A framework for assessing confidence in freedom from infection in animal disease control programmes.

In the Surveillance Tool for Outcome-based Comparison of FREEdom from infection (STOC free) project (https://www.stocfree.eu), a data collection tool was constructed to facilitate standardised collection of input data, and a model was developed to allow a standardised and harmonised comparison of the outputs of different control programmes (CPs) for cattle diseases. The STOC free model can be used to evaluate the probability of freedom from infection for herds in CPs and to determine whether these CPs comply with the European Union's pre-defined output-based standards. Bovine viral diarrhoea virus (BVDV) was chosen as the case disease for this project because of the diversity in CPs in the six participating countries. Detailed BVDV CP and risk factor information was collected using the data collection tool. For inclusion of the data in the STOC free model, key aspects and default values were quantified. A Bayesian hidden Markov model was deemed appropriate, and a model was developed for BVDV CPs. The model was tested and validated using real BVDV CP data from partner countries, and corresponding computer code was made publicly available. The STOC free model focuses on herd-level data, although that animal-level data can be included after aggregation to herd level. The STOC free model is applicable to diseases that are endemic, given that it needs the presence of some infection to estimate parameters and enable convergence. In countries where infection-free status has been achieved, a scenario tree model could be a better suited tool. Further work is recommended to generalise the STOC free model to other diseases.

Dans le cadre du projet européen STOC free (Surveillance Tool for Outcome-based Comparison of FREEdom from infection, outil de surveillance permettant de comparer les probabilités d'absence d'infection sur la base des résultats, https://www.stocfree.eu), un outil de recueil des données a été construit pour faciliter une collecte normalisée des données d'entrée ; un modèle a également été élaboré pour permettre une comparaison normalisée et harmonisée des données sur les résultats des différents programmes de contrôle des maladies des bovins. Le modèle STOC free peut être utilisé pour évaluer la probabilité d'absence d'infection au sein des troupeaux dans le cadre des programmes de contrôle et déterminer si ces programmes sont conformes aux normes définies par l'Union européenne en termes de résultats attendus. L'infection par le virus de la diarrhée virale bovine a été choisie comme maladie d'étude pour ce projet en raison de la diversité des programmes de contrôle dans les six pays participants. Les informations relatives aux programmes de contrôle et aux facteurs de risque d'infection ont été recueillies à l'aide de l'outil de collecte des données. Les aspects clés et valeurs par défaut ont été quantifiés en vue d'être inclus dans le modèle STOC free. Un modèle de Markov caché dont les paramètres sont estimés par inférence bayésienne a été considéré comme le plus adapté et développé pour une application aux données issues des programmes de contrôle de la diarrhée virale bovine. Ce modèle a été testé et validé en utilisant des données réelles des programmes de contrôle du virus de la diarrhée virale bovine des pays participants ; le code informatique correspondant a été rendu public. Le modèle STOC free utilise des données au niveau des troupeaux, même si des données au niveau des animaux individuels peuvent être incluses une fois agrégées au niveau du troupeau. Le modèle STOC free s'applique aux maladies endémiques, puisqu'un certain niveau de présence de l'infection est nécessaire pour estimer les paramètres et permettre la convergence. Dans les pays ayant obtenu le statut indemne d'infection, un modèle du type arbre de scénario pourrait être un outil plus adapté. Des travaux supplémentaires sont recommandés pour généraliser le modèle STOC free à d'autres maladies.

