Endocrine and metabolic responses to plasma volume expansion during halothane anaesthesia in ponies

The study was designed to contribute to identification of the stimulus to adrenocortical activity during halothane anaesthesia in equidae . Two groups of six ponies were premedicated with acepromazine before induction of anaesthesia with thiopentone and maintenance for 120 min with halothane in oxygen. In group H Haemaccel® modified gelatine plasma replacer was infused (48 ± 13 mL/kg) to maintain mean arterial blood pressure (MABP) close to preanaesthetic values. In group DH, blood pressure was maintained close to preanaesthetic levels with a lower dose of Haemaccel® (10 mL/kg) combined with an infusion of dobutamine. Measurements were made before anaesthesia, at 20 min intervals during anaesthesia and 20 and 120 min after anaesthesia. MABP and blood gases, pulse and respiratory rates were measured, and blood was withdrawn for assay of cortisol, adrenocorticotrophic hormone (ACTH), glucose and lactate. Ponies in both groups became hyperoxic, hypercapnic and developed a respiratory acidosis; pulse rate increased in both groups but this was more marked in group H. Haematocrit decreased by 50% in H and by 20% in DH. Cortisol and ACTH did not change significantly during anaesthesia in either group and the area under the time curve ( AUC _(0–140)) was lower in the DH group. Plasma glucose and lactate remained stable. After the H treatment all ponies had a watery nasal discharge and one pony died from endotoxaemia. This investigation demonstrated that the adrenocortical response to halothane anaesthesia in ponies can be ameliorated by manipulation of ABP using plasma expansion with or without inotrope infusion; however, low dose Haemaccel® with dobutamine was safer and more practical. It is suggested that, although hypotension is not the sole stimulus to adrenocortical activity during halothane anaesthesia, it may contribute, probably through an effect on tissue perfusion.     

Investigation of the EEG effects of intravenous lidocaine during halothane anaesthesia in ponies

OBJECTIVE: To record the electroencephalographic changes during castration in ponies anaesthetized with halothane and given intravenous (IV) lidocaine by infusion. The hypothesis tested was that in ponies, IV lidocaine is antinociceptive and would therefore obtund EEG changes during castration. ANIMALS: Ten Welsh mountain ponies referred to the Department of Clinical Veterinary Medicine, Cambridge for castration under general anaesthesia. MATERIALS AND METHODS: Following pre-anaesthetic medication with intramuscular acepromazine (0.02 mg kg(-1)) anaesthesia was induced with IV guaiphenesin (60 mg kg(-1)) and thiopental (9 mg kg(-1)) and maintained with halothane at an end-tidal concentration (FE'HAL) of 1.2%. A constant rate infusion of IV lidocaine (100 microg kg(-1) minute(-1)) was administered throughout anaesthesia. The electroencephalogram (EEG) was recorded continuously using subcutaneous needle electrodes. All animals were castrated using a closed technique. The raw EEG signal was analysed after completion of each investigation, and the mean values of EEG variables (median frequency, spectral edge frequency, total amplitude) recorded during a baseline period (before surgery began) and the removal of each testicle were compared using anova for repeated measures. RESULTS: Spectral edge frequency (SEF) 95% decreased during removal of the second testicle compared with baseline recordings. No other significant EEG changes during castration were measured. CONCLUSIONS: Lidocaine obtunded the EEG changes identified during castration in a previous control study, providing indirect evidence that lidocaine administered peri-operatively was antinociceptive and contributed to anaesthesia during castration. CLINICAL RELEVANCE: The antinociceptive effect of lidocaine combined with its minimal cardiovascular effects indicate a potential use for systemic lidocaine in clinical anaesthetic techniques.     

Effects of glucose infusion on the endocrine, metabolic and cardiorespiratory responses to halothane anaesthesia of ponies.

Glucose was infused intravenously into six ponies during halothane anaesthesia, to evaluate its effect on their endocrine response to anaesthesia. The ponies were premedicated with acepromazine, and anaesthesia was induced with thiopentone and maintained with halothane in oxygen for two hours. Glucose was infused to maintain the plasma glucose concentration above 20 mmol/litre. Anaesthesia was associated with hypothermia, a decrease in haematocrit, hypotension, hyperoxaemia, respiratory acidosis and an increase in the plasma concentrations of lactate and arginine vasopressin. The concentration of beta-endorphin in plasma increased transiently after 20 minutes but there were no changes in concentrations of adrenocorticotrophic hormone, dynorphin, cortisol or catecholamines. These data suggest that the glucose infusion attenuated the normal adrenal response of ponies to halothane anaesthesia.     

