Correlation between jugular and central venous pressures in laterally recumbent horses

Objective To compare and correlate right atrial pressure, which represents central venous pressure (CVP) to jugular vein pressure (JVP) in laterally recumbent horses under anesthesia. Study design Retrospective clinical trial. Animals Seven adult healthy horses (411 ± 8.7 kg). Methods Horses were sedated with IV xylazine and anesthesia was obtained with IV ketamine and diazepam. Anesthesia was maintained with sevoflurane in oxygen. All horses were positioned in left lateral recumbency. An 8F catheter introducer was inserted into the right jugular vein to measure JVP. An 8F catheter introducer was inserted into the left jugular vein to be used as the port for a 7F 110 cm catheter that reached the right atrium to measure CVP. Both, CVP and JVP were measured simultaneously with a water calibrated aneroid manometer using the sternum as the 0 cmH₂O reference point. Measurements were compared using Spearman correlation and the Bland‐Altman plot. Results Twenty paired samples were obtained over a period of 2 hours. The CVP ranged from 7 to 31 cmH₂O, while the JVP ranged from 5 to 30 cmH₂O. The Spearman correlation coefficient indicated that CVP and JVP had a strong correlation with r = 0.88. The Bland‐Altman plot showed a bias of 0.7 cmH₂O. Conclusion and clinical relevance Jugular vein pressure showed a strong correlation with CVP in healthy, euvolemic, laterally recumbent anesthetized adult horses. Thus, JVP cannot replace CVP but it may be used clinically to monitor CVP in laterally recumbent horses.     

Evaluation of peripheral and central venous pressure in awake dogs and cats

OBJECTIVE: To determine whether peripheral venous pressure (PVP) was correlated with central venous pressure (CVP) when measured by use of different catheter sizes, catheterization sites, and body positions in awake dogs and cats. ANIMALS: 36 dogs and 10 cats. PROCEDURES: Dogs and cats with functional jugular and peripheral venous catheters were enrolled in the study. Peripheral venous catheters (18 to 24 gauge) were placed in a cephalic, lateral saphenous, or medial saphenous vein. Central venous catheters (5.5 to 8.5 F) were placed in the jugular vein and advanced into the cranial vena cava. Catheters were connected to pressure transducers and a blood pressure monitor capable of displaying 2 simultaneous pressure tracings. For each animal, the mean of 5 paired measurements of PVP and CVP was calculated. The relationship between PVP and CVP when measured by use of different catheter sizes, catheterization sites, and body positions was determined. RESULTS: Mean +/- SD PVP was 5.7 +/- 5.8 mm Hg higher than CVP in dogs and 6.0 +/- 6.9 mm Hg higher than CVP in cats. However, results of multiple regression analysis did not indicate a significant correlation between PVP and CVP, regardless of catheter size, catheter position, or body position. The relationship was weak in both dogs and cats. CONCLUSIONS AND CLINICAL RELEVANCE: The PVP was poorly correlated with CVP when different catheter sizes, catheterization sites, and patient positions were evaluated. Peripheral venous pressure should not be used to approximate CVP in awake dogs and cats.     

Evaluation of gastric pressures as an indirect method for measurement of intraabdominal pressures in the horse

Objective – To develop an indirect method for measurement of intraabdominal pressures in the standing horse using measurement of gastric pressures as a less invasive technique, and to compare this method with direct intraabdominal pressures obtained from the peritoneal cavity. Design – Prospective, experimental study. Setting – University‐based equine research facility. Animals – Ten healthy adult horses, 7 geldings and 3 mares. Interventions – Gastric pressures were measured using a nasogastric tube with a U‐tube manometry technique, while intraperitoneal pressures were measured with a peritoneal cannula. Measurements of intraabdominal pressure were obtained by both methods, simultaneously, and were evaluated using 5 increasing volumes of fluid infused into the stomach (0, 400, 1,000, 2,000, and 3,000 mL). Bias and agreement between the 2 methods were determined using Bland‐Altman analysis and Lin's concordance correlation coefficients. Measurements and Main Results – Mean gastric pressure was 14.44±4.69 cm H₂O and ranged from 0 to 25.8 cm H₂O. Intraperitoneal pressure measurements were generally subatmospheric, and ranged from ?6.6 to 3.1 cm H₂O (mean±SD, ?1.59±2.09 cm H₂O). Measurements of intraperitoneal pressures were repeatable; however, intra‐ and interindividual variance was significantly larger for measurements of gastric pressures. The mean and relative bias for comparison between the 2 techniques was 15.9±5.3 cm H₂O and 244.3±199.2%, respectively. The Lin's concordance correlation coefficient between gastric and intraperitoneal pressures was ?0.003 but this was not statistically significant (P=0.75). Conclusions – There was no statistical concordance between measurements of intraabdominal pressure using gastric and intraperitoneal pressure measurement, indicating that gastric pressures cannot be substituted for intraperitoneal pressure measurement. Direct measurement of intraperitoneal pressures may be a more consistent method for comparison of intraabdominal pressures between horses, due to less variability within and between individuals.     

