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Gandini M, Giusto G. Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses. Equine Vet J 2023; 55:1021-1028. [PMID: 36645415 DOI: 10.1111/evj.13926] [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: 04/26/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND In jejunocaecal anastomosis leaving a necrotic ileal stump has been implicated in complications and poor outcomes. Elective inversion of the necrotic stump using a nasogastric tube has been previously described, although this procedure can be cumbersome and can cause caecocolic orifice occlusion. OBJECTIVE To describe the use of a new device for elective inversion of necrotic ileal stumps. STUDY DESIGN Case report. METHODS Details of the four horses that underwent intestinal resection and anastomosis with elective inversion of the ileal stump were retrieved from their medical records. For each case, a device was constructed by securing 0.7 m of hemp tape to a 0.5 m long electrical cable puller. The device was inserted into the ileum and passed through the caecum. The ileal lumen was closed using sutures or staples, and the tape was simultaneously secured to the intestine. The ileum was then resected. A small typhlotomy was performed at the proposed site for jejunocaecal anastomosis. The device was retrieved, the hemp tape was cut, and jejunocaecal anastomosis was completed. RESULTS The device was easily secured to the intestines. Small enterotomies were sufficient for device insertion and removal. In four clinical cases the procedure was effective in inverting the stump, and three out of the four horses recovered uneventfully and were discharged from the hospital. One horse was euthanised due to colic 27 months following discharge. MAIN LIMITATIONS Small number of cases admitted to single tertiary hospital. CONCLUSIONS The device was effective in inverting the ileal stump in the included clinical cases. By leaving a short, inverted stump, this method may help improve the prognosis for jejunocaecal anastomosis, possibly avoiding certain undesired effects of the procedure. Further studies with large numbers of cases are required.
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Affiliation(s)
- Marco Gandini
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Gessica Giusto
- Department of Veterinary Sciences, University of Turin, Turin, Italy
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Freeman DE, Bauck AG. Repeat Celiotomy-Current Status. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00024-X. [PMID: 37121783 DOI: 10.1016/j.cveq.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Repeat celiotomy can be lifesaving in horses with a surgically treatable postoperative obstruction, although guidelines for its use are lacking, except for uncontrollable postoperative pain. Overdiagnosis of ileus as the cause of postoperative obstruction could delay a second surgery so the disease progresses beyond a manageable level of severity. Although many horses respond favorably to repeat celiotomy, complications can be severe and life threatening, such as incisional infection and adhesions. Repeat celiotomy does not seem to exacerbate postoperative ileus, despite additional surgical manipulation. An important benefit of repeat celiotomy is termination of hopeless cases, thereby reducing cost and suffering.
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Affiliation(s)
- David E Freeman
- University of Florida, College of Veterinary Medicine, Gainesville, FL, USA.
| | - Anje G Bauck
- University of Florida, College of Veterinary Medicine, Gainesville, FL, USA
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Bishop RC, Gutierrez‐Nibeyro SD, Stewart MC, McCoy AM. Performance of predictive models of survival in horses undergoing emergency exploratory laparotomy for colic. Vet Surg 2022; 51:891-902. [PMID: 35674231 PMCID: PMC9545965 DOI: 10.1111/vsu.13839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/13/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate previously published predictive survival models in a population of horses undergoing colic surgery in the midwestern United States. Study design Retrospective cohort study; single referral hospital. Animals A total of 260 horses met the inclusion criteria. Methods Medical records of horses undergoing surgical treatment for colic were reviewed. Previously published models were applied to cohort data to predict outcome. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for prediction of short‐term survival were calculated. Results Single‐variable and multivariable models performed similarly for prediction of survival, with a mean 79% sensitivity (range: 44%–94%), 48% specificity (range: 22%–83%), 63% PPV (range: 56%–72%), 73% NPV (range: 60%–83%), and 64% accuracy (range: 59%–72%). Blood lactate ≤6 mmol/l and the colic severity score (CSS) were highly sensitive for prediction of survival; however, both had poor specificity. Conclusion Single‐variable and multivariable predictive models did not perform as well for prediction of survival in the study cohort compared to original reports, suggesting that population‐specific factors contribute to patient survival. Clinical significance Predictive models of survival developed in one population may be less reliable when used to predict outcome in horses undergoing colic surgery from an independent population. Additional model testing and refinement using data from multiple surgical centers could be considered to improve prediction of outcome for horses undergoing laparotomy for treatment of colic.
