Pulse oximetry--a non-invasive method for direct and continuous monitoring of oxygen saturation and pulse rate--comparative studies with blood gas analysis and hemoreflectometry in the dog, swine and sheep

The use of pulse oximeters as a non-invasive, real time and online method for the continuous monitoring of oxygen saturation is discussed and compared to other methods like hemoreflectometry, and blood gas analysis. Analyses of linear regression show extraordinarily good correlations between all three monitoring systems. Pulse oximetry and hemoreflectometry on the one hand and blood gas analysis on the other hand sometimes show quite differing values of oxygen saturation. This phenomenon is due to the fact that the measuring methods are based on different working principles as well as it can be explained by the various hemoglobin-types. The pulse rate also measured by the pulse oximeter is nearly completely identical to the heart rate of the ECG. A slight temporal delay between the two acoustic signals is noticed and justified. Pulse oximetry seems to be superior to other oxygen monitoring systems because of its continuous noninvasive measuring technique.     

Agreement of SpO2, SaO2 and ScO2 in anesthetized cynomolgus monkeys (Macaca fascicularis)

Objective To assess the agreement between three measurements of arterial oxygen saturation (SpO₂, SaO₂ and ScO₂) in anesthetized cynomolgus monkeys. Study Design Prospective study. Animals Eleven mature, male cynomolgus monkeys (Macaca fasicularis). Methods Monkeys were anesthetized with intramuscular ketamine followed by intravenous propofol. The trachea of each was intubated and the lungs ventilated. Arterial oxygen saturation was measured with a Nonin 8500 V pulse oximeter, using a lingual clip on the cheek. Arterial blood samples were taken from an indwelling catheter. Inspired oxygen concentration was varied from 12 to 20%, and 88 paired arterial blood samples and saturation measurements were taken. Arterial oxygen saturation in the blood samples was measured using a cooximeter. The saturation was also calculated from the arterial oxygen tension using the Adair equation. The results were compared using Bland and Altman's method. Results The pulse oximeter readings were 2.7% higher than that of the cooximeter, with a limit of agreement of ?3.9 to 9.3%. The pulse oximeter readings were 1.8% higher than the calculated saturation, with a limit of agreement of ?6.5% to 10.1%. The cooximeter readings were 0.9% lower than the calculated saturation, with a limit of agreement of ?5.6% to 3.8%. Conclusions The agreement between SpO₂ and other measurements of arterial oxygen saturation in this study is typical for this technique. The bias and limits of agreement are consistent with reports in other species. Clinical relevance The Nonin 8500 V is a useful pulse oximeter for clinical use in primates.     

Steady-state response characteristics of a pulse oximeter on equine intestine

The steady-state response characteristics of a pulse oximeter were evaluated on intestinal segments of seven clinically normal halothane-anesthetized horses. Arterial oxygen tension greater than 200 mm of Hg, end tidal carbon dioxide from 30 to 35 mm of Hg, and systemic mean arterial pressure greater than 70 mm of Hg were maintained throughout the recording periods. Values for percentage of pulse oximeter oxygen saturation, pulsatile blood flow, and percentage of signal strength were recorded from jejunum, ileum, cecum, left ventral colon, left dorsal colon, and descending colon. Probe placement on intestinal segments was recorded as over or not over visible subserosal or transmural vessels. There was no significant difference between median values on the basis of vessel codes for pulse oximeter oxygen saturations, pulsatile flow, and signal strength. Median values recorded for pulse oximeter oxygen saturation were 93% from jejunum and ileum and 95% from cecum, left ventral colon, left dorsal colon, and descending colon; median values for pulsatile flow were 576 from jejunum, 560 from ileum, 560 from cecum, 574 from left ventral colon, 578 from left dorsal colon, and 560 from descending colon; median values for signal strength were 50% from jejunum, 67.5% from ileum, 60% from cecum, 75% from left ventral colon, 50% from left dorsal colon, and 52.5% from descending colon. Median values obtained from each anatomic location were not significantly different for pulsatile flow or signal strength. Median pulse oximetry oxygen values recorded from jejunum and ileum were significantly lower than values obtained from other intestinal segments.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pulse Oximetry in Horses

