Disturbances of cardiopulmonary function in anaesthetised horses

Incidence of severe hypoxaemia in anaesthetised horses undergoing emergency exploratory laparotomy

Prevalence and risk factors of severe hypoxaemia in anaesthetised horses undergoing emergency exploratory laparotomy are sparsely documented. The aim of this study was to report incidence of severe hypoxaemia ( PaO 2 < 60 mmHg) in horses undergoing emergency exploratory laparotomy and identify potential risk factors for this complication. A single centre retrospective cross sectional designed was used. Clinical data of 714 horses undergoing general anaesthesia for emergency explorative laparotomy were reviewed. A backward stepwise elimination procedure was used to determine the final multivariable logistic regression model; all covariables with univariable P-values <0.25 were incorporated, with retention of covariables with Wald P-values <0.05 at each step, in order to determine which explanatory variables would be included in the final model. The overall incidence of severe hypoxaemia in our population was 15.3%. Multivariable logistic regression analysis showed that increasing body weight (OR 1.01, 95% CI 1.0-1.01, P = .002), colon torsion (OR 3.0, 95% CI 1.3-6.8, P = .006), increased dead space ventilation (OR 1.06, 95% CI 1.04-1.09, P = <0.001), shorter time between induction of anaesthesia and collection of arterial blood gas samples (OR 0.98, 95% CI 0.98-0.99, P = <0.001) and intra-tracheal aerosolised salbutamol (OR 13.5, 95% CI 7.6-24, P = <0.001) were associated with the outcome. The incidence of hypoxaemia found in our study was in line with previous literature. Increasing body weight, colon torsion and shorter time between the time of induction of anaesthesia and collection of arterial blood gas samples represented risk factors for hypoxaemia.

Effect of 15° Reverse Trendelenburg Position on Arterial Oxygen Tension during Isoflurane Anesthesia in Horses

Simple Summary

Horses commonly develop low blood oxygen levels during anesthesia, especially when they are placed on their backs. This study investigated whether a 15° head-up tilt, in a homogenous group of anesthetized horses positioned on their backs, would result in better blood oxygen levels as compared to no tilt. The results showed significantly greater blood oxygen levels with tilt compared to no tilt in five out of six horses tested. In one horse the effect was the opposite. The concurrent effect on cardiovascular function remains to be tested in detail. Further studies are needed to confirm these findings in a larger group of horses and to determine the effects on blood pressure and treatment options.

Abstract

Lower than expected arterial oxygen tension (PaO₂) continues to be an unresolved problem in equine anesthesia. The aim of this randomized, crossover, and prospective study using six adult horses is to determine if a 15° reverse Trendelenburg position (RTP) increases PaO₂ during inhalation anesthesia. Under constant-dose isoflurane anesthesia, dorsally recumbent horses were positioned either horizontally (HP) or in a 15° RTP for 2 h. Lungs were mechanically ventilated (15 mL/kg, 6 breaths/min). Arterial carbon dioxide tension (PaCO₂), PaO₂, inspired oxygen fraction (FiO₂), and end-tidal carbon dioxide tension (EtCO₂) were determined every 30 min during anesthesia. Indices of dead-space ventilation (Vd/Vt), oxygenation (P–F ratio), and perfusion (F–shunt) were calculated. Dobutamine and phenylephrine were used to support mean arterial pressure (MAP). Data are presented as median and range. In one horse, which was deemed an outlier due to its thoracic dimensions and body conformation, indices of oxygenation worsened in RTP compared to HP (median PaO₂ 438 vs. 568 mmHg; P–F ratio 454 vs. 586 mmHg, and F–shunt 13.0 vs. 5.7 mmHg). This horse was excluded from calculations. In the remaining five horses they were significantly better with RTP compared to HP. Results in remaining five horses showed that PaO₂ (502, 467–575 vs. 437, 395–445 mmHg), P-F ratio (518, 484–598 vs. 455, 407–458 mmHg), and F-shunt (10.1, 4.2–11.7 vs. 14.2, 13.8–16.0 mmHg) were significantly different between RTP and HP (p = 0.03). Other variables were not significantly different. In conclusion, the 15° RTP resulted in better oxygenation than HP in dorsally recumbent, isoflurane-anesthetized horses, although worsening of oxygenation may occur in individual horses. A study detailing the cardiovascular consequences of RTP is necessary before it can be recommended for clinical practice.

Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia

Horses, due to their unique anatomy and physiology, are particularly prone to intraoperative cardiopulmonary disorders. In dorsally recumbent horses, chest wall movement is restricted and the lungs are compressed by the abdominal organs, leading to the collapse of the alveoli. This results in hypoventilation, leading to hypercapnia and respiratory acidosis as well as impaired tissue oxygen supply (hypoxia). The most common mechanisms disturbing gas exchange are hypoventilation, atelectasis, ventilation-perfusion (V/Q) mismatch and shunt. Gas exchange disturbances are considered to be an important factor contributing to the high anaesthetic mortality rate and numerous post-anaesthetic side effects. Current monitoring methods, such as a pulse oximetry, capnography, arterial blood gas measurements and spirometry, may not be sufficient by themselves, and only in combination with each other can they provide extensive information about the condition of the patient. A new, promising, complementary method is near-infrared spectroscopy (NIRS). The purpose of this article is to review the negative effect of general anaesthesia on the gas exchange in horses and describe the post-operative complications resulting from it. Understanding the changes that occur during general anaesthesia and the factors that affect them, as well as improving gas monitoring techniques, can improve the post-aesthetic survival rate and minimize post-operative complications.

Comparison of various types of inert gas components on efficacy of an alveolar recruitment maneuver in dorsally recumbent anesthetized horses

OBJECTIVE

To assess effects of nitrogen and helium on efficacy of an alveolar recruitment maneuver (ARM) for improving pulmonary mechanics and oxygen exchange in anesthetized horses.