Stress responses in ponies during halothane or isoflurane anaesthesia after induction with thiopentone or xylazine/ketamine

Endocrine and metabolic responses to anaesthesia with three different anaesthetic regimes were examined in six ponies. All animals were anaesthetised with each protocol: acepromazine-thiopentone-isoflurane, xylazine-ketamine- halothane and xylazine-ketamine-isoflurane. Anaesthesia was maintained for 2 h. Pulse rate, respiratory rate, arterial blood pressure, arterial blood gases and pharyngeal and skin temperature were measured and blood was withdrawn for glucose, lactate, cortisol, insulin, liver and muscle enzymes and total protein assay. Measurements were made before anaesthesia, at 20 min intervals during anaesthesia and at 20 mins and 2, 4, 6 and 24 h after anaesthesia. The effects of anaesthesia were similar in all groups. Arterial blood pressure decreased and oxygen tension and plasma cortisol concentration increased in all groups. Arterial carbon dioxide tension increased and respiratory rate and pH decreased in all ponies anaesthetised with isoflurane. There was a tendency for increased glucose and lactate concentrations and decreased insulin concentration and packed cell volume, particularly in the xylazine-ketamine groups. There was no change in pulse rate except for a transient increase at induction with thiopentone. The results were compared with data reported by Taylor (1989), which were collected from the same animals during acepromazine-thiopentone-halothane anaesthesia, and were found to be similar. It was concluded that these commonly used anaesthetic protocols themselves constitute a considerable insult or stressor in horses. However, the stress response to all the regimes investigated was similar and the precise stimulus to this response has yet to be elucidated.     

Endocrine and metabolic responses in sheep during halothane and pentobarbitone anaesthesia with dobutamine infusion

The study investigated the stimulus to pituitary-adrenocortical activity (PACA) during halothane anaesthesia. Groups of six sheep were anaesthetized with thiopentone/halothane (TH group), acepromazine/thiopentone/halothane (ATH group) or pentobarbitone (P group). Dobutamine was infused in the TH and ATH groups to prevent hypotension (0.3–1.4 μg/kg/min) and in the P group at 0.05 μg/kg/min. Pulse rate, arterial blood gases and pressure (ABP) were measured and sequential blood samples taken for assay of cortisol, adrenocorticotrophic hormone (ACTH), arginine vasopressin (AVP), glucose and lactate. Pulse rate increased in all groups. Arterial blood pressure decreased by 13% in TH, by 24% in ATH and remained stable in P. All three groups developed hypercapnia and acidosis but were well oxygenated. Cortisol increased in all groups; with ATH the sevenfold rise occurred earlier than with either TH (sixfold rise) or P (fivefold rise). Adrenocorticotrophic hormone changes were as for cortisol but AVP increases were not consistent. Glucose and lactate were stable, but lactate was lowest with ATH. Dobutamine infusion failed to prevent hypotension during halothane anaesthesia and PACA appeared proportional to the hypotension. Dobutamine may have stimulated ACTH and cortisol release after 120 min. Halothane-induced hypotension may cause adrenocortical activity but a direct effect of halothane cannot be ruled out.     

Cardiopulmonary effects of romifidine and detomidine used as premedicants for ketamine/halothane anaesthesia in ponies

The cardiopulmonary effects of romifidine at 80 microg/kg (R80) or 120 pg/kg (R120), and detomidine at 20 pg/kg (D20) when used as premedicants for ketamine/halothane anaesthesia were investigated in six ponies. Using a blinded crossover design, acepromazine (0-04 mg/kg) was administered followed by the alpha-2 agonist. Anaesthesia was induced with ketamine at 2.2 mg/kg and maintained with halothane (expired concentration 1.0 per cent) in oxygen for three hours. During anaesthesia, arterial blood pressure, cardiac index, PaO2 and PmvO2 decreased, and systemic vascular resistance and PaCO2 increased. The cardiac indices for R80, R120 and D20 were, respectively, 39, 39 and 32 ml/kg/minute at 30 minutes and 29, 29 and 26 ml/kg/minute at 180 minutes. The alpha-2 agonists had similar cardiovascular effects, but PaO2 was significantly lower with R120. The quality of anaesthesia was similar in all three groups.     