Comparison of direct and indirect methods of intra‐abdominal pressure measurement in normal horses

Objectives – To develop a direct method for measuring intra‐abdominal pressures in the standing horse, identify a reference interval for direct intra‐abdominal pressures, compare these pressures to indirect intra‐abdominal pressures measured from the bladder, and determine the optimal bladder infusion volume for indirect pressure measurement. Design – Prospective, experimental study. Setting – A university‐based equine research facility. Animals – Ten healthy adult horses, 5 males and 5 females. Interventions – Direct intra‐abdominal pressures were measured through an intraperitoneal cannula and zeroed at the height midway between the height of the tuber ishii and point of the shoulder. Indirect measurements of intra‐abdominal pressure were performed by measuring intravesicular pressures through a transurethral catheter zeroed at the tuber ishii. Measurements and Main Results – Direct pressure measurements obtained in the standing horse were subatmospheric (mean, ?1.80 cm H₂O; SD, 1.61 cm H₂O; 95% CI, ?2.80 to ?0.80) and were shown to decrease as the horse's weight increased (Pearson's r=?0.67, P=0.04), with no effect of head position (P=0.15). Mean baseline indirect pressure measurements (mean, ?8.63 cm H₂O; SD, 4.37 cm H₂O; 95% CI, ?13.05 to ?4.21) were significantly different from the pressures measured directly from the abdomen (P<0.001). Indirect pressure measurements were noted to increase with increasing volumes infused into the bladder, and were statistically different at a volume of 100 mL (P=0.004). There was low to moderate correlation between direct and indirect pressure measurements of intra‐abdominal pressure over a range of fluid volumes infused into the bladder (Pearson's correlation range ?0.38 to 0.58). Conclusion – Pressures measured directly in the standing horse were subatmospheric, and increased as the horse's weight increased. Indirect pressures measured were altered by increasing volumes infused in the bladder. There was no significant correlation between the 2 methods of intra‐abdominal pressure measurement.     

Continuous positive airway pressure administered via face mask in tranquilized dogs

Objective – To evaluate the tolerance of a continuous positive airway pressure (CPAP) mask in tranquilized dogs and compare PaO₂ in arterial blood in dogs receiving oxygen with a regular face mask or CPAP mask set to maintain a pressure of 2.5 or 5 cm H₂O. Design – Prospective, randomized clinical study. Setting – University teaching hospital. Animals – Sixteen client‐owned dogs without evidence of cardiopulmonary disease were studied. Interventions – Eight animals were randomly assigned to each of 2 treatment groups: group A received 2.5 cm H₂O CPAP and group B received 5 cm H₂O CPAP after first receiving oxygen (5 L/min) by a regular face mask. Animals were tranquilized with acepromazine 0.05 mg/kg, IV and morphine 0.2 mg/kg, IM. An arterial catheter was then placed to facilitate blood sampling for pHa, PaO₂, and PaCO₂ determinations before and after treatments. Direct mean arterial pressure, heart rate, respiratory rate, and temperature were also recorded after each treatment. Measurements and Main Results – CPAP administration was well tolerated by all animals. The mean arterial pressure, heart rate, respiratory rate, temperature, PaCO₂, and pHa, did not differ at any time point between groups. Differences were seen in oxygenation; in group A, PaO₂ significantly increased from a mean of 288.3±47.5 mm Hg with a standard mask to a mean of 390.3±65.5 mm Hg with the CPAP mask and in group B, PaO₂ increased similarly from 325.0±70.5 to 425.2±63.4 mm Hg (P<0.05); no differences were detected between the 2 CPAP treatments. Conclusions – In healthy tranquilized dogs noninvasive CPAP is well tolerated and increases PaO₂ above values obtained when using a regular face mask.     

