Peri-anesthetic environmental and occupational exposure to desflurane waste anesthetic gas in a large animal veterinary hospital.

OBJECTIVES: The goals were to determine the environmental levels of desflurane waste anesthetic gas and the desflurane occupational exposure of operating room staff during the anesthesia of large animal veterinary patients. METHODS: Active environmental sampling was performed using single-beam infrared spectrophotometry. Passive sampling with dosimeter badges was used to measure the occupational exposure of anesthesia and operating room staff. RESULTS: Higher concentrations of desflurane (n = 16) were measured at all recovery timepoints relative to the concentrations measured at all locations and timepoints at the start of anesthesia and surgery (p < 0.05). Time-weighted average desflurane concentrations from dosimeter badges (n = 310) were higher for anesthesia staff than for other operating room personnel (p < 0.0001). CONCLUSIONS: The anesthetic recovery of large animal patients is a period of increased exposure to desflurane waste anesthetic gas for veterinary staff.

Flow-controlled expiration reduces positive end-expiratory pressure requirement in dorsally recumbent, anesthetized horses.

Introduction: Equine peri-anesthetic mortality is higher than that for other commonly anesthetized veterinary species. Unique equine pulmonary pathophysiologic aspects are believed to contribute to this mortality due to impairment of gas exchange and subsequent hypoxemia. No consistently reliable solution for the treatment of peri-anesthetic gas exchange impairment is available. Flow-controlled expiration (FLEX) is a ventilatory mode that linearizes gas flow throughout the expiratory phase, reducing the rate of lung emptying and alveolar collapse. FLEX has been shown to improve gas exchange and pulmonary mechanics in anesthetized horses. This study further evaluated FLEX ventilation in anesthetized horses positioned in dorsal recumbency, hypothesizing that after alveolar recruitment, horses ventilated using FLEX would require a lower positive end-expiratory pressure (PEEP) to prevent alveolar closure than horses conventionally ventilated. Methods: Twelve adult horses were used in this prospective, randomized study. Horses were assigned either to conventional volume-controlled ventilation (VCV) or to FLEX. Following induction of general anesthesia, horses were placed in dorsal recumbency mechanically ventilated for a total of approximately 6.5 hours. Thirty-minutes after starting ventilation with VCV or FLEX, a PEEP-titration alveolar recruitment maneuver was performed at the end of which the PEEP was reduced in decrements of 3 cmH2O until the alveolar closure pressure was determined. The PEEP was then increased to the previous level and maintained for additional three hours. During this time, the mean arterial blood pressure, pulmonary arterial pressure, central venous blood pressure, cardiac output (CO), dynamic respiratory system compliance and arterial blood gas values were measured. Results: The alveolar closure pressure was significantly lower (6.5 ± 1.2 vs 11.0 ± 1.5 cmH2O) and significantly less PEEP was required to prevent alveolar closure (9.5 ± 1.2 vs 14.0 ± 1.5 cmH2O) for horses ventilated using FLEX compared with VCV. The CO was significantly higher in the horses ventilated with FLEX (37.5 ± 4 vs 30 ± 6 l/min). Discussion: We concluded that FLEX ventilation was associated with a lower PEEP requirement due to a more homogenous distribution of ventilation in the lungs during expiration. This lower PEEP requirement led to more stable and improved cardiovascular conditions in horses ventilated with FLEX.

Comparison of Four Arteries for Invasive Blood Pressure Measurements and Dixtal 2010 Oscillometric Values in Horses Anesthetized With Isoflurane: Does the Artery Matter?

This study evaluated the agreement between invasive blood pressure (IBP) values measured in three different arteries and by an oscillometric device (NIBP) with the ones from the transverse facial artery (FA). Six horses (424.2 ± 40.7 kg) were sedated with xylazine (0.6 mg/kg IV), induced with ketamine (2 mg/kg IV) and midazolam (0.1 mg/kg IV), and maintained with isoflurane (1.2 MAC) for 90 minutes in lateral recumbency. FA, auricular artery (AA), lateral digital artery (LDA), and metatarsal artery (MA) were catheterized, and a standard adult cuff was placed on the tail. IBP and NIBP values were recorded at 30, 45, 60, 75, and 90 minutes of anesthesia. Data were analyzed with Shapiro-Wilk and Repeated-Measures Bland-Altman. Values for FA (mm Hg) were 85.4 ± 10.3 for SAP, 70.6 ± 9.3 for MAP, and 58.5 ± 9.5 for DAP. Mean bias and 95% Limit of agreement (LOA) for AA were -1.7 (-29.0 to 25.6), 2.2 (-18.4 to 22.9), 1.9 (-18.2 to 22.0), for LDA: 1.4 (-25.1 to 27.8), 2.9 (-19.3 to 25.0), 2.3 (-18.4 to 22.9), for MA: -3.2 (-28.3 to 22.0), 2.7 (-16.6 to 22.1), 4.9 (-13.8 to 22.2), and for NIBP: -5.7 (-28.3 to 16.9), 7.9 (-9.5 to 25.3), 17.2 (-2.4 to 36.8), for SAP, MAP and DAP respectively. There is a reasonable bias for IBP values among the arteries evaluated, however a wide LOA, demonstrating the arteries are not interchangeable. NIBP method from Dixtal 2010 results in inaccurate blood pressure values in horses.

Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes.

The placement of caudal epidural catheters in horses has become more frequent as a multi-modal analgesic strategy. Despite its integration into clinical practice, there are limited reports describing the use of caudal epidural catheterization for prolonged use in horses. The purpose of this study was to characterize the hospitalized caseload undergoing epidural catheterization for long-term epidural analgesic administration, to report the response to epidural therapy and observed complications, and to describe patient outcomes. Medical records of hospitalized equine patients that underwent placement of a caudal epidural catheter for analgesic management between 2017 and 2021 were analyzed retrospectively. For the 62 catheters placed in the 48 cases, the most frequent diagnosis category prompting epidural analgesia was orthopedic (43/48, 89.6%). Synovial sepsis was the most frequent specific diagnosis prompting epidural catheter placement (11/48, 22.9%). The initial response to epidural therapy was characterized as positive for 37/62 (59.7%) catheters. Complications were documented for 46/62 (74.2%) catheters. However, most of these complications were classified as mild (51.6%) or moderate (14.5%), and exaggerated physiologic responses were observed most frequently. Of the horses studied, 52.1% survived to be discharged from the hospital. With awareness of potential complications and vigilant monitoring, caudal epidural catheters should be considered for equine patients as an analgesic strategy.

Evaluation of the Effects of Doxapram in Combination with Xylazine on Recovery of Horses Isoflurane-Anesthetized.

This randomized double-blinded study evaluated the recovery from isoflurane anesthesia in horses receiving doxapram and xylazine. 6 horses were anesthetized 4 times (minimum of 2-week washout period). Anesthesia was performed with xylazine (0.6 mg/kg), ketamine (2.2 mg/kg), midazolam (0.1 mg/kg), and maintained with isoflurane for 90 minutes. At recovery, horses received one of the following randomized treatments: RX: xylazine (0.2 mg/kg), RXD1: xylazine (0.2 mg/kg) and doxapram (0.1 mg/kg), RXD2: xylazine (0.2 mg/kg) and doxapram (0.2 mg/kg), or RS: saline. Recoveries were rope-assisted and evaluated with a descriptive qualitative scale. Heart rate, respiratory frequency (fR), and blood gas analysis were evaluated at 5 minutes intervals while the horse allowed. Data were analyzed with ANOVA or Friedman test (P < .05). Times to sternal (minutes) were RX: 40.5 ± 12.3, RXD1: 25.8 ± 11.5, RXD2: 31.4 ± 7.0, and RS: 33.4 ± 5.3, and were not different. Times to standing (minutes) were RX: 41.0 ± 9.9, RXD1: 33.5 ± 6.2, RXD2: 40.0 ± 11.3, and RS: 36.3 ± 9.9, and were not different. Heart rate decrease over time within RXD1 and RXD2 (T0 = 47 ± 15 and 47 ± 15, T5 = 38 ± 8 and 38 ± 8, T10 = 39 ± 4 and 36 ± 6, respectively), but was not different among groups. There was no difference in fR among groups or over time. There was no difference in recovery scores among groups. In conclusion, administration of doxapram to isoflurane-anesthetized horses did not change recovery time or quality.

Assessment of qualitative and quantitative parameters of healthy thyroid gland in adult horses by magnetic resonance imaging.

In humans and pets, magnetic resonance imaging (MRI) provides important adjunctive anatomic information about the thyroid and its adjacent structures. To the best of our knowledge, however, no studies have been reported regarding the use of MRI for thyroid evaluation in horses. The aim of this study was to obtain qualitative and quantitative parameters of healthy thyroid gland in adult horses by MRI. Eleven horses were submitted to thyroid MRI evaluation. The healthy thyroid of these animals was ensured by normal examinations performed before (free thyroxine and ultrasound) and after (cytology) to MRI. It was concluded that the dorsal spin-echo T1-weighted, fast spin-echo T2-weighted, sagittal STIR and a three-dimensional T1-weighted gradient echo were the sequences that best characterized the thyroid lobes. Qualitatively, there was a significant variation in the elliptical format of some lobes considering the sagittal plane, which oscillated between rounded and flattened conformation. Excellent reproducibility of the quantitative thyroid parameters obtained was verified. The thyroid gland total volume mean of observers was 14.31 cm3 (±0.69). In relation with comparisons between quantitative parameters of left and right lobes, only differences regarding their respective lengths were observed. Thus, we can infer that the difference in some thyroid lobes format can be explained by the significant variation identified between left and right lobes lengths.

