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Kim D, Seo M, Choi G, Lee SK, Lee S, Lee WJ, Yun SH, Kwon YS, Jang M. Cardiovascular and Respiratory Effects of Increased Intra-Abdominal Pressure with and without Dexmedetomidine in Anesthetized Dogs. Vet Sci 2023; 10:634. [PMID: 37999457 PMCID: PMC10675810 DOI: 10.3390/vetsci10110634] [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: 08/07/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Intra-abdominal pressure (IAP) elevation during capnoperitoneum can cause adverse cardiovascular and respiratory effects. This study aimed to determine if a sequentially increased IAP affects cardiovascular and respiratory variables in anesthetized dogs and evaluate the effects of the constant-rate infusion of dexmedetomidine (Dex) on cardiovascular and respiratory variables with increased IAP. Five dogs were anesthetized and instrumented, and a Veress needle was equipped to adjust the IAP using a carbon dioxide insufflator. Stabilization was conducted for 1 h, and physiological variables were measured at IAPs of 0, 5, 10, 15, and 20 mmHg and after desufflation. After the washout period, the dogs underwent similar procedures along with a constant-rate infusion of dexmedetomidine. The cardiovascular effects of increased IAP up to 20 mmHg were not significant in healthy beagle dogs and those administered with dexmedetomidine. When comparing the control and dexmedetomidine groups, the overall significant effects of dexmedetomidine were noted on heart rate, cardiac output, and systemic vascular resistance during the experiment. Respiratory effects were not observed during abdominal insufflation when compared between different IAPs and between the two groups. Overall, an increased IAP of up to 20 mmHg did not significantly affect cardiovascular and respiratory variables in both the control and dexmedetomidine groups. This study suggests that the administration of a dexmedetomidine infusion is applicable in laparoscopic procedures in healthy dogs.
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Affiliation(s)
- Dongseok Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Minjun Seo
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Geonho Choi
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Sang-Kwon Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Sungin Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea;
| | - Won-Jae Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Sung-Ho Yun
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Young-Sam Kwon
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
| | - Min Jang
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea; (D.K.); (G.C.); (S.-K.L.); (W.-J.L.); (S.-H.Y.); (Y.-S.K.)
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McCready JE, Sanchez A, Tisotti T, Beaufrère H. Some cardiopulmonary effects of capnoperitoneum in anesthetized guinea pigs (Cavia porcellus): spontaneous ventilation versus intubation and mechanical ventilation. Vet Anaesth Analg 2023; 50:72-80. [PMID: 36435693 DOI: 10.1016/j.vaa.2022.10.002] [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: 02/04/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare cardiopulmonary variables and blood gas analytes in guinea pigs (Cavia porcellus) during anesthesia with and without abdominal carbon dioxide (CO2) insufflation at intra-abdominal pressures (IAPs) 4 and 6 mmHg, with and without endotracheal intubation. STUDY DESIGN Prospective experimental trial. ANIMALS A total of six intact female Hartley guinea pigs. METHODS A crossover study with sequence randomization for IAP and intubation status was used. The animals were sedated with intramuscular midazolam (1.5 mg kg-1) and buprenorphine (0.2 mg kg-1) and anesthetized with isoflurane, and an abdominal catheter was inserted for CO2 insufflation. Animals with endotracheal intubation were mechanically ventilated and animals maintained using a facemask breathed spontaneously. After 15 minutes of insufflation, the following variables were obtained at each IAP: pulse rate, respiratory rate, rectal temperature, oxygen saturation, end-tidal CO2 (intubated only), peak inspiratory pressure (intubated only), noninvasive blood pressure and blood gas and electrolyte values, with a rest period of 5 minutes between consecutive IAPs. After 4 weeks, the procedure was repeated with the guinea pigs assigned the opposite intubation status. RESULTS Intubated guinea pigs had significantly higher pH and lower partial pressure of CO2 in cranial vena cava blood (PvCO2) than nonintubated guinea pigs. An IAP of 6 mmHg resulted in a significantly higher PvCO2 (65.9 ± 19.0 mmHg; 8.8 ± 2.5 kPa) than at 0 (53.2 ± 17.2 mmHg; 7.1 ± 2.3 kPa) and 4 mmHg (52.6 ± 10.8 mmHg; 7.01 ± 1.4 kPa), mean ± standard deviation, with intubated and nonintubated animals combined. CONCLUSIONS AND CLINICAL RELEVANCE Although the oral anatomy of guinea pigs makes endotracheal intubation difficult, capnoperitoneum during anesthesia induces marked hypercapnia in the absence of mechanical ventilation. An IAP of 4 mmHg should be further evaluated for laparoscopic procedures in guinea pigs because hypercapnia may be less severe than with 6 mmHg.
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Affiliation(s)
- Julianne E McCready
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
| | - Andrea Sanchez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Tainor Tisotti
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Hugues Beaufrère
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada; Department of Veterinary Medicine and Epidemiology, University of California Davis, School of Veterinary Medicine, Davis, CA, USA
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Fernández-Martín S, Valiño-Cultelli V, González-Cantalapiedra A. Laparoscopic versus Open Ovariectomy in Bitches: Changes in Cardiorespiratory Values, Blood Parameters, and Sevoflurane Requirements Associated with the Surgical Technique. Animals (Basel) 2022; 12:ani12111438. [PMID: 35681900 PMCID: PMC9179476 DOI: 10.3390/ani12111438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to examine the cardiorespiratory and blood changes associated with pneumoperitoneum (PNP) in laparoscopic ovariectomy (LAP Ove), as well as sevoflurane requirements, comparing them to those determined in open surgery (LPT Ove). The study was performed in 16 bitches submitted to LAP or LPT Ove. The cardiorespiratory and end-tidal sevoflurane concentration values were recorded as follows: at the beginning of surgery (T1), after the right ovary resection (T2), after the left ovary resection (T3), and after surgical closure (T4). Blood samples were taken before and after PNP. Among the cardiorespiratory parameters, no differences were observed in the values of end-tidal CO2, minute volume, and heart rate. In the LAP Ove group, a significant increase in inspiratory pressures and a decreased compliance were identified at T2 and T3. Significant higher arterial pressure values were observed in both groups at T2 and T3, with this increase especially marked at T2 in the LPT Ove group. Sevoflurane requirements were significantly higher in the LPT group during ovarian resection. Finally, in terms of the hematochemical parameters, statistical differences were recorded between pre- and post-operative assessments, but not between both surgical groups. The pathophysiological effects associated with PNP seemed to be transient and well-tolerated by healthy dogs.
