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Kieffer PJ, Williams JM, Shepard MK, Giguère S, Epstein KL. Effect of Hypotension and Dobutamine on Gastrointestinal Microcirculations of Healthy, Anesthetized Horses. Vet Sci 2024; 11:95. [PMID: 38393113 PMCID: PMC10891611 DOI: 10.3390/vetsci11020095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/25/2024] Open
Abstract
Horses undergoing abdominal exploratory surgery are at risk of hypotension and hypoperfusion. Normal mean arterial pressure is used as a surrogate for adequate tissue perfusion. However, measures of systemic circulation may not be reflective of microcirculation. This study measured the mean arterial pressure, cardiac index, lactate, and four microcirculatory indices in six healthy, anesthetized adult horses undergoing elective laparotomies. The microcirculatory parameters were measured at three different sites along the gastrointestinal tract (oral mucosa, colonic serosa, and rectal mucosa) with dark-field microscopy. All macro- and microcirculatory parameters were obtained when the horses were normotensive, hypotensive, and when normotension returned following treatment with dobutamine. Hypotension was induced with increases in inhaled isoflurane. The horses successfully induced into hypotension did not demonstrate consistent, expected changes in systemic perfusion or microvascular perfusion parameters at any of the three measured gastrointestinal sites. Normotension was successfully restored with the use of dobutamine, while the systemic perfusion and microvascular perfusion parameters remained relatively unchanged. These findings suggest that the use of mean arterial pressure to make clinical decisions regarding perfusion may or may not be accurate.
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Affiliation(s)
- Philip J. Kieffer
- Evidensia Specialisthästsjukhuset Helsingborg, Bergavägen 3, 254 52 Helsingborg, Sweden
| | - Jarred M. Williams
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (J.M.W.)
| | - Molly K. Shepard
- MedVet Medical & Cancer Centers for Pets, Chicago, IL 60618, USA
| | - Steeve Giguère
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (J.M.W.)
| | - Kira L. Epstein
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA; (J.M.W.)
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Foth PW, Gardner A, Pereira CR, Cooper E, Schroeder E, Mudge MC. Assessment and comparison of microcirculation and macrocirculation in horses undergoing emergency exploratory celiotomy versus elective surgical procedures. Vet Surg 2023; 52:1015-1023. [PMID: 37280741 DOI: 10.1111/vsu.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess oral buccal microcirculation by hand-held videomicroscopy in horses during colic surgery, comparing microcirculation values with macrocirculatory parameters and with those of healthy elective surgical horses. STUDY DESIGN Clinical prospective study. ANIMALS Client-owned horses (nine in the colic group; 11 in the elective group). METHODS In the colic group, buccal mucosal side stream dark-field microscopy (DFM) videos, cardiac output (CO), mean arterial pressure (MAP), and lactate were obtained at three timepoints under general anesthesia (30, 90, and 150 min after induction). Video analysis was used to determine total vessel density, proportion of perfused vessels, perfused vessel density, and heterogeneity index. Dark-field microscopy videos, MAP, and lactate were obtained at a single timepoint under general anesthesia (45 min after induction) in the elective group. RESULTS There were no differences in microcirculatory parameters between colic and elective horses, nor was there a difference across timepoints in the colic group. There was a weak negative correlation between microvascular parameters and CO (rho = -0.23). CONCLUSION The colic group did not have decreased microcirculation in comparison with the healthy elective group. Dark-field microscopy did not correlate well with macrocirculatory parameters in the colic group. IMPACT Dark-field microscopy may not be a sensitive enough indicator to detect differences in microcirculation between colic and elective groups. The lack of difference in microcirculation may be due to sample size, probe location, or variation in disease severity.
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Affiliation(s)
- Patrick W Foth
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Alison Gardner
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Carolina Ricco Pereira
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Edward Cooper
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Eric Schroeder
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Margaret C Mudge
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
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Freccero F, Di Maio C, Mariella J, Lanci A, Castagnetti C, Hallowell G. Assessment of the microvascular perfusion using sidestream dark-field imaging in healthy newborn foals. Vet Med Sci 2022; 9:158-166. [PMID: 36524796 PMCID: PMC9857114 DOI: 10.1002/vms3.1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Different methods to measure tissue perfusion are available in equine neonatology, but they are not representative of microvascular derangements. OBJECTIVE To evaluate the feasibility of the sidestream dark-field (SDF) capillaroscopy to visualize the capillary microvasculature in conscious newborn foals, the differences between two imaging sites and times of measurements, and the measurements' reproducibility. METHODS Seventeen healthy newborn foals were enrolled. Three sites at the upper and lower lip mucosa were assessed by SDF, using a hand-held capiscope, at 24 h and at 4-5 days after birth. Videos were assessed independently by two observers for quality and for semiquantitative calculation of microvascular parameters, including vascular density (VD), microvascular flow index (MFI), proportion of perfused vessels (PPV), and functional capillary density (FCD). Data were analyzed using unpaired and paired Student's T-tests to assess differences between sites and time-points. Bland-Altman plots and intraclass correlation coefficient (ICC) were used to assess measurement reproducibility. RESULTS Differences were found between the upper and the lower lip for VD at both 24 h and 4-5 days, and for FCD at 24 h, and between the two time-points for PPV at the lower lip. ICC for measurement reproducibility was good for all parameters (0.64-0.79) for the lower lip, and was good for VD and FCD (0,76-0,79) and fair to moderate for MFI and PPV (0.31-0.41) for the upper lip. CONCLUSIONS Measurement of the capillary microvasculature is feasible in the conscious newborn foal. The lower lip has the best measurement reproducibility. Further investigations are warranted in cardiovascularly compromised cases, particularly in septic foals.
