The effects of halothane and isoflurane on cardiovascular function in dorsally recumbent horses undergoing surgery

ObjectiveTo determine the haemodynamic effects of halothane and isoflurane with spontaneous and controlled ventilation in dorsally recumbent horses undergoing elective surgery.Study designProspective randomized clinical trial.AnimalsTwenty-five adult horses, body mass 487 kg (range: 267–690).MethodsHorses undergoing elective surgery in dorsal recumbency were randomly assigned to one of four treatment groups, isoflurane (I) or halothane (H) anaesthesia, each with spontaneous (SB) or controlled ventilation (IPPV). Indices of cardiac function and femoral arterial blood flow (ABF) and resistance were measured using transoesophageal and transcutaneous Doppler echocardiography, respectively. Arterial blood pressure was measured directly.ResultsFour horses assigned to receive isoflurane and spontaneous ventilation (SBI) required IPPV, leaving only three groups for analysis: SBH, IPPVH and IPPVI. Two horses were excluded from the halothane groups because dobutamine was infused to maintain arterial blood pressure. Cardiac index (CI) was significantly greater, and pre-ejection period (PEP) shorter, during isoflurane compared with halothane anaesthesia with both spontaneous (p = 0.04, p = 0.0006, respectively) or controlled ventilation (p = 0.04, p = 0.008, respectively). There was an association between CI and PaCO₂ (p = 0.04) such that CI increased by 0.45 L minute⁻¹m⁻² for every kPa increase in PaCO₂. Femoral ABF was only significantly higher during isoflurane compared with halothane anaesthesia during IPPV (p = 0.0006). There was a significant temporal decrease in CI, but not femoral arterial flow.ConclusionThe previously reported superior cardiovascular function during isoflurane compared with halothane anaesthesia was maintained in horses undergoing surgery. However, in these clinical subjects, a progressive decrease in CI, which was independent of ventilatory mode, was observed with both anaesthetic agents.Clinical relevanceCardiovascular function may deteriorate progressively in horses anaesthetized for brief (<2 hours) surgical procedures in dorsal recumbency. Although cardiovascular function is superior with isoflurane in dorsally recumbent horses, the need for IPPV may be greater.     

Time-related responses of spontaneously breathing, laterally recumbent horses to prolonged anesthesia with halothane

Cardiovascular and respiratory functions were serially evaluated in ten healthy, fasting, spontaneously breathing, laterally recumbent adult horses during five hours of constant 1.06% alveolar halothane (equivalent to 1.2 times the minimum alveolar concentration for horses). Mean carotid arterial pressure was about 25% higher after one hour of constant-dose halothane than after 30 minutes of constant-dose (P less than 0.05), and remained increased throughout the study. Mean carotid arterial pressure peaked after 90 minutes, and was about 30% higher than at 30 minutes. Total peripheral vascular resistance initially increased (20% at one hour), then gradually returned to the 0.5-hour value over the next four hours. Cardiac output progressively increased with time (P less than 0.05; 20% by two hours; nearly 40% by five hours) because of an increase in stroke volume. An increase (P less than 0.05) in mixed venous PO2 accompanied the increase in cardiac output. Heart rate did not change significantly (P greater than 0.05). Some measures of ventilation changed significantly with time (P less than 0.05). After four and five hours of constant alveolar halothane, the PaCO2, inspired gas flow, and ratio of inspired vs expired gas flow were significantly higher than the 0.5-hour values. Inspiratory time significantly decreased, beginning at three hours. All horses recovered from anesthesia and recumbency without complications.     

Cardiopulmonary function during 5 hours of constant-dose isoflurane in laterally recumbent, spontaneously breathing horses

Hemodynamic and respiratory effects of 5 h of unvarying 1.57%, end-tidal (1.2 MAC) isoflurane in O2 anesthesia were characterized in ten left laterally recumbent horses. Compared to base line values at 30 min of constant dose isoflurane, cardiac output, hematocrit, total plasma solids, PaCO2, and peak inspired gas flow progressively and significantly (P less than 0.05) increased over the course of study. Arterial blood pressure increased (P less than 0.05) during the first 2 h of constant dose of isoflurane then decreased and remained near base line values. Inspiratory time progressively decreased with time of anesthesia. All horses recovered from anesthesia uneventfully within 1 h of termination of isoflurane.     

