Effect of gentamicin administration on the neuromuscular blockade induced by atracurium in cats

Atracurium besylate, a nondepolarizing neuromuscular blocking agent, was administered as an infusion to 8 anesthetized cats in which neuromuscular blockade was assessed, using the train-of-four response. Once 50% depression of the first-twitch (T1) response was achieved, the infusion was held constant for 60 minutes before being discontinued and the recovery time was determined. The time for recovery was recorded as the time for the train-of-four (T4 ratio) to increase from 50% to 75%. After recovery, atracurium infusion was reinstituted and the cats were again maintained for 60 minutes at 50% depression. A single bolus of gentamicin sulfate (2.0 mg/kg of body weight) was administered IV, and the infusion was continued for another 60 minutes before it was discontinued and the time for recovery was recorded. Within 1 minute of gentamicin administration, the mean +/- SD T1 response decreased from 49 +/- 5% to 33 +/- 8% of baseline and the T4 ratio decreased from 28 +/- 19% to 14 +/- 11%. Peak effect occurred at 5 minutes, with a T1 response of 29 +/- 6% of baseline and a T4 ratio of 13 +/- 12%. By 60 minutes after gentamicin administration, the T1 response had increased to 38 +/- 7% of baseline and the T4 ratio had increased to 21 +/- 13%. The time for recovery significantly (P less than 0.03) increased from 9.9 +/- 3.4 minutes during the control study to 18.1 +/- 10.7 minutes during the gentamicin study. In this study, gentamicin potentiated the neuromuscular blockade induced by atracurium and increased the recovery time. Residual blockade, observed after gentamicin administration was reversed with edrophonium.     

Edrophonium-induced asystole following neuromuscular blockade antagonism in a dog: a case report

Edrophonium was used to antagonise neuromuscular block in a healthy eight-year-old dog following ophthalmic surgery; this caused arrhythmias and asystole lasting 46 sees. The complication probably occurred because of inadequate muscarinic blockade prior to antagonism. The dog made an uneventful recovery.     

Clinical use of the neuromuscular blocking agents atracurium and pancuronium for equine anesthesia

Neuromuscular blocking agents (muscle relaxants) are useful and common adjuncts to general anesthesia for human beings, but have not been used extensively during anesthesia of large animal species. Over a 3-year period, atracurium or pancuronium were used as adjuncts to general anesthesia for 89 anesthetic procedures in 88 equids (of 18 breeds and age ranging in age from 5 weeks to 25 years) at the teaching hospital. Forty-one of the anesthetic procedures were for abdominal surgery, and orthopedic (n = 19), ophthalmologic (n = 17), thoracotomy (n = 1), and soft tissue (n = 14) procedures composed the rest. Most equids were given atracurium because it was less expensive than pancuronium. Initial dosage of either relaxant ranged from 0.12 to 0.2 mg/kg of body weight IV, and repeat doses ranged from 10 to 30 mg. Relaxants were used for as long as 205 minutes. Muscles of the face or hind limb digital extensor muscles were used to monitor relaxation. Muscles of the hind limb were more sensitive to the effects of relaxants than were muscles of the face. At the end of a surgical procedure, just prior to being taken to the recovery stall, a relaxant antagonist, edrophonium (0.5 to 1 mg/kg), was administered IV to each equid. Edrophonium caused blood pressure to increase in most of the equids. Heart rate change was variable, with approximately half the equids having no change or increased heart rate and the remainder having decreased heart rate. Recovery to standing after anesthesia was rated excellent or good for 72 equids, fair for 11, and poor for 2.(ABSTRACT TRUNCATED AT 250 WORDS)     

Unusual response following use of succinylcholine in a horse anesthetized with halothane

A syndrome similar to malignant hyperthermia developed in a 545-kg Quarter Horse while anesthetized with halothane for cataract removal. Succinylcholine administration caused prolonged, severe muscle fasciculations followed by tachycardia, and an elevated blood pressure. Later, while the horse was still under anesthesia, its body temperature rose 2 degrees C, and respiratory acidosis developed. Myositis developed after surgery, but the horse recovered.     

