Editor's Choice - Renal complications after EVAR with suprarenal versus infrarenal fixation among all users and routine users.

BACKGROUND: Previous studies comparing endografts with suprarenal and infrarenal fixation for endovascular abdominal aortic aneurysm repair (EVAR) have found conflicting results and did not account for differences in patient selection. This study aims to evaluate the differences in outcomes among surgeons who routinely use either suprarenal or infrarenal fixation, as well as all surgeons in the Vascular Study Group of New England (VSGNE). METHODS: All patients undergoing EVAR in the VSGNE from 2003 to 2014 were identified. All ruptured aneurysms, repairs with concomitant procedures, and infrequently used stent grafts (<50) were excluded. Suprarenal endografts included Talent, Zenith, and Endurant; infrarenal endografts included AneuRx and Excluder. Grafts were compared among surgeons who used only one type of endograft (suprarenal or infrarenal) for >80% of cases, as well as all surgeons. Multivariate regression and Cox hazard models were utilised to account for patient demographics, comorbidities, operative differences, and procedure year. RESULTS: This study identified 2574 patients (suprarenal, 1264; infrarenal, 1310) with 888 endografts placed by routine users (suprarenal, 409; infrarenal, 479). There were no differences in baseline comorbidities, including the estimated glomerular filtration rate, between suprarenal and infrarenal fixation, or between patients with endografts placed by routine and non-routine users. Patients treated with suprarenal endografts received more contrast than all users (102 mL vs. 100 mL, p = .01) and routine users (110 mL vs. 88 mL, p < .01), but other vascular and operative details were similar. Among all users, patients treated with suprarenal grafts had higher rates of creatinine increase >.5 mg/dL (3.7% vs. 2.0%, p = .01), length of stay >2 days (27% vs. 19%, p < .01), and discharge to a skilled nursing facility (9.2% vs. 6.7%, p = .02). There were no differences in 30 day or 1 year mortality. Following adjustment, suprarenal stent grafts remained associated with an increased risk of renal deterioration (OR 2.0; 95% CI 1.2-3.4) and prolonged length of stay (OR 1.8; 95% CI 1.4-2.2). Among routine users, suprarenal fixation was also associated with higher rates of renal dysfunction (3.7% vs. 1.3%, p = .02; OR 2.9; 95% CI 1.1-7.8). CONCLUSION: Despite potential differences in patient selection, endografts with suprarenal fixation among all users and routine users were associated with higher rates of renal deterioration and longer length of hospital stay. Longer-term data are needed to determine the duration and severity of renal function decline and to identify potential benefits of decreased migration or endoleak.

[Computed tomography with computer-assisted detection of pulmonary nodules in dogs and cats]. / Computertomographische Untersuchungen mit computerassistierter Detektion von pulmonalen Rundherden bei Hund und Katze.

OBJECTIVE: The aim of this study was to assess the potential benefit of computer-assisted detection (CAD) of pulmonary nodules in veterinary medicine. Therefore, the CAD rate was compared to the detection rates of two individual examiners in terms of its sensitivity and false-positive findings. MATERIALS AND METHODS: We included 51 dogs and 16 cats with pulmonary nodules previously diagnosed by computed tomography. First, the number of nodules ≥ 3 mm was recorded for each patient by two independent examiners. Subsequently, each examiner used the CAD software for automated nodule detection. With the knowledge of the CAD results, a final consensus decision on the number of nodules was achieved. The software used was a commercially available CAD program. RESULTS: The sensitivity of examiner 1 was 89.2%, while that of examiner 2 reached 87.4%. CAD had a sensitivity of 69.4%. With CAD, the sensitivity of examiner 1 increased to 94.7% and that of examiner 2 to 90.8%. CONCLUSION AND CLINICAL RELEVANCE: The CAD-system, which we used in our study, had a moderate sensitivity of 69.4%. Despite its severe limitations, with a high level of false-positive and false-negative results, CAD increased the examiners' sensitivity. Therefore, its supportive role in diagnostics appears to be evident.

[Sonographically detectable splenic disorders in dogs with malignant lymphoma]. / Sonographisch erfassbare Milzveränderungen bei Hunden mit malignem Lymphom.

