A retrospective analysis of the epidural use of bupivacaine 0.0625-0.125% with opioids in bitches undergoing cesarean section.

Epidural anesthesia, often used during cesarean surgery, can exacerbate hypotension from general anesthesia and delay discharge due to motor block. Decreasing the local anesthetic dose might reduce those complications. Cases of dogs undergoing cesarean section that were anesthetized without epidural (n = 29) (control) and dogs with low-dose epidural bupivacaine with fentanyl or buprenorphine (n = 37) were reviewed. The incidence of hypotension was equal between groups. Intraoperative opioids were administered more to control (93%) than to treated dogs (18%; P < 0.0001). Epidural bupivacaine 0.0625-0.125% combined with an opioid reduced the use of intraoperative opioids and did not exacerbate arterial hypotension during cesarean section in anesthetized dogs.

Analyse rétrospective de l'utilisation de bupivacaine 0,0625­0,125 % avec des opioïdes lors d'épidurale chez des chiennes soumises à une césarienne. L'anesthésie épidurale, souvent utilisée lors d'une césarienne, peut exacerber l'hypotension due à l'anesthésie générale et retarder le congé à cause d'un bloc moteur. Une diminution de la dose d'anesthésique local pourrait réduire ces complications. Une revue fut effectuée des cas de chiennes soumises à une césarienne et anesthésiées sans épidurale (n = 29) (témoin) et des chiennes avec une épidurale en utilisant une faible dose de bupivacaine avec du fentanyl ou de la buprenorphine (n = 37). L'incidence d'hypotension était égale entre les groupes. Des opioïdes intra-opératoires furent administrés plus fréquemment chez les témoins (93 %) que chez les animaux traités (18 %; P < 0,001). De la bupivacaine 0,0625­0,125 % en épidurale combinée à un opioïde réduisit l'utilisation d'opioïdes intra-opératoires et n'a pas exacerbé l'hypotension artérielle durant la césarienne chez des chiennes anesthésiées.(Traduit par Dr Serge Messier).

Anesthesia for dystocia and anesthesia of the equine neonate.

Equine anesthesia is complicated regardless of the procedure being performed. Anesthesia for the mare experiencing dystocia is complicated by the size of the fetus, positioning of the mare for the procedure, and concern over drug effect on the fetus through the neonatal period. Anesthesia of the neonate is complicated by multiple factors, specifically, sensitivity to the drugs administered. Ventilatory support, minimizing drugs administered, and minimizing anesthesia time are essential for a positive outcome.

Retrospective study on the use of lumbosacral epidural analgesia during caesarean section surgery in 182 dogs: Impact on blood pressure, analgesic use and delays.

BACKGROUND: We evaluated the use of lumbosacral epidural anaesthesia (LEA) in dogs undergoing caesarean section over 10 years. METHODS: Anaesthetic records were reviewed and divided into two treatment groups: LEA and control. Outcome variables identified a priori as potentially affected by LEA were compared between groups. Results are frequency or median (minimum-maximum). RESULTS: Ninety-five dogs received LEA and 87 did not. LEA consisted of 0.2 (0.1-0.3) ml/kg containing bupivacaine (n = 63), ropivacaine (n = 15), or lidocaine (n = 12) at concentrations ranging between 0.06% and 2%. Morphine, fentanyl, or buprenorphine were used as part of LEA. Groups were similar for demographic variables (all p > 0.06). Intravenous opioids were used more often in control than in LEA (p < 0.0005). Incidence of hypotension (MAP < 60 mm Hg) was LEA 68% and control 56% (p = 0.12). Duration of hypotension was longer in LEA (p = 0.03). Use of crystalloids and vasoactive drugs did not differ (all p > 0.1). Time from induction to operating room was 30 (8-75) min for control and 35 (18-65) min for LEA (p = 0.003). DISCUSSION: LEA during caesarean section in dogs was associated with lower rates of opioid administration and did not exacerbate the incidence of hypotension.

