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Quinn CT. What is the best treatment for hypotension in healthy dogs during anaesthesia maintained with isoflurane? Aust Vet J 2024; 102:264-273. [PMID: 38343013 DOI: 10.1111/avj.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 04/30/2024]
Abstract
Hypotension is a common and potentially life-threatening complication of general anaesthesia in dogs. Due to the combination of cardiovascular side effects of many anaesthetic, sedative and analgesic drugs used peri-operatively hypotension is frequently reported even in healthy dogs undergoing elective procedures. Several treatment options for hypotension have been advocated. Potential treatments include rapid administration of either crystalloid or colloid fluids; pharmacological treatments to increase cardiac output and/or systemic vascular resistance; or reduction in the delivery of the volatile anaesthetic agents. This critical appraisal considers the current evidence for which treatment is the best option for treating hypotension in healthy euvolemic dogs undergoing general anaesthesia maintained with isoflurane. Fourteen relevant studies were appraised, including 12 laboratory studies and two small clinical trials. One study demonstrated that reduction in the delivery of isoflurane may correct hypotension, but this treatment may not always be feasible. In general, rapid administration of fluids did not increase blood pressure and failed to correct hypotension. Synthetic colloids demonstrated some efficacy, but results were inconsistent between studies and large volumes may be required. Infusion of dopamine appears to be the most reliable pharmacological option consistently increasing blood pressure, cardiac output and correcting hypotension.
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Affiliation(s)
- C T Quinn
- School of Agricultural, Environmental and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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2
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Henao-Guerrero N, Ricco-Pereira CH, Paranjape VV. A Comparison of Dobutamine, Norepinephrine, Vasopressin, and Hetastarch for the Treatment of Isoflurane-Induced Hypotension in Healthy, Normovolemic Dogs. Animals (Basel) 2023; 13:2674. [PMID: 37627465 PMCID: PMC10451654 DOI: 10.3390/ani13162674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Isoflurane is a commonly used inhalation anesthetic in species undergoing veterinary care that induces hypotension, impacting organ perfusion, making it imperative to minimize its occurrence or identify effective strategies for treating it. This study evaluated and compared the hemodynamic effects of DOB, NEP, VAS, and HES in twelve isoflurane-anesthetized Beagle dogs. The order of the first three treatments was randomized. HES was administered last. Data were collected before treatments (baseline) and after 10 min of a sustained MAP of <45 mmHg induced by a high end-tidal isoflurane concentration (T0). Once treatment was initiated and the target MAP was achieved (65 to 80 mmHg) or the maximum dose reached, data were collected after 15 min of stabilization (T1) and 15 min after (T2). A 15 min washout period with a MAP of ≥65 mmHg was allowed between treatments. The intravenous dosage regimens started and were increased by 50% every five minutes until the target MAP or maximum dose was reached. The dosages were as follows: DOB, 5-15 μg/kg/min; NEP, 0.1-2 μg/kg/min; VAS, 0.5-5 mU/kg/min; and HET, 6% 1-20 mL/kg/min. DOB improved CO, DO2, and VO2, but reduced SVR. VAS elevated SVR, but decreased CO, DO2, and VO2. HES minimally changed BP and mildly augmented CO, DO2, and VO2. These treatments failed to reach the target MAP. NEP increased the arterial BP, CO, MPAP, and PAWP, but reduced HR. Norepinephrine infusion at 0.44 ± 0.19 μg/kg/min was the most efficient therapy for correcting isoflurane-induced hypotension.
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Affiliation(s)
- Natalia Henao-Guerrero
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA;
| | - Carolina H. Ricco-Pereira
- Department of Veterinary Clinical Sciences, The Ohio State University-College of Veterinary Medicine, Columbus, OH 43210, USA;
| | - Vaidehi V. Paranjape
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA;
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Vézina-Audette R, Kantyka M, Gianotti G, Silverstein DC. Comparison of Mean Arterial Blood Pressure and Heart Rate Changes in Response to Three Different Randomized Isotonic Crystalloid Boluses in Hypotensive Anesthetized Dogs. Animals (Basel) 2022; 12:ani12141781. [PMID: 35883328 PMCID: PMC9312031 DOI: 10.3390/ani12141781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this prospective, randomized, nonblinded, controlled clinical trial was to compare mean arterial blood pressure (MAP) and heart rate (HR) during an intravenous bolus of three different balanced isotonic crystalloid solutions in euvolemic, anesthetized dogs with hypotension. Thirty healthy dogs (American Society of Anesthesiologists Physical Status I–II) weighing at least 15 kg that presented for elective orthopedic or dental surgical procedures at the Ryan Veterinary Hospital for Small Animals of the University of Pennsylvania were included in this study. Anesthetized hypotensive patients (defined as a MAP ≤ 65 mmHg), were administered an infusion of Lactated Ringer’s solution (LRS), Plasma-Lyte (PLYTE) or Canadian Plasma-Lyte (PLYTECA), selected at random. The infusion was administered over 15 min via a volumetric fluid pump. Differences in oscillometric MAP and HR between time points and across treatments were evaluated by mANOVA. Intravenous isotonic crystalloid infusions over 15 min did not significantly change MAP or HR in hypotensive dogs under general anesthesia. Neither LRS, PLYTE nor PLYTECA exacerbated hypotension or caused tachycardia.