ISOFLURANE RESPIRATORY ANESTHETIC INDEX IN CHICKENS (GALLUS GALLUS DOMESTICUS).

Respiratory depression from isoflurane seems to be greater in birds than in mammals. Isoflurane respiratory anesthetic index (AI) has only been evaluated in ducks (Anas platyrhynchos), which indeed showed a lower AI compared to mammals, but the isoflurane AI for other avian species is not known. The aim of this study was to evaluate the isoflurane AI in chickens (Gallus gallus domesticus). Six adult hens were anesthetized with isoflurane for determination of the minimum anesthetic concentration (MAC) using the bracketing method. During a second anesthetic event, the isoflurane AI was determined by progressively increasing the expired fraction of isoflurane by 0.5 times MAC until apnea was achieved (ETiso-apnea). The isoflurane AI was considered the ratio between the ETiso-apnea and the MAC. Heart rate, systolic arterial pressure, respiratory rate, and end-tidal carbon dioxide were continuously monitored throughout both anesthetic events. Data were analyzed using a mixed-effect model with Greenhouse-Geisser correction, followed by Tukey's test. The MAC for isoflurane was 1.18% ± 0.09% (mean ± SD). The ETiso-apnea was 3.31% ± 0.34% and the isoflurane AI was 2.80 ± 0.26. In chickens, isoflurane AI is similar to that measured in mammals, which is in contrast with published data in other avian species.

Tramadol Effects on Lameness Score After Inhibition of P-GP by Ivermectin Administration in Horses: Preliminary Results.

This study aimed to evaluate the effects and lameness degree in horses administered tramadol after the P-glycoprotein (P-gp) enteric inhibitor ivermectin. Six horses were randomly distributed into three groups, which received two different doses of tramadol by a nasogastric tube: 1 mg/kg (tramadol group 1(GT1)), 4 mg/kg (tramadol group 4 (GT4)), and tramadol 1 mg/kg combined with ivermectin 0.2 mg/kg PO (ivermectin tramadol group (GT1 + Ive)), with one-week washout interval. Heart rate (HR), respiratory rate (RR), intestinal motility, body temperature, and the degree of lameness were evaluated for 360 minutes. The blood gas parameters were evaluated at 0, 60 minutes, and 120 minutes. There were no differences in HR and the degree of lameness. Hypomotility occurred in GT1 and GT4 only at the end of the evaluation period, and RR increased in all groups. We conclude that inhibition of enteric P-gp by ivermectin did not alter the effects of tramadol, suggesting that tramadol is not a substrate for P-gp. However, future studies should be conducted to assess the interaction between P-gp inhibitors on the pharmacokinetics of tramadol.

Ultrasonographic features of the normal thyroid gland in adult horses / Características ultrassonográficas da glândula tireoide hígida em equinos adultos

Few reports have been published regarding the use of ultrasonography as a method of evaluating the normal thyroid gland in horses. For these reasons, this study aimed at determining reliably of the thyroid measurements from the comparison between the left and right thyroid lobes, as well as assessing the contour, format, echotexture and echogenicity of the healthy thyroid by mode-B ultrasonography. Additionally, the equine thyroid vascularization was quali-quantitatively characterized the by Doppler. The sample size initially was determined by the animal selection with advanced age and without volume increase in the neck proximal region. Finally, eleven horses were selected by laboratory test, search of thyroid neoformations by ultrasonography and cytology thyroid. Next, these animals were submitted to thyroid lobes ultrasonographic evaluation. Excellent reproducibility was observed for all measurements obtained. Among the comparisons made between the quantitative parameters of the left and right lobes, it was observed that there was only difference between their respective lengths. Qualitatively, there was a significant variation between the lobes elliptical format in the longitudinal plane of some glands, which oscillated between a rounded and flattened conformation. Thus, we can conclude that the difference between the lobes format of some thyroids can be explained by the significant difference observed between the length of the left and right lobes. Additionally, it was verified that there was no difference between the Doppler quantitative parameters. Therefore, we may suggest that unilateral analysis of the cranial thyroid artery by spectral Doppler can be used to evaluate equine thyroid diffuse disorders.(AU)