Como parte del proyecto europeo STOC free (Surveillance Tool for Outcome-based Comparison of FREEdom from infection, herramienta de vigilancia para comparaciones por resultados respecto a la ausencia de infecciones, https://www.stocfree.eu), se confeccionó una herramienta de obtención de datos para facilitar la recogida normalizada de datos entrantes y se elaboró un modelo que posibilitara una comparación normalizada y armonizada de los resultados (datos salientes) de distintos programas de control de enfermedades bovinas. El modelo STOC free puede servir para calcular la probabilidad de ausencia de infección en los rebaños como parte de los programas de control y para determinar si estos programas se ajustan a las normas predefinidas de resultados de la Unión Europea. Como ejemplo de estudio para el proyecto se eligió el virus de la diarrea viral bovina (virus DVB) por la diversidad que presentaban los correspondientes programas de control de los seis países participantes. Empleando la herramienta de obtención de datos, se reunió información pormenorizada de los programas de control del virus DVB y los factores de riesgo. Para incluir los datos en el modelo STOC free, se cifraron unos aspectos clave y valores predeterminados Juzgando conveniente el empleo de un modelo oculto de Markov cuyos parámetros se estiman por inferencia bayesiana, se elaboró un modelo de esta índole aplicable a los programas de control del virus DVB. Para ensayar y validar el modelo se utilizaron datos reales de los programas de control del virus DVB de los países participantes, tras lo cual se hizo público el correspondiente código informático. El modelo STOC free trabaja con los datos por rebaño, aunque tras la agregación por rebaños pueden incluirse también datos por individuo. Para que este modelo sea aplicable a una enfermedad es preciso que esta sea endémica, pues el modelo requiere la presencia de cierto nivel de infección para calcular los parámetros y determinar convergencias. En aquellos países donde ya esté reconocida la ausencia de infección, sería más apropiado utilizar como herramienta un modelo de árbol de hipótesis. Los autores recomiendan ahondar en esta línea de trabajo para poder extender a otras enfermedades el uso del modelo STOC free.

Output-based assessment of herd-level freedom from infection in endemic situations: Application of a Bayesian Hidden Markov model.

Countries have implemented control programmes (CPs) for cattle diseases such as bovine viral diarrhoea virus (BVDV) that are tailored to each country-specific situation. Practical methods are needed to assess the output of these CPs in terms of the confidence of freedom from infection that is achieved. As part of the STOC free project, a Bayesian Hidden Markov model was developed, called STOC free model, to estimate the probability of infection at herd-level. In the current study, the STOC free model was applied to BVDV field data in four study regions, from CPs based on ear notch samples. The aim of this study was to estimate the probability of herd-level freedom from BVDV in regions that are not (yet) free. We additionally evaluated the sensitivity of the parameter estimates and predicted probabilities of freedom to the prior distributions for the different model parameters. First, default priors were used in the model to enable comparison of model outputs between study regions. Thereafter, country-specific priors based on expert opinion or historical data were used in the model, to study the influence of the priors on the results and to obtain country-specific estimates. The STOC free model calculates a posterior value for the model parameters (e.g. herd-level test sensitivity and specificity, probability of introduction of infection) and a predicted probability of infection. The probability of freedom from infection was computed as one minus the probability of infection. For dairy herds that were considered free from infection within their own CP, the predicted probabilities of freedom were very high for all study regions ranging from 0.98 to 1.00, regardless of the use of default or country-specific priors. The priors did have more influence on two of the model parameters, herd-level sensitivity and the probability of remaining infected, due to the low prevalence and incidence of BVDV in the study regions. The advantage of STOC free model compared to scenario tree modelling, the reference method, is that actual data from the CP can be used and estimates are easily updated when new data becomes available.

A description and qualitative comparison of the elements of heterogeneous bovine viral diarrhea control programs that influence confidence of freedom.

