Suspected venous air embolism in three horses

Venous air embolism was suspected in 3 hospitalised horses on the basis of an inadvertently open jugular venous line. Subsequently the 3 horses developed clinical signs including cardiovascular collapse, cardiac dysrhythmia, pulmonary oedema, behavioural abnormalities and neurological signs consistent with central nervous system injury. Treatment included intranasal oxygen therapy, i.v. fluid administration and anti‐inflammatory therapy. Specific therapy aimed at treating air embolism in man is reviewed, with pertinent therapy potentially applicable to horses emphasised.     

Effect of acute intraocular pressure elevation on blood flow velocity and resistance in the rabbit ophthalmic artery

Objective To determine the effect of intraocular pressure (IOP) on blood flow velocity and resistance in the rabbit ophthalmic artery. Animals Ten adult New Zealand White rabbits were used. Procedures Right eyes were cannulated and the IOP was raised in a stepwise manner from 20 to 70 mmHg. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) in the ophthalmic artery were measured by color Doppler imaging. Values of PSV, EDV and RI were compared at various IOPs via the analysis of variance (anova ) of a randomized block design with post hoc Bonferroni test. Results Significant differences of PSV, EDV and RI at different IOP points (all P < 0.001) were observed. Over the entire IOP range, linear regression showed a negative correlation between IOP and both PSV and EDV (β = ?0.07434, P = 0.0020 and β = ?0.07829, P < 0.001, respectively), as well as a positive correlation between the RI and IOP (β = 0.00221, P < 0.001). Moreover, line plots identified a point with IOP = 40 mmHg, splitting the IOP range with different regression slopes. Piecewise linear regression indicated no correlation between PSV, EDV, RI and IOP when the IOP was elevated from 20 to 40 mmHg (P = 0.1832, P = 0.5932 and P = 0.5819, respectively). However, piecewise linear regression detected a stronger negative correlation between PSV, EDV and IOP (β = ?0.15760, P = 0.0011 and β = ?0.11872, P = 0.001, respectively) and a stronger positive correlation between RI and IOP (β = 0.00273, P = 0.0015) during the stage from 40 to 70 mmHg. Conclusions The ophthalmic artery in the rabbits was capable of maintaining normal blood velocity and resistance when IOP was below 40 mmHg. However, the autoregulatory capacity was greatly limited when IOP was over 40 mmHg.     

Post‐anesthetic pulmonary edema in two horses

Case 1 A two‐year old, 462 kg Standard bred horse was anesthetized for arthroscopy and castration. During anesthesia, hyperemia of the mucosal membranes and urticaria were noticed. During 5 hours of anesthesia subcutaneous edema of the eyelids and neck region developed. In the recovery box, the orotracheal (OT) tube was left in situ and secured in place with tape. Following initial attempts to stand, the horse became highly agitated and signs consistent with pulmonary edema developed subsequently. Arterial hypoxemia (PaO₂: 3.7 kPa [28 mmHg]) and hypocapnia (PaCO₂: 3.1 kPa [23 mmHg]) were confirmed. Oxygen and furosemide were administered. The horse was assisted to standing with a sling. Therapy continued with bilateral intra‐nasal oxygen insufflation. Ancillary medical therapy included flunixin meglumine, penicillin, gentamycin and dimethylsulfoxide. Following 7 hours of treatment the arterial oxygen tensions began to increase towards normal values. Case 2 An 11‐year old, 528 kg Paint horse was anesthetized for surgery of a submandibular mass. The 4‐hour anesthetic period was unremarkable. The OT tube was left in situ for the recovery. During recovery, the horse was slightly agitated and stood after three attempts. Clinical signs consistent with pulmonary edema and arterial hypoxemia (PaO₂: 5 kPa [37.5 mmHg]) subsequently developed following extubation. Respiratory signs resolved with medical therapy, including unilateral nasal oxygen insufflation, furosemide, flunixin meglumine and dimethylsulfoxide. The diagnosis of pulmonary edema in these horses was made by clinical signs and arterial blood‐gas analysis. While pulmonary radiographs were not taken to confirm the diagnosis, the clinical signs following anesthesia support the diagnosis in both cases. The etiology of pulmonary edema was most likely multifactorial.     

Post-anaesthetic pulmonary oedema in horses: a review

OBJECTIVES: To review information on the pathogenesis, diagnosis and treatment of post-anaesthetic pulmonary oedema in horses. DATABASES USED: Pubmed 1970-present, personal files.