The clinical usefulness of two pulse oximeters was evaluated at two probe sites in nine anesthetized horses. The hemoglobin saturation determined by the pulse oximeters (SaOx) was compared with the hemoglobin saturation calculated from the measured arterial oxygen tension (SaO2). The mean and standard deviation (SD) were calculated from the differences in saturation measurements, over the saturation range of 80% to 100%, for each oximeter used at the tongue probe site and for one oximeter used at the ear. The oximeter results tended to underestimate the SaO2 with mean differences of -3.7% on the tongue and -6.0% on the ear. The limits of agreement were defined as the mean difference +/- 2 SD. Each oximeter used at the tongue produced limits of agreement of +1% to -8%, which meant that 95% of the SaOx values were 1 percentage point above or 8 percentage points below the SaO2. The variability of the differences and limits of agreement were larger when the ear was used as the probe site and at saturations less than 80%. Although both oximeters tended to underestimate the SaO2, they appeared to be clinically useful in detecting changes in arterial hemoglobin saturation.     

The use of pulse oximetry in clinical veterinary anaesthesia

A commercial human pulse oximeter was used in several species to measure heart rate and arterial oxygen saturation (SaO₂), and the results compared with those from an ECG and bench oximeter. The heart rates were always the same, but differences in the SaO₂ ranged between 4.2 per cent to 10.3 per cent. Correlation coefficients between the two SaO₂ measurement techniques ranged from 0.81 to 0.94, depending on the species investigated.     

Evaluation of the reliability of pulse oximetry,at different attachment sites,to detect hypoxaemia in immobilized impala (Aepyceros melampus)

ObjectiveEvaluation of the reliability of pulse oximetry at four different attachment sites compared to haemoglobin oxygen saturation measured by a co-oximeter and calculated by a blood gas analyser in immobilized impala.Study designRandomized crossover study.AnimalsA total of 16 female impala.MethodsImpala were immobilized with etorphine or thiafentanil alone, or etorphine in combination with a novel drug. Once immobilized, arterial blood samples were collected at 5 minute intervals for 30 minutes. Then oxygen was insufflated (5 L minute⁻¹) intranasally at 40 minutes and additional samples were collected. A blood gas analyser was used to measure the arterial partial pressure of oxygen and calculate the oxygen haemoglobin saturation (cSaO₂); a co-oximeter was used to measure the oxygen haemoglobin saturation (SaO₂) in arterial blood. Pulse oximeter probes were attached: under the tail, to the pinna (ear) and buccal mucosa (cheek) and inside the rectum. Pulse oximeter readings [peripheral oxygen haemoglobin saturation (SpO₂) and pulse quality] were recorded at each site and compared with SaO₂ and cSaO₂ using Bland-Altman and accuracy of the area root mean squares (A_rms) methods to determine the efficacy. P value < 0.05 was considered significant.ResultsPulse quality was ‘good’ at each attachment site. SpO₂ measured under the tail was accurate and precise but only when SaO₂ values were above 90% (bias = 3, precision = 3, A_rms = 4). The ear, cheek and rectal probes failed to give accurate or precise readings (ear: bias = −4, precision = 14, A_rms = 15; cheek: bias = 12, precision = 11, A_rms = 16; and rectum: bias = 5, precision = 12, A_rms = 13).Conclusions and clinical relevanceIn order to obtain accurate and precise pulse oximetry readings in immobilized impala, probes must be placed under the tail and SaO₂ must be above 90%. Since SaO₂ values are usually low in immobilized impala, pulse oximeter readings should be interpreted with caution.     

Evaluation of accuracy of pulse oximetry in newborn calves

In human medicine, pulse oximetry is widely used to measure non-invasively and accurately the percentage of oxygen saturation of arterial haemoglobin (SpO(2)). Recently, pulse oximetry has been used in calves, but its accuracy has not been evaluated in newborn calves. The purpose of this study was to evaluate the accuracy of a pulse oximeter in newborn calves by comparing SpO(2) with arterial oxyhaemoglobin saturation (SaO(2)) obtained by use of a blood gas analyser. Fifty-five newborn calves were investigated from birth to 20 days old. Pulse oximetry readings and arterial blood samples were performed 5, 15, 30, 45, 60 min, 2, 3, 6, 12, 24 h and 1 and 3 weeks after birth. The transmission-type sensors of the pulse oximeter were fixed at the recommended site in the bovine species (at the base of the calf tail, where the skin had been shaved and was not pigmented) and arterial blood samples were withdrawn from the subclavian artery and analysed for SaO(2). Five-hundred paired data of SaO(2) and mean SpO(2)(mSpO(2)) were collected. Linear regression of the pooled data indicated a highly significant correlation of mSpO(2) with SaO(2) (r = 0.87;P< 0.001; mSpO(2) = 15.8 + 0.84 SaO(2)). The overall data bias value was positive (+2.1%), which indicated that the pulse oximeter tended to overestimate the SaO(2). The bias value for each SaO(2) category tended to become higher for lower ranges of SaO(2). Precision was also lower when SaO(2) values were low. The lower the SaO(2) value, the higher the positive bias (overestimation) and the lower the precision. These results suggest that pulse oximetry provides a relatively accurate non-invasive, immediate and portable method to monitor SaO(2) and to evaluate objectively the pulmonary function effectiveness in newborn calves during their adaptation to extra-uterine life.     

