Effects of intermittent positive pressure ventilation on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using combination of medetomidine, lidocaine, butorphanol and propofol (MLBP-TIVA).

Effects of intermittent positive pressure ventilation (IPPV) on cardiopulmonary function were evaluated in horses anesthetized with total intravenous anesthesia using constant rate infusions of medetomidine (3.5 µg/kg/hr), lidocaine (3 mg/kg/hr), butorphanol (24 µg/kg/hr) and propofol (0.1 mg/kg/min) (MLBP-TIVA). Five horses were anesthetized twice using MLBP-TIVA with or without IPPV at 4-week interval (crossover study). In each occasion, the horses breathed 100% oxygen with spontaneous ventilation (SB-group, n=5) or with IPPV (CV-group, n=5), and changes in cardiopulmonary parameters were observed for 120 min. In the SB-group, cardiovascular parameters were maintained within acceptable ranges (heart rate: 33-35 beats/min, cardiac output: 27-30 l/min, mean arterial blood pressure [MABP]: 114-123 mmHg, mean pulmonary arterial pressure [MPAP]: 28-29 mmHg and mean right atrial pressure [MRAP]: 19-21 mmHg), but severe hypercapnea and insufficient oxygenation were observed (arterial CO(2) pressure [PaCO(2)]: 84-103 mmHg and arterial O(2) pressure [PaO(2)]: 155-172 mmHg). In the CV-group, normocapnea (PaCO(2): 42-50 mmHg) and good oxygenation (PaO(2): 395-419 mmHg) were achieved by the IPPV without apparent cardiovascular depression (heart rate: 29-31 beats/min, cardiac output: 17-21 l /min, MABP: 111-123 mmHg, MPAP: 27-30 mmHg and MRAP: 15-16 mmHg). MLBP-TIVA preserved cardiovascular function even in horses artificially ventilated.

Intermittent positive pressure ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvre during inhalation anaesthesia in horses undergoing surgery for colic, and its influence on the early recovery period.

OBJECTIVE: To compare, ventilation using intermittent positive pressure ventilation (IPPV) with constant positive end-expiratory pressure (PEEP) and alveolar recruitment manoeuvres (RM) to classical IPPV without PEEP on gas exchange during anaesthesia and early recovery. STUDY DESIGN: Prospective randomized study. ANIMALS: Twenty-four warm-blood horses, weight mean 548 ± SD 49 kg undergoing surgery for colic. METHODS: Premedication, induction and maintenance (isoflurane in oxygen) were identical in all horses. Group C (n = 12) was ventilated using conventional IPPV, inspiratory pressure (PIP) 35-45 cmH2O; group RM (n = 12) using similar IPPV with constant PEEP (10 cmH2O) and intermittent RMs (three consecutive breaths PIP 60, 80 then 60 cmH2O, held for 10-12 seconds). RMs were applied as required to maintain arterial oxygen tension (PaO2) at >400 mmHg (53.3 kPa). Physiological parameters were recorded intraoperatively. Arterial blood gases were measured intra- and postoperatively. Recovery times and quality of recovery were measured or scored. RESULTS: Statistically significant findings were that horses in group RM had an overall higher PaO2 (432 ± 101 mmHg) than those in group C (187 ± 112 mmHg) at all time points including during the early recovery period. Recovery time to standing position was significantly shorter in group RM (49.6 ± 20.7 minutes) than group C (70.7 ± 24.9). Other measured parameters did not differ significantly. The median (range) of number of RMs required to maintain PaO2 above 400 mmHg per anaesthetic was 3 (1-8). CONCLUSION: Ventilation using IPPV with constant PEEP and RM improved arterial oxygenation lasting into the early recovery period in conjunction with faster recovery of similar quality. However this ventilation mode was not able to open up the lung completely and to keep it open without repeated recruitment. CLINICAL RELEVANCE: This mode of ventilation may provide a clinically practicable method of improving oxygenation in anaesthetized horses.

Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003-2009).

