Evaluation of the Nonin 8600V Veterinary Pulse Oximeter in Anesthetized Horses

S_pO₂ values from the Nonin 8600V veterinary pulse oximeter, using a lingual clip-type, transmittance sensor applied to the tongue, were compared to directly-measured S_aO₂ values from a co-oximeter, calibrated for equine blood, in 5 halothane-anesthetized horse. Normocapnia was maintained with controlled ventilartion. The inspired oxygen concentration was varied by mixing nitrogen in oxygen to obtain S_pO₂ readings of approximately 60, 65, 70, 75, 80, 85, 90, 92, and 100%. At the time of each S_pO₂ recording, an arterial blood sample was collected for immediate analysis of S_aO₂. A total of sixty paired measurements were made. The results showed excellent data correlation with a bias (precision) of 0.55 (2.57) and an R-value of 0.98 over the entire S_aO₂ range tested. Based on these findings, the Nonin 8600V veterinary pulse oximeter, with the lingual sensor, performed accurately and reliably, and appears to be suitable for clinical use in anesthetized horses. (Vet Emerg & Crit Care, 1999: 13–18)     

Effects of Intermittent Positive Pressure Ventilation on Cardiopulmonary Function in Horses Anesthetized with Total Intravenous Anesthesia Using Combination of Medetomidine,Lidocaine, Butorphanol and Propofol (MLBP-TIVA)

Effects of intermittent positive pressure ventilation (IPPV) on cardiopulmonary function were evaluated in horses anesthetized with total intravenous anesthesia using constant rate infusions of medetomidine (3.5 µg/kg/hr), lidocaine (3 mg/kg/hr), butorphanol (24 µg/kg/hr) and propofol (0.1 mg/kg/min) (MLBP-TIVA). Five horses were anesthetized twice using MLBP-TIVA with or without IPPV at 4-week interval (crossover study). In each occasion, the horses breathed 100% oxygen with spontaneous ventilation (SB-group, n=5) or with IPPV (CV-group, n=5), and changes in cardiopulmonary parameters were observed for 120 min. In the SB-group, cardiovascular parameters were maintained within acceptable ranges (heart rate: 33–35 beats/min, cardiac output: 27–30 l/min, mean arterial blood pressure [MABP]: 114–123 mmHg, mean pulmonary arterial pressure [MPAP]: 28–29 mmHg and mean right atrial pressure [MRAP]: 19–21 mmHg), but severe hypercapnea and insufficient oxygenation were observed (arterial CO₂ pressure [PaCO₂]: 84–103 mmHg and arterial O₂ pressure [PaO₂]: 155–172 mmHg). In the CV-group, normocapnea (PaCO₂: 42–50 mmHg) and good oxygenation (PaO₂: 395–419 mmHg) were achieved by the IPPV without apparent cardiovascular depression (heart rate: 29–31 beats/min, cardiac output: 17–21 l /min, MABP: 111–123 mmHg, MPAP: 27–30 mmHg and MRAP: 15–16 mmHg). MLBP-TIVA preserved cardiovascular function even in horses artificially ventilated.     

Blood Gas Values During Intermittent Positive Pressure Ventilation and Spontaneous Ventilation in 160 Anesthetized Horses Positioned in Lateral or Dorsal Recumbency