Poucas análises foram publicadas com relação ao uso da ultrassonografia como método de avaliação da glândula tireoide hígida em equinos. Alguns trabalhos incluem a determinação das dimensões e características do parênquima. Por essas razões, este estudo teve como objetivo determinar com segurança as medidas tireoidianas a partir da comparação entre o lobo tireoidiano esquerdo e direito, bem como avaliar os contornos, formato, ecotextura e ecogenicidade das glândulas tireoides hígidas pela ultrassonografia em modo B. Além disso, a vascularização da tireoide equina foi caracterizada quali-quantitativamente pela ferramenta Doppler. O tamanho da amostra inicialmente foi determinado pela seleção dos animais com idade avançada e sem aumento de volume na região proximal do pescoço. Por fim, onze equinos foram selecionados por meio de exame laboratorial, pesquisa de neoformações tireoidianas por ultrassonografia e citologia da tireoide. Em seguida, estes animais foram submetidos à avaliação de lobos tireoidianos por ultrassonografia. Observou-se excelente reprodutibilidade em relação a todas as medidas deste estudo. Foram observadas diferenças qualitativas entre os lobos tireoidianos direito e esquerdo. Assim, podemos concluir que tais diferenças entre o formato dos lobos tireoidianos podem ser explicadas pela diferença significativa e/ou tendência observada no parâmetro comprimento entre os respectivos lobos. Além disso, não foi encontrada diferença significativa entre os valores da artéria tireoidiana cranial esquerda em relação aos obtidos na artéria tireoidiana cranial direita, sugerindo que a análise dos valores espectrais do Doppler de uma das artérias tireoidianas craniais possa ser utilizada como método de avaliação de distúrbios difusos da tireoide equina.(AU)

EFFECTS OF TRAMADOL ON THE MINIMUM ANESTHETIC CONCENTRATION OF ISOFLURANE IN WHITE-EYED PARAKEETS (PSITTACARA LEUCOPHTHALMUS).

The aim of this study was to determine the minimum anesthetic concentration (MAC) of isoflurane, and to investigate if tramadol changes the isoflurane MAC in white-eyed parakeets (Psittacara leucophthalmus). Ten adult birds weighing 157 ± 9 g were anesthetized with isoflurane in oxygen under mechanical ventilation. Isoflurane concentration for the first bird was adjusted to 2.2%, and after 15 min an electrical stimulus was applied in the thigh area to observe the response (movement or nonmovement). Isoflurane concentration for the subsequent bird was increased by 10% if the previous bird moved, or decreased by 10% if the previous bird did not move. This procedure was performed serially until at least four sequential crossover events were detected. A crossover event was defined as a sequence of two birds with different responses (positive or negative) to the electrical stimulus. Isoflurane MAC was calculated as the mean isoflurane concentration value at the crossover events. After 1 wk, the same birds were reanesthetized with isoflurane and MAC was determined at 15 and 30 min after intramuscular administration of 10 mg/kg of tramadol using the same method. A paired t-test (P < 0.05%) was used to detect significant differences for MAC between treatments. Isoflurane MAC in this population of white-eyed parakeets was 2.47 ± 0.09%. Isoflurane MAC values 15 and 30 min after tramadol administration were indistinguishable from each other (pooled value was 2.50 ± 0.18%); they were also indistinguishable from isoflurane MAC without tramadol. The isoflurane MAC value in white-eyed parakeets is higher than reported for other bird species. Tramadol (10 mg/kg, i.m.) does not change isoflurane MAC in these birds.

Anesthetic effects of different volumes of lidocaine for spermatic cord block in cattle.

OBJECTIVE: To evaluate three volumes of lidocaine for spermatic cord block to perform castration in cattle. STUDY DESIGN: Randomized blinded clinical study. ANIMALS: Thirty mixed-breed Nellore cattle, aged 28-40 months and weighing 395±21 (352-452) kg [mean±standard deviation (range)]. METHODS: Cattle were restrained in a chute and allowed to stand without sedation. Three milliliters of 2% lidocaine without epinephrine were infiltrated subcutaneously at each site of scrotal incision in all animals. The animals were allocated to three groups of 10 animals each. Lidocaine 2% was injected into each spermatic cord using a volume of 2, 3 or 4 mL in groups A, B, or C, respectively. The total volumes of lidocaine used were 10, 12, and 14 mL in groups A, B, and C, respectively. The duration of surgery and the retraction of the testicle (scored as positive or negative according to retraction of the testicle) during the procedure were recorded. The data were statistically analyzed by one-way anova followed by Tukey's and chi-square tests. Differences were considered significant when p<0.05. RESULTS: The mean surgical time was shorter in group C than in groups A and B (p<0.001). In groups A, B and C, 90%, 60% and 10% of the animals showed retraction of the testicle, respectively. Fewer animals retracted the spermatic cord in group C than in group A (p=0.002) and B (p=0.02). CONCLUSIONS AND CLINICAL RELEVANCE: Optimal spermatic cord block was achieved by injection of 4 mL of 2% lidocaine 5 minutes before castration and following incisional infiltration of lidocaine, in adult cattle weighing about 400 kg.