Original Study: Determination of normal intra‐abdominal pressure using urinary bladder catheterization in clinically healthy cats

Objective – To establish a reference interval for intra‐abdominal pressure (IAP) measured by urinary bladder catheterization in normal cats and determine if IAP is affected by observer variation, volume of saline instillation before measurement, or subject variables of gender, positioning, body condition score, and sedation. Design – Prospective experimental study. Setting – Private referral center. Animals – Twenty healthy adult cats. Interventions – Sedation with butorphanol, midazolam, and propofol for catheterization of the urinary bladder and measurement of IAP. Measurements and Main Results – A 5‐Fr red rubber urinary catheter was placed under sedation, and IAP was determined using a water manometer with the cats in right lateral and sternal recumbency. Three readings were taken in each position by 2 observers. The cats were allowed to recover with the urinary catheter in place, and IAP was measured in each cat while they were awake in right lateral and sternal recumbency. Conclusions – In this population of clinically healthy cats, median (interquartile range) IAP taken over all measurements was 7.00 cm H₂O (5.23–8.83 cm H₂O). There was no statistical difference between observers or subject gender. Factors associated with a statistically significant increase in IAP were right lateral compared with sternal recumbency (P=0.002), being awake compared with sedated (P<0.001), having a higher body condition score (P=0.01 and 0.001), instillation of a higher volume of saline into the bladder for measurement (P<0.001), and struggling during awake measurements (P<0.001).     

Repeatability, reproducibility, and effect of head position on central venous pressure measurement in standing adult horses

Background: Central venous pressure (CVP) is a used as an estimation of intravascular volume status in various species. Techniques for measuring CVP in horses have been described, but the repeatability of these readings at a single time point or over time has not been established. Hypothesis: That CVP measurements in healthy adult horses would be repeatable at each time point, that these readings would be reproducible over time, and that alteration in head position relative to the heart would alter CVP. Animals: Ten healthy adult research horses. Methods: In an experimental study, horses were instrumented with a central venous catheter. Readings were taken in triplicate q6h for 2 days by water manometry, and twice daily with the head in neutral, elevated, and lowered positions by electronic manometry. Results: Variation in the “neutral” measurements obtained at each time point was <0.1 ± 1.0 cmH₂O (P= .718). There was a significant decrease in CVP over time (P= .015), which was eliminated when results were controlled for acute decrease in body weight of ?1.35% (presumed hypohydration because of lack of acclimatization and decreased water intake). Head height had a significant and directional effect on CVP in that the elevated head position decreased CVP ?2.0 ± 6.5 cmH₂O (P < .001) while the lowered head position increased CVP by 3.7 ± 5.5 cmH₂O (P < .001). Conclusions and Clinical Importance: CVP values obtained by water manometry were repeatable in adult horses, but were reproducible only when controlled for changes in hydration. Care should be taken to maintain consistency in head position to prevent erroneous readings.     

The effects of hypohydration on central venous pressure and splenic volume in adult horses

Background: Central venous pressure (CVP) is used in many species to monitor right‐sided intravascular volume status, especially in critical care medicine. Hypothesis: That hypohydration in adult horses is associated with a proportional reduction in CVP. Animals: Ten healthy adult horses from the university teaching herd. Methods: In this experimental study, horses underwent central venous catheter placement and CVP readings were obtained by water manometry. The horses were then deprived of water and administered furosemide (1 mg/kg IV q6h) for up to 36 hours. Weight, CVP, vital signs, PCV, total protein (TP), and serum lactate were monitored at baseline and every 6 hours until a target of 5% decrease in body weight loss was achieved. The spleen volume was estimated sonographically at baseline and peak volume depletion. Linear regression analysis was used to assess the association of CVP and other clinical parameters with degree of body weight loss over time. Results: There was a significant association between CVP and decline in body weight (P < .001), with a decrease in CVP of 2.2 cmH₂O for every percentage point decrease in body weight. Other significant associations between volume depletion and parameters measured included increased TP (P= .007), increased serum lactate concentration (P= .048), and decreased splenic volume (P= .046). There was no significant association between CVP and vital signs or PCV. Conclusions and Clinical Importance: These findings suggest that CVP monitoring might be a useful addition to the clinical evaluation of hydration status in adult horses.     

