
the Viikki Campus at the University of Helsinki.
Study design
All dogs received four different treatments in a
randomized crossover design, with a minimum of
14 days’ washout period between treatments. The
drugs used in the treatments were medetomidine
(Dorbene 1 mg mL)1, laboratories Syva S.A., León,
Spain), butorphanol (Butordol 10 mg mL)1, Inter-
vet International B.V., Netherlands) and MK-467
(Merck, Sharpe & Dohme, PA, USA). 10 mg of
MK-467 was solubilised into 1 mL of saline.
The treatments consisted of the following combi-
nations: medetomidine 20 lg kg)1 and butorphanol
0.1 mg kg)1 (MB) with or without MK-467
500 lg kg)1 (MK). Both combinations (MB and
MB+MK) were given IV and IM as separate treat-
ments. All drugs were mixed in the same syringe
prior to administration. In treatments without MK,
saline was added to the syringe in order to keep the
administered volume constant. A catheter was
inserted in the cephalic vein (for each dog) to enable
medications. After catheterization, the dogs were
allowed to rest in the room for a minimum of 1 hour.
The dogs were then placed in lateral recumbency
on a mattress made of insulating material, without
 2012 The Authors. Veterinary Anaesthesia and Analgesia
 Thermographic imaging in sedated dogs Mari Vainionpää et al.
any covering blankets, in an ambient room tem-
perature of 21 C. The thermal conductance of the
10 mm insulation mattress (Nomalen, NMC Cell-
foam Oy, Finland) was low (0.039 W mK)1); the
material is used mainly for the insulation of houses.
The same mattress was used for all cases.
Thermometer, thermal camera and software
A digital rectal thermometer for animals (Vet-Temp
1831, Microlife, Switzerland) was used to measure
the rectal temperature. A thermal camera with a
resolution of 320 by 240 pixels (T425, FLIR
Systems Inc., Sweden) was used for imaging.
The freeware FLIR QuickReport 2.1. (FLIR, 2011)
was applied to interpret the thermographicy images.
The person taking the thermal images was unaware
of the treatment.
Thermal imaging
The upper hind leg of the recumbent dog was the
region of interest in this study. The hind leg was
positioned on a holder made of the insulation mat-
tress material to minimize the effects of the sur-
roundings or heat from a human hand holding the
leg (Fig. 1). Thermographs and rectal temperatures
were taken before administering the treatment
(baseline) and repeated 3, 10, 20, 30, 45 and
60 minutes after the treatment.
(a)
(b)
(e) (d)
(c)
Figure 1 A thermographer (a) taking an image with a
thermal camera, size 106 · 201 · 125 mm, weight
0.88 kg (b). Holder (c) made of insulating mattress holding
the dog’s upper hind leg (d). The dog lying in lateral
recumbency.
 2012 The Authors. Veterinary Anaesthesia and Analgesia
 2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists
Three different temperatures were measured:
rectal (RT), digital footpad (DFT) and metatarsal
footpad (MFT). MFT and DFT were recorded from
the thermograms using the software. The fourth or
fifth digital footpad was used for the temperature
measurement depending on which footpad was
pointing directly to the camera (Fig. 2).
Statistical Analysis
The differences in the change from baseline values
between the treatment groups and routes of
administration were assessed with repeated mea-
sures analysis of covariance (RM ANCOVA) models.
The models consisted of a baseline covariate, the
main effects of treatment, the period and time point
of measurement as well as two-way interactions of
period*time point and treatment*time point as fixed
effects and the main effect of dog, in addition to two-
way interaction terms of period*dog and time
point*dog as random effects. Group differences were
estimated from the model parameters. Ninety-five
percent confidence intervals (95% CIs) and p-values
were calculated for the estimated group differences.
A p-value of <0.05 was considered statistically
significant. All temperature results are reported in
degrees centigrade.
All statistical analyses were performed with the
SAS System for Windows, version 9.2 (SAS
Institute Inc., NC, USA).
Results
The RT was lower with MB+MK than with the MB
treatment regardless of the route of administration
(b)
(a)
Figure 2 A thermogram of a sole of a dog’s foot. Temper-
ature measurements taken from the metatarsal footpad (a)
and the fourth digital footpad (b).
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Thermographic imaging in sedated dogs Mari Vainionpää et al.

