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Objective: To compare the effects of 7.2% hypertonic and 0.9% isotonic saline (sodium chloride) solutions on cardiovascular parameters and plasma arginine vasopressin (AVP) concentrations in healthy, isoflurane-anesthetized horses., Animals: 8 healthy horses., Procedures: In a prospective, randomized, crossover study, horses were anesthetized with isoflurane twice with a 14-day washout period between anesthetic episodes. While anesthetized, horses received a bolus (4 mL/kg) of 7.2% hypertonic saline solution (HS) or 0.9% isotonic saline solution (IS). Heart rate; systolic, mean, and diastolic arterial blood pressures; and central venous and pulmonary artery pressures were measured every 5 minutes; cardiac output was measured by means of thermodilution every 15 minutes. Systemic vascular resistance (SVR) was calculated. Blood samples were collected before and during anesthesia, and plasma AVP concentrations were determined with a validated ELISA. Data were analyzed with repeated-measures ANOVA and Pearson correlations., Results: HS caused an increase in systolic (P = .003) and mean (P = .023) arterial blood pressures that lasted for 30 minutes. The SVR was increased (P < .001) for 45 minutes with HS compared with the SVR after IS administration. Mean plasma AVP concentration increased (P = .03) 15 minutes after HS administration, with the increase lasting 90 minutes., Clinical Relevance: A bolus of HS resulted in a clinically relevant increase in blood pressure in healthy, isoflurane-anesthetized horses. This effect was attributed to volume recruitment and an increase in SVR. Administration of HS offers an option for improving arterial blood pressure in anesthetized horses.

Background: Flumazenil antagonises the actions of benzodiazepines. There has been no prior research specifically investigating this anaesthetic reversal agent for horses., Objectives: To determine the effects of flumazenil administration in horses on (a) ventilatory parameters after midazolam-ketamine induction and maintenance with isoflurane in oxygen and on (b) the characteristics of recovery from general anaesthesia., Study Design: Blinded, randomised, crossover experiment., Methods: Six horses were randomly assigned to receive high-dose flumazenil (F high , 20 µg/kg), low-dose flumazenil (F low , 10 µg/kg) and saline (control). Cardioventilatory parameters were monitored. After 90 minutes of isoflurane anaesthesia, a bolus of F high , F low or saline was administered i.v. The horses were recovered using head and tail rope assistance. The times to first movement, to achievement of sternal recumbency, to the first attempt to stand and the total recovery time were determined. The recovery quality was evaluated using a 115-point recovery scoring system. The cardioventilatory parameters and recovery times were analysed using mixed-effects regression analyses. Intraclass correlation (ICC) analysis was used to evaluate the recovery scores. A Mann-Whitney U test assessed the relationship between recovery score and flumazenil administration., Results: A significant difference with flumazenil administration was found for SpO 2 , mean arterial pressure, I:E ratio, minute volume of ventilation (MV) and peak inspiratory pressure. There was a significant difference with flumazenil administration for the time to sternal recumbency, the time to the first attempt to rise and the total recovery time. There was no significant difference in total recovery score with flumazenil administration., Main Limitations: Plasma levels of midazolam and flumazenil were not obtained., Conclusions: Flumazenil has a dose-dependent effect on MV and recovery time, which may make it useful in cases for which a prolonged anaesthetic recovery is undesirable., (© 2020 EVJ Ltd.)

