Comparison between pulse pressure variation and systolic pressure variation measured from a peripheral artery for accurately predicting fluid responsiveness in mechanically ventilated dogs

ObjectiveTo compare pulse pressure variation (PPV) and systolic pressure variation (SPV) measured from a peripheral artery to predict fluid responsiveness in anesthetized healthy dogs.Study designProspective study.AnimalsA total of 39 dogs (13.8–26.8 kg) anesthetized with isoflurane for elective ovariohysterectomy.MethodsVentilation was controlled (tidal volume 12 mL kg^–1; 40% inspiratory pause). PPV and SPV were recorded from a dorsal pedal artery catheter using an automated algorithm. A fluid challenge (FC) with lactated Ringer’s solution (20 mL kg^–1 over 15 minutes) was administered once (21 animals) or twice (18 animals) before surgery. Increases in transpulmonary thermodilution stroke volume index > 15% from values recorded before each FC defined responders to volume expansion. Final fluid responsiveness status was based on the response to single FC or second FC. Predictive ability of PPV and SPV was compared by receiver operating characteristic (ROC) curve analysis and by the range of cut-off values associated with uncertain results (gray zone).ResultsAll animals after the single FC were responders; all animals administered two FCs were nonresponders after the second FC. The area under the ROC curve (AUROC) of PPV (0.968) did not differ from that of SPV (0.937) (p = 0.45). Best cut-off thresholds to discriminate responders from nonresponders were >11.7% (PPV) and >7.4 mmHg (SPV). The gray zone of PPV and SPV was 8.2–14.6% and 7.0–7.4 mmHg, respectively. The percentage of animals with PPV and SPV values within the gray zone was less for SPV (10.2%) than for PPV (30.8%).Conclusions and clinical relevancePPV and SPV obtained from the dorsal pedal artery are useful predictors of fluid responsiveness in dogs. Using an automated algorithm, SPV may more accurately predict fluid responsiveness than PPV, with responders identifiable by PPV > 14.6% and SPV > 7.4 mmHg.     

Comparison of pulse pressure variation versus echocardiography-derived stroke volume variation for prediction of fluid responsiveness in mechanically ventilated anesthetized dogs

ObjectiveTo evaluate the ability and accuracy of aortic flow velocity–time integral variation (ΔVTI) and peak aortic velocity variation (ΔVpeak) compared with pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated dogs.Study designProspective clinical study.AnimalsA group of 50 mechanically ventilated dogs with spontaneous hypotension during orthopedic or oncologic surgery.MethodsInvestigations were performed in the surgery room. When mean arterial pressure (MAP) decreased to <65 mmHg, measurements were performed before and after a fluid challenge (lactated Ringer’s solution 5 mL kg⁻¹ over 15 minutes). Responders were defined as a change in stroke volume (SV; transesophageal Doppler) ≥15%. Data were analyzed using paired/unpaired t test or Mann–Whitney/Wilcoxon test when appropriate and receiver operating characteristics (ROC) curves; a p value <0.05 was considered statistically significant.ResultsAfter the fluid challenge, 35 (70%) of 50 dogs were responders with significant increases in SV and decreases in PPV; 15 dogs were nonresponders. ΔVTI and ΔVpeak correlated with a 15% increase in SV. The optimum cut-off value for PPV was 15.6% (sensitivity, 88%; specificity, 100%), for ΔVTI was 10.65% (sensitivity, 65%; specificity, 100%) and for ΔVpeak was 10.15% (sensitivity, 80%; specificity, 100%). The area under the ROC curve for PPV was (0.93 ± 0.08) and for ΔVpeak was (0.89 ± 0.09), before fluid challenge. The gray zone area spread from 6.15% to 15.6% for PPV (18 dogs), 2.45% to 10.65% for ΔVTI (22 dogs) and 0.6% to 10.15% for ΔVpeak (25 dogs).ConclusionsWhen using mechanical ventilation, ΔVTI and ΔVpeak predicted fluid responsiveness with the same ability as PPV, based on the area under the ROC curve analysis. However, PPV showed great accuracy demonstrated by a narrower gray zone that included fewer individuals.Clinical relevanceΔVTI and ΔVpeak can be used as indices of fluid responsiveness in anesthetized dogs.     

