Predictors of arterial oxygen tension in anesthetized horses: 1,610 cases (1992-1994).

OBJECTIVE: To identify factors associated with various arterial partial pressures of oxygen (Pao2) in anesthetized horses. DESIGN: Retrospective study. ANIMALS: 1,450 horses anesthetized a total of 1,610 times with isoflurane or halothane. PROCEDURE: Anesthesia records, particularly results of blood gas analyses, were reviewed, and horses were grouped on the basis of lowest Pao2. RESULTS: For horses with lowest Pao2 < 120 mm Hg, those with low pulse pressure, that underwent anesthesia on an emergency basis, or that were males were more likely to have Pao2 < 80 mm Hg. For horses with lowest Pao2 < 250 mm Hg, those that were positioned in dorsal recumbency, that underwent anesthesia on an emergency basis, or that had a shorter duration of anesthesia were more likely to have lowest Pao2 < 120 mm Hg. For horses with lowest Pao2 < 400 mm Hg, those that were positioned in dorsal recumbency, that underwent anesthesia on an emergency basis, that had a shorter duration of anesthesia, that were older, that were heavier, or that were being ventilated mechanically were more likely to have lowest Pao2 < 250 mm Hg. CONCLUSIONS AND CLINICAL RELEVANCE: Low pulse pressure, emergency case status, dorsal recumbency, and short duration of anesthesia were significantly related with lower Pao2 in anesthetized horses.

Effects of inhalation anesthetic agents on response of horses to three hours of hypoxemia.

OBJECTIVE: To study the effects of inhalation anesthetic agents on the response of horses to 3 hours of hypoxemia. DESIGN: Controlled crossover study. ANIMALS: Five healthy adult horses. PROCEDURE: Horses were anesthetized twice: once with halothane, and once with isoflurane in O2. Anesthetized horses were positioned in left lateral recumbency. Constant conditions for the study began at 2 hours of anesthesia. A constant agent dose of 1.2 minimum alveolar concentration, PaO2 of 50 +/- 5 mm of Hg, and PaCO2 of 45 +/- 5 mm of Hg were maintained for 3 hours. Circulatory measurements were made at 0.5, 1, 2, and 3 hours of hypoxemia (anesthesia hours 2.5, 3, 4, and 5). Blood was collected from horses for biochemical analyses before anesthesia, within a few minutes after standing, and at 1, 2, 4, and 7 days after anesthesia. RESULTS: Cardiac index was greater (P = 0.018) during isoflurane than halothane anesthesia. Cardiac index remained constant during the 3 hours of hypoxemia during halothane anesthesia, whereas it decreased from the baseline during isoflurane anesthesia. Marginally nonsignificant P values for an agent difference were detected for arterial O2 content (P = 0.051), and oxygen delivery (P = 0.057). Serum activities of aspartate transaminase (P = 0.050) and sorbitol dehydrogenase (P = 0.017) were higher in halothane-anesthetized horses than in isoflurane-anesthetized horses. Circulatory function was better in hypoxemic horses anesthetized with isoflurane than with halothane. Isoflurane resulted in less muscular injury in hypoxemia horses than did halothane anesthesia. Halothane anesthesia and hypoxemia were associated with hepatic insult. CONCLUSION: Isoflurane is better than halothane for hypoxemic horses.

Clinical applications of quantitative acid-base chemistry.

Stewart used physicochemical principles of aqueous solutions to develop an understanding of variables that control hydrogen ion concentration (H+) in body fluids. He proposed that H+ concentration in body fluids was determined by PCO2, strong ion difference (SID = sum of strong positive ion concentrations minus the sum of the strong anion concentrations) and the total concentration of nonvolatile weak acid (Atot) under normal circumstances. Albumin is the major weak acid in plasma and represents the majority of Atot. These 3 variables were defined as independent variables, which determined the values of all other relevant variables (dependent) in plasma, including H+. The major strong ions in plasma are sodium and chloride. The difference between Na+ and Cl- may be used as an estimation of SID. A decrease in SID below normal results in acidosis (increase in H+) and an increase in SID above normal results in alkalosis (decrease in H+). Unidentified strong anions such as lactate will decrease the SID, if present. Equations developed by Fencl allow Stewart's work to be easily applied clinically for evaluating the metabolic (nonrespiratory) contribution to acid-base balance. This approach separates the net metabolic abnormality into components, and allows one to easily detect mixed metabolic acid-base abnormalities. The Fencl approach provides insight into the nature and severity of the disturbances that exist in the patient. Sodium, chloride, protein, and unidentified anion derangements may contribute to the observed metabolic acid-base imbalance.

Recovery of horses from inhalation anesthesia.