One hundred sixty horses were anesthetized with xylazine, guaifenesin, thiamylal, and halothane for elective soft tissue and orthopedic procedures. Horses were randomly assigned to one of four groups. Group 1 (n = 40): Horses positioned in lateral (LR_G1,; n = 20) or dorsal (DR_G1,; n = 20) recumbency breathed spontaneously throughout anesthesia. Group 2 (n = 40): Intermittent positive pressure ventilation (IPPV) was instituted throughout anesthesia in horses positioned in lateral (LR_G2; n = 20) or dorsal (DR_G2; n = 20) recumbency. Group 3 (n = 40): Horses positioned in lateral (LR_G3; n = 20) or dorsal (DR_G3; n = 20) recumbency breathed spontaneously for the first half of anesthesia and intermittent positive pressure ventilation was instituted for the second half of anesthesia. Group 4 (n = 40): Intermittent positive pressure ventilation was instituted for the first half of anesthesia in horses positioned in lateral (LR_G4; n = 20) or dorsal (DR_G4; n = 20) recumbency. Spontaneous ventilation (SV) occured for the second half of anesthesia. The mean time of anesthesia was not significantly different within or between groups. The mean time of SV and IPPV was not significantly different in groups 3 and 4. Variables analyzed included pH, PaCO₂, PaO₂, and P(A-a)O₂ (calculated). Spontaneous ventilation resulted in significantly higher PaCO₂ and P(A-a)O₂ values and significantly lower PaO₂ values in LR_G1, and DR_G1, horses compared with LR_G2 and DR_G2 horses. Intermittent positive pressure ventilation resulted in normocarbia and significantly lower P(A-a)O₂ values in LR_G2 and DR_G2 horses. In LR_G2 the Pao₂ values significantly increased from 20 minutes after induction to the end of anesthesia. The PaO₂ and P(A-a)O₂ values were not significantly different from the beginning of anesthesia after IPPV in DR_G2 or DR_G3. The PaO₂ values significantly decreased and the P(A-a)O₂ values significantly increased after return to SV in horses in LR_G4, and DR_G4. The PaO₂ values were lowest and the P(A-a)O₂ values were highest in all horses positioned in dorsal recumbency compared with lateral recumbency and in SV horses compared with IPPV horses. The pH changes paralleled the changes in PaCO₂. Blood gas values during right versus left lateral recumbency in all groups were also evaluated. The PaO₂ values were significantly lower and the P(A-a)O₂ values were significantly higher during SV in horses positioned in left lateral (LR_LG1) compared with right lateral (LR_RG1) recumbency. No other significant changes were found comparing left and right lateral recumbency. Arterial hypoxemia (PaO₂ < 60 mm Hg) developed in 35% of DR_G1 horses and 20% of DR_G2 horses at the end of anesthesia. Arterial hypercarbia (PaCO₂= 50–60 mm Hg) developed in DRoi horses. Arterial hypoxemia that developed in 20% of DR_G3 horses was not improved with IPPV. Arterial hypoxemia developed in 55% of DR_G4 horses after return to SV. Some DR_G4 horses with hypoxemia also developed hypercarbia, whereas some had PaCO₂ values within normal limits. Arterial hypoxemia developed in one LR_G1, and two LR_G4, horses. Hypercarbia developed in onlv one LR_G4 horse.     

A study of cardiovascular function under controlled and spontaneous ventilation in isoflurane–medetomidine anaesthetized horses

Objective To determine, in mildly hypercapnic horses under isoflurane–medetomidine balanced anaesthesia, whether there is a difference in cardiovascular function between spontaneous ventilation (SV) and intermittent positive pressure ventilation (IPPV). Study design Prospective randomized clinical study. Animals Sixty horses, undergoing elective surgical procedures under general anaesthesia: ASA classification I or II. Methods Horses were sedated with medetomidine and anaesthesia was induced with ketamine and diazepam. Anaesthesia was maintained with isoflurane and a constant rate infusion of medetomidine. Horses were assigned to either SV or IPPV for the duration of anaesthesia. Horses in group IPPV were maintained mildly hypercapnic (arterial partial pressure of carbon dioxide (PaCO₂) 50–60 mmHg, 6.7–8 kPa). Mean arterial blood pressure (MAP) was maintained above 70 mmHg by an infusion of dobutamine administered to effect. Heart rate (HR), respiratory rate (f_R), arterial blood pressure and inspiratory and expiratory gases were monitored continuously. A bolus of ketamine was administered when horses showed nystagmus. Cardiac output was measured using lithium dilution. Arterial blood‐gas analysis was performed regularly. Recovery time was noted and recovery quality scored. Results There were no differences between groups concerning age, weight, body position during anaesthesia and anaesthetic duration. Respiratory rate was significantly higher in group IPPV. Significantly more horses in group IPPV received supplemental ketamine. There were no other significant differences between groups. All horses recovered from anaesthesia without complications. Conclusions There was no difference in cardiovascular function in horses undergoing elective surgery during isoflurane–medetomidine anaesthesia with SV in comparison with IPPV, provided the horses are maintained slightly hypercapnic. Clinical relevance In horses with health status ASA I and II, cardiovascular function under general anaesthesia is equal with or without IPPV if the PaCO₂ is maintained at 50–60 mmHg.     

Respiratory monitoring: arterial blood gas analysis, pulse oximetry, and end-tidal carbon dioxide analysis

The use of arterial blood gas analysis, pulse oximetry, and capnography has become commonplace in the assessment of veterinary patients. Blood gas analysis allows for the qualitative and quantitative assessment of both metabolic and respiratory acid-base problems, including the interrelationships between ventilation, oxygenation, and metabolic conditions. Blood gas analysis is a useful adjunct to clinical patient assessment and other diagnostics in determining appropriate therapy for specific and complex conditions. Both pulse oximetry and capnography are useful monitoring tools. However, they have technical limitations and cannot comprehensively evaluate patient oxygenation and ventilation. Pulse oximetry and capnography are not replacements for arterial blood gas analysis, but rather serve as adjunctive monitoring tools.     

