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Midon M, Yamada DI, Filho DZ, Natalini CC, Escobar A, Clark-Price SC. Evaluation of the effects of doxapram in combination with xylazine on recovery of horses isoflurane-anesthetized. J Equine Vet Sci 2022; 111:103872. [DOI: 10.1016/j.jevs.2022.103872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration. Vet Sci 2021; 8:vetsci8080142. [PMID: 34437464 PMCID: PMC8402790 DOI: 10.3390/vetsci8080142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
To evaluate the use of ketamine-medetomidine-midazolam total intravenous infusion as part of a balanced anaesthetic technique for surgical castration in horses. Five healthy Standardbred cross colts were premedicated with IV acepromazine (0.01–0.02 mg/kg), medetomidine (7 µg/kg) and methadone (0.1 mg/kg) and anaesthesia induced with IV ketamine (2.2 mg/kg) and midazolam (0.06 mg/kg). Horses were anaesthetised for 40 min with an IV infusion of ketamine (3 mg/kg/h), medetomidine (5 µg/kg/h) and midazolam (0.1 mg/kg/h) while routine surgical castration was performed. Cardiorespiratory variables, arterial blood gases, and anaesthetic depth were assessed at 5 to 10 min intervals. Post-anaesthesia recovery times were recorded, and the quality of the recovery period was assessed. The anaesthetic period and surgical conditions were acceptable with good muscle relaxation and no additional anaesthetic required. The median (range) time from cessation of the infusion to endotracheal tube extubation, head lift and sternal recumbency were 17.2 (7–35) min, 25 (18.9–53) min and 28.1 (23–54) min, respectively. The quality of anaesthetic recovery was good, with horses standing 31.9 (28–61) min after the infusion was ceased. During anaesthesia, physiological variables, presented as a range of median values for each time point were: heart rate 37–44 beats/min, mean arterial pressure 107–119 mmHg, respiratory rate 6–13 breaths/min, arterial partial pressure of oxygen 88–126 mmHg, arterial partial pressure of carbon dioxide 52–57 mmHg and pH 7.36–7.39. In conclusion, the co-administration of midazolam, ketamine and medetomidine as in IV infusion, when used as part of a balanced anaesthetic technique, was suitable for short term anaesthesia in horses undergoing castration.
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Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021; 11:ani11061777. [PMID: 34198637 PMCID: PMC8232193 DOI: 10.3390/ani11061777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions. Abstract Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.
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François I, Lepage OM, Carpenter E, Desjardins I, De Guio C, Benedetti ICC, Maddens S, Saulnier N, Grant BD. Mesenchymal stem cell transplantation into the spinal cord of healthy adult horses undergoing cervical ventral interbody fusion. Vet Surg 2021; 50:1107-1116. [PMID: 33709467 DOI: 10.1111/vsu.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the feasibility of umbilical cord-derived mesenchymal stem cell (UC-MSC) transplantation into the cervical spinal cord of horses by using fluoroscopy with or without endoscopic guidance and to evaluate the neurological signs and tissue reaction after injection. STUDY DESIGN Experimental study. ANIMALS Eight healthy adult horses with no clinical signs of neurological disease. METHODS After cervical ventral interbody fusion (CVIF), ten million fluorescently labeled allogeneic UC-MSC were injected into the spinal cord under endoscopic and fluoroscopic guidance (n = 5) or fluoroscopic guidance only (n = 3). Postoperative neurological examinations were performed, and horses were humanely killed 48 hours (n = 4) or 14 days (n = 4) postoperatively. Spinal tissues were examined after gross dissection and with bright field and fluorescent microscopy. RESULTS Needle endoscopy of the cervical canal by ventral approach was associated with intraoperative spinal cord puncture (2/5) and postoperative ataxia (3/5). No intraoperative complications occurred, and one (1/3) horse developed ataxia with cell transplantation under fluoroscopy alone. Umbilical cord-derived MSC were associated with small vessels and detected up to 14 days in the spinal cord. Demyelination was observed in six of eight cases. CONCLUSION Fluoroscopically guided intramedullary UC-MSC transplantation during CVIF avoids spinal cord trauma and decreases risk of ataxia from endoscopy. Umbilical cord-derived MSC persist in the spinal cord for up to 14 days. Cell injection promotes angiogenesis and induces demyelination of the spinal tissue. CLINICAL SIGNIFICANCE Umbilical cord-derived MSC transplantation into the spinal cord during CVIF without endoscopy is recommended for future evaluation of cell therapy in horses affected by cervical vertebral compressive myelopathy.
