Effect of body position on cranial migration of epidurally injected methylene blue in recumbent dogs

OBJECTIVE: To determine the relationship between different body positions during recumbency on the cranial migration of epidurally injected methylene blue in canine cadavers. SAMPLE POPULATION: 21 fresh cadavers of clinically normal adult female mixed-breed dogs. PROCEDURE: Dogs were randomly assigned to the following 3 groups: dogs remaining in right lateral recumbency (n = 7), dogs rotated from left to right lateral recumbency (7), and dogs rotated from dorsal to right lateral recumbency (7). Each dog received an epidural injection of 0.05% methylene blue (0.1 mL/kg) at the lumbosacral space. A dorsal laminectomy of the vertebral column was made, and cranial extent of methylene blue in 4 quadrants (right lateral, left lateral, ventral, and dorsal) was determined by examining dura mater staining. RESULTS: No significant difference was found among groups in regard to body weight or body condition score. Epidural cranial migration of methylene blue in the right lateral quadrant was significantly greater in dogs that remained in right lateral recumbency than in dogs that were rotated from left to right lateral recumbency. No significant difference was found within groups for epidural cranial migration of methylene blue between each quadrant. No significant relationship was found between body weight or body condition score and epidural cranial migration of methylene blue. CONCLUSIONS AND CLINICAL RELEVANCE: Body positioning and amount of recumbency time influence cranial migration of epidurally injected methylene blue. If greater cranial migration of an epidurally administered drug is desired, placing the patient in lateral recumbency with the surgical site on the dependent side may precede surgery.     

Effect of body position on oesophageal and gastric pressures in the anaesthetised dog

The effect of body position on lower oesophageal sphincter pressure (LOSP), gastric pressure and barrier pressure (BrP) was investigated in 40 dogs anaesthetised for neutering procedures. The dogs were placed in lateral recumbency followed by dorsal recumbency (group 1) or vice versa (group 2). LOSP decreased significantly in the animals which were positioned initially in lateral recumbency, when they were then placed in dorsal recumbency, while those initially positioned in dorsal recumbency showed no significant change in their LOSP or BrP when their position was altered to lateral recumbency. When the data from both groups were pooled, LOSP and BrP were significantly lower when the dogs were in dorsal compared to lateral recumbency (P<0–05).     

RADIOGRAPHIC HEART-VOLUME ESTIMATION IN NORMAL CATS

Heart volume mensuration was evaluated on conventional radiographs from eight normal cats in different body positions using computed tomography (CT). Heart volumes were calculated from orthogonal thoracic radiographs in ventral and dorsal recumbency and from radiographs exposed with a vertical X-ray beam in dorsal and lateral recumbency using the formula for an ellipsoid body. Heart volumes were also estimated with CT in ventral, dorsal, right lateral and left lateral recumbency. No differences between heart volumes from CT in ventral recumbency and those from CT in right and left lateral recumbency were seen. In dorsal recumbency, however, significantly lower heart volumes were obtained. Heart volumes from CT in ventral recumbency were similar to those from radiographs in ventral and dorsal recumbency and dorsal/left lateral recumbency. Close correlation was also demonstrated between heart volumes from radiographs in dorsal/ left lateral recumbency and body weights of the eight cats.     

Comparison of ultrasonographic and radiographic measurements of bladder dimensions and volume determinations

The purpose of this study was to compare the linear dimensions of the bladder measured by ultrasonographic and radiographic methods and the accuracy of these methods for evaluation of bladder volume. Forty dogs were included in this study. Each dog was placed in right lateral recumbency and a plain lateral caudal abdominal radiograph was made. The bladder length and depth were measured in centimetres from the radiograph, taking into account magnification errors. Immediately after radiography was completed, ultrasonographic measurements of bladder length and depth on longitudinal section were measured in centimetres. The bladder was then emptied by catheterisation and the actual urine volume measured. 'Best subsets' analysis indicated that radiographic and ultrasonographic bladder lengths were the best predictors of actual bladder volume. Formulae were derived from radiographic and ultrasonographic bladder dimensions for estimating bladder volume. The formula using radiographic measurements was found to be a better predictor of actual bladder volume than the formula derived from ultrasonographic measurements, since it had higher F and lower error mean square values.     

