Desflurane vapor pressure depression

Due to its high vapor pressure and low boiling point, desflurane requires a specially designed, electronically controlled, temperature and pressure compensated vaporizer to regulate agent delivery to the anesthetic circuit. However, if the vapor pressure and boiling point were decreased, desflurane could be used in any conventional variable bypass vaporizer. Raoult's Law states that the vapor pressure of a liquid is proportional to its molar fraction in a solution. Accordingly, propylene glycol was used as a solvent for desflurane, and the physical characteristics of this mixture were evaluated at various molar concentrations and temperatures. Desflurane boiling point increased and vapor pressure decreased as a nonlinear function of dilution, but these changes were less than predicted by Raoult's Law. Using a circle system with a breathing bag attached at the patient end and a mechanical ventilator to simulate respiration, an in‐circuit, nonprecision vaporizer containing 40% desflurane and 60% propylene glycol achieved a 11.5 ± 1.0% (mean ± SD) circuit desflurane concentration with a 5.2 ± 0.4 (0 = off, 10 = maximum) vaporizer setting. This experiment was repeated with a dog attached to the breathing circuit under spontaneous ventilation with a fresh gas flow of 0.5 L min^–1. Anesthesia was maintained for over two hours at a mean vaporizer setting of 6.2 ± 0.4, yielding mean inspired and end‐tidal desflurane concentrations of 8.7 ± 0.5% and 7.9 ± 0.7%, respectively. Within 5 minutes after cessation of anesthesia, the dog was awake, extubated and standing. In clinical practice, propylene glycol may not prove an ideal solvent for desflurane due to its instability in solution and substantial positive deviation from Raoult's Law. However, rather than alter the vaporizer to suit physical properties of anesthetic agents, this study demonstrates that it may also be possible to alter anesthetic agents to suit physical properties of the vaporizer.     

Minimum alveolar concentration of desflurane in llamas and alpacas

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of desflurane in llamas and alpacas. DESIGN: Prospective study. Animals Six healthy adult llamas and six healthy adult alpacas. PROCEDURE: Anesthesia was induced with desflurane delivered with oxygen through a mask. An endotracheal tube was inserted, and a port for continuous measurement of end-tidal and inspired desflurane concentrations was placed between the endotracheal tube and the breathing circuit. After equilibration at an end-tidal-to-inspired desflurane concentration ratio >0.90 for 15 minutes, a 50-Hz, 80-mA electrical stimulus was applied to the antebrachium until a response was obtained (i.e. gross purposeful movement) or for up to 1 minute. The vaporizer setting was increased or decreased to effect a 10-20% change in end-tidal desflurane concentration, and equilibration and stimulus were repeated. The MAC was defined as the average of the lowest end-tidal desflurane concentration that prevented a positive response and the highest concentration that allowed a positive response. RESULTS: Mean +/- SD MAC of desflurane was 7.99 +/- 0.58% in llamas and 7.83 +/- 0.51% in alpacas. CONCLUSIONS AND CLINICAL RELEVANCE: The MAC of desflurane in llamas and alpacas was in the range of that reported for other species.     

Evaluation of the induction and recovery characteristics of anesthesia with desflurane in cats

OBJECTIVE: To qualitatively and quantitatively evaluate the characteristics of desflurane with regard to the induction of and recovery from anesthesia in cats. ANIMALS: 6 cats. PROCEDURE: Anesthesia was induced and maintained with desflurane in oxygen. Individual minimum alveolar concentration (MAC) values were determined; anesthesia was maintained at 1.25 x MAC for a total anesthesia time (including MAC determination) of 5 hours. Cats were allowed to recover from anesthesia. Induction and recovery periods were video recorded and later scored by use of a grading scale from 0 to 100 (100 being the best outcome). Timing of events was recorded. RESULTS: The MAC of desflurane was 10.27 +/- 1.06%, and mean dose was 5.6 +/- 0.2 MAC-hours. Times to loss of coordination, recumbency, and endotracheal intubation were 1.3 +/- 0.4, 2.3 +/- 0.3, and 6.4 +/- 1.1 minutes, respectively. Median score for quality of anesthetic induction was 93 (range, 91 to 94). Times to first movement, extubation, standing, and ability to jump and land with coordination were 2.8 +/- 1.0, 3.8 +/- 0.5, 14.3 +/- 3.9, and 26.4 +/- 5.1 minutes, respectively. Alveolar washout of desflurane was rapid. Median score for quality of anesthetic recovery was 94 (range, 86 to 96). CONCLUSIONS AND CLINICAL RELEVANCE: Desflurane was associated with rapid induction of and recovery from anesthesia in cats; assessors rated the overall quality of induction and recovery as excellent. Results appear to support the use of desflurane for induction and maintenance of anesthesia in healthy cats.     