Correlation between jugular and central venous pressures in laterally recumbent horses

Objective To compare and correlate right atrial pressure, which represents central venous pressure (CVP) to jugular vein pressure (JVP) in laterally recumbent horses under anesthesia. Study design Retrospective clinical trial. Animals Seven adult healthy horses (411 ± 8.7 kg). Methods Horses were sedated with IV xylazine and anesthesia was obtained with IV ketamine and diazepam. Anesthesia was maintained with sevoflurane in oxygen. All horses were positioned in left lateral recumbency. An 8F catheter introducer was inserted into the right jugular vein to measure JVP. An 8F catheter introducer was inserted into the left jugular vein to be used as the port for a 7F 110 cm catheter that reached the right atrium to measure CVP. Both, CVP and JVP were measured simultaneously with a water calibrated aneroid manometer using the sternum as the 0 cmH₂O reference point. Measurements were compared using Spearman correlation and the Bland‐Altman plot. Results Twenty paired samples were obtained over a period of 2 hours. The CVP ranged from 7 to 31 cmH₂O, while the JVP ranged from 5 to 30 cmH₂O. The Spearman correlation coefficient indicated that CVP and JVP had a strong correlation with r = 0.88. The Bland‐Altman plot showed a bias of 0.7 cmH₂O. Conclusion and clinical relevance Jugular vein pressure showed a strong correlation with CVP in healthy, euvolemic, laterally recumbent anesthetized adult horses. Thus, JVP cannot replace CVP but it may be used clinically to monitor CVP in laterally recumbent horses.     

A comparison of the haemodynamic effects of isoflurane and halothane anaesthesia in horses

The purpose of this study was to compare the haemodynamic effects of equipotent isoflurane and halothane anaesthesia. Six adult horses were investigated on two separate occasions at least 4 weeks apart. On both occasions anaesthesia was induced by ketamine 2.2 mg/kg bwt given 5 min after i.v. administration 100 microg/kg bwt romifidine. Anaesthesia was maintained either by halothane or isoflurane (end-tidal concentrations 0.9-1.0% and 1.3-1.4%, respectively). Horses were ventilated by intermittent positive pressure to maintain PaCO2 between 40-50 mmHg. Haemodynamic variables were measured using catheter-mounted strain gauge transducers in the left and right ventricle, aorta, and right atrium. Cardiac output (CO), velocity time integral (VTI), maximal aortic blood flow velocity (Vmax) and acceleration (dv/dt(max)), left ventricular pre-ejection period (PEP) and ejection time (ET) were measured from aortic blood flow velocity waveforms obtained by transoesophageal Doppler echocardiography. Flow velocity waveforms were recorded from the femoral arteries and veins using low pulse repetition frequency Doppler ultrasound. Time-averaged mean velocity (TAV), velocity of component a (TaVa), velocity of component b (TaVb) and early diastolic deceleration slope (EDDS) were measured. Pulsatility index (PI) and volumetric flow were calculated. Microvascular blood flow was measured in the left and right semimembranosus muscles by laser Doppler flowmetry. Maximal rate of rise of LV pressure (LVdp/dt(max)), CO, Vmax, dv/dt(max), ET, VTI were significantly higher at all time points during isoflurane anaesthesia compared to halothane anaesthesia. Pre-ejection period and diastolic aortic blood pressure were significantly less throughout isoflurane anaesthesia compared to halothane. Isoflurane anaesthesia was associated with significantly lower systemic vascular resistance than halothane anaesthesia. Femoral arterial and venous blood flow were significantly higher and EDDS and PI were significantly lower during isoflurane anaesthesia compared to halothane anaesthesia. In addition during both halothane and isoflurane anaesthesia, femoral arterial flow was higher and EDDS and PI lower in the left (dependent) artery compared to the right (nondependent) artery. This study supports previous work demonstrating improved left ventricular systolic function during isoflurane compared to halothane anaesthesia. This improvement was still evident after premedication with a potent-long acting alpha2-adrenoreceptor agonist, romifidine, and induction of anaesthesia with ketamine. There was also evidence of increased hindlimb blood flow during isoflurane anaesthesia. However, there were differences observed in flow between the left and right hindlimb during maintenance of anaesthesia with each agent, suggesting that there were differences in regional perfusion in anaesthetised horses caused by factors unrelated to agents administered.     

