Variability of resting endoscopic grading for assessment of recurrent laryngeal neuropathy in horses

Reasons for performing study: The extent to which variability affects endoscopic grading of arytenoid cartilage movement is uncertain. Objective: To determine the observer and within horse variability of grading arytenoid cartilage movement in horses during resting endoscopic examination, using a 7‐grade system. Methods: Endoscopic recordings of the upper respiratory tract made at rest in 270 draught horses were reviewed independently by 2 veterinarians to assess interobserver variability when scoring horses' laryngeal function with a 7‐grade system. Grading was repeated by both examiners in 80 randomly selected recordings in order to assess intraobserver variability. In 120 horses, endoscopy was repeated after 24–48 h, with videos graded by both veterinarians to assess intrahorse variability. Results: The mean weighted κ statistic for concordance within examiners was 0.867, with a mean intraobserver agreement of 76.3%. The weighted κ statistic for concordance between the 2 examiners was 0.765, with an interobserver agreement of 63.1%. Of the horses receiving 2 endoscopic examinations, the same grade was assigned to 57.1% of horses at the second examination, when effects resulting from interobserver variability were removed. The mean weighted κ statistic for concordance between the grade assigned at first vs. second examinations was 0.588, indicating only moderate agreement. Conclusions and potential relevance: Intra‐ and interobserver reliability of resting endoscopic grading of arytenoid cartilage movement using a 7‐grade system was high when examinations were conducted by experienced veterinarians. However, there was moderate daily intrahorse variability, suggesting that results of resting endoscopic examinations performed on a single day should be interpreted with caution.     

Evaluation of a polyurethane jugular catheter in cats placed using a modified Seldinger technique

OBJECTIVE: To describe and evaluate the placement of a new design of polyurethane jugular catheter in cats using a modification of the technique of Seldinger. The maintenance and use of these catheters for repeated blood sampling over several days in healthy and diabetic cats is reported. PROCEDURE: Thirty polyurethane jugular catheters were placed in 10 clinically healthy cats and 10 cats with diabetes mellitus using the modified Seldinger technique. Catheters were placed while the cats were under general anaesthesia. RESULTS: The catheters remained in place for a range of 2 to 14 days (median 5 days) with no major complications. In all cats patency of the catheters was maintained until removal. All cats examined had patent jugular veins when assessed 4 or more weeks after the catheters were removed. CONCLUSIONS: These polyurethane jugular catheters, when placed by a modified Seldinger technique, are effective and safe in cats, and jugular patency returns after the catheters are removed.     

Long-term jugular vein catheterization in horses

The use of soft catheter materials in large-bore veins has allowed safe long-term venous access in human patients. Similar principles were applied to groups of horses; the jugular vein was catheterized for 14 days (group 1) and for 30 days (group 2). Three catheter materials were compared, and the clinical and histologic findings indicated that the least reaction was associated with silastic, followed by polyurethane; polytetraflouroethylene caused marked reaction. Our results suggest that by using catheters made of materials (especially silastic) that are less stiff or rigid, the duration of catheterization can be increased to 14 days or longer with minimal complications.     

Lack of systemic absorption of lidocaine from 5% patches placed on horses

OBJECTIVE: To measure concentrations of lidocaine serum after application of two 5% patches on horses. STUDY DESIGN: Prospective experimental trial ANIMALS: Six client-owned, systemically healthy horses. METHODS: The hair was clipped on the medial aspect above the carpus of both fore limbs and 2 patches of 5% lidocaine were applied within 30 minutes of jugular catheter placement and the area was then bandaged. Venous blood was drawn from a jugular vein catheter that was inserted using lidocaine as a local block. Samples were drawn immediately before and at 2, 4, 6, 8, and 12 hours after patch application. The presence of lidocaine in serum was determined using an ELISA test. RESULTS: Lidocaine was detected in the serum of three horses at 0 hours immediately following the local block for catheter placement. Lidocaine was not detected at any other time from 2 to 12 hours. There was mild erythema at the site of patch placement at 12 hours in one horse but this resolved within 1 hour of patch removal. There were no other apparent adverse effects from the patches on any other horse. CONCLUSION: Five percent lidocaine patches applied proximally to the carpus did not result in detectable systemic concentrations of lidocaine. CLINICAL RELEVANCE: Any analgesic effects that might be produced by application of 5% lidocaine patches on horses will not be due to systemic absorption of the drug.     

