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.     

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).     

A technique for central venous pressure measurement in normal horses

Objective – To investigate a technique of central venous pressure (CVP) measurement using a newly developed catheter in healthy adult horses. Design – Prospective experimental study. Setting – University research facility. Animals – Twenty healthy adult horses. Interventions – An equine central venous catheter was inserted into the jugular vein to a length of approximately 80 cm from the mid‐cervical region in an attempt to catheterize the pulmonary artery. Pulmonary arterial catheterization was confirmed by echocardiography. Insertion distance and pressure were measured at this location with a disposable manometer. The catheter was then withdrawn until presence in the right atrium was confirmed by echocardiography. Insertion distance and pressure were also measured at this location. The catheter was then withdrawn in 5 cm increments until exiting the jugular insertion site with pressure measured at each location. All pressure measurements were taken with the manometer zero position at the point of the shoulder. Measurements and Main Results – Pulmonary artery catheterization was successful in 16 of 20 horses. Mean pulmonary arterial pressure was 23.8 cm H₂O (17.5 mm Hg) (95% confidence interval [CI] 20.9–26.7 cm H₂O [15.4–19.6 mm Hg]). Mean right atrial pressure was 8.3 cm H₂O (6.1 mm Hg) (95% CI 7.1–9.4 cm H₂O [5.2–6.9 mm Hg]). Right atrial pressure was compared with pressures recorded at sequential insertion distances and resulted in a recommendation for catheter insertion of at least 40 cm for CVP measurement in adult horses. Jugular venous pressure measurement was statistically different from CVP measurement. Conclusions – This catheter measurement technique is well tolerated in normal horses. Routine clinical use of this equine central venous catheter may improve our ability to monitor patients and improve patient care and outcomes of ill horses in hospital.     

Evaluation of an indirect oscillometric blood pressure monitor in normotensive and hypotensive anesthetized dogs

Objective – To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs. Design – Prospective observational study. Setting – University teaching hospital. Animals – Eight crossbred adult dogs. Interventions – Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end‐tidal isoflurane concentration at 1.2±0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia. Measurements and Main Results – Agreement between the direct and indirect BP measurements was determined by the Bland‐Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were ?14.7 mm Hg (15.5 mm Hg), ?16.4 mm Hg (12.1 mm Hg), and ?14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were ?32 mm Hg (22.6 mm Hg), ?24.2 mm Hg (19.5 mm Hg), and ?16.8 mm Hg (17.2 mm Hg), respectively. Conclusion – The oscillometric device was not reliably predictive of intra‐arterial BP during hypotension associated with acute hemorrhage.     

Direct Measurement of Intra-abdominal Pressures in a Horse by Using a Solid Microsensor

Current techniques to measure intra-abdominal pressures in horses use metal cannulas. Concerns that the metal cannula could puncture abdominal viscera if left in place prevent continual pressure measurements. The aim of this study was to validate the use of a solid microsensor and digital monitoring system in the measurement of direct intra-abdominal pressure in horses by comparing its values with the ones simultaneously obtained by means of an intraperitoneal cannula. Ten healthy adult horses had intra-abdominal pressures measured simultaneously through an intraperitoneal cannula zeroed midway between the height of the tuber ishii and point of the shoulder and by the use of an intraperitoneal solid microsensor placed within the abdomen at the same level as the metal cannula. Three repeated intra-abdominal pressure measurements were obtained at rest, after placement of a nasogastric tube, and after placement of 5-L increments of water into the stomach, up to a total volume of 20 L of water. The difference between values obtained (after conversion) was 3.6 mm Hg. The correlation coefficient was 0.825. Direct intra-abdominal pressure monitoring with a solid microsensor allows continuous monitoring without concern for gastrointestinal perforation, is simple to use and to calibrate, and is minimally invasive.     

