Measurement of the puncture profile and extradural pressure of cattle during extradural anaesthesia

ObjectiveTo measure the pressure profile during caudal extradural puncture and subsequent extradural anaesthesia in cattle and to investigate the presence of extradural pressure waves.Study designProspective experimental study.AnimalsEleven cattle aged 4.1 ± 2.5 years (range 0.8 to 8.8 years), with a body weight of 613 ± 162 kg (range 302–840 kg).MethodsCaudal extradural puncture was performed. To measure the extradural pressure profile, the needle was connected to an electronic pressure transducer placed at the height of the base of the tail. The pressure profile was recorded for 3 minutes following extradural puncture. Lack of resistance to injection of saline was assessed. One minute and 10 minutes after extradural anaesthesia with procaine extradural pressure was recorded. Correct extradural needle placement was assessed by clinical response.ResultsThree minutes after extradural puncture the median pressure was ?16 (range ?25 to 25) mmHg. Pressure in the extradural space 1 minute after the lack of resistance, 3 seconds after injection, and 10 minutes after injection was ?15 (?24 to 33) mmHg, 8 (?17 to 84) mmHg, and ?7 (?25 to 27) mmHg respectively. Pressure waves were visible after puncture, after lack of resistance, 3 seconds and 10 minutes after injection, in 4, 6, 8 and 7 cattle respectively. Pressure after testing lack of resistance, after the injection of local anaesthetic, as well as at the end of the measurement, period was significantly higher than baseline. All cattle showed clinical signs indicative of successful extradural needle placement.Conclusion and clinical relevance Extradural pressure was sub-atmospheric in 82% of the animals. Pressure waves were not consistently present before or after extradural injection, which limits their usefulness to confirm correct extradural needle placement. Extradural pressures increase significantly after injection of local anaesthetic solution. However, the clinical significance of the increase in extradural pressures was not clear.     

The extradural pressure profile in goats following extradural injection

ObjectiveTo measure the extradural pressures in goats before and after extradural injection, and to investigate the occurrence of extradural pressure waves.Study designProspective experimental trial.AnimalsNine healthy adult goats weighing 59.4 ± 6.4 kg, scheduled for stifle arthroscopy.MethodsThe goats were pre–medicated with midazolam and anaesthesia was induced with propofol and maintained with sevoflurane. The goats were placed in lateral recumbency and extradural puncture was performed via the lumbosacral space. Correct placement of the needle was assessed by lack of resistance to the injection of saline. The needle was connected to an electronic pressure transducer to record extradural pressure. Measurements were taken before and after extradural injection of methadone (0.1 mg kg^?1, diluted to a total volume of 0.2 mL kg^?1) and 10 minutes later. Contrast medium was injected and correct extradural needle placement confirmed by radiography.ResultsLack of resistance to injection of saline occurred in all goats, but there were no pressure waves observed before injection in any animal. Radiography indicated incorrect needle placement in four animals and one had pressure waves synchronous with the arterial pulse after methadone injection. Correct needle placement was confirmed in the remaining five animals which exhibited pressure waves after extradural methadone injection. In the five goats with successful needle placement the baseline extradural pressure ranged from 0.4 to 2.5 kPa (3–19 mmHg), increasing to 4.4–39.9 kPa (33–300 mmHg) after injection. Ten minutes after injection, extradural pressure remained elevated and ranged from 2.5 to 17.3 kPa (19–130 mmHg).Conclusions and clinical relevanceExtradural pressure waves were not useful to confirm correct extradural needle placement in laterally recumbent goats. The presence of such waves after injection of 0.2 mL kg^?1 may be indicative of correct placement but even here we saw one of nine animals with extradural pressure waves where we failed to confirm correct needle placement. Extradural pressure increases after extradural injection.     

Pressure profile in the caudal extradural space of standing horses before and after extradural drug administration

The objectives of this study were to measure the pressure in the caudal extradural space of standing horses and to evaluate the usefulness of pressure waves to identify correct needle placement. Caudal extradural pressure was measured in 12 healthy horses. The pressure and any extradural pressure waves were recorded for 3min after puncture, for 1min after testing for lack of resistance (LOR), and for 10min after lidocaine injection. Successful extradural drug administration was confirmed in all horses. The median extradural pressure findings after puncture, after LOR, immediately after injection and 10min after needle placement were -1.60kPa (range -2.27 to 1.33kPa), -0.67kPa (-2.27 to 5.73kPa), 5.00kPa (0.93 to 9.87kPa) and 0.13kPa (-0.67 to 4.53kPa), respectively. Extradural pressure waves were not always present. Extradural space pressure was sub-atmospheric in most horses and extradural injection significantly increased this pressure for up to 10min. Extradural pressure waves had limited usefulness in the confirmation of the correct placement of the needle.     

