Effect of body position on intra-abdominal pressures and abdominal perfusion pressures measured at three sites in horses anesthetized with short-term total intravenous anesthesia

Victoria H. Scott Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Victoria H. Scott in
Current site
Google Scholar
PubMed
Close
 BVetMed, MS
,
Jarred M. Williams Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Jarred M. Williams in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Margaret C. Mudge Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Margaret C. Mudge in
Current site
Google Scholar
PubMed
Close
 VMD
, and
Samuel D. Hurcombe Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Samuel D. Hurcombe in
Current site
Google Scholar
PubMed
Close
 BVMS, MS

Abstract

Objective—To assess effects of body position on direct measurements of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) in horses anesthetized with total intravenous anesthesia (TIVA).

Animals—9 healthy adult horses.

Procedures—Instrumentation in unsedated standing horses involved insertion of an arterial catheter for blood pressure measurements and 3 intraperitoneal cannulas (left flank, right flank, and ventral abdomen) for IAP measurements. Baseline values were measured for heart rate, respiratory rate, systolic arterial blood pressure, mean arterial blood pressure (MAP), diastolic arterial blood pressure, and IAP. Horses were medicated with xylazine, and pressures were measured again. Anesthesia was induced with ketamine-diazepam and maintained with a ketamine-guaifenesin infusion. Horses were positioned twice into left lateral recumbency, right lateral recumbency, or dorsal recumbency. Hemodynamic pressures and accessible abdominal pressures were measured for each recumbency position. The APP was calculated as MAP – IAP. Differences in IAP, MAP, APP and sedation (standing horses) or body position (anesthetized horses) were compared by means of repeated-measures ANOVA or paired t tests.

Results—Baseline hemodynamic and IAPs were not different after xylazine administration. Ventral abdomen IAP and MAP were lower for horses in dorsal recumbency than in right or left lateral recumbency. Ventral abdomen APP remained unchanged. For lateral recumbencies, flank IAP was lower and APP was higher than pressure measurements at the same sites during dorsal recumbency.

Conclusions and Clinical Relevance—Body position affected IAP and APP in healthy anesthetized horses. These effects should be considered when developing IAP acquisition methods for use in horses with abdominal disease.

Abstract

Objective—To assess effects of body position on direct measurements of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) in horses anesthetized with total intravenous anesthesia (TIVA).

Animals—9 healthy adult horses.

Procedures—Instrumentation in unsedated standing horses involved insertion of an arterial catheter for blood pressure measurements and 3 intraperitoneal cannulas (left flank, right flank, and ventral abdomen) for IAP measurements. Baseline values were measured for heart rate, respiratory rate, systolic arterial blood pressure, mean arterial blood pressure (MAP), diastolic arterial blood pressure, and IAP. Horses were medicated with xylazine, and pressures were measured again. Anesthesia was induced with ketamine-diazepam and maintained with a ketamine-guaifenesin infusion. Horses were positioned twice into left lateral recumbency, right lateral recumbency, or dorsal recumbency. Hemodynamic pressures and accessible abdominal pressures were measured for each recumbency position. The APP was calculated as MAP – IAP. Differences in IAP, MAP, APP and sedation (standing horses) or body position (anesthetized horses) were compared by means of repeated-measures ANOVA or paired t tests.

Results—Baseline hemodynamic and IAPs were not different after xylazine administration. Ventral abdomen IAP and MAP were lower for horses in dorsal recumbency than in right or left lateral recumbency. Ventral abdomen APP remained unchanged. For lateral recumbencies, flank IAP was lower and APP was higher than pressure measurements at the same sites during dorsal recumbency.

Conclusions and Clinical Relevance—Body position affected IAP and APP in healthy anesthetized horses. These effects should be considered when developing IAP acquisition methods for use in horses with abdominal disease.

Contributor Notes

Dr. Scott's present address is Department of Veterinary Medicine, Cambridge Veterinary School, University of Cambridge, Cambridge, CB3 0ES, England.

Presented in part in abstract form at the 2012 American College of Veterinary Internal Medicine forum, New Orleans, May 2012.

Address correspondence to Dr. Scott (vikki.scott7@gmail.com).
  • 1. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006; 32: 17221732.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Cheatham ML, White MW, Sagraves SG, et al. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000; 49: 621626.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3. Malbrain ML, Vidts W, Ravyts M, et al. Acute intestinal distress syndrome: the importance of intra-abdominal pressure. Minerva Anestesiol 2008; 74: 657673.

    • Search Google Scholar
    • Export Citation
  • 4. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiologic study. Crit Care Med 2005; 33: 315322.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. Carlotti AP, Carvalho WB. Abdominal compartment syndrome: a review. Pediatr Crit Care Med 2009; 10: 115120.

  • 6. Vasquez DG, Berg-Copas GM, Wetta-Hall R. Influence of semirecumbent position on intra-abdominal pressure as measured by bladder pressure. J Surg Res 2007; 139: 280285.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Cheatham ML, De Waele JJ, De Laet I, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med 2009; 37: 21872190.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. De Keulenaer BL, De Waele JJ, Powell B, et al. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med 2009; 35: 969976.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. McBeth PB, Zygun DA, Widder S, et al. Effect of patient positioning on intra-abdominal pressure monitoring. Am J Surg 2007; 193: 644647.

  • 10. Yi M, Leng Y, Yao G, et al. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. J Crit Care 2012; 27:222.e1222.e6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Malbrain ML, Verbrugghe W, Daelemans R, et al. Effects of different body positions on intra-abdominal pressure and dynamic respiratory compliance. Crit Care 2003; 29: 11771181.

