Effects of nitrous oxide on mask induction of anesthesia with sevoflurane or isoflurane in dogs

Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

Objective

Optimizing cardiac stroke volume during high-risk surgical anesthesia is of particular interest with regard to a therapeutic target to reduce the incidence of postoperative complications. However, intensive fluid management in critically ill small animals with pulmonary hypertension (PH) has been empirically performed, and thus it can be challenging. Stroke volume variation (SVV) has been used as a dynamic preload predictor of fluid responsiveness. We hypothesized that if SVV exhibited robust reliability in the setting of hemodynamically unstable condition, it would provide more precise information on fluid resuscitation to translate it into veterinary anesthesia. Thus the aim of this study was to investigate the utility of SVV measured by the electrical velocimetry (EV) method for predicting fluid responsiveness in dogs with PH.

Methods

Sixteen dogs undergoing emergency abdominal surgery and diagnosed with PH secondary to myxomatous mitral valve disease (MMVD) on preoperative transthoracic echocardiogram were included. Dogs were randomly assigned to 2 groups with and without inotropic cardiac support with dobutamine. Hemodynamic measurements including stroke volume and SVV derived from the EV device were performed under general anesthesia before (baseline) and after surgery (fluid challenge with a colloid solution defined by a SV increase of ≥ 10%).

Results

In both groups, SVV elevated significantly after abdominal surgery compared with baseline. In dobutamine infused group, the SVV values decreased significantly after fluid challenge (P < 0.05) with a greater number of responders than saline infused control group (P < 0.01). Receiver operating curve analysis of SVV confirmed high positive predictive value for dogs during dobutamine infusion (P < 0.05; cut-off value of 15%; specificity 90%, sensitivity 82%).

Conclusions

Noninvasive EV monitoring may be useful for the prediction of fluid responsiveness in critically ill dogs with left-sided heart failure-related PH. This normalization of dynamic preload indices, which could be achieved more precisely under inotropic support, may prevent further detrimental consequence of fluid loading.

Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery

Background

Fluid resuscitation is a cornerstone of minimizing morbidity and mortality in critically ill patients, but the techniques for predicting fluid responsiveness is still a matter of debate. In this study, we aimed to evaluate the utility of noninvasive stroke volume variation (SVV), pulse pressure variation (PPV), and systolic pressure variation (SPV) as a dynamic predictor for assessing fluid responsiveness during different ventilation modes in anaesthetized, intubated dogs recovering from cardiac surgery.

Material/Methods

Thirty-six adult Beagle dogs undergoing experimental surgery for isolated right ventricular failure were monitored for SVV, PPV, and SPV simultaneously using electrical velocimetry device. The relationships between each indicator and SVI before and after volume loading were compared in 3 ventilatory modes: assist control (A/C), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP). Responders were defined as those whose stroke volume index increased by ≥10%.

Results

In all of the indices, the baseline values were greater in responders than in nonresponders (P<0.01) under A/C and SIMV. Receiver operating curve analysis confirmed the best predictive value during A/C [area under the curve (AUC): SVV, 0.90; PPV, 0.88; SPV, 0.85; P<0.05] followed by SIMV (AUC: SVV, 0.86; PPV, 0.83; CPAP, 0.80; P<0.05), with their sensitivities and specificities of ≥7 5%. By contrast, no statistically significance detected in any parameter during CPAP (AUC: SVV, 0.71; PPV, 0.66; CPAP, 0.65; P>0.05).

Conclusions

SVV, PPV, and SVV are all useful to predict cardiac response to fluid loading in dogs during A/C and SIMV, while their reliabilities during CPAP are poor.

Combining nitrous oxide with carbon dioxide decreases the time to loss of consciousness during euthanasia in mice--refinement of animal welfare?