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Affiliation(s)
- Silvia Fernández-Martín
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
- Correspondence:
| | - Victoria Valiño-Cultelli
- Department of Anatomy, Animal Production and Veterinary Clinical Sciences, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
| | - Antonio González-Cantalapiedra
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
- Department of Anatomy, Animal Production and Veterinary Clinical Sciences, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
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Beazley S, Focken A, Fernandez-Parra R, Thomas K, Adler A, Duke-Novakovski T. Evaluation of lung ventilation distribution using electrical impedance tomography in standing sedated horses with capnoperitoneum. Vet Anaesth Analg 2022; 49:382-389. [DOI: 10.1016/j.vaa.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
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Munsterman AS, Gillen AM, Coleridge MOD, Hanson RR. Evaluation of the effects of medial saphenous venous pressures as an indirect method of measurement of intra-abdominal pressures in the horse. J Vet Emerg Crit Care (San Antonio) 2020; 30:660-669. [PMID: 33030803 DOI: 10.1111/vec.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 12/17/2018] [Accepted: 02/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the effect of changes in intra-abdominal pressure (IAP) on medial saphenous venous pressure (MSVP) and hemodynamics in normal horses. DESIGN Experimental, in-vivo study. SETTING University Teaching Hospital. ANIMALS Convenience sample of 7 mixed breed horses; 5 geldings, and 2 mares. INTERVENTIONS Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20 mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intra-abdominal hypertension. The MSVP and vital parameters were recorded, along with direct arterial blood pressure from the transverse facial artery. MEASUREMENTS AND MAIN RESULTS As IAP increased, MSVP increased in a stepwise manner, in concert with changes in IAP. The consistency in measurement between MSVP and IAP was high (intraclass correlation coefficient = 0.92; P < 0.001) and repeated measures correlation was excellent (r = 0.98; P < 0.001). Heart rate was unchanged over the course of the experiment (P = 0.09), however, respiratory rate increased with increasing IAP (P < 0.001). Arterial blood pressure also increased with insufflation (P < 0.001), with a significant difference at an IAP of 15 mm Hg (P = 0.04). CONCLUSIONS This report provides preliminary data demonstrating a strong correlation between equine MSVP and changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this relationship, and to confirm these results in clinical patients.
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Affiliation(s)
- Amelia S Munsterman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Alexandra M Gillen
- The Philip Leverhulme Equine Hospital, University of Liverpool, Chester High Road, Neston, Cheshire, United Kingdom
| | | | - R Reid Hanson
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
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Pressure-Volume Curve during Capnoperitoneum in Cats. Animals (Basel) 2020; 10:ani10081408. [PMID: 32823512 PMCID: PMC7459975 DOI: 10.3390/ani10081408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022] Open
Abstract
Laparoscopy is a growing field in veterinary medicine, although guidelines are lacking. The objective of this study was to evaluate the pressure-volume curve during capnoperitoneum in cats. A total of 59 female cats were scheduled for routine laparoscopy. Pressure and volume data were recorded and processed, and the yield point of the curve was calculated using a method based on a capacitor discharging function. For the remaining 40 cats, a linear-like pressure-volume curve was observed until a yield point with a mean cutoff pressure (COP) of 6.44 ± 1.7 mmHg (SD) (range, 2.72-13.00 mmHg) and a mean cutoff volume (COV) of 387 ± 144.35 mL (SD) (range, 178.84-968.43 mL) was reached. The mean mL/kg CO2 value in cats was 208 ± 34.69 mL/kg (range, 100.00-288.46 mL/kg). The COV correlated with COP and body weight but not with body condition score (BCS). COP correlated only with the COV. This study suggests that feline patients have a pressure-volume curve similar to that of canine patients, and the same pressure limit recommendations can be used for both species. After a yield point of 6.44 mmHg is reached, the increment in volume decreases exponentially as the intra-abdominal pressure (IAP) increases.
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Scott J, Singh A, Valverde A. Pneumoperitoneum in Veterinary Laparoscopy: A Review. Vet Sci 2020; 7:E64. [PMID: 32408554 PMCID: PMC7356543 DOI: 10.3390/vetsci7020064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO2 insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO2 insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.
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Affiliation(s)
- Jacqueline Scott
- College of Veterinary Medicine, University of Illinois, Urbana-Champaign, IL 61802, USA
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (A.S.); (A.V.)
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (A.S.); (A.V.)
