1
|
Bayley KD, Gates MC, Anastassiadis Z, Read RA. The use of sub-Tenon's anesthesia versus a low-dose neuromuscular blockade for canine cataract surgery: A comparative study of 224 eyes. Vet Ophthalmol 2024; 27:114-126. [PMID: 37199512 DOI: 10.1111/vop.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Assess the utility of a Sub-Tenon's anesthesia (STA) protocol to provide suitable operating conditions for canine cataract surgery and compare it to an alternative low-dose neuromuscular blockade (LD-NMB) protocol used for canine cataract surgery. PROCEDURES Clinical study of dog eyes undergoing cataract surgery with either an STA or LD-NMB protocol. While intraoperative vitreal expansion scores and intraoperative complications were collected prospectively, globe position, intraocular pressure, return of vision, and postoperative complications were collected retrospectively. Statistical testing was used to compare results between the STA and the LD-NMB groups for the data available. RESULTS A total of 224 eyes from 126 dogs were assessed, with 133/224 (59.4%) eyes from 99/126 (78.6%) dogs receiving STA and 91/124 (40.6%) eyes from 72/126 (57.1%) dogs receiving LD-NMB. Forty-five of these dogs (45/126; 37.7%) received STA for one eye and LD-NMB for the other eye. There was no significant change in intraocular pressure measurements following STA administration. This was not measured for the LD-NMB group. The globe achieved a central position in 110/133 (82.7%) of eyes that received STA. This was not measured for the LD-NMB group. Intraoperative vitreal expansion scores were slightly higher in STA-treated eyes compared to LD-NMB-treated eyes. The intraoperative complication rate for STA-treated eyes was higher (73/133; 54.8%) compared to NMB-treated eyes (12/91; 13.2%). The most common intraoperative complication for STA was chemosis (64/133; 48.1%), the risk of which increased with an increase in the volume of local anesthetic injected. The post-operative complication rate was higher in STA-treated eyes (28/133; 21.1%) compared to NMB-treated eyes (16/91; 17.6%). Post-operative corneal ulceration was the most common postoperative complication in STA-treated eyes (6/133; 4.5%). CONCLUSION The STA protocol described resulted in suitable operating conditions, but more intraoperative and postoperative complications compared to the LD-NMB protocol. Despite these complications, the STA protocol did not cause a significant deleterious impact on post-operative outcomes as defined in the present study.
Collapse
Affiliation(s)
| | - M Carolyn Gates
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | | | - R A Read
- Veterinary Ophthalmic Referrals, Adelaide, Australia
| |
Collapse
|
2
|
Costa GL, Leonardi F, Interlandi C, Spadola F, Fisichella S, Macrì F, Nastasi B, Macrì D, Ferrantelli V, Di Pietro S. Levobupivacaine Combined with Cisatracurium in Peribulbar Anaesthesia in Cats Undergoing Corneal and Lens Surgery. Animals (Basel) 2023; 13:ani13010170. [PMID: 36611778 PMCID: PMC9817947 DOI: 10.3390/ani13010170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
The aims of the study included evaluating the effects of levobupivacaine combined with cisatracurium on akinesia and mydriasis when administered by peribulbar injection, and evaluating if the chosen dose of cisatracurium is enough to avoid the use of systemic neuromuscular blockade in cats. The animals were divided into four groups as follows: group L received 1.25 mg kg-1 levobupivacaine administered by peribulbar injection; group LC received the same dose of levobupivacaine combined with 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group C received 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group GC received 0.01 mg kg-1 of cisatracurium intravenously. Physiological variables, intraocular pressure, akinesia, and mydriasis were measured before and up to 30 min after peribulbar injection. The onset of akinesia, duration of akinesia, and train of four (TOF) were evaluated. Physiological variables remained in the physiological range in all groups. Effective akinesia and mydriasis were observed in all groups. The (TOF) was 0.9 in all groups. Throughout the study was observed in group LC a shortened onset of akinesia and a prolonging its duration. The peribulbar injection of cisatracurium and levobupivacaine provided effective akinesia and mydriasis, and shortened the onset of akinesia while prolonging its duration.