The use of an acoustic device to identify the epidural space in cattle

Twelve healthy cattle (weighing 188–835 kg) were placed in stocks and sedated with xylazine. Caudal epidural puncture was performed using an acoustic device that indicated a decrease in resistance with a change in pitch. Lidocaine was injected to verify correct needle placement by assessing needle prick stimuli applied on the left and right side of the tail root and the perineal region, and the loss of tail and anal sphincter tone. Pressure measurements were recorded during penetration of the different tissue layers and in the epidural space. A clear and sudden decrease in the pitch of the acoustic signal was audible in all 12 cattle. All cows showed clinical effects indicating successful epidural anaesthesia. The pressure in the epidural space after puncture was ?19 ± 10 mm Hg. The device may be of assistance in identifying the epidural space in cattle.     

Successful resuscitation from cardiac arrest associated with extradural lidocaine in a dog

BACKGROUND: Extradural lidocaine exerts several adverse effects which are seldom fatal. While cardiac arrest following extradural lidocaine injection has been reported in human beings, it has not hitherto been reported in dogs. OBSERVATIONS: The emergency management of a dog with complete urethral obstruction is described. We intended to perform vaginoscopy and cystostomy under extradural lidocaine anaesthesia, but cardiac asystole occurred a few minutes after injection. Resuscitation was successful. About 20 minutes later cardiac arrest recurred, and was treated successfully. The dog remained hypothermic for approximately 7 hours. Complete recovery without neurological deficit occurred the next day and the dog remained normal for at least 3 months. The probable cause of the problem was cranial lidocaine dispersion causing a drop in cardiac preload and cardiac arrest. The successful neurological outcome was attributed to early diagnosis and effective treatment. Hypothermia may have conferred cerebral protection during ischemia. CONCLUSIONS: Extradural local anaesthetic administration is not without risk and the technique should be tailored to individual animals. Constant monitoring is required to detect potentially fatal complications and increase the likelihood of successful outcome.     

In Vitro Model for Testing Novel Implants for Equine Laryngoplasty

Objective— To develop an in vitro laryngeal model to mimic airflow and pressures experienced by horses at maximal exercise with which to test laryngoplasty techniques.
Study Design— Randomized complete block.
Sample Population— Cadaveric equine larynges (n=10).
Methods— Equine larynges were collected at necropsy and a bilateral prosthetic laryngoplasty suture was placed with #5 Fiberwire^™ suture to achieve bilateral maximal arytenoid abduction. Each larynx was positioned in a flow chamber and subjected to static flow and dynamic flow cycling at 2 Hz. Tracheal pressure and flow, and pressure within the flow chamber were recorded at a sampling frequency of 500 Hz. Data obtained were compared with the published physiologic values for horses exercising at maximal exercise.
Results— Under static flow conditions, the testing system produced inspiratory tracheal pressures (mean±SEM) of −33.0±0.98 mm Hg at a flow of 54.48±1.8 L/s. Pressure in the flow chamber was −8.1±2.2 mm Hg producing a translaryngeal impedance of 0.56±0.15 mm Hg/L/s. Under dynamic conditions, cycling flow and pressure were reproduced at a frequency of 2 Hz, the peak inspiratory (mean±SEM) pharyngeal and tracheal pressures across all larynges were −8.85±2.5 and −35.54±1.6 mm Hg, respectively. Peak inspiratory flow was 51.65±2.3 L/s and impedance was 0.57±0.06 mm Hg/L/s.
Conclusions— The model produced inspiratory pressures similar to those in horses at maximal exercise when airflows experienced at exercise were used.
Clinical Relevance— This model will allow testing of multiple novel techniques and may facilitate development of improved techniques for prosthetic laryngoplasty.     

