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This article provides a report of a case of organ dysfunction, myonecrosis, rhabdomyolysis, multifocal ischemic cerebral infarcts, and cerebral edema after a patient's use of xylazine and fentanyl. Within the US opioid epidemic, xylazine is emerging as a troubling national sub-story. The prevalence of xylazine within illicitly manufactured opioids and the proportion of opioid-involved overdose deaths with detected xylazine are rising dramatically, the latter increasing 276% between 2019 and 2022. A 27-year-old woman with opioid use disorder, active intravenous drug use, and prior bacteremia presented to our institution's emergency department (ED) with left lower extremity pain and associated weakness, new acute bilateral hearing loss, multiple electrolyte derangements, and cerebral infarcts followed by cerebral edema, leading to an emergent sub-occipital decompressive craniectomy and placement of an external ventricular drain. A definitive mechanism was not determined; however, we hypothesized that xylazine toxicity played a role in her clinical presentation, which could have future clinical implications, including the possibility to incorporate xylazine as part of toxicology screens., Competing Interests: George L. Anesi reports payments for authoring chapters for UpToDate and expert witness consulting and reports that his spouse is employed by the U.S. Food and Drug Administration (FDA). All other authors declare no conflicts of interest., (© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Objective: To investigate the mechanisms underlying the improved arterial oxygenation described with flow-limited expiration (FLEX) ventilation in anesthetized horses., Animals: 5 healthy adult research horses., Methods: Horses underwent volume-controlled ventilation for 60 minutes (VCV1), followed by 60 minutes of FLEX, and 30 minutes of VCV (VCV2). Main outcomes included the arterial partial pressure of oxygen-to-Fio2 (PF) ratio and electrical impedance tomography (EIT)-derived functional indices at the end of each phase. The EIT data were used to create regional maps of relative lung ventilation and perfusion as well as regional maps of ventilation/perfusion (V/Q) ratios. Ventilation indices derived from EIT included the fraction of expired volume in 1 second (FEV1; %) and the time it took for the EIT signal to drop to 50% of the peak signal at end-inspiration (TClose50; seconds). Data were analyzed with 2-way ANOVA for repeated measures. P < .05 was considered significant., Results: The PF ratio increased significantly with FLEX compared to both VCV1 and VCV2 (P < .01). There were no differences in the relative distribution of ventilation nor perfusion between ventilation strategies. However, when ventilation and perfusion were superimposed and V/Q ratio maps were constructed, FLEX had a homogenizing effect toward values of 1.0. The FEV1 was shorter (P < .01) and the TClose50 was longer (P < .001) in all regions during FLEX compared to both VCV1 and VCV2., Clinical Relevance: Our findings suggest that FLEX ventilation in anesthetized horses enhances regional V/Q matching, likely by prolonging expiratory aeration and reducing airway closure.

Maxillary nerve blocks (MNBs) commonly facilitate dental surgeries in standing horses. The goal of this prospective, blinded, cross-over design trial including 15 client-owned horses was to evaluate 3 methods of sensory function testing for confirming a successful MNB. Testing was performed bilaterally before sedation, 5 min after sedation, and 15 and 30 min after MNB with 0.5% bupivacaine and involved a needle prick dorsal to each naris, hemostat clamping of each nostril, and gingival algometry (measuring sensitivity to pain). Responses to stimulation were numerically scored and scores were summed up to a total score. Total score increases on the blocked side by ≥ 2 between baseline and 30 min Post MNB recordings signified a successful MNB. Sedation in the preceding 6 h, presence of sino-nasal disease, side of dental pathology, age, butorphanol administration, and detomidine dosing (µg/kg/min) throughout the tooth extraction procedure were recorded. In 73% of horses, MNB was successful. Sedation in the preceding 6 h ( P  = .732), age ( P  = .936), side of pathology ( P  = .516), and sino-nasal disease ( P  = .769) were not associated with total scores. Detomidine dosage and butorphanol use did not differ between horses in which the MNB was considered successful and for those in which it was not ( P  = .967 and P  = .538, respectively). Scores obtained with gingival algometry were less closely associated with total scores (rho = .649) than those obtained with needle prick and nostril clamping (rho = .819 and .892, respectively). Therefore, needle prick and nostril clamping are considered the more reliable methods for use in clinical practice to determine the success of an MNB.

The placement of caudal epidural catheters in horses has become more frequent as a multi-modal analgesic strategy. Despite its integration into clinical practice, there are limited reports describing the use of caudal epidural catheterization for prolonged use in horses. The purpose of this study was to characterize the hospitalized caseload undergoing epidural catheterization for long-term epidural analgesic administration, to report the response to epidural therapy and observed complications, and to describe patient outcomes. Medical records of hospitalized equine patients that underwent placement of a caudal epidural catheter for analgesic management between 2017 and 2021 were analyzed retrospectively. For the 62 catheters placed in the 48 cases, the most frequent diagnosis category prompting epidural analgesia was orthopedic (43/48, 89.6%). Synovial sepsis was the most frequent specific diagnosis prompting epidural catheter placement (11/48, 22.9%). The initial response to epidural therapy was characterized as positive for 37/62 (59.7%) catheters. Complications were documented for 46/62 (74.2%) catheters. However, most of these complications were classified as mild (51.6%) or moderate (14.5%), and exaggerated physiologic responses were observed most frequently. Of the horses studied, 52.1% survived to be discharged from the hospital. With awareness of potential complications and vigilant monitoring, caudal epidural catheters should be considered for equine patients as an analgesic strategy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Douglas, Midon, Shroff, Floriano, Driessen and Hopster.)

Objective: Mechanical ventilation is usually achieved by active lung inflation during inspiration and passive lung emptying during expiration. By contrast, flow-controlled expiration (FLEX) ventilation actively reduces the rate of lung emptying by causing linear gas flow throughout the expiratory phase. Our aim was to evaluate the effects of FLEX on lung compliance and gas exchange in anesthetized horses in dorsal recumbency., Animals: 8 healthy horses., Procedures: All animals were anesthetized twice and either ventilated beginning with FLEX or conventional volume-controlled ventilation in a randomized, crossover design. Total anesthesia time was 3 hours, with the ventilatory mode being changed after 1.5 hours. During anesthesia, cardiac output (thermodilution), mean arterial blood pressures, central venous pressure, and pulmonary arterial pressure were recorded. Further, peak, plateau, and mean airway pressures and dynamic lung compliance (Cdyn) were measured. Arterial blood gases were analyzed every 15 minutes. Data were analyzed using ANOVA (P < 0.05)., Results: FLEX ventilation resulted in significantly higher arterial oxygen partial pressures (521 vs 227 mm Hg) and Cdyn (564 vs 431 mL/cm H2O) values compared to volume-controlled ventilation. The peak and plateau airway pressure were lower, but mean airway pressure was significantly higher (4.8 vs 9.2 cm H2O) in FLEX ventilated horses. No difference for cardiovascular parameters were detected., Clinical Relevance: The results of this study showed a significant improvement of the Pao2 and Cdyn without compromising the cardiovascular system when horses were ventilated by use of FLEX compared to conventional ventilation.

One of the biggest challenges in managing laminitis in horses remains the control of pain. The best analgesic approach is a multimodal approach, including nonsteroidal anti-inflammatory drugs, opioids, and/or constant rate infusions of α-2 agonists, ketamine, and lidocaine. Recent literature indicates that amitriptyline and soluble epoxide hydrolase inhibitor might be beneficial. Clinically oriented studies will be needed if they have a place in laminitis pain management. The systemic pain control can be combined with local techniques such as long-acting local anesthetics or epidural catheterization that allows for administration of potent analgesic therapy with a lower risk of negative side effects., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

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.)