Maternal and fetal effects of propofol anaesthesia in the pregnant ewe.

The objective of this study was to determine the effects of propofol (PRF) on maternal and fetal cardiopulmonary function during the last trimester of pregnancy. Six pregnant 2-3 year-old Ripollesa sheep, each weighing 78+/-8 kg were used in the study and prepared by placing catheters in the maternal jugular vein and carotid artery. A catheter was also placed in the fetal femoral artery. Twenty-four hours later the sheep were anaesthetized with PRF (6 mg/kg intravenous (IV) followed by a continuous infusion at a rate of 0.4 mg/kg/min for 60 min) and cardiopulmonary data collected. Further data were collected for 105 min following termination of the infusion. The maternal mean arterial pressure (MAP) and diastolic arterial pressure (DAP) were significantly decreased (P<0.05) during the first 15 min of the infusion period, while the maternal pH was also significantly decreased. Maternal PaCO(2) and PaO(2) were significantly increased throughout the total infusion period. It was further observed that the fetal pH decreased significantly, throughout the infusion period, whereas the fetal MAP, DAP and PaCO(2) were significantly increased during the first 15 min of the infusion, after which time all parameters returned to control values. No differences in either maternal or fetal parameters were observed between control and recovery times.

Description of a technique for anaesthetizing pregnant ewes for fetal surgery.

General anaesthesia in 12 pregnant ewes undergoing surgery for fetal physiological research was supplemented with an intravenous infusion of remifentanil. This allowed us to employ a lighter plane of surgical anaesthesia and to use intermittent positive pressure ventilation. Our aim was to improve fetomaternal outcome. We monitored maternal pulse, blood pressure, transcutaneous oxygen saturation and end-tidal carbon dioxide levels. Remifentanil doses of 0.75-2.0 microg/kg/min were needed and typically this allowed halothane concentrations of 1-1.5% to be used for maintenance of anaesthesia. Surgery lasted up to 2.5 h. All 12 ewes and their singleton fetuses survived the peri- and postoperative period in good condition.

Periparturient and neonatal anesthesia.

Small animal patients may need to be anesthetized in the periparturient period for emergency, nonobstetric reasons, elective ovariohysterectomy, or cesarean section. In each case, the physiologic changes in the dam must be accounted for in designing an anesthetic protocol, but the requirements of the fetuses will be different. Subsequent to birth, the neonatal animal may need to be anesthetized, and the unique physiology and pharmacology at this age is described.

Cesarean section. Anesthetic management and surgical technique.

Cesarean section can be an elective procedure but more often it is an emergency procedure that is made necessary because of dystocia. A successful outcome for both the maternal and fetal patients is primarily dependent on a thorough understanding of the physiologic alterations during normal and abnormal pregnancy and parturition. A complete history and physical examination are necessary for assessment of the dam and planning of fluid therapy and anesthetic technique. Timely coordination of presurgical preparation, anesthesia, and the surgical procedure is crucial. Because little documentation exists to prove that any one anesthetic protocol is best, this article will stress the basic principles of obstetrical anesthesia and patient management.

Elective caesarean operation in Hereford cattle.

An elective left flank Caesarean operation was performed on 56 Hereford cattle and the influence of various surgical techniques on the postoperative progress assessed. A paravertebral nerve block produced effective analgesia in all layers of the abdominal wall of all cattle. In contrast, tissue infiltration, in the form of an inverted L block, did not produce analgesia of the peritoneum and was generally only partly effective in the muscle layers of fat animals. The use of spasmolytic drug facilitated handling of the uterus. Xylazine, when given to unmanageable animals, noticeably increased uterine tone even when used in conjunction with a spasmolytic. Three animals (5.4%) died from generalised peritonitis. Peritoneal adhesions developed in 29 animals (51.8%) and minor wound dehiscence and/or suture infection occurred in 8 animals (14.1%). Postoperative subcutaneous emphysema developed in ;23 cattle (41%). The absence of sutures in the peritoneum was associated with a significant increase in the occurrence of subcutaneous emphysema. Although the prevalence of retained foetal membranes was high this did not seem to influence the postoperative progress of the animal.