The effect of body position on the 'hanging drop' method for identifying the extradural space in anaesthetized dogs

ObjectivesTo assess the accuracy of the ‘hanging drop method’ for identifying the extradural space in anaesthetized dogs positioned in sternal or lateral recumbency.Study designProspective randomized-experimental study.AnimalsSeventeen clinically healthy adult dogs, 10 females and seven males weighing 8.4–26.2 kg.MethodsDogs were positioned in either sternal (n = 8) or lateral (n = 9) recumbency under general anaesthesia. A 20 SWG spinal needle pre-filled with 0.9% saline was advanced through the skin into the lumbosacral extradural space and the response of the saline drop recorded, i.e. whether it: 1) was aspirated from the hub into the needle; 2) remained within the hub, or 3) moved synchronously with i) spontaneous respiration, ii) heart beat or iii) manual lung inflation. The position of the needle tip was ultimately determined by positive contrast radiography.ResultsOne dog positioned in lateral recumbency was excluded from the study because bleeding occurred from the needle hub. Saline was aspirated into the needle in seven of eight dogs held in sternal recumbency but in none of the dogs positioned in lateral recumbency. Accurate needle tip placement in the extradural space was confirmed by positive contrast radiography in all dogs.Conclusion and clinical relevanceThe ‘hanging drop’ method, when performed with a spinal needle, appears to be a useful technique for identifying the location of the extradural space in anaesthetized medium-sized dogs positioned in sternal, but not in lateral recumbency. The technique may yield ‘false negative’ results when performed in dogs positioned in sternal recumbency.     

Effects of extradural morphine on end-tidal isoflurane concentration and physiological variables in pigs undergoing abdominal surgery: a clinical study

OBJECTIVE: To evaluate the effects of preoperative extradural morphine on the end-tidal isoflurane (Fe'ISO) concentration and on physiological variables in pigs undergoing abdominal surgery. STUDY DESIGN: Prospective, randomized, blinded study. ANIMALS: Fourteen healthy pigs (20 +/- 4 kg) undergoing intestinal cannulation. MATERIALS AND METHODS: Anaesthesia was induced with a combination of medetomidine (50 microg kg(-1)) and tiletamine-zolazepam (2.5 mg kg(-1)) injected intramuscularly, and was maintained with isoflurane in air and oxygen (FiO(2) = 50% O(2)). In the first group, morphine (0.1 mg kg(-1)) was administered extradurally before surgery. The second group received an equivalent volume of extradural saline as control. During the experiment, heart and respiratory rates, mean arterial blood pressure, tidal volume and minute ventilation were recorded every 10 minutes. The concentration of Fe'ISO was adjusted, according to the depth of anaesthesia, by an experienced animal nurse. Within treatment groups, time-related changes in Fe'ISO and physiological variables were analysed using a repeated measurement anova. Differences in data between treatment groups were analysed at specific time points using a Mann-Whitney U-test. Results are presented as mean +/- SD; p < 0.05 was considered as significant. RESULTS: After the onset of action of the morphine, the Fe'ISO required to maintain anaesthesia was significantly lower in the extradural morphine group compared with control. During the expected maximal effect of the drug, Fe'ISO was significantly lower in the morphine group (0.6 +/- 0.2%) than in the control group (0.9 +/- 0.2%). The decrease in Fe'ISO indicated that the onset of action of morphine was approximately 30 minutes after injection. No significant differences in other clinical variables were found between the groups. CONCLUSION: Pigs that received extradural morphine before abdominal surgery achieved surgical anaesthetic depth at a lower Fe'ISO concentration. CLINICAL RELEVANCE: Extradural morphine allows abdominal surgery to be performed at a lower Fe'ISO concentrations.     

Brightness of venous blood in South American camelids: implications for jugular catheterization

Objective  To compare the brightness of South American camelid venous blood to that of Equidae.
Study design  Prospective clinical evaluation.
Animals  Twelve South American camelids (eight llamas, four alpacas), eight horses and ponies (control group).
Methods  Appropriately sized catheters were placed in the jugular vein of each animal under local anaesthesia. The blood spilt before the catheter was capped was caught on a white tile. A sample of blood was drawn for blood-gas analysis. The brightness of the blood (both on the tile and in the syringe) was matched to a colour chart (1 = darkest red, 8 = brightest red) by a single observer under bright light conditions. Packed cell volume (PCV) and partial pressure of oxygen (PvO₂) in the blood were also measured on the syringe blood. Normally distributed data were compared using a two tailed t -test, and non-normally distributed data were compared using a Mann–Whitney U -test. Significance was set at p  < 0.05.
Results  Camelid venous blood was significantly brighter red than that of horses and ponies both on the white tile ( p  = 0.0003) and in the syringe ( p  = 0.0001). PCV was significantly lower in camelids (32 ± 4%) compared with horses (37 ± 5%). Partial pressure of oxygen values were similar between groups.
Conclusions and clinical relevance  Jugular venous blood in alpacas and llamas is significantly brighter red than that of horses. Colour should not be used as a sole determinant of venous or arterial catheterization in this species.     

