Malignant hyperthermia in a horse anesthetized with halothane

Ahealthy, 565-kg, 14-year-old Quarter Horse gelding, negative for equine protozoal myelitis on serum Western blot and for hyperkalemic periodic paralysis (HYPP) by polymerase chain reaction, was selected for use in an electrophysiology study performed under inhalation anesthesia. The study was performed by following the guidelines of an Animal Use and Care Committee Protocol of the University of California at Davis (UCD 8578). Anesthesia was induced with halothane delivered via a face-mask. The horse was intubated 17 minutes later with an orotracheal tube and anesthesia was maintained with halo-thane by using a semiclosed, large-animal breathing circuit. Although muscle relaxation was otherwise good, the horse's ears remained tensed in a caudal direction throughout the study     

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.     

Arrhythmogenic effect of hypercapnia in ducks anesthetized with halothane

OBJECTIVE: To determine effects of hypercapnia on arrhythmias in ducks anesthetized with halothane. ANIMALS: 12 ducks, 6 to 8 months old, weighing 1.1 to 1.6 kg. PROCEDURES: Each duck was anesthetized with a 1.5% mixture of halothane in oxygen, and anesthetic depth was stabilized during a 20-minute period. We added CO2 to the inspired oxygen to produce CO2 partial pressures of 40, 60, and 80 mm Hg in the inspired gas mixture.The CO2 partial pressure was increased in a stepwise manner. When arrhythmias were not evident during inhalation of the gas mixture at a specific CO2 partial pressure, the CO2 partial pressure was maintained for 10 minutes before a sample was collected for blood gas analysis. When arrhythmias were detected, a sample for blood gas analysis was collected after the CO2 partial pressure was maintained for at least 2 minutes, and CO2 inhalation then was terminated. RESULTS: During the stabilization period, PaCO2 (mean +/- SD) was 33 +/- 5 mm Hg,and arrhythmias were not detected. In 6 ducks, arrhythmias such as unifocal and multifocal premature ventricular contractions developed during inhalation of CO2. Mean PaCO2 at which arrhythmias developed was 67 +/- 12 mm Hg. In 5 of 6 ducks with arrhythmias, the arrhythmias disappeared after CO2 inhalation was terminated. CONCLUSION AND CLINICAL RELEVANCE: Analysis of data from this study indicated that hypercapnia can lead to arrhythmias in ducks during halothane-induced anesthesia. Thus, ventilatory support to maintain normocapnia is important for managing ducks anesthetized with halothane.     

Succinylcholine infusion associated with hyperthermia in ponies anesthetized with halothane

Succinylcholine was administered by infusion to halothane-anesthetized ponies to determine dosage requirements for surgical relaxation up to 3 hours' duration. This was not possible to do, since 4 of 6 ponies studied developed severe reactions characterized by prolonged muscle fasciculations after the initial succinylcholine dose, muscle rigidity, hyperthermia, hypercapnia, tachycardia, increasing pulse pressure, and metabolic acidosis. The reactions resembled those associated with malignant hyperthermia, a disease recognized in persons and swine. Two ponies showed signs of the phase II or desensitization block of succinylcholine. All ponies recovered from anesthesia without signs of muscle injury.     

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.     

Supportive therapy in the anesthetized horse

In conclusion, vigilant supportive care is necessary to prevent morbidity and death in the anesthetized horse. Because some of the equipment and drugs are specialized and the consequences of some postanesthetic complications are severe, availability of those items must be confirmed prior to anesthesia. Proper positioning and padding will help to reduce the incidence of postanesthetic myopathy-neuropathy syndrome in these large patients. Adequate tissue perfusion is important and can be achieved by controlling anesthetic depth, increasing intravascular volume with fluid administration, and by administering sympathomimetic agents.     

Neuromuscular and cardiovascular effects of atracurium in ponies anesthetized with halothane

Atracurium besylate, a recently developed, intermediate-duration acting, neuromuscular-blocking agent, was given to 15 halothane-anesthetized ponies to produce surgical relaxation (95% to 99% reduction of hoof twitch). All 15 ponies were given 3 injections; 8 of the 15 ponies were given 2 additional injections. Initial dosage of 0.11 +/- 0.01 mg/kg (mean +/- SD) and all subsequent injections of 0.052 mg/kg produced desired relaxation. Paralysis phase (maximum twitch reduction to 10% twitch recovery) lasted 24 +/- 5 minutes for the initial injection. Paralysis from subsequent injections lasted for a slightly shorter time. Recovery phase (10% to 75% twitch recovery) was similar for all injections (initial and repeated) and lasted approximately 11 minutes. Cardiovascular side effects were not seen. Reversal of effects of atracurium with administration of 0.5 mg of edrophonium/kg was achieved when the evoked digital extensor tension (twitch height) had returned to 95% of base line after the last atracurium injection. Edrophonium caused systolic blood pressure to increase 121% +/- 7% of base-line pressure, which was 133 +/- 18 mm of Hg. Heart rate changed to 93% +/- 9% of base line after edrophonium was given, which was 49 +/- 7 beat/min, but this change did not occur until after the blood pressure increased. Recovery to standing was smooth and strong. Five ponies stood on their first attempt to rise, 5 on the 2nd attempt, 2 on the 3rd, and 1 on the 4th. Seven ponies stood within 30 minutes after transportation to the recovery stall, 7 within an hour.(ABSTRACT TRUNCATED AT 250 WORDS)     

Respiratory reflexes in response to nasal administration of halothane to anesthetized, spontaneously breathing dogs

