OBJECTIVE To determine the impact of mechanical ventilation (MV) and perfusion conditions on the efficacy of pulse-delivered inhaled nitric oxide (PiNO) in anesthetized horses. ANIMALS 27 healthy adult horses. PROCEDURES Anesthetized horses were allocated into 4 groups: spontaneous breathing (SB) with low (< 70 mm Hg) mean arterial blood pressure (MAP; group SB-L; n = 7), SB with physiologically normal (≥ 70 mm Hg) MAP (group SB-N; 8), MV with low MAP (group MV-L; 6), and MV with physiologically normal MAP (group MV-N; 6). Dobutamine was used to maintain MAP > 70 mm Hg. Data were collected after a 60-minute equilibration period and at 15 and 30 minutes during PiNO administration. Variables included Pao2, arterial oxygen saturation and content, oxygen delivery, and physiologic dead space-to-tidal volume ratio. Data were analyzed with Shapiro-Wilk, Mann-Whitney U, and Friedman ANOVA tests. RESULTS Pao2, arterial oxygen saturation, arterial oxygen content, and oxygen delivery increased significantly with PiNO in the SB-L, SB-N, and MV-N groups; were significantly lower in group MV-L than in group MV-N; and were lower in MV-N than in both SB groups during PiNO. Physiologic dead space-to-tidal volume ratio was highest in the MV-L group. CONCLUSIONS AND CLINICAL RELEVANCE Pulmonary perfusion impacted PiNO efficacy during MV but not during SB. Use of PiNO failed to increase oxygenation in the MV-L group, likely because of profound ventilation-perfusion mismatching. During SB, PiNO improved oxygenation irrespective of the magnitude of blood flow, but hypoventilation and hypercarbia persisted. Use of PiNO was most effective in horses with adequate perfusion.

OBJECTIVE To evaluate the effects of injectable dexmedetomidine-ketamine-midazolam (DKM) and isoflurane inhalation (ISO) anesthetic protocols on selected ocular variables in captive black-tailed prairie dogs (Cynomys ludovicianus; BTPDs). ANIMALS 9 zoo-kept BTPDs. PROCEDURES The BTPDs received dexmedetomidine hydrochloride (0.25 mg/kg, IM), ketamine hydrochloride (40 mg/kg, IM), and midazolam hydrochloride (1.5 mg/kg, IM) or inhalation of isoflurane and oxygen in a randomized complete crossover design (2-day interval between anesthetic episodes). Pupil size, globe position, tear production, and intraocular pressure measurements were recorded at 5, 30, and 45 minutes after induction of anesthesia. For each BTPD, a phenol red thread test was performed in one randomly selected eye and a modified Schirmer tear test I was performed in the other eye. Intraocular pressure was measured by rebound tonometry. RESULTS Compared with findings for the DKM protocol, pupil size was smaller at all time points when the BTPDs underwent the ISO protocol. Globe position remained central during anesthesia with the DKM protocol, whereas it varied among central, ventromedial, and ventrolateral positions during anesthesia with the ISO protocol. Tear production and intraocular pressure decreased significantly over time when the BTPDs underwent either protocol. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that ophthalmic examination findings for anesthetized BTPDs can be influenced by the anesthetic protocol used. The DKM protocol may result in more consistent pupil size and globe position, compared with that achieved by use of the ISO protocol. Tear production and intraocular pressure measurements should be conducted promptly after induction of anesthesia to avoid the effect of anesthetic episode duration on these variables.