Cardiopulmonary effects associated with head-down position in halothane-anesthetized ponies with or without capnoperitoneum

Objective To compare the cardiopulmonary effects of the head‐down position, with or without capnoperitoneum, in halothane‐anesthetized horses. Study design Prospective randomized study. Animals Five ponies (four mares, one stallion; bodyweight 302 ± 38.4 kg [mean ± SD]) were used. Methods The ponies were anesthetized with xylazine, guiafenesin, ketamine, and maintained with halothane/oxygen and lungs were ventilated to 40 ± 2 mm Hg (5.3 ± 0.3 kPa) end‐tidal CO₂ tension. After baseline cardiopulmonary measurements, ponies were kept in horizontal position for 30 minutes, then tilted head‐down 30° to the horizontal position for 60 minutes, and then returned to a horizontal position for final measurements. Capnoperitoneum (intra‐abdominal pressure: 12 mm Hg [1.6 kPa]) was introduced after baseline cardiopulmonary measurements, until 5 minutes before the final measurements (treatment INS). Ponies in the control treatment (CON) did not receive capnoperitoneum. Cardiopulmonary data were collected every 10 minutes following the baseline measurements until recovery. Results In the head‐down position, in both treatments, significant decreases were observed in PaO₂, and significant increases were observed in PaCO₂, right atrial blood pressure, arterial to end‐tidal CO₂ gradient, calculated V_d/V_t and ratios. During the head‐down position, in CON there was decreased cardiac index, and in INS, there were decreases in arterial plasma pH and increases in mean systemic arterial and airway pressures. Treatment INS developed ventilation–perfusion mismatch earlier in the study, and had longer recovery times compared to CON. Conclusion Cardiac index and systemic blood pressure appeared to be preserved in INS during the head‐down position, but ventilation–perfusion mismatch appeared earlier with head‐down position and capnoperitoneum. Clinical relevance Healthy ponies tolerate capnoperitoneum at 12 mm Hg (1.6 kPa) intra‐abdominal pressure when tilted head down 30° to the horizontal position.     

A hypothetical,aetiological relationship between the horse's bit,nasopharyngeal asphyxia and negative pressure pulmonary oedema

Tentative explanations for the aetiology of soft palate instability and dorsal displacement at exercise are based on the proposition that it is caused by one or more, as yet unidentified, neuromuscular or inflammatory diseases. As judged by reviews, none of the treatments based on these assumptions are entirely satisfactory. Most researchers agree that their cause is unknown. In 1999, Cook proposed that they were caused by the bit breaking what should be an airtight lip seal. The present article describes a development of this hypothesis – loss of oral compartment subatmospheric pressure. The feral horse is an obligate nose‐breather and runs with a closed mouth and no air in the oral cavity and oropharynx. Evacuation of air from these compartments is proposed as the primary mechanism, strengthened by the cohesive force of surface tension, whereby the soft palate resists the elevating force of negative pressure on inspiration. It is suggested that subatmospheric pressure in the oral compartment is generated by a single swallow before running. Poll extension supplements the rigidity of the nasopharyngeal tube and reinforces the ostium intrapharyngium seal. In the domesticated horse, the lip seal is broken by a bit and bit‐induced poll flexion, jaw and tongue movement often breaks the ostium seal. Oral atmospheric pressure is proposed as the mechanism for nasopharyngeal asphyxia. It is considered that negative pressure pulmonary oedema – currently known as exercise‐induced pulmonary haemorrhage and conventionally thought to be a separate problem – is one of its clinical signs. It is suggested that the bit is the most common cause of nasopharyngeal asphyxia and that this, in turn, results in a cascade of dynamic obstructions in the larynx and cervical trachea, leading ultimately to pulmonary oedema and ‘bleeding.’ It is concluded that these are sequelae to rules in many disciplines that mandate bit usage.     

Relationship between the forces acting on the horse's back and the movements of rider and horse while walking on a treadmill

Reasons for performing study: The exact relationship between the saddle pressure pattern during one stride cycle and the movements of horse and rider at the walk are poorly understood and have never been investigated in detail. Hypothesis: The movements of rider and horse account for the force distribution pattern under the saddle. Method: Vertical ground reaction forces (GRF), kinematics of horse and rider as well as saddle forces (FS) were measured synchronously in 7 high level dressage horses while being ridden on an instrumented treadmill at walk. Discrete values of the total saddle forces (FStot) were determined for each stride and related to kinematics and GRF. The pressure sensitive mat was divided into halves and sixths to assess the force distribution over the horse's back in more detail. Differences were tested using a one sample t test (P<0.05). Results: FStot of all the horses showed 3 peaks (P1‐P3) and 3 minima (M1‐M3) in each half‐cycle, which were systematically related to the footfall sequence of the walk. Looking at the halves of the mat, force curves were 50% phase‐shifted. The analysis of the FS of the 6 sections showed a clear association to the rider's and horse's movements. Conclusion: The saddle force distribution during an entire stride cycle has a distinct pattern although the force fluctuations of the FStot are small. The forces in the front thirds were clearly related to the movement of the front limbs, those in the mid part to the lateral flexion of the horse's spine and the loading of the hind part was mainly influenced by the axial rotation and lateral bending of the back. Potential relevance: These data can be used as a reference for comparing different types of saddle fit.     