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Affiliation(s)
- Raphaël Vézina-Audette
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, 3900 Delancey Street, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.G.); (D.C.S.)
- Correspondence:
| | - Marta Kantyka
- Section of Anaesthesiology and Pain Therapy, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland;
| | - Giacomo Gianotti
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, 3900 Delancey Street, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.G.); (D.C.S.)
| | - Deborah C. Silverstein
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, 3900 Delancey Street, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.G.); (D.C.S.)
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Chohan AS, Campbell BG, Martin LG. Anesthesia Case of the Month. J Am Vet Med Assoc 2022; 260:999-1002. [PMID: 35298405 DOI: 10.2460/javma.21.06.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rauserova-Lexmaulova L, Prokesova B, Blozonova A, Vanova-Uhrikova I, Rehakova K, Fusek M. Effects of the Administration of Different Buffered Balanced Crystalloid Solutions on Acid-Base and Electrolyte Status in Dogs with Gastric Dilation-Volvulus Syndrome: a randomized clinical trial. Top Companion Anim Med 2021; 46:100613. [PMID: 34737069 DOI: 10.1016/j.tcam.2021.100613] [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: 02/13/2020] [Revised: 08/22/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the effect of three different buffered balanced crystalloid solutions on acid-base status and electrolyte concentrations in dogs with gastric dilation-volvulus (GDV) syndrome. METHODS The study design was a prospective, randomized clinical trial of 40 dogs. The dogs were randomly assigned to one of three groups according to the fluid used: Hartmann's solution (H), Plasmalyte (PL), and Ringerfundin (RF). Hemoglobin, albumin, lactate, electrolyte, and acid-base parameters were determined before fluid administration (T0) and at the end of surgery (T1). Results were assessed by one-way ANOVA, Fisher's exact test, the Wilcoxon signed-rank test, the Kruskal-Wallis test, and a linear mixed-effect regression model. A significance level of 0.05 was used in all analyses. RESULTS Bicarbonate and base excess (BE) levels increased and chloride concentration decreased in the PL group; in contrast, strong ion difference apparent (SIDapp) decreased and chloride concentration increased in the RF group. The mixed-effect model confirmed a significant interaction between the type of solution and time on the changes in bicarbonate, BE, anion gap (AG), SIDapp, and chloride levels. CLINICAL SIGNIFICANCE Significantly different effects in acid-base parameters were observed in dogs after intravenous administration of H, PL, and RF. However, clinical significance of these changes is lacking, requiring further investigation in a larger randomized controlled clinical trial.
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Affiliation(s)
- Leona Rauserova-Lexmaulova
- Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Czech Republic.