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Affiliation(s)
- Rebecca C. Bishop
- Department of Veterinary Clinical Medicine University of Illinois Urbana Illinois USA
| | | | - Matthew C. Stewart
- Department of Veterinary Clinical Medicine University of Illinois Urbana Illinois USA
| | - Annette M. McCoy
- Department of Veterinary Clinical Medicine University of Illinois Urbana Illinois USA
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Iglesias-García M, Rodríguez Hurtado I, Ortiz-Díez G, De la Calle del Barrio J, Fernández Pérez C, Gómez Lucas R. Predictive Models for Equine Emergency Exploratory Laparotomy in Spain: Pre-, Intra-, and Post-Operative-Mortality-Associated Factors. Animals (Basel) 2022; 12:1375. [PMID: 35681838 PMCID: PMC9179522 DOI: 10.3390/ani12111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
The extrinsic and intrinsic characteristics of an equine population may influence the onset of gastrointestinal lesions and affect the survival rate of patients. The equine population in Spain has been the focus of a small number of studies, none of which have involved more than one surgical center. In this retrospective cohort study, we aimed to analyze the survival rate, identify the variables that influenced death, and generate multivariate models using clinical variables. Data were collected from the clinical records of two surgical referral centers in the same region, and a total of 566 horses met the inclusion criteria. The statistical analysis was divided into three parts: The first and second included logistic analysis, in order to identify the variables most closely associated with survival. The third part assessed all previous variables in terms of survival and hospitalization time, using a COX survival analysis. The main risk factors associated with intra-operative mortality were related to seasonality (winter and summer), patient age (older than 9 years), distance from the hospital, the presence of a strangulating lesion, and the bowel segment affected (small intestine). Furthermore, the main factors associated with mortality during hospitalization were the characteristics of the lesions (strangulating) and the differences between surgical centers. The models generated in this study have good predictive value and use only reliable and easily obtainable variables. The most reliable characteristics are those related to the type of colic and the location of the lesion.
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Affiliation(s)
| | - Isabel Rodríguez Hurtado
- Large Animal Department, Alfonso X el Sabio University, 28691 Madrid, Spain; (I.R.H.); (J.D.l.C.d.B.); (R.G.L.)
| | - Gustavo Ortiz-Díez
- Department of Animal Medicine and Surgery, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Cristina Fernández Pérez
- Servicio de Medicina Preventiva, Área de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago (IDIS), 15706 Santiago de Compostela, Spain;
| | - Raquel Gómez Lucas
- Large Animal Department, Alfonso X el Sabio University, 28691 Madrid, Spain; (I.R.H.); (J.D.l.C.d.B.); (R.G.L.)
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Giusto G, Vercelli C, Gandini M. Comparison of liberal and goal-directed fluid therapy after small intestinal surgery for strangulating lesions in horses. Vet Rec 2021; 188:e5. [PMID: 34651880 DOI: 10.1002/vetr.5] [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] [Received: 06/16/2020] [Revised: 10/02/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There are few guidelines for the appropriate mode of fluid administration during and after colic surgery, and is challenging to reach the right balance while avoiding overhydration. This study aimed to compare goal-directed fluid therapy (GDFT) and 'liberal' fluid regimens (LFRs) in horses undergoing small intestinal surgery. METHODS Eighteen horses subjected to small intestinal surgery were matched according to the surgical lesion, type of anastomosis, length of resection, and duration of clinical signs. Horses in the LFR group were administered intravenous (IV) fluids for at least 24 h. In the GDFT group, IV fluids were administered only when considered necessary based on clinical parameters. Postoperative reflux (POR), packed cell volume, total protein, heart rate, venous lactate level, complications, and long-term survival rates were compared. RESULTS Three horses in the LFR and one in the GDFT group developed POR. Horses in the GDFT group had a shorter time interval to first oral water intake and shorter hospitalisation time. Postoperative complication rates and survival were not different between groups. CONCLUSION Further studies are necessary to set guidelines for the evaluation of hydration status and to plan postoperative fluid administration; however, GDFT may be a valid alternative to liberal fluid therapy after colic surgery.