Endotracheal intubation in horses: a study of two cuff inflation pressures, correlation with liquid aspiration, and tracheal wall damage

Nine adult horses were anesthetized for a nonsurvival abdominal adhesion study. Horses were randomly assigned into two groups to receive endotracheal tube cuff pressures of either 80 cm H₂O (Group P80) or 120 cm H₂O (Group P120). After intubation (Bivona 30 mm ID), anesthesia was maintained with isoflurane. Horses were ventilated 10 times per minute with a suitable inspiratory pressure to maintain Pe ′CO₂ in the 35–40 mm Hg (4.7–6.0 kPa) range. Cuff pressure was continuously monitored with a pressure transducer (TruWave, Baxter) calibrated to the atmospheric pressure and maintained at a constant pressure. Twenty‐five millilitres of methylene blue dye in saline were instilled proximal to the cuff over 5 minutes. The horses were euthanized 123 ± 23 minutes later (mean ± SD). Immediately, the trachea was opened distal to the tip of the endotracheal tube, and the mucosa was observed for evidence of dye leaking past the cuff. The cervical trachea was resected and the lumen exposed by a ventral longitudinal incision. Biopsies (1–2 rings) were obtained at mid‐cuff level and distal to the tip of the endotracheal tube, and placed in formalin for later histologic examinations (H&E stain). Methylene blue stain was not observed distal to the endotracheal tube cuff in any horse. Visual examination of the tracheal mucosa revealed hyperemic or hemorrhagic lesions at the level of cuff contact both ventrally and dorsally. Histologic changes included epithelium damage, submucosal neutrophil infiltrates, and acute submucosal hemorrhages. P80 horses had none or focal to multifocal lesions on the ventral and dorsal aspects of the rings. P120 horses had multifocal to diffuse lesions on all aspects (dorsal, ventral, and lateral). We concluded that the endotracheal tube cuff produced a seal sufficient to prevent leakage at both pressures. Tracheal damages on gross and microscopic examinations were more severe and occurred more frequently at the higher cuff pressure.     

Accuracy and precision of the portable StatPal II and the laboratory-based NOVA stat profile 1 for measurement of pH, P(CO2), and P(O2) in equine blood

OBJECTIVE: To investigate the accuracy and precision of the portable, battery-powered StatPal II and the laboratory-based NOVA StatProfile 1 blood gas and pH analyzers for use in analysis of equine blood. STUDY DESIGN: Patient sample comparison and whole blood tonometry. SAMPLE POPULATION: Patient sample comparison: 125 arterial or venous blood samples from 49 healthy, awake, or anesthetized horses or ponies. Tonometry: venous blood samples from 11 healthy Thoroughbred horses. MATERIALS AND METHODS: Arterial and venous blood taken from awake and anesthetized equine patients was placed in an ice-water bath, then analyzed within 30 minutes of collection. Bias and limits of agreement between analyzers in measurement of pH, P(CO2), and P(O2) were calculated according to the method of Bland and Altman. Tonometry, using analyzed gases with a range of P(O2) of 28 to 286 mm Hg and P(CO2) of 21 to 85 mm Hg, was performed on equine whole blood or blood with abnormally high (55%) or low (20%) hematocrit. Samples were introduced directly from the tonometer into the analyzers. Inaccuracy (% of target value) and imprecision (coefficient of variation) were determined for each instrument. In addition, results of analysis of blood samples introduced into the analyzers at 36 degrees C, 0 to 3 degrees C, and 22 degrees C were compared. RESULTS: In the patient sample comparisons, bias between analyzers (StatPal-NOVA) for measurement of P(O2) less than 60 mm Hg was -0.33+/-6.2 mm Hg (x +/-2 SD) and for P(O2) between 60 and 110 mm Hg bias was -1.48+/-9.2 mm Hg. Bias was 46.5+/-67 mm Hg (significantly different from bias at the lower P(O2) levels) for measurement of P(O2) values of 111 to 505 mm Hg, and at P(O2) values greater than 110 mm Hg, bias increased with increasing P(O2). During the course of the study, a significant shift in bias between instruments occurred for P(CO2) and pH measurement, coincident with a change of P(CO2) and pH electrodes in the NOVA and use of a new lot of StatPal sensors. Bias (StatPal-NOVA) for P(CO2) before and after the electrode change was -3.74+/-4.2 and -0.88+/-6.8 mm Hg, and bias for pH before and after the electrode change was 0.026+/-0.034 and -0.024+/-0.038. The change in bias was significant (P<.05). In the whole blood tonometry trials, mean recovered values of P(CO2) and P(O2) from blood with a normal hematocrit ranged from 94% to 109% of target values for StatPal and from 98% to 107% for NOVA. Imprecision ranged from 3.3% to 5.3% for StatPal and from 2.2% to 4.3% for NOVA. With extremes of hematocrit (55% and 20%), StatPal's mean recovered P(CO2) values were 115% and 112% of the target value of 21 mm Hg, whereas NOVA's recovered P(CO2) values were similar to those recovered from samples with normal hematocrit. Introduction of cold blood samples (0 to 3 degrees C) into StatPal resulted in P(CO2) readings that were approximately 2 mm Hg lower than those of 22 degrees C and 36 degrees C samples (P<.05). No other effects of sample temperature were found for either instrument. CONCLUSIONS: StatPal and NOVA are of similar accuracy and demonstrate acceptable precision for measurement of P(CO2) and P(O2) in equine blood with values in the normal arterial and venous range. Mean recovered values during tonometry differed by as much as 10% between instruments, indicating that they should not be used interchangeably for a single patient or for a group of subjects in a research setting. CLINICAL RELEVANCE: The StatPal is a portable blood gas analyzer of acceptable accuracy and precision, for clinical or investigational work in horses.     

