Cardiopulmonary and acid–Base effects of desflurane and sevoflurane in spontaneously breathing cats

Cardiorespiratory Effects and Desflurane Requirement in Dogs Undergoing Ovariectomy after Administration Maropitant or Methadone

General anesthesia for ovariectomy in dogs is based on a balanced anesthesia protocol such as using analgesics along with an inhalant agent. While opioids such as fentanyl and methadone are commonly used for their analgesic potency, other drugs can also have analgesic effects. Maropitant, an antiemetic for dogs and cats, has also been shown to exert analgesic effects, especially on visceral pain. The aim of this study was to compare the cardiorespiratory effects and analgesic properties of maropitant and methadone combined with desflurane in dogs undergoing ovariectomy. Two groups of 20 healthy mixed-breeds bitches undergoing elective ovariectomy received intravenous either maropitant at antiemetic dose of 1 mg kg^-1 or methadone at the dose of 0.3 mg kg^-1. Cardiorespiratory variables were collected before premedication, 10 min after sedation and during surgery. Recovery quality and postoperative pain were evaluated 15, 30, 60, 120, 240 and 360 min postoperatively. Results showed that maropitant produced analgesia and reduced the requirement of desflurane in amounts similar to those determined by methadone (5.39 ± 0.20% and 4.91 ± 0.26%, respectively) without significant difference, while maintaining heart rate, arterial blood pressure, respiratory rate and carbon dioxide end-tidal partial pressure even at a more satisfactory level. Therefore, maropitant may be recommended as an analgesic drug for abdominal surgery not only in healthy dogs but also in those with reduced cardiorespiratory compensatory capacities or at risk of hypotension, especially when combined with a sedative such as dexmedetomidine.

Comparison of Venous Blood Gas and Biochemical Parameters in Sunda Pangolin (Manis javanica) and Chinese Pangolin (Manis pentadactyla) before and after Isoflurane Anesthesia

Venous blood gas analytes are commonly examined in animals, and the results may be important when evaluating the overall health status of an animal. Pangolins are critically endangered mammals, and there is limited information on their physiological reference values in the literature. The aim of this study was to analyze venous blood gas and biochemical parameters before and during isoflurane anesthesia in wild healthy Sunda and Chinese pangolins. The results obtained showed that the blood gas index trends of the two pangolin species before and after isoflurane anesthesia were the same. After anesthesia, the partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), total carbon dioxide (CO2), mean blood bicarbonate (HCO3−), extracellular fluid compartment (BEecf) base excess and the mean blood glucose (Glu) levels of both pangolin species showed a significant increase compared to the pre-anesthesia period. In contrast, the mean blood potassium (K+), lactate (Lac) and mean blood pH levels were significantly lower. No significant differences in the mean blood sodium (Na+) or blood ionized calcium (iCa) levels were observed during anesthesia. This study is important for future comparisons and understanding the health status of this endangered species.

Describing acid-base balance using three different methods of analysis in a feline acute haemorrhage-resuscitation model

OBJECTIVE

To describe acid-base status using the Henderson-Hasselbalch, Stewart and semi-quantitative methods of analysis in a feline haemorrhage-resuscitation model.

STUDY DESIGN

Randomized crossover study.

ANIMALS

A total of six domestic cats (mean age, 21 months; weight, 4.9 kg).

METHODS

Venous blood samples were taken before haemorrhage, after haemorrhage at 30 minute intervals during fluid resuscitation and at 24 hours. The cats were anaesthetized and underwent following treatments: no purposeful haemorrhage and resuscitation (NoPHR), purposeful haemorrhage followed by either lactated Ringer's solution (LRS) or 6% tetrastarch 130/0.4 (Voluven) for resuscitation. LRS and Voluven were administered at 60 and 20 mL kg^-1 hour^-1, respectively, for 120 minutes. Variables used for the analysis methods were measured or calculated from the blood samples and then compared among treatments over time using a general linear mixed model (p < 0.05; data reported as mean and standard deviation).

