Accuracy of tidal volume delivery by five different models of large-animal ventilators

Assessment of Magnetic Resonance Imaging Artefacts Caused by Equine Anaesthesia Equipment: A Cadaver Study

Acquisition of magnetic resonance images of the equine limb is still sometimes conducted under general anaesthesia. Despite low-field systems allow the use of standard anaesthetic equipment, possible interferences of the extensive electronic componentry of advanced anaesthetic machines on image quality is unknown. This prospective, blinded, cadaver study investigated the effects of seven standardised conditions (Tafonius positioned as in clinical cases, Tafonius on the boundaries of the controlled area, anaesthetic monitoring only, Mallard anaesthetic machine, Bird ventilator, complete electronic silence in the room (negative control), source of electronic interference [positive control]) on image quality through the acquisition of 78 sequences using a 0.31T equine MRI scanner. Images were graded with a 4-point scoring system, where 1 denoted absence of artefacts and 4 major artefacts requiring repetition in a clinical setting. A lack of STIR fat suppression was commonly reported (16/26). Ordinal logistic regression showed no statistically significant differences in image quality between the negative control and either the non-Tafonius or the Tafonius groups (P = 0.535 and P = 0.881, respectively), and with the use of Tafonius compared to the other anaesthetic machines (P = 0.578). The only statistically significant differences in scores were observed between the positive control and the non-Tafonius (P = 0.006) and the Tafonius groups (P = 0.017). Our findings suggest that anaesthetic machines and monitoring do not appear to affect MRI scan quality and support the use of Tafonius during acquisition of images with a 0.31T MRI system in a clinical context.

Predicting the effect of fresh gas flow on tidal volume in volume-controlled mechanically ventilated dogs

OBJECTIVES

To determine if the tidal volume (V_T) delivered (V_TDEL) to canine patients being