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Affiliation(s)
- Isé François
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, GREMERES-ICE Lyon Equine Research Center, France
| | - Olivier M Lepage
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, GREMERES-ICE Lyon Equine Research Center, France
| | - Elaine Carpenter
- Cave Creek Equine Surgical and Diagnostic Imaging Center, Phoenix, Arizona, United States
| | - Isabelle Desjardins
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, GREMERES-ICE Lyon Equine Research Center, France
| | - Cécile De Guio
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, GREMERES-ICE Lyon Equine Research Center, France
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Guedes A, Knych H, Tucker L, Almeida DC, Baldo CF, Wendt-Hornickle E, Allweiler S. Pharmacokinetics and clinical effects of xylazine and dexmedetomidine in horses recovering from isoflurane anesthesia. J Vet Pharmacol Ther 2020; 43:369-376. [PMID: 32166760 DOI: 10.1111/jvp.12855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/29/2020] [Accepted: 02/23/2020] [Indexed: 12/01/2022]
Abstract
This study determined the pharmacokinetics and compared the clinical effects of xylazine and dexmedetomidine in horses recovering from isoflurane anesthesia. Six healthy horses aged 8.5 ± 3 years and weighing 462 ± 50 kg were anesthetized with isoflurane for 2 hr under standard conditions on two occasions one-week apart. In recovery, horses received 200 μg/kg xylazine or 0.875 μg/kg dexmedetomidine intravenously and were allowed to recover without assistance. These doses were selected because they have been used for postanesthetic sedation in clinical and research studies. Serial venous blood samples were collected for quantification of xylazine and dexmedetomidine, and the pharmacokinetic parameters were calculated. Two individuals blinded to treatment identity evaluated recovery quality with a visual analog scale. Times to stand were recorded. Results (mean ± SD) were compared using paired t tests or Wilcoxon signed-ranked test with p < .05 considered significant. Elimination half-lives (62.7 ± 21.8 and 30.1 ± 8 min for xylazine and dexmedetomidine, respectively) and steady-state volumes of distribution (215 ± 123 and 744 ± 403 ml/kg) were significantly different between xylazine and dexmedetomidine, whereas clearances (21.1 ± 17.3 and 48.6 ± 28.1 ml/minute/kg), times to stand (47 ± 24 and 53 ± 12 min) and recovery quality (51 ± 24 and 61 ± 22 mm VAS) were not significantly different. When used for postanesthetic sedation following isoflurane anesthesia in healthy horses, dexmedetomidine displays faster plasma kinetics but is not associated with faster recoveries compared to xylazine.
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Affiliation(s)
- Alonso Guedes
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Heather Knych
- K. L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Laura Tucker
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel C Almeida
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Caroline F Baldo
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Erin Wendt-Hornickle
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sandra Allweiler
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA
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Jarrett MA, Bailey KM, Messenger KM, Prange T, Gaines B, Posner LP. Recovery of horses from general anesthesia after induction with propofol and ketamine versus midazolam and ketamine. J Am Vet Med Assoc 2019; 253:101-107. [PMID: 29911938 DOI: 10.2460/javma.253.1.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate quality of recovery from general anesthesia in horses after induction with propofol and ketamine versus midazolam and ketamine. DESIGN Prospective randomized crossover study. ANIMALS 6 healthy adult horses. PROCEDURES Horses were premedicated with xylazine (1.0 mg/kg [0.45 mg/lb], IV), and general anesthesia was induced with midazolam (0.1 mg/kg [0.045 mg/lb], IV) or propofol (0.5 mg/kg [0.23 mg/lb], IV), followed by ketamine (3.0 mg/kg [1.36 mg/lb], IV). Horses were endotracheally intubated, and anesthesia was maintained with isoflurane. After 60 minutes, horses were given romifidine (0.02 mg/kg [0.009 mg/lb], IV) and allowed to recover unassisted. Times to first movement, sternal recumbency, and standing and the number of attempts to stand were recorded. Plasma concentrations of propofol or midazolam were measured following induction and immediately before recovery. Recovery quality was scored by 3 graders with a recovery rubric and a visual analog scale. RESULTS Number of attempts to stand was significantly lower when horses received propofol (median, 2; range, 1 to 3) than when they received midazolam (median, 7.5; range, 3 to 16). For both the recovery rubric and visual analog scale, recovery quality was significantly better when horses received propofol than when they received midazolam. Plasma drug concentration at recovery, as a percentage of the concentration at induction, was significantly lower when horses received propofol than when they received midazolam. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that for horses undergoing short (ie, 60 minutes) periods of general anesthesia, recovery quality may be better following induction with propofol and ketamine, compared with midazolam and ketamine.
