Monitoring changes in distribution of pulmonary ventilation by functional electrical impedance tomography in anaesthetized ponies

Objective

To assess changes in the distribution in pulmonary ventilation in anaesthetized ponies using electrical impedance tomography (EIT).

Evaluation of lung ventilation distribution using electrical impedance tomography in standing sedated horses with capnoperitoneum

ObjectiveTo determine changes in distribution of lung ventilation with increasing intra-abdominal pressure (IAP) from carbon dioxide (CO₂) insufflation in standing sedated horses.Study designProspective experimental study.AnimalsA group of six healthy adult horses.MethodsEach horse was sedated with acepromazine, detomidine and butorphanol and sedation maintained with a detomidine infusion. The horse was restrained in a stocks system and a 32 electrode electrical impedance tomography (EIT) belt was wrapped around the thorax at the fifth–sixth intercostal space. EIT images and arterial blood samples for PaO₂ and PaCO₂, pH and lactate concentration were obtained during capnoperitoneum at 0 (baseline A), 5, 8 and 12 mmHg as IAP increased and at 8, 5, 0 (baseline B) mmHg as IAP decreased. At each IAP, after a 2 minute stabilization period, EIT images were recorded for ≥ 2 minutes to obtain five consecutive breaths. Statistical analysis was performed using anova for repeated measures with Geisser-Greenhouse correction and a Tukey’s multiple comparison test for parametric data. The relationship between PaO₂ and the center of ventilation in the ventral-dorsal (CoV-VD) and right-left (CoV-RL) directions or total impedance change as a surrogate for tidal volume (ΔZV_T) were tested using linear regression analysis. Significance was assumed when p ≤ 0.05.ResultsThere were no significant changes in CoV-VD, CoV-RL, PaO₂, PaCO₂, lactate concentration, pH, heart rate and respiratory rate with targeted IAP. There was a significant decrease in ΔZV_T compared with baseline A at 5 mmHg IAP as IAP was increased.Conclusions and clinical relevanceCapnoperitoneum causes a significant decrease in ΔZV_T in standing sedated horses with increasing IAP.     

Assessment of distribution of ventilation and regional lung compliance by electrical impedance tomography in anaesthetized horses undergoing alveolar recruitment manoeuvres

Objective

To examine changes in the distribution of ventilation and regional lung compliances in anaesthetized horses during the alveolar recruitment manoeuvre (ARM).

Regional distribution of ventilation in horses in dorsal recumbency during spontaneous and mechanical ventilation assessed by electrical impedance tomography: a case series

ObjectiveTo evaluate the regional distribution of ventilation in horses during spontaneous breathing and controlled mechanical ventilation (CMV) using electrical impedance tomography (EIT).Study designProspective, experimental case series.AnimalsFour anaesthetized experimental horses.MethodsHorses were anaesthetized with isoflurane in an oxygen-air mixture and medetomidine continuous rate infusion, placed in dorsal recumbency with an EIT belt around the thorax, and allowed to breathe spontaneously until PaCO₂ reached 13.3 kPa (100 mmHg), when volume CMV was started. For each horse, the EIT signal was recorded for at least 2 minutes immediately before (T1), and at 30 (n = 3) or 60 (n = 1) minutes after the start of CMV (T2). The centre of ventilation (CoV), dependent silent spaces (DSS) (likely to represent atelectatic lung areas), non-dependent silent spaces (NSS) (likely to represent lung areas with low ventilation) and total ventilated area (TVA) were evaluated. Cardiac output (CO) was measured and venous admixture and oxygen delivery (DO₂) were calculated at T1 and T2. Data are presented as median and range.ResultsAfter the initiation of CMV, the CoV moved ventrally towards the non-dependent lung by 10% [from 57.4% (49.6–60.2%) to 48.3% (41.9–54.4%)]. DSS increased [from 4.1% (0.2–13.9%) to 18.7% (7.5–27.5%)], while NSS [21.7% (9.4–29.2%) to 9.9% (1.0–20.7%)] and TVA [920 (699–1051) to 837 (662–961) pixels] decreased. CO, venous admixture and DO₂ also decreased.Conclusions and clinical relevanceIn spontaneously breathing anaesthetized horses in dorsal recumbency, ventilation was essentially centred within the dependent dorsal lung regions and moved towards non-dependent ventral regions as soon as CMV was started. This shows a major lack of ventilation in the dependent lung, which may be indicative of atelectasis.     