For endemic infections in cattle that are not regulated at the European Union level, such as bovine viral diarrhea virus (BVDV), European Member States have implemented control or eradication programs (CEP) tailored to their specific situations. Different methods are used to assign infection-free status in CEP; therefore, the confidence of freedom associated with the "free" status generated by different CEP are difficult to compare, creating problems for the safe trade of cattle between territories. Safe trade would be facilitated with an output-based framework that enables a transparent and standardized comparison of confidence of freedom for CEP across herds, regions, or countries. The current paper represents the first step toward development of such a framework by seeking to describe and qualitatively compare elements of CEP that contribute to confidence of freedom. For this work, BVDV was used as a case study. We qualitatively compared heterogeneous BVDV CEP in 6 European countries: Germany, France, Ireland, the Netherlands, Sweden, and Scotland. Information about BVDV CEP that were in place in 2017 and factors influencing the risk of introduction and transmission of BVDV (the context) were collected using an existing tool, with modifications to collect information about aspects of control and context. For the 6 participating countries, we ranked all individual elements of the CEP and their contexts that could influence the probability that cattle from a herd categorized as BVDV-free are truly free from infection. Many differences in the context and design of BVDV CEP were found. As examples, CEP were either mandatory or voluntary, resulting in variation in risks from neighboring herds, and risk factors such as cattle density and the number of imported cattle varied greatly between territories. Differences were also found in both testing protocols and definitions of freedom from disease. The observed heterogeneity in both the context and CEP design will create difficulties when comparing different CEP in terms of confidence of freedom from infection. These results highlight the need for a standardized practical methodology to objectively and quantitatively determine confidence of freedom resulting from different CEP around the world.

Toxoplasma gondii infection and toxoplasmosis in farm animals: Risk factors and economic impact.

The protozoan parasite Toxoplasma gondii is a zoonotic parasite that can be transmitted from animals to humans. Felids, including domestic cats, are definitive hosts that can shed oocysts with their feces. In addition to infections that occur by accidental oral uptake of food or water contaminated with oocysts, it is assumed that a large proportion of affected humans may have become infected by consuming meat or other animal products that contained infective parasitic stages of T. gondii. Since farm animals represent a direct source of infection for humans, but also a possible reservoir for the parasite, it is important to control T. gondii infections in livestock. Moreover, T. gondii may also be pathogenic to livestock where it could be responsible for considerable economic losses in some regions and particular farming systems, e.g. in areas where the small ruminant industry is relevant. This review aims to summarize actual knowledge on the prevalence and effects of infections with T. gondii in the most important livestock species and on the effects of toxoplasmosis on livestock. It also provides an overview on potential risk factors favoring infections of livestock with T. gondii. Knowledge on potential risk factors is prerequisite to implement effective biosecurity measures on farms to prevent T. gondii infections. Risk factors identified by many studies are cat-related, but also those associated with a potential contamination of fodder or water, and with access to a potentially contaminated environment. Published information on the costs T. gondii infections cause in livestock production, is scarce. The most recent peer reviewed reports from Great Britain and Uruguay suggest annual cost of about 5-15 million US $ per country. Since these estimates are outdated, future studies are needed to estimate the present costs due to toxoplasmosis in livestock. Further, the fact that T. gondii infections in livestock may affect human health needs to be considered and the respective costs should also be estimated, but this is beyond the scope of this article.

Why German farmers have their animals vaccinated against Bluetongue virus serotype 8: results of a questionnaire survey.

In response to the Bluetongue disease epidemic in 2006-2007, Germany started in 2008 a country-wide mandatory vaccination campaign. By 2009 the number of new outbreaks had decreased so that vaccination became voluntary in 2010. We conducted a questionnaire survey in cattle and sheep farms in three German federal states, namely North-Rhine Westphalia, Rhineland Palatinate and Saxony-Anhalt to estimate the vaccination uptake in 2010, the intention to vaccinate in 2011 and the main determinants of refusal or acceptance to do so. The results showed that 42.8% (40.6-45.1) of the cattle farmers and 33.8% (31.8-35.8) of the sheep farmers had their animals vaccinated in 2010, whereas 40.7% (38.5-43.0) of cattle and 37.93% (35.8-40.1) sheep farmers expressed their intention to vaccinate in 2011. The main reasons mentioned for having animals vaccinated against BTV-8 were ability to export animals, prevention of production losses, subsidized vaccination, and recommendation by the veterinarian. Motives for refusing vaccination were presumed low risk of infection, costs, absence of clinical BT symptoms, presumed negative cost-benefit ratio, and negative experience with previous vaccination events (side effects). We assume that in order to increase farmers' motivation to have their animals immunized against BTV-8, (1) the vaccination needs to be subsidized, (2) combined vaccines with several different BT serotypes or even other diseases should be available and (3) farmers need to be better informed about the safety and benefit of vaccination.