Accuracy of a third (Dolphin Voyager) versus first generation pulse oximeter (Nellcor N-180) in predicting arterial oxygen saturation and pulse rate in the anesthetized dog

OBJECTIVE: To compare the accuracy of a 3rd (Dolphin Voyager) versus 1st generation pulse oximeter (Nellcor N-180). STUDY DESIGN: Prospective laboratory investigation. ANIMALS: Eight adult dogs. METHODS: In anesthetized dogs, arterial oxygen saturation (SpO(2)) was recorded simultaneously with each pulse oximeter. The oxygen fraction in inspired gas (FiO(2)) was successively reduced from 1.00 to 0.09, with re-saturation (FiO(2) 0.40) after each breathe-down step. After each 3-minute FiO(2) plateau, SpO(2) and pulse rate (PR) were compared with the fractional arterial saturation (SaO(2)) and PR determined by co-oximetry and invasive blood pressure monitoring, respectively. Data analysis included Bland-Altman (B-A) plots, Lin's concordance correlation factor (rho(c)), and linear regression models. RESULTS: Over a SaO(2) range of 33-99%, the overall bias (mean SpO(2) - SaO(2)), precision (SD of bias), and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were 4.3%, 4.4%, and 6.1%, and 3.2%, 3.0%, and 4.3%, respectively. Bias increased at SaO(2) < 90%, more so with the Dolphin Voyager (from 1.6% to 8.6%) than Nellcor N-180 (from 3.2% to 4.5%). The SpO(2) readings correlated significantly with SaO(2) for both the Dolphin Voyager (rho(c) = 0.94) and Nellcor N-180 (rho(c) = 0.97) (p < 0.001). Regarding PR, bias, precision, and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were -0.5, 4.6, and 4.6 and 1.38, 4.3, and 4.5 beats minute(-1), respectively. Significant correlation existed between pulse oximeter and directly measured PR (Dolphin Voyager: rho(c) = 0.98; Nellcor N-180: rho(c) = 0.99) (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: In anesthetized dogs with adequate hemodynamic function, both instruments record SaO(2) relatively accurately over a wide range of normal saturation values. However, there is an increasing overestimation at SaO(2) < 90%, particularly with the Dolphin Voyager, indicating that 3rd generation pulse oximeters may not perform better than older instruments. The 5.4-fold increase in bias with the Dolphin Voyager at SaO(2) < 90% stresses the importance of a 93-94% SpO(2) threshold to ensure an arterial saturation of >or=90%. In contrast, PR monitoring with both devices is very reliable.     

Evaluation of Pulse Oximetry as a Continuous Monitoring Technique in Critically Ill Dogs in the Small Animal Intensive Care Unit

To assess the clinical applicability of pulse oximetry in the intensive care setting, a comparison was made of arterial hemoglobin saturation values determined by in vitro oximetry (SaO₂) and pulse oximetry (SpO₂) in 21 critically ill dogs. Single SaO₂ measurements were compared to simultaneously obtained SpO₂ readings. The correlation between these two methods was statistically significant (r = 0.8944, p = 0.0001). In addition, heart rates read by the pulse oximeter were compared to simultaneously obtained electrocardiograms (ECG). The correlation between these two methods was statistically significant (r = 0.9966, p = 0.0001). The pulse oximeter was easy to use, and recorded trends in oxygenation virtually instantaneously. Pulse oximetry appears to be an accurate and practical technique for the continuous non-invasive monitoring of oxygenation in critically ill dogs in the intensive care unit.     

