1
|
Kim H, Son WG, Jang M, Kim D, Shin D, Kim J, Lee I. Cardiovascular Responses to Nasal Stimulation Under Ethmoidal-Maxillary Nerve Block and Lidocaine Gel in Anesthetized Beagles. J Am Anim Hosp Assoc 2022; 58:265-270. [PMID: 36315859 DOI: 10.5326/jaaha-ms-7183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2021] [Indexed: 06/16/2023]
Abstract
This study aimed to compare the effect of ethmoidal-maxillary nerve block (EMBLOCK) and topical application of 2% lidocaine gel (LGEL) on cardiovascular variables (heart rate and arterial blood pressure) during mechanical stimulation of the nasal cavity. The working hypothesis was that both techniques (EMBLOCK and LGEL) similarly blunt the cardiovascular responses to the stimulation. Six beagles were anesthetized using alfaxalone and isoflurane on three occasions with each treatment (EMBLOCK, LGEL, and control) in random order. The nasal cavity from the nose tip to the medial canthus was stimulated with a standard-tip cotton swab, and cardiovascular variables were recorded before and after stimulation. The maximum increases in heart rate and blood pressure were significantly smaller in EMBLOCK and LGEL than in the control. There was no significant difference between EMBLOCK and LGEL. Therefore, although further clinical studies are required, EMBLOCK and LGEL can be used because both EMBLOCK and LGEL attenuated the cardiovascular response to mechanical stimulation of the nasal cavity in dogs.
Collapse
Affiliation(s)
- Hyunseok Kim
- Department of Veterinary Clinical Sciences (H.K., W.-g.S., M.J., D.K., D.S., J.K.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Won-Gyun Son
- Department of Veterinary Clinical Sciences (H.K., W.-g.S., M.J., D.K., D.S., J.K.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Min Jang
- Department of Veterinary Clinical Sciences (H.K., W.-g.S., M.J., D.K., D.S., J.K.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Dalhae Kim
- Department of Veterinary Clinical Sciences (H.K., W.-g.S., M.J., D.K., D.S., J.K.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Donghwi Shin
- Department of Veterinary Clinical Sciences (H.K., W.-g.S., M.J., D.K., D.S., J.K.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jiyoung Kim
- Department of Veterinary Clinical Sciences (H.K., W.-g.S., M.J., D.K., D.S., J.K.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Inhyung Lee
- From the Department of Veterinary Surgery/Anesthesiology (I.L.), College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
2
|
Kim H, Kim D, Shin D, Kim J, Sung T, Rhee S, Lee I, Son WG. Ethmoidal and maxillary nerve block versus systemic opioid administration during rhinoscopy in dogs: a non-randomised clinical trial. J Small Anim Pract 2022; 63:816-820. [PMID: 35859528 DOI: 10.1111/jsap.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate the clinical effects of ethmoidal and maxillary nerve blocks during rhinoscopy in dogs. MATERIALS AND METHODS Fourteen dogs underwent rhinoscopy. Under general anaesthesia with isoflurane, ethmoidal and maxillary nerve blocks were applied bilaterally using 2% lidocaine before rhinoscopy in eight dogs (EM group). Six dogs were premedicated with hydromorphone (0.05 mg/kg) as a substitute for local nerve block (H group). During rhinoscopy, the heart rate, arterial blood pressure and end-tidal isoflurane concentration were recorded. The vaporizer setting was adjusted to increase the end-tidal isoflurane concentration when reflex movement was caused by nasal stimulation. RESULTS The H group, compared to the EM group, had an increase in HR that was 18 beats/minute (95% CI: 11 to 26) higher, an increase in SAP that was 22 mmHg (12 to 31) higher, an increase in MAP that was 15 mmHg (7 to 23) higher, an increase in DAP that was 12 mmHg (5 to 19) higher, and an increase in end-tidal isoflurane concentration that was 0.4% (0.3 to 0.5) higher. Head movement due to endoscope insertion was observed in 5/6 dogs (83.3%) in the H group and 1/8 dogs (12.5%) in the EM group (odds ratio, 0.029; ra95% CI, 0.001-0.574). CLINICAL SIGNIFICANCE Compared with administration of 0.05 mg/kg hydromorphone, concurrent block of the ethmoidal and maxillary nerves can reduce the cardiovascular response, reflex movement and anaesthetic requirement during rhinoscopy in dogs.