| | - Barbara Prokesova
- Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Czech Republic
| | - Aneta Blozonova
- Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Czech Republic
| | - Ivana Vanova-Uhrikova
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Czech Republic
| | - Kristina Rehakova
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Czech Republic
| | - Michal Fusek
- Department of Mathematics, Faculty of Electrical Engineering and Communication, Brno University of Technology, Czech Republic
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Kojima K, Ishizuka T, Sasaki N, Nakamura K, Takiguchi M. Cardiovascular effects of dose escalating of norepinephrine in healthy dogs anesthetized with isoflurane. Vet Anaesth Analg 2021; 48:654-662. [PMID: 34332897 DOI: 10.1016/j.vaa.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the systemic cardiovascular effects of dose escalating administration of norepinephrine in healthy dogs anesthetized with isoflurane. STUDY DESIGN Experimental study. ANIMALS A total of six adult laboratory Beagle dogs, 10.5 (9.2-12.0) kg [median (range)]. METHODS Each dog was anesthetized with isoflurane at an end-tidal concentration of 1.7%, mechanically ventilated and administered a continuous rate infusion of rocuronium (0.5 mg kg-1 hour-1). Each dog was administered incremental dose rates of norepinephrine (0.05, 0.125, 0.25, 0.5, 1.0 and 2.0 μg kg-1 minute-1), and each dose was infused for 15 minutes. Cardiovascular variables were recorded before administration and at the end of each infusion period. RESULTS Norepinephrine infusion increased mean arterial pressure (MAP), cardiac output (CO) and oxygen delivery in a dose-dependent manner. Systemic vascular resistance did not significantly change during the experiment. Stroke volume increased at the lower dose rates and heart rate increased at the higher dose rates. Oxygen consumption and lactate concentrations did not significantly change during infusions. CONCLUSIONS In dogs anesthetized with isoflurane, norepinephrine increased MAP by increasing the CO. CO increased with a change in stroke volume at lower dose rates of norepinephrine. At higher dosage, heart rate also contributed to an increase in CO. Norepinephrine did not cause excessive vasoconstriction that interfered with the CO during this study. CLINICAL RELEVANCE Norepinephrine can be useful for treating hypotension in dogs anesthetized with isoflurane.
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Affiliation(s)
- Kazuki Kojima
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomohito Ishizuka
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kensuke Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
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Valverde A. Fluid Resuscitation for Refractory Hypotension. Front Vet Sci 2021; 8:621696. [PMID: 33778035 PMCID: PMC7987676 DOI: 10.3389/fvets.2021.621696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022] Open
Abstract
Hypotension is a common occurrence, especially in anesthetized patients and in critical patients suffering from hypovolemia due to shock and sepsis. Hypotension can also occur in normovolemic animals, anesthetized or conscious, under conditions of vasodilation or decreased cardiac function. The main consequence of hypotension is decreased organ perfusion and tissue injury/dysfunction. In the human literature there is no consensus on what is the threshold value for hypotension, and ranges from < 80 to < 100 mmHg for systolic blood pressure and from < 50 to < 70 mmHg for mean arterial blood pressure have been referenced for intraoperative hypotension. In veterinary medicine, similar values are referenced, despite marked differences in normal arterial blood pressure between species and with respect to humans. Therapeutic intervention involves fluid therapy to normalize volemia and use of sympathomimetics to enhance cardiac function and regulate peripheral vascular resistance. Despite these therapeutic measures, there is a subset of patients that are seemingly refractory and exhibit persistent hypotension. This review covers the physiological aspects that govern arterial blood pressure control and blood flow to tissues/organs, the pathophysiological mechanisms involved in hypotension and refractory hypotension, and therapeutic considerations and expectations that include proper interpretation of cardiovascular parameters, fluid recommendations and therapy rates, use of sympathomimetics and vasopressors, and newer approaches derived from the human literature.
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Affiliation(s)
- Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Chi TT, Hay Kraus BL. The effect of intravenous maropitant on blood pressure in healthy awake and anesthetized dogs. PLoS One 2020; 15:e0229736. [PMID: 32108177 PMCID: PMC7046230 DOI: 10.1371/journal.pone.0229736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effects of intravenous maropitant on arterial blood pressure in healthy dogs while awake and under general anesthesia. DESIGN Experimental crossover study. ANIMALS Eight healthy adult Beagle dogs. PROCEDURE All dogs received maropitant (1 mg kg-1) intravenously under the following conditions: 1) awake with non-invasive blood pressure monitoring (AwNIBP), 2) awake with invasive blood pressure monitoring (AwIBP), 3) premedication with acepromazine (0.005 mg kg-1) and butorphanol (0.2 mg kg-1) intramuscularly followed by propofol induction and isoflurane anesthesia (GaAB), and 4) premedication with dexmedetomidine (0.005 mg kg-1) and butorphanol (0.2 mg kg-1) intramuscularly followed by propofol induction and isoflurane anesthesia (GaDB). Heart rate (HR), systolic (SAP), diastolic (DAP), and mean blood pressures (MAP) were recorded before injection of maropitant (baseline), during the first 60 seconds of injection, during the second 60 seconds of injection, at the completion of injection and every 2 minutes post injection for 18 minutes. The data were compared over time using a Generalized Linear Model with mixed effects and then with simple effect comparison with Bonferroni adjustments (p <0.05). RESULTS There were significant decreases from baseline in SAP in the GaAB group (p < 0.01) and in MAP and DAP in the AwIBP and GaAB (p < 0.001) groups during injection. A significant decrease in SAP (p < 0.05), DAP (p < 0.05), and MAP (p < 0.05) occurred at 16 minutes post injection in GaDB group. There was also a significant increase in HR in the AwIBP group (p < 0.01) during injection. Clinically significant hypotension occurred in the GaAB group with a mean MAP at 54 ± 6 mmHg during injection. CONCLUSION Intravenous maropitant administration significantly decreases arterial blood pressure during inhalant anesthesia. Patients premedicated with acepromazine prior to isoflurane anesthesia may develop clinically significant hypotension.
