Cardiac dysrhythmias associated with gastric dilatation-volvulus in the dog

Of 16 dogs treated medically and surgically for gastric dilatation-volvulus, 11 developed electrocardiographic evidence of ventricular dysrhythmias. Seven of these dogs had ventricular dysrhythmias for the first time during their hospitalization after surgery. The ventricular dysrhythmias included ventricular premature depolarizations, slow ventricular rhythms, paroxysmal ventricular tachycardia, ventricular tachycardia, and multifocal ventricular tachycardia. Two of these dogs had electrocardiographic evidence of atrial premature depolarizations at the time of hospitalization. Treatment with lidocaine hydrochloride or procainamide hydrochloride was successful in reestablishing sinus rhythm in 9 of the 11 dogs with ventricular dysrhythmias.     

Hemodynamic effects of intravenous lidocaine in isoflurane anesthetized cats

Lidocaine dose‐dependently decreases the minimum alveolar concentration (MAC) of isoflurane in cats. The purpose of this study was to determine the hemodynamic effects of six lidocaine plasma concentrations in isoflurane anesthetized cats. Six cats were studied. After instrumentation, end‐tidal isoflurane concentration was set at 1.25 times the individual minimum alveolar concentration (MAC), which was determined in a previous study. Lidocaine was administered intravenously to target pseudo‐steady state plasma concentrations of 0, 3, 5, 7, 9, and 11 μg ml^–1, and isoflurane concentration was reduced to an equipotent concentration, determined in a previous study. Cardiovascular variables; blood gases; PCV; total protein and lactate concentrations; and lidocaine and monoethylglycinexylidide concentrations were measured at each lidocaine target concentration, before and during noxious stimulation. Derived variables were calculated. Data were analyzed using a repeated measures anova , followed by a Tukey test for pairwise comparisons where appropriate. One cat was excluded from analysis because the study was aborted at 7 μg ml^–1 due to severe cardiorespiratory depression. Heart rate, cardiac index, stroke index, right ventricular stroke work index, total protein concentration, mixed‐venous PO₂ and hemoglobin oxygen saturation, arterial and mixed‐venous bicarbonate concentrations, and oxygen delivery were significantly lower during lidocaine administration than when no lidocaine was administered. Mean arterial pressure, central venous pressure, pulmonary artery pressure, systemic and pulmonary vascular resistance indices, PCV, arterial and mixed‐venous hemoglobin concentrations, lactate concentration, arterial oxygen concentration, and oxygen extraction ratio were significantly higher during administration of lidocaine than when no lidocaine was administered. Most changes were significant at lidocaine target plasma concentrations of 7 μg ml^–1 and above. Noxious stimulation did not significantly affect most variables. Despite significantly decreasing in inhalant requirements, when combined with isoflurane, lidocaine produces greater cardiovascular depression than an equipotent dose of isoflurane alone. The use of lidocaine to reduce isoflurane requirements is not recommended in cats.     

Treatment of sustained monomorphic narrow‐complex ventricular tachycardia in a 16‐year‐old Arab mare with a constant rate of infusion of lidocaine and oral propranolol

A 16‐year‐old Arab mare was referred for treatment of a tachydysrhythmia detected on electrocardiogram by the referring veterinarian. Monomorphic, narrow‐complex ventricular tachycardia (VT) was confirmed by electro‐cardiogram in a normal base‐apex configuration. Subsequent diagnostic testing, including echocardiography and measurement of plasma cardiac troponin concentration, did not reveal a definitive cause for the dysrhythmia. Conversion of VT to ventricular bigeminy occurred following treatment with magnesium sulfate and lidocaine hydrochloride, administered intravenously. Treatment with orally administered propranolol subsequently led to conversion to sinus rhythm with intermittent ventricular premature complexes (VPCs). Oral prednisolone treatment was also initiated to address the possibility that VT resulted from underlying myocarditis. The mare was discharged with oral propranolol, a tapering course of prednisolone, and exercise restriction. Follow‐up cardiac examination 6 weeks later revealed persistent, intermittent VPCs and reversion to VT occurred during exercise. Sinus rhythm with intermittent VPCs was re‐established following the administration of lidocaine. The mare was again discharged with oral propranolol therapy, which was subsequently replaced with oral sotalol. Sudden death occurred 4 weeks later but a post mortem examination was not performed.     