Collapse
Affiliation(s)
- H Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - D Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - D Shin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - J Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - T Sung
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - S Rhee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - I Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| | - W G Son
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, 08826, South Korea
| |
Collapse
|
3
|
Retrograde Approach to Maxillary Nerve Block: An Alternative in Orofacial Surgeries in Horses. Animals (Basel) 2022; 12:ani12111369. [PMID: 35681833 PMCID: PMC9179549 DOI: 10.3390/ani12111369] [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: 02/22/2022] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Maxillary nerve (MN) desensitization can improve quality and safety of orofacial surgeries in horses, especially when a standing procedure is elected. The purpose of this retrospective study is to report results from 15 horses undergoing orofacial surgery which received an MN block with the retrograde approach within the infraorbital canal. The same technique was used in horses scheduled for orofacial surgeries and grouped as requiring general anesthesia or standing analgo-sedation. From the retrieved anesthetic records, regardless of the group, clinical and physiological parameters continuously monitored during surgery were stable, and none of the horses showed complications during or after the block. These results confirm the feasibility of this loco-regional anesthetic technique as a valid approach to the MN without risk of damaging periorbital structures, which is reported with traditional techniques. Evident landmarks for this approach and limited chances to injure vital structures enclosed within the infraorbital canal make the operator experience less relevant than the ability required to block the MN according to approaches, which currently aim at the pterygopalatine fossa. This substantiates the retrograde approach to block the MN is safe and easy to perform in horses undergoing orofacial surgeries at regions where this nerve provides sensory innervation. Abstract The aim of this study was to retrospectively report outcomes resulting from the approach to the maxillary nerve block (MNB) through the infraorbital canal, in terms of needles selection, drawbacks or side effects during or after block execution, and analgesic efficacy leading to clinical and cardiovascular stability during surgery. Anesthetic records of 15 horses undergoing orofacial surgery in standing analgo-sedation (STA, n = 6) and in general anesthesia (GEN, n = 9) were retrieved and analyzed. Horses in group STA required surgery for dental extraction, nasal polyp resection and maxillary/frontal sinusitis. Horses in group GEN underwent surgery for fronto-maxillary, nasal and dental diseases. Size 19 and 20 G Tuohy needles were used in adult horses weighing 350–600 kg, while size 21 and 22 G were used in younger horses or ponies. None of the horses in both groups showed complications related to the block and physiological parameters were stable and within normal ranges during surgery; overall, an adequate anesthetic/sedation depth was achieved. Our results confirm the in vivo applicability of the MNB approached within the infraorbital canal, which had been described only on cadaveric specimens. The retrograde technique resulted in a valid and easy approach to the maxillary nerve that avoids damage to periorbital structures and side effects reported with traditional techniques.
Collapse
|
4
|
Ryan A, Gurney M, Steinbacher R. Suspected vagal reflex and hyperkalaemia inducing asystole in an anaesthetised horse. Equine Vet J 2021; 54:927-933. [PMID: 34738246 PMCID: PMC9543672 DOI: 10.1111/evj.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022]
Abstract
A 10‐year‐old 466 kg mustang gelding presented to an equine referral hospital for surgical repair of nasal, frontal and lacrimal bone fractures from an unknown trauma. Surgical repair was performed under general anaesthesia, including a right‐sided maxillary regional anaesthetic block with mepivacaine hydrochloride. Progressive hyperkalaemia was documented perianaesthetically (T‐3 mins; 134 mins after induction; potassium 6.4 mmol/L (ref 3.5‐5.1 mmol/L). Perianaesthetic bradycardia was attributed to alpha −2 agonist infusion administration, and other characteristic ECG changes (flattened P waves, narrow T waves of increased amplitude, prolonged QRS complex) were not documented. Asystole occurred 137 min after induction of anaesthesia; however, a review of the available literature suggests the degree of hyperkalaemia documented was unlikely to be the primary cause of asystole but may have been a contributing factor. It is hypothesised that a trigeminocardiac reflex was the primary contributory factor to asystole in the described case, and may represent a maxillomandibulocardiac reflex that has not been previously described in the horse.