Medetomidine-ketamine anaesthesia induction followed by medetomidine-propofol in ponies: infusion rates and cardiopulmonary side effects

REASONS FOR PERFORMING STUDY: To search for long-term total i.v. anaesthesia techniques as a potential alternative to inhalation anaesthesia. OBJECTIVES: To determine cardiopulmonary effects and anaesthesia quality of medetomidine-ketamine anaesthesia induction followed by 4 h of medetomidine-propofol anaesthesia in 6 ponies. METHODS: Sedation consisted of 7 microg/kg bwt medetomidine i.v. followed after 10 min by 2 mg/kg bwt i.v. ketamine. Anaesthesia was maintained for 4 h with 3.5 microg/kg bwt/h medetomidine and propofol at minimum infusion dose rates determined by application of supramaximal electrical pain stimuli. Ventilation was spontaneous (F(I)O2 > 0.9). Cardiopulmonary measurements were always taken before electrical stimulation, 15 mins after anaesthesia induction and at 25 min intervals. RESULTS: Anaesthesia induction was excellent and movements after pain stimuli were subsequently gentle. Mean propofol infusion rates were 0.89-0.1 mg/kg bwt/min. No changes in cardiopulmonary variables occured over time. Range of mean values recorded was: respiratory rate 13.0-15.8 breaths/min; PaO2 29.1-37.9 kPa; PaCO2 6.2-6.9 kPa; heart rate 31.2-40.8 beats/min; mean arterial pressure 90.0-120.8 mmHg; cardiac index 44.1-59.8 ml/kg bwt/min; mean pulmonary arterial pressure 11.8-16.4 mmHg. Recovery to standing was an average of 31.1 mins and ponies stood within one or 2 attempts. CONCLUSIONS: In this paper, ketamine anaesthesia induction avoided the problems encountered previously with propofol. Cardiovascular function was remarkably stable. Hypoxaemia did not occur but, despite F(I)O2 of > 0.9, minimal PaO2 in one pony after 4 h anaesthesia was 8.5 kPa. POTENTIAL RELEVANCE: The described regime might offer a good, practicable alternative to inhalation anaesthesia and has potential for reducing the fatality rate in horses.     

The stress response to anaesthesia in ponies: barbiturate anaesthesia

Information on the equine stress response to anaesthesia and surgery is sparse but offers a promising approach to elucidating the high anaesthetic risk in this species. Previous work has shown that halothane anaesthesia induces substantial metabolic and endocrine changes. This paper reports the effects of barbiturate anaesthesia. Anaesthesia was induced with thiopentone in six ponies and no further agents were given. They stood within 30 mins. On another occasion, these animals, and three further ponies, were anaesthetised with pentobarbitone and anaesthesia was maintained for 2 h. No surgery was performed on either occasion. Plasma concentrations of glucose, lactate, non esterified fatty acids, cortisol, insulin, catecholamines and adrenocorticotrophic hormone were measured at the same time intervals in both groups before, during and after anaesthesia. There were no significant changes in hormones or metabolites during either period of anaesthesia and normotension was maintained. This was in marked contrast to the substantial stress response and hypotension under halothane anaesthesia in the same ponies. These results suggest that barbiturates may induce less of a stress response than halothane in horses. Recovery after 2 h of pentobarbitone anaesthesia was poor, precluding its clinical use. The need for a non-cumulative intravenous agent or a non-hypotensive volatile agent for use in equine anaesthesia is discussed.     

Blood biochemical response to sodium bicarbonate infusion during sublethal endotoxemia in ponies

Hypertonic NaHCO3 infusion caused blood volume expansion, increased blood bicarbonate concentration, and delayed the onset of hypophosphatemia in ponies with endotoxemia. However, NaHCO3 infusion did not normalize blood pH, and it increased blood L-lactate concentration, and caused hypokalemia, hypernatremia, and hyperosmolality. The deleterious effects of NaHCO3 infusion in endotoxemia ponies outweighed the beneficial effects. The role of hypertonic NaHCO3 given IV for treatment of endotoxemia in equids must be reevaluated.     

