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1.
ObjectiveTo determine the minimal electrical threshold (MET) necessary to elicit muscle contraction of the pelvic limb or tail when an insulated needle is positioned outside (METout) and inside (METin) the lumbosacral epidural space in cats.Study designProspective, blinded study.AnimalsTwelve mixed-breed healthy adult cats, scheduled for a therapeutic procedure where lumbosacral epidural administration was indicated.MethodsUnder general anesthesia, an insulated needle was advanced through tissues of the lumbosacral interspace until its tip was thought to be just dorsal to the interarcuate ligament. An increasing electrical current (0.1 ms, 2 Hz) was applied through the stimulating needle in order to determine the MET necessary to obtain a muscle contraction of the pelvic limb or tail (METout), and then 0.05 mL kg?1 of iohexol was injected. The needle was further advanced until its tip was thought to be in the epidural space. The MET was determined again (METin) and 0.2 mL kg?1 of iohexol was injected. The cats were maintained in sternal position. Contrast medium spread was determined through lateral radiographic projections.ResultsThe radiographic study confirmed the correct needle placement dorsal to the interarcuate ligament in all cats. When the needle was placed ventrally to the interarcuate ligament, iohexol was injected epidurally in ten and intrathecally in two cats. The METout and METin was 1.76 ± 0.34 mA and 0.34 ± 0.07 mA, respectively (p < 0.0001).Conclusion and clinical relevanceNerve stimulation can be employed as a tool to determine penetration of the interarcuate ligament but not the piercing of the dura mater at the lumbosacral space in cats.  相似文献   

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3.
ObjectiveTo determine if a nerve stimulation test (NST) could act as a monitoring technique to confirm sacrococcygeal epidural needle placement in cats.Study designProspective experimental trial in a clinical setting.AnimalsTwenty-four adult cats, scheduled for a therapeutic procedure where epidural anesthesia was indicated.MethodsUnder general anesthesia, an insulated needle was inserted through the S3-Cd1 intervertebral space guided by the application of a fixed electrical current (0.7 mA) until a motor response was obtained. The NST was considered positive when the epidural nerve stimulation produced a motor response of the muscles of the tail, whereas it was considered negative when no motor response was evoked. In the NST positive cases, 0.3 mL kg−1 of 0.5% bupivacaine was administrated before needle withdrawal. Ten minutes after injection, epidural blockade was confirmed by the loss of perineal (anal), and pelvic limbs reflexes (patellar and withdrawal).ResultsThe use of a fixed electrical stimulation current of 0.7 mA resulted in correct prediction of sacrococcygeal epidural injection, corroborated by post bupivacaine loss of perineal and pelvic limb reflexes, in 95.8% of the cases.Conclusion and clinical relevanceThis study demonstrates the feasibility of using, in a clinical setting, an electrical stimulation test as an objective and in real-time method to confirm sacrococcygeal epidural needle placement in cats.  相似文献   

4.
Objective-To determine the minimal electric threshold of neurostimulation dorsally and ventrally to the interarcuate ligament in the lumbosacral area necessary to cause muscle contraction of the hind limb or tail and determine whether a continuous electrical stimulation applied to an insulated needle during lumbosacral epidural needle placement could be used to distinguish the epidural from the intrathecal space in rabbits. Animals-24 New Zealand white rabbits. Procedures-Rabbits received iohexol (0.2 mL/kg) either dorsally (group 1) or ventrally to the interarcuate ligament in the lumbosacral area (groups 2 and 3). Correct placement of the needle was determined by use of the loss of resistance to injection technique (group 2) or a continuous electrical stimulation (group 3) and confirmed by examination of the iohexol distribution pattern on radiographs. Results-In all rabbits of group 1, iohexol was injected in the lumbosacral area, outside the epidural space. In groups 2 and 3, iohexol was injected intrathecally. No pure iohexol epidural migration of iohexol was observed. Mean ± SD minimal electric threshold to elicit a motor response was 1.2 ± 0.3 mA, 0.3 ± 0.1 mA, and 0.3 ± 0.1 mA in groups 1, 2, and 3, respectively. Conclusions and Clinical Relevance-Neurostimulation was a useful technique to determine correct intrathecal needle placement in rabbits but failed to detect the lumbosacral epidural space when the common technique, used in dogs and cats for the lumbosacral epidural approach, was used.  相似文献   