Proper pain therapy requires adequate pain assessment. This study evaluated the reliability and validity of the Unesp-Botucatu horse acute pain scale (UHAPS), the Orthopedic Composite Pain Scale (CPS) and unidimensional scales in horses admitted for orthopedic and soft tissue surgery. Forty-two horses were assessed and videotaped before surgery, up to 4 hours postoperatively, up to 3 hours after analgesic treatment, and 24 hours postoperatively (168 video clips). After six evaluators viewing each edited video clip twice in random order at a 20-day interval, they chose whether analgesia would be indicated and applied the Simple Descriptive, Numeric and Visual Analog scales, CPS, and UHAPS. For all evaluators, intra-observer reliability of UHAPS and CPS ranged from 0.70 to 0.97. Reproducibility was variable among the evaluators and ranged from poor to very good for all scales. Principal component analysis showed a weak association among 50% and 62% of the UHAPS and CPS items, respectively. Criterion validity based on Spearman correlation among all scales was above 0.67. Internal consistency was minimally acceptable (0.51-0.64). Item-total correlation was acceptable (0.3-0.7) for 50% and 38% of UHAPS and CPS items, respectively. UHAPS and CPS were specific (90% and 79% respectively), but both were not sensitive (43 and 38%, respectively). Construct validity (responsiveness) was confirmed for all scales because pain scores increased after surgery. The cut-off point for rescue analgesia was ≥ 5 and ≥ 7 for the UHAPS and CPS, respectively. All scales presented adequate repeatability, criterion validity, and partial responsiveness. Both composite scales showed poor association among items, minimally acceptable internal consistency, and weak sensitivity, indicating that they are suboptimal instruments for assessing postoperative pain. Both composite scales require further refinement with the exclusion of redundant or needless items and reduction of their maximum score applied to each item or should be replaced by other tools., Competing Interests: Professor Bernd Driessen and Associate Professors Klaus Hopster and Laura Zarucco are shareholders of Narkovet Consulting®, LLC, which provided parts of the funding for the present study. However, Narkovet Consulting®, LLC did not in any way or form impact these authors’ adherence to all PLOS ONE policies on sharing data and materials as detailed in the online guide for authors (http://journals.plos.org/plosone/s/competing-interests) or had any influence on data presentation and interpretation. All other authors declare that they have no conflicts of interest.

Background: In anesthetized adult horses, changes in recumbency can influence the cardiovascular system but how arterial blood pressures and oxygen tension change in isoflurane anesthetized animals as a direct result of hoisting has not been investigated. Objective: To evaluate effects of hoisting on hemodynamic function and pulmonary gas exchange in isoflurane-anesthetized horses. Study Design: Prospective, experimental study. Methods: Six adult horses were anesthetized three times using isoflurane in pure oxygen (inspired fraction 0.9-1.0), and allowed breathing spontaneously in lateral recumbency. After 45 min horses were hoisted using a single hoist-hobble system for 5 min and returned into left lateral recumbency. Heart rate (HR), respiratory rate (RR), and systolic (SAP), diastolic (DAP), and mean arterial blood pressures (MAP) were measured every minute starting from 5 min before to 5 min after hoisting. Arterial blood gas samples were collected before, during, and after hoisting. Results: Significant changes in hemodynamic parameters and PaO 2 but not PaCO 2 were found between baseline recordings and measurements obtained during and early after hoisting. The MAP decreased within the 1st min of hoisting from a mean of 74 ± 17 mmHg at baseline to 57 ± 20 mmHg ( p < 0.05). Thereafter, it rapidly recovered to baseline before continuing to rise to higher than baseline values and then remaining elevated for 5 min after horses were returned into lateral recumbency. Simultaneously, the HR increased by 6-9 beats per min during the initial 3 min of hoisting before returning close to baseline values ( p < 0.05). The PaO 2 decreased significantly from a mean of 324.9 ±137.0 mmHg at baseline to a mean of 141.3 ± 104.2 mmHg during hoisting ( p < 0.001) without recovering any more to baseline values. Clinical significance: Hoisting an adult horse during or at the end of isoflurane anesthesia carries the risk of a precipitous, though short-lived (1-2 min), drop in arterial blood pressures and a persistent decrease in arterial oxygenation. While in systemically healthy animals the observed functional impairments were not life-threatening, they may be more severe in systemically compromised horses.Therefore, arterial blood pressures and oxygenation must be carefully monitored when hoisting sick equine patients during or at the end of inhalant anesthesia., (Copyright © 2020 Cerullo, Driessen, Douglas and Hopster.)

The final phase in pork production is the transport of finisher pigs to the slaughterhouse. Fasting is one of the parameters that influence the stress coping ability of the pigs during transport and lairage. When implemented correctly with attention to the local factors, pre-slaughter fasting can improve animal welfare, pathogen risk and carcass hygiene. The length of pre-slaughter feed withdrawal time is important to the success of the production practice. In practice, a fasting time before slaughter between 12 and 18 h enhances pork safety, pork quality, and animal welfare. This means that communication between producer and slaughterhouse is essential when planning the fasting and lairage times to avoid carcass and technological pork quality problems (such as pale, soft, and exudative (PSE) meat or dark, firm and dry (DFD) meat).

Objective: To determine the accuracy of tidal volume (V T ) delivery among 5 different models of large-animal ventilators when tested at various settings for V T delivery, peak inspiratory flow (PIF) rate, and fresh gas flow (FGF) rate., Sample: 4 different models of pneumatically powered ventilators and 1 electrically powered piston-driven ventilator., Procedures: After a leak flow check, each ventilator was tested 10 times for each experimental setting combination of 5 levels of preset V T , 3 PIF rates, and 4 FGF rates. A thermal mass flow and volume meter was used as the gold-standard method to measure delivered V T . In addition, circuit systems of rubber versus polyvinyl chloride breathing hoses were evaluated with the piston-driven ventilator. Differences between preset and delivered V T (volume error [ΔV T ]) were calculated as a percentage of preset V T , and ANOVA was used to compare results across devices. Pearson correlation coefficient analyses and the coefficient of determination ( r 2 ) were used to assess potential associations between the ΔV T and the preset V T , PIF rate, and FGF rate., Results: For each combination of experimental settings, ventilators had ΔV T values that ranged from 1.2% to 22.2%. Mean ± SD ΔV T was 4.8 ± 2.5% for the piston-driven ventilator, compared with 6.6 ± 3.2%, 10.6 ± 2.9%, 13.8 ± 2.97%, and 15.2 ± 2.6% for the 4 pneumatic ventilators. The ΔV T increased with higher PIF rates ( r 2 = 0.69), decreased with higher FGF rates ( r 2 = 0.62), and decreased with higher preset V T ( r 2 = 0.58)., Conclusions and Clinical Relevance: Results indicated that the tested ventilators all had ΔV T but that the extent of each of ΔV T varied among ventilators. Close monitoring of delivered V T with external flow and volume meters is warranted, particularly when pneumatic ventilators are used or when very precise V T delivery is required.

Intravenous (i.v.) bolus administration of xylazine (XYL) (0.5 mg/kg) immediately followed by a continuous rate infusion (CRI) of 1 mg kg -1  hr -1 for 2, 4, and 6 hr produced immediate sedation, which lasted throughout the duration of the CRI. Heart rate decreased and blood pressure increased significantly (p > .05) in all horses during the first 15 min of infusion, both returned to and then remained at baseline during the duration of the infusion. Compartmental models were used to investigate the pharmacokinetics of XYL administration. Plasma concentration-time curves following bolus and CRI were best described by a one-compartment model. No differences were found between pharmacokinetic estimates of the CRIs for the fractional elimination rate constant (K e ), half-life (t 1/2e ), volume of distribution (V d ), and clearance (Cl). Median and range were 0.42 (0.15-0.97)/hr, 1.68 (0.87-4.52) hr, 5.85 (2.10-19.34) L/kg, and 28.7 (19.6-39.5) ml min -1  kg -1 , respectively. Significant differences were seen for area under the curve ( AUC 0 ∞ ) (p < .0002) and maximum concentration (C max ) (p < .04). This indicates that with increasing duration of infusion, XYL may not accumulate in a clinically relevant way and hence no adjustments are required in a longer XYL CRI to maintain a constant level of sedation and a rapid recovery., (© 2020 John Wiley & Sons Ltd.)