Median effective dose of isoflurane, sevoflurane, and desflurane in green iguanas

OBJECTIVE: To determine the median effective dose (ED(50); equivalent to the minimum alveolar concentration [MAC]) of isoflurane, sevoflurane, and desflurane for anesthesia in iguanas. ANIMALS: 6 healthy adult green iguanas. PROCEDURE: In unmedicated iguanas, anesthesia was induced and maintained with each of the 3 volatile drugs administered on separate days according to a Latin square design. Iguanas were endotracheally intubated, mechanically ventilated, and instrumented for cardiovascular and respiratory measurements. During each period of anesthesia, MAC was determined in triplicate. The mean value of 2 consecutive expired anesthetic concentrations, 1 that just permitted and 1 that just prevented gross purposeful movement in response to supramaximal electrical stimulus, and that were not different by more than 15%, was deemed the MAC. RESULTS: Mean +/- SD values for the third MAC determination for isoflurane, sevoflurane, and desflurane were 1.8 +/- 0.3%, 3.1 +/- 1.0%, and 8.9 +/- 2.1% of atmospheric pressure, respectively. The MAC for all inhaled agents was, on average, 22% greater for the first measurement than for the third measurement. CONCLUSIONS AND CLINICAL RELEVANCE: Over time, MACs decreased for all 3 agents. Final MAC measurements were similar to values reported for other species. The decrease in MACs over time may be at least partly explained by limitations of anesthetic uptake and distribution imposed by the reptilian cardiorespiratory system. Hence, for a constant end-tidal anesthetic concentration in an iguana, the plane of anesthesia may deepen over time, which could contribute to increased morbidity during prolonged procedures.     

Respiratory reflexes in spontaneously breathing anesthetized dogs in response to nasal administration of sevoflurane, isoflurane, or halothane

OBJECTIVE: To characterize respiratory reflexes elicited by nasal administration of sevoflurane (Sevo), isoflurane (Iso), or halothane (Hal) in anesthetized dogs. ANIMALS: 8 healthy Beagles. PROCEDURE: A permanent tracheostomy was created in each dog. Two to 3 weeks later, dogs were anesthetized by IV administration of thiopental and alpha-chloralose. Nasal passages were isolated such that inhalant anesthetics could be administered to the nasal passages while the dogs were breathing 100% O2 via the tracheostomy. Respiratory reflexes in response to administration of each anesthetic at 1.2 and 2.4 times the minimum alveolar concentration (MAC) and the full vaporizer setting (5%) were recorded. Reflexes in response to administration of 5% of each anesthetic also were recorded following administration of lidocaine to the nasal passages. RESULTS: Nasal administration of Sevo, Iso, and Hal induced an immediate ventilatory response characterized by a dose-dependent increase in expiratory time and a resulting decrease in expired volume per unit of time. All anesthetics had a significant effect, but for Sevo, the changes were smaller in magnitude. Responses to administration of each anesthetic were attenuated by administration of lidocaine to the nasal passages. CONCLUSIONS AND CLINICAL RELEVANCE: Nasal administration of Sevo at concentrations generally used for mask induction of anesthesia induced milder reflex inhibition of breathing, presumably via afferent neurons in the nasal passages, than that of Iso or Hal. Respiratory reflexes attributable to stimulation of the nasal passages may contribute to speed of onset and could promote a smoother induction with Sevo, compared with Iso or Hal.     