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Pratt S, Cunneen A, Perkins N, Farry T, Kidd L, McEwen M, Rainger J, Truchetti G, Goodwin W. Total intravenous anaesthesia with ketamine, medetomidine and guaifenesin compared with ketamine, medetomidine and midazolam in young horses anaesthetised for computerised tomography. Equine Vet J 2018; 51:510-516. [PMID: 30451308 DOI: 10.1111/evj.13045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is no information directly comparing midazolam with guaifenesin when used in combination with an alpha-2 agonist and ketamine to maintain anaesthesia via i.v. infusion in horses. OBJECTIVES To compare ketamine-medetomidine-guaifenesin with ketamine-medetomidine-midazolam for total intravenous anaesthesia (TIVA) in young horses anaesthetised for computerised tomography. STUDY DESIGN Prospective, randomised, blinded, crossover trial. METHODS Fourteen weanlings received medetomidine 7 μg/kg bwt i.v. and anaesthesia was induced with ketamine 2.2 mg/kg bwt i.v. On two separate occasions horses each received infusions of ketamine 3 mg/kg bwt/h, medetomidine 5 μg/kg bwt/h, guaifenesin 100 mg/kg bwt/h (KMG) or ketamine 3 mg/kg bwt/h, medetomidine 5 μg/kg bwt/h, midazolam 0.1 mg/kg bwt/h (KMM) for 50 min. Cardiorespiratory variables and anaesthetic depth were assessed every 5-10 min. Recovery times after the infusions ceased were recorded and recovery quality was assessed using a composite score system (CSS), simple descriptive scale (SDS) and visual analogue scale (VAS). Multivariable models were used to generate mean recovery scores for each treatment and each recovery score system and provide P-values comparing treatment groups. RESULTS Anaesthesia was uneventful with no difference in additional anaesthetic requirements and little clinically relevant differences in cardiopulmonary variables between groups. All horses recovered without incident with no significant difference in recovery times. Quality of the anaesthetic recovery was significantly better for the KMM group compared with the KMG group using the CSS (P<0.001), SDS (P<0.001) and VAS (P<0.001). MAIN LIMITATIONS No surgical stimulus was applied and study animals may not represent general horse population. CONCLUSION Midazolam is a suitable alternative to guaifenesin when co-infused with ketamine and medetomidine for anaesthesia in young horses undergoing noninvasive procedures. Both infusions produce a clinically comparable quality of anaesthesia; however, recovery from anaesthesia is of a better quality following an infusion of ketamine-medetomidine-midazolam.
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Affiliation(s)
- S Pratt
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - A Cunneen
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - N Perkins
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - T Farry
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - L Kidd
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - M McEwen
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - J Rainger
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - G Truchetti
- Centre Vétérinaire Rive Sud, Brossard, Quebec, Canada.,Centre Vétérinaire Laval, Laval, Quebec, Canada
| | - W Goodwin
- The School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
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Tokushige H, Kushiro A, Okano A, Maeda T, Ito H, Wakuno A, Nagata SI, Ohta M. Clinical evaluation of constant rate infusion of alfaxalone-medetomidine combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery. Acta Vet Scand 2018; 60:50. [PMID: 30180855 PMCID: PMC6123962 DOI: 10.1186/s13028-018-0406-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Alfaxalone has a number of pharmacological properties which are desirable for constant rate infusion (CRI). Previously, the co-administration of alfaxalone and medetomidine is shown to be suitable for short-term anesthesia in horses. However, the use of alfaxalone–medetomidine CRI with inhalational anesthesia under surgical procedures have not been investigated in clinical cases. The aim of the present study was to evaluate the clinical efficacy of alfaxalone–medetomidine CRI in sevoflurane-anesthetized Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane requirement, cardiovascular function, and induction/recovery quality were compared between horses maintained with sevoflurane in combination with medetomidine CRI (3 µg/kg/h) (Group M; n = 25) and those maintained with sevoflurane in combination with alfaxalone–medetomidine CRI (0.5 mg/kg/h and 3 µg/kg/h, respectively) (Group AM; n = 25). Results The mean end-tidal sevoflurane concentrations were significantly lower in Group AM (1.8 ± 0.2%) than in Group M (2.4 ± 0.1%). The mean dobutamine infusion rate required for maintaining mean arterial blood pressure within the target values (60–80 mmHg) was significantly lower in Group AM (0.53 ± 0.20 µg/kg/min) than in Group M (0.85 ± 0.32 µg/kg/min). Induction and recovery scores were not significantly different between two groups. However, excitatory response during recovery were observed in five horses in Group AM. The mean plasma alfaxalone concentrations were stable throughout the maintenance period (0.77 ± 0.12 to 0.85 ± 0.13 µg/mL), and decreased significantly immediately after standing (0.32 ± 0.07 µg/mL). Conclusions Alfaxalone–medetomidine CRI reduced sevoflurane requirement by approximately 26% with good maintenance of cardiopulmonary function in Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane in combination with alfaxalone–medetomidine CRI may be a clinically effective anesthetic technique for Thoroughbred racehorses. However, 20% of horses administered alfaxalone showed remarkable excitatory response during recovery. Greater attention to excitatory response may be advisable if alfaxalone is used for induction or maintenance of anesthesia. A larger study is needed to explore the clinical relevance of these findings.
