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- Author or Editor: Alexander Valverde x
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Abstract
Objective—To evaluate the cardiopulmonary effects of IV fentanyl administration in dogs during isoflurane anesthesia and during anesthetic recovery with or without dexmedetomidine or acepromazine.
Animals—7 sexually intact male purpose-bred hound-type dogs aged 11 to 12 months.
Procedures—Dogs received a loading dose of fentanyl (5 μg/kg, IV) followed by an IV infusion (5 μg/kg/h) for 120 minutes while anesthetized with isoflurane and for an additional 60 minutes after anesthesia was discontinued. Dogs were randomly assigned in a crossover design to receive dexmedetomidine (2.5 μg/kg), acepromazine (0.05 mg/kg), or saline (0.9% NaCl) solution (1 mL) IV after anesthesia ceased. Cardiopulmonary data were obtained during anesthesia and for 90 minutes after treatment administration during anesthetic recovery.
Results—Concurrent administration of fentanyl and isoflurane resulted in significant decreases in mean arterial blood pressure, heart rate, and cardiac index and a significant increase in Paco2. All but Paco2 returned to pretreatment values before isoflurane anesthesia was discontinued. During recovery, dexmedetomidine administration resulted in significant decreases in heart rate, cardiac index, and mixed venous oxygen tension and a significant increase in arterial blood pressure, compared with values for saline solution and acepromazine treatments. Acepromazine administration resulted in significantly lower blood pressure and higher cardiac index and Po2 in mixed venous blood than did the other treatments. Dexmedetomidine treatment resulted in significantly lower values for Pao2 and arterial pH and higher Paco2 values than both other treatments.
Conclusions and Clinical Relevance—Fentanyl resulted in transient pronounced cardiorespiratory effects when administered during isoflurane anesthesia. During anesthetic recovery, when administered concurrently with an IV fentanyl infusion, dexmedetomidine resulted in evidence of cardiopulmonary compromise and acepromazine transiently improved cardiopulmonary performance.
Abstract
Objective—To compare cardiac output (CO) measured by use of the partial carbon dioxide rebreathing method (NICO) or lithium dilution method (LiDCO) in anesthetized foals.
Sample Population—Data reported in 2 other studies for 18 neonatal foals that weighed 32 to 61 kg.
Procedures—Foals were anesthetized and instrumented to measure direct blood pressure, heart rate, arterial blood gases, end-tidal isoflurane and carbon dioxide concentrations, and CO. Various COs were achieved by administration of dobutamine, norepinephrine, vasopressin, phenylephrine, and isoflurane to allow comparisons between LiDCO and NICO methods. Measurements were obtained in duplicate or triplicate. We allowed 2 minutes between measurements for LiDCO and 3 minutes for NICO after achieving a stable hemodynamic plane for at least 10 to 15 minutes at each CO.
Results—217 comparisons were made. Correlation (r = 0.77) was good between the 2 methods for all determinations. Mean ± SD measurements of cardiac index for all comparisons with the LiDCO and NICO methods were 138 ± 62 mL/kg/min (range, 40 to 381 mL/kg/min) and 154 ± 55 mL/kg/min (range, 54 to 358 mL/kg/min), respectively. Mean difference (bias) between LiDCO and NICO measurements was −17.3 mL/kg/min with a precision (1.96 × SD) of 114 mL/kg/min (range, −131.3 to 96.7). Mean of the differences of LiDCO and NICO measurements was 4.37 + (0.87 × NICO value).
Conclusions and Clinical Relevance—The NICO method is a viable, noninvasive method for determination of CO in neonatal foals with normal respiratory function. It compares well with the more invasive LiDCO method.