Prolonged anesthesia with desflurane and fentanyl in dogs during conventional and laparoscopic surgery

OBJECTIVE: To determine the effects of prolonged anesthesia with desflurane in dogs undergoing laparotomy or abdominal laparoscopy. DESIGN: Randomized prospective study. ANIMALS: 20 adult mixed-breed dogs. PROCEDURE: Dogs were randomly assigned to 1 of 2 groups with 10 dogs/group. Anesthesia was induced with propofol and maintained with desflurane and fentanyl, and pyloroplasty was performed. In 10 dogs, a ventral midline laparotomy was performed; in the other 10, abdominal laparoscopy was performed. Dogs were monitored for cardiovascular and respiratory responses (ECG, oxygen saturation [SpO2], arterial blood pressure, rectal temperature, end-tidal partial pressure of carbon dioxide [PETCO2], and expired desflurane concentration). Recovery times were recorded. RESULTS: Mean +/- SD duration of anesthesia was 201 +/- 25 minutes for dogs undergoing laparotomy and 287 +/- 15 minutes for dogs undergoing laparoscopy. Anesthesia was accompanied by hypotension that was less severe in dogs undergoing laparoscopy. Heart rate did not vary significantly during anesthesia. The SpO2 was > 97% in all dogs at all times, and PETCO2 remained within reference limits. Recovery times for dogs that underwent laparotomy were not significantly different from those for dogs that underwent laparoscopy. Mean +/- SD time to standing was 13.6 +/- 2.4 minutes for dogs that underwent laparotomy and 12.5 +/- 2.9 minutes for dogs that underwent laparoscopy. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that induction of anesthesia with propofol and maintenance with desflurane and fentanyl is safe in dogs undergoing abdominal surgery.     

Fatal propylene glycol toxicosis in a horse

Toxicosis attributable to propylene glycol (1,2-propanediol) was suspected in an 8-year-old 450- to 500-kg male Quarter Horse. Clinical signs of toxicosis developed within 15 minutes of the accidental iatrogenic oral administration of 3.8 L of propylene glycol. Clinical signs of toxicosis included salivation, sweating, ataxia, and signs of pain. Additionally, at 24 hours after propylene glycol ingestion, the horse became increasingly atactic, had an abnormal breath odor, developed rapid shallow breathing, and was cyanotic. The horse died of apparent respiratory arrest 28 hours after the propylene glycol ingestion. Analysis of serum and combined urine and blood from the kidneys confirmed the presence of propylene glycol. Propylene glycol is used for the treatment and prevention of bovine ketosis, and is similar in appearance to mineral oil. The accidental administration of propylene glycol to horses may result in fatal poisoning.     

Recent advances in inhalation anesthesia.

Both desflurane and sevoflurane offer theoretical and practical advantages over other inhalation anesthetics for horses. The lower solubility of both agents provides improved control of delivery and helps to counteract the confounding influence of the voluminous patient breathing circuit commonly used for anesthetizing horses. The lower solubility should account for faster rates of recovery compared with the older agents; whether or not the quality of recovery differs remains to be objectively evaluated in a broad range of circumstances. The pharmacodynamic effects are, in large part, similar to those of isoflurane (e.g., low arrhythmogenicity) but with some differences. For example, desflurane may be overall more sparing to cardiovascular function (especially during controlled ventilation) compared with isoflurane and sevoflurane, which are roughly similar. Respiratory depression with both new agents is equal to or more depressing than isoflurane, suggesting the use of mechanical ventilation, especially in circumstances of prolonged management (i.e., hours of anesthesia). Both new anesthetics, not surprisingly, are expensive. From this point there are some agent-unique considerations. The anesthetic potency of both agents is less than that of isoflurane, which influences the cost of anesthesia, but also places an upper limit on inspired oxygen concentration (of particular concern with desflurane). Both agents require new vaporizers, but because of the high boiling point and steep vapor-pressure curve of desflurane, new technology was required. This translates into more costly equipment, adding to the cost of desflurane use. In addition, electricity is necessary for the new desflurane vaporizer to function, which limits its portability and adds additional practical considerations in its clinical use. On the other hand, desflurane strongly resists degradation both in vitro and in vivo, but in vitro degradation of sevoflurane by CO2 absorbents may produce renal injury. This may be true especially in association with low fresh-gas inflow rates (used to reduce the cost of using the new agent), and university based practices, where prolonged anesthesia is common.     

