USAARL Report No. 88- 4

IIFiLE WPN

AD- A198 719

Comparison of Three Anesthetics for Chinchilla

By

C.E. Hargett, Jr.*lil M. Lomba GautierMelvin Carrier, Jr.Carol S. London

Irvin W. McConnell**James H. Patterson, Jr.

Sensory Research Division I5TIt,ELECTE~AU 1 5I98

April 1988E

*Research Foundation, State University of New York at Plattsburgh**Schering Research, Safety Evaluation Center, Lafayette, New Jerseyk

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United States Army Aeromedical Research LaboratoryFort Rucker, Alabama 36362-5292

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Comparison of Three Anesthetics for Chinchilla (U)12. PERSONALAUTHOR(S) C.E. Hargett, Jr., IIla M. Lomba-Gautier, Melvin Carrier, Jr., Carol S.Landon, Irving W. McConnell, James H. Patterson, Jr.

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17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number)

FIEO I GROUP SUB-GROUP Chinchilla ,Acepromazine;2001 Ketamine Anesthesia ('-,24, 07 1 Xylazine:

19, ABSTRACT (Continue on reverse if necessary"d Identify by block number)

--' Anesthesia techniques which 'Successfully induce surgical anesthesia in Chinchillavillidera are described and compared. Two injectables, ketamine-acepromazine and ketamine-xylazine, are compared to halothane-nitrous oxide administered by mask only and the samemixture administered by induction chamber until loss of righting reflex and then mask. Fortylaboratory-raised adult chinchillas in four groups were used in this study. Subjects wereweighed and dosages calculated and administered.-, All achieved surgical anesthesia with nodeaths. Time to loss of righting reflex, time to surgical anesthesia, duration of surgicalanesthesia, time from end of surgical anesthesia to standing unaided, and total time fromadministration of anesthesia to standing unaided are detailed. Findings indicate that thedoses evaluated of ketamine-acepromazine, ketamine-xylazine, and halothane-nitrous oxide allprovide safe, dependable surgical anesthesia..

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The views, opinions, and/or findings contained in this reportare those of the author(s) and should not be construed as anofficial Department of the Army position, policy, or decision,unless so designated by other official documentation.Citation of trade names in this report does not constitute anofficial Department of the Army endorsement or approval of theuse of such commercial items.

Reviewed:

BRUCE C.LEBREcHT, Ph.D.LTC, MS

Director, Sensory ResearchDivision

Released for publication:

D. LaMITHE, Ph.b.COL, MS Colonel,Chairman, Scientific CommandingReview Committee

11111 1 11 1 1 1 1 10 1

Acknowledgments

This work was supported by the U.S. Army Medical Researchand Development Command (USAMRDC) under Contract Number DAMDl7-86-C-6139.

C.E. Hargett, Jr., an employee of the Research Foundation,State University of New York at Plattsburgh, is assigned full-time at the U.S. Army Aeromedical Research Laboratory (USAARL)

* as part of the above contract.

Irving W. McConnell, at the time of this research, was aVeterinary Corps officer in the U.S. Army. Dr. McConnell now isat Schering Research, Safety Evaluation Center, Lafayette, NJ.

The views of the authors do not purport to reflect thepositions of the Department of the Army or the Department ofDefense.

In conducting research using animals, the investigatorsadhered to the "Guide for the Care and Use of LaboratoryAnimals,' prepared by the Committee on Care and Use ofLaboratory Animals of the Institute of Laboratory AnimalResources, National Research Council (NIH Publication 86-23,revised 1985).

The authors wish to acknowledge and thank Ms. Linda S.Barlow for her valuable statistical assistance.

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Table of contents

Page no.

Introduction . . . . .. . .. . .. .. . . **........................... * ** * 3

Methods and procedures ....... ... . . .. .. ........ ........ .. 4

Results and discussion ....................... .......... 7

Conclusion .................................... .......... 9

Appendix

A. List of manufacturers ........................... 12

List of tables

Table no. Page no.