Transport and associated handling can have adverse effects on pig welfare and meat quality. The purpose of the study was to determine (the variation of) effects of farm management, climate parameters, transport and lairage conditions on the meat quality of fattening pigs, heterozygous for the halothane gene. A total of 4763 fattening pigs were transported from 1 farm to a commercial slaughterhouse (distance 110 km) in 121 transports. From 2404 carcasses, carcass temperature and pH were measured 45 min post-mortem; 48 hours post-mortem pH, electrical conductivity, drip loss and meat color were registered. During the raising period sex, conditions at weaning (purchased or not as piglet, vaccination against mycoplasma) and (type of) pen during fattening (i.e., from about 22 kg to 105 kg) were registered to relate with pork quality. Transport season, weather parameters, regrouping or not during loading, transport combination (truck, trailer and driver), transport compartment and transport conditions (loading density, transport duration and unloading time) were monitored. At the slaughterhouse, duration of lairage and carcass conformation were followed up to examine correlations with meat quality parameters. Effects of farm management, climate parameters during transport, transport and slaughterhouse conditions on pork quality were demonstrated. Specifically, reducing lung lesions by vaccination during raising, no mixing of pigs during the transport process, sufficient lairage time and transporting no extreme muscled pigs can improve meat quality., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Between November 2016 and October 2017, 23 horse transports from 18 collection points to two slaughterhouses in Argentina and one in Uruguay were monitored. The goal of this study was to characterize the current practices in commercial horse transports and to detect potential threats to horse welfare. A total of 596 horses were transported over an average distance of 295 ± 250 km. Average transport duration was 294 ± 153 min. The infrastructure did not always promote smooth loading, but the amount of horses that refused to enter the trailers was limited. In each loading space, a camera was mounted to observe horse behaviour during the journey. Ambient temperature and relative humidity (RH) were recorded every five minutes in each loading space. In 14 of the 23 transports, the maximum temperature rose above 25 °C and the average temperature was over 25 °C during six transports. The average temperature humidity index (THI) exceeded 72 during six transports. The average stocking density was 1.40 ± 0.33 m 2 per horse, or 308 ± 53 kg/m 2 . The degree of aggression differed between the front and rear loading space. Stocking density, environmental parameters, trailer characteristics, and transport duration and distance did not influence aggressiveness.

Transport and associated handling can have adverse effects on pig welfare. The transport of fattening pigs can cause economic losses by virtue of mortality, skin damage, and the general deterioration of meat quality. A total of 4507 fattening pigs were transported from a farm to a commercial slaughterhouse (distance 110 km) in 128 transports. Skin damage was visually assessed in the slaughter line in different parts of the carcass, i.e., shoulder, middle, and ham, using a 4-point scale. The incidence of skin damage was most prevalent (31%) in the shoulder region of the pig carcass. Sex, wind velocity, regrouping, transport combination, transport compartment, lairage time, and ham angle affected the skin damage incidence. In conclusion, scoring the incidence of skin damage is an indicator of the level of welfare exercised during transport and the slaughterhouse conditions. Furthermore, skin damage monitoring can be used to determine critical control points in the transport procedure. Given the importance from both a commercial and welfare perspective, it should be a powerful incentive to handle fattening pigs with care during the transport process and the lairage period.

In practice, unfamiliar pigs are frequently mixed prior to loading in order to obtain groups of uniform weight and to adjust the group size to the dimensions of the trailer compartments. Mixing pigs induces aggressive interactions to establish a new social rank. Fighting results in skin lesions and pre-slaughter stress and, in turn, reduced meat quality. A study was performed to compare the effect of non-regrouping and regrouping at fattening (at 80 kg and kept till slaughter), loading and lairage. A total of 1332 pigs were included over 30 transports from one pig farm to one slaughterhouse (110 km). Skin lesions were determined on 1314 carcasses. Meat quality was measured on 620 pigs. The non-regrouped pigs had fewer skin lesions and better meat quality than the pigs regrouped at loading or in lairage. Pigs mixed at 80 kg at the farm had, in general, a comparable amount of skin lesions and comparable meat quality as the non-mixed group. If mixing is unavoidable, due to large within-group weight variations, mixing at 80 kg can be an alternative to reduce skin lesions at slaughter and to optimise meat quality., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Objective: To assess effects of nitrogen and helium on efficacy of an alveolar recruitment maneuver (ARM) for improving pulmonary mechanics and oxygen exchange in anesthetized horses., Animals: 6 healthy adult horses., Procedures: Horses were anesthetized twice in a randomized crossover study. Isoflurane-anesthetized horses in dorsal recumbency were ventilated with 30% oxygen and 70% nitrogen (treatment N) or heliox (30% oxygen and 70% helium; treatment H) as carrier gas. After 60 minutes, an ARM was performed. Optimal positive end-expiratory pressure was identified and maintained for 120 minutes. Throughout the experiment, arterial blood pressures, heart rate, peak inspiratory pressure, dynamic compliance (C dyn ), and Pao 2 were measured. Variables were compared with baseline values and between treatments by use of an ANOVA., Results: The ARM resulted in significant increases in Pao 2 and C dyn and decreases in the alveolar-arterial gradient in the partial pressure of oxygen in all horses. After the ARM and during the subsequent 120-minute phase, mean values were significantly lower for treatment N than treatment H for Pao 2 and C dyn . Optimal positive end-expiratory pressure was consistently 15 cm H 2 O for treatment N, but it was 10 cm H 2 O (4 horses) and 15 cm H 2 O (2 horses) for treatment H., Conclusions and Clinical Relevance: An ARM in anesthetized horses might be more efficacious in improving Pao 2 and C dyn when animals breathe helium instead of nitrogen as the inert gas.

OBJECTIVE To evaluate the effects of 4 gas compositions at various volumes (simulated tidal volumes [V T s]) on accuracy of measurements obtained with 2 types of flow sensors and accuracy of gas volume delivery by a piston-driven ventilator. SAMPLE 4 gas mixtures (medical air [21% O 2 :79% N 2 ], > 95% O 2 , O 2 -enriched air [30% O 2 :70% N 2 ], and heliox [30% O 2 :70% He]). PROCEDURES For each gas mixture, reference V T s of 1 to 8 L were delivered into an anesthetic breathing circuit via calibration syringe; measurements recorded by a Pitot tube-based flow sensor (PTFS) connected to a multiparameter host anesthesia monitor and by a thermal mass flow and volume meter (TMFVM) were compared with the reference values. Following leak and compliance testing, the ventilator was preset to deliver each gas at V T s of 1 to 8 L into the calibration syringe. Effects of gas volume and composition on accuracy of V T measurement and delivery were assessed by ANOVA. Agreements between delivered and flow sensor-measured V T and preset versus ventilator-delivered V T were determined by Bland-Altman analysis. RESULTS Flow sensor measurements were accurate and not influenced by gas composition. Mean measurement error ranges for the PTFS and TMFVM were -4.99% to 4.21% and -4.50% to 0.17%, respectively. There were no significant differences between ventilator-delivered and reference V T s regardless of gas volume or composition. Bland-Altman analysis yielded biases of -0.046 L, -0.007 L, -0.002 L, and 0.031 L for medical air, > 95% O 2 , O 2 -enriched air, and heliox, respectively. CONCLUSIONS AND CLINICAL RELEVANCE The PTFS and the TMFVM measured V T s and the piston-driven ventilator delivered V T s with error rates of < 5% for all gas compositions and volumes tested.