Mean rectal temperatures by treatment group and Mean metatarsal footpad temperatures by treatment
time point group and time point
40.0 40
39.5 38 § * *° *° *° *°
§

Metatarsal foorpad temperature

39.0 36
* *
38.5 34
*
Rectal temperature

38.0
*° 32
37.5 30
37.0 28
36.5 26
36.0 24
MB+MK IV MB IV MB+MK IV MB IV
35.5 22
MB+MK IM MB IM MB+MK IM MB IM
35.0 20
0 3 10 20 30 45 60 0 3 10 20 30 45 60
Time point Time point

Figure 3 Mean rectal temperatures (±SD) in degrees C in
dogs (n = 8) treated with MB or MB+MK IV or IM.
*Statistically significant difference between MB+MK IM
and MB IM (p < 0.05) and between MB+MK IV and MB
IV (p < 0.05).
Figure 4 Mean metatarsal footpad temperatures (±SD) in
degrees C in dogs (n = 8) treated with MB or MB+MK, IV
or IM. *Statistically significant difference between MB+MK
IV and MB IV (p < 0.05) and between MB+MK IM and
MB IM (p < 0.05). §Statistically significant difference
between MB+MK IV and MB+MK IM (p < 0.05).

(Fig. 3). The overall difference between treatment

Mean digital footpad temperatures by treatment
groups was approximately 0.5. The difference
group and time point
between treatments did not arise immediately after 40
the administration. At the last measurement at 38 *§ *°§ *°
60 minutes, the difference between treatments *° *°
36
Digital footpad temperature

MB+MK and MB alone had reached 1.0 (95% CI:

