Ventilation-perfusion relationships in the anaesthetised horse

Ventilation-perfusion relationships were studied by the multiple inert gas elimination technique in seven horses while they were conscious and during inhalation anaesthesia with halothane. A generally good match between ventilation and perfusion was found in the conscious, standing horse. During anaesthesia a huge shunt developed, ie perfusion of completely unventilated lung regions, both in dorsal and left lateral recumbency and whether the horse was breathing spontaneously or mechanically ventilated. The shunt was significantly greater and the arterial oxygen tension (PaO2) significantly lower in dorsal than in left lateral recumbency. Little or no perfusion of low VA/Q regions was observed during anaesthesia, whether ventilation was spontaneous or mechanical. Positive end-expiratory pressure (PEEP) did not significantly improve PaO2 or reduce the shunt. Selective mechanical ventilation of dependent lung regions with PEEP reduced the shunt markedly, an effect that was not achieved by conventional mechanical ventilation with general PEEP. The findings seem compatible with alveolar collapse during anaesthesia, causing shunt, whereas the absence of clearly low VA/Q regions questions the role of airway closure as the major disturbance of gas exchange.     

High frequency jet ventilation in horses: an experimental study

High frequency jet ventilation (HFJV) is a recently developed mode of ventilation that delivers small tidal volumes at frequencies greater than 60 cycles per min via an injection catheter to the animal's airway. The construction of a high frequency jet ventilator suitable for use in adult horses is described. The effectiveness of this ventilator in maintaining normal arterial blood-gas tension was evaluated in five healthy adult horses. The horses were anaesthetised with intravenous acetylpromazine, guaifenesin, and thiamylal, positioned in lateral recumbency and baseline measurements were made during spontaneous ventilation. The horses were then paralysed with succinylcholine and ventilated for at least 20 mins with HFJV. Air was delivered from the ventilator to the animal by a polyethylene tube. The tip of this tube remained within and approximately 30 cm from the cuffed end of a standard 30 mm internal diameter large animal orotracheal tube. Frequency of flow interruption was 3 Hz with a constant source pressure of 275 kPa and an inspiratory to expiratory ratio of approximately 1:2.6. Gas delivery to the horse, as estimated with a resonator system was approximately 2 litres/breath. During HFJV, arterial carbon dioxide tension was significantly reduced and arterial oxygen tension significantly increased above measurements made when the horses were spontaneously breathing air.     

Comparative ventilation and gas exchange in the horse and the cow

Ventilation and gas exchange were studied in healthy, adult horses and cows, two large species with different lung structures and different breathing patterns. The oxygen uptake (VO2), carbon dioxide output (VCO2), respiratory rate (fR), minute ventilation (VE), alveolar ventilation (VA), alveolar oxygen pressure (PAO2), and VE/VO2 ratio were higher in the cows, while the tidal volume (VT) and physiological dead space (VD) were larger in the horses. The arterial blood gases, alveolar-arterial oxygen pressure difference (PAO2-PaO2) and VD/VT ratio did not differ between the two species. The higher VO2 in the cows was most likely due to the energy cost of standing, and possibly to a higher cost of digestion. The higher VE, VA, VE/VO2 and PAO2 were most likely secondary to the increased VO2 and the slightly higher respiratory exchange ratio (R) in the cows. In contrast to hypotheses based on allometric equations, the PAO2 of horses and cows did not appear to differ from that of smaller mammals. The VD was larger than that predicted from allometric equations, and even though the VD/VT ratio (0.50) was lower than the previously reported values for horses and cows, it was significantly larger than the predicted weight-independent value of 0.36. Re-examination of the data used to derive the equation for VD raised questions as to the validity of this equation, and it is suggested that caution be exercised in the use of allometric equations for prediction.     

The relationship between respiratory exchange ratio, plasma lactate and muscle lactate concentrations in exercising horses using a valved gas collection system.