Transvenous electrical cardioversion of atrial fibrillation in six horses using custom made cardioversion catheters

Pharmacological conversion of atrial fibrillation (AF) to sinus rhythm in horses can be difficult. The objective of this study was to investigate the feasibility of transvenous electrical cardioversion with custom made catheters in eight horses, of which three had failed cardioversion using quinidine sulfate. Two cardioversion catheters and one pacing/sensing electrode were inserted via the right jugular vein and placed using ultrasound guidance into the left pulmonary artery, the right atrium and the right ventricle, respectively. Because immediate recurrence of AF was encountered in the second horse treated, pre-treatment with amiodarone was given to each of the remaining six horses. Induction of general anaesthesia was associated with dislocation of the cardioversion catheter in three horses, requiring a second catheterisation procedure. During general anaesthesia, biphasic R wave synchronised shocks of up to 360 J were delivered between both cardioversion electrodes. In six horses (75%), including two which had failed quinidine sulfate treatment, sinus rhythm was restored with a mean energy level of 295+/-62 J. No side effects were observed. Blood analysis 3 h after cardioversion revealed normal parameters, including cardiac troponin I values. Transvenous electrical cardioversion of atrial fibrillation with custom made cardioversion catheters can be considered as a treatment option for atrial fibrillation in horses, especially when conventional drugs fail.     

Effects of 5% and 10% Guaifenesin Infusion on Equine Vascular Endothelium

Twelve horses of various breeds and either sex were anesthetized with xylazine and ketamine injected into a median or lateral thoracic vein. During anesthesia, with the horse in sternal recumbency, a 14-gauge, 8.9 cm catheter was inserted into each jugular vein by using aseptic technique. Guaifenesin in water (100 mg/kg or a maximum dose of 50 grams) was infused into one jugular vein and an equal volume of 0.9% saline solution was infused into the other jugular vein. Seven horses received 10% guaifenesin, and five horses received 5% guaifenesin. The catheters were removed before the horses recovered from anesthesia. The horses were euthanatized approximately 48 hours later, and the jugular veins were removed for histologic examination. Adherent thrombus material was observed in all veins exposed to 10% guaifenesin and in one vein exposed to 5% guaifenesin. No evidence of thrombus was observed in four veins infused with 5% guaifenesin or in those infused with saline solution. These findings are of particular significance with horses at increased risk for thrombosis or thrombophlebitis.     

Outcome of epidural catheterization for delivery of analgesics in horses: 43 cases (1998-2001)

OBJECTIVE: To determine reasons for epidural catheter placement among horses examined at a veterinary teaching hospital, efficacy of epidural administration of analgesics, duration of catheter placement, reasons for catheter removal, and complications encountered. DESIGN: Retrospective study. ANIMALS: 43 horses. PROCEDURE: Medical records were reviewed. RESULTS: A total of 50 epidural catheters were placed in the 43 horses. Underlying conditions included fractures, lacerations, septic arthritis, myositis, perineal injuries, and cellulitis. Horses ranged from 2 to 21 years old and weighed between 365 and 795 kg (803 and 1,749 lb). Median duration of catheter placement was 96 hours (range, 1.5 to 480 hours). The response to epidural drug administration was reported as positive in 34 horses and negative in 4. There was no apparent response in 2 horses, and response could not be determined in 3. Three temporary patient-related complications associated with epidural catheter administration were observed. Technical problems associated with the epidural catheters included dislodgement of the catheter itself (7 catheters) or of the adapter or filter (5), obstruction (5), and leakage (5). Twenty-two catheters were removed because of resolution of the underlying condition, and 10 were removed because of complications. For 6 catheters, the reason for catheter removal was not recorded. The remaining 12 catheters were in place when the horses were euthanatized. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that epidural catheterization can be used successfully for repeated epidural delivery of analgesics and anesthetics in horses with various clinical conditions. Complications associated with epidural catheters or epidural drug administration were infrequent and transient.     