Surface oximetry of healthy and ischemic equine intestine

Measurements of jejunal, ileal, and large colon (pelvic flexure) surface O2 tension (PSO2) were made in halothane-anesthetized horses with a nonheated miniature oxygen polarographic electrode. Assisted ventilation with 100% O2 was used to maintain PaCO2 tension at 50 +/- 8 mm of Hg while mean arterial blood pressure was maintained greater than or equal to 70 mm of Hg. Mean +/- SD PSO2 for the intestinal segments were: jejunum (horses 1 to 4), 71 +/- 20 mm of Hg; ileum (horses 1 to 4), 61 +/- 8 mm of Hg; and pelvic flexure of the large colon (horses 1 to 10), 55 +/- 13 mm of Hg. The response of the sensor to intestinal ischemia was studied in the large colon of an additional 12 halothane-anesthetized horses, using 4 types of vascular occlusion: venous (4 horses); arterial and venous (4 horses); venous and intramural vascular obstruction (2 horses); and arterial, venous, and intramural obstruction (2 horses). Venous and arterial occlusions were maintained for 30, 60, 90, and 120 minutes, whereas intramural obstruction combined with either type of vascular obstruction was studied for 60 to 120 minutes. After vascular occlusion, PSO2 decreased to 8 +/- 7 mm of Hg for venous obstruction, 4 +/- 3 mm of Hg for arterial and venous obstruction, 6 +/- 0 mm of Hg for intramural and venous obstruction, and 3 +/- 0 mm of Hg after intramural and arterial and venous obstruction. Thirty minutes after release of the clamps, the PSO2 increased to greater than or equal to 50% of the preoccluded large colon value.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of Hypercapnia or Xylazine on Lateral Ventricle and Lumbosacral Cerebrospinal Fluid Pressures in Pentobarbital-anesthetized Horses

Facial artery pressure, central venous pressure, heart rate, and lateral ventricle cerebrospinal fluid (CSF) pressure (LV-CSFP) were measured in 10 pentobarbital-anesthetized horses at arterial partial pressure of carbon dioxide (PaCO₂) values of 40,60, and 80 mm Hg, produced by varying the inspired carbon dioxide concentration. Variables were recorded at 5-minute intervals for 15 minutes at each level of PaCO₂. Arterial blood gas analysis was performed at the end of the 15-minute time period for each level of PaCO₂. Lateral ventricle CSF pressure was significantly increased (p < .05) at a PaCO₂ of 80 mm Hg. Cardiovascular variables were not significantly changed by changing PaCO₂. The PaCO₂ was returned to 40 mm Hg; 1.1 mg xylazine/kg body weight was injected intravenously in eight horses, and data were collected for 60 minutes. No significant changes were observed. No changes were observed in two control horses not receiving xylazine. Subsequently, placement of a lumbosacral subarachnoid catheter allowed simultaneous measurement of LV-CSFP and lumbosacral CSF pressure (LS-CSFP) at PaCO₂ values of 40,60, and 80 mm Hg. The Pearson Correlation Coefficient between LV-CSFP and LS-CSFP was 0.94 (p < .0001) It was concluded that changes in CSF pressure could be detected at the lateral ventricle and the lumbosacral space; increasing PaCO₂ to 80 mm Hg resulted in significant increases in LV-CSFP; xylazine does not increase LV-CSFP in pentobarbital-anesthetized, normocapnic horses; and under the conditions of this experiment, LV-CSFP and LS-CSFP were closely correlated.     