Collapse
Affiliation(s)
- Aoife Ryan
- University of Veterinary Medicine, Vienna, Austria.,Anderson Moores Veterinary Specialists, Winchester, UK
| | | | | |
Collapse
|
5
|
Campoy L, Sedgwick SR. Standing Sedation and Iocoregional Analgesia in Equine Dental Surgery. Vet Clin North Am Equine Pract 2021; 36:477-499. [PMID: 33189231 DOI: 10.1016/j.cveq.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Procedural sedation has become popular for describing a semiconscious state that allows patients to be comfortable during certain surgical or diagnostic procedures. Sedation may be enhanced by locoregional anesthetic techniques to produce sufficient analgesia and muscle relaxation for surgery to occur. Sedation and local anesthesia for standing diagnostic and surgical procedures on the horse's head circumvents the potential complications of general anesthesia (particularly, complications related to recovery). However, the implementation of a locoregional anesthetic technique requires a thorough understanding of the anatomy to maximize success and minimize possible complications.
Collapse
Affiliation(s)
- Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Mailbox 32, Ithaca, NY 14853, USA
| | - Samantha R Sedgwick
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Mailbox 32, Ithaca, NY 14853, USA.
| |
Collapse
|
6
|
Kim H, Jang M, Shin CW, Han H, Cha J, Lee I, Son WG. The effects of maxillary nerve block, ethmoidal nerve block and their combination on cardiopulmonary responses to nasal stimulation in anesthetized Beagle dogs. Vet Anaesth Analg 2020; 48:92-100. [PMID: 33012661 DOI: 10.1016/j.vaa.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe an approach for ethmoidal nerve block (EBLOCK) and to compare the effects of a maxillary nerve block (MBLOCK), EBLOCK and their combination (M-EBLOCK) on heart rate (HR), systolic (SAP), mean (MAP), diastolic (DAP) arterial pressures and respiratory rate (fR) during nasal stimulation in dogs. STUDY DESIGN Prospective, blinded, randomized, crossover placebo-controlled study. ANIMALS Beagle dogs (five cadavers, nine live dogs), with a median (interquartile range) weight of 10.5 (10.3-11.0) kg. METHODS The accuracy of iohexol injections (each 1 mL) at the maxillary and ethmoidal foramina in cadavers was evaluated using computed tomography. Then, anesthetized dogs were administered four bilateral treatments separated by 1 week, saline or 2% lidocaine 1 mL per injection: injections of saline at the maxillary and ethmoidal foramina (Control), injections of lidocaine at the maxillary foramina and saline at the ethmoidal foramina (MBLOCK), injections of saline at the maxillary foramina and lidocaine at the ethmoidal foramina (EBLOCK) and injections of lidocaine at all foramina (M-EBLOCK). The ventral nasal meatus was bilaterally stimulated using cotton swabs, and HR, SAP, MAP, DAP and fR were continuously recorded. Values for each variable were compared before and after stimulation using Wilcoxon signed-rank test. Changes in variables among treatments were analyzed using Mann-Whitney U and Kruskal-Wallis tests (p ≤ 0.05). RESULTS Computed tomography revealed iohexol distribution around the openings of the target foramina in all cadavers. In living dogs, HR, SAP, MAP, DAP and fR significantly increased after stimulation within each treatment (p < 0.03). Physiologic responses were significantly attenuated, but not absent, in the M-EBLOCK [HR (p = 0.019), SAP, MAP, DAP and fR (all p ≤ 0.001)] compared with those in the Control. CONCLUSIONS AND CLINICAL RELEVANCE Concurrent injections of lidocaine at the maxillary and ethmoidal foramina attenuated HR, arterial pressure and fR responses to nasal stimulation in Beagle dogs.
