Comparison of electrical impedance tomography and spirometry-based measures of airflow in healthy adult horses.

Electrical impedance tomography (EIT) is a non-invasive diagnostic tool for evaluating lung function. The objective of this study was to compare respiratory flow variables calculated from thoracic EIT measurements with corresponding spirometry variables. Ten healthy research horses were sedated and instrumented with spirometry via facemask and a single-plane EIT electrode belt around the thorax. Horses were exposed to sequentially increasing volumes of apparatus dead space between 1,000 and 8,500 mL, in 5-7 steps, to induce carbon dioxide rebreathing, until clinical hyperpnea or a tidal volume of 150% baseline was reached. A 2-min stabilization period followed by 2 minutes of data collection occurred at each timepoint. Peak inspiratory and expiratory flow, inspiratory and expiratory time, and expiratory nadir flow, defined as the lowest expiratory flow between the deceleration of flow of the first passive phase of expiration and the acceleration of flow of the second active phase of expiration were evaluated with EIT and spirometry. Breathing pattern was assessed based on the total impedance curve. Bland-Altman analysis was used to evaluate the agreement where perfect agreement was indicated by a ratio of EIT:spirometry of 1.0. The mean ratio (bias; expressed as a percentage difference from perfect agreement) and the 95% confidence interval of the bias are reported. There was good agreement between EIT-derived and spirometry-derived peak inspiratory [-15% (-46-32)] and expiratory [10% (-32-20)] flows and inspiratory [-6% (-25-18)] and expiratory [5% (-9-20)] times. Agreement for nadir flows was poor [-22% (-87-369)]. Sedated horses intermittently exhibited Cheyne-Stokes variant respiration, and a breath pattern with incomplete expiration in between breaths (crown-like breaths). Electrical impedance tomography can quantify airflow changes over increasing tidal volumes and changing breathing pattern when compared with spirometry in standing sedated horses.

Effects of 2 modes of positive pressure ventilation on respiratory mechanics and gas exchange in foals.

BACKGROUND: Continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) can improve respiratory mechanics and gas exchange, but different airway pressures have not been compared in foals. HYPOTHESIS/OBJECTIVES: Assess the effect of different airway pressures during CPAP and PSV have on respiratory function in healthy foals with pharmacologically induced respiratory insufficiency. We hypothesized that increased airway pressures would improve respiratory mechanics and increased positive end-expiratory pressure (PEEP) would be associated with hypercapnia. ANIMALS: Six healthy foals from a university teaching herd. METHODS: A prospective, 2-phase, 2-treatment, randomized cross-over study design was used to evaluate sequential interventions in sedated foals using 2 protocols (CPAP and PSV). Outcome measures included arterial blood gases, spirometry, volumetric capnography, lung volume and aeration assessed using computed tomography (CT). RESULTS: Sedation and dorsal recumbency were associated with significant reductions in arterial oxygen pressure (PaO2 ), respiratory rate, and tidal volume. Continuous positive airway pressure was associated with improved PaO2 , without concurrent hypercapnia. Volumetric capnography identified improved ventilation:perfusion (V/Q) matching and increased carbon dioxide elimination during ventilation, and spirometry identified decreased respiratory rate and increased tidal volume. Peak inspiratory pressure was moderately associated with PaO2 and lung volume. Improved pulmonary aeration was evident in CT images, and lung volume was increased, particularly during CPAP. CONCLUSIONS AND CLINICAL IMPORTANCE: Both CPAP and PSV improved lung mechanics and gas exchange in healthy foals with induced respiratory insufficiency.

Use of Electrical Impedance Tomography (EIT) to Estimate Tidal Volume in Anaesthetized Horses Undergoing Elective Surgery.

This study explores the application of electric impedance tomography (EIT) to estimate tidal volume (VT) by measuring impedance change per breath (∆Zbreath). Seventeen healthy horses were anaesthetised and mechanically ventilated for elective procedures requiring dorsal recumbency. Spirometric VT (VTSPIRO) and ∆Zbreath were recorded periodically; up to six times throughout anaesthesia. Part 1 assessed these variables at incremental delivered VT of 10, 12 and 15 mL/kg. Part 2 estimated VT (VTEIT) in litres from ∆Zbreath at three additional measurement points using a line of best fit obtained from Part 1. During part 2, VT was adjusted to maintain end-tidal carbon dioxide between 45-55 mmHg. Linear regression determined the correlation between VTSPIRO and ∆Zbreath (part 1). Estimated VTEIT was assessed for agreement with measured VTSPIRO using Bland Altman analysis (part 2). Marked variability in slope and intercepts was observed across horses. Strong positive correlation between ∆Zbreath and VTSPIRO was found in each horse (R2 0.9-0.99). The agreement between VTEIT and VTSPIRO was good with bias (LOA) of 0.26 (-0.36-0.88) L. These results suggest that, in anaesthetised horses, EIT can be used to monitor and estimate VT after establishing the individual relationship between these variables.

