Comparison between invasive blood pressure and a non-invasive blood pressure monitor in anesthetized sheep

Evaluation of agreement between invasive and non-invasive blood pressure measurement using the PetMAP™ device in rabbits

Background

Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the gold standard, however it is also technically challenging, requires specialised equipment and carries certain risks. For these reasons, non-invasive blood pressure measurement devices are commonly used and are expected to provide accurate and reliable results. This requirement is particularly true for rabbits, in whom peri-anaesthetic hypotension is commonly observed and in whom perioperative mortality remains disproportionally high. Several authors have compared different non-invasive devices with invasive measurements in rabbits and have reported contrasting results. However, to date no comparison between invasive measurements and the PetMAP^™ device, that has been designed specifically for veterinary medicine, has been reported.

Aim and hypothesis

The aim of the study was the comparison of invasive blood pressure measurement with PetMAP^™ in rabbits. We hypothesised that PetMAP^™ would show acceptable agreement with the invasive measurements according to the American College of Veterinary Internal Medicine guidelines.

Materials and methods

Sixteen client-owned rabbits presenting for various surgical interventions were included in the study. Invasive measurements were performed by cannulation of an auricular artery. The PetMAP^™ cuff was applied distal to the elbow according to the manufacturer's guidelines. For each measurement with PetMAP^™, three invasive blood pressure values were recorded. The mean of the three invasive values was compared with one value measured with PetMAP^™.

Results

Data collected from 16 rabbits were used for statistical analysis. In the clinical setting, the PetMAP^™ device showed significant overestimation of systolic, diastolic and mean arterial pressure, which were measured in the auricular artery. In addition, the bias was not constant, implying that the device poorly predicted changes in blood pressure.

Conclusion

The PetMAP^™ device did not meet any of the American College of Veterinary Internal Medicine recommendations.

Effects of vatinoxan on xylazine-induced pulmonary alterations in sheep

It was hypothesized that premedication with vatinoxan, a peripheral α₂ -adrenoceptor antagonist, would mitigate xylazine-induced pulmonary alterations in sheep. Fourteen adult sheep were allotted into two equal groups and premedicated with either vatinoxan (750 µg/kg IV) or saline and sedated 10 min later with xylazine (500 µg/kg IV). Arterial oxygen saturation (SpO₂ ) was measured and respiratory rate (RR) counted at intervals. The sheep were euthanized with IV pentobarbital 10 min after xylazine administration. The severity of pulmonary parenchymal alterations was assessed and graded grossly and histologically and correlations of the morphological changes with SpO₂ evaluated. Following xylazine injection, SpO₂ was significantly higher and RR significantly lower with vatinoxan than with saline and the sheep administered vatinoxan exhibited significantly smaller quantities of tracheal foam than those receiving saline. No significant differences in macroscopic oedema scores were detected between treatments. In contrast, the vatinoxan-treated animals exhibited significantly graver microscopic interstitial alveolar oedema and haemorrhage than saline-treated animals. The histological severity scores did not correlate with changes in SpO₂ . In conclusion, xylazine induced a marked reduction in SpO₂ which was abolished by the prior administration of vatinoxan. The histologically detected alterations after pentobarbital euthanasia with vatinoxan premedication need to be studied further.

Developmental and cardiac toxicities of propofol in zebrafish larvae

Propofol, a commonly used anesthetic, is convenient to use, induces quick effect, enables rapid recovery, and is widely accessible given its stable supply. However, its adverse effects are a concern. Reportedly, propofol exhibits a significant inhibitory effect on the respiratory and circulatory systems. Furthermore, intravenous administration of this drug results in hypotension, rapid heart rate, and respiratory failure. Because many pregnant women are administered propofol during childbirth, it may have a significant negative effect on the development of infants. Propofol can cause considerable developmental neurotoxicity and has known activity on the heart. However, the underling mechanisms of these toxicities remain unclear. In the present study, zebrafish embryos were exposed to propofol at different concentrations (0.05, 0.1, 0.5, 1, 5, 10, and 20 μg/ml) to determine its developmental and cardiac toxicities. Propofol exposure decreased the survival rate and hatchability of zebrafish embryos. Additionally, the embryo malformation rate increased in a concentration-dependent manner. Different types of malformations were observed following propofol administration. The proportion of pericardial cysts increased, whereas the heart rate and size decreased with an increase in propofol concentration. The quantitative reverse-transcription polymerase chain reaction revealed that propofol significantly altered the expression of genes related to cardiac development and functions in zebrafish. Collectively, our findings indicate that propofol exposure induces significant developmental and cardiac toxicities in zebrafish.

