Cardiovascular and Gas Exchange Effects of Individualized Positive End-Expiratory Pressures in Cats Anesthetized With Isoflurane.

Objectives: To compare the effects of four levels of end-expiratory pressure [zero (ZEEP) and three levels of positive end-expiratory pressure (PEEP)] on the cardiovascular system and gas exchange of cats anesthetized with isoflurane and mechanically ventilated for 3 h with a tidal volume of 10 ml/kg. Study Design: Prospective, randomized, controlled trial. Animals: Six healthy male neutered purpose-bred cats. Methods: Anesthesia was induced with isoflurane and maintained at 1.3 minimum alveolar concentration. PEEP of maximal respiratory compliance (PEEPmaxCrs) was identified in a decremental PEEP titration, and cats were randomly ventilated for 3 h with one of the following end-expiratory pressures: ZEEP, PEEPmaxCrs minus 2 cmH2O (PEEPmaxCrs-2), PEEPmaxCrs, and PEEPmaxCrs plus 2 cmH2O (PEEPmaxCrs+2). Cardiovascular and gas exchange variables were recorded at 5, 30, 60, 120, and 180 min (T5 to T180, respectively) of ventilation and compared between and within ventilation treatments with mixed-model ANOVA followed by Dunnet's and Tukey's tests (normal distribution) or Friedman test followed by the Dunn's test (non-normal distribution). Significance to reject the null hypothesis was considered p < 0.05. Results: Mean arterial pressure (MAP-mmHg) was lower in PEEPmaxCrs+2 [63 (49-69); median (range)] when compared to ZEEP [71 (67-113)] at T5 and stroke index (ml/beat/kg) was lower in PEEPmaxCrs+2 (0.70 ± 0.20; mean ± SD) than in ZEEP (0.90 ± 0.20) at T60. Cardiac index, oxygen delivery index (DO2I), systemic vascular resistance index, and shunt fraction were not significantly different between treatments. The ratio between arterial partial pressure and inspired concentration of oxygen (PaO2/FIO2) was lower in ZEEP than in the PEEP treatments at various time points. At T180, DO2I was higher when compared to T5 in PEEPmaxCrs. Dopamine was required to maintain MAP higher than 60 mmHg in one cat during PEEPmaxCrs and in three cats during PEEPmaxCrs+2. Conclusion: In cats anesthetized with isoflurane and mechanically ventilated for 3 h, all levels of PEEP mildly improved gas exchange with no significant difference in DO2I when compared to ZEEP. The PEEP levels higher than PEEPmaxCrs-2 caused more cardiovascular depression, and dopamine was an effective treatment. A temporal increase in DO2I was observed in the cats ventilated with PEEPmaxCrs. The effects of these levels of PEEP on respiratory mechanics, ventilation-induced lung injury, as well as in obese and critically ill cats deserve future investigation for a better understanding of the clinical use of PEEP in this species.

Continuous measurement of arterial oxygenation in mechanically ventilated horses.

BACKGROUND: The possibility of accurately and continuously measuring arterial oxygen partial pressure (PaO2 ) in horses may facilitate the management of hypoxaemia during general anaesthesia. OBJECTIVES: The aim of this study was to evaluate the ability of a novel fibreoptic sensor to measure PaO2 (PaO2Sensor ) continuously and in real time in horses undergoing ventilatory manoeuvres during general anaesthesia. STUDY DESIGN: In vivo experimental study. METHODS: Six adult healthy horses were anaesthetised and mechanically ventilated in dorsal recumbency. A fibreoptic sensor was placed in one of the facial arteries through a catheter to continuously measure and record PaO2Sensor . After an alveolar recruitment manoeuvre, a decremental positive end-expiratory pressure (PEEP) titration using 20-minute steps of 5 cm H2 O from 20 to 0 cm H2 O was performed. An arterial blood sample was collected at 15 minutes of ventilation at each PEEP level for PaO2 measurement using an automated blood gas machine (PaO2Ref ). The agreement between PaO2Sensor and PaO2Ref was assessed by Pearson's correlation, Bland-Altman plot and four-quadrant plot analysis. In the last minute of ventilation at each PEEP level, a slow tidal inflation/deflation manoeuvre was performed. RESULTS: The mean relative bias between PaO2Sensor and PaO2Ref was 4% with limits of agreement between -17% and 29%. The correlation coefficient between PaO2Sensor and PaO2Ref was 0.98 (P < .001). The PaO2Sensor and PaO2Ref concordance rate for changes was 95%. Measurements of PaO2Sensor during the slow inflation/deflation manoeuvre at PEEP 15 and 10 cm H2 O were not possible because of significant noise on the PaO2 signal generated by a small blood clot. MAIN LIMITATIONS: Small sample size. CONCLUSION: The tested fibreoptic probe was able to accurately and continuously measure PaO2Sensor in anaesthetised horses undergoing ventilatory manoeuvres. A heparinised system in the catheter used by the fibreoptic sensor should be used to avoid blood clots and artefacts in the PaO2 measurements.