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Affiliation(s)
- Ting-Ting Chi
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, United States of America
| | - Bonnie L. Hay Kraus
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, United States of America
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Zersen KM, Mama K, Mathis JC. Retrospective evaluation of paired plasma creatinine and chloride concentrations following hetastarch administration in anesthetized dogs (2002-2015): 244 cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:309-313. [PMID: 31066159 DOI: 10.1111/vec.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 06/13/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate changes in serum creatinine and chloride concentrations in anesthetized dogs that received 6% hydroxyethyl starch (HES) 670/0.7. DESIGN Retrospective case series, 2002-2015. SETTING University veterinary teaching hospital. ANIMALS Two hundred forty-four client-owned dogs undergoing general anesthesia that received an HES solution. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records of dogs that received an HES solution (6%, 670/0.7) while under general anesthesia during the study period were reviewed. Information obtained from the medical record included patient signalment, reason for anesthesia or diagnosis, body weight, amount of HES solution administered, pre- and postanesthesia creatinine value, pre- and postanesthesia chloride value, and day interval between measurements. Corrected chloride values were used for all statistical analysis. Dogs received a median dose of 6.3 mL/kg hetastarch during anesthesia. Median preanesthesia creatinine and corrected chloride values were 79.5 μmol/L (0.9 mg/dL) (range 8.8-689.5 μmol/L [0.1-7.8 mg/dL]) and 111 mmol/L (111 mEq/L) (range 80-123 mmol/L [80-123 mg/dL]), respectively. Median postanesthesia creatinine was 57.4 μmol/L (0.65 mg/dL) (8.8-716 μmol/L [0.1-8.1 mg/dL]). Median postanesthesia corrected chloride was 115 mmol/L (115 mEq/L) (range 87.5-129.6 mmol/L [87.5-129.6 mEq/L]). Mann-Whitney test analysis revealed a significant decrease in creatinine (Δ Cr 17.7 μmol/L [0.2 mg/dL], P < 0.01) and a significant increase in corrected chloride (Δ Cl 4.1 mmol/L [4.1mEq/L], P < 0.01) between pre- and postanesthesia values. CONCLUSIONS In a mixed population of hospitalized dogs undergoing general anesthesia that received a median dose of 6 mL/kg of HES, creatinine was lower and chloride was higher in the postanesthetic than in the preanesthetic period. The clinical significance of these changes and the role that HES administration played in them relative to concurrent therapies is unknown.
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Affiliation(s)
- Kristin M Zersen
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
| | - Khursheed Mama
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
| | - Justin C Mathis
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
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Grasso SC, Ko JC, Weil AB, Hess JA, Paranjape V, Payton M. Effects of transdermal fentanyl solution application and subsequent naloxone hydrochloride administration on minimum alveolar concentration of isoflurane in dogs. J Am Vet Med Assoc 2019; 253:431-436. [PMID: 30058966 DOI: 10.2460/javma.253.4.431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the isoflurane-sparing effect of a transdermal formulation of fentanyl solution (TFS) and subsequent naloxone administration in dogs. DESIGN Experiment. ANIMALS 6 healthy mixed-breed dogs. PROCEDURES Minimum alveolar concentration (MAC) of isoflurane was determined in each dog with a tail clamp method (baseline). Two weeks later, dogs were treated with TFS (2.7 mg/kg [1.23 mg/lb]), and the MAC of isoflurane was determined 4 and 24 hours later. After the 4-hour MAC assessment, saline (0.9% NaCl) solution was immediately administered IV and MAC was reassessed. After the 24-hour MAC assessment, naloxone hydrochloride (0.02 mg/kg [0.01 mg/lb], IV) was immediately administered and MAC was reassessed. Heart rate, respiratory rate, arterial blood pressure, end-tidal partial pressure of CO2, and oxygen saturation as measured by pulse oximetry were recorded for each MAC assessment. RESULTS Mean ± SD MAC of isoflurane at 4 and 24 hours after TFS application was 45.4 ± 4.0% and 45.5 ± 4.5% lower than at baseline, respectively. Following naloxone administration, only a minimal reduction in MAC was identified (mean percentage decrease from baseline of 13.1 ± 2.2%, compared with 43.8 ± 5.6% for saline solution). Mean heart rate was significantly higher after naloxone administration (113.2 ± 22.2 beats/min) than after saline solution administration (76.7 ± 20.0 beats/min). No significant differences in other variables were identified among treatments. CONCLUSIONS AND CLINICAL RELEVANCE The isoflurane-sparing effects of TFS in healthy dogs were consistent and sustained between 4 and 24 hours after application, and these effects should be taken into consideration when anesthetizing or reanesthetizing TFS-treated dogs.
