Broken nasotracheal tube aspiration in a horse during anaesthetic recovery

A horse was presented for soft palate thermocautery and surgical advancement of the larynx under general anaesthesia, following a history of respiratory noise and poor athletic performance. Physical examination prior to surgery was unremarkable. The horse was anaesthetised and a 20 mm cuffed endotracheal tube (ETT) used to intubate the trachea via the right nostril. The cuff was deflated at the end of the procedure and the tube secured in place around the head of the horse for the recovery. The horse was assisted to standing and during this process the end of the nasotracheal tube broke and was observed hanging from the head collar. The remainder of the tube was aspirated into the trachea of the horse. The remaining length of endotracheal tube was removed using a modified endoscopic technique. The horse recovered with no further problems. An unusual complication of a nasotracheal tube left in situ for recovery in a horse is reported and possible reasons for this complication are discussed.     

Acute Life-threatening Laryngeal Dysfunction in a Draft Horse Recovering from General Anesthesia: A Case Report

A 13-year-old Shire horse was anesthetized for an elective orthopedic procedure. During recovery from anesthesia, the occurrence of severe acute dyspnea required a second anesthetic to allow endoscopy-guided nasotracheal intubation. Endoscopic findings were decreased mobility and swelling of the arytenoids with narrowing of the laryngeal aditus. Owing to a dislodgement of the nasotracheal tube during recovery, a third anesthetic was carried out to perform emergency tracheostomy. Recovery from the third anesthetic was long and the horse developed a post-anesthetic myopathy. The clinical conditions improved during the following 48 hours, and an endoscopic examination performed before discharge revealed unremarkable laryngeal function. It was hypothesized that mechanical stimulation of the trachea during the phases of intubation and extubation caused traumatic laryngeal dysfunction, and that draft horses might require additional care during the perioperative period.     

Management of apposing,full‐thickness tracheal perforations in two horses

Two horses, one 15‐year‐old Arabian gelding and one 10‐year‐old Quarter Horse gelding, presented with a history of marked subcutaneous emphysema. The first case exhibited no external wound, although there was a depression noted on the ventral neck. The second case had a laceration on the ventral aspect of the neck over the trachea. Endoscopic examination revealed both horses to have concurrent dorsal and ventral perforations of the trachea. The horses were managed by placing a short, cuffed, J‐shaped tracheostomy tube in the ventral perforation, while the dorsal perforation healed. The dorsal perforation in the first horse was allowed to heal by second intention, whereas sutures were placed in the dorsal perforation in the second case to reduce the healing time. Both horses were maintained on oral antimicrobial and nonsteroidal anti‐inflammatory medications throughout treatment. The dorsal perforation healed after 13 days in the first horse, and 22 days in the second horse. The ventral perforation healed in both horses by second intention following tracheostomy removal, giving a cosmetically acceptable result. In addition to facilitating tracheal healing, the tracheostomy tubes prevented the progression of subcutaneous emphysema, and promoted its resolution.     

Treatment of mycotic tracheitis in a horse with fluconazole and systemic iodine

Fungal infections of the equine trachea have been rarely reported. This case report describes the successful treatment of a mare with fungal infection of the trachea that had severe diffuse granulomatous thickening, erosions and haemorrhage of the proximal half of the trachea. The horse was treated with oral fluconazole and systemic iodine therapy. Serial endoscopic examinations confirmed rapid resolution of the condition.     

Evaluation of Horse Fitness for Exercise: The Use of a Logit-Log Function to Model Horse Postexercise Heart Rate Recovery

The aim of this study was to test the adjustment of the logistic-log model with postexercise heart rate (HR) recovery data in horses and introduce the logit-log model as a parsimonious model, with the half recovery time as a measure of horse fitness. Postexercise HR (bpm) measurements at different timings were obtained from 32 polo ponies in two different exercise regimes: n = 16 “full chukker” and n = 16 in “half chukker.” Measurements were taken at rest, immediately after exercise and then 2, 4, 6, 10, and 20 minutes after exercise. The HR variable was transformed into a logit (HR) variable, and time was transformed into log (time). Means of logit (HR) at the different log (times) were obtained, creating two time series of transformed variables that were then adjusted by simple linear regression. The degree of adjustment of the model is high with values of r² = 0.989 for the full chukker and r² = 0.998 for the half chukker. Full chukker ponies have a half recovery time of 5.7 minutes and half chukker ponies of 11.2 minutes, with the former showing to be fitter than the latter, which is why they are chosen to play for longer periods. The logit-log model is parsimonious, and the half recovery time can be easily determined. The half recovery time has potential to be used as a measure of fitness degree, allowing comparison between horses.     