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Bird AR, Morley SJ, Sherlock CE, Mair TS. The outcomes of epidural anaesthesia in horses with perineal and tail melanomas: Complications associated with ataxia and the risks of rope recovery. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. R. Bird
- Department of Veterinary Medicine University of Cambridge CambridgeUK
| | | | | | - T. S. Mair
- Bell Equine Veterinary Clinic Mereworth Kent UK
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Mizobe F, Wakuno A, Okada J, Otsuka T, Ishikawa Y, Kurimoto S. Clinical usefulness of intravenous constant rate infusion of fentanyl and medetomidine under sevoflurane anesthesia in Thoroughbred racehorses undergoing internal fixation surgery. J Equine Sci 2017; 28:143-147. [PMID: 29270071 PMCID: PMC5735311 DOI: 10.1294/jes.28.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/18/2017] [Indexed: 11/30/2022] Open
Abstract
A total of 20 racehorses with longitudinal fractures underwent internal fixation surgery under sevoflurane anesthesia combined with infusion of medetomidine (3 µg/kg/hr) alone (10 horses, group M) or medetomidine and
fentanyl (7 µg/kg/hr) (10 horses, group FM). In group FM, the end-tidal sevoflurane concentration during surgery was maintained significantly lower than in group M (2.8–2.9% for group M vs. 2.2–2.6% for group FM,
P<0.01). The mean arterial blood pressure was maintained over 70 mmHg using dobutamine infusion (group M, 0.36–0.54 µg/kg/min; group FM, 0.27–0.65 µg/kg/min), and the recovery qualities were clinically acceptable in
both groups. In conclusion, co-administration of fentanyl and medetomidine by constant rate infusion may be a clinically useful intraoperative anesthetic adjunct for horses to reduce the requirement of sevoflurane when
they undergo orthopedic surgery.
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Affiliation(s)
- Fumiaki Mizobe
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
| | - Ai Wakuno
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
| | - Jun Okada
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
| | - Tasuku Otsuka
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
| | - Yuhiro Ishikawa
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
| | - Shinjiro Kurimoto
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
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Clark-Price SC, Lascola KM, Carter JE, da Cunha AF, Donaldson LL, Doherty TJ, Martin-Flores M, Hofmeister EH, Keating SCJ, Mama KR, Mason DE, Posner LP, Sano H, Seddighi R, Shih AC, Weil AB, Schaeffer DJ. Assessment of agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scoring the recovery of horses from anesthesia by use of subjective grading scales and development of a system for evaluation of the recovery of horses from anesthesia by use of accelerometry. Am J Vet Res 2017; 78:668-676. [PMID: 28541154 DOI: 10.2460/ajvr.78.6.668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scores determined by use of a simple descriptive scale (SDS) or a composite grading scale (CGS) for quality of recovery of horses from anesthesia and to investigate use of 3-axis accelerometry (3AA) for objective evaluation of recovery. ANIMALS 12 healthy adult horses. PROCEDURES Horses were fitted with a 3AA device and then were anesthetized. Eight diplomates evaluated recovery by use of an SDS, and 7 other diplomates evaluated recovery by use of a CGS. Agreement was tested with κ and AC1 statistics for the SDS and an ANOVA for the CGS. A library of mathematical models was used to map 3AA data against CGS scores. RESULTS Agreement among diplomates using the SDS was slight (κ = 0.19; AC1 = 0.22). The CGS scores differed significantly among diplomates. Best fit of 3AA data against CGS scores yielded the following equation: RS = 9.998 × SG0.633 × ∑UG0.174, where RS is a horse's recovery score determined with 3AA, SG is acceleration of the successful attempt to stand, and ∑UG is the sum of accelerations of unsuccessful attempts to stand. CONCLUSIONS AND CLINICAL RELEVANCE Subjective scoring of recovery of horses from anesthesia resulted in poor agreement among diplomates. Subjective scoring may lead to differences in conclusions about recovery quality; thus, there is a need for an objective scoring method. The 3AA system removed subjective bias in evaluations of recovery of horses and warrants further study.