5.
ObjectiveTo describe the landmarks and methodology to approach the thoracic paravertebral space in dogs; to evaluate if intercostal muscular response could be evoked by a nerve-stimulator; to radiographically assess the distribution pattern of a radio-opaque contrast medium after thoracic paravertebral injections.Study designRandomized, controlled, experimental trial.AnimalsTwo mongrel dog cadavers (anatomical study) and 24 mongrel dogs (experimental study).MethodsFor the anatomic study 0.2 mL kg?1 of new methylene blue (NMB) was injected at the 5th thoracic paravertebral space; for the experimental study dogs were divided into three groups and received 1 (T5), 2 (T4 and T6) or 4 (T4, T5, T6 and T7) paravertebral injections of iohexol. The paravertebral approach was performed with insulated needles using landmarks and a blind technique. When the needle tip reached the respective thoracic paravertebral space, the nerve-stimulator was switched-on and the presence/absence of intercostal muscular twitch was registered, thus a total volume of 0.2 mL kg?1 of iohexol, divided into equal parts for each injection point, was administered. Radiological studies were performed with two orthogonal projections at different times. Positive injection was confirmed when the paravertebral space was occupied by iohexol in both projections.ResultsNMB was distributed in the T5 paraverterbal space. In the experimental study, when the needle tip reached the respective paravertebral space, intercostal twitching was obtained in 80% of the total injections with a stimulating current of 0.5 mA. The incidence of positive cases when the intercostal twitch was obtained with 0.5 mA was 83.3%. The main distribution pattern observed was cloud like without longitudinal diffusion.Conclusion and clinical relevanceIntercostal muscular responses obtained with a stimulating current of 0.5 mA could be useful to locate thoracic spinal nerves in dogs and in our study the injected solution was confined to one thoracic paravertebral space.  相似文献   

6.
ObjectiveTo evaluate the use of ultrasound for identifying the site for needle puncture and to determine the depth to the epidural space in obese dogs.Study designProspective study in dogs undergoing elective orthopedic surgery.AnimalsA group of seven obese Labrador male dogs aged 6.93 ± 2.56 years and weighing 46.5 ± 4.1 kg (mean ± standard deviation).MethodsThe anesthetic protocol for these dogs included epidural anesthesia. With the dogs anesthetized and positioned in sternal recumbency with the pelvic limbs flexed forward, ultrasound imaging was used to locate the lumbosacral intervertebral space. Intersection of dorsal and transverse lines about the probe identified the point of needle insertion. A 17 gauge, 8.9 cm Tuohy needle was inserted perpendicularly through the skin and advanced to the lumbosacral intervertebral space. The number of puncture attempts was recorded and needle depth was compared with skin to ligamentum flavum distance.ResultsEpidural injection was performed in all dogs at the first attempt of needle insertion. The distance from skin to epidural space was 5.95 ± 0.62 cm measured by ultrasound and 5.89 ± 0.64 cm measured with the Tuohy needle. These measurements were not different (p = 0.26). A highly significant correlation coefficient of 0.966 between measurement techniques was obtained (p < 0.001).Conclusions and clinical relevanceUltrasound imaging identified the point of needle insertion for lumbosacral epidural injection in seven obese dogs. The results indicate that ultrasound can be used to locate the lumbosacral intervertebral space and identify an appropriate point for needle insertion to perform epidural injection.  相似文献   