OBJECTIVE: To characterize and determine the sensory innervation of respiratory reflexes elicited by nasal administration of halothane to dogs. ANIMALS: 10 healthy Beagles. PROCEDURE: Dogs underwent permanent tracheostomy and, 2 to 3 weeks later, were anesthetized with thiopental and alpha-chloralose administered IV. The nasal passages were functionally isolated so that halothane could be administered to the nasal passages while dogs were breathing 100% O2 via the tracheostomy. Respiratory reflexes in response to administration of halothane at concentrations of 1.25, 1.75, and 2.5 times the minimum alveolar concentration (MAC), and 5% (administered in 100% O2 at a flow rate of 5 L/min) were recorded. Reflexes in response to administration of 5% halothane were also recorded following transection of the infraorbital nerve, transection of the caudal nasal nerve, and nasal administration of lidocaine. RESULTS: Nasal administration of halothane induced an inhibition of breathing characterized by a dose-dependent increase in expiratory time and a resultant decrease in expired volume per unit time. Effects were noticeable immediately after the onset of halothane administration and lasted until its cessation. Reflex responses to halothane administration were attenuated by transection of the caudal nasal nerve and by nasal administration of lidocaine, but transection of the infraorbital nerve had no effect. CONCLUSIONS AND CLINICAL RELEVANCE: Nasal administration of halothane at concentrations generally used for mask induction of anesthesia induces reflex inhibition of breathing. Afferent fibers in the caudal nasal nerve appear to play an important role in the reflex inhibition of breathing induced by halothane administration.     

Blood pressure response to tourniquet use in anesthetized horses

Blood pressure during anesthesia and surgery was compared for 2 groups of horses. Group A, consisting of 23 horses, had a tourniquet placed on the distal portion of a limb. The other group of 20 horses (group B) had surgery of comparable nature and duration as did group-A horses, but a tourniquet was not used. There was a statistical difference (P less than 0.05) in the peak systolic arterial blood pressure between the groups; group-A horses had a mean (+/- SEM) peak of 151 +/- 6 mm of Hg and group-B horses had a peak of 118 +/- 4 mm of Hg. In addition, group-A horses had immediate decrease in blood pressure, coincident with tourniquet deflation. The blood pressure decrease of 23 +/- 3 mm of Hg represented 16% of immediate predeflation blood pressure. Comparable blood pressure decrease was not observed at the end of surgery in group-B horses. Significant difference was not found when other factors that could affect blood pressure were considered. These factors included preanesthetic medication, anesthetic agents, mode of ventilation, pretourniquet inflation blood pressure, and duration of tourniquet inflation. Significant (P less than 0.05) difference in peak blood pressure was observed when the tourniquet was placed on the dependent, compared with the uppermost, limb, with changes more pronounced when the tourniquet was placed on the dependent limb. Tourniquet placement was associated with hypertension, and tourniquet deflation was associated with blood pressure decrease in these anesthetized horses.     

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.     

Neuromuscular and cardiovascular effects of pancuronium bromide in calves anesthetized with halothane

Pancuronium bromide was administered to calves to define the dosage level necessary to produce surgical relaxation (90% to 99% reduction of base-line evoked, hindlimb digital-extensor muscle twitch tension). Initial dosage level requirement was 43 +/- 9 micrograms/kg of body weight. Calves with this degree of relaxation required 26 +/- 14 minutes to achieve 50% recovery and 43 +/- 19 minutes to achieve complete return of base-line muscle twitch. Calves given a repeat injection of pancuronium at base-line muscle twitch required 27 +/- 9 micrograms/kg to achieve relaxation similar to that of the 1st dose. The 2nd dose did not last as long as the 1st, with complete recovery occurring in 37 +/- 12 minutes. Maximum evoked tension occurred at 200- to 400-g resting tension on the hoof. There was an absence of heart rate or blood pressure changes after injection of relaxant and a variable and inconsistent fade response to train-of-four and tetanic stimulus of the facial muscles. Acid-base values were alkalemic (pHa 7.5 +/- 0.08) when ventilation was controlled at eucapnia (PaCO2, 25 to 45 mm of Hg).     

Unusual osteochondral lesions of the talus in a horse

A 2-year-old Thoroughbred gelding was evaluated for a grade 3 out of 5 unilateral hind limb lameness. Flexion of the right hock and stifle joints (spavin test) exacerbated the lameness. Response to intra-articular and perineural anaesthesia isolated the source of lameness to the tarsocrural area, despite an absence of tarsocrural joint effusion. Routine radiographic examination of the hock did not reveal any significant abnormalities. Skeletal nuclear scintigraphic evaluation revealed a focal region of increased bone activity in the proximal medial trochlear ridge of the talus. Flexed lateromedial radiographic views identified three discrete semicircular lytic lesions at the proximal articular margin of the medial trochlear ridge of the talus. Conservative management of the lesions was associated with a successful return to racing. The location and appearance of the osteochondral lesions of this report have not been previously reported and may be a manifestation of developmental orthopaedic disease and abnormal endochondral ossification. Nuclear scintigraphy and flexed lateromedial radiographic views facilitated identification of the lesions. This radiographic view is recommended when lameness is isolated to the tarsocrural joint and standard radio-graphic projections fail to identify a cause.     

Use of halothane and isoflurane in the horse

When compared with halothane, isoflurane has several distinct characteristics. Vaporizer settings are higher because of its lower potency. Respiratory rates will be slower, and intraoperative changes in depth and recovery from surgical depth of anesthesia will be more rapid, although total recovery times frequently will not be different. Halothane and isoflurane appear similar in their effects on ocular reflexes and mean arterial blood pressure. Recovery from isoflurane should be managed to provide added sedation or physical support if the horse attempts to stand prematurely.