OBJECTIVE To evaluate efficacy and safety of anesthesia with dexmedetomidine-ketamine-midazolam (DKM) in five-striped palm squirrels (Funambulus pennantii). ANIMALS 8 male squirrels. PROCEDURES Squirrels were anesthetized with DKM (dexmedetomidine, 0.1 mg/kg; ketamine hydrochloride, 30 mg/kg; and midazolam, 0.75 mg/kg) administered IM. Atipamezole (0.15 mg/kg) and flumazenil (0.1 mg/kg) were administered IM 40 minutes after induction of anesthesia. Vital signs and responses were recorded every 5 minutes during anesthesia. RESULTS Anesthetic induction and recovery from anesthesia were rapid and without complications in all squirrels. Median anesthetic induction time was 67.5 seconds (interquartile [25th to 75th percentile] range, 5.5 seconds), and mean ± SD recovery time after drug reversal was 147 ± 79 seconds. Heart rate, respiratory rate, and rectal temperature significantly decreased during the anesthetic period. All squirrels became hypothermic by 40 minutes after induction. The righting reflex was absent during the 40-minute anesthetic period in all squirrels, with variable responses for the palpebral reflex, jaw tone, forelimb withdrawal reflex, and hind limb withdrawal reflex. Only 2 of 8 squirrels had loss of the limb withdrawal reflex in both the forelimbs and hind limbs from anesthetic induction to 25 minutes after induction. CONCLUSIONS AND CLINICAL RELEVANCE DKM appeared to provide safe and effective anesthesia in five-striped palm squirrels, but oxygen and thermal support were indicated. At the doses administered, deep surgical anesthesia was not consistently achieved, and anesthetic depth of individual squirrels must be determined before surgical procedures are performed in palm squirrels anesthetized with this drug combination.

OBJECTIVE To evaluate the effects of providing 100% O2, compared with provision of room air, in sedated spontaneously breathing inland bearded dragons (Pogona vitticeps). ANIMALS 8 adult bearded dragons. PROCEDURES Animals were sedated with alfaxalone (20 mg/kg, SC) and received 21% O2 (equivalent to room air) or 100% O2 via face mask (flow rate, 1 L/min) in a randomized, blinded, complete crossover study (2-week interval between treatments). Sedation variables, cardiopulmonary variables, venous blood gas values, and postsedation food intake were evaluated. RESULTS Respiratory rate, heart rate, oxygen saturation, and sedation quality were comparable between treatments. Venous blood gas analysis revealed a higher total Pco2 and HCO3− concentration for the 21% O2 treatment. Postsedation food intake was not affected by the inspired oxygen fraction provided during sedation. CONCLUSIONS AND CLINICAL RELEVANCE The fraction of inspired oxygen did not appear to have clinically relevant effects on physiologic variables of bearded dragons during and after sedation. Therefore, provision of 100% O2 can be considered for use in sedated bearded dragons without the risk of inducing hypoventilation. Similarly, failure to provide 100% O2 would be unlikely to result in clinically relevant consequences in healthy sedated bearded dragons.

The degree of analgesia provided by blind techniques for brachial plexus blocks (BPBs) has not been compared in clinical cases undergoing surgery of the thoracic limb. The objective of this study was to evaluate the anesthetic conditions and postoperative analgesia resulting from 3 different BPB local anesthetic techniques in canine patients undergoing such surgery. Twenty-four client-owned dogs received a standardized premedication/induction protocol (hydromorphone and acepromazine/propofol), maintained with isoflurane in oxygen using mechanical ventilation, in a prospective, randomized, blinded clinical trial. Before surgery, dogs received 1 of 3 anatomical BPB techniques: traditional, perpendicular, or axillary, with 0.2 mL/kg body weight (BW) of bupivacaine 0.5%. Cardiorespiratory variables and isoflurane end-tidal concentrations were recorded throughout anesthesia. Scores for anesthetic maintenance (0-best to 4-responsive), recovery quality (0-not responsive to 3-responsive), and Glasgow pain scale were recorded for up to 24 h postoperatively. All dogs recovered uneventfully from anesthesia and no differences in the measured variables or scores were noted among groups, during and after anesthesia. When thoracic limb amputations in each of the 3 groups (n = 9; 4 in traditional, 3 in perpendicular, 2 in axillary) were compared to the other surgical procedures (n = 15); however, scores for anesthetic maintenance were higher [0 (0 to 1) versus 0 (0 to 0); median (interquartile range)], recovery [1 (0 to 2) versus 0 (0 to 0)], and pain [2.4 (2.4 to 3.0) versus 1.6 (1.4 to 2.2)] in the first 3 h post-extubation. Surgery times were also longer with amputations [115 min (100 to 138 min) versus 50 min (41 to 90 min)]. The 3 BPB techniques provided similar anesthesia and postoperative pain scores. Despite higher pain scores in thoracic limb amputations than in less invasive surgeries, the BPB appeared to provide significant comfort.

