Effects of head-down positioning on regional central nervous system perfusion in isoflurane-anesthetized horses

OBJECTIVE: To test the hypothesis that head-down positioning in anesthetized horses increases intracranial pressure (ICP) and decreases cerebral and spinal cord blood flows. ANIMALS: 6 adult horses. PROCEDURES: For each horse, anesthesia was induced with ketamine hydrochloride and xylazine hydrochloride and maintained with 1.57% isoflurane in oxygen. Once in right lateral recumbency, horses were ventilated to maintain normocapnia. An ICP transducer was placed in the subarachnoid space, and catheters were placed in the left cardiac ventricle and in multiple vessels. Blood flow measurements were made by use of a fluorescent microsphere technique while each horse was in horizontal and head-down positions. Inferential statistical analyses were performed via repeated-measures ANOVA and Dunn-Sidak comparisons. RESULTS: Because 1 horse developed extreme hypotension, data from 5 horses were analyzed. During head-down positioning, mean +/- SEM ICP increased to 55+/-2 mm Hg, compared with 31+/-2 mm Hg during horizontal positioning; cerebral perfusion pressure was unchanged. Compared with findings during horizontal positioning, blood flow to the cerebrum, cerebellum, and cranial portion of the brainstem decreased significantly by approximately 20% during head-down positioning; blood flows within the pons and medulla were mildly but not significantly decreased. Spinal cord blood flow was low (9 mL/min/100 g of tissue) and unaffected by position. CONCLUSIONS AND CLINICAL RELEVANCE: Head-down positioning increased heart-brain hydrostatic gradients in isoflurane-anesthetized horses, thereby decreasing cerebral blood flow and, to a greater extent, increasing ICP. During anesthesia, CNS regions with low blood flows in horses may be predisposed to ischemic injury induced by high ICP.     

Use of bispectral index to monitor depth of anesthesia in isoflurane-anesthetized dogs

OBJECTIVE: To evaluate the correlation between the bispectral index (BIS) and end-tidal isoflurane (ET(ISO)) concentration and compare the use of 3 BIS sensor positions in dogs. ANIMALS: 6 adult dogs. PROCEDURES: Mechanically ventilated dogs received pancuronium, and depth of anesthesia was altered by increasing ET(ISO) concentration from 1.5% to 2.3% and 3.0%. The BIS, suppression ratio (relative percentage of isoelectric electroencephalographic waveforms), and signal quality index (SQI) were recorded at each ET(ISO) concentration for each of 3 BIS sensor positions (frontal-occipital, bifrontal, and frontal-temporal positions). RESULTS: The BIS and ET(ISO) concentration were poorly correlated; regardless of sensor positioning, mean BIS values did not change significantly as ET(ISO) was increased. At 3% isoflurane, regardless of sensor positioning, there was an increase in suppression ratio coincident with BIS < 40 in some dogs, whereas paradoxic increases in BIS (> 60) were recorded in others. Furthermore, at 3.0% isoflurane, the SQI was significantly lower for the bifrontal sensor position (compared with values for the other positions), but low SQI values prevented recording of BIS values from the frontal-occipital sensor position in 2 dogs. Overall, BIS values derived from the 3 sensor positions did not differ. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs, BIS values may not reflect changes in depth of isoflurane anesthesia in the absence of noxious stimulation. Of the 3 sensor positions, frontal-temporal positioning provided better correlation with changes in depth of anesthesia induced via changes in isoflurane concentrations. However, the sensor placements yielded similar results at SQI values > 50.     

Imaging suppurative infections of the central nervous system in horses

Suppurative infections are typically caused by pyogenic bacteria, and are characterised by the formation of purulent exudates (pus). These infections may occur anywhere in the body and are particularly life‐threatening when pertaining to the central nervous system (CNS). Suppurative infections of the CNS may be due to trauma, local extension of disease, and haematogenous spread. In horses, suppurative infections are an important cause of morbidity and mortality, but only infrequently involve the CNS. The gross morphology of suppurative inflammation is described as phlegmon, abscess and empyema, with each form having characteristic morphological features that may be identified during advanced imaging of the CNS. In horses with known or suspected suppurative infection of the CNS, imaging may be performed to reduce diagnostic uncertainty, determine prognosis, or to describe the character and extent of the disease to guide case management.     

