Clinical evaluation of the anaesthetic sparing effect of brachial plexus block in cats

ObjectiveTo evaluate the isoflurane sparing effect and the post-surgical analgesia provided by a brachial plexus block (BPB) in cats undergoing distal thoracic limb surgery.Study designProspective randomized blinded clinical study.AnimalsTwenty client-owned cats.MethodsCats were assigned to receive either no BPB (group NB) or a nerve stimulator guided BPB (group BPB) using lidocaine (3.6 mg kg^?1) and bupivacaine (1.2 mg kg^?1). Pre-medication consisted of midazolam and ketamine intravenously (IV). Anaesthesia was induced with propofol IV to effect and maintained with isoflurane delivered in oxygen and a continuous rate infusion of fentanyl (2 μg kg^?1 hour^?1). End-tidal isoflurane concentration (Fe′ISO) was adjusted every 3 minutes guided by changes in cardiorespiratory parameters and reflexes present, to maintain a stable depth of anaesthesia. Five time points were chosen to record all parameters and compare values between groups. Recovery and post-operative pain assessment were performed using a visual analogue scale (VAS) at 15 and 45 minutes after extubation and thereafter at hourly intervals until 5 hours after placement of the BPB.ResultsNo clinically significant differences were seen for heart rate, respiratory rate and non-invasive blood pressure between groups. Mean Fe′ISO was significantly lower in group BPB compared with group NB at all time points. In group NB, all intraoperative measurements of Fe′ISO were significantly higher compared with baseline (3 minutes before start of surgery) measurements. During recovery, VAS scores for group BPB were significantly lower than for group NB. Additional analgesics were needed in all cats within the study period.Conclusion and Clinical relevanceIn cats undergoing orthopaedic surgery of the thoracic limb, BPB reduced intra-operative isoflurane requirement and pain during the early post-operative period when compared with procedures without a BPB. BPB is a useful adjunct to anaesthesia in such cases.     

Plasma volume and electrolyte changes following intravenous infusion of hypertonic hydroxyethyl starch versus mannitol in healthy dogs

In a prospective cross-over study, the duration and magnitude of effect on the electrolyte and plasma volume changes of intravenous (IV) hypertonic hydroxyethyl starch (hyperHES) (7.5%/6%) and mannitol (20%) were compared. Eight Beagle dogs received an IV infusion of 4mL/kg hyperHES (group H) and 4mL/kg mannitol 20% (group M) on separate occasions. Urine and blood samples were taken in the first (T(60)) and second (T(120)) hour after infusion. Significant increases in plasma volume at each time point in group H and M were noted when compared to baseline (start of infusion=T(0)) level. There was no significant difference between groups. Both fluids resulted in diuresis, although no significant difference between groups was noted. A significant increase in plasma sodium (Na) was demonstrated in group H between T(0) and T(60) with a significant increase in the Na and chloride (Cl) fractional excretion (FE) between T(0), T(60) and T(120). In group M no changes in plasma electrolyte concentrations were detected, although FE of Na, Cl and K was increased significantly between T(0) and T(60). In conclusion, hyperHES and mannitol appear to have a volume expanding effect lasting at least 120 min. The hypernatraemia induced by hyperHES was minimal compared to previous reports of hypertonic saline use, and no clinical side effects were noted. HyperHES showed comparable effects to mannitol in increasing plasma volume and diuresis and could be considered for these applications.     

Comparison of the effects of propofol or alfaxalone for anaesthesia induction and maintenance on respiration in cats