Leukemic small cell lymphoma or chronic lymphocytic leukemia in a horse

A 16‐year‐old, Irish Draft mare was admitted to the referring veterinarian for an annual health check. A mild generalized lymphadenomegaly was noted. Rectal palpation and transrectal ultrasonographic examination revealed prominent mesenteric lymph nodes. A transcutaneous abdominal ultrasonographic evaluation was unremarkable. A CBC revealed a marked leukocytosis (63.06 × 10³/μL) and lymphocytosis (58.2 × 10³/μL) due to increased numbers of small lymphocytes. No evidence of anemia or thrombocytopenia was found and neutrophil counts were low‐normal. Cytologic examination of fine‐needle aspirates of multiple lymph nodes and a bone‐marrow aspirate revealed the presence of a monomorphic population of small lymphocytes similar to those observed in the peripheral blood, suggesting a leukemic small cell lymphoma (SCL) or chronic lymphocytic leukemia (CLL). As the lymphadenomegaly and peripheral blood lymphocytosis were present simultaneously, the distinction between these 2 conditions was not possible. Immunophenotyping by immunocytochemistry and flow cytometry of the lymphoid cells in peripheral blood determined a T‐cell phenotype. As the horse was clinically stable, no treatment was initiated, but regular examinations were undertaken. A CBC repeated 120 days after the diagnosis showed a marked lymphocytosis (157.6 × 10³/μL) with no evidence of anemia or other cytopenias. The horse was euthanized 194 days after the initial diagnosis. Histopathology and immunohistochemistry of submandibular lymph nodes and bone marrow confirmed the diagnosis of leukemic SCL or CLL, and a T‐cell phenotype. SCL and CLL are rare in horses; previous immunohistochemical studies determined that the T‐cell phenotype is predominant. To the authors' knowledge, this is the first report of the combined use of immunocytochemistry and flow cytometry in a horse with leukemic SCL or CLL.     

Alleviation of postanesthetic hypoxemia in the horse

This study was designed to investigate the effect of the nasotracheal insufflation of oxygen at a flow rate of 15 L/min on the arterial partial pressure of oxygen during the recovery period following inhalation anesthesia in the horse. It has been stated that this is a suitable flow rate to prevent postoperative hypoxemia but without any experimental evidence to support those statements. Horses being used for the study of healing of cartilage were anesthetized on two separate occasions. Following one period of anesthesia they were allowed to recover breathing room air, and following the other period of anesthesia oxygen was insufflated into the trachea at 15 L/min throughout the recovery period. This permitted each horse to act as its own control and allowed statistical analysis using Student's t-test for paired samples.

The insufflated horses had a higher arterial partial pressure of oxygen during the recovery period than did the noninsufflated horses (p < 0.05).

     

Heart Rate,Net Cost of Transport,and Metabolic Power in Horse Subjected to Different Physical Exercises

Considering that workload can also be expressed in terms of estimated net transport cost (COT), the metabolic energy needed to transport unit mass of animal unit distance, the aim of our study was to describe the heart rate (HR), COT, and the total metabolic power requirement per kilogram (P) during different exercises (aerobic, anaerobic, and aerobic–anaerobic exercises). On the basis of their attitude, 25 horses, divided into five equal groups, traveled a distance of 6,000 m, walking at 100 m/min in a horse walker (group A); performed 20-minute treadmill walk at 130 m/min, average speed up gradient of 5% (group B); performed a 700-m-long show jumping course with 13 fences (group C); traveled a distance of 2,100 m galloping at a speed of 700 m/min (group D); and traveled a distance of 2,000 m trotting at a speed of 660 m/min (group E). On each horse, HR was continuously recorded by means of an equine HR monitor. COT was calculated with the following formula: (HR − 35) kg⁻¹ m⁻¹ 10³; P was calculated applying the formula: (HR − 35) min⁻¹ kg⁻¹. COT and P values, estimated from the mean HR, measured continuously during each experimental condition showed no linear relationship with HR and speed. The use of combined weight of horse and tack (group C and D) and horse, tack, and sulky (group E) statistically changed the results of formula application. COT and P change in different exercises and provide additional information about performance in athletic horses.     

