Effects of cuff size and position on the agreement between arterial blood pressure measured by Doppler ultrasound and through a dorsal pedal artery catheter in anesthetized cats.

OBJECTIVE: To compare the effects of cuff size/position on the agreement between arterial blood pressure measured by Doppler ultrasound (ABPDoppler) and dorsal pedal artery catheter measurements of systolic (SAPinvasive) and mean arterial pressure (MAPinvasive) in anesthetized cats. STUDY DESIGN: Prospective study. ANIMALS: A total of eight cats (3.0-3.8 kg) for neutering. METHODS: During isoflurane anesthesia, before surgery, changes in end-tidal isoflurane concentrations and/or administration of dopamine were performed to achieve SAPinvasive within 60-150 mmHg. Cuff sizes 1, 2 and 3 (bladder width: 20, 25 and 35 mm, respectively) were placed on distal third of the antebrachium, above the tarsus and below the tarsus for ABPDoppler measurements. Agreement between ABPDoppler and SAPinvasive or between ABPDoppler and MAPinvasive was compared with reference standards for noninvasive blood pressure devices used in humans and small animals. RESULTS: Mean bias and precision (±standard deviation) between ABPDoppler and SAPinvasive met veterinary standards (≤10 ± 15 mmHg), but not human standards (≤5 ± 8 mmHg), with cuffs 1 and 2 placed on the thoracic limb (7.4 ± 13.9 and -5.8 ± 9.5 mmHg, respectively), and with cuff 2 placed proximal to the tarsus (7.2 ± 12.4 mmHg). Cuff width-to-limb circumference ratios resulting in acceptable agreement between ABPDoppler and SAPinvasive were 0.31 ± 0.04 (cuff 1) and 0.42 ± 0.05 (cuff 2) on the thoracic limb, and 0.43 ± 0.05 (cuff 2) above the tarsus. ABPDoppler showed no acceptable agreement with MAPinvasive by any reference standard. CONCLUSIONS AND CLINICAL RELEVANCE: The agreement between ABPDoppler and SAPinvasive can be optimized by placing the occlusive cuff on the distal third of the antebrachium and above the tarsus. In these locations, cuff width should approach 40% of limb circumference to provide clinically acceptable estimations of SAPinvasive. Doppler ultrasound cannot be used to estimate MAPinvasive in cats.

Effects of ketamine constant rate infusions on cardiac biomarkers and cardiac function in dogs.

OBJECTIVE: To evaluate the effects of ketamine continuous rate infusions (CRI) at two dose rates on cardiovascular function and serum creatine kinase MB isoenzyme (CK-MB) and troponin I in healthy conscious dogs. STUDY DESIGN: Experimental, prospective, crossover, randomized, blinded study. ANIMALS: Eight adult mixed-breed dogs, aged 6±1 years and weighing 19±8.6 kg (mean±standard deviation). METHODS: Dogs were administered an intravenous bolus of ketamine (0.5 mg kg-1) followed by a ketamine CRI for 12 hours (20 µg kg-1 minute-1; treatment TC20 or 40 µg kg-1 minute-1; treatment TC40). Sedation, heart rate (HR), mean arterial pressure (MAP), electrocardiographic and echocardiographic parameters were evaluated at baseline (T0) and 1 (T1), 2 (T2), 4 (T4), 8 (T8), 12 (T12) and 24 (T24) hours after ketamine infusion started. Serum concentrations of CK-MB and troponin I were measured at baseline and 12, 24 and 48 hours after infusion started. RESULTS: HR increased over the first 4 hours, significantly at T1 in TC20 and at T4 in TC40 when compared with T0 (p < 0.05). MAP was significantly increased at T2 in TC40 when compared with TC20. Behavioral changes, such as stereotypical head movements and twitches, occurred within 4 hours in TC40. There were no significant changes in echocardiographic examinations in any dog when compared with baseline. There were no temporal changes in serum CK-MB activity either within or between treatments (p > 0.05). No troponin I was detected in any sample. CONCLUSIONS AND CLINICAL RELEVANCE: No indication of myocardial injury resulting from ketamine infusion was detected in this study in healthy dogs. Further studies are needed to assess the ketamine infusion effects on antinociception and other organ function not evaluated in the present study.

Effects of pneumoperitoneum and of an alveolar recruitment maneuver followed by positive end-expiratory pressure on cardiopulmonary function in sheep anesthetized with isoflurane-fentanyl.