Hemodynamic effects of ionized calcium in horses anesthetized with halothane or isoflurane

OBJECTIVES: To evaluate the effects of halothane and isoflurane on cardiovascular function and serum total and ionized calcium concentrations in horses, and to determine whether administration of calcium gluconate would attenuate these effects. ANIMALS: 6 clinically normal adult Thoroughbreds. PROCEDURE: Catheters were inserted for measurement of arterial blood pressures, pulmonary arterial blood pressures, right ventricular pressure (for determination of myocardial contractility), right atrial pressure, and cardiac output and for collection of arterial blood samples. Anesthesia was then induced with xylazine hydrochloride and ketamine hydrochloride and maintained with halothane or isoflurane. An i.v. infusion of calcium gluconate was begun 75 minutes after anesthetic induction; dosage of calcium gluconate was 0.1 mg/kg of body weight/min for the first 15 minutes, 0.2 mg/kg/min for the next 15 minutes, and 0.4 mg/kg/min for an additional 15 minutes. Data were collected before, during, and after administration of calcium gluconate. RESULTS: Halothane and isoflurane decreased myocardial contractility, cardiac index, and mean arterial pressure, but halothane caused greater depression than isoflurane. Calcium gluconate attenuated the anesthetic-induced depression in cardiac index, stroke index, and maximal rate of increase in right ventricular pressure when horses were anesthetized with isoflurane. When horses were anesthetized with halothane, a higher dosage of calcium gluconate was required to attenuate the depression in stroke index and maximal rate of increase in right ventricular pressure; cardiac index was not changed with calcium administration. CONCLUSIONS AND CLINICAL RELEVANCE: I.v. administration of calcium gluconate may support myocardial function in horses anesthetized with isoflurane.     

Radiographic evidence of impaired pulmonary function in laterally recumbent anaesthetised horses.

Studies in conscious and anaesthetised ponies demonstrated that starvation, anaesthesia and changes in body position influence the radiographic appearance of the lungs in the lateral and dorsoventral views. Radiographic appearances could not be closely correlated with blood gas values, but they suggested that the volume of the lowermost lung of the laterally recumbent animal is greatly reduced.     

Effects of halothane and isoflurane on baroreflex sensitivity in horses

Baroreflex sensitivity (BS) was used to quantitatively assess the effects of halothane and isoflurane on the heart rate/arterial pressure relationship during steady-state (10 minutes) and dynamic pressure changes in adult horses. Arterial pressure was decreased in response to nitroglycerin or sodium nitroprusside and increased in response to phenylephrine HCl. Mean (+/- SEM) BS in awake horses was 28.9 +/- 2.6 and 13.2 +/- 2.0 ms/mm of Hg during steady-state decreases and increases in systolic arterial pressure (SAP), respectively. Halothane and isoflurane either significantly (P less than 0.05) decreased or eliminated BS during steady-state decreases in SAP, with no significant differences detected between anesthetic agents. During steady-state decreases in SAP, significant (P less than 0.05) correlation between R-R interval and arterial pressure was not observed for 6 of 10 and 4 of 11 halothane and isoflurane anesthesia periods, respectively. Halothane significantly (P less than 0.05) decreased BS during steady-state increases in SAP to 7.9 +/- 0.6 and 6.5 +/- 1.1 ms/mm of Hg during low and high minimal alveolar concentration (MAC) multiples, respectively. Isoflurane decreased BS during steady-state increases in SAP to 9.6 +/- 1.5 and 6.6 +/- 1.1 ms/mm of Hg during low and high MAC anesthesia, respectively, with high MAC of isoflurane decreasing BS significantly (P less than 0.05), compared with awake and low MAC values. Plasma catecholamine (epinephrine and norepinephrine) concentrations increased significantly (P less than 0.05), compared with baseline values during steady-state vasodilator infusions in halothane- and isoflurane-anesthetized horses.(ABSTRACT TRUNCATED AT 250 WORDS)     

Physiologic effects of succinylcholine chloride in mechanically ventilated horses anesthetized with halothane in oxygen.