A valved gas collection system for horses was validated, then used to examine the relationship between the respiratory exchange ratio (RER), and plasma and muscle lactate in exercising horses. Four healthy Standardbred horses were trained to breathe through the apparatus while exercising on a treadmill. Comparisons of arterial blood gas tensions were made at 3 work levels for each horse, without (control), and with the gas collection system present. At the highest work level, the arterial oxygen tension (PaO2) was significantly lower (P < 0.05), and the arterial carbon dioxide tension (PaCO2) was significantly higher (P < 0.05), than control levels when the apparatus was present; however arterial oxygen content remained unchanged. The horses completed a standardized incremental treadmill test on 4 occasions to determine the repeatability of measurements of oxygen consumption (VO2), carbon dioxide production (VCO2), inspired minute ventilation (VI), respiratory exchange ratio (RER), ventilatory equivalent for oxygen (VI/VO2), tidal volume (VT), and ventilatory frequency (VF). All gas exchange and respiratory measurements showed good reproducibility with the mean coefficient of variation of the 4 horses ranging from 3.8 to 12%. We examined the relationship between 3 indices of energy metabolism in horses performing treadmill exercise: respiratory exchange ratio (RER), central venous plasma and muscle lactate concentrations. A relationship between RER and plasma lactate concentration was established. To compare muscle and plasma lactate concentrations, the horses completed a discontinuous exercise test without the gas collection apparatus present. Significant relationships (P < 0.05), between plasma lactate concentration and RER, and between plasma and muscle lactate concentration, were described for each horse. The valved gas collection system produced a measurable but tolerable degree of interference to respiration, and provided reproducible measurements of gas exchange and ventilatory measurements. It was concluded that measurements of both gas exchange and blood lactate may be used to indicate increased glycolytic activity within exercising skeletal muscle.     

Hemodynamic effects of carbon dioxide during intermittent positive-pressure ventilation in horses

The hemodynamic effects of high arterial carbon dioxide pressure (PaCO2) during anesthesia in horses were studied. Eight horses were anesthetized with xylazine, guaifenesin, and thiamylal, and were maintained with halothane in oxygen (end-tidal halothane concentration = 1.15%). Baseline data were collected while the horses were breathing spontaneously; then the horses were subjected to intermittent positive-pressure ventilation, and data were collected during normocapnia (PaCO2, 35 to 45 mm of Hg), moderate hypercapnia (PaCO2, 60 to 70 mm of Hg), and severe hypercapnia (PaCO2, 75 to 85 mm of Hg). Hypercapnia was induced by adding carbon dioxide to the inspired gas mixture. Moderate and severe hypercapnia were associated with significant (P less than 0.05) increases in aortic blood pressure, left ventricular systolic pressure, cardiac output, stroke volume, maximal rate of increase and decrease in left ventricular pressure (positive and negative dP/dtmax, respectively), and median arterial blood flow, and decreased time constant for ventricular relaxation. These hemodynamic changes were accompanied by increased plasma epinephrine and norepinephrine concentrations. Administration of the beta-blocking drug, propranolol hydrochloride, markedly depressed the response to hypercapnia. This study confirmed that in horses, hypercapnia is associated with augmentation of cardiovascular function.     

Cardiovascular effects of halothane in the horse

Cardiovascular effects of venous alveolar concentrations of halothane in oxygen were studied in 8 young, healthy horses under conditions of constant arterial carbon dioxide tension. The alveolar concentration of halothane was expressed as a multiple of the minimal alveolar concentration (MAC) which was known for each animal. Increasing alveolar halothane concentrations to MAC 2.0 resulted in a progressive and significant (P less than 0.05) decline in systemic arterial pressure and left ventricular work. Cardiac output decreased between MAC 1.0 and MAC 2.0 as a result of a significant (P less than 0.05) decrease in stroke volume. Heart rate, total peripheral resistance, pulmonary artery pressure, hematocrit, plasma protein concentration, arterial oxygen tension, and arterial pH remained constant over the same range of anesthetic dosages. Continuation of anesthesia, spontaneous ventilation, and the accompanying rise in arterial carbon dioxide tension and electrical stimulation of the horse's oral mucous membranes produced varying degrees of stimulation of cardiovascular function at MAC 1.5.     

Positive end-expiratory pressure during colic surgery in horses: 74 cases (1986-1988).