A COMPUTED TOMOGRAPHIC STUDY OF VOLUME AND X-RAY ATTENUATION OF THE LUNGS OF BEAGLES IN VARIOUS BODY POSITIONS

The influence of body position on volume and x-ray attenuation of the lungs of three Beagles was investigated with computed tomography. In left and right lateral recumbency, the dependent lung had decreased volume and increased x-ray attenuation compared with ventral recumbency. Volume and x-ray attenuation of the nondependent lung, however, were unchanged. In dorsal recumbency, there was a vertical gradient of x-ray attenuation being increased dorsally and decreased ventrally compared with ventral recumbency where regional differences in x-ray attenuation were not found. Results indicate a risk of overlooking a mass in the dependent pulmonary parenchyma of dogs in lateral and dorsal recumbency. Regional differences in x-ray attenuation of the lungs of dogs can be avoided if the radiographs are obtained with the dog in ventral recumbency.     

Influence of patient positioning on sensitivity of mesenteric portography for detecting an anomalous portosystemic blood vessel in dogs: 34 cases (1997-2000).

OBJECTIVE: To determine whether sensitivity of detecting an anomalous portosystemic blood vessel during operative mesenteric portography varied with patient positioning. DESIGN: Retrospective study. ANIMALS: 34 dogs with a portosystemic shunt diagnosed via scintigraphy or surgery. PROCEDURE: Portograms were evaluated for a portosystemic blood vessel. Sensitivity was calculated from results obtained with dogs in left lateral, right lateral, and dorsal recumbency and from results obtained with dogs in 2 or 3 positions. Differences in sensitivity among positions and between 2 examiners were evaluated. RESULTS: Sensitivity was 85, 91, and 100% in dorsal, right lateral, and left lateral recumbency, respectively. Sensitivity was lower in dorsal recumbency than in left lateral recumbency, although differences were not significant. There was no significant difference between sensitivity of results obtained in dorsal and right lateral recumbency or right lateral and left lateral recumbency. Sensitivity for combined right lateral and dorsal positions was 97%, which was better than that in dorsal recumbency alone, although the difference was not significant. Because sensitivity in left lateral recumbency was 100%, there was no need to evaluate the improvement obtained by combining the result of this position with the results of other positions. CONCLUSION AND CLINICAL RELEVANCE: Results of mesenteric portography varied with patient positioning. The optimal position varied among patients but left lateral recumbency may be better and dorsal recumbency worse. Sensitivity may be improved by performing the test with the patient in orthogonal recumbent positions.     

USE OF CONE‐BEAM COMPUTED TOMOGRAPHY TO CHARACTERIZE DAILY URINARY BLADDER VARIATIONS DURING FRACTIONATED RADIOTHERAPY FOR CANINE BLADDER CANCER

Urinary bladder cancer is difficult to treat accurately with fractionated radiation therapy (RT) due to daily positional changes of the bladder and surrounding soft‐tissue structures. We quantified the daily motion experienced by the canine bladder with patients in dorsal vs. sternal vs. lateral recumbency. We also described the dose distribution for three different planning target volume expansions (5, 10, and 15 mm) for each of the three positions to ensure adequate bladder dose and minimize irradiation of nearby healthy tissues. Analysis was based on data from retrospective daily cone‐beam computed tomography (CT) (CBCT) images obtained for positioning of canine patients undergoing routine RT. Organs of interest were contoured on each CBCT data set and the images, along with the contours, were registered to the original planning CT. All measurements were made relative to the planning CT and dosimetric data for the organs of interest was determined using a dose volume histogram generated from sample parallel‐opposed beam configuration. There was a wide range in bladder position throughout treatment. The least amount of bladder variation and the lowest rectal dose was with dogs in lateral recumbency. It was also determined that a margin of 10 mm would allow for sufficient dose to be delivered to the bladder while minimizing rectal dose.     

Effects of urinary bladder distention on location of the urinary bladder and urethra of healthy dogs and cats