OBJECTIVE: To describe the application of intermittent positive pressure ventilation (IIPV) in dogs with lower motor neuron disease (LMND). DESIGN: Multi-institutional, retrospective study (2003-2009). SETTING: Intensive care units at multiple university teaching hospitals. ANIMALS: Fourteen dogs with LMND that underwent IIPV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The ventilatory logs of 4 teaching hospitals were searched for dogs undergoing IIPV in association with a diagnosis of acute LMND. The medical records were evaluated for signalment, specific LMND, ventilatory management and duration, complications associated with ventilation, duration of hospitalization, and outcome. Descriptive statistics were used as indicated. Fifteen records were evaluated, 1 dog was excluded since it experienced cardiopulmonary arrest (CPA) before commencement of IIPV. The median age was 7.0 years (range 10 mo to 12 y). There were 5 Labrador retrievers, 4 mixed breeds, and 5 other breeds were each represented once. Five dogs were diagnosed with myasthenia gravis, 4 dogs with polyradiculoneuritis, and 5 dogs had an undetermined LMND. Clinical signs of weakness before ventilation were present for a median of 36 hours (range 6 h to 14 d). Dogs were ventilated for a median of 109 hours (range 5-261 h). Nine dogs had temporary tracheostomies performed, and 8 dogs received nutritional support. Five dogs developed ventilator associated pneumonia. Six dogs were successfully weaned from the ventilator with a median ventilatory time of 49 hours (range 25-192 h). Three dogs survived to discharge. No single LMND was associated with a better outcome. CONCLUSIONS: High euthanasia rates and iatrogenic complications limit the ability to accurately prognosticate for affected dogs in this retrospective study, but in dogs with LMND that is severe enough to require IIPV, support may be required days to weeks.

Factors affecting the relationship between arterial and end-tidal carbon dioxide pressures in the anaesthetised horse.

OBJECTIVE: To assess the effects of the duration of anaesthesia, position of recumbency, mode of ventilation, anaesthetic drug protocol, patient age and type of surgical procedure on the usefulness of capnometry as a measure of the partial pressure of arterial carbon dioxide (P(a)co(2)) during general anaesthesia in horses. DESIGN: A prospective study compared the P(a)co(2) values with those of partial pressure of end-tidal carbon dioxide (ETco(2)) in horses anaesthetised for elective or emergency surgical procedures. The difference between P(a)co(2) and ETco(2) (P(a)co(2)- ETco(2)) and the physiological dead space to tidal volume ratio (V(D)/V(T)) were calculated. The effects of the study parameters on these variables was determined. RESULTS: The agreement between P(a)co(2) and ETco(2) was poor. P(a)co(2)- ETco(2) and V(D)/V(T) during the first 60 min of anaesthesia was significantly less than after 60 min of anaesthesia. Mode of ventilation, position of recumbency, anaesthetic drug protocol, patient age and type of procedure did not have a significant affect on either value. CONCLUSIONS: P(a)co(2)- ETco(2) in anaesthetised horses can be large, making ETco(2) unreliable as a predictor of P(a)co(2) and for assessment of pulmonary ventilation. For anaesthesia lasting less than 60 min at least one blood gas analysis of an arterial blood sample is required to assess P(a)co(2)- ETco(2). Arterial blood gas analysis should be repeated after 60 min of general anaesthesia.

Influence of modified open lung concept ventilation on the cardiovascular and pulmonary function of horses during total intravenous anaesthesia.