OBJECTIVE: To investigate the effects of pneumoperitoneum alone or combined with an alveolar recruitment maneuver (ARM) followed by positive end-expiratory pressure (PEEP) on cardiopulmonary function in sheep. STUDY DESIGN: Prospective, randomized, crossover study. ANIMALS: A total of nine adult sheep (36-52 kg). METHODS: Sheep were administered three treatments (≥10-day intervals) during isoflurane-fentanyl anesthesia and volume-controlled ventilation (tidal volume: 12 mL kg-1) with oxygen: CONTROL (no intervention); PNEUMO (120 minutes of CO2 pneumoperitoneum); PNEUMOARM/PEEP (PNEUMO protocol with an ARM instituted after 60 minutes of pneumoperitoneum). The ARM (5 cmH2O increases in PEEP of 1 minute duration until 20 cmH2O of PEEP) was followed by 10 cmH2O of PEEP until the end of anesthesia. Cardiopulmonary data were recorded until 30 minutes after abdominal deflation. RESULTS: PaO2 was decreased from 435-462 mmHg (58.0-61.6 kPa) (range of mean values in CONTROL) to 377-397 mmHg (50.3-52.9 kPa) in PNEUMO (p < 0.05). Quasistatic compliance (Cqst, mL cmH2O-1 kg-1) was decreased from 0.85-0.92 in CONTROL to 0.52-0.58 in PNEUMO. PaO2 increased from 383-385 mmHg (51.1-51.3 kPa) in PNEUMO to 429-444 mmHg (57.2-59.2 kPa) in PNEUMOARM/PEEP (p < 0.05) and Cqst increased from 0.52-0.53 in PNEUMO to 0.70-0.74 in PNEUMOARM/PEEP. Abdominal deflation in PNEUMO did not restore PaO2 and Cqst to control values. Cardiac index (L minute-1 m2) decreased from 4.80-4.70 in CONTROL to 3.45-3.74 in PNEUMO and 3.63-3.76 in PNEUMOARM/PEEP. Compared with controls, ARM/PEEP with pneumoperitoneum decreased mean arterial pressure from 81 to 68 mmHg and increased mean pulmonary artery pressure from 10 to 16 mmHg. CONCLUSIONS AND CLINICAL RELEVANCE: Abdominal deflation did not reverse the pulmonary function impairment associated with pneumoperitoneum. The ARM/PEEP improved respiratory compliance and reversed the oxygenation impairment induced by pneumoperitoneum with acceptable hemodynamic changes in healthy sheep.

Comparison of two species-specific oscillometric blood pressure monitors with direct blood pressure measurement in anesthetized cats.

OBJECTIVE: To compare the performance of 2 species-specific oscillometric blood pressure (OBP) monitors (petMAPclassic and petMAPgraphic ) with direct blood pressure measurement in anesthetized cats. DESIGN: Prospective, experimental study. SETTING: Veterinary teaching hospital. ANIMALS: Eight adult cats (3.2-5.5 kg). INTERVENTIONS: During isoflurane anesthesia, OBP cuffs were placed on the thoracic limb and on the base of the tail while invasive blood pressure (IBP) was recorded from a dorsal pedal artery. End-tidal isoflurane concentrations, with or without intravenous dopamine (n = 8), norepinephrine (n = 1), or phenylephrine (n = 1) were adjusted to change invasive mean arterial pressure (MAP) between 40 to 100 mm Hg. Data were analyzed by the Bland-Altman method and 4-quadrant plots. MEASUREMENTS AND MAIN RESULTS: Mean biases and limits of agreement (LOA: ± 1.96 SD) (mm Hg) recorded between the petMAPclassic (thoracic limb) and IBP for systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and MAP were 4.2 ± 28.5, -6.1 ± 13.2, and -1.9 ± 14.6, respectively; mean biases and LOA (mm Hg) recorded with the tail cuff were 7.2 ± 31.3 (SAP), -6.1 ± 11.6 (DAP), and -1.1 ± 11.7 (MAP). Mean biases and LOA (mm Hg) between petMAPgraphic (thoracic limb) and IBP were 7.7 ± 27.0 (SAP), -4.3 ± 11.5 (DAP), 0.2 ± 13.0 (MAP); values recorded with the tail cuff were 10.9 ± 29.6 (SAP), -4.4 ± 11.7 (DAP), and -0.1 ± 12.1 (MAP). Concordance rates after excluding arterial pressure changes ≤ 5 mm Hg was ≥ 93% for both devices. CONCLUSIONS: Although both OBP monitors provide unacceptable SAP estimations, MAP values derived from both monitors and DAP measured by the petMAPgraphic result in acceptable agreement with the reference method according to the Association for the Advancement of Medical Instrumentation (mean bias ≤ 5 mm Hg with LOA ≤ ± 16 mm Hg). Both monitors provide acceptable trending ability for SAP, DAP, and MAP.