Evaluation of the anatomic location of the distended and empty urinary bladders and urethras of healthy adult male and female dogs and cats by retrograde urethrocystography revealed substantial variations. In 15 dogs in lateral recumbency with empty bladder lumens, the caudal portion of the urinary bladder was within the pelvic canal in 5 of 7 male and 5 of 8 female dogs. In female dogs examined in ventrodorsal recumbency, only 4 of 8 had the empty urinary bladders in part within the pelvic canal. After luminal distention, 3 of 7 male and 3 of 8 female dogs, while in lateral recumbency, had the urinary bladders in part intrapelvically. However, when female dogs were placed in ventrodorsal recumbency, only 1 of 7 urinary bladders was in part within the pelvis. The urinary bladders of 14 cats were consistently within the abdominal cavity, irrespective of whether the bladder lumen was distended or empty. Urethral flexures occurred in dogs with intrapelvic bladders that were distended or empty. Urethral flexures were not found in cats. The urethras of dogs and cats in lateral recumbency were generally closer to the floor of the pelvis after urinary bladder distention than when the bladder was empty. The urethra of the dogs and cats in ventrodorsal recumbency was to the left or right of or on the midsagittal plane, whether the urinary bladder was empty or distended. A greater degree of lateral displacement was encountered in ventrodorsal recumbency after urinary bladder distention.     

Evaluation of six-lead electrocardiograms obtained from dogs in a sitting position or sternal recumbency

OBJECTIVE: To compare 6-lead ECG traces in clinically normal conscious dogs in a sitting position and sternal recumbency to that of right lateral recumbency. ANIMALS: 31 healthy dogs with no history of cardiac disease. PROCEDURE: Six-lead ECGs were recorded for dogs in right lateral recumbency, a sitting position, and sternal recumbency. Q-, R-, and S-wave amplitudes as well as QRS-complex duration were measured in all leads. Additionally, P-wave amplitude and duration, PR interval, ST-segment elevation or depression, and OT interval were measured in lead II. RESULTS: Compared with measurements in right lateral recumbency, the sitting position resulted in increased Q-wave amplitude (lead III), increased R-wave amplitude (leads I and aVL), decreased R-wave amplitude (leads III and aVF), increased S-wave amplitude (lead aVR), decreased S-wave amplitude (lead aVL), increased P-wave amplitude (lead II), and a leftward shift in the mean electrical axis. Compared with measurements in right lateral recumbency, sternal recumbency resulted in decreased Q-wave amplitude (leads I, II, and aVF), increased R-wave amplitude (leads 11, III, and aVF), decreased R-wave amplitude (lead aVR), increased S-wave amplitude (lead aVR), increased P-wave amplitude (lead II), and decreased ST-segment depression (lead II). Compared with right lateral recumbency, the sitting position or sternal recumbency did not result in significant differences in PR interval, QT interval, or QRS-complex duration. CONCLUSIONS AND CLINICAL RELEVANCE: Significant changes are found in ECG measurements in the sitting position and sternal recumbency, compared with right lateral recumbency. In dogs, many ECG reference range values for right lateral recumbency are not valid for ECGs obtained in the sitting position or sternal recumbency.     

POSITIVE-CONTRAST ARTHROGRAPHY

Normal colony Beagle dogs were used to evaluate the effect of concentration, volume, and limb positioning on positive-contrast arthrography in the humeral joint. An 8.4% w/v (33.3 mg/ml ± volume) concentration of analytic grade metrizamide (33 mg/ml of iodine) was thought to provide arthrograms of the highest diagnostic quality. Optimal volume of contrast medium was 2–4 ml in dogs with weight of 7.0–15.6 kg (mean, 10.3 kg). Radiographs thought to be of greatest diagnostic value were those made with the dog in lateral recumbency and the limb positioned for neutral, traction, flexion, supination, and pronation views, plus a caudocranial radiograph made with the dog in dorsal recumbency and the limb in traction.     

Nuclear scintigraphic assessment of liver size in clinically normal dogs

Measurement of liver size was made on nuclear scintigraphic images obtained from 16 clinically normal, anesthetized dogs in ventral, dorsal, right and left lateral, and left dorsal oblique positions after administration of technetium 99m-sulfur colloid. Linear measurements of liver length and width were made from each scintiscan, and liver surface area was determined by setting a region of interest manually and by use of a computer count of pixels above a minimal intensity (threshold method). All linear measurements had a statistically significant (P less than 0.05) correlation with liver and body weight, with the exception of the measurements of liver width made on dogs in dorsal and left lateral dorsal oblique positions. The highest correlation (r = 0.89) between the scintigraphic measurements and liver weight was the multiplication of measurements of liver width and length from the right lateral view. Although all area determinations were significantly (P less than 0.05) correlated with liver and body weight, for most views, the manual method of determining the region of interest had a slightly better correlation with the liver weight than did the threshold method.     

