利多卡因、布吡卡因行硬膜外阻滞对犬循环系统影响的研究

选择 1 4条健康的成年犬 ,随机分为 2组 ,利多卡因组 8只 ,布吡卡因组 6只。分别用 2 %利多卡因和 0 5 %布吡卡因行硬膜外阻滞麻醉 ,测定 2组心率和动脉压的变化 ,观察其对心血管系统的影响。结果 :利多卡因连续硬膜外阻滞下 ,犬心率在注药后 5min开始下降 ,下降最大幅度为基础值的 (82 8± 5 4) % ,但注药 1 0min后心率变化不明显 ;收缩压在 30min后下降到最低 ,降至基础值的 (84 3± 3 9) % ,舒张压在 45min下降至基础值的 (80 3± 6 6) %。布吡卡因组犬心率在注药后 30min下降到最低 ,平均为基础值的 (72 6± 7 6) % ;收缩压和舒张压在 30min下降至最低 ,但平均降幅分别为基础值的 (83 3± 2 8) %和 (82 2± 7 1 ) % ,而后缓慢上升。结论 :利多卡因硬膜外阻滞对犬的心率和动脉压没有明显影响 ;布吡卡因对犬的心率抑制作用较明显 ,但对动脉压没有明显影响。     

Laser fenestration of the mesial septum for treatment of guttural pouch chondroids in a pony

OBJECTIVE: To describe removal of guttural pouch chondroids through a laser fenestrated mesial septum in a pony with an obstructed pharyngeal ostium of the left guttural pouch. STUDY DESIGN: Case report. ANIMALS: Pony. METHODS: Transendoscopic laser neodymium:yttrium aluminum garnet (Nd:YAG) fenestration of the mesial guttural pouch septum was made by contact method (bare fiber, 15-25 W, exposure time 4 seconds). Dissected tissue was removed by transendoscopic monopolar electrosurgery (loop electrode, cutting blade) and multiple chondroids of varying size were removed from the left guttural pouch through the fenestration. RESULTS: After removing all chondroids and repeated flushing of the left guttural pouch via the right side, inflammation of the guttural pouch membranes decreased remarkably. The pony was discharged with instructions for transendoscopic lavage once weekly and was reevaluated at 2 months. A permanent septal fenestration was observed and the pony was free of abnormal clinical signs and being used for carriage driving competitions. CONCLUSION: Nd:YAG laser fenestration of the mesial septum is an approach for access to guttural pouch chondroids. CLINICAL RELEVANCE: When guttural pouch empyema and/or chondroids is associated with adhesion of the pharyngeal ostium, laser fenestration of the mesial septum from the opposite guttural pouch should be considered as an alternative approach for access, rather than classic external surgical approaches.     

利多卡因、布吡卡因行硬膜外阻滞对羊肝、肾功能的影响

为研究利多卡因、布吡卡因硬膜外阻滞对山羊肝、肾功能的影响,将16只成年山羊被随机分成2组(n=8),L3-4之间行硬膜外穿刺、置管后,分别注入2%多利卡因6mg/kg和0.75%布吡卡因2mg/kg。在注药前及注药后的30min、24h、72h和120h采集血样,测定ALT、AST、ALP、γ-GT及LDH的活性和Bilirubin、Grea、UA和Gluc等生化指标。结果表明,利多卡因、布吡卡因行硬膜外阻滞对血清ALT、AST、ALP、γ-GT及LDH活性和Grea、Urea、Gluc和Bilirubin均没有明显影响。     