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12
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Platt JP, Simon BT, Coleman M, Martinez EA, Lepiz MA, Watts AE. The effects of multiple anaesthetic episodes on equine recovery quality. Equine Vet J 2017; 50:111-116. [PMID: 28772349 DOI: 10.1111/evj.12728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although rare, 70% of equine fatalities during recovery from general anaesthesia (GA) are due to catastrophic fractures from poor recovery quality. OBJECTIVE To determine the effect of repeated GA recovery on GA recovery quality. STUDY DESIGN Experimental blinded trial. METHODS Eight adult horses underwent six GA events on sevoflurane for distal limb MRI examination over a 14-week period. Prior to GA recovery, xylazine was administered. Randomly ordered video-recorded GA recoveries were scored by three blinded board certified veterinary anaesthesiologists, unaware of patient identity or GA event number, for nine parameters using a 100 mm visual analogue scale (VAS) where 0 = worst and 100 = best. The number of attempts to stand, duration of lateral and sternal recumbency, total recovery duration and physiologic parameters during each GA event were recorded. Repeated measures ANOVA were used to detect differences. Agreement between observer VAS scores was determined via inter-rater reliability using an intraclass correlation. RESULTS With GA recovery experience, VAS scores for balance and coordination, knuckling, and overall quality of recovery were improved and the duration of lateral recumbency was increased. There were no differences in total recovery duration, number of attempts to stand, physiologic parameters other than heart rate during GA, or VAS scores for activity in lateral recumbency, move to sternal, move to stand, or strength. MAIN LIMITATIONS Each GA event was relatively short and there was no surgical stimulation. The same results may not occur if there was surgical stimulation and pain during each GA event. CONCLUSION Recovery from GA improves with multiple anaesthetic episodes in horses. Clinicians can advise clients that horses are likely to have better GA recovery on repeated GA recovery due to improved balance and coordination and reduced knuckling. Additionally, there is no change in anaesthetic morbidity with six repeated GA events over a 14-week period.
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Affiliation(s)
- J P Platt
- Comparative Orthopedics and Regenerative Medicine Laboratory, Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - B T Simon
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - M Coleman
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - E A Martinez
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - M A Lepiz
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - A E Watts
- Comparative Orthopedics and Regenerative Medicine Laboratory, Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
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13
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Guedes AGP, Tearney CC, Cenani A, Aristizabal F, Nieto J. Comparison between the effects of postanesthetic xylazine and dexmedetomidine on characteristics of recovery from sevoflurane anesthesia in horses. Vet Anaesth Analg 2017; 44:273-280. [PMID: 28258815 DOI: 10.1016/j.vaa.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare postanesthetic xylazine and dexmedetomidine on recovery characteristics from sevoflurane anesthesia in horses. STUDY DESIGN Randomized, crossover study. ANIMALS Six geldings, mean±standard deviation (SD) (range), 17±4 (11-24) years and 527±80 (420-660) kg. METHODS Horses were anesthetized with sevoflurane for 60 minutes under standardized conditions for a regional limb perfusion study. In recovery, horses were administered either xylazine (200 μg kg-1) or dexmedetomidine (0.875 μg kg-1) intravenously. Recoveries were unassisted and were video-recorded for later evaluation of recovery events and quality by two individuals unaware of treatment allocation. Recovery quality was assessed using a 100 mm visual analog scale (VAS) (0=poor recovery, 100=excellent recovery), the Edinburgh Scoring System (ESS) (0-100; 100=excellent recovery) and the mean attempt interval (MAI) (longer=better). Data are mean±SD. RESULTS All recovery quality assessments (xylazine and dexmedetomidine, respectively: VAS: 71±21 mm, 84±13 mm; ESS: 65±22, 67±30; MAI: 52±24 minutes, 60±32 minutes) and events (first limb movement: 37±8 minutes, 42±10 minutes; first attempt to lift head: 44±12 minutes, 48±9 minutes; first attempt to sternal posture: 57±28 minutes, 50±7 minutes; number of head bangs: 2.0±3.0, 0.5±0.5; time to first attempt to stand: 72±6 minutes, 78±13 minutes; time to standing: 79±14 minutes, 84±13 minutes) did not differ significantly between treatments (p>0.05). CONCLUSIONS AND CLINICAL RELEVANCE Recovery characteristics did not differ significantly between postanesthetic xylazine and dexmedetomidine following 1 hour of sevoflurane anesthesia in horses in this study. Further evaluations in more horses and in younger horses are required to confirm these results.