In vitro effects of lidocaine on the contractility of equine jejunal smooth muscle challenged by ischaemia‐reperfusion injury

Reasons for performing study: Post operative ileus (POI) in horses is a severe complication after colic surgery. A commonly used prokinetic drug is lidocaine, which has been shown to have stimulatory effects on intestinal motility. The cellular mechanisms through which lidocaine affects smooth muscle activity are not yet known. Objectives: To examine the effects of lidocaine on smooth muscle in vitro and identify mechanisms by which it may affect the contractility of intestinal smooth muscle. Hypothesis: Ischaemia and reperfusion associated with intestinal strangulation can cause smooth muscle injury. Consequently, muscle cell functionality and contractile performance is decreased. Lidocaine can improve basic cell functions and thereby muscle cell contractility especially in ischaemia‐reperfusion‐challenged smooth muscle. Methods: To examine the effects of lidocaine on smooth muscle function directly, isometric force performance was measured in vitro in noninjured and in vivo ischaemia‐reperfusion injured smooth muscle tissues. Dose‐dependent response of lidocaine was measured in both samples. To assess membrane permeability as a marker of basic cell function, release of creatine kinase (CK) was measured by in vitro incubations. Results: Lidocaine‐stimulated contractility of ischaemia‐reperfusion injured smooth muscle was more pronounced than that of noninjured smooth muscle. A 3‐phasic dose‐dependency was observed with an initial recovery of contractility especially in ischaemia‐reperfusion injured smooth muscle followed by a plateau phase where contractility was maintained over a broad concentration range. CK release was decreased by lidocaine. Conclusion: Lidocaine may improve smooth muscle contractility and basic cell function by cellular repair mechanisms which are still unknown. Improving contractility of smooth muscle after ischaemia‐reperfusion injury is essential in recovery of propulsive intestinal motility. Potential relevance: Characterisation of the cellular mechanisms of effects of lidocaine, especially on ischaemia‐reperfusion injured smooth muscle, may lead to improved treatment strategies for horses with POI.     

Comparison of cardiovascular function and quality of recovery in isoflurane‐anaesthetised horses administered a constant rate infusion of lidocaine or lidocaine and medetomidine during elective surgery

Reasons for performing study: The effects of lidocaine combined with medetomidine or lidocaine alone on cardiovascular function during anaesthesia and their effects on recovery have not been thoroughly investigated in isoflurane‐anaesthetised horses. Objectives: To determine the effects of an intraoperative i.v. constant rate infusion of lidocaine combined with medetomidine (Group 1) or lidocaine (Group 2) alone on cardiovascular function and on the quality of recovery in 12 isoflurane‐anaesthetised horses undergoing arthroscopy. Hypothesis: The combination would depress cardiovascular function but improve the quality of recovery when compared to lidocaine alone in isoflurane‐anaesthetised horses. Methods: Lidocaine (2 mg/kg bwt i.v. bolus followed by 50 µg/kg bwt/min i.v.) or lidocaine (same dose) and medetomidine (5 µg/kg bwt/h i.v.) was started 30 min after induction of anaesthesia. Lidocaine administration was discontinued 30 min before the end of surgery in both groups, whereas medetomidine administration was continued until the end of surgery. Cardiovascular function and quality of recovery were assessed. Results: Horses in Group 1 had longer recoveries, which were of better quality due to better strength and overall attitude during the recovery phase than those in Group 2. Arterial blood pressure was significantly higher in Group 1 than in Group 2 and this effect was associated with medetomidine. No significant differences in cardiac output, arterial blood gases, electrolytes and acid‐base status were detected between the 2 groups. Conclusions and potential relevance: The combination of an intraoperative constant rate infusion of lidocaine and medetomidine did not adversely affect cardiovascular function in isoflurane‐anaesthetised horses and improved the quality of recovery when compared to an intraoperative infusion of lidocaine alone.     