OBJECTIVE To evaluate efficacy of an alveolar recruitment maneuver (ARM) with positive end-expiratory pressures (PEEPs) in anesthetized horses ventilated with oxygen or heliox (70% helium and 30% oxygen). ANIMALS 6 healthy adult horses. PROCEDURES In a randomized crossover study, horses were anesthetized and positioned in dorsal recumbency. Volume-controlled ventilation was performed with heliox or oxygen (fraction of inspired oxygen [Fio 2 ] > 90%). Sixty minutes after mechanical ventilation commenced, an ARM with PEEP (0 to 30 cm H 2 O in steps of 5 cm H 2 O every 5 minutes, followed by incremental steps back to 0 cm H 2 O) was performed. Peak inspiratory pressure, dynamic lung compliance (C dyn ), and Pao 2 were measured during each PEEP. Indices of pulmonary oxygen exchange and alveolar dead space were calculated. Variables were compared with baseline values (PEEP, 0 cm H 2 O) and between ventilation gases by use of repeated-measures ANOVAs. RESULTS For both ventilation gases, ARM significantly increased pulmonary oxygen exchange indices and C dyn . Mean ± SD C dyn (506 ± 35 mL/cm H 2 O) and Pao 2 -to-Fio 2 ratio (439 ± 36) were significantly higher and alveolar-arterial difference in Pao 2 (38 ± 11 mm Hg) was significantly lower for heliox, compared with values for oxygen (357 ± 50 mL/cm H 2 O, 380 ± 92, and 266 ± 88 mm Hg, respectively). CONCLUSIONS AND CLINICAL RELEVANCE An ARM in isoflurane-anesthetized horses ventilated with heliox significantly improved pulmonary oxygen exchange and respiratory mechanics by decreasing resistive properties of the respiratory system and reducing turbulent gas flow in small airways.

Objective: To determine sevoflurane's minimum alveolar concentration (MAC SEVO ) and its cardiopulmonary effects in sheep., Study Design: Prospective experimental study., Animals: A group of 10 female nonpregnant Sardinian milk sheep., Methods: Anesthesia was induced in each sheep twice with sevoflurane in oxygen. After a 30 minute equilibration at end-tidal sevoflurane concentration (Fe'Sevo) of 2.8%, an electrical stimulus (5 Hz/1 ms/50 mA) was applied to the right thoracic limb for 1 minute or until gross purposeful movement occurred. The Fe'Sevo was then changed using a 0.2% up-and-down protocol, dependent on whether or not the response was positive, and then noxious stimulation was repeated. The MAC SEVO was defined as the mean Fe'Sevo between that allowing purposeful movement and that not. The group of 10 sheep were re-anesthetized and MAC SEVO was re-determined. Thereafter, Fe'Sevo was maintained for 15 minutes each at concentrations corresponding to 1.0, 1.3, 1.6, 1.9 and 0.75 MAC SEVO multiples, and cardiopulmonary, blood gas, acid-base variables and plasma electrolytes were determined. Also, time to induction of anesthesia, extubation and recovery were recorded., Results: The mean ± standard deviation of the MAC SEVO was 2.74 ± 0.38%. Median (interquartile range) time to intubation was 3.13 (2.98-3.33) minutes, time to extubation was 6.85 ± 2.65 minutes and time to recovery was 13.4 ± 5.2 minutes. With increasing Fe'Sevo, arterial blood pressures progressively decreased as did minute ventilation, which in turn caused end-tidal carbon dioxide, arterial partial pressure of carbon dioxide and bicarbonate values to steadily increase without significantly affecting arterial partial pressure of oxygen., Conclusions and Clinical Relevance: The reported MAC SEVO agrees with published data in this and other species. Administration of sevoflurane in sheep caused marked hemodynamic and respiratory depression, but soon after turning off the vaporizer, sheep could be extubated and recovered rapidly and event-free., (Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

OBJECTIVE To determine the minimum alveolar concentration of desflurane (MAC DES ) and effects on cardiovascular variables in positive-pressure ventilated sheep. ANIMALS 13 adult female sheep. PROCEDURES Anesthesia was induced with desflurane. After a 30-minute equilibration at an end-tidal concentration of desflurane (et DES ) of 10.5%, an electrical stimulus (5 Hz/ms and 50 mA) was applied for 1 minute or until gross purposeful movement occurred. The et DES was then changed by 0.5% (modified up-down method), depending on whether a positive motor response had been elicited, and stimulation was repeated. The MAC DES was the et DES midway between a positive and negative response. After MAC DES was determined, et DES was increased to 1.3 and 1.6 MAC DES . Animals were allowed to equilibrate for 15 minutes, and cardiovascular, blood gas, acid-base, and hematologic variables were measured. Times to induction of anesthesia, extubation, attainment of sternal position, and standing and duration of anesthesia were recorded. RESULTS Mean ± SD MAC DES was 9.81 ± 0.79%. Times to intubation, extubation, and standing were 4.81 ± 2.21 minutes, 14.09 ± 4.05 minutes, and 32.4 ± 12.5 minutes, respectively. Duration of anesthesia was 226 ± 22 minutes. Heart rate increased significantly at induction of anesthesia but otherwise remained at preanesthetic rates. Arterial blood pressures progressively decreased with increasing et DES ; pressures increased slightly only in response to noxious stimulation. CONCLUSIONS AND CLINICAL RELEVANCE The MAC DES determined here compared favorably with that determined for other sheep populations and indicated similar anesthetic potency as in other species. Desflurane caused dose-dependent arterial hypotension, which indicated the need for careful blood pressure monitoring.

Introduction: Nitrous oxide (N2O) is an anesthetic gas with antinociceptive properties and reduces the minimum alveolar concentration (MAC) for volatile anesthetic agents, potentially through mechanisms involving central alpha2-adrenoceptors. We hypothesized that 70% N2O in the inspired gas will significantly reduce the MAC of sevoflurane (MACSEVO) in sheep, and that this effect can be reversed by systemic atipamezole., Materials and Methods: Animals were initially anesthetized with SEVO in oxygen (O2) and exposed to an electrical current as supramaximal noxious stimulus in order to determine MACSEVO (in duplicates). Thereafter, 70% N2O was added to the inspired gas and the MAC re-determined in the presence of N2O (MACSN). A subgroup of sheep were anesthetized a second time with SEVO/N2O for re-determination of MACSN, after which atipamezole (0.2 mg kg-1, IV) was administered for MACSNA determinations. Sheep were anesthetized a third time, initially with only SEVO/O2 to re-determine MACSEVO, after which atipamezole (0.2 mg kg-1, IV) was administered for determination of MACSA., Results: MACSEVO was 2.7 (0.3)% [mean (standard deviation)]. Addition of N2O resulted in a 37% reduction of MACSEVO to MACSN of 1.7 (0.2)% (p <0.0001). Atipamezole reversed this effect, producing a MACSNA of 3.1 (0.7)%, which did not differ from MACSEVO (p = 0.12). MACSEVO did not differ from MACSA (p = 0.69). Cardiorespiratory variables were not different among experimental groups except a lower ETCO2 in animals exposed to SEVO/N2O., Conclusions: N2O produces significant MACSEVO-reduction in sheep; this effect is completely reversed by IV atipamezole confirming the involvement of alpha2-adrenoreceptors in the MAC-sparing action of N2O.