Comparative Efficacy of Histrelin Acetate and hCG for Inducing Ovulation in Brazilian Northeastern Jennies (Equus africanus asinus).

The goal of this study was to compare the efficiency of histrelin acetate (GnRH analog) and human chorionic gonadotropin (hCG) to hasten ovulation in Brazilian Northeastern jennies (Equus africanus asinus). Thirty cycles of ten jennies were randomly assigned in one of the three groups: G0 (control group), saline; G1, 250 µg of histrelin acetate; G2, 2500 IU of hCG. Jennies were evaluated by transrectal palpation and ultrasonography, and had the administration of an ovulation-inducing agent when a follicle measuring between 29 and 32 mm of diameter was diagnosed. Jennies were monitored every 6 hours by transrectal ultrasonography until ovulation. The interval between prostaglandin administration and ovulation was lower (P < .05) in jennies from the G1 (145.2 ± 34.6 hours) and G2 (147.4 ± 27.3 hours) groups compared with the control cycle (220.0 ± 41.8 hours). Both treatments (G1, 41.15 ± 3.5 hours; G2, 37.8 ± 2.5 hours) also reduced (P < .05) the interval that jennies took to ovulate after the administration of the ovulation-inducing agent compared with the control (81.8 ± 28.8 hours). All jennies from G1 and G2 ovulated up to 48 hours after ovulation induction, whereas 100% of jennies in the control cycle ovulated later (>48 hours from the administration of saline). In conclusion, both histrelin acetate and hCG at the used dose are efficient ovulation-inducing agents in jennies promoting ovulation up to 48 hours after administration.

Hemodynamic effects of target-controlled infusion of propofol alone or in combination with a constant-rate infusion of remifentanil in dogs.

The objective of this study was to evaluate the hemodynamic effects of target-controlled infusion (TCI) of propofol alone or in combination with a constant-rate infusion (CRI) of remifentanil. Six adult dogs were given 2 treatments in a randomized crossover study with a 7-day interval between treatments. Treatment 1 was propofol (P) and treatment 2 was propofol and remifentanil (P-Rem), without any premedication. Propofol was induced using a TCI system with a predicted plasma concentration (Cp) of 6.0 µg/mL. Anesthesia was maintained within the Cp range (0.65 to 3.0 µg/mL) for 120 min and remifentanil was administered at a rate of 0.3 µg/kg body weight (BW) per minute, CRI. Cardiopulmonary variables were recorded before (baseline), during, and 120 min after drug administration. Heart rate (HR) decreased significantly in the P-Rem group (46%) compared with baseline values. In the P-Rem group, the cardiac index (CI) decreased significantly (49% to 58%) and the stroke volume (SV) decreased compared with baseline values. The systemic vascular resistance index (SVRI) increased significantly in the P-Rem group compared with baseline values. There was no difference in mean arterial pressure (MAP) between the groups. Central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) significantly increased in the P-Rem group compared with baseline values. In conclusion, the hemodynamic changes observed in this study indicate a compromise of the cardiovascular system, although the dogs in this study were healthy/euvolemic and there was no change in preload. More studies are required in order to evaluate the actual safety of the combination of propofol and remifentanil in patients with reduced cardiac reserve.