What hinders pulmonary gas exchange and changes distribution of ventilation in immobilized white rhinoceroses (Ceratotherium simum) in lateral recumbency?

This study used electrical impedance tomography (EIT) measurements of regional ventilation and perfusion to elucidate the reasons for severe gas exchange impairment reported in rhinoceroses during opioid-induced immobilization. EIT values were compared with standard monitoring parameters to establish a new monitoring tool for conservational immobilization and future treatment options. Six male white rhinoceroses were immobilized using etorphine, and EIT ventilation variables, venous admixture, and dead space were measured 30, 40, and 50 min after becoming recumbent in lateral position. Pulmonary perfusion mapping using impedance-enhanced EIT was performed at the end of the study period. The measured impedance (∆Z) by EIT was compared between pulmonary regions using mixed linear models. Measurements of regional ventilation and perfusion revealed a pronounced disproportional shift of ventilation and perfusion toward the nondependent lung. Overall, the dependent lung was minimally ventilated and perfused, but remained aerated with minimal detectable lung collapse. Perfusion was found primarily around the hilum of the nondependent lung and was minimal in the periphery of the nondependent and the entire dependent lung. These shifts can explain the high amount of venous admixture and physiological dead space found in this study. Breath holding redistributed ventilation toward dependent and ventral lung areas. The findings of this study reveal important pathophysiological insights into the changes in lung ventilation and perfusion during immobilization of white rhinoceroses. These novel insights might induce a search for better therapeutic options and is establishing EIT as a promising monitoring tool for large animals in the field.NEW & NOTEWORTHY Electrical impedance tomography measurements of regional ventilation and perfusion applied to etorphine-immobilized white rhinoceroses in lateral recumbency revealed a pronounced disproportional shift of the measured ventilation and perfusion toward the nondependent lung. The dependent lung was minimally ventilated and perfused, but still aerated. Perfusion was found primarily around the hilum of the nondependent lung. These shifts can explain the gas exchange impairments found in this study. Breath holding can redistribute ventilation.

Cardiovascular effects of two adenosine constant rate infusions in anaesthetized dogs.

OBJECTIVE: Adenosine induces vasodilatation. The aim of this study was to investigate cardiovascular effects of two adenosine constant rate infusion (CRI) doses in dogs. STUDY DESIGN: Experimental, longitudinal repeated measure design. ANIMALS: Ten healthy purpose-bred Beagle dogs. METHODS: Each dog was sedated with butorphanol. Anaesthesia was induced with propofol intravenously and maintained with sevoflurane (inspired oxygen fraction = 47-55%). Controlled mechanical ventilation was used to maintain normocapnia. Two doses of adenosine were administered as CRIs to each dog: 140 µg kg-1 minute-1 (A140) followed by 280 µg kg-1 minute-1 (A280). Pulse rate, invasive arterial pressure and stroke volume (by magnetic resonance phase contrast angiography) were measured at baseline, 3 minutes after starting adenosine and 3 and 10 minutes after discontinuing adenosine. Cardiac output, cardiac index and approximated systemic vascular resistances (approximate SVR) were calculated. Additionally, arterial blood gases, co-oximetry, electrolytes, glucose and lactate were measured and oxygen content and delivery calculated. One-way repeated measures analysis of variance (p < 0.05) was used for data analysis. RESULTS: A140 and A280 resulted in a significant decrease in arterial blood pressure [systolic (p = 0.008), mean (p = 0.003), and diastolic arterial pressure (p = 0.004)] and approximate SVR (p = 0.008) compared with baseline. No significant changes were detected for the other variables. All values returned to baseline within 3 minutes after adenosine discontinuation. CONCLUSIONS AND CLINICAL RELEVANCE: Adenosine CRI decreases arterial pressure by vasodilatation in healthy dogs. No additional effects were observed with the higher dose. The effects in compromised dogs remain to be investigated.

Neuraxial morphine induced pruritus in two cats and treatment with sub anaesthetic doses of propofol.