7.
ObjectiveTo determine the effect of injection speed on epidural pressure (EP), injection pressure (IP), epidural distribution (ED) of solution, and extent of sensory blockade (SB) during lumbosacral epidural anesthesia in dogs.Study designProspective experimental trial.AnimalsTen healthy adult Beagle dogs weighing 8.7 ± 1.6 kg.MethodsGeneral anesthesia was induced with propofol administered intravenously and maintained with isoflurane. Keeping the dogs in sternal recumbency, two spinal needles connected to electrical pressure transducers were inserted into the L6-L7 and the L7-S1 intervertebral epidural spaces for EP and IP measurements, respectively. Bupivacaine 0.5% diluted in iohexol was administered epidurally to each dog via spinal needle at L7-S1 intervertebral space, at two rates of injection (1 and 2 mL minute?1 groups), with a 1-week washout period. Epidural distribution was verified with computed tomography, and SB was evaluated after arousal by pinching the skin with a mosquito hemostatic forceps over the vertebral dermatomes. The results were analyzed according to each injection speed, using paired t- and Wilcoxon signed-rank tests.ResultsMean ± SD of baseline EP and IP values were 2.1 ± 6.1 and 2.6 ± 7.1 mmHg, respectively. Significant differences were observed between 1 and 2 mL minute?1 groups for peak EP (23.1 ± 8.5 and 35.0 ± 14.5 mmHg, p = 0.047) and peak IP (68.5 ± 10.7 and 144.7 ± 32.6 mmHg, p <0.001). However, the median (range) of the ED, 11.5 (4–22) and 12 (5–21) vertebrae, and SB, 3.5 (0–20) and 1 (0–20) dermatomes, values of the two groups were not related to injection speed.Conclusions and clinical relevanceThe EP profile during injection was measured by separating the injection and pressure monitoring lines. The increase in epidural injection speed increased the EP, but not the ED or the SB in dogs.  相似文献   

8.
ObjectiveTo evaluate the accuracy of epidural catheter placement at different levels of the spinal cord guided solely by electrical nerve stimulation and resultant segmental muscle contraction.Study designProspective, experiment.AnimalsSix male and two female Beagles, age (1 ± 0.17 years) and weight (12.9 ± 1.1 kg).MethodsAnimals were anesthetized with propofol and maintained with isoflurane. An insulated epidural needle was used to reach the lumbosacral epidural space. A Tsui epidural catheter was inserted and connected to a nerve stimulator (1.0 mA, 0.1 ms, 2 Hz) to assess positioning of the tip at specific spinal cord segments. The catheter was advanced to three different levels of the spinal cord: lumbar (L2–L5), thoracic (T5–T10) and cervical (C4–C6). Subcutaneous needles were previously placed at these spinal levels and the catheter was advanced to match the needle location, guided only by corresponding muscle contractions. Catheter position was verified by fluoroscopy. If catheter tip and needle were at the same vertebral body a score of zero was assigned. When catheter tip was cranial or caudal to the needle, positive or negative numbers, respectively, corresponding to the number of vertebrae between them, were assigned. The mean and standard deviation of the number of vertebrae between catheter tip and needle were calculated to assess accuracy. Results are given as mean ± SD.ResultsThe catheter position in relation to the needle was within 0.3 ± 2.0 vertebral bodies. Positive predictive values (PPV) were 57%, 83% and 71% for lumbar, thoracic and cervical regions respectively. Overall PPV was 70%. No significant difference in PPV among regions was found.Conclusion and clinical relevancePlacement of an epidural catheter at specific spinal levels using electrical nerve stimulation was feasible without radiographic assistance in dogs. Two vertebral bodies difference from the target site may be clinically acceptable when performing segmental epidural regional anesthesia.  相似文献   

9.
ObjectiveTo determine the needle‐to‐nerve distances during electrical nerve location in dogs at different currents and pulse duration using a peripheral nerve stimulator (PNS) under ultrasound control (US), and the minimal electrical thresholds (MET) necessary to obtain a motor response (MR) after achieving needle‐to‐nerve contact.Study designProspective in vivo experimental trial in a clinical settingAnimalsThirty dogs, scheduled for locoregional anaesthesia of the sciatic nerve.MethodsNeedle‐to‐nerve distance was measured ultrasonographically after obtaining the MR of sciatic nerve with 2, 1 and 0.5 mA and pulse duration 0.1 ms (NS0.1). Thereafter the needle was placed in contact with the nerve and MET was determined. The procedure was repeated with 0.3 ms (NS0.3). Finally the needle was reintroduced to contact the sciatic nerve guided only by US, thus MET‐US was determined. Data were analysed using Kruskal–Wallis or Mann–Whitney tests.ResultsNeedle‐to‐nerve distances were greater when MR was obtained with 2 mA than with 1 and 0.5 mA at 0.1 and 0.3 ms. No significant differences were observed between the needle‐to‐nerve distances using 0.1 or 0.3 ms.The MET [median (range)] was 0.4 (0.18–1.3) mA in NS0.1, 0.32 (0.12–0.8) mA in NS0.3; while MET‐US was 0.7 (0.32–1.5) mA. When the needle contacted the nerve, the MR achieved with currents below 0.3 mA was obtained in 17.2, 40 and 0% of cases using NS0.1, NS0.3 and US respectively.Conclusions and clinical relevanceThe electrical current necessary to obtain a MR decreased as the needle moved towards the nerve. However when the needle tip contacted the nerve, an MR with low current intensity could not be obtained. Thus the absence of motor response at currents below 0.3 mA cannot rule out needle‐epineurium contact. When ultrasound is combined with PNS, it is more important to assess the correct needle position than searching for an MR at low currents.  相似文献   