SUMMARY
The hemodynamic effects of 1.5 minimal alveolar concentration of halothane alone (1.6% end-tidal) and 1.5 minimal alveolar concentration of halothane (1.1% end-tidal concentration) combined with epidurally administered morphine were compared during controlled ventilation in 10 dogs used on 2 occasions and randomly allocated to 2 groups. Arterial blood pressure, cardiac index, stroke volume, left ventricular work, and pulmonary arterial pressure were significantly (P < 0.05) higher in dogs of the morphine-treated group before administration of morphine. After epidural administration of morphine (0.1 mg/kg of body weight diluted in 0.26 ml of saline solution/kg), hemodynamic changes were not observed, and the aforementioned variables remained significantly (P < 0.05) higher than values in dogs of the halothane only group. Compared with halothane (1.6%) alone, the reduction in halothane end-tidal concentration (1.1%) associated with epidurally administered morphine is beneficial in maintaining hemodynamic function.
SUMMARY
Midazolam HCl (1.0 or 2.0 mg/kg of body weight) was administered im to 6 Canada geese to determine a sedative dose that would allow positioning for radiologic examination. The effects of both test doses on cardiopulmonary function were evaluated at 5, 10, 15, 20, 30, and 40 minutes after drug administration and were compared with 2 end-tidal isoflurane concentrations (1.5 and 2.5%). The 2.0 mg/kg dosage induced moderate sedation at 15 and 20 minutes; sedation was adequate for positioning the geese. Sedation induced by the 1.0 mg/kg dosage was inadequate. The effects of both test doses on blood pressure, heart rate, and temperature were not significantly different from each other and from baseline data. Respiratory rate increased significantly (P < 0.05) at 10, 15, 20, and 30 minutes with the 2.0 mg/kg dosage, and at 15 and 20 minutes with the 1.0 mg/kg dosage. Blood pressure and respiratory rate were significantly (P < 0.05) decreased with isoflurane when compared with baseline data and the midazolam test doses. The results of this study indicate that midazolam at a dosage of 2.0 mg/kg induces adequate sedation with minimal cardiopulmonary changes, and, as an alternative to general anesthesia with isoflurane, provides a satisfactory level of restraint for radiography.
Abstract
Objective—To compare cardiac output (CO) measured by lithium arterial pressure waveform analysis (PULSECO) and CO measured by transpulmonary pulse contour analysis (PICCO) in anesthetized foals, with CO measured by use of lithium dilution (LIDCO) considered the criterion-referenced standard.
Sample Population—6 neonatal (1- to 4-day-old) foals that weighed 38 to 45 kg.
Procedures—Foals were anesthetized and instrumented to measure direct blood pressure, heart rate, arterial blood gases, and CO. The CO was measured by use of PULSECO, PICCO, and LIDCO techniques. Measurements were converted to specific CO (sCO) values for statistical analysis. Measurements were obtained during low, intermediate, and high CO states.
Results—sCO ranged from 75.5 to 310 mL/kg/min. Mean ± SD PICCO bias varied significantly among CO states and was −51.9 ± 23.1 mL/kg/min, 20.0 ± 19.5 mL/kg/min, and 87.2 ± 19.5 mL/kg/min at low, intermediate, and high CO states, respectively. Mean PULSECO bias (11.0 ± 37.5 mL/kg/min) was significantly lower than that of PICCO and did not vary among CO states. Concordance correlation coefficient between LIDCO and PULSECO was significantly greater than that between LIDCO and PICCO. The proportion of observations with a relative bias < ± 30% was significantly lower with the PULSECO method than with the PICCO method.
Conclusions and Clinical Relevance—Values for the PULSECO method were more reproducible and agreed better with values for the LIDCO method than did values for the PICCO method and were able to more accurately monitor changes in CO in anesthetized newborn foals.
Abstract
OBJECTIVE To evaluate effects of pneumoperitoneum created with warmed humidified CO2 (WHCO2) during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs.
ANIMALS 6 mature purpose-bred dogs.
PROCEDURES In a randomized crossover study, each dog was anesthetized twice, and pneumoperitoneum was created with standard-temperature CO2 (STCO2; 22°C and 0% relative humidity) and WHCO2 (37°C and 98% relative humidity). Data were collected during each procedure, including core body temperature, cardiorespiratory and thromboelastography variables, and inflammatory biomarkers. Peritoneal biopsy specimens were collected and evaluated with scanning electron microscopy. Dogs were assessed for signs of postoperative pain.