Intermittent positive pressure ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvre during inhalation anaesthesia in horses undergoing surgery for colic, and its influence on the early recovery period

Objective To compare, ventilation using intermittent positive pressure ventilation (IPPV) with constant positive end‐expiratory pressure (PEEP) and alveolar recruitment manoeuvres (RM) to classical IPPV without PEEP on gas exchange during anaesthesia and early recovery. Study design Prospective randomized study. Animals Twenty‐four warm‐blood horses, weight mean 548 ± SD 49 kg undergoing surgery for colic. Methods Premedication, induction and maintenance (isoflurane in oxygen) were identical in all horses. Group C (n = 12) was ventilated using conventional IPPV, inspiratory pressure (PIP) 35–45 cmH₂O; group RM (n = 12) using similar IPPV with constant PEEP (10 cmH₂O) and intermittent RMs (three consecutive breaths PIP 60, 80 then 60 cmH₂O, held for 10–12 seconds). RMs were applied as required to maintain arterial oxygen tension (PaO₂) at >400 mmHg (53.3 kPa). Physiological parameters were recorded intraoperatively. Arterial blood gases were measured intra‐ and postoperatively. Recovery times and quality of recovery were measured or scored. Results Statistically significant findings were that horses in group RM had an overall higher PaO₂ (432 ± 101 mmHg) than those in group C (187 ± 112 mmHg) at all time points including during the early recovery period. Recovery time to standing position was significantly shorter in group RM (49.6 ± 20.7 minutes) than group C (70.7 ± 24.9). Other measured parameters did not differ significantly. The median (range) of number of RMs required to maintain PaO₂ above 400 mmHg per anaesthetic was 3 (1–8). Conclusion Ventilation using IPPV with constant PEEP and RM improved arterial oxygenation lasting into the early recovery period in conjunction with faster recovery of similar quality. However this ventilation mode was not able to open up the lung completely and to keep it open without repeated recruitment. Clinical relevance This mode of ventilation may provide a clinically practicable method of improving oxygenation in anaesthetized horses.     

Factors affecting the relationship between arterial and end-tidal carbon dioxide pressures in the anaesthetised horse

Objective To assess the effects of the duration of anaesthesia, position of recumbency, mode of ventilation, anaesthetic drug protocol, patient age and type of surgical procedure on the usefulness of capnometry as a measure of the partial pressure of arterial carbon dioxide (P_aco ₂) during general anaesthesia in horses. Design A prospective study compared the P_aco ₂ values with those of partial pressure of end-tidal carbon dioxide (ETco ₂) in horses anaesthetised for elective or emergency surgical procedures. The difference between P_aco ₂ and ETco ₂ (P_aco ₂− ETco ₂) and the physiological dead space to tidal volume ratio (V_D/V_T) were calculated. The effects of the study parameters on these variables was determined. Results The agreement between P_aco ₂ and ETco ₂ was poor. P_aco ₂− ETco ₂ and V_D/V_T during the first 60 min of anaesthesia was significantly less than after 60 min of anaesthesia. Mode of ventilation, position of recumbency, anaesthetic drug protocol, patient age and type of procedure did not have a significant affect on either value. Conclusions P_aco ₂− ETco ₂ in anaesthetised horses can be large, making ETco ₂ unreliable as a predictor of P_aco ₂ and for assessment of pulmonary ventilation. For anaesthesia lasting less than 60 min at least one blood gas analysis of an arterial blood sample is required to assess P_aco ₂− ETco ₂. Arterial blood gas analysis should be repeated after 60 min of general anaesthesia.     

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.     

Evaluation of Masimo signal extraction technology pulse oximetry in anaesthetized pregnant sheep