Evaluation of accuracy of pulse oximetry in dogs.

The accuracy of a pulse oximeter was evaluated over a wide range of arterial oxygen and carbon dioxide tensions, using 2 probes (finger probe and ear probe) and 2 monitoring sites (tongue and tail) in anesthetized dogs. The arterial oxygen saturation of hemoglobin (SaO2) measured directly with a multiwavelength spectrophotometer was compared with saturation estimated by pulse oximetry (SpO2). Linear regression analysis of the pooled data from 399 simultaneous measurements of SpO2 and SaO2 indicated a highly significant correlation of SpO2 with SaO2 (r = 0.97; P less than or equal to 0.0001). Although the mean difference (+/- SD) between SpO2 and SaO2 for pooled data was small (-0.06 +/- 6.8%), SpO2 tended to underestimate high SaO2 values (greater than or equal to 70%) and to overestimate low SaO2 values (less than 70%). When SaO2 values were greater than or equal to 70%, the ear probe applied to the tail was less accurate (produced a significantly greater SpO2-SaO2 difference) than the ear probe on the tongue, or the finger probe at either site. When SaO2 values were less than or equal to 50%, the finger probe applied at the tail was more accurate (produced significantly smaller SpO2-SaO2 differences) than the ear probe at either site. When SaO2 values were less than or equal to 70%, high arterial carbon dioxide tension (greater than or equal to 60 mm of Hg) was associated with greater overestimation of SaO2.     

Low central venous oxygen saturation is associated with increased mortality in critically ill dogs

Objectives : To investigate relationships between central venous oxygen saturation (ScvO₂) and survival to hospital discharge in dogs. Central venous oxygen saturation is an accessible measure of the balance between systemic oxygen delivery and consumption. Methods : Prospective observational cohort study, enrolling 126 client‐owned dogs with central venous catheters. Central venous oxygen saturation was measured over the 24 hours following intensive care unit admission. Poor outcome was defined as death or euthanasia performed for moribund status. Regression analysis identified independent predictors of non‐survival and physiologic parameters associated with central venous oxygen saturation. Area under the receiver operator curve analysis identified a cut‐off point of central venous oxygen saturation, below which central venous oxygen saturation decrease was associated with increased mortality risk. Results : Mortality risk was 30·9%. Low central venous oxygen saturation was associated with poor outcome (P<0·05). Area under the receiver operator curve analysis selected a central venous oxygen saturation of 68% as the point below which a fall in central venous oxygen saturation was associated with increased mortality risk. For each 10% drop in central venous oxygen saturation below 68%, odds of non‐survival increased by 2·66 times (P=0·0002, 95% confidence interval of odds ratio=1·45 to 4·85). Central venous oxygen saturation was equivalent to lactate in predicting non‐survival. Predictors of central venous oxygen saturation (packed cell volume, mean arterial blood pressure, fever, % arterial haemoglobin saturation as measured by pulse oximeter) were consistent with hypothesised physiologic mechanisms. Clinical Significance : Central venous oxygen saturation was a strong mortality predictor. Further work is needed to determine if therapy targeting central venous oxygen saturation can reduce mortality in canine intensive care unit patients.     

Accuracy of pulse oximetry and capnography in healthy and compromised horses during spontaneous and controlled ventilation

The objective of this prospective clinical study was to evaluate the accuracy of pulse oximetry and capnography in healthy and compromised horses during general anesthesia with spontaneous and controlled ventilation. Horses anesthetized in a dorsal recumbency position for arthroscopy (n = 20) or colic surgery (n = 16) were instrumented with an earlobe probe from the pulse oximeter positioned on the tip of the tongue and a sample line inserted at the Y-piece for capnography. The horses were allowed to breathe spontaneously (SV) for the first 20 min after induction, and thereafter ventilation was controlled (IPPV). Arterial blood, for blood gas analysis, was drawn 20 min after induction and 20 min after IPPV was started. Relationships between oxygen saturation as determined by pulse oximetry (S_pO₂), arterial oxygen saturation (S_aO₂)_, arterial carbon dioxide partial pressure (P_aCO₂), and end tidal carbon dioxide (P_(et)CO₂), several physiological variables, and the accuracy of pulse oximetry and capnography, were evaluated by Bland–Altman or regression analysis. In the present study, both S_pO₂ and P_(et)CO₂ provided a relatively poor indication of S_aO₂ and P_aCO₂, respectively, in both healthy and compromised horses, especially during SV. A difference in heart rate obtained by pulse oximetry, ECG, or palpation is significantly correlated with any pulse oximeter inaccuracy. If blood gas analysis is not available, ventilation to P_(et)CO₂ of 35 to 45 mmHg should maintain the P_aCO₂ within a normal range. However, especially in compromised horses, it should never substitute blood gas analysis.     

