Lung aeration and volumes following alveolar recruitment maneuvers with three airway pressures in healthy anesthetized and mechanically ventilated Beagle dogs

ObjectiveTo compare the effects of three recruitment airway pressures (RP_aw) on lung aeration and volumes in mechanically ventilated dogs during propofol anesthesia.Study designProspective, crossover randomized experimental study.AnimalsA total of eight healthy anesthetized experimental Beagle dogs in dorsal recumbency.MethodsDogs were mechanically ventilated with a tidal volume of 15 mL kg^–1 and zero positive end-expiratory pressure and 100% oxygen. Three maneuvers consisting of a 30 second inspiration at RP_aws of 15 (RP_aw15), 25 (RP_aw25) and 35 (RP_aw35) cmH₂O were performed randomly, 15 minutes apart. Changes in lung aeration and lung deformation were compared with end-expiratory baseline (before the application of each RP_aw) and between-RP_aws using computed tomography scans and calculations of global lung strain. Between-group comparisons were performed with one-way anova for repeated measures followed by Tukey test for multiple comparisons. A p value < 0.05 was considered significant.ResultsThe amount of nonaeration was minimal (<1%) at baseline and not different with the application of the RP_aws. The amount of hypoaeration and normoaeration during baseline decreased with all RP_aws (p < 0.001). There was no difference between RP_aws regarding hypoaeration (all p > 0.999), whereas normoaeration was higher at RP_aw15 than RP_aw25 and RP_aw35 (p < 0.009). Compared with baseline, the fraction of hyperaerated alveoli increased with each RP_aw (p < 0.001) and was lower during RP_aw15 than RP_aw25 and RP_aw35 (both p ≤ 0.007). Global lung strain was lower during RP_aw15 than at higher RP_aw (p < 0.001).Conclusions and clinical relevanceA RP_aw of 15 cmH₂O for 30 seconds was the recommended RP_aw because it was as effective at reversing hypoaeration as RP_aws of 25 and 35 cmH₂O but with less hyperaeration and potential for overdistension of the lungs in this particular population of dogs with negligible atelectasis.     

The effect of fentanyl on the end‐tidal sevoflurane concentration needed to prevent motor movement in dogs

ObjectiveThe objectives of this study were to determine the effects of fentanyl on the end-tidal concentration of sevoflurane needed to prevent motor movement (MAC_NM) in response to noxious stimulation, and to evaluate if acute tolerance develops.Study designRandomized cross-over experimental study.AnimalsSix healthy, adult (2–3 years old), intact male, mixed-breed dogs weighing 16.2 ± 1.1 kg.MethodsSix dogs were randomly assigned to receive one of three separate treatments over a 3 week period. After baseline sevoflurane MAC_NM (MAC_NM-B) determination, fentanyl treatments (T) were administered as a loading dose (Ld) and constant rate infusion (CRI) as follows: T1-Ld of 7.5 μg kg^?1 and CRI at 3 μg kg^?1 hour^?1; T2-Ld of 15 μg kg^?1 and CRI at 6.0 μg kg ^?1 hour^?1; T3-Ld of 30 μg kg^?1 and CRI at 12 μg kg^?1 hour^?1. The MAC_NM was defined as the minimum end-tidal sevoflurane concentration preventing motor movement. The first post-treatment MAC_NM (MAC_NM-I) determination was initiated 90 minutes after the start of the CRI, and a second MAC_NM (MAC_NM-II) determination was initiated 3 hours after MAC_NM-I was established.ResultsThe overall least square mean MAC_NM-B for all groups was 2.66%. All treatments decreased (p < 0.05) MAC_NM, and the decrease from baseline was 22%, 35% and 41% for T1, T2 and T3, respectively. Percentage change in T1 differed (p < 0.05) from T2 and T3; however, T2 did not differ from T3. MAC_NM-I was not significantly different from MAC_NM-II within treatments.Conclusions and clinical relevanceFentanyl doses in the range of 3–12 μg kg^?1 hour^?1 significantly decreased the sevoflurane MAC_NM. Clinically significant tolerance to fentanyl did not occur under the study conditions.     