ObjectiveEvaluation of the accuracy of Masimo signal extraction technology (SET) pulse oximetry in anaesthetized late gestational pregnant sheep.Study designProspective experimental study.AnimalsSeventeen pregnant Merino ewes.MethodsAnimals included in study were late gestation ewes undergoing general anaesthesia for Caesarean delivery or foetal surgery in a medical research laboratory. Masimo Radical-7 pulse oximetry (SpO₂) measurements were compared to co-oximetry (SaO₂) measurements from arterial blood gas analyses. The failure rate of the pulse oximeter was calculated. Accuracy was assessed by Bland &; Altman's (2007) limits of agreement method. The effect of mean arterial blood pressure (MAP), perfusion index (PI) and haemoglobin (Hb) concentration on accuracy were assessed by regression analysis.ResultsForty arterial blood samples paired with SpO₂ and blood pressure measurements were obtained. SpO₂ ranged from 42 to 99% and SaO₂ from 43.7 to 99.9%. MAP ranged from 24 to 82 mmHg, PI from 0.1 to 1.56 and Hb concentration from 71 to 114 g L^?1. Masimo pulse oximetry measurements tended to underestimate oxyhaemoglobin saturation compared to co-oximetry with a bias (mean difference) of ?2% and precision (standard deviation of the differences) of 6%. Accuracy appeared to decrease when SpO₂ was <75%, however numbers were too small for statistical comparisons. Hb concentration and PI had no significant effect on accuracy, whereas MAP was negatively correlated with SpO₂ bias.Conclusions and clinical relevanceMasimo SET pulse oximetry can provide reliable and continuous monitoring of arterial oxyhaemoglobin saturation in anaesthetized pregnant sheep during clinically relevant levels of cardiopulmonary dysfunction. Further work is needed to assess pulse oximeter function during extreme hypotension and hypoxaemia.     

Pulmonary gas exchange and plasma lactate in horses with gastrointestinal disease undergoing emergency exploratory laparotomy: a comparison with an elective surgery horse population

Objective: To characterize pulmonary gas exchange and arterial lactate in horses with gastrointestinal disease undergoing anesthesia, compared with elective surgical horses, and to correlate these variables with postoperative complications and mortality. Study Design: Prospective clinical study. Animals: Horses undergoing emergency laparotomy for acute intestinal disease (n=50) and healthy horses undergoing elective surgery in dorsal recumbency (n=20). Methods: Arterial blood gas analysis was performed at predetermined intervals on horses undergoing a standardized anesthetic protocol. Alveolar–arterial oxygen gradient was calculated. Predictive factors for postoperative complications and death in colic horses were determined. Results: Arterial oxygen tension (P_aO₂) varied widely among horses in both groups. P_aO₂ significantly increased in the colic group after exteriorization of the ascending colon. P_aO₂ and alveolar–arterial oxygen gradient were not significantly different between groups, and neither were correlated with horse outcome. Arterial lactate in recovery ≥5 mmol/L was associated with a 2.25 times greater relative risk of complications and lactate ≥7 mmol/L was associated with a 10.5 times higher relative risk of death. Conclusion: Colic horses in this population were not more likely to be hypoxemic than elective horses, nor was gas exchange impaired to a greater degree in colic horses relative to controls. Arterial lactate sampled immediately after anesthetic recovery was predictive for postoperative complications and death.     

A comparison of the effects of hydromorphone HCl and a novel extended release hydromorphone on arterial blood gas values in conscious healthy dogs

The purpose of this study was to evaluate arterial blood gases in dogs that were given hydromorphone or extended release liposome-encapsulated hydromorphone (LEH). Dogs were randomly administered LEH, n = 6, (2.0 mg kg⁻¹), hydromorphone, n = 6, (0.2 mg kg⁻¹) or a placebo of blank liposomes, n = 3, subcutaneously on separate occasions. Arterial blood samples were drawn at serial time points over a 6-h time period for blood gas analysis. There was no change from baseline values in P_aCO₂, P_aO₂, (HCO₃-), pH, and SBEc in the dogs that received the placebo. Administration of hydromorphone resulted in significant increases in P_aCO₂ (maximum (mean + SD] 44.4 + 1.1 mm of Hg) and significant decreases in P_aO₂ (minimum (mean + SD) 82.4 + 4.7 mm of Hg) and pH (minimum (mean + SD) 7.31 + 0.01) compared with baseline. Administration of LEH resulted in significant increases in P_aCO₂ (maximum (mean + SD) 44.6 + 0.9 mm of Hg) and significant decreases in P_aO₂ (minimum (mean + SD) 84.8 + 2.6 mm of Hg) and pH (minimum (mean + SD) 7.34 + 0.02) compared with baseline. There was no significant difference between these two groups at any time point. The changes observed in P_aCO₂, P_aO₂, and pH, however, were within clinically acceptable limits for healthy dogs. LEH was determined to cause moderate changes in arterial blood gas values similar to those caused by hydromorphone.     