L'objectif de la présente étude était d'évaluer les effets hémodynamiques d'une infusion à objectif de concentration (IOC) de propofol uniquement ou en combinaison avec une infusion à débit constant (IDC) de remifentanyl. Six chiens adultes reçurent deux traitements dans un essai aléatoire croisé avec un intervalle de sept jours entre les traitements. Le traitement 1 consistait en du propofol (P) et le traitement 2 était du propofol et du remifentanyl (P-Rem), sans aucune prémédication. Le propofol fut induit à l'aide d'un système d'IOC avec une concentration plasmatique prédéterminée (Cp) de 6,0 mg/mL. L'anesthésie fut maintenue à l'intérieur de l'écart de Cp (0,65 à 3,0 µg/mL) pendant 120 min et du remifentanyl administré à un taux de 0,3 µg/kg de poids corporel (PC) par minute, IDC. Les variables cardiopulmonaires furent enregistrées avant (valeurs de base), pendant, et 120 min après l'administration des médicaments. Le rythme cardiaque (RC) a diminué significativement dans le groupe P-Rem (46 %) comparativement aux valeurs de base. Dans le groupe P-Rem, l'index cardiaque (IC) a diminué significativement (49 % à 58 %) et le volume du débit systolique (VDS) a diminué comparativement aux valeurs de base. L'index de résistance vasculaire systémique (IRVS) a augmenté de manière significative dans le groupe P-Rem comparativement aux valeurs de base. Il n'y avait aucune différence entre les groupes pour la pression artérielle moyenne (PAM). La pression veineuse centrale (PVC) et la pression d'occlusion de l'artère pulmonaire (POAP) ont augmenté significativement dans le groupe P-Rem comparativement aux valeurs de base. En conclusion, les changements hémodynamiques observés dans cette étude indiquent un compromis du système cardio-vasculaire, bien que les chiens utilisés étaient en santé/euvolémiques et qu'il n'y avait pas de changement dans la précharge. Des études supplémentaires sont requises afin d'évaluer la sécurité de la combinaison de propofol et de remifentanyl chez des patients avec une réserve cardiaque diminuée.(Traduit par Docteur Serge Messier).

A clinical comparison of remifentanil or alfentanil in propofol-anesthetized cats undergoing ovariohysterectomy.

Sixteen cats were used to compare the cardiovascular and anesthetic effects of remifentanil (REMI) or alfentanil (ALF) in propofol-anesthetized cats undergoing ovariohysterectomy. After premedication with acepromazine, anesthesia was induced and maintained with a constant rate infusion of propofol (0.3 mg/kg/min). REMI or ALF infusions were administered simultaneously with propofol. Heart rate (HR), systolic arterial pressure (SAP), pulse oximetry (SpO(2)), rectal temperature (RT), and response to surgical stimulation were recorded at predefined time points during anesthesia. Data [mean±standard deviation (SD)] were analyzed by analysis of variance (ANOVA) for repeated measures followed by a Dunnett's test and Student t-test (P<0.05). SAP was significantly lower in ALF group than in REMI group. Extubation time was significantly shorter in REMI than in ALF group. Overall infusion rate of REMI and ALF was 0.24±0.05 µg/kg/min and 0.97±0.22 µg/kg/min, respectively. The combination of propofol and REMI or ALF provided satisfactory anesthesia in cats undergoing ovariohysterectomy.

Determination of the sevoflurane sparing effect of methadone in cats.

OBJECTIVE: To determine the magnitude and duration of sevoflurane minimum alveolar concentration (MAC) reduction following a single intravenous (IV) dose of methadone in cats. STUDY DESIGN: Prospective experimental study. ANIMALS: Eight (four females and four males) healthy mixed-breed adult (1-2 years) cats weighing 5.82 ± 0.42 kg. METHODS: Anesthesia was induced and maintained with sevoflurane. Intravenous catheters facilitated administration of methadone and lactated Ringer's solution. After baseline MAC determination in triplicate using a tail clamp technique, 0.3 mg kg(-1) of methadone was administered IV. End-tidal sevoflurane concentration (e'SEVO) was reduced and MAC was redetermined. In an effort to determine the duration of MAC reduction, measurements were repeated in a stepwise manner until MAC values returned to baseline. After the last stimulation, the e'SEVO was increased to 1.2 individual MAC for 15 minutes, then sevoflurane was discontinued and cats were allowed to recover from anesthesia. RESULTS: Baseline sevoflurane MAC was 3.18 ± 0.06%. When compared with baseline the sevoflurane MAC after methadone administration was significantly reduced by 25, 15 and 7% at 26, 76 and 122 minutes, respectively. The final MAC value (3.09 ± 0.07%) determined 156 minutes after methadone administration was not significantly different from baseline. CONCLUSIONS AND CLINICAL RELEVANCE: Intravenous methadone (0.3 mg kg(-1)) significantly decreased MAC of sevoflurane in cats but the effect was short-lived.