ANIMALS

6 healthy adult horses.

PROCEDURES

Horses were anesthetized twice in a randomized crossover study. Isoflurane-anesthetized horses in dorsal recumbency were ventilated with 30% oxygen and 70% nitrogen (treatment N) or heliox (30% oxygen and 70% helium; treatment H) as carrier gas. After 60 minutes, an ARM was performed. Optimal positive end-expiratory pressure was identified and maintained for 120 minutes. Throughout the experiment, arterial blood pressures, heart rate, peak inspiratory pressure, dynamic compliance (C_dyn), and Pao₂ were measured. Variables were compared with baseline values and between treatments by use of an ANOVA.

RESULTS

The ARM resulted in significant increases in Pao₂ and C_dyn and decreases in the alveolar-arterial gradient in the partial pressure of oxygen in all horses. After the ARM and during the subsequent 120-minute phase, mean values were significantly lower for treatment N than treatment H for Pao₂ and C_dyn. Optimal positive end-expiratory pressure was consistently 15 cm H₂O for treatment N, but it was 10 cm H₂O (4 horses) and 15 cm H₂O (2 horses) for treatment H.

CONCLUSIONS AND CLINICAL RELEVANCE

An ARM in anesthetized horses might be more efficacious in improving Pao₂ and C_dyn when animals breathe helium instead of nitrogen as the inert gas.

Prolonged Recovery From General Anesthesia Possibly Related to Persistent Hypoxemia in a Draft Horse

Horses are susceptible to developing large areas of pulmonary atelectasis during recumbency and anesthesia. The subsequent pulmonary shunt is responsible for significant impairment of oxygenation. Since ventilation perfusion mismatch persists into the post-operative period, hypoxemia remains an important concern in the recovery stall. This case report describes the diagnosis and supportive therapy of persistent hypoxemia in a 914 kg draft horse after isoflurane anesthesia. It highlights how challenging it can be to deal with hypoxemia after disconnection from the anesthesia machine and how life-threatening it can become if refractory to treatment. Furthermore, it stresses the point on the interactions between hypoxemia and other factors, such as residual drug effects and hypothermia, that should also be considered in the case of delayed recovery from general anesthesia.

An evaluation of apnea or spontaneous ventilation in early recovery following mechanical ventilation in the anesthetized horse

OBJECTIVE

To compare arterial oxygen and carbon dioxide tensions in apneic and spontaneously ventilating horses recovering from anesthesia.

STUDY DESIGN

Randomized clinical trial.

ANIMAL POPULATION

Forty-two healthy horses averaging 466 ± 106 kg and 6 ± 5 years of age.

METHODS

Anesthetized horses undergoing a variety of surgical procedures and receiving positive pressure ventilation (IPPV) were divided into two equal groups. One group was allowed to return to spontaneous ventilation prior to disconnection from the anesthetic circuit (weaned). The other group remained apneic during transport to a recovery stall. Arterial blood gas data were collected at five time points: 20 minutes before moving to a recovery stall (t = - 20); at the time the anesthetic circuit was disconncted (t = 0); at 3 and 5 minutes post-disconnection (t = 3 and t = 5) and at the time of the first spontaneous breath (t = sv). The data were analyzed using an anova method for repeated measures and paired, two-tailed t-tests. Significance was assumed when p < 0.05.

RESULTS

The apneic group took a mean of 5 minutes 18 seconds (± 135 seconds) before starting spontaneous ventilation. This group maintained significantly higher PaO₂ levels at intermediate time points (t = 0 and t = 3) but no difference was noted after 5 minutes. PaCO₂ levels were higher in the weaned group at time 0 minutes, returning to a comparable level to the apneic group at t = 3 minutes.

CONCLUSIONS AND CLINICAL RELEVANCE

Horses can survive a short period of apnea during transport from the surgery suite to recovery stall and may benefit from a reduced incidence of transient hypoxemia compared with spontaneously ventilating horses. This information has practical implications for the anesthetist evaluating the options for discontinuing IPPV when horses are moved to a recovery stall.

Cardiovascular, respiratory and metabolic responses to apnea induced by atlanto-occipital intrathecal lidocaine injection in anesthetized horses

OBJECTIVE

To determine physiologic responses to apnea-induced severe hypoxemia in anesthetized horses.

STUDY DESIGN

Prospective experimental study.

ANIMALS

Six university-owned horses with a median (range) body weight of 500 (220-510) kg and aged 13.5 (0.8-24.0) years scheduled for euthanasia.

METHODS

Xylazine-midazolam-ketamine-anesthetized horses breathing room air spontaneously were instrumented with a facial artery catheter for pressure measurement and blood sampling, and were made apneic with atlanto-occipital intrathecal lidocaine (4 mg kg^-1 ). Cardiopulmonary, biochemical and hematologic variables were recorded before (baseline) and every minute for 10 minutes after lidocaine injection.

RESULTS

PaO₂ values were: baseline, 55 mmHg (7.3 kPa); 1 minute, 28 mmHg (3.8 kPa); 2 minutes, 18 mmHg (2.4 kPa); 3 minutes, 15 mmHg (2.0 kPa), and 4-10 minutes, (8-11 mmHg (1.1-1.5 kPa). PaCO₂ values were: baseline, 50 mmHg (6.7 kPa); 1 minute, 61 mmHg (8.1 kPa), and 2-10 minutes, 64-66 mmHg (8.5-8.8 kPa). Base excess values at baseline, 1 minute and 2-10 minutes were 5.3 mmol L^-1 , 6.5 mmol L^-1 and 7.0-8.1 mmol L^-1 , respectively. Pulse rates at baseline, 1 minute and 2-7 minutes were 36, 53 and 54-85 beats minute^-1 , respectively. Asystole occurred at 8 minutes. Pulse pressures were 50 mmHg at baseline and 1 minute, and 39 mmHg, 31 mmHg, 22 mmHg, 17 mmHg and 1-9 mmHg at 2, 3, 4, 5 and 6-10 minutes, respectively. Lactate was 0.9 mmol L^-1 at baseline, progressively increasing to 1.7-2.4 mmol L^-1 at 7-10 minutes. Packed cell volume increased after 7 minutes of apnea. There were no other major changes.