Isoflurane measurement error using short wavelength infrared techniques in horses: influence of fresh gas flow and pre-anaesthetic food deprivation

OBJECTIVE: To quantify the isoflurane measurement error arising from the use of short wavelength infrared (IR) anaesthetic gas analysis during low flow anaesthesia in horses. STUDY DESIGN: Prospective clinical study. ANIMAL POPULATION: Sixty-four client-owned horses referred for elective or emergency surgery (age 1-16 years, body mass 400-650 kg). MATERIALS AND METHODS: Horses were divided into four groups based on duration of pre-anaesthetic food deprivation period (FDP) and fresh gas flow during anaesthesia: a high flow group with normal FDP (n = 16) and three groups with low flow and normal (n = 29), long (n = 5) or no (n = 14) FDP, respectively. Circuit isoflurane concentrations were measured simultaneously using a short wavelength (methane-sensitive) analyser (Datex Capnomac Ultima) and a long wavelength (methane-insensitive) analyser (Hewlett Packard M 1025 B) for at least 60 minutes. The difference between the readings of both analysers gave the isoflurane measurement error of short wavelength IR analysis, from which the circuit methane concentration was calculated. RESULTS: In the low flow groups, isoflurane measurement error increased over time, whereas in the high flow group, error remained constant after an initial rise in the first 15 minutes. The isoflurane measurement error was significantly lower (p < 0.005) in the high flow group compared with the low flow-normal FDP group from 15 to 60 minutes. Compared to the low flow - normal FDP group, isoflurane measurement error was significantly smaller (p < 0.001, from 15 to 60 minutes) in the low flow-long FDP group and significantly larger (p = 0.016, at 60 minutes) in the low flow-no FDP group. Within the low flow-no FDP group, values in colic cases did not differ from those in noncolic cases (p > 0.7). CONCLUSIONS: Isoflurane measurement using short wavelength IR absorption is inaccurate. The fresh gas flow and duration of pre-anaesthetic food deprivation influence the isoflurane measurement error during anaesthesia in horses. CLINICAL RELEVANCE: Short wavelength IR analysers are not reliable for isoflurane measurement during (low flow) anaesthesia in horses.     

Computed tomography of the upper cheek teeth in horses with infundibular changes and apical infection

Reasons for performing study: Infundibular changes are frequently encountered computed tomographic studies of the equine maxillary cheek teeth but the possible importance of this finding is not known. Infundibular caries is a possible cause for pulpitis and apical infection in some horses. Objectives: To study the relationship between the 2 pathologies and the frequency of changes. Methods: The maxillary cheek teeth 108‐ 208 , 109–209 and 110–210 of 25 horses were evaluated using computed tomography and both the prevalence of infundibular and apical infection changes as the possible link with apical infection evaluated statistically. Results: The prevalence of infundibular changes was high in both normal and diseased teeth. Both apical infection and the occurrence of infundibular changes were more prevalent in 109–209 and 110–210. In spite of this, the 2 processes could not be linked to one another. No differences were noted between the left and right sides. Conclusions: A direct relationship between the 2 processes was not established statistically and other underlying causes for the high occurrence of both apical infection and infundibular changes in diseased and normal 108‐ 208 , 109–209 and 110210 are considered.     

Analysis of conformational variations of the cricoid cartilages in Thoroughbred horses using computed tomography

Reasons for performing study: Loss of arytenoid abduction is a common post operative complication of laryngoplasty without a definitive cause. It has been a clinical impression during laryngoplasty surgery that there is great conformational variability along the caudal edge of the Thoroughbred cricoid cartilage that could impact post operative retention of suture position. A change in suture position would probably lead to some loss of abduction. Defining any structural variability of the cricoid would be an initial step in determining whether this variability could impact on the retention of suture position. Hypothesis: Anatomical variations in the larynx of Thoroughbred horses may be detected and measured using objective analysis and computed tomography. Methods: Larynges were harvested from 15 mature Thoroughbred horses. Helical CT scans were performed on each specimen. Three independent observers performed a series of measurements on 2D and 3D reconstruction images using digital software. Measurements included the lateral cricoid angle, the caudal cricoid prominences, the distance to the cricoid slope, the angle of the cricoarytenoid joints (CAJ), the cricoid thickness and the suture angle. Mean, standard deviation, coefficient of variation and linear regression analysis were performed among all observers and all measurements. Results: Notable conformational differences were evident on the 3D reconstructions. The highest degree of variability was found in 3 measurements: the distance to the lateral cricoid slope, the lateral cricoid angle and the cricoid thickness. A larger left CAJ angle directly and significantly correlated with a larger suture angle. Conclusions: There are notable conformational differences among cricoid specimens in the Thoroughbred larynx. Potential relevance: The morphometric differences identified may impact on optimal prosthesis placement and long‐term retention. Since a larger lateral cricoid angle may facilitate abduction loss secondary to a displaced and loosened suture, alternative techniques for suture placement may be of value to prevent arytenoid abduction loss.     