Evaluation of intraocular and partial CO2 pressure in dogs anesthetized with propofol

The effects of propofol on intraocular pressure (IOP) and end tidal CO₂ (ETCO₂) were studied because an elevation in the latter may alter IOP. Twenty dogs were divided into two groups (G1 and G2). G1 dogs were induced with 10 mg/kg (IV) of propofol followed by a 0.4 mg/kg/min continuous infusion of the same agent diluted in a 0.2% dextrose solution for 1 h. G(CAPS) 2 dogs served as the control group, where only dextrose solution was administered, under the same time intervals as in G1. Applanation tonometry (Tono-Pen) was used to determine IOP and ETCO₂ as a method to determine partial CO₂ pressure. Measurements were taken every 15 min for 1 h, with M1 occurring immediately before IV administration. IOP and ETCO₂ were not statistically significant in either groups. Based on the results, it may be concluded that propofol does not alter IOP and ETCO₂.     

Effect of the reverse Trendelenburg position on the incidence of gastroesophageal reflux in dogs anesthetized for elective stifle surgery

ObjectiveTo determine if a 15° reverse Trendelenburg position decreases the incidence of gastroesophageal reflux (GER) compared with a horizontal position in dogs anesthetized for stifle surgery.Study designProspective, randomized parallel-arm study.AnimalsA total of 44 healthy client-owned dogs were enrolled and data from 36 dogs were analyzed.MethodsDogs requiring preoperative radiographs under anesthesia, or with a history of gastrointestinal signs or administered gastroprotectant therapy within 1 month of surgery were excluded. Anesthesia protocol was standardized to include hydromorphone, dexmedetomidine, ketamine, propofol and isoflurane. Dogs were randomly assigned at enrollment to be positioned in a 15° reverse Trendelenburg or a horizontal position for surgery. Continuous pH monitoring was documented throughout the procedure with a 6.4 Fr (2.13 mm) esophageal pH probe positioned in the distal esophagus via the oral cavity. GER was defined as pH < 4.0 (acidic) or > 7.5 (alkaline) for more than 30 seconds. The proportions of dogs developing GER were compared between groups using Fisher’s exact test. Time to reflux was compared using survival curves and the Gehan–Breslow–Wilcoxon test. Statistical significance was set as p < 0.05.ResultsAn episode of GER occurred in 11/36 (30%) dogs. Reflux was alkaline in two dogs and acidic in nine dogs. The proportion of dogs with GER was 5/18 (28%) and 6/18 (33%) for dogs in the reverse Trendelenburg position and horizontal position, respectively, and was not statistically significant (p > 0.99). Median (range) time until reflux was 44 (23–135) and 44.5 (9–56) minutes when dogs were positioned in reverse Trendelenburg position and horizontal position, respectively (p = 0.66; two-tailed Mann–Whitney U test).Conclusions and clinical relevancePositioning the surgery table in a 15° rostral elevation for dogs anesthetized for elective stifle surgical procedures did not decrease the incidence of GER.     

Indirect measurement of blood pressure using a pulse oximeter in isoflurane anesthetized dogs

Objective: To determine the accuracy of indirect blood pressure (BP) measurements obtained with a pulse oximeter as compared with direct measurements in dogs under isoflurane anesthesia. The Doppler and oscillometric BP monitors were included for comparison. Design: Prospective, experimental study. Animals: Twenty healthy dogs (23 ± 8 kg) anesthetized for research or teaching. Interventions: Dogs were anesthetized with propofol or thiopental and maintained using positive pressure ventilation with isoflurane in 100% O₂. Random adjustment of BP was achieved by inhalant adjustment or dopamine infusion to achieve low (≤85 mmHg), normal (90–120 mmHg), or high systolic BP (≥125 mmHg). Triplicate measurements for BP were taken with direct (dorsal pedal artery), Doppler (forelimb), oscillometric (same forelimb), and plethysmographic (pulse oximeter on tongue) methods. Measurements and main results: Using regression analysis and a modified Bland–Altman's technique, the lowest bias was achieved with the Doppler. Systolic BP readings at low, normal, and high BP were within 10 mmHg of direct recordings 95%, 70%, and 30% of the time for pulse oximetry; 95%, 85%, and 55% of the time for Doppler; 42%, 65%, and 30% of the time for oscillometric determination, respectively. Oscillometric mean BP readings were within 10 mmHg of direct measurements 53%, 60%, and 45% of the time, respectively. Conclusions: The pulse oximeter is an acceptable method for measuring BP in anesthetized dogs if assessment of trends is sufficient. All indirect methods showed greater bias and poorer precision at high BP. The Doppler may be the preferred indirect method.     

