Standing flank laparotomy for colic: 37 cases.

BACKGROUND: Standing flank laparotomy can be an alternative to ventral midline laparotomy in horses with colic. Standing flank laparotomy avoids general anaesthesia, provides excellent access to some regions of the abdominopelvic cavity and costs less than ventral midline laparotomy. OBJECTIVE: To report a series of cases of peritoneal and intestinal diseases other than SC diseases managed with standing flank laparotomy. STUDY DESIGN: Retrospective case series. METHODS: Records from equids with colic subjected to standing flank laparotomy at five hospitals (2003-2020) were reviewed. Descriptive data analysis was performed. RESULTS: Thirty horses (sixteen survived to discharge), six ponies (four survived) and one donkey (euthanised) were subjected to standing flank laparotomy via the left flank (n = 31), right flank (n = 2) or both flanks (n = 4). The primary disease affected the peritoneum (0/5 survived), SI (5/9 survived) and caecum and/or LC (15/23 survived). Enterotomy was performed in four animals (all survived). Partial typhlectomy was performed in one horse (euthanised). Resection-anastomosis of the SI or LC was performed in three animals (one survived). Three animals had intraoperative complications that negatively affected the outcome: Two ponies had intolerance to abdominopelvic exploration; one mare had spontaneous exteriorisation of a long segment of the SI leading to a large tear in the mesentery. In seven cases, severe/extensive lesions found during standing flank laparotomy warranted immediate euthanasia. The survival rate was 54%. All owners were satisfied with the decision to perform standing flank laparotomy. MAIN LIMITATIONS: The retrospective design, lack of a control group, small number of cases and lack of standardised protocols between hospitals. CONCLUSIONS: Although ventral midline laparotomy is the standard of care for horses with colic, standing flank laparotomy is a viable approach for some types of colic. Systemic administration of analgesics may not produce sufficient peritoneal analgesia, which can lead to intolerance to abdominopelvic exploration during standing flank laparotomy in horses with colic and may negatively affect the outcome.

General anesthesia with an injectable 8% v/v sevoflurane lipid emulsion administered intravenously to dogs.

OBJECTIVE: To evaluate the potential of an intravenous (IV) sevoflurane formulation for maintenance of general anesthesia in dogs. STUDY DESIGN: Prospective crossover design. ANIMALS: Six healthy, mature, mixed-breed dogs, four males and two females, weighing 11.7 ± 3.4 kg. METHODS: Anesthesia was induced and maintained with propofol IV for instrumentation. Baseline measurements were recorded before administration of either sevoflurane in oxygen (Sevo-Inh) or lipid-emulsified sevoflurane 8% v/v in 30% Intralipid IV (Sevo-E), 0.5 mL kg(-1) over 5 minutes followed by an infusion at 0.1-0.3 mL kg(-1)  minute(-1) . Dogs were breathing spontaneously. The 'up-and-down' technique was used to determine the minimum alveolar concentration (MAC) of sevoflurane. Over 120 minutes, a tail clamp was applied every 15 minutes and sevoflurane administration was adjusted depending on the response. End-tidal sevoflurane concentration and variables were recorded at 30, 60, 90, and 120 minutes: heart rate (HR), systemic arterial pressure (sAP), respiratory rate (fR ), end-tidal carbon dioxide tension, hemoglobin oxygen saturation (SaO2 ), arterial pH and blood gases, blood urea nitrogen, alanine aminotransferase, creatine kinase, gamma-glutamyl transferase, and aspartate aminotransferase. RESULTS: There were no significant differences between treatments for HR, sAP, fR , SaO2 , and biochemical variables (p > 0.05). pH and HCO3-were significantly decreased, and PaCO2 increased from baseline in Sevo-E (p < 0.05). MAC was significantly lower for Sevo-E than for Sevo-Inh, although the required dose of sevoflurane (g hour(-1) ) to maintain general anesthesia was not significantly different between treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of 8% v/v sevoflurane lipid emulsion IV was effective in maintaining general anesthesia in dogs, but resulted in moderate cardiopulmonary depression, metabolic and respiratory acidosis. The amount of sevoflurane (g hour(-1) ) required to maintain general anesthesia was significantly lower for inhaled than for IV sevoflurane.

Effects of epidural morphine on gastrointestinal transit in unmedicated horses.

OBJECTIVE: To evaluate the effect of epidural morphine on gastrointestinal (GI) motility in horses. STUDY DESIGN: Randomly ordered crossover design. ANIMALS: Six healthy adult horses weighing 585± 48 kg (mean±SD). METHODS: Horses were randomly assigned to receive either 0.2 mg kg(-1) morphine or an equal volume (0.04 mL kg(-1)) of saline epidurally (the first inter coccygeal space) with 2 weeks between treatments. The horses were stabled, fed a standardized diet and allowed water ad libitum throughout the duration of the study. Radiopaque spheres were administered by stomach tube. Xylazine 0.2 mg kg(-1) intravenously was administered prior to epidural injection. Heart rate, respiratory rate, GI sounds score and behavior score were recorded before drug administration and after epidural injection at 4, 8, 12, 18, 24 hours and every 12 hours thereafter for 6 days. Feces were weighed, radiographed and the number of spheres counted. Data were analyzed using a mixed effect model. RESULTS: At no time did horses exhibit signs of colic or show significant differences between treatments regarding heart rate, respiratory rate, GI sounds score, behavior score, or cumulative number of spheres. The concentration of spheres per kg of feces was significantly lower (p<0.05) for the morphine group at 18 and 24 hours. Using the centroid of the curves (spheres kg(-1) plotted versus time) the average transit time after saline epidural was 38 hours and after morphine it was 43 hours. The weight of feces hour(-1) was significantly lower (p<0.05) at only 4 and 8 hours after morphine. CONCLUSIONS AND CLINICAL RELEVANCE: Epidural morphine, at a dose of 0.2 mg kg(-1) , temporarily reduced GI motility but did not cause ileus or colic in this small group of healthy unfasted horses. Care should be taken when extrapolating these data to situations in which other factors may also affect GI motility.