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Gómez Fernández L, Potter J, Hughes JML, Fernandez Perez C, Brama PAJ, Niimura Del Barrio MC. Effects of two alveolar recruitment manoeuvres (sustained inflation and stepwise) followed by positive end-expiratory pressure on cardiac output (measured with lithium dilution), invasive blood pressure and arterial oxygen tension in isoflurane-anaesthetised goats. Res Vet Sci 2022; 150:195-203. [PMID: 35842951 DOI: 10.1016/j.rvsc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Alveolar recruitment manoeuvres (ARM) performed during general anaesthesia improve oxygenation; however cardiovascular depression may be observed. The aim of the study was to compare the effects of sustained inflation (SI) and stepwise ARMs on cardiac output (CO), mean arterial blood pressure and arterial oxygen tension (PaO2) in ten mechanically ventilated goats anaesthetised with isoflurane. In the SI ARM, peak inspiratory presure (PIP) was increased to 30 cmH2O and sustained for 20 s. In the stepwise ARM, the PIP was increased by 5 cmH2O each minute for three minutes from 10 to 25 cmH2O. Both ARMs were followed by positive end-expiratory pressure of 5 cmH2O. Paired lithium dilution CO measurements and arterial blood samples were obtained before and after each ARM. The order of the ARM was randomised and each goat was subjected to both techniques. Data was reported as median and interquartile range (IQR). Significance was set at 0.05. The median change in CO (measured by subtracting values after and before ARM) was -0.15 L min-1 (IQR -0.51; 0.03) and - 0.90 L min-1 (IQR -1.69; -0.58) for SI and stepwise ARM respectively (p = 0.04). The median change in PaO2 was 3 kPa (IQR -2.7; 7.6) and 0.4 kPa (IQR -3.4; 5.5) for SI and stepwise ARM respectively (p = 0.03). In conclusion, SI ARM causes less impact on CO and provides a better improvement in PaO2 compared to stepwise ARM in goats.
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Affiliation(s)
- L Gómez Fernández
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland; Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.
| | - J Potter
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - J M L Hughes
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - C Fernandez Perez
- Servicio de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación Sanitaria de Santiago de Compostela, A Coruña, Spain
| | - P A J Brama
- University College Dublin, UCD Veterinary Hospital, Belfield, Dublin 4 D04W6F6, Ireland
| | - M C Niimura Del Barrio
- Lumbry Park Veterinary Specialists, Selborne Road, Alton, Hampshire GU34 3HL, United Kingdom
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do Nascimento PRL, de Gouvêa LV, Leite TRS, Teixeira ALDS, da Silva PCAR, Filho JADF, Helayel MJSA, Júnior AN, da Cunha IM, Mendonça JDS, Silva PL, Lessa DAB. Cardiorespiratory effects of different intraabdominal pressures in sheep: An experimental study. Physiol Rep 2022; 10:e15506. [PMID: 36353885 PMCID: PMC9647340 DOI: 10.14814/phy2.15506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023] Open
Abstract
Increased intraabdominal pressure (IAP) during laparoscopy can reduce venous return, but changes in respiratory system mechanics and their effect in left cardiac function are not well documented. This study evaluated the effects of different IAPs on respiratory mechanics and cardiac function in 10 healthy nonpregnant adult Santa Ines ewes randomly submitted to a crossover study using different IAPs: 0 mm Hg (G1), 10 mm Hg (G2), 12 mmHg (G3), and 15 mmHg (G4). Animals were anesthetized and mechanically ventilated (VT = 15 ml/kg; positive end-expiratory pressure = 3 cmH2 O; FiO2 = 1.0). Pneumoperitoneum was induced by Hasson's trocar cannula. Variables were measured at INITIAL (IAP, 0 mmHg) and FINAL time points for each IAP after 1 h. At FINAL, driving airway pressure (ΔP,RS ), and percentage fraction of dead space (Vd/Vt) were higher in G3 and G4 than G1 (p = 0.002, difference in means [MD] 4.60, 95% CI: 7.91-1.28, and p < 0.001, MD 5.4, 95% CI: 8.7-2.0; p = 0.016, MD -9.5, 95% CI: -17.9 to -1.2; and p = 0.027, MD -8.7, 95% CI: -17.1 to -0.4). The ejection fraction and fractional shortening were lower in G3 (p = 0.039, MD -11.38, 95% CI: -0.07--22.68; p = 0.015, MD -13.05, 95% CI: -1.74--24.36) and G4 (p = 0.039, MD -9.94, 95% CI: -0.07 to -19.80; p = 0.015, MD -11.43, 95%CI: -1.57 to -21.30, respectively) than G2. In G3, the maximum pulmonary flow velocity correlated negatively with ΔP,RS (r = -0.740; p = 0.018), and Vd/Vt correlated positively with ΔP,RS (r = 0.738, p = 0.046). At IAP of 12 and 15 mm Hg impaired respiratory system mechanics, reduced left cardiac function and no change in maximum pulmonary artery flow velocity were detected. Therefore, respiratory mechanics should be monitored as an interplay to reduce left cardiac function.