ObjectiveTo compare the effects of propofol and alfaxalone on respiration in cats.Study designRandomized, ‘blinded’, prospective clinical trial.AnimalsTwenty cats undergoing ovariohysterectomy.MethodsAfter premedication with medetomidine 0.01 mg kg⁻¹ intramuscularly and meloxicam 0.3 mg kg⁻¹ subcutaneously, the cats were assigned randomly into two groups: group A (n = 10) were administered alfaxalone 5 mg kg⁻¹ minute⁻¹ followed by 10 mg kg⁻¹ hour⁻¹ intravenously (IV) and group P (n = 10) were administered propofol 6 mg kg⁻¹ minute⁻¹ followed by 12 mg kg⁻¹hour⁻¹ IV for induction and maintenance of anaesthesia, respectively. After endotracheal intubation, the tube was connected to a non-rebreathing system delivering 100% oxygen. The anaesthetic maintenance drug rate was adjusted (± 0.5 mg kg⁻¹ hour⁻¹) every 5 minutes according to a scoring sheet based on physiologic variables and clinical signs. If apnoea > 30 seconds, end-tidal carbon dioxide (Pe′CO₂) > 7.3 kPa (55 mmHg) or arterial haemoglobin oxygen saturation (SpO₂) < 90% occurred, manual ventilation was provided. Methadone was administered postoperatively. Data were analyzed using independent-samples t-tests, Fisher's exact test, linear mixed-effects models and binomial test.ResultsManual ventilation was required in two and eight of the cats in group A and P, respectively (p = 0.02). Two cats in both groups showed apnoea. Pe′CO₂ > 7.3 kPa was recorded in zero versus four and SpO₂ < 90% in zero versus six cats in groups A and P respectively. Induction and maintenance dose rates (mean ± SD) were 11.6 ± 0.3 mg kg⁻¹ and 10.7 ± 0.8 mg kg⁻¹ hour⁻¹ for alfaxalone and 11.7 ± 2.7 mg kg⁻¹ and 12.4 ± 0.5 mg kg⁻¹ hour⁻¹ for propofol.Conclusion and clinical relevanceAlfaxalone had less adverse influence on respiration than propofol in cats premedicated with medetomidine. Alfaxalone might be better than propofol for induction and maintenance of anaesthesia when artificial ventilation cannot be provided.     

A comparison of two different methods for dead space measurements in ventilated dogs

The aim of the study was to compare two methods of measuring physiological dead space/tidal volume ratio (Vd /Vt ) and alveolar dead space (Vd _ALV). Measurements were obtained by automated single breath CO₂ analysis (Ventrak 1550/Capnoguard 1265 (V&C)) and classical calculations were carried out using the Enghoff–Bohr equation in anaesthetized dogs. The V&C consists of a mainstream capnometer, a pneumotachometer, a signal processor, and computer software to determine continuous single‐breath CO₂ analysis (SBT‐CO₂). Eleven dogs of mixed breed (five female, six male) mean body mass 35 ± 10 kg, aged 9 months to 8 years were studied. Pre‐anaesthetic medication was acepromazine (0.03 mg kg^?1) and methadone (0.1 mg kg^?1). Anaesthesia was induced with propofol given to effect and maintained with propofol (10 mg kg^?1 hour^?1) and fentanyl (0.02 mg kg^?1 hour^?1) by infusion. The dog's trachea were intubated and the carbon dioxide and flow sensor were placed between the tube and the Y‐piece of a circle system (Fi O₂ = 1.0). Controlled ventilation was started (tidal volume 10–15 mL kg^?1) and settings were not changed throughout the measurement period. Mixed expired PCO₂ (P e ?CO₂) was measured by analyzing expired gas collected in a mixing box in the expiratory limb of the circle system. The dorsal pedal artery was cannulated for arterial blood sampling and analysis. Measurements were done every 15 minutes for 1 hour. The Vd /Vt was automatically calculated and displayed from the SBT‐CO₂ analysis and also obtained using the Enghoff modification of the Bohr equation (Vd /Vt = (PaCO₂ ? P e ?CO₂)/PaCO₂). Alveolar dead space was determined by calculating the physiological dead space (Vd phys = expired volume × (Vd /Vt )) and subtracting the anatomical dead space measured by SBT‐CO₂. Values for Vd /Vt and Vd _ALV obtained with both methods were compared using Students t‐test. The mean values from the automatic dead space calculation (Vd /Vt : 0.62–0.63; Vd _ALV: 56.1–64.3 mL) did not differ significantly from those calculated arithmetically (Vd /Vt : 0.62–0.63; Vd _ALV: 54.09–66.31 mL). The mean differences and standard deviation in Vd /Vt was 0.63 ± 0.00 and in Vd _ALV 58.98 ± 4.28 mL for the two measurement techniques. Our data indicate that V&C can be used for accurate noninvasive online Vd /Vt and Vd _ALV measurements in anaesthetized ventilated dogs.     