Concurrent with a tendency toward higher slaughter weights of fattening pigs, minimum requirements for space allowance are increasing. Allowing pigs more space in existing standard pens, however, leads to a decrease in the number of pigs per pen, which jeopardizes the economic viability of the pig farm. A possible solution includes creating a two-level pen by constructing a second level in an existing pen, to enable an increase in space allowance per pig with the same number of pigs. We investigated the effect of such a pen on the behavior, performance, and postslaughter results of fattening pigs during the entire fattening period (30 to 110 kg). A total of 444 pigs were distributed over standard control pens (0.74 m/pig) and two-level pens (0.99 m/pig). Feed was provided only in a trough at the ground level of the pen. The results show that the increased space allowance and choice of levels in two-level pens influenced the pigs' behavior in a positive way, as they performed less manipulation of pen mates ( < 0.0001). Moreover, pigs lay down more ( = 0.0007) and showed less head knocking ( = 0.005) in two-level pens, suggesting that they were calmer. In line with the behavioral results, pigs in two-level pens had fewer lesions on tails ( = 0.006), ears ( = 0.008), and shoulders ( = 0.01). Growth performance was not affected ( > 0.05), but postslaughter measurements revealed fewer livers with white spots in pigs from two-level pens. This result might be related to lower disease pressure in pens with lower stocking densities. In conclusion, a two-level pen seemed to have positive effects on the behavior of pigs (in terms of pen mate manipulation) and the increase in space allowance seemed to make the pigs calmer. The use of the second level by heavier pigs should, however, be further studied to investigate whether this extra space could be fully counted for the minimal space requirements.

Today, early weaning is more frequently applied by the modern pig breeder to obtain more litters per year. In addition, more and more European pig breeders apply a batch management system, which allows weaning to occur at fixed time points but entails that the offspring are treated at the litter level and not as individuals. Both evolutions might result in weaning lightweight piglets, which can cause, e.g., growth retardation of the offspring. Hence, the objective of this research was to improve the weaning weight of piglets of the same age by breeding with a highly conformed sire line. Therefore, a total of 23 sows were inseminated, 10 sows with semen of a well-conformed sire line (sire line B) and 13 sows with semen of a less conformed boar (sire line A). In total, 299 offspring were observed to monitor behavior, growth performance, and carcass characteristics. Subsequently, linear mixed models were developed to analyze the growth performance and carcass characteristics wherein only variables classified as significant ( < 0.05) were introduced as fixed factors. Results indicate that no significantly increased weaning weight could be accomplished by breeding with semen of sire line B. This could be due to the significant ( < 0.05) shorter gestation length of sows inseminated with semen of sire line B. However, the offspring of sire line B was defined by better carcass classification characteristics. Furthermore, this study presents that the mean birth weight of each piglet was significantly lower if a bigger litter size was recorded. When considering behavior, it was observed that piglets that did not seclude themselves from the litter had a significantly greater daily weight gain from birth to weaning compared to piglets that showed signs of isolation from the litter. A significantly greater daily gain from birth to slaughter was established for piglets with a greater birth weight. Also, results indicate that barrows had a significantly greater daily growth from weaning to slaughter than gilts. To conclude, this research determines that breeding with highly conformed sire lines does not improve the weaning weight of the offspring and thus cannot serve as a solution for early weaning. However, more research is required by performing more experiments with a greater number of boars and sows to confirm this result. In general, this study allows researchers to continue to improve and standardize the weaning weight of piglets of the same age.

Objective: To assess agreement between infrared (IR) analysers and a refractometer for measurements of isoflurane, sevoflurane and desflurane concentrations and to demonstrate the effect of customized calibration of IR analysers., Study Design: In vitro experiment., Subjects: Six IR anaesthetic monitors (Datex-Ohmeda) and a single portable refractometer (Riken)., Methods: Both devices were calibrated following the manufacturer's recommendations. Gas samples were collected at common gas outlets of anaesthesia machines. A range of agent concentrations was produced by stepwise changes in dial settings: isoflurane (0-5% in 0.5% increments), sevoflurane (0-8% in 1% increments), or desflurane (0-18% in 2% increments). Oxygen flow was 2 L minute(-1) . The orders of testing IR analysers, agents and dial settings were randomized. Duplicate measurements were performed at each setting. The entire procedure was repeated 24 hours later. Bland-Altman analysis was performed. Measurements on day-1 were used to yield calibration equations (IR measurements as dependent and refractometry measurements as independent variables), which were used to modify the IR measurements on day-2., Results: Bias ± limits of agreement for isoflurane, sevoflurane and desflurane were 0.2 ± 0.3, 0.1 ± 0.4 and 0.7 ± 0.9 volume%, respectively. There were significant linear relationships between differences and means for all agents. The IR analysers became less accurate at higher gas concentrations. After customized calibration, the bias became almost zero and the limits of agreement became narrower., Conclusions and Clinical Relevance: If similar IR analysers are used in research studies, they need to be calibrated against a reference method using the agent in question at multiple calibration points overlapping the range of interest., (© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.)

Objective: To provide a brief introduction into Critical Incident Reporting Systems (CIRS) as used in human medicine, and to report the discussion from a recent panel meeting discussion with 23 equine anaesthetists in preparation for a new CEPEF-4 (Confidential Enquiry into Perioperative Equine Fatalities) study., Study Design: Moderated group discussions, and review of literature., Methods: The first group discussion focused on the definition of 'preventable critical incidents' and/or 'near misses' in the context of equine anaesthesia. The second group discussion focused on categorizing critical incidents according to an established framework for analysing risk and safety in clinical medicine., Results: While critical incidents do occur in equine anaesthesia, no critical incident reporting system including systematic collection and analysis of critical incidents is in place., Conclusions and Clinical Relevance: Critical incident reporting systems could be used to improve safety in equine anaesthesia - in addition to other study types such as mortality studies., (© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.)

Objective: To compare analgesic efficacy of preoperative epidural anesthesia with efficacy of femoral and sciatic nerve blockade in dogs undergoing hind limb orthopedic surgery., Design: Prospective randomized blinded clinical study., Animals: 22 dogs requiring stifle joint surgery., Procedures: Dogs were premedicated with acepromazine and morphine, and anesthesia was induced with diazepam and propofol and maintained with sevoflurane in oxygen. Prior to surgery, a combination of 1.0% lidocaine solution with 0.25% bupivacaine solution was administered either into the lumbosacral epidural space (11 dogs) or perineurally along the femoral and sciatic nerves (11). Intraoperative nociception was assumed if heart rate or systolic blood pressure increased by > 10% from baseline, in which case fentanyl (2 μg/kg [0.9 μg/lb], IV) was administered as rescue analgesia. Following recovery from anesthesia, signs of postoperative pain were assessed every 30 minutes for 360 minutes from the time of local anesthetic administration via the modified Glasgow pain scale. Patients with scores > 5 (scale, 0 to 20) received hydromorphone (0.1 mg/kg [0.05 mg/lb], IV) as rescue analgesia and were then withdrawn from further pain scoring., Results: Treatment groups did not differ significantly in the number fentanyl boluses administered for intraoperative rescue analgesia. Time to administration of first postoperative rescue analgesia was comparable between groups. Furthermore, there was no significant difference between groups in baseline pain scores, nor were there significant differences at any other point during the postoperative period., Conclusions and Clinical Relevance: Femoral and sciatic nerve blocks provided intraoperative antinociception and postoperative analgesia similar to epidural anesthesia in dogs undergoing stifle joint surgery.