Positive end-expiratory pressure (PEEP) was applied in 74 anesthetized, ventilated horses during colic surgery, to attempt to increase arterial oxygen tensions. In 28 horses with an initial PaO2 less than 70 mm of Hg, PEEP increased PaO2 values to a mean of 173 +/- 24 mm of Hg. Arterial oxygen content increased from 14.1 +/- 0.05 ml/dl to 17.2 +/- 0.05 ml/dl. In the remaining 46 horses, PEEP increased PaO2 from a mean value of 101 +/- 6 mm of Hg to 194 +/- 15 mm of Hg, and arterial oxygen content increased from 14.9 +/- 0.09 ml/dl to 16.9 +/- 0.07 ml/dl. Cardiovascular depression and decrease in arterial blood pressure was observed after the application of PEEP in 54 horses. These 54 horses required use of pressors (n = 8), inotropes (n = 32), or both (n = 14) to keep the mean arterial blood pressure greater than 60 mm of Hg. Combined with pharmacologic support of blood pressure, PEEP could be a useful clinical treatment of arterial hypoxemia in horses.     

Use of end-tidal CO2 tension to predict arterial CO2 values in isoflurane-anesthetized equine neonates.

End-tidal carbon dioxide tension (PetCO2) and arterial carbon dioxide tension (PaCO2) were determined and compared in isoflurane-anesthetized spontaneously breathing equine neonates. End-tidal carbon dioxide and PaCO2 values increased with respect to time. Difference between values of PetCO2 and PaCO2 increased over time. End-tidal carbon dioxide tension was useful to predict changes in and was more closely correlated with PaCO2 early in the anesthetic period (T less than or equal to 60 minutes). The dead space volume to tidal volume (Vd/Vt) ratio increased with respect to time, indicating increase in physiologic dead space in isoflurane-anesthetized foals. The data indicate that the increased difference between widening of the PetCO2 and PaCO2 values over time may have been attributable to hypoventilation and decreased pulmonary capillary perfusion of alveoli.     

Effect of a respiratory gas collection mask on some measurements of cardiovascular and respiratory function in horses exercising on a treadmill

The effects of a respiratory gas collection mask on arterial blood gases, acid base values, oxygen content, respiratory frequency and heart rate, were investigated in standardbred horses during treadmill exercise at speeds up to 10 m sec-1 and a treadmill slope of 10 per cent. The mask had no significant effect on heart rates during exercise, but respiratory frequency was lower when the mask was used. The increase in respiratory frequency as treadmill velocity increased was also significantly slower with the mask operative. Arterial carbon dioxide tensions were significantly higher during exercise with the mask than without, and arterial oxygen tension was significantly lower at the highest exercise intensity. Arterial oxygen content was significantly lower at all work speeds when the mask was used. There were minimal effects of the mask on arterial acid base values. It was concluded that a respiratory gas collection mask caused alveolar hypoventilation in exercising horses, but did not markedly influence heart rate or arterial acid base values during exercise.     

The cardiovascular sparing effect of fentanyl and atropine, administered to enflurane anesthetized dogs.

Cardiovascular effects of high dose opioid together with low dose inhalant were compared with inhalant alone to determine whether opioid/inhalant techniques were less depressant on the cardiovascular system. The effects of positive pressure ventilation and increasing heart rate to a more physiological level were also studied. Cardiovascular measurements recorded during administration of enflurane at 1.3 minimum alveolar concentration (MAC; 2.89 +/- 0.02%) to spontaneously breathing dogs (time 1) and during controlled ventilation [arterial carbon dioxide tension at 40 +/- 3 mmHg (time 2)] were similar. At time 2, mixed venous oxygen tension and arterial and mixed venous carbon dioxide tensions were significantly decreased, while arterial and mixed venous pH were significantly increased compared to measurements at time 1. After administration of fentanyl to achieve plasma fentanyl concentration of 71.7 +/- 14.4 ng/mL and reduction of enflurane concentration to yield 1.3 MAC multiple (0.99 +/- 0.01%), heart rate significantly decreased, while mean arterial pressure, central venous pressure, stroke index, and systemic vascular resistance index increased compared to measurements taken at times 1 and 2. Pulmonary arterial occlusion pressure was significantly increased compared to measurements taken at time 2. After administration of atropine until heart rate was 93 +/- 5 beats/min (plasma fentanyl concentration 64.5 +/- 13.5 ng/mL) heart rate, mean arterial pressure, cardiac index, oxygen delivery index, and venous admixture increased significantly compared to values obtained at all other times.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pulmonary function changes induced by experimental dichlorvos toxicosis in calves