A preliminary report on estimating the pressures exerted by a crank noseband in the horse

The pressures applied to horses via restrictive nosebands are of growing concern to equitation scientists and horse sport administrators. They prevent the expression of normal behavior, may compromise blood flow, and even damage bone. This report describes an approach to estimate in vivo pressures applied to the dorsal and ventral aspects of a horse's nose via a so-called crank noseband. A load cell calibrated over a load range of 0-100 N was integrated into a commercially available crank noseband. These force values were combined with anatomical curvature data to estimate the pressure applied by the noseband to the underlying tissue at any point along the internal surface of the noseband using Laplace's law. Partial profiles of both dorsal and ventral aspects of the horse's nose, at a position corresponding to that of the noseband, were taken by contouring a flexible curve ruler to the nose. The ruler was stiff enough to retain the profile when removed from the nose, thereby allowing faithful transfer of the profile to paper for digitization. Once digitized, straightforward mathematical algorithms were used to provide an analytical expression describing each profile, to calculate profile curvature point by point, and, using measured noseband force values, to transform the curvature into a corresponding sub-noseband pressure profile. This process was used to study pressures applied when the horse chewed hay, chewed concentrate mix, and when it was cued to step backward. The calculated pressures ranged from 200 to 400 mm Hg; pressures that, in humans, are associated with nerve damage and other complications. As such, these preliminary data strongly suggest the need for more research in this domain. The current approach should inform some of the welfare concerns in ridden horses but should also be of use in studies of oral behaviors around foraging as well as crib biting and wind sucking.     

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.     

Assessment of blood pressure in cats presented with urethral obstruction

Objective: To determine the arterial blood pressure at presentation in male cats with acute urethral obstruction, and to determine whether there was any correlation between these measurements and concurrent metabolic abnormalities. Design: Prospective, single cohort, observational study. Setting: Private, small animal, after‐hours emergency clinic. Animals: Twenty‐eight client‐owned male cats with acute urethral obstruction and no other known coexisting disease. Interventions: Indirect oscillometric blood pressure measurements obtained before blood sampling and treatment. Measurements and main results: Mean arterial blood pressure (MAP) measurements, physical examination parameters, serum blood urea nitrogen (BUN), creatinine, potassium, phosphorus, total calcium and magnesium concentration, venous pH, lead II electrocardiogram, and urine volume in bladder were evaluated. No cats were hypotensive at presentation; 71% (20/28) were normotensive (median MAP=100 mmHg, range 93–140 mmHg); and 29% (8/28) were hypertensive (median MAP=153 mmHg, range 145–176 mmHg). Compared with hypertensive cats, normotensive cats had significantly lower heart rates (P=0.0201) and lower calcium (P=0.0152). For all 28 cats, MAP correlated with serum potassium and total calcium (P=0.0033). Conclusions: Though potassium and total calcium were inversely and directly correlated respectively with blood pressure in cats with urethral obstruction, none of the cats were hypotensive on presentation. Normotension on admission does not support the absence of biochemical and physical abnormalities in obstructed cats.     

Evaluation of indirect blood pressure monitoring in awake and anesthetized red-tailed hawks (Buteo jamaicensis): effects of cuff size, cuff placement, and monitoring equipment

