CASE DESCRIPTION A 14-year-old spayed female American Cocker Spaniel with bilateral otitis media and no evidence of cardiovascular instability was anesthetized to allow performance of a deep ear flush.
CLINICAL FINDINGS Otoscopic examination of the left ear revealed evidence of chronic inflammation; the ear was flushed with sterile saline (0.9% NaCl) solution. Examination of the right ear revealed more severe chronic inflammation than in the left ear, including a ruptured tympanum (timing of rupture unknown). The right ear was flushed with sterile saline solution, and several drops of otic medication were instilled. During infusion of saline solution, the ECG revealed a rapid decrease in heart rate until no more electrical activity was noted. Pulse also ceased to be detectable via pulse oximetry and femoral artery palpation.
TREATMENT AND OUTCOME Isoflurane was discontinued immediately after recognition of cardiac arrest. Shortly after, atropine (0.04 mg/kg [0.02 mg/lb]) and epinephrine (0.3 mg/kg [0.14 mg/lb]) were administered IV, chest compressions and ventilation were performed for 2 to 3 minutes, and 3 boluses (each 5 mL/kg) of lactated Ringer solution were administered IV. The dog was extubated 8 minutes after anesthesia was discontinued, and its recovery was monitored for the next 5 hours. No further incidents of cardiac arrest occurred after recovery from anesthesia.
CLINICAL RELEVANCE This case represented a rarely documented potential complication associated with otic manipulation in a dog: cardiac arrest secondary to stimulation of the auricular branch of the vagus nerve. Veterinarians should be prepared for and warn clients of this possibility prior to otic flushing.
OBJECTIVE To evaluate the use of a modified passive leg-raising maneuver (PLRM) to predict fluid responsiveness during experimental induction and correction of hypovolemia in isoflurane-anesthetized pigs.
ANIMALS 6 healthy male Landrace pigs.
PROCEDURES Pigs were anesthetized with isoflurane, positioned in dorsal recumbency, and instrumented. Following induction of a neuromuscular blockade, pigs were mechanically ventilated throughout 5 sequential experimental stages during which the blood volume was manipulated so that subjects transitioned from normovolemia (baseline) to hypovolemia (blood volume depletion, 20% and 40%), back to normovolemia, and then to hypervolemia. During each stage, hemodynamic variables were measured before and 3 minutes after a PLRM and 1 minute after the pelvic limbs were returned to their original position. The PLRM consisted of raising the pelvic limbs and caudal portion of the abdomen to a 15° angle relative to the horizontal plane.
RESULTS Hemodynamic variables did not vary in response to the PLRM when pigs were normovolemic or hypervolemic. When pigs were hypovolemic, the PLRM resulted in a significant increase in cardiac output and decrease in plethysomographic variability index and pulse pressure variation. When the pelvic limbs were returned to their original position, cardiac output and pulse pressure variation rapidly returned to their pre-PLRM values, but the plethysomographic variability index did not.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested a modified PLRM might be useful for identification of hemodynamically unstable animals that are likely to respond to fluid therapy. Further research is necessary to validate the described PLRM for prediction of fluid responsiveness in clinically ill animals.
OBJECTIVE To compare cardiac output (CO) measured by use of CT coronary angiography and thermodilution (criterion-referenced standard) at various CO values, record adverse effects, and determine the time needed to measure CO.
ANIMALS 5 healthy purpose-bred Beagles (2 males and 3 females).
PROCEDURES A prospective nonrandomized crossover study was conducted. Dogs were premedicated with butorphanol tartrate (0.2 mg•kg−1, IM). Anesthesia was induced by IV administration of etomidate (1 to 2 mg•kg−1) and midazolam (0.25 mg•kg−1). Orotracheal intubation was performed, and anesthesia was maintained by administration of isoflurane. The CO was determined by use of thermodilution and by use of CT at 3 CO values. Dobutamine was infused at various rates to obtain the 3 CO values.
RESULTS 13 values were obtained and analyzed. The mean ± SD difference between methods was 0.09 ± 0.71 L•min−1 (95% confidence interval [CI], 0.52 to −0.34 L•min−1). Only 1 of 13 values was located on the 100% agreement line (ie, 0 line), 7 of 13 values were located within the 95% CI, and 5 of 13 values were outside the 95% CI.
CONCLUSIONS AND CLINICAL RELEVANCE For this study, there was poor agreement between the 2 methods. The 95% CI interval was 0.52 to −0.34 L•min−1, and 5 of 13 values were outside the 95% CI. Therefore, results for the CT method appeared to be inappropriate for use in making clinical decisions.
OBJECTIVE To evaluate the potential usefulness of epiduroscopy for clinical diagnosis and treatment of vertebral canal and spinal cord lesions in dogs.