Minimal alveolar concentration of desflurane in combination with an infusion of medetomidine for the anaesthesia of ponies

The minimum alveolar concentration of desflurane when combined with a continuous infusion of medetomidine at 3.5 microg/kg/hour was measured in seven ponies. Anaesthesia was induced with medetomidine (7 microg/kg intravenously) followed by ketamine (2 mg/kg intravenously) and maintained with desflurane in oxygen. The infusion of medetomidine was started 20 minutes after the induction of anaesthesia. The electrical test stimulus was applied at the coronary band (50 V, 10 ms bursts at 5 Hz for one minute), and heart rates and rhythms, arterial blood pressures, and arterial blood gas tensions were measured at intervals, just before the application of the stimulus. The mean (sd) minimum alveolar concentration of desflurane was 5.3 (1.04) per cent (range 3.2 to 6.4 per cent), 28 per cent less than the previously published value for desflurane alone after the induction of anaesthesia with xylazine and ketamine. The cardiopulmonary parameters remained stable throughout the period of anaesthesia. The mean (sd) time taken by the ponies to stand after the administration of desflurane ceased was 16.5 (6.17) (range 5.8 to 26) minutes, and the quality of recovery was good or excellent. However, one pony died shortly after standing; a postmortem examination revealed that it had chronic left atrial dilatation.     

Motility of the oesophagus and gastro-oesophageal junction during halothane anaesthesia in sheep

Electromanometry and electromyography were used to study gastro-oesophageal motility in two planes of halothane anaesthesia in sheep. Gastro-oesophageal motility when present was greater in light than in deep anaesthesia. The caudal thoracic oesophagus contracted more frequently and for longer than the rostral thoracic oesophagus. In light anaesthesia oesophageal movements were peristaltic in direction with a propagation velocity of 26–29 cm sec^-1. Rumen pressures increased throughout anaesthesia and the rate of increase was greatest when the plane of anaesthesia was deep at the start. Gastro-oesophageal reflux (GOR) occurred in both planes of anaesthesia and must occur by passive mechanisms during deep anaesthesia because gastro-oesophageal motility was inhibited.A high pressure zone (HPZ) was demonstrated for a length of 2.9 cm at the gastro-oesophageal junction with a balloon-tipped catheter and a pull through technique. Open-tipped catheters could detect the HPZ but were less sensitive. The pressure in the HPZ was not significantly influenced by the depth of anaesthesia used. In 80% of cases of light anaesthesia an increase in HPZ pressure preceeded the contraction of the cranial sac of the rumen. In deep anaesthesia the HPZ continued to have rhythmic changes in tone. Spontaneous GOR coincided with a maximum gastro-oesophageal pressure gradient in 24% of cases. Rumen insufflation with oxygen provoked GOR at a rumen pressure above 33 mmHg compared with 7.2 mmHg during spontaneous reflux.The study demonstrates that a gastro-oesophageal pressure gradient was not primarily responsible for the initiation of GOR during anaesthesia and that the HPZ at the gastro-oesophageal junction of sheep had some of the properties of a lower oesophageal sphincter and played an important role in the initiation of GOR during anaesthesia.     

The bispectral index during recovery from halothane and sevoflurane anaesthesia in horses

ObjectiveTo record the bispectral index (BIS) when horses moved during either halothane or sevoflurane anaesthesia and when they made volitional movements during recovery from these anaesthetics.Study designRandomized prospective clinical study.AnimalsTwenty-five client-owned horses undergoing surgery aged 8.8 (± 5.3; 1–19) years (mean ± SD; range).MethodsBaseline BIS values were recorded before pre-anaesthetic medication (BIS_B) and during anaesthesia (BIS_A) maintained with halothane (group H; n = 12) or sevoflurane (group S; n =13) at approximately 0.8–0.9 × minimum alveolar concentrations (MAC). Bispectral indices were recorded during the surgery when unexpected movement occurred (BIS_MA), during recovery when the first movement convincingly associated with consciousness was observed (BIS_M1) and once sternal recumbency was achieved (BIS_ST).ResultsNo significant difference in BIS_M1 was found between halothane- (85 ± 7; 75–93) and sevoflurane- (87 ± 10; 70–98) anaesthetized horses although BIS_A was significantly (p = 0.0002) lower in group S (62 ± 7; 53–72) than group H (74 ± 7; 60–84). Differences between BIS_M1 and BIS_A were significant in sevoflurane (p = 0.00001) and halothane recipients (p = 0.002) but were greater in group S (25 ± 9; 4–38) compared with group H (12 ± 10; ?9–25). In six of eight horses, BIS_MA values ranged between those recorded during anaesthesia and at first movement.Conclusions and clinical relevanceBispectral indices appear to approximate levels of unconsciousness, suggesting that monitoring the BIS may assist equine anaesthesia. However, it does not predict intra-operative movement.     