Thoracotomy is an uncommon procedure in horses but remains essential in a variety of cases of pleuropneumonia, pericarditis, thoracic trauma or diaphragmatic herniation, and for experimental thoracic and cardiac procedures. This study aimed at developing an experimental surgical procedure allowing access to the entire circumference of the heart and describing the effect of thoracotomy on pulmonary gas exchange in these horses. The study consisted of two arms, arm one (undergoing thoracotomy), was a terminal experimental study that included 11 Standardbred horses with experimentally induced (by tachypacing) atrial fibrillation. Arm two consisted of 6 Standardbred horses undergoing anesthesia for reasons unrelated to the present study. These horses functioned as controls. Anesthesia was induced using zolazepam and tiletamine. Anesthesia was maintained with isoflurane in 100% oxygen and ventilation with intermittent positive pressure (IPPV); no positive end-expiratory pressure (PEEP) was performed. Rib resection and pericardiotomy were performed for complete exposure of the entire circumference of the heart. Arterial blood samples were collected prior to, 5 and 30 minutes after puncture of pleura parietalis. In 10 horses, resection of the fifth rib was adequate for exposure of the heart. In one horse, removal of the sixth rib was also necessary. The duration of the surgical procedure (thoracotomy, pericardiotomy) was < 45 minutes. During a thoracotomy, PaO 2 decreased significantly (P < .05) from 291.8 ± 82.8 mmHg to 165.2 ± 73.5 mmHg but was not different from normal anesthetized controls. The PaCO 2 remained within normal limits. This surgical approach provided access to the entire circumference of the heart., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To evaluate the effects of intra-articular (IA) mepivacaine administration prior to carpal arthroscopy on anesthetic drug requirements, blood pressure support, hemodynamic variables, and quality of recovery in horses., Study Design: Experimental, analytical, cohort study., Sample Population: Twenty-two horses (n = 11 horses/group)., Methods: Horses were anesthetized by using the same protocol, but an IA injection of mepivacaine or saline was performed before carpal arthroscopy. End-tidal isoflurane concentration, heart rate, and mean arterial pressure were recorded at specific time points. Quality of recovery was scored by the anesthetist, who was unaware of group assignment. Data were analyzed by using two-way repeated-measures analysis of variance., Results: Mean arterial pressure was higher during joint distension in the control group compared with baseline (7% higher, P = .02) and with the treatment group (10% higher, P = .04). Heart rate was higher in the control group compared with the treatment group during joint distension (8% higher, P = .04) and chip removal (11% higher, P = .03). Heart rate was higher in the control group compared with baseline during chip removal (5.5% higher, P = .04). Two horses in the control group required additional ketamine vs none in the treatment group. Quality of recovery was not different between groups., Conclusion: Intra-articular mepivacaine resulted in fewer detectable reactions to surgical stimulation, with similar recovery scores and blood pressure support requirements., Clinical Significance: Intra-articular anesthesia prior to arthroscopy can be used safely in the horse and should be considered as a part of balanced anesthetic protocols., (© 2020 American College of Veterinary Surgeons.)

OBJECTIVE To determine global and peripheral perfusion and oxygenation during anesthesia with equipotent doses of desflurane and propofol combined with a constant rate infusion of dexmedetomidine in horses. ANIMALS 6 warmblood horses. PROCEDURES Horses were premedicated with dexmedetomidine (3.5 μg•kg -1 , IV). Anesthesia was induced with propofol or ketamine and maintained with desflurane or propofol (complete crossover design) combined with a constant rate infusion of dexmedetomidine (7 μg•kg -1 •h -1 ). Microperfusion and oxygenation of the rectal, oral, and esophageal mucosa were measured before and after sedation and during anesthesia at the minimal alveolar concentration and minimal infusion rate. Heart rate, mean arterial blood pressure, respiratory rate, cardiac output, and blood gas pressures were recorded during anesthesia. RESULTS Mean ± SD minimal alveolar concentration and minimal infusion rate were 2.6 ± 0.9% and 0.04 ± 0.01 mg•kg -1 •min -1 , respectively. Peripheral microperfusion and oxygenation decreased significantly after dexmedetomidine administration for both treatments. Oxygenation returned to baseline values, whereas tissue microperfusion remained low during anesthesia. There were no differences in peripheral tissue microperfusion and oxygenation between treatments. Cardiac index was significantly higher and systemic vascular resistance was significantly lower for desflurane treatment than for propofol treatment. For the propofol treatment, Pao 2 was significantly higher and there was less dead space and venous admixture than for the desflurane treatment. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine decreased blood flow and oxygen saturation in peripheral tissues. Peripheral tissues were well oxygenated during anesthesia with desflurane and propofol combined with dexmedetomidine, whereas blood flow was reduced.