10.
ObjectiveTo compare the nerve stimulation test (group NS) with the running-drip method (group RUN) for successful identification of the sacrococcygeal (SCo) epidural space prior to drug administration in dogs.AnimalsA total of 62 dogs.Study designA randomized clinical study.MethodsDogs requiring an epidural anaesthetic as part of the multimodal anaesthetic plan were randomly allocated to one of the two study groups. In group NS, the epidural space was located using an insulated needle connected to a nerve stimulator; in group RUN, the epidural space was identified using a Tuohy needle connected to a fluid bag elevated 60 cm above the spine via an administration set. The success of the technique was assessed 5 minutes after epidural injection by the disappearance of the patella reflex. Data were checked for normality, nonparametric data was analysed using a Mann–Whitney U test and success rate was analysed using a Fisher’s exact test. The significance level was set at p < 0.05, and the results are presented in absolute values, percentage (95% confident interval) and median (range).ResultsThe success in identification of the epidural space did not differ between groups NS and RUN [87.1% (70.2%–96.4%) versus 90.3% (74.2%–98%); p = 1.000]. The time required for identification of the epidural space was shorter in group RUN [26 (15–53) seconds] than in group NS [40 (19–137) seconds] (p = 0.0225). No other differences were found in any studied variables.Conclusionand clinical relevance In this study, both RUN and NS techniques were successful in identifying the epidural space at the SCo intervertebral space. RUN requires no specialised equipment, can be performed rapidly and offers an alternative to the NS for use in general veterinary practice.  相似文献   

11.
ObjectivesTo assess the accuracy of the ‘hanging drop method’ for identifying the extradural space in anaesthetized dogs positioned in sternal or lateral recumbency.Study designProspective randomized-experimental study.AnimalsSeventeen clinically healthy adult dogs, 10 females and seven males weighing 8.4–26.2 kg.MethodsDogs were positioned in either sternal (n = 8) or lateral (n = 9) recumbency under general anaesthesia. A 20 SWG spinal needle pre-filled with 0.9% saline was advanced through the skin into the lumbosacral extradural space and the response of the saline drop recorded, i.e. whether it: 1) was aspirated from the hub into the needle; 2) remained within the hub, or 3) moved synchronously with i) spontaneous respiration, ii) heart beat or iii) manual lung inflation. The position of the needle tip was ultimately determined by positive contrast radiography.ResultsOne dog positioned in lateral recumbency was excluded from the study because bleeding occurred from the needle hub. Saline was aspirated into the needle in seven of eight dogs held in sternal recumbency but in none of the dogs positioned in lateral recumbency. Accurate needle tip placement in the extradural space was confirmed by positive contrast radiography in all dogs.Conclusion and clinical relevanceThe ‘hanging drop’ method, when performed with a spinal needle, appears to be a useful technique for identifying the location of the extradural space in anaesthetized medium-sized dogs positioned in sternal, but not in lateral recumbency. The technique may yield ‘false negative’ results when performed in dogs positioned in sternal recumbency.  相似文献   