Succinylcholine chloride, administered to horses anesthetized with halothane in oxygen and mechanically ventilated, caused slight but significant (P less than 0.01) increases in heart rate. Significant alteration in mean arterial blood pressure did not occur, and there were clinically insignificant increases in serum K+ and C1- concentration. Cardiac dysrhythmia and myoglobinuria did not occur. Thus, effects of halothane anesthesia and mechanical ventilation prevented cardiac dysrhythmia and hypertension and greatly reduced the tachycardia generally associated with siccinylcholine administration.     

Cardiopulmonary effects of xylazine and yohimbine in laterally recumbent sheep.

The effects of yohimbine (0.125 mg/kg) on cardiopulmonary parameters in six adult, xylazine treated (0.15 mg/kg), laterally recumbent sheep were studied. Following collection of baseline data, xylazine was administered intravenously and data were collected five and fifteen minutes later. At twenty minutes post-xylazine either yohimbine (0.125 mg/kg) or saline was given and further collection of data occurred at 25, 30, 40 and 50 minutes. Xylazine administration resulted in significant (P less than 0.05) respiratory depression, as reflected by a decrease in arterial oxygen partial pressure (PaO2). No significant changes in haemodynamic variables were observed. Yohimbine produced a significant improvement in PaO2 at the 50 minute period and abolished the paradoxical respiratory pattern when present. The results indicated that yohimbine can be used as an antagonist to control the duration of xylazine induced respiratory depression, although the degree of reversal was less than is clinically desirable.     

The hemodynamic, tissue oxygenation, and selected biochemical effects of isoflurane and halothane anesthesia in horses

Eight healthy horses (337 to 643 kgs) were used to determine the effects of halothane and isoflurane (1.5 MAC) on cardiovascular and blood gas parameters over a 4 hour perio d, while in left lateral recumbency. Each animal was used twice (2 weeks apart) and the order in which the agents were used was randomized. End tidal CO2 was maintained at 45-55 mmHg using positive pressure ventilation. The following parameters were measured every 30 minutes; HR, ET CO2, ET anes. gas cone., SAP, CVP, PAP, and CO. Heparinized samples were also drawn for blood gas analysis from the right lateral metatarsal artery, right jugular vein, and the femoral veins in each rear limb. The 02 delivered to the tissues (TOD) was calculated using the following equation: {ie396-1} It was determined that more 02 was delivered to the tissues during isoflurane anesthesia (382m102/min/m2 + 21 SEM) than halothane anesthesia (280m102min/m2 + 11 SEM). Furthermore the 02 extraction ratio (OER) in the dependent limb was significantly higher during halothane anesthesia. The differences seen in the OER's are due to both anesthetic and positional effects. Serum biochemical changes also suggest differences in tissue damage related to differences in TOD and OER.     

Comparison of recoveries from halothane vs isoflurane anesthesia in horses.

Recovery from isoflurane anesthesia was shorter, with no difference in quality, compared with halothane anesthesia in 2 groups of horses. In 1 group, 12 horses scheduled for elective arthroscopy were randomly assigned to receive halothane or isoflurane for maintenance of anesthesia during surgery. In the other group, 6 horses received anesthesia only, on 2 occasions, with halothane on 1 occasion, and isoflurane on the other. Difference in the quality of recovery was not seen between isoflurane and halothane anesthesia in either group. In the group that had surgery, recovery to sternal position was significantly shorter when isoflurane was used. In the group not treated surgically, recovery to sternal and standing positions was significantly shorter with isoflurane.     

The effect of anesthetic drug choice on accuracy of high-definition oscillometry in laterally recumbent horses

Objective

To determine the accuracy of high-definition oscillometry (HDO) for arterial pressure measurement during injectable or inhalation anesthesia in horses.