Plasma concentrations and behavioral, antinociceptive, and physiologic effects of methadone after intravenous and oral transmucosal administration in cats.

OBJECTIVE: To determine plasma concentrations and behavioral, antinociceptive, and physiologic effects of methadone administered via IV and oral transmucosal (OTM) routes in cats. ANIMALS: 8 healthy adult cats. PROCEDURES: Methadone was administered via IV (0.3 mg/kg) and OTM (0.6 mg/kg) routes to each cat in a balanced crossover design. On the days of drug administration, jugular catheters were placed in all cats under anesthesia; a cephalic catheter was also placed in cats that received methadone IV. Baseline measurements were obtained ≥ 90 minutes after extubation, and methadone was administered via the predetermined route. Heart and respiratory rates were measured; sedation, behavior, and antinociception were evaluated, and blood samples were collected for methadone concentration analysis at predetermined intervals for 24 hours after methadone administration. Data were summarized and evaluated statistically. RESULTS: Plasma concentrations of methadone were detected rapidly after administration via either route. Peak concentration was detected 2 hours after OTM administration and 10 minutes after IV administration. Mean ± SD peak concentration was lower after OTM administration (81.2 ± 14.5 ng/mL) than after IV administration (112.9 ± 28.5 ng/mL). Sedation was greater and lasted longer after OTM administration. Antinociceptive effects were detected 10 minutes after administration in both groups; these persisted ≥ 2 hours after IV administration and ≥ 4 hours after OTM administration. CONCLUSIONS AND CLINICAL RELEVANCE: Despite lower mean peak plasma concentrations, duration of antinociceptive effects of methadone was longer after OTM administration than after IV administration. Methadone administered via either route may be useful for perioperative pain management in cats.

Use of an osteoconductive compound as an aid in the management of a maxillary fracture in a boa constrictor.

A boa constrictor was presented with a short oblique compound fracture of the rostral third of the right maxilla. The fracture was reduced and biomaterial was placed around the fracture. A computed tomography scan at 1.5 mo post-surgery showed that the fracture had healed with slight displacement of the bone fragments.

Effects of methadone on the minimum alveolar concentration of isoflurane in dogs.

OBJECTIVE: To investigate the effects of methadone on the minimum alveolar concentration of isoflurane (ISO(MAC)) in dogs. STUDY DESIGN: Prospective, randomized cross-over experimental study. ANIMALS: Six adult mongrel dogs, four males and two females, weighing 22.8 +/- 6.6 kg. METHODS: Animals were anesthetized with isoflurane and mechanically ventilated on three separate days, at least 1 week apart. Core temperature was maintained between 37.5 and 38.5 degrees C during ISO(MAC) determinations. On each study day, ISO(MAC) was determined using electrical stimulation of the antebrachium (50 V, 50 Hz, 10 mseconds) at 2.5 and 5 hours after intravenous injection of physiological saline (control) or one of two doses of methadone (0.5 or 1.0 mg kg(-1)). RESULTS: Mean (+/-SD) ISO(MAC) in the control treatment was 1.19 +/- 0.15% and 1.18 +/- 0.15% at 2.5 and 5 hours, respectively. The 1.0 mg kg(-1) dose of methadone reduced ISO(MAC) by 48% (2.5 hours) and by 30% (5 hours), whereas the 0.5 mg kg(-1) dose caused smaller reductions in ISO(MAC) (35% and 15% reductions at 2.5 and 5 hours, respectively). Both doses of methadone decreased heart rate (HR), but the 1.0 mg kg(-1) dose was associated with greater negative chronotropic actions (HR 37% lower than control) and mild metabolic acidosis at 2.5 hours. Mean arterial pressure increased in the MET1.0 treatment (13% higher than control) at 2.5 hours. CONCLUSIONS AND CLINICAL RELEVANCE: Methadone reduces ISO(MAC) in a dose-related fashion and this effect is lessened over time. Although the isoflurane sparing effect of the 0.5 mg kg(-1) dose of methadone was smaller in comparison to the 1.0 mg kg(-1) dose, the lower dose is recommended for clinical use because it results in less evidence of cardiovascular impairment.