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Sano H, Seo J, Wightman P, Cave NJ, Gieseg MA, Johnson CB, Chambers P. Evaluation of pulse pressure variation and pleth variability index to predict fluid responsiveness in mechanically ventilated isoflurane-anesthetized dogs. J Vet Emerg Crit Care (San Antonio) 2018; 28:301-309. [PMID: 29898246 DOI: 10.1111/vec.12728] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/29/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether pulse pressure variation (PPV) and pleth variability index (PVI) are more accurate than central venous pressure (CVP) for predicting fluid responsiveness in mechanically ventilated isoflurane-anesthetized dogs after premedication with acepromazine. DESIGN Prospective experimental trial. SETTING University teaching hospital. ANIMALS Twelve Harrier hound dogs. INTERVENTIONS Each dog was anesthetized and had a fluid challenge performed. This was repeated 4 weeks later for a total of 24 fluid challenges. After premedication with intramuscular acepromazine, anesthesia was induced with propofol and maintained with isoflurane. The dogs were mechanically ventilated with constant settings. The fluid challenge consisted of 10 mL/kg of 6% hydroxyethyl starch intravenously over 13 minutes. MEASUREMENTS AND MAIN RESULTS Before and after the fluid challenge, PPV, PVI, CVP, and other hemodynamics were recorded. Change in velocity time integral of pulmonary arterial blood flow by echocardiography was calculated as an indication of change in stroke volume. A fluid responder was defined as an increase in velocity time integral ≥ 15%. Receiver operator characteristic (ROC) curves were used to determine cutoff values. Areas under ROC curve were calculated and compared. Dogs responded on 14 fluid challenges and did not on 10. Cutoff values for PPV and PVI were 11% (sensitivity 79%; specificity 80%) and 9.3% (sensitivity 86%; specificity 70%), respectively. The areas under the ROC curve of PPV [0.85, 95% confidence interval (CI): 0.70-1.00, P = 0.038] and PVI (0.84, 95% CI: 0.68-1.00, P = 0.043) were significantly higher than CVP (0.56, 95% CI: 0.32-0.81). CONCLUSIONS PPV and PVI predicted fluid responsiveness more accurately than CVP and may be useful to guide fluid administration in mechanically ventilated isoflurane-anesthetized dogs after premedication with acepromazine.