Evaluation of the ability of haemodynamic variables obtained with minimally invasive techniques to assess fluid responsiveness in endotoxaemic Beagles

ObjectiveTo examine the ability of different haemodynamic variables recorded by minimally invasive monitoring techniques to assess fluid responsiveness (FR) in endotoxaemic Beagles.Study designProspective terminal experimental study.AnimalsA group of six healthy, purpose-bred Beagle dogs (three intact females and males), age 5–9.8 years (range) and weighing 11.4–17.9 kg.MethodsEndotoxaemic shock was induced by injecting 1 mg kg^–1 Escherichia coli lipopolysaccharide (LPS) intravenously in six sevoflurane-anaesthetized mechanically ventilated Beagles for another project. After 10 minutes, three Ringer’s acetate boluses (10 mL kg^–1) were administered each over 10 minutes with collection of haemodynamic data immediately before and after each bolus. Thereafter, arterial hypotension was treated with noradrenaline ± dexmedetomidine until arterial pressures increased to a target value. After a wash-out period of 20 minutes another three boluses of fluid were administered and measurements were repeated equally. For each fluid bolus, FR was considered positive when change (Δ) in stroke volume measured by pulmonary artery thermodilution was ≥15%. To test predictive accuracy for FR, we recorded heart rate, invasive arterial, right atrial and pulmonary capillary wedge pressures, pulse wave transit time with haemodynamic monitors, calculated pulse pressure, shock index and rate over pressure evaluation (ROPE) and measured stroke distance and corrected flow time (FTc) with oesophageal Doppler monitoring.ResultsA total of 35 measurements (19 positive and 16 negative responses) were evaluated. A FTc < 330 ms, Δ pulse pressure ≥20%, Δ shock index ≤–14% and ΔROPE ≤–17% were the most significant indicators of positive FR with an area under the receiver operating characteristics curve between 0.72 and 0.74.Conclusions and clinical relevanceIn endotoxaemic Beagles, none of the assessed haemodynamic variables could predict FR with high sensitivity and specificity.     

Change of Vertebral Left Atrial Size in Dogs With Preclinical Myxomatous Mitral Valve Disease Prior to the Onset of Congestive Heart Failure

Introduction/objectivesIt has been proposed that vertebral left atrial size (VLAS) on thoracic radiographs can be used to assess the left atrial enlargement in dogs with myxomatous mitral valve disease (MMVD). However, it remains unclear whether VLAS can be used to distinguish dogs between pre-clinical MMVD that are at a greater risk of developing congestive heart failure (CHF) from those at a lower risk. We investigated this possibility.Animals, materials and methodsForty-one dogs with MMVD were retrospectively classified into one of two groups, a group that developed CHF (group CHF, n = 17) or remained CHF-free (group no-CHF, n = 24). The value of vertebral heart scale (VHS) and VLAS at three time-points, change in VHS and VLAS at a specific time interval (ΔVHS, ΔVLAS) and rate of change in the values per month (ΔVHS/month, ΔVLAS/month) were compared.ResultsAt the first visit, there were no significant differences in VLAS between the groups. At the median of 105 (interquartile ranges 83–155) days prior to the onset of CHF (group CHF) or the last visit (group no-CHF), VLAS was significantly higher in group CHF (mean, 2.9; standard deviation ± 0.4) than in group no-CHF (2.6 ± 0.3) (p = 0.028). ΔVLAS/month (area under the curve, 0.91; p<0.001) showed high diagnostic accuracy in distinguishing which dogs would develop CHF within 180 days and which would not.ConclusionsVLAS and ΔVLAS/month in dogs with pre-clinical MMVD may be useful to identify dogs at risk of developing CHF within the next 180 days.     

Evaluation of the dynamic predictors of fluid responsiveness in dogs receiving goal-directed fluid therapy

Objectives

Goal-directed fluid therapy (GDFT) based on pulse pressure variation (PPV) was used in anaesthetized dogs undergoing abdominal surgeries. The aims were 1) to evaluate the success rate of the PPV ≥13% in detecting fluid responsiveness [delta stroke volume (ΔSV) ≥10%]; 2) to assess the correlation between PPV, systolic pressure variation (SPV), Plethysmograph Variability Index (PVI) and central venous pressure (CVP) and 3) to establish the threshold value for the PVI that would predict a PPV value of ≥13% and indirectly discriminate responders from nonresponders to fluid therapy.

Training satisfaction and well-being among veterinary anaesthesia residents: time for action