RESULTS Mean core body temperature was significantly lower (35.2°C; 95% confidence interval, 34.5° to 35.8°C) with WHCO2 than with STCO2 (35.9°C; 95% confidence interval, 35.3° to 36.6°C) across all time points. Cardiac index increased during the procedure for both treatments but was not significantly different between treatments. Thromboelastography variables did not differ significantly between treatments as indicated by the coagulation index. Subjective evaluation of peritoneal biopsy specimens revealed mesothelial cell loss with STCO2. There was no significant difference in circulating C-reactive protein or interleukin-6 concentrations. There was a significant increase in the number of postoperative pain scores > 0 for the WHCO2 treatment versus the STCO2 treatment.
CONCLUSIONS AND CLINICAL RELEVANCE Analysis of these data suggested that effects on evaluated variables attributable to the use of WHCO2 for creating pneumoperitoneum in healthy mature dogs undergoing laparoscopy did not differ from effects for the use of STCO2.
Abstract
Objective—To evaluate the effects of increasing doses of remifentanil hydrochloride administered via constant rate infusion (CRI) on the minimum alveolar concentration (MAC) of isoflurane in cats.
Animals—6 healthy adult cats.
Procedures—For each cat, 2 experiments were performed (2-week interval). On each study day, anesthesia was induced and maintained with isoflurane; a catheter was placed in a cephalic vein for the administration of lactated Ringer's solution or remifentanil CRIs, and a catheter was placed in the jugular vein for collection of blood samples for blood gas analyses. On the first study day, individual basal MAC (MACBasal) was determined for each cat. On the second study day, 3 remifentanil CRIs (0.25, 0.5, and 1.0 μg/kg/min) were administered (in ascending order); for each infusion, at least 30 minutes elapsed before determination of MAC (designated as MACR0.25, MACR0.5, and MACR1.0, respectively). A 15-minute washout period was allowed between CRIs. A control MAC (MACControl) was determined after the last remifentanil infusion.
Results—Mean ± SD MACBasal and MACControl values at sea level did not differ significantly (1.66 ± 0.08% and 1.52 ± 0.21%, respectively). The MAC values determined for each remifentanil CRI did not differ significantly. However, MACR0.25, MACR0.5, and MACR1.0 were significantly decreased, compared with MACBasal, by 23.4 ± 7.9%, 29.8 ± 8.3%, and 26.0 ± 9.4%, respectively.
Conclusions and Clinical Relevance—The 3 doses of remifentanil administered via CRI resulted in a similar degree of isoflurane MAC reduction in adult cats, indicating that a ceiling effect was achieved following administration of the lowest dose.
Abstract
Objective—To determine the effects of dobutamine, norepinephrine, and vasopressin on cardiovascular function and gastric mucosal perfusion in anesthetized foals during isoflurane-induced hypotension.
Animals—6 foals that were 1 to 5 days of age.
Procedures—6 foals received 3 vasoactive drugs with at least 24 hours between treatments. Treatments consisted of dobutamine (4 and 8 μg/kg/min), norepinephrine (0.3 and 1.0 μg/kg/min), and vasopressin (0.3 and 1.0 mU/kg/min) administered IV. Foals were maintained at a steady hypotensive state induced by a deep level of isoflurane anesthesia for 30 minutes, and baseline cardiorespiratory variables were recorded. Vasoactive drugs were administered at the low infusion rate for 15 minutes, and cardiorespiratory variables were recorded. Drugs were then administered at the high infusion rate for 15 minutes, and cardiorespiratory variables were recorded a third time. Gastric mucosal perfusion was measured by tonometry at the same time points.