CONCLUSIONS AND CLINICAL RELEVANCE

Apnea immediately exacerbated hypoxemia and hypercapnia and rapidly caused hemodynamic instability. Apnea in hypoxemic anesthetized horses is associated with a serious risk for progress to cardiovascular collapse.

Effects of intermittent positive pressure ventilation on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using combination of medetomidine, lidocaine, butorphanol and propofol (MLBP-TIVA)

Effects of intermittent positive pressure ventilation (IPPV) on cardiopulmonary function were evaluated in horses anesthetized with total intravenous anesthesia using constant rate infusions of medetomidine (3.5 µg/kg/hr), lidocaine (3 mg/kg/hr), butorphanol (24 µg/kg/hr) and propofol (0.1 mg/kg/min) (MLBP-TIVA). Five horses were anesthetized twice using MLBP-TIVA with or without IPPV at 4-week interval (crossover study). In each occasion, the horses breathed 100% oxygen with spontaneous ventilation (SB-group, n=5) or with IPPV (CV-group, n=5), and changes in cardiopulmonary parameters were observed for 120 min. In the SB-group, cardiovascular parameters were maintained within acceptable ranges (heart rate: 33–35 beats/min, cardiac output: 27–30 l/min, mean arterial blood pressure [MABP]: 114–123 mmHg, mean pulmonary arterial pressure [MPAP]: 28–29 mmHg and mean right atrial pressure [MRAP]: 19–21 mmHg), but severe hypercapnea and insufficient oxygenation were observed (arterial CO₂ pressure [PaCO₂]: 84–103 mmHg and arterial O₂ pressure [PaO₂]: 155–172 mmHg). In the CV-group, normocapnea (PaCO₂: 42–50 mmHg) and good oxygenation (PaO₂: 395–419 mmHg) were achieved by the IPPV without apparent cardiovascular depression (heart rate: 29–31 beats/min, cardiac output: 17–21 l /min, MABP: 111–123 mmHg, MPAP: 27–30 mmHg and MRAP: 15–16 mmHg). MLBP-TIVA preserved cardiovascular function even in horses artificially ventilated.

Intravenous butorphanol improves cardiopulmonary parameters in game-ranched white rhinoceroses (Ceratotherium simum) immobilized with etorphine and azaperone

Abstract We immobilized 47 white rhinoceroses (Ceratotherium simum) for dehorning with 1-4 mg of etorphine HCl, 10-40 mg of azaperone, and 7,500 IU of hyaluronidase, at a game ranch in South Africa in November 2012. Forty-four received butorphanol intravenously 5 min after recumbency, at the rate of 10 mg of butorphanol per 1 mg of etorphine, and three animals did not. When possible, blood gas and physiologic parameters were measured immediately before butorphanol administration and 10 min later. Statistically significant improvements were observed, with a reduction in pH, partial pressure of carbon dioxide in arterial blood, heart rate, systolic blood pressure, and diastolic blood pressure, and with an increase in arterial partial pressure of oxygen, arterial hemoglobin oxygen saturation, and respiratory rate in animals administered butorphanol. In the three animals that did not receive butorphanol, no improvement was apparent. Butorphanol given to recumbent white rhinoceroses immediately after immobilization was associated with improved blood gas values and cardiopulmonary function for at least 10 min. Studies on the sustainability of these effects are necessary.

Effect of postoperative xylazine administration on cardiopulmonary function and recovery quality after isoflurane anesthesia in horses

OBJECTIVE

To evaluate equine cardiopulmonary function and recovery quality after administration of 0.25 or 0.50 mg/kg xylazine intravenously (IV) during recovery.

STUDY DESIGN

Randomized, blinded, prospective, clinical study.

ANIMALS

Horses (n = 20).

METHODS

During recovery after 3 hours of isoflurane anesthesia for arthroscopic surgery, horses were administered either 0.25 mg/kg (G25, n = 10) or 0.50 mg/kg (G50, n = 10) xylazine intravenously. Vital signs and arterial blood samples were obtained during recovery before sedation (baseline), 5, 10, 20, 30, and 45 minutes after xylazine and 30 minutes after standing. The quality of recovery scores ranged from 10 to 72 (10 = best, 72 = worst).

RESULTS

G25 horses recovered faster (mean ± SD, 33 ± 5 min) than G50 horses (50 ± 7 min, P < .0001). Mean maximal decrease in arterial oxygen tension was 55 ± 11 mmHg in G25 (at 10 minutes; P < .05) and 54 ± 7 mmHg in G50 (at 20 minutes; P < .01). G25 group had a total recovery score (23 [range 18-29]) and number of attempts to stand (4 ± 2) greater than the G50 group (18 [10-23] and 1 ± 1, respectively; P < .001).

CONCLUSIONS

Both doses of xylazine promoted a moderate and transient hypoxemia during recovery; however, the 0.5 mg/kg dose produced a longer and improved quality of recovery from anesthesia.

Effects of tidal volume, ventilatory frequency, and oxygen insufflation flow on the fraction of inspired oxygen in cadaveric horse heads attached to a lung model

OBJECTIVE

To measure the effects of tidal volume, ventilatory frequency, and oxygen insufflation flow on the fraction of inspired oxygen in cadaveric horse heads attached to a lung model.

