Comparison of Fick and thermodilution cardiac output determinations in standing horses

The Fick and thermodilution (TD) methods are two currently popular techniques for determination of cardiac output (CO) in adult horses. To our knowledge, a comparison of these two techniques has not been reported. Six healthy, resting, fit, adult horses of either sex and weighing 516.5+/-33.2 kg (mean+/-SD) were instrumented to enable measurement of cardiac output. Resting CO was determined by the Fick method and by thermodilution while the horses stood quietly in the stocks. Fick and thermodilution CO measurements were repeated under conditions of increased cardiac output achieved with the use of a dobutamine infusion (5 microg kg(-1) min(-1), IV), and again under conditions of decreased CO induced by administration of xylazine (0.5 mg/kg, IV). Fick and thermodilution cardiac outputs were compared using Bland-Altman analysis for repeated measures. The mean of the differences+/-1.96SD (bias and precision) between the two techniques was 1.88+/-24.17 L/min. Variability between measurements with the two techniques was decreased to 3.41+/-46.78 mL kg(-1) min(-1) when CO was normalized for body size by calculation of cardiac index.     

Accuracy of the thermodilution method in estimating high flow - an in vitro study

The accuracy of thermodilution for measuring flow rates of 10–40 L/min was evaluated using a commercially available thermodilution cardiac output computer in an in vitro model. Water (36.5–37.5°C) was directed through a mixing chamber via a constant flow pump. Thermodilution estimates of flow using four different volumes (10, 20, 30, 40 ml) of iced water injectate were compared to simultaneous measurements of timed samples of effluent from the mixing chamber. Injectate volume had a significant impact on the accuracy of thermodilution estimation (p < 0.05). Thermodilution overestimated measured flow when 10 and 20 ml of injectate were used to determine flow rates < 20 L/min but underestimated flow when injectate volumes of 30 and 40 ml were used, or when measured flow was > 25 L/min. The discrepancy between thermodilution flow and measured flow increased as rate of fluid flow increased.     

Thermodilution estimation of cardiac output at high flows in anesthetized horses.

The purpose of this study was to compare the thermodilution technique for estimation of cardiac output with the indocyanine green dye dilution technique at flows between 10 and 39 L/min in halothane-anesthetized horses. The estimation of area of dye dilution cardiac output curves was made by using the fore-'n-aft (FA) triangle method. This shorthand technique was compared with logarithmic exponential extrapolation and summation (extrapolated area), using 64 cardiac output curves. Then, 256 simultaneous thermodilution measurements were compared with dye dilution measurements calculated by use of the FA technique. Forty milliliters of iced 0.9% NaCl solution containing 15 mg of indocyanine green dye was used as the indicator. This was delivered in less than 1 second to the right atrium, using a power injector. A thermistor positioned in the pulmonary artery detected the thermal indicator. Blood was withdrawn from the carotid artery through a densitometer cuvette to measure the dye concentration. The FA estimations of area were higher than those determined by use of extrapolated area. A multiplicative adjustment of 0.837 was estimated. On average, thermodilution estimates of cardiac output exceeded the adjusted FA determinations. Using a weighted linear regression, we determined the following calibration adjustment: thermal dilution cardiac output/1.048 = indocyanine green dye dilution cardiac output.     

Thermodilution cardiac output determination in the guinea pig

Thermodilution cardiac output was compared with simultaneously determined aortic flow in 5 guinea pigs during thoracotomy. Total cardiac output was affected by volume expansion, adrenergic stimulation, and the volume of hemorrhage. For the equation y = mx, where y is aortic flow, x is thermodilution cardiac output, and m is the slope of the regression line, m = 0.88 +/- 0.02 (95% confidence interval). The SE of the regression was 27.8 ml/min. Thermodilution may have been overestimated because the aortic flow measurement did not take into account the coronary arterial blood flow, which is approximately 4% of total cardiac output in the guinea pig. Indicator loss (ie, temperature) also may be an important factor in the calculation of cardiac output, as determinations of thermodilution cardiac output were affected by sampling site in the guinea pig. Thermodilution appears to be a useful and reliable means of determining cardiac output in the guinea pig.     