Cardiopulmonary effects of thiopental/lidocaine combination during anesthetic induction in the dog

The cardiopulmonary effects and tendencies to produce ventricular arrhythmias were evaluated in 13 dogs given a surgical plane of anesthesia by thiopental (IV) or a combination of thiopental and lidocaine (IV). Thiopental (22 mg/kg of body weight) was compared with a combination of thiopental (11 mg/kg) and lidocaine (8.8 mg/kg). Preanesthetic agents were not given. Both methods for IV anesthesia provided a smooth induction suitable for easy intubation. The thiopental/lidocaine combination had a shorter duration, produced no arrhythmias, and resulted in less cardiopulmonary depression than did thiopental alone. Bigeminy developed after intubation during 19 of 20 thiopental inductions as compared with that in 0 of 22 thiopental/lidocaine inductions. The bigeminies were preceded by systemic hypertension and tachycardia which developed as the trachea was being intubated. The increase in aortic pressure and heart rate was minimal after intubation during the thiopental/lidocaine inductions. Five minutes after administration of thiopental alone, increases in heart rate, aortic pressure, total peripheral vascular resistance, and left ventricular systolic and end-diastolic pressures were observed. When these increases in rate, preload, and afterload were considered in relation to a stabile maximum positive first derivative of left ventricular pressure, left ventricular contractility was considered to be decreased. Mild respiratory acidosis and hypoxemia were present at 5 and 10 minutes after thiopental induction. Because the combination of thiopental/lidocaine had less cardiopulmonary depressive effects and protected against arrhythmias, it would appear to be a good method for anesthetic induction of the patient with cardiopulmonary disease. In the patient with normal cardiopulmonary function, thiopental produces only a moderate and reversible depression.     

Lidocaine converts acute vagally associated atrial fibrillation to sinus rhythm in German Shepherd dogs with inherited arrhythmias

BACKGROUND: Lidocaine is most frequently used to treat ventricular arrhythmias. However, lidocaine may have an antiarrhythmic effect for certain supraventricular arrhythmias. HYPOTHESIS: We hypothesized that lidocaine would be effective in converting experimentally induced atrial fibrillation (AF) to sinus rhythm and that a decrease in the dominant frequency (DF) and an increase in the organization as judged by the spectral entropy (SE) would occur over the course of the conversion. ANIMALS: Seven German Shepherd (GS) Dogs. METHODS: Dogs were anesthetized with fentanyl and pentobarbital. AF was induced with standard pacing protocols while left and right atrial monophasic action potentials (MAP) were recorded. The power spectra from the MAP recordings were analyzed to determine DF and SE during treatment with boluses of 2 mg/kg lidocaine. RESULTS: Lidocaine converted AF to sinus rhythm in all dogs and all episodes (n = 19). Conversion time was 27-87 seconds. After atropine, sustained AF was not induced; however, 5 episodes of atrial tachycardia resulted, and 3 were converted with lidocaine. Frequency domain analysis of 12 conversion sequences showed that left and right DF of the MAP signals decreased from the time of injection to conversion to sinus rhythm (P < .001). Mean SE indicated a gradient between the left and right atria (P = .003) that did not change during conversion. CONCLUSIONS AND CLINICAL IMPORTANCE: Vagally associated AF in GS dogs is terminated with lidocaine. Lidocaine is likely an effective treatment in clinical dogs with vagally associated AF.     

Use of intravenous lidocaine to prevent reperfusion injury and subsequent multiple organ dysfunction syndrome

Objective: The objective of this article is to review the human and veterinary literature and provide evidence for the potential beneficial effects of intravenous (IV) lidocaine hydrochloride in preventing post‐ischemic–reperfusion injury, the systemic inflammatory response syndrome (SIRS), and subsequent multiple organ dysfunction syndrome (MODS). Human data synthesis: Lidocaine is a local anesthetic and antiarrhythmic agent that has been used for years in human and veterinary medicine for the treatment of ventricular dysrhythmias associated with blunt cardiac trauma, myocardial ischemia, and cardiac surgery. More recently, the drug has been touted as a scavenger of reactive oxygen species (ROS), and has been used to prevent reperfusion dysrhythmias after treatment of myocardial infarction, cross‐clamping of the aorta, and in trauma medicine. Veterinary data synthesis: Although no clinical experiments with prophylactic intravenous lidocaine exist in veterinary medicine, there is a large body of evidence from experimental animals that support the use of lidocaine as a Na⁺/Ca²⁺ channel blocker, superoxide and hydroxyl radical scavenger, inflammatory modulator, and potent inhibitor of granulocyte functions. Lidocaine is being used in some clinical situations in an attempt to prevent the SIRS in veterinary trauma patients. ^a,b, ^a,b Conclusions: A large body of experimental evidence exists supporting the use of lidocaine as an anti‐oxidant and inflammatory modulator useful in preventing reperfusion injury. With the lack of cost‐effective and safe treatments for reperfusion injury in veterinary and human trauma medicine, the use of IV lidocaine to prevent the ensuing inflammatory response and MODS makes it an attractive addition to existing treatments. Therefore, it is essential that prospective clinical trials involving lidocaine as a treatment for prevention of reperfusion injury be performed in companion animals to demonstrate its safety and efficacy.     