12.
ObjectiveTo determine the specific lung elastance (SEL) in anesthetized dogs and to evaluate the efficacy of a SEL-based recruiting airway pressure (RPaw) at improving global and regional lung aeration.Study designRetrospective and prospective clinical study.AnimalsA total of 28 adult dogs were included in the retrospective study and six adult dogs in the prospective study.MethodsRetrospective study: SEL and SEL-based RPaw were determined using previously published data. In mechanically ventilated dogs undergoing thoracic computed tomography (CT), SEL was calculated as ΔPL/(VT/EELV), where ΔPL is the driving transpulmonary pressure, VT is the tidal volume and EELV is the end-expiratory lung volume. The ratio of lung to respiratory system elastance (EL/Ers) was determined. SEL and EL/Ers were used to calculate the SEL-based RPaw. Prospective study: dogs underwent thoracic CT at end-expiration and at end-inspiration using the SEL-based RPaw, and global and regional aeration was determined. For analysis of regional aeration, lungs were divided into cranial, intermediate and caudal regions. Regional compliance was also calculated. A p value <0.05 was considered significant.ResultsThe SEL and EL/Ers were 12.7 ± 3.1 cmH2O and 0.54 ± 0.07, respectively. The SEL-based RPaw was 29.1 ± 7.6 cmH2O. In the prospective study, the RPaw was 28.2 ± 1.3 cmH2O. During RPaw, hyperinflation increased (p = 0.0003) whereas poorly aerated (p < 0.0001) and nonaerated (p = 0.01) tissue decreased. Normally aerated tissue did not change (p = 0.265). Regional compliance was higher in the intermediate (p = 0.0003) and caudal (p = 0.034) regions compared with the cranial region. Aeration did not differ between regions (p > 0.05).Conclusions and clinical relevanceAn SEL-based RPaw reduces poorly and nonaerated lung tissue in anesthetized dogs. In nonsurgical anesthetized dogs, an RPaw near 30 cmH2O is effective at improving lung aeration.  相似文献   

13.
ObjectiveTo compare the procedural failure rate (PFR), intraoperative rescue analgesia (iRA) probability and postoperative duration of motor block after epidural and intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery.Study designProspective, randomized clinical trial.AnimalsNinety-two client-owned dogs.MethodsDogs were assigned randomly to receive either lumbosacral epidural anaesthesia (EA) (bupivacaine 0.5% and morphine 1%) or intrathecal anaesthesia with the same drugs in a hyperbaric solution (HIA). Inaccurate positioning of the needle, assessed by radiographic imaging, and lack of cerebral spinal fluid outflow were considered procedural failures (PFs) of EA and HIA, respectively. Fentanyl (1 μg kg−1 IV) was provided for intraoperative rescue analgesia, when either the heart rate or the mean arterial pressure increased by 30% above the pre-stimulation value. Its use was recorded as a sign of intraoperative analgesic failure. The motor block resolution was evaluated postoperatively. Variables were compared using Fisher's exact test, the Mann–Whitney U test and the Kaplan–Meier ‘survival’ analysis as relevant.ResultsThe PFRs in the EA and HIA groups were 15/47 (32%) and 3/45 (7%), respectively (p = 0.003). Differences in iRA were analysed in 26 and 30 subjects in the EA and HIA groups respectively, using Kaplan–Meier survival analysis. The iRA probability within the first 80 minutes of needle injection (NI) was higher in the EA group (p = 0.045). The incidence of dogs walking within 3 hours of NI was significantly higher in the HIA group (8/20, 40%) than in the EA group (0/17) (p = 0.004).Conclusions and clinical relevanceHIA was found to have lower PF, lower intraoperative analgesic failure and faster motor block resolution. In this study HIA was shown to provide some advantages over EA in dogs undergoing commonly performed pelvic limb orthopaedic surgery in a day-hospital regime.  相似文献   

14.
ObjectiveCompare the efficacy of two cardiac pacing catheters for transesophageal atrial pacing (TAP).AnimalsTen healthy dogs.MethodsTransesophageal atrial pacing was attempted in left lateral recumbency under general anesthesia. In series, a curved electrophysiologic (EP) catheter and a straight transesophageal pacing (TP) catheter were passed transorally into the distal esophagus, caudal to the heart. Each catheter was slowly withdrawn until pacing was initiated. The catheter continued to be withdrawn in 5 mm increments until capture was no longer achieved at maximal pacing setting creating a total zone of capture (tZOC). Minimum pacing threshold (Thmin) and degree of extraneous muscle stimulation (EMS) were determined at each site.ResultsThe EP catheter achieved TAP in 10/10 dogs with a Thmin of 8.8 ± 4.8 mA and tZOC of 4.0 ± 1.7 cm. The TP catheter achieved TAP in 7/10 dogs with a Thmin of 22.5 ± 5.6 mA and tZOC of 1.2 ± 1.6 cm. No EMS was noted during TAP at Thmin using the EP catheter. Of the 7 dogs in which TAP was successful, 3/7 experienced considerable EMS at Thmin. There was no significant relationship between patient body weight and Thmin with either catheter (EP catheter P = 0.09; TP catheter P = 0.81).ConclusionsThe electrophysiology catheter captured the atria of more dogs over a larger area without EMS as compared to the TP catheter. The electrophysiology catheter is recommended for transesophageal atrial pacing in dogs.  相似文献   