SAMPLE

8 heads of equine cadavers.

PROCEDURES

Each cadaveric horse head was intubated with a nasotracheal tube that extended into the proximal portion of the trachea. Oxygen was delivered through an oxygen catheter contained within and extending to the tip of the nasotracheal tube. The trachea was connected to the lung model by use of a spiral-wound hose with a sampling adaptor. Eight treatment combinations involving 2 tidal volumes (5 and 8 L), 2 ventilatory frequencies (6 and 12 mechanical breathes/min), and 2 insufflation rates (10 and 15 L/min) were applied to each head. Hand-drawn inspired gas samples were collected and analyzed for oxygen concentrations.

RESULTS

The fraction of inspired oxygen (measured at mid trachea) ranged from 26.8% to 39.4%. Fraction of inspired oxygen was significantly higher with a smaller tidal volume, lower ventilatory frequency, and higher insufflation rate.

CONCLUSIONS AND CLINICAL RELEVANCE

In the study model, measured fraction of inspired oxygen varied with ventilatory pattern as well as oxygen insufflation rate. Clinically, this information could be beneficial for interpretation of data regarding arterial blood gases and hemoglobin saturation and in making appropriate oxygen insufflation decisions for anesthetized horses that are breathing room air.

Effect of 50% and maximal inspired oxygen concentrations on respiratory variables in isoflurane-anesthetized horses

Background

The purpose of this study was to compare the effects of 0.5 fraction of inspired oxygen (FiO₂) and >0.95 FiO₂ on pulmonary gas exchange, shunt fraction and oxygen delivery (DO₂) in dorsally recumbent horses during inhalant anesthesia. The use of 0.5 FiO₂ has the potential to reduce absorption atelectasis (compared to maximal FiO₂) and augment alveolar oxygen (O₂) tensions (compared to ambient air) thereby improving gas exchange and DO₂. Our hypothesis was that 0.5 FiO₂ would reduce ventilation-perfusion mismatching and increase the fraction of pulmonary blood flow that is oxygenated, thus improving arterial oxygen content and DO₂.

Results

Arterial partial pressures of O₂ were significantly higher than preanesthetic levels at all times during anesthesia in the >0.95 FiO₂ group. Arterial partial pressures of O₂ did not change from preanesthetic levels in the 0.5 FiO₂ group but were significantly lower than in the >0.95 FiO₂ group from 15 to 90 min of anesthesia. Alveolar to arterial O₂ tension difference was increased significantly in both groups during anesthesia compared to preanesthetic values. The alveolar to arterial O₂ tension difference was significantly higher at all times in the >0.95 FiO₂ group compared to the 0.5 FiO₂ group. Oxygen delivery did not change from preanesthetic values in either group during anesthesia but was significantly lower than preanesthetic values 10 min after anesthesia in the 0.5 FiO₂ group. Shunt fraction increased in both groups during anesthesia attaining statistical significance at varying times. Shunt fraction was significantly increased in both groups 10 min after anesthesia but was not different between groups. Alveolar dead space ventilation increased after 3 hr of anesthesia in both groups.

Conclusions

Reducing FiO₂ did not change alveolar dead space ventilation or shunt fraction in dorsally recumbent, mechanically ventilated horses during 3 hr of isoflurane anesthesia. Reducing FiO₂ in dorsally recumbent isoflurane anesthetized horses does not improve oxygenation or oxygen delivery.

Cardiovascular effects of enoximone in isoflurane anaesthetized ponies

OBJECTIVE

Enoximone is a phosphodiesterase III inhibitor frequently used to improve cardiac output (CO) in man. As the use of enoximone has not been reported in horses, the effects of this inodilator were examined in isoflurane anaesthetized ponies.

STUDY DESIGN

Prospective, randomised, experimental study.

ANIMALS

Six healthy ponies, weighing 286 (212-367) +/- 52 kg, aged 5.0 +/- 1.6 years (4-6.5).

METHODS

After sedation with romifidine [80 microg kg(-1) intravenously (IV)], general anaesthesia was induced with midazolam (0.06 mg kg(-1) IV) and ketamine (2.2 mg kg(-1) IV) and maintained with isoflurane in oxygen (Et Iso 1.7%). The ponies were ventilated to maintain eucapnia (PaCO(2) 4.66-6.00 kPa). Each pony was anaesthetized twice with an interval of 3 weeks; receiving enoximone 0.5 mg kg(-1) IV (E) or saline (S) 90 minutes post-induction. Heart rate (HR), arterial (AP) and right atrial pressure (RAP) were measured before treatment, every 5 minutes between T0 (treatment) and T30 and then every 10 minutes until T120. Cardiac output measurements (lithium dilution technique) and blood gas analysis (arterial and central venous samples) were performed before T0 and at T5, T10, T20, T40, T60, T80, T100 and T120. Stroke volume (SV), systemic vascular resistance (SVR), venous admixture (Qs/Qt) and oxygen delivery (DO(2)) were calculated.

RESULTS

Enoximone induced significant increases in HR, CO, SV, Qs/Qt and DO(2) and a significant decrease in RAP. No significant differences were detected for AP, SVR and blood gases. No cardiac arrhythmias or other side effects were observed.

CONCLUSIONS AND CLINICAL RELEVANCE

The present results suggest that in isoflurane anaesthetized ponies, enoximone has beneficial effects on CO and SV without producing significant changes in blood pressure. Despite an increase in Qs/Qt, DO(2) to the tissues was improved.