Inhaled carbon monoxide concentration during halothane or isoflurane anesthesia in horses

OBJECTIVE: The purpose of this study was to assess carbon monoxide (CO) exposure during equine anesthesia with either halothane (H) or isoflurane (I) delivered in a circle rebreathing system. STUDY DESIGN: Prospective clinical investigation. ANIMALS: Fifty client-owned horses. METHODS: Horses were randomly assigned for anesthetic maintenance with H (n = 26) or I (n = 24). Two large animal anesthetic machines were used and assigned to a single agent for 2-4 weeks at a time. Machines were disassembled and soda lime changed prior to switching anesthetic agents. Inhalant anesthetic concentration and CO concentration were measured in gas samples obtained from the inspiratory limb of the anesthetic circuit. Values were recorded at 15 minute intervals for 90 minutes. Soda lime status (new or used) and mode of ventilation (spontaneous or mechanical) were also recorded. Data were analyzed using a five-factor ANCOVA with repeated measures. RESULTS: Inspired CO concentration for H and I increased from 1 +/- 3 and 6 +/- 11 ppm at baseline to 54 +/- 33 and 21 +/- 18 ppm at 90 min, respectively (mean +/- sd). H was associated with significantly greater CO concentrations than I at 30 to 90 min, although baseline CO was significantly greater in the I group than the H group. Oxygen flow rates were 9.9 +/- 0.5 L/min at baseline for H and I, and 5.0 +/- 0.4 and 5.0 +/- 0.7 L/min at 90 min for H and I, respectively. There were no significant differences between groups for O2 flow at any time point. Neither mechanical ventilation nor new versus used soda lime affected CO concentration. CONCLUSIONS: Significantly higher concentrations of CO were recorded during the administration of H than I. CLINICAL RELEVANCE: Levels of CO observed during the administration of either H or I for 90 minutes to horses were not clinically significant.     

The effect of changing the mode of ventilation on the arterial-to-end-tidal CO2 difference and physiological dead space in laterally and dorsally recumbent horses during halothane anesthesia

OBJECTIVE: To evaluate the effect of changing the mode of ventilation from spontaneous to controlled on the arterial-to-end-tidal CO2 difference [P(a-ET)CO2] and physiological dead space (VD(phys)/VT) in laterally and dorsally recumbent halothane-anesthetized horses. STUDY DESIGN; Prospective, experimental, nonrandomized trial. ANIMALS: Seven mixed breed adult horses (1 male and 6 female) weighing 320 +/- 11 kg. METHODS: Horses were anesthetized in 2 positions-right lateral and dorsal recumbency-with a minimum interval of 1 month. Anesthesia was maintained with halothane in oxygen for 180 minutes. Spontaneous ventilation (SV) was used for 90 minutes followed by 90 minutes of controlled ventilation (CV). The same ventilator settings were used for both laterally and dorsally recumbent horses. Arterial blood gas analysis was performed every 30 minutes during anesthesia. End-tidal CO2 (PETCO2) was measured continuously. P(a-ET)CO2 and VD(phys)NT were calculated. Statistical analysis included analysis of variance for repeated measures over time, followed by Student-Newman-Keuls test. Comparison between groups was performed using a paired t test; P < .05 was considered significant. RESULTS: P(a-ET)CO2 and VD(phys)/VT increased during SV, whereas CV reduced these variables. The variables did not change significantly throughout mechanical ventilation in either group. Dorsally recumbent horses showed greater P(a-ET)CO2 and VD(phys)/VT values throughout. PaCO2 was greater during CV in dorsally positioned horses. CONCLUSIONS AND CLINICAL RELEVANCE: Changing the mode of ventilation from spontaneous to controlled was effective in reducing P(a-ET)CO2 and physiological dead space in both laterally and dorsally recumbent halothane-anesthetized horses. Dorsal recumbency resulted in greater impairment of effective ventilation. Capnometry has a limited value for accurate estimation of PaCO2 in anesthetized horses, although it may be used to evaluate pulmonary function when paired with arterial blood gas analysis.     