Methods and Reliability of Tissue Doppler Imaging for Assessment of Left Ventricular Radial Wall Motion in Horses

Background: Noninvasive assessment of left ventricular (LV) function is incompletely studied in horses.
Objectives: The goals of this study were to investigate the feasibility, techniques, and reliability of tissue Doppler imaging (TDI) for characterization of LV radial wall motion in healthy horses.
Animals: Three Standardbreds, 3 Thoroughbreds; age 8–14 years; body weight 517–606 kg.
Methods: Repeated echocardiographic examinations were performed by 2 observers in unsedated horses using TDI. Test reliability was determined by estimating measurement variability, within-day interobserver variability, and between-day interobserver and intraobserver variability of all echocardiographic variables. Variability was expressed as coefficient of variation (CV) and the absolute value below which the difference between 2 measurements will lie with 95% probability.
Results: Assessment of LV radial wall motion by TDI was feasible in all horses. Measurement variabilities were very low (CV < 5%) to low (CV 5–15%) for most variables. Within-day interobserver variability as well as between-day interobserver and intraobserver variabilities were low to moderate (CV 16–25%) for most variables. All pulsed-wave TDI variables of systolic LV function showed very low to low variability, whereas some of the variables of LV diastolic and LA function showed moderate to high (CV > 25%) variability. Pulsed-wave TDI variables appeared more reliable than color TDI variables.
Conclusions and Clinical Importance: Measurement of TDI indices of LV function is feasible and reliable in adult Standardbred and Thoroughbred horses. The clinical relevance of LV function assessment by TDI remains to be determined.     

Peritoneal Lavage and Drainage with Fenestrated Balloon Catheters in Standing Horses: A Comparative Study

This experimental study compares the efficiency of two fenestrated balloon catheters in allowing drainage of fluid during abdominal lavage in 12 healthy horses. Catheter A (with multiple side holes) or catheter B (with a single side hole) was placed in the ventral abdominal wall. Lactated Ringer's solution was instilled through a catheter in each paralumbar fossa of the standing horse. Drainage was performed through two catheters A in group 1, one catheter A in group 2, and one catheter B in group 3. Drainage was not significantly faster when using two, as compared with one, catheters A (P = 1). Amount of fluids recovered was greater using catheter A compared with catheter B (P = .004). Abdominal fluid analysis on day 30 was significantly higher (P = .008) for total protein in individuals with catheter B compared with catheter A. Use of one multiple fenestrated balloon catheter may be justified in clinical cases that need abdominal lavage and drainage.     

Repeatability and Intra‐ and Inter‐observer Agreement of Cervical Vertebral Sagittal Diameter Ratios in Horses with Neurological Disease

Background

Sagittal ratio values (SRVs) of cervical vertebrae are used for ante‐mortem diagnosis of cervical vertebral stenotic myelopathy, but intraobserver and interobserver variability in measurement may influence radiographic interpretation of vertebral stenosis in horses with neurological disease.

Objectives

To determine intraobserver repeatability in SRVs, intra‐ and interobserver agreement in SRVs and whether or not agreement was influenced by animal age.

Animals

Forty‐two horses (>1 year old) with neurological disease from which laterolateral computed radiographic images of C2–C7 were obtained.

Methods

Four observers made measurements from C2 to C7 for each horse and interobserver agreement for intra‐ and intervertebral SRVs was determined using Bland–Altman analysis (acceptable agreement: limits of agreement [LOA] ≤ 0.05) on all horses and those ≤3 (n = 25) and >3 (n = 17) years old. Each observer also made repeated measurements for 10 horses and intraobserver repeatability and agreement were determined.

Results

Adequate intraobserver repeatability was achieved for 6 sites. Within observers, paired measurements had a median difference ≤5.7%, but a large range in differences often occurred, most frequently at intervertebral sites. For C5, C6, C7, and C3–4, LOA ≤ 0.05 were achieved by at least 1 observer. With the exception of C5 for 1 pair, LOA were >0.05 for interobserver agreement, regardless of animal age. LOA were largest at intervertebral sites.

Conclusions and Clinical Importance

Within and between observers, measurement error may limit the diagnostic accuracy of SRVs and result in discrepancies of diagnosis and treatment and warrants consideration when used clinically in horses with neurological disease.     