SAMPLE Cadavers of 6 mixed-breed dogs.
PROCEDURES Dogs were positioned in sternal recumbency, and an endoscope was introduced into the lumbosacral epidural space. A fiberscope (diameter, 0.9 mm; length, 30 cm) was used for 3 dogs, and a videoscope (diameter, 2.8 mm; length, 70 cm) was used for the other 3 dogs. Visibility and identities of anatomic structures were recorded, and maneuverability of the endoscopes was assessed. Extent of macroscopic tissue damage was evaluated by manual dissection of the vertebral canal at the end of the procedure.
RESULTS Intermittent saline (0.9% NaCl) solution infusion, CO2 insufflation, and endoscope navigation improved visualization by separating the epidural fat from the anatomic structures of interest. Images obtained with the fiberscope were small and of poor quality, making identification of specific structures difficult. Maneuverability of the fiberscope was difficult, and target structures could not be reliably reached or identified. Maneuverability and image quality of the videoscope were superior, and spinal nerve roots, spinal dura mater, epidural fat, and blood vessels could be identified. Subsequent manual dissection of the vertebral canal revealed no gross damage in the spinal cord, nerve roots, or blood vessels.
CONCLUSIONS AND CLINICAL RELEVANCE A 2.8-mm videoscope was successfully used to perform epiduroscopy through the lumbosacral space in canine cadavers. Additional refinement and evaluation of the technique in live dogs is necessary before its use can be recommended for clinical situations.
To compare cardiac output (CO) measurements by transesophageal echocardiography (TEECO) and esophageal Doppler monitor (EDMCO) with pulmonary artery thermodilution (PATDCO) in anesthetized dogs subjected to pharmacological interventions. The effect of treatments on EDM-derived indexes was also investigated.
6 healthy male dogs (10.8 ± 0.7 kg).
Dogs were anesthetized with propofol and isoflurane, mechanically ventilated, and monitored with invasive mean arterial pressure (MAP), end-tidal isoflurane concentration (ETISO), PATDCO, TEECO, EDMCO, and EDM-derived indexes. Four treatments were administered to all dogs by randomization. Baseline data were collected before each treatment: (1) dobutamine infusion; (2) esmolol infusion; (3) phenylephrine infusion; and (4) ETISO > 3%. Data were collected after 10-minute stabilization and after 30 minutes of washout between treatments. Statistical tests were pairwise t test, Bland-Altman analysis, Lin's concordance correlation (ρc), and polar plot analysis with P < .05 set as significance.
The mean ± SD relative bias (limits of agreement) for TEECO was 0.35 ± 25.2% (−49.1% to 49.8%) and for EDMCO was −27.2 ± 22.5% (−71.4% to 17%) versus PATDCO. The percent error for TEECO and EDMCO was 27.6% and 44.1%, respectively. The ρc value was 0.82 for TEECO and 0.66 for EDMCO. TEECO and EDMCO showed good trending ability. EDM-derived indexes displayed significant changes specific to the drug administered (P < .001).
For minimally invasive CO monitoring, TEE may provide more favorable performance than EDM in clinical settings; however, EDM-derived indexes yield valuable hemodynamic information that reliably follows trends in CO, thus supporting critical decision-making in canine patients.
Objective—To determine the minimal electric threshold (MET) of neurostimulation in and out of the lumbosacral epidural space necessary to cause muscle contraction of the hind limb or tail, determine an MET cutoff value that indicates epidural needle placement, and compare predictability of epidural needle placement attained by use of neurostimulation versus the standard technique that uses loss of resistance in dogs.
Animals—96 healthy Beagles.
Procedures—Dogs received nonionic contrast medium (90 mg/kg) either in or out of the epidural space. Correct placement of the needle was evaluated by use of neurostimulation and loss of resistance of injection and confirmed by use of epidurography.
Results—With the neurostimulator test, MET was significantly lower in dogs with needle placement in the epidural space (mean ± SEM, 0.30 ± 0.07 mA) than those with needle placement out of the epidural space (1.2 ± 0.13 mA). When an electric current cutoff of ≤ 0.28 mA for the neurostimulator test was used to suggest correct needle placement in the lumbosacral epidural space, sensitivity and specificity were 74% and 93%, respectively. The loss of resistance test had sensitivity of 63% and specificity of 90%. The combination of both tests yielded a sensitivity of 89% and specificity of 83%.
Conclusions and Clinical Relevance—Neurostimulation is a useful tool to suggest correct lumbosacral epidural needle placement in dogs.