Collapse
Affiliation(s)
- Hyunseok Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Min Jang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chi Won Shin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyungjoo Han
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jeesoo Cha
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Inhyung Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Won-Gyun Son
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
7
|
Tremaine H. Local analgesia techniques for dental and head procedures in horses. IN PRACTICE 2019. [DOI: 10.1136/inp.l662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Weber S, Ohlerth S, Mosing M, Torgerson PR, Fürst A, Bischofberger AS. Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Weber
- Vetsuisse Faculty Equine Hospital University of Zurich Zurich Switzerland
| | - S. Ohlerth
- Department of Diagnostics and Clinical Services Vetsuisse Faculty Clinic of Diagnostic Imaging University of Zurich Zurich Switzerland
| | - M. Mosing
- College of Veterinary Medicine Murdoch University Perth Australia
- Section of Anaesthesiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - P. R. Torgerson
- Section of Veterinary Epidemiology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - A. Fürst
- Vetsuisse Faculty Equine Hospital University of Zurich Zurich Switzerland
| | | |
Collapse
|
9
|
Robert MP, Stemmet GP, Smit Y. A bilateral sinus cyst treated via a bilateral frontonasal bone flap in a standing horse. J S Afr Vet Assoc 2019; 90:e1-e6. [PMID: 31038323 PMCID: PMC6556708 DOI: 10.4102/jsava.v90i0.1729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/10/2018] [Accepted: 01/23/2019] [Indexed: 11/01/2022] Open
Abstract
Bilateral paranasal sinus diseases are rarely reported in horses. Treatment using a bilateral frontonasal bone flap on a standing, regular-sized adult horse has not been described previously. A 13-year-old Thoroughbred gelding was evaluated for bilateral mucopurulent nasal discharge. Radiographic, endoscopic and computed tomographic examinations revealed bilateral sinus pathological changes consistent with an ethmoid haematoma involving the maxillary and frontal sinuses. A bilateral frontonasal bone flap was created under standing sedation and local anaesthesia. A tracheotomy was performed initially to ensure a patent airway during the procedure. Additional analgesia had to be given to transect the dorsal part of the nasal septum while elevating the flap. The sinus masses were removed and communications with the nasal cavities created uneventfully. Small sequestra were removed transendoscopically from the left caudal maxillary sinus 4 weeks after the initial procedure. The horse made a complete recovery with an excellent cosmetic outcome. Histopathology revealed the mass to be a sinus cyst. We concluded that a bilateral sinus bone flap can be used in adult regular-sized horses to access the left and right paranasal sinuses simultaneously. Regional nerve blocks should be performed in order to increase analgesia. A temporary tracheotomy prevents any airway obstruction during the procedure. The post-operative cosmesis is excellent.
Collapse
Affiliation(s)
- Mickaël P Robert
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort.
| | | | | |
Collapse
|
10
|
Hermans H, Veraa S, Wolschrijn CF, van Loon JPAM. Local anaesthetic techniques for the equine head, towards guided techniques and new applications. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Hermans
- Department of Equine SciencesFaculty of Veterinary Medicine Utrecht UniversityUtrecht The Netherlands
| | - S. Veraa
- Division of Diagnostic ImagingFaculty of Veterinary Medicine Utrecht UniversityUtrecht The Netherlands
| | - C. F. Wolschrijn
- Department of Pathobiology Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
| | - J. P. A. M. van Loon
- Department of Equine SciencesFaculty of Veterinary Medicine Utrecht UniversityUtrecht The Netherlands
| |
Collapse
|
11
|
Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|