Clinical and pulmonary function changes induced by intravenous dichlorvos (2,2-dichlorvinyldimethyl phosphate) (DDVP) toxicosis, and reversibility of these changes after atropine treatment were investigated in six Friesian calves one to three months old. From one minute after dosage, all animals showed severe respiratory distress, excitation, weakness, muscle fasciculation and cholinesterase inhibition. Decrease in dynamic lung compliance and arterial oxygen tension and increase in total pulmonary resistance, viscous work of breathing and alveolar arterial oxygen gradient were highly significant (P less than 0.01). On the other hand, body secretions, heart rate, respiratory rate, tidal volume and arterial carbon dioxide tension were not significantly affected by DDVP injection. Atropine promptly and completely reversed these changes, except for muscle fasciculations, central depression and cholinesterase inhibition which disappeared progressively within 24 hours.     

Early experience with continuous positive airway pressure (CPAP) in 5 horses �� A case series

This case series is the first report of the use of CPAP (continuous positive airway pressure) ventilation in adult horses. Two horses and 3 ponies anesthetized for orthopedic procedures in lateral recumbency received 10 cm H₂O CPAP. During anesthesia, arterial oxygen partial pressure tended to increase and arterial carbon dioxide pressure tended to increase despite increased minute ventilation index. The measured cardiovascular parameters were within physiologic limits.     

Effects of Carbon Dioxide Insufflation and Body Position on Blood Gas Values in Horses Anesthetized for Laparoscopy

The objective of the study was to describe the effects of carbon dioxide pneumoperitoneum and Trendelenburg position on arterial blood gas values in horses anesthetized for laparoscopy. The study design was a prospective case series using 14 healthy adult horses anesthetized for elective laparoscopic surgery. All horses in the study were maintained under anesthesia with halothane in oxygen with intermittent positive-pressure ventilation. A pneumoperitoneum of 15 mmHg or less was achieved with carbon dioxide, and horses were tilted to a 35-degree Trendelenburg position to allow the completion of laparoscopic cryptorchidectomy (n = 13) or ovariectomy (n = 1). Heart rate, mean arterial pressure, and arterial blood gases were recorded at six time intervals throughout the procedure. Results of the study indicated a pH that decreased and partial pressure of carbon dioxide (PaCO₂) and mean arterial pressure that increased over time and differed significantly from baseline during Trendelenburg position. Partial pressure of oxygen (PaO₂) was significantly lower than baseline after assumption of Trendelenburg position and did not improve on return to normal recumbency and abdominal pressure. As body weight increased, pH and PaO₂ decreased and PaCO₂ increased. We concluded that horses placed in Trendelenburg position have changes that are transient, with the exception of PaO₂. Heavier horses have a greater change in pH, PaCO₂, and PaO₂ than lighter horses during abdominal insufflation and Trendelenburg position. The changes incurred during CO₂ abdominal insufflation and Trendelenburg position are transient, with the exception of a decreased PaO₂. Heavy horses undergoing abdominal insufflation and Trendelenburg position should be closely monitored for critical cardiopulmonary values.     