Portal blood flow in beef steers: comparison of techniques and relation to hepatic blood flow, cardiac output and oxygen uptake

We compared two techniques for measuring blood flow through portal-drained viscera (PDV) of beef steers and measured portions of cardiac output and total oxygen uptake attributable to PDV and hepatic tissues. Four steers (198 +/- 2 kg), equipped with chronic catheters in appropriate vessels, a transit-time ultrasound probe around the hepatic portal vein and a temporary cardiac output thermodilution catheter, were fed a 60:40 hay: concentrate diet. Treatments, designed to alter blood flow, were: 12 equal meals every 2 h (CNTL); CNTL plus 2 mg clenbuterol in one meal (CLEN); and a 65-h fast (FAST). Blood flow through PDV was measured by dilution of p-aminohippurate (PAH) and transit-time ultrasound. Hepatic blood flow was measured by PAH dilution and cardiac output was measured by thermodilution. Blood flow measured by transit-time ultrasound was consistently slower (45%, P less than .01) than blood flow measured by PAH dilution. Necropsy revealed anatomical constraints that precluded proper placement and function of the flow probes. Cardiac output (liters/h) was greater (P less than .05) for CLEN (3,082) than for CNTL (1,655) or FAST (1,047). Percentage of cardiac output flowing through PDV and hepatic tissues was less (P less than .05) for CLEN (23 and 24%) than for CNTL (31 and 38%) or FAST (32 and 38%). Whole body oxygen uptake (mmol/h) was greatest (P less than .05) for CLEN (4,220), intermediate for CNTL (2,999) and least for FAST (1,965). Percentage of oxygen uptake attributable to hepatic tissues was greater (P less than .05) for FAST (31%) than for CLEN (18%), with CNTL intermediate (24%). Percentage of oxygen uptake attributable to PDV (22%) was not affected (P greater than .05) by treatments.     

Cardiopulmonary effects of a ketamine/acepromazine combination in hypovolemic cats.

The cardiopulmonary effects of a ketamine/ acepromazine combination was studied in ten cats subjected to a 25% whole blood volume loss. Test parameters included cardiac output, measured via thermodilution, heart rate, respiratory rate, arterial blood pressure (systolic, diastolic and mean) and blood gas analysis. Values for cardiac index, stroke volume and systemic vascular resistance were calculated from these data. Posthemorrhage, cardiac output, cardiac index, stroke volume, heart rate and measurements of arterial blood pressure were significantly decreased (p less than 0.05). Following the induction of ketamine/ acepromazine anesthesia, cardiac output, cardiac index, stroke volume and heart rate showed mild but statistically insignificant declines and were above their respective posthemorrhage values 120 min into ketamine/ acepromazine anesthesia. Measurements of arterial blood pressure showed further declines from their respective posthemorrhage values that were statistically significant (p less than 0.05). Following hemorrhage, respiratory rate increased significantly (p less than 0.05), associated with a fall in arterial CO2 tension. During ketamine/ acepromazine anesthesia, respiratory rate showed a dramatic and significant decline (p less than 0.05) with arterial CO2 tension rising to prehemorrhage values. Systemic vascular resistance, arterial O2 tension and pH remained essentially unchanged throughout the experimental period.     