Response to an emerging vector-borne disease: surveillance and preparedness for Schmallenberg virus.

Surveillance for new emerging animal diseases from a European perspective is complicated by the non-harmonised approach across Member States for data capture, recording livestock populations and case definitions. In the summer of 2011, a new vector-borne Orthobunyavirus emerged in Northern Europe and for the first time, a coordinated approach to horizon scanning, risk communication, data and diagnostic test sharing allowed EU Member States to develop early predictions of the disease, its impact and risk management options. There are many different systems in place across the EU for syndromic and scanning surveillance and the differences in these systems have presented epidemiologists and risk assessors with concerns about their combined use in early identification of an emerging disease. The emergence of a new disease always will raise challenging issues around lack of capability and lack of knowledge; however, Schmallenberg virus (SBV) gave veterinary authorities an additional complex problem: the infection caused few clinical signs in adult animals, with no indication of the possible source and little evidence about its spread or means of transmission. This paper documents the different systems in place in some of the countries (Germany and the Netherlands) which detected disease initially and predicted its spread (to the UK) and how information sharing helped to inform early warning and risk assessment for Member States. Microarray technology was used to identify SBV as a new pathogen and data from the automated cattle milking systems coupled with farmer-derived data on reporting non-specific clinical signs gave the first indications of a widespread issue while the UK used meteorological modelling to map disease incursion. The coordinating role of both EFSA and the European Commission were vital as are the opportunities presented by web-based publishing for disseminating information to industry and the public. The future of detecting emerging disease looks more positive in the light of this combined approach in the EU.

Schmallenberg virus epidemic: impact on milk production, reproductive performance and mortality in dairy cattle in the Netherlands and Kleve district, Germany.

Schmallenberg virus (SBV), a novel orthobunyavirus that rapidly spread throughout north-western Europe in 2011, caused congenital malformations in lambs and goat kids (Van den Brom et al., 2012) and newborn calves (Hoffmann et al., 2012). The impact of the SBV epidemic seemed limited however, in terms of the number of affected herds with malformed offspring (European Food Safety Authority, 2012b). Nevertheless, little is known with regard to the overall within-herd impact of SBV infection. The objective of the current study was to quantify the impact of the 2011 SBV epidemic on the productivity of dairy cattle in the Netherlands and the district of Kleve, Germany. For the Netherlands, several multilevel multivariable statistical models were applied on eight productivity parameters regarding milk production, reproductive performance and mortality. All four fertility parameters analysed were slightly but significantly reduced between August 1st and November 1st 2011 compared to the reference period in 2009-2010. Between August 15th and September 19th 2011, the average loss in milk production per cow was -0.26kg (95% CI: -0.30; -0.22) per day in dairy herds, compared to the reference period (p<0.001). The total loss per cow in a subgroup of dairy herds that notified malformations in newborn calves during the mandatory notification period in the Netherlands was -0.43kg (95% CI: -0.59; -0.28) per day (p<0.001). For Germany, a study was carried out in the district of Kleve, situated in the state of North Rhine-Westphalia near the Dutch border. Data on milk yield, two fertility parameters and the number of rendered calves in this specific region were analysed. There was a small but significant increase in the number of secondary and third inseminations between August 1st and November 1st 2011, indicating reduced fertility. No significant change in calf mortality was observed in the assumed SBV period. Milk production at district level did not seem to be affected by SBV in August and September 2011. SBV had no or limited impact on mortality rates, which was as expected given the relatively mild expression of SBV in adult cows and the low incidence of notified malformations in newborn calves. Our results indicate that SBV had a limited impact on productivity of dairy cattle. However, the total economic impact of SBV on the ruminant industry not only consists of productivity caused losses; it is expected that international trade restrictions formed a larger part of the total economic impact.

Direct costs of bovine spongiform encephalopathy control measures in Germany.