Comparison of invasive and non-invasive blood pressure measurements in anesthetized female Dorset cross-bred lambs (Ovis aries)

The purpose of this study was to determine the level of agreement between invasive and noninvasive blood pressure measurements in anesthetized, non-surgically manipulated Dorset cross-bred lambs. Twelve healthy female Dorset cross-bred lambs, weighing 37.3 ± 7.4 kg (mean ± SD) underwent isoflurane anesthesia for simultaneous measurement of systolic arterial pressure (SAP), mean arterial pressure (MAP) and diastolic arterial pressure (DAP) from an invasive blood pressure source and a noninvasive oscillometric source (O-NIBP). The femoral artery was catheterized for invasive blood pressure measurements, while noninvasive blood pressure was measured from a cuff placed on the antebrachium. The Bland-Altman method was used to calculate agreement between SAP, MAP and DAP measurements. The bias ± SD between SAP, MAP and DAP measurements was 3.6 ± 12.0, 4.9 ± 9.1 mmHg and 4.1 ± 8.0, respectively. The 95% limits of agreement for SAP, MAP and DAP were - 19.9 to 27.1, -13.0 to 22.8 mmHg, and - 11.7 to 19.9, respectively. Overall, agreement was poor between femoral IBP and O-NIBP monitoring techniques in anesthetized Dorset cross-bred lambs, with O-NIBP underestimating the femoral IBP. Arterial blood pressure should be most accurately measured using an invasive blood pressure monitoring technique in lambs undergoing isoflurane anesthesia.

Anaemia and Hypoproteinaemia in Pregnant Sheep during Anaesthesia

Simple Summary

Anaemia during pregnancy is commonly reported in humans and is considered a significant health issue as it is associated with adverse neonatal outcomes including low birth weight, preterm birth and possible perinatal mortality. Pregnant sheep are a common model for research investigating the causes and consequences of preterm birth, but the incidence and significance of anaemia during pregnancy is not known. However, intraoperative anaemia in pregnant sheep has been reported previously. In addition, it has been demonstrated that the cause of intraoperative anaemia is not pregnancy alone as pregnant sheep in a farm environment did not develop anaemia. The aim of this study was to document the red blood cell and protein content of maternal blood before, during and after anaesthesia and surgery to elucidate the cause and duration of intraoperative anaemia in pregnant sheep in a research context. The concentration of red blood cells and protein decreased during anaesthesia and were attributed to the use of anaesthetic drugs and fluids as opposed to the pregnancy status of the sheep.

Abstract

The aim of this study was to document the packed cell volume (PCV), haemoglobin concentration and total protein concentration of maternal blood before, during and after anaesthesia. Six singleton Merino-cross pregnant ewes at 116-117 days of gestation were premedicated with intramuscular acepromazine (0.02 mg/kg) and buprenorphine (0.01 mg/kg), and anaesthesia was induced with intravenous midazolam and ketamine. Anaesthesia was maintained with isoflurane in 100% oxygen. Serial blood samples were collected the day before anaesthesia (baseline), immediately prior to induction of anaesthesia (pre-op), at the end of the procedure (intra-op) and the following day (post-op). There was a significant change in the PCV during the study (p = 0.003) with an initial decrease of 12.5% from the baseline (0.36 (0.36–0.4) to 0.315 (0.29–0.34), p = 0.044), a further intraoperative decrease of 41.7% from the baseline (0.21 (0.195–0.245), p = 0.002) and an increase the day afterwards (0.3 (0.285–0.35), p > 0.99 compared with baseline). The haemoglobin concentration also changed (p < 0.0001) (baseline: 114 (111.8–123); pre-op: 97 (77.25–104.5), 14.9% decrease, p = 0.022; intra-op: 70 (61.5–83.25), 38.5% decrease, p = 0.0009; post-op: 101.5 (96.25–114) g/L, p > 0.99). Likewise the change in total protein during the study was significant (p = 0.0003) and decreased from the baseline [70 (67.25–70.75) g/L] prior to anaesthesia (61 (58.25–64.5) g/L, 12.9% decrease, p = 0.0437) and further during anaesthesia (55.5 (53.75–63.25) g/L, 20.7% decrease, p = 0.0021) with an increase [63 (61.25–67) g/L, p > 0.99] on the first post-op day. In conclusion, intraoperative anaemia and hypoproteinaemia occurred in this study. These alterations are attributed to a combination of the side effects of acepromazine and haemodilution.