The influence of a modified open lung concept (mOLC) on pulmonary and cardiovascular function during total intravenous anaesthesia (TIVA) in horses was evaluated. Forty-two warmblood horses (American Society of Anesthesiologists class 1 to 2), scheduled for elective surgery (mean [sd] weight 526 [65] kg, age 6.4 [5.4] years) were randomly divided into three groups: ventilation with mOLC, intermittent positive-pressure ventilation (IPPV), and spontaneous breathing. Premedication (0.8 mg/kg xylazine), induction (2.2 mg/kg ketamine and 0.05 mg/kg diazepam) and maintenance of anaesthesia with TIVA (1.4 mg/kg/hour xylazine, 5.6 mg/kg/hour ketamine and 131.1 mg/kg/hour guaifenesin), with inhalation of 35 per cent oxygen in air, were identical in all horses. Heart rate, respiratory rate, mean arterial blood pressure (MAP), pH, and arterial partial pressure of oxygen (p(a)O(2)) and carbon dioxide (p(a)CO(2)) were evaluated. Data were collected every 10 minutes from 20 to 90 minutes anaesthesia time. Factorial analysis of variance and Tukey's post hoc test were used for statistical analysis (a=5 per cent). Horses in the mOLC-ventilated group had an overall significantly higher p(a)O(2) (16.9 [1.0] v 11.7 [1.34] v 10.5 [0.57] kPa) and lower MAP (93.1 [5.47] v 107.1 [6.99] v 101.2 [5.45] mmHg) than the IPPV and spontaneously breathing groups, respectively.

The use of intermittent positive pressure ventilation to differentiate pneumonia from atelectasis during anesthesia in a red panda (Ailurus fulgens).

Radiography is a valuable tool for assessment of pulmonary disease. Specifically, radiographs utilizing positive pressure ventilation can distinguish between anesthesia-induced atelectasis and pulmonary disease when survey radiographs are ambiguous. Positive pressure ventilation can be used to radiographically prove or disprove pulmonary disease. This is of particular clinical importance when working with exotic, zoo, or wildlife species because the majority of these patients require general anesthesia to perform physical examinations and diagnostics such as radiography safely and efficiently. This report is a case example of pulmonary disease in a red panda (Ailurus fulgens) and demonstrates how positive pressure ventilation verified both the presence of pulmonary disease and the eventual resolution of the disease. Anesthetized patients on gas anesthesia will rapidly become atelectic. Through the use of positive pressure ventilation, anesthesia-induced atelectasis and true pulmonary disease can readily be distinguished. This is a technique that should not be overlooked when performing thoracic radiography in zoo species.

Use of controlled ventilation in a clinical setting.

Mechanical ventilation has long been used to maintain ventilation in humans when the lungs are rendered incapable of oxygenation or when respiration is affected by central nervous system depression, but it has only recently been applied to similar cases in dogs and cats. Although manual ventilation is still the more common form of ventilation in dogs and cats, mechanical intermittent positive-pressure ventilation (IPPV) is a much more efficient and reliable means of maintaining the highest quality of respiratory assistance. With proper training, technicians can use IPPV to support compromised animals until they are capable of maintaining normal oxygen concentrations.

The effects of halothane and isoflurane on cardiovascular function in laterally recumbent horses.

BACKGROUND: Experimental studies in adult horses have shown that general anaesthesia maintained with isoflurane is associated with less depression of cardiovascular function compared with halothane anaesthesia. Adverse effects of intermittent positive-pressure ventilation (IPPV) have also been demonstrated. Nevertheless, the haemodynamic effects of these agents and the effects of differing modes of ventilation have not been assessed during clinical anaesthesia in horses undergoing surgery. METHODS: The haemodynamic effects of isoflurane or halothane anaesthesia during spontaneous or IPPV were studied non-invasively in 32 laterally recumbent horses undergoing elective surgery. Indices of cardiac function and measurements of femoral arterial blood flow and resistance were recorded using transoesophageal and transcutaneous Doppler echocardiography, respectively. Arterial pressure was measured directly using a facial artery catheter. RESULTS: Cardiac index (CI) was significantly higher during isoflurane anaesthesia than during halothane anaesthesia and was also higher during spontaneous ventilation with isoflurane. CI decreased significantly over time and an inverse relationship was observed between CI and mean arterial pressure (MAP). Horses with higher MAP had a significantly lower CI. During isoflurane anaesthesia, femoral arterial blood flow was significantly higher in both pelvic limbs compared with halothane anaesthesia, and flow in the lower limb was significantly higher during spontaneous ventilation than during IPPV. No significant change in femoral blood flow was observed over time. CONCLUSION: The effects of anaesthetics and mode of ventilation on cardiovascular function recorded under surgical conditions in horses are similar to those reported under experimental conditions. However, in contrast with previous experimental studies, CI progressively decreased over time regardless of agent used or mode of ventilation employed.

A new airway device for small laboratory animals.

There is a need for a device for improved management of the airway of small laboratory animals during general anaesthesia. This report introduces such a device, referred to here as the airway device (AD). The AD has some similarity to the laryngeal mask airway (LMA) developed for human patients, but the mask portion of the device is specifically designed for small laboratory animals. In addition, the device has an oesophageal extension and unlike the LMA does not have a cuff associated with the mask. This report also shares experience of tests of one prototype AD with six New Zealand white rabbits. The AD was used for administering isoflurane and its effectiveness was evaluated during conditions of spontaneous and controlled intermittent positive pressure ventilation. The results provide encouragement for further development of the AD for airway management of small laboratory animals.

The influence of ventilation mode (spontaneous ventilation, IPPV and PEEP) on cardiopulmonary parameters in sevoflurane anaesthetized dogs.

The purpose of this study was to investigate the cardiopulmonary influences of sevoflurane in oxygen at two anaesthetic concentrations (1.5 and 2 MAC) during spontaneous and controlled ventilation in dogs. After premedication with fentany-droperidol (5 microg/kg and 0.25 mg/kg intramuscularly) and induction with propofol (6 mg/kg intravenously) six dogs were anaesthetized for 3 h. Three types of ventilation were compared: spontaneous ventilation (SpV), intermittent positive pressure ventilation (IPPV), and positive end expiratory pressure ventilation (PEEP, 5 cm H2O). Heart rate, haemoglobin oxygen saturation, arterial blood pressures, right atrial and pulmonary arterial pressures, pulmonary capillary wedge pressure and cardiac output were measured. End tidal CO2%, inspiratory oxygen fraction, respiration rate and tidal volume were recorded using a multi-gas analyser and a respirometer. Acid-base and blood gas analyses were performed. Cardiac index, stroke volume, stroke index, systemic and pulmonary vascular resistance, left and right ventricular stroke work index were calculated. Increasing the MAC value during sevoflurane anaesthesia with spontaneous ventilation induced a marked cardiopulmonary depression; on the other hand, heart rate increased significantly, but the increases were not clinically relevant. The influences of artificial respiration on cardiopulmonary parameters during 1.5 MAC sevoflurane anaesthesia were minimal. In contrast, PEEP ventilation during 2 MAC concentration had more pronounced negative influences, especially on right cardiac parameters. In conclusion, at 1.5 MAC, a surgical anaesthesia level, sevoflurane can be used safely in healthy dogs during spontaneous and controlled ventilation (IPPV and PEEP of 5 cm H2O).

Capnographic monitoring of anesthetized African grey parrots receiving intermittent positive pressure ventilation.

OBJECTIVE: To determine whether end-tidal partial pressure of carbon dioxide (PETCO2) correlated with PaCO2 in isoflurane-anesthetized African grey parrots receiving intermittent positive pressure ventilation (IPPV). DESIGN: Prospective study. ANIMALS: 14 healthy mature African grey parrots (Psittacus erithacus timnus). PROCEDURE: Each bird was anesthetized via mask with isoflurane, intubated, and connected to a pressure-limited intermittent-flow ventilator. Respiratory rate was altered while holding peak inspiratory pressure constant (5 cm H2O) to achieve a PETCO2 in 1 of 3 ranges: < 30 mm Hg, 30 to 40 mm Hg, and > 40 mm Hg. Blood was collected from the superficial ulnar artery of each bird at least once during each of the 3 ranges. Arterial blood samples were collected for blood gas analysis while PETCO2 was recorded simultaneously. RESULTS: A strong correlation between PETCO2 and PaCO2 was detected over a wide range of partial pressures, although PETCO2 consistently overestimated PaCO2 by approximately 5 mm Hg. End-tidal partial pressure of CO2 and PaCO2 also correlated well with arterial blood pH, and the acute response of the bicarbonate buffer system to changes in ventilation was similar to that of mammals. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that PETCO2 reliably estimates PaCO2 in isoflurane-anesthetized African grey parrots receiving IPPV and suggest that IPPV combined with capnography is a viable option for anesthetic maintenance in avian anesthesia.

A simple method of providing intermittent positive-pressure ventilation to etorphine-immobilized elephants (Loxodonta africana) in the field.

Five African elephants (Loxodonta africana) were immobilized with etorphine in Waza National Park, Cameroon, for the purpose of deploying radio/satellite tracking collars. A portable ventilator constructed from two high-flow demand valves and the Y-piece of a large animal anesthesia circuit was used to provide intermittent positive-pressure ventilation with 100% oxygen. Oxygenation status improved dramatically in all five elephants. In one hypoxemic elephant, arterial PaO2 increased from 40 to 366 mm Hg. The results of this study demonstrate that both oxygenation and ventilation can be readily controlled in etorphine-immobilized elephants even under remote field conditions.

Respiratory failure attributable to moxidectin intoxication in a dog.

A 5-month-old 22-kg (48.4-lb) sexually intact male Collie was examined after ingesting a moxidectin-containing deworming medication. The dog was comatose and had respiratory arrest after progressively worsening lethargy, ataxia, and seizures. Exposure was confirmed by isolation of moxidectin from a biopsy specimen of adipose tissue, using liquid chromatography-mass spectroscopy methods. Treatment included use of intermittent positive-pressure ventilation, activated charcoal and cathartic administered enterally, nutrients administered via nasogastric tube, and intensive supportive care. The dog was weaned from a ventilator on day 6 after ingestion and was discharged on day 10. The dog was considered clinically normal during examination 24 days after ingestion. On the basis of the dog reported here and toxicologic data provided by the manufacturer of the deworming product, some Collies may have increased susceptibility to products containing high doses of moxidectin.

Influence of tidal volume and positive end-expiratory pressure on inspiratory gas distribution and gas exchange during mechanical ventilation in horses positioned in lateral recumbency.

OBJECTIVE: To study effects of intermittent positive-pressure ventilation (IPPV) with large tidal volumes and addition of positive end-expiratory pressure (PEEP) on maldistribution of ventilation in anesthetized horses positioned in lateral recumbency. ANIMALS: 6 healthy adult horses. PROCEDURE: Anesthesia was induced by i.v. infusion of thiopental sodium and guiafenesin and was maintained with supplemental doses of thiopental and i.v. infusion of chloral hydrate. Functional separation of the lungs was achieved, using a tube-in-tube intubation technique. Intermittent positive-pressure ventilation of both lungs with air was done by use of an anesthetic circle system and a ventilator. Data were collected during spontaneous respiration and during IPPV, using increasing tidal volumes with and without PEEP of 10 and 20 cm of H2O. RESULTS: Uneven distribution of inspired gas between the lungs that existed during spontaneous respiration was not altered by IPPV and large tidal volumes. Addition of PEEP caused a significant and reversible shift of inspired gas to the dependent lung and preferentially increased functional residual capacity of the nondependent lung. This was accompanied by significant increase in PaO2. With IPPV, the combined effects of PEEP and large tidal volume caused an increase of the fractional distribution of inspired gas to the dependent lung from 34% to 50%, accompanied by an increase in PaO2 and alveolar dead space of both lungs. CONCLUSIONS AND CLINICAL RELEVANCE: Use of PEEP during IPPV changes distribution of inspired gas. Increased in PaO2 can be attributed to improved ventilation-perfusion, especially in the dependent lung, in which previously collapsed lung units might have been reopened and participated again in gas exchange after redistribution of inspired gas. The most pronounced effects of IPPV and PEEP were associated with high airway pressures, which are likely to offset the beneficial effects of the increase of PaO2 on total oxygen availability to the tissues because of the expected negative effects on cardiac output.