Response to nasopharyngeal oxygen administration in horses with lung disease

REASONS FOR PERFORMING STUDY: Guidelines for administration of oxygen to standing horses are unavailable because previous investigations of the efficacy of oxygen administration to increase arterial oxygenation in standing horses have produced equivocal results. OBJECTIVE: To determine the effect of nasal oxygen supplementation on inspired and arterial blood gas tensions in control horses and those with moderate to severe recurrent airway obstruction (RAO). METHODS: Normal horses (n = 6) and horses during an attack of RAO induced by stabling (n = 6) were studied. Oxygen was administered through either one or 2 cannulae, passed via the nares into the nasopharynx to the level of the medial canthus of each eye. Intratracheal inspired oxygen and carbon dioxide concentration and arterial blood gas tensions were measured at baseline and during delivery of 5, 10, 15, 20 and 30 l/min oxygen. RESULTS: Nasal cannulae and all but the highest oxygen flow rates were well tolerated. Fractional inspired oxygen concentration (F(I)O2) increased with flow but was significantly lower at all flow rates in horses with RAO compared with controls. Arterial oxygen tension (PaO2) was significantly increased (P < 0.001) by all flow rates, but was always lower in RAO-affected animals. At 30 l/min, PaO2 increased to 319 +/- 31 mmHg in control horses and 264 +/- 69 mmHg in horses with RAO. Additionally, a large arterial to end-tidal gradient for CO2 in RAO-affected horses was observed, indicating increased alveolar deadspace ventilation in these animals. CONCLUSIONS: The use of nasal cannulae to deliver oxygen effectively increases both F(I)O2 and PaO2 in horses with moderate to severe RAO. Oxygen flow rates up to 20 l/min are well tolerated, but flow rates of 30 l/min produce occasional coughing or gagging. POTENTIAL RELEVANCE: Oxygen therapy delivered by means of an intranasal cannula is a highly effective means of increasing arterial oxygen tension in horses with respiratory disease. Generally, flows of 10-20 l/min should be effective. If higher flows (20-30 l/min) are necessary, they should be delivered by means of 2 cannulae.     

Effects of acetylpromazine on ventilatory variables in the horse.

The influence of breathing various concentrations of carbon dioxide and oxygen upon minute volume, tidal volume, and respiratory rate were examined in acetylpromazine-tranquilized horses. Responses in the horses before (control period) and after tranquilization were qualitatively similar to increases in carbon dioxide and to alterations in oxygen. The quantitative responses to these changes were less in tranquilized horses than in the same horses studied in the untranquilized state. Tranquilization had its most prominent effect upon respiratory rate in horses breathing room air.     

Acid-base values of standardbred horses recovering from strenuous exercise.

Blood gases, lactic acid concentrations, and pH were measured in arterial and mixed venous blood in moderately conditioned Standardbred horses after a standardized exercise load of 1.6 km in 2 minutes, 40 seconds. Samples were obtained at rest, immediately after exercise, and at 3, 6, 15, 30, and 60 minutes after exercise. Arterial oxygen tension and mixed venous oxygen tension increased after exercise, reaching peak values at 6 minutes. Arterial oxygen tension returned to the resting (preexercise) value by 15 minutes, and mixed venous oxygen tension by 30 minutes. Arterial carbon dioxide tension decreased immediately after exercise, reaching its lowest value at 6 minutes, and returned to resting value by 30 minutes. Mixed venous carbon dioxide tension reached its highest value immediately after exercise, then decreased to less than the resting value, reaching its lowest value by 15 minutes, and returned to normal by 60 minutes. Lactic acid concentration increased immediately after exercise, reaching its highest value at 6 minutes, and returned toward normal by 60 minutes. Arterial pH decreased immediately after exercise, reaching its lowest value at 6 minutes, and returned to normal by 60 minutes. Mixed venous pH reached its lowest value immediately after exercise, then began to increase, and returned to normal by 60 minutes. The decrease in mixed venous pH was more pronounced than that in arterial blood since, in addition to the increase in lartic acid, there was a considerable increase in mixed venous carbon dioxide tension.     

Effects of small and large face masks and translaryngeal and tracheostomy intubation on ventilation, upper-airway dead space, and arterial blood gases

Pulmonary function was examined in pentobarbital-anesthetized dogs that were spontaneously breathing through a large poorly fitted face mask, a small snug-fitted face mask, an endotracheal tube, and a tracheostomy tube. Increasing upper-airway dead space volumes were associated with higher minute ventilation and faster breathing rates. Minute and tidal alveolar ventilation, calculated ideal alveolar oxygen, alveolar-arterial oxygen gradient, venous admixture, arterial pH and blood gases, cardiac output, and systemic and pulmonary arterial blood pressure were not changed. The functional dead space of each mask was considerably less than that measured by water displacement. The small mask only slightly increased, and the endotracheal tube slightly decreased, the dead space estimated for a nasally breathing healthy dog.     

Cardiovascular and respiratory effects of propofol administration in hypovolemic dogs.

