Objective—To evaluate pulmonary and cardiovascular effects of a recruitment maneuver (RM) combined with positive end-expiratory pressure (PEEP) during total intravenous anesthesia in ponies.
Animals—6 healthy adult Shetland ponies.
Procedure—After premedication with detomidine (10 μg/kg, IV), anesthesia was induced with climazolam (0.06 mg/kg, IV) and ketamine (2.2 mg/kg, IV) and maintained with a constant rate infusion of detomidine (0.024 mg/kg/h), climazolam (0.036 mg/kg/h), and ketamine (2.4 mg/kg/h). The RM was preceded by an incremental PEEP titration and followed by a decremental PEEP titration, both at a constant airway pressure difference ([.Delta]P) of 20 cm H2O. The RM consisted of a stepwise increase in [.Delta]P by 25, 30, and 35 cm H2O obtained by increasing peak inspiratory pressure (PIP) to 45, 50, and 55 cm H2O, while maintaining PEEP at 20 cm H2O. Hemodynamic and pulmonary variables were analyzed at every step of the PEEP titration–RM.
Results—During the PEEP titration–RM, there was a significant increase in PaO 2 (+12%), dynamic compliance (+ 62%), and heart rate (+17%) and a decrease in shunt (-19%) and mean arterial blood pressure (-21%) was recorded. Cardiac output remained stable.
Conclusions and Clinical Relevance—Although baseline oxygenation was high, PaO 2 and dynamic compliance further increased during the RM. Despite the use of high PIP and PEEP and a high tidal volume, limited cardiovascular compromise was detected. A PEEP titration–RM may be used to improve oxygenation in anesthetized ponies. During stable hemodynamic conditions, PEEP titration–RM can be performed with acceptable adverse cardiovascular effects.
Objective—To determine whether inhaled nitric oxide
(NO) prevents pulmonary hypertension and improves
oxygenation after IV administration of a bolus of
dexmedetomidine in anesthetized sheep.
Animals—6 healthy adult sheep.
Procedure—In a crossover study, sevoflurane-anesthetized
sheep received dexmedetomidine (2 µg/kg,
IV) without NO (DEX treatment) or with inhaled NO
(DEX-NO treatment). Cardiopulmonary variables,
including respiratory mechanics, were measured
before and for 120 minutes after bolus injection of
Results—Dexmedetomidine induced a transient
decrease in heart rate and cardiac output. A short-lived
increase in mean arterial pressure (MAP) and
systemic vascular resistance (SVR) was followed by a
significant decrease in MAP and SVR for 90 minutes.
Mean pulmonary arterial pressure (MPAP) and pulmonary
vascular resistance increased transiently after
dexmedetomidine injection. The PaO2 was significantly
decreased 3 minutes after injection and reached a
minimum of (mean ± SEM) 13.3 ± 7.8 kPa 10 minutes
after injection. The decrease in PaO2 was accompanied
by a sudden and prolonged decrease in dynamic
compliance and a significant increase in airway resistance,
shunt fraction, and alveolar dead space. Peak
changes in MPAP did not differ between the 2 treatments.
For the DEX-NO treatment, PaO2 was significantly
lower and the shunt fraction significantly higher
than for the DEX treatment.
Conclusions and Clinical Relevance—Inhalation of
NO did not prevent increases in pulmonary arterial
pressures induced by IV administration of
dexmedetomidine. Preemptive inhalation of NO
intensified oxygenation impairment, probably through
increases in intrapulmonary shunting. (Am J Vet Res
Objective—To evaluate the use of a micro-lightguide tissue spectrophotometer for measurement of tissue oxygenation and blood flow in the small and large intestines of horses under anesthesia.
Animals—13 adult horses without gastrointestinal disease.
Procedures—Horses were anesthetized and placed in dorsal recumbency. Ventral midline laparotomy was performed. Intestinal segments were exteriorized to obtain measurements. Spectrophotometric measurements of tissue oxygenation and regional blood flow of the jejunum and pelvic flexure were obtained under various conditions that were considered to have a potential effect on measurement accuracy. In addition, arterial oxygen saturation at the measuring sites was determined by use of pulse oximetry.
Results—12,791 single measurements of oxygen saturation, relative amount of hemoglobin, and blood flow were obtained. Errors occurred in 381 of 12,791 (2.98%) measurements. Most measurement errors occurred when surgical lights were directed at the measuring site; covering the probe with the surgeon's hand did not eliminate this error source. No measurement errors were observed when the probe was positioned on the intestinal wall with room light, at the mesenteric side, or between the mesenteric and antimesenteric side. Values for blood flow had higher variability, and this was most likely caused by motion artifacts of the intestines.
Conclusions and Clinical Relevance—The micro-lightguide spectrophotometry system was easy to use on the small and large intestines of horses and provided rapid evaluation of the microcirculation. Results indicated that measurements should be performed with room light only and intestinal motion should be minimized.
Objective—To evaluate the influence of 3 anesthetic protocols and multiples of minimum alveolar concentration (MAC) on heart rate variability (HRV) with and without nociceptive stimulation in dogs.