Relationship between inspiratory pressure and tidal volume in the anesthetized canine.

Hounds undergoing prolonged or complicated surgical procedures are often underventilated, as indicated by blood gas and end-tidal CO2 (CO2) values when using published ventilatory guidelines. We investigated the relationship between body weight, tidal volume, and inspiratory pressure delivered by the ventilator (lung inflation pressure) in 59 anesthetized hounds (19 to 33 kg). Animals were ventilated under positive pressure control and noninvasively instrumented to monitor blood pressure, ECG, oxygen saturation, CO2, and tidal volume. Weight, sex, and thorax measurements were recorded. All dogs were monitored at lung inflation pressures of 10, 14, and 18 cm H2O, with measurements recorded once CO2 stabilized. Veterinary guidelines recommend tidal volumes of 10 to 15 ml/kg of body weight and lung inflation pressures of 15 to 25 cm H2O. When inflation pressure was below guidelines (10), tidal volume was "normal" (10 to 15 ml/kg), but the animals were underventilated. When inflation pressure was "normal" (14 or 18 cm H2O), tidal volume was above guidelines. Physiologic variables were normal only when inflation pressure was 14 cm H2O. Weight and thorax depth accounted for 32 and 6%, respectively, of tidal volume variability, and tidal volume varied by +/- 250 ml at any given body weight and inflation pressure. None of the measured physical variables accurately predicted tidal volume. These data suggest that the inconsistency in tidal volume is due to a previously undescribed variability in respiratory compliance in the anesthetized hound and that the guidelines for ventilation during surgery need further investigation.

Monitoring adequacy of ventilation by capnometry during thoracotomy in dogs.

OBJECTIVE: To determine whether end-tidal partial pressure of carbon dioxide (PETCO2) was a reliable estimate of PaCO2 in dogs undergoing thoracotomy. DESIGN: Case series. ANIMALS: 18 dogs that underwent thoracotomy. PROCEDURE: PaCO2 and PETCO2 were measured shortly after induction of anesthesia, while dogs were breathing spontaneously; 5 minutes prior to initial skin incision, while dogs were receiving intermittent positive-pressure ventilation (IPPV); 5, 30, and 60 minutes after the thoracic cavity was opened, while dogs were receiving IPPV; and after the thoracic cavity was closed and evacuated, when dogs were again breathing spontaneously. For each period, arterial-end-tidal difference in partial pressure of carbon dioxide (PaCO2-PETCO2) was compared with PaCO2-PETCO2 for the preceding period. RESULTS: Significant changes in PaCO2-PETCO2 from one period to the next were not detected except when values obtained 5 minutes after the thoracic cavity was opened were compared with values obtained 5 minutes before incision. The PaCO2-PETCO2 was not constant for individual dogs. CLINICAL IMPLICATIONS: PETCO2 was not a reliable indicator of adequacy of ventilation during thoracotomy in these dogs, because it differed greatly from PaCO2, and PaCO2-PETCO2 was not consistent.

Cardiopulmonary effects of hypercapnia during controlled intermittent positive pressure ventilation in the horse.