ObjectiveTo explore the satisfaction and well-being experienced by anaesthesia residents during their training, and to investigate factors that may have influenced their experiences.Study designCross-sectional online anonymous voluntary survey.Sample populationA total of 150 (of approximately 600 canvassed) former veterinary anaesthesia residents.MethodsParticipants were invited to complete an internet-based survey regarding the satisfaction and well-being experienced during their residency. Multiple choice, categorical, dichotomous, Likert-type rating scales and slider questions were used to investigate five domains (demographic, working conditions, educational environment, training satisfaction, well-being). Sampling adequacy, questionnaire reliability and participant responses were investigated by Kaiser-Meyer-Olkin (KMO) indices, Cronbach’s α and standard statistical techniques, respectively (p < 0.05).ResultsThe questionnaire demonstrated good sampling adequacy (median KMO index 0.74; range 0.51–0.89) and high item ‘reliability’ (α = 0.82–0.94). Of the 150 responders, (25% participation rate) 62% were satisfied, 14% were neutral and 24% were dissatisfied with their residency training; 60.6% would do the residency again, 39.3% would not or were unsure. Sex and age did not correlate with training satisfaction (p > 0.05). Salary/stipend was considered inadequate by 70% of responders; 66% received no on-call supplement. Greater supervisory input, a good working environment and extra income when on-call were positively correlated with training satisfaction (p < 0.01). The majority (94.6%) of trainees suffered from at least one medical condition during their residency, with fatigue, sleep disturbance or anxiety reported by > 62%.ConclusionsAlthough a quarter of responders were dissatisfied with their residency, several modifiable factors were identified, particularly with respect to supervisors’ input, working environment and pay, which could inform improvements for future residency programmes. Most trainees experienced negative health impacts; however, this parallels the general situation in both the medical and veterinary professions, which requires greater attention from the supervisors, trainees and colleges.     

Oxygen reserve index as a noninvasive indicator of arterial partial pressure of oxygen in anaesthetized donkeys: a preliminary study

ObjectiveTo evaluate the oxygen reserve index (ORI) as a noninvasive estimate of the PaO₂ during moderate hyperoxaemia [100–200 mmHg (13.3–26.6 kPa)], and to determine ORI values identifying PaO₂ > 100, > 150 (20.0 kPa) and > 200 mmHg in anaesthetized donkeys with an inspired fraction of oxygen (FiO₂) > 0.95.Study designProspective observational study.AnimalsA group of 28 adult standard donkeys aged (mean ± standard deviation) 4 ± 2 years and weighing 135 ± 15 kg.MethodsDonkeys were sedated intramuscularly with xylazine and butorphanol; anaesthesia was induced with ketamine and diazepam and maintained with isoflurane in oxygen. An adhesive sensor probe was applied to the donkey’s tongue and connected to a Masimo pulse co-oximeter to determine ORI values. An arterial catheter was inserted into an auricular artery. After ORI signal stabilization, the value was noted and PaO₂ determined by blood gas analysis. The Pearson correlation coefficient was used to assess the relationship between ORI and PaO₂ for oxygen tension < 200 mmHg (< 26.6 kPa). The Youden index was used to identify the value of ORI that detected PaO₂ > 150 and 200 mmHg (20.0 and 26.6 kPa) with the highest sensitivity and specificity.ResultsA total of 106 paired measurements were collected. A mild positive correlation was observed between ORI and PaO₂ for values < 200 mmHg (26.6 kPa; r = 0.52). An ORI > 0.0, > 0.1 and > 0.3 indicated a PaO₂ > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) with negative predictive values > 94%.Conclusions and clinical relevanceORI may provide a noninvasive indication of PaO₂ > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) in anaesthetized donkeys with an FiO₂ > 0.95, although it does not replace blood gas analysis for assessment of oxygenation.     

Noninvasive electrocardiographic parameters to assess interventricular dyssynchrony in dogs with bundle branch blocks

ObjectivesTo define electrocardiographic features of complete left bundle branch block (LBBB) and right bundle branch block (RBBB), and the use of R-peak time (RPT) to identify interventricular dyssynchrony in dogs with BBB.Animals, materials and methodsTwelve-lead ECG tracings of 20 dogs with RBBB, 20 with LBBB, and 60 healthy dogs were retrospectively analyzed and RPT was measured in precordial leads. Interventricular dyssynchrony index (IDI) was than calculated.ResultsIn RBBB, mean electrical axis (MEA) was −111° [−120/−100°], V₁RPT was significantly longer (61 ms [55–72 ms]) than left precordial leads RPT (V₂:25 ms [22–30 ms]; V₃:25 ms [22–29 ms]; V₄:24 ms [21–29 ms]; V₅:25 ms [22–29 ms]; V₆:25 ms [22–29 ms]) and when compared to normal dogs (P < 0.001). In LBBB, MEA was 76° [70/81°], RPT in left precordial leads was significantly longer (V₂:49 ms [34–58 ms]; V₃:49 ms [43–57 ms]; V₄:52 ms [45–62 ms]; V₅:53 ms [45–63 ms]; V₆:55 ms [45–63 ms]) than V₁RPT (17 ms [15–20 ms]) and when compared to normal dogs (P < 0.001). V₁RPT > 28 ms and V₅RPT > 36 ms were found to predict the presence of RBBB and LBBB with a sensitivity of 100% and 96.7%, and a specificity of 96.7% and 99.5%, respectively. The IDI was 23% [16–29%] in normal dogs and significantly greater in dogs with RBBB (33% [30–38%]; P < 0.001) and LBBB (32% [23–41%]; P = 0.006).ConclusionsThis study defines ECG features and RPT in dogs with BBB. Electrical interventricular dyssynchrony can be defined using IDI in dogs with BBB.     