Treatment of Intraoperative Persistent Penile Erection in a Stallion

This case report describes the occurrence of persistent penile erection in a breeding stallion that occurred while the horse was under inhalant anesthesia for a carpal arthroscopy. The horse had no history of breeding problems, and no abnormalities were detected on physical examination, complete blood count, or serum chemistry tests performed prior to surgery. Anesthesia was induced with guaifenesin and ketamine after sedation with xylazine and was maintained with isoflurane in 100% oxygen. Penile erection developed approximately 35 minutes after induction and persisted for over 2 hours despite various physical and pharmacological attempts to alleviate it (massage, cold compresses, intravenous benztropine administration, and intracavernosal phenylephrine). Successful resolution of the erection was obtained by cannulation and drainage of blood from the corpus cavernosum and subsequent irrigation with heparinized sterile saline and infusion of phenylephrine in the corpus cavernosum. The detumescent penis was placed back into the sheath, and purse string sutures were placed in the sheath to ensure the penis would remain inside the sheath during recovery. The stallion's recovery from anesthesia was uneventful, the sutures were removed, and the horse was fitted with a penile sling to prevent additional edema or trauma. The stallion recovered completely from the persistent penile erection. Semen was collected 6 days after the event, and he returned to normal pasture breeding 6 weeks after surgery.     

Treatment of traumatic tracheal collapse with extraluminal titanium mesh screens

A 12‐year‐old Thoroughbred gelding presented with a history of exercise intolerance and inspiratory stridor. Physical examination revealed a blunt crush injury to the ventral neck and underlying trachea of unknown duration. Tracheoscopy revealed a grade 3 tracheal collapse. Surgical management of the case involved placement of extraluminal titanium mesh screens circumferentially around the trachea for complete support. During the period of hospitalisation, the only post operative complication was seroma formation, which resolved with routine care. Follow‐up after 5 years revealed no further evidence of exercise intolerance, inspiratory dyspnoea or stridor. The horse returned to his previous level of work as a show hunter.     

α-Lipoic acid supplementation enhances heat shock protein production and decreases post exercise lactic acid concentrations in exercised standardbred trotters

Heat shock protein (HSP) expression is an adaptive mechanism against the disruption of cell homeostasis during exercise. Several antioxidant supplementation strategies have been used to enhance tissue protection. In this study, we examined the effects of a redox modulator, α-lipoic acid (LA) on HSP responses in six standardbred trotters following intense aerobic exercise. DL–LA supplementation (25 mg kg⁻¹ d⁻¹) for five weeks increased the resting levels of HSP90 (1.02 ± 0.155 in control and 1.26 ± 0.090 after supplementation in arbitrary units) and the recovery levels of inducible HSP70 (0.89 ± 0.056 in control and 1.05 ± 0.089 after supplementation in arbitrary units) in skeletal muscle. Furthermore, LA increased skeletal muscle citrate synthase activity at rest and lowered the blood lactate concentration during exercise without any changes in the heart rate. LA had no effect on concentrations of HSP60, HSP25 or GRP75 in skeletal muscle. LA decreased the exercise-induced increases in plasma aspartate aminotransferase and creatine kinase concentrations during recovery. Our results suggest that LA supplementation may enhance tissue protection and increase oxidative capacity of the muscle in horse.     

Preliminary results suggest an influence of psychological and physiological stress in humans on horse heart rate and behavior

People may involuntarily emit fear or distress signals when around horses, and interpreting how horses respond to these messages is important, particularly for human safety around horses. No studies have been done to determine if horses can differentiate between humans who are physiologically stressed (e.g., after exercising) as opposed to psychologically stressed (e.g., afraid). Horses (N = 10) loose in a round pen were randomly subjected to the presence of a stationary blindfolded human in each of 4 treatments: (1) calm human comfortable around horses (CALM), (2) physically stressed human (PHYS; exercised to 70% maximum heart rate [HR]), (3) psychologically stressed human (PSYCH; afraid of horses), or (4) no human (CONTROL). Both humans and horses were equipped with an HR monitor. Physiological and behavioral observations (gait, head position relative to the withers, distance and orientation toward human) were recorded and analyzed using a mixed model with horse and human as random effects. Increasing human fearfulness was associated with a decrease in horse HR (P = 0.0156). Horses moved at a slower gait in PSYCH (P < 0.0001), and horse head position was lower during PHYS and PSYCH compared with CALM or CONTROL (P < 0.0001). Human HR was highest in PHYS (P < 0.0001) and decreased over time in all treatments. Human HR increased when the horse was facing away (P = 0.0395). Overall, horses appear less stressed in the presence of a stationary fearful or physically stressed human than a calm person. Thus, horses in the presence of fearful humans, particularly where participants may not be comfortable around horses, should not pose any additional risk provided normal safety precautions are used.     