Background: In the horse, effects of cardiovascular-active drugs on local perfusion of the gastrointestinal tract are poorly understood., Objectives: To determine the effect of drugs commonly used to support blood pressure, on local intestinal blood flow and tissue oxygenation under isoflurane anaesthesia., Study Design: In vivo randomised crossover experiment., Methods: Ten horses were anaesthetised with isoflurane. After 90 min of equilibration three doses (μg/kg bwt/min) of dobutamine (DOB 0.5/1/3), dopamine (DA 1/2/5), noradrenaline (NA 0.1/0.2/0.5) and phenylephrine (PHE 0.5/1/3) were infused for 15 min, in a randomised order, with a 45 min washout-period. Blood flow and tissue oxygenation (sO 2 ) of jejunum, colon and stomach were measured using white light remission spectrophotometry and laser doppler flowmetry; heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO) were measured and systemic vascular resistance (SVR) calculated., Results: Compared to baseline high dose dobutamine significantly increased CO, HR, MAP (P<0.001) and blood flow to the jejunum (+47 ± 26%, P = 0.001) and colon (+29 ± 15%, P<0.001) (mean ± s.d.). Dopamine (DA5) increased CO but decreased colonic blood flow (-39 ± 21% from baseline, P<0.001), as well as SVR and MAP compared to baseline (P<0.001). Noradrenaline had no significant influence on intestinal perfusion, but increased MAP and SVR from baseline (P<0.001). Phenylephrine (PHE3) caused a significant decrease in blood flow and sO 2 , most profoundly at the colon compared to baseline (flow -44 ± 21%; sO 2 -16 ± 3%, P<0.001), while MAP and SVR increased and CO and HR decreased (P<0.001)., Main Limitations: The measurement technique only allows for flow measurements in arbitrary units, which can limit comparability to other techniques., Conclusion: At the investigated doses dobutamine improved systemic and peripheral haemodynamics, while dopamine decreased MAP and peripheral perfusion. Noradrenaline increased MAP and SVR while peripheral blood flow was maintained, phenylephrine increased MAP, but reduced both local and systemic perfusion., (© 2017 EVJ Ltd.)

Background: Aim of this prospective experimental study was to assess effects of systemic hypoxemia and hypovolemia on global and gastrointestinal oxygenation and perfusion in anesthetized horses. Therefore, we anesthetized twelve systemically healthy warmblood horses using either xylazine or dexmedetomidine for premedication and midazolam and ketamine for induction. Anesthesia was maintained using isoflurane in oxygen with either xylazine or dexmedetomidine and horses were ventilated to normocapnia. During part A arterial oxygen saturation (SaO 2 ) was reduced by reducing inspiratory oxygen fraction in steps of 5%. In part B hypovolemia was induced by controlled arterial exsanguination via roller pump (rate: 38 ml/kg/h). Mean arterial blood pressure (MAP), heart rate, pulmonary artery pressure, arterial and central venous blood gases and cardiac output were measured, cardiac index (CI) was calculated. Intestinal microperfusion and oxygenation were measured using laser Doppler flowmetry and white-light spectrophotometry. Surface probes were placed via median laparotomy on the stomach, jejunum and colon., Results: Part A: Reduction in arterial oxygenation resulted in a sigmoid decrease in central venous oxygen partial pressure. At SaO 2  < 80% no further decrease in central venous oxygen partial pressure occurred. Intestinal oxygenation remained unchanged until SaO 2 of 80% and then decreased. Heart rate and pulmonary artery pressure increased significantly during hypoxemia. Part B: Progressive reduction in circulating blood volume resulted in a linear decrease in MAP and CI. Intestinal perfusion was preserved until blood loss resulted in MAP and CI lower 51 ± 5 mmHg and 40 ± 3 mL/kg/min, respectively, and then decreased rapidly., Conclusions: Under isoflurane, intestinal tissue oxygenation remained at baseline when arterial oxygenation exceeded 80% and intestinal perfusion remained at baseline when MAP exceeded 51 mmHg and CI exceeded 40 mL/kg/min in this group of horses., Trial Registry Number: 33.14-42,502-04-14/1547.

To investigate the effects of a xylazine infusion during isoflurane anesthesia on global perfusion parameters and gastrointestinal oxygenation and microperfusion, 8 adult warmblood horses were sedated with xylazine and anesthesia induced with midazolam and ketamine. Horses were mechanically ventilated during anesthesia. After 3 h of stable isoflurane anesthesia (F E Iso 1.3 Vol %), a xylazine infusion with 1 mg/kg body weight (BW) per hour was started for 1 h and then stopped. Before, during, and after xylazine infusion, heart rate (HR), arterial blood pressure (MAP), cardiac output (CO), central venous pressure (CVP), and pulmonary artery pressure (PAP) were measured and systemic vascular resistance (SVR) was calculated. Arterial blood gases were taken and oxygen delivery (DO 2 ) and alveolar dead space (V D alv) were calculated. Further intestinal oxygen and microperfusion were measured using white light spectroscopy and laser Doppler flowmetry. Surface probes were placed via median laparotomy on the stomach, the jejunum, and the colon. Wilcoxon rank-sum test was used to compare values over time ( P < 0.05). During xylazine infusion, MAP, CVP, PAP, SVR, and V D alv increased significantly, whereas CO, DO 2 , and intestinal microperfusion decreased. Intestinal oxygenation remained unchanged. All parameters returned to pre-xylazine values within 1 h after stopping xylazine infusion. A xylazine infusion during constant isoflurane anesthesia in horses impairs global and intestinal perfusion without changing tissue oxygenation in normoxic healthy horses. Further studies are necessary, however, to evaluate whether a possible reduction of isoflurane concentration by xylazine infusion will ameliorate these negative effects., Competing Interests: No funding was received for this study. None of the authors has any financial conflicts of interest.