Pulmonary gas exchange in anaesthetised horses mechanically ventilated with oxygen or a helium/oxygen mixture

Reason for performing study: It is unknown whether administration of gas‐mixtures high in inspired fraction of oxygen (FiO₂) under general anaesthesia may increase formation of pulmonary atelectasis and impair gas exchange. Objective: To evaluate the effects of different FiO₂ on pulmonary gas exchange in isoflurane‐anaesthetised horses breathing a helium/oxygen (He/O₂) mixture. Methods: Thirty healthy mature horses were sedated with i.v. acepromazine (0.02 mg/kg bwt), detomidine (0.002 mg/kg bwt) and xylazine (0.2‐0.4 mg/kg bwt). General anaesthesia was induced with i.v. 5% guaifenesin to effect, diazepam (0.1 mg/kg bwt) and ketamine (2 mg/kg bwt), and maintained with isoflurane. Fifteen horses (Group HX) were ventilated mechanically with gas mixtures of successively increasing FiO₂ (0.25‐0.30, 0.50‐0.55, >0.90), obtained by blending O₂with Heliox (70% He/30% O₂). The other 15 horses (Group O) were ventilated immediately with 100% O₂(FiO₂>0.90). After 20 min of ventilation at the different FiO₂levels in Group HX and after 60 min in Group O, PaO₂ and PaCO₂ were measured and the alveolar to arterial PO₂gradient (P(_A‐a)O₂) was calculated. Data analysis included robust categorical regression with clustering on horse (P<0.05). Results: Inhalation of a He/O₂ mixture with FiO₂ as low as 0.25‐0.30 ensured adequate arterial oxygenation and was associated with a smaller P_(A‐a)O₂ gradient than inhalation of pure O₂ (P<0.05). In Group HX, PaO₂ increased with each rise in FiO2 and so did P(A‐a)O₂ (P<0.05). The PaO₂ was significantly lower and the P_(A‐a)O₂ higher in Group O compared to Group HX at a FiO₂ >0.90 (P<0.05). Conclusions and potential relevance: Administration of a He/O₂gas mixture low in FiO₂ can better preserve lung function than ventilation with pure oxygen. A step‐wise increase of FiO₂ using a He/O₂ gas mixture might offer advantages with respect to pulmonary gas exchange over an immediate exposure to 100% O₂.     

Arterial blood gas parameters of normal foals born at 1500 metres elevation

Reasons for performing study: Arterial blood gas analysis is widely accepted as a diagnostic tool to assess respiratory function in neonates. To the authors' knowledge, there are no published reports of arterial blood gas parameters in normal neonatal foals at altitude. Objective: To provide information on arterial blood gas parameters of normal foals born at 1500 m elevation (Fort Collins, Colorado) in the first 48 h post partum. Hypothesis: Foals born at 1500 m will have lower P_aO₂ and P_aCO₂ than foals born at sea level due to low inspired oxygen and compensatory hyperventilation occurring at altitude. Methods: Sixteen foals were studied. Arterial blood gas analysis was performed within 1 h of foaling and subsequent samples were evaluated at 3, 6, 12, 24 and 48 h post partum. Data were compared to those previously reported in healthy foals born near sea level. Results: Mean P_aO₂ was 53.0 mmHg (7.06 kPa) within 1 h of foaling, rising to 67.5 mmHg (9.00 kPa) at 48 h post partum. P_aCO₂ was 44.1 mmHg (5.88 kPa) within one hour of foaling, falling to 38.3 mmHg (5.11 kPa) at 48 h. Both P_aO₂ and P_aCO₂ were significantly lower in foals born at 1500 m elevation than those near sea level at several time points during the first 48 h. Conclusions and potential relevance: Foals at 1500 m elevation undergo hypobaric hypoxia and compensatory hyperventilation in the first 48 h. Altitude specific normal arterial blood values are an important reference for veterinarians providing critical care to equine neonates.     

The effect of a 50% inspired mixture of nitrous oxide on arterial oxygen tension in spontaneously breathing horses anaesthetised with halothane

The effect of nitrous oxide (N₂O) on arterial partial pressure of oxygen (P_aO₂) was evaluated in 20 adult horses anaesthetised with halothane. A fresh gas flow rate of 20ml/kg/min, comprising a 1:1 N₂O/oxygen (O₂) mixture, was supplied via the rotameter flowmeters of an anaesthetic machine to a large animal breathing system. The horses breathed spontaneously from the circuit immediately after endotracheal intubation. Ten horses were subsequently positioned in lateral recumbency and ten in dorsal recumbency. A further twenty adult horses were anaesthetised with halothane and acted as controls; halothane in 20mls/kg/min of O₂ being supplied to the same breathing system. Fifty percent NO caused significant decreases in P_aO₂ for horses in lateral and dorsal recumbency. However when administered to horses in lateral recumbency it did not promote arterial hypoxaemia. There was a higher risk of intraopera- tive arterial hypoxaemia (P_aO₂ < 8.6kPa) associated with its use in spontaneously breathing horses in dorsal recumbency. Arterial hypoxaemia occurred in all horses during the first fifteen minutes of recovery but when N₂O was discontinued, halothane in oxygen supplied to the breathing circuit for five minutes at a flow rate of 20ml/kg/minute was sufficient to ensure that diffusion hypoxia did not occur. The magnitude of the hypoxaemia was not signficantly different between the groups. The time taken to adopt sternal recumbency was significantly shorter in the horses that had received N₂O.     