15.
ObjectiveTo compare the epidural anesthesia device (EPIA), which facilitates an automatic approach to location of the epidural space, with the performance of clinicians using tactile sensation and differences in pressure when inserting an epidural needle into the epidural space of a dog.Study designProspective, crossover experiment.AnimalsA total of 14 Beagle dogs weighing 7.5 ± 2.4 kg (mean ± standard deviation).MethodsEach dog was anesthetized three times at 2 week intervals for three anesthesiologists (two experienced, one novice) to perform 14 epidural injections (seven manual and EPIA device each). The sequence of methods was assigned randomly for each anesthesiologist. The dogs were anesthetized with medetomidine (10 μg kg–1), alfaxalone (2 mg kg–1) and isoflurane and positioned in sternal recumbency with the pelvic limbs extended cranially. Epidural puncture in the manual method was determined by pop sensation, hanging drop technique and reduced injection pressure, whereas using the device a sudden decrease in reaction force on the device was detected. A C-arm identified needle placement in the epidural space, and after administration of iohexol (0.3 mL), the needle length in the epidural space was defined as the mean value measured by three radiologists. Normality was tested using the Kolmogorov–Smirnov test, and significant differences between the two methods were analyzed using an independent sample t test.ResultsIn both methods, the success rates of epidural insertion were the same at 95.2%. The length of the needle in the epidural space using the device and manual methods was 1.59 ± 0.50 and 1.68 ± 0.88 mm, respectively, with no significant difference (p = 0.718).Conclusions and clinical relevanceEPIA device was comparable to human tactile sense for an epidural needle insertion in Beagle dogs. Further research should be conducted for application of the device in clinical environments.  相似文献   

16.
Daniel A.  Feeney  DVM  MS  Petra  Evers  DVM  Thomas F.  Fletcher  DVM  PhD  Robert M.  Hardy  DVM  MS  Larry J.  Wallace  DVM  MS 《Veterinary radiology & ultrasound》1996,37(6):399-411
The lumbosacral spine of six normal dogs weighing 4.5 to 24.5kg was imaged by computed tomography in 5.0 mm & 10.0 mm transverse planes. The vertebral canal and thecal sac (including emerging nerve roots not distinguished as separate structures from the spinal cord) were measured along dorsoventral and transverse dimensions at cranial, middle and caudal levels within each vertebra from transverse tomographic images. Linear measurements were standardized to the dorsoventral dimension of the L6 vertebral midbody to permit comparison and averaging of the vertebral and thecal sac dimensions among different sized dogs. The dorsoventral and transverse vertebral canal size progressively increased from cranial to caudal within each vertebra from L1?L6 (p ≤ 0.05). The transverse dimension of the thecal sac image increased caudally within each vertebra from L1?L4 (p ≤ 0.05). The vertebral canal dorsoventral and transverse dimensions were largest in the midlumbar area (p ≤ 0.05). The transverse, but not the dorsoventral, imaged dimension of the thecal sac peaked in the L4 vertebra (p ≤ 0.05). The dorsoventral thecal sac image was observed to fill the vertebral canal in the cranial and middle vertebral levels in vertebrae L1 through L5 in over 60% of these normal dogs. However, epidural fat could almost always be seen lateral to the thecal sac regardless of what lumbar vertebra or vertebral level was imaged. Cranial to the lumbosacral junction, the dorsal intervertebral disk margin was almost always concave relative to the thecal sac. However, at the L7-S1 junction, some dogs had flat or even slightly convex dorsal intervertebral disk margins. The dorsal and ventral longitudinal ligaments and the ligamentum flavum could not be identified as distinct structures on the 5.0 mm transverse tomographic images.  相似文献   

