Muscarinic receptor subtypes in equine tracheal smooth muscle

Selective muscarinic receptor antagonists were used to identify muscarinic receptor subtypes in equine trachealis strips. The M₁ receptor antagonist pirenzepine (10^–7 mol/L to 3 × 10^–5 mol/L) and the M₃ receptor antagonist 4-diphenylacetoxy-N-methylpiperidine (4-DAMP, 10^–9 mol/L to 3 × 10^–7 mol/L³) dose dependently inhibited the contractile responses to electrical field stimulation (EFS) and exogenous acetylcholine (ACh). Schild plots yielded a pA₂ value for pirenzepine vs ACh of 6.75 ± 0.09, which is consistent with the affinity for M₂ or M₃ receptors, and a pA₂ value for 4-DAMP vs ACh of 8.47 ± 0.09, which is in agreement with the affinity for M₃ receptors. The M₂ receptor antagonist gallamine (10^–5 mol/L and 10^–4 mol/L) did not affect the response of trachealis to exogenous ACh and low-frequency EFS (0.1–2 Hz) but decreased the responses to high-frequency EFS (4–16 Hz). These results suggest that the muscarinic receptors mediating contractions induced by ACh in equine tracheal smooth muscle are of the M₃ subtype. The lack of an increase in the response to EFS following gallamine suggests that functional prejunctional inhibitory M₂ receptors are not present on the cholinergic nerves innervating equine tracheal smooth muscle.     

Quantification of reservoir bags as airway pressure-limiting devices in a nonrebreathing system

ObjectiveTo evaluate the influence of reservoir bag types, volumes and previous use on the peak pressures (Pmax) and the times to develop 30 cmH₂O pressure (P30) within a nonrebreathing system with a closed adjustable pressure-limiting (APL) valve.Study designIn vitro study using three-way factorial design with repeated measure on one factor.SubjectsA total of 75 new anesthesia reservoir bags (five types, three volumes, five bags from each type × volume). The bag types were reusable latex (RL), disposable latex (DL) and three disposable neoprene (DN-1, DN-2 and DN-3).MethodsEach bag was tested three times (treatments): new, after prestretching and 1 week later. The bags were attached to a Bain system and anesthesia machine with closed APL valve and patient port with O₂ flow 2 L minute^–1 until Pmax was reached. The Pmax and time to reach P30 values were determined from recorded pressure traces. General linear mixed model analysis was used to examine the effects of bag type, volume and treatment. One-sided 95% upper prediction limits of Pmax were calculated to test the null hypothesis that predicted Pmax of new bags would be ≥ 50 cmH₂O for each factor combination.ResultsRL bags were the least and DN-3 bags were the most compliant. Prestretching increased compliance in all bag types. Smaller bags of RL, DL and DN-1 were less compliant than larger ones. The predicted Pmax values were < 50 cmH₂O only for DN-3 bags after prestretching. The time to reach P30 was critically low when using 0.5 L bags (median 17 seconds).Conclusions and clinical relevanceTo minimize the risk of barotrauma, highly compliant reservoir bags (e.g. DN-3) are recommended and reusable bags should be avoided. Bags should be prestretched before first use, 0.5 L bags should be avoided and fresh gas flow minimized.     

Development and evaluation of an anatomically designed and 3D printed device to enhance orotracheal intubation success in rabbits by inexperienced veterinarians

ObjectiveTo assess whether the use of a three-dimensional (3D) printed device enhances the success rate of orotracheal intubation in rabbits.Study designProspective, crossover randomized controlled trial.AnimalsA total of six mixed-breed rabbits.MethodsA device to guide the endotracheal tube was designed based on computed tomography images and then manufactured using 3D printing. Rabbits were randomly assigned for intubation by two inexperienced veterinarians using the blind (BLI), borescope- (BOR) or device- (DEV) guided techniques. Success rate, number of attempts, time to success, injury scores and propofol dose were recorded and compared. Significance was considered when p < 0.05.ResultsSuccess rate was higher in DEV (58.3%) than in BLI (8.3%) (p < 0.023), but not different from that in BOR (41.6%). Total time until successful intubation was lower in DEV (45 ± 23 seconds) and BOR (85 ± 62 seconds) than in BLI (290 seconds; p < 0.006). Time for the successful attempt was lower for DEV (35 ± 10 seconds) and BOR (74 ± 43 seconds) than in BLI (290 seconds; p < 0.0001). The propofol dose required was lower for DEV (2.3 ± 1.2 mg kg^–1) than for BLI (3.4 ± 1.6 mg kg^–1) (p < 0.031), but not different from BOR (2.4 ± 0.9 mg kg^–1). Number of attempts and oxygen desaturation events were not different among techniques (p < 0.051 and p < 0.326, respectively). Injury scores [median (range)] before and after attempts were different in BLI [0 versus 1 (0–3), p < 0.005] and BOR [0 (0–1) versus 1 (0–3), p < 0.002] but not in DEV [0 (0–2) versus 0 (0–3), p < 0.109].Conclusions and clinical relevanceThe device facilitated orotracheal intubation with a time similar to the borescope-guided technique but faster than the traditional blind technique.