Effects of posture and accumulated airway secretions on tracheal mucociliary transport in the horse

Tracheal mucociliary clearance was determined in horses by measuring the rostrad transport of the radiopharmaceutical ^99mtechnetium-sulphur colloid following deposition on the tracheal epithelium by intratracheal injection. The effects of head position (head elevated to normal standing position vs head lowered) and of accumulated purulent secretions on tracheal mucociliary clearance were evaluated for the first time in the horse. In normal horses tracheal mucociliary clearance was greatly accelerated by lowering the head so that the cranial trachea was lower than the caudal trachea. Horses confined with their heads elevated for 24 hours developed an accumulation of purulent airway secretions (and associated increased numbers of bacteria) in the lower respiratory tract and showed a decrease in tracheal mucociliary clearance when compared with their previously measured rate when the lower airway contained only normal secretions. These findings have implications for management practices where horses are prevented from lowering their heads, such as transportation and cross-tying, which may therefore contribute to lower respiratory tract disease in horses.     

The pharmacokinetics and pharmacodynamics of the injectable anaesthetic alfaxalone in the horse

ObjectiveTo determine the pharmacokinetics and pharmacodynamics of the neurosteroidal anaesthetic, alfaxalone, in horses after a single intravenous (IV) injection of alfaxalone, following premedication with acepromazine, xylazine and guaiphenesin.Study designProspective experimental study.AnimalsTen (five male and five female), adult, healthy, Standardbred horses.MethodsHorses were premedicated with acepromazine (0.03 mg kg^?1 IV). Twenty minutes later they received xylazine (1 mg kg^?1 IV), then after 5 minutes, guaiphenesin (35 mg kg^?1 IV) followed immediately by IV induction of anaesthesia with alfaxalone (1 mg kg^?1). Cardiorespiratory variables (pulse rate, respiratory rate, pulse oximetry) and clinical signs of anaesthetic depth were evaluated throughout anaesthesia. Venous blood samples were collected at strategic time points and plasma concentrations of alfaxalone were assayed using liquid chromatography-mass spectrometry (LC/MS) and analysed by noncompartmental pharmacokinetic analysis. The quality of anaesthetic induction and recovery was scored on a scale of 1–5 (1 very poor, 5 excellent).ResultsThe median (range) induction and recovery scores were 4 (3–5) (good: horse slowly and moderately gently attained recumbency with minimal or no rigidity or paddling) and 4 (1–5) (good: horse stood on first attempt with some knuckling and ataxia) respectively. The monitored cardiopulmonary variables were within the range expected for clinical equine anaesthesia. The mean ± SD durations of anaesthesia from induction to sternal recumbency and from induction to standing were 42.7 ± 8.4 and 47 ± 9.6 minutes, respectively. The mean ± SD plasma elimination half life (t_1/2), plasma clearance (Clp) and volume of distribution (V_d) for alfaxalone were 33.4 minutes, 37.1 ± 11.1 mL minute^?1 kg^?1 and 1.6 ± 0.4 L kg^?1, respectively.Conclusions and clinical relevanceAlfaxalone, in a 2-hydroxypropyl-beta-cyclodextrin formulation, provides anaesthesia with a short duration of recumbency that is characterised by a smooth induction and satisfactory recovery in the horse. As in other species, alfaxalone is rapidly cleared from the plasma in the horse.     