Carbon dioxide (CO(2)) is the most commonly used euthanasia agent for rodents despite potentially causing pain and distress. Nitrous oxide is used in man to speed induction of anaesthesia with volatile anaesthetics, via a mechanism referred to as the "second gas" effect. We therefore evaluated the addition of Nitrous Oxide (N(2)O) to a rising CO(2) concentration could be used as a welfare refinement of the euthanasia process in mice, by shortening the duration of conscious exposure to CO2. Firstly, to assess the effect of N(2)O on the induction of anaesthesia in mice, 12 female C57Bl/6 mice were anaesthetized in a crossover protocol with the following combinations: Isoflurane (5%)+O(2) (95%); Isoflurane (5%)+N(2)O (75%)+O(2) (25%) and N(2)O (75%)+O(2) (25%) with a total flow rate of 3 l/min (into a 7 l induction chamber). The addition of N(2)O to isoflurane reduced the time to loss of the righting reflex by 17.6%. Secondly, 18 C57Bl/6 and 18 CD1 mice were individually euthanized by gradually filling the induction chamber with either: CO(2) (20% of the chamber volume.min-1); CO(2)+N(2)O (20 and 60% of the chamber volume.min(-1) respectively); or CO(2)+Nitrogen (N(2)) (20 and 60% of the chamber volume.min-1). Arterial partial pressure (P(a)) of O(2) and CO(2) were measured as well as blood pH and lactate. When compared to the gradually rising CO(2) euthanasia, addition of a high concentration of N(2)O to CO(2) lowered the time to loss of righting reflex by 10.3% (P<0.001), lead to a lower P(a)O(2) (12.55 ± 3.67 mmHg, P<0.001), a higher lactataemia (4.64 ± 1.04 mmol.l(-1), P = 0.026), without any behaviour indicative of distress. Nitrous oxide reduces the time of conscious exposure to gradually rising CO(2) during euthanasia and hence may reduce the duration of any stress or distress to which mice are exposed during euthanasia.

Effects of nitrous oxide on minimum alveolar concentration of desflurane in dogs

Effects of nitrous oxide (N2O) on minimum alveolar concentration (MAC) of desflurane were studied. For that purpose, 30 dogs were randomly allocated into two groups: desflurane group (GD) and N2O and desflurane group (GDN). GD animals received propofol to intubation, and 11.5V% of desflurane diluted in 100% O2. After 30 minutes, they received electric stimulus and if the animal did not react to stimulus, desflurane concentration was reduced by 1.5V%. This protocol was repeated at each 15 minutes, and stimulus was interrupted when voluntary reaction was observed. GDN dogs were submitted to diluent flow 30% O2 and 70% N2O. Desflurane's MAC; heart (HR) and respiratory (RR) rates; systolic, diastolic and mean arterial pressures (SAP, DAP, and MAP, respectively); end tidal carbon dioxide (ETCO2); oxyhemoglobin saturation (SpO2) and body temperature (T) were evaluated. In both groups increase in HR and ETCO2, and decrease in RR and T were associated with administration of the highest dose of desflurane. Blood pressures decreased 30 minutes after desflurane administration in GDN, and after this measurement the values increased. Reduction in desflurane's MAC was observed as well. It is concluded that N2O associated with desflurane reduced desflurane's MAC by 16% with increase in HR and respiratory depression.

INHALATION ANESTHESIA IN DUMERIL'S MONITOR (VARANUS DUMERILI) WITH ISOFLURANE, SEVOFLURANE, AND NITROUS OXIDE: EFFECTS OF INSPIRED GASES ON INDUCTION AND RECOVERY

Induction and recovery from inhalation anesthesia of Dumeril's monitors (Varanus dumerili) using isoflurane, sevoflurane, and nitrous oxide (N2O) were characterized using a randomized crossover design. Mean times to induction for isoflurane in 100% oxygen (O2), sevoflurane in 100% O2, sevoflurane in 21% O2:79% nitrogen (N2; room air), and sevoflurane in 66% N2O:34% O2 were 13.00 +/- 4.55, 11.20 +/- 3.77, 10.40 +/- 2.50, and 9.40 +/- 2.80 min, respectively, at 26 degrees C (n = 10). Mask induction with sevoflurane was significantly faster than with isoflurane. There was no significant difference between the induction time for sevoflurane in O2 or in room air, but sevoflurane combined with N2O resulted in significantly faster inductions than were obtained with sevoflurane in 100% O2. All treatments resulted in a significantly higher respiratory rate than in undisturbed animals. There were no significant differences in respiratory rate among lizards receiving O2, isoflurane in 100% O2, sevoflurane in room air, and sevoflurane combined with N2O, but animals receiving sevoflurane in O2 had a lower respiratory rate than those receiving pure O2. The sequence of complete muscle relaxation during induction was consistent and not significantly different among the four treatments: front limbs lost tone first, followed by the neck and the hind limbs; then the righting reflex was lost and finally tail tone. There were no significant differences in recovery times between isoflurane and sevoflurane or between sevoflurane in 100% O2 and sevoflurane combined with N2O. Similar recovery times were observed in animals recovering in 100 and 21% O2.