Evaluation of isoflurane and sevoflurane vaporizers over a wide range of oxygen flow rates

OBJECTIVE: To examine the accuracy and precision of isoflurane and sevoflurane anesthetic vaporizers. SAMPLE POPULATION: 5 identical isoflurane and 5 identical sevoflurane vaporizers. PROCEDURES: Oxygen flow rates from 0.02 to 10 L/min were used with different vaporizer dial settings. Agent concentrations were measured at the common gas outlet by use of a refractometer. Accuracy was defined as the difference between measured agent concentrations, and dial settings were expressed as a percentage of the applied dial settings. Precision was defined as SD of the measured agent concentrations for each combination of dial setting and flow. RESULTS: Isoflurane values were generally greater than the dial settings. Accuracy of the isoflurane vaporizer was > 20% when 0.6% and 1% was dialed. Accuracy of the sevoflurane vaporizer was always within +/- 20% but decreased at 0.02 L/min flow and at combinations of high flow and high dial settings. Overall precision of the isoflurane vaporizer was better than that of the sevoflurane vaporizer. CONCLUSIONS AND CLINICAL RELEVANCE: A possible explanation for the inaccuracy of the isoflurane vaporizer may be that it was manufactured to be accurate with air but not oxygen, which must be accounted for when using the vaporizer with oxygen, especially with nonrebreathing systems. The sevoflurane vaporizer may not deliver accurate agent concentrations at high flow and high dial settings. Both vaporizers are suitable for clinical use with a wide range of oxygen flow rates if these precautions are properly addressed.     

Evaluation of induction characteristics and hypnotic potency of isoflurane and sevoflurane in healthy dogs

OBJECTIVE: To determine induction characteristics and the minimum alveolar concentration (MAC) at which consciousness returned (MACawake) in dogs anesthetized with isoflurane or sevoflurane. ANIMALS: 20 sexually intact male Beagles. PROCEDURES: In experiment 1, 20 dogs were randomly assigned to have anesthesia induced and maintained with isoflurane or sevoflurane. The MAC at which each dog awoke in response to auditory stimulation (MACawake-noise) was determined by decreasing the end-tidal concentration by 0.1 volume (vol %) every 15 minutes and delivering a standard audible stimulus at each concentration until the dog awoke. In experiment 2, 12 dogs received the same anesthetic agent they were administered in experiment 1. After duplicate MAC determination, the end-tidal concentration was continually decreased by 10% every 15 minutes until the dog awoke from anesthesia (MACawake). RESULTS: Mean induction time was significantly greater for isoflurane-anesthetized dogs (212 seconds), compared with the sevoflurane-anesthetized dogs (154 seconds). Mean+/-SD MACawake-noise was 1.1+/-0.1 vol % for isoflurane and 2.0+/-0.2 vol % for sevoflurane. Mean MAC was 1.3+/-0.2 vol % for isoflurane and 2.1+/-0.6 vol % for sevoflurane, and mean MACawake was 1.0+/-0.1 vol % for isoflurane and 1.3+/-0.3 vol % for sevoflurane. CONCLUSIONS AND CLINICAL RELEVANCE: Sevoflurane resulted in a more rapid induction than did isoflurane. The MACawake for dogs was higher than values reported for both agents in humans. Care should be taken to ensure that dogs are at an appropriate anesthetic depth to prevent consciousness, particularly when single-agent inhalant anesthesia is used.     

