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1.
An 8-year-old Trakehner mare developed fulminant pulmonary edema following suspected upper airway obstruction 50 minutes into an otherwise unremarkable anesthetic recovery after surgery for left cricoarytenoideus dorsalis muscle reinnervation and ventriculocordectomy. Establishing a patent airway by orotracheal reintubation and cardiopulmonary resuscitation attempts were unsuccessful. Gross, histological, and electron microscopic postmortem examination showed severe hemorrhagic pulmonary edema. Laryngeal swelling or hemorrhage were not evident, suggesting laryngospasm or functional airway collapse associated with the underlying left laryngeal paralysis, as a cause of the upper airway obstruction. Negative pressure pulmonary edema is rarely reported in the veterinary literature as a postanesthetic complication.  相似文献   

2.
After an uneventful general anesthesia, in a horse negative pressure pulmonary edema developed due to acute upper airway obstruction during the anesthetic recovery phase after colic surgery. No pathologic alteration of respiration was observed until the horse stood up and began suffocating. The horse had recovered with the nasogastric tube in situ. This, together with the postmortem diagnosis of laryngeal hemiplegia resulted in impairment of airflow through the larynx and development of pulmonary edema. Our objective is to alert clinicians about the possible hazard of recovery with an in-situ nasogastric tube.  相似文献   

3.
A 523 kg Quarter Horse was anesthetized for unilateral eye enucleation. The anesthetic period was unremarkable. During anesthetic recovery the cap on the jugular venous catheter became dislodged. Clinical signs of pulmonary edema associated with moderate arterial hypoxemia subsequently developed. Although pulmonary edema resolved with medical therapy, the day following anesthetic recovery, clinical signs of vestibular disease and blindness developed. Treatment included nasal oxygen insufflation, flunixin meglumine, furosemide, dexamethasone, thiamine, dimethylsulfoxide, antimicrobials, and phenylbutazone. The horse recovered and was discharged from the hospital after 7 days of treatment and was neurologically normal at 6 weeks. While venous air embolism was not confirmed in this case, the catheter cap complication followed by signs of pulmonary edema and neurologic sequelae support the presumptive pathogenesis of this horse's complications. Diagnostic confirmation of air embolism in horses with compatible acute clinical signs should be documented with echocardiography.  相似文献   

4.
Anesthetic complications have multiple causes making it difficult to distinguish between inciting causes and coincidental events. Case-control analysis is used to analyze clinical cases retrospectively and identify causes of complications. This approach was used to identify causes of airway complications that occurred during recovery in 30 horses at Cornell University between 1990 and 1997. In the 30 index cases, airway complications included airway obstruction ( n  = 6), bronchial asthma (1), dyspnea (8), pulmonary edema (14), and respiratory arrest (1).
Based on breed, age, gender and surgical procedure, each index horse was matched to six control horses, three that were operated on prior to surgery on the index case, and three that were operated on after surgery on the index case. Data were analyzed using chi-square analysis; significance was set at p  ≤ 0.05.
Factors not significantly associated with the index horses included: breed, gender, day of the week, physical status, surgical body region, surgeon, type of complication that may have occurred intraoperatively, fluid volume, drugs given intraoperatively, and use of nasotracheal or nasopharyngeal tubes during recovery. Factors that were associated with the index cases included: a nonsignificant tendency to be older than controls; significantly longer anesthetic episodes; fewer than expected received antibiotics, anti-inflammatory drugs, and tetanus toxoid compared with controls; and more received colloid and hypertonic saline than controls.
This study did not identify a specific cause of the airway complications, but it allowed us to rule out a number of possible causes while identifying some factors that warrant further investigation such as plasma oncotic pressure effects on airway-associated complications.  相似文献   

5.
Isoflurane as an inhalational anesthetic agent in clinical practice   总被引：2，自引：2，他引：0       下载免费PDF全文
Isoflurane is the most recently available inhalational anesthetic agent on the market today. Although there have been few clinical trials comparing its use to halothane and methoxyflurane, the pharmacology of the agent suggests certain situations in which it may be the preferable agent. These include avian anesthesia, geriatric patients, patients with cardiovascular disease or hepatic disease, critically ill and unstable patients, cases such as brachiocephalics where upper airway obstruction is a concern during recovery, patients where increases in intracranial pressure should be avoided, and cesarean section. In addition, the rapid recoveries seen with isoflurane may be an advantage for outpatient surgeries.  相似文献   