α-Lipoic acid supplementation enhances heat shock protein production and decreases post exercise lactic acid concentrations in exercised standardbred trotters

Heat shock protein (HSP) expression is an adaptive mechanism against the disruption of cell homeostasis during exercise. Several antioxidant supplementation strategies have been used to enhance tissue protection. In this study, we examined the effects of a redox modulator, α-lipoic acid (LA) on HSP responses in six standardbred trotters following intense aerobic exercise. DL–LA supplementation (25 mg kg⁻¹ d⁻¹) for five weeks increased the resting levels of HSP90 (1.02 ± 0.155 in control and 1.26 ± 0.090 after supplementation in arbitrary units) and the recovery levels of inducible HSP70 (0.89 ± 0.056 in control and 1.05 ± 0.089 after supplementation in arbitrary units) in skeletal muscle. Furthermore, LA increased skeletal muscle citrate synthase activity at rest and lowered the blood lactate concentration during exercise without any changes in the heart rate. LA had no effect on concentrations of HSP60, HSP25 or GRP75 in skeletal muscle. LA decreased the exercise-induced increases in plasma aspartate aminotransferase and creatine kinase concentrations during recovery. Our results suggest that LA supplementation may enhance tissue protection and increase oxidative capacity of the muscle in horse.     

Horse Preference,Forage Yield,and Species Persistence of 12 Perennial Cool-Season Grass Mixtures Under Horse Grazing

Cool-season grass mixtures are rarely evaluated for preference, yield, and persistence under horse grazing. The objectives of this research were to evaluate horse preference, forage yield, and persistence of cool-season grass mixtures under horse grazing. Eight commercially marketed and four experimental perennial cool-season grass mixtures were planted in 2009 in a randomized complete block with five replicates and grazed by four adult horses during 2010, 2011, and 2012. All mixtures contained four to six cool-season perennial grass species. Specie density measurements were taken in each spring and fall, and yield was mechanically measured before each grazing period. After grazing, preference was determined by visually assessing percentage of forage removal on a scale of 0 (no grazing) to 100 (100% of vegetation removed). Data were analyzed using a mixed-model analysis of variance and liner regression. Horses preferred mixtures containing tall fescue, perennial ryegrass, Kentucky bluegrass, and timothy (P < .001). Horses had less preference for mixtures containing ≥30% orchardgrass (P < .001). Mixtures had similar (P = .11) forage yields that ranged from 6,100 to 7,082 kg ha⁻¹. After 2 years of grazing, orchardgrass and tall fescue increased; Kentucky bluegrass remained stable; and festulolium, meadow fescue, and perennial ryegrass had the greatest rate of decline in mixtures. Orchardgrass became the dominate species, regardless of initial percentage in the mixture. Mixtures containing tall fescue, perennial ryegrass, Kentucky bluegrass, and timothy should be planted in midwestern US horse pastures; however, mixtures will likely transition to tall fescue and Kentucky bluegrass–dominated pastures.     

An acute outbreak of equine dysautonomia (equine grass sickness) in a group of eight Przewalski's horses (Equus ferus [caballus] przewalskii)

Equine grass sickness (EGS) is a neurodegenerative disease affecting grazing equids of which a single case of the chronic clinical presentation has previously been reported in a Przewalski's horse (Equus ferus [caballus] przewalskii). A group of 8 Przewalski's horses were moved to a new enclosure, recently vacated by a group of 4 Eastern kiang (Equus kiang holdereri) that showed no evidence of disease. After 23 days the first Przewalski's horse showed clinical signs of acute EGS including flank sweating, belly kicking, rapid loss of body condition, cessation of faecal passage, nasogastric reflux and mouthing water. It was subjected to euthanasia within 48 h due to lack of therapeutic response. Within 24 h of this first case developing clinical signs, a further 5 Przewalski's horses showed similar clinical signs of acute EGS and were subjected to euthanasia. Post mortem examinations confirmed acute EGS, with all animals demonstrating typical chromatolysis, cytoplasmic hypereosinophilia, cellular swelling, vacuolation, pyknosis and loss of nuclei in approximately 90% of neurones in the cranial cervical and cranial mesenteric ganglia and myenteric and submucosal plexi of the ileum. Two Przewalski's horses within the group showed no clinical signs of disease. No single pathogen was identified as the causal agent, but the epidemiological pattern of the outbreak was typical for that previously reported for acute EGS in domestic equids. All affected animals and the 2 surviving Przewalski's horses had low antibody titres to Clostridium botulinum type C. This is the first report of acute EGS in a herd of Przewalski's horses.     