Influence of Vaporizer Setting on Mask Induction of Dogs With Isoflurane Using an In-circuit Vaporizer

The speed of mask induction using an in-circuit vaporizer may be influenced by vaporizer setting. To investigate this in clinical patients, 18 dogs were randomly assigned to one of three groups. Each dog was premedicated and then mask induced with isoflurane using a Stephen's in-circuit vaporizer set at 1/2, 3/4, or full ON. We determined inspired isoflurane and oxygen concentrations at the level of the mask, respiratory rate, resistance to mask induction, and time to intubation. No significant differences were found between groups in resistance to induction or in time to intubation. At settings of 3/4 and full ON, inspired isoflurane concentrations at time of intubation ranged from 3.3% to 8.25%, and were significantly higher than those resulting from the 1/2 setting (range 2.1% to 4.6%). We conclude that it may be preferable to avoid settings greater than 1/2 when using the Stephen's vaporizer for mask induction because of the potential adverse effects of high inspired inhalant anesthetic concentrations. In addition, use of higher vaporizer settings may not significantly speed induction.     

Assessment of halothane and sevoflurane anesthesia in spontaneously breathing rats

OBJECTIVE: To characterize halothane and sevoflurane anesthesia in spontaneously breathing rats. ANIMALS: 16 healthy male Sprague-Dawley rats. PROCEDURE: 8 rats were anesthetized with halothane and 8 with sevoflurane. Minimum alveolar concentration (MAC) was determined. Variables were recorded at anesthetic concentrations of 0.8, 1.0, 1.25, and 1.5 times the MAC of halothane and 1.0, 1.25, 1.5, and 1.75 times the MAC of sevoflurane. RESULTS: Mean (+/- SEM) MAC for halothane was 1.02 +/- 0.02% and for sevoflurane was 2.99 +/- 0.19%. As sevoflurane dose increased from 1.0 to 1.75 MAC, mean arterial pressure (MAP) decreased from 103.1 +/- 5.3 to 67.9 +/- 4.6 mm Hg, and PaCO2 increased from 58.8 +/- 3.1 to 92.2 +/- 9.2 mm Hg. As halothane dose increased from 0.8 to 1.5 MAC, MAP decreased from 99 +/- 6.2 to 69.8 +/- 4.5 mm Hg, and PaCO2 increased from 59.1 +/- 2.1 to 75.9 +/- 5.2 mm Hg. Respiratory rate decreased in a dose-dependent fashion from 88.5 +/- 4.5 to 58.5 +/- 2.7 breaths/min during halothane anesthesia and from 42.3 +/- 1.8 to 30.5 +/- 4.5 breaths/min during sevoflurane anesthesia. Both groups of rats had an increase in eyelid and pupillary aperture with an increase in anesthetic dose. CONCLUSIONS AND CLINICAL RELEVANCE: An increase in PaCO2 and a decrease in MAP are clinical indicators of an increasing halothane and sevoflurane dose in unstimulated spontaneously breathing rats. Increases in eyelid aperture and pupil diameter are reliable signs of increasing depth of halothane and sevoflurane anesthesia. Decreasing respiratory rate is a clinical indicator of an increasing dose of halothane.     

Cardiopulmonary effects of desflurane in horses

OBJECTIVE: To determine the cardiopulmonary effects of desflurane (DES) in horses. ANIMALS: Six healthy adult horses, three males and three females, aged 9 +/- 4 (mean +/- SD) years and weighing 370 +/- 36 kg. MATERIALS AND METHODS: Anaesthesia was induced with an O2 (10 L minute(-1)) and DES mixture (vaporizer setting 18%). After oro-tracheal intubation, horses were positioned in right lateral recumbency. Anaesthesia was maintained with DES in O2 (20 mL kg(-1) minute(-1)) delivered through a large animal circle breathing system. The minimum alveolar concentration of DES (MAC(DES)) that prevented purposeful movement in response to 60 seconds of electrical stimulation of the oral mucous membranes was determined for each horse. The delivered concentration of DES was then increased to achieve end-tidal concentrations corresponding to 1.5 x MAC(DES), 1.75 x MAC(DES), and 2.0 x MAC(DES). Heart rate (HR), mean arterial blood pressure (MAP), respiratory rate (fr), tidal volume (VT), minute volume (VM) and core temperature were determined, and blood samples for arterial blood gas analysis taken at each DES concentration. All data were analysed by two-way anova for repeated measures and Fisher's test for multiple comparisons. A probability level of p < 0.05 was applied. RESULTS: Desflurane concentrations of 2.0 x MAC(DES) increased HR whereas lower concentrations did not. Mean arterial pressure was not affected by 1.0 x MAC(DES) 1.5 x MAC(DES) or 1.75 x MAC(DES), whereas it decreased at 2.0 x MAC(DES). All concentrations of DES examined significantly depressed fr, VT and VM. CONCLUSIONS AND CLINICAL RELEVANCE: Desflurane concentrations between 1.0 and 1.75 x MAC(DES) reduces fr and VM but does not affect HR or MAP in horses.     