Correlation between jugular and central venous pressures in laterally recumbent horses

Objective To compare and correlate right atrial pressure, which represents central venous pressure (CVP) to jugular vein pressure (JVP) in laterally recumbent horses under anesthesia. Study design Retrospective clinical trial. Animals Seven adult healthy horses (411 ± 8.7 kg). Methods Horses were sedated with IV xylazine and anesthesia was obtained with IV ketamine and diazepam. Anesthesia was maintained with sevoflurane in oxygen. All horses were positioned in left lateral recumbency. An 8F catheter introducer was inserted into the right jugular vein to measure JVP. An 8F catheter introducer was inserted into the left jugular vein to be used as the port for a 7F 110 cm catheter that reached the right atrium to measure CVP. Both, CVP and JVP were measured simultaneously with a water calibrated aneroid manometer using the sternum as the 0 cmH₂O reference point. Measurements were compared using Spearman correlation and the Bland‐Altman plot. Results Twenty paired samples were obtained over a period of 2 hours. The CVP ranged from 7 to 31 cmH₂O, while the JVP ranged from 5 to 30 cmH₂O. The Spearman correlation coefficient indicated that CVP and JVP had a strong correlation with r = 0.88. The Bland‐Altman plot showed a bias of 0.7 cmH₂O. Conclusion and clinical relevance Jugular vein pressure showed a strong correlation with CVP in healthy, euvolemic, laterally recumbent anesthetized adult horses. Thus, JVP cannot replace CVP but it may be used clinically to monitor CVP in laterally recumbent horses.     

Long-term facial artery catheter implantation for serial arterial blood sampling and invasive arterial blood pressure measurement in horses

The purpose of this investigation was to evaluate surgical catheter implantation in the facial artery of horses and the long-term maintenance of such arteries using heparin and ascorbic acid as filling solution. Nine horses were implanted with a polyurethane catheter. The catheters were flushed with a heparin/ascorbic acid solution every 8h and remained patent for 25 days. Arterial blood samples were collected twice a day, and one exercise test that included serial blood samples and arterial pressure recordings was performed on a treadmill. Polyurethane catheters surgically implanted in the facial artery can be kept patent by filling with a heparin/ascorbic acid solution and provide convenient invasive arterial access in horses which is suitable for use for serial blood sampling and blood pressure recordings, even during exercise on treadmill.     

A Comparison of Daily Rhythm of Creatinine and Creatine Kinase in the Sedentary and Athlete Horse

The goal of this study was to investigate the existence of a daily rhythm of creatinine or creatine kinase (CK) and the influence of physical exercise on these rhythms. Blood samples from 20 Sella Italiana horses were collected every 4 hours for 48 consecutive hours via an intravenous cannula inserted into the jugular vein. The horses were divided into two equal groups (Sedentary [S] and Athlete [A]). After 2 weeks of rest, athletes (AR) were subjected again to sample collection every 4 hours for 48 consecutive hours, and sera creatinine and CK were assessed. Statistical analysis of the data was performed by one-way repeated analysis of variance (ANOVA), paired Student's t-test, unpaired Student's t-test, and analysis of single cosinor method. Cosinor analysis identified the periodic parameters and their acrophases (expressed in hours) during the 2 days of monitoring. In all horses, we found a highly significant effect of time of the day on the studied parameters (P < .01). Statistically significant differences were observed for mean serum CK values between sedentary and athlete horses. The application of the periodic model showed a daily rhythm of the parameters studied in all experimental conditions. The results obtained during the experimental period indicated a daily rhythm of creatinine and CK in sedentary and athlete horses and also indicated that physical exercise was able to influence amplitude, acrophase, and robustness of the creatinine and CK circadian rhythm.     

An interobserver and intraobserver study of buccal mucosal bleeding time in Greyhounds

Two observers experienced with the buccal mucosal bleeding-time technique using a standardised device (Surgicutt) performed the test on 20 Greyhounds, to evaluate interobserver and intraobserver repeatability. The interobserver and intraobserver repeatability were both about 2 minutes. The results indicated that, for any two readings within a dog, the buccal mucosal bleeding time may differ by up to +/- 2 minutes. A single reading was accurate to within +/- 80 seconds. Sixty-one Greyhounds were used to establish a reference interval for the buccal mucosal bleeding time, and to assess the relationship between the buccal mucosal bleeding time and plasma von Willebrand factor concentration. The mean was 129.5 (SD 44.2) seconds. The reference interval was 53 to 235 seconds, which was slightly lower than non-greyhounds. No significant correlation (r=-0. 18, P=0.17) between the buccal mucosal bleeding time and plasma von Willebrand factor concentration was found in the 61 Greyhounds, where plasma von Willebrand factor concentration was in the range 29 to 160 Canine Units dL(-1).     