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Affiliation(s)
- Hiroki Sano
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Joonbum Seo
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Paul Wightman
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Nick J Cave
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Mike A Gieseg
- Veterinary Health Research NZ, Hamilton 3240, New Zealand
| | - Craig B Johnson
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Paul Chambers
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
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Endo Y, Kawase K, Miyasho T, Sano T, Yamashita K, Muir WW. Plethysmography variability index for prediction of fluid responsiveness during graded haemorrhage and transfusion in sevoflurane-anaesthetized mechanically ventilated dogs. Vet Anaesth Analg 2017; 44:1303-1312. [PMID: 29113716 DOI: 10.1016/j.vaa.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/29/2017] [Accepted: 07/29/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the accuracy of plethysmography variability index (PVI) as a noninvasive indicator of fluid responsiveness in hypovolaemic dogs. STUDY DESIGN Prospective experimental study. ANIMALS Six adult healthy sevoflurane-anaesthetized Beagle dogs. METHODS Dogs were anaesthetized with 1.3-fold their individual minimum alveolar concentration of sevoflurane. The lungs were mechanically ventilated after neuromuscular blockade with vecuronium bromide. Cardiopulmonary variables including mean arterial blood pressure (MAP), central venous pressure (CVP), transpulmonary thermodilution cardiac output (TPTDCO), stroke volume (SV), perfusion index (PI), pulse pressure variation (PPV), stroke volume variation (SVV) and PVI were determined during six stages of graded venous blood withdrawal (5 mL kg-1 increments) and six stages of graded blood infusion (5 mL kg-1 increments). The cardiopulmonary variables were analysed using paired t test or Wilcoxon signed rank test. Correlations between PPV and SVV or PVI were analysed by linear regression. The accuracy of PPV, SVV and PVI for predicting fluid responsiveness was examined by using receiver operating characteristic curve analysis. A value of p < 0.05 was considered statistically significant. RESULTS Blood withdrawal resulted in significant increases in PPV and PVI and decreases in MAP, CVP, TPTDCO, SV and PI. Blood infusion resulted in significant increases in MAP, CVP, TPTDCO, SV and PI and decreases in PPV and PVI. PPV and PVI showed a relevant correlation (p < 0.001, r2 = 0.62) and threshold values of PPV ≥ 16% (sensitivity 71%, specificity 82%) and PVI ≥ 12% (sensitivity 78%, specificity 72%) for identifying fluid responsiveness. SVV did not change. CONCLUSIONS AND CLINICAL RELEVANCE Noninvasive measurement of PVI predicted fluid responsiveness with moderate accuracy equal to PPV in sevoflurane-anaesthetized mechanically ventilated dogs. Provisional threshold values for identification of fluid responsiveness were PPV ≥ 16% and PVI ≥ 12%. Clinical trials are needed to confirm these threshold values in dogs.
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Affiliation(s)
- Yusuke Endo
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Koudai Kawase
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Taku Miyasho
- Department of Veterinary Nursing Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Tadashi Sano
- Department of Veterinary Nursing Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan.
| | - William W Muir
- College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN, USA
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McBride D, Raisis AL, Hosgood G, Smart L. Hydroxyethyl starch 130/0.4 compared with 0.9% NaCl administered to greyhounds with haemorrhagic shock. Vet Anaesth Analg 2017; 44:444-451. [DOI: 10.1016/j.vaa.2016.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 12/16/2022]
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Coleman AE, Shepard MK, Schmiedt CW, Hofmeister EH, Brown SA. Effects of orally administered enalapril on blood pressure and hemodynamic response to vasopressors during isoflurane anesthesia in healthy dogs. Vet Anaesth Analg 2016; 43:482-94. [DOI: 10.1111/vaa.12338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022]
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Yozova ID, Howard J, Adamik KN. Retrospective evaluation of the effects of administration of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in dogs (2010-2013): 201 dogs. J Vet Emerg Crit Care (San Antonio) 2016; 26:568-77. [PMID: 27144501 DOI: 10.1111/vec.12483] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/12/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine changes in creatinine concentrations following the administration of 6% tetrastarch (hydroxyethyl starch [HES] 130/0.4) compared to crystalloids (CRYSs) in critically ill dogs. DESIGN Retrospective case series (2010-2013). SETTING University teaching hospital. ANIMALS Two hundred and one dogs admitted to the intensive care unit with initial plasma creatinine concentrations not exceeding laboratory reference intervals (52-117 μmol/L [0.6-1.3 mg/dL]) and receiving either CRYSs alone (CRYS group, n = 115) or HES with or without CRYSs (HES group, n = 86) for at least 24 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Creatinine concentrations at admission to the intensive care unit (T0), and 2-13 days (T1) and 2-12 weeks (T2) after initiation of fluid therapy were analyzed. Creatinine concentrations were analyzed as absolute values and as the maximum percentage change from T0 to T1 (T1max%) and from T0 to T2 (T2max%), respectively. Creatinine concentrations were available for 192 dogs during T1 and 37 dogs during T2. The median cumulative dose of HES was 86 mL/kg (range, 12-336 mL/kg). No difference was detected between the groups for age, gender, body weight, and length of hospitalization. Outcome was significantly different between the HES (66% survived) and the CRYS (87% survived) groups (P = 0.014). No significant difference was detected between groups for creatinine concentrations at T0, T1, T2, T1max%, or T2max%. No significant difference was detected between the groups for T1max% creatinine in dogs subclassified as having systemic inflammatory response syndrome or sepsis. CONCLUSIONS HES administration in this canine population did not result in increased creatinine concentrations compared to administration of CRYSs. Further studies are needed to establish the safety of HES in critically ill dogs.