Effects of Two Different Dosages of Dobutamine on Pulmonary Artery Wedge Pressure, Systemic Arterial Blood Pressure and Heart Rate in Anaesthetized Horses

The purpose of the present study was to investigate the effects of two different dobutamine concentrations on pulmonary artery wedge pressure (PAWP) and on mean systemic arterial blood pressure (MAP) in horses anaesthetized with isoflurane, after induction of general anaesthesia with xylazine, ketamine and diazepam. Eight healthy warm-blood horses were included in the study. Each horse was subjected to general anaesthesia twice with two different dosages of dobutamine, 3 and 5 microg/kg bw/min, being infused over 15 min, starting 50 min after induction of general anaesthesia (T(0)). The heart rate, the PAWP and the MAP were recorded after 10 min (T(1)) and then every 5 min until 15 min after cessation of intravenous dobutamine administration (T(3)-T(5)). The PAWP was measured by a right heart catheter, which was positioned in the pulmonary capillaries. Mean systemic arterial blood pressure was monitored at the facial artery for the duration of general anaesthesia. All parameters increased at both dosage rates of dobutamine and decreased significantly when dobutamine administration ceased. The increase in heart rate was significantly higher after administration of 3 microg/kg bw/min dobutamine compared with the dosage of 5 microg/kg bw/min dobutamine. The increase in MAP was also higher at this dosage, but not significantly different to the dosage of 5 microg/kg bw/min dobutamine. During both dosages the MAP was above a value considered to be compatible with good peripheral circulation. The greater increase in PAWP was observed during administration of 5 g/kg bw/min dobutamine, but PAWP was not significantly different with the dosage of 3 microg/kg bw/min dobutamine. In conclusion, the administration of dobutamine led to an increase in MAP and PAWP above a value considered to be compatible with a good peripheral circulation. The results of the present study indicate that dobutamine improves circulation, in addition to its well-known effect on the periphery.

Morphine administration in horses anaesthetized for upper respiratory tract surgery

OBJECTIVE

To determine the effect of morphine administration on commonly monitored cardio-respiratory variables and recovery quality in horses undergoing anaesthesia and surgery.

STUDY DESIGN

Prospective, randomized clinical study.

ANIMALS

Thirty-eight thoroughbred horses, 32 geldings and six mares, 3-13 years old, weighing 411-600 kg.

MATERIALS AND METHODS

A standard anaesthetic technique was used. Twenty minutes after induction of anaesthesia horses received 0.1 mg kg(-1) (0.1 m) or 0.2 mg kg(-1) (0.2 m) morphine by intravenous injection. A control group did not receive morphine. Heart rate, respiratory rate (fr), mean arterial pressure (MAP) and blood gases were measured before morphine administration and every 10 minutes thereafter. Horses were positioned for 35 minutes in right lateral recumbency for tension palatoplasty by cautery and were then moved into dorsal recumbency for additional intraluminal surgery comprising one or more of aryepiglottic fold resection, sub-epiglottal mucosal resection, ventriculectomy and cordectomy. A subjective recovery score from 0 (worst) to 5 (best) was assigned by a single observer who was unaware of treatment group. Two-way repeated measures anova, one-way anova, Kruskal-Wallis test, Mann-Whitney test, Pearson and Spearman correlation coefficients, and chi-squared tests were used to analyse the data where appropriate.

RESULTS

Arterial partial pressure of oxygen (PaO(2)) decreased significantly over time and was significantly lower in horses that received morphine. One horse in the control group and two horses in each of the morphine groups had a PaO(2) <13 kPa. No other significant cardiopulmonary effects were detected. Recovery scores [median (range)] were higher in morphine recipients: 4 (2-5) in 0.1 m, 4 (3-5) in 0.2 m compared with 3 (2-4) in the control group.

CONCLUSIONS AND CLINICAL RELEVANCE

The lower PaO(2) in morphine recipients did not appear to be of clinical significance in healthy horses because the number of horses with a low PaO(2) was similar between groups. The quality of recovery was significantly better in morphine recipients. These results indicate that morphine may be considered for use in clinical cases although further work is required to assess the analgesic properties of the drug in this species.

Effects of ventilation and isoflurane end-tidal concentration on intracranial and cerebral perfusion pressures in horses

OBJECTIVE

To measure the effects of isoflurane end-tidal concentration and mode of ventilation (spontaneous vs controlled) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in horses.

ANIMAL

adult horses of various breeds.

PROCEDURES

Anesthesia was induced and maintained with isoflurane in O2 in 6 healthy, unmedicated, adult horses. Using a subarachnoid strain gauge transducer, ICP was measured. Blood gas tensions and carotid artery pressures also were measured. Four isoflurane doses were studied, corresponding to the following multiples of the minimum alveolar concentration (MAC): 1.0 MAC, 1.2 MAC, 1.4 MAC, and 1.6 MAC. Data were collected during controlled ventilation and spontaneous ventilation at each dose.

RESULTS

increasing isoflurane end-tidal concentration induced significant dose-dependent decreases in mean arterial pressure (MAP) and CPP but no change in ICR Hypercapnic spontaneous ventilation caused significant increases in MAP and ICR compared with normocapnic controlled ventilation; no change in CPP was observed.

CONCLUSIONS AND CLINICAL RELEVANCE

Hypercapnia likely increases cerebral blood flow (CBF) by maintaining CPP in the face of presumed cerebral vasodilation in healthy anesthetized horses. The effect of isoflurane dose on CBF however, remains unresolved because it depends on the opposing influences of a decrease in CCP and cerebral vasodilation.

Diaphragmatic hernia repair in three young horses

OBJECTIVE

This clinical report describes surgical correction of diaphragmatic hernia in three young horses.

STUDY DESIGN

Retrospective investigation of medical records and subsequent racing performance.

ANIMALS

Three young horses with diaphragmatic hernia.