6.
New evidence confirmed that over 90% of Thoroughbreds have some degree of recurrent laryngeal neuropathy (RLN). This and the recognition that anything less than full extension of the atlanto-occipital joint in a racehorse implied a reduction in patency of the nasopharynx provided the basis of the hypothesis that exercise-induced pulmonary hemorrhage (EIPH) may be caused by an upper airway obstruction and that partial asphyxia could be the primary mechanism. EIPH was associated most frequently with the congenital (hereditary), left-sided, hemiparetic form of RLN. Other obstructive diseases, such as laryngeal chondritis and subepiglottic cysts, may be rare causes. Atlanto-occipital flexion on its own might also cause EIPH but more commonly was thought to be a factor which added to the upper airway obstruction resulting from RLN. Supporting evidence for this hypothesis was derived from retrospective and prospective studies of medical records; from necropsy findings on naturally occurring and experimentally produced cases of EIPH; from surveys on the prevalence of RLN; and from a literature review on asphyxia in man and animals.Clinical evidence which supported the hypothesis indicated that EIPH was a clinical sign of RLN. The epidemiology and prevalence of EIPH and congenital RLN appeared to be the same and both problems had a similar historical antiquity. It was already known that bilateral RLN caused asphyxia and EIPH and it appeared from this study that so also does untilateral RLN also does. Clinical signs of both EIPH and RLN were induced by exercise; both were capable of causing exercise intolerance; both were exacerbated by high ambient temperatures and humidity; both problems were permanent and incurable. EIPH was associated with neither the clinical signs nor the pathology of any other pulmonary disease, but was consistently associated with RLN. For it to be argued that EIPH was predominantly a clinical sign of RLN it was necessary that both problems should belong to the same etiological family. Once again, this condition seemed to be met, as EIPH and RLN both appeared more likely to be hereditary rather than environmental diseases.The pulmonary pathology of EIPH was compatible with asphyxia and similar to asphyxia in man. The bilateral symmetry of pulmonary hemorrhage in EIPH suggested an upper airway location for its causal mechanism. Secondary mechanisms might include such factors as increased upper airway resistance, increased pulmonary negative pressure, pulmonary congestion, hypoxemia, hypercapnia, pulmonary hypertension, increased capillary-alveolar pressure gradient, pulmonary edema, increased capillary permeability and microrupture of alveolar walls.Attempts to disprove the hypothesis failed. A prospective study of 201 Thoroughbreds showing EIPH revealed that all had an upper airway obstruction and 98% had RLN. The authors concluded that the hypothesis appeared to be viable. EIPH would seem to be not only a clinical sign of congenital RLN but possibly the most common sign of this common disease. In relation to RLN, the hypothesis could be restated as follows:
a) A horse with laryngeal paraplegia, a rare form of RLN, may develop pulmonary hemorrhage with minimal exercise.
b) A horse with laryngeal hemiplegia, a more common form of RLN, may develop pulmonary hemorrhage with severe exercise.
c) A horse with laryngeal hemiparesis, the most common form of RLN, may develop pulmonary hemorrhage with maximal exercise.
From this a maxim could be distilled regarding the conditions which may be needed for inducing pulmonary hemorrhage: The greater the airway obstruction, the smaller the exercise stress; the smaller the airway obstruction, the greater the exercise stress. The study drew attention to the importance of including in the routine necropsy protocol an examination of the intrinsic muscles of the larynx. Asphyxia has not in the past been considered as a possible explanation for sudden death in the horse but it became apparent that this represented an omission.  相似文献   