RESULTS

The total blood loss at 120 minutes was 10.2 ± 2.3, 29.3 ± 9.0 and 29.1 ± 6.3 mL kg^-1 for NoPHR, LRS and Voluven, respectively. Total volumes of LRS and Voluven administered were 120 and 40 mL kg^-1, respectively. All cats became acidaemic during anaesthesia regardless of treatment. The Henderson-Hasselbalch method indicated that anaesthetized cats undergoing severe haemorrhage and resuscitation manifest a mixed acidosis. The Stewart method indicated two counter metabolic processes that contributed to the overall pH-decrease in apparent strong ion difference (acidosis) and decrease in total weak acids (alkalosis). The semi-quantitative method identified the free water and chloride effects as variables causing acidosis and the albumin effect causing alkalosis.

CONCLUSIONS AND CLINICAL RELEVANCE

In an experimental haemorrhage and resuscitation model in cats, blood pH was similar among treatments over time regardless of severe haemorrhage and resuscitation with LRS or Voluven or mild haemorrhage and no resuscitation.

Pharmacokinetics of midazolam in sevoflurane-anesthetized cats

OBJECTIVE

To estimate the pharmacokinetics of midazolam and 1-hydroxymidazolam after midazolam administration as an intravenous bolus in sevoflurane-anesthetized cats.

STUDY DESIGN

Prospective pharmacokinetic study.

ANIMALS

A group of six healthy adult, female domestic cats.

METHODS

Anesthesia was induced and maintained with sevoflurane. After 30 minutes of anesthetic equilibration, cats were administered midazolam (0.3 mg kg^-1) over 15 seconds. Venous blood was collected at 0, 1, 2, 4, 8, 15, 30, 45, 90, 180 and 360 minutes after administration. Plasma concentrations for midazolam and 1-hydroxymidazolam were measured using high-pressure liquid chromatography. The heart rate (HR), respiratory rate (f_R), rectal temperature, noninvasive mean arterial pressure (MAP) and end-tidal carbon dioxide (Pe'CO₂) were recorded at 5 minute intervals. Population compartment models were fitted to the time-plasma midazolam and 1-hydroxymidazolam concentrations using nonlinear mixed effect modeling.

RESULTS

The pharmacokinetic model was fitted to the data from five cats, as 1-hydroxymidazolam was not detected in one cat. A five-compartment model best fitted the data. Typical values (% interindividual variability where estimated) for the volumes of distribution for midazolam (three compartments) and hydroxymidazolam (two compartments) were 117 (14), 286 (10), 705 (14), 53 (36) and 334 mL kg^-1, respectively. Midazolam clearance to 1-hydroxymidazolam, midazolam fast and slow intercompartmental clearances, 1-hydroxymidazolam clearance and 1-hydroxymidazolam intercompartment clearance were 18.3, 63.5 (15), 22.1 (8), 1.7 (67) and 3.8 mL minute^-1 kg^-1, respectively. No significant changes in HR, MAP, f_R or Pe'CO₂ were observed following midazolam administration.

CONCLUSION AND CLINICAL RELEVANCE

In sevoflurane-anesthetized cats, a five-compartment model best fitted the midazolam pharamacokinetic profile. There was a high interindividual variability in the plasma 1-hydroxymidazolam concentrations, and this metabolite had a low clearance and persisted in the plasma for longer than the parent drug. Midazolam administration did not result in clinically significant changes in physiologic variables.

Cardiorespiratory dose-response relationship of isoflurane in Cinereous vulture (Aegypius monachus) during spontaneous ventilation

Anesthesia is an inevitably important component of diagnosis and treatments examining the health condition of wild animals. Not only does anesthesia become an essential tool in minimizing stress of the patients and providing an opportunity to deliver accurate and safe procedures, but it also ensures the safety of the medical crew members. This study was conducted to investigate the dose-response cardiorespiratory effects of isoflurane during spontaneous ventilation in ten cinereous vultures. Each bird was administered isoflurane at initial concentration of 1.0, 1.5, 2.0, 2.5 and 3.0 and then an end-tidal isoflurane concentrations (ETiso) of 1.0% for an equilibration period of 15 min in the given order. At the end of the equilibration period, the direct blood pressure (BP), heart rate (HR), respiratory rate (RR) and end tidal CO₂ partial pressure (P_ETCO₂) were recorded, and blood gas analysis was performed. Increasing isoflurane concentrations during spontaneous ventilation led to dose-dependent increases in HR and P_ETCO₂, with minimal changes in RR, decreased arterial BP and respiratory acidosis. Overall, isoflurane for anesthesia of spontaneously breathing cinereous vultures is a suitable choice for diagnostic or surgical procedures.