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Affiliation(s)
- Ivayla D Yozova
- Emergency and Critical Care Section, Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, 3012 Bern, Switzerland
| | - Judith Howard
- Diagnostic Clinical Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, 3012 Bern, Switzerland
| | - Katja-Nicole Adamik
- Emergency and Critical Care Section, Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, 3012 Bern, Switzerland
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Adamik KN, Yozova ID, Regenscheit N. Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care. J Vet Emerg Crit Care (San Antonio) 2016; 25:20-47. [PMID: 25655725 DOI: 10.1111/vec.12283] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/14/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals. DATA SOURCES Human and veterinary original research articles, scientific reviews, and textbook sources from 1950 to the present. HUMAN DATA SYNTHESIS HES solutions have been used extensively in people for over 30 years and ever since its introduction there has been a great deal of debate over its safety and efficacy. Recently, results of seminal trials and meta-analyses showing increased risks related to kidney dysfunction and mortality in septic and critically ill patients, have led to the restriction of HES use in these patient populations by European regulatory authorities. Although the initial ban on the use of HES in Europe has been eased, proof regarding the benefits and safety profile of HES in trauma and surgical patient populations has been requested by these same European regulatory authorities. VETERINARY DATA SYNTHESIS The veterinary literature is limited mostly to experimental studies and clinical investigations with small populations of patients with short-term end points and there is insufficient evidence to generate recommendations. CONCLUSIONS Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines.
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Affiliation(s)
- Katja N Adamik
- Department of Veterinary Clinical Medicine, Division of Small Animal Emergency and Critical Care, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Silverstein DC, Cozzi EM, Hopkins AS, Keefe TJ. Microcirculatory effects of intravenous fluid administration in anesthetized dogs undergoing elective ovariohysterectomy. Am J Vet Res 2014; 75:809-17. [PMID: 25157884 DOI: 10.2460/ajvr.75.9.809] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the microcirculatory effects of IV fluid administration in healthy anesthetized dogs undergoing elective ovariohysterectomy. ANIMALS 49 client-owned dogs. PROCEDURES Dogs were sedated, and anesthesia was induced with propofol and diazepam and maintained with isoflurane in oxygen. Dogs received lactated Ringer's solution (LRS) IV at rates of 0, 10, or 20 mL/kg/h. Videomicroscopy was used to assess and record effects of LRS administration on microcirculation in the buccal mucosa. Measurements of microcirculatory (total vessel density, proportion of perfused vessels, microcirculatory flow index, and perfused vessel density by vessel size [< 20 μm, ≥ 20 μm, and all diameters]) and other physiologic variables (heart rate, Doppler-measured blood pressure, oxygen saturation as measured by pulse oximetry, capillary refill time, and body temperature) were compared among groups at baseline (immediately after anesthetic induction), 30 and 60 minutes afterward, and overall. RESULTS Neither the proportion of perfused vessels nor microcirculatory flow index varied among treatment groups at any time point, regardless of vessel size. For vessels < 20 μm in diameter and for all vessels combined, total and perfused vessel density were similar among groups. For vessels ≥ 20 μm in diameter, total vessel density was significantly greater in the 20 mL/kg/h group than in other groups, and perfused vessel density was significantly greater in the 20 mL/kg/h group than in the 0 mL/kg/h group, when all time points were considered. Other physiologic variables were similar among groups. CONCLUSIONS AND CLINICAL RELEVANCE Total and perfused vessel density of vessels ≥ 20 μm in diameter (mostly venules) were greatest in dogs that received 20 mL of LRS/kg/h. Further research is required to evaluate clinical importance of these findings.