Hepatic effects of halothane and isoflurane anesthesia in goats

OBJECTIVE: To determine hepatic effects of halothane and isoflurane anesthesia in young healthy goats. DESIGN: Randomized prospective clinical trial. ANIMALS: 24 healthy 9-month-old female goats. PROCEDURE: Goats were sedated with xylazine hydrochloride and ketamine hydrochloride and anesthetized with halothane (n = 12) or isoflurane (12) while undergoing tendon surgery. End-tidal halothane and isoflurane concentrations were maintained at 0.9 and 1.2 times the minimal alveolar concentrations, respectively, and ventilation was controlled. Venous blood samples were collected approximately 15 minutes after xylazine was administered and 24 and 48 hours after anesthesia, and serum aspartate aminotransferase (AST), sorbitol dehydrogenase (SDH), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) activities and bilirubin concentration were measured. Goats were euthanatized 25 or 62 days after anesthesia, and postmortem liver specimens were submitted for histologic examination. RESULTS: All goats recovered from anesthesia and survived until euthanasia. Serum SDH, GGT, and ALP activities and bilirubin concentration did not increase after anesthesia, but serum AST activity was significantly increased. However, serum hepatic enzyme activities were within reference limits at all times in all except 1 goat in which serum AST activity was high 24 and 48 hours after anesthesia. This goat had been anesthetized with halothane and had the longest duration of anesthesia. No clinically important abnormalities were seen on histologic examination of liver specimens. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that use of halothane or isoflurane for anesthesia in young healthy goats is unlikely to cause hepatic injury.     

Measurements of muscular microcirculation by laser Doppler flowmetry in isoflurane and halothane anaesthetised horses

The cardiovascular function of horses was less depressed during anaesthesia with isoflurane than during anaesthesia with halothane. Muscular microcirculation measured by laser Doppler flowmetry was significantly greater in horses anaesthetised with isoflurane.     

Effects of five hours of constant 1.2 MAC halothane in sternally recumbent, spontaneously breathing horses

Circulatory and respiratory effects of five h of constant 1.06 per cent alveolar halothane in oxygen were identified in eight healthy horses, which breathed spontaneously, were otherwise unmedicated and positioned in sternal recumbency. Only a few important significant (P less than 0.05) changes occurred with time. Total peripheral resistance was about 15 per cent lower after two hours of constant dose halothane than after 30 mins of constant dose (P less than 0.05) and accounted for the significant 10 per cent reduction in mean carotid arterial blood pressure. By 5 h, the reduction in resistance and arterial blood pressure was 20 and 25 per cent respectively. Heart rate increased progressively with time and the increase became significant at 5 h (15 per cent increase). However, the heart rate change was not large enough to alter cardiac output. There were no major time-related changes in PaO2 or PaCO2. Three of four horses recovered from anaesthesia had markedly elevated serum creatine kinase levels and clinical signs of severe post anaesthetic myopathy.     

The recovery of horses from inhalant anesthesia: a comparison of halothane and isoflurane

Objective— Recovery is one of the more precarious phases of equine general anesthesia. The quality and rate of recovery of horses from halothane and isoflurane anesthesia were compared to determine differences in the characteristics of emergence from these commonly used inhalant anesthetics. Experimental Design— Prospective, randomized blinded clinical trial. Sample Population— A total of 96 Thoroughbred and 3 Standardbred racehorses admitted for elective distal forelimb arthroscopy. Methods— All horses were premedicated with intravenous xylazine, induced with guaifenesin and ketamine, and maintained on a large animal circle system fitted with an out of the circle, agent specific vaporizer. Recoveries were managed by a blinded scorer with a standardized protocol. A 10 category scoring system was used to assess each horse's overall attitude, purposeful activity, muscle coordination, strength and balance from the time of arrival in recovery to standing. Times to extubation, sternal recumbency and standing were recorded. Median recovery scores and mean times to extubation, sternal and standing were compared using the Mann‐Whitney U test and student's t test, respectively. Results— The median score for horses recovering from halothane was lower (20.0; range, 10 to 57) than that for horses recovering from isoflurane (27.5; range, 10 to 55). Horses in the two groups were extubated at similar mean times (halothane, 11.3 ± 5.5 and isoflurane, 9.5 ± 5.2 minutes ) but horses recovering from isoflurane achieved sternal recumbency (halothane, 37.7 ± 12.1 and isoflurane, 24.7 ± 8.8 minutes ) and stood (halothane, 40.6 ± 12.9 and isoflurane, 27.6 ± 9.6 minutes ) sooner than those recovering from halothane. Conclusions— The recovery of horses from isoflurane anesthesia was more rapid but less composed than that from halothane. Clinical Relevance— The quality of recovery following isoflurane was worse than after halothane anesthesia using the criteria chosen for this study. However, the range of recovery scores was similar for both groups and all horses recovered without significant injury.