OBJECTIVE: To evaluate the frequency of different sonographic splenic disorders in dogs with different anatomic forms of malignant lymphoma. Additionally, the occurrence of the moth-eaten pattern in the parenchyma of the spleen in patients with diseases other than lymphoma should be investigated. MATERIAL AND METHODS: Retrospective analysis of patient data collected from dogs histologically or cytologically diagnosed with malignant lymphoma and for which ultrasonographic images were available before the initiation of therapy. Patient data from dogs with a moth-eaten pattern within the splenic parenchyma were evaluated separately. Exclusion criterion was the administration of cytostatic agents prior to diagnosis. RESULTS: In 84% of 164 dogs with malignant lymphoma, an altered pattern of the spleen was diagnosed ultrasonographically. Ninety-four of these 137 patients had a moth-eaten pattern of the splenic parenchyma and 43 dogs displayed abnormalities in the form of splenomegaly, coarse echotexture or other changes of the parenchyma. When a moth-eaten pattern was diagnosed, the affected dogs suffered significantly more often from a multicentric lymphoma (95%) than from any other anatomical lymphoma form. Only one dog displayed a moth-eaten pattern of the splenic parenchyma without diagnosis of a malignant lymphoma. The positive predictive value of the moth-eaten pattern for malignant lymphoma was 99% and, in particular, for the multicentric lymphoma this was 95%. In total, 84% of the 164 dogs displayed a multicentric lymphoma, 5% a mediastinal or a cutaneous lymphoma, respectively, 4% a gastrointestinal lymphoma, and one animal had an ocular or renal lymphoma, respectively. CONCLUSION AND CLINICAL RELEVANCE: Sonographic changes of the spleen are often diagnosed in dogs with malignant lymphoma, independent of the anatomical lymphoma form. When the moth-eaten pattern is observed, it is very likely that the affected dog suffers from a malignant lymphoma, most probably a multicentric lymphoma.

[Sonographically detectable changes in abdominal lymph nodes in dogs with malignant lymphoma. Evaluation with special consideration of the Solbiati-Index]. / Sonographische Veränderungen abdominaler Lymphknoten bei Hunden mit einem malignen Lymphom. Auswertung unter besonderer Berücksichtigung des Solbiati-Index.

OBJECTIVE: Characterization of the disorders of abdominal lymph nodes in dogs with malignant lymphoma and evaluation of the Solbiati-Index (SI) and the relationship between the short axis and the length of the lymph node (S  :  L ratio) as malignancy criteria. MATERIAL AND METHODS: Retrospective analysis of data from dogs with malignant lymphoma. Inclusion criteria were cytological or histological diagnosis of the malignant lymphoma and an ultrasound examination of the abdomen prior to initiation of therapy. Criterion for exclusion was the application of a cytostatic agent prior to diagnosis. Furthermore, abdominal lymph nodes with non-neoplastic disorders were examined, when sonography as well as cytological/histological examinations were available. RESULTS: A total of 261 lymph nodes (127 dogs) with malignant lymphoma and 17 lymph nodes (nine dogs) with benign disorders were evaluated. Sonography revealed massively rounded, clearly enlarged lymph nodes in 115/127 dogs (91%) with malignant lymphoma, while the lymph nodes of the other 12 dogs (9%) displayed an enlargement in the long axis. All 17 lymph nodes with benign disorders were enlarged in the long axis. The nodal parenchyma of 91% of the 127 dogs (malignant lymphoma) presented as hypoechoic to anechoic, and the cortex and medulla could not be differentiated. In the remaining 9% of dogs, a physiological isoechoic nodal parenchyma was observed. The parenchyma of lymph nodes with benign disorders was sonographically inconspicuous. In 71% of the 127 dogs with malignant lymphoma, the SI was < 2 and the S  :  L ratio > 0.5 (indicative for malignancy). Of the nine dogs with benign lymph node disorders, 71% had an SI of > 2 and 76% of them had an S  :  L ratio < 0.5 (indicative of a benign process). CONCLUSION AND CLINICAL RELEVANCE: The significant increase in the size, rounding and hypoechoic changes in the lymph nodes in dogs with malignant lymphoma are indicative parameters of malignancy. In addition, the SI and the S:L ratio serve as a differentiation between benign and malign processes. Because of blurred boundaries between the malignant and benign changes, the various parameters should always be considered in conjunction.

[Evidence-based guidelines for cardio-pulmonary resuscitation in the dog and cat]. / Evidenzbasierte Leitlinien zur kardiopulmonalen Reanimation bei Hund und Katze.