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Affiliation(s)
- Gessica Giusto
- Department of Veterinary Sciences of Turin, University of Turin, Turin, Italy
| | - Cristina Vercelli
- Department of Veterinary Sciences of Turin, University of Turin, Turin, Italy
| | - Marco Gandini
- Department of Veterinary Sciences of Turin, University of Turin, Turin, Italy
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Maleas G, Drumm N. Jejunocecostomy in a Grant's zebra (
Equus quagga boehmi
). VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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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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Freeman DE. Effect of Feed Intake on Water Consumption in Horses: Relevance to Maintenance Fluid Therapy. Front Vet Sci 2021; 8:626081. [PMID: 33732739 PMCID: PMC7956953 DOI: 10.3389/fvets.2021.626081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Maintenance fluid therapy is challenging in horses that cannot drink or are denied feed and water because of concerns about gastrointestinal tract function and patency. Intravenous fluid delivery to meet water needs based on current recommendations for maintenance requirements were obtained in fed horses and therefore might not apply to horses that are not being fed. This is a critical flaw because of the interdependence between intestinal tract water and extracellular water to support digestion while preserving water balance, a concept explained by the enterosystemic cycle. Because horses drink less when they are not eating and hence have lower water needs than fed horses, maintenance water requirements need to be adjusted accordingly. This article reviews this topic and identifies benefits of adjusting maintenance fluid therapy to meet lower demands from gastrointestinal function, such as reduced volumes, lower cost, avoidance of overhydration.
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Affiliation(s)
- David E. Freeman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
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Kilcoyne I, Nieto JE, Dechant JE. Diagnostic value of plasma and peritoneal fluid procalcitonin concentrations in horses with strangulating intestinal lesions. J Am Vet Med Assoc 2020; 256:927-933. [PMID: 32223710 DOI: 10.2460/javma.256.8.927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the diagnostic value of plasma and peritoneal fluid procalcitonin concentrations for identification of horses with strangulating intestinal lesions. ANIMALS 65 horses with signs of colic of intestinal origin and 10 healthy (control) horses. PROCEDURES For each horse, plasma and peritoneal fluid samples were obtained for a CBC and determination of total protein, procalcitonin, and lactate concentrations. Signalment and clinicopathologic findings were compared among control horses and horses with strangulating and nonstrangulating intestinal lesions. RESULTS Mean ± SD plasma (274.9 ± 150.8 pg/mL) and peritoneal fluid (277 ± 50.6 pg/mL) procalcitonin concentrations for horses with colic were significantly greater than the mean ± SD plasma (175.5 ± 46.0 pg/mL) and peritoneal fluid (218.8 ± 48.7 pg/mL) procalcitonin concentrations for control horses. Mean procalcitonin concentration in peritoneal fluid, but not plasma, differed significantly between horses with strangulating lesions and those with nonstrangulating lesions. A peritoneal fluid procalcitonin concentration ≥ 281.7 pg/mL had a sensitivity of 81%, specificity of 69%, positive predictive value of 56.7%, and negative predictive value of 87.9% for detection of strangulating lesions. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that peritoneal fluid procalcitonin concentration, when evaluated in conjunction with other clinicopathologic results, might be a sensitive indicator of intestinal ischemia and facilitate early identification of horses that require surgery to address a strangulating lesion.