Romifidine HCl (romifidine) is an α(2)-agonist commonly used in horses. This study was undertaken to investigate the pharmacokinetics (PK) of romifidine following intravenous (i.v.) administration and describe the relationship between PK parameters and simultaneously recorded pharmacodynamic (PD) parameters. Romifidine (80 μg/kg) was administered by i.v. infusion over 2 min to six adult Thoroughbred horses, and plasma samples were collected and analyzed using liquid chromatography-mass spectrometry. Limit of quantification was <0.1 ng/mL. PD parameters and arterial blood gases were measured for 300 min following romifidine administration. Statistical PD data analysis included mixed-effect modeling. After i.v. administration of romifidine, the plasma concentration-vs.-time curve was best described by a two-compartmental model. Terminal elimination half-life (t(1/2β) ) was 138.2 (104.6-171.0) min and volumes for central (V(c)) and peripheral (V(2)) compartments were 1.89 (0.93-2.39) and 2.57 (1.71-4.19) L/kg, respectively. Maximum plasma concentration (C(max)) was 51.9 ± 13.1 ng/mL measured at 4 min following commencement of drug administration. Systemic clearance (Cl) was 32.4 (25.5-38.4) mL · min/kg. Romifidine caused a significant reduction in heart rate and cardiac index and an increase in mean arterial pressure (P < 0.05). Sedation score and head height values were significantly different from the baseline values for 120 min (P < 0.05). The decline in cardiovascular and sedative effects correlated with the decline in plasma romifidine concentration (P < 0.05). In conclusion, a highly sensitive analytical technique for the detection of romifidine in equine plasma allowed detailed description of its PK profile. The drug produces long-lasting sedation in horses that corresponds with the long terminal elimination half-life of the drug., (© 2012 Blackwell Publishing Ltd.)

The effects of constant rate infusion (CRI) of lidocaine on sevoflurane (SEVO) requirements, autonomic responses to noxious stimulation, and postoperative pain relief were evaluated in dogs undergoing opioid-based balanced anesthesia. Twenty-four dogs scheduled for elective ovariectomy were randomly assigned to one of four groups: BC, receiving buprenorphine without lidocaine; FC, receiving fentanyl without lidocaine; BL, receiving buprenorphine and lidocaine; FL, receiving fentanyl and lidocaine. Dogs were anesthetized with intravenous (IV) diazepam and ketamine and anesthesia maintained with SEVO in oxygen/air. Lidocaine (2mg/kg plus 50 μg/kg/min) or saline were infused in groups BL/FL and BC/FC, respectively. After initiation of lidocaine or saline CRI IV buprenorphine (0.02 mg/kg) or fentanyl (4 μg/kg plus 8 μg/kg/h CRI) were administered IV in BC/BL and FC/FL, respectively. Respiratory and hemodynamic variables, drug plasma concentrations, and end-tidal SEVO concentrations (E'SEVO) were measured. Behaviors and pain scores were subjectively assessed 1 and 2h post-extubation. Lidocaine CRI produced median drug plasma concentrations <0.4 μg/mL during peak surgical stimulation. Lidocaine produced a 14% decrease in E'SEVO in the BL (P<0.01) but none in the FL group and no change in cardio-pulmonary responses to surgery or postoperative behaviors and pain scores in any group. Thus, depending on the opioid used, supplementing opioid-based balanced anesthesia with lidocaine (50 μg/kg/min) may not have any or only a minor impact on anesthetic outcome in terms of total anesthetic dose, autonomic responses to visceral nociception, and postoperative analgesia., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the effect of general anesthesia on plasma cTnI concentrations in horses., Animals, Materials and Methods: Thirty-two horses undergoing general anesthesia and either elective surgery or MRI without surgery were prospectively studied. Twenty-nine horses (22 surgical, 7 imaging) completed the study. Plasma cTnI concentrations were determined prior to anesthesia and at 6, 12 and 24 h following discontinuation of the inhalant anesthetic., Results: All horses had cTnI values within the reference range at all time points. Six horses (21%) developed detectable cTnI 6 or 12 h following anesthesia. Risk factors for detectable cTnI include increasing age and dorsal recumbency. Horses with detectable cTnI had significantly lower mean and diastolic arterial blood pressures than those without detectable cTnI., Conclusion: Uncomplicated general anesthesia with or without surgery does not result in cardiac troponin I elevations above the reference range in the first 24 h postoperatively., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The purpose of this investigation was to study lateral palmar nerve (LPN) and medial palmar nerve (MPN) morphology and determine nociception and sensory nerve conduction velocity (SNCV) following placement of continuous peripheral nerve block (CPNB) catheters along LPN and MPN with subsequent bupivacaine (BUP) infusion. Myelinated nerve fiber distribution in LPN and MPN was examined after harvesting nerve specimens in 3 anesthetized horses and processing them for morphometric analysis. In 5 sedated horses, CPNB catheters were placed along each PN in both forelimbs. Horses then received in one forelimb 3 mL 0.125% BUP containing epinephrine 1:200 000 and 0.04% NaHCO(3) per catheter site followed by 2 mL/h infusion over a 6-day period, while in the other forelimb equal amounts of saline (SAL) solution were administered. The hoof withdrawal response (HWR) threshold during pressure loading of the area above the dorsal coronary band was determined daily in both forelimbs. On day 6 SNCV was measured under general anesthesia of horses in each limb's LPN and MPN to detect nerve injury, followed by CPNB catheter removal. The SNCV was also recorded in 2 anesthetized non-instrumented horses (sham controls). In both LPN and MPN myelinated fiber distributions were bimodal. The fraction of large fibers (>7 μm) was greater in the MPN than LPN (P < 0.05). Presence of CPNB catheters and SAL administration did neither affect measured HWR thresholds nor SNCVs, whereas BUP infusion suppressed HWRs. In conclusion, CPNB with 0.125% BUP provides pronounced analgesia by inhibiting sensory nerve conduction in the distal equine forelimb.

Managing pain in horses afflicted by chronic laminitis is one of the greatest challenges in equine clinical practice because it is the dreadful suffering of the animals that most often forces the veterinarian to end the battle with this disease. The purpose of this review is to summarize our current understanding of the complex mechanisms involved in generating and amplifying pain in animals with laminitis and, based on this information, to propose a modified approach to pain therapy. Furthermore, a recently developed pain scoring technique is presented that may help better quantify pain and the monitoring of responses to analgesic treatment in horses with laminitis., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Objective: To evaluate the effects of 10 cm H(2)O of positive end-expiratory pressure (PEEP) on lung aeration and gas exchange in mechanically ventilated sheep during general anesthesia induced and maintained with propofol., Animals: 10 healthy adult Bergamasca sheep., Procedures: Sheep were sedated with diazepam (0.4 mg/kg, IV). Anesthesia was induced with propofol (5 mg/kg, IV) and maintained with propofol via constant rate infusion (0.4 mg/kg/min). Muscular paralysis was induced by administration of vecuronium (25 microg/kg, bolus IV) to facilitate mechanical ventilation. After intubation, sheep were positioned in right lateral recumbency and mechanically ventilated with pure oxygen and zero end-expiratory pressure (ZEEP). After 60 minutes, 10 cm H(2)O of PEEP was applied for 20 minutes. Spiral computed tomography of the thorax was performed, and data were recorded for hemodynamic and gas exchange variables and indicators of respiratory mechanics after 15 (T(15)), 30 (T(30)), and 60 (T(60)) minutes of ZEEP and after 20 minutes of PEEP (T(PEEP)). Computed tomography images were analyzed to determine the extent of atelectasis before and after PEEP application., Results: At T(PEEP), the volume of poorly aerated and atelectatic compartments was significantly smaller than at T(15), T(30), and T(60), which indicated that there was PEEP-induced alveolar recruitment and clearance of anesthesia-induced atelectasis. Arterial oxygenation and static respiratory system compliance were significantly improved by use of PEEP., Conclusions and Clinical Relevance: Pulmonary atelectasis can develop in anesthetized and mechanically ventilated sheep breathing pure oxygen; application of 10 cm H(2)O of PEEP significantly improved lung aeration and gas exchange.