Evaluation of the reliability of pulse oximetry,at different attachment sites,to detect hypoxaemia in immobilized impala (Aepyceros melampus)

ObjectiveEvaluation of the reliability of pulse oximetry at four different attachment sites compared to haemoglobin oxygen saturation measured by a co-oximeter and calculated by a blood gas analyser in immobilized impala.Study designRandomized crossover study.AnimalsA total of 16 female impala.MethodsImpala were immobilized with etorphine or thiafentanil alone, or etorphine in combination with a novel drug. Once immobilized, arterial blood samples were collected at 5 minute intervals for 30 minutes. Then oxygen was insufflated (5 L minute⁻¹) intranasally at 40 minutes and additional samples were collected. A blood gas analyser was used to measure the arterial partial pressure of oxygen and calculate the oxygen haemoglobin saturation (cSaO₂); a co-oximeter was used to measure the oxygen haemoglobin saturation (SaO₂) in arterial blood. Pulse oximeter probes were attached: under the tail, to the pinna (ear) and buccal mucosa (cheek) and inside the rectum. Pulse oximeter readings [peripheral oxygen haemoglobin saturation (SpO₂) and pulse quality] were recorded at each site and compared with SaO₂ and cSaO₂ using Bland-Altman and accuracy of the area root mean squares (A_rms) methods to determine the efficacy. P value < 0.05 was considered significant.ResultsPulse quality was ‘good’ at each attachment site. SpO₂ measured under the tail was accurate and precise but only when SaO₂ values were above 90% (bias = 3, precision = 3, A_rms = 4). The ear, cheek and rectal probes failed to give accurate or precise readings (ear: bias = −4, precision = 14, A_rms = 15; cheek: bias = 12, precision = 11, A_rms = 16; and rectum: bias = 5, precision = 12, A_rms = 13).Conclusions and clinical relevanceIn order to obtain accurate and precise pulse oximetry readings in immobilized impala, probes must be placed under the tail and SaO₂ must be above 90%. Since SaO₂ values are usually low in immobilized impala, pulse oximeter readings should be interpreted with caution.     

Indirect measurement of blood pressure using a pulse oximeter in isoflurane anesthetized dogs

Objective: To determine the accuracy of indirect blood pressure (BP) measurements obtained with a pulse oximeter as compared with direct measurements in dogs under isoflurane anesthesia. The Doppler and oscillometric BP monitors were included for comparison. Design: Prospective, experimental study. Animals: Twenty healthy dogs (23 ± 8 kg) anesthetized for research or teaching. Interventions: Dogs were anesthetized with propofol or thiopental and maintained using positive pressure ventilation with isoflurane in 100% O₂. Random adjustment of BP was achieved by inhalant adjustment or dopamine infusion to achieve low (≤85 mmHg), normal (90–120 mmHg), or high systolic BP (≥125 mmHg). Triplicate measurements for BP were taken with direct (dorsal pedal artery), Doppler (forelimb), oscillometric (same forelimb), and plethysmographic (pulse oximeter on tongue) methods. Measurements and main results: Using regression analysis and a modified Bland–Altman's technique, the lowest bias was achieved with the Doppler. Systolic BP readings at low, normal, and high BP were within 10 mmHg of direct recordings 95%, 70%, and 30% of the time for pulse oximetry; 95%, 85%, and 55% of the time for Doppler; 42%, 65%, and 30% of the time for oscillometric determination, respectively. Oscillometric mean BP readings were within 10 mmHg of direct measurements 53%, 60%, and 45% of the time, respectively. Conclusions: The pulse oximeter is an acceptable method for measuring BP in anesthetized dogs if assessment of trends is sufficient. All indirect methods showed greater bias and poorer precision at high BP. The Doppler may be the preferred indirect method.     