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Affiliation(s)
- Francesca Freccero
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'Emilia (BO)Italy
| | | | - Jole Mariella
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'Emilia (BO)Italy
| | - Aliai Lanci
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'Emilia (BO)Italy
| | - Carolina Castagnetti
- Department of Veterinary Medical SciencesUniversity of BolognaOzzano dell'Emilia (BO)Italy,Health Science and Technologies Interdepartmental Center for Industrial Research (HST‐ICIR)University of BolognaBolognaItaly
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Mansour C, Chaaya R, Sredensek J, Mocci R, Santangelo B, Allaouchiche B, Bonnet-Garin JMM, Boselli E, Junot SA. Evaluation of the sublingual microcirculation with sidestream dark field video microscopy in horses anesthetized for an elective procedure or intestinal surgery. Am J Vet Res 2021; 82:574-581. [PMID: 34166089 DOI: 10.2460/ajvr.82.7.574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the sublingual microcirculation between healthy horses anesthetized for elective procedures and horses with colic anesthetized for abdominal surgery and to determine the effect of mean arterial blood pressure (MAP) on the microcirculation. ANIMALS 9 horses in the elective group and 8 horses in the colic group. PROCEDURES Sublingual microcirculation was assessed with sidestream dark field video microscopy. Videos were captured at 3 time points during anesthesia. Recorded microvasculature parameters were De Backer score (DBS), total density of perfused vessels (PVD) and small vessels (PVD-S), total proportion of perfused vessels (PPV) and small vessels (PPV-S), vascular flow index (MFI), and heterogeneity index (HI). Blood pressure during hypotensive (MAP < 60 mm Hg) and normotensive (MAP ≥ 60 mm Hg) episodes was also recorded. RESULTS During normotensive episodes, the elective group had significantly better PPV and PPV-S versus the colic group (median PPV, 76% vs 50%; median PPV-S, 73% vs 51%). In both groups, PPV decreased during anesthesia (elective group, -29%; colic group, -16%) but significantly improved in the elective group 15 minutes before the end of anesthesia (59%). During hypotensive episodes, PVD-S was better preserved in the colic group (11.1 vs 3.8 mm/mm2). No differences were identified for the microcirculatory parameters between normo- and hypotensive episodes in the colic group. CONCLUSIONS AND CLINICAL RELEVANCE Sublingual microcirculation was better preserved in healthy horses anesthetized for elective procedures than in horses with colic anesthetized for abdominal surgery despite resuscitation maneuvers. Results indicated that the macrocirculation and microcirculation in critically ill horses may be independent.