    • Search Google Scholar
    • Export Citation
  • 12. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 2007; 33: 951962.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Loring SH, Yoshino K, Kimball WR, et al. Gravitational and shear-associated pressure gradients in the abdomen. J Appl Physiol 1994; 77: 13751382.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Munsterman AS, Hanson RR. Comparison of direct and indirect methods of intra-abdominal pressure measurement in normal horses. J Vet Emerg Crit Care (San Antonio) 2009; 19: 545553.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Munsterman AS, Hanson RR. Evaluation of gastric pressures as an indirect method for measurement of intra-abdominal pressures in the horse. J Vet Emerg Crit Care (San Antonio) 2011; 21: 2935.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Hurcombe SDA, Scott VHL. Direct intra-abdominal pressures and abdominal perfusion pressures in unsedated normal horses. J Vet Emerg Crit Care (San Antonio) 2012; 22: 441446.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. De Waele JJ, Beniot D, Hoste E, et al. A role for muscle relaxation in patients with abdominal compartment syndrome. Intensive Care Med 2003; 29:332.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. McMurphy RM, Young LE, Marlin DJ, et al. Comparison of the cardiopulmonary effects of anesthesia maintained by continuous infusion of romifidine, guaifenesin, and ketamine with anesthesia maintained by inhalation of halothane in horses. Am J Vet Res 2002; 63: 16551661.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Bettschart-Wolfensberger R, Bowen MI, Freeman SL, et al. Cardiopulmonary effects of prolonged anesthesia via propofolmedetomidine infusion in ponies. Am J Vet Res 2001; 62: 14281435.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Bueno AC, Cornick-Seahorn J, Seahorn TL, et al. Cardiopulmonary and sedative effects of intravenous administration of low doses of medetomidine and xylazine to adult horses. Am J Vet Res 1999; 60: 13711376.

    • Search Google Scholar
    • Export Citation
  • 21. England GC, Clarke KW, Goossens L. A comparison of the sedative effects of three alpha 2-adrenoceptor agonists (romifidine, detomidine and xylazine) in the horse. J Vet Pharmacol Ther 1992; 15: 194201.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. Henneke DR, Potter GD, Kreider JL, et al. Relationship between condition score, physical measurements and body fat percentage in mares. Equine Vet J 1983; 15: 371372.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. Brosnahan MM, Holbrook TC, Gilliam LL, et al. Intra-abdominal hypertension in two adult horses. J Vet Emerg Crit Care (San Antonio) 2009; 19: 174180.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Boutros A, Albert S. Effect of the dynamic response of transducer tubing system on accuracy of direct blood pressure measurement in patients. Crit Care Med 1983; 11: 124127.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. England GC, Clarke KW. Alpha 2 adrenoceptor agonists in the horse—a review. Br Vet J 1996; 152: 641657.

  • 26. Chionh JJ, Wei BP, Martin JA, et al. Determining normal values for intra-abdominal pressure. ANZ J Surg 2006; 76: 11061109.

  • 27. Iberti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology 1989; 70: 4750.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28. Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 2001; 50: 297302.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004; 30: 822829.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Steffey EP, Kelly AB, Hodgson DS, et al. Effect of body posture on cardiopulmonary function in horses during five hours of constant-dose halothane anesthesia. Am J Vet Res 1990; 51: 1116.

    • Search Google Scholar
    • Export Citation
  • 31. Steffey EP, Dunlop CI, Cullen LK, et al. Circulatory and respiratory responses of spontaneously breathing, laterally recumbent horses to 12 hours of halothane anesthesia. Am J Vet Res 1993; 54: 929936.

    • Search Google Scholar
    • Export Citation
  • 32. Brosnan RJ, Steffey EP, LeCouteur RA, et al. Effects of body position on intracranial and cerebral perfusion pressures in isoflurane-anesthetized horses. J Appl Physiol 2002; 92: 25422546.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. Stegmann GF, Littlejohn A. The effect of lateral and dorsal recumbency on cardiopulmonary function in the anaesthetized horse. J S Afr Vet Assoc 1987; 58: 2127.

    • Search Google Scholar
    • Export Citation
  • 34. Gasthuys F, de Moor A, Parmentier D. Haemodynamic effects of change in position and respiration mode during a standard halothane anaesthesia in ponies. Zentralbl Veterinarmed A 1991; 38: 203211.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35. Day TK, Gaynor JS, Muir WW, et al. Blood gas values during intermittent positive pressure ventilation and spontaneous ventilation in 160 anesthetized horses positioned in lateral or dorsal recumbency. Vet Surg 1995; 24: 266276.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36. Bornscheuer A, Mahr KH, Bötel C, et al. Cardiopulmonary effects of lying position in anesthetized and mechanically ventilated dogs. J Exp Anim Sci 1996; 38: 2027.

    • Search Google Scholar
    • Export Citation
  • 37. Kundra P, Velraj J, Amirthalingam U, et al. Effect of positioning from supine and left lateral positions to left lateral tilt on maternal blood flow velocities and waveforms in full-term parturients. Anaesthesia 2012; 67: 889893.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38. Ahmadi-Noorbakhsh S, Malbrain ML. Integration of inspiratory and expiratory intra-abdominal pressure: a novel concept looking at mean intra-abdominal pressure. Ann Intensive Care 2012; 2 (suppl 1): S18.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement