Pain management in horses and farm animals

Objective: This review discusses the different analgesic drugs and routes of administration used in large animals for acute pain management. General guidelines and doses are given to assist in choosing techniques that provide effective analgesia. Etiology: Noxious stimuli are perceived, recognized, and localized by specialized sensory systems located at spinal and supraspinal levels. Diagnosis: Localizing the source of the noxious stimulus as well as understanding the behavioral aspects and physiological changes that result from such insult is important to adequately diagnose and treat pain. Pain assessment is far from being definite and objective; not only are there species differences, but also individual variation. In addition, the behavioral and physiological manifestations vary with the acute or chronic nature of pain. Therapy: Pain management should include (1) selecting drugs that better control the type of pain elicited by the insult; (2) selecting techniques of analgesic drug administration that act on pathways or anatomical locations where the nociceptive information is being processed or originating from; (3) combining analgesic drugs that act on different pain pathways; and (4) provide the best possible comfort for the animal. Prognosis: Providing pain relief improves the animal's well being and outcome; however, interpreting and diagnosing pain remains difficult. Continuing research in pain management will contribute to the evaluation of the pathophysiology of pain, pain assessment, and newer analgesic drugs and techniques.     

Evaluation of an indirect oscillometric blood pressure monitor in normotensive and hypotensive anesthetized dogs

Objective – To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs. Design – Prospective observational study. Setting – University teaching hospital. Animals – Eight crossbred adult dogs. Interventions – Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end‐tidal isoflurane concentration at 1.2±0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia. Measurements and Main Results – Agreement between the direct and indirect BP measurements was determined by the Bland‐Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were ?14.7 mm Hg (15.5 mm Hg), ?16.4 mm Hg (12.1 mm Hg), and ?14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were ?32 mm Hg (22.6 mm Hg), ?24.2 mm Hg (19.5 mm Hg), and ?16.8 mm Hg (17.2 mm Hg), respectively. Conclusion – The oscillometric device was not reliably predictive of intra‐arterial BP during hypotension associated with acute hemorrhage.     

Continuous positive airway pressure administered via face mask in tranquilized dogs

Objective – To evaluate the tolerance of a continuous positive airway pressure (CPAP) mask in tranquilized dogs and compare PaO₂ in arterial blood in dogs receiving oxygen with a regular face mask or CPAP mask set to maintain a pressure of 2.5 or 5 cm H₂O. Design – Prospective, randomized clinical study. Setting – University teaching hospital. Animals – Sixteen client‐owned dogs without evidence of cardiopulmonary disease were studied. Interventions – Eight animals were randomly assigned to each of 2 treatment groups: group A received 2.5 cm H₂O CPAP and group B received 5 cm H₂O CPAP after first receiving oxygen (5 L/min) by a regular face mask. Animals were tranquilized with acepromazine 0.05 mg/kg, IV and morphine 0.2 mg/kg, IM. An arterial catheter was then placed to facilitate blood sampling for pHa, PaO₂, and PaCO₂ determinations before and after treatments. Direct mean arterial pressure, heart rate, respiratory rate, and temperature were also recorded after each treatment. Measurements and Main Results – CPAP administration was well tolerated by all animals. The mean arterial pressure, heart rate, respiratory rate, temperature, PaCO₂, and pHa, did not differ at any time point between groups. Differences were seen in oxygenation; in group A, PaO₂ significantly increased from a mean of 288.3±47.5 mm Hg with a standard mask to a mean of 390.3±65.5 mm Hg with the CPAP mask and in group B, PaO₂ increased similarly from 325.0±70.5 to 425.2±63.4 mm Hg (P<0.05); no differences were detected between the 2 CPAP treatments. Conclusions – In healthy tranquilized dogs noninvasive CPAP is well tolerated and increases PaO₂ above values obtained when using a regular face mask.     

Partial pressure of end-tidal CO2 sampled via an intranasal catheter as a substitute for partial pressure of arterial CO2 in dogs

Objective: To demonstrate correlation and clinical usefulness of the partial pressure of end‐tidal CO₂ (ETCO₂) measurement by nasal catheter placement in sedated dogs with and without concurrent nasal oxygen administration as a substitute for partial pressure of arterial CO₂ (PaCO₂). Design: Prospective, cross‐over trial. Setting: University of Saskatchewan veterinary research laboratory. Animals: Six cross‐breed dogs with a mean (±SD) weight of 29.1±4.03 kg. Interventions: All dogs were sedated with 5 μg/kg medetomidine intravenously (IV) and an arterial catheter was placed in a dorsal pedal artery for removal of blood for gas analysis. A nasal catheter was placed in the ventral meatus and connected to a capnometer for ETCO₂ measurements in all dogs. Dogs receiving supplemental nasal oxygen had a second nasal catheter placed in the contralateral naris. Measurements and main results: In the group without nasal oxygen supplementation, the ETCO₂ measurement underestimated (negative bias) the PaCO₂ by ?2.20 mmHg with limits of agreement (95% confidence interval) of ?5.79, 1.39 mmHg. In the group receiving oxygen supplementation, ETCO₂ measurement underestimated (negative bias) the PaCO₂ by ?2.46 mmHg with limits of agreement (95% confidence interval) of ?8.42, 3.50 mmHg. Conclusions: The results of this study demonstrate that ETCO₂ monitoring via a nasal catheter provides a clinically acceptable substitute to arterial blood gas analysis as a means of monitoring ventilation in healthy, sedated dogs. The limits of agreement were within acceptable limits with and without concurrent insufflation of oxygen.