RESULTS

Three young horses with signs of abdominal pain had diaphragmatic hernia causing small intestinal strangulation. The strangulated small intestine was resected and an end-to-end jejuno-jejunal (two horses) or a side-to-side jejuno-cecal anastomosis (one horse) was performed. Diaphragmatic hernias were closed with a continuous suture pattern. All horses recovered and raced. No difference in race records was found between the subject horses and their siblings. One subject horse died of colic at 5 years of age, but the cause of the colic was undetermined. The remaining two horses are in use as broodmares and have produced multiple foals without recurrence of signs of diaphragmatic hernia.

CONCLUSIONS

Diaphragmatic hernias can be repaired in horses. These horses can achieve race records similar to their siblings and can produce foals without recurrence of signs of diaphragmatic hernia.

Distribution of inspired gas to each lung in the anaesthetised horse and influence of body shape

The distribution of inspired gas to each lung, time constants of the lungs and parameters of gas exchange were studied in 2 groups of horses (mean bwt 606 kg), anaesthetised using thiopentone and chloral hydrate and breathing room air. One group (n = 4) had a downward curved abdominal contour (round-bellied) and the other group (n = 4) had an upward curved abdominal contour (flat-bellied). An equal distribution of inspired gas between the lungs existed in both groups in dorsal recumbency. Flat-bellied horses maintained this equal distribution in lateral recumbency whereas in round-bellied horses an uneven distribution of tidal volume (VT) developed. The percentage of (VT) distributed to the dependent lung was 23% and 38% for left and right lateral recumbency respectively. The distribution of VT agreed with the ratio of time constants of the lungs in flat-bellied horses but differed markedly from this ratio in round-bellied horses suggesting that, in the latter, factors other than compliance and resistance play a role in distribution of ventilation. Round-bellied horses had a lower PaO2 and a larger (A-a)PaO2 than flat-bellied horses in all body positions. The results are compatible with the known hypothesis that pressure exerted by abdominal contents on the dependent lung and diaphragm is an important factor in ventilation/perfusion mismatch of the anaesthetised horse.

Pharmacokinetics of thiopentone in the horse

The pharmacokinetics of thiopentone sodium administered intravenously as a single dose (11 mg/kg) were studied in acepromazine pre-medicated horses and ponies in which anaesthesia was maintained with either halothane (Group 1) or isoflurane (Group 2). The results showed that the disposition kinetics of thiopentone in horses and ponies were best described by a three-compartment open model. In plasma, a very short initial distribution phase in both horses and ponies, half-life 1.4 +/- 1.2 min (mean +/- SD) and 1.3 +/- 0.7 min, respectively, was obtained, which was followed by a second comparatively slower redistribution phase, half-life 16 +/- 12 min and 11 +/- 5 min, respectively. The volume of distribution for the drug was large, especially in the ponies which received isoflurane (1127 +/- 86 ml/kg), compared to the horses which received halothane (742 +/- 89 ml/kg). The drug had a somewhat shorter elimination half-life in the horses (147 +/- 21 min) than in than ponies (222 +/- 44 min), but no obvious difference in clearance of the drug was observed between the horses (3.5 +/- 0.5 ml/min/kg) and ponies (3.6 +/- 0.8 ml/min/kg).

Influence of dopamine and dobutamine on the cardiovascular depression during a standard halothane anaesthesia in dorsally recumbent, ventilated ponies

The influence of different rates of dopamine and dobutamine on the cardiovascular depression during a standard halothane anesthesia was studied in dorsally recumbent ventilated ponies. Haemodynamic and respiratory responses were investigated by means of cardiac output (CO) determination (thermodilution technique), mean systemic (MAP) and pulmonary artery pressure (MPAP) (direct intravascular method) and arterial blood analysis (blood gases and packed cell volume). An important cardiopulmonary depression characterized by decreases (55% of the standing values) in CO, cardiac index (CI), MAP, MPAP and other cardiovascular related parameters occurred in the dorsally recumbent anaesthetized ponies after a stabilization period of 30 minutes. Dopamine at 2 different infusion rates (2.5 and 5.0 micrograms/kg/min) induced few changes of the cardiopulmonary parameters (non-significant increases in MAP, CI, left ventricular work [LVW], stroke volume [SV]; non-significant decrease in total peripheral resistance [TPR]). Several minor time related influences were also observed (increases in MPAP and total pulmonary resistance [TpR]). Arterial blood gases did not change during the different dopamine infusions. Low doses of dobutamine (1.25 micrograms/kg/min) were efficient to counteract the cardiovascular depression. Significant increases in CO, CI, MAP, MPAP and SV were observed. TPR and TpR tended to decrease but non-significantly. Heart rate and blood gases remained constant. The higher doses of dobutamine (2.5 and 5.0 micrograms/kg/min) accentuated these changes but a significant increase in heart rate with even periods of severe tachycardia and an increase of the packed cell volume were also observed. Apparently, low doses of dobutamine were indicated for the management of the cardiovascular depression during anaesthesia in the dorsally recumbent ventilated horse.

Haemodynamic effects of change in position and respiration mode during a standard halothane anaesthesia in ponies

The effects of change in position and respiration modes were studied in 5 experimental ponies during a standard halothane anaesthesia. A marked cardiovascular depression (decrease in mean arterial blood pressure, cardiac output, stroke volume and left ventricle work) occurred in recumbent, spontaneously breathing ponies. No significant differences were found between right and left lateral recumbency. The most pronounced cardiovascular depression was observed in the dorsal position. Sternal recumbency appeared to be slightly beneficial (higher systemic blood pressure and arterial oxygenation). Peripheral resistance tended to decrease in the lateral positions (peripheral vasodilatation) but increased slightly in dorsally recumbent ponies. The mean pulmonary artery pressure decreased significantly in the dorsal position. Pulmonary resistance increased slightly in the laterally and the sternally positioned ponies, suggesting a pulmonary vasoconstriction. On the other hand, pulmonary resistance decreased in dorsal recumbency. Arterial oxygenation decreased progressively during anaesthesia but remained always above standing control values. Hypoventilation (increase in arterial carbon dioxide to +/- 60 mm Hg) was observed in all positions. Controlled intermittent positive pressure ventilation (I.P.P.V.) induced a further decrease of all cardiovascular parameters although no significant differences in cardiac indexes were found regarding the spontaneous breathing protocol. In ventilated ponies the greatest cardiovascular depression was again observed in dorsal recumbency. Peripheral resistance increased slightly in the sternally positioned ponies. A gradual time-dependent increase in pulmonary resistance was observed. Apparently, the arterial oxygenation improved slightly in all positions (especially the sternal posture) when I.P.P.V. was applied.