7.
Noncardiogenic pulmonary edema is an important cause of respiratory disease in dogs and cats but few reports describe its radiographic appearance. The purpose of this retrospective case series study was to describe radiographic findings in a large cohort of dogs and cats with presumed noncardiogenic pulmonary edema and to test associations among radiographic findings versus cause of edema. Medical records were retrieved for dogs and cats with presumed noncardiogenic edema based on history, radiographic findings, and outcome. Radiographs were reviewed to assess lung pattern and distribution of the edema. Correlation with the cause of noncardiogenic pulmonary edema was evaluated with a Fisher's exact test. A total of 49 dogs and 11 cats were included. Causes for the noncardiogenic edema were airway obstruction (n = 23), direct pulmonary injury (n = 13), severe neurologic stimulation (n = 12), systemic disease (n = 6), near‐drowning (n = 3), anaphylaxis (n = 2) and blood transfusion (n = 1). Mixed, symmetric, peripheral, multifocal, bilateral, and dorsal lung patterns were observed in 44 (73.3%), 46 (76.7%), 55 (91.7%), 46 (76.7%), 46 (76.7%), and 34 (57.6%) of 60 animals, respectively. When the distribution was unilateral, pulmonary infiltration involved mainly the right lung lobes (12 of 14, 85.7%). Increased pulmonary opacity was more often asymmetric, unilateral, and dorsal for postobstructive pulmonary edema compared to other types of noncardiogenic pulmonary edema, but no other significant correlations could be identified. In conclusion, noncardiogenic pulmonary edema may present with a quite variable radiographic appearance in dogs and cats.  相似文献   

8.
Anesthesia for patients with head trauma.   总被引：1，自引：0，他引：1  
Patients undergoing anesthesia soon after head trauma are at great risk for further neural damage during the anesthetic, especially if the head injury is severe or the anesthetic technique is suboptimal. Secondary complications of the anesthetic that are often lethal include hypoventilation, increases in ICP, airway obstruction, and brain-stem herniation. Anesthetic management of patients with head injury must include intravenous induction with barbiturates or narcotics, smooth endotracheal intubation, controlled ventilation with oxygen, and minimal amounts of inhalational agents. It is important to position the patient so that jugular veins are not occluded, in about 10 degrees head up position, and to avoid inducing patient coughing and straining. Recovery from anesthesia should be quiet and rapid, with the maintenance of a clear airway and the use of as little depressant medication post-operatively as possible. Oxygen should be provided.  相似文献   

9.
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10.
All equine anaesthetists should take steps to mitigate the risk of anaesthetic‐related morbidities and mortalities where they can, and whilst some interventions against some of these are widely practiced, the number of approaches adopted by equine anaesthetists to mitigate the risk of airway obstruction suggests not only that the causes and severity of airway obstruction vary, but also that evidence for the superiority of any approach over another is limited. The limited evidence available suggests that the prevalence of severe airway obstruction in both the general and upper respiratory tract surgical equine populations is likely to be low, and that when cases do occur, rapid recognition and intervention often results in successful treatment. The above evidence considered with the understanding that pre‐emptively placing endotracheal or nasotracheal tubes in situ for recovery may only delay the recognition of some causes (e.g. laryngeal) of airway obstruction, alongside an awareness that this approach is not a benign risk‐free intervention, may lead some anaesthetists to re‐evaluate the perceived risk of respiratory obstruction and whether their chosen intervention will reduce that risk, potentially exacerbate it or introduce a further risk.  相似文献   

11.
Pulmonary function and airway reactivity to IV histamine were measured in a group of ponies with a history of recurrent airway obstruction (heaves) and their age-, weight-, and gender-matched controls. Ponies were studied during a period of clinical remission (period A), after exposure to a barn environment (period B), and twice during a 2-week recovery phase (periods C and D). At periods A, C, and D, PaO2, dynamic compliance (Cdyn), pulmonary resistance, tidal volume, respiratory frequency, and the log dose of histamine required to reduce Cdyn to 65% of base-line value (log ED65Cdyn) of principals and controls did not differ. Barn exposure (period B) decreased Cdyn, PaO2, and ED65Cdyn and increased pulmonary resistance in principals but not controls. The slope of the histamine dose-Cdyn response curves was not different between principal and control groups of ponies and was unaffected by barn exposure or return to pasture. There was a poor correlation between ED65Cdyn and indices of airway caliber. During acute airway obstruction, ponies with a history of heaves were hyperreactive to IV histamine, but during disease remission, airway response to histamine was not different from that of control ponies. Seemingly, hyperreactivity in principal ponies after exposure to a barn environment cannot be explained solely by alterations in base-line airway caliber.  相似文献   