A comparison of systolic blood pressure measurement obtained using a pulse oximeter, and direct systolic pressure measurement in anesthetized sows.

Systolic blood pressure measurement obtained with a pulse oximeter has been compared to values obtained by other indirect methods in man. Direct pressure measurement is subject to less error than indirect techniques. This study was designed to compare systolic pressure values obtained using a pulse oximeter, with values obtained by direct arterial pressure measurement. The pulse oximeter waveform was used as an indication of perfusion. A blood pressure cuff was applied proximal to the pulse oximeter probe. The cuff was inflated until the oximeter waveform disappeared, this value was recorded as the systolic pressure at the disappearance of the waveform (SPD). The cuff was inflated to a pressure > 200 mmHg, then gradually deflated until the waveform reappeared, this value was recorded as the systolic pressure at reappearance of the waveform (SPR). The average of the two values, SPD and SPR, was calculated and recorded as SPA. The study was performed in sows (n = 21) undergoing cesarean section under epidural anesthesia and IV sedation. A total of 280 measurements were made of SPD, SPR and SPA. Regression analysis of SPA and direct measurement revealed a correlation coefficient (r) of 0.81. Calculation of mean difference (bias) and standard deviation of the bias (precision) for direct pressure--SPA revealed a value of 1.3 +/- 12.1. When compared with direct measurement, the correlation of this technique was similar to that recorded for other indirect techniques used in small animals. This indicates that this technique would be useful for following systolic pressure trends.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of Transmittance and Reflectance Pulse Oximetry in a Canine Model of Hypotension and Desaturation

Ten, anesthetized dogs were instrumented with three pulse oximeter probes; two lingual transmittance probes and one rectal reflective probe. Arterial oxygen desaturation was produced by decreasing the inspired oxygen concentration. Hypotension was produced with an infusion of nitroprusside. Simultaneous pulse oximeter readings (SpO₂) were compared to co-oximeter measured arterial saturation (SaO₂) collected over a range of SaO₂ (50–100%) and mean arterial pressures (40–100mmHg). Each of the monitors and means of evaluating SpO₂ studied provided accurate SpO₂ measurements over a range of mean arterial pressure from 40–100mmHg. All of the monitors tested tended to overestimate the SaO₂ when the arterial saturation was less than 70%.     

Evaluation of the Nonin 8600V Veterinary Pulse Oximeter in Anesthetized Horses

S_pO₂ values from the Nonin 8600V veterinary pulse oximeter, using a lingual clip-type, transmittance sensor applied to the tongue, were compared to directly-measured S_aO₂ values from a co-oximeter, calibrated for equine blood, in 5 halothane-anesthetized horse. Normocapnia was maintained with controlled ventilartion. The inspired oxygen concentration was varied by mixing nitrogen in oxygen to obtain S_pO₂ readings of approximately 60, 65, 70, 75, 80, 85, 90, 92, and 100%. At the time of each S_pO₂ recording, an arterial blood sample was collected for immediate analysis of S_aO₂. A total of sixty paired measurements were made. The results showed excellent data correlation with a bias (precision) of 0.55 (2.57) and an R-value of 0.98 over the entire S_aO₂ range tested. Based on these findings, the Nonin 8600V veterinary pulse oximeter, with the lingual sensor, performed accurately and reliably, and appears to be suitable for clinical use in anesthetized horses. (Vet Emerg & Crit Care, 1999: 13–18)     

Blood oxygen concentration of fast-growing and slow-growing broiler chickens, and chickens with ascites from right ventricular failure.