Evaluation of the isoflurane-sparing effects of lidocaine infusion during umbilical surgery in calves

ObjectiveTo evaluate the isoflurane-sparing effects of lidocaine administered by constant rate infusion (CRI) during umbilical surgery in calves.Study designRandomized ‘blinded’ prospective clinical study.AnimalsThirty calves (mean 4.7 ± SD 2.5 weeks old) undergoing umbilical surgery.MethodsAfter premedication with xylazine (0.1 mg kg^?1, IM), anaesthesia was induced with ketamine (4 mg kg^?1, IV) and maintained with isoflurane in O₂ administered through a circle breathing system. The calves were assigned randomly to receive a bolus of 2 mg kg^?1 lidocaine IV after induction of anaesthesia, followed by CRI of 50 μg kg^?1 minute^?1 (group L, n = 15) or a bolus and CRI of 0.9% sodium chloride (NaCl, group S, n = 15). End-tidal isoflurane was adjusted to achieve adequate depth of anaesthesia. Heart rate, direct arterial blood pressure and body temperature were measured intraoperatively. Groups were compared by t- tests, anova or Mann–Whitney rank sum test as appropriate.ResultsThe end-tidal concentration of isoflurane (median, IQR) was significantly lower in group L [1.0% (0.94–1.1)] compared to group S [1.2% (1.1–1.5)], indicating a 16.7% reduction in anaesthetic requirement during lidocaine CRI. Cardiopulmonary parameters and recovery times did not differ significantly between groups.Conclusion and clinical relevanceLidocaine CRI may be used as a supplement to inhalation anaesthesia during umbilical surgery in calves in countries where such a protocol would be within the legal requirements for veterinary use in food animals. This study did not show any measurable benefit to the calves other than a reduction in isoflurane requirement.     

Determination of lidocaine concentrations producing therapeutic and toxic effects in dogs

Lidocaine was infused at a fixed zero-order rate to eight healthy mongrel dogs until tonic extension ( n = 5) and cortical seizures ( n = 7) were produced. Lidocaine concentrations determined at 5-min intervals were used to calculate concentrations at which these effects occurred. The tonic extension phase occurred at a mean lidocaine concentration of 8.21 ± 1.69 μg/ml. After a 1-month rest period, the same dogs were anaesthetized and ventricular tachycardia was produced by administering ouabain. Lidocaine was again infused at a fixed zero-order rate until all beats of ventricular origin were abolished. This occurred at a mean lidocaine concentration of 6.25 ± 1.49 μg/ml.     

Comparison of postoperative effects between lidocaine infusion,meloxicam, and their combination in dogs undergoing ovariohysterectomy

ObjectiveTo compare the postoperative analgesic effects of intravenous (IV) lidocaine, meloxicam, and their combination in dogs undergoing ovariohysterectomy.Study designProspective, randomized, double‐blind, controlled clinical trial.AnimalsTwenty‐seven dogs aged (mean ± SD) 16.1 ± 7.5 months and weighing 22.4 ± 17.9 kg scheduled for ovariohysterectomy.MethodsAnaesthesia was induced with propofol and maintained with isoflurane. Dogs (n = 9 in each group) were allocated to receive just prior to and during surgery one of the following regimens: M group, 0.2 mg kg^?1 IV meloxicam then a continuous rate infusion (CRI) of lactated Ringer's at 10 mL kg^?1 hour^?1; L group, a bolus of lidocaine (1 mg kg^?1 IV) then a CRI of lidocaine at 0.025 mg kg^?1 minute^?1; and M + L group, both the above meloxicam and lidocaine treatments. Pain and sedation were scored, and venous samples taken for serum cortisol and glucose measurement before and at intervals for 12 hours after anaesthesia. Pain scores were assessed using a multi‐parameter subjective scoring scale (cumulative scale 0–21) by three observers. The protocol stated that dogs with a total score exceeding 9 or a sub‐score above 3 in any one category would receive rescue analgesia. Sedation was scored on a scale of 0–4.ResultsThere were no significant differences in subjective pain scores, serum cortisol, and glucose concentrations between the three groups. The highest pain score at any time was 5, and no dog required rescue analgesia. None of the three regimens caused any observable side effects during or after anaesthesia. At 1 and 2 hours after extubation dogs in group L were significantly more sedated than in the other two groups.Conclusions and Clinical relevanceThis study suggests that, with the scoring system used, IV lidocaine and meloxicam provide similar and adequate post‐operative analgesia in healthy dogs undergoing ovariohysterectomy.     