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Son H, Ko J, Jeong J, Lee S, Sihn D, Kweon OK, Kim WH. Cardiopulmonary changes induced by retroperitoneal insufflation in healthy dogs in sternal recumbency with the abdomen unsupported. J Vet Med Sci 2019; 82:94-100. [PMID: 31801923 PMCID: PMC6983665 DOI: 10.1292/jvms.19-0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study assessed the effects of retroperitoneal carbon dioxide (CO2) insufflation on cardiopulmonary variables and intra-abdominal pressure (IAP) in mechanically ventilated dogs in sternal recumbency with the abdomen unsupported, following placement of a positioning kit and towels under the pectoral and pelvic regions. General anesthesia was induced in eight healthy adult male Beagles. A Swan-Ganz catheter was placed in the pulmonary artery via the jugular vein for cardiac output measurements. A Foley urethral catheter was placed to monitor transvesical IAP. A 10 mm balloon blunt-tip trocar was inserted into the retroperitoneal space. With a fixed respiratory rate and tidal volume by mechanical ventilation, insufflation pressure was sequentially increased from 0 to 10 mmHg in 5 mmHg increments, followed by desufflation. All variables were measured before insufflation, 5 min after the establishment of each insufflation pressure, and after desufflation. At 10 mmHg, the IAP was nearly equal to insufflation pressure. Cardiopulmonary function was not compromised at any point, although the cardiac index (CI), heart rate, mean arterial pressure (MAP), and mean pulmonary arterial pressure increased within normal ranges. End-tidal CO2 concentration, arterial CO2 partial pressure, and oxygen delivery index (DO2I) increased, whereas pH decreased, at 10 mmHg. CI, MAP, and DO2I did not recover to baseline after decompression. Thus, retroperitoneal CO2 insufflation up to 10 mmHg is well tolerated by mechanically ventilated dogs positioned in sternal recumbency with the abdomen unsupported, although sympathetic changes may occur with an insufflation pressure increase.
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Affiliation(s)
- Hyunglak Son
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jonghyeok Ko
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Junemoe Jeong
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Sungin Lee
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Dongmin Sihn
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Wan Hee Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
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Mariano R, Uscategu R, Nociti R, Barros F, Santos V, Coutinho L, Padilha-Nakaghi L, Silva P, Teixeira P, Vicente WR. Comparison of two surgical approaches for Laparoscopic Ovum Pick Up in Ewes. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The present study had as an aim to evaluate a right lateral access as an alternative method to laparoscopic ovum pick-up (LOPU) in sheep. Twenty-four Santa Ines ewes were randomly assigned in two groups with twelve animals each: RLD - positioned in right lateral decubitus, with 10º head-down tilt; and DD - positioned in dorsal decubitus with 35º head-down tilt. The following parameters were evaluated every 10 minutes during the procedure: total surgical time (ST), visualized follicles (VF), aspirated follicles (AF), recovered oocytes (RO), mean arterial pressure (MAP), heart rate (HR), respiratory rate (fR) and end tidal CO2 pressure (EtCO2). Pre and postoperative arterial hemogasometry parameters (PaO2, PaCO2, pH, CHCO3 and BE) were also evaluated; and serum fibrinogen levels (SFL) on postoperative period. The values of VF, AF, RO, fR, PaO2, pH, CHCO3, BE and SFL were similar between groups, although ST, HR, MAP, EtCO2 and PaCO2 were higher in LG. Regarding operative periods, PaO2 and pH were lower after surgery (PaO2: 79.1±16.4; 79.2±11.7mmHg; pH: 7.30±0.09; 7.32±0.08) in both groups when compared to preoperative (PaO2: 80.1±14.3; 83.4±10.5 mmHg; pH: 7.38±0.05; 7.39±0.05) while PaCO2 (43.6±4.6; 41.9±5.4mmHg) and CHCO3 (22.8±1.5; 22.7±3.0mmol/L) increased (PaCO2: 54.3±10.9; 46.9±6.3mmHg; CHCO3: 24.8±3.4; 24.4±2.7mmol/L) postoperative. This alternative decubitus presented is a viable procedure and did not differ in oocyte recovery rates in ewes. However, entails cardiorespiratory major alterations compared to conventional procedure, making its practical applicability limited.
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Affiliation(s)
| | - R.A.R. Uscategu
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Brazil
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Di Bella C, Lacitignola L, Fracassi L, Skouropoulou D, Crovace A, Staffieri F. Pulse Pressure Variation Can Predict the Hemodynamic Response to Pneumoperitoneum in Dogs: A Retrospective Study. Vet Sci 2019; 6:vetsci6010017. [PMID: 30791578 PMCID: PMC6466147 DOI: 10.3390/vetsci6010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/25/2022] Open
Abstract
Pneumoperitoneum may induce important hemodynamic alterations in healthy subjects. Pulse pressure variation (PPV) is a hemodynamic parameter able to discriminate preload dependent subjects. Anesthesia records of dogs undergoing laparoscopy were retrospectively evaluated. The anesthetic protocol included acepromazine, methadone, propofol and isoflurane administered with oxygen under mechanical ventilation. The hemodynamic parameters were considered five minutes before (BASE) and ten minutes after (P10) the pneumoperitoneum. Based on the cardiac index (CI) variation, at P10, dogs were classified as sensitive (S group, CI ≤ 15%) and non-sensitive (NO-S group). Data were analyzed with the ANOVA test and the ROC curve (p < 0.05). Fifty-five percent of dogs (S) had a reduction of CI ≥ 15% at P10 (2.97 ± 1.4 L/min/m2) compared to BASE (4.32 ± 1.62 L/min/m2) and at P10 in the NO-S group (4.51 ± 1.41 L/min/m2). PPV at BASE was significantly higher in the S group (22.4% ± 6.1%) compared to the NO-S group (10.9% ± 3.3%). The ROC curve showed a threshold of PPV > 16% to distinguish the S and NO-S groups. PPV may be a valid predictor of the hemodynamic response to pneumoperitoneum in dogs. A PPV > 16% can identify patients that may require fluid administration before the creation of pneumoperitoneum.
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Affiliation(s)
- Caterina Di Bella
- PhD Course in Tissues and Organs Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70010 Bari, Italy.
| | - Luca Lacitignola
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari, Italy.
| | - Laura Fracassi
- PhD Course in Tissues and Organs Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70010 Bari, Italy.
| | - Despoina Skouropoulou
- PhD Course in Tissues and Organs Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70010 Bari, Italy.
| | - Antonio Crovace
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari, Italy.
| | - Francesco Staffieri
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari, Italy.