Clinical use of yohimbine as an antagonist of xylazine depression of the central nervous system in cats

Antagonizing effects of various doses of yohimbine on a xylazine depression of the cerebroneural system (CNS) were studied in cats. Administration of various doses of yohimbine was investigated with respect to its antagonizing effects on various doses of xylazine. The time of CNS depression induced by commonly recommended doses of xylazine (2-4 mg/kg live weight) was shortened statistically significantly by intramuscular injections of yohimbine at a dose of 3 mg per kg live weight. After this yohimbine dose, the animals recovered consciousness already 10-15 minutes from application, with the complete resumption of reflexes. Preventive administration of the same dose of yohimbine hindered reliably the full development of CNS depression after the two xylazine doses (2 and 4 mg/kg live weight).     

Inoculation of Sarcocystis neurona merozoites into the central nervous system of horses

Equine protozoal myeloencephalitis (EPM) is a neurologic syndrome in horses from the Americas and is usually caused by infection with the apicomplexan parasite, Sarcocystis neurona. A horse model of EPM is needed to test the efficacy of chemotherapeutic agents and potential vaccines. Five horses that were negative for antibodies to S. neurona in their serum and cerebrospinal fluid (CSF) were injected in the subarachnoid space with living merozoites of the SN2 isolate of S. neurona. None of the horses developed clinical disease or died over a 132-day observation period. All five horses developed antibodies to S. neurona in their CSF and serum 3-4 weeks after injection. Two of the horses were examined at necropsy and no parasite induced lesions were observed in their tissues and no parasites were recovered from portions of their spinal cords inoculated on to cell cultures. Results of this study demonstrate that merozoites of the SN2 isolate of S. neurona will induce seroconversion but not clinical disease when inoculated directly into the CSF of nonimmune horses.     

Estrone sulfate concentrations as an indicator of fetal demise in horses

Serum and urinary estrone sulfate concentrations were determined in 7 pregnant mares before and after prostaglandin-induced abortion (n = 4) or surgical removal of the fetus (n = 3) to determine the source of estrogen during early pregnancy (gestation days [GD] 44 to 89). Estrone sulfate concentrations also were determined in serum samples (stored frozen for 2 years) from 3 mares that had been ovariectomized between GD 51 and 58. Estrone sulfate concentrations decreased in serum and urine after expulsion or removal of the fetus (urinary patterns were more definitive than were patterns for serum), whereas a transient decrease in serum estrone sulfate concentration was observed after ovariectomy. Seemingly, products of conception are the major source of estrone sulfate during early pregnancy, although there appears to be some ovarian contribution. Serum or urinary estrone sulfate measurements provide a simple and accurate test for fetal viability after GD 44 in the mare.     

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.     

Evaluation of an in-shoe pressure measurement system in horses

OBJECTIVE: To develop an objective, accurate method for quantifying forelimb ground reaction forces in horses by adapting a human in-shoe pressure measurement system and determine the reliability of the system for shod and unshod horses. ANIMALS: 6 adult Thoroughbreds. PROCEDURE: Horses were instrumented with a human in-shoe pressure measurement system and evaluated at a trot (3 m/s) on a motorized treadmill. Maximum force, stance time, and peak contact area were evaluated for shod and unshod horses. Three trials were performed for shod and unshod horses, and differences in the measured values were examined with a mixed model ANOVA for repeated measures. Sensor accuracy was evaluated by correlating measured variables to clinically observed lameness and by a variance component analysis. RESULTS: 4 of 6 horses were determined to be lame in a forelimb on the basis of clinical examination and measured values from the system. No significant differences were observed between shod and unshod horses for maximum force and stance time. A significant decrease in peak contact area was observed for shod and unshod horses at each successive trial. Maximum force measurements provided the highest correlation for detecting lameness (r = 0.91, shod horses; r = 1.0, unshod horses). A variance component analysis revealed that 3 trials provided a variance of 35.35 kg for maximum force (+/- 5.78% accuracy), 0.007 seconds for stance time (+/- 2.5% accuracy), and 8.58 cm2 for peak contact area (+/- 11.95% accuracy). CONCLUSIONS AND CLINICAL RELEVANCE: The in-shoe pressure measurement system provides an accurate, objective, and effective method to evaluate lameness in horses.     