Cardiopulmonary effects of intrathoracic insufflation in dogs

This study was designed to quantify the effects of incremental positive insufflation of the intrathoracic space on cardiac output (CO), heart rate (HR), arterial pressure (AP), central venous pressure (CVP), and percent saturation of hemoglobin with oxygen (SPO2) in anesthetized dogs. Seven healthy, adult dogs from terminal teaching laboratories were maintained under anesthesia with isoflurane delivered with a mechanical ventilator. The experimental variables were recorded before introduction of an intrathoracic catheter, at intrathoracic pressures (IP) of 0 mm Hg, 3 mm Hg insufflation, and additional increments of 1 mm Hg insufflation thereafter until the SPO2 remained <85% despite increases in minute volume. Finally the variables were measured again at 0 mm Hg IP. The cardiac output and systolic and diastolic AP significantly (P < 0.05) decreased at 3 mm Hg IP. Significant decreases in SPO2 were seen at 10 mm Hg IP. Significant increase in CVP was noted at 6 mm Hg IP. Heart rate decreased significantly at 5 to 6 mm Hg IP but was not decreased above 6 mm Hg IP. Given the degree of CO decrease at low intrathoracic pressures, insufflation-aided thoracoscopy should be used with caution and at the lowest possible insufflation pressure. Standard anesthetic monitoring variables such as HR and AP measurements may not accurately reflect the animal's cardiovascular status.     

Destructive lesions of the proximal sesamoid bones as a complication of dorsal metatarsal artery catheterization in three horses

OBJECTIVE: To describe focal destructive lesions of the proximal sesamoid bones (PSBs) as a complication of dorsal metatarsal artery catheterization performed for direct blood pressure monitoring during equine general anesthesia. STUDY DESIGN: Retrospective study. ANIMALS: Three client-owned horses. METHODS: A dorsal metatarsal artery was catheterized in each of 3 horses for direct blood pressure monitoring during anesthesia. Radiography, ultrasonography, synoviocentesis, and arthroscopy were used to diagnose postoperative lameness that occurred in the limb used for blood pressure monitoring. RESULTS: Horses developed severe lameness, localized to the fetlock region of the catheterized limb within 21 days of surgery. Antibiotic therapy was administered. Surgical debridement was possible in 1 horse. Two horses that had lesions that were inaccessible, failed to respond to medical management and were euthanatized. The 3rd horse that had surgical debridement of affected bone, survived. Changes in hospital protocol, by improving aseptic technique during catheter insertion and use of new manometer tubing and heparinized saline for each arterial catheter inserted in the dorsal metatarsal artery, have eliminated this complication. CONCLUSIONS: Diagnosis and treatment of destructive lesions of the PSB were difficult. Strict aseptic technique should be followed during insertion of arterial catheters. CLINICAL RELEVANCE: Focal destructive lesions of the PSB subsequent to dorsal metatarsal arterial catheterization is a rare but serious complication of equine anesthesia.     

Method for Blind Catheter Placement in the Equine Pulmonary Artery

The navigation behavior of catheters within the equine pulmonary artery (PA) was investigated using en bloc heart and lung preparations for the purpose of developing a method of blind catheter placement. An equine ex vivo heart and lung perfusion system with controlled perfusate pulsatile flow, pressure, and temperature was used to evaluate a blind navigation technique for placement of balloon-tipped catheters into the distal main stem of the PA. Catheter performance was observed with an intravascular endoscope. Three balloon catheters were selected for navigation trials: a 4 mm diameter × 1.2 cm, 2.7Fr, 142 cm angioplasty catheter (C4mm); a 10 mm diameter × 4 cm, 5Fr, 150-cm angioplasty catheter (C10mm); and a 16-mm diameter, 7Fr, 200-cm pancreatic duct sphincteroplasty catheter (C16mm). Successful catheter placement was defined as insertion within a left or right main stem of the PA to a distance greater than 20 cm beyond the bifurcation. A method of blind catheter placement into the distal main stem of the equine PA using balloon-tipped catheters was successfully developed. The 16-mm catheter was superior with an average proportion of successful insertions (PSIavg) of 93.6%; an average insertion distance in the main stem (IDMavg) of 30.1 ± 5.7 cm; and an average insertion distance anywhere in the PA (IDAavg) of 29.3 ± 6.4 cm versus the 10 mm (PSIavg 25%, IDMavg 39.3 ± 11.4 cm, IDAavg 19.3 ± 15.1 cm) and 4 mm (PSIavg 11%, IDMavg 40.0 ± 11.0 cm, IDAavg 12.8 ± 13.2 cm), respectively.     