Early recognition of a cardio-pulmonary arrest (CPA) is crucial for patient survival. Every non-breathing and non-responsive patient should be considered to have CPA, and examination of the vital signs should last no longer than 5-10 seconds. If in doubt, effective chest compressions should be started immediately (frequency of 100-120 compressions per minute, compression depth one third to half of the chest diameter, full chest wall recoil between the compressions, no interruption, change of compressing person every 2 minutes). Furthermore, the patient should be intubated and ventilated as early as possible with a frequency of 10 breaths per minute and a volume of 10 ml/kg. Additional measures include monitoring (electrocardiogram, end-expiratory carbon dioxide concentration), placement of an intravenous or intraosseous catheter, administration of opioid-, benzodiazepine- and/or α2-antagonists and ECG-dependent therapy to restore spontaneous circulation. In the case of asystole and pulseless electric activity, epinephrine (0.01 mg/kg every 3-5 minutes, alternative dose concept: 0.1 mg/kg epinephrine) is advised. In the case of CPA due to elevated vagal tonus or bradycardia, atropine should be given (0.04 mg/kg every 3-5 minutes). If ventricular fibrillation or pulseless ventricular tachyarrhythmia is present, defibrillation is the therapy of choice. When this is not possible, amiodarone (5 mg/kg) or lidocaine (2 mg/kg) should be administered. Furthermore, 100% oxygen should be given during resuscitation, while only a few patients benefit from infusion therapy. Following the return of spontaneous circulation, intensive care of the patient is necessary. This involves intense monitoring and support of the haemodynamic situation using intravenous fluids, vasopressors and positive inotropic drugs as well as an improvement of gas exchange and neuroprotection.

[Sonographic measurement of soft-palate thickness and comparison with the measurement by computed tomography]. / Sonographische Messung der Gaumensegeldicke beim Hund im Vergleich zur computertomographischen Messung.

OBJECTIVE: The aim of this study was to measure the thickness of the soft palate at specific locations in normocephalic dogs using sonography and computed tomography (CT), and to subsequently compare the two different methods. MATERIAL AND METHODS: A total of 15 normocephalic dogs were examined under general anesthesia. The CT was performed while patients were in a sternal recumbent position, their mouth held open by placing their upper jaw on a positioning device. Dorsal recumbency together with submental and midsagittal positioning of the transducer were chosen for sonography. Measurements were made in both sonographic and reconstructed sagittal CT images. Two measuring points (MP) were defined for measuring the cranial and the middle part of the soft palate (MP1: 1 cm caudal to the transition from the hard to the soft palate; MP2: at the origin of the dorsal pharyngeal muscles). It was investigated whether repeated procedures with one measuring method provided consistent values and, furthermore, whether the two different measuring methods (sonography and CT) provided comparable data. RESULTS: The data acquired by repeat measurements within one method corresponded very well. However, the data provided by the two different measurement methods showed varying results for the first measuring point and was even greater for the second measuring point. Sonography overestimated the measurements obtained by CT by up to 0.26 cm for MP1 and up to 0.79 cm for MP2. CONCLUSION: Due to the significant discrepancies in their results, the two measurement methods are not interchangeable. Sonography showed good reliability for repeat measurements. Consequently, the variable values between CT and sonography appeared to result from differing examination conditions. Sonography may be a rapid and non-invasive diagnostic tool to measure soft palate thickness if the applied method proves to be applicable in clinical practice.

[Comparison of projection radiography and computed tomography for the detection of pulmonary nodules in the dog and cat]. / Vergleich von Projektionsradiographie und Computertomographie zur Detektion pulmonaler Rundherde bei Hund und Katze.

OBJECTIVE: The aim of our study was to evaluate the value of projection radiography as a standard screening method for the detection of lung nodules compared to computed tomography (CT). Furthermore, we attempted to describe the reasons that might lead to a failed detection of pulmonary nodules in radiography. MATERIALS AND METHODS: From dogs and cats which were diagnosed in CT (multislice CT) with nodular changes in the lung pattern we selected radiographs (projection radiography with soft copy reading) in at least two projection planes produced in the same timeframe as the CT images. Exclusion criteria were nodules > 3 cm and homogenously calcified nodules (osteomata). A total of 70 animals (50 dogs and 20 cats) met the inclusion criteria. RESULTS: In 43 animals (61%), nodular changes had already been detected using radiography and were then confirmed by the results of the computed tomography. In detail, 32 of 50 dogs (64%) and 11 of 20 cats (55%) showed nodular lesions in the radiographs. In cats, undetected nodules were often accompanied by highly changed lung opacities, resulting in a poor contrast of the lung. In dogs the reasons for a failed detection of lung nodules were relatively equally distributed to several causes. Interestingly, small nodule size itself was not the predominant reason for missing the nodules in radiographs. CONCLUSION AND CLINICAL RELEVANCE: In general, radiography still plays an important role as a screening method for the detection of nodular lung lesions. However, one needs to be aware, that a quite high percentage of nodular lung changes can be missed in radiographs. The overall detection rate in this study was 61%. Furthermore, we showed that plane radiographs are of poor diagnostic value when concurrent problems exist which lead to increased lung opacity.