Variety of non‐invasive continuous monitoring methodologies including electrical impedance tomography provides novel insights into the physiology of lung collapse and recruitment – case report of an anaesthetized horse

IntroductionThe use of alveolar recruitment maneuvers during general anaesthesia of horses is a potentially useful therapeutic option for the ventilatory management. While the routine application of recruitments would benefit from the availability of dedicated large animal ventilators their impact on ventilation and perfusion in the horse is not yet well documented nor completely understood.Case historyA healthy 533 kg experimental horse underwent general anaesthesia in lateral recumbency. During intermittent positive pressure ventilation a stepwise alveolar recruitment maneuver was performed.ManagementAnaesthesia was induced with ketamine and midazolam and maintained with isoflurane in oxygen using a large animal circle system. Mechanical ventilation was applied in pressure ventilation mode and an alveolar recruitment maneuver performed employing a sequence of ascending and descending positive end expiratory pressures. Next to the standard monitoring, which included spirometry, additionally three non-invasive monitoring techniques were used: electrical impedance tomography (EIT), volumetric capnography and respiratory ultrasonic plethysmography. The functional images continuously delivered by EIT initially showed markedly reduced ventilation in the dependent lung and allowed on-line monitoring of the dynamic changes in the distribution of ventilation during the recruitment maneuver. Furthermore, continuous monitoring of compliance, dead space fraction, tidal volumes and changes in end expiratory lung volume were possible without technical difficulties.Follow upThe horse made an unremarkable recovery.ConclusionThe novel non-invasive monitoring technologies used in this study provided unprecedented insights into the physiology of lung collapse and recruitment. The synergic information of these techniques holds promise to be useful when developing and evaluating new ventilatory strategies in horses.     

Congenital hypodontia in three horses diagnosed by computed tomography

Dental agenesis is a congenital disease defined as failure of formation of one or more teeth, which has been extensively described in human literature and that has been documented in several other species including cats, dogs, seals and sea lions, mice, and ungulates. The aim of this study was to review the clinical and computed tomographic (CT) features of tooth agenesis in a population of horses. Retrospective review of the imaging records from the Langford Equine Hospital was performed, including all horses that underwent head CT between January 2015 and June 2017. Of a total number of 167 CT scans, three horses with hypodontia were found. All three cases had agenesis of the maxillary 08s and one case had additional agenesis of the 307 and 308 teeth. Delayed resorption of the corresponding deciduous teeth was reported in all cases. The empty space left by the absent teeth was filled either by heterogeneous bone tissue alone (two cases) or by a combination of bone and soft tissue (one case). Alignment between teeth was preserved, and there was no displacement of the neighbouring teeth adjacent to the agenesis site. All three horses presented a symmetric pattern of dental agenesis within the maxillary arcades. The maxillary 08s, which are the latest to erupt, were the most affected teeth. This was similar to that reported in human literature, where the teeth that form later during development are the most vulnerable to dental agenesis.     

Computed tomography in the diagnosis of malignant sinonasal tumours in three horses

Malignant tumours are uncommon in horses, but when they do occur, they are most frequently found in the head. Clinical findings, such as facial swelling and nasal discharge, are frequently encountered but are nonspecific. To highlight the usefulness of a computed tomography (CT) examination in malignancy in the equine head, this Case Report describes the CT features of a leiomyosarcoma, an osteosarcoma and a sarcoma in 3 horses. CT of the equine head was able to provide more information about the extent and severity of lesions than conventional radiography in these cases.     