Impact of endotracheal tube size and cuff pressure on tracheal and laryngeal mucosa of adult horses

ObjectiveTo assess the effects of two sizes of silicone endotracheal tubes with internal diameter 26 mm (ETT₂₆) and 30 mm (ETT₃₀) inflated to minimum occlusive volume on tracheal and laryngeal mucosa of adult horses anesthetized for 2 hours with isoflurane.Study designProspective, randomized, blinded, crossover experimental study.AnimalsA total of eight healthy adult mares.MethodsUpper airway endoscopy and ultrasound measurements of internal tracheal diameter were performed the day before anesthesia. Horses were anesthetized and orotracheally intubated with ETT₂₆ or ETT₃₀. Ease of intubation was scored. The cuff was inflated in 10 mL increments to produce a seal. Final volume of air used and intracuff (IC) pressure (measured by pressure transducer) were recorded. At the end of anesthesia, a manometer was used to measure IC pressure and these measurements compared against measurements from the pressure transducer. Laryngeal and tracheal mucosa were assessed via endoscopy and assigned a score 0–3 before anesthesia, and at 2 and 24 hours following extubation.ResultsData are from seven horses because one horse with laryngeal hemiplegia was excluded. Mean tracheal ultrasound measurement was 3.5 ± 0.4 cm. No significant differences were noted between endotracheal tube sizes for intubation score, IC pressures, inflation volumes or tracheal or laryngeal injury scores at any time point. IC pressure measured by manometer was slightly higher than that by transducer (+1.0 ± 2.8 mmHg).Conclusions and clinical relevanceResults identified no clear advantage of one endotracheal tube size over the other in the population of horses studied, when endotracheal intubation is properly applied and IC pressure is carefully monitored. However, given that ETT₂₆ was associated with the highest observed IC pressures and the only observed incidents of tracheal circumferential erythema, the larger ETT₃₀ may be the better choice in most cases where tracheal size is sufficient.     

Evaluation of the effect of pleural effusion on central venous pressure in cats

This study was undertaken to determine if pleural effusion (PEF) increases central venous pressure (CVP) in cats, to define any relationship between volume of PEF and CVP and to ascertain the significance of CVP alterations in cats having PEF and suspected right heart failure (RHF). CVP was measured from a jugular vein before (CVPpre) and after (CVPpost) bilateral thoracentesis in 9 cats with naturally occurring PEF and under experimental conditions in 3 spontaneously breathing anesthetized cats receiving graded intrathoracic infusion of saline. Volumes of introduced and recovered fluid were recorded. A significant decrease occurred in CVP after thoracentesis in cats with naturally occurring PEF (mean difference, 4.5 cm H2O; range, 0-7.0 cm H2O, P < .005). The magnitude of change in CVP was constant (r = 0.36, P > .05) over the range of volumes recovered (range, 95-450 mL or 16.4-90 mL/kg). Five cats had CVPpre suggestive of RHF (range, 8.16-20.4 cm H2O). After thoracentesis, RHF was ruled out in 1 cat (CVPpost, 4.08 cm H2O) and the CVP declined but remained abnormally high (9.52 cm H2O) in 1 cat with a mediastinal mass. In 2 cats with confirmed RHF (CVPpre, 20.4 and 16.3 cm H2O), CVP decreased after thoracentesis but remained abnormally high (CVPpost, 14.96 and 10.88 cm H2O). In 1 cat with noncardiogenic PEF and inadequate removal of fluid, CVPpost (8.16 cm H2O) did not decrease. Experimentally, a positive linear relationship was observed between CVP and volume of PEF. The threshold volume required to increase CVP (17 mL/kg) approximated that suggested by clinical observation (22 mL/kg). PEF increases CVP and can cause abnormally high CVP in the absence of RHF.     