ObjectiveTo compare Doppler and oscillometric methods of indirect arterial blood pressure (IBP) with direct arterial measurements in anesthetized and awake red-tailed hawks.Study designProspective, randomized, blinded study.AnimalsSix, sex unknown, adult red-tailed hawks.MethodsBirds were anesthetized and IBP measurements were obtained by oscillometry (IBP-O) and Doppler (IBP-D) on the pectoral and pelvic limbs using three cuffs of different width based on limb circumference: cuff 1 (20–30% of circumference), cuff 2 (30–40%), and cuff 3 (40–50%). Direct arterial pressure measurements were obtained from the contralateral superficial ulnar artery. Indirect blood pressure measurements were compared to direct systolic arterial pressure (SAP) and mean arterial pressure (MAP) during normotension and induced states of hypotension and hypertension. Measurements were also obtained in awake, restrained birds. Three-way anova, linear regression and Bland–Altman analyses were used to evaluate the IBP-D data. Results are reported as mean bias (95% confidence intervals).ResultsThe IBP-O monitor reported errors during 54% of the measurements. Indirect blood pressure Doppler measurements were most accurate with cuff 3 and were comparable to MAP with a bias of 2 (?9, 13 mmHg). However, this cuff consistently underestimated SAP with a bias of 33 (19, 48 mmHg). Variability in the readings within and among birds was high. There was no significant difference between sites of cuff placement. Awake birds had SAP, MAP and diastolic arterial pressure that were 56, 43, and 38 mmHg higher than anesthetized birds.Conclusions and clinical relevanceIndirect blood pressure (oscillometric) measurements were unreliable in red-tailed hawks. Indirect blood pressure (Doppler) measurements were closer to MAP measurements than SAP measurements. There was slightly better agreement with the use of cuff 3 on either the pectoral or pelvic limbs. Awake, restrained birds have significantly higher arterial pressures than those under sevoflurane anesthesia.     

A study of measurement of noninvasive blood pressure with the oscillometric device,Sentinel, in isoflurane‐anaesthetized horses

ObjectiveTo assess accuracy of noninvasive blood pressure (NIBP) measured by oscillometric device Sentinel compared to invasive blood pressure (IBP) in anaesthetized horses undergoing surgery. To assess if differences between the NIBP measured by the Sentinel and IBP are associated with recumbency, cuff placement, weight of the horse or acepromazine premedication and to describe usefulness of the Sentinel.Study designProspective study examining replicates of simultaneous NIBP and IBP measurements.AnimalsTwenty-nine horses.MethodsInvasive blood pressure was measured via a catheter in the facial artery, transverse facial artery or metatarsal artery. NIBP was measured using appropriate size cuffs placed on one of two metacarpal or metatarsal bones or the tail in random order. With both techniques systolic (SAP), mean (MAP), and diastolic (DAP) arterial blood pressures and heart rates (HR) were recorded. A mixed effects model compared the IBP to the NIBP values and assessed potential effects of catheter placement, localisation of the cuffs in combination with recumbency, weight of the horse or acepromazine premedication.ResultsNoninvasive blood pressure yielded higher measurements than IBP. Agreement varied with recumbency and cuff position. Estimated mean differences between the two methods decreased from SAP (lateral recumbency: range -5.3 to -56.0 mmHg; dorsal recumbency: range 0.8 to -20.7 mmHg), to MAP (lateral recumbency: range -1.8 to -19.0 mmHg; dorsal recumbency: range 13.9 to -16.4 mmHg) to DAP (lateral recumbency: range 0.5 to -6.6 mmHg; dorsal recumbency: range 21.0 to -15.5 mmHg). NIBP measurement was approximately two times more variable than IBP measurement. No significant difference between IBP and NIBP due to horse's weight or acepromazine premedication was found. In 227 of 1047 (21.7%) measurements the Sentinel did not deliver a result.Conclusion and clinical relevanceAccording to the high variability of NIBP compared to IBP, NIBP measurements as measured by the Sentinel in the manner described here are not considered as an appropriate alternative to IBP to measure blood pressure in anaesthetized horses.     

Comparison of ultrasonic Doppler flow monitor,oscillometric, and direct arterial blood pressure measurements in ill dogs

Objective – To compare blood pressure measurements obtained via ultrasonic Doppler flow monitor (DOP) and 2 oscillometric noninvasive blood pressure monitors (CAR and PAS) to invasive blood pressure (IBP) in hospitalized, conscious dogs with a range of blood pressures. Design – Prospective clinical study. Setting – University teaching hospital. Animals – Eleven client‐owned dogs aged between 4 months and 11.5 years (median 6 y), and weighing between 5.8 and 37.5 kg (median 30.2 kg). Interventions – Blood pressure measurement. Measurements and Main Results – Three consecutive measurements of systolic, diastolic, and mean arterial pressure (MAP) were recorded for each of the 3 indirect devices (only systolic for DOP), along with concurrent IBP measurements. The data were categorized into 3 groups: hypotensive (direct MAP<80 mm Hg), normotensive (80 mm Hg≤direct MAP≥100 mm Hg), and hypertensive (direct MAP>100 mm Hg). Each indirect method was compared with the corresponding direct arterial pressure using the Bland‐Altman method. Within the hypotensive group, each indirect method overestimated the corresponding IBP. Within the normotensive group all indirect systolic measurements and the PAS diastolic measurements underestimated the corresponding IBP. The remaining indirect measurements overestimated the corresponding IBP. Within the hypertensive group, DOP and CAR systolic measurements underestimated the corresponding IBP, and the remaining indirect measurements overestimated the corresponding IBP. In hypertensive dogs oscillometric systolic measurements were more accurate than MAP. In hypotensive dogs MAP measurements were more accurate than systolic measurements. All indirect measurements were most accurate in hypertensive dogs. Conclusions – The noninvasive blood pressure monitors in our study did not meet the validation standards set in human medicine. However, CAR diastolic and MAP measurements within the normotensive group, CAR MAP measurements within the hypertensive group, and PAS diastolic measurements in all groups were close to these standards. All indirect measurements showed greater bias during hypotension. Precision was poorer for all indirect systolic measurements than for MAP.     