Cardiorespiratory effects of isoflurane in Asiatic black bears (Ursus thibetanus) anesthetized with intramuscular medetomidine and zolazepam/tiletamine

The objective of this study was to determine the dose-dependent effects of isoflurane on various cardiovascular parameters and the stable range of isoflurane concentrations in Asiatic black bears (Ursus thibetanus). Seven Asiatic black bears were intramuscularly injected with medetomidine, zolazepam and tiletamine (MZT) to induce anesthesia, and anesthesia was maintained by administering isoflurane in 100% oxygen (4 l/min) without mechanical ventilation. Several cardiovascular parameters were measured at five end-tidal isoflurane concentrations (0.5, 1.0, 1.5, 2.0, and 2.5%). Blood was collected from the femoral artery before administration of isoflurane and after each administration for immediate blood gas analysis. Isoflurane produced dose-dependent increases in heart rate, respiratory rate, minute volume, end-tidal carbon dioxide (CO₂) partial pressure and the partial pressure of arterial CO₂, and dose-dependent decreases in non-invasive blood pressure and tidal volume. Rectal temperature, oxygenation and acid-base balance were unaffected by isoflurane. All parameters in this study were in a clinically acceptable range at all times. The data show that the combination of MZT and isoflurane is suitable for general anesthesia in Asiatic black bears with spontaneous breathing during prolonged procedures. End-tidal isoflurane concentrations of 0.5 to 2.5% can be used in Asiatic black bears without adverse side effects.

Anaesthesia with sevoflurane in pigeons: minimal anaesthetic concentration (MAC) determination and investigation of cardiorespiratory variables at 1 MAC

The objective of the study was to determine the minimal anaesthetic concentration (MAC) of sevoflurane (SEVO) in pigeons and investigate the effects of 1 MAC SEVO anaesthesia on cardiovascular and respiratory variables compared with the awake state. This is a prospective, experimental study. Animals were seven healthy adult pigeons. After acclimatisation to handling, heart rate (HR), heart rhythm, respiratory rate (fR), end-expired carbon dioxide tension (PE'CO2), inspired CO2 tension, indirect systolic arterial blood pressure (SAP) and cloacal temperature were measured to determine baseline, 'awake' values. Pigeons were then anaesthetised with SEVO and MAC was determined by the 'bracketing' method. The same variables were monitored during a 40 minute period at 1.0 MAC SEVO for each bird. Mean MAC was 3.0±0.6 per cent for SEVO. During maintenance of anaesthesia at 1.0 MAC, SAP decreased significantly (P<0.001) without any significant change in HR. Although PE'CO2 increased significantly (P=0.001) despite an increase in fR, awake PE'CO2 values were unexpectedly low. Sinus arrhythmias were detected in two birds under SEVO anaesthesia. The times to tracheal intubation and to recovery were 2.5±0.7 and 6.4±1.7 minutes, respectively. Recovery was rapid and uneventful in all birds. In conclusion, SEVO is suitable for anaesthesia in pigeons.

Venous blood gas analytes during isoflurane anesthesia in black-tailed prairie dogs (Cynomys ludovicianus)

OBJECTIVE

To describe changes in venous blood gas analytes during isoflurane anesthesia in black-tailed prairie dogs (Cynomys ludovicianus).

DESIGN

Prospective study.

ANIMALS

16 black-tailed prairie dogs.

PROCEDURES

Black-tailed prairie dogs were placed in an anesthesia chamber for induction of general anesthesia, which was maintained with isoflurane in oxygen delivered via mask. Immediately following anesthetic induction, a venous blood sample was obtained from the medial saphenous vein; a second venous blood sample was obtained just prior to anesthetic gas shutoff. An evaluation of venous blood gas analytes was performed on each sample. General linear mixed models with repeated measures were used for data analyses.

