Comparison of cardiopulmonary responses during sedation with epidural and local anesthesia for laparoscopic-assisted jejunostomy feeding tube placement with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical jejunostomy feeding tube placement in healthy dogs

Saundra A. Hewitt Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Brigitte A. Brisson Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Melissa D. Sinclair Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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William C. Sears Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Abstract

Objective—To evaluate the use of laparoscopic-assistedjejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement.

Animals—15 healthy mixed-breed dogs.

Procedures—Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O2 delivery were calculated.

Results—All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O2 delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were foundbetween groups undergoing laparoscopic-assistedandopen surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs.

Conclusions and Clinical Relevance—Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.

Abstract

Objective—To evaluate the use of laparoscopic-assistedjejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement.

Animals—15 healthy mixed-breed dogs.

Procedures—Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O2 delivery were calculated.

Results—All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O2 delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were foundbetween groups undergoing laparoscopic-assistedandopen surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs.

Conclusions and Clinical Relevance—Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.

  • 1

    Remedios AM, Ferguson J. Minimally invasive surgery: laparoscopy and thoracoscopy in small animals. Compend Contin Educ Pract Vet 1996;8:11911199.

    • Search Google Scholar
    • Export Citation
  • 2

    Richter KP. Laparoscopy in dogs and cats. Vet Clin North Am Small Anim Pract 2001;31:707725.

  • 3

    Milki AA, Tazuke TA. Office laparoscopy under local anesthesia for gemete intrafallopian transfer: technique and tolerance. Fertil Steril 1997;68:128132.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Schippers E, Tittel A, Ottinger A, et al. Laparoscopy versus laparotomy: comparison of adhesion-formation after bowel resection in a canine model. Dig Surg 1998;15:145147.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Portilla de Buen I, Castanon Morales J, Ramos Mora A, et al. Changes in arterial gases in Beagle dogs during carbon dioxide pneumoperitoneum. Vet Mex 1998;29:5356.

    • Search Google Scholar
    • Export Citation
  • 6

    Bozkurt P, Kaya G, Yeker Y, et al. The cardiorespiratory effects of laparoscopic procedures in the infant. Anaesthesia 1999;54:831834.

  • 7

    Joshi GP. Anesthesia for laparoscopic surgery. Can J Anaesth 2002;49:1113.

  • 8

    Bufalari A, Short CE, Giannoni C, et al. Evaluation of selected cardiopulmonary and cerebral responses during medetomidine, propofol and halothane anesthesia for laparoscopy in dogs. Am J Vet Res 1997;58:14431450.

    • Search Google Scholar
    • Export Citation
  • 9

    Duke T, Steinacher S, Remedios AM, et al. Cardiopulmonary effects of using carbon dioxide for laparoscopic surgery in dogs. Vet Surg 1996;25:7782.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Martin MF, Lima JR, Ezquerra LJ, et al. Prolonged anesthesia with desflurane and fentanyl in dogs during conventional and laparoscopic surgery. J Am Vet Med Assoc 2001;219:941945.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Joris JL, Chiche JD, Canivet JLM. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol 1998;2:13891396.

    • Search Google Scholar
    • Export Citation
  • 12

    Ho HS, Saunders CJ, Gunther RA, et al. Effector of hemodynamics during laparoscopy: CO2 absorption or intra-abdominal pressure? J Surg Res 1995;59:497503.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Donaldson LL, Trostle SS, White A. Cardiopulmonary changes associated with abdominal insufflation of carbon dioxide in mechanically ventilated, dorsally recumbent, halothane anesthetized horses. Equine Vet J 1998;30:144151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Safran DB, Orlando R III. Physiologic effects of pneumoperitoneum. Am J Surg 1994;167:281286.

  • 15

    Leonard IE, Cunningham AJ. Anaesthetic considerations for laparoscopic choleocystectomy. Best Pract Res Clin Anaesthesiol 2002;16:120.

  • 16

    Gross ME, Jones BD, Bergstresser DR, et al. Effects of abdominal insufflation with nitrous oxide on cardiorespiratory measurements in spontaneously breathing isoflurane-anesthetized dogs. Am J Vet Res 1993;54:13521358.

    • Search Google Scholar
    • Export Citation
  • 17

    Cruz AM, Kerr CL, Boure LP, et al. Cardiovascular effects of insufflation of the abdomen with carbon dioxide in standing horses sedated with detomidine. Am J Vet Res 2004;65:357362.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Latimer FG, Eades SC, Pettifer G, et al. Cardiopulmonary, blood and peritoneal fluid alterations associated with abdominal insufflation of carbon dioxide in standing horses. Equine Vet J 2003;35:283290.

    • Search Google Scholar
    • Export Citation
  • 19

    Quandt JE. Anesthetic considerations for laser, laparoscopy, and thoracoscopic procedures. Clin Tech Small Anim Pract 1999;14:5055.

  • 20

    Jones B. Laparoscopy. Vet Clin North Am Small Anim Pract 1990;20:12431263.

  • 21

    Jergens AE, Riedesel DH, Ries PA, et al. Cardiopulmonary responses in healthy dogs during endoscopic examination of the gastrointestinal tract. Am J Vet Res 1995;56:215220.