Use of gastric balloon manometry for estimation of intra-abdominal pressure in horses

Reasons for performing study: Standing laparoscopic procedures, facilitated by abdominal insufflation with carbon dioxide, are being employed to an increasingly greater extent in horses. However, a sustained increase in abdominal pressure may be life‐threatening. A practical method for intra‐abdominal pressure (IAP) assessment is imperative. Although indirect methods for estimating IAP have been extensively studied in man, little work has been performed in veterinary medicine. Objectives: To investigate the utility of gastric manometry for purposes of evaluating IAP in horses. Methods: Gastric pressure (P_ga) was estimated by balloon manometry in 8 healthy, mature horses, before and during a 30 min passive pneumoperitoneum induced by right paralumbar puncture. The balloon manometer was positioned within the gastric lumen and inflated using 2 separate volumes of air: 10 and 50 ml. P_ga Gastric pressure was determined at baseline (0) and 5, 15 and 30 min after induction of passive pneumoperitoneum. Intra‐abdominal pressure was measured directly by right paralumbar puncture using an 8 gauge needle at baseline and immediately following establishment of passive pneumoperitoneum. Results: Baseline IAP values were negative and increased (P≤0.05) during development of passive pneumoperitoneum. However, recorded P_ga measurements for both inflation volumes were positive before (baseline) and during the course of the passive pneumoperitoneum. Measured P_ga values did not correlate with IAP at any time. Conclusions and potential relevance: Our results suggest that the indirect method used in human patients for estimating IAP by P_ga is not applicable for horses.     

Alternative Intrabladder Manometry Technique for the Indirect Measurement of Intra-abdominal Pressure in Horses

Although indirect methods for estimating intra-abdominal pressure (IAP) have been extensively studied in humans, mainly for identification of IAP increments in critical care unit patients (life-threatening condition), little work has been performed in veterinary medicine, especially in horses. The standard method of acquisition of intrabladder pressure (IBP) in human subjects (fluid-filled system with no balloon distention) has been previously evaluated in horses with an unfavorable outcome. Therefore, we reexamined the previously performed method of IBP investigation in horses by using an air-filled intrabladder manometry system in female horses. Intrabladder pressure was estimated by air-filled balloon manometry in seven healthy adult mares. The results were compared with two sets of directly acquired IAP values obtained by right paralumbar puncture using an 8-G needle in seven horses. Direct IAP values were obtained at times unrelated to IBP measurement acquisitions, and three of the seven horses used (for direct IAP measurement) were different animals from the mares used for assessment of IBP. Both sets of IAP measurements yielded subatmospheric values (IAP₁ = −10.5 ± 2.2 mm Hg; IAP₂ = −11.6 ± 2.0 mm Hg). Slightly subatmospheric IBP values were also recorded in some mares, but the mean (±SD) IBP was 1.4 ± 2.0 mm Hg. There was no correlation between IBP and IAP. These results suggest that this indirect (IBP) method for estimating IAP is not applicable for female horses.     