Sequential Plasma Lactate Concentrations as Prognostic Indicators in Adult Equine Emergencies

Background: Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate.
Hypothesis: Prognosis for survival is decreased in horses with a delayed return to normal [LAC].
Animals: Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement.
Methods: Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC]Δ T ) was calculated from changes in [LAC] between sampling points.
Results: Median [LAC] was significantly ( P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60–18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30–13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17–1.43) at admission to 49.90 (6.47–384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC]Δ T was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24–72 hours (− 0.47, P = .001) and 48–72 hours (− 0.07, P = .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors.
Conclusions and Clinical Importance: These results indicate that lactate metabolism is impaired in critically ill horses and [LAC]Δ T can be a useful prognostic indicator in horses.     

A comparison of extradural and intravenous methadone on intraoperative isoflurane and postoperative analgesia requirements in dogs

Objective To compare the effects of intravenous (IV) and extradural (ED) methadone on end‐tidal isoflurane concentration (Fe ′ISO) and postoperative analgesic requirements in dogs undergoing femoro‐tibial joint surgery. Study Design Randomized, blinded, clinical study. Animals Twenty‐four healthy client‐owned dogs undergoing surgical repair of ruptured cruciate ligaments. Methods Dogs were randomly assigned to two groups of 12 animals and received either ED or IV methadone (0.3 mg kg^?1 diluted with saline to 0.2 mL kg^?1). Pre‐anaesthetic medication was IV acepromazine (0.05 mg kg^?1). Anaesthesia was induced with propofol and maintained initially with an Fe ′ISO of 1.0% delivered in oxygen. Methadone was injected with the dogs in sternal recumbency; the observer was unaware of the administration route. At 10 minutes (stimulation 1) and 20 minutes (stimulation 2) after methadone administration pelvic limb reflexes were tested by digit‐clamping. The time at skin incision (stimulation 3), joint‐capsule incision (stimulation 4), tibial tuberosity drilling (stimulation 5), fabellar suturing (stimulation 6) and extracapsular tightening (stimulation 7) were noted. Changes in heart rate (HR) and respiratory rate and arterial blood pressure associated with surgery were recorded along with the corresponding Fe ′ISO. After 20 minutes of anaesthesia, Fe ′ISO was decreased to the minimum required to maintain stable anaesthesia. Immediately after tracheal extubation, 1, 2, 3 and 6 hours postoperatively and on the morning after surgery, the degree of pain present was assessed using a numerical rating scale. The HR, respiratory rates and blood pressure were also recorded at these times. Serum cortisol and blood glucose concentrations were measured before pre‐anaesthetic medication and at each postoperative pain scoring interval except at 1 and 2 hours. Ketoprofen (2 mg kg^?1), carprofen (4 mg kg^?1) or meloxicam (0.2 mg kg^?1) were given by subcutaneous injection whenever pain scoring indicated moderate discomfort was present. Results Controlled ventilation was required in six dogs which stopped breathing after IV methadone. The median Fe ′ISO at stimulus 5 was 1.0% in the IV and 0.83% in the ED group. At stimulus 6, Fe ′ISO was 1.0% in the IV and 0.8% in the ED group; the difference was statistically significant (p ≤ 0.05). There was no significant difference in the duration of postoperative analgesia associated with administration route. Conclusions Extradural methadone significantly reduces the isoflurane requirement compared with IV methadone during femoro‐tibial joint surgery in dogs. Clinical relevance Extradural methadone provides safe and effective pain relief in dogs undergoing cruciate ligament repair.     

Laparoscopic Cryptorchidectomy in Standing Horses

Objective — The purpose of this study was to determine the feasibility of using laparoscopy to remove cryptorchid testes from standing horses.
Study Design — Prospective clinical study.
Animals or Sample Population — Eleven client-owned horses ranging in age from 4 months to 2 years.
Methods — Abdominal insufflation was initiated and maintained using a 20 F insufflation tube, attached via a stopcock, to the low pressure regulator on a standard carbon dioxide pressure tank. After trocar and laparoscope placement in the ipsilateral flank the testes were identified. Local anesthesia of the structures to be manipulated was administered through the instrument channel on the operative laparoscope, using a catheter with a needle attached. Testes were grasped with large laparoscopic forceps and exteriorized through the abdominal wall. Ligation and transection of the mesorchium was extracorporeal. The descended testes were removed using a standard standing technique.
Results — Complications were minor, including mild colic in one horse. The mean surgical time for standing laparoscopic cryptorchidectomy and castration of these colts was 58.9 ±24.3 minutes.
Conclusions and Clinical Relevance — Standing laparoscopic cryptorchidectomy, using the instrumentation described, is a safe and practical technique in young horses.     