Reasons for Performing Study: High airway pressures, necessary to keep equine lungs open, can have a detrimental impact on central and peripheral perfusion., Objective: The aim of this study was to assess the effects of stepwise increasing airway pressure recruitment on central and intestinal perfusion and oxygenation during isoflurane anaesthesia in horses., Study Design: In vivo experimental study., Methods: Ten anaesthetised horses were ventilated using intermittent positive pressure ventilation immediately after induction. After 90 min, end-expiratory pressure (PEEP) was increased by steps of 5 cmH 2 O every 10 min up to a PEEP of 30 cmH 2 O and decreased back to zero maintaining a constant airway pressure difference of 20 cmH 2 O. Mean arterial blood pressure (MAP), heart rate, central venous pressure, pulmonary artery pressure, expiratory isoflurane concentration and cardiac output (thermodilution method) were measured. Cardiac index (CI) was calculated. Arterial blood gases were taken to measure arterial partial oxygen pressure (PaO 2 ) and calculate arterial oxygen saturation (SaO 2 ). Intestinal microperfusion and oxygenation were measured by laser Doppler flowmetry and white-light spectrophotometry. After ventral median laparotomy, a probe was placed on the stomach, jejunum and pelvic flexion of the colon. An ANOVA for repeated measurements and Tukey's post hoc test were used for statistical analysis (α = 5%)., Results: Recruitment of the lungs resulted in a significant increase in PaO 2 from 201 ± 58 mmHg (baseline) to a maximum of 495 ± 75 mmHg. The CI and MAP decreased continuously with increasing airway pressures. When CI and MAP were 37 ± 9 ml/kg/min and 52 ± 8 mmHg (at PEEP of 25 cmH 2 O), respectively, a sudden decrease in intestinal perfusion followed by a delayed decrease in oxygenation occurred., Conclusions: There was linear correlation between airway pressures and CI and MAP but not between central and gastrointestinal perfusion. Despite improvement of arterial oxygenation the decrease in CI and, therefore, in oxygen delivery PEEP resulted in a decrease in gastrointestinal oxygenation., (© 2016 EVJ Ltd.)

