Effects of pulse-delivered inhaled nitric oxide administration on pulmonary perfusion and arterial oxygenation in dorsally recumbent isoflurane-anesthetized horses.

OBJECTIVE: To image the spatial distribution of pulmonary blood flow by means of scintigraphy, evaluate ventilation-perfusion (VA/Q) matching and pulmonary blood shunting (Qs/Qt) by means of the multiple inert gas elimination technique (MIGET), and measure arterial oxygenation and plasma endothelin-1 concentrations before, during, and after pulse-delivered inhaled nitric oxide (PiNO) administration to isoflurane-anesthetized horses in dorsal recumbency. ANIMALS: 3 healthy adult Standardbreds. PROCEDURES: Nitric oxide was pulsed into the inspired gases in dorsally recumbent isoflurane-anesthetized horses. Assessment of VA/Q matching, Qs/Qt, and Pao2 content was performed by use of the MIGET, and spatial distribution of pulmonary blood flow was measured by perfusion scintigraphy following IV injection of technetium Tc 99m-labeled macroaggregated human albumin before, during, and 30 minutes after cessation of PiNO administration. RESULTS: During PiNO administration, significant redistribution of blood flow from the dependent regions to the nondependent regions of the lungs was found and was reflected by improvements in VA/Q matching, decreases in Qs/Qt, and increases in Pao2 content, all of which reverted to baseline values at 30 minutes after PiNO administration. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of PiNO in anesthetized dorsally recumbent horses resulted in redistribution of pulmonary blood flow from dependent atelectatic lung regions to nondependent aerated lung regions. Because hypoxemia is commonly the result of atelectasis in anesthetized dorsally recumbent horses, the addition of nitric oxide to inhaled gases could be used clinically to alleviate hypoxemia in horses during anesthesia.

Evaluation of a positioning method for equine lateral stifle scintigrams.

BACKGROUND: The current lack of a standardized protocol for positioning of the gamma camera relative to the horse limb in a lateral stifle scintigram, and thus the reliance on subjective positioning, may be a cause of diagnostic error and inter-operator variability due to variations of the view angle. The aims of this study were to develop a reliable method to obtain a lateral scintigram of the equine stifle based on fixed anatomical landmarks and measure the resulting foot to gamma camera angle on sequential measurements of the same horse and of different horses METHODS: Technetium filled capsules were glued on the skin on sites adjacent to the origin of the medial and lateral femorotibial collateral ligaments in 22 horses using ultrasound guidance. A lateral view of the stifle was defined as the image where the two radioactive point sources were aligned vertically (point sources guided method). Five sequential lateral acquisitions (one to five) of the stifle with the point sources vertically aligned were acquired in each horse, and the angle between the mid-sagittal foot-axis and the vertical axis of the gamma camera (FC angle) was measured for each of these acquisitions RESULTS: For acquisition group one to five, the mean of the means FC angle was 91.6 ± 2° (2SD) and the coefficient of variation (COV) was 1.1%. In the 22 horses the 95% CI for the mean FC angles was 91.6° ± 12.1° (2SD) and the COV was 6.6%. CONCLUSIONS: The use of point sources to guide gamma camera position results in less variation in the lateral scintigram than if the distal limb is used as guidance due to a difference in FC angle between horses. The point source guided positioning method is considered suitable as a reference standard method to obtain lateral scintigrams of the equine stifle, and it will be of value in clinical scintigraphy and research. The use of alignment of specifically located point sources may also be applied in other regions to standardize scintigraphic views.

The scintigraphic anatomy of the equine sacroiliac joint.

The aim of this study was to describe the scintigraphic appearance and location of the sacroiliac joint (SI-joint) in dorsal and dorso 30 degree lateral views of the equine pelvis in a scintigram. The pelvis from 10 different horses was prepared by attaching plastic tubes along relevant margins of the bone and around the SI-joint. A radioactive solution was injected into the tubes, and scintigraphic images were acquired with a gamma camera. Five specific landmarks were identified on the left and right sides of the pelvis. There was no significant difference in the distance measurements between the left and right sides in the dorsal view. The SI-joint was roughly ovoid in shape, with its long axis angled to the midline. The most craniolateral point of the SI-joint (Y) was located at the middle (SD = 0.04) of a line drawn from the caudal margin of the tuber sacrale (TS) to the craniolateral margin of the tuber coxa (TC), which was called TS-TC. In 85% of the specimens, the long axis of the SI-joint (SILA) was located caudal to or intersecting TS-TC, and the mean angle between SILA and TS-TC was 16.4 degrees (SD = 5.6 degrees). The distance from the caudomedial point of the SI-joint (Z) to Y was 0.38 times (SD = 0.04) the length of TS-TC. The distance from the tuber sacrale to the medial border of the SI-joint (TS-X) was 0.15 times (SD = 0.02) the length of TS-TC. In the oblique view, the SI-joint appeared wider and was positioned more laterally compared to the dorsal view. The distance TS-Y increased to 0.61 times (SD = 0.046) TS-TC, but SILA/TS-TC was essentially unchanged. The mean angle between TS-TC and SILA increased to 20.9 degrees (SD = 5.6 degrees). TS-X increased to 0.31 times (SD = 0.037) TS-TC. The location of the SI-joint was very similar in all horses, which makes it possible to estimate the location of the SI-joint in a scintigram in which the tuber sacrale and the craniolateral margin of the tuber coxa are identified.