Collapse
Affiliation(s)
- Giovanna L. Costa
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| | - Fabio Leonardi
- Department of Veterinary Science, University of Parma, Via del Taglio 10, 43126 Parma, Italy
| | - Claudia Interlandi
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
- Correspondence: ; Tel.: +39(0)90-676-6758
| | - Filippo Spadola
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| | - Sheila Fisichella
- Evidensia Veterinarhuset Sundsvall, Regementsvagen 9, 85238 Sundsvall, Sweden
| | - Francesco Macrì
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| | - Bernadette Nastasi
- École Nationale Vétérinaire d’Alfort Unité d’anesthésie et reanimation, Pôle anesthésie et réanimation, Urgences et Soins Intensives 7, Av Du Général de Gaulle, 94700 Maisons-Alfort, France
| | - Daniele Macrì
- Zooprophylactic Institute, Via Gino Marinuzzi 3, 90100 Palermo, Italy
| | | | - Simona Di Pietro
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, Via Palatucci Annunziata, 98168 Messina, Italy
| |
Collapse
|
3
|
Comparing Blind and Ultrasound-Guided Retrobulbar Nerve Blocks in Equine Cadavers: The Training Effect. Animals (Basel) 2022; 12:ani12020154. [PMID: 35049776 PMCID: PMC8772549 DOI: 10.3390/ani12020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Standing ophthalmic surgeries have become more and more common in horses. For these standing surgeries, the blind retrobulbar block is often used for anesthesia and akinesia of the eye. However, placing a retrobulbar block using this blind technique can lead to complications, for example, penetration of the globe, nerve injury or chemosis due to spreading of the local anesthetic in the region of the globe. For this reason, it might be better to perform the retrobulbar block using guidance by ultrasound. Ultrasound-guided retrobulbar block has only been described twice in the literature using equine cadavers. Comparison of the ultrasound-guided peribulbar technique to the blind technique has only been carried out once. Furthermore, the learning curve of ultrasound-guided retrobulbar nerve block placement has not been evaluated. Our study aimed to compare the blind and ultrasound-guided approaches to retrobulbar block placement in horses and to evaluate the success and complication rates, analyzing the effect of training on ultrasound guidance. A trend towards a significant improvement in accuracy was seen for ultrasound guidance, and larger scale follow-up studies might show a significant training effect on the use of ultrasound in retrobulbar nerve block placement and that the use of ultrasound guidance could be promising. Abstract In standing ophthalmic surgery in horses, a retrobulbar nerve block (RNB) is often placed blindly for anesthesia and akinesia. The ultrasound (US)-guided RNB may have fewer complications, but the two techniques have only been compared once in equine cadavers. This study compares the techniques for success and complication rates and analyzes the effect of training on US guidance. Twenty-two equine cadavers were divided into three groups: blind RNBs were performed bilaterally in eight cadavers, US-guided RNBs were performed bilaterally in seven cadavers, and after US-guided training, blind RNBs were performed bilaterally in seven cadavers. All RNBs were performed by the same two inexperienced operators, and a combination of contrast medium (CM; 1.25 mL) and methylene blue dye (1.25 mL) were injected (2.5 mL total volume). Needle positioning in the periorbita and the distance of the CM to the optic foramen were assessed using computerized tomography (CT). Dye spreading was evaluated by dissection. In group 1, 37.5% of the injections were in the optimal central position in the periorbita; in group 2, 75% and in group 3, 71.4%. There was no significant difference between the groups regarding needle position (groups 1 and 2 p = 0.056; groups 1 and 3 p = 0.069, groups 2 and 3 p = 0.8). The mean CM distribution distance was not significantly different between all groups. Group 1 had 18.75% intraocular injections versus 0% in group 2 and 7.1% in group 3 (not significant). US guidance showed no significant increases in accuracy nor decreases in complications. However, the effects on accuracy showed a trend towards significant improvement, and larger scale follow-up studies might show significant training effects on US guidance.
Collapse
|
4
|
Greco A, Costanza D, Senatore A, Bruzzese D, Micieli F, Chiavaccini L, Di Giancamillo M, Della Valle G, Vesce G, Brunetti A, Meomartino L. A computed tomography-based method for the assessment of canine retrobulbar cone volume for ophthalmic anaesthesia. Vet Anaesth Analg 2021; 48:759-766. [PMID: 34391668 DOI: 10.1016/j.vaa.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/01/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a comprehensive formula for calculating the volume of local anaesthetic solution used for retrobulbar anaesthesia in dogs with different skull morphologies. STUDY DESIGN Retrospective cohort imaging study. ANIMALS Skull computed tomography (CT) images of 188 dogs of different breeds collected between January 2009 and December 2017. METHODS Anatomical integrity of the orbit and adjacent structures, presenting complaint, clinical signs and CT findings were verified to exclude ocular abnormalities. The volume of the retrobulbar cone of 376 eyes was calculated using CT scans of the dogs' skulls. Additional data recorded included morphology of the skull, body weight, sex and size of the dogs, all of which were matched for possible association to the retrobulbar cone volume through univariable and multivariable linear regression models. Results of linear regression models were expressed as estimated beta coefficients with the corresponding 95% confidence intervals (95% CIs). RESULTS Using univariate analysis, the retrobulbar cone volume was positively associated with weight and male sex. In addition, brachycephalic and dolichocephalic dogs showed a larger retrobulbar cone volume than mesocephalic dogs, while sex was no longer significantly associated with the retrobulbar cone volume. In multivariate analysis, when considering all variables in the model, weight emerged as the strongest predictor (beta coefficient: 0.062 mL kg-1, 95% CI: 0.056-0.067 mL kg-1, p < 0.001). CONCLUSIONS and clinical relevance In the veterinary literature, there is no agreement on the precise volume of local anaesthetic solution that should be used to achieve intraconal retrobulbar anaesthesia in dogs. Here we suggest a formula to calculate the retrobulbar cone volume and, accordingly, the injection volume of local anaesthetic solution for effective retrobulbar anaesthesia.