Assessment of lithium dilution cardiac output as a technique for measurement of cardiac output in dogs

OBJECTIVES: To determine agreement of cardiac output measured by use of lithium dilution cardiac output (LiDCO) and thermodilution cardiac output (TDCO) techniques in dogs and to determine agreement of low- and high-dose LiDCO with TDCO. ANIMALS: 10 dogs (7 males, 3 females). PROCEDURE: Cardiac output was measured in anesthetized dogs by use of LiDCO and TDCO techniques. Four rates of cardiac output were induced by occlusion of the caudal vena cava, changes in depth of anesthesia, or administration of dobutamine. Lithium dilution cardiac output was performed, using 2 doses of lithium chloride (low and high dose). Each rate of cardiac output allowed 4 comparisons between LiDCO and TDCO. RESULTS: 160 comparisons were determined of which 68 were excluded. The remaining 92 comparisons had values ranging from 1.10 to 12.80 L/min. Intraclass correlation coefficient (ICC) between low-dose LiDCO and TDCO was 0.9898 and between high-dose LiDCO and TDCO was 0.9896. When all LiDCO determinations were pooled, ICC was 0.9894. For determinations of cardiac output < 5.0 L/min, ICC was 0.9730. Mean +/- SD of the differences of TDCO minus LiDCO for all measurements was -0.084+/-0.465 L/min, and mean of TDCO minus LiDCO for cardiac outputs < 5.0 L/min was -0.002+/-0.245 L/min. CONCLUSIONS AND CLINICAL RELEVANCE: The LiDCO technique is a suitable substitute for TDCO to measure cardiac output in dogs. Use of LiDCO eliminates the need for catheterization of a pulmonary artery and could increase use of cardiac output monitoring, which may improve management of cardiovascularly unstable animals.     

Comparison of three methods for cardiac output determination in cats

Cardiac output (CO) was measured in sodium pentobarbital-anesthetized cats over a wide range of blood flow rates. In 10 cats, CO was measured simultaneously, using Fick determination and thermodilution techniques. Echocardiography was used to estimate contractility of the heart by measuring percentage change in minor diameter and velocity of circumferential fiber shortening. These indices were compared with CO by the other techniques. Echocardiographic equations used for CO determination in man were evaluated for reliability in the cat. Thermodilution and Fick determination correlated best with low CO (r = 0.89) and less with intermediate (r = 0.69) and high (r = 0.75) CO. Percentage change in minor diameter and velocity of circumferential fiber shortening correlated with thermodilution measurements of the cardiac index (r = 0.71 and r = 0.84, respectively). The value of echocardiography for CO estimation was questionable, using existing equations. Fick determination of CO was more inconsistent and was more prone to technical error than was thermodilution.     

Cardiopulmonary effects of a ketamine hydrochloride/acepromazine combination in healthy cats.

The effect of a ketamine hydrochloride/acepromazine combination on the cardiopulmonary function of 11 healthy cats was studied. Test parameters included cardiac output, measured by thermodilution, heart rate, respiratory rate, arterial blood pressure (systolic, diastolic and mean) and arterial blood gas analysis. Values for systemic vascular resistance, cardiac index and stroke volume were calculated. The cardiac output, cardiac index, stroke volume, arterial blood pressure and arterial blood pH decreased significantly (p less than 0.006). The arterial CO2 increased significantly (p less than 0.006). All changes occurred during the five to 45 minute postinduction time period. The heart rate, respiratory rate, arterial O2 and systemic vascular resistance were not significantly altered. The anesthetic regime maintained an adequate plane of surgical anesthesia for 30-45 minutes.     

Comparison of lithium dilution and thermodilution cardiac output measurements in anaesthetised neonatal foals

Knowledge of cardiac output is expected to help guide the treatment of hypotension associated with critical illness and/or anaesthesia in neonatal foals. However, a practical and safe method of measuring cardiac output has not been described for the foal. Lithum dilution, a new method of cardiac output determination not requiring cardiac catheterisation, has recently been reported in mature horses. We compared this method to thermodilution in isoflurane-anaesthetised foals age 30-42 h and found good agreement between the 2 methods in a range of cardiac outputs 5.4-20.4 l/min. The lithium dilution technique is a practical and reliable method of measuring cardiac output in anaesthetised neonatal foals, and warrants investigation in critically ill conscious foals.     