Anesthetic complications in the horse

The basis for management of all complications is early recognition, preparation, and a problem-solving approach. Some anesthetic complications, such as equipment malfunction and injuries from endotracheal intubation or misplaced drug injections, are common to all animals and can be prevented almost entirely by careful management. Other problems, such as pulmonary dysfunction and cardiovascular depression, seem to occur more often in healthy horses than in healthy members of other domestic species. Postoperative myopathy-neuropathy, sometimes a devastating complication, seems to be peculiar to the horse, and its incidence has been linked to hypotensive inhalant anesthesia. Careful positioning and padding, monitoring of anesthetic depth, and treating of cardiovascular depression may prevent most cases of postanesthetic myopathy. Idiosyncratic drug reactions, such as MH, are entirely unpredictable and can be rapidly fatal unless recognized early and treated vigorously and specifically.

Time-related responses to a constant-dose halothane anaesthesia in dorsally recumbent ventilated ponies

Haemodynamic and respiratory responses to halothane were investigated in dorsally recumbent, ventilated ponies during 2 hours. Normocapnia was maintained using intermittent positive pressure ventilation. Compared to the base line values at 30 minutes of constant dose halothane, no significant changes in heart rate, systemic blood pressure, cardiac output, cardiac index, stroke volume and left ventricle work were observed during a 2 hours anaesthesia. Arterial oxygenation increased initially (greater than 300 mm Hg) but tended to decrease non-significantly during the rest of the anaesthesia. Blood temperature decreased significantly during anaesthesia (p less than 0.05 after 30 minutes), probably due to the cold thermodilution injections but also to peripheral losses of body heat. Time-related increases in mean pulmonary artery pressure (p less than 0.05 after 90 minutes), total peripheral and pulmonary resistance (p less than 0.05 after respectively 60 and 90 minutes) were observed. Increases in peripheral and pulmonary resistance probably reflected vasoconstriction of respectively the peripheral and pulmonary vasculature. These changes might be caused by an increase in circulating catecholamines during prolonged anaesthesia. To avoid possible erroneous conclusions the observed time-dependent responses in anaesthetized dorsally recumbent ponies have to be taken in consideration when other influences (e.a. drugs) are investigated during anaesthesia.

Pulse oximetry in horses

The clinical usefulness of two pulse oximeters was evaluated at two probe sites in nine anesthetized horses. The hemoglobin saturation determined by the pulse oximeters (SaOx) was compared with the hemoglobin saturation calculated from the measured arterial oxygen tension (SaO2). The mean and standard deviation (SD) were calculated from the differences in saturation measurements, over the saturation range of 80% to 100%, for each oximeter used at the tongue probe site and for one oximeter used at the ear. The oximeter results tended to underestimate the SaO2 with mean differences of -3.7% on the tongue and -6.0% on the ear. The limits of agreement were defined as the mean difference +/- 2 SD. Each oximeter used at the tongue produced limits of agreement of +1% to -8%, which meant that 95% of the SaOx values were 1 percentage point above or 8 percentage points below the SaO2. The variability of the differences and limits of agreement were larger when the ear was used as the probe site and at saturations less than 80%. Although both oximeters tended to underestimate the SaO2, they appeared to be clinically useful in detecting changes in arterial hemoglobin saturation.

Ventilation-perfusion relationships in the anaesthetised horse

Ventilation-perfusion relationships were studied by the multiple inert gas elimination technique in seven horses while they were conscious and during inhalation anaesthesia with halothane. A generally good match between ventilation and perfusion was found in the conscious, standing horse. During anaesthesia a huge shunt developed, ie perfusion of completely unventilated lung regions, both in dorsal and left lateral recumbency and whether the horse was breathing spontaneously or mechanically ventilated. The shunt was significantly greater and the arterial oxygen tension (PaO2) significantly lower in dorsal than in left lateral recumbency. Little or no perfusion of low VA/Q regions was observed during anaesthesia, whether ventilation was spontaneous or mechanical. Positive end-expiratory pressure (PEEP) did not significantly improve PaO2 or reduce the shunt. Selective mechanical ventilation of dependent lung regions with PEEP reduced the shunt markedly, an effect that was not achieved by conventional mechanical ventilation with general PEEP. The findings seem compatible with alveolar collapse during anaesthesia, causing shunt, whereas the absence of clearly low VA/Q regions questions the role of airway closure as the major disturbance of gas exchange.

Arterial-alveolar carbon dioxide tension difference and alveolar dead space in halothane anaesthetised horses

Arterial-alveolar carbon dioxide tension differences (a-A) PCO2 and alveolar dead space were measured during clinical halothane anaesthesia of 110 horses with the help of continuous infra-red carbon dioxide analysis of expiratory gas. Mean (a-A) PCO2 was 1.6 +/- 0.8 kPa. Alveolar dead space expressed as a percentage of alveolar tidal volume had a mean value of 23 +/- 13 per cent. Influence on (a-A) PCO2 and alveolar dead space of the following variables was tested statistically: age, weight, body position, respiration mode and duration of anaesthesia. (a-A) PCO2 was influenced positively by weight (P less than 0.0001) and adoption of dorsal recumbency (P less than 0.01). Alveolar dead space was influenced positively by weight (P less than 0.0005), adoption of dorsal recumbency (P less than 0.01), intermittent positive pressure ventilation (P less than 0.0001) and duration of anaesthesia (P less than 0.05).