Minimum alveolar concentration of sevoflurane in spontaneously breathing llamas and alpacas

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of sevoflurane in spontaneously breathing llamas and alpacas. DESIGN: Prospective study. ANIMALS: 6 healthy adult llamas and 6 healthy adult alpacas. PROCEDURE: Anesthesia was induced with sevoflurane delivered with oxygen through a mask. An endotracheal tube was inserted, and a port for continuous measurement of end-tidal and inspired sevoflurane concentrations was placed between the endotracheal tube and the breathing circuit. After equilibration at an end-tidal-to-inspired sevoflurane concentration ratio > 0.90 for 15 minutes, a 50-Hz, 80-mA electrical stimulus was applied to the antebrachium until a response was obtained (ie, gross purposeful movement) or for up to 1 minute. The vaporizer setting was increased or decreased to effect a 10 to 20% change in end-tidal sevoflurane concentration, and equilibration and stimulus were repeated. The MAC was defined as the mean of the lowest end-tidal sevoflurane concentration that prevented a positive response and the highest concentration that allowed a positive response. RESULTS: Mean +/- SD MAC of sevoflurane was 2.29 +/- 0.14% in llamas and 2.33 +/- 0.09% in alpacas. CONCLUSIONS AND CLINICAL RELEVANCE: The MAC of sevoflurane in llamas and alpacas was similar to that reported for other species.     

Rate of change of oxygen concentration for a large animal circle anesthetic system

OBJECTIVE: To describe the effects of changes in circuit volume and oxygen inflow rate on inspired oxygen concentration for a large animal circle anesthetic system. STUDY POPULATION: A large animal circle anesthetic system, a 10 L/min flowmeter, and 20- and 40-L breathing bags. PROCEDURE: Circuit volume was determined by a carbon dioxide dilution technique. Oxygen flow rates of 3, 6, and 10 L/min were delivered to the circuit with the large breathing bag, and a flow rate of 6 L/min was used with the small bag. Gas samples were collected during a 20-minute period. The time constant (tau) and half-time (T1/2) were calculated and compared with measured values. RESULTS: Mean +/- SEM volume of the breathing circuit with a 20- and 40-L breathing bag was 32.97 +/- 0.91 L and 49.26 +/- 0.58 L, respectively. The tau from measurements was 11.97, 6.10, and 3.60 minutes at oxygen flow rates of 3, 6, and 10 L/min, respectively, for the large breathing bag and 3.73 minutes at a flow rate of 6 L/min for the small breathing bag. The T1/2 was 8.29, 4.22, and 2.49 minutes at oxygen flow rates of 3, 6, and 10 L/min, respectively, for the large breathing bag and 2.58 minutes for the small breathing bag. CONCLUSIONS AND CLINICAL RELEVANCE: This study emphasizes that there are delays in the rate of increase in the inspired oxygen concentration that accompany use of conventional large animal circle anesthetic systems and low rates of inflow for fresh oxygen.     