Cardiopulmonary effects of propofol were studied in hypovolemic dogs from completion of, until 1 hour after administration. Hypovolemia was induced by withdrawal of blood from dogs until mean arterial pressure of 60 mm of Hg was achieved. After stabilization at this pressure for 1 hour, 6 mg of propofol/kg of body weight was administered IV to 7 dogs, and cardiopulmonary effects were measured. After blood withdrawal and prior to propofol administration, oxygen utilization ratio increased, whereas mean arterial pressure, mean pulmonary arterial pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac index, oxygen delivery, mixed venous oxygen tension, and mixed venous oxygen content decreased from baseline. Three minutes after propofol administration, mean pulmonary arterial pressure, pulmonary vascular resistance, oxygen utilization ratio, venous admixture, and arterial and mixed venous carbon dioxide tensions increased, whereas mean arterial pressure, arterial oxygen tension, mixed venous oxygen content, arterial and mixed venous pH decreased from values measured prior to propofol administration. Fifteen minutes after propofol administration, mixed venous carbon dioxide tension was still increased; however by 30 minutes after propofol administration, all measurements had returned to values similar to those measured prior to propofol administration.     

Cardiopulmonary effects of an infusion of remifentanil or morphine in horses anesthetized with isoflurane and dexmedetomidine

ObjectiveTo examine the cardiopulmonary effects of infusions of remifentanil or morphine, and their influence on recovery of horses anesthetized with isoflurane and dexmedetomidine.Study designRandomized crossover study with 7-day rest periods.AnimalsSix adult horses (507 ± 61 kg).MethodsAfter the horses were sedated with xylazine, anaesthesia was induced with ketamine and diazepam, and maintained with isoflurane. After approximately 60 minutes, a dexmedetomidine infusion was started (0.25 μg kg^?1 then 1.0 μg^?1 kg^?1 hour^?1) in combination with either saline (group S), morphine (0.15 mg kg^?1 then 0.1 mg kg^?1 hour^?1; group M), or remifentanil (6.0 μg kg^?1 hour^?1; group R) for 60 minutes. Mean arterial pressure, heart rate, end-tidal carbon dioxide tension, and end-tidal isoflurane concentration were recorded every 5 minutes. Core body temperature, cardiac output, right ventricular and arterial blood-gas values were measured every 15 minutes. Cardiac index, systemic vascular resistance (SVR), intrapulmonary shunt fraction, alveolar dead space, oxygen delivery and extraction ratio were calculated. Recoveries were videotaped and scored by two observers blinded to the treatment. Data were analyzed using repeated measures anova followed by Dunnett’s or Bonferroni’s significant difference test. Recovery scores were analyzed using a Kruskal–Wallis test.ResultsNo significant differences were found among groups. Compared to baseline, heart rate decreased and SVR increased significantly in all groups, and cardiac index significantly decreased in groups S and M. Hemoglobin concentration, oxygen content and oxygen delivery significantly decreased in all groups. The oxygen extraction ratio significantly increased in groups M and R. Lactate concentration significantly increased in group S. Recovery scores were similar among groups.Conclusions and clinical relevanceDexmedetomidine alone or in combination with remifentanil or morphine infusions was infused for 60 minutes without adverse effects in the 6 healthy isoflurane-anesthetized horses in this study.     

Improvement in arterial oxygen tension with change in posture in anaesthetised horses

Observations were made on horses spontaneously breathing oxygen, with halothane at a constant end tidal concentration. The horses were positioned in dorsal recumbency for the first 45 minutes of each anaesthetic episode during which the arterial oxygen tension (PaO2) was found to peak and then decline. The remaining 60 minutes of each anaesthesia was used to test the effect of various manoeuvres on PaO2. The PaO2 of horses decreased further both when remaining in dorsal recumbency and when repositioned in right or left recumbency. In contrast, placing the horses in sternal recumbency for these remaining 60 minutes caused the PaO2 to rise rapidly providing evidence for redistribution of ventilation. Replacing some inspired oxygen with less absorbable nitrogen did not improve PaO2 in dorsal recumbency. Thus there was no evidence that the low PaO2 of dorsal recumbency was associated with alveoli that had collapsed because of gas absorption.