1 Time to loss of righting reflex inseconds ............. 11 ..... t** .. *..... 7

2 Time to surgical anesthesia in seconds ....... 7

3 Duration of surgical anesthesia in

4 Minutes from end of surgical anesthesiato standing unaided ....................... 9

5 Time from administration of anesthesiato standing unaided ....................... 9

X == = = == = = -- - --------

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v 1I

Introduction

The chinchilla (Chinchilla villidera) is the animal modelof choice for certain types of auditory research (Miller, 1970).The Acoustical Sciences Branch, Sensory Research Division of theU.S. Army Aeromedical Research Laboratory (USAARL), Fort Rucker,Alabama, has used the chinchilla as a research animal modelsince 1977 (Burdick, et al., 1978).

In auditory research, it is necessary to perform surgicalprocedures such as monauralizations and electrode implants aspart of acoustical experimentation. This requires an acceptablemethod of anesthetizing the animals. Relatively few studieshave been reported documenting the use of anesthetics in thechinchilla. Intramuscular injections of ketamine-acepromazinehave been used successfully by some research teams (Morgan, etal., 1981). Ketamine is a nonbarbiturate that rapidly producesa cataleptic state of anesthesia characterized as disassociateanesthesia. Acepromazine has a depressant effect on the centralnervous system. While anesthesia is rapid with thiscombination, recovery tends to be slow. In one study, theduration of surgical anesthesia exceeded 40 minutes and required120 to 300 minutes for complete recovery (Morgan, et al., 1981).

There were no references in the literature that we found toketamine-xylazine combinations used to anesthetize chinchillas.CI-744 (tiletamine-HCL and zolezepan-HCL) was reported to beeffective for chinchilla anesthesia with a mean duration of 202minutes for five animals given the minimum dosage (22 mg/kg)that provides surgical anesthesia (Schultz and Fowler, 1974).Xylazine is an alternative to acepromazine.

Experience at USAARL has shown that 20 to 25 minutes ofsurgical anesthesia is sufficient for most procedures. For thisreason, a mixture of halothane and nitrous oxide has been usedto anesthetize our chinchillas for surgery. Halothane is ahalogenated hydrocarbon that produces a potent nonexplosiveanesthesia agent (Deutsch, 1978). Inhalation anesthesia has anumber of advantages. The agents are eliminated primarilythrough the lungs, so recovery from anesthesia does not relyupon redistribution within the body and detoxificationmechanisms (Lumb and Jones, 1973). Halothane is a "completeanesthetic" capable of producing surgical anesthesia withoutoxygen deprivation and is nonirritating to the upper and lowerrespiratory tracts (Deutsch, 1971). Salivary, mucous, andbronchial secretions, as well as laryngospasms and vomiting, arenot problems when using halothane anesthesia. Nitrous oxide isused with halothane to provide rapid induction, analgesia, andto complement the more potent anesthetic agent (Lumb and Jones,1973; Soma, 1971). Inhalation anesthesia requires specializedequipment, but it is the only technique that allows for control

of anesthetic depth and surgical anesthesia duration. Thepresent study was undertaken to compare halothane anesthesiawith ketamine in combination with either acepromazine orxylazine. In addition, two methods for inducing halothaneanesthesia were compared.

Methods and procedures

This study utilized 40 healthy chinchillas of both sexesfrom the USAARL colony. Individual stainless steel laboratorycages (483mm x 607mm x 203mm) were used as housing for thesechinchillas. They were provided with commercial chinchillaration* and water ad libitum. They weighed from 375.2 grams to643.1 grams with a mean weight of 496.1 grams and a mediar.weight of 487.2 grams. Ages ranged from 10 to 48 months. Theywere assigned rancomly to four groups of 10 subjects each. Thechinchillas were not deprived of food or water prior to theexperiment and were returned to individual cages upon being ableto stand unaided.