17.
ObjectiveTo compare the analgesic efficacy of buprenorphine plus detomidine with that of morphine plus detomidine when administered epidurally in horses undergoing bilateral stifle arthroscopy.Study designProspective, randomized, blinded clinical trial.AnimalsTwelve healthy adult horses participating in an orthopedic research study. Group M (n = 6) received morphine (0.2 mg kg?1) and detomidine (0.15 mg kg?1) epidurally; group B (n = 6) received buprenorphine (0.005 mg kg?1) and detomidine (0.15 mg kg?1) epidurally.MethodsHorses received one of two epidural treatments following induction of general anesthesia for bilateral stifle arthroscopy. Heart rate (HR), mean arterial blood pressure (MAP), end-tidal CO2 (Pe’CO2), and end-tidal isoflurane concentrations (E’Iso%) were recorded every 15 minutes following epidural administration. Post-operative assessment was performed at 1, 2, 3, 6, 9, 12, and 24 hours after standing; variables recorded included HR, respiratory rate (fR), abdominal borborygmi, defecation, and the presence of undesirable side effects. At the same times post-operatively, each horse was videotaped at a walk and subsequently assigned a lameness score (0-4) by three ACVS diplomates blinded to treatment and who followed previously published guidelines. Nonparametric data were analyzed using Wilcoxon’s rank-sum test. Inter- and intra-rater agreement were determined using weighted kappa coefficients. Statistical significance was set at p = 0.05.ResultsNo statistically significant differences were found between groups with respect to intra-operative HR, MAP, E’Iso%, or post-operative HR, gastrointestinal function and cumulative median lameness scores. Post-operative fR in group B [24 (12-30), median (range)] breaths per minute was significantly higher than in group M [18 (15-20)] breaths per minute, p = 0.04.Conclusions and clinical relevanceIn horses undergoing bilateral stifle arthroscopy, these doses of buprenorphine plus detomidine injected epidurally produced analgesia similar in intensity and duration to that of morphine plus detomidine injected epidurally.  相似文献   

18.
ObjectiveTo compare the cardiovascular effects of four epidural treatments in isoflurane anaesthetised dogs.Study designProspective, randomized. experimental study.AnimalsSix female, neutered Beagle dogs (13.3 ± 1.0 kg), aged 3.6 ± 0.1 years.MethodsAnaesthesia was induced with propofol (8.3 ± 1.1 mg kg?1) and maintained with isoflurane in a mixture of oxygen and air [inspiratory fraction of oxygen (FiO2) = 40%], using intermittent positive pressure ventilation. Using a cross-over model, NaCl 0.9% (P); methadone 1% 0.1 mg kg?1 (M); ropivacaine 0.75% 1.65 mg kg?1 (R) or methadone 1% 0.1 mg kg?1 + ropivacaine 0.75% 1.65 mg kg?1 (RM) in equal volumes (0.23 mL kg?1) using NaCl 0.9%, was administered epidurally at the level of the lumbosacral space. Treatment P was administered to five dogs only. Cardiovascular and respiratory variables, blood gases, and oesophageal temperature were recorded at T-15 and for 60 minutes after epidural injection (T0).ResultsMean overall heart rate (HR in beats minute?1) was significantly lower after treatment M (119 ± 16) (p = 0.0019), R (110 ± 18) (p < 0.0001) and RM (109 ± 13) (p < 0.0001), compared to treatment P (135 ± 21). Additionally, a significant difference in HR between treatments RM and M was found (p = 0.04). After both ropivacaine treatments, systemic arterial pressures (sAP) were significantly lower compared to other treatments. No significant overall differences between treatments were present for central venous pressure, cardiac output, stroke volume, systemic vascular resistance, oxygen delivery and arterial oxygen content (CaO2). Heart rate and sAP significantly increased after treatment P and M compared to baseline (T-15). With all treatments significant reductions from baseline were observed in oesophageal temperature, packed cell volume and CaO2. A transient unilateral Horner’s syndrome occurred in one dog after treatment R.Conclusions and clinical relevanceClinically important low sAPs were observed after the ropivacaine epidural treatments in isoflurane anaesthetised dogs. Systemic arterial pressures were clinically acceptable when using epidural methadone.  相似文献   