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Ranninger E, Bettschart‐Wolfensberger R. Polymorphic tachycardia in an anaesthetised horse with an undiagnosed pheochromocytoma undergoing emergency coeliotomy. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Elisabeth Ranninger
- Department of Clinical Diagnostics and ServicesSection of AnaesthesiologyVetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Regula Bettschart‐Wolfensberger
- Department of Clinical Diagnostics and ServicesSection of AnaesthesiologyVetsuisse FacultyUniversity of ZurichZurichSwitzerland
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Pye J, Espinosa-Mur P, Roca R, Kilcoyne I, Nieto J, Dechant J. Preoperative factors associated with resection and anastomosis in horses presenting with strangulating lesions of the small intestine. Vet Surg 2019; 48:786-794. [PMID: 30834566 DOI: 10.1111/vsu.13184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/10/2018] [Accepted: 02/02/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if preoperative and intraoperative clinical variables correlate with resection and anastomosis (RA) in horses presenting with strangulating small intestinal (SI) lesions. STUDY DESIGN Retrospective case series. ANIMALS Horses undergoing exploratory celiotomy for a strangulating SI lesion (n = 243). METHODS The records of horses undergoing surgical correction for strangulating SI lesions from January 1, 2000 to December 31, 2017 were reviewed. Horses were categorized as treated with RA or not treated with RA. Obtained information included history, signalment, clinical findings, diagnostic test results, intraoperative findings, and survival to discharge. Univariable and multivariable analyses were used to compare data between horses treated with RA vs those not treated with RA (P = .05). RESULTS In total, 172 SI lesions were resected, and 71 were not resected. Horses that had gastric reflux at admission to the hospital (odds ratio [OR] 5.56; 95% CI 1.76, 17.59) and horses with amotile SI according to abdominal ultrasonography (OR 9.69; 95% CI 3.09, 30.37) were more likely to undergo RA. Increased difference between peritoneal fluid and blood lactate was higher in horses that underwent RA (OR 1.55; 95% CI 1.12, 2.13). Survival to hospital discharge was lower in the group of horses that underwent RA compared with horses that did not undergo RA. CONCLUSION Resection and anastomosis of strangulating SI lesions was associated with several preoperative variables. CLINICAL SIGNIFICANCE This study highlights the value of preoperative diagnostic procedures in aiding intraoperative decision making and prognostication in horses presenting with strangulating SI lesions.
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Affiliation(s)
- Jannah Pye
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Pablo Espinosa-Mur
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Rodrigo Roca
- Department of Surgery and Orthopedics, Austin Veterinary Emergency and Specialty, Austin, Texas
| | - Isabelle Kilcoyne
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jorge Nieto
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Julie Dechant
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
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Noel-Morgan J, Muir WW. Anesthesia-Associated Relative Hypovolemia: Mechanisms, Monitoring, and Treatment Considerations. Front Vet Sci 2018; 5:53. [PMID: 29616230 PMCID: PMC5864866 DOI: 10.3389/fvets.2018.00053] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/02/2018] [Indexed: 12/14/2022] Open
Abstract
Although the utility and benefits of anesthesia and analgesia are irrefutable, their practice is not void of risks. Almost all drugs that produce anesthesia endanger cardiovascular stability by producing dose-dependent impairment of cardiac function, vascular reactivity, and compensatory autoregulatory responses. Whereas anesthesia-related depression of cardiac performance and arterial vasodilation are well recognized adverse effects contributing to anesthetic risk, far less emphasis has been placed on effects impacting venous physiology and venous return. The venous circulation, containing about 65–70% of the total blood volume, is a pivotal contributor to stroke volume and cardiac output. Vasodilation, particularly venodilation, is the primary cause of relative hypovolemia produced by anesthetic drugs and is often associated with increased venous compliance, decreased venous return, and reduced response to vasoactive substances. Depending on factors such as patient status and monitoring, a state of relative hypovolemia may remain clinically undetected, with impending consequences owing to impaired oxygen delivery and tissue perfusion. Concurrent processes related to comorbidities, hypothermia, inflammation, trauma, sepsis, or other causes of hemodynamic or metabolic compromise, may further exacerbate the condition. Despite scientific and technological advances, clinical monitoring and treatment of relative hypovolemia still pose relevant challenges to the anesthesiologist. This short perspective seeks to define relative hypovolemia, describe the venous system’s role in supporting normal cardiovascular function, characterize effects of anesthetic drugs on venous physiology, and address current considerations and challenges for monitoring and treatment of relative hypovolemia, with focus on insights for future therapies.
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Affiliation(s)
- Jessica Noel-Morgan
- Center for Cardiovascular & Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - William W Muir
- QTest Labs, Columbus, OH, United States.,College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN, United States
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Freeman DE. Fifty years of colic surgery. Equine Vet J 2018; 50:423-435. [DOI: 10.1111/evj.12817] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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14
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Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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