OBJECTIVE To compare anesthetic effects of alfaxalone-ketamine-dexmedetomidine (AKD) and alfaxalone-butorphanol-midazolam (ABM) in naked mole-rats (Heterocephalus glaber). ANIMALS 20 naked mole-rats. PROCEDURES Naked mole-rats received AKD (alfaxalone, 2 mg/kg; ketamine, 20 mg/kg; and dexmedetomidine, 0.02 mg/kg; n = 10) or ABM (alfaxalone, 2 mg/kg; butorphanol, 2 mg/kg; and midazolam, 1 mg/kg; 9) IM; 1 animal was removed from the study. Atipamezole (I mg/kg) and flumazenil (0.1 mg/kg) were administered 40 minutes after anesthetic induction (defined as loss of the righting reflex) with AKD and ABM, respectively. Heart rate, respiratory rate, oxygen saturation, and reflexes were recorded every 5 minutes. RESULTS The ABM group had significantly longer median times for induction and recovery than the AKD group. Administration of ABM resulted in significantly lower respiratory rates than administration of AKD from time of anesthetic induction to 10 minutes after induction. Respiratory rate significantly decreased in the AKD group from I0 minutes after induction through the end of the anesthetic period but did not change over time in the ABM group. Males had higher respiratory rates in both groups. Loss of the righting reflex was still evident 40 minutes after induction in both groups. In the AKD group, all tested reflexes were absent from I0 to 40 minutes after induction; the ABM group had variable reflexes that recovered within individual animals over time. CONCLUSIONS AND CLINICAL RELEVANCE Both AKD and ABM provided effective immobilization in naked mole-rats, but AKD appeared to provide more consistent and deeper anesthesia, compared with administration of ABM.

OBJECTIVE To compare IV doses of alfaxalone and ketamine needed to facilitate orotracheal intubation and assess effects of each treatment on selected physiologic variables in goats undergoing orthopedic surgery with isoflurane anesthesia. ANIMALS 18 healthy adult goats. PROCEDURES Behavior was assessed before and after sedation with midazolam (0.1 mg/kg, IV) for IV catheter placement. Anesthesia was induced with additional midazolam (0.1 mg/kg, IV) and alfaxalone (n = 9) or ketamine (9) at 2 mg/kg, IV, over 30 seconds. An additional dose of alfaxalone or ketamine (1 mg/kg) was given IV if needed for intubation; anesthesia was maintained with isoflurane in oxygen and IV fluids with ketamine (0.5 to 1 mg/kg/h). Direct systolic (SAP), diastolic (DAP), and mean (MAP) arterial blood pressures; heart rate; and respiratory rate were recorded before induction, immediately after intubation, and during surgery. Qualitative anesthetic induction and recovery characteristics were assessed. Variables were compared within and between groups by statistical methods. RESULTS No preinduction variables differed significantly between groups. Postintubation and 30-minute intraoperative SAP, DAP, and MAP were higher for the ketamine group than for the alfaxalone group; within the alfaxalone group, postintubation SAP, MAP, and respiratory rate prior to mechanical ventilation were lower than respective preinduction values. All alfaxalone-group goats were intubated after 1 dose of the induction agent; 5 of 9 ketamine-group goats required an additional (1-mg/kg) dose. Postoperative recovery was good to excellent for all animals. CONCLUSIONS AND CLINICAL RELEVANCE Both drugs were suitable for induction of anesthesia after sedation with midazolam, but most goats required higher doses of ketamine to allow intubation. For situations in which alfaxalone administration is appropriate, the potential for decreased arterial blood pressures and respiratory rate should be considered.