Reversal of atracurium neuromuscular block with neostigmine in the dog

A dose response relationship and the time of onset to 50 per cent and 100 per cent peak action were investigated for neostigmine reversal of atracurium in the dog. Two levels of neuromuscular block were used, 10 per cent and 50 per cent of the first twitch of the train of four. The ED50 from the first group was 0.1 mg kg-1 and for the second group was 0.019 mg kg-1. There was little difference between the onset times at the two levels of block. It is concluded that the main factor in determining the dose of neostigmine is the depth of the initial blockade.     

Prolonged anesthesia using sevoflurane,remifentanil and dexmedetomidine in a horse

HistoryA 10–year old Arabian mare had a slow–growing mass on the lower right mandible and required a large partial mandibulectomy.Physical examinationNo abnormalities were detected apart from the mass.ManagementA temporary tracheostomy was performed pre–operatively. Anesthesia was induced with xylazine followed by ketamine and diazepam. For 13 hours, anesthesia was maintained using sevoflurane, dexmedetomidine and remifentanil infusions, with the exception of surgical preparation time. Intra–operatively, ventilation was delivered through the cuffed tracheotomy tube. Heart and respiratory rates, ECG, arterial pressures, inspired and expired gases, pulse oximetry values and body temperature were monitored. Dobutamine and whole blood were necessary, and romifidine was used to control recovery. Post–operatively, phenylbutazone and buprenorphine given systemically and bupivacaine administered through a wound soaker catheter were used to provide analgesia. Head–shaking from buprenorphine was controlled with acepromazine and detomidine once standing after 87 minutes in recovery. For 3 days after surgery, analgesia was provided with butorphanol, phenylbutazone and bupivacaine. The mare recovered well, appeared comfortable and started eating the following day with no signs of ileus.Follow–upSeven months later, the mare was doing well.ConclusionsSevoflurane, dexmedetomidine and remifentanil infusions were suitable for a long and invasive procedure.     

Prolonged suppression of the innate immune system in the horse following an 80 km endurance race

REASONS FOR PERFORMING STUDY: An increased susceptibility to bacterial and viral infections of the respiratory tract, which results in a loss of performance, has been reported in racehorses. Much research has focused on the influence of high-intensity exercise of a short duration on immune system function in horses, but scant attention has been given to prolonged endurance exercise as an immune modulator. OBJECTIVES: The objective of this study was to evaluate the effect of an 80 km endurance race on the monocyte and neutrophil oxidative burst, serum cortisol, glutamine and plasma glucose concentrations in 8 endurance-trained horses (mean +/- s.d. age 9.4 +/- 2.2 years). METHODS: Blood samples were drawn from the horses prior to and following an 80 km ride. RESULTS: Mean time for completion of the 80 km race was 306 +/- 40 mins. Immediately post race mean serum cortisol concentration, blood monocyte and neutrophil counts were higher and blood lymphocyte counts and plasma glucose concentration were lower compared with prerace values (P < 0.05). Neutrophil and monocyte oxidative burst activity decreased following the race and had not regained prerace values after 3 days of rest (P < 0.05). CONCLUSIONS: The present study indicates that long duration exercise in horses has a negative impact on the function of the innate immune system that lasts several days post race. Precise mechanisms instigating the fall in innate immune system function are unclear and multifactorial, but may be attributed, at least in part, to a high serum cortisol response during very prolonged exercise. POTENTIAL CLINICAL RELEVANCE: A prolonged bout of exercise results in a long-term suppression of the innate immune system function in horses which may, in part, account for the observed increase of infectious episodes in horses during training.     

Osseous lesion of the calcaneus following the use of shock wave therapy in a horse

An 8-year-old Dutch warmblood gelding was presented with a mechanical lameness (2/10) because of the presence of a soft tissue injury on the top of the right tuber calcanei. Plain radiographs of the tarsus demonstrated the presence of soft tissue swelling caudal to the right tuber calcanei, without osseous involvement, and ultrasonography revealed excessive scar tissue within and around the superficial digital flexor tendon. Extra-corporeal shock wave therapy was applied on the right hock to decrease the amount of scar tissue. One month after the therapy the lameness was greater (3/10) and a marginal increase in the size of the swelling was found. Periosteal new bone formation associated with an ill-defined radiolucent area and two bony fragments were detected radiographically at the caudo-proximal aspect of the right tuber calcanei. A blister containing oil of croton, camphor, pine and thyme, turpentine and cantharides was applied on the right calcaneus. Twenty days after blister application, the size of the swelling had been reduced by 50% and the degree of lameness had also been decreased (1/10). On clinical re-evaluation 6 months after treatment, the degree of lameness was stable (1/10) and flexion test of the limb was negative.     