Ventricular tachycardia in English bulldogs with localised right ventricular outflow tract enlargement

Objectives : To describe the electrocardiographic characteristics of ventricular tachycardia arising from the right ventricular outflow tract and the particular association between this arrhythmia and the presence of localised right ventricular outflow tract enlargement in English bulldogs. Methods : Five English bulldogs were referred with a history of syncope or cardiogenic shock. In all dogs, 12‐lead surface ECG, thoracic radiograph and echocardiography were collected. In all but one dog 24‐hours Holter monitoring and signal‐averaged ECGs was examined and in one dog electrophysiological study and radiofrequency catheter ablation of the VT substrate was performed. Results : Documented arrhythmias included a single sustained monomorphic wide QRS tachycardia in four dogs, and an alternans of two different monomorphic forms in one dog. Mean QRS duration during tachy‐cardia was 91·6 ±9·83 milliseconds. QRS complexes manifested a left bundle branch block morphology and an inferior axis (81 ±13·73°). R wave notching was present in the caudal (inferior) leads in three tachy‐cardias. Lead I was negative in 3 of 6, positive in 1 of 6 and isodiphasic in 2 of 6. Lead aVL was negative in 5 of 6 and positive in 1 of 6. Signal‐averaged electrocardiograms revealed late potentials in three dogs. Echocardiography showed a localised right ventricular outflow tract enlargement in all dogs. Cardiac map‐ping established two sites of origin of ventricular tachycardia within the right ventricular outflow tract in one dog: caudal free‐wall and cranial‐septal. Clinical Significance : The presence of a localised right ventricular outflow tract enlargement and ventricular tachycardia with left bundle branch block morphology could suggest segmental arrhythmogenic right ven‐tricular cardiomyopathy in the English bulldog.     

Prophylactic use of a lidocaine constant rate infusion versus saline in dogs undergoing balloon valvuloplasty for management of pulmonic stenosis: A randomized control trial

ObjectiveTo evaluate the effect of a prophylactic lidocaine constant rate infusion (CRI) on the incidence and malignancy of catheter-induced ventricular ectopic complexes (VECs) during balloon valvuloplasty for management of pulmonic stenosis in dogs.Study designSingle-centre, prospective, randomized study.AnimalsClient-owned dogs (n = 70) with pulmonic stenosis.MethodsDogs were randomly assigned to one of two anaesthetic protocols: administration of lidocaine 2 mg kg^–1 bolus followed by a CRI (50 μg kg^–1 minute^–1; group LD) or a saline placebo (group SL) during balloon valvuloplasty. All dogs were premedicated with methadone (0.3 mg kg^–1) intramuscularly and a digital three-lead Holter monitor was applied. Anaesthetic co-induction was performed with administration of alfaxalone (2 mg kg^–1) and diazepam (0.4 mg kg^–1), and anaesthesia was maintained with isoflurane vaporised in 100% oxygen. CRIs were started on positioning of the dog in theatre and discontinued as the last vascular catheter was removed from the heart. All dogs recovered well and were discharged 24 hours postoperatively. Blinded Holter analysis was performed by an external veterinary cardiologist using commercially available dedicated analysis software; p < 0.05.ResultsOf the 70 dogs enrolled in the study, 61 were included in the final analysis: 31 in group LD and 30 in group SL.There was no significant difference between sinus beats (p = 0.227) or VECs (p = 0.519) between groups. In group LD, 19/31 (61.3%) dogs had a maximum ventricular rate ≥250 units and 20/30 (66.7%) dogs in group SL (p = 0.791).Conclusion and clinical relevanceIn this study, the use of a prophylactic lidocaine bolus followed by CRI in dogs undergoing balloon valvuloplasty for management of pulmonic stenosis did not significantly decrease the incidence nor the malignancy of VECs during right heart catheterization compared with a saline CRI.     