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 Pao2 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.

OBJECTIVE To compare the effects of a dexmedetomidine-ketamine-midazolam (DKM) anesthetic protocol versus isoflurane inhalation anesthesia on echocardiographic variables and plasma cardiac troponin 1 (cTnI) concentration in black-tailed prairie dogs (BTPDs; Cynomys ludovicianus). ANIMALS Nine 6-month-old sexually intact male captive BTPDs. PROCEDURES Each BTPD was randomly assigned to be anesthetized by IM administration of dexmedetomidine (0.25 mg/kg), ketamine (40 mg/kg), and midazolam (1.5 mg/kg) or via inhalation of isoflurane and oxygen. Three days later, each BTPD underwent the alternative anesthetic protocol. Echocardiographic data and a blood sample were collected within 5 minutes after initiation and just prior to cessation of each 45-minute-long anesthetic episode. RESULTS Time or anesthetic protocol had no significant effect on echocardiographic variables. For either protocol, plasma cTnI concentration did not differ with time. When administered as the first treatment, neither anesthetic protocol significantly affected plasma cTnI concentration. However, with regard to findings for the second treatments, plasma cTnI concentrations in isoflurane-treated BTPDs (n = 4; data for 1 animal were not analyzed because of procedural problems) were higher than values in DKM-treated BTPDs (4), which was suspected to be a carryover effect from prior DKM treatment. CONCLUSIONS AND CLINICAL RELEVANCE The DKM and isoflurane anesthetic protocols did not have any significant effect on echocardiographic measurements in the BTPDs. Increases in plasma cTnI concentration during the second anesthetic episode were evident when BTPDs underwent the DKM anesthetic protocol as the first of the 2 treatments, suggestive of potential myocardial injury associated with that anesthetic protocol. Clinicians should consider these findings, especially when evaluating BTPDs with known or suspected cardiac disease.

OBJECTIVE To compare effects of tiletamine-zolazepam, alfaxalone, ketamine-diazepam, and propofol for anesthetic induction on cardiorespiratory and acid-base variables before and during isoflurane-maintained anesthesia in healthy dogs. ANIMALS 6 dogs. PROCEDURES Dogs were anesthetized with sevoflurane and instrumented. After dogs recovered from anesthesia, baseline values for cardiorespiratory variables and cardiac output were determined, and arterial and mixed-venous blood samples were obtained. Tiletamine-zolazepam (5 mg/kg), alfaxalone (4 mg/kg), propofol (6 mg/kg), or ketamine-diazepam (7 and 0.3 mg/kg) was administered IV in 25% increments to enable intubation. After induction (M0) and at 10, 20, 40, and 60 minutes of a light anesthetic plane maintained with isoflurane, measurements and sample collections were repeated. Cardiorespiratory and acid-base variables were compared with a repeated-measures ANOVA and post hoc t test and between time points with a pairwise Tukey test. RESULTS Mean ± SD intubation doses were 3.8 ± 0.8 mg/kg for tiletamine-zolazepam, 2.8 ± 0.3 mg/kg for alfaxalone, 6.1 ± 0.9 mg/kg and 0.26 ± 0.04 mg/kg for ketamine-diazepam, and 5.4 ± 1.1 mg/kg for propofol. Anesthetic depth was similar among regimens. At M0, heart rate increased by 94.9%, 74.7%, and 54.3% for tiletamine-zolazepam, ketamine-diazepam, and alfaxalone, respectively. Tiletamine-zolazepam caused higher oxygen delivery than propofol. Postinduction apnea occurred in 3 dogs when receiving alfaxalone. Acid-base variables remained within reference limits. CONCLUSIONS AND CLINICAL RELEVANCE In healthy dogs in which a light plane of anesthesia was maintained with isoflurane, cardiovascular and metabolic effects after induction with tiletamine-zolazepam were comparable to those after induction with alfaxalone and ketamine-diazepam.