In vitro validation of a Pitot-based flow meter for the measurement of respiratory volume and flow in large animal anaesthesia

Objective  To remodel and validate commercially available monitors and their Pitot tube-based flow sensors for use in large animals, using in vitro techniques.
Study design  Prospective, in vitro experiment.
Methods  Both the original and the remodelled sensor were studied with a reference flow generator. Measurements were taken of the static flow-pressure relationship and linearity of the flow signal. Sensor airway resistance was calculated. Following recalibration of the host monitor, volumes ranging from 1 to 7 L were generated by a calibration syringe, and bias and precision of spirometric volume was determined. Where manual recalibration was not available, a conversion factor for volume measurement was determined. The influence of gas composition mixture and peak flow on the conversion factor was studied.
Results  Both the original and the remodelled sensor showed similar static flow–pressure relationships and linearity of the flow signal. Mean bias (%) of displayed values compared with the reference volume of 3, 5 and 7 L varied between −0.4% and +2.4%, and this was significantly smaller than that for 1 L (4.8% to +5.0%). Conversion factors for 3, 5 and 7 L were very similar (mean 6.00 ± 0.2, range 5.91–6.06) and were not significantly influenced by the gas mixture used. Increasing peak flow caused a small decrease in the conversion factor. Volume measurement error and conversion factors for inspiration and expiration were close to identity.
Conclusion  The combination of the host monitor with the remodelled flow sensor allowed accurate in vitro measurement of flows and volumes in a range expected during large animal anaesthesia.
Clinical relevance  This combination has potential as a reliable spirometric monitor for use during large animal anaesthesia.     

Tunnel grafting for wound repair in horses: a novel technique in graft production and placement

There are several skin grafting methods described in the human and animal literature. Currently, there are five types of free grafts used in horses: pinch and punch grafts, split and full-thickness sheet or mesh grafts and tunnel grafts. Published methods of tunnel grafting describe the use of alligator forceps. The alligator forceps create a poor tunnel and are excessively traumatic to the granulation bed. This technique utilised a 13G Jamshidi needle that was placed across the granulation bed and created a uniform tunnel. The Jamshidi needle was atraumatic to the granulation bed increasing the opportunity for graft survival. A twin bladed scalpel allowed for the quick creation of uniform width grafts. Removal of the overlying tunnel ‘roof’ took place 5–14 days later to allow graft expansion. This case series included five horses with distal limb wounds and one with a wither injury. Four horses required general anaesthesia for graft placement and three required general anaesthesia for the removal of the tunnel roof. The acceptance of the grafts varied from 70% to 100%. Graft expansion to cover the granulation tissue took 2–5 months. This case series demonstrates that this technique of graft production and placement is an easy method for achieving successful skin grafting. Compared to other graft types, tunnel grafts are more readily accepted. Cosmetic and functional results achieved are better than those with pinch and punch grafts. Tunnel grafting does not require expensive equipment or advanced training, and in some cases can be performed under standing sedation.     

Gastro-oesophageal reflux during anaesthesia in the kitten: comparison between use of a laryngeal mask airway or an endotracheal tube

Objective  To compare the incidence of gastro-oesophageal reflux (GOR) during anaesthesia in the kitten when using a laryngeal mask airway (LMA) or an endotracheal tube (ET).
Study design  Prospective randomized cross-over experimental study.
Animals  Forty Domestic Short Hair laboratory cats, 19 females and 21 males, aged 12–15 weeks and weighing 0.57–1.73 kg (mean 1.13 ± SD 0.26).
Methods  Kittens were anaesthetized twice, once using the LMA and once the ET. Following induction of anaesthesia with isoflurane in an anaesthetic chamber and intubation of the trachea with the ET or placement of the LMA, a pH-electrode was introduced into the lower oesophagus. Monitoring of the oesophageal pH was performed for 45 minutes while anaesthesia was maintained with isoflurane. At the end of the experiment, gastric pH was measured. Kittens that had GOR during the experiment were treated with sucralfate, cisapride and ranitidine for 15 days.
Results  Oesophageal pH was 6.51 ± 0.76 and gastric pH was 1.54 ± 0.59. GOR was observed in nine kittens when the ET was used, and in 20 kittens when the LMA was used, the difference being significant ( p  =   0.013). The refluxate nearly always was acidic, being alkaline in only one kitten. Most of the GOR episodes occurred shortly after induction of anaesthesia and the oesophageal pH remained below 4.0 until the end of the experiment. No regurgitation was observed.
Conclusions and clinical relevance  The use of the LMA is associated with an increased incidence of GOR during anaesthesia in the kitten, which is not detected by observation. That this may have occurred should be considered if the kitten demonstrates signs of oesophagitis in the postoperative period.     