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Scott JE, Singh A, Valverde A, Blois SL, Foster RA, Kilkenny JJ, Linden AZ. Effect of pneumoperitoneum with warmed humidified or standard-temperature carbon dioxide during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs. Am J Vet Res 2019; 79:1321-1334. [PMID: 30457909 DOI: 10.2460/ajvr.79.12.1321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate effects of pneumoperitoneum created with warmed humidified CO2 (WHCO2) during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs. ANIMALS 6 mature purpose-bred dogs. PROCEDURES In a randomized crossover study, each dog was anesthetized twice, and pneumoperitoneum was created with standard-temperature CO2 (STCO2; 22°C and 0% relative humidity) and WHCO2 (37°C and 98% relative humidity). Data were collected during each procedure, including core body temperature, cardiorespiratory and thromboelastography variables, and inflammatory biomarkers. Peritoneal biopsy specimens were collected and evaluated with scanning electron microscopy. Dogs were assessed for signs of postoperative pain. RESULTS Mean core body temperature was significantly lower (35.2°C; 95% confidence interval, 34.5° to 35.8°C) with WHCO2 than with STCO2 (35.9°C; 95% confidence interval, 35.3° to 36.6°C) across all time points. Cardiac index increased during the procedure for both treatments but was not significantly different between treatments. Thromboelastography variables did not differ significantly between treatments as indicated by the coagulation index. Subjective evaluation of peritoneal biopsy specimens revealed mesothelial cell loss with STCO2. There was no significant difference in circulating C-reactive protein or interleukin-6 concentrations. There was a significant increase in the number of postoperative pain scores > 0 for the WHCO2 treatment versus the STCO2 treatment. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of these data suggested that effects on evaluated variables attributable to the use of WHCO2 for creating pneumoperitoneum in healthy mature dogs undergoing laparoscopy did not differ from effects for the use of STCO2.
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Di Bella C, Lacitignola L, Grasso S, Centonze P, Greco A, Ostuni R, Crovace A, Staffieri F. An alveolar recruitment maneuver followed by positive end-expiratory pressure improves lung function in healthy dogs undergoing laparoscopy. Vet Anaesth Analg 2018; 45:618-629. [DOI: 10.1016/j.vaa.2018.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/27/2018] [Accepted: 03/07/2018] [Indexed: 01/16/2023]
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Asthana R, Oblak ML, Singh A, Mutsaers AJ. In vitro evaluation of a simulated pneumoperitoneum environment using carbon dioxide on canine transitional cell carcinoma. Vet Surg 2018; 47:412-420. [DOI: 10.1111/vsu.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/29/2017] [Accepted: 01/09/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Rashi Asthana
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Michelle L. Oblak
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Ameet Singh
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Anthony J. Mutsaers
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
- Department of Biomedical Sciences; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
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Dorn MJ, Bockstahler BA, Dupré GP. Influence of body weight and body conformation on the pressure-volume curve during capnoperitoneum in dogs. Am J Vet Res 2017; 78:631-637. [PMID: 28441048 DOI: 10.2460/ajvr.78.5.631] [Citation(s) in RCA: 5] [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 evaluate the pressure-volume relationship during capnoperitoneum in dogs and effects of body weight and body conformation. ANIMALS 86 dogs scheduled for routine laparoscopy. PROCEDURES Dogs were allocated into 3 groups on the basis of body weight. Body measurements, body condition score, and body conformation indices were calculated. Carbon dioxide was insufflated into the abdomen with a syringe, and pressure was measured at the laparoscopic cannula. Volume and pressure data were processed, and the yield point, defined by use of a cutoff volume (COV) and cutoff pressure (COP), was calculated. RESULTS 20 dogs were excluded because of recording errors, air leakage attributable to surgical flaws, or trocar defects. For the remaining 66 dogs, the pressure-volume curve was linear-like until the yield point was reached, and then it became visibly exponential. Mean ± SD COP was 5.99 ± 0.805 mm Hg. No correlation was detected between yield point, body variables, or body weight. Mean COV was 1,196.2 ± 697.9 mL (65.15 ± 20.83 mL of CO2/kg), and COV was correlated significantly with body weight and one of the body condition indices but not with other variables. CONCLUSION AND CLINICAL RELEVANCE In this study, there was a similar COP for all dogs of all sizes. In addition, results suggested that increasing the abdominal pressure after the yield point was reached did not contribute to a substantial increase in working space in the abdomen. No correlation was found between yield point, body variables, and body weight.
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Quirós-Carmona S, Navarrete R, Domínguez JM, Granados MDM, Gómez-Villamandos RJ, Muñoz-Rascón P, Aguilar D, Funes FJ, Morgaz J. A comparison of cardiopulmonary effects and anaesthetic requirements of two dexmedetomidine continuous rate infusions in alfaxalone-anaesthetized Greyhounds. Vet Anaesth Analg 2017; 44:228-236. [PMID: 28190788 DOI: 10.1016/j.vaa.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/13/2016] [Accepted: 03/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the effects of two dexmedetomidine continuous rate infusions on the minimum infusion rate of alfaxalone for total intravenous anaesthesia (TIVA), and subsequent haemodynamic and recovery effects in Greyhounds undergoing laparoscopic ovariohysterectomy. STUDY DESIGN Prospective, randomized and blinded clinical study. ANIMALS Twenty-four female Greyhounds. METHODS Dogs were premedicated with dexmedetomidine 3 μg kg-1 and methadone 0.3 mg kg-1 intramuscularly. Anaesthesia was induced with IV alfaxalone to effect and maintained with a TIVA mixture of alfaxalone in combination with two different doses of dexmedetomidine (0.5 μg kg-1 hour-1 or 1 μg kg-1 hour-1; groups DEX0.5 and DEX1, respectively). The alfaxalone starting dose rate was 0.07 mg kg-1 minute-1 and was adjusted (± 0.02 mg kg-1 minute-1) every 5 minutes to maintain a suitable depth of anaesthesia. A rescue alfaxalone bolus (0.5 mg kg-1 IV) was administered if dogs moved or swallowed. The number of rescue boluses was recorded. Heart rate, arterial blood pressure and arterial blood gas were monitored. Qualities of sedation, induction and recovery were scored. Differences between groups were tested for statistical significance using a Student's t test or Mann-Whitney U test as appropriate. RESULTS There were no differences between groups in sedation, induction and recovery quality, the median (range) induction dose of alfaxalone [DEX0.5: 2.2 (1.9-2.5) mg kg-1; DEX1: 1.8 (1.2-2.9) mg kg-1], total dose of alfaxalone rescue boluses [DEX0.5: 21.0 (12.5-38.8) mg; DEX1: 22.5 (15.5-30.6) mg] or rate of alfaxalone (DEX0.5: 0.12±0.04 mg kg-1 minute-1; DEX1: 0.12±0.03 mg kg-1 minute-1). CONCLUSIONS AND CLINICAL RELEVANCE Co-administration of dexmedetomidine 1 μg kg-1 hour-1 failed to reduce the dose rate of alfaxalone compared with dexmedetomidine 0.5 μg kg-1 hour-1 in Greyhounds undergoing laparoscopic ovariohysterectomy. The authors recommend an alfaxalone starting dose rate of 0.1 mg kg-1 minute-1. Recovery quality was good in the majority of dogs.