Animals—6 healthy adult Beagles.
Procedures—Each dog was anesthetized 3 times: with isoflurane alone, with isoflurane and a constant rate infusion of dexmedetomidine (IsoD; 3 μg/kg/h, IV), and with isoflurane and a constant rate infusion of remifentanil (IsoR; 18 μg/kg/h, IV). Individual MAC was determined via supramaximal electrical stimulation. Sinus rhythm–derived intervals between 2 adjacent R-R intervals were exported from ECG recordings. Selected HRV time and frequency domain variables were obtained (at 2-minute intervals) and analyzed offline with signed rank tests before and after stimulation at 0.75, 1.0, and 1. 5 MAC for each anesthetic session.
Results—The isoflurane session had the overall lowest prestimulation SDNN (SD of all R-R intervals) values. Prestimulation SDNN values decreased significantly with increasing MAC in all sessions. For the IsoD session, SDNN (milliseconds) or high-frequency power (milliseconds2) was inversely correlated with MAC (Spearman rank correlation coefficient for both variables, −0.77). In the isoflurane and IsoR sessions, heart rate increased significantly after stimulation. In the IsoD session, poststimulation SDNN was increased significantly, compared with prestimulation values, at 0.75 and 1.0 MAC.
Conclusions and Clinical Relevance—On the basis of SDNN and high-frequency power values, anesthetic levels between 0.75 and 1.5 MAC within the same anesthetic protocol could be differentiated, but with a large overlap among protocols. Usefulness of standard HRV variables for assessment of anesthetic depth and nociception in dogs is questionable.
OBJECTIVE To determine global and peripheral perfusion and oxygenation during anesthesia with equipotent doses of desflurane and propofol combined with a constant rate infusion of dexmedetomidine in horses.
ANIMALS 6 warmblood horses.
PROCEDURES Horses were premedicated with dexmedetomidine (3.5 μg•kg−1, IV). Anesthesia was induced with propofol or ketamine and maintained with desflurane or propofol (complete crossover design) combined with a constant rate infusion of dexmedetomidine (7 μg•kg−1 •h−1). Microperfusion and oxygenation of the rectal, oral, and esophageal mucosa were measured before and after sedation and during anesthesia at the minimal alveolar concentration and minimal infusion rate. Heart rate, mean arterial blood pressure, respiratory rate, cardiac output, and blood gas pressures were recorded during anesthesia.
RESULTS Mean ± SD minimal alveolar concentration and minimal infusion rate were 2.6 ± 0.9% and 0.04 ± 0.01 mg•kg−1 •min−1, respectively. Peripheral microperfusion and oxygenation decreased significantly after dexmedetomidine administration for both treatments. Oxygenation returned to baseline values, whereas tissue microperfusion remained low during anesthesia. There were no differences in peripheral tissue microperfusion and oxygenation between treatments. Cardiac index was significantly higher and systemic vascular resistance was significantly lower for desflurane treatment than for propofol treatment. For the propofol treatment, Pao2 was significantly higher and there was less dead space and venous admixture than for the desflurane treatment.
CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine decreased blood flow and oxygen saturation in peripheral tissues. Peripheral tissues were well oxygenated during anesthesia with desflurane and propofol combined with dexmedetomidine, whereas blood flow was reduced.
Objective—To evaluate the influence of various anesthetic protocols and 3 multiples of isoflurane minimum alveolar concentration (MAC) before and after supramaximal stimulation on electroencephalographic (EEG) variables in dogs.
Procedures—All dogs underwent 3 anesthesia sessions with a minimum of 1 week separating sessions: isoflurane alone, isoflurane and a constant rate infusion of dexmedetomidine (3 μg/kg/h, IV; ID), and isoflurane and a constant rate infusion of remifentanil (18 μg/kg/h, IV; IR). The MAC of isoflurane was determined via supramaximal electrical stimulation. Quantitative variables (frequency bands and their ratios, median frequency, 95% spectral edge frequency [SEF], and an EEG index) were determined directly before and after supramaximal stimulation at 0.75, 1.0, and 1.5 times the MAC for each session of 20-second epochs.
Results—Mean ± SD isoflurane MACs for isoflurane alone, ID, and IR were 1.7 ± 0.3%, 1.0 ± 0.1%, and 1.0 ± 0.1%, respectively. Prestimulation 95% SEF decreased significantly with increasing MAC during the isoflurane alone and ID sessions. Significant decreases in δ frequency band (0.5 to 3.5 Hz) presence and significant increases in β frequency band (> 12.5 Hz) presence, median frequency, and 95% SEF after stimulation were dependent on the MAC and anesthetic protocol. The EEG index had the strongest correlation with increasing MAC during the isoflurane-alone session (ρ = −0.89) and the least in the IR session (ρ = −0.15).
Conclusions and Clinical Relevance—Anesthesia with isoflurane alone resulted in the greatest overall EEG depression of all protocols. Use of remifentanil depressed the EEG response to nociceptive stimulation more strongly than did dexmedetomidine. The EEG variables evaluated did not appear useful when used alone as indicators of anesthetic depth in dogs.