RESULTS

Median anesthetic time was 90 minutes (range, 60 to 111 minutes). A significant increase from immediately after induction to completion of anesthesia was observed in Pco2 and mean blood chloride ion, BUN, and creatinine concentrations. A decrease in Po2, mean blood pH, and anion gap was observed from induction of anesthesia to completion. No significant differences during anesthesia were observed in mean base excess or blood bicarbonate, sodium, potassium, calcium, magnesium, blood glucose, lactate, and total CO2 concentrations. No complications occurred during or after anesthesia for any animal.

CONCLUSIONS AND CLINICAL RELEVANCE

Examination of prairie dogs often requires general anesthesia, with isoflurane currently the inhalation agent of choice. Results suggested respiratory acidosis and relative azotemia may occur during isoflurane anesthesia of prairie dogs. Given the increased risk associated with anesthesia in small mammals and the propensity for respiratory disease in prairie dogs, insight into physiologic changes associated with isoflurane anesthesia in healthy prairie dogs can aid in perioperative evaluation and anesthetic monitoring in this rodent species.

The use of a double-lumen central venous catheter for airway management in pediatric patients undergoing laryngeal papillomatosis surgery

PURPOSE

To evaluate the efficacy and safety of a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a double-lumen central venous catheter (DLCVC) in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis.

METHODS

Thirty-six pediatric patients with laryngeal papillomatosis undergoing suspension laryngoscopic surgery were anesthetized with oxygen and volatile anesthetic insufflation while spontaneously breathing. Anesthesia was induced by inhalation of 8% sevoflurane in oxygen by mask. Atropine, dexamethasone, lidocaine, and midazolam were administered intravenously. The tip of a 7Fr DLCVC was inserted below the glottis after placement of the laryngoscope and establishing suspension. Anesthesia was maintained with insufflation of 4-6% sevoflurane and oxygen with a total fresh gas flow of 6 l·min(-1) through the 14G (larger lumen) of the DLCVC. Endtidal carbon dioxide tension (PetCO2) was monitored using the other lumen of the DLCVC, which was connected to the CO2 sampling line. Duration of the procedure as well as total anesthesia time was recorded. Electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), and PetCO2 were also monitored. Arterial blood was sampled for blood gas analysis including pH, PaO2 , PaCO2 , and actual base excess (ABE). Complications, including intraoperative patient movement, hypoxemia (SpO2 < 95% during oxygen insufflation), nausea, vomiting, bronchospasm, and arrhythmias, were recorded.

RESULTS

There was a significant increase in PetCO2 and PaCO2 (P values <0.05) as well as a decrease in ABE, pH, and PaO2 (P values <0.05) in samples collected before and after surgery. MAP, HR, and SpO2 after surgery were not significantly different from after induction values (P values >0.05). During surgery, SpO2 < 95% in three cases and body movements in three cases were observed. No patient had any other of the complications previously described. Furthermore, no postsurgical endotracheal intubation was needed in any patient.

CONCLUSION

After establishing an adequate depth of anesthesia, a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a DLCVC is feasible in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis.

Cardiorespiratory effects of isoflurane anesthesia in crested caracaras (Caracara plancus)

To evaluate the cardiorespiratory changes induced by isoflurane (ISO) anesthesia in the crested caracara (Caracara plancus), eight crested caracaras that weighed 1.0 kg (range 0.9-1.1 kg) were the subjects for the study. The birds were anesthetized by face mask with ISO for brachial artery catheterization. After recovery, anesthesia was re-induced and maintained with ISO with spontaneous ventilation. Electrocardiography, direct systolic arterial blood pressure (SAP), diastolic arterial blood pressure (DAP), mean arterial blood pressure (MAP), respiratory rate (RR), end-tidal carbon dioxide (P(ET)CO2), and cloacal temperature (T degrees C) were measured before induction (baseline, under physical restraint) and after 5, 10, 15, 20, 25, 30, 35, and 40 min of ISO anesthesia. Arterial blood samples were collected for blood gas analysis at baseline, 10, 25, and 40 min. No cardiac arrhythmias were observed in the present study. RR, SAP, DAP, MAP, T degrees C and pH decreased from baseline values, whereas arterial partial pressures of oxygen and carbon dioxide, bicarbonate concentration, and P(ET)CO2 were significantly higher than baseline. Apnea was not observed in any bird. ISO anesthesia is suitable for use in healthy members of this species despite the moderate cardiovascular and respiratory depression produced.