Objective: To test the hypothesis that subarachnoid administration of buprenorphine and lidocaine provides more intense and longer lasting perioperative analgesia with less side effects than xylazine and lidocaine in goats., Study Design: Randomized, blinded, controlled study. STUDY ANIMALS: Ten healthy female goats randomly assigned to two groups of five animals each., Methods: After sedation with acepromazine (0.1 mg kg(-1)) intravenously (i.v.), lidocaine 2% (0.1 mL kg(-1)) combined with either xylazine (0.05 mg kg(-1); Group X) or buprenorphine (0.005 mg kg(-1); Group B) were injected intrathecally at the lumbo-sacral junction prior to stifle surgery. Electrocardiogram, heart rate, direct systolic, mean, and diastolic arterial blood pressures, rectal temperature and arterial blood gases were recorded as were post-operative sedation and pain scores using a visual analogue and numeric rating scale, respectively. Data were analyzed with one-way ANOVA for repeated measures, one-way anova, Friedman's and Kruskal-Wallis tests as necessary (p < 0.05)., Results: Surgery was successfully performed under both analgesia protocols. Total pain and sedation scores were significantly lower in the B as compared with X group from 3-24 hours and 30-120 minutes, respectively after subarachnoid drug administration (SDA). Heart rate and arterial blood pressures decreased post SDA and were consistently lower in X versus B (p < 0.05). In B arterial blood gas parameters did not change post SDA, but in group X PaCO(2) increased slightly within 15 minutes of SDA and remained elevated for at least 3 hours (p < 0.05)., Conclusion: In these goats intrathecal administration of buprenorphine and lidocaine produced more profound and longer lasting analgesia with less sedation and hemodynamic and respiratory impairment than xylazine with lidocaine., Clinical Relevance: In these goats undergoing hind limb surgery, subarachnoid buprenorphine/lidocaine offered more intense and longer lasting analgesia than a xylazine/lidocaine combination, with less sedation and impairment of cardiopulmonary function.

Objectives: Because oxidation affects platelet and coagulation factors, hemoglobin auto-oxidation in HBOCs results in the transformation to methemoglobin, which may have additive adverse effects on coagulation. The risk of coagulopathy after different dilutions of HBOC-200 with low and high methemoglobin concentrations was studied., Design: A laboratory study on donor blood using thromboelastography (TEG; Haemoscope, Niles, IL)., Setting: A university laboratory., Participants: Volunteer donor blood., Interventions: Blood samples simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOC-200 (Oxyglobin; Biopure Corp, Cambridge, MA). Coagulopathy related to 1:11, 1:5, 1:2, and 1:1 dilution of whole blood with HBOC-200 high methemoglobin concentrations (65%) and HBOC-200 low methemoglobin concentrations (1%) were analyzed., Measurements and Main Results: Analysis of fixed effects of dilution on coagulation showed that the progressive dilution of HBOC-200 (low methemoglobin) and HBOC-200 (high methemoglobin) produced significant prolongation in reaction time (R) and clot propagation (K) and significant decreases in clot kinetics (alpha) and clot strength (MA and G). Analysis of fixed effects of treatment group on coagulation showed that clot propagation (K, alpha) and clot strength (MA and G) are significantly different in HBOC-200 (high methemoglobin) compared with HBOC-200 (low methemoglobin)., Conclusions: High methemoglobin concentrations in HBOC-200 cause additive coagulation impairment that likely results from the effects of oxidative substances on platelet function and coagulation proteins. Oxidative products adversely react with coagulation factors and modify redox-sensitive sites in the platelets. Therefore, if methemoglobinemia occurs as a result of HBOC administration and if the levels are significantly elevated (greater than 10%), impairment of coagulation is possible.

Objective: To develop a technique for placing continuous peripheral nerve block (CPNB) catheters adjacent to palmar nerves in horses and to evaluate the effect of low-volume local anesthetic (LA) infusion on nociception in the distal equine thoracic limb., Study Design: In vitro and in vivo laboratory investigation. STUDY MATERIAL AND ANIMALS: Forty-two thoracic limbs from 22 equine cadavers and five horses., Methods: Thoracic limb specimens were dissected to find landmarks for catheter insertion adjacent to medial and lateral palmar nerves. Based on the anatomy of the proximal metacarpus, a technique for placing palmar CPNB catheters was developed and the potential for catheter dislodgement studied in vitro by fluoroscopic visualization during passive carpal flexion and dye injection following simulated limb motion. The feasibility of CPNB catheter instrumentation in standing, sedated horses was tested in five animals, with ultrasound control. Electrical and mechanical stimulation thresholds and response latencies for hoof withdrawal responses (HWR) were determined following saline or LA infusion., Results: Medial and lateral CPNB catheters were inserted percutaneously 2 and 4-5 cm, respectively, distal to the accessory carpal bone and advanced for approximately 7 and 10 cm, respectively, to place the tip just proximal to the communicating branch of the nerves. Catheters were placed correctly in 88% and 85% of cadaver limbs. In the standing horses, LA infusion not only increased HWR thresholds and latencies to noxious mechanical or electrical stimulation but also caused vasodilation and limb swelling over time., Conclusion: The technique, developed in vitro, for placing and maintaining palmar CPNB catheters in the equine thoracic limb was successfully applied in vivo. Catheters were well tolerated but LA infusion may cause limb swelling, suggesting a need for further exploration of drug and infusion regimens., Clinical Relevance: Continuous perineural LA infusion along palmar nerves may develop into an effective analgesic technique in horses suffering from lower limb pain.

The objective of this study was to determine if coagulation is different between 6% hetastarch in normal saline (NS) and 6% hetastarch in lactated Ringer's solution (LR), with use of an ex vivo thromboelastography (TEG) model with healthy donated volunteer blood. We simulated hemodilution that occurs during clinical resuscitation of hemorrhagic or hypovolemic shock, using healthy human donor whole blood (WB) ex vivo. Coagulopathy related to low, medium, high, or very high dilution of WB with NS or a high-molecular-weight hetastarch-based plasma expander, 6% hetastarch in NS (HSNS) or 6% hetastarch in lactated Ringer's [Hextend (HSLR)], was analyzed by thromboelastography (TEG). No changes were noted in the TEG profile of undiluted WB controls during the 6-hour period of use (P > 0.95). Dilution with HSNS and HSLR significantly impaired coagulation compared to both WB control and NS. Progressive dilution with NS impaired coagulation but to a lesser extent than colloids (P < 0.01). Low dilution of blood with NS increased clot strength by 12% (not significant; P = 0.097). We conclude that WB containing citrate obtained from healthy donors for TEG analysis yields reproducible data over a minimum of 6 hours. Either hetastarch, when present at concentrations comparable to the manufacturer's maximum recommended dose of 20 mL/kg (equivalent to the high dilution used in these experiments), decreases clot tensile strength to levels associated with an increased risk of bleeding. Substitution of lactated Ringer's for NS in 6% hetastarch appears to offer no advantage in avoiding hemostatic compromise in an in vitro model.