ASSESSMENT OF THE REPEATABILITY OF FELINE ECHOCARDIOGRAPHY USING CONVENTIONAL ECHOCARDIOGRAPHY AND SPECTRAL PULSE-WAVE DOPPLER TISSUE IMAGING TECHNIQUES

The objective of this study was to determine the intraoperator, intraobserver, and interobserver repeatability in a series of conventional echocardiographic parameters and in some of the newer measurements of diastolic function, including color M-mode flow propagation velocity, isovolumic relaxation time and pulsed-wave Doppler tissue imaging velocities. Four healthy cats were each scanned five times over a 3-day period. The repeatability of these echocardiographic analyses was compared using Bland-Altman analysis (intraoperator repeatability). After a minimum of 5 weeks, one scan was randomly selected from each cat, and was remeasured by the original observer and the results compared using a standard paired Student's t-test (intraobserver repeatability). One scan from each cat was then randomly selected and two observers, with similar levels of experience, measured each of these scans. The repeatability of these echocardiographic analyses was compared using Bland-Altman analysis (interobserver repeatability). The conventional two-dimensional (2D), M-mode and spectral Doppler measurements were repeatable in both their acquisition and measurement by a single investigator; there was a greater degree of variation between the two observers. The predominant (S', E', and A') pulsed-wave Doppler tissue imaging velocities from the left apical four-chambered view, generally had a coefficient of variation of approximately 20% (range 9.62-34.08%). However, with pulsed-wave Doppler tissue imaging, velocities recorded during the isovolumic phases, the velocity of the tricuspid annulus, and the radial fiber velocity within the interventricular septum, frequently had coefficients of variation in excess of 20% and should therefore be interpreted with caution.     

A technique for central venous pressure measurement in normal horses

Objective – To investigate a technique of central venous pressure (CVP) measurement using a newly developed catheter in healthy adult horses. Design – Prospective experimental study. Setting – University research facility. Animals – Twenty healthy adult horses. Interventions – An equine central venous catheter was inserted into the jugular vein to a length of approximately 80 cm from the mid‐cervical region in an attempt to catheterize the pulmonary artery. Pulmonary arterial catheterization was confirmed by echocardiography. Insertion distance and pressure were measured at this location with a disposable manometer. The catheter was then withdrawn until presence in the right atrium was confirmed by echocardiography. Insertion distance and pressure were also measured at this location. The catheter was then withdrawn in 5 cm increments until exiting the jugular insertion site with pressure measured at each location. All pressure measurements were taken with the manometer zero position at the point of the shoulder. Measurements and Main Results – Pulmonary artery catheterization was successful in 16 of 20 horses. Mean pulmonary arterial pressure was 23.8 cm H₂O (17.5 mm Hg) (95% confidence interval [CI] 20.9–26.7 cm H₂O [15.4–19.6 mm Hg]). Mean right atrial pressure was 8.3 cm H₂O (6.1 mm Hg) (95% CI 7.1–9.4 cm H₂O [5.2–6.9 mm Hg]). Right atrial pressure was compared with pressures recorded at sequential insertion distances and resulted in a recommendation for catheter insertion of at least 40 cm for CVP measurement in adult horses. Jugular venous pressure measurement was statistically different from CVP measurement. Conclusions – This catheter measurement technique is well tolerated in normal horses. Routine clinical use of this equine central venous catheter may improve our ability to monitor patients and improve patient care and outcomes of ill horses in hospital.     