Each subject was anesthetized to surgical depth by themethod of anesthesia for its assigned group. Surgical depth isdefined as not exhibiting pedal reflex, or palpebral reflex, andis corroborated by subjective observations evaluating thechinchilla's overall appearance and condition. On each subject,we collected the following data: respiration rates, time toloss of righting reflex, time to loss of palpebral reflex, timeto loss of pedal reflex, time at surgical depth, time to returnof pedal reflex, and time to standing unaided. Time to headlift from lateral recumbency and both pinna and whisker reflexwere taken on some of the injectable subjects. However, it wasnot possible to acquire these data on the gas anesthesiasubjects as the mask is in place providing oxygen flow at thetime these reflexes occur. Time at surgical depth for theinhalation anesthesia subjects was limited to 20 minutes for thepurposes of this report. This is not to be taken as an uppertime limit for this technique, merely the time we find to beoptimal for our surgical techniques.

The four methods used to induce surgical anesthesia were:

Group I: Halothane* and nitrous oxide administered bythe mask only.

Group II: Halothane and nitrous oxide administered bythe anesthesia chamber until loss of righting reflex, then bythe mask.

'kSee Appendix A.

4

Group III: Ketamine*-acepromazine administered byinjection.

Group IV: Ketamine-xylazine* administered byinjection.

All times were taken with a stopwatch and recorded as thenearest minute and second, except duration of surgical depth andtime to standing unaided for Groups III and IV, which were takento the nearest minute.

The long duration of the effects of the injections maketime rounded to the nearest whole minute more appropriate.Statistical tests of the equivalence of means across the fourgroups were accomplished using a one-way analysis of variancefollowed by a Dosteriori comparisons using Tukey's honestlysignificant dfferences (Winer, 1971). A separate analysis wasdone for each dependent variable.

Group I

Ten chinchillas with a mean weight of 522.6 grams wereanesthetized using a mask-only system of inhalation anesthesia.The mask system is a nonrebreathing system. It is well-suitedfor smaller animals such as a chinchilla. The chinchillas werepicked up from the transport cage, placed on the surface of theNark.vct* n--sthesia Tachine Rnd their heads inserted into themask. They were held with heads in the mask until loss ofrighting reflex occurred. A 4 percent setting of halothane,with a flow rate of 4 liters per minute of nitrous oxide and 2liters per minute of oxygen, was used.

When the palpebral reflex was gone, the chinchilla wasremoved from the mask and Optivet* chloramphenocol eye ointmentwas placed in each eye, and the eyes were closed. This kept theeye tissue from drying out. Then, the subject was returned tothe mask. The loss of pedal reflex was taken as beginning ofsurgical depth. The chinchilla was maintained at surgical depthusing a 2 1/2 percent halothane setting, with a flow rate of 2liters per minute of nitrous oxide and 2 liters per minute ofoxygen.

At the end of the procedure, the halothane was set at 0percent (no flow), the nitrous oxide at zero liters per minute(no flow) and the oxygen maintained at 2 liters per minute.This enabled the chinchilla to return to consciousness rapidly,without complications induced by nitrous oxide (Soma, 1971).

5

Group II

Ten chinchillas with a mean weight of 459.6 grams wereanesthetized using a precharged Ejay* international anesthesiachamber. It is made of tough, lightweight, transparent plastic.This chamber is supposed to reduce the stress on the subjectprior to being anesthetized. The unit was precharged withhalothane-nitrous oxide. Then the chinchilla was inserted andthe lid quickly closed. The chamber is transparent, so ataxiacould be observed.

Gently shaking the unit would cause the chinchilla totopple over at the onset of loss of righting reflex. At theloss of righting reflex, the chinchilla was removed from theunit, tested for palpebral reflex, eyes filled with Optivetointment, and placed on the mask that is attached to theNarkovet anesthesia machine. At this point, all further detailswere the same as for subjects in Group I.