Immunohistochemical analysis of cyclin A, cyclin D1 and P53 in mammary tumors, squamous cell carcinomas and basal cell tumors of dogs and cats

The involvement of cyclin A, cyclin D1 and p53 proteins in canine and feline tumorigenesis was analyzed immunohistochemically. In the present study, a total of 176 cases were examined, among which there were 108 canine cases (75 mammary lesions, 16 squamous cell carcinomas and 17 basal cell tumors) and 68 feline cases (43 mammary lesions, 20 squamous cell carcinomas and 5 basal cell tumors). Speckled nuclear staining for cyclin A was observed in 19/38 (50%) canine malignant mammary tumors and 18/37 (48.6%) feline mammary carcinomas, while this was not seen in benign mammary tumors of either dogs or cats. Marked intense nuclear cyclin A staining was seen in 7/16 (43.8%) canine squamous cell carcinomas and 18/20 (90.0%) feline squamous cell carcinomas. Only 3/17 (17.6%) canine basal cell tumors showed slight and scattered staining for cyclin A. Expression of cyclin D1 was very rare in both canine and feline tumors. Nuclear staining of p53 was found in 7/37 (18.9%) feline mammary carcinomas. Intense immunoreactivity for p53 was found in 6/16 (37.5%) canine squamous cell carcinomas and 8/20 (40%) feline squamous cell carcinomas. These results suggest that cyclin A may have a role in the proliferation of canine malignant mammary tumors, feline mammary carcinomas and squamous cell carcinomas of dogs and cats, and p53 may associate with the tumorigenesis of feline mammary carcinomas and squamous cell carcinomas of dogs and cats.     

Inhibition of canine and feline alcohol dehydrogenase activity by fomepizole

OBJECTIVE: To determine and compare substrate specificity and kinetic rate constants of feline and canine alcohol dehydrogenase (ADH) with ethanol (EtOH) and ethylene glycol (EG) as substrates in vitro, with and without fomepizole. SAMPLE POPULATION: Livers from 3 dogs and 3 cats. PROCEDURE: Canine and feline ADH activity, in cytosolic fractions of homogenized liver, was determined by use of various concentrations of nicotinamide adenine dinucleotide (NAD), EtOH, or EG as substrates. Initial reaction velocities were calculated, and kinetic inhibition rate constants (Ki) for fomepizole were determined. RESULTS: Substrate specificity of canine and feline ADH for EtOH or EG was not significantly different. A 2-fold difference was detected in the maximal velocity of canine, compared with feline, ADH, using either substrate. Fomepizole Ki in feline hepatic homogenates was significantly greater than Ki in canine hepatic homogenates when either EtOH or EG was used as substrate (10- and 30-fold, respectively). A 6-fold increase in the concentration of fomepizole was required to achieve ADH inhibition, with feline homogenates equivalent to those of canine homogenates. CONCLUSIONS AND CLINICAL RELEVANCE: Feline ADH has lower enzymatic capacity for turnover or is less concentrated in liver than canine ADH with regard to EtOH and EG catalysis. Canine ADH was more effectively inhibited by fomepizole than feline ADH. Results suggest that higher dosages of fomepizole may be more effective to treat cats with EG intoxication than dosages reported to treat dogs.     

Cardiac output measured by lithium dilution, thermodilution, and transesophageal Doppler echocardiography in anesthetized horses