On 26 November 2000, the first autochthonous case of bovine spongiform encephalopathy (BSE) was detected in Germany. Since then, a total of 413 BSE cases have been confirmed, resulting in the culling and destruction of 17 313 heads of cattle. In view of the possible risks for human and animal health, Germany has adopted EU regulations along with some additional requirements concerning active surveillance and response measures after detecting a BSE-positive animal. In this study, we used a stochastic model to estimate the costs incurred by the ensuing legislative amendments responding to BSE between November 2000 and December 2010. The total costs were estimated to range between 1847 and 2094 million Euros. They peaked in 2001 (about 394 million Euros) and declined since. About 54% of the costs (approximately 1000 million Euros) were incurred by the extension of the feed ban for animal protein to all farmed livestock. Active surveillance accounted for 21% (405 million Euros), the incineration of animal protein for 13% (249 million Euros) and the removal of specified risk material for 11% (225 million Euros). Only 1% of the costs was related to response measures after detecting a BSE-positive animal, including indemnity payments for culled cattle and confiscated carcasses at the slaughterhouse.

Comparative safety study of three inactivated BTV-8 vaccines in sheep and cattle under field conditions.

After massive epidemics of bluetongue disease in 2006 and 2007, Germany has started a compulsory vaccination program against bluetongue virus serotype 8 (BTV-8). Since the available vaccines had not yet been registered and only limited data were available on their performance, a safety study was conducted with three different inactivated monovalent vaccines under consideration for use in Germany. A total of 1007 sheep and 893 cattle were vaccinated and subsequently compared with 638 control animals (324 sheep and 314 cattle). During the study, all animals remained in good health condition. After the initial immunisation, only local swellings were observed in a small number of animals. Following revaccination, several sheep developed more distinct local reactions and a temporary rise in body temperature. Severe systemic reactions were not detected in any of the study groups. Among cattle, neither fever, nor a decrease in milk production and only temporary low-grade local reactions were observed. Overall, our results demonstrate a high level of safety of all vaccines tested.

No evidence for early decrease in blood oxygenation in rat whisker cortex in response to functional activation.

Using optical methods through a closed cranial window over the rat primary sensory cortex in chloralose/urethane-anesthetized rats we evaluated the time course of oxygen delivery and consumption in response to a physiological stimulus (whisker deflection). Independent methodological approaches (optical imaging spectroscopy, single fiber spectroscopy, oxygen-dependent phosphorescence quenching) were applied to different modes of whisker deflection (single whisker, full whisker pad). Spectroscopic data were evaluated using different algorithms (constant pathlength, differential pathlength correction). We found that whisker deflection is accompanied by a significant increase of oxygenated hemoglobin (oxy-Hb), followed by an undershoot. An early increase in deoxygenated hemoglobin (deoxy-Hb) proceeded hyperoxygenation when spectroscopic data were analyzed by constant pathlength analysis. However, correcting for the wavelength dependence of photon pathlength in brain tissue (differential pathlength correction) completely eliminated the increase in deoxy-Hb. Oxygen-dependent phosphorescence quenching did not reproducibly detect early deoxygenation. Together with recent fMRI data, our results argue against significant early deoxygenation as a universal phenomenon in functionally activated mammalian brain. Interpreted with a diffusion-limited model of oxygen delivery to brain tissue our results are compatible with coupling between neuronal activity and cerebral blood flow throughout stimulation, as postulated 110 years ago by C. Roy and C. Sherrington (1890, J. Physiol. 11:85--108).

[High doses of thiopental for therapy of post-ischaemic anoxia of the brain. A case report (author's transl)]. / Hochdosierte Thiopentalgabe zur Therapie der postischaemischen Anoxie des Gehirns.

The case of a 7-year-old child is presented, who suffered circulatory arrest during induction of anaesthesia for surgery for a posterior fossa tumour. A brain ischaemia lasting 6 minutes duration had to be assumed. After restoration of circulation, 825 mg ethiopenta were administered in order to ameliorate a possible post-ischaemic anoxia of the brain according to a protocol by Safar [18]. 11 hours after circulatory arrest the child awoke. Except for a more pronounced left sided hemiparesis and paresis of the left n. abducens no additional neurological deficit was observed compared to the neurological status before induction of anaesthesia.