Observations of the potency and duration of vecuronium in isoflurane-anesthetized horses

ObjectiveTo evaluate the potency and duration of three subparalyzing doses of vecuronium (VEC) in isoflurane-anesthetized horses.Study designProspective experimental study.AnimalsThirteen healthy adult horses undergoing arthroscopic surgery.MethodsDuring isoflurane anesthesia, horses received one of three doses of vecuronium (25, 50, or 100 μg kg^?1). Neuromuscular transmission was monitored with acceleromyography (AMG) with train-of-four (TOF) stimulation of the radial nerve. Maximal depression of the first twitch (T1), and onset time were recorded for each dose. Recovery time to a TOF ratio >90% was also evaluated.ResultsVecuronium 25 μg kg^?1 produced no observable T1 depression in four horses. VEC 50 μg kg^?1 (n = 5) produced a maximal T1 depression of [median (min, max)] 41 (20, 71) % in four horses, and no neuromuscular block was seen in the fifth. VEC 100 μg kg^?1 was given to four horses and produced a T1 depression of 73 (64, 78) %. Of the four horses in which VEC 50 μg kg^?1 produced a measurable neuromuscular block, three recovered spontaneously 43 (40, 52) minutes after VEC administration; a fourth subject received edrophonium to reverse residual block at the end of the surgery. Spontaneous recovery after VEC 100 μg kg^?1 occurred by 112 minutes in one horse, and had to be facilitated by edrophonium in the remaining three horses, more than 2 hours after VEC had been given.Conclusions and clinical relevanceA dose of 100 μg kg^?1 VEC in isoflurane anesthetized horses failed to produce complete paralysis. The partial neuromuscular block lasted at least 2 hours after this dose had been administered. Edrophonium was required to reverse the neuromuscular block in three of four horses. It is likely that more than 100 μg kg^?1 VEC would be necessary for complete neuromuscular blockade in horses, and that this dose will last >2 hours.     

Mean platelet component as an indicator of platelet activation in foals and adult horses

BACKGROUND: Mean platelet component (MPC) is a new platelet variable, measured by modern commercial complete blood count analyzers, that is reduced during platelet activation in humans and small animals. HYPOTHESIS: MPC decreases in horses with clinical conditions that cause platelet activation and disseminated intravascular coagulation (DIC). ANIMALS: We obtained 418 CBCs from 100 sick and 20 healthy neonates and 178 sick and 45 sound adult horses. Sick neonates were classified into septic and nonseptic, and DIC and non-DIC groups. Adults were grouped by diagnoses (systemic inflammatory disorders, gastrointestinal problems, and thrombocytopenia). METHODS: MPC together with platelet count, mean platelet volume, platelet distribution width, and platelet component distribution width were measured with a commercial analyzer and compared between the different disease and control groups in neonates and in adults. RESULTS: MPC values were significantly lower in the septic and nonseptic neonates (24.0 +/- 3.5 g/dL and 26.6 +/- 2.6 g/dL, respectively) than in the control group (28.1 +/- 1.7 g/dL). Neonates with DIC had the lowest MPC values (23.8 +/- 6.3 g/dL). MPC values in adult horses were significantly lower in the inflammatory (23.5 +/- 4.7 g/dL), gastrointestinal obstruction (23.0 +/- 5.0 g/dL), enteritis (23.6 +/- 4.6 g/dL), ischemic (23.9 +/- 5.1 g/dL), and thrombocytopenia (20.2 +/- 5.7 g/dL) groups when compared with control horses (26.2 +/- 3.5 g/dL). Other platelet variables were not different between the control and the disease groups. CONCLUSION AND CLINICAL IMPORTANCE: MPC might be a useful variable for quickly and easily detecting platelet activation in sick neonates and adult horses.     