Evaluation of an automatic approach device to the epidural space of Beagle dogs

ObjectiveTo compare the epidural anesthesia device (EPIA), which facilitates an automatic approach to location of the epidural space, with the performance of clinicians using tactile sensation and differences in pressure when inserting an epidural needle into the epidural space of a dog.Study designProspective, crossover experiment.AnimalsA total of 14 Beagle dogs weighing 7.5 ± 2.4 kg (mean ± standard deviation).MethodsEach dog was anesthetized three times at 2 week intervals for three anesthesiologists (two experienced, one novice) to perform 14 epidural injections (seven manual and EPIA device each). The sequence of methods was assigned randomly for each anesthesiologist. The dogs were anesthetized with medetomidine (10 μg kg^–1), alfaxalone (2 mg kg^–1) and isoflurane and positioned in sternal recumbency with the pelvic limbs extended cranially. Epidural puncture in the manual method was determined by pop sensation, hanging drop technique and reduced injection pressure, whereas using the device a sudden decrease in reaction force on the device was detected. A C-arm identified needle placement in the epidural space, and after administration of iohexol (0.3 mL), the needle length in the epidural space was defined as the mean value measured by three radiologists. Normality was tested using the Kolmogorov–Smirnov test, and significant differences between the two methods were analyzed using an independent sample t test.ResultsIn both methods, the success rates of epidural insertion were the same at 95.2%. The length of the needle in the epidural space using the device and manual methods was 1.59 ± 0.50 and 1.68 ± 0.88 mm, respectively, with no significant difference (p = 0.718).Conclusions and clinical relevanceEPIA device was comparable to human tactile sense for an epidural needle insertion in Beagle dogs. Further research should be conducted for application of the device in clinical environments.     

Presumed generalised seizure following caudal epidural administration of morphine and detomidine in a pony

A 9-year-old show pony mare became acutely lame following removal of a bone sequestrum of the distal phalanx of the right thoracic limb. The mare also suffered from ongoing right dorsal colitis secondary to previous long-term nonsteroidal anti-inflammatory drug (NSAID) use. To avoid further NSAID use, a protocol for caudal epidural administration of morphine and detomidine in an increased volume was used to provide analgesia to the thoracic limbs. A total volume of 50 mL (0.2 mL/kg bwt) was administered over approximately 90 s. Immediately following the injection, the pony collapsed into lateral recumbency and experienced an apparent generalised seizure characterised by loss of consciousness and frantic paddling of all four limbs. The pony recovered rapidly without intervention, and no residual neurological deficits were noted. The epidural analgesia resulted in a marked improvement in comfort levels. The speed of injection is thought to have caused a change in epidural and intracranial pressures resulting in a generalised seizure and highlights the importance of administering large volumes slowly.     

Evaluation of perfusion index as a noninvasive tool to determine epidural anesthesia effectiveness in dogs

ObjectiveTo evaluate perfusion index (PI) as a noninvasive tool to determine effectiveness and onset of epidural anesthesia in dogs.Study designProspective clinical trial.AnimalsA total of 21 adult dogs, aged 6.5 ± 3 years and weighing 34.9 ± 6.4 kg, undergoing a tibial plateau leveling osteotomy.MethodsDogs were premedicated intramuscularly with acepromazine (0.03 mg kg^–1) and hydromorphone (0.1 mg kg^–1) and anesthetized with intravenous propofol (to effect) and isoflurane in oxygen. A surface transflectance probe was secured to the tail base to monitor PI and a dorsal pedal artery catheter was placed for invasive blood pressure monitoring. A lumbosacral epidural was performed with the dog in sternal recumbency. Dogs were randomly assigned for inclusion of epidural morphine (0.1 mg kg^–1) or morphine (0.1 mg kg^–1) and lidocaine (4 mg kg^–1). PI was recorded following instrumentation of each dog just prior to the epidural (baseline), at 10 minute intervals for 30 minutes, before and after the surgical skin incision and before and after completion of the osteotomy. Physiological variables and end-tidal isoflurane were recorded at the same time points.ResultsThere was no significant difference in PI between the groups at any time point. There was a significant change in end-tidal isoflurane before and after the skin incision in the epidural morphine and epidural morphine–lidocaine groups (p = 0.04, p = 0.05, respectively) and before and after the osteotomy in each group for heart rate (p = 0.001, p = 0.04), diastolic (p = 0.01, p = 0.01) and mean arterial blood pressure (p = 0.03, p = 0.05).Conclusions and clinical relevancePI did not provide an objective means for determining the onset or effectiveness of epidural anesthesia in anesthetized dogs and alternate methods of noninvasive assessment should be investigated.     