Arterial blood PO2 and PCO2 in horses during early halothane-oxygen anaesthesia

Arterial blood was collected from 25 clinically normal horses immediately before and serially throughout the first hour of halothane oxygen anaesthesia. Blood was analysed for oxygen and carbon dioxide partial pressure (PaO2, PaCO2). Measurements of inspired oxygen concentration during anaesthesia permitted direct correlation with blood gases. Horses were divided arbitrarily into two groups based on their age: two to seven years, n = 15; over seven years, n = 10. Average (+/- sd) PaO2 and PaCO2 was 14.1 +/- 1.5 kPa (106 +/- 11 mmHg) and 5.9 +/- 0.6 kPa (44.4 +/- 4.4 mmHg) respectively in conscious, young horses and 14.0 +/- 0.7 and 5.8 +/- 0.5 kPa (105 +/- 5 and 43.3 +/- 3.8 mmHg) respectively in conscious older horses. Arterial oxygen tension decreased to 9.3 +/- 1.0 and 8.5 +/- 1.4 kPa (69.6 +/- 7.8 and 63.7 +/- 10.4 mmHg) in young and older air breathing horses respectively immediately following intravenous anaesthetic induction, recumbency and orotracheal intubation. At this time, PaCO2 was 6.5 +/- 0.5 and 6.0 +/- 0.7 kPa (48.7 +/- 3.5 and 45.1 +/- 4.9 mmHg) respectively. By 30 mins after the start of halothane in oxygen (6 litres/min) anaesthesia PaO2 increased to a maximum in both study groups. Arterial PCO2 increased steadily during anaesthesia and 60 mins after induction PaCO2 was 10.5 +/- 2.4 kPa (78.5 +/- 17.8 mmHg) in the younger horses and 9.2 +/- 1.6 kPa (68.8 +/- 11.8 mmHg) in the older horses. During inhalation anaesthesia PaO2 tended to be greater at comparable time periods in the younger horses despite a slightly greater degree of hypoventilation.

Apneic oxygenation in anesthetized ponies and horses

Apneic oxygenation was studied in six ponies for 30 minutes, and six horses for 10 minutes. Arterial blood was sampled at regular intervals for measurement of oxygen and carbon dioxide tensions (PaO2 and PaCO2) and calculation of alveolar-arterial oxygen tension difference (PAO2-PaO2). In both groups of animals, PaO2 decreased rapidly during the first 3 minutes of apnea, then more slowly. Although the mean value was above 100 mmHg at 10 minutes, there was considerable inter-animal variability. Before apnea, PAO2-PaO2 was slightly, but not significantly, larger in horses than in ponies and increased in both groups during the first 3 minutes of apnea, after which the increase was slower. There was no significant difference between ponies and horses up to 10 minutes, suggesting that PAO2-PaO2 is independent of body size. In ponies, the PAO2-PaO2 did not change significantly between 10 and 30 minutes. Final PaO2 could not be correlated with initial PaO2 or initial PAO2-PaO2. The rate of rise of PAO2-PaO2 could not be predicted from baseline values. The rate of rise of PaCO2 was similar and fairly constant in ponies and horses, and did not contribute to the rapid initial decrease in PaO2. It appears that apneic oxygenation should not be used in the equine species, since it is impossible to predict in which animals the technique is safe for more than a few minutes.

Review of exercise induced pulmonary haemorrhage and its possible relationship with mechanical stress

Exercise induced pulmonary haemorrhage (EIPH) is a condition of uncertain aetiology. This article reviews the evidence relating to its incidence, clinical findings, radiological observations, histopathology and certain aspects of respiratory physiology. It is proposed that EIPH is primarily caused by mechanical stress in the dorsocaudal region of the lung.

Cardiovascular and pulmonary effects of recumbency in two conscious ponies

Respiratory dead-space, tidal volume, respiratory rate, blood gases, cardiac output, heart rate and arterial and pulmonary arterial blood pressures were measured in two conscious, trained ponies in the standing position and in left lateral recumbency. The ponies were reluctant to remain lying down for more than about 20 mins but the reason for this did not become apparent. Tidal volume was reduced during recumbency but the respiratory rate increased, tending to maintain the minute volume at about that of the standing animal. Arterial carbon dioxide tension did not change significantly from standing values but the mean arterial oxygen tension values tended to decrease in both ponies during recumbency because of a slight increase in pulmonary venous admixture. Venous admixture in these two laterally recumbent conscious animals was considerably less than previously reported for anaesthetised subjects.

Observations on the use of glyceryl guaiacolate as an adjunct to general anaesthesia in horses

Twenty-one horses undergoing clinical surgery and diagnostic procedures received 15% glyceryl guaiacolate followed by a rapid intravenous injection of a thiobarbiturate for induction of anaesthesia. Premedication was with atropine and acepromazine. Induction was smooth and free from problems apart from transient apnoea in some horses. Maintenance of anaesthesia was with oxygen and halothane administered by means of a closed circle system with soda-lime absorber and with the vaporiser out of circuit. During the period immediately following induction, the heart rate increased and the respiratory rate fell. Blood gas estimations were carried out on 6 horses during anaesthesia. These horses showed respiratory acidosis. Arterial blood oxygen tension values were above those reported in conscious horses. Use of glyceryl guaiacolate in this way provides a safe induction and enables transition to a stable maintenance period which is followed by a quiet and uneventful recovery.