Behavioral and cardiopulmonary effects of dexmedetomidine alone and in combination with butorphanol, methadone, morphine or tramadol in conscious sheep.

OBJECTIVE: To compare cardiopulmonary and sedative effects following administration of dexmedetomidine alone or with butorphanol, methadone, morphine or tramadol in healthy sheep. STUDY DESIGN: Randomized crossover study. ANIMALS: Six Santa Inês sheep, five females, one male, aged 12-28 months and weighing 40.1 ± 6.2 kg. METHODS: Sheep were assigned treatments of dexmedetomidine (0.005 mg kg(-1) ; D); D and butorphanol (0.15 mg kg(-1) ; DB); D and methadone (0.5 mg kg(-1) ; DM); D and morphine (0.5 mg kg(-1) ; DMO); or D and tramadol (5.0 mg kg(-1) ; DT). All drugs were administered intravenously with at least 7 days between each treatment. Rectal temperature, heart rate (HR), respiratory rate (fR ), invasive arterial pressure, blood gases and electrolytes were measured prior to administration of drugs (baseline, T0) and every 15 minutes following drug administration for 120 minutes (T15-T120). Sedation was scored by three observers blinded to treatment. RESULTS: HR decreased in all treatments and fR decreased in DM at T30 and DMO at T30 and T45. PaCO2 was increased in D, DB and DM compared with baseline, and PaO2 decreased in D at T15 and T45; in DB at T15 to T75; in DM at T15 to T60; in DMO at T15; and in DT at T15, T30 and T75. There was a decrease in temperature in D, DB and DM. An increased pH was measured in D at all time points and in DT at T30-T120. HCO3- and base excess were increased in all treatments compared with baseline. There were no statistical differences in sedation scores. CONCLUSIONS AND CLINICAL RELEVANCE: The combination of dexmedetomidine with butorphanol, methadone, morphine or tramadol resulted in similar changes in cardiopulmonary function and did not improve sedation when compared with dexmedetomidine alone.

Sedative and cardiopulmonary effects of xylazine alone or in combination with methadone, morphine or tramadol in sheep.

OBJECTIVE: To evaluate the cardiopulmonary and sedative effects of xylazine alone or in combination with methadone, morphine or tramadol in sheep. STUDY DESIGN: Experimental, prospective, crossover, randomized, blinded study. ANIMALS: Six Santa Inês breed sheep (females) aged 12 ± 8 months and weighing 39.5 ± 7.4 kg. METHODS: Sheep were sedated with each of four treatments in a randomized, crossover design, with a minimum washout period of 7 days between treatments. Treatments were: X [xylazine (0.1 mg kg(-1))]; XM [xylazine (0.1 mg kg(-1)) and methadone (0.5 mg kg(-1))]; XMO [xylazine (0.1 mg kg(-1)) and morphine (0.5 mg kg(-1))], and XT [xylazine (0.1 mg kg(-1)) and tramadol (5 mg kg(-1))]. Each drug combination was mixed in the syringe and injected intravenously. Sedation, heart rate (HR), mean arterial blood pressure (MAP), rectal temperature (RT°C), respiratory rate (fR), arterial blood gases and electrolytes were measured before drug administration (T0) and then at 15 minute intervals for 120 minutes (T15-T120). RESULTS: Heart rate significantly decreased in all treatments compared with T0. PaCO2 values in XM and XMO were higher at all time points compared with T0. In treatments X and XM, pH, bicarbonate (HCO3-) and base excess were increased at all time points compared with T0. PaO2 was significantly decreased at T15-T75 in XM, at all time points in XMO, and at T15 and T30 in XT. Sedation at T15 and T30 in XM and XMO was greater than in the other treatments. CONCLUSIONS AND CLINICAL RELEVANCE: The combinations of methadone, morphine or tramadol with xylazine resulted in cardiopulmonary changes similar to those induced by xylazine alone in sheep. The combinations provided better sedation, principally at 15 minutes and 30 minutes following administration.