To evaluate cardiac output (CO) measurements using transpulmonary ultrasound (TPUD) technology and compare results with those of the gold standard, pulmonary arterial catheter thermodilution (PACTD), in 6 healthy anesthetized pigs during acute hemodynamic changes caused by manipulation of the blood volume.
6 healthy male Landrace pigs.
Over a period of 1 week, pigs were anesthetized with isoflurane, mechanically ventilated, and underwent instrumentation in dorsal recumbency. They were subjected to sequential experimental states during which the blood volume was manipulated so that the animals transitioned from normovolemia to hypovolemia (20% and 40% of blood volume depletion), back to normovolemia (autologous blood transfusion), and then to hypervolemia (following colloid bolus). During each volume state, CO measurements were compared between TPUD and PACTD.
The mean ± SD relative bias between TPUD and PACTD was 7.71% ± 21.2% with limits of agreement –33.9% to 49.3%, indicating TPUD slightly underestimated CO values, compared with values obtained with PACTD. The mean ± SD of the bias between the 2 methods was 0.13 ± 0.5 L/min. Only 5 of 36 (13.9%) TPUD CO measurements had an absolute value of relative bias > 30%. The percentage error calculated for TPUD was 29.4%.
Results suggested that TPUD measurements have acceptable agreement with PACTD measurements. Moreover, TPUD exhibits promising potential in being used interchangeably with PACTD for future hemodynamic research involving swine as species of interest.
OBJECTIVE To evaluate the feasibility of laparoscopy versus exploratory laparotomy for the diagnosis of specific lesions in dogs with suspected gastrointestinal obstruction.
DESIGN Controlled trial.
ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with gastrointestinal obstruction.
PROCEDURES Single-incision laparoscopy with intracorporeal and extracorporeal examination of the gastrointestinal tract was performed by 1 surgeon. Immediately afterward, exploratory laparotomy was performed by a second surgeon. Accessibility and gross appearance of organs, surgical diagnoses, incision lengths, procedure duration, and complications were compared between diagnostic techniques.
RESULTS Mean (95% confidence interval) incision length was 4.9 cm (3.9 to 5.9 cm) for laparoscopy and 16.4 cm (14.0 to 18.7 cm) for exploratory laparotomy. Mean (95% confidence interval) procedure duration was 36.8 minutes (31.6 to 41.2 minutes) and 12.8 minutes (11.4 to 14.3 minutes), respectively. Diagnoses of the cause of obstruction were the same with both methods. In 13 dogs, the laparoscopic examination was successfully completed, and in the other 3, it was incomplete. In 4 dogs in which laparoscopy was successful, conversion to exploratory laparotomy or considerable extension of the laparoscopic incision would have been required to allow subsequent surgical treatment of identified lesions. No dogs developed major complications, and minor complication rates were similar between procedures.
CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopy was feasible and clinically applicable in dogs with suspected gastrointestinal obstruction. Careful patient selection and liberal criteria for conversion to an open surgical approach are recommended when laparoscopy is considered for the diagnosis of gastrointestinal lesions in dogs.
Objective—To evaluate effects of commonly used anesthetics administered as single bolus injections on splenic volume.
Animals—10 adult Beagles.
Procedures—A randomized crossover study was conducted. Computed tomography was performed on dogs to determine baseline splenic volume and changes after IV injection of assigned drug treatments. Dogs were allowed to acclimate for 10 minutes in a plastic crate before acquisition of abdominal CT images. Treatments were administered at 7-day intervals and consisted of IV administration of saline (0.9% NaCl) solution (5 mL), acepromazine maleate (0.03 mg/kg), hydromorphone (0.1 mg/kg), and dexmedetomidine (0.005 mg/kg) to all 10 dogs; thiopental (8 mg/kg) to 5 of the dogs; and propofol (5 mg/kg) to the other 5 dogs. Splenic volume was calculated from the CT images with image processing software. A repeated-measures ANOVA was performed, followed by a Bonferroni post hoc test.
Results—No significant difference in splenic volume was detected between the acepromazine, propofol, and thiopental treatments, but splenic volume was greater with these drugs than with saline solution, hydromorphone, and dexmedetomidine. Splenic volume was less with hydromorphone, compared with dexmedetomidine, but splenic volume with hydromorphone and dexmedetomidine did not differ significantly from that with saline solution.
Conclusions and Clinical Relevance—Administration of acepromazine, thiopental, and propofol resulted in splenomegaly. Dexmedetomidine did not alter splenic volume. Hydromorphone slightly decreased splenic volume. Propofol should not be used when splenomegaly is not desirable, whereas hydromorphone and dexmedetomidine may be used when it is best to avoid splenic enlargement.
OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter.
ANIMALS 6 healthy male large-breed dogs.
PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours.
RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery.
CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.