Group III

Ten chinchillas with a mean weight of 513.6 grams wereinjected intramuscularly in the left gluteal area with a mixtureof ketamine hydrochloride (40 mg/kg) and acepromazine(approximately 0.5 mg/kg) using the technique described byMorgan et al., 1981.

Subjects were weighed and individual doses calculated anddrawn up into a I cc tuberculin syringe. Upon injection,subjccts were placed in a 457 mm x 304 mm x 228 mm transparentplastic box for observation.

At loss of righting reflex, subjects were tested forpalpebral reflex and then eyes were filled with Optivet ointmentand closed to prevent drying. Then, subjects were placed in arecumbent position for further observations.

Group IV

Ten chinchillas with a mean weight of 488.7 grams wereinjected in the left gluteal area with a mixture of ketaminehydrochloride (40 mg/kg) and xylazine (2 mg/kg). Aftercalculating the dosage of ketamine to be injected, this dosagewas drawn into a I cc tuberculin syringe, then cleared of airbubbles. This syringe was inserted into the xylazine vial andthe calculated osage of xylazine drawn on top of the ketamine.Next, air was drawn into the syringe and the two agents wellblended. All the air was expelled and then the blend of

ketamine-xylazinc wan injected. Upon injection, subjects wereplaced in a 457mm x 304 mm x 228 mm transparent plastic box forobservation.

6

Results and Discussion

The times to loss of righting reflex are shown in Table 1.The analysis of variance revealed significant differences (a -.05) in mean time to loss of righting reflex among the fourgroups. However, a posteriori analysis failed to find anydifferences between tdv idual groups.

Table 1

Time to loss of righting reflex in seconds

Group I Group II Group III Group IVMedian M. 5711/.5 -. 5 65.URange (46-170) (60-205) (72-135) (61-124)Average 124.1 129.4 94.9 86.8S.D. 34.3 54.9 22.6 20.5

Group I = Mask onlyGroup II = Induction chamber, then maskGroup III = Ketamine-acepromazine •Group IV = Ketamine-xylazine

Table 2 shows the time to surgical anesthesia in seconds.The time to surgical anesthesia was shortest for the ketamine-xylazine combination; both gas techniques required about thesame time. The ketamine-acepromazine combination yielded thelongest time to surgical depth. The slowest subject to reachsurgical anesthesia (no pedal reflex, no palpebral reflex) inthis group took 723 seconds (just over 12 minutes). Theanalysis of variance showed a significant difference (a = .05)between groups. The a posteriori analysis revealed significantdifferences between Group IV and both Groups I and II, andbetween Group III and the other groups. No significant N

difference existed between Groups I and II.

Table 2

Time to surgical anesthesia in seconds

Group I Group II Group III Group IV

Median 33Z.I zs.0 455.I--- ZU.URange (150-402) (230-445) (324-723) (121-311)Average 308.2 298.8 481.8 197.7S.D. 72.7 67.6 123.6 453.4

Group I = Mask onlyGroup IT = Induction chamber, then maskGroup III = Ketamine-acepromazineGroup IV = Ketamine-xylazine

7

The durations of surgical anesthesia are shown in Table 3.The time at surgical anesthesia can best be controlled by use ofa gas anesthesia machine. If using injectables, onceadministered, the rate at which the agent is metabolized is themajor factor. Although additional doses can be given toincrease time at surgical depth, this method is not as readilycontrolled as with the gas machine. The average time for GroupIII (ketamine-acepromazine) to be at surgical anesthesia was54.4 minutes while for Group IV (ketamine-xylazine) it was 121.8minutes. Both Groups I and II (gas techniques) began to recoverfairly rapidly a6 soon as there was no flow of both halothaneand nitrous oxide and oxygen remained at 2 liters per minute.The analysis of variance showed a significant difference betweengroups. Significant differences between Group IV and Groups Iand II, and Group III were found with the a posteriori analysis.The difference between Groups I and II was not significant.

Table 3

Duration of surgical anesthesia in minutes

Group I Group II Group III Group IV

Median 24.5 Z5.T T5.U 114.5Range (24-26) (23-26) (30-82) (103-153)Average 24.6 24.7 54.4 121.8S.D. 0.7 1.0 16.7 16.8

Group I = Mask onlyGroup II = Induction chamber, then maskGroup III = Ketamine-acepromazineGroup IV = Ketamine-xylazine

One of the major considerations is the total time from theend of surgical depth anesthesia to complete recovery,determined as the time to standing unaided shown in Table 4.Groups I and II showed very rapid recovery with an average of8.2 and 9.5 minutes, respectively. As expected, there was nostatistical difference between the two gas methods. Group III(ketamine-acepromazine) showed an average time of 81.3 minutesand Group IV (ketamine-xylazine) showed an average time of 55.8minutes. These are significantly different from each other andfrom Groups I and II. Rapid recovery is one of the primaryadvantages of the gas anesthesia method.

81

Table 4

Minutes from end of surgical anesthesia to standing unaided

Group I Group II Group III Group IV

Median 7.3 9.Z v5.0 51.5Range (4.2-16.0) (7.3-12.3) (52-135) (23-97)Average 8.2 9.5 81.3 55.8S.D. 3.2 1.7 32.9 26.1

Group I = Mask onlyGroup II = Induction chamber, then maskGroup III = Ketamine-acepromazineGroup IV = Ketamine-xylazine

Table 5 summarizes the total time from administration ofanesthesia to standing unaided, defined as complete recovery.The average for this measure was over 100 minutes longer withinjectables than the worst of the two gas methods. The analysisof variance showed a significant difference between groups. Thea posteriori analysis revealed differences between Group IV,Groups I and II, and Group III. No significant differencebetween Groups I and II was found.

Table 5

Time from administration of anesthesia to standing unaidedGroup I Group II Group III Group IV

Median 32.U 34.U 121.J IRange (30-47) (31-39) (83-216) (138-231)Average 33.8 34.4 135.7 180.4S.D. 4.9 2.6 42.1 32.8

Group I = Mask onlyGroup II = Induction chamber, then maskGroup III = Ketamine-acepromazineGroup IV = Ketamine-xylazine

Conclusion

Although each of the four methods of anesthesia willprovide a satisfactory depth and duration of surgicalanesthesia, there are advantages to each. Our findings withketamine-acepromazine injected IM are in general agreement withthose of Morgan, et al., 1981. They reported an inductionperiod of about 5 minutes. We found a range of about 5-12minutes with an average of 5.2 minutes. They reported surgicalanesthesia lasting from 40-60 minutes. We found a range of 30-82 minutes with an average of 54.4 minutes. They reported

9

complete recovery in 2-5 hours. We found a range of 1.4-3.6hours with an average of 2.3 hours from injection until thesubject could stand unaided.

The injectables are less controllable once the ketamine-acepromazine or ketamine-xylazine is administered and have along duration from injection to complete recovery. The ease ofadministering gas is apparent, but so is the initial expense ofprocuring the anesthesia unit. The use of the anesthesiachamber allows a smoother induction of anesthesia with minimalstress to the subject, but the subject must be removed from theanesthesia chamber and placed on the mask. This results in lossof gas anesthesia from the chamber. Then the chamber must beprecharged again for each subsequent subject. With the ketaminecombination injections, time to loss of righting reflex issomewhat shorter. The ketamine-xylazine has the shortest timeto loss of righting reflex and to surgical anesthesia, howeverduration of surgical depth and time to complete recovery areexcessive for our needs. On the other hand, time at surgicaldepth can be controlled with either gas method, minimizing thetime at surgical depth.

We conclude that for situations requiring control overlength of anesthesia and rapid recovery from anesthesia, eitherinhalation technique is superior to either ketamine-acepromazineor ketamine-xylazine injections, with the anesthesia chamberminimizing stress on the individual subjects.

10

Appendix A

List of Manufacturers

IS,

Ralston Purina Company I.

Checkerboard SquareSt. Louis, MO 63164(Purina Chin Chow)

Halocarbon Laboratories, Incorporated82 Berlews CourtHackensack, NJ 07601(Halothane U.S.P.)

Bristol LaboratoriesDivision of Bristol-Myers CompanySyracuse, NY 13201(Ketaset)

CEVA Laboratories, IncorporatedOverland Park, KS 66212(Acepromazine)

Bayvet DivisionMiles Laboratories, IncorporatedShawnee, KS 66201(Rompum)

North American Drager148B Quarry RoadTelford, PA 18969(Narkovet)

Burns-Biotec Laboratories, Incorporated8536 K StreetOmaha, NE 68127(Optivet)

Ejay International, IncorporatedP.O. Box 1835Glendora, CA 91740(Ejay)

MUM

References

Burdick, C. K., Patterson, J. H., Jr., Mozo, B. T. and Camp,R. T. 1978. Threshold shifts in chinchillas exposed tooctave bands of noise centered at 63 and 1000 Hz for threedays. Journal of the Acoustical Society of America.Volume 64:458-466.

Deutsch, S. 1978. The pharmacodynamics of halothane. TheTextbook of Veterinary Medicine. Baltimore, MD:Williams and Wilkins Company.

Lumb, W. V., and Jones, E. W. 1973. Veterinary Anesthesia.Philadelphia, PA: Lea & Febiger.

Miller, J. D. 1970. Audibility curve of the chinchilla.Journal of the Acoustical Society of America. Volume48:513-523.

Morgan, R. J., Eddy, L. B., Solie, T. N. and Turbes, C. C.1981. Ketamine-acepromazine as an anesthetic agent forchinchillas (Chinchilla laniger). Laboratory Animal(United Kingdom). Volume 15:281-283.

Schultz, T. A., and Fowler M. E. 1974. The clinical effectsof CI 744 in chinchilfas, Chinchilla villidera (laniger).Laboratory Animal Science. Volume 24(5):810-812.

Soma, L. R. 1971. Systems and techniques for inhalationanesthesia. The Textbook of Veterinary Anesthesia.Baltimore, MD: Williams and Wilkins Company.

Winer, B. J. 1971. Statistical Principlies in Experimental.Design. New York, NY: McGraw-Hill Book Company.

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Commander U.S. Army AviationU.S. Army Aviation Systems Command

Aviation Systems Command Library and InformationATTN: DRSAV-ED Center Branch4300 Goodfellow Blvd ATTN: DRSAV-DILSt. Louis, MO 63120 4300 Goodfellow Blvd

St. Louis, MO 63120

Commanding Officer Federal Aviation AdministrationNaval Biodynamics Laboratory Civil Aeromedical InstituteP.O. Box 24907 CAMI Library AAC 64D1New Orleans, LA 70189 P.O. Box 25082

Oklahoma City, OK 73125

U.S. Army Field Artillery School CommanderATTN: Library U.S. Army AcademySnow Hall, Room 14 of Health SciencesFort Sill, OK 73503 ATTN: Library

Fort Sam Houston, TX 78234

Commander CommanderU.S. Army Health Services Command U.S. Army InstituteATTN: HSOP-SO of Surgical ResearchFort Sam Houston, TX 78234-6000 ATTN: SGRD-USM (Jan Duke)

Fort Sam Houston, TX 78234-6200

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Director of Professional Services U.S. Air Force SchoolAFMSC/GSP of Aerospace MedicineBrooks Air Force Base, TX 78235 Strughold Aeromedical Library

Documents Section, USAFSAM/TSK-4Brooks Air Force Base, TX 78235

U.S. Army Dugway Proving Ground Dr. Diane DamosTechnical Library Department of Human FactorsBldg 5330 ISSM, USCDugway, UT 84022 Lc. Angeles, CA 90089-0021

U.S. Army Yuma Proving Ground U.S. Army White SandsTechnical Library Missile RangeTechnical Library Technical Library DivisionYuma, AZ 85364 White Sands Missile Range,