Gastro-oesophageal reflux in halothane anaesthetized sheep. The effects of feeding and positioning

The frequency of gastro-oesophageal reflux (GOR) in sheep anaesthetized with halothane was reduced by withholding food and water for 24 hours. The total reflux volume increased. The effect of body position on GOR was studied by inclining the operating table at angles to the horizontal and positioning the head up or down on sand bags. The operative positions investigated were: right and left lateral recumbency with head down, dorsal recumbency with head down and right lateral recumbency with head up. Least GOR occurred when the sheep was in right lateral recumbency with a head up tilt and the body inclined at 20° from the horizontal. A cuffed oesophageal drainage tube increased the incidence of GOR but prevented the chances of the aspiration of rumen material.     

Effect of body position on intraocular pressure in dogs without glaucoma

OBJECTIVE: To determine the effects of body position on intraocular pressure (IOP) in dogs without glaucoma. ANIMALS: 24 healthy dogs with no evidence of glaucoma. PROCEDURES: Dogs underwent ophthalmic examinations to ensure that no IOP-affecting ocular diseases were present. Each dog was sequentially placed in dorsal recumbency, sternal recumbency, and sitting position. For each of the 3 positions, IOP in the right eye was measured by use of an applanation tonometer immediately after positioning (0 minutes) and after 3 and 5 minutes had elapsed. The initial body position was randomly assigned; each position followed the other positions an equal number of times, and IOP measurements were initiated immediately after moving from one body position to the next. Proparacaine hydrochloride (0.5%) was applied to the right eye immediately prior to IOP measurements. RESULTS: Intraocular pressure was affected by body position. During the 5-minute examination, IOP decreased significantly in dogs that were dorsally recumbent or sitting but did not change significantly in dogs that were sternally recumbent. For the 3 positions, overall mean IOP differed significantly at each time point (0, 3, and 5 minutes). Mean IOP in dorsal recumbency was significantly higher than that in sternal recumbency at 0 and at 3 minutes; although the former was also higher than that in sitting position at 3 minutes, that difference was not significant. CONCLUSIONS AND CLINICAL RELEVANCE: Body position affects IOP in dogs. When IOP is measured in dogs, body position should be recorded and consistent among repeat evaluations.     

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).     

Effect of body position on intravesical pressure in the anaesthetised bitch.

The position adopted by 50 recumbent dogs was recorded while they were sleeping or resting; the commonest orientation of their hindquarters was right lateral recumbency. The intravesical pressure in the urinary bladder of 24 anaesthetised bitches lying in right lateral recumbency was compared with the intravesical pressure recorded when the same bitches were supported in a standing position. The intravesical pressure was significantly higher when the bitches were in right lateral recumbency (P less than 0.001) and the difference was unaffected by whether they were continent or not, and had no significant correlation with bodyweight. These findings help to explain why bitches with an incompetent urethral sphincter mechanism tend to leak predominantly when they are recumbent.     

Standard planes for ultrasonographic examination of the portal system in dogs

A scanning protocol for the systematic ultrasonographic examination of the portal system in dogs was developed. Seven planes were used to image the portal system. With the dogs in left lateral recumbency, 3 transverse planes obtained via the right intercostal spaces were used to visualize the portal vein and right portal branch, and a longitudinal plane obtained with the transducer caudal to the last right rib was used to visualize the portal bifurcation. With the dogs in dorsal recumbency, a longitudinal plane was used as an alternative method of visualizing the portal vein and its bifurcation. Finally, with the dogs in right lateral recumbency, longitudinal planes obtained with the transducer in the left flank were used to visualize the hepatic artery, the left renal vein, and the left testicular or ovarian vein. To diagnose or rule out portosystemic shunting, the right portal branch, the left testicular or ovarian vein, the portal vein immediately caudal to the portal bifurcation, and the portal vein at the level of the celiac artery should be examined with this scanning protocol.     