[Multiphasic contrast-enhanced CT: correlation of the peak attenuation in the aorta abdominalis and portal vein with easily detectable clinical parameters]. / Multiphasen-Kontrastcomputertomographie: Korrelation der Anreicherungskurven in Aorta abdominalis und Vena portae mit einfach klinisch messbaren Parametern.

OBJECTIVE: The diagnostic value of a multiphase CT strongly depends on the correct timepoints of analysis. Therefore, we investigated whether the peak attenuation time in the aorta and portal vein are predictable using easily detectable clinical parameters. Regression equations were developed that enable an approximate prediction of these scan times. MATERIAL AND METHODS: Contrast dynamic CT was performed in 39 anaesthetised dogs of different breeds. The heart rate at the onset of the examination, the age and the body weight were documented. The contrast agent Imeron 300® was injected into a cephalic vein at 3 ml/s with 600 mg iodine/kg body weight using an automatic injector and a dynamic axial CT was started at the same time. The peak enhancement time in the aorta (pETA) and portal vein (pETP) were measured. RESULTS: The mean pETA was 24.5 ± 8.6 seconds and the mean pETP was 43.6 ± 13.4 seconds. There was a strong correlation (r = 0.92) between pETA and body weight in combination with the heart rate, and a moderate correlation (r = 0.66) between pETP and body weight in combination with the age. The regression equation was: pETA = 12.23 + 0.61 body weight - 0.07 heart rate. The time between pETA and pETP was 8-24 seconds in 34 animals. CONCLUSION: To plan the arterial peak the authors recommend the use of the established regression equations based on the statistical results or alternatively bolus tracking to plan the arterial peak. When it is planned to examine the portal venous peak, an interscan duration of 8-14 seconds is recommended.

[Liver abscess in a dog. A case report]. / Leberabszess bei einem Hund. Ein Fallbericht.

The presented case report describes diagnostic and therapy of a liver abscess in a male Golden Retriever dog. The dog was adversely affected by fever, apathy, and vomitus. Diagnostic imaging including radiography, sonography and computed tomography, revealed an abscess-forming lesion of 10 × 5 cm in the left middle liver lobe with detectable multiple gas accumulation within the lesion. The surgical therapy included lobectomy with adjacent omentopexy. Four days after the operation the dog was discharged in a good general condition and with physiological body temperature. Detecting multiple gas accumulation in circular, inhomogeneous lesions by sonography allowed confirmation of the diagnosis. Surgical removal of the affected liver lobe led to recovery of the patient. In human medicine, less invasive methods are preferred, e.g. percutaneous drainage and alcoholization of the lesion. Exclusive medicamentous therapy yields the worst outcome in humans.

[Effects of a neuroleptic analgesia with acepromazine on the blood perfusion of the canine kidney. Examination using the sonographic recordable blood circulation parameters of resistance index and pulsatility index]. / Auswirkung einer Neuroleptanalgesie mit Acepromazin auf die Durchblutung der Niere beim Hund. Überprüfung anhand der sonographisch erfassbaren Durchblutungsparameter Resistance-Index und Pulsatilitätsindex.

OBJECTIVE: Kidney failure after anaesthesia constitutes a serious clinical complication. A number of patients suffer from compensated kidney insufficiency, which may be transformed into an acute kidney insufficiency through additional stress, such as an operation and anaesthesia. The aim of the present study was to investigate the effects of a neurolept analgesia with acepromazine on sonographically accessible blood perfusion parameters. MATERIAL AND METHODS: Following anaesthesia with acepromazine/l-methadone (0.1 mg/kg BW acepromazine, 0.5 mg/kg BW l-methadone) a sonographic examination of the left kidney was performed in 19 clinically healthy foxhound and beagle dogs. Every 5 minutes resistance index and pulsatility index as well as invasive blood pressure were measured and digitally recorded. RESULTS: Within 5 minutes after induction of anaesthesia a transient increase of the mean arterial blood pressure occurred. After 10 minutes the blood pressure decreased to the initial value and remained essentially constant to the end of the investigation. Resistance index and pulsatility index showed a similar behaviour: After a small initial decrease during the first 5 minutes both parameters displayed a significant increase. This rise was very pronounced up to approximately 15 minutes and then flattened significantly until the end of the test period after 30 minutes. The values corresponded to those found in vessel stenosis. CONCLUSION AND CLINICAL RELEVANCE: Due to the described changes this type of anaesthesia should not be used in dogs with nephropathy, even though the results of this experimental study might not be necessarily transferable to the clinical patient.