HISTORY: Two cats were presented for orthopaedic surgery. PHYSICAL EXAMINATION: With the exception of the orthopaedic injuries found, clinical examination showed no abnormality. MANAGEMENT: As part of anaesthetic management, one cat received intrathecal morphine, the other epidural morphine. Following recovery, intense grooming was observed. After ensuring adequate analgesia this behaviour was interpreted as pruritus. In the first cat, pruritus was initially managed with medetomidine constant rate infusion (CRI) at 1 and 1.5 µg kg(-1)  hour(-1) . The lower dose produced sedation and no relief from pruritus, the higher dose ablated pruritus but induced sedation. Two propofol (lipid emulsion formulation) boli of 0.1 mg kg(-1) ablated pruritus without causing sedation. The second cat was successfully treated with four boli of 0.1 mg kg(-1) propofol over 20 minutes. FOLLOW-UP: Following treatment with propofol, pruritus did not recur in either cat and both were discharged from the hospital. CONCLUSIONS: This is the first clinical report of morphine-induced pruritus in cats and management with low-dose propofol. These cases suggest an antipruritic mechanism for lipid-formulation propofol.

Acid-base and electrolyte balance following administration of three crystalloid solutions in dogs undergoing elective orthopaedic surgery.

OBJECTIVE: To compare acid-base balance and incidence of hyperchloraemic metabolic acidosis following administration of three crystalloid solutions to dogs undergoing anaesthesia for orthopaedic surgery. STUDY DESIGN: Prospective, randomised, clinical study. ANIMALS: Sixty dogs. METHODS: During a non-standardised anaesthetic, 0.9% saline (S), Hartmann's solution (H) or a polyionic glucose-free maintenance solution (M) was administered IV at 10 mL kg(-1)  hour(-1) . Venous blood pH, PCO2 , PCV, total protein, urea, sodium, potassium and chloride concentrations were measured at induction of anaesthesia (T0) and after 2 hours of fluid therapy (T2). Base excess (BE), bicarbonate, corrected chloride concentration (corrCl), osmolality, change in plasma volume (PV) and strong ion gap (SIG) were calculated. Changes in variables within groups (1-sample Student's t-test/Wilcoxon signed rank test) and between groups (1-way anova/Kruskal-Wallis) were assessed. Data are presented as median (interquartile range). Significance was set at p < 0.05. RESULTS: No significant differences existed between groups for pH, PCO2 , PCV, total protein, urea, potassium, corrCl, PV and SIG. Potassium significantly increased in all groups. Significant differences existed between groups S and M for BE, sodium, chloride, bicarbonate and osmolality, and between groups H and M for sodium and osmolality. Chloride concentration significantly changed from 116 (114-117) to 117 (116-119) mmol L(-1) in group S, 116 (115-118) to 115 (113-117) mmol L(-1) in group H and 116 (115-118) to 114 (113-118)  mmol L(-1) in group M. In groups H and M, sodium and osmolality decreased, and BE and bicarbonate concentration increased significantly. Plasma volume increased by 28 (14-44)%, 25 (5-40)% and 24 (13-33)% in groups S, H and M, respectively. CONCLUSION AND CLINICAL RELEVANCE: Hyperchloraemic metabolic acidosis did not develop after intraoperative 0.9% saline, Hartmann's solution or maintenance solution at 10 mL kg(-1)  hour(-1) for 2 hours in dogs undergoing elective orthopaedic surgery. Bicarbonate and BE increased after Hartmann's and maintenance solutions. Increases in potassium concentration were unexplained.

Measurement of respiratory system compliance and respiratory system resistance in healthy dogs undergoing general anaesthesia for elective orthopaedic procedures.