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Affiliation(s)
- Paulo R. L. do Nascimento
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Liana V. de Gouvêa
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Thiago R. S. Leite
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - André L. de Sousa Teixeira
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Paulo C. A. R. da Silva
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - José A. D. F. Filho
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Michel J. S. A. Helayel
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Amary N. Júnior
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Isabelle M. da Cunha
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Júlia de Souza Mendonça
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Pedro L. Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics InstituteFederal University of Rio de JaneiroRio de JaneiroRJBrazil
| | - Daniel A. B. Lessa
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
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Navarrete-Calvo R, Parra P, Rodríguez-Gómez IM, Morgaz J, Domínguez JM, Gómez-Villamandos RJ, Quirós-Carmona S, Pineda C, Granados MDM. Comparison of the efficacy of two alveolar recruitment manoeuvres in improving the lung mechanics and the degree of atelectasis in anaesthetized healthy sheep. Res Vet Sci 2022; 150:164-169. [PMID: 35841725 DOI: 10.1016/j.rvsc.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to evaluate whether the application of two types of alveolar recruitment manoeuvres (ARMs) followed by a positive end-expiratory pressure (PEEP) improved lung mechanics and the degree of atelectasis caused by general anaesthesia. Twenty-one female Merino sheep were divided into three groups: sustained inflation ARM (ARMsust), stepwise ARM (AMRstep), and control (without ARM). Sheep received detomidine-morphine for premedication, propofol for induction, and isoflurane during general anaesthesia in a volume-controlled mode with 100% oxygen during the first 15 min of anaesthesia and 40% the rest of the study. The right jugular vein and metacarpal artery were catheterised for mixed venous and arterial blood sample collection, respectively. The quasistatic compliance (Cqst), oxygenation parameters, and shunt fraction (Qs/Qt) were monitored before ARM application (TpreARM), and at 10 (T10) and 60 min (T60) after ARM application. A pulmonary histopathological study was conducted on five animals from each group. A significant increase in Cqst was observed in both ARM groups at T10 compared to TpreARM (ARMsust: P = 0.001; ARMstep: P = 0.002), although only the ARMsust group showed significant differences compared to the control group. The ARMstep group presented a significant improvement in oxygenation parameters and Qs/Qt fraction (T10: 4.84 (3.26-16.48)%, P = 0.048; T60: 4.40 (4.31-14.16)%, P = 0.004) compared with TpreARM (21.48 (20.61-28.32)%). The ARMstep group had the highest percentage of alveolar area and the most homogeneous values. In conclusion, the application of a stepwise ARM followed by PEEP improved atelectasis caused by isoflurane anaesthesia in healthy sheep.
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Affiliation(s)
- Rocío Navarrete-Calvo
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Pablo Parra
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Irene Magdalena Rodríguez-Gómez
- Department of Anatomy and Comparative Pathology and Toxicology, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain..
| | - Juan Morgaz
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Juan Manuel Domínguez
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Rafael Jesús Gómez-Villamandos
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Setefilla Quirós-Carmona
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Carmen Pineda
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - María Del Mar Granados
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
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