Cardiopulmonary effects of combined xylazine-guaiphenesin-ketamine infusion and extradural (inter-coccygeal lidocaine) anaesthesia in calves

Objective To investigate the cardiopulmonary effects of a xylazine–guaiphenesin–ketamine infusion combined with inter‐coccygeal extradural (lidocaine) anaesthesia in calves. Study design Prospective study. Animals Five Holstein Friesian calves (one steer, four heifers) aged 6 weeks weighing 65.2 ± 2.7 kg. Materials and methods Calves were anaesthetized with isoflurane in oxygen for instrumentation. At least 12 hours later, xylazine (0.2 mg kg^?1 IM) was given. After 15 minutes, an infusion of xylazine hydrochloride (0.1 mg mL^?1), guaiphenesin (50 mg mL^?1) and ketamine (1 mg mL^?1) (X–G–K) was infused at a rate of 1.1 mL kg^?1 hour^?1 IV. Oxygen (4 L minute^?1) was delivered by nasotracheal tube 30 minutes later. Inter‐coccygeal (Co₁–Co₂) extradural anaesthesia (lidocaine 2%, 0.18 mL kg^?1) was administered 30 minutes later. Cardiopulmonary variables were obtained in the unsedated standing calves 10 minutes after xylazine, 15 and 30 minutes after X–G–K without O₂, 15 and 30 minutes after X–G–K with O₂ and 5, 15, 30, 45 and 60 minutes after extradural anaesthesia. Data were analysed using a repeated measurement analysis of variance including an autoregressive covariance structure of order 1 (correlations at different time intervals). Results Xylazine caused significant (p < 0.05) decreases in heart rate (HR), cardiac output (Qt) and index (CI), stroke volume and stroke index, mean, systolic and diastolic arterial blood pressure (MAP, SAP, DAP), left (LVWSI) and right ventricular stroke work index (RVWSI), mean, systolic and diastolic pulmonary arterial pressure (MPAP, SPAP, DPAP), arterial pH, arterial oxygen tension (P_aO₂), arterial base excess, arterial HCO₃^? concentration, arterial saturation, packed cell volume, arterial and venous oxygen content (C_aO₂, C_vO₂), O₂ consumption and O₂ delivery (V?O₂, ?O₂). Increases in systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were observed. During X–G–K infusion without O₂, HR, Qt and CI increased gradually while SVR, PVR and MAP decreased. Left ventricular stroke work index and P_aO₂ remained constant, while O₂ supplementation improved P_aO₂. Coccygeal extradural anaesthesia had little effect on cardiopulmonary variables. Respiratory rate (f) and P_aCO₂ significantly increased over the experiment. Conclusions and clinical relevance Xylazine caused adverse cardiopulmonary effects in calves. Improvement occurred during xylazine–guiaphenesin–ketamine infusion. Cardiac index and arterial blood pressure remained below baseline values while sustained increases in respiration rate and P_aCO₂ were observed. Inter‐coccygeal extradural anaesthesia had only minor effects. Oxygen supplementation proved advantageous during guiaphenesin, ketamine and xylazine infusion in healthy calves in combination with coccygeal extradural anaesthesia induced persistent cardiopulmonary depression.     

A commercial foot pump for emergency ventilation of horses,proof‐of‐principle during equine field anaesthesia

At present there is no alternative to the use of a demand valve and pressurised oxygen for emergency ventilation in large animal field anaesthesia, therefore we aimed at providing a proof‐of‐principle of a small (2.5 l) commercial foot pump to provide emergency intermittent positive pressure ventilation (IPPV) in large animals. The study was performed during elective field anaesthesia for castration of 5 Haflinger stallions. Horses were premedicated with acepromazine i.m. after catheterisation of the jugular vein, further sedation was obtained with detomidine and butorphanol i.v. Anaesthesia was induced with ketamine and midazolam i.v. and maintained with a constant rate infusion of midazolam, ketamine and xylazine. After endotracheal intubation the foot pump, modified with a manually operated expiratory valve, was connected to the endotracheal tube and oxygen (6 l/min) was supplied. Anaesthesia was monitored using spirometry, respiratory gas analysis, pulse oximetry and arterial blood gas analysis. When arterial partial pressure of carbon dioxide (PaCO₂) exceeded 6.65 kPa, IPPV was provided by 2–4 consecutive compressions of the pump aiming at a tidal volume of 10 ml/kg bwt. The PaCO₂ was maintained at 6.18 ± 3.06 kPa (mean ± s.d.) with a respiratory rate of 4–10 breaths/min. The tidal volume was 2678–8300 ml with a peak inspiratory pressure of 24 ± 6.6 cmH₂O and a mean minute volume of 68.5 ± 13 l/min. Inspired oxygen concentration ranged from 26–46% (36 ± 7%) and arterial partial pressure of oxygen from 8.38–11.03 kPa (10.1 ± 0.93 kPa). The modified foot pump enables the practitioner to provide IPPV to large animals in emergency situations.     