[Effect of high dosages of fentanyl and piritramide upon haemodynamics, coronary blood flow and myocardial oxygen consumption (author's transl)]. / Hämodynamik, Koronardurchblutung und myokardialer Sauerstoffverbrauch unter hohen Fentanyl- und Piritramiddosen

High dosages of narcotic analgesics are frequently utilized as the sole anaesthetic agents for patients requiring open-heart surgery. The purpose of this study was to investigate the effect of high dosages of fentanyl and piritramide upon the cardiovascular system. In anaesthetized dogs (N2O:O2=2:1; 0.5 vol% halothane) 0.03 mg/kg fentanyl (=8) and 1.5 mg/kg piritramide (n=8) respectively were given intravenously as a bolus. After the administration of fentanyl there was a slight decrease in blood pressure (10%). The hypotension was the result of a decrease in cardiac output (thermodilution technique) by 13% due to bradycardia. Total peripheral resistance and myocardial contractility remained unaffected. Similar effects were only found late after injection of piritramide, since there was an initial cardiovascular response to piritramide characterized by a marked fall in blood pressure (29%). The major cause of arterial hypotension was peripheral vasodilatation. Load data and the decrease in max dp/dt however indicated also a slight myocardial depression. The altered haemodynamics led to a decrease in myocardial oxygen consumption with both narcotics, which was nearly paralleled by a reduction in coronary blood flow. The narrowing of arteriovenous oxygen difference of the heart proved coronary dilatatory properties of fentanyl and especially of piritramide. This study indicated that high dosages of fentanyl have advantages in comparison to high dosages of piritramide. The clinical implications of the results are discussed.

[The effect of ketamine on haemodynamics and myocardial oxygen consumption in anaesthetized dogs (author's transl)]. / Einfluss der Ketaminnarkose auf die Hämodynamik und den myokardialen Sauerstoffverbrauch narkotisierter Hunde

Ketamine is an induction agent. This experimental study was designed to investigate the immediate effects of ketamine upon haemodynamics, inotropism and myocardial oxygen consumption during induction. In a circulatory steady state of a piritramide - nitrous oxide - oxygen basic anaesthesia normoventilated dogs (n = 8) received intravenous injections of 5.0 and 10.0 mg/kg ketamine within 30 sec at random. Immediately after administration of 10.0 mg/kg ketamine the cardiac output (thermo dilution method) rose (27%) on account of tachycardia while the total peripheral resistance (40%) and the mean arterial pressure (23%) decreased. The decrease in stroke volume (37%) and the inotropic parameter dp/dt max (42%) as well as the increase in the end-diastolic left ventricular pressure (31%) and in the pressure of the pulmonary artery (11%) suggest considerable myocardial depressor properties of ketamine. The change in haemodynamics was paralleled with an increase in myocardial oxygen consumption (47%), which was initially met by an increase in coronary blood flow (25%) and an additional oxygen utilization (20%). The increase in arterio-coronary venous oxygen difference is believed to be due to a constriction of the coronary arteries after ketamine. Since external cardiac work remained unchanged,while myocardial contractility and myocardial wall tension (Psyst) decreased, the increase in heart rate (63%) explains the rise in myocardial oxygen consumption. The efficiency of cardiac work, which is defined as the ratio of myocardial displacement work to myocardial energy demand, decreased (31%) and illustrated the uneconomic work of the heart under the influence of ketamine. The clinical utilization of the data obtained from this study are discussed.

Blood pH and PaCO2 as chemical factors in myocardial blood flow control.