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Affiliation(s)
- Setefilla Quirós-Carmona
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain.
| | - Rocío Navarrete
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Juan M Domínguez
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - María Del Mar Granados
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Rafael J Gómez-Villamandos
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Pilar Muñoz-Rascón
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Daniel Aguilar
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Francisco J Funes
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - Juan Morgaz
- Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain
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Duke T, Cruz AM, Cruz JI, Howden KJ. Cardiopulmonary effects associated with head-down position in halothane-anesthetized ponies with or without capnoperitoneum. Vet Anaesth Analg 2016; 29:76-89. [PMID: 28404303 DOI: 10.1046/j.1467-2995.2002.00077.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2000] [Accepted: 06/29/2001] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the cardiopulmonary effects of the head-down position, with or without capnoperitoneum, in halothane-anesthetized horses. STUDY DESIGN Prospective randomized study. ANIMALS Five ponies (four mares, one stallion; bodyweight 302 ± 38.4 kg [mean ± SD]) were used. METHODS The ponies were anesthetized with xylazine, guiafenesin, ketamine, and maintained with halothane/oxygen and lungs were ventilated to 40 ± 2 mm Hg (5.3 ± 0.3 kPa) end-tidal CO2 tension. After baseline cardiopulmonary measurements, ponies were kept in horizontal position for 30 minutes, then tilted head-down 30° to the horizontal position for 60 minutes, and then returned to a horizontal position for final measurements. Capnoperitoneum (intra-abdominal pressure: 12 mm Hg [1.6 kPa]) was introduced after baseline cardiopulmonary measurements, until 5 minutes before the final measurements (treatment INS). Ponies in the control treatment (CON) did not receive capnoperitoneum. Cardiopulmonary data were collected every 10 minutes following the baseline measurements until recovery. RESULTS In the head-down position, in both treatments, significant decreases were observed in PaO2, and significant increases were observed in PaCO2, right atrial blood pressure, arterial to end-tidal CO2 gradient, calculated Vd/Vt and Q˙s/Q˙t ratios. During the head-down position, in CON there was decreased cardiac index, and in INS, there were decreases in arterial plasma pH and increases in mean systemic arterial and airway pressures. Treatment INS developed ventilation-perfusion mismatch earlier in the study, and had longer recovery times compared to CON. CONCLUSION Cardiac index and systemic blood pressure appeared to be preserved in INS during the head-down position, but ventilation-perfusion mismatch appeared earlier with head-down position and capnoperitoneum. CLINICAL RELEVANCE Healthy ponies tolerate capnoperitoneum at 12 mm Hg (1.6 kPa) intra-abdominal pressure when tilted head down 30° to the horizontal position.
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Affiliation(s)
- Tanya Duke
- Department of Veterinary Anesthesiology, Radiology and Surgery, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Antonio M Cruz
- Department of Veterinary Anesthesiology, Radiology and Surgery, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J Ignacio Cruz
- Department of Veterinary Anesthesiology, Radiology and Surgery, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Krista J Howden
- Department of Veterinary Anesthesiology, Radiology and Surgery, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kennedy KC, Fransson BA, Gay JM, Roberts GD. Comparison of Pneumoperitoneum Volumes in Lift Laparoscopy With Variable Lift Locations and Tensile Forces. Vet Surg 2015; 44 Suppl 1:83-90. [DOI: 10.1002/vsu.12306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Katie C. Kennedy
- Department of Veterinary Clinical Sciences; Washington State University; Veterinary Clinical Sciences; Pullman Washington
| | - Boel A. Fransson
- Department of Veterinary Clinical Sciences; Washington State University; Veterinary Clinical Sciences; Pullman Washington
| | - John M. Gay
- Department of Veterinary Clinical Sciences; Washington State University; Veterinary Clinical Sciences; Pullman Washington
| | - Gregory D. Roberts
- Department of Veterinary Clinical Sciences; Washington State University; Veterinary Clinical Sciences; Pullman Washington
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Park YT, Okano S. Influence of pneumoperitoneum and postural change on the cardiovascular and respiratory systems in dogs. J Vet Med Sci 2015; 77:1223-6. [PMID: 26027843 PMCID: PMC4638287 DOI: 10.1292/jvms.14-0687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated the influence of pneumoperitoneum#(PP) and postural change under inhalation anesthesia with isoflurane, which is routinely used in dogs, on the cardiovascular and respiratory systems. As test animals, 6 adult beagles were used. To induce anesthesia, atropine, butorphanol and propofol were intravenously injected. Anesthesia was maintained with 1.3 MAC (1.7%) isoflurane. The following were the experiment conditions: I:E ratio, 1:1.9; tidal air exchange, 20 ml/kg; and ventilation frequency, 14 times/min. Respiration was regulated so that the PaCO2 was approximately 35 to 40 mmHg before the start of the experiment. PP with CO2 (intraperitoneal pressure 15 mmHg) and a postural change (15°C) was performed during the experiment. As parameters of circulatory kinetics, heart rate (HR), mean aortic pressure (MAP), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP), femoral venous pressure (FVP) and cardiac output (CO) were measured. As parameters of respiratory kinetics, airway pressure (PAW) and blood gas (BG) were measured. There were significant increases in HR, MAP, MPAP, CVP, FVP, CO, PAW and PaCO2 after PP in the horizontal position. There were significant increases in CVP, FVP, PAW and PaCO2 after PP in the Trendelenburg position. There were significant increases in the MPAP, CVP, FVP, PAW and PaCO2 after PP in the inverse Trendelenburg position. There was a significant difference in FVP after PP between the Trendelenburg position and inverse Trendelenburg position. The results of this experiment suggest that appropriate anesthesia control, such as changing the ventilation conditions after PP, is required for laparoscopic surgery under inhalation anesthesia with isoflurane.