Dermatographism in a horse,responsive to cetirizine treatment

Dermatographism is a common condition in man that occurs when pressure is applied to the skin and mast cells are triggered to release histamine, causing local urticarial lesions. This case report concerns a 4-year-old Quarter Horse gelding that was presented with pressure induced urticaria. Moderate pressure on the skin induced nonpruritic urticaria-like swelling after approximately 3–5 min, which lasted for approximately 2–3 h. Initial treatment with cyproheptadine gave an incomplete response and unacceptable sedation as a side effect. On the second generation antihistamine cetirizine (0.2 mg/kg bwt twice daily), dermatographism was no longer present and no side effects occurred. Treatment was continued for 4 months, with at least three attempts to discontinue therapy resulting in recurrence of lesions within 24 h. Lesions resolved each time within 24 h of recommencing therapy. Dermatographism did not recur after the horse was moved to another location despite discontinuation of therapy. This report describes a case of equine dermatographism responsive to cetirizine.     

RESEARCH PAPER: Romifidine as a constant rate infusion in isoflurane anaesthetized horses: a clinical study

Objective To evaluate the effects of a constant rate infusion (CRI) of romifidine on the requirement of isoflurane, cardiovascular performance and recovery in anaesthetized horses undergoing arthroscopic surgery. Study design Randomized blinded prospective clinical trial. Animals Thirty horses scheduled for routine arthroscopy. Methods After premedication (acepromazine 0.02 mg kg^?1, romifidine 80 μg kg^?1, methadone 0.1 mg kg^?1) and induction (midazolam 0.06 mg kg^?1 ketamine 2.2 mg kg^?1), anaesthesia was maintained with isoflurane in oxygen. Horses were assigned randomly to receive a CRI of saline (group S) or 40 μg kg^?1 hour^?1 romifidine (group R). The influences of time and treatment on anaesthetic and cardiovascular parameters were evaluated using an analysis of variance. Body weight (t‐test), duration of anaesthesia (t‐test) and recovery score (Wilcoxon Rank Sum Test) were compared between groups. Significance was set at p < 0.05. Results All but one horse were positioned in the dorsal recumbent position and ventilated from the start of anaesthesia. End tidal isoflurane concentrations were similar in both groups at similar time points and over the whole anaesthetic period. Cardiac output was significantly lower in horses of the R group, but there were no significant differences between groups in cardiac index, body weight or age. All other cardiovascular parameters were similar in both groups. Quality of recovery did not differ significantly between groups, but more horses in group R stood without ataxia at the first attempt. One horse from group S had a problematic recovery. Conclusions and clinical relevance No inhalation anaesthetic sparing effect or side effects were observed by using a 40 μg kg^?1 hour^?1 romifidine CRI in isoflurane anaesthetized horses under clinical conditions. Cardiovascular performance remained acceptable. Further studies are needed to identify the effective dose of romifidine that will induce an inhalation anaesthetic sparing effect in anaesthetized horses.     

Effect of Lavender Aromatherapy on Acute-Stressed Horses

Methods to reduce the effects of acute stress could benefit the equine industry; therefore, the objective of this experiment was to determine whether aromatherapy would hasten the recovery time in acute-stressed horses. A total of seven horses were used in this experiment, using a crossover design where each horse received each treatment 7 days apart. The heart rates (HRs) and respiratory rates (RRs) were recorded for each horse at rest in stalls; then an air horn was blown twice for 15 seconds. The horses were allowed 60 seconds to calm, and then the stressed HRs and RRs were recorded. Control-treated horses were then exposed to humidified air, whereas aromatherapy-treated horses were exposed to humidified air with a 20% mixture of 100% pure lavender essential oil for 15 minutes. Following the 15-minute control or aromatherapy treatment, the recovery HRs and RRs were recorded (15 minutes). There were no statistical differences (P > .05) between the control and aromatherapy treatment for resting HR 33.7 ± 3.6 versus 34.0 ± 3.1 beats per minute (bpm), or change to increased HR in response to the air horn. However, the change in HR, after treatment, was significantly greater (P < .02) after aromatherapy (−9.25 ± 3.4 bpm) compared with the control treatment (0.29 ± 1.5 bpm). The RR did not differ (P > .05) between the control or aromatherapy treatment groups for the resting RR or change in RR. These results demonstrate that lavender aromatherapy can significantly decrease HR after an acute stress response and signal a shift from the sympathetic nervous control from the parasympathetic system.