Echocardiographic and right-sidedcardiac pressure comparison of the mule and horse

There are few physiologic studies that substantiate thepopular belief that mules are superior to horses as working animals. The purpose of this study was to compare selected cardiac dimensions and right-sided cardiac pressures of mules and horses. Using 2-D real time and M-mode echocardiography and transjugular cardiac catheterization resting cardiac dimensions and right-sided pressures were recorded from 10 adult mules and 10 adult horses. The mules and horses were similar in size and physical condition, and both groups had served equally as pack animals. The end diastolic left ventricular lumen diameter, interventricular septal thickness, left ventricular free wall thickness, and aortic root diameter measured (mean ± SD) 9.51 ±0.92 cm, 2.63±0.34 cm, 2.28±0.31 cm, 7.9±0.57 cm, respectively, in mules, and 9.83±0.87 cm, 2.83±0.29 cm, 2.39±0.33 cm, 7.9±0.36 cm, respectively, in horses. The end systolic left ventricular lumen diameter measured 5.79 cm in mules and 5.94±0.99 cm in horses, yielding left ventricular luminal shortening fractions of 39.2±7.15% in mules and 39.7±6.91% in horses. Right atrial mean pressure was 5.3±2.3 mm of Hg in mules and 5.8±1.2 mm Hg in horses. Right ventricular peak systolic pressure was 47.9±4.9 mm Hg in mules and 47.7±3.5 mm Hg in horses. Pulmonary artery mean pressure was 27.3±3.2 mm Hg in mules and 28.1±3.6 mm Hg in horses. No significant differences were detected between mules and horses for the resting cardiac dimensions examined or right-sided pressures measured.     

Serum markers of lamellar basement membrane degradation and lamellar histopathological changes in horses affected with laminitis

In order better to evaluate the extent to which degradation of the lamellar basement membrane (LBM) by matrix metalloproteinases (MMP) occurs in equine laminitis, we determined the concentration of type IV collagen and laminin in normal and laminitic horses, using specific immunoassays. Blood samples were obtained from both the jugular and the cephalic veins of horses (n = 10) before and after the induction of acute alimentary laminitis by carbohydrate overload. Jugular and cephalic venous blood samples were also obtained from horses affected with naturally occurring laminitis (n = 16) and nonlaminitic controls (n = 8). The serum collagen IV concentration was not changed following the induction of laminitis in the experimental group. Serum collagen IV concentration was increased in jugular venous blood obtained from cases of naturally occurring laminitis (mean +/- s.e. 218.04 +/- 18.59 ng/ml) compared with nonlaminitic controls (157.50 +/- 10.93 ng/ml) (P<0.05). Serum collagen IV concentration was also increased in jugular venous blood obtained from severely laminitic horses (219.50 +/- 18.18 ng/ml) compared with nonlaminitic controls (157.50 +/- 10.93 ng/ml) (P<0.05). A difference in serum concentration of collagen IV was not identified based on chronicity of naturally occurring laminitis. Serum laminin concentration did not differ between laminitic and nonlaminitic horses. Differences in serum laminin concentration were not identified based on sampling location (jugular or cephalic vein), severity of laminitic pain, or chronicity of spontaneous laminitis. In conclusion, the circulating concentration of collagen IV was increased in horses affected with naturally occurring laminitis. The potential role for serum collagen IV assay for characterisation of equine laminitis warrants further investigation.     

Central Venous Pressure Measurements in the Caudal Vena Cava of Sedated Cats

The caudla vena cava (CVA) was evaluated as an laternative site for the measurement of central venous pressure (CPV) in six healthy, sedated (ketamine 10 mg/km, midazolam 0.1 mg/kg, and atropine 0.04 mg/kg IM) cats. The CVC was cathererized via medial saphenous puncture, and estimates of CPV from this site compared to those obtained via a jugular catheter. Simulataneous CPV values were recorded electronically (mmgh), via calibrated pressure transducer positioned at the level of the manubrium in cats in lateral recumbency. Five readings, performed at 1 minute intervals, were collected from the jugular and CVC catheters at rest (baseline) and following a rapid fluid bolus. Twenty-four hours later, cats were resedated, baseline measurements repeated, and CVPs recorded following a rapid, 25% whole-blood volume bleed. CVP measurements from the jugular and CVC were statistically compared using repeated measures ANOVA (p<0.05). There were no significant differences between the two sites in the baseline and bleed trials. Significant defferences between jugular and CVC CVPs were noted at 1 and 2 minutes following the fluid bolus. It was concluded that CVC is an alternative site for measurement of CPV in sedated cats.