19.
ObjectiveTo evaluate and compare perioperative morbidity and mortality in dogs undergoing cervical and thoracolumbar spinal surgery.Study designProspective case series.Animals157 dogs undergoing cervical or thoracolumbar spinal surgery.MethodsData were collected sequentially on canine cases presented from the Neurology Section of the North Carolina State University Veterinary Teaching Hospital for anesthesia and surgery for cervical spinal cord disease. Simultaneously, data were collected on all thoracolumbar spinal surgery cases during the same time period. Data included signalment, drugs administered, surgical approach, disease process, cardiac arrhythmias during anesthesia, and outcome.ResultsData were collected from 164 surgical events in 157 dogs. There were 52 cervical approaches; four dorsal and 48 ventral. All thoracolumbar surgeries were approached dorsolaterally. Four dogs 4/52 (7.6%) undergoing a cervical approach did not survive to discharge. Two dogs (2/8; 25%) underwent atlanto-axial (AA) stabilization and suffered cardiovascular arrest and two dogs (2/38; 5.2%) undergoing cervical ventral slot procedures were euthanized following anesthesia and surgery due to signs of aspiration pneumonia. All dogs undergoing thoracolumbar surgery survived until discharge (112/112). Mortality in dogs undergoing cervical spinal surgery was greater compared with dogs undergoing thoracolumbar spinal surgery (p = 0.009), however, in dogs undergoing decompressive disc surgery, intraoperative death rates were not different between dogs undergoing a cervical compared with thoracolumbar approaches (p = 0.32) nor was there a significant difference in overall mortality (p = 0.07).Conclusion and clinical relevanceOverall, dogs undergoing cervical spinal surgery were less likely to survive until discharge compared with dogs undergoing thoracolumbar spinal surgery. Mortality in dogs undergoing cervical intervertebral disc decompression surgery was no different than for dogs undergoing thoracolumbar intervertebral disc decompression surgery. However, dogs undergoing cervical intervertebral disc decompression surgery should be considered at risk for aspiration pneumonia.  相似文献   

20.
ObjectiveTo evaluate the analgesic and physiological effects of epidural morphine administered at the sixth and seventh lumbar or the fifth and sixth thoracic vertebrae in dogs undergoing thoracotomy.Study designProspective, randomized, blinded trial.AnimalsFourteen mixed-breed dogs, weighing 8.6 ± 1.4 kg.MethodsThe animals received acepromazine (0.1 mg kg?1) IM and anesthesia was induced with propofol (4 mg kg?1) IV. The lumbosacral space was punctured and an epidural catheter was inserted up to the region between the sixth and seventh lumbar vertebrae (L, n = 6) or up to the fifth or sixth intercostal space (T, n = 8). The dogs were allowed to recover and after radiographic confirmation of correct catheter position, anesthesia was reinduced with propofol IV and maintained with 1.7% isoflurane. Following stabilization of monitored parameters, animals received morphine (0.1 mg kg?1) diluted in 0.9% NaCl to a final volume of 0.25 mL kg?1 via the epidural catheter, and after 40 minutes, thoracotomy was initiated. Heart rate and rhythm, systolic, mean and diastolic arterial pressures, respiratory rate, arterial hemoglobin oxygen saturation, partial pressure of expired CO2 and body temperature were measured immediately before the epidural administration of morphine (0 minute) and every 10 minutes during the anesthetic period. The Melbourne pain scale and the visual analog scale were used to assess post-operative pain. The evaluation began 3 hours after the epidural administration of morphine and occurred each hour until rescue analgesia.ResultsThere were no important variations in the physiological parameters during the anesthetic period. The post-operative analgesic period differed between the groups, being longer in T (9.9 ± 1.6 hours) compared with L (5.8 ± 0.8 hours).ConclusionsThe use of morphine, at a volume of 0.25 mL kg?1, administered epidurally over the thoracic vertebrae provided longer lasting analgesia than when deposited over the lumbar vertebrae.Clinical relevanceThe deposition of epidural morphine provided longer lasting analgesia when administered near to the innervation of the injured tissue without increasing side effects.  相似文献   

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