Pulse pressure variation as a guide for volume expansion in dogs undergoing orthopedic surgery

Objective

To investigate whether pulse pressure variation (PPV) can predict fluid responsiveness in healthy dogs during clinical surgery.

Evaluation of the nociception–antinociception balance using the Parasympathetic Tone Activity index in dogs anaesthetized for castration

ObjectiveTo evaluate the performance of the Parasympathetic Tone Activity (PTA) index in assessing the nociception–antinociception balance in anaesthetized dogs undergoing castration.Study designProspective clinical study.AnimalsA group of 22 healthy client-owned dogs.MethodsThe dogs underwent general anaesthesia, with continuous monitoring of mean and instantaneous PTA (PTAm, PTAi), mean arterial pressure and heart rate. The values of these variables were divided according to the occurrence or absence of a haemodynamic reaction (HDR) at different time points: during surgical preparation, cutaneous incision, testicles extraction, cutaneous suture, after fentanyl administration, and after dexmedetomidine administration during recovery. Data were collected initially and 1, 3 and 5 minutes after each time point. The performance of the dynamic variation of the PTA (ΔPTA) to predict HDR or its resolution within 3 or 5 minutes was assessed using receiver operating characteristic (ROC) curves analysis. A p value < 0.05 was considered significant.ResultsDuring HDR, a decrease in PTAi (–34% and –31%) and PTAm (–26% and –30%) occurred at 3 (p = 0.005; p = 0.004) and 5 minutes (p = 0.001), respectively. After fentanyl administration, a decrease in haemodynamic variables occurred with a 45% increase in PTAi (p = 0.004). The ROC curve analysis of pooled data of the ΔPTAi for the prediction of HDR within 3 minutes indicated an area under the curve (AUC) of 0.70 (p = 0.0016) (threshold value: –16%). After fentanyl administration, the ROC curve analysis of ΔPTAi for the prediction of resolution of HDR within 3 minutes indicated an AUC of 0.69 (threshold value: +12%).Conclusions and clinical relevanceThe PTAi appears to be an interesting tool to assess the nociception–antinociception balance. However, further studies with a variety of clinical scenarios and anaesthesia protocols are required to conclude on its performance.     

Peripheral nerve block versus systemic analgesia in dogs undergoing tibial plateau levelling osteotomy: Analgesic efficacy and pharmacoeconomics comparison

ObjectiveTo compare the perioperative effects and pharmacoeconomics of peripheral nerve blocks (PNBs) versus fentanyl target-controlled infusion (fTCI) in dogs undergoing tibial plateau levelling osteotomy (TPLO).Study designRandomized clinical study.AnimalsA total of 39 dogs undergoing unilateral TPLO.MethodsAfter acepromazine and methadone, anaesthesia was induced with propofol and maintained with isoflurane. Dogs were allocated to group fTCI [target plasma concentration (TPC) 1 ng mL^–1] or group PNB (nerve stimulator-guided femoral-sciatic block using 0.2 and 0.1 mL kg^–1 of levobupivacaine 0.5%, respectively). If nociceptive response occurred, isoflurane was increased by 0.1%, and TPC was increased by 0.5 ng mL^–1 in group fTCI; a fentanyl bolus (1 μg kg^–1) was administered in group PNB. During the first 24 postoperative hours, methadone (0.2 mg kg^–1) was administered intramuscularly according to the Short Form Glasgow Composite Pain Scale, or if pain was equal to 5/24 or 4/20 for two consecutive assessments, or if the dog was non-weight bearing. The area under the curve (AUC) of pain scores, cumulative postoperative methadone requirement, food intake and pharmacoeconomic implications were calculated.ResultsIncidence of bradycardia (p = 0.025), nociceptive response to surgery (p = 0.041) and AUC of pain scores (p < 0.0001) were greater in group fTCI. Postoperatively, 16/19 (84.2%) and eight/20 (40%) dogs in groups fTCI and PNB, respectively, were given at least one dose of methadone (p = 0.0079). Food intake was greater in group PNB (p = 0.049). Although total cost was not different (p = 0.083), PNB was more cost-effective in dogs weighing >15 kg.Conclusions and clinical relevanceCompared with group fTCI, incidence of bradycardia, nociceptive response to surgery, postoperative pain scores, cumulative methadone requirement were lower, and food intake was greater in group PNB, with an economic advantage in dogs weighing >15 kg.     