[Sonographic examination of the soft palate in dogs]. / Sonografische Untersuchung des weichen Gaumens beim Hund.

PURPOSE: The aim of this study was to characterize the normal sonographic anatomy of the soft palate in dogs. MATERIALS AND METHODS: The study was performed on seven canine heads via a submental and intraoral approach. The detected anatomical structures were then reexamined via a submental approach in a water bath. Each anatomic layer was subsequently dissected starting with the submental layers and working towards the soft palate. After every preparation a sonographic examination was carried out. RESULTS: Differentiation between the soft palate and the surrounding oropharyngeal tissue can be effectively achieved. Using the submental approach, the transition between hard palate and soft palate as well as the middle section of the soft palate were distinguished from other oropharyngeal structures in all cases. Visualization of the caudal part of the velum and evaluation of the echogenicity of the soft palate were difficult and not always possible. In the two brachycephalic dogs of the study, it was challenging to distinguish the soft palate from the surrounding tissue. CONCLUSION: The sonographic appearance of the canine soft palate in cadavers was described in this study. The submental approach allows differentiation between intraoral structures. Evaluation of the echogenicity and length of the soft palate is limited.

Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy.

BACKGROUND: Hyperparathyroidism is associated with subjective feelings of fatigue and depression as well as limitations in physical activity from musculoskeletal complaints. These quality of life symptoms are not widely accepted as an indication for parathyroidectomy. This study quantifies and compares subjective symptoms of patients with hyperparathyroidism before and after surgery. METHODS: Between February 2001 and June 2002, 61 patients (14 males and 47 females, mean age of 60.8+/-14.4 years) underwent parathyroidectomy. There were 45 patients with single-gland adenomas, 9 patients with double adenomas, 3 patients with primary hyperparathyroidism from 4-gland hyperplasia, 3 patients with secondary hyperparathyroidism, and 1 patient with tertiary hyperparathyroidism. Patients filled out a 53-question survey based on the Health Outcomes Institute Health Status Questionnaire 2.0 before surgery, 1 month postoperatively, and 3-24 months postoperatively. The survey included questions on overall health, daily activities, mood, and medical conditions. Surveys were analyzed for changes in symptoms attributable to parathyroidectomy. Serum calcium and intact parathyroid hormone levels were obtained preoperatively and at 1- and 3-month follow-up visits. RESULTS: At both postoperative evaluations, patients' perception of general health, muscle strength, energy level, and mood significantly improved (P<.05). Moreover, there was a significant correlation between the changes in serum calcium and intact parathyroid hormone levels and improvement in symptoms. CONCLUSIONS: Parathyroidectomy for hyperparathyroidism is associated with significant improvement in patient quality of life. These subjective symptoms represent a valid indication for parathyroidectomy.

[Reflections on anesthetic risk]. / Uberlegungen zum Narkoserisiko.

All anaesthetic drugs and techniques inhere risks, that can cause illness and death even in the sound. Beside this common anaesthetic risk caused by anaesthesia itself, risks specific for the patient and the surgery, the influence of the anaesthetist and the available facilities are additional factors contributing to the risk involved for any particular animal. In this article the factors in anaesthetic risk and their importance for the individual risk of a patient are discussed. Distinct is that a systemic disease and the resulting incapacity stand for a much higher risk than anaesthesia by itself or the surgery. Beside the preoperative physical status the urgency of the operation has a decisive influence upon the anaesthetic risk. Deficient monitoring and an unrecognized and/or untreated respiratory depression are the most common reasons for anaesthetic death in veterinary medicine. The anaesthetist has a profound bearing on the degree of risk to which a patient is exposed, because most of the avoidable anaesthetic mishaps are caused by human mistakes. The individual anaesthetic risk of a patient is determined with the help of the preanaesthetic examination. Referring to the factors in anaesthetic risk strategies for the prevention of anaesthetic mishaps and complications are discussed.

[Oximetry in veterinary anesthesia: the continuous determination of mixed venous oxygen saturation in dogs and horses]. / Oxymetrie in der Veterinäranästhesie: Die kontinuierliche Bestimmung der gemischtvenösen Sauerstoffsättigung bei Hund und Pferd.