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Affiliation(s)
- Christelle Mansour
- From the APCSe Unit UPSP 2016.A101, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
| | - Rana Chaaya
- From the Department of Pharmacology, Faculty of Agronomy and Veterinary Medicine, Lebanese University, Beirut, Lebanon
| | - Jerneja Sredensek
- From the Anesthesia Service at the Veterinary Campus of Lyon, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
| | - Rita Mocci
- From the Anesthesia Service at the Veterinary Campus of Lyon, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
| | - Bruna Santangelo
- From the Anesthesia Service at the Veterinary Campus of Lyon, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
| | - Bernard Allaouchiche
- From the APCSe Unit UPSP 2016.A101, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
- From the Lyon University Hospital Center, ICU, 69310 Pierre-Bénite, France
| | | | - Emmanuel Boselli
- From the APCSe Unit UPSP 2016.A101, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
- From the Department of Anesthesia, Hospital Center Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - Stéphane A Junot
- From the APCSe Unit UPSP 2016.A101, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
- From the Anesthesia Service at the Veterinary Campus of Lyon, VetAgro Sup, University of Lyon, 69280 Marcy-l'Étoile, France
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Orr KE, Baker WT, Lynch TM, Hughes FE, Clark CK, Slone DE, Fogle CA, Gonzalez LM. Prognostic value of colonic and peripheral venous lactate measurements in horses with large colon volvulus. Vet Surg 2020; 49:472-479. [PMID: 31916608 DOI: 10.1111/vsu.13361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/01/2019] [Accepted: 11/13/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the prognostic value of (1) colonic venous lactate or peripheral lactate values obtained before and after manual correction of a large colon volvulus and (2) a combination of variables including pelvic flexure biopsy. STUDY DESIGN Prospective clinical study. ANIMALS Forty adult horses in which large colon volvulus was diagnosed intraoperatively. METHODS Colonic venous, peripheral venous, and arterial blood samples were collected to measure lactate values before and after manual correction. Mucosal biopsy samples were obtained in cases that underwent enterotomy or colonic resection and anastomosis. Interstitium to crypt (I:C) ratio and hemorrhage scores were measured. Optimal cutoff values were determined by receiver operator curve analysis, and associations between variables and short-term outcome were determined by univariable regression. Short-term survival was defined as horses being discharged from the hospital. P ≤ .05 was considered significant. RESULTS No association was found between colonic venous lactate values before (P = .011) or after (P = .201) manual correction of large colon volvulus and determination of short-term outcome. Peripheral venous lactate at admission ≥3.2 mmol/L and after manual correction ≥5 mmol/L, arterial lactate postmanual correction ≥3.53 mmol/L, and histomorphometric measurements of mucosal hemorrhage ≥3 and I:C ratio > 1 were associated with poor short-term outcome. CONCLUSION Peripheral lactate values, histomorphometric measures of I:C ratio, and hemorrhage score provided prognostic information that could help guide recommendations made to owners. CLINICAL SIGNIFICANCE Peripheral lactate values after manual correction provide important intraoperative diagnostic information to assist in predicting case outcome in the operative and immediately postoperative period.
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Affiliation(s)
- Kindra E Orr
- Peterson and Smith Equine Hospital, Ocala, Florida
| | - W True Baker
- Hagyard Equine Medical Institute, Lexington, Kentucky
| | - Tim M Lynch
- Peterson and Smith Equine Hospital, Ocala, Florida
| | | | | | | | - Callie A Fogle
- North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina
| | - Liara M Gonzalez
- North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina
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Gardner A, Dockery A, Quam V. Exploratory Celiotomy in the Horse Secondary to Acute Colic: A Review of Indications and Success Rates. Top Companion Anim Med 2019; 34:1-9. [PMID: 30808489 DOI: 10.1053/j.tcam.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/11/2022]
Abstract
To review indications and risk factors for exploratory celiotomy secondary to acute colic in the horse; decision making for and during surgery; and prognosis for return to function after exploratory celiotomy for the practicing veterinarian. Data sources included scientific reviews and original research publications from veterinary sources, as well as clinical data specifically in regard to underlying disease and survival rates from a tertiary referral hospital where exploratory celiotomy is commonly performed. There is a high positive predictive value of specific clinical preoperative parameters of the equine acute abdomen, many of which rely on techniques available to field practitioners, relative to the need for surgical intervention. Decision making regarding surgical procedure or even intraoperative euthanasia depends on owner expectations. Survival rates following exploratory celiotomy range from fair to excellent (60%-100%) depending on underlying lesion and return to athleticism following celiotomy is good to excellent (76%-90%). A knowledge base of indications for and rates of survival from colic requiring exploratory celiotomy in the horse is of paramount importance to the equine practitioner. Preconceived notions of poor survival rates are rampant among horse owners, and owners rely on their primary veterinarian's advice for continuation to referral center and in further treatment including exploratory celiotomy.
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du Preez S, Trope GD, Owens C, Hughes KJ. Volvulus of the large colon in a neonatal foal. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. du Preez
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - G. D. Trope
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - C. Owens
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - K. J. Hughes
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
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Burke M, Blikslager A. Advances in Diagnostics and Treatments in Horses with Acute Colic and Postoperative Ileus. Vet Clin North Am Equine Pract 2018; 34:81-96. [PMID: 29402479 DOI: 10.1016/j.cveq.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Differentiating between medical and surgical causes of colic is one of the primary goals of the colic workup, because early surgical intervention improves prognosis in horses requiring surgery. Despite the increasing availability of advanced diagnostics (hematologic analyses, abdominal ultrasound imaging, etc), the most accurate indicators of the need for surgery remain the presence of moderate to severe signs of abdominal pain, recurrence of pain after appropriate analgesic therapy, and the absence of intestinal borborygmi. Investigation of novel biomarkers, which may help to differentiate surgical lesions from those that can be managed medically, continues to be an active area of research.
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Affiliation(s)
- Megan Burke
- NC State Veterinary Hospital, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA.
| | - Anthony Blikslager
- NC State Veterinary Hospital, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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Diseases of the Alimentary Tract. Vet Med (Auckl) 2017. [PMCID: PMC7167529 DOI: 10.1016/b978-0-7020-5246-0.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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