Evaluation of radiographic liver size in twenty-seven normal deep-chested dogs

Radiographic liver size was established in 27 clinically normal deep-chested dogs. In addition, the influence on radiographic liver size of technical factors such as positioning, respiratory phase and position of the central X-ray beam was evaluated. Exact measurement was complicated by two facts. First, the outline of the ventral and caudoventral borders of the liver shadow was not clearly delineated in all dogs. Secondly, in some dogs merging of the silhouettes of liver and spleen was present. As a result in only 14 out of 27 dogs used for this study could exact measurements be made. In this group of deep-chested dogs, the liver shadow was better delineated in left lateral recumbency. In left lateral recumbency less merging of the silhouettes of liver and spleen was noticed. Normal radiographic liver length measured on right lateral views made on expiration and expressed as a ratio to the length of the 11 th thoracic vertebra varied between 4·8 and 7·8 with a mean and standard deviation of 6·1 ± 0·8. The length of the liver tip protruding behind the curve of the 12th rib varied between -0·5 and 1·7 with a mean and standard deviation of 0·6 ± 0.7. This great variability in radiographic liver size between normal dogs of the same thoracic conformnation makes it rather difficult to diagnose hepatomegaly in individual cases. No difference in radiographic liver size of statistical significance could be found between right and left lateral recumbency. The respiratory phase during which the radiograph was made was the only factor causing a difference of statistical significance in radiographic liver size. In all dogs the length of the liver tip protruding behind the costal arch was longer on the view made during inspiration.     

ASSESSMENT OF RESPIRATION‐INDUCED DISPLACEMENT OF CANINE ABDOMINAL ORGANS IN DORSAL AND VENTRAL RECUMBENCY USING MULTISLICE COMPUTED TOMOGRAPHY

Respiratory‐induced organ displacement during image acquisition can produce motion artifacts and variation in spatial localization of an organ in diagnostic computed tomography (CT) examinations. The purpose of this prospective study was to quantify respiratory‐induced abdominal organ displacement in dorsal and ventral recumbency using five normal dogs. All dogs underwent CT examinations using 64 multidetector row CT (64‐MDCT). A “3‐dimensional (3D) apneic CT exam” of the abdomen was acquired followed by a “4‐dimensional (4D) ventilated CT exam.” The liver, pancreas, both kidneys, both medial iliac lymph nodes, and urinary bladder were delineated on the 3D‐apneic examination and the organ outlines were compared to the maximum alteration in organ position in the 4D‐ventilated examination. Displacement was measured in dorsal‐to‐ventral (DV), right‐to‐left (RL), and cranial‐to‐caudal (CC) directions. Respiratory‐induced displacement of canine abdominal organs was not predictable and showed large variability in the three directions evaluated. For most canine abdominal organs, dorsal recumbency provided overall the least amount of displacement among all directions evaluated except for liver and urinary bladder. For liver, a large variability was found for all directions and a statistically significant difference was found only in the RL direction with ventral recumbency exhibiting less displacement (P = 0.0099). For the urinary bladder, ventral recumbency also provided less displacement but this was statistically significant only in the RL direction (P < 0.0001). Findings from this study indicated that dorsal recumbency may be preferred for minimizing respiratory motion artifacts in whole abdomen studies, but ventral recumbency may be preferred for liver and urinary bladder studies when respiration cannot be controlled.     

THE CANINE LATERAL THORACIC RADIOGRAPH

Selected structures seen on right and left lateral thoracic radiographs of 12 dogs were evaluated for differences in position, size, and shape. The size and position of the cardiac silhouette were different when thoracic radiographs made in left and right lateral recumbency were compared. These changes were, however, considered insignificant. The position of the right cranial lobe bronchus relative to the left varied in right lateral recumbency and left lateral recumbency. The right cranial lung lobe was better aerated when dogs were positioned in left lateral recumbency.
Lesions seen in the caudal portion of the left cranial lung lobe or the right middle lobe were masked when the affected lobe was dependent, and enhanced when the affected lung lobe was non-dependent. It is believed that this difference occurred due to compression of the dependent lung with greater aeration of the non-dependent lung.     

Effects of posture and intraruminal pressure on the bronchial calibre of cattle during xylazine/halothane anaesthesia

The effects of changes in body position and intraruminal pressure on the bronchial calibre of anaesthetised, paralysed adult cattle were investigated using a computer-aided forced airflow oscillation technique which enabled the measurement of specific lower airways conductance (sGlaw), expiratory reserve volume (ERV) and residual resistance (RA). sGlaw and RA were highest in dorsal and lowest in sternal recumbency, but ERV was very much greater in sternal recumbency than in other positions. Turning the animals from right to left lateral recumbency resulted in a marked reduction in sGlaw and increase in ERV, providing further evidence of functional impairment of the dependent areas of the lungs of large animals. Changes in intraruminal pressure had little effect on bronchial calibre, suggesting that the respiratory dysfunction resulting from ruminal tympany is primarily caused by a reduction in compliance rather than an increase in airway resistance.