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Affiliation(s)
- Deborah C Silverstein
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104
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Muir WW, Ueyama Y, Pedraza-Toscano A, Vargas-Pinto P, Delrio CL, George RS, Youngblood BL, Hamlin RL. Arterial blood pressure as a predictor of the response to fluid administration in euvolemic nonhypotensive or hypotensive isoflurane-anesthetized dogs. J Am Vet Med Assoc 2014; 245:1021-7. [DOI: 10.2460/javma.245.9.1021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R, Shafford H. 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats*. J Am Anim Hosp Assoc 2013; 49:149-59. [DOI: 10.5326/jaaha-ms-5868] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ohta M, Kurimoto S, Tokushige H, Kuroda T, Ishikawa Y. Hemodynamic effects of 6% hydroxyethyl starch infusion in sevoflurane-anesthetized thoroughbred horses. J Vet Med Sci 2013; 75:841-5. [PMID: 23411483 DOI: 10.1292/jvms.12-0426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine hemodynamic effects of hydroxyethyl starch (HES) infusion during anesthesia in horses, incremental doses of 6% HES were administered to 6 healthy Thoroughbred horses. Anesthesia was induced with xylazine, guaifenesin and thiopental and maintained with sevoflurane at 2.8% of end-tidal concentration in all horses. The horses were positioned in right lateral recumbency and administered 3 intravenous dose of 6% HES (5 ml/kg) over 15 min with 15-min intervals in addition to constant infusion of lactated Ringer's solution at 10 ml/kg/hr. Hemodynamic parameters were measured before and every 15 min until 90 min after the administration of 6% HES. There was no significant change in heart rate and arterial blood pressures throughout the experiment. The HES administration produced significant increases in mean right atrial pressure, stroke volume, cardiac output (CO) and decrease in systemic vascular resistance (SVR) in a dose-dependent manner. There was no significant change in electrolytes (Na(+), K(+), Cl(-)) throughout the experiment, however, packed cell volume, hemoglobin concentration, and total protein and albumin concentrations decreased in a dose-dependent manner following the HES administration. In conclusion, the HES administration provides a dose-dependent increase in CO, but has no impact upon arterial blood pressures due to a simultaneous decrease in SVR.
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Affiliation(s)
- Minoru Ohta
- Racehorse Clinic, Ritto Training Center, Japan Racing Association (JRA), 1028 Misono, Ritto-shi, Shiga 520-3085, Japan.
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Sinclair MD, Dyson DH. The impact of acepromazine on the efficacy of crystalloid, dextran or ephedrine treatment in hypotensive dogs under isoflurane anesthesia. Vet Anaesth Analg 2012; 39:563-73. [DOI: 10.1111/j.1467-2995.2012.00766.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Muir WW, Kijtawornrat A, Ueyama Y, Radecki SV, Hamlin RL. Effects of intravenous administration of lactated Ringer's solution on hematologic, serum biochemical, rheological, hemodynamic, and renal measurements in healthy isoflurane-anesthetized dogs. J Am Vet Med Assoc 2011; 239:630-7. [PMID: 21879963 DOI: 10.2460/javma.239.5.630] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the hematologic, serum biochemical, rheological, hemodynamic, and renal effects of IV administration of lactated Ringer's solution (LRS) to healthy anesthetized dogs. DESIGN 4-period, 4-treatment cross-over study. ANIMALS 8 healthy mixed-breed dogs. PROCEDURES Each dog was anesthetized, mechanically ventilated, instrumented, and randomly assigned to receive LRS (0, 10, 20, or 30 mL/kg/h [0, 4.5, 9.1, or 13.6 mL/lb/h]), IV, on 4 occasions separated by at least 7 days. Blood hemoglobin concentration and serum total protein, albumin, lactate, and electrolyte concentrations; PCV; colloid osmotic pressure; arterial and venous pH and blood gases (Po2; Pco2); whole blood and plasma viscosity; arterial and venous blood pressures; cardiac output; results of urinalysis; urine production; glomerular filtration rate; and anesthetic recovery times were monitored. Oxygen delivery, vascular resistance, stroke volume, pulse pressure, and blood and plasma volume were calculated. RESULTS Increasing rates of LRS administration resulted in dose-dependent decreases in PCV; blood hemoglobin concentration and serum total protein and albumin concentrations; colloid osmotic pressure; and whole blood viscosity. Plasma viscosity; serum electrolyte concentrations; data from arterial and venous blood gas analysis; glomerular filtration rate; urine production; heart rate; pulse, central venous, and arterial blood pressures; pulmonary vascular resistance; and oxygen delivery did not change. Pulmonary artery pressure, stroke volume, and cardiac output increased, and systemic vascular resistance decreased. CONCLUSIONS AND CLINICAL RELEVANCE Conventional IV infusion rates of LRS to isoflurane-anesthetized dogs decreased colligative blood components; increased plasma volume, pulmonary artery pressure, and cardiac output; and did not change urine production or oxygen delivery to tissues.
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Affiliation(s)
- William W Muir
- QTest Laboratories, 6456 Fiesta Dr, Columbus, OH 43235, USA.
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