Comparison of two anesthetic protocols for feline blood donation

OBJECTIVE

To compare hemodynamic variables during, and recovery quality following, anesthesia for feline blood donation using intramuscular ketamine-midazolam-butorphanol (KMB) versus inhaled sevoflurane in oxygen (SEV).

STUDY DESIGN

Prospective blinded, randomized, crossover study.

ANIMALS

Twenty healthy, client-owned, mixed breed cats, aged 4-8 years, weighing 5.2-6.4 kg.

METHODS

Cats were anesthetized with KMB for one donation and SEV for another. Heart rate (HR), respiratory rate (f(R)), pulse quality, mucous membrane color, capillary refill time, arterial hemoglobin saturation with oxygen (SpO(2)), and noninvasive arterial blood pressure (Doppler) were assessed by a blinded observer every 1 minute during collection. A nonblinded anesthesiologist delivered drugs and responded to hemodynamic changes. Each donation consisted of 55 mL of whole blood drawn via jugular puncture over 5-22 minutes. Donors received 60 mL subcutaneous lactated Ringer's solution before recovery. Donors were monitored for a minimum of 4 hours post-donation, before returning home. Owners, unaware of anesthetic protocol, completed a questionnaire regarding their cat's behavior during the 24 hours following donation.

RESULTS

Both protocols provided adequate restraint but were complicated by significant hypotension, requiring intervention in 16 (84%) SEV cats, and eight (42%) KMB cats. KMB cats experienced post-procedure hyperthermia, with body temperatures >103.5 degrees F. All animals responded to symptomatic therapy within 2 hours. Owners noted a significantly faster return to normal behavior at home following SEV.

CONCLUSION

All cats experienced hypotension, with many animals requiring intervention. There was no significant difference between protocols in incidence and severity of hypotension. The primary post-procedure complication was hyperthermia with KMB.

CLINICAL RELEVANCE

As a result of the potential for hypotension during blood donation, intravenous (IV) access and blood pressure monitoring are recommended for all anesthetized donor cats, regardless of the anesthetic protocol. Post-procedure hyperthermia is a risk with KMB, so temperature monitoring is recommended. Return to normal behavior is faster with SEV.

Some cardiopulmonary effects of sevoflurane in crested caracara (Caracara plancus)

OBJECTIVE

To evaluate the cardiorespiratory changes induced by sevoflurane (SEV) anesthesia in the crested caracara (Caracara plancus).

STUDY DESIGN

Prospective experimental trial.

ANIMALS

Eight crested caracaras (Caracara plancus) weighing 1.0 (0.9-1.1) kg were used for the study.

METHODS

The birds were anesthetized by face mask with isoflurane for brachial artery catheterization. After recovery, anesthesia was re-induced with 6% SEV via face mask. After induction, a noncuffed endotracheal tube was placed and anesthesia was maintained with SEV (3.5% end-tidal) in oxygen (1 L minute(-1)) using an Ayre's T-piece nonrebreathing circuit, with spontaneous ventilation. Electrocardiography (ECG), direct systolic, diastolic and mean arterial blood pressure (SAP, DAP, and MAP), respiratory rate (f(R)), end-tidal carbon dioxide (Pe'CO(2)), and cloacal temperature (T degrees C) were measured before induction (baseline - under physical restraint) and after 5, 10, 15, 20, 25, 30, 35 and 40 minutes of SEV anesthesia. Arterial blood samples were collected for gas analysis at baseline and then at 10, 25 and 40 minutes.

RESULTS

No ventricular arrhythmias were observed in the present study. Respiratory rate, SAP, DAP, MAP, T degrees C and pH decreased from pre-induction values, while arterial partial pressures of oxygen and carbon dioxide, bicarbonate concentration, and Pe'CO(2) were significantly higher than baseline. None of the birds were apneic.

CONCLUSION AND CLINICAL RELEVANCE

Sevoflurane anesthesia is suitable for use in healthy members of this species, despite the moderate cardiovascular and respiratory depression produced.