Effect of a constant rate infusion of lidocaine on the quality of recovery from sevoflurane or isoflurane general anaesthesia in horses

REASONS FOR PERFORMING STUDY: Lidocaine constant rate infusions (CRIs) are common as an intraoperative adjunct to general anaesthesia, but their influence on quality of recovery has not been thoroughly determined. OBJECTIVES: To determine the effects of an intraoperative i.v. CRI of lidocaine on the quality of recovery from isoflurane or sevoflurane anaesthesia in horses undergoing various surgical procedures, using a modified recovery score system. HYPOTHESIS: The administration of intraoperative lidocaine CRI decreases the quality of recovery in horses. METHODS: Lidocaine (2 mg/kg bwt bolus followed by 50 microg/kg bwt/min) or saline was administered for the duration of surgery or until 30 mins before the end of surgery under isoflurane (n = 27) and sevoflurane (n = 27). RESULTS: Horses receiving lidocaine until the end of surgery had a significantly higher degree of ataxia and a tendency towards significance for a lower quality of recovery. There was no correlation between lidocaine plasma concentrations at recovery and the quality of recovery. CONCLUSIONS: Intraoperative CRI of lidocaine affects the degree of ataxia and may decrease the quality of recovery. POTENTIAL RELEVANCE: Discontinuing lidocaine CRI 30 mins before the end of surgery is recommended to reduce ataxia during the recovery period.     

Evaluation of anti-nociceptive effect of epidural tramadol, tramadol-lidocaine and lidocaine in goats

Objective To compare the anti‐nociceptive effect of tramadol, a combination of tramadol‐lidocaine, and lidocaine alone when administered in the epidural space. Study design Experimental randomized cross‐over study. Animals Seven healthy male goats, aged 9–11 months, weight 17.5–25.5 kg. Methods Treatments were lidocaine, 2.86 mg kg^?1, tramadol‐lidocaine (1 mg kg^?1 and 2.46 mg kg^?1, respectively) and tramadol (1 mg kg^?1) given into the epidural space. The volume of all treatments was 0.143 mL kg^?1. Nociception was tested by pin prick and by pressure from a haemostat clamp. Times to the onset and duration of anti‐nociception in the perineal region were recorded. Recumbency and ataxia were noted. Rectal temperature, heart rate and respiratory rate were recorded before and at 15 minute intervals for 2 hours after the administration of each treatment. Statistical comparison used one‐way anova with a post hoc Duncan’s test as a post hoc. Significance was taken as p < 0.05. Results Times (mean ± SD) to onset of and duration of loss of sensation, respectively in minutes were; lidocaine, 3 ± 1 and 85 ± 11), tramadol‐lidocaine 4 ± 1 and 140 ± 2; tramadol 12 ± 1 and 235 ± 18. Onset and duration times were significantly longer with tramadol than the other two treatments. Duration was significantly longer with tramadol‐lidocaine than with lidocaine alone. With lidocaine treatment all goats were severely ataxic or recumbent, after tramadol‐lidocaine mildly ataxic, and after tramadol not ataxic. Rectal temperature, heart and respiratory rates did not differ significantly from baseline after any treatment. Conclusions and clinical relevance The combination of tramadol‐lidocaine given by epidural injection produced an anti‐nociceptive effect in the perineal region, which was rapid in onset and had a longer duration of action than lidocaine alone. This combination might prove useful clinically to provide analgesia in goats for long‐duration obstetrical and surgical procedures but surgical stimuli were not investigated in this study.     