12.
Case 1 A two‐year old, 462 kg Standard bred horse was anesthetized for arthroscopy and castration. During anesthesia, hyperemia of the mucosal membranes and urticaria were noticed. During 5 hours of anesthesia subcutaneous edema of the eyelids and neck region developed. In the recovery box, the orotracheal (OT) tube was left in situ and secured in place with tape. Following initial attempts to stand, the horse became highly agitated and signs consistent with pulmonary edema developed subsequently. Arterial hypoxemia (PaO2: 3.7 kPa [28 mmHg]) and hypocapnia (PaCO2: 3.1 kPa [23 mmHg]) were confirmed. Oxygen and furosemide were administered. The horse was assisted to standing with a sling. Therapy continued with bilateral intra‐nasal oxygen insufflation. Ancillary medical therapy included flunixin meglumine, penicillin, gentamycin and dimethylsulfoxide. Following 7 hours of treatment the arterial oxygen tensions began to increase towards normal values. Case 2 An 11‐year old, 528 kg Paint horse was anesthetized for surgery of a submandibular mass. The 4‐hour anesthetic period was unremarkable. The OT tube was left in situ for the recovery. During recovery, the horse was slightly agitated and stood after three attempts. Clinical signs consistent with pulmonary edema and arterial hypoxemia (PaO2: 5 kPa [37.5 mmHg]) subsequently developed following extubation. Respiratory signs resolved with medical therapy, including unilateral nasal oxygen insufflation, furosemide, flunixin meglumine and dimethylsulfoxide. The diagnosis of pulmonary edema in these horses was made by clinical signs and arterial blood‐gas analysis. While pulmonary radiographs were not taken to confirm the diagnosis, the clinical signs following anesthesia support the diagnosis in both cases. The etiology of pulmonary edema was most likely multifactorial.  相似文献   

13.
Golden Gate Estates (GGE), an exurban development in southwest Florida, is the site of the highest recorded number of conflicts between people and the Florida panther. We used qualitative data provided by 157 GGE residents and 19 nonresident stakeholders to investigate attitudes toward the panther, and appropriate measures to mitigate human–panther conflicts. Although a subset of GGE residents expressed some concerns about human safety risks associated with living with the panther, a higher share of residents viewed the panther positively. Residents and nonresident stakeholders agreed that GGE residents are responsible for securing their livestock against panthers. This point of agreement may improve adoption of appropriate practices to prevent human–panther conflicts. Outreach and education programs should reinforce expectations within the GGE community that residents are responsible for securing livestock against predators and adopting other conflict mitigation practices, as well as encouraging positive attitudes toward the panther.  相似文献   

14.
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15.
A one-time oral gavage can be enough to cause of alveologenic edema with higher expression of AQP-1 and -4 than that with repeated-dose oral gavage, which caused both profound perivascular edema and hydrostatic pressure edema, while AQP-5 was similarly expressed. The alteration of AQPs expression was probably related to alveolar fluid clearance across the alveolar and bronchiolar epithelium in different stages of lung injury. The results clarified the type of lung edema in acute and sub-chronic toxicity studies without treatment related effect of tested material. The pathogenesis of pulmonary edema due to oral gavage toxicological study is associated with the cellular immune response to the reflux materials. Mast cell and leukocyte accumulation may contribute to increase vascular permeability leading to permeability edema. The increase in alveolar septum epithelium, perivascular and peribronchial cuffing, accumulation alveolar lipid containing macrophage and medial hyperplasia of the pulmonary artery might have been caused to increase airway resistance, which resulted in hydrostatic pressure edema.  相似文献   

