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Stijn Schauvliege Anna Binetti Luc Duchateau Jacoba Johanna van Dijk Frank Gasthuys 《Veterinary anaesthesia and analgesia》2018,45(5):648-657
Objective
To evaluate the cardiorespiratory effects of a 7° reverse Trendelenburg position (RTP) in anaesthetized horses.Study design
Randomized, non-blinded clinical trial.Animals
A total of 125 horses undergoing elective surgery in dorsal recumbency.Methods
Horses were allocated to one of three weight classes and assigned to be positioned either on a horizontal table or on a table in 7° RTP, according to a randomized block design. In all horses, anaesthesia was maintained with isoflurane in oxygen and a constant rate infusion of romifidine. All horses were mechanically ventilated throughout anaesthesia, and routine cardiovascular monitoring and arterial blood gas analysis were performed at 15-minute intervals and relevant variables calculated. Data from the first 60 minutes of anaesthesia were compared between both positions using a mixed model analysis of variance.Results
A significant interaction was found between position and weight class for the alveolar to arterial oxygen tension gradient and F-shunt: these variables were lower in RTP than in horizontal position in the two lowest weight classes and vice versa in the highest weight class. Arterial oxygen tension and oxygenation indices were significantly worse in the horses in the higher weight classes.Conclusions and clinical relevance
A 7° RTP did not result in clinically relevant changes in gas exchange or cardiovascular function. Horses with a higher body weight are at increased risk for hypoxaemia during anaesthesia in dorsal recumbency. 相似文献2.
Marcelo A. Araújo Maurício Deschk Juliana T. Wagatsuma Beatriz P. Floriano Carlos E. Siqueira Valéria NLS. Oliva Paulo SP. Santos 《Veterinary anaesthesia and analgesia》2017,44(4):854-864
Objective
To assess the cardiopulmonary effects caused by reverse Trendelenburg position (RTP) at 5° and 10° in sevoflurane-anesthetized yearling steers.Study design
Prospective, experimental study.Animals
Eight Holstein steers aged (mean ± standard deviation) 12 ± 2 months and weighing 145 ± 26 kg.Methods
In the first phase of the study, the individual minimum alveolar concentration (MAC) of sevoflurane was determined using electrical stimulation. In the second phase, the effects of RTP were assessed. The animals were anesthetized on three separate events separated by ≥7 days in an incomplete crossover design: control treatment using a table without tilt (RTP0); treatment with the table at 5° RTP (RTP5) and table tilted 10° RTP (RTP10). Subjects were physically restrained in dorsal recumbency on the table, which was already tilted according to each treatment. Anesthesia was induced with sevoflurane at 8% in 5 L minute–1 oxygen via face mask followed by maintenance with sevoflurane at 1.3 MAC and spontaneous breathing. Cardiopulmonary variables were obtained immediately after instrumentation (T0) and then after 30, 60, 120 and 180 minutes (T30, T60, T120 and T180, respectively).Results
The mean sevoflurane MAC for the eight steers was 2.12 ± 0.31%. Cardiac output was lower at all time points and the systemic vascular resistance index was higher at T120 and T180 in RTP10 compared with RTP0. Oxygen consumption was lower at T0 and at T180 in RTP10 compared with RTP0 and at all time points except T30 compared with RTP5. Oxygen extraction was lower at T0 in RTP10 compared with RTP0 and RTP5, and at T60 and T180 compared with RTP5.Conclusions and clinical relevance
RTP 5° and 10° did not improve ventilatory and oxygenation variables in sevoflurane-anesthetized steers when compared with no tilt, however the cardiovascular variables were adversely affected in RTP10. 相似文献3.