The effect of metabolic and hypercapnic acidosis on myocardial blood flow was studied during intravenous infusions of hydrochloric acid solutions (n = 12) and during passive ventilation with 5% CO2 (n = 5) in anaesthetized, closed chest dogs. Below a pH of 7.2 metabolic acidosis at normal arterial CO2-tensions caused an increase of coronary blood flow and a decrease of coronary vascular resistance associated with a narrowed myocardial arteriovenous O2-difference, indicating vasodilation at unchanged myocardial oxygen consumption. In propranolol-pretreated dogs myocardial blood flow and coronary oxygen AV difference remained unaffected, suggesting that the coronary dilatory effect of metabolic acidemia involves beta adrenergic stimulation. Coronary vasodilation induced by increasing arterial pCO2 was found to the significantly greater as compared with the dilatory effect of metabolic acidosis at the same blood pH level. Blocking of beta receptors did not reduce the coronary response to increased arterial CO2-tensions. It is concluded that the coronary vasodilation observed during hypercapnic acidosis is neither mediated by a beta adrenergic stimulation nor dependent of the concomitant change in blood pH. The possible sites of the coronary dilatory actions of increased arterial CO2-tensions are discussed.

Comparison of the immediate effects of etomidate, propanidid and thiopentone on haemodynamics, coronary bloodflow and myocardial oxygen consumption.

Since cardiovascular depression at induction is among the most common complications of anesthesia this comparative study was undertaken. Unpremedicated dogs (n = 16) were induced with 3 mg/kg piritramide i.v. and normoventilated (N2O/O2 = 2/1). In 8 animals 0.8 and 1.6 mg/kg Etomidate and 5.0 and 10.0 mg/kg thiopentone and in 8 further dogs 5.0 and 10.0 mg/kg Propanidid were tested. Equipotent doses of Thiopentone and Propanidid caused a marked myocardial depression, which was seen in a decrease in stroke volume and max dp/dt and in an increase of leftventricular end-diastolic pressure and pulmonary arterial pressure. The increased myocardial O2- cosumption mainly due to the rise in heart rate was covered after Thiopentone by an increase of coronary bloodflow (measured with a pitot-catheter) and an increase of arterio-coronaryvenous difference in oxygen. As the latter decreased after Propanidid, it appeared that Propanidid has coronary dilatory properties. The results demonstrated the uneconomic work of the heart under the influence of Thiopentone and Propanidid. In contrast to this the cardiovascular system after Etomidate remained nearly unaffected. The data of this study suggest the use of Etomidate rather than Thiopentone and Propanidid in cases of shock syndrome, heart and/or coronary insufficiency.

[Anaesthetic management of patients with hyperdynamic circulation in hepatic cirrhosis (author's transl)]. / Narkoseführung bei Patienten mit hyperdynamer Zirkulation infolge Lebercirrhose

Cirrhosis of the liver is frequently associated with arterial hypoxaemia and a hyperdynamic state of the systemic circulation. The hypoxaemia and the circulatory changes probably have a common aetiology, namely, shynting in the systemic and pulmonary vascular beds. Experiences in two well-documented cases suggest that anaesthetic agents may increase arteriovenous shunting and hypoxaemia in patients with hepatic cirrhosis. A plan for preanaesthetic identification and anaesthetic management in this type of patients is outlined.

[Effects of glucagon on systemic circulation, coronary blood flow and myocardial oxygen consumption in the anesthetized dog (author's transl)]. / Hämodynamik, Koronardurchblutung und Sauerstoffverbrauch des Herzens unter Glukagon. Untersuchungen am narkotisierten Hund

The systemic and coronary hemodynamic effects of 10, 20, 40 and 80 mug/kg glucagon have been studied in 9 anesthetized normoventilated closed-chest dogs. Intravenous administration of this agent produced a dose-related increase in the average coronary blood flow between 19% (10 mug/kg) and 49% (80 mug/kg). Coronary vascular resistance decreased by between 16% (10 mug/kg) and 39% (80 mug/kg). A--V O2 difference 1 min after the administration of glucagon no changes in myocardial oxygen extraction were observed after 5, 10 and 20 min. The calculated myocardial oxygen consumption rose up to 50% after 80 mug/kg glucagon. We conclude that the increase in coronary blood flow and the decrease in coronary resistance are mainly secondary to the metabolic effects of the increased myocardial contractility and heart rate, and that there is only an initial direct vasodilating effect on the coronary vessels.