OBJECTIVE: To assess the suitability of lithium dilution as a method for measuring cardiac output in anesthetized horses, compared with thermodilution and transesophageal Doppler echocardiography. ANIMALS: 6 horses (3 Thoroughbreds, 3 crossbreeds). PROCEDURE: Cardiac output was measured in 6 anesthetized horses as lithium dilution cardiac output (LiDCO), thermodilution cardiac output (TDCO), and transesophageal Doppler echocardiographic cardiac output (DopplerCO). For the LiDCO measurements, lithium chloride was administered i.v., and cardiac output was derived from the arterial lithium dilution curve. Sodium nitroprusside, phenylephrine hydrochloride, and dobutamine hydrochloride were used to alter cardiac output. Experiments were divided into 4 periods. During each period, 3 LiDCO measurements, 3 DopplerCO measurements, and 3 sets of 3 TDCO measurements were obtained. RESULTS: 70 comparisons were made between LiDCO, DopplerCO, and triplicate TDCO measurements over a range of 10 to 43 L/min. The mean (+/- SD) of the differences of LiDCO - TDCO was -0.86 +/- 2.80 L/min; LiDCO = -1.90 + 1.05 TDCO (r = 0.94). The mean of the differences of DopplerCO - TDCO was 1.82 +/- 2.67 L/min; DopplerCO = 2.36 + 0.98 TDCO (r = 0.94). The mean of the differences of LiDCO - DopplerCO was -2.68 +/- 3.01 L/min; LiDCO = -2.53 + 0.99 DopplerCO (r = 0.93). CONCLUSIONS AND CLINICAL RELEVANCE: These results indicate that lithium dilution is a suitable method for measuring cardiac output in horses. As well as being accurate, it avoids the need for pulmonary artery catheterization and is quick and safe to use. Monitoring cardiac output during anesthesia in horses may help reduce the high anesthetic mortality in this species.     

Cardiopulmonary effects of a halothane/oxygen combination in hypovolemic cats.

The cardiopulmonary effects of a halothane/oxygen combination were studied in eight cats subjected to a 25% whole blood volume loss. Test parameters included cardiac output measured via thermodilution, heart rate, respiratory rate, arterial blood pressure (systolic, diastolic and mean) and blood gas analysis. Values for cardiac index, stroke volume and systemic vascular resistance were calculated from these data. Posthemorrhage cardiac output, cardiac index, stroke volume and measurements of arterial blood pressure were significantly decreased (p less than 0.05). Heart rate remained unchanged. Following induction of halothane anesthesia the above parameters experienced a further significant decline (p less than 0.05) from their immediate preanesthetic (i.e. posthemorrhage) values. Heart rate also significantly decreased (p less than 0.05). Thirty minutes following the cessation of halothane anesthesia these values returned to near-hemorrhage levels, being above their respective preanesthetic values. Systemic vascular resistance initially rose, peaking ten minutes into halothane anesthesia, before gradually falling to prehemorrhage values at the end of halothane anesthesia. Following hemorrhage, respiratory rate demonstrated a transient increase, associated with an arterial CO2 tension fall, before returning to initial values at the preanesthetic time. During halothane anesthesia respiratory rate remained unchanged whereas arterial CO2 tension rose significantly (p less than 0.05) and pH declined slightly from preanesthetic readings. These returned to prehemorrhage values 30 minutes following the cessation of halothane anesthesia.     

Survival time in dogs with spontaneous atrial fibrillation related to scintigraphically measured cardiac performance

In 40 canine patients with spontaneous atrial fibrillation (AF) cardiac performance was measured scintigraphically and correlated with the survival time (ST) following the diagnosis of AF. The parameters used for cardiac performance were heart rate (HR), end-diastolic left ventricular volume (EDV), ejection fraction of the left ventricle (EF), left ventricular regurgitation fraction (RF) and cardiac output (CO). ST varied from 3 days to 780 days. Two groups of animals were distinguished as previously described: group A (EF less than 0.3, n = 26) and group B (EF greater than or equal to 0.3, n = 14). The median ST (90 days) in group A was only weakly significant (p = 0.1) shorter than in group B (150 days). RF was significantly lower in group A than in group B (p less than 0.001). A weak correlation was found between ST and EF (r = 0.28; p = 0.04). It was concluded that the prognosis in the described AF patients is slightly favourable if EF is normal or only moderately reduced.     