Endocrine response to lactate infusion during pentobarbitone anaesthesia

Lactic acid was infused iv in 6 Welsh ponies during pentobarbitone anaesthesia to investigate whether lactate triggers the pituitary-adrenal response to anaesthesia. Ponies were premedicated with acepromazine and anaesthesia was induced with pentobarbitone iv and maintained with pentobarbitone/oxygen for 2 h. Immediately after induction, 3% L(+) lactic acid infusion was started and adjusted to maintain plasma lactate concentration between 2 and 2.5 mmol/l. Cardiorespiratory function, temperature. PCV, plasma glucose, lactate, βendorphin, ACTH, cortisol and catecholamine concentrations were measured before, during and after anaesthesia. Hypothermia, reduced PCV, slight hypotension (minimum value 84 ± 6 mmHg 20 min after induction of anaesthesia), hyperoxia and marked bradypnoea developed during anaesthesia. No acidaemia occurred. Plasma glucose concentration increased at the end of anaesthesia. There were no changes in plasma ACTH, cortisol and catecholamine concentrations, but plasma & endorphin increased after induction until the end of anaesthesia. There was a correlation between plasma lactate and β-endorphin concentrations (P<0.001, r=0.63), which may suggest that lactate stimulates βendorphin release. Beta-endorphin was apparently secreted independently from ACTH and appears to be a sensitive marker of a stress response.     

Stress responses during total intravenous anaesthesia in ponies with detomidine - guaiphenesin - ketamine

Six ponies were anaesthetised for two hours with intermittent injections of a combination of guaiphenesin (72 mg/kg/hr), ketamine (1.4 mg/kg/hr) and detomidine (0.015 mg/kg/hr) after premedication with detomidine 0.01 mg/kg and induction of anaesthesia with guaiphenesin 50 mg/kg and ketamine 2 mg/kg. Induction of anaesthesia was smooth, the ponies were easily intubated and after intubation breathed 100% oxygen spontaneously. During anaesthesia mean pulse rate ranged between 31–44 beats per minute and mean respiratory rate between 12–23 breaths per minute. Mean arterial blood pressure remained between 110–130 mm Hg, mean arterial carbon dioxide tension between 6.1–6.9 kPa and pH between 737–7.42. Arterial oxygen tension was over 23 kPa throughout anaesthesia. Plasma glucose increased to more than 25 mmol per litre during anaesthesia; there was no change in lactate or ACTH concentration and plasma cortisol concentration decreased. Recovery was rapid and smooth. A guaiphenesin, ketamine and detomidine combination appeared to offer potential as a total intravenous technique for maintenance of anaesthesia in horses.     

Effect of low-dose butorphanol on halothane minimum alveolar concentration in ponies

Minimum alveolar concentration (MAC) for halothane was measured before and after administration of intravenous butorphanol (0.022 and 0.044 mg/kg in bodyweight in nine yearling Shetland ponies. Arterial blood pressure, heart rate, respiratory rate, expired CO2 and rectal temperature was also measured. Even though mean MAC values decreased 10 and 9 per cent after the low and high doses respectively, they were not statistically different from those measured prior to butorphanol. Halothane MAC values increased after butorphanol in two ponies, both animals increasing locomotor activity and demonstrating apparent central nervous system stimulation. No significant differences were seen in any variable measured after butorphanol administration.     

Analysis of the frequency spectrum of the equine electroencephalogram during halothane anaesthesia

The electroencephalogram (EEG) has been used in human clinical anaesthesia as an indicator of cortical activity and as an indicator of the depth of anaesthesia. It would be useful if it provided a reliable indication of the depth of anaesthesia of horses. In this study anaesthesia was induced with thiopentone and maintained with halothane in nine ponies. The end tidal halothane concentration (P_E-Hal) was monitored and 20 seconds of EEG were recorded at 0·8 per cent, 1·0 per cent and 1·2 per cent halothane, equivalent to the minimum alveolar concentration (mac), 1·25 mac and 1.5 mac. Each 20 second block of data was divided into one second segments and averaged to give one second of averaged EEG from which a frequency spectrum was obtained by using a fast Fourier transformation. The power of the waveform at low frequency (1 to 3 Hz) was compared with that at higher frequency (9 to 11 Hz). The median frequency and 95th percentile (spectral edge) were also calculated. The spectral edge frequency had the best correlation with P_E-Hal