Effect of intravenous lidocaine on isoflurane MAC in dogs

Lidocaine decreases minimum alveolar concentration (MAC) of inhalational anesthetics. This study determined the influence of a low dose, 50 µg kg^?1 minute^?1 (LDI) and high dose, 200 µg kg^?1 minute^?1 (HDI) constant rate infusion of lidocaine on the MAC of isoflurane (I) in dogs. Ten mongrel dogs were anesthetized with I in oxygen and mechanically ventilated. End‐tidal anesthetic (Fe ′A) and CO₂ (Pe ′CO₂) concentrations were monitored at the endotracheal tube adaptor with an infrared gas analyzer calibrated before each experiment with a standardized calibration gas mixture designed for the analyzer. Pe ′CO₂ and body temperature were maintained within normal limits. Noxious stimuli included clamping the hindlimb paw (HC) and electrical current (50 V at 50 cycles second^?1 for 10 milliseconds pulse^?1) applied subcutaneously to the forelimb (FE) at the level of the ulna. After an initial equilibration period of at least 40 minutes at an Fe ′A of 1.7%, the Fe ′A was decreased to a value close to the estimated MAC for dogs. MAC was defined as the Fe ′A mid‐way between the value permitting and preventing purposeful movement. Following baseline MAC, a loading dose of 2 mg kg^?1 of lidocaine IV was administered over 3 minutes followed by the LDI, and MAC determinations for the combination started after 30 minutes of infusion. Once determined, the lidocaine infusion was stopped for 30 minutes and the dog maintained at the ETC that prevented movement without the lidocaine. Following this period, a second loading dose of lidocaine was given (2 mg kg^?1) over 3 minutes followed by the HDI, and the MAC determination procedure repeated after 30 minutes of infusion. Data were analyzed using an anova for repeated measures. MAC of I was 1.34 ± 0.035% (mean ± SEM) for both the FE and HC stimuli. The LDI significantly decreased MAC to 1.09 ± 0.043% (18.7% reduction) and HDI to 0.76 ± 0.030% (43.3% reduction). In conclusion, lidocaine infusions decreased the MAC of isoflurane in a dose‐dependent manner.     

Intravenous regional anesthesia in isoflurane anesthetized cats: lidocaine plasma concentrations and cardiovascular effects

Objective To determine if intravenous regional anesthesia (IVRA) can be used in cats without resulting in excessive plasma lidocaine concentrations or adverse cardiovascular effects. Study design Prospective, blinded crossover study. Animals Seven healthy male young adult cats weighing 3.96 ± 0.63 kg. Methods At 2.3% end‐tidal isoflurane concentration, lidocaine (L) 3 mg kg^?1 (1%) or saline (S) was injected in a distal cephalic venous catheter after application of two tourniquets to that forelimb which remained in place for 20 minutes. Heart and respiratory rates, arterial blood pressures and ECG were recorded every 5 minutes during tourniquet application and for 20 minutes following tourniquet removal. Lidocaine plasma concentrations were measured 5 minutes after injection and 0.5, 1, 2, 4, 8, 20 and 40 minutes after tourniquet removal. End tidal isoflurane concentrations were reduced to 1.5–2.0% to elicit a response to toe pinch (RTP) in the contralateral leg. The study was repeated similarly in the contralateral leg and RTP was graded for 40 minutes. Response was also tested in the leg previously injected, the differences between the two scores determined and those differences compared between the L and S treatments. The data were analyzed using anova for repeated measures comparing values to baseline. Significance was set at p < 0.005 using the Bonferroni method for multiple comparisons. Results There were no significant differences in physiologic parameters at either isoflurane concentration. Differences in RTP were significantly larger in the lidocaine treatment. The highest mean lidocaine concentrations were measured 0.5 minutes after tourniquet removal after both injections and were 2.79 ± 1.05 and 3.10 ± 1.11 µg mL^?1. The highest individual plasma concentration was 6.46 µg mL^?1. Conclusion No adverse hemodynamic effects were evident after IVRA lidocaine in any cat. The lidocaine dose studied inhibited a RTP until 20 minutes after tourniquet removal. Lidocaine concentrations varied and were measurable prior to tourniquet removal. Clinical relevance IVRA may be a suitable technique for cats undergoing surgery of the distal limbs.     

Resolution of sustained narrow complex ventricular tachycardia and tachycardia-induced cardiomyopathy in a Quarter Horse following quinidine therapy

Sustained narrow-QRS tachycardia of three months duration and left ventricular systolic dysfunction were identified in a fifteen-year-old Quarter Horse. No underlying cause for the tachyarrhythmia was found and no predisposing structural cardiac lesions were evident by echocardiography. Intravenous diltiazem and lidocaine were administered without achieving successful conversion of the arrhythmia. Oral quinidine therapy converted the tachyarrhythmia to sinus rhythm. Ventricular systolic dysfunction and chamber dilatation subsequently resolved. As with other species, echocardiographic features of dilated cardiomyopathy can be tachycardia-induced and may resolve following successful control of heart rate and rhythm.     