    • Search Google Scholar
    • Export Citation
  • 22

    Robertson SA. Newer diagnostic and surgical techniques and their impact on anesthesia. Vet Clin North Am Small Anim Pract 1999;29:665681.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Giradis M, Broi UD, Antonutto G, et al. The effect of laparoscopic choleocystectomy on cardiovascular function and pulmonary gas exchange. Anesth Analg 1996;83:134140.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Chung RS, Chari V. Laparoscopic-assisted jejunostomy under local anesthesia facilitated by a new suture technique. Dig Surg 1995;12:247249.

  • 25

    Vaghadia H, Viskari D, Mitchell GWE, et al. Regional anesthesia: selective spinal anesthesia for outpatient laparoscopy. I: characteristics of three hypobaric solutions. Can J Anaesth 2001;48:256260.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Gramatica L, Brasesco OE, Luna AM, et al. Laparoscopic choleocystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc 2002;16:472475.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Hanley ES. Anesthesia for laparoscopic surgery. Surg Clin North Am 1992;72:10131019.

  • 28

    Duh QY, Senokozleiff-Englehart AL, Siperstein AE, et al. Laparoscopic gastrostomy and jejunostomy: safety and cost with local vs. general anesthesia. Arch Surg 1999;134:151156.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Kelly D, Kraus PA, Brull SJ. Laparoscopic pelvic lymphadenectomy during epidural anesthesia. J Clin Anesth 1995;7:648651.

  • 30

    Edelman DS, Unger SW. Laparoscopic gastrostomy and jejunostomy: review of 22 cases. Surg Laparosc Endosc 1994;4:297300.

  • 31

    Troncy E, Junot S, Keroack S, et al. Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997–1999). J Am Vet Med Assoc 2002;221:666671.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Gueugniaud PY, Abisseror M, Moussa M, et al. The hemodynamic effects of pneumoperitoneum during laparoscopic surgery in healthy infants: assessment by continuous esophageal aortic blood flow echo-Doppler. Anesth Analg 1998;86:290293.

    • Search Google Scholar
    • Export Citation
  • 33

    Freeman LJ. Complications. In:Freeman LJ, ed.Veterinary endosurgery. St Louis: CV Mosby Co, 1998;92101.

  • 34

    Torske KE, Dyson DH. Epidural analgesia and anesthesia. Vet Clin North Am Small Anim Pract 2000;30:859874.

  • 35

    Linton RA, Young LE, Marlin DJ, et al. Cardiac output measured by lithium dilution, thermodilution, and transesophageal Doppler echocardiography in anesthetized horses. Am J Vet Res 2000;61:731737.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Mason DJ, O'Grady M, Woods JP, et al. Assessment of lithium dilution cardiac output as a technique for measurement of cardiac output in dogs (Erratum published in Am J Vet Res 2001;62:1611). Am J Vet Res 2001;62:12551261.

    • Search Google Scholar
    • Export Citation
  • 37

    Mason DJ, O'Grady M, Woods JP, et al. Comparison of a central and a peripheral (cephalic vein) injection site for the measurement of cardiac output using the lithium-dilution cardiac output technique in anesthetized dogs. Can J Vet Res 2002;66:207210.

    • Search Google Scholar
    • Export Citation
  • 38

    Lithium dilution cardiac output Web site. Hemodynamic parameters. Available at: www.LiDCO.com. Accessed May 6, 2004.

  • 39

    Chun R, Garret L, MacEwen EG. Cancer chemotherapy. In:Withrow SJ, MacEwen EG, ed.Small animal clinical oncology. 3rd ed. Philadelphia: WB Saunders Co, 2001;92118.

    • Search Google Scholar
    • Export Citation
  • 40

    Rawlings CA, Howerth EW, Bement S, et al. Laparoscopic-assisted enterostomy tube placement and full-thickness biopsy of the jejunum with serosal patching in dogs. Am J Vet Res 2002;63:13131319.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41

    Hewitt SA, Brisson BA, Sinclair MD, et al. Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs. J Am Vet Med Assoc 2004;225:6571.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42

    Mathews KA, Pettifer G, Foster R, et al. Safety and efficacy of preoperative administration of meloxicam, compared with that of ketoprofen and butorphanol in dogs undergoing abdominal surgery. Am J Vet Res 2001;62:882888.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43

    Everitt B. The analysis of repeated measures: a practical review with examples. Statistician 1995;44:113135.

  • 44

    Wilson DV, Evans AT, Mullineaux DR. The effect of four anesthetic protocols on splenic size in dogs. Vet Anaesth Analg 2004;31:102108.

  • 45

    Lukasik VM. Premedication and sedation. In:Seymore C, ed.Manual of small animal anaesthesia and analgesia. Shurdington, England: British Small Animal Veterinary Association, 1999;7183.

    • Search Google Scholar
    • Export Citation
  • 46

    McEwan AI, Smith C, Dyar O, et al. Isoflurane minimum alveolar concentration reduction by fentanyl. Anesthesiology 1993;78:864869.