Effect of intravenous propofol and remifentanil on heart rate, blood pressure and nociceptive response in acepromazine premedicated dogs

ObjectiveTo investigate the cardiorespiratory, nociceptive and endocrine effects of the combination of propofol and remifentanil, in dogs sedated with acepromazine.Study designProspective randomized, blinded, cross-over experimental trial.AnimalsTwelve healthy adult female cross-breed dogs, mean weight 18.4 ± 2.3 kg.MethodsDogs were sedated with intravenous (IV) acepromazine (0.05 mg kg^?1) followed by induction of anesthesia with IV propofol (5 mg kg^?1). Anesthesia was maintained with IV propofol (0.2 mg kg^?1 minute^?1) and remifentanil, infused as follows: R1, 0.125 μg kg^?1 minute^?1; R2, 0.25 μg kg^?1 minute^?1; and R3, 0.5 μg kg^?1 minute^?1. The same dogs were administered each dose of remifentanil at 1-week intervals. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (f_R), end tidal CO₂ (Pe′CO₂), arterial hemoglobin O₂ saturation, blood gases, and rectal temperature were measured before induction, and 5, 15, 30, 45, 60, 75, 90, and 120 minutes after beginning the infusion. Nociceptive response was investigated by electrical stimulus (50 V, 5 Hz and 10 ms). Blood samples were collected for plasma cortisol measurements. Statistical analysis was performed by anova (p < 0.05).ResultsIn all treatments, HR decreased during anesthesia with increasing doses of remifentanil, and increased significantly immediately after the end of infusion. MAP remained stable during anesthesia (72–98 mmHg). Antinociception was proportional to the remifentanil infusion dose, and was considered satisfactory only with R2 and R3. Plasma cortisol concentration decreased during anesthesia in all treatments. Recovery was smooth and fast in all dogs.Conclusions and clinical relevanceInfusion of 0.25–0.5 μg kg^?1 minute^?1 remifentanil combined with 0.2 mg kg^?1 minute^?1 propofol produced little effect on arterial blood pressure and led to a good recovery. The analgesia produced was sufficient to control the nociceptive response applied by electrical stimulation, suggesting that it may be appropriate for performing surgery.     

Evaluation of an indirect oscillometric blood pressure monitor in normotensive and hypotensive anesthetized dogs

Objective – To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs. Design – Prospective observational study. Setting – University teaching hospital. Animals – Eight crossbred adult dogs. Interventions – Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end‐tidal isoflurane concentration at 1.2±0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia. Measurements and Main Results – Agreement between the direct and indirect BP measurements was determined by the Bland‐Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were ?14.7 mm Hg (15.5 mm Hg), ?16.4 mm Hg (12.1 mm Hg), and ?14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were ?32 mm Hg (22.6 mm Hg), ?24.2 mm Hg (19.5 mm Hg), and ?16.8 mm Hg (17.2 mm Hg), respectively. Conclusion – The oscillometric device was not reliably predictive of intra‐arterial BP during hypotension associated with acute hemorrhage.     

Evaluation of a new oscillometric blood pressure monitor in isoflurane-anesthetized dogs