16.
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17.
OBJECTIVE: To determine the cardiovascular and respiratory effects of water immersion in horses recovering from general anesthesia. ANIMALS: 6 healthy adult horses. PROCEDURE: Horses were anesthetized 3 times with halothane and recovered from anesthesia while positioned in lateral or sternal recumbency in a padded recovery stall or while immersed in a hydropool. Cardiovascular and pulmonary functions were monitored before and during anesthesia and during recovery until horses were standing. Measurements and calculated variables included carotid and pulmonary arterial blood pressures (ABP and PAP respectively), cardiac output, heart and respiratory rates, arterial and mixed venous blood gases, minute ventilation, end expiratory transpulmonary pressure (P(endXes)), maximal change in transpulmonary pressure (deltaP(tp)max), total pulmonary resistance (RL), dynamic compliance (Cdyn), and work of breathing (W). RESULTS: Immersion in water during recovery from general anesthesia resulted in values of ABP, PAP P(endXes), deltaP(tp)max, R(L), and W that were significantly greater and values of Cdyn that were significantly less, compared with values obtained during recovery in a padded stall. Mode of recovery had no significant effect on any other measured or calculated variable. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in pulmonary and cardiovascular function between horses during recovery from anesthesia while immersed in water and in a padded recovery stall were attributed to the increased effort needed to overcome the extrathoracic hydrostatic effects of immersion. The combined effect of increased extrathoracic pressure and PAP may contribute to an increased incidence of pulmonary edema in horses during anesthetic recovery in a hydropool.  相似文献   

18.
A novel model for equine recurrent airway obstruction   总被引：2，自引：0，他引：2  
Equine recurrent airway obstruction (RAO; a term combining both chronic obstructive pulmonary disease (COPD) and summer pasture associated obstructive pulmonary disease (SPAOPD)) is one of the most common equine respiratory diseases with up to 50% of horses affected worldwide. The etiopathogenesis of RAO is unknown although pulmonary hypersensitivity to inhaled mold antigens may be involved. Recent work in our laboratory demonstrating elevated levels of IL-4 and IL-13 mRNA in the airways and peripheral blood of horses with RAO is consistent with an atopic component to RAO. Little is known regarding the earliest phases of RAO in horses. Here we describe the development of a novel airway model for equine RAO that utilizes ovalbumin-coated polystyrene beads for airway sensitization and challenge. Aerosol challenge of sensitized ponies with OVA-coated microbeads resulted in decreased airway compliance, increased percentage of lymphocytes and neutrophils in the bronchoalveolar lavage fluid, and evidence of a Th2 cytokine response in the bronchoalveolar cells. These results suggest that this approach may be useful in describing the initial stages of RAO development in the horse.  相似文献   

19.
REASONS FOR PERFORMING STUDY: Acupuncture may be recommended for horses with 'heaves' because it is being increasingly applied to treat human asthma. Therefore, its efficacy was investigated in horses with this asthma-like disease. OBJECTIVE: To evaluate the efficacy of a single acupuncture treatment for the relief of airway obstruction in heaves-affected horses. METHODS: The efficacy of a single acupuncture treatment was tested in 10 heaves-affected horses, and the effect of removal from the dusty stall environment in 5 heaves-affected horses. Before treatment, horses were stabled to induce airway obstruction and, apart from trips to the laboratory for pulmonary function measurements, they remained stabled for the duration of each treatment. The severity of airway obstruction was quantified by measurement of lung function before treatment (baseline), and at 20, 60, 120 and 240 mins and 24 h after the following treatments administered in random order: halter restraint and patting, a single acupuncture treatment by an experienced acupuncturist, and a single acupuncture treatment using predetermined points (recipe) by a veterinarian with no acupuncture training. In a second study, horses were untreated and remained either in their stall or in a paddock for all measurements of lung function, after baseline readings were made. RESULTS: In the first study, after all treatments, there was a temporal improvement in maximal change in pleural pressure, pulmonary resistance, dynamic compliance, respiratory rate, and tidal volume that lasted less than 24 h. There was no specific effect of acupuncture treatment. In the second study, removal from the dusty environment did not produce an improvement in lung function in the first 6 h. We conclude that most of the improvements in lung function observed in the study were due to handling. CONCLUSIONS: Assessed objectively, a single acupuncture treatment during an attack of heaves causes no more improvement in lung function than does handling the horse. POTENTIAL RELEVANCE: Acupuncture should not replace conventional medical treatments for heaves.  相似文献   

20.
Alpha2 agonists are commonly used in combination with other anesthetic agents to chemically immobilize wildlife and may cause potentially serious hypoxemia in wild ruminants. In some domestic ruminants, they are associated with significant changes to the pulmonary parenchyma, increased venous admixture, pulmonary edema, and hypoxemia. Effective and safe immobilization of these animals requires knowledge of the mechanisms behind these changes and the methods that offset their effects, including the use of supplemental oxygen.  相似文献   

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