Diabetes mellitus does not affect the neuromuscular blocking action of atracurium in dogs

Objective

To compare the duration of action of atracurium in diabetic and nondiabetic dogs.

Correction of organophosphate-induced neuromuscular blockade by diphenhydramine

Dogs exposed to topical organophosphate (fenthion) developed decreased plasma and muscle cholinesterase activities. After 2 doses were applied (1 week between doses), plasma concentrations declined 80% and muscle cholinesterase activity was reduced by 56%. Decremental responses to repetitive nerve stimulation developed after fenthion administration. Diphenhydramine, but not placebo, corrected the electrical abnormalities caused by organophosphate application, but without altering plasma or muscle cholinesterase activity. Control dogs housed in the same kennel demonstrated a slight decrease (18%) of plasma cholinesterase, which indicates that there may be potential cross contamination. Diphenydramine may be effective in treating organophosphate-induced neuromuscular weakness which is refractory to other forms of therapy.     

Tracheal rupture following general anaesthesia in a horse

A Dutch Warmblood, with no other underlying clinical disease, presented for surgical excision of a sarcoid tumour on the distal right pinna under general anaesthesia. At the end of the procedure, immediately before being moved to recovery, the horse became light and made repeated attempts to move whilst attached to the hoist. Anaesthesia was deepened with intravenous thiopental sodium (Thiopentone)¹ and the horse was moved into the recovery room. The trachea was extubated with the cuff of the endotracheal tube inadvertently left partially inflated. Recovery was smooth and the horse stood uneventfully. The following day subcutaneous emphysema was noted along the neck and tracheoscopy revealed an abnormal dorsoventrally flattened trachea and a 5 cm tear in the dorsal aspect of the trachea. Symptomatic treatment resulted in progressive healing of the lesion and the horse recovered fully with no evidence of respiratory complications.     

Prolonged, continuous distal limb cryotherapy in the horse

REASONS FOR PERFORMING STUDY: The recommended duration of cryotherapy in horses is currently extrapolated from human medicine. Prolonged, continuous cryotherapy (days rather than minutes) may be of therapeutic value if it is safe and well tolerated. OBJECTIVES: To evaluate the effect of prolonged, continuous application of ice and water to the equine distal limb. METHODS: A slurry of ice and water was applied to the right forelimb of 4 Standardbred horses for 48 h. Hoof temperature, ambient temperature and ice boot temperature were logged continuously and clinical observations recorded every 2 h. Lameness examinations were performed prior to application and 1 week, 6 months and 1 year after removal of the ice boot. RESULTS: Continuous cryotherapy was well tolerated and resulted in marked cooling of the treated foot. No significant variation in clinical parameters was noted, and no lameness or gross pathology noted in the treated limbs at any examination period. CONCLUSIONS: The continuous application of ice and water is a safe and effective means of cooling the equine distal limb. The extremely low, constant temperatures achieved may be of benefit in the management of various distal limb conditions. POTENTIAL RELEVANCE: Providing clinicians and research workers with a potent therapeutic/prophylactic modality for disorders of the equine distal limb.     

Anticholinesterase-resistant neuromuscular blockade in sheep given amino-steroid muscle relaxants

Three cases of anticholinesterase-resistant neuromuscular blockade in sheep are described. Neuromuscular blockade produced with pancuronium (n = 2) and vecuronium was only temporarily antagonised with anticholinesterases and signs of residual block-muscular weakness, recumbency, hypoventilation, dyspnoea, dysphagia, 'fade' in evoked responses to repetitive nerve stimulation and rapid exhaustion of cranial nerve reflexes - were observed. Responses to repeated edrophonium and, or neostigmine injections were incomplete and shortlived. These complications probably arose because high loading doses, incremental injections (pancuronium and vecuronium) and infusion (pancuronium) created high plasma drug concentrations at antagonism. This occurred because the facial nerve-levator nasolabialis muscle unit used to monitor drug effects proved resistant to blockade. The effects of relative overdose were probably augmented by the sensitivity of sheep to non-depolarizing neuromuscular blocking agents and the relative insensitivity of monitoring blockade using tactile and visual evaluation of evoked responses.