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Affiliation(s)
- Young Tae Park
- Laboratory of Small Animal Surgery, Kitasato University, 35-1, Higashi 23-bancho, Towada, Aomori 034-8628, Japan
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Shih AC, Case JB, Coisman JG, Isaza NM, Amora-Junior D, Maisenbacher HW. Cardiopulmonary Effects of Laparoscopic Ovariectomy of Variable Duration in Cats. Vet Surg 2014; 44 Suppl 1:2-6. [PMID: 25164690 DOI: 10.1111/j.1532-950x.2014.12241.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the cardiopulmonary effects of low-pressure (6 mmHg) peritoneal insufflation of varying duration in healthy cats during ovariectomy (OVE). STUDY DESIGN Prospective, randomized study. ANIMALS Female cats (n = 24). METHODS After anesthesia induction, cats had short (Short LAP; n = 8) or long duration (Long LAP; n = 8) laparoscopic ovariectomy, or Open OVE (Open; n = 8) for comparison. Hemodynamic and pulmonary measurements were recorded after induction of anesthesia (T0), 5 minutes after abdominal insufflation had reached 6 mmHg of pressure (T1), after the 2nd ovary had been resected (T2), after abdominal decompression (T3), and at the end of anesthesia, after abdominal closure (T4). Hemodynamic and pulmonary variables were compared between groups. RESULTS Low-pressure abdominal insufflation caused cardiopulmonary changes in cats. At T1 and T2, Long LAP and Short LAP caused a significant change in PvCO2 and RC when compared with Open. During T3, RC was lower only in Long LAP. At T2, there was decrease in SV, but not CO for Long LAP when compared with Open. CONCLUSIONS Duration of insufflation was associated with worsening of negative cardiopulmonary effects; however, these effects were reversible and resolved by the end of the procedure.
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Affiliation(s)
- Andre C Shih
- Department of Large Animal, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - James G Coisman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Natalie M Isaza
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Dorli Amora-Junior
- Department de Medicina Veterinaria, University of Parana, Parana, Brazil
| | - Herbert W Maisenbacher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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Fransson BA, Grubb TL, Perez TE, Flores K, Gay JM. Cardiorespiratory Changes and Pain Response of Lift Laparoscopy Compared to Capnoperitoneum Laparoscopy in Dogs. Vet Surg 2014; 44 Suppl 1:7-14. [DOI: 10.1111/j.1532-950x.2014.12198.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/01/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Boel A. Fransson
- Washington State University, Department of Veterinary Clinical Sciences; Pullman Washington
| | - Tamara L. Grubb
- Washington State University, Department of Veterinary Clinical Sciences; Pullman Washington
| | - Tania E. Perez
- Washington State University, Department of Veterinary Clinical Sciences; Pullman Washington
| | - Krystina Flores
- Washington State University, Department of Veterinary Clinical Sciences; Pullman Washington
| | - John M. Gay
- Washington State University, Department of Veterinary Clinical Sciences; Pullman Washington
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Abstract
Practical relevance: Laparoscopic surgery minimizes tissue trauma and speeds recovery, but its uptake into veterinary clinical practice has been slow. Clinical challenges: Laparoscopy is distinctly different from traditional open surgery and a reduced working area and loss of depth perception are among the challenges that the surgeon must get to grips with. Indeed, it is often lack of the necessary skills, rather than the cost of equipment, that presents the greatest obstacle. Audience: This article is aimed at practitioners keen to embrace minimally invasive surgery and advises on how to develop excellence in laparoscopic skills. It makes the case for simulation training and outlines methods that can be instituted in practice at low cost and with comparatively little time expenditure. It also describes technological advances that have already increased the success of veterinary ‘keyhole’ surgery, as well as those that look promising for the future. Evidence base: Simulation training has been an intense area of research and publication within the past 15 years. This article draws on that evidence base and the experience gained by the author and her research team, which is at the forefront of efforts to develop laparoscopic training for veterinarians.