Results—Dobutamine and norepinephrine administration improved cardiac index. Vascular resistance was increased by norepinephrine and vasopressin administration but decreased by dobutamine at the high infusion rate. Blood pressure was increased by all treatments but was significantly higher during the high infusion rate of norepinephrine. Oxygen delivery was significantly increased by norepinephrine and dobutamine administration; O2 consumption decreased with dobutamine. The O2 extraction ratio was decreased following norepinephrine and dobutamine treatments. The gastric to arterial CO2gap was significantly increased during administration of vasopressin at the high infusion rate.
Conclusion and Clinical Relevance—Norepinephrine and dobutamine are better alternatives than vasopressin for restoring cardiovascular function and maintaining splanchnic circulation during isofluraneinduced hypotension in neonatal foals.
Abstract
Objective—To determine the effectiveness and safety of 2 sedative-analgesic protocols to facilitate assisted ventilation in healthy dogs.
Animals—12 healthy dogs.
Procedures—Dogs were randomly assigned to 2 groups. Mean dosages for protocol 1 were diazepam (0.5 mg/kg/h [n = 3 dogs]) or midazolam (0.5 mg/kg/h [3]), morphine (0.6 mg/kg/h [6]), and medetomidine (1.0 μg/kg/h [6]). Mean dosages for protocol 2 were diazepam (0.5 mg/kg/h [n = 3]) or midazolam (0.5 mg/kg/h [3]), fentanyl (18 μg/kg/h [6]), and propofol (2.5 mg/kg/h [6]). Each dog received the drugs for 24 consecutive hours. All dogs were mechanically ventilated with adjustments in minute volume to maintain normocapnia and normoxemia. Cardiorespiratory variables were recorded. A numeric comfort score was assigned hourly to assess efficacy. Mouth care, position change, and physiotherapy were performed every 6 hours. Urine output was measured every 4 hours.
Results—Use of both protocols maintained dogs within optimal comfort ranges > 85% of the time. The first dog in each group was excluded from the study. Significant decreases in heart rate, oxygen consumption, and oxygen extraction ratio were evident for protocol 1. Cardiac index values in ventilated dogs were lower than values reported for healthy unsedated dogs. Oxygen delivery, lactate concentration, and arterial base excess remained within reference ranges for both protocols.
Conclusions and Clinical Relevance—Use of both protocols was effective for facilitating mechanical ventilation. A reduction in cardiac index was detected for both protocols as a result of bradycardia. However, oxygen delivery and global tissue perfusion were not negatively affected.
Abstract
Objective—To compare 3 types of noxious stimuli applied to various anatomic areas of anesthetized dogs and rabbits for determination of the minimum alveolar concentration (MAC).
Animals—10 dogs and 10 rabbits.
Procedure—Dogs were anesthetized with isoflurane and halothane in a randomized order. Rabbits were anesthetized with isoflurane. The MAC was determined by skin incision on the lateral aspect of the chest; clamping of the tail, paw of the forelimb, and paw of the hind limb; and application of electrical current to the oral mucosa (dogs only), forelimb, and hind limb. The MAC was the end-tidal concentration midway between the value permitting and preventing purposeful movement in response to noxious stimuli.
Results—In dogs, mean ± SEM MAC for isoflurane was 1.27 ± 0.05% for clamping stimuli, 1.36 ± 0.04% for oral electrical stimulation, 1.35 ± 0.04% for electrical stimulation to the limbs, and 1.01 ± 0.07% for surgical incision. The MAC for halothane was 0.97 ± 0.03% for tail clamping, 0.96 ± 0.03% for clamping of the limbs, 1.04 ± 0.03% for electrical stimulation, and 0.75 ± 0.06% for surgical incision. In rabbits, MAC for isoflurane was 2.08 ± 0.02% for clamping stimuli, 2.04 ± 0.02% for electrical stimulation, and 0.90 ± 0.02% for surgical incision. The MAC for surgical incision was significantly lower than values for the other methods in both species.
Conclusions and Clinical Relevance—Use of electrical current and clamping techniques resulted in similar MAC values. Surgical incision underestimated MAC values in dogs and rabbits. (Am J Vet Res 2003;64:957–962)