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Affiliation(s)
- Alonso G P Guedes
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, MN, USA.
| | - Caitlin C Tearney
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Alessia Cenani
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Fabio Aristizabal
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Jorge Nieto
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
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Tokushige H, Ohta M, Okano A, Kuroda T, Kakizaki M, Ode H, Aoki M, Wakuno A, Kawasaki K. Effects of Medetomidine Constant Rate Infusion on Sevoflurane Requirement, Cardiopulmonary Function, and Recovery Quality in Thoroughbred Racehorses Undergoing Arthroscopic Surgery. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2014.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cagnardi P, Ferraresi C, Zonca A, Pecile A, Ravasio G, Zani D, Villa R. Clinical pharmacokinetics of tramadol and main metabolites in horses undergoing orchiectomy. Vet Q 2014; 34:143-51. [DOI: 10.1080/01652176.2014.963208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tzelos T, Blissitt KJ, Clutton RE. Electrocardiographic indicators of excitability in horses for predicting recovery quality after general anaesthesia. Vet Anaesth Analg 2014; 42:269-79. [PMID: 25041033 DOI: 10.1111/vaa.12199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/30/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether preoperative electrocardiographic measurements linked to sympathetic nervous activity could be used to predict recovery quality after general anaesthesia in horses. STUDY DESIGN Prospective, clinical study. ANIMALS Eighteen adult client-owned horses. METHODS The electrocardiogram (ECG) was recorded presurgery in horses under three standard conditions: stabled unattended; with a groom whilst being led along a standard course; alone in the induction box. After surgery, each animal's recovery quality was scored by eight experienced anaesthetists or technicians using Donaldson's scoring system (2000). The digitized ECG recordings were analyzed for T-wave morphology, mean heart rate (HR), HR variability (HRV) and HRV derivatives including mean R-R interval, standard deviation of normal intervals (SDNN) and the root mean square of successive intervals (RMSSD), low (LF) and high frequency (HF) activity and the LF/HF ratio in both fast Fourier transformed and autoregressive spectra. Correlations between ECG variables and recovery score were examined using Spearman's rank correlation. RESULTS There was no significant correlation between preanaesthetic ECG measurements and recovery quality. CONCLUSIONS Predictions of recovery quality after general anaesthesia in horses cannot be based on preanaesthetic ECG variables. CLINICAL RELEVANCE Measures other than those based on the ECG should be investigated as predictors of recovery quality.
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Affiliation(s)
- Thomas Tzelos
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, UK
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Ferraresi C, Villa R, Ravasio G, Zonca A, Carli S, Pecile A, Fonda D, Cagnardi P. Pharmacokinetics of IV Ketorolac in Horses Undergoing Orchiectomy. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2014.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Farmer E, Chase-Topping M, Lawson H, Clutton RE. Factors affecting the perception of recovery quality in horses after anaesthesia. Equine Vet J 2013; 46:328-32. [PMID: 23819890 DOI: 10.1111/evj.12133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 06/24/2013] [Indexed: 12/01/2022]
Abstract
REASONS FOR PERFORMING STUDY A significant effect of gender, experience and background, i.e. an evaluator's relationship with horses as equine anaesthetists, orthopaedic surgeons, practitioners or owners, on perceptions of recovery quality after anaesthesia would reduce the validity of recovery quality scoring systems. OBJECTIVES To determine the effects of evaluator background, experience and gender on their perceptions of recovery quality; and questionnaire response rate as a function of background. STUDY DESIGN Cross-sectional survey. METHODS A total of 440 potential evaluators were invited to evaluate the video-recorded recoveries of 24 horses using a visual analogue scale (VAS) in which 0 = worst, 100 = best possible recovery. A mean score was generated for each of the 1-24 recoveries within each background group. These were compared using Spearman's rank correlation. The effect of gender and experience on VAS scores were analysed using an ordinal logistic regression after scores were categorised into 'intermediate, 'worst' and 'best' recovery categories based on median, 25th and 75th percentile VAS scores, respectively. RESULTS The overall response rate was 35%. The greatest was from the anaesthetists (78%) followed by surgeons (43%). The response rate among owners and practitioners was 26%. Correlation among VAS scores across all background groups was high (Spearman rank > 0.90; P < 0.001). Among the combined veterinarians, there was no significant gender (P = 0.551) or experience (P = 0.103) effect. Among horse owners, the effect of experience was not significant (P = 0.116) although gender was (P = 0.027). Male horse owners awarded significantly greater scores than females. CONCLUSIONS When VAS are used to grade recovery quality, neither the background nor the gender of veterinary evaluators affects quality perception. Male owners awarded greater scores than female owners, implying that they are less critical of recovery quality and a gender effect among horse owners must be considered when VAS are used to score recovery quality.