Comparison of oscillometric, Doppler and invasive blood pressure measurement in anesthetized goats

Arterial blood pressure (BP) can be measured directly using an invasive intra-arterial method. This method is considered a gold standard, however it is potentially hazardous and requires expensive equipment and professional skills. Therefore, two non-invasive methods–Doppler ultrasonic sphygmomanometry and oscillometry–have been introduced in veterinary medicine. Their accuracy has so far been reliably evaluated in various animal species, however only one study included a small group of goats. Therefore, we carried out a large-scale study which aimed to evaluate agreement between the two non-invasive methods and invasive intra-arterial BP measurement in anesthetized goats at various age. The study included 122 goats of two Polish local breeds (Polish White Improved and Polish Fawn Improved): 67 adult females, 35 adult males, and 20 two-month-old female kids. Goats were anesthetized with the intravenous mixture of xylazine and ketamine. BP was measured simultaneously with the three methods in each goat with 7 measurements on average taken. The study showed that according to the criteria of the American College of Veterinary Internal Medicine (ACVIM) oscillometric method yielded BP measurements sufficiently consistent with invasive intra-arterial method in anesthetized adult goats– 95% of oscillometric BP measurements were expected to differ from invasive BP measurements by at most ±20–25 mmHg. The agreement was worse in goat kids–oscillometry significantly overestimated invasive BP measurements, which resulted in highly asymmetrical 95% limits of agreement. Doppler systolic BP very poorly conformed to invasive systolic BP both in adult goats and in kids and all the ACVIM criteria were violated. Concluding, oscillometry, but not Doppler ultrasonic sphygmomanometry, may be regarded as an alternative to invasive BP measurement in large-scale scientific studies involving adult goats, however, individual oscillometric BP measurements should be treated with caution as estimated 95% limits of agreement were wide.

Accuracy of an oscillometric blood pressure monitor in anesthetized pigs

The purpose of this study is to evaluate the accuracy of an oscillometric blood pressure monitor in anesthetized pigs. Invasive blood pressure (IBP) and noninvasive blood pressure (NIBP) measurements were taken using a DRE Waveline Pro multiparameter monitor at four different time points in 17 pigs undergoing injectable anesthesia. NIBP measurements were taken on both the thoracic and pelvic limbs. Bland Altman analysis was used to assess agreement between methods and a linear mixed-effects model was used to evaluate the effect of cuff position and blood pressure on bias. Invasive systolic arterial pressure (SAP) ranged between 112 and 161 mmHg (mean ± SD: 138.8 ± 13.3; median: 139.5). Invasive diastolic arterial pressure (DAP) ranged between 60 and 104 mmHg (mean ± SD: 86.0 ± 9.1; median: 87.0). Invasive mean arterial pressure (MAP) ranged between 79 and 121 mmHg (mean ± SD: 103.2 ± 9.3; median 103.0). Only the diastolic and mean measurements obtained from the pelvic limb met criteria outlined by the American College of Internal Medicine for required accuracy of NIBP monitors. Bias was significantly higher in the thoracic limb in comparison to the pelvic limb and was significantly higher at blood pressures above median. In general, NIBP measurements underestimated IBP measurements. In conclusion, the use of the DRE Waveline Pro to assess NIBP in anesthetized pigs may be useful in monitoring trends in mean and diastolic blood pressure and is most accurate when used on the pelvic limb.