Antagonistic effect of idazoxan on xylazine-induced central nervous system depression and bradycardia in calves

Two doses of an alpha 2-adrenoreceptor antagonist, idazoxan, were administered to reverse the CNS depressant and bradycardia effects of xylazine in calves. Once a week for 3 weeks, each of 6 calves were administered IV one treatment of: (1) 0.2 mg of xylazine/kg of body weight followed in 10 minutes by 1 ml of 0.9% NaCl, (2) 0.2 mg of xylazine/kg followed in 10 minutes by 10 micrograms of idazoxan/kg, or (3) 0.2 mg of xylazine/kg followed in 10 minutes by 30 micrograms of idazoxan/kg. The order of the 3 treatments in each calf was selected at random. Xylazine alone caused lateral recumbency for 27.2 +/- 3.0 minutes (mean +/- SEM). Idazoxan administered at dosages of 10 and 30 micrograms/kg shortened xylazine-induced lateral recumbency to 11.5 +/- 0.8 and 10.3 +/- 0.2 minutes, respectively. Calves given xylazine alone stood at greater than 60 minutes after the onset of recumbency. Idazoxan given at dosages of 10 and 30 micrograms/kg shortened the time to standing to 16.8 +/- 1.7 and 11.3 +/- 0.2 minutes, respectively. Idazoxan given at a dosage of 30 micrograms/kg also reversed xylazine-induced bradycardia. Results indicated that idazoxan should be a useful antidote for xylazine overdose in cattle.     

Assessment of the IgG index in dogs by indirect immunoenzimatic assays as diagnostic tool for inflammatory diseases of central nervous system

The IgG index measures the intrathecal immunoglobulin production and it is a useful tool for diagnosis of inflammatory diseases involving the central nervous system. This index is based on the precise quantification of albumin and IgG in canine cerebrospinal fluid and serum. Here, we report the development of an indirect competitive ELISAs for the detection of both antigens. Thirty-two dogs were included in this study, divided into three experimental groups. Group A was composed of 22 healthy animals, as determined by standard clinical examination. In group B, six animals, presented neurological pathologies associated with endogenous IgG production and, in group C four animals presented neurological diseases or symptoms not associated with intrathecal IgG production. Cerebrospinal fluid and serum samples were obtained from these animals. As expected, by using the indirect ELISAs proposed here, the IgG indexes obtained in healthy animals (A) were 0.371+/-0.252 (SD). In B and C, the values (3.002+/-1.897; 0.36+/-0.306, respectively), were in agreement with the pathologic conditions of the individuals in each group. Thus, the immunometric competition ELISA methods proposed here allow the discrimination of abnormal intrathecal IgG production, in a variety of inflammatory pathologic conditions of the central nervous system.     

Bispectral index as an indicator of anaesthetic depth during isoflurane anaesthesia in the pig

The objective of the study was to examine the relationship between the ‘depth’ of anaesthesia - as determined by clinical signs - and the bispectral index (BIS). Electroencephalograms (EEG)s were recorded in 8 female and 8 castrated male, healthy Norwegian landrace pigs undergoing isoflurane anaesthesia, from which the bispectral index (BIS) was calculated. Isoflurane was delivered in pure oxygen at end-tidal concentrations of 1.6, 1.9, 2.2 and 2.5%, in randomised order, for 30 min after which the EEG was recorded over a 5 min period. Anaesthetic depth was evaluated on a visual analogue scale (VAS) by an experienced anaesthetist. The 95% confidence interval for the mean correlation coefficient between BIS and VAS was calculated to be -0.52–0.30. Confidence intervals (95%) for the mean change in the BIS obtained during the conscious state and that obtained during anaesthesia at different isoflurane concentrations was also calculated. There was a significant decrease in the BIS recorded during consciousness and after 1.6% isoflurane anaesthesia, and between readings after inhalation of 2.2% and 2.5% isoflurane. This indicates that BIS does not accurately reflect ‘depth’ at surgical levels of isoflurane anaesthesia in the pig, and is of no use for this purpose.     

Inflammatory disease of the central nervous system

Inflammatory diseases involving the central nervous system can be difficult to diagnose and frustrating to treat. The clinician can maximize successful treatment of these patients by recognizing the clinical signs in the early stages of disease, following a logical diagnostic plan to identify the specific etiologic agent involved, and formulating an appropriate and aggressive therapeutic plan. Treatment will not always be successful owing to lack of effective treatments and irreversible neurologic damage.