Determination of the effective dosage of tiletamine–zolazepam–ketamine–xylazine,with or without methadone,in dogs

ObjectiveTo determine the effective dosage of the combination tiletamine–zolazepam–ketamine–xylazine (TKX), with or without methadone, in dogs.Study designProspective, randomized, experimental study.AnimalsA total of 29 dogs.MethodsDogs were randomly administered TKX (group TKX, n = 13) or combined with 0.3 mg kg^–1 of methadone (group TKXM, n = 16) intramuscularly. The TKX solution contained tiletamine (50 mg mL^–1), zolazepam (50 mg mL^–1), ketamine (80 mg mL^–1) and xylazine (20 mg mL^–1). The effective dosages for immobility in 50% and 95% of the population (ED₅₀ and ED₉₅) were estimated using the up-and-down method. Approximately 20 minutes after drug administration, a skin incision was performed and the response was judged as positive or negative if the dogs moved or did not move, respectively. The TKX volume for the subsequent dog in the same group was increased or decreased by 0.005 mL kg^–1 if the response of the previous dog was positive or negative, respectively. Heart and respiratory rates, and sedation/anesthesia scores (range 0–21) were recorded before and 15 minutes after drug administration.ResultsEstimated ED₅₀ and ED₉₅ (95% confidence intervals) were: TKX, 0.025 (0.020–0.029) and 0.026 (0.010–0.042) mL kg^–1; TKXM, 0.022 (0.018–0.025) and 0.033 (0.017–0.049) mL kg^–1. Median (interquartile range) scores for sedation/anesthesia were 17 (16–18) and 17 (15–20), and times until lateral recumbency were 5 (4–6) and 6 (4–10) minutes in TKX and TKXM, respectively (p > 0.05). In both groups heart and respiratory rates decreased, but values remained acceptable for anesthetized dogs.Conclusions and clinical relevanceThe results provide a guide for volumes of TKX and TKXM in dogs requiring restraint for minimally invasive procedures. Inclusion of methadone in the TKX combination did not influence ED₅₀.     

Effects of cuff size and position on the agreement between arterial blood pressure measured by Doppler ultrasound and through a dorsal pedal artery catheter in anesthetized cats

ObjectiveTo compare the effects of cuff size/position on the agreement between arterial blood pressure measured by Doppler ultrasound (ABP_Doppler) and dorsal pedal artery catheter measurements of systolic (SAP_invasive) and mean arterial pressure (MAP_invasive) in anesthetized cats.Study designProspective study.AnimalsA total of eight cats (3.0–3.8 kg) for neutering.MethodsDuring isoflurane anesthesia, before surgery, changes in end-tidal isoflurane concentrations and/or administration of dopamine were performed to achieve SAP_invasive within 60–150 mmHg. Cuff sizes 1, 2 and 3 (bladder width: 20, 25 and 35 mm, respectively) were placed on distal third of the antebrachium, above the tarsus and below the tarsus for ABP_Doppler measurements. Agreement between ABP_Doppler and SAP_invasive or between ABP_Doppler and MAP_invasive was compared with reference standards for noninvasive blood pressure devices used in humans and small animals.ResultsMean bias and precision (±standard deviation) between ABP_Doppler and SAP_invasive met veterinary standards (≤10 ± 15 mmHg), but not human standards (≤5 ± 8 mmHg), with cuffs 1 and 2 placed on the thoracic limb (7.4 ± 13.9 and –5.8 ± 9.5 mmHg, respectively), and with cuff 2 placed proximal to the tarsus (7.2 ± 12.4 mmHg). Cuff width-to-limb circumference ratios resulting in acceptable agreement between ABP_Doppler and SAP_invasive were 0.31 ± 0.04 (cuff 1) and 0.42 ± 0.05 (cuff 2) on the thoracic limb, and 0.43 ± 0.05 (cuff 2) above the tarsus. ABP_Doppler showed no acceptable agreement with MAP_invasive by any reference standard.Conclusions and clinical relevanceThe agreement between ABP_Doppler and SAP_invasive can be optimized by placing the occlusive cuff on the distal third of the antebrachium and above the tarsus. In these locations, cuff width should approach 40% of limb circumference to provide clinically acceptable estimations of SAP_invasive. Doppler ultrasound cannot be used to estimate MAP_invasive in cats.     