《Veterinary anaesthesia and analgesia》2023,50(4):333-340
ObjectiveTo determine if a 15° reverse Trendelenburg position decreases the incidence of gastroesophageal reflux (GER) compared with a horizontal position in dogs anesthetized for stifle surgery.Study designProspective, randomized parallel-arm study.AnimalsA total of 44 healthy client-owned dogs were enrolled and data from 36 dogs were analyzed.MethodsDogs requiring preoperative radiographs under anesthesia, or with a history of gastrointestinal signs or administered gastroprotectant therapy within 1 month of surgery were excluded. Anesthesia protocol was standardized to include hydromorphone, dexmedetomidine, ketamine, propofol and isoflurane. Dogs were randomly assigned at enrollment to be positioned in a 15° reverse Trendelenburg or a horizontal position for surgery. Continuous pH monitoring was documented throughout the procedure with a 6.4 Fr (2.13 mm) esophageal pH probe positioned in the distal esophagus via the oral cavity. GER was defined as pH < 4.0 (acidic) or > 7.5 (alkaline) for more than 30 seconds. The proportions of dogs developing GER were compared between groups using Fisher’s exact test. Time to reflux was compared using survival curves and the Gehan–Breslow–Wilcoxon test. Statistical significance was set as p < 0.05.ResultsAn episode of GER occurred in 11/36 (30%) dogs. Reflux was alkaline in two dogs and acidic in nine dogs. The proportion of dogs with GER was 5/18 (28%) and 6/18 (33%) for dogs in the reverse Trendelenburg position and horizontal position, respectively, and was not statistically significant (p > 0.99). Median (range) time until reflux was 44 (23–135) and 44.5 (9–56) minutes when dogs were positioned in reverse Trendelenburg position and horizontal position, respectively (p = 0.66; two-tailed Mann–Whitney U test).Conclusions and clinical relevancePositioning the surgery table in a 15° rostral elevation for dogs anesthetized for elective stifle surgical procedures did not decrease the incidence of GER. 相似文献
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The objective of the study was to describe the effects of carbon dioxide pneumoperitoneum and Trendelenburg position on arterial blood gas values in horses anesthetized for laparoscopy. The study design was a prospective case series using 14 healthy adult horses anesthetized for elective laparoscopic surgery. All horses in the study were maintained under anesthesia with halothane in oxygen with intermittent positive-pressure ventilation. A pneumoperitoneum of 15 mmHg or less was achieved with carbon dioxide, and horses were tilted to a 35-degree Trendelenburg position to allow the completion of laparoscopic cryptorchidectomy (n = 13) or ovariectomy (n = 1). Heart rate, mean arterial pressure, and arterial blood gases were recorded at six time intervals throughout the procedure. Results of the study indicated a pH that decreased and partial pressure of carbon dioxide (PaCO2) and mean arterial pressure that increased over time and differed significantly from baseline during Trendelenburg position. Partial pressure of oxygen (PaO2) was significantly lower than baseline after assumption of Trendelenburg position and did not improve on return to normal recumbency and abdominal pressure. As body weight increased, pH and PaO2 decreased and PaCO2 increased. We concluded that horses placed in Trendelenburg position have changes that are transient, with the exception of PaO2. Heavier horses have a greater change in pH, PaCO2, and PaO2 than lighter horses during abdominal insufflation and Trendelenburg position. The changes incurred during CO2 abdominal insufflation and Trendelenburg position are transient, with the exception of a decreased PaO2. Heavy horses undergoing abdominal insufflation and Trendelenburg position should be closely monitored for critical cardiopulmonary values. 相似文献
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Anna Binetti Martina Mosing Muriel Sacks Luc Duchateau Frank Gasthuys Stijn Schauvliege 《Veterinary anaesthesia and analgesia》2018,45(6):760-771
Objective
To describe the cardiorespiratory effects of a change in table position in anaesthetized horses.Study design
Prospective, crossover, randomized, experimental study.Animals
Six adult horses (mean body weight 621 ± 59 kg, aged 13 ± 4 years).Methods
The horses were anaesthetized twice in dorsal recumbency. They were either placed in the Trendelenburg position (head down; HD) followed by reverse Trendelenburg position (head up; HU) or in reverse order. Every position was maintained for 90 minutes. The order of positions was randomly assigned at initial anaesthesia. Extensive cardiorespiratory monitoring was performed. Statistical analysis consisted of a mixed model with horses as random effect and time, position, section of anaesthesia and interaction between those as fixed effects (p < 0.05).Results
When HU was applied during the first section of anaesthesia, PaO2, (p = 0.012), oxygen saturation (SaO2, p < 0.01) and oxygen content (CaO2, p < 0.01) were significantly higher, while venous admixture (s/t, p < 0.01), mean arterial (p = 0.039), right atrial (p < 0.01) and mean pulmonary arterial pressure (p < 0.01) were lower than in HD. After changing from HU to HD, PaO2 and SaO2 remained higher and s/t lower compared to the inverse order. Independent of the order, in the HD position s/t (p = 0.019) increased while PaO2 (p < 0.01), SaO2 (p = 0.011), CaO2 (p < 0.01), venous PO2 (PO2; p = 0.019), venous saturation (p = 0.004) and venous oxygen content (p = 0.010) decreased over time. No significant differences were found for cardiac output, oxygen delivery, oxygen consumption and dobutamine requirement between the two positions.Conclusions and clinical relevance
Gas exchange is better preserved in HU compared to HD, especially if applied from the start of the anaesthesia. 相似文献
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