Catheters: a review of the selection, utilisation and complications of catheters for peripheral venous access

Intravenous catheters are used for the administration of medications and fluids and are an integral part of veterinary practice. The aim of catheter use is to optimise administration of medication and minimise complications such as thrombus formation, thrombophlebitis and sepsis. Catheters made from teflon are less flexible, less durable and stimulate more tissue reaction than polyurethane or silicon. However silicon catheters are more expensive and complicated to insert. Generally, for veterinary practice, the biostability and cost of polyurethane catheters make them preferable for short and long-term use. The smallest diameter catheter should be selected to minimise internal vessel wall contact and irritation without compromising medication delivery. The site of insertion varies with individual preference, vessel access and patient compliance. The jugular, cephalic, saphenous, ear, lateral thoracic and subcutaneous abdominal veins are accessible. Hair removal and a thorough aseptic skin preparation should be performed prior to catheter insertion. Daily maintenance is required to detect complications and maximise catheter longevity. Potential complications include thrombus formation, thromboembolism, bacterial colonisation and septicaemia, blood loss and air embolism. Permanent or transient skin dwelling bacteria are commonly isolated if sepsis occurs. The development of novel antiseptic and antibiotic impregnated catheters may reduce the complications associated with catheter infection in the future.     

Metabolic acidosis in healthy mules under general anaesthesia with halothane

ObjectiveTo report the severe metabolic acidosis identified in a group of 11 healthy mules anaesthetized with halothane for castration.Study designData generated from a prospective study.AnimalsEleven mules aged 2.5–8 years, weighing 230–315 kg and 11 horses aged 1.5–3.5 years, weighing 315–480 kg.MethodsAnimals were anaesthetized for castration as part of an electroencephalographic study. Preanaesthetic medication was acepromazine (0.03 mg kg^?1) administered through a preplaced jugular venous catheter. Anaesthesia was induced 30–90 minutes later with intravenous thiopental (10 mg kg^?1). After orotracheal intubation, anaesthesia was maintained with halothane vaporised in oxygen. The animals’ lungs were ventilated to maintain the end-tidal CO₂ concentration between 3.9 and 4.5 kPa (29–34 mmHg). Anaesthetic monitoring included invasive blood pressure measurement via the auricular artery (mules) and submandibular branch of the facial artery (horses). Arterial blood gas samples were drawn from these catheters at three time points during surgery and pH, PaCO₂, base excess (ecf) and HCO₃^? were measured. Values were compared between groups using a Mann–Whitney test. p was taken as <0.05. Results are reported as median (range).ResultsPaCO₂ did not differ between groups but pH was significantly lower in mules [7.178 (7.00–7.29)] compared to horses [7.367 (7.24–7.43)] (p = 0.0002). HCO₃^? values were significantly lower in the mules [16.6 (13.0–22.3) mM] compared to horses [23.7 (20.9–23.7) mM] (p = 0.0001), whilst base excess (ecf) was significantly more negative in the mules [?11.4 (?1.27 to ?16) mM] compared to horses [?1.3 (?5.8 to +2.4) mM] (p = 0.0004).Conclusion and clinical relevanceThis study demonstrated severe metabolic acidosis in healthy mules, which may have prompted intervention with drug therapies in a clinical arena. It is probable that the acidosis existed prior to anaesthesia and caused by diet, but other possible causes are considered.     

Efficacy of an Epidural Combination of Morphine and Detomidine in Alleviating Experimentally Induced Hindlimb Lameness in Horses

Amphotericin B-induced synovitis of the left tarsocrural joint was used to create a grade 3 of 4 lameness in 11 horses. Caudal epidural catheters were placed and advanced to the lumbosacral region. Baseline heart and respiratory rates were recorded and horses were videotaped at a walk and trot. Morphine sulphate (0.2 mg/kg) and detomidine hydrochloride (30 μg/kg) were administered to treated horses (n = 8) through the epidural catheter; an equivalent volume of physiologic saline solution was administered to control horses (n = 3) through the catheter. At hourly intervals after epidural injection for a total of 6 hours, heart and respiratory rates were recorded, and horses were videotaped walking and trotting. At the end of the observation period, video recordings were scrambled onto a master videotape. Lamenesses were scored by three investigators unaware of group assignment or treatment time. Lameness scores, heart rates, and respiratory rates were compared between groups using repeated measures analysis of variance. There was a significant decrease in lameness score after treatment with epidural morphine and detomidine ( P =.0003); average lameness scores of treated horses were less than grade 1 at each hourly observation for 6 hours after drug administration. Early in the observation period, heart rates significantly increased in control horses and decreased in treated horses ( P =.03). A similar trend occurred for respiratory rates ( P =.07). Results of this study demonstrate that epidural administration of a combination of morphine and detomidine is capable of providing profound hindlimb analgesia in horses.