Kinetics and potency of halothane,isoflurane, and desflurane in the Northern Leopard frog <Emphasis Type="Italic">Rana pipiens</Emphasis>

Equilibration between delivered and effect site anesthetic partial pressure is slow in frogs. The use of less soluble agents or overpressure delivery may speed equilibration. Ten Northern leopard frogs were exposed to 3-4 constant concentrations of halothane, isoflurane or desflurane and their motor response to noxious electrical stimulation of the forelimb evaluated every 30 minutes until a stable proportion of frogs were immobile. Each frog received each anesthetic and concentration in random order and allowed at least 14 hours to recover between anesthetic exposures. An overpressure technique based upon the kinetics in the first study was then tested with 4 concentrations of desflurane. For halothane, isoflurane and desflurane respectively; the proportion of frogs immobile in response to stimulus became stable after 510, 480 and 180 minutes, and ED50 values were 1.36, 1.67 and 6.78 % atm. Desflurane ED50 delivered by overpressure was not significantly different at 6.85 % atm. Halothane, isoflurane and desflurane are effective general anesthetics in frogs with potencies similar to those reported in mammals. The time required for anesthetic equilibration is fastest with desflurane and can be hastened further by initial delivery of higher partial pressures.     

Determination of the minimum alveolar concentration of isoflurane in llamas

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of isoflurane (ISO) in llamas. STUDY DESIGN: Prospective study. ANIMALS: Eight adult neutered male llamas (9 +/- 1 years [x +/- SD], 177 +/- 29 kg). METHODS: Anesthesia was induced and maintained in otherwise unmedicated llamas with a mixture of ISO in oxygen administered through a standard small-animal, semi-closed circle system using an out-of-circle, agent-specific vaporizer. The time from mask placement to intubation was recorded. Inspired and end-tidal (ET) ISO was sampled continuously. At each anesthetic concentration, a constant ET ISO was maintained for at least 20 minutes before application of a noxious electrical stimulus (50 volts, 5 Hz, 10 ms for up to 1 minute). A positive or negative response to the stimulus was recorded, and ET ISO then increased (if positive response) or decreased (if negative response) by 10% to 20%. Individual MAC was the average of multiple determinations. Body temperature was maintained at 37 +/- 1 degrees C. Selected cardiopulmonary variables (heart rate [HR], respiratory rate [RR], arterial blood pressure [ABP]) and ET ISO were recorded at hourly intervals from first ISO. Arterial blood was collected for pH, PCO2, PO2 analysis and measurement of packed cell volume (PCV) and total protein (TP) at 2 hour intervals. Following MAC determination, the anesthetic was discontinued and llamas were allowed to recover. Duration and quality of recovery were noted. RESULTS: The time from start of induction by mask to completion of intubation took 19.1 +/- 4.8 minutes. The MAC of ISO corrected to one atmosphere at sea level (barometric pressure 760 mm Hg) in these llamas was 1.05 +/- 0.17%. Mean ABP increased from 70 +/- 26 mm Hg at the end of the first hour of anesthesia to 102 +/- 7 mm Hg measured at the end of the sixth hour of anesthesia. ET ISO decreased from 2.06 +/- 0.10% to 1.27 +/- 0.07% over the same time period, but MAC did not change with time. The duration from first ISO to discontinuation of ISO averaged 6.19 +/- 0.9 hours. Animals were able to support their heads in a sternal posture at 23 +/- 10 minutes, and stood 62 +/- 26 minutes following discontinuation of the anesthetic. CONCLUSION: The MAC for ISO is similar to, but slightly lower than, values reported for other species. CLINICAL RELEVANCE: Knowledge of MAC may facilitate appropriate clinical use and provide the basis for future investigation of ISO in llamas.     