Background: Direct determination of the circulating blood volume (CBV) is clinically desirable, especially when hemodynamic parameters such as blood pressure and heart rate are pharmacologically altered and may not be used with confidence for monitoring of CBV. In a rabbit model, we demonstrated that small volumes of hemoglobin-based oxygen carriers (HBOC) may be used for measuring of CBV with the indicator-dilution technique. This study aimed to verify the technique in a canine hypovolemia model with varying concentrations of infused HBOC., Methods: Twenty-four healthy mongrel dogs were anesthetized and anesthesia maintained with isoflurane in 21% oxygen and sufentanil infusion. All animals were mechanically ventilated. After splenectomy and insertion of arterial, venous, and balloon-tipped pulmonary arterial catheters and recording of baseline values of total and plasma hemoglobin (Hb), hematocrit, and major hemodynamic parameters, dogs were bled (average 36.6 +/- 5.8 mL/kg) to a mean arterial pressure of 50 mm Hg and maintained hypovolemic for 1 hour. Thereafter, measurements were repeated, and dogs were resuscitated. Animals in group 1 were resuscitated with 30 mL/kg of 6% hetastarch solution (HES). Animals in other groups received either 10 mL/kg of Hb glutamer-200 (Hb-200; Oxyglobin) plus 20 mL/kg HES (group 2), 20 mL/kg Hb-200 plus 10 mL/kg HES (group 3), or 30 mL/kg Hb-200 (group 4). Solutions were infused at 30 mL/kg/hr. Measurements were repeated immediately after volume resuscitation. Plasma Hb concentration was determined after centrifugation using the HemoCue. Lactated Ringer's solution was infused in all subjects at 5 mL/kg/hr for maintenance. CBV at baseline was estimated as 85 mL/kg. CBV values immediately posthemorrhage were calculated by subtracting the volume of withdrawn blood from the baseline value. On the basis of the assumption that hemorrhage and subsequent volume resuscitation would not cause any hemolysis (as confirmed in group 1), all plasma Hb was considered to represent infused HBOC. The calculation of CBV using HBOC as an indicator was performed as previously published by Kasuya et al. CBV values derived from measured HBOC concentrations in plasma were compared with calculated (based on an original CBV of 85 mL/kg and withdrawn blood volume) values of CBV using the Bland-Altman analysis and by linear correlation. Agreement between the methods was analyzed by calculating the bias estimated by the mean difference and the standard deviation of the difference., Results: Calculated and measured CBV values were highly correlated (r = 0.97). The difference between indicator dilution-derived and calculated values of CBV did not exceed 4% of calculated CBV in 97% of the measurements. The mean difference between measured and calculated values of CBV was 72 +/- 16 mL and did not vary significantly among groups 2, 3, and 4 (at varying concentrations of HBOC infused)., Conclusions: In a canine hypovolemia model, knowing both the HBOC volume infused and the HBOC concentration measured in plasma allows for reliably determining the CBV. Our data verify the indicator-dilution technique with HBOC as an appropriate and clinically valuable method for monitoring CBV in treatment of hypovolemia.

Objectives: Because hetastarches have deleterious effects on coagulation that increase with molecular weight (MWt), risk of coagulopathy associated with a high MWt hemoglobin-based oxygen carrier (HBOC) was studied., Design: Preliminary laboratory study of donor blood using thromboelastography (TEG)., Setting: University laboratory., Participants: Volunteer donor blood., Interventions: Experiments simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOCs. Coagulopathy related to 1:11, 1:5, 1:2, or 1:1 dilution of whole blood with normal saline, 6% hetastarch (670 kilodaltons [kD]), hemoglobin glutamer-200 (HBOC-200, 200 kD), or OxyVita (OXYVITA Inc, New Windsor, NY) (a new-generation, zero-link polymerized bovine hemoglobin-based oxygen carrier, 33 megadaltons) were analyzed., Measurements and Main Results: At 2 lower levels of hemodilution, hetastarch, HBOC-200, and OxyVita produced equivalent reductions in maximum clot strength (TEG-MA and TEG-G) that reached statistical significance compared with whole blood and normal saline. At 2 higher dilutions, OxyVita and HBOC-200 impaired maximum clot strength compared with whole blood, normal saline, and hetastarch. Dilution with hetastarch had a greater effect on clot propagation (K and alpha) than either HBOC., Conclusions: OxyVita and HBOC-200, HBOCs with different MWt, had similar effects on coagulation as measured by TEG. The impairment of coagulation by HBOCs and hetastarch occurred at doses corresponding to 12 mL/kg or a blood volume replacement of 17%. The use of HBOCs at doses corresponding to 23 mL/kg or a blood volume replacement of 33% significantly decreased coagulation to levels associated with increased clinical bleeding in this preliminary study. Minimal coagulopathic effects are expected with use of OxyVita at the manufacturer's anticipated effective dose of 10 g or 2 to 3 mL/kg.

Objective: To compare the effect of 2 concentrations of oxygen in inspired gas (fraction of inspired oxygen [FIO(2)] 1.0 or 0.4) on pulmonary aeration and gas exchange in dogs during inhalation anesthesia., Animals: 20 healthy dogs., Procedures: Following administration of acepromazine and morphine, anesthesia was induced in each dog with thiopental and maintained with isoflurane in 100% oxygen (100% group; n = 10) or a mixture of 40% oxygen and air (40% group; 10). Dogs were placed in dorsal recumbency and were mechanically ventilated. After surgery, spiral computed tomography (CT) of the thorax was performed and PaO(2), PaCO(2), and the alveolar-arterial oxygen tension difference (P([A-a])O(2)) were assessed. The lung CT images were analyzed, and the extent of hyperinflated (-1,000 to -901 Hounsfield units [HUs]), normally aerated (-900 to -501 HUs), poorly aerated (-500 to -101 HUs), or nonaerated (-100 to +100 HUs) areas was determined., Results: Compared with the 100% oxygen group, the normally aerated lung area was significantly greater and the poorly aerated and nonaerated areas were significantly smaller in the 40% oxygen group. The time to CT (duration of surgery) was similar in both groups. Although PaCO(2) was similar in both groups, PaO(2) and P((A-a))O(2) were significantly higher in the 100% oxygen group. In both groups, pulmonary atelectasis developed preferentially in caudal lung fields., Conclusion and Clinical Relevance: In isoflurane-anesthetized dogs, mechanical ventilation with 40% oxygen appeared to maintain significantly better lung aeration and gas exchange than ventilation with 100% oxygen.

Objective: To determine the effects of nonsteroidal anti-inflammatory drugs of various cyclooxygenase selectivities on hemostasis and prostaglandin expression in dogs., Animals: 8 client-owned dogs with clinical signs of osteoarthritis., Procedures: Dogs received aspirin (5 mg/kg, PO, q 12 h), carprofen (4 mg/kg, PO, q 24 h), deracoxib (2 mg/kg, PO, q 24 h), and meloxicam (0.1 mg/kg, PO, q 24 h) for 10 days each, with an interval of at least 14 days between treatments. On days 0 and 10, blood was collected for platelet aggregation assays, thrombelastography, and measurement of lipopolysaccharide-stimulated prostaglandin E(2), platelet thromboxane B(2) (TXB(2)), and free serum TXB(2) and 6-keto-prostaglandin F (PGF)-1alpha concentrations., Results: Platelet aggregation decreased after treatment with aspirin and carprofen, whereas significant changes from baseline were not detected for the other drugs tested. Thrombelastograms obtained after treatment with carprofen revealed decreased maximum amplitude and alpha-angle, suggesting hypocoagulability. Maximum amplitude and coagulation index increased after treatment with deracoxib. Plasma concentrations of prostaglandin E(2) decreased after treatment with carprofen or deracoxib, and platelet TXB(2) production increased after treatment with aspirin. Serum concentrations of the prostacyclin metabolite 6-keto-PGF-1alpha did not change significantly after treatment with any of the drugs, although the ratio of free TXB(2) to 6-keto-PGF-1alpha decreased slightly after treatment with carprofen and increased slightly after treatment with deracoxib., Conclusions and Clinical Relevance: At the dosages tested, treatment with meloxicam affected platelet function minimally in dogs with osteoarthritis. Treatment with carprofen decreased clot strength and platelet aggregation. Clot strength was increased after treatment with deracoxib.