Effects of butorphanol on the withdrawal reflex using threshold, suprathreshold and repeated subthreshold electrical stimuli in conscious horses

OBJECTIVE: To assess the effects of a single intravenous dose of butorphanol (0.1 mg kg(-1)) on the nociceptive withdrawal reflex (NWR) using threshold, suprathreshold and repeated subthreshold electrical stimuli in conscious horses. STUDY DESIGN: 'Unblinded', prospective experimental study. ANIMALS: Ten adult horses, five geldings and five mares, mean body mass 517 kg (range 487-569 kg). METHODS: The NWR was elicited using single transcutaneous electrical stimulation of the palmar digital nerve. Repeated stimulations were applied to evoke temporal summation. Surface electromyography was performed to record and quantify the responses of the common digital extensor muscle to stimulation and behavioural reactions were scored. Before butorphanol administration and at fixed time points up to 2 hours after injection, baseline threshold intensities for NWR and temporal summation were defined and single suprathreshold stimulations applied. Friedman repeated-measures analysis of variance on ranks and Wilcoxon signed-rank test were used with the Student-Newman-Keul's method applied post-hoc. The level of significance (alpha) was set at 0.05. RESULTS: Butorphanol did not modify either the thresholds for NWR and temporal summation or the reaction scores, but the difference between suprathreshold and threshold reflex amplitudes was reduced when single stimulation was applied. Upon repeated stimulation after butorphanol administration, a significant decrease in the relative amplitude was calculated for both the 30-80 and the 80-200 millisecond intervals after each stimulus, and for the whole post-stimulation interval in the right thoracic limb. In the left thoracic limb a decrease in the relative amplitude was found only in the 30-80 millisecond epoch. CONCLUSION: Butorphanol at 0.1 mg kg(-1) has no direct action on spinal Adelta nociceptive activity but may have some supraspinal effects that reduce the gain of the nociceptive system. CLINICAL RELEVANCE: Butorphanol has minimal effect on sharp immediate Adelta-mediated pain but may alter spinal processing and decrease the delayed sensations of pain.     

Training-induced changes in clotting parameters of athletic horses

The purpose of this study was to investigate the effects of training on prothrombin time, activated partial thromboplastin time, and fibrinogen (Fb) concentrations in horses to assess potential adaptive response to training. Fifteen clinically healthy horses were enrolled in the present study and equally divided into three groups. Group A completed an intense training program, group B participated in a light training program, and group C included sedentary horses. After 5 weeks, group B was subjected to the same training program completed by group A and renamed group B1. Blood samples were collected by jugular venipuncture from each animal at rest and analyzed within 2 h after sampling. A two-way ANOVA for repeated measures showed a significant effect of training (p < 0.05) on Fb concentrations in group B1 alone during the first week after changing the training program. Our findings demonstrated that Fb is a parameter susceptible to training. Fb plasma levels increase with a more intense training program. However, Fb plasma levels decreased after the first week and returned to basel levels, suggesting that the horses had adapted to the new training program.     

Evaluation of different doses of propofol in xylazine pre-medicated horses

Objective To characterize responses to different doses of propofol in horses pre‐medicated with xylazine. Animals Six adult horses (five females and one male). Methods Each horse was anaesthetized four times with either ketamine or propofol in random order at 1‐week intervals. Horses were pre‐medicated with xylazine (1.1 mg kg^?1 IV over a minute), and 5 minutes later anaesthesia was induced with either ketamine (2.2 mg kg^?1 IV) or propofol (1, 2 and 4 mg kg^?1 IV; low, medium and high doses, respectively). Data were collected continuously (electrocardiogram) or after xylazine administration and at 5, 10 and 15 minutes after anaesthetic induction (arterial pressure, respiratory rate, pH, PaO₂, PaCO₂ and O₂ saturation). Anaesthetic induction and recovery were qualitatively and quantitatively assessed. Results Differences in the quality of anaesthesia were observed; the low dose of propofol resulted in a poorer anaesthetic induction that was insufficient to allow intubation, whereas the high dose produced an excellent quality of induction, free of excitement. Recorded anaesthesia times were similar between propofol at 2 mg kg^?1 and ketamine with prolonged and shorter recovery times after the high and low dose of propofol, respectively (p < 0.05; ketamine, 38 ± 7 minutes; propofol 1 mg kg^?1, 29 ± 4 minutes; propofol 2 mg kg^?1, 37 ± 5 minutes; propofol 4 mg kg^?1, 50 ± 7 minutes). Times to regain sternal and standing position were longest with the highest dose of propofol (32 ± 5 and 39 ± 7 minutes, respectively). Both ketamine and propofol reversed bradycardia, sinoatrial, and atrioventricular blocks produced by xylazine. There were no significant alterations in blood pressure but respiratory rate, and PaO₂ and O₂ saturation were significantly decreased in all groups (p < 0.05). Conclusion The anaesthetic quality produced by the three propofol doses varied; the most desirable effects, which were comparable to those of ketamine, were produced by 2 mg kg^?1 propofol.