Evaluation of outflow temperatures generated by a dry heat fluid warmer at low fluid rates

ObjectiveTo evaluate the output temperature of a dry heat fluid warmer at fluid rates typically used in small animal veterinary patients.Study designProspective in vitro study.AnimalsNone.MethodsAmbient temperature lactated Ringer’s (17.9-18.8 °C) was delivered via a dry heat fluid warmer. A temperature probe was used to measure fluid outflow temperature from the compatible giving set at 5, 10, 20, 50, 70, 80, 100, 200, 300, 400 and 500 mL hour^–1. Outflow fluid temperature at plateau (two consecutive readings within 0.1 °C) was compared with baseline fluid temperature (fluid warmer turned off) to calculate temperature changes at each rate. Kruskal–Wallis test was used to compare changes in temperature and time to plateau temperature. Dunn’s post hoc test was used to test for significant differences in temperature compared to 5 mL hour^–1; p value < 0.05.ResultsMedian plateau outflow temperature increased as fluid rate increased, with temperatures of 18.5, 18.6, 18.7, 18.8, 19.4, 19.4, 21.5, 25.3, 28.5, 30.7 and 32.6 °C, at flow rates of 5, 10, 20, 50, 70, 80, 100, 200, 300, 400 and 500 mL hour^–1. Fluid rates > 100 mL hour^–1 showed significant increases from baseline (p = 0.021) There was no difference in temperature change from baseline at fluid rates < 100 mL hour^–1 (p > 0.05). Compared to plateau temperature at 5 mL hour^-1, there was a statistical difference in plateau temperature above 100 mL hour^–1 (p = 0.0207). Maximum outflow plateau temperature was 32.6 °C at 500 mL hour^–1.Conclusions and clinical relevanceA dry heat fluid warmer has significantly decreased efficacy at low fluid rates, with no statistically significant increase in fluid temperature at fluid rates below 100 mL hour^–1 at the end of a compatible fluid line. Inline dry heat fluid warmers are ineffective at fluid rates below 100 mL hour^–1.     

Comparison between intravenous lidocaine and fentanyl on cough reflex and sympathetic response during endotracheal intubation in dogs

ObjectiveTo compare the effects of intravenous (IV) lidocaine and fentanyl on the cough reflex and autonomic response during endotracheal intubation in dogs.Study designRandomized, blinded, superiority clinical trial.AnimalsA total of 46 client-owned dogs undergoing magnetic resonance imaging.MethodsAfter intramuscular methadone (0.2 mg kg^–1), dogs were randomized to be administered either IV lidocaine (2 mg kg^–1; group L) or fentanyl (7 μg kg^–1; group F). After 5 minutes, alfaxalone was administered until endotracheal intubation was possible (1 mg kg^–1 IV over 40 seconds followed by 0.4 mg kg^–1 increments to effect). Total dose of alfaxalone was recorded and cough reflex at endotracheal intubation was scored. Heart rate (HR) was continuously recorded, Doppler systolic arterial blood pressure (SAP) was measured every 20 seconds. Vasovagal tonus index (VVTI) and changes (Δ) in HR, SAP and VVTI between pre-intubation and intubation were calculated. Groups were compared using univariate and multivariate analysis. Statistical significance was set as p < 0.05.ResultsGroup F included 22 dogs and group L 24 dogs. The mean (± standard deviation) alfaxalone dose was 1.1 (± 0.2) and 1.35 (± 0.3) mg kg^–1 in groups F and L, respectively (p = 0.0008). At intubation, cough was more likely in group L (odds ratio = 11.3; 95% confidence intervals, 2.1 – 94.2; p = 0.01) and HR increased in 87.5% and 54.5% of groups L and F, respectively (p = 0.02). The median (range) ΔHR between pre-intubation and intubation was higher (13.1%; – 4.3 to + 55.1) in group L (p = 0.0021). Between groups, SAP and VVTI were similar.Conclusion and clinical relevanceAt the stated doses, whilst reducing the alfaxalone dose, fentanyl is superior to lidocaine in suppressing the cough reflex and blunting the increase in HR at endotracheal intubation in dogs premedicated with methadone.     

Postoperative oxygenation in healthy dogs following mechanical ventilation with fractions of inspired oxygen of 0.4 or >0.9

ObjectiveTo evaluate arterial oxygenation during the first 4 postoperative hours in dogs administered different fractions of inspired oxygen (FiO₂) during general anesthesia with mechanical ventilation.Study designProspective, randomized clinical trial.AnimalsA total of 20 healthy female dogs, weighing >15 kg and body condition scores 3–7/9, admitted for ovariohysterectomy.MethodsDogs were randomized to breathe an FiO₂ >0.9 or 0.4 during isoflurane anesthesia with intermittent positive pressure ventilation. The intraoperative PaO₂:FiO₂ ratio was recorded during closure of the linea alba. Arterial blood was obtained 5, 60 and 240 minutes after extubation for measurement of PaO₂ and PaCO₂ (FiO₂ = 0.21). Demographic characteristics, duration of anesthesia, PaO₂:FiO₂ ratio and anesthetic agents were compared between groups with Wilcoxon tests. The postoperative PaO₂, PaCO₂, rectal temperature, a visual sedation score and events of hypoxemia (PaO₂ < 80 mmHg) were compared between groups with mixed-effects models or generalized linear mixed models.ResultsGroups were indistinguishable by demographic characteristics, duration of anesthesia, anesthetic agents administered and intraoperative PaO₂:FiO₂ ratio (all p > 0.08). Postoperative PaO₂, PaCO₂, rectal temperature or sedation score were not different between groups (all p > 0.07). During the first 4 postoperative hours, hypoxemia occurred in three and seven dogs that breathed FiO₂ >0.9 or 0.4 during anesthesia, respectively (p = 0.04).Conclusions and clinical relevanceThe results identified no advantage to decreasing FiO₂ to 0.4 during anesthesia with mechanical ventilation with respect to postoperative oxygenation. Moreover, the incidence of hypoxemia in the first 4 hours after anesthesia was higher in these dogs than in dogs breathing FiO₂ >0.9.     