Objective This study was conducted to evaluate the performance of a new veterinary oscillometric noninvasive blood pressure (NIBP) monitor in anesthetized dogs. Study design Assessment was made to determine how closely indirect measurements were associated with direct measurements, and if there were statistically significant differences between the measurements by site. Animals Six mongrel dogs weighing 27.8 ± 2.9 kg. Methods Dogs were anesthetized with thiopental and maintained with isoflurane, which was delivered with controlled ventilation. Direct pressure measurements were obtained via a percutaneously placed arterial catheter. A range of systolic arterial pressures (SAP) were achieved by changing the isoflurane concentrations. Sites of cuff placement for indirect measurements were identified as metacarpus, metatarsus, and anterior tibial. Results At pressures below 80 mm Hg, indirect systolic measurements averaged 4 ± 3 mm Hg, higher than the direct values. At normal and high levels, indirect systolic measurements underestimated direct values by 18 ± 6 and 23 ± 6 mm Hg, respectively. Diastolic and mean pressure measurements followed the same trend, with indirect values being lower than the direct arterial pressures. Systolic, diastolic and mean arterial pressure measurements differed by cuff‐placement site. Conclusions When analyzed by site and level, indirect systolic and mean arterial blood pressures during hypotension were essentially the same as direct pressures. However, at pressures within the normal or high range, indirect measurements underestimated the direct pressures. Clinical relevance Noninvasive blood pressure measurements with a new oscillometric monitor provided an excellent means of detecting arterial hypotension in anesthetized dogs. The metatarsal site for cuff placement was slightly better than the metacarpal or anterior tibial site, considering that the regression line was closest to complete equality between the indirect and direct measurements for SAP.     

The effect of experimentally induced hypothyroidism on the isoflurane minimum alveolar concentration in dogs

ObjectiveTo determine the effect of experimentally induced hypothyroidism on isoflurane (ISO) minimum alveolar concentration (MAC) in dogs.Study designProspective experimental study.AnimalsEighteen adult female mongrel dogs, age 2–4 years and weighing 8.2–13.1 kg.MethodsHypothyroidism was induced in nine dogs by the intravenous administration of 1 mCi kg⁻¹ of ¹³¹Iodine. The remaining nine dogs served as controls. Dogs were studied 9–12 months after the induction of hypothyroidism. Anesthesia was induced with ISO in oxygen via a mask. The trachea was intubated, and anesthesia was maintained using ISO in oxygen using a semi-closed rebreathing circle system. The dogs were mechanically ventilated to maintain an end-tidal carbon dioxide concentration between 35 and 45 mmHg. End-tidal ISO concentrations were measured with an infrared gas analyzer. The MAC was determined in duplicate using a tail clamp technique. The mean values for the groups were compared using a two sample t-test.ResultsThe mean ± SD MAC of isoflurane in the hypothyroid and euthyroid dogs was 0.98 ± 0.31% and 1.11 ± 0.26%, respectively. The mean MAC of isoflurane in hypothyroid dogs was not significantly different from the mean MAC of isoflurane in the control dogs (p=0.3553).Conclusion and clinical relevanceThe MAC of ISO in dogs was not significantly affected by experimentally induced hypothyroidism. The dose of ISO in dogs with hypothyroidism does not need to be altered.     

Evaluation of intraocular pressure in association with cardiovascular parameters in normocapnic dogs anesthetized with sevoflurane and desflurane

The objective of this study was to determine intraocular pressure (IOP) and cardiac changes in normocapnic dogs maintained under controlled ventilation and anesthetized using sevoflurane or desflurane. Sixteen healthy adult mixed-breed dogs, seven males and nine females, weighing 10-15 kg were used. The dogs were randomly assigned to one of two groups composed of eight animals anesthetized with sevoflurane (SEVO) or desflurane (DESF). In both groups, anesthesia was induced with propofol (10 mg/kg), and neuromuscular blockade was achieved with rocuronium (0.6 mg/kg/h i.v.). No premedication was given. Ventilation was adjusted to maintain end-tidal carbon dioxide partial pressure at 35 mmHg. Anesthesia was maintained with 1.5 minimum alveolar concentration (MAC) of sevoflurane or desflurane. In both groups IOP was measured by applanation tonometry (Tono-Pen) before induction of anesthesia. IOP, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI) and central venous pressure (CVP) were also measured 45 min after the beginning of inhalant anesthesia and then every 20 min for 60 min. A one-way repeated measures anova was used to compare data within the same group and Student's t-test was used to assess differences between groups. P < 0.05 was considered statistically significant. Measurements showed normal IOP values in both groups, even though IOP increased significantly from baseline during the use of desflurane. IOP did not differ between groups. CI in the desflurane group was significantly greater than in the sevoflurane group. Sevoflurane and desflurane have no clinically significant effects on IOP, MAP, HR, CI or VCP in the dog.     