OBJECTIVE: The aim of this study was to investigate normal values for the dynamic compliance of the respiratory system (Crs) and respiratory system resistance (Rrs) in mechanically ventilated anaesthetized dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Forty healthy dogs undergoing elective orthopaedic surgery. Body weight was (mean ± SD) 26.8 ± 10.7 kg (range: 1.9-45.0 kg), age 4.7 ± 2.9 years (range: 0.1-10.6 years). METHODS: Dogs were premedicated with acepromazine and methadone administered intramuscularly and anaesthesia induced with propofol intravenously. After endotracheal intubation the dog's lungs were connected to an appropriate breathing system depending on body weight and isoflurane in oxygen administered for maintenance of anaesthesia. The lungs were ventilated mechanically with variables set to maintain normocapnia (end-tidal carbon dioxide concentration 4.7-6.0 kPa). Peak inspiratory pressure, Crs, Rrs, tidal volume, respiratory rate and positive end-expiratory pressure were recorded at 5, 30, 60, 90 and 120 minutes after start of mechanical ventilation. Cardiovascular variables were recorded at time of collection of respiratory data. RESULTS: General additive modeling revealed the following relationships: Crs =[0.895 × body weight (kg)] + 8.845 and Rrs=[-0.0966 × body weight (kg)] + 6.965. Body weight and endotracheal tube diameter were associated with Crs (p<0.001 and p=0.002 respectively) and Rrs (p=0.017 and p=0.002 respectively), body weight being linearly related to Crs and inversely to Rrs. CONCLUSION AND CLINICAL RELEVANCE: Body weight was linearly related to Crs while Rrs has an inverse linear relationship with body weight in mechanically ventilated dogs. The derived values of Crs and Rrs may be used for monitoring of lung function and ventilation in healthy dogs under anaesthesia.

Total intravenous anesthesia with midazolam, ketamine, and xylazine or detomidine following induction with tiletamine, zolazepam, and xylazine in red deer (Cervus elaphus hippelaphus) undergoing surgery.

Sixteen captive female red deer were successfully anesthetized to surgically implant a telemetry system. The deer were immobilized with (mean±SD) 1.79±0.29 mg/kg xylazine and 1.79±0.29 mg/kg tiletamine/zolazepam given intramuscularly with a dart gun. Anesthesia was maintained for 69±2 min using a total intravenous protocol with a catheter placed in the jugular vein. Group X received xylazine (0.5±0.055 mg/kg/hr) and group D, detomidine (2±0.22 µg/kg/hr), both in combination with ketamine (2±0.02 mg/kg/hr) and midazolam (0.03±0.0033 mg/kg/hr), as a constant rate infusion. Anesthesia was reversed with 0.09±0.01 mg/kg atipamezole and 8.7±1.21 µg/kg sarmazenil given intravenously in both groups. These drug combinations provided smooth induction, stable anesthesia for surgery, and rapid recovery. Respiratory depression and mild hypoxemia were seen, and we, therefore, recommend using supplemental intranasal oxygen.

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

OBJECTIVE: To 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 DESIGN: Prospective randomized blinded clinical study. ANIMALS: Twenty client-owned cats. METHODS: Cats 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 microg 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. RESULTS: No 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 RELEVANCE: In 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.

Influence of the collection and oxygenation method on quantitative bacterial composition in bronchoalveolar lavage fluid samples from healthy dogs.

The purpose of the study was to evaluate the effects on quantitative and qualitative microbial content of endoscopic bronchoalveolar lavage fluid (BALF) in healthy dogs using a laryngeal mask airway (LMA). It was hypothesised that oropharyngeal protection might prevent contamination of BALF with oropharyngeal microflora. Ten healthy Beagle dogs were randomly assigned to two groups and underwent endoscopic BAL on two occasions, either via an open unprotected oropharynx with oxygen supply provided via a nasal catheter (NT) or through a sterile LMA. For the second sampling, groups were switched. BALF analysis included quantitative microbial culture, nucleated cell counts and cytology. The mean (+/-SD) number of colony forming units (CFU)/mL found in the BALF using the LMA was 25,610+/-22,943 in the right lung (RL) and 22,510+/-18,779 in the left (LL). With the NT technique, the figures were 21,068+/-19,375 for the RL and 16,060+/-15,523 for the LL, respectively. Nucleated cell counts/microL were 691.0+/-181.6 (RL) and 734.0+/-171.6 (LL) for LMA, and 772.0+/-251.0 (RL) and 748+/-163.2 (LL) for NT. No significant differences were detected either in the number of CFU/mL or in the diversity of bacterial species with the two methods. A significant increase in BALF bacterial counts (with reduced species diversity) was observed on the second compared to the first sampling regardless of the method used. Protection of the oral cavity and oropharynx using an LMA had no significant influence on BALF bacterial counts. The findings suggest that with careful endoscope insertion, the risk of contamination of BALF by resident and transient oropharyngeal microflora can be negligible.

Metabolic changes associated with anaesthesia and cherry poisoning in a pony.