Percent hemoglobin oxygen saturation was measured with a pulse oximeter in 6-week-old slow-growing (light) and fast-growing (heavy) male broiler chickens and those with ascites from right ventricular failure (RVF). Pulse rate and percent oxygen saturation were read from the ulnar artery just proximal to the carpus. Percent oxygen saturation was significantly (P less than or equal to 0.0001) higher in light chickens (mean 91.6%) than in heavy chickens (mean 86.0%), and the percent oxygen saturation was significantly (P less than or equal to 0.0001) higher in both groups with normal hearts than in the group with RVF from valvular insufficiency (mean 62.1%). All RVF chickens and those with normal hearts were confirmed at necropsy. Light chickens were males with leg deformity or stunting and were 20-50% lighter than the heavy chickens.     

Evaluation of Masimo signal extraction technology pulse oximetry in anaesthetized pregnant sheep

ObjectiveEvaluation of the accuracy of Masimo signal extraction technology (SET) pulse oximetry in anaesthetized late gestational pregnant sheep.Study designProspective experimental study.AnimalsSeventeen pregnant Merino ewes.MethodsAnimals included in study were late gestation ewes undergoing general anaesthesia for Caesarean delivery or foetal surgery in a medical research laboratory. Masimo Radical-7 pulse oximetry (SpO₂) measurements were compared to co-oximetry (SaO₂) measurements from arterial blood gas analyses. The failure rate of the pulse oximeter was calculated. Accuracy was assessed by Bland &; Altman's (2007) limits of agreement method. The effect of mean arterial blood pressure (MAP), perfusion index (PI) and haemoglobin (Hb) concentration on accuracy were assessed by regression analysis.ResultsForty arterial blood samples paired with SpO₂ and blood pressure measurements were obtained. SpO₂ ranged from 42 to 99% and SaO₂ from 43.7 to 99.9%. MAP ranged from 24 to 82 mmHg, PI from 0.1 to 1.56 and Hb concentration from 71 to 114 g L^?1. Masimo pulse oximetry measurements tended to underestimate oxyhaemoglobin saturation compared to co-oximetry with a bias (mean difference) of ?2% and precision (standard deviation of the differences) of 6%. Accuracy appeared to decrease when SpO₂ was <75%, however numbers were too small for statistical comparisons. Hb concentration and PI had no significant effect on accuracy, whereas MAP was negatively correlated with SpO₂ bias.Conclusions and clinical relevanceMasimo SET pulse oximetry can provide reliable and continuous monitoring of arterial oxyhaemoglobin saturation in anaesthetized pregnant sheep during clinically relevant levels of cardiopulmonary dysfunction. Further work is needed to assess pulse oximeter function during extreme hypotension and hypoxaemia.     

The cardiovascular dose-response effects of isoflurane alone and combined with butorphanol in the green iguana (Iguana iguana)

Objective To assess the cardiovascular effects (arterial blood pressure, heart rate, and metabolic acid–base status) of three doses (MAC multiples) of isoflurane alone and combined with butorphanol in the green iguana (Iguana iguana). Study design Prospective randomized double‐blind, two‐period cross‐over trial. Animals Six mature healthy green iguanas (Iguana iguana). Methods The iguanas received each of two treatments, saline 0.1 mL kg^?1 (SAL) and butorphanol 1.0 mg kg^?1 (BUT) during isoflurane anesthesia. Treatments were separated by at least 1 week. The iguanas were exposed to each of the three minimum alveolar concentration (MAC) multiples (1.0, 1.5, and 2.0) in random order. Anesthesia was induced with isoflurane and maintained using controlled ventilation. Instrumentation included use of an ECG, airway gas monitor, cloacal thermometer, esophageal pulse oximeter, and the placement of a femoral arterial catheter. Body temperature was stabilized and maintained at 32 °C. The treatment was administered, and the animals were equilibrated for 20 minutes at each MAC multiple. At each concentration, the heart rate, blood pressure (systolic, mean, diastolic), end‐tidal CO₂, and SpO₂ were measured. At 1.0 and 2.0 MAC, simultaneous blood samples were drawn from the tail vein/artery complex and femoral catheter for blood gas analysis. Data were analyzed using a two‐way analysis of variance for repeated measures looking for differences between treatments and among MAC multiples. Results There were no significant differences in any of the cardiovascular variables between the treatments. Significant differences among isoflurane MAC multiples were observed for HR, mean, diastolic, and systolic blood pressures. Blood pressure and heart rate decreased with an increasing dose of anesthetic. There were no significant differences between treatments or MAC multiples for any of the blood gas variables. The blood pH, PCO₂, HCO₃^?, and hemoglobin saturation differed significantly between sites. Pulse oximetry values measured from the carotid complex did not correlate with and were significantly different from the calculated hemoglobin saturation values determined using the gas analyzer. Conclusion and clinical relevance Cardiovascular depression associated with isoflurane anesthesia in the green iguana is dose dependent. The degree of cardiovascular depression was not significantly different when isoflurane was combined with butorphanol. This finding suggests that the pre‐emptive or intraoperative use of butorphanol is unlikely to be detrimental to cardiovascular function. Butorphanol may be a useful anesthetic adjunct to isoflurane anesthesia in the green iguana.     