Changes in colloid osmotic pressure as a function of anesthesia and surgery in the presence and absence of isotonic fluid administration in dogs

Objective  To determine how a combination of anesthetic drugs; including pre-medication, induction agents and inhalational agents; affect colloid osmotic pressure (COP) in the presence and absence of isotonic fluid administration. Secondarily, to determine if changes in total plasma protein (TPP) correlate with COP in anesthetized patients.
Study Design  Prospective, randomized clinical study.
Animals  Ten female dogs, 4 months to 4 years of age and >8 kg undergoing elective ovariohysterectomy.
Methods  All dogs were anesthetized in a similar fashion. After induction, five dogs received lactated ringer's solution (LRS) at 10 mL kg⁻¹ hour⁻¹ and five dogs received no fluid therapy during anesthesia. Blood samples were collected prior to pre-medication, prior to induction, immediately post-induction/prior to the inhalational agent, 30 minutes post-induction, at the time of recovery and 45 minutes post-discontinuation of inhalant. TPP and COP were measured from each sample.
Results  Administration of fluids resulted in a decrease in COP and TPP over time that did not return to baseline by 45 minutes after recovery. Anesthesia without the administration of fluids also resulted in a significant decrease in COP over time, that was rebounding by recovery (but still significantly less than baseline). TPP had variable correlation with COP at different time points with or without fluid administration.
Conclusions and clinical relevance  Anesthetic drugs alter COP similarly in the presence and absence of isotonic fluids. These changes in COP did not have a simple relationship to TPP and so the latter could not be used to predict COP in this patient population.     

Effect of morphine on the bispectral index during isoflurane anesthesia in dogs

ObjectiveTo assess the effect of morphine on the bispectral index (BIS) in dogs during isoflurane anesthesia maintained at a constant end–tidal concentration.Study designProspective, randomized, experimental trial.AnimalsEight adult Beagle dogs, weighing between 7.1 and 9.8 kg.MethodsAnesthesia was induced with isoflurane via a face mask. Dog's tracheas were intubated and anesthesia maintained with isoflurane at a constant end–tidal concentration (e′Iso) of 1.81% for a 30–minute equilibration period. Pulmonary ventilation was controlled to normocapnia. After equilibration, baseline values were recorded prior to intravenous administration of morphine sulfate (0.5 mg kg^?1) (MT) or an equal volume of saline (CT). Measurements for heart rate, systolic, diastolic and mean arterial pressure (SAP, DAP and MAP) were recorded at 10, 20, 30, 45, 60, 75, 90, 105 and 120 minutes after treatment. Bispectral index was recorded every 10 seconds for 3 minutes for each time measurement. Venous blood samples were collected at baseline, 10, 20, 30, 45, 60 and 120 minutes for determination of morphine serum concentrations. Anesthesia was discontinued after the last measurement and dogs were allowed to recover.ResultsBaseline BIS for MT and CT at 1.81%e′Iso were 63 ± 10 and 58 ± 9, respectively. Bispectral index in MT was 4–8% lower at 20, 75, 90 and 105 minutes compared with CT. There were no differences in BIS between baseline and any subsequent measurement within either MT or CT. Heart rate, SAP, MAP, and DAP decreased after morphine administration.Conclusion and clinical relevanceIntravenous administration of 0.5 mg kg^?1 morphine sulfate did not cause clinically significant changes in the BIS of unstimulated dogs during isoflurane anesthesia at an e′Iso of 1.81%.     

Effect of fentanyl on the induction dose and minimum infusion rate of alfaxalone preventing movement in dogs

Objective

To determine the effect of fentanyl on the induction dose and minimum infusion rate of alfaxalone required to prevent movement in response to a noxious stimulus (MIR_NM) in dogs.

Effect of fentanyl on the induction dose and minimum infusion rate of propofol preventing movement in dogs

Objective

To determine the effect of fentanyl on the induction dose of propofol and minimum infusion rate required to prevent movement in response to noxious stimulation (MIR_NM) in dogs.

Effect of oral trazodone on the minimum alveolar concentration of isoflurane in dogs

Objective

To determine the effect of oral trazodone on the minimum alveolar concentration (MAC) of isoflurane in dogs.