Hypoventilation following oxygen administration associated with alfaxalone–dexmedetomidine–midazolam anesthesia in New Zealand White rabbits

ObjectiveTo investigate the relationship between oxygen administration and ventilation in rabbits administered intramuscular alfaxalone–dexmedetomidine–midazolam.Study designProspective, randomized, blinded study.AnimalsA total of 25 New Zealand White rabbits, weighing 3.1–5.9 kg and aged 1 year.MethodsRabbits were anesthetized with intramuscular alfaxalone (4 mg kg^–1), dexmedetomidine (0.1 mg kg^–1) and midazolam (0.2 mg kg^–1) and randomized to wait 5 (n = 8) or 10 (n = 8) minutes between drug injection and oxygen (100%) administration (facemask, 1 L minute^–1). A control group (n = 9) was administered medical air 10 minutes after drug injection. Immediately before (PRE_oxy/air5/10) and 2 minutes after oxygen or medical air (POST_oxy/air5/10), respiratory rate (f_R), pH, PaCO₂, PaO₂, bicarbonate and base excess were recorded by an investigator blinded to treatment allocation. Data [median (range)] were analyzed with Wilcoxon, Mann–Whitney U and Kruskal–Wallis tests and p < 0.05 considered significant.ResultsHypoxemia (PaO₂ < 88 mmHg, 11.7 kPa) was observed at all PRE times: PRE_oxy5 [71 (61–81) mmHg, 9.5 (8.1–10.8) kPa], PRE_oxy10 [58 (36–80) mmHg, 7.7 (4.8–10.7) kPa] and PRE_air10 [48 (32–64) mmHg, 6.4 (4.3–8.5) kPa]. Hypoxemia persisted when breathing air: POST_air10 [49 (33–66) mmHg, 6.5 (4.4–8.8) kPa]. Oxygen administration corrected hypoxemia but was associated with decreased f_R (>70%; p = 0.016, both groups) and hypercapnia (p = 0.016, both groups). Two rabbits (one per oxygen treatment group) were apneic (no thoracic movements for 2.0–2.5 minutes) following oxygen administration. f_R was unchanged when breathing air (p = 0.5). PaCO₂ was higher when breathing oxygen than air (p < 0.001).Conclusions and clinical relevanceEarly oxygen administration resolved anesthesia-induced hypoxemia; however, f_R decreased and PaCO₂ increased indicating that hypoxemic respiratory drive is an important contributor to ventilation using the studied drug combination.     

Lung aeration and volumes following alveolar recruitment maneuvers with three airway pressures in healthy anesthetized and mechanically ventilated Beagle dogs

ObjectiveTo compare the effects of three recruitment airway pressures (RP_aw) on lung aeration and volumes in mechanically ventilated dogs during propofol anesthesia.Study designProspective, crossover randomized experimental study.AnimalsA total of eight healthy anesthetized experimental Beagle dogs in dorsal recumbency.MethodsDogs were mechanically ventilated with a tidal volume of 15 mL kg^–1 and zero positive end-expiratory pressure and 100% oxygen. Three maneuvers consisting of a 30 second inspiration at RP_aws of 15 (RP_aw15), 25 (RP_aw25) and 35 (RP_aw35) cmH₂O were performed randomly, 15 minutes apart. Changes in lung aeration and lung deformation were compared with end-expiratory baseline (before the application of each RP_aw) and between-RP_aws using computed tomography scans and calculations of global lung strain. Between-group comparisons were performed with one-way anova for repeated measures followed by Tukey test for multiple comparisons. A p value < 0.05 was considered significant.ResultsThe amount of nonaeration was minimal (<1%) at baseline and not different with the application of the RP_aws. The amount of hypoaeration and normoaeration during baseline decreased with all RP_aws (p < 0.001). There was no difference between RP_aws regarding hypoaeration (all p > 0.999), whereas normoaeration was higher at RP_aw15 than RP_aw25 and RP_aw35 (p < 0.009). Compared with baseline, the fraction of hyperaerated alveoli increased with each RP_aw (p < 0.001) and was lower during RP_aw15 than RP_aw25 and RP_aw35 (both p ≤ 0.007). Global lung strain was lower during RP_aw15 than at higher RP_aw (p < 0.001).Conclusions and clinical relevanceA RP_aw of 15 cmH₂O for 30 seconds was the recommended RP_aw because it was as effective at reversing hypoaeration as RP_aws of 25 and 35 cmH₂O but with less hyperaeration and potential for overdistension of the lungs in this particular population of dogs with negligible atelectasis.     