The Effect of Reversible Left Recurrent Laryngeal Neuropathy on the Metabolic Cost of Locomotion and Peak Aerobic Power in Thoroughbred Racehorses

W. ROBERT COOK, BVSc, FRCVS The effect of left recurrent laryngeal neuropathy (LRLN) on the metabolic cost of locomotion (MCL) and peak aerobic power (V?O₂peak) was evaluated in four trained Thoroughbred racehorses. Oxygen consumption (V?O₂), carbon dioxide production (V?CO₂), venous lactate concentrations (LAC), and heart rate (HR) were measured during a treadmill exercise test (TET). Each horse performed the exercise test four times, alternating between normal upper airway function and reversibly induced LRLN. Subcutaneous infusion of 2% mepivicaine, a local anesthetic, into the region where the left recurrent laryngeal nerve passes caudal to the cricoid cartilage was used to induce LRLN. The induction of LRLN did not alter the relationship between V?O₂ and treadmill speed at exercise intensities where V?O₂ was less than V?O₂peak (<9 m/sec). However, a 15.3% reduction in V?O₂peak (Normal = 165.3 ± 3.4, LRLN = 140.0 ± 3.2 mL/kg/min ± SE, P <.001) occurred at higher treadmill speeds in horses with induced LRLN. A significant group (Normal v LRLN) by treadmill speed effect was found for LAC and R only at treadmill speeds where V?O₂=V?O₂peak. Peak lactate (LACpeak) did not change after the induction of LRLN. The relationship between HR and treadmill speed increased in horses with induced LRLN at exercise intensities where V?O₂ < V?O₂peak. Peak heart rate (HRpeak) remained unchanged. Performance as indicated by the maximum number of speed intervals completed (STEPmax) decreased 7% in horses with induced LRLN (Normal = 9.1 ± 0.04, LRLN = 8.5 ± 0.2 minutes ± SE, P <.04). A comparison of paired exercise test measurements showed no evidence of a training effect, or decreased performance caused by a learned response, over the course of the experiment. The results of this study indicate that alterations in ventilation caused by LRLN cause a significant reduction in V?O₂peak, but do not cause an increase in the metabolic cost of locomotion at exercise intensities where V?O₂ is less than V?O₂peak.     

Detomidine and the combination of detomidine and MK‐467, a peripheral alpha‐2 adrenoceptor antagonist,as premedication in horses anaesthetized with isoflurane

ObjectiveTo investigate MK-467 as part of premedication in horses anaesthetized with isoflurane.Study designExperimental, crossover study with a 14 day wash-out period.AnimalsSeven healthy horses.MethodsThe horses received either detomidine (20 μg kg⁻¹ IV) and butorphanol (20 μg kg⁻¹ IV) alone (DET) or with MK-467 (200 μg kg⁻¹ IV; DET + MK) as premedication. Anaesthesia was induced with ketamine (2.2 mg kg⁻¹) and midazolam (0.06 mg kg⁻¹) IV and maintained with isoflurane. Heart rate (HR), mean arterial pressure (MAP), end-tidal isoflurane concentration, end-tidal carbon dioxide tension, central venous pressure, fraction of inspired oxygen (FiO₂) and cardiac output were recorded. Blood samples were taken for blood gas analysis and to determine plasma drug concentrations. The cardiac index (CI), systemic vascular resistance (SVR), ratio of arterial oxygen tension to inspired oxygen (P_aO₂/FiO₂) and tissue oxygen delivery (DO₂) were calculated. Repeated measures anova was applied for HR, CI, MAP, SVR, lactate and blood gas variables. The Student's t-test was used for pairwise comparisons of drug concentrations, induction times and the amount of dobutamine administered. Significance was set at p < 0.05.ResultsThe induction time was shorter, reduction in MAP was detected, more dobutamine was given and HR and CI were higher after DET+MK, while SVR was higher with DET. Arterial oxygen tension and P_aO₂/FiO₂ (40 minutes after induction), DO₂ and venous partial pressure of oxygen (40 and 60 minutes after induction) were higher with DET+MK. Plasma detomidine concentrations were reduced in the group receiving MK-467. After DET+MK, the area under the plasma concentration time curve of butorphanol was smaller.Conclusions and clinical relevanceMK-467 enhances cardiac function and tissue oxygen delivery in horses sedated with detomidine before isoflurane anaesthesia. This finding could improve patient safety in the perioperative period. The dosage of MK-467 needs to be investigated to minimise the effect of MK-467 on MAP.