  • 47

    Hellyer PW, Fails AD. Pain management of the surgical patient. In:Slatter D, ed.Textbook of small animal surgery. 3rd ed. Philadelphia: WB Saunders Co, 2003;2511.

    • Search Google Scholar
    • Export Citation
  • 48

    Mathews KA, Dyson D. Chemical restraint, analgesia, anesthesia. In:Mathews KA, ed.Veterinary emergency and critical care manual. Guelph, Canada: Lifelearn Inc, 1996;2:2224.

    • Search Google Scholar
    • Export Citation
  • 49

    Hall RI, Szlam F, Hug CC Jr. Pharmacokinetics and pharmacodynamics of midazolam in the enflurane-anesthetized dog. J Pharmacokinet Biopharm 1988;16:251262.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50

    Hall RI, Schwieger IM, Hug CC Jr. The anesthetic efficacy of midazolam in the enflurane-anesthetized dog. Anesthesiology 1988;68:862866.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51

    Court MH, Dodman NH, Greenblatt DJ, et al. Effect of midazolam infusion and flumazenil administration on epinephrine arrhythmogenicity in dogs anesthetized with halothane. Anesthesiology 1993;78:155162.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52

    Lansdowne JL, Kerr CL, Boure LP, et al. Epidural migration of new methylene blue in 0.9% sodium chloride solution or 2% mepivicaine solution following injection into the first intercoccygeal space in foal cadavers and anesthetized foals undergoing laparoscopy. Am J Vet Res 2005;66:13241329.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53

    Trim C. Epidural analgesia with 0.75% bupivacaine for laparotomy in goats. J Am Vet Med Assoc 1989;194:12921296.

  • 54

    Lopez MJ, Johnson R, Hendrickson DA, et al. Craniad migration of differing doses of new methylene blue injected into the epidural space after death of calves and juvenile pigs. Am J Vet Res 1997;58:786790.

    • Search Google Scholar
    • Export Citation
  • 55

    Johnson RA, Lopez MJ, Hendrickson DA, et al. Cephalad distribution of three differing volumes of new methylene blue injected into the epidural space in adult goats. Vet Surg 1996;25:448451.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56

    Lee I, Soehartono RH, Yamagishi N, et al. Distribution of new methylene blue injected into the dorsolumbar epidural space in cows. Vet Anaesth Analg 2001;28:140145.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57

    Duggan J, Bowler JMR, McClure JH, et al. Extradural block with bupivacaine: influence of dose, volume, concentration and patient characteristics. Br J Anaesth 1988;61:324331.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58

    Rist M, Hemmerling TM, Rauh R, et al. Influence of pneumoperitoneum and patient positioning on preload and splanchnic blood volume in laparoscopic surgery of the lower abdomen. J Clin Anesth 2001;13:244249.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59

    Klopfenstein CL, Morel DR, Clergue F, et al. Effects of abdominal CO2 insufflation and changes of position on hepatic blood flow in anesthetized pigs. Am J Physiol Heart Circ Physiol 1998;275:900905.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60

    Williams MD, Muir PC. Laparoscopic insufflation of the abdomen depresses cardiopulmonary function. Surg Endosc 1993;7:1216.

  • 61

    Richards DW. Cardiac output by catheterization techniques in various clinical conditions. Fed Proc 1945;4: 215.

  • 62

    Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intraabdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992;33:4548.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63

    Duke T, Caulkett NA, Ball SA. Comparative analgesic and cardiopulmonary effects of bupivacaine and ropivacaine in the epidural space of the conscious dog. Vet Anaesth Analg 2000;27:1321.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64

    Tracey JA, Holland AJ, Unger L. Morbidity in minor gynaecological surgery: a comparison of halothane, enflurane and isoflurane. Br J Anaesth 1982;54:12131215.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65

    Alahuhta S, Kangas-Saarela T, Hollmen AI, et al. Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesthesiol Scand 1990;34:9598.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66

    Fong SY, Pavy TJ, Yeo ST, et al. Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy. Reg Anesth Pain Med 2001;26:131136.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67

    Kato J, Ogawa S, Katz J, et al. Effects of presurgical local infiltration of bupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecolocial examinations: a possible preemptive analgesic effect. Clin J Pain 2000;16:1217.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 68

    Uzunkoy A, Coskun A, Akinci OF. The value of pre-emptive analgesia in the treatment of postoperative pain after laparoscopic cholecystectomy. Eur J Surg 2000;166:467471.

    • Search Google Scholar
    • Export Citation
  • 69

    Ke RW, Portera SG, Lincoln SR. A randomized blinded trial of preemptive local anesthesia in laparoscopy. Prim Care Update Ob Gyns 1998;5:197198.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 70

    Labaille R, Mazoit JX, Paqueron X, et al. The clinical efficacy and pharmacokinetics of intraperitoneal ropivicaine for laparoscopic cholecystectomy. Anesth Analg 2002;94:100105.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71

    Shaw IC, Stevens J, Krishnamurthy S. The influence of intraperitoneal bupivacaine on pain following major laparoscopic gynaecological procedures. Anaesthesia 2001;56:10411044.

    • Search Google Scholar
    • Export Citation

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