OBSERVATIONS: A case of a pony with severe cyanide intoxication as a result of cherry ingestion is presented. General anaesthesia was performed for colic surgery. Severe metabolic lactate acidosis in combination with a high arterial oxygen partial pressure and clinically good peripheral perfusion parameters were the remarkable signs during anaesthesia. Severe hypothermia was obvious during recovery. Ten hours post-surgery the pony was euthanized as a result of neurological signs. The diagnosis of cyanide intoxication was made post-mortem. CONCLUSION: Cherry ingestion can lead to lethal cyanide intoxication in horses indicated by severe nonhypoxic lactic acidosis during anaesthesia.

Endoscopic removal of a bronchial carcinoma in a dog using one-lung ventilation.

OBJECTIVE: To describe anesthetic management of endoscopic electrosurgical removal of a bronchial carcinoma, partially blocking the right main stem bronchus in a Cocker Spaniel. STUDY DESIGN: Clinical case report. ANIMALS: Dog with a bronchial carcinoma. METHODS: To allow sufficient space for the endoscope and to avoid an oxygen-rich gas mixture in the trachea, which carries the risk of an airway fire when electrocautery is used, a 1 lumen endobronchial tube (EBT) was inserted into the left main stem bronchus. One-lung ventilation (OLV) started with a volume-controlled ventilator was switched to pressure-controlled ventilation in combination with positive end-expiratory pressure (PEEP). RESULTS: Resection of the bronchial carcinoma was successful. The dog was hypercapnic throughout the procedure and a high alveolar-arterial oxygen gradient was measured. CONCLUSION: An EBT may be a feasible and safe option to provide OLV for bronchoscopic electrocautery with a closed thoracic cavity in dogs. CLINICAL RELEVANCE: EBT intubation for OLV should be considered as part of the anesthetic management of airway diseases treated with bronchoscopic electrocautery.

A clinical study of the effects of rocuronium in isoflurane-anaesthetized cats.

OBJECTIVE: To evaluate the neuromuscular blocking and chronotropic effects of rocuronium bromide in cats anaesthetized for surgery. STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty-two healthy cats of mixed breed presented for ovariectomy (n = 13) or castration (n = 9). Mean body mass (+/-SD) was 3.6 +/- 0.65 kg and mean age was 10.25 +/- 2.63 months. METHODS: Anaesthesia was induced with intravenous (IV) midazolam (0.3 mg kg(-1)), ketamine (3 mg kg(-1)) and butorphanol (0.4 mg kg(-1)). Tracheal intubation was performed and anaesthesia was maintained with isoflurane delivered in 100% oxygen. Neuromuscular function was monitored using acceleromyography applied at the ulnar nerve. This was stimulated by using the train-of-four (TOF) stimulus pattern (2 Hz) delivered every 15 seconds. The first train was made to establish baseline values for the first twitch (T1) and the TOF-ratio (T4:T1). Rocuronium (0.6 mg kg(-1) IV) was given and the following periods were recorded beginning at the end of injection: (1) lag time (LT) - to the first signs of T1 depression; (2) onset time (OT) - to the total ablation of T1; (3) duration of action (T1(25)) - to 25% recovery of the baseline value for T1; (4) T1(50)- to 50% baseline T1 restoration; (5) to TOF-ratios of 0.7 and 0.9. The time taken for T1 to recover from 75% to 25% depression (T1(25-75)) was also recorded. Heart rate (HR) was taken every minute for 15 minutes, beginning 5 minutes before rocuronium was injected. RESULTS: Rocuronium (0.6 mg kg(-1)) had a mean LT of 15.0 +/- 0 seconds, OT of 46 +/- 11 seconds and T1(25) of 13.2 +/- 2.7 minutes. The mean time for TOF 0.7 and 0.9 was 17.3 +/- 5.4 and 20.7 +/- 5.4 minutes respectively. The mean T1(25-75) was 4.8 +/- 2.4 minutes. No significant changes in HR were observed at any of the time intervals recorded. CONCLUSION: Rocuronium is an effective nondepolarizing muscle relaxant in the cat under the clinical conditions of this study. It has a rapid onset, a short duration of action and did not cause significant changes in HR.

A comparison of cardiorespiratory variables during isoflurane-fentanyl and propofol-fentanyl anaesthesia for surgery in injured cats.