Indirect measurement of blood pressure using a pulse oximeter in isoflurane anesthetized dogs

Objective: To determine the accuracy of indirect blood pressure (BP) measurements obtained with a pulse oximeter as compared with direct measurements in dogs under isoflurane anesthesia. The Doppler and oscillometric BP monitors were included for comparison. Design: Prospective, experimental study. Animals: Twenty healthy dogs (23 ± 8 kg) anesthetized for research or teaching. Interventions: Dogs were anesthetized with propofol or thiopental and maintained using positive pressure ventilation with isoflurane in 100% O₂. Random adjustment of BP was achieved by inhalant adjustment or dopamine infusion to achieve low (≤85 mmHg), normal (90–120 mmHg), or high systolic BP (≥125 mmHg). Triplicate measurements for BP were taken with direct (dorsal pedal artery), Doppler (forelimb), oscillometric (same forelimb), and plethysmographic (pulse oximeter on tongue) methods. Measurements and main results: Using regression analysis and a modified Bland–Altman's technique, the lowest bias was achieved with the Doppler. Systolic BP readings at low, normal, and high BP were within 10 mmHg of direct recordings 95%, 70%, and 30% of the time for pulse oximetry; 95%, 85%, and 55% of the time for Doppler; 42%, 65%, and 30% of the time for oscillometric determination, respectively. Oscillometric mean BP readings were within 10 mmHg of direct measurements 53%, 60%, and 45% of the time, respectively. Conclusions: The pulse oximeter is an acceptable method for measuring BP in anesthetized dogs if assessment of trends is sufficient. All indirect methods showed greater bias and poorer precision at high BP. The Doppler may be the preferred indirect method.     

Assessment of pulse co-oximetry technology after in vivo adjustment in anaesthetized dogs

ObjectiveTo compare values of haemoglobin concentration (SpHb), arterial haemoglobin saturation (SpO₂) and calculated arterial oxygen content (SpOC), measured noninvasively with a pulse co-oximeter before and after in vivo adjustment (via calibration of the device using a measured haemoglobin concentration) with those measured invasively using a spectrophotometric-based blood gas analyser in anaesthetized dogs.Study designProspective observational clinical study.AnimalsA group of 39 adult dogs.MethodsIn all dogs after standard instrumentation, the dorsal metatarsal artery was catheterised for blood sampling, and a pulse co-oximeter probe was applied to the tongue for noninvasive measurements. Paired data for SpHb, SpO₂ and SpOC from the pulse co-oximeter and haemoglobin arterial oxygen saturation (SaO₂) and arterial oxygen content (CaO₂) from the blood gas analyser were obtained before and after in vivo adjustment. Bland–Altman analysis for repeated measurements was used to evaluate the bias, precision and agreement between the pulse co-oximeter and the blood gas analyser. Data are presented as mean differences and 95% limits of agreement (LoA).ResultsA total of 39 data pairs were obtained before in vivo adjustment. The mean invasively measured haemoglobin–SpHb difference was –2.7 g dL^?1 with LoA of –4.9 to –0.5 g dL^?1. After in vivo adjustment, 104 data pairs were obtained. The mean invasively measured haemoglobin–SpHb difference was –0.2 g dL^?1 with LoA of –1.1 to 0.6 g dL^?1. The mean SaO₂–SpO₂ difference was 0.86% with LoA of –0.8% to 2.5% and that between CaO₂–SpOC was 0.66 mL dL^–1 with LoA of –2.59 to 3.91 mL dL^–1.ConclusionsBefore in vivo adjustment, pulse co-oximeter derived values overestimated the spectrophotometric-based blood gas analyser haemoglobin and CaO₂ values. After in vivo adjustment, the accuracy, precision and LoA markedly improved. Therefore, in vivo adjustment is recommended when using this device to monitor SpHb in anaesthetised dogs.