Cardiopulmonary arrest and resuscitation following an extradural injection in a normovolemic dog

Objective – To describe general anesthesia and successful resuscitation of a dog developing asystole and apnea during extradural injection of local anesthetic and an opioid. Case Summary – A Beagle with a ruptured cranial cruciate was premedicated with acepromazine and methadone. Anesthesia was induced with propofol and, after endotracheal intubation, maintained using isoflurane in oxygen. During extradural injection of a mixture of lidocaine, bupivacaine, and morphine the dog developed apnea and asystole. Cardiopulmonary cerebral resuscitation was started promptly and the dog was successfully resuscitated. New Information Provided – Asystole and apnea are possible serious side effects of extradural anesthesia in dogs. With adequate monitoring and early detection successful resuscitation is possible.     

Review of hypoxaemia in anaesthetized horses: predisposing factors,consequences and management

Objective

To discuss how hypoxaemia might be harmful and why horses are particularly predisposed to developing it, to review the strategies that are used to manage hypoxaemia in anaesthetized horses, and to describe how successful these strategies are and the adverse effects associated with them.

Intra-abdominal hypertension in two adult horses

Objective – To describe the clinical and pathological findings in 2 adult horses with documented increases in intra-abdominal pressure (IAP), and to describe the direct puncture technique used to measure this pressure.
Series Summary – Two adult horses developed increases in IAP secondary to large-volume abdominal effusion. A 9-year-old Quarter Horse cross gelding was presented for evaluation of urinary and neurologic signs. Abdominal ultrasonographic examination showed a hepatic abscess along with abdominal effusion. A 4-year-old Quarter Horse gelding was presented for evaluation of castration complications. A castration site infection extended into surrounding tissues, resulting in peritonitis, abdominal effusion, and severe cellulitis of the limbs. IAP measured in both horses was increased relative to reported equine reference values. Changes in hemodynamic parameters in both horses, notably increased central venous pressure, were consistent with those seen in other species in which intra-abdominal hypertension (IAH) and its sequellae have been documented.
New or Unique Information Provided – Extensive research and clinical literature guides management of humans with IAH and abdominal compartment syndrome. Knowledge of these conditions in companion animal and large domestic species is less well developed. Recent research has established reference values for standing, sedated and recumbent, anesthetized horses. Detailed reports of equine clinical cases of IAH have not been reported in the literature. This report provides information on the clinical, hemodynamic, and pathologic characteristics of 2 horses with measured increases in IAP, and describes the direct puncture technique used to perform these measurements.     

Holmium:YAG Laser Lithotripsy for Urolithiasis in Horses

Background: Laser lithotripsy has been used as an alternative to surgical removal of uroliths.
Objective: To describe the procedure and efficacy of laser lithotripsy for removal of lower urinary tract uroliths in horses. Additionally, the ultrastructure and the differences in mineralogy and microstructure from 1 successful and 1 unsuccessful laser lithotripsy case are described.
Animals: Six client-owned horses with 7 episodes of naturally occurring urocystoliths, urethroliths, or both.
Methods: Retrospective study of all horses treated between 2006 and 2008 by laser lithotripsy. All horses were sedated followed by laser lithotripsy. Quantitative urolith analysis was performed in all cases. Ultrastructure and microstructure analyses were performed on uroliths from 2 horses.
Results: Procedural success was achieved in 5 of 7 laser lithotripsy procedures. No complications occurred as a result of laser lithotripsy. One horse developed uroabdomen likely as a result of manual lithotrite disruption of the bladder after failure of laser lithotripsy. There were differences in microstructure between 1 urolith that was successfully fragmented by laser lithotripsy and 1 urolith that was resistant to laser fragmentation.
Conclusions and Clinical Importance: Laser lithotripsy is an effective procedure for removal of some urocystoliths, urethroliths, or both in horses.