The cardiopulmonary effects of eucapnia (arterial CO2 tension [PaCO2] 40.4 +/- 2.9 mm Hg, mean +/- SD), mild hypercapnia (PaCO2, 59.1 +/- 3.5 mm Hg), moderate hypercapnia (PaCO2, 82.6 +/- 4.9 mm Hg), and severe hypercapnia (PaCO2, 110.3 +/- 12.2 mm Hg) were studied in 8 horses during isoflurane anesthesia with volume controlled intermittent positive pressure ventilation (IPPV) and neuromuscular blockade. The sequence of changes in PaCO2 was randomized. Mild hypercapnia produced bradycardia resulting in a significant (P < 0.05) decrease in cardiac index (CI) and oxygen delivery (DO2), while hemoglobin concentration (Hb), the hematocrit (Hct), systolic blood pressure (SBP), mean blood pressure (MBP), systemic vascular resistance (SVR), and venous admixture (QS/QT) increased significantly. Moderate hypercapnia resulted in a significant rise in CI, stroke index (SI), SBP, MBP, mean pulmonary artery pressure (PAP), Hct, Hb, arterial oxygen content (CaO2), mixed venous oxygen content (CvO2), and DO2, with heart rate (HR) staying below eucapnic levels. Severe hypercapnia resulted in a marked rise in HR, CI, SI, SBP, PAP, Hct, Hb, CaO2, CvO2, and DO2. Systemic vascular resistance was significantly decreased, while MBP levels were not different from those during moderate hypercapnia. No cardiac arrhythmias were recorded with any of the ranges of PaCO2. Norepinephrine levels increased progressively with each increase in PaCO2, whereas plasma cortisol levels remained unchanged. It was concluded that hypercapnia in isoflurane-anesthetized horses elicits a biphasic cardiopulmonary response, with mild hypercapnia producing a fall in CI and DO2 despite an increase in MBP, while moderate and severe hypercapnia produce an augmentation of the cardiopulmonary performance and DO2.

Blood gas values during intermittent positive pressure ventilation and spontaneous ventilation in 160 anesthetized horses positioned in lateral or dorsal recumbency.

One hundred sixty horses were anesthetized with xylazine, guaifenesin, thiamylal, and halothane for elective soft tissue and orthopedic procedures. Horses were randomly assigned to one of four groups. Group 1 (n = 40): Horses positioned in lateral (LRG1; n = 20) or dorsal (DRG1; n = 20) recumbency breathed spontaneously throughout anesthesia. Group 2 (n = 40): Intermittent positive pressure ventilation (IPPV) was instituted throughout anesthesia in horses positioned in lateral (LRG2; n = 20) or dorsal (DRG2; n = 20) recumbency. Group 3 (n = 40): Horses positioned in lateral (LRG3; n = 20) or dorsal (DRG3; n = 20) recumbency breathed spontaneously for the first half of anesthesia and intermittent positive pressure ventilation was instituted for the second half of anesthesia. Group 4 (n = 40): Intermittent positive pressure ventilation was instituted for the first half of anesthesia in horses positioned in lateral (LRG4; n = 20) or dorsal (DRG4; n = 20) recumbency. Spontaneous ventilation (SV) occured for the second half of anesthesia. The mean time of anesthesia was not significantly different within or between groups. The mean time of SV and IPPV was not significantly different in groups 3 and 4. Variables analyzed included pH, PaCO2, PaO2, and P(A-a)O2 (calculated). Spontaneous ventilation resulted in significantly higher PaCO2 and P(A-a)O2 values and significantly lower PaO2 values in LRG1 and DRG1 horses compared with LRG2 and DRG2 horses. Intermittent positive pressure ventilation resulted in normocarbia and significantly lower P(A-a)O2 values in LRG2 and DRG2 horses. In LRG2 the PaO2 values significantly increased from 20 minutes after induction to the end of anesthesia. The PaO2 and P(A-a)O2 values were not significantly different from the beginning of anesthesia after IPPV in DRG2 or DRG3. The PaO2 values significantly decreased and the P(A-a)O2 values significantly increased after return to SV in horses in LRG4 and DRG4. The PaO2 values were lowest and the P(A-a)O2 values were highest in all horses positioned in dorsal recumbency compared with lateral recumbency and in SV horses compared with IPPV horses. The pH changes paralleled the changes in PaCO2. Blood gas values during right versus left lateral recumbency in all groups were also evaluated. The PaO2 values were significantly lower and the P(A-a)O2 values were significantly higher during SV in horses positioned in left lateral (LRLG1) compared with right lateral (LRRG1) recumbency.(ABSTRACT TRUNCATED AT 400 WORDS)