In vitro evaluation of canine and feline calcium oxalate urolith fragility via shock wave lithotripsy

OBJECTIVE: To test the hypothesis that feline calcium oxalate uroliths are intrinsically more resistant to comminution via shock wave lithotripsy (SWL) than canine calcium oxalate uroliths through comparison of the fragility of canine and feline uroliths in a quantitative in vitro test system. SAMPLE POPULATION: Calcium oxalate uroliths (previously obtained from dogs and cats) were matched by size and mineral composition to create 7 pairs of uroliths (1 canine and 1 feline urolith/pair). PROCEDURE: Uroliths were treated in vitro with 100 shock waves (20 kV; 1 Hz) by use of an electrohydraulic lithotripter. Urolith fragmentation was quantitatively assessed via determination of the percentage increase in projected area (calculated from the digital image area of each urolith before and after SWL). RESULTS: After SWL, canine uroliths (n = 7) fragmented to produce a mean +/- SD increase in image area of 238 +/- 104%, whereas feline uroliths (7) underwent significantly less fragmentation (mean image area increase of 78 +/- 97%). The post-SWL increase in fragment image area in 4 of 7 feline uroliths was < 50%, whereas it was > 150% in 6 of 7 canine uroliths. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that feline calcium oxalate uroliths are less susceptible to fragmentation via SWL than canine calcium oxalate uroliths. In some cats, SWL may not be efficacious for fragmentation of calcium oxalate nephroliths or ureteroliths because the high numbers of shock waves required to adequately fragment the uroliths may cause renal injury.     

Effects of isovolemic resuscitation with hemoglobin-based oxygen carrier Hemoglobin glutamer-200 (bovine) on systemic and mesenteric perfusion and oxygenation in a canine model of hemorrhagic shock: a comparison with 6% hetastarch solution and shed blood

OBJECTIVE: To study Hemoglobin glutamer-200 bovine (Hb-200), 6% hetastarch (HES) and shed whole blood (WB) resuscitation in canine hemorrhagic shock. STUDY DESIGN: Prospective laboratory investigation. Animals Twelve adult dogs [29 +/- 1 kg (mean +/- SD)]. METHODS: Anesthetized dogs were instrumented for recording systemic and mesenteric hemodynamic parameters and withdrawal of arterial, mixed and mesenteric venous blood, in which hematological, oxygenation, blood gas and acid-bases variables were determined. Recordings were made before [baseline (BL)], after 1 hour of hypovolemia and immediately and 3 hours post-resuscitation with 30 mL kg(-1) of either Hb-200, HES, or WB. RESULTS: Blood withdrawal (average 34 +/- 2 mL kg(-1)) caused significant hemodynamic changes, metabolic acidosis and hyperlactatemia characteristic for hemorrhagic shock. Only WB transfusion restored all variables. Hemoglobin glutamer-200 bovine infusion returned most hemodynamic parameters including cardiac output and mesenteric arterial blood flow to BL but increased mean arterial pressure above BL (p < 0.05). However, Hb-200 failed to restore total Hb and arterial oxygen content (CaO2), leaving systemic (DO2I) and mesenteric O2 delivery (DO2Im) below BL (p < 0.05). Nevertheless, acid-base variables recovered completely after Hb-200 resuscitation, and met-hemoglobin (Met-Hb) levels increased (p < 0.05). Hetastarch resuscitation returned hemodynamic variables to or above BL but further decreased total Hb and CaO2, preventing recovery of sDO2I and mDO2I (p < 0.05). Thus, systemic and mesenteric O2 extraction stayed above BL (p < 0.05) while acid-base variables recovered to BL, although slower than in Hb-200 and WB groups (p < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE: Resuscitation with Hb-200 seemed to resolve metabolic acidosis and lactatemia more rapidly than HES, but not WB; yet it is not superior to HES in improving DO2I and DO2Im. The hyperoncotic property of solutions like Hb-200 that results in rapid volume expansion with more homogenous microvascular perfusion and the ability to facilitate diffusive O2 transfer accelerating metabolic recovery may be the key mechanisms underlying their beneficial effects as resuscitants.     