The cardiac anesthetic index of isoflurane in green iguanas

OBJECTIVE: To determine the cardiac anesthetic index (CAI) of isoflurane in green iguanas and whether butorphanol affected the CAI. DESIGN: Prospective randomized controlled trial. ANIMALS: 7 healthy mature iguanas. PROCEDURE: In 5 iguanas, CAI was determined after induction of anesthesia with isoflurane alone, and in 5 iguanas, CAI was determined after induction of anesthesia with isoflurane and IM administration of butorphanol (1 mg/kg [0.45 mg/lb]). Three iguanas underwent both treatments. Animals were equilibrated for 20 minutes at 1.5 times the minimum alveolar concentration (MAC) of isoflurane and observed for evidence of cardiovascular arrest. If there was no evidence of cardiovascular arrest, end-tidal isoflurane concentration was increased by 20%, and animals were allowed to equilibrate for another 20 minutes. This process was repeated until cardiovascular arrest occurred or vaporizer output could no longer be consistently increased. The CAI was calculated by dividing the highest end-tidal isoflurane concentration by the MAC. RESULTS: None of the iguanas developed cardiovascular arrest and all survived. Mean +/- SD highest end-tidal isoflurane concentration during anesthesia with isoflurane alone (9.2 +/- 0.60%) was not significantly different from mean concentration during anesthesia with isoflurane and butorphanol (9.0 +/- 0.43%). The CAI was > 4.32. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the CAI of isoflurane in green iguanas is > 4.32 and not affected by administration of butorphanol. Isoflurane appears to be a safe anesthetic in green iguanas.     

Use of sevoflurane for anesthetic management of horses during thoracotomy

OBJECTIVE: To evaluate sevoflurane as an inhalation anesthetic for thoracotomy in horses. ANIMALS: 18 horses between 2 and 15 years old. PROCEDURE: 4 horses were used to develop surgical techniques and were euthanatized at the end of the procedure. The remaining 14 horses were selected, because they had an episode of bleeding from their lungs during strenuous exercise. General anesthesia was induced with xylazine (1.0 mg/kg of body weight, IV) followed by ketamine (2.0 mg/kg, IV). Anesthesia was maintained with sevoflurane in oxygen delivered via a circle anesthetic breathing circuit. Ventilation was controlled to maintain PaCO2 at approximately 45 mm Hg. Neuromuscular blocking drugs (succinylcholine or atracurium) were administered to eliminate spontaneous breathing efforts and to facilitate surgery. Cardiovascular performance was monitored and supported as indicated. RESULTS: 2 of the 14 horses not euthanatized died as a result of ventricular fibrillation. Mean (+/- SD) duration of anesthesia was 304.9 +/- 64.1 minutes for horses that survived and 216.7 +/- 85.5 minutes for horses that were euthanatized or died. Our subjective opinion was that sevoflurane afforded good control of anesthetic depth during induction, maintenance, and recovery. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of sevoflurane together with neuromuscular blocking drugs provides stable and easily controllable anesthetic management of horses for elective thoracotomy and cardiac manipulation.     

Effects of desflurane and mode of ventilation on cardiovascular and respiratory functions and clinicopathologic variables in horses

OBJECTIVE: To quantitate the effects of desflurane and mode of ventilation on cardiovascular and respiratory functions and identify changes in selected clinicopathologic variables and serum fluoride values associated with desflurane anesthesia in horses. ANIMALS: 6 healthy adult horses. PROCEDURE: Horses were anesthetized on 2 occasions: first, to determine the minimum alveolar concentration (MAC) of desflurane in O2 and second, to characterize cardiopulmonary and clinicopathologic responses to 1X, 1.5X, and 1.75X desflurane MAC during both controlled and spontaneous ventilation. RESULTS: Mean +/- SEM MAC of desflurane in horses was 8.06 +/- 0.41 %; inhalation of desflurane did not appear to cause airway irritation. During spontaneous ventilation, mean PaCO2 was 69 mm Hg. Arterial blood pressure, stroke volume, and cardiac output decreased as the dose of desflurane increased. Conditions of intermittent positive pressure ventilation and eucapnia resulted in further cardiovascular depression. Horses recovered quickly from anesthesia with little transient or no clinicopathologic evidence of adverse effects. Serum fluoride concentration before and after administration of desflurane was below the limit of detection of 0.05 ppm (2.63microM/L). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that desflurane, like other inhalation anesthetics, causes profound hypoventilation in horses. The magnitude of cardiovascular depression is related to dose and mode of ventilation; cardiovascular depression is less severe at doses of 1X to 1.5X MAC, compared with known effects of other inhalation anesthetics under similar conditions. Desflurane is not metabolized to an important degree and does not appear to prominently influence renal function or hepatic cellular integrity or function.