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Mayhew PD, Pascoe PJ, Kass PH, Shilo-Benjamini Y. Effects of pneumoperitoneum induced at various pressures on cardiorespiratory function and working space during laparoscopy in cats. Am J Vet Res 2013; 74:1340-6. [DOI: 10.2460/ajvr.74.10.1340] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bart Van G, Sebastiaan Alexander van N, Ies A, Joanna Claire M, Kirpensteijn J. The Effect of Neuromuscular Blockade on Canine Laparoscopic Ovariectomy: A Double-Blinded, Prospective Clinical Trial. Vet Surg 2012; 41:374-80. [DOI: 10.1111/j.1532-950x.2011.00962.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Goethem Bart Van
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Yalelaan 108 3584CM Utrecht The Netherlands
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McClaran JK, Buote NJ. Complications and Need for Conversion to Laparotomy in Small Animals. Vet Clin North Am Small Anim Pract 2009; 39:941-51. [DOI: 10.1016/j.cvsm.2009.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duerr FM, Twedt DC, Monnet E. Changes in pH of peritoneal fluid associated with carbon dioxide insufflation during laparoscopic surgery in dogs. Am J Vet Res 2008; 69:298-301. [PMID: 18241030 DOI: 10.2460/ajvr.69.2.298] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate changes in pH of peritoneal fluid associated with CO2 insufflation during laparoscopy in dogs. ANIMALS 13 client-owned dogs and 10 purpose-bred teaching dogs. PROCEDURES Laparotomy was performed on control dogs; peritoneal fluid pH was measured at time of incision of the abdominal cavity (time 0) and 30 minutes later. Laparoscopic insufflation with CO2 was performed and routine laparoscopic procedures conducted on the teaching dogs. Insufflation pressure was limited to 12 mm Hg. Intraperitoneal fluid pH was measured by use of pH indicator paper at 4 time points. Arterial blood gas analysis was performed at the same time points. RESULTS Peritoneal fluid pH did not change significantly between 0 and 30 minutes in the control dogs. For dogs with CO2 insufflation, measurements obtained were a mean of 8.5, 24.5, 44.5, and 72.0 minutes after insufflation. The pH of peritoneal fluid decreased significantly between the first (7.825 +/- 0.350) and second (7.672 +/- 0.366) time point. Blood pH decreased significantly between the first (7.343 +/- 0.078), third (7.235 +/- 0.042), and fourth (7.225 +/- 0.038) time points. The PaCO2 increased significantly between the first (39.9 +/- 9.8 mm Hg) and fourth (54.6 +/- 4.4 mm Hg) time points. Base excess decreased significantly between the first and all subsequent time points. CONCLUSIONS AND CLINICAL RELEVANCE Pneumoperitoneum attributable to CO2 insufflation caused a mild and transient decrease in peritoneal fluid pH in dogs. Changes in peritoneal fluid associated with CO2 insufflation in dogs were similar to those in other animals.
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Affiliation(s)
- Felix M Duerr
- Department of Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Hewitt SA, Brisson BA, Sinclair MD, Sears WC. Comparison of cardiopulmonary responses during sedation with epidural and local anesthesia for laparoscopic-assisted jejunostomy feeding tube placement with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical jejunostomy feeding tube placement in healthy dogs. Am J Vet Res 2007; 68:358-69. [PMID: 17397290 DOI: 10.2460/ajvr.68.4.358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the use of laparoscopic-assisted jejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement. ANIMALS 15 healthy mixed-breed dogs. PROCEDURES Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5 dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O(2) delivery were calculated. RESULTS All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O(2) delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were found between groups undergoing laparoscopic-assisted and open surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs. CONCLUSIONS AND CLINICAL RELEVANCE Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.
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Affiliation(s)
- Saundra A Hewitt
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
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Hendrix PK. Anesthetic management of an orangutan (Pongo abelii/pygmaeus) undergoing laparoscopic tubal ligation. J Zoo Wildl Med 2007; 37:531-4. [PMID: 17315439 DOI: 10.1638/05-087.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An adult hybrid orangutan (Pongo abelii/pygmaeus) was presented to a veterinary teaching hospital for laparoscopic tubal ligation. The orangutan was immobilized with the use of injectable anesthetic agents, then orotracheally intubated. Anesthesia was maintained with the use of isoflurane in oxygen, and positive-pressure ventilation was used to ensure adequate gas exchange. Parameters monitored included arterial blood pressure, ECG, capnometry, and arterial blood gases. Anesthesia was uneventful, and recovery was smooth.
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Affiliation(s)
- Paula K Hendrix
- University of Minnesota Veterinary Teaching Hospital, 1365 Gortner Avenue, St. Paul, Minnesota 55108, USA
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Sánchez-Margallo FM, Ezquerra-Calvo LJ, Soria-Gálvez F, Usón-Gargallo J. Comparison of the effect of laparoscopic and conventional pyloric surgery on gastric emptying in dogs. Vet Radiol Ultrasound 2005; 46:57-62. [PMID: 15693561 DOI: 10.1111/j.1740-8261.2005.00011.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The effect of a laparoscopic approach and pyloric surgery on canine gastrointestinal activity, particularly gastric emptying time, is not well understood. The purpose of this study was to compare the effect of laparoscopic and conventional pyloric surgery, in Ramstedt pyloromyotomy and Heineke-Mikulicz pyloroplasty, on complete gastric emptying time in 20 clinically normal dogs. Dogs were divided into four groups of five animals: dogs with laparoscopic Ramstedt pyloromyotomy, conventional Ramstedt pyloromyotomy, or laparoscopic Heineke-Mikulicz pyloroplasty, and the conventional Heineke-Mikulicz pyloroplasty group. Gastric emptying time using barium sulfate mixed with dry kibble dog food was measured fluoroscopically before and 1 month after surgery. Gastric emptying of solids was significantly enhanced in the pyloroplasty groups in the postoperative period compared with preoperative emptying. Just as after conventional pyloromyotomy, gastric emptying time after laparoscopic pyloromyotomy was not statistically different as compared with preoperative values. This study indicates that the fluoroscopic test meal is a valuable tool for defining complete gastric emptying time in normal dogs. We conclude that pyloromyotomy was less effective in decreasing complete gastric emptying time than Heineke-Mikulicz pyloroplasty in normal dogs. The possibility of decreasing complete gastric emptying time by laparoscopic surgery suggests a potential clinical application for this technique in small animals.
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Abstract
Laparoscopy is a minimally invasive technique for both diagnostic biopsy and surgical procedures. After the basic technique of laparoscopy is mastered and the appropriate indications are learned, these procedures become an easy and rewarding addition to any small animal veterinary practice.
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Affiliation(s)
- Eric Monnet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.