Cardiovascular effects of a continuous rate infusion of lidocaine in calves anesthetized with xylazine,midazolam, ketamine and isoflurane

ObjectiveTo assess the cardiovascular changes of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane during mechanical ventilation.Study designProspective, randomized, cross-over, experimental trial.AnimalsA total of eight, healthy, male Holstein calves, aged 10 ± 1 months and weighing 114 ± 11 kg were included in the study.MethodsCalves were administered xylazine followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane (1.3%) using mechanical ventilation. Forty minutes after induction, lidocaine (2 mg kg^?1 bolus) or an equivalent volume of saline (0.9%) was administered IV followed by a continuous rate infusion (100 μg kg^?1 minute^?1) of lidocaine (treatment L) or saline (treatment C). Heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP and MAP), central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), pulmonary arterial occlusion pressure (PAOP), cardiac output, end-tidal carbon dioxide (Pe’CO₂) and core temperature (CT) were recorded before lidocaine or saline administration (Baseline) and at 20-minute intervals (T20-T80). Plasma concentrations of lidocaine were measured in treatment L.ResultsThe HR was significantly lower in treatment L compared with treatment C. There was no difference between the treatments with regards to SAP, DAP, MAP and SVRI. CI was significantly lower at T60 in treatment L when compared with treatment C. PAOP and CVP increased significantly at all times compared with Baseline in treatment L. There was no significant difference between times within each treatment and between treatments with regards to other measured variables. Plasma concentrations of lidocaine ranged from 1.85 to 2.06 μg mL^?1 during the CRI.Conclusion and clinical relevanceAt the studied rate, lidocaine causes a decrease in heart rate which is unlikely to be of clinical significance in healthy animals, but could be a concern in compromised animals.     

Evaluation of the isoflurane‐sparing effects of fentanyl,lidocaine, ketamine,dexmedetomidine, or the combination lidocaine‐ketamine‐dexmedetomidine during ovariohysterectomy in dogs

ObjectiveTo evaluate the isoflurane‐sparing effects of an intravenous (IV) constant rate infusion (CRI) of fentanyl, lidocaine, ketamine, dexmedetomidine, or lidocaine‐ketamine‐dexmedetomidine (LKD) in dogs undergoing ovariohysterectomy.Study designRandomized, prospective, blinded, clinical study.AnimalsFifty four dogs.MethodsAnesthesia was induced with propofol and maintained with isoflurane with one of the following IV treatments: butorphanol/saline (butorphanol 0.4 mg kg^?1, saline 0.9% CRI, CONTROL/BUT); fentanyl (5 μg kg^?1, 10 μg kg^?1 hour^?1, FENT); ketamine (1 mg kg^?1, 40 μg kg^?1 minute^?1, KET), lidocaine (2 mg kg^?1, 100 μg kg^?1 minute^?1, LIDO); dexmedetomidine (1 μg kg^?1, 3 μg kg^?1 hour^?1, DEX); or a LKD combination. Positive pressure ventilation maintained eucapnia. An anesthetist unaware of treatment and end‐tidal isoflurane concentration (Fe′Iso) adjusted vaporizer settings to maintain surgical anesthetic depth. Cardiopulmonary variables and Fe′Iso concentrations were monitored. Data were analyzed using anova (p < 0.05).ResultsAt most time points, heart rate (HR) was lower in FENT than in other groups, except for DEX and LKD. Mean arterial blood pressure (MAP) was lower in FENT and CONTROL/BUT than in DEX. Overall mean ± SD Fe′Iso and % reduced isoflurane requirements were 1.01 ± 0.31/41.6% (range, 0.75 ± 0.31/56.6% to 1.12 ± 0.80/35.3%, FENT), 1.37 ± 0.19/20.8% (1.23 ± 0.14/28.9% to 1.51 ± 0.22/12.7%, KET), 1.34 ± 0.19/22.5% (1.24 ± 0.19/28.3% to 1.44 ± 0.21/16.8%, LIDO), 1.30 ± 0.28/24.8% (1.16 ± 0.18/32.9% to 1.43 ± 0.32/17.3%, DEX), 0.95 ± 0.19/54.9% (0.7 ± 0.16/59.5% to 1.12 ± 0.16/35.3%, LKD) and 1.73 ± 0.18/0.0% (1.64 ± 0.21 to 1.82 ± 0.14, CONTROL/BUT) during surgery. FENT and LKD significantly reduced Fe′Iso.Conclusions and clinical relevanceAt the doses administered, FENT and LKD had greater isoflurane‐sparing effect than LIDO, KET or CONTROL/BUT, but not at all times. Low HR during FENT may limit improvement in MAP expected with reduced Fe′Iso.