The effect of epidural injection speed on epidural pressure and distribution of solution in anesthetized dogs

ObjectiveTo determine the effect of injection speed on epidural pressure (EP), injection pressure (IP), epidural distribution (ED) of solution, and extent of sensory blockade (SB) during lumbosacral epidural anesthesia in dogs.Study designProspective experimental trial.AnimalsTen healthy adult Beagle dogs weighing 8.7 ± 1.6 kg.MethodsGeneral anesthesia was induced with propofol administered intravenously and maintained with isoflurane. Keeping the dogs in sternal recumbency, two spinal needles connected to electrical pressure transducers were inserted into the L6-L7 and the L7-S1 intervertebral epidural spaces for EP and IP measurements, respectively. Bupivacaine 0.5% diluted in iohexol was administered epidurally to each dog via spinal needle at L7-S1 intervertebral space, at two rates of injection (1 and 2 mL minute^?1 groups), with a 1-week washout period. Epidural distribution was verified with computed tomography, and SB was evaluated after arousal by pinching the skin with a mosquito hemostatic forceps over the vertebral dermatomes. The results were analyzed according to each injection speed, using paired t- and Wilcoxon signed-rank tests.ResultsMean ± SD of baseline EP and IP values were 2.1 ± 6.1 and 2.6 ± 7.1 mmHg, respectively. Significant differences were observed between 1 and 2 mL minute^?1 groups for peak EP (23.1 ± 8.5 and 35.0 ± 14.5 mmHg, p = 0.047) and peak IP (68.5 ± 10.7 and 144.7 ± 32.6 mmHg, p <0.001). However, the median (range) of the ED, 11.5 (4–22) and 12 (5–21) vertebrae, and SB, 3.5 (0–20) and 1 (0–20) dermatomes, values of the two groups were not related to injection speed.Conclusions and clinical relevanceThe EP profile during injection was measured by separating the injection and pressure monitoring lines. The increase in epidural injection speed increased the EP, but not the ED or the SB in dogs.     

Myoclonus and urinary retention following subarachnoid morphine injection in a dog

A 5-year-old German Shepherd dog which presented for total hip replacement developed myoclonus and urinary retention after the subarachnoid injection of preservative-free morphine. Myoclonus was resistant to treatment, except pentobarbital anesthesia. Urinary retention was treated with bethanechol and subsided within a few days. Involuntary muscular activity can result from the epidural, subarachnoid or systemic injection of various opioid drugs, or as a result of the toxic or irritant effect of preservatives or autologous blood. The latter were not causative factors in this case. Opioid agonist inhibition of central inhibitory neurotransmitter action may have explained the myoclonus. Postoperative urinary retention was attributed to the spinal action of morphine inhibiting efferent parasympathetic nervous activity.     

A comparison of epidural buprenorphine plus detomidine with morphine plus detomidine in horses undergoing bilateral stifle arthroscopy

ObjectiveTo compare the analgesic efficacy of buprenorphine plus detomidine with that of morphine plus detomidine when administered epidurally in horses undergoing bilateral stifle arthroscopy.Study designProspective, randomized, blinded clinical trial.AnimalsTwelve healthy adult horses participating in an orthopedic research study. Group M (n = 6) received morphine (0.2 mg kg^?1) and detomidine (0.15 mg kg^?1) epidurally; group B (n = 6) received buprenorphine (0.005 mg kg^?1) and detomidine (0.15 mg kg^?1) epidurally.MethodsHorses received one of two epidural treatments following induction of general anesthesia for bilateral stifle arthroscopy. Heart rate (HR), mean arterial blood pressure (MAP), end-tidal CO₂ (Pe’CO₂), and end-tidal isoflurane concentrations (E’Iso%) were recorded every 15 minutes following epidural administration. Post-operative assessment was performed at 1, 2, 3, 6, 9, 12, and 24 hours after standing; variables recorded included HR, respiratory rate (f_R), abdominal borborygmi, defecation, and the presence of undesirable side effects. At the same times post-operatively, each horse was videotaped at a walk and subsequently assigned a lameness score (0-4) by three ACVS diplomates blinded to treatment and who followed previously published guidelines. Nonparametric data were analyzed using Wilcoxon’s rank-sum test. Inter- and intra-rater agreement were determined using weighted kappa coefficients. Statistical significance was set at p = 0.05.ResultsNo statistically significant differences were found between groups with respect to intra-operative HR, MAP, E’Iso%, or post-operative HR, gastrointestinal function and cumulative median lameness scores. Post-operative f_R in group B [24 (12-30), median (range)] breaths per minute was significantly higher than in group M [18 (15-20)] breaths per minute, p = 0.04.Conclusions and clinical relevanceIn horses undergoing bilateral stifle arthroscopy, these doses of buprenorphine plus detomidine injected epidurally produced analgesia similar in intensity and duration to that of morphine plus detomidine injected epidurally.