Anesthetic indices of sevoflurane and isoflurane in unpremedicated dogs

OBJECTIVE

To compare the anesthetic index of sevoflurane with that of isoflurane in unpremedicated dogs.

DESIGN

Randomized complete-block crossover design.

ANIMALS

8 healthy adult dogs.

PROCEDURE

Anesthesia was induced by administering sevoflurane or isoflurane through a face mask. Time to intubation was recorded. After induction of anesthesia, minimal alveolar concentration (MAC) was determined with a tail clamp method while dogs were mechanically ventilated. Apneic concentration was determined while dogs were breathing spontaneously by increasing the anesthetic concentration until dogs became apneic. Anesthetic index was calculated as apneic concentration divided by MAC.

RESULTS

Anesthetic index of sevoflurane (mean +/- SEM, 3.45 +/- 0.22) was significantly higher than that of isoflurane (2.61 +/- 0.14). No clinically important differences in heart rate; systolic, mean, and diastolic blood pressures; oxygen saturation; and respiratory rate were detected when dogs were anesthetized with sevoflurane versus isoflurane. There was a significant linear trend toward lower values for end-tidal partial pressure of carbon dioxide during anesthesia with sevoflurane, compared with isoflurane, at increasing equipotent anesthetic doses.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that sevoflurane has a higher anesthetic index in dogs than isoflurane. Sevoflurane and isoflurane caused similar dose-related cardiovascular depression, but although both agents caused dose-related respiratory depression, sevoflurane caused less respiratory depression at higher equipotent anesthetic doses.

Effects of medetomidine-midazolam, midazolambutorphanol, or acepromazine-butorphanol as premedicants for mask induction of anesthesia with sevoflurane in dogs

OBJECTIVE

To characterize the effects of medetomidine-midazolam, midazolam-butorphanol, or acepromazine-butorphanol as premedicants for mask induction of anesthesia with sevoflurane in dogs.

ANIMALS

10 healthy Beagles.

PROCEDURE

The following premedicants were administered intramuscularly: medetomidine-midazolam (20 microg/kg and 0.3 mg/kg, respectively), midazolam-butorphanol (0.1 and 0.2 mg/kg, respectively), and acepromazine-butorphanol (0.05 and 0.2 mg/kg, respectively). Saline (0.9% NaCI) solution (0.1 ml/kg) was administered intramuscularly as a control. Anesthesia was induced in each dog with sevoflurane in a 100% O2 at a flow rate of 4 L/min developed by a facemask. Vaporizer settings were increased by 0.8% at 15-second intervals until the value corresponding to 4.8% sevoflurane was achieved. Time to onset and cessation of involuntary movements, loss of the palpebral reflex, negative response to tail-clamp stimulation, and endotracheal intubation were recorded, and the cardiopulmonary variables were measured.

RESULTS

Mask induction with sevoflurane in dogs that received each premedicant resulted in a shorter induction time and milder changes in heart rate, mean arterial blood pressure, cardiac output, and respiratory rate, compared with mask induction without premedicants. Treatment with medetomidine-midazolam resulted in a shorter and smoother induction, compared with acepromazine-butorphanol or midazolam-butorphanol treatment, whereas the cardiovascular changes were greater. Cardiopulmonary variables of dogs during induction following treatment with acepromazine-butorphanol or midazolam-butorphanol were maintained close to the anesthetic maintenance values for sevoflurane, with the exception of mild hypotension that was observed in dogs following acepromazine-butorphanol treatment.

CONCLUSION AND CLINICAL RELEVANCE

In dogs use of premedicants provides a smoother and better quality mask induction with sevoflurane.