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Affiliation(s)
- E Farmer
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, UK
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Valverde A, Black B, Cribb NC, Hathway A, Daw A. Assessment of unassisted recovery from repeated general isoflurane anesthesia in horses following post-anesthetic administration of xylazine or acepromazine or a combination of xylazine and ketamine. Vet Anaesth Analg 2012; 40:3-12. [PMID: 23016627 DOI: 10.1111/j.1467-2995.2012.00782.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the effects of sedative doses of acepromazine, xylazine or xylazine/ketamine administered to horses after isoflurane anesthesia on the quality of recovery and anesthesia recovery times. To determine if recovery scores improve after repeated consecutive anesthetic episodes. STUDY DESIGN Prospective, randomized, crossover study. ANIMALS Fifteen adult research horses, 6.5±3.4 years old and weighing 499±40 kg. METHODS Horses undergoing three anesthetic episodes with isoflurane for magnetic resonance of the forelimbs were administered acepromazine (0.02 mg kg(-1) i.v.) or xylazine (0.3 mg kg(-1) i.v.) or xylazine (0.15 mg kg(-1) i.v.) combined with ketamine (0.3 mg kg(-1) i.v.) in random order upon arrival in recovery. The quality of recovery was compared between the three treatments using a composite numerical rating and a general descriptive scoring system. RESULTS Horses administered xylazine had better recovery scores than horses administered xylazine/ketamine, associated with better scores during their move to sternal, strength and number of attempts to standing. Horses administered acepromazine had similar recovery scores to horses administered xylazine and to horses administered xylazine/ketamine. Time to sternal recumbency and time to extubation were statistically longer for the xylazine treatment. Time to standing was similar between treatments. Horses had better recovery scores during the third anesthetic episode, regardless of the sedative drug administered, associated with better scores for strength and number of attempts to standing. CONCLUSIONS Xylazine administration was superior to xylazine/ketamine but similar to acepromazine. This study also indicates that horses improve the quality of recovery during consecutive anesthetics associated with longer time to sternal and to standing, regardless of the sedative used. CLINICAL RELEVANCE All treatments provided good quality recoveries. The experience of the individual horse gained during recent previous anesthetic episodes may have a positive effect in facilitating a better recovery.
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Affiliation(s)
- Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
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Portier KG, Séna A, Senior M, Clutton RE. A study of the correlation between objective and subjective indices of recovery quality after inhalation anaesthesia in equids. Vet Anaesth Analg 2010; 37:329-36. [PMID: 20529009 DOI: 10.1111/j.1467-2995.2010.00542.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between objective and subjective descriptors used for assessing recovery quality in horses after anaesthesia. STUDY DESIGN Prospective clinical study. ANIMALS Two hundred and seventy-six equids (110 mares, 85 entire males and 81 geldings), ASA 1-5, weighing 50-850 kg and aged 1 month - 25 years. METHODS Recoveries after general anaesthesia were assisted with head and tail ropes by two anaesthetists. One scored dichotomous objective descriptors (DOD) of recovery. Two dichotomous objective scales (DOS) were then generated from those descriptors. The same individual also scored overall recovery quality using a visual analogue scale (VAS). The second anaesthetist scored recovery (good or bad) using a dichotomous subjective scale (DSS). Each DOD, the DSS and VAS were compared with each other using Pearson's chi-square test. DOSs were compared to the DSS using Wilcoxon's test and to the VAS using a Spearman's correlation test. RESULTS Most DODs were associated (p < 0.05) with DSS and VAS. The DSS was not associated with resting/not resting in sternal recumbency (p = 0.535) nor with the time spent in sternal recumbency (p = 0.09). VAS and DSS scores were strongly associated (p < 0.0001). The two DOSs were in agreement with DSS (p < 0.0001) and negatively correlated to VAS (r(1)(2) = 0.38, r(2)(2) = 0.34, respectively, p-value <0.0001). CONCLUSION Objective descriptors were linked closely with the subjective evaluations of recovery quality except for the presence or absence of a sternal recumbency phase and its duration. CLINICAL RELEVANCE These components may not be essential in recovery scoring systems. The DOS were in agreement with DSS and VAS and could be a useful tool for further studies on recoveries.