Antiproliferation and colony-forming inhibition activities of recombinant feline interferon (rFeIFN) on various cells in vitro.

The antiproliferative and colony inhibiting activities of recombinant feline interferon (rFeIFN Type I) against various cells in vitro were examined. Feline and canine cells were both sensitive to rFeIFN. To inhibit the growth of feline cells by 50% approximately 5 x 10(2) to 1 x 10(3) U/mL rFeIFN was required and maximum activity was achieved at a concentration of 1 x 10(5) U/mL. Approximately 5 x 10(3) to 5 x 10(4) U/mL rFeIFN was necessary to inhibit the growth of canine cells by 50%. The antiproliferative and colony inhibiting activities of rFeIFN on canine cells appeared to be cell-specific and dose-dependent. However, human, monkey and hamster cells were resistant to rFeIFN. We suggest that rFeIFN might be useful for treatment of feline and some canine neoplastic conditions.     

Cardiovascular Effects of Enoximone and Epinephrine on Heparin Reversal With Protamine in Conscious Dogs

Objective—To compare enoximone with epinephrine as treatments for the cardiotoxic effects of protamine sulfate.
Study Design—Prospective randomized study.
Animal Population—12 healthy cross-bred dogs weighing 23 ± 4 kg.
Methods—The dogs were anesthetized with xylazine and ketamine to allow instrumentation. Femoral arterial and venous catheters were inserted for pressure monitoring and to allow drug infusion. A thermodilution catheter mounted with a fast response thermistor was inserted into the pulmonary artery via the jugular vein to measure cardiac output and right ventricular volumes. Heparin 300 units/kg followed by protamine 4.5 mg/kg were administered 45 minutes after the xylazine/ketamine. Four animals were not treated (controls), four received enoximone, and four were given epinephrine. Cardiopulmonary parameters were monitored for a period of 30 minutes.
Results—Cardiac index was 104 ± 15 mL/kg/min in the enoximone group, 72 ± 13 mL/kg/ min in the epinephrine group, and 63 ± 10 mL/kg/min in the control group ( P < .05 enoximone versus control and epinephrine). Right ventricular end systolic volume was 18 ± 3, 27 ± 4, and 29 ± 6 mL in the enoximone, epinephrine, and control groups ( P < .05 enoximone versus control and epinephrine). There were no differences in mean arterial pressure or pulmonary and systemic vascular resistance between the groups.
Conclusions and Clinical Relevance—In this study, enoximone was more effective than epinephrine at reversing the hemodynamic changes associated with protamine sulfate administration.     

The relationship between the degree of thrombocytopenia and infection with Ehrlichia canis in an endemic area

Ehrlichia canis is the causative agent of canine monocytic ehrlichiosis. In order to evaluate platelet counts as a screening test for E. canis in an endemic area, 217 whole blood samples from dogs were divided into three groups: 71 non-thrombocytopenic samples (group A, platelet counts greater than 200 000/mL) and 146 thrombocytopenic samples (less than 200 000/mL). The thrombocytopenic group was further divided into 62 with platelet counts between 100 000-200 000/mL (Group B) and 84 samples with less than 100 000 platelets/mL (Group C). All samples were examined for the presence of a segment of the Ehrlichia canis 16S rRNA gene using a nested polymerase chain reaction. Sixty-seven of the 217 samples (30.9%) were positive for the presence of the E. canis 16S rRNA gene; 53 (63.1%) of the group C samples and 13 (21%) of group B. Only one (1.4%) of the non-thrombocytopenic samples (Group A) was positive. These data support the concept that platelet counts may be a good screening test for canine monocytic ehrlichiosis, and that the magnitude of thrombocytopenia may increase the reliability of diagnosis.