Effect of remifentanil hydrochloride administered via constant rate infusion on the minimum alveolar concentration of isoflurane in cats.

OBJECTIVE: To evaluate the effects of increasing doses of remifentanil hydrochloride administered via constant rate infusion (CRI) on the minimum alveolar concentration (MAC) of isoflurane in cats. ANIMALS: 6 healthy adult cats. PROCEDURES: For each cat, 2 experiments were performed (2-week interval). On each study day, anesthesia was induced and maintained with isoflurane; a catheter was placed in a cephalic vein for the administration of lactated Ringer's solution or remifentanil CRIs, and a catheter was placed in the jugular vein for collection of blood samples for blood gas analyses. On the first study day, individual basal MAC (MAC(Basal)) was determined for each cat. On the second study day, 3 remifentanil CRIs (0.25, 0.5, and 1.0 microg/kg/min) were administered (in ascending order); for each infusion, at least 30 minutes elapsed before determination of MAC (designated as MAC(R0.25), MAC(R0.5), and MAC(R1.0), respectively). A 15-minute washout period was allowed between CRIs. A control MAC (MAC(Control)) was determined after the last remifentanil infusion. RESULTS: Mean +/- SD MAC(Basal) and MAC(Control) values at sea level did not differ significantly (1.66 +/- 0.08% and 1.52 +/- 0.21%, respectively). The MAC values determined for each remifentanil CRI did not differ significantly. However, MAC(R0.25), MAC(R0.5), and MAC(R1.0) were significantly decreased, compared with MAC(Basal), by 23.4 +/- 7.9%, 29.8 +/- 8.3%, and 26.0 +/- 9.4%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The 3 doses of remifentanil administered via CRI resulted in a similar degree of isoflurane MAC reduction in adult cats, indicating that a ceiling effect was achieved following administration of the lowest dose.

Two surgical approaches to fracture malunion repair.

Two birds were presented with malunion fractures. The first was a young toco toucan (Ramphastos toco) with malunion of the tarsometatarsus that was treated by an opening-wedge corrective osteotomy and an acrylic-pin external skeletal fixator (type II) to stabilize the osteotomy. The second bird was an adult southern caracara (Caracara plancus) with radial and ulnar malunion that was treated by closing-wedge osteotomies. Stabilization of the osteotomy sites was accomplished through a bone plate fixed cranially on the ulna with 6 cortical screws and an interfragmentary single wire in radius. In both cases, the malunion was corrected, but the manus of the southern caracara was amputated because of carpal joint luxation that induced malposition of the feathers.

Use of bispectral index to monitor depth of anesthesia in isoflurane-anesthetized dogs.

OBJECTIVE: To evaluate the correlation between the bispectral index (BIS) and end-tidal isoflurane (ET(ISO)) concentration and compare the use of 3 BIS sensor positions in dogs. ANIMALS: 6 adult dogs. PROCEDURES: Mechanically ventilated dogs received pancuronium, and depth of anesthesia was altered by increasing ET(ISO) concentration from 1.5% to 2.3% and 3.0%. The BIS, suppression ratio (relative percentage of isoelectric electroencephalographic waveforms), and signal quality index (SQI) were recorded at each ET(ISO) concentration for each of 3 BIS sensor positions (frontal-occipital, bifrontal, and frontal-temporal positions). RESULTS: The BIS and ET(ISO) concentration were poorly correlated; regardless of sensor positioning, mean BIS values did not change significantly as ET(ISO) was increased. At 3% isoflurane, regardless of sensor positioning, there was an increase in suppression ratio coincident with BIS < 40 in some dogs, whereas paradoxic increases in BIS (> 60) were recorded in others. Furthermore, at 3.0% isoflurane, the SQI was significantly lower for the bifrontal sensor position (compared with values for the other positions), but low SQI values prevented recording of BIS values from the frontal-occipital sensor position in 2 dogs. Overall, BIS values derived from the 3 sensor positions did not differ. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs, BIS values may not reflect changes in depth of isoflurane anesthesia in the absence of noxious stimulation. Of the 3 sensor positions, frontal-temporal positioning provided better correlation with changes in depth of anesthesia induced via changes in isoflurane concentrations. However, the sensor placements yielded similar results at SQI values > 50.