OBJECTIVE: To compare haemodynamic and respiratory variables during isoflurane-fentanyl (IF) and propofol-fentanyl (PF) anaesthesia for surgery in injured cats. STUDY DESIGN: Prospective, randomized, controlled clinical study. ANIMALS: Thirty-three client-owned injured cats undergoing orthopaedic surgery. MATERIALS AND METHODS: Pre-anaesthetic medication was intravenous midazolam 1 mg kg(-1), butorphanol 0.4 mg kg(-1) and ketamine 2 mg kg(-1). Anaesthesia was induced with propofol (P) and maintained with either: (a) a continuous rate infusion (CRI) of fentanyl (F) 0.02 mg kg(-1) hour(-1) and isoflurane (initial end-tidal concentration of 1%), (b) a fentanyl CRI (dose as before) and sevoflurane (initial end-tidal concentration of 2%) or (c) a CRI of propofol (12 mg kg(-1) hour(-1)). All three techniques were given to effect until surgical anaesthesia was achieved. Heart rate and rhythm (ECG), mean arterial blood pressure, respiratory rate, tidal volume and end-tidal CO(2) concentration were recorded. Venous blood gas analysis was performed before and after sedation, and at the end of anaesthesia. Blood chemistry and blood cell counts were assessed before, at the end of, and 24 hours after anaesthesia. The variables recorded from cats anaesthetized with IF and PF were compared. RESULTS: Mean end-expiratory isoflurane concentration was 1.19 +/- 0.19%. The propofol infusion rate was 11.4 +/- 0.8 mg kg(-1) hour(-1). No significant differences between the two groups in heart rate were identified; no cardiac dysrhythmias were recorded. Mean arterial blood pressure was significantly lower in IF cats during skin incision (p = 0.01), during surgery without intense surgical stimulation (p < 0.01) and during surgery with intense surgical stimulation (p = 0.01). Nine of 11 cats in the IF group were markedly hypotensive (34-49 mmHg) while seven of 11 cats in group PF were mildly hypotensive (49-59 mmHg). One of 11 cats in group IF and nine of 11 cats in group PF required intermittent positive pressure ventilation (IPPV) to maintain end-tidal CO(2) levels below 6.66 kPa (50 mmHg). CONCLUSION AND CLINICAL RELEVANCE: Despite the necessity to ventilate the lungs of cats in the PF group, arterial blood pressure was better maintained. Propofol-fentanyl anaesthesia is better for surgery in injured cats providing the means to impose IPPV are available.

A comparison of extradural and intravenous methadone on intraoperative isoflurane and postoperative analgesia requirements in dogs.

OBJECTIVE: To compare the effects of intravenous (IV) and extradural (ED) methadone on end-tidal isoflurane concentration (Fe'ISO) and postoperative analgesic requirements in dogs undergoing femoro-tibial joint surgery. STUDY DESIGN: Randomized, blinded, clinical study. Animals Twenty-four healthy client-owned dogs undergoing surgical repair of ruptured cruciate ligaments. METHODS: Dogs were randomly assigned to two groups of 12 animals and received either ED or IV methadone (0.3 mg kg(-1) diluted with saline to 0.2 mL kg(-1)). Pre-anaesthetic medication was IV acepromazine (0.05 mg kg(-1)). Anaesthesia was induced with propofol and maintained initially with an Fe'ISO of 1.0% delivered in oxygen. Methadone was injected with the dogs in sternal recumbency; the observer was unaware of the administration route. At 10 minutes (stimulation 1) and 20 minutes (stimulation 2) after methadone administration pelvic limb reflexes were tested by digit-clamping. The time at skin incision (stimulation 3), joint-capsule incision (stimulation 4), tibial tuberosity drilling (stimulation 5), fabellar suturing (stimulation 6) and extracapsular tightening (stimulation 7) were noted. Changes in heart rate (HR) and respiratory rate and arterial blood pressure associated with surgery were recorded along with the corresponding Fe'ISO. After 20 minutes of anaesthesia, Fe'ISO was decreased to the minimum required to maintain stable anaesthesia. Immediately after tracheal extubation, 1, 2, 3 and 6 hours postoperatively and on the morning after surgery, the degree of pain present was assessed using a numerical rating scale. The HR, respiratory rates and blood pressure were also recorded at these times. Serum cortisol and blood glucose concentrations were measured before pre-anaesthetic medication and at each postoperative pain scoring interval except at 1 and 2 hours. Ketoprofen (2 mg kg(-1)), carprofen (4 mg kg(-1)) or meloxicam (0.2 mg kg(-1)) were given by subcutaneous injection whenever pain scoring indicated moderate discomfort was present. RESULTS: Controlled ventilation was required in six dogs which stopped breathing after IV methadone. The median Fe'ISO at stimulus 5 was 1.0% in the IV and 0.83% in the ED group. At stimulus 6, Fe'ISO was 1.0% in the IV and 0.8% in the ED group; the difference was statistically significant (p