The continuous fiberoptical measurement of the mixed venous partial oxygen saturation is described. It is an enrichment of the diagnostical possibilities in veterinary medicine. In the horse it is of great interest, because disturbances of the pulmonary gas exchange and the myocardial function are common in the anaesthetised horse, and reliable methods of assessing the cardiac output are rare. Using this monitoring technique in nearly 100 equine high risk patients facilitated insight into the complex changes of the pulmonary, cardiac and circulatory function in the anaesthetised horse. The registered data are the basis of the presented case reports. Values measured "behind the tissue" are influenced by the oxygen supply and the oxygen consumption within the periphery. Changes of the mixed venous oxygen status can be caused by a disturbance of the arterial oxygen status, by a insufficient performance of the cardiovascular system or by a change in metabolic activity. Being a multifactorial influenced parameter the mixed venous oxygen saturation can only be interpreted in connection with other parameters. The mixed venous oxygen status gives global information about the whole organism, but it is not able to inform about the oxygen supply of single organs. From our own personal experience it reflects an aggravation of the patient very early and reliable.

[Non-invasive patient monitoring in veterinary medicine: pulse oximetry and capnography. II. Capnography]. / Nichtinvasive Patientenüberwachung in der Tiermedizin: Pulsoxymetrie und Kapnographie. Teil II: Kapnographie.

Capnography measures carbon dioxide concentration or partial pressure of the respiratory gas continuously and non-invasively. The endtidal value is of great diagnostic value, it corresponds approximately to the arterial value, except for ventilation-perfusion-mismatching (horse), shunting (horse), or increased dead-space-ventilation (panting in the dog). Capnography primarily serves for monitoring of spontaneous and artificial ventilation, it is a reliable method for detecting hypo- and hyperventilation. Because metabolism and circulation influence the amount of carbon dioxide eliminated in the lung, capnography monitors these functions too. The plotting of the carbon dioxide concentration as a carbon dioxide-time-diagram draws attention to malfunctions of the equipment. Technical problems of capnography depend on the design of the capnograph (main- or side-stream) used as well as on the weight of the patient. In the discussion the value of pulse oximetry and capnography in detection of critical events during anaesthesia is compared. Capnography is superior to pulse oximetry in the capability to detect critical events. But pulse oximetry complements capnography perfectly, both methods together give a good impression of the patient's state of health.

[Noninvasive patient observation in veterinary medicine: pulse oximetry and capnography. I. Pulse oximetry]. / Nichtinvasive Patientenüberwachung in der Tiermedizin: Pulsoxymetrie und Kapnographie. Teil I: Pulsoxymetrie.

Two non-invasive continuous techniques for monitoring the respiratory function during anaesthesia have been established during the last year: pulse oximetry for monitoring the adequate oxygen supply and capnography for measuring the carbon dioxide elimination. In human medicine both are accepted as essential monitors with great reliability. Whether clinical use and interpretation can be transferred to animals without any restrictions will be discussed by looking on the physical and engineering background as well as the physiologic interpretation of the measured variable and their capability to detect critical events during administration of anaesthesia. Part I: Pulse oximetry measures the arterial oxygen saturation continuously and non-invasively. Its application in veterinary medicine must be discussed critically concerning the method as well as the interpretation. The information obtained is very different during injectable and inhalant anaesthesia. Respiratory depression is easy to detect while the animal breathes room air spontaneously. Is the inspired air enriched with oxygen, like during inhalant anaesthesia, normal values of oxygen saturation can mask the respiratory insufficiency and may give a false sense of security.

[Anesthesia of horses with xylazine and ketamine. 2. Anesthesia in adult horses]. / Ein Beitrag zur Anästhesie des Pferdes mit Xylazin und Ketamin. Teil 2: Die Anästhesie des adulten Pferdes.

Xylazine and Ketamine were used for anaesthesia in 250 adult horses. This combination is useful both for induction and maintenance of anaesthesia. The induction with Xylazine and Ketamine has been successful not only with foals but also with high risk patients such as horses with colic. During the maintenance of anaesthesia Xylazine/Ketamine can be used with injectable anaesthetics as well as with volatile anaesthetics at the same time. A form of injection anaesthesia for short-time surgical procedures like castration and wound repair is presented. The maintenance of a Thiobarbiturate/Guaifenesin anaesthesia with Xylazine/Ketamine seems to be suitable for field conditions.