Collapse
Affiliation(s)
- Adelaide Greco
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy; Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy.
| | - Dario Costanza
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy
| | - Andrea Senatore
- Centro Intedipartimentale di Ricerca sui Biomateriali, Università degli Studi di Napoli 'Federico II', Naples, Italy
| | - Dario Bruzzese
- Dipartimento di Sanità Pubblica, Università di Napoli 'Federico II', Naples, Italy
| | - Fabiana Micieli
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Ludovica Chiavaccini
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Della Valle
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Giancarlo Vesce
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli 'Federico II', Naples, Italy
| | - Leonardo Meomartino
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy; Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| |
Collapse
|
5
|
Shilo-Benjamini Y. A review of ophthalmic local and regional anesthesia in dogs and cats. Vet Anaesth Analg 2019; 46:14-27. [DOI: 10.1016/j.vaa.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/17/2022]
|
6
|
Abstract
OBJECTIVE To test a sub-Tenon's anesthesia technique in dogs as an alternative to systemic neuromuscular blockade to aid in canine cataract surgery under general anesthesia. PROCEDURES A prospective controlled clinical study was performed involving 12 dogs undergoing bilateral cataract surgery under general anesthesia. One eye was randomly assigned to have phacoemulsification and prosthetic lens implantation performed with sub-Tenon's anesthesia (STA), and the control eye had surgery performed with systemic neuromuscular blockade (NMB). Intraocular pressure (IOP) was measured immediately before and after STA administration. Globe position, globe rotation, pupillary dilation, and vitreal expansion were assessed for both STA and NMB eyes during surgery. RESULTS Sub-Tenon's anesthesia produced a globe position suitable for cataract surgery with the degree of vitreal expansion not significantly different to control NMB eyes. STA produced greater anterior globe displacement than NMB in all cases. STA had no significant effect on IOP. CONCLUSION Sub-Tenon's anesthesia was an effective alternative to systemic neuromuscular blockade for canine cataract surgery and may be beneficial for surgical exposure in deep orbited breeds.
Collapse
Affiliation(s)
| | - R A Read
- Veterinary Ophthalmic Referrals, Plympton, SA, Australia
| |
Collapse
|
7
|
Stadler S, Dennler M, Hetzel U, Del Chicca F, Hoey S, Spiess BM, Voelter K, Pot SA. Sub-Tenon's injection in equine cadaver eyes: MRI visualization of anesthetic fluid distribution and comparison of two different volumes. Vet Ophthalmol 2016; 20:488-495. [PMID: 28008696 DOI: 10.1111/vop.12452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the localization and distribution of two different anesthetic fluid volumes around equine cadaver eyes to determine an appropriate volume for a single sub-Tenon's injection in horses. PROCEDURE A single sub-Tenon's injection of 2% lidocaine was performed in 10 equine cadaver heads (20 eyes) using two different volumes (7 mL on one side and 10 mL on the opposite side). The posterior circular distribution of the anesthetic was quantified in sagittal, dorsal, and transverse MRI (T2W-TSE) sequences and evaluated independently by three board-certified radiologists. The distribution of the two fluid volumes was compared via a paired Student's t-test. The interobserver reliability was evaluated via a Kruskal-Wallis test. RESULTS Extension of the injection fluid was observed along the dorsal and temporal quadrants of the globe within the subconjunctival space, the anterior and posterior sub-Tenon's space, and into the muscle sheaths along the extraocular muscles. Accumulation of anesthetic fluid directly surrounding the optic nerve was detected in three of 20 cadaver eyes. Circular distribution of the 7 and 10 mL anesthetic volumes was not significantly different (P = 0.849). More retrograde leakage of the anesthetic was observed using the 10 mL volume. Evaluation of interobserver reliability revealed no significant differences between observers (P = 0.21-0.92). CONCLUSIONS Sub-Tenon's anesthesia can have potential as an alternative to retrobulbar anesthesia for ophthalmic surgeries in equines. A 7- to 10-mL injection volume should be appropriate based on the results of this study. The distribution of the anesthetic solution in live tissues, the clinical effects, and the potential for complications will have to be evaluated in vivo.
Collapse
Affiliation(s)
- Silvia Stadler
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| | - Matthias Dennler
- Diagnostic Imaging Unit, Vetsuisse Faculty, Department for Small Animals, University of Zurich, Zurich, CH-8057, Switzerland
| | - Udo Hetzel
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, CH-8057, Switzerland
| | - Francesca Del Chicca
- Diagnostic Imaging Unit, Vetsuisse Faculty, Department for Small Animals, University of Zurich, Zurich, CH-8057, Switzerland
| | - Sèamus Hoey
- Diagnostic Imaging Unit, Vetsuisse Faculty, Department for Small Animals, University of Zurich, Zurich, CH-8057, Switzerland
| | - Bernhard M Spiess
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| | - Katrin Voelter
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| | - Simon A Pot
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| |
Collapse
|