34
0.7;1.3) with the IV route and 0.7 (0.5;1.0) with
the IM route (Fig. 3). 32

With MB IV and IM, the MFT declined immedi- 30

ately after administration and at 10 minutes began 28
to slowly increase again towards the temperatures 26
measured before administration (Fig. 4). The MFT
24
with MB+MK were higher (average 3.5) than with MB+MK IV MB IV
22
MB alone treatments (Fig. 4). MB+MK IM MB IM
The DFTs were similar to the MFTs (Fig. 5). With 20
0 3 10 20 30 45 60
MB+MK IV, the DFT increased more rapidly after Time point
administration than MFT (Figs 4 and 5). A similar
Figure 5 Mean digital footpad temperatures (±SD) in
but slower change was seen with MB+MK IM. After
degrees C in dogs (n = 8) treated with MB or MB+MK,
the 30-minute point, the temperatures remained
IV or IM. *Statistically significant difference between
constant with MB+MK. On average, the tempera- MB+MK IV and MB IV (p < 0.05) and between MB+MK
tures stayed within 2 throughout the study with IM and MB IM (p < 0.05). §Statistically significant differ-
both routes of MB administration (Fig. 5). Figure 6 ence between MB+MK IV and MB+MK IM (p < 0.05).
visualises the temperature changes at several time
points with the different treatments. of thermographic imaging and a digital rectal
thermometer. The four treatments applied in the
study gave significantly different results for all of the
Discussion
three temperature measurements. In the MB+MK-
The present study examined the superficial tem- treated dogs (both IM and IV), the MFT and DFT
perature change and corresponding core heat loss in increased and the RT decreased. The change from
dogs sedated with MB with or without MK by means baseline was greater with MB+MK than MB in all of
 2012 The Authors. Veterinary Anaesthesia and Analgesia
4  2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists
 Thermographic imaging in sedated dogs Mari Vainionpää et al.
Baseline 10 minutes
MB
IM
MB
IV
MB+
MK
IM
MB+
MK
IV
Figure 6 Thermograms from all treatments at different time points.
the responses, which leads to a significant difference
between the treatments over time. When comparing
the routes of administration with the MB+MK
treatment, differences were seen in the MFT and
DFT. The superficial temperature change was faster
with intravenous than with intramuscular admin-
istration. With MB, no differences were seen in any
of the responses between the administration routes.
The results indicated that when the peripheral blood
flow was enhanced by a given medication
(MB+MK), heat loss was also, as expected, signifi-
cantly higher and could, if not treated appropriately,
lead to hypothermia more easily than with MB
alone.
In our study, the dogs were isolated from the table
using an insulating mattress. This did not seem to
be completely adequate for keeping the RT from
declining further when the animals were sedated
with MB+MK as opposed to MB. Heat is known to
dissipate through the skin via radiation, convection,
conduction and evaporation (Turner 2001), conse-
quently cooling the skin surface. Sedated and
anaesthetized animals have an impaired ability to
 2012 The Authors. Veterinary Anaesthesia and Analgesia
 2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists
20 minutes 60 minutes
regulate heat loss, and vasodilative agents can
enhance cooling during drug effect (Dı́az & Becker
2010).
Rectal temperature is routinely used as an indi-
cator of core temperature and an animal’s thermal
status although it is known that many factors (for
example, the presence of faeces and local blood flow)
can influence the results (Robinson et al. 1998). In
the present study, we opted for RT measurement
since it is used commonly in clinical settings.
In humans, the heat emitted from the body is not
trapped inside insulating fur as in dogs, and direct
measurement of skin temperature is possible (Gaze-
rani & Arendt-Nielsen 2011; Park et al. 2011). In
the present study the thermograms were taken from
the soles of the dogs’ feet (footpads) that can more or
less be compared to human skin. In our study the
dogs were acclimatised to the room temperature for
a minimum 1 hour before starting the study,
although a study on horses has suggested that no
adjustment or equilibration time is required for
performing thermographic imaging (Tunley & Hen-
son 2004). Since exercise has also been shown to
5
Thermographic imaging in sedated dogs Mari Vainionpää et al.
affect thermograms (Simon et al. 2006), the base-
line thermograms were taken after the dog had been
resting in lateral recumbency for at least 5 minutes.
The emissivity of one was used in all thermo-
grams. This (e = 1) is the emissivity of a theoretical
black body that represents a perfect absorption of
light (Kastberger & Stachl 2003). When using this
emissivity, an assumption of not reflecting but only
emitting heat radiation is made of the subject.
Although this is not absolutely correct with dogs or
other animals, this emissivity is used commonly to
make thermograms comparable since there are no
studies on the emissivity of animals to date. Another
option would have been to use the emissivity of
0.98 which is the emissivity of human skin (Ring
2006), or 0.95 which has been used in a study on
horses (Autio et al. 2006), but with no previous
studies to support this, we decided to use the most
commonly used emissivity (Holmes et al. 2003;
McCafferty 2007; Levet et al. 2009).
Since the thermography study was carried out on
sedated dogs, it was considered even more impor-
tant than with non-sedated dogs that the ambient
temperature was even. Cold or hot air from
windows or doors and strong spotlights might have
a significant effect on the thermograms, especially if
the room in question is small. This was considered
crucial in studying temperature changes using
drugs affecting the central nervous system and
known to inhibit the normal heat regulation of the
subject (Dı́az & Becker 2010). In the present study
the room temperature was kept even and no direct
spotlight to the paw area was used.
We concluded that, as a physiological diagnostic
tool falling in the category of functional imaging
techniques (Denoble et al. 2010), thermography is
useful for imaging the peripheral temperature
changes in sedated dogs. The changes in peripheral
temperature differed between MB and MB+MK
suggesting that peripheral heat loss could be higher
when MK-467 is used. Furthermore, it should be
recognised that any sedation protocol may have an
effect on thermographic images.
Acknowledgements
FLIR Sweden and Infradex Oy Finland (Seppo Vihi-
nen) made this study possible by providing the
camera. Merck & CO., INC. Rahway, New Jersey,
US, is acknowledged for donating the MK-467 and
Vetcare Oy, Mäntsälä, Finland, for donating the
other study drugs.
6  2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists
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Received 21 December 2011; accepted 10 April 2012.
7