Reliability of pulse oximetry at four different attachment sites in immobilized white rhinoceros (Ceratotherium simum)

ObjectivesTo determine the reliability of peripheral oxygen haemoglobin saturation (SpO₂), measured by a Nonin PalmSAT 2500A pulse oximeter with 2000T transflectance probes at four attachment sites (third eyelid, cheek, rectum and tail), by comparing these measurements to arterial oxygen haemoglobin saturation (SaO₂), measured by an AVOXimeter 4000 co-oximeter reference method in immobilized white rhinoceros (Ceratotherium simum).Study designRandomized crossover study.AnimalsA convenience sample of eight wild-caught male white rhinoceros.MethodsWhite rhinoceros were immobilized with etorphine (0.0026 ± 0.0002 mg kg^–1, mean ± standard deviation) intramuscularly, after which the pinna was aseptically prepared for arterial blood sample collection, and four pulse oximeters with transflectance probes were fixed securely to their attachment sites (third eyelid, cheek, rectum and tail). At 30 minutes following recumbency resulting from etorphine administration, the animals were given either butorphanol (0.026 ± 0.0001 mg kg^–1) or an equivalent volume of saline intravenously. At 60 minutes following recumbency, insufflated oxygen (15 L minute^–1 flow rate) was provided intranasally. In total, the SpO₂ paired measurements from the third eyelid (n = 80), cheek (n = 67), rectum (n = 59) and tail (n = 76) were compared with near-simultaneous SaO₂ measurements using Bland-Altman to assess bias (accuracy), precision, and the area root mean squares (ARMS) method.ResultsCompared with SaO₂, SpO₂ measurements from the third eyelid were reliable (i.e., accurate and precise) above an SaO₂ range of 70% (bias = 1, precision = 3, ARMS = 3). However, SpO₂ measurements from the cheek, rectum and tail were unreliable (i.e., inaccurate or imprecise).Conclusions and clinical relevanceA Nonin PalmSAT pulse oximeter with a transflectance probe inserted into the space between the third eyelid and the sclera provided reliable SpO₂ measurements when SaO₂ was > 70%, in immobilized white rhinoceros.     

Sedative and cardiorespiratory effects of intranasal atomized alfaxalone in Japanese White rabbits

ObjectiveTo investigate the sedative and cardiorespiratory effects of intranasal atomization (INA) of alfaxalone using a mucosal atomization device in Japanese White rabbits.Study designRandomized, prospective, crossover study.AnimalsA total of eight healthy female rabbits, weighing 3.6–4.3 kg and aged 12–24 months.MethodsEach rabbit was randomly assigned to four INA treatments administered 7 days apart: Control treatment, 0.15 mL 0.9% saline in both nostrils; treatment INA0.3, 0.15 mL 4% alfaxalone in both nostrils; treatment INA0.6, 0.3 mL 4% alfaxalone in both nostrils; treatment INA0.9, 0.3 mL 4% alfaxalone in left, then right, then left nostril. Sedation was scored 0–13 using a composite measure scoring system for rabbits. Simultaneously, pulse rate (PR), respiratory rate (f_R), noninvasive mean arterial pressure (MAP), peripheral hemoglobin oxygen saturation (SpO₂) and arterial blood gases were measured until 120 minutes. The rabbits breathed room air during the experiment and were administered flow-by oxygen when hypoxemia (SpO₂ <90% or PaO₂ <60 mmHg; 8.0 kPa) developed. Data were analyzed using the Fisher's exact test and the Friedman test (p < 0.05).ResultsNo rabbit was sedated in treatments Control and INA0.3. All rabbits in treatment INA0.9 developed loss of righting reflex for 15 (10–20) minutes [median (25th–75th percentile)]. Sedation score significantly increased from 5 to 30 minutes in treatments INA0.6 and INA0.9 with maximum scores of 2 (1–4) and 9 (9–9), respectively. f_R decreased in an alfaxalone dose-dependent manner and one rabbit developed hypoxemia in treatment INA0.9. No significant changes were observed in PR and MAP.Conclusions and clinical relevanceINA alfaxalone resulted in dose-dependent sedation and respiratory depression in Japanese White rabbits to values considered not clinically relevant. Further investigation of INA alfaxalone in combination with other drugs is warranted.