Inappropriate mechanical ventilation can lead to ventilator-induced lung injury (VILI). Aim of this study was to evaluate the effects of inhalation anaesthesia and ventilation with and without recruitment (RM) and PEEP titration on alveolar integrity in horses. Twenty-three horses were divided into 4 groups (group OLC ventilated with OLC, group IPPV ventilated with intermittent positive pressure ventilation, group NV non-ventilated, and group C non-anaesthetized control group). After sedation with xylazine and induction with diazepam and ketamine anaesthetized horses were under isoflurane anaesthesia for 5.5h. The horses were euthanized and tissue samples of the dependent and non-dependent lung areas were collected. Histopathological examinations of the lung tissue as well as relative quantification of mRNA of IL-1β, IL-6, iNOS, MMP1 and MMP9 by PCR were performed. Horses of group OLC had significantly less alveolar congestion and atelectasis but greater alveolar overdistension compared to groups NV and IPPV. In groups OLC and group IPPV an increase in IL-1β/6 and MMP1/9 was detected compared to groups NV and C. In conclusion, in breathing spontaneously or IPPV-ventilated horses a higher degree of atelectasis was detected, whereas in OLC-ventilated horses a higher degree of overdistention was present. Elevated levels in IL and MMP might be early signs of VILI in ventilated horses., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The aim of this study was to assess the effect of duration of anaesthesia and concentration of isoflurane on global perfusion as well as intestinal microperfusion and oxygenation. Nine Warmblood horses were premedicated with xylazine; anaesthesia was induced with midazolam and ketamine, and maintained with isoflurane. Horses were ventilated to normocapnia. During 7 h of anaesthesia, mean arterial blood pressures (MAP), heart rate, central venous pressure, pulmonary artery pressure, expiratory isoflurane concentration (ETIso) and cardiac output using lithium dilution were measured; cardiac index (CI) was calculated. Intestinal microperfusion and oxygenation were measured using laser Doppler flowmetry and white-light spectrophotometry. Surface probes were placed via median laparotomy on the serosal and mucosal site of the jejunum and the pelvic flexion of the colon. After 3 h of constant ETIso (1.4%), ETIso was increased in 0.2% increments up to 2.4%, followed by a decrease to 1.2% and an increase to 1.4%. The CI and MAP decreased continuously with increasing ETIso to 40 ± 5 mL/kg/min and 52 ± 8 mmHg, respectively. Microperfusion and oxygenation remained unchanged until an ETIso of 2.0% resulted in CI and MAP of 48 ± 5 mL/kg/min and 62 ± 6 mmHg, respectively, and then decreased rapidly. When ETIso decreased back to baseline, CI, MAP, microperfusion and oxygenation recovered to baseline. Isoflurane concentration but not duration of isoflurane anaesthesia influenced central and intestinal oxygenation and perfusion in healthy horses. Under isoflurane, intestinal perfusion appeared to be preserved until a threshold MAP or blood flow was reached., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: Previous studies showed an influence of xylazine on the LiDCO sensor in vitro and in standing horses, but did not prove that this interaction caused error in LiDCO measurements. Therefore, agreement of cardiac output (CO) measurements by LiDCO and bolus-thermodilution (BTD) was determined in horses receiving xylazine infusions., Study Design: Prospective, experimental study., Animals: Eight Warmblood horses., Methods: All horses were premedicated with xylazine. Anaesthesia was induced with midazolam and ketamine and was maintained with isoflurane in oxygen. During six hours of anaesthesia CO measurements and blood samples were taken before, during and after a 60 minute period of xylazine infusion. Pairs of LiDCO and bolus thermo-dilution (BTD) measurements of CO were performed. Sensor voltages exposed to blood and saline were measured before, during and after xylazine infusion and compared using Bland-Altman method of agreement with corrections for repeated measures., Results: The CO values (mean ± SD) before xylazine were 34.8 ± 7.3 and 36.4 ± 8.1 L minute(-1) for BTD and LiDCO, respectively. After starting the xylazine infusion, the CO values for BTD decreased to 27.5 ± 6.1 L minute(-1) whereas CO values measured by LiDCO increased to 54.7 ± 18.4 L minute(-1) . One hour after discontinuing xylazine infusion, CO values were 33 ± 6.7 and 36.5 ±11.9 L minute(-1) for BTD and LiDCO, respectively. The difference between saline and blood exposed sensor voltages decreased during xylazine infusion and these differences were positive numbers before but negative during the infusion. There were correlations between xylazine plasma concentrations, CO differences and sensor voltage differences (saline - blood)., Conclusions and Clinical Relevance: This study proved that xylazine infusion caused concentration dependent bias in LiDCO measurements leading to an overestimation of readings. Sensor voltage differences (saline - blood) may become valuable clinical tool to predict drug-sensor interactions., (© 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.)

Objectives: To determine the influence of ketamine or xylazine constant rate infusions on isoflurane requirements, cardiovascular parameters and quality of anaesthesia in horses undergoing elective surgery., Study Design: Prospective, matched paired clinical trial., Animals: Fifty four adult Warmblood horses., Methods: After premedication with acepromazine, xylazine and butorphanol, anaesthesia was induced with ketamine-midazolam and maintained with isoflurane alone (I), isoflurane with either 1 mg kg(-1)  hour(-1) ketamine (IK) or same dose of xylazine (IX). End tidal concentration of isoflurane (Fe'Iso) was adjusted by the same anaesthetist in all horses according to a scoring system. Dobutamine was infused to maintain mean arterial pressure (MAP) ≥70 mmHg. Arterial blood gases, heart rate (HR), respiratory rate, MAP and cardiac output (lithium dilution) were measured. Groups I and IK received xylazine before recovery. Recovery quality was scored., Results: Mean ± SD averaged Fe'Iso (volume%) was significantly lower in IX (0.95 ± 0.07) and IK (0.97 ± 0.08) than in I (1.16 ± 0.13). In group IX, HR was significantly lower and averaged MAP (90 ± 13 mmHg) significantly higher than in groups I (71 ± 7 mmHg) and IK (76 ± 7 mm Hg). Differences in other cardiopulmonary variables did not reach statistical significance. All horses recovered well with best score in group IX., Conclusions: Both CRIs of xylazine and of ketamine resulted in pronounced reduction of isoflurane requirements and blood pressure support based on routinely monitored parameters. Cardiac output appeared well maintained in all three protocols, but lithium dilution induced errors mean the results are untrustworthy. The work requires repetition with another mode of measurement of cardiac output., Clinical Relevance: All three protocols provided good clinical anaesthesia with clinically acceptable cardiovascular effects., (© 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.)