The effects of CT1341, thiopentone and induction- delivery time on the blood gas and acid-base status of lambs delivered by casesarean operation and on the onset of respiration.

Caesarean sections were performed on 18 Romney ewes on day 144 of pregnancy. Anaesthesia was induced in 9 ewes with CT 1341 and in 9 ewes with thiopentone and maintained in both groups with halothane administered with oxygen. Surgery was performed with the ewes in lateral recumbency, with respiration unassisted. Blood samples were collected from the intact umbilical artery at the time of delivery and analysed for PO2, PCO2, pH (base deficit was derived). The intervals between ewe induction and lamb delivery (lD), delivery and the onset of breathing (TSR), and delivery and the lamb standing were recorded. Lambs in the CT 1341 group both breathed and stood sooner than lambs in the thiopentone group. Significant linear relationships were only found in the CT 1341 group between TSR interval and PCO2 and pH. No significant correlations were found between the lD interval and any of the biochemical characteristics. The results of this study suggest that lateral recumbency does not interfere with uteroplacental circulation, that CT 1341 (2.2 mg/kg) is associated with less neonatal depression than thiopentone (10 mg/kg) and that severe neonatal hypercarbia may delay the onset of respiration in lambs with minimal drug depression.

Comparison of disposable circle and 'to-and-fro' breathing systems during anaesthesia in dogs.

Low-flow anaesthesia is beneficial in terms of reducing atmospheric pollution with waste anaesthetics and improving economy. This study compared a disposable circle and a 'to-and-fro' breathing system at low fresh gas flows (10 ml/kg/minute) in 19 dogs undergoing ovariohysterectomy. Ten dogs were assigned to the circle and nine to the to-and-fro breathing system. Fractional inspired halothane, end-tidal carbon dioxide and halothane were higher and mean blood pressure was lower in dogs using the to-and-fro system, possibly indicating an increased anaesthetic depth in this group. Use of both systems resulted in an elevated inspired carbon dioxide level, although this was significantly lower in the circle system. Further work will be required to determine the clinical relevance of this difference and whether rebreathing can be eliminated by higher fresh gas flows. The disposable circle studied may be used safely in dogs.

Extradural anesthesia with lidocaine combined with fentanyl or methadone to ovariohisterectomy in dogs.

PURPOSE: To compare the cardiopulmonary effects and the quality of anesthesia of the extradural lidocaine in combination with fentanyl or morphine in bitches undergoing ovariohysterectomy. METHODS: Sixteen female dogs, were sedated with intramuscular acepromazine (0.05 mg kg-1), followed by anesthetic induction with intravenous propofol (4 mg kg-1), to perform the lumbosacral puncture. The animals were randomly assigned to two treatments: T-F (n=8) extradural administration of fentanyl (5 µg kg-1), T-M (n=8) extradural administration of methadone (0.3mg kg-1). In both treatment groups, opioids were combined with lidocaine, in order to make up a final volume of 0.4 mL kg-1. Heart rate (HR), respiratory rate (RR), systolic arterial blood pressure (SABP), intra-operative anesthetic supplementation, blood gases and adverse effects were investigated. RESULTS: HR, arterial pH and blood gases did not differ between treatments at any time point. RR and SABP decreased after epidural anesthesia, but the values were in terms of the physiological range of dogs. Intra-operative anesthetic supplementation was required in 50% and 62.5% of the fentanyl and methadone treated dogs, respectively. CONCLUSION: The extradural lidocaine in combination with fentanyl or morphine allowed cardiopulmonary stability, however sufficient sensitive blockade was not provided in 100% of the dogs.