To study behavioral and cardiopulmonary characteristics of horses recovering from inhalation anesthesia, 6 nonmedicated horses were anesthetized under laboratory conditions on 3 different days, with either halothane or isoflurane in O2. Anesthesia was maintained at constant dose (1.5 times the minimum alveolar concentration [MAC]) of halothane in O2 for 1 hour (H1), halothane in O2 for 3 hours (H3), or isoflurane in O2 for 3 hours (I3). The order of exposure was set up as a pair of Latin squares to account for horse and trial effects. Circulatory (arterial blood pressure and heart rate) and respiratory (frequency, PaCO2, PaO2, pHa) variables were monitored during anesthesia and for as long as possible during the recovery period. End-tidal percentage of the inhaled agent was measured every 15 seconds by automated mass spectrometry, then by hand-sampling after horses started moving. Times of recovery events, including movement of the eyelids, ears, head, and limbs, head lift, chewing, swallowing, first sternal posture and stand attempts, and the number of sternal posture and stand attempts, were recorded. The washout curve or the ET ratio (end-tidal percentage of the inhaled agent at time t to end-tidal percentage of the inhaled agent at the time the anesthesia circuit was disconnected from the tracheal tube) plotted against time was similar for H1 and H3. The slower, then faster (compared with halothane groups) washout curve of isoflurane was explainable by changes in respiratory frequency as horses awakened and by lower blood/gas solubility of isoflurane. The respiratory depressant effects of isoflurane were marked and were more progressive than those for halothane at the same 1.5 MAC dose. During the first 15 minutes of recovery, respiratory frequency for group-I3 horses increased significantly (P < 0.05), compared with that for the halothane groups. For all groups, arterial blood pressure increased throughout the early recovery period and heart rate remained constant. Preanesthesia temperament of horses and the inhalation agent used did not influence the time of the early recovery events (movement of eyelids, ears, head, and limbs), except for head lift. For events that occurred at anesthetic end-tidal percentage < 0.20, or when horses were awake, temperament was the only factor that significantly influenced the nature of the recovery (chewing P = 0.04, extubation P = 0.001, first stand attempt P = 0.008, and standing P = 0.005).(ABSTRACT TRUNCATED AT 400 WORDS)

Regional limb perfusion with antibiotics in three horses.

Antibiotics were delivered to chronically infected tissues by regional limb perfusion in three horses with osteomyelitis associated with orthopedic implants. Two infections were resolved with implants in place; in one, a sequestrum was resorbed. In one horse, regional antibiotic perfusion was applied to treat progressively worsening bone infection after initial implants loosened and were removed.

Regional perfusion of the equine carpus for antibiotic delivery.

Regional perfusion of carpal tissues by forced intramedullary administration of fluids was evaluated in 10 horses. Results of subtraction radiography after perfusion with a contrast medium demonstrated that perfusate was delivered to the carpal tissues by the venous system. Perfused India ink was distributed uniformly in the antebrachiocarpal and middle carpal synovial membranes. Histologically, the ink was within the venules of the synovial villi. Immediately after perfusion with gentamicin sulfate (1 g), the gentamicin concentrations in the synovial fluid and synovial membrane of the antebrachiocarpal joint were 349 +/- 240 micrograms/mL and 358 +/- 264 micrograms/g, respectively. When gentamicin concentrations in the synovial fluid of the antebrachiocarpal joint and serum were measured 0, 0.5, 1, 4, 8, 12, and 24 hours after carpal perfusion, the mean peak gentamicin concentration in the synovial fluid was 589 +/- 429 micrograms/mL. At hour 24, the mean gentamicin concentration in the synovial fluid was 4.8 +/- 2.0 micrograms/mL. The resulting peak gentamicin concentration in the serum was 23.7 +/- 14.5 micrograms/mL immediately after the perfusion; it decreased below the desired trough level of 1 micrograms/mL between hours 4 and 8.

Arthrodesis for congenital flexural deformity of the metacarpophalangeal and metatarsophalangeal joints.

A llama, a miniature horse, and a miniature donkey with severe bilateral congenital flexural deformities of the metacarpophalangeal and metatarsophalangeal joints were treated successfully by arthrodesis with dynamic compression plating or external skeletal fixation. The flexor tendons were more taut than the suspensory ligaments and were transected. In the llama, the suspensory ligament was transected, and overcorrection caused ischemic necrosis of one distal limb and subluxation of the other fetlock joint. In the horse and donkey, the suspensory ligament was preserved and wedge osteotomy was performed to correct the deformity.

Serum levels of type III procollagen peptide in Equidae before and after intestinal ischemia.

Serum levels of type III procollagen peptide (P-III-P) were measured by radioimmunoassay in clinically normal adult ponies (n = 15) and horses (n = 10). The mean serum levels of P-III-P from the ponies, 10.4 +/- 2.9 (SD) ng/mL, and the horses, 12.2 +/- 2.6 (SD) ng/mL, were not significantly different. Segments of jejunum were made ischemic to induce fibrous peritoneal adhesions in two ponies, and serum P-III-P levels were measured on days 4, 5, 7, 14, and 21. An exploratory celiotomy on day 21 revealed that the ischemic injury had induced fibrosis of the mesentery and bowel, but no adhesions had formed. The fibrotic mesentery contained type III collagen. The highest mean serum level of P-III-P, 23.0 +/- 3.5 (SD) ng/mL on day 7, was more than 4 SD above the mean from the normal ponies. There was a significant difference in the serum P-III-P levels in the ponies on days 0 (7.1 +/- 1.6 ng/mL) and 7 (23.0 +/- 3.5 ng/mL). Serum levels of P-III-P may be useful to study fibrosis associated with intestinal ischemia.

Pulse oximetry in horses.

The clinical usefulness of two pulse oximeters was evaluated at two probe sites in nine anesthetized horses. The hemoglobin saturation determined by the pulse oximeters (SaOx) was compared with the hemoglobin saturation calculated from the measured arterial oxygen tension (SaO2). The mean and standard deviation (SD) were calculated from the differences in saturation measurements, over the saturation range of 80% to 100%, for each oximeter used at the tongue probe site and for one oximeter used at the ear. The oximeter results tended to underestimate the SaO2 with mean differences of -3.7% on the tongue and -6.0% on the ear. The limits of agreement were defined as the mean difference +/- 2 SD. Each oximeter used at the tongue produced limits of agreement of +1% to -8%, which meant that 95% of the SaOx values were 1 percentage point above or 8 percentage points below the SaO2. The variability of the differences and limits of agreement were larger when the ear was used as the probe site and at saturations less than 80%. Although both oximeters tended to underestimate the SaO2, they appeared to be clinically useful in detecting changes in arterial hemoglobin saturation.