Volumetric capnography curves as lung function test to confirm bronchoconstriction after carbachol challenge in sedated dogs

This study investigated volumetric capnography (VC) in detecting airway responsiveness following airway challenge using carbachol in seven sedated dogs via face mask. Nebulised saline was administered, followed by increasing concentrations of nebulised carbachol until airflow limitation occurred (EP). Dead space (DS) variables and shape indices of the VC curve were calculated automatically after entering arterial carbon dioxide tension. Airway DS, airway DS to tidal volume (V(T)) ratio and the intercept of slope 2 of the VC curve decreased significantly at EP by 10%, 13% and 16%, respectively, minute ventilation, V(T) and alveolar DS increased significantly at EP by 49%, 22% and 200%, respectively. We conclude that VC and derived indices may be used to verify a reaction to airway challenge caused by carbachol in sedated dogs.     

Cardiopulmonary arrest and resuscitation following an extradural injection in a normovolemic dog

Objective – To describe general anesthesia and successful resuscitation of a dog developing asystole and apnea during extradural injection of local anesthetic and an opioid. Case Summary – A Beagle with a ruptured cranial cruciate was premedicated with acepromazine and methadone. Anesthesia was induced with propofol and, after endotracheal intubation, maintained using isoflurane in oxygen. During extradural injection of a mixture of lidocaine, bupivacaine, and morphine the dog developed apnea and asystole. Cardiopulmonary cerebral resuscitation was started promptly and the dog was successfully resuscitated. New Information Provided – Asystole and apnea are possible serious side effects of extradural anesthesia in dogs. With adequate monitoring and early detection successful resuscitation is possible.     

Observations on the muscle relaxant rocuronium bromide in the horse--a dose-response study

OBJECTIVE: To investigate the onset and duration of neuromuscular blockade of rocuronium bromide and its associated haemodynamic effects at three doses in healthy horses. STUDY DESIGN: Prospective, randomized experimental study. ANIMALS: Seven adult horses aged 3-20 (mean 10.3) years and weighing 466 +/- 44 (mean +/- SD) kg. METHODS: Horses were anaesthetized three times with at least 2 weeks between. They were pre-medicated with 0.6 mg kg(-1) xylazine and 0.01 mg kg(-1) butorphanol i.v.. Anaesthesia was induced with 2.2 mg kg(-1) ketamine and 0.1 mg kg(-1) diazepam i.v.. Following orotracheal intubation anaesthesia was maintained with isoflurane in 100% oxygen. Intermittent positive pressure ventilation was initiated and the horses were ventilated at a respiratory rate (fr) of 4-8 breaths minute(-1). Neuromuscular function was monitored with an acceleromyograph. The peroneal nerve was stimulated with train-of-four (TOF) mode at 2 Hz every 15 seconds. Each horse received, in randomly assigned order, one of the three doses of rocuronium: 0.2 mg kg(-1) (D02), 0.4 mg kg(-1) (D04) or 0.6 mg kg(-1) (D06) i.v.. Lag time, onset time, time of no response, duration of action and the TOF ratio 0.7 and 0.9 were measured. Recovery time (T1(25-75)) was calculated. Vital parameters were recorded at 5-minute intervals on a standard anaesthetic record form. RESULTS: Rocuronium produced a dose-dependent duration of action in isoflurane-anaesthetized horses. 100% block was observed in D04 and D06 but not in D02, in which the maximum decrease of the first twitch of TOF attained was 91.5 +/- 16.5%. Time to T1(25) was 13.1 +/- 5.5 minutes, 38.6 +/- 10.1 minutes and 55 +/- 9.8 minutes in D02, D04 and D06 respectively. There was a significantly shorter time for TOFR 0.9 with 0.2 mg kg(-1) compared with 0.4 and 0.6 mg kg(-1) rocuronium. T1(25-75) in D04 and D6 was not statistically significantly different. Heart rate, systolic, diastolic and mean arterial blood pressure increased slightly during the observation period. CONCLUSION: Rocuronium is an effective nondepolarizing muscle relaxant in horses under isoflurane anaesthesia. It had a dose-dependent onset and duration of action. Rocuronium did not produce significant changes in the measured cardiovascular parameters.