The effect of Hetastarch (670/0.75) in vivo on platelet closure time in the dog

Objective – To evaluate the effect of 6% hydroxyethyl starch (HES) solution in vivo, with an average molecular weight of 670 kDa and degree of substitution of 0.75, on canine platelet function.
Design – Prospective, controlled-experimental study.
Setting – University of California, Davis, Veterinary Medical Teaching Hospital.
Animals – Seven healthy employee-owned dogs.
Interventions – Seven dogs were included in the treatment group. Four of these dogs also served as the control group. Platelet closure time (CT) was measured using a platelet function analyzer and collagen/ADP cartridges. Dogs were given 20 mL/kg of either sodium chloride 0.9% (control group, n =4) or HES (treatment group, n =7) IV over 1 hour. CT was measured before the infusion, and at 1, 3, 5, and 24 hours after the start of the infusion.
Measurements and Main Results – There was a significant change over time from 0 to 24 hours ( P <0.001), a significant difference between groups across time ( P <0.001), and a significant group-by-time interaction ( P =0.007). At 3 hours, mean CT for the treatment group was 122.3±18.1 seconds, which was significantly different ( P <0.001) from the control group (71.0±3.5 s). At 5 hours, mean CT for the treatment group was 142.7±33.9 seconds, which was significantly different ( P =0.001) from the control group (75.0±8.6 s). Mean CT at 24 hours was within the reference interval for both the control and treatment group (66.0±2.9 and 81.8±11.9 s, respectively); however, CT in 3 individual dogs in the treatment group at this time point remained prolonged.
Conclusions – A clinically relevant dose of HES 670/0.75 prolongs CT in dogs for up to 24 hours. This may be due to platelet dysfunction in addition to the effects of hemodilution, and therefore, may increase the risk of bleeding.     

A technique for central venous pressure measurement in normal horses

Objective – To investigate a technique of central venous pressure (CVP) measurement using a newly developed catheter in healthy adult horses. Design – Prospective experimental study. Setting – University research facility. Animals – Twenty healthy adult horses. Interventions – An equine central venous catheter was inserted into the jugular vein to a length of approximately 80 cm from the mid‐cervical region in an attempt to catheterize the pulmonary artery. Pulmonary arterial catheterization was confirmed by echocardiography. Insertion distance and pressure were measured at this location with a disposable manometer. The catheter was then withdrawn until presence in the right atrium was confirmed by echocardiography. Insertion distance and pressure were also measured at this location. The catheter was then withdrawn in 5 cm increments until exiting the jugular insertion site with pressure measured at each location. All pressure measurements were taken with the manometer zero position at the point of the shoulder. Measurements and Main Results – Pulmonary artery catheterization was successful in 16 of 20 horses. Mean pulmonary arterial pressure was 23.8 cm H₂O (17.5 mm Hg) (95% confidence interval [CI] 20.9–26.7 cm H₂O [15.4–19.6 mm Hg]). Mean right atrial pressure was 8.3 cm H₂O (6.1 mm Hg) (95% CI 7.1–9.4 cm H₂O [5.2–6.9 mm Hg]). Right atrial pressure was compared with pressures recorded at sequential insertion distances and resulted in a recommendation for catheter insertion of at least 40 cm for CVP measurement in adult horses. Jugular venous pressure measurement was statistically different from CVP measurement. Conclusions – This catheter measurement technique is well tolerated in normal horses. Routine clinical use of this equine central venous catheter may improve our ability to monitor patients and improve patient care and outcomes of ill horses in hospital.     

Use of therapeutic plasmapheresis in a case of canine immune-mediated hemolytic anemia

Objective – To investigate the clinical application and potential utility of plasmapheresis in canine immune-mediated hemolytic anemia.
Case Summary – A 7-year-old spayed female Maltese diagnosed with immune-mediated hemolytic anemia was initially treated with prednisone, cyclosporine, and received multiple transfusions of packed RBC. Because of the progression of clinical signs despite traditional medical therapy, plasmapheresis was initiated. Plasma immunoglobulin G and immunoglobulin M levels were measured before, during, and after treatment to help determine if there had been a significant decrease in immunoglobulin levels with plasmapheresis. Plasmapheresis was successfully performed over a 2.5-hour period in this dog with minimal complications. Hypocalcemia was identified as a known complication of circuit anticoagulation, and was corrected through calcium supplementation. Post-plasmapheresis there was a decrease in immunoglobulin G and immunoglobulin M levels, and the patient showed clinical improvement. Following discharge the dog had no known complications of therapy, and had complete resolution of the anemia.
New or Unique Information Provided – Plasmapheresis was performed successfully with minimal complications. Because transfusion requirements appeared to be reduced, and the procedure was well tolerated, there may be a place for this modality in severe cases to act as a bridge until medical therapy takes full effect. Because of the cost of performing this therapy, and the potential requirement for multiple treatments, it should be reserved for selected patients.     

Comparison of femoral and auricular arterial blood pressure monitoring in pigs

Objective To compare arterial blood pressure measurements obtained from the femoral and auricular arteries in anaesthetized pigs. Study design Prospective experimental study. Animals Fifteen female Large White pigs were used weighing 21.3 ± 2.3 kg. Methods The pigs were anaesthetized with tiletamine/zolazepam and xylazine administered intramuscularly, and anaesthesia maintained with isoflurane delivered in oxygen/nitrogen. Arterial oxygen partial pressures were maintained between 11.3 and 13.3 kPa and PaCO₂ between 4.6 and 6.0 kPa. Monitoring included electrocardiogram, capnography and invasive blood pressure. The auricular and femoral arteries were catheterized for continuous systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) measurements. Measurements were recorded every 15 minutes. Statistical analysis involved a Bland–Altman plot analysis. Results The mean difference ± confidence intervals between the femoral and the auricular arterial diastolic, systolic and mean blood pressure measurements during hypotension were 2 ± 7, 2 ± 5 and 2 ± 5 mmHg respectively. In conditions of normotension mean difference ± confidence intervals, of femoral and auricular arterial blood pressure measurements of diastolic, systolic and mean blood pressure were 4 ± 5, 3 ± 7 and 4 ± 4 mmHg respectively. In conditions of increased arterial blood pressure, mean difference ± confidence intervals, of femoral and auricular arterial blood pressure measurements of diastolic, systolic and mean blood pressure were 4 ± 5, 3 ± 8 and 4 ± 4 mmHg respectively. Conclusion Auricular artery catheterization is easier and quicker to perform. Pressure measurements from the auricular artery compared well with the femoral artery. Clinical relevance We found that auricular arterial blood pressures were similar to femoral arterial values under the conditions of this experiment. We did not test extremes of blood pressure or significant alterations in body temperature.