Clinically significant,nontraumatic, degenerative joint disease of the temporomandibular joints in a horse

Horses with degenerative joint disease (DJD) of the temporomandibular joint (TMJ) have been reported infrequently, with the majority of cases describing the disease as a consequence of an earlier traumatic event. A case of clinically significant TMJ‐DJD due to a nontraumatic event has not been published. This retrospective case report describes a case of bilateral, DJD of the TMJ. Case management, subsequent review and interpretation of the clinical records, tangential radiographic views of each TMJ, computed tomography and magnetic resonance imaging of the head, and post mortem histological examination of the TMJs were performed. The horse exhibited both quidding and a ‘clicking’ sound during mastication; episodes of intermittent colic were also prevalent in the horse's history. Computed tomography illustrated bilateral mineralisation of the rostral aspect of both intra‐articular discs. Treatment, by intra‐articular injection of corticosteroid, resulted in temporary resolution of both the quidding and the ‘clicking’ sound, as well as the recurrent episodes of colic. Repeated treatment over time was required. Ultimately the horse was subjected to euthanasia for reasons other than disease of the TMJ. The development of TMJ‐DJD may not be confined to traumatic events. Age‐related degeneration of this joint may occur and manifest through quidding and abnormal sounds noted during mastication.     

Evaluation of a new oscillometric blood pressure monitor in isoflurane-anesthetized dogs

Objective This study was conducted to evaluate the performance of a new veterinary oscillometric noninvasive blood pressure (NIBP) monitor in anesthetized dogs. Study design Assessment was made to determine how closely indirect measurements were associated with direct measurements, and if there were statistically significant differences between the measurements by site. Animals Six mongrel dogs weighing 27.8 ± 2.9 kg. Methods Dogs were anesthetized with thiopental and maintained with isoflurane, which was delivered with controlled ventilation. Direct pressure measurements were obtained via a percutaneously placed arterial catheter. A range of systolic arterial pressures (SAP) were achieved by changing the isoflurane concentrations. Sites of cuff placement for indirect measurements were identified as metacarpus, metatarsus, and anterior tibial. Results At pressures below 80 mm Hg, indirect systolic measurements averaged 4 ± 3 mm Hg, higher than the direct values. At normal and high levels, indirect systolic measurements underestimated direct values by 18 ± 6 and 23 ± 6 mm Hg, respectively. Diastolic and mean pressure measurements followed the same trend, with indirect values being lower than the direct arterial pressures. Systolic, diastolic and mean arterial pressure measurements differed by cuff‐placement site. Conclusions When analyzed by site and level, indirect systolic and mean arterial blood pressures during hypotension were essentially the same as direct pressures. However, at pressures within the normal or high range, indirect measurements underestimated the direct pressures. Clinical relevance Noninvasive blood pressure measurements with a new oscillometric monitor provided an excellent means of detecting arterial hypotension in anesthetized dogs. The metatarsal site for cuff placement was slightly better than the metacarpal or anterior tibial site, considering that the regression line was closest to complete equality between the indirect and direct measurements for SAP.     

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.     

Comparison of cardiac output determined by arterial pulse pressure waveform analysis method (FloTrac/Vigileo) versus lithium dilution method in anesthetized dogs

Objective – To compare the determination of cardiac output (CO) via arterial pulse pressure waveform analysis (FloTrac/Vigileo) versus lithium dilution method. Design – Prospective study. Setting – University teaching hospital. Animals – Six adult dogs. Interventions – Dogs were instrumented for CO determinations using lithium dilution (LiDCO) and FloTrac/Vigileo methods. Direct blood pressure, heart rate, arterial blood gases, and end‐tidal isoflurane (ETIso) and CO₂ concentrations were measured throughout the study while CO was manipulated with different depth of anesthesia and rapid administration of isotonic crystalloids at 60 mL/kg/h. Measurements and Main Results – Baseline CO measurements were obtained at 1.3% ETIso and were lowered by 3% ETIso. Measurements were obtained in duplicate or triplicate with LiDCO and averaged for comparison with corresponding values measured continuously with the FloTrac/Vigileo method. For 30 comparisons between methods, a mean bias of ?100 mL/kg/min and 95% limits of agreement between ?311 and +112 mL/kg/min (212 mL/kg/min) was determined. The mean (mL/kg/min) of the differences of LiDCO?Vigileo=62.0402+?0.8383 × Vigileo, and the correlation coefficient (r) between the 2 methods 0.70 for all CO determinations. The repeatability coefficients for the individual LiDCO and FloTrac/Vigileo methods were 187 and 400 mL/kg/min, respectively. Mean LiDCO and FloTrac/Vigileo values from all measurements were 145 ± 68 mL/kg/min (range, 64–354) and 244 ± 144 mL/kg/min (range, 89–624), respectively. The overall mean relative error was 48 ± 14%. Conclusion – The FloTrac/Vigileo overestimated CO values compared with LiDCO and the relative error was high, which makes this method unreliable for use in dogs.