NM 88002

AFFTC Technical Library U.S. Army Aviation Engineering6520 TESTG/ENXL Flight ActivityEdwards Air Force Base, ATTN: SAVTE-M (Tech Lib)CAL 93523-5000 Stop 217

Edwards Air Force Base,CA 93523-5000

Commander U.S. Army Combat DevelopmentsCode 3431 Experimental CenterNaval Weapons Center Technical Information CenterChina Lake, CA 93555 Bldg 2925

Fort Ord, CA 93941-5000

Aeromechanics Laboratory CommanderU.S. Army Research Letterman Army Institute

and Technical Labs of ResearchAmes Research Center, ATTN: Medical Research Library

M/S 215-1 Presidio of San Francisco,Moffett Field, CA 94035 CA 94129

Sixth U.S. Army DirectorATTN: SMA Naval Biosciences LaboratoryPresidio of San Francisco, Naval Supply Center, Bldg 844CA 94129 Oakland, CA 94625

Commander CommanderU.S. Army Aeromedical Center U.S. Army Aviation CenterFort Rucker, AL 36362 and Fort Rucker

ATTN: ATZQ-CDRFort Rucker, AL 36362

Directorate Directorateof Combat Developments of Training Development

Bldg 507 Bldg 502Fort Rucker, AL 36362 Fort Rucker, AL 36362

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Chief ChiefArmy Research Institute Human Engineering Laboratory

Field Unit Field UnitFort Rucker, AL 36362 Fort Rucker, AL 36362

Commander CommanderU.S. Army Safety Center U.S. Army Aviation CenterFort Rucker, AL 36362 and Fort Rucker

ATTN: ATZQ-T-ATLFort Rucker, AL 36362

U.S. Army Aircraft Development PresidentTest Activity U.S. Army Aviation Board

ATTN: STi.BL-MP-QA Cairns AAFCairns AAF Fort Rucker, AL 36362Fort Rucker, AL 36362

Chief USA Medical Liaison OfficerDefence and Civil Institute U.S. Embassy Box 54

of Environmental Medicine ATTN: USADO-AMLOP.O. Box 2000 FPO New York 09509ATTN: Director MLSDDownsview, Ontario Canada M3M 3B9

Staff Officer, Aerospace Medicine HQ, Department of the ArmyRAF Staff, British Embassy Office of The Surgeon General3100 Massachusetts Avenue, NW British Medical Liaison OfficerWashington, DC 20008 DASG-ZX/COL M. Daly

5109 Leesburg PikeFalls Church, VA 22401-3258

Canadian Society Canadian Airline Pilot'sof Aviation Medicine Association

c/o Academy of Medicine, Toronto MAJ (Retired) J. SoutendamATTN: Ms. Carment King 1300 Steeles Avenue East288 Bloor Street West Brampton, Ontario, Canada L6T 1A2Toronto, Canada M55 1V8

Canadian Forces Commanding OfficerMedical Liaison Officer 404 Squadron CFB Greenwood

Canadian Defence Liaison Staff Greenwood, NS, Canada BOP 1NO2450 Massachusetts Avenue, NWWashington, DC 20008

Officer Commanding National Defence HeadquartersSchool of Operational 101 Colonel By Drive

and Aerospace Medicine ATTN: DPMDCIEM P.O. Box 2000 Ottawa, Ontario, Canada KIA 0K21133 Sheppard Avenue WestDownsview, Ontario, Canada M3M 3B9

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Commanding Officer Canadian Army Liaison OfficeHeadquarters, RAAF Base Building 602Point Cook Victoria, Fort Rucker, AL 36362Australia 3029

Netherlands Army Liaison Office German Army Liaison OfficeBuildingg 602 Buildingg 602Fort Rucker, AL 36362 Fort Rucker, AL 36362

British Army Liaison office French Army Liaison OfficeBuilding 602 Building 602Fort Rucker, AL 36362 Fort Rucker, AL 36362

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