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Affiliation(s)
- Karine G Portier
- University of Lyon, Lyon, France, and VetAgro Sup (Veterinary Campus of Lyon), Anaesthesiology, Equine Department, Marcy L'Etoile, France.
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Vettorato E, Chase-Topping ME, Clutton RE. A comparison of four systems for scoring recovery quality after general anaesthesia in horses. Equine Vet J 2010; 42:400-6. [PMID: 20636775 DOI: 10.1111/j.2042-3306.2010.00093.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
REASON FOR PERFORMING STUDY The recovery quality scoring systems (RQSSs) in current use have not been critically reviewed for reliability. OBJECTIVE To examine reliability (reproducibility) of 4 RQSSs when applied to a ranked series. METHODS A DVD incorporating the recordings of 9 horses recovering from general anaesthesia was evaluated by final year students over 5 days. On Day 1, each evaluator ranked recoveries from 1-9 (1 = best). Over the following 4 days, each evaluator scored the same recoveries using 4 different RQSSs (3 of them in common usage and previously published) applied in random order. The scores from each RQSS were ranked and plotted against the Day 1 ranking of each evaluator to establish the extent of agreement using generalisability theory. The same 9 recoveries were also ranked by 12 experienced equine anaesthetists and the Spearman Rank Correlation coefficient calculated to determine the agreement between experienced and inexperienced evaluators. RESULTS The recoveries were evaluated by 117 students. All 4 RQSSs were equally reliable with low (<4%) interobserver variability. The main (80%) source of total variation arose from differences between horses. The overall ranking within each RQSS was strongly correlated with Day 1 ranking. There was strong correlation (r = 0.983) between the students' ranking and that established by experienced anaesthetists. Interobserver reliability was similar with all 4 RQSSs. CONCLUSION All 4 RQSSs studied were similarly reliable. POTENTIAL RELEVANCE The selection of a universally acceptable RQSS from amongst the 4 examined can be based on criteria other than reliability, e.g. ease of use. This will facilitate wider scale multi-centre studies in recovery quality after anaesthesia in horses.
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Affiliation(s)
- E Vettorato
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian.
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Ishihara A, Madigan JE, Hubert JD, McConnico RS. Full body support sling in horses. Part 2: indications. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2006.tb00463.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Valverde A, Gunkelt C, Doherty TJ, Giguère S, Pollak AS. Effect of a constant rate infusion of lidocaine on the quality of recovery from sevoflurane or isoflurane general anaesthesia in horses. Equine Vet J 2010; 37:559-64. [PMID: 16295936 DOI: 10.2746/042516405775314772] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Lidocaine constant rate infusions (CRIs) are common as an intraoperative adjunct to general anaesthesia, but their influence on quality of recovery has not been thoroughly determined. OBJECTIVES To determine the effects of an intraoperative i.v. CRI of lidocaine on the quality of recovery from isoflurane or sevoflurane anaesthesia in horses undergoing various surgical procedures, using a modified recovery score system. HYPOTHESIS The administration of intraoperative lidocaine CRI decreases the quality of recovery in horses. METHODS Lidocaine (2 mg/kg bwt bolus followed by 50 microg/kg bwt/min) or saline was administered for the duration of surgery or until 30 mins before the end of surgery under isoflurane (n = 27) and sevoflurane (n = 27). RESULTS Horses receiving lidocaine until the end of surgery had a significantly higher degree of ataxia and a tendency towards significance for a lower quality of recovery. There was no correlation between lidocaine plasma concentrations at recovery and the quality of recovery. CONCLUSIONS Intraoperative CRI of lidocaine affects the degree of ataxia and may decrease the quality of recovery. POTENTIAL RELEVANCE Discontinuing lidocaine CRI 30 mins before the end of surgery is recommended to reduce ataxia during the recovery period.
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Affiliation(s)
- A Valverde
- Department of Large Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
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Hubbell JAE, Muir WW. Use of the alpha-2 agonists xylazine and detomidine in the perianaesthetic period in the horse. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2004.tb00322.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Development of a composite orthopaedic pain scale in horses. Res Vet Sci 2008; 85:294-306. [DOI: 10.1016/j.rvsc.2007.10.011] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 10/03/2007] [Accepted: 10/23/2007] [Indexed: 11/20/2022]
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Ashley FH, Waterman-Pearson AE, Whay HR. Behavioural assessment of pain in horses and donkeys: application to clinical practice and future studies. Equine Vet J 2006; 37:565-75. [PMID: 16295937 DOI: 10.2746/042516405775314826] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F H Ashley
- Department of Clinical Veterinary Science, University of Bristol, Langford House, Langford, Somerset BS40 5DU, UK
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