Analgesia after feline ovariohysterectomy under midazolam-medetomidine-ketamine anaesthesia with buprenorphine or butorphanol, and carprofen or meloxicam: a prospective, randomised clinical trial.

One hundred female cats undergoing routine ovariohysterectomy under midazolam-medetomidine-ketamine anaesthesia were included in a blinded, randomised, prospective clinical study to compare postoperative analgesia produced by four analgesic drug combinations given preoperatively (n = 25 per group). A secondary aim was to assess the effects in kittens and pregnant animals. Buprenorphine 180 µg/m(2) or butorphanol 6 mg/m(2) were given with either carprofen 4 mg/kg (groups BUPC and BUTC, respectively) or meloxicam 0.3 mg/kg (groups BUPM or BUTM, respectively). Medetomidine was not antagonised. A simple, descriptive scale (SDS; 0-4), a dynamic and interactive visual analogue scale (DIVAS; 0-100 mm) and mechanical nociceptive thresholds (MT; 2.5-mm diameter probe) were used to evaluate postoperative pain. All pain scores were low (DIVAS <10 mm, SDS <2 and MT >10 N) and there were no significant differences between the groups. It was concluded that all protocols provided adequate analgesia and when used with midazolam-medetomidine-ketamine are effective for routine feline ovariohysterectomy.

Extradural anesthesia with lidocaine combined with fentanyl or methadone to ovariohisterectomy in dogs

PURPOSE: To compare the cardiopulmonary effects and the quality of anesthesia of the extradural lidocaine in combination with fentanyl or morphine in bitches undergoing ovariohysterectomy. METHODS: Sixteen female dogs, were sedated with intramuscular acepromazine (0.05mg kg-1), followed by anesthetic induction with intravenous propofol (4mg kg-1), to perform the lumbosacral puncture. The animals were randomly assigned to two treatments: T-F (n=8) extradural administration of fentanyl (5µg kg-1), T-M (n=8) extradural administration of methadone (0.3mg kg-1). In both treatment groups, opioids were combined with lidocaine, in order to make up a final volume of 0.4mL kg-1. Heart rate (HR), respiratory rate (RR), systolic arterial blood pressure (SABP), intra-operative anesthetic supplementation, blood gases and adverse effects were investigated. RESULTS: HR, arterial pH and blood gases did not differ between treatments at any time point. RR and SABP decreased after epidural anesthesia, but the values were in terms of the physiological range of dogs. Intra-operative anesthetic supplementation was required in 50% and 62.5% of the fentanyl and methadone treated dogs, respectively. CONCLUSION: The extradural lidocaine in combination with fentanyl or morphine allowed cardiopulmonary stability, however sufficient sensitive blockade was not provided in 100% of the dogs.

[Caesarean section in sows anesthetized with Azaperone and Metomidate (author's transl)]. / Sedaperone og Hypnodil til anaestesi ved kejsersnit på søoer

213 caesarean sections and 157 hysterectomies were carried out in gilts and sows with different body weight (table I). The neuroleptic Azaperone and the hypnotic Metomidate were used for anaesthesia with different administration (table II). Local analgesia and premedication with Atropine. The duration of the anaesthesia was 45 minutes and where prolongation was necessary, Metomidate, Azaperone or barbiturates were used alone or in combinations once or more. The indications (table III) for caesarean section were retarded birth in 70 sows, dislocation of uterus in 74 sows and in 69 sows by other indications. Hysterectomy was indicated by retarded birth in 93 sows, dislocations of uterus in 40 cases and in 24 cases by other indications. In 183 operations (table IV) 1006 living piglets were delivered, and 703 were alive at discharge (70%). The chances of survival depends on the composition of the litter, in litters of piglets alive only, 76% survived at discharge; in litters consisting of both alive and stillborn 69% survived and 59% survived in litters consisting of piglets alive and post mortem piglets. The total survival of the sows was 78%, 80% after caesarean section and 76% after hysterectomy. It is pointed out that most of the patients operated were in a very late phase of birth.