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Andersson L, Lagerstrand L, Thörne A, Sollevi A, Brodin LA, Odeberg-Wernerman S. Effect of CO(2) pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2002; 46:552-60. [PMID: 12027850 DOI: 10.1034/j.1399-6576.2002.460513.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO(2)) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation-perfusion (V(A)/Q) before and during pneumoperitoneum by using the multiple inert gas technique. METHODS Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The V(A)Q relationships were evaluated by the multiple inert gas elimination technique before and during pneumoperitoneum to obtain a direct measure of the pulmonary shunt. RESULTS Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO(2) from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low V(A)Q was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation. CONCLUSIONS In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.
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Affiliation(s)
- L Andersson
- Department of Anaesthesiology, Huddinge University Hospital, Stockholm, Sweden.
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Robertson SA. Newer diagnostic and surgical techniques and their impact on anesthesia. Vet Clin North Am Small Anim Pract 1999; 29:665-82. [PMID: 10332816 DOI: 10.1016/s0195-5616(99)50054-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There are several newer diagnostic and surgical techniques available to veterinarians today. Careful anesthetic management is essential when using these modalities both to avoid accidents and to enable their use. For example, total intravenous anesthetic techniques can be used if the airway is occupied by an endoscope or laser surgery is being performed in the airway. The anesthesiologist must also be aware of the physiological changes that may occur during procedures such as laparoscopy and act to minimize their impact on patients.
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Affiliation(s)
- S A Robertson
- Department of Small Animal Clinical Sciences, Michigan State University, College of Veterinary Medicine, East Lansing, USA.
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Donaldson LL, Trostle SS, White NA. Cardiopulmonary changes associated with abdominal insufflation of carbon dioxide in mechanically ventilated, dorsally recumbent, halothane anaesthetised horses. Equine Vet J 1998; 30:144-51. [PMID: 9535071 DOI: 10.1111/j.2042-3306.1998.tb04474.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of laparoscopy for the diagnosis or therapeutic management of abdominal disease in the horse has distinct advantages when it allows the horse to remain standing. However, distending the abdomen by insufflation of a biologically active gas in an anaesthetised horse may add to the physiological challenge of general anaesthesia and recumbency. The cardiopulmonary responses to abdominal insufflation with carbon dioxide (CO2) to 15 mmHg pressure were evaluated in 6 horses in dorsal recumbency anaesthetised with halothane in oxygen and subjected to laparoscopic colopexy. Vaporiser settings targeted a fractional expired halothane of 1.5 MAC and a clinically acceptable depth of anaesthesia. Pressure and rate controlled positive pressure ventilation was adjusted to an ETCO2 of 35 mmHg before abdominal insufflation and was not changed thereafter. Cardiopulmonary data were collected before, at 30 and 60 min during and 30 min after CO2 insufflation. ANOVA for repeated measures followed by Tukey's protected t test were used to determine differences. Partial pressure of oxygen and pH of arterial blood, tidal volume and systemic vascular resistance decreased during abdominal insufflation and laparoscopic surgery whereas mean arterial blood pressure, right atrial pressure, cardiac index, stroke index, partial pressure of CO2 in arterial blood and end tidal respiratory gases, and calculated physiological shunt increased significantly. Only systemic vascular resistance returned to the pre-insufflation level after desufflation. The hypercapnia, acidosis and apparent increase in cardiac work that accompany CO2 pneumoperitoneum for laparoscopic surgery could place the anaesthetised horse at additional risk of perioperative complications.
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Affiliation(s)
- L L Donaldson
- Marion duPont Scott Equine Medical Center, Virginia-Maryland, Regional College of Veterinary Medicine, Leesburg 20177, USA
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Lin HC, Baird AN, Pugh DG, Anderson DE, Gaughan EM. Effects of carbon dioxide insufflation combined with changes in body position on blood gas and acid-base status in anesthetized llamas (Llama glama). Vet Surg 1997; 26:444-50. [PMID: 9381667 DOI: 10.1111/j.1532-950x.1997.tb01703.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To study the combined effects of intra-abdominal CO2 insufflation with changes in body position during laparoscopy in xylazine-ketamine-halothane anesthetized llamas. STUDY DESIGN Prospective, controlled study. ANIMALS Nine castrated, male llamas weighing 114 +/- 23 kg, 3 to 13 years old. METHODS Three llamas (preliminary study [PS] group) were used to study the effect of right, lateral, dorsal, and left lateral recumbency on gas exchange and acid-base status. The other six (experimental study [ES] group) were used to study the combined effects of changes in body position and CO2 insufflation to an intraabdominal pressure of 10 to 12 mm Hg. Heart rate, respiratory rate, and indirect arterial blood pressures (systolic [SAP], mean [MAP], and diastolic [DAP]) were recorded every 5 minutes during anesthesia. Arterial blood gases (PaO2 and PaCO2) and acid-base status (pHa and HCO3-) were measured immediately after induction of anesthesia and before each change of position. RESULTS In the PS group, significant decreases in SAP, MAP and PaCO2 and increases in PaO2 and pHa were observed when the llamas were turned from right lateral to dorsal recumbency. Values for HCO3- were lower than the postinduction values, but they remained unaffected by the changes in position. In the ES group, values for MAP were significantly lower when the llamas were placed in dorsal and left lateral recumbency than those observed during right lateral recumbency. Arterial O2 tension during right lateral recumbency was lower but returned to preinsufflation values when the llamas were placed in the dorsal position. All llamas recovered uneventfully within 30 minutes after termination of anesthesia. CONCLUSIONS Insufflation of CO2 and changing body position induce minor and transient changes in cardiovascular and respiratory function. CLINICAL RELEVANCE Laparoscopy with mild intra-abdominal CO2 insufflation (10 to 12 mm Hg) can be used safely in spontaneously breathing llamas anesthetized with xylazine, ketamine, and halothane.
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Affiliation(s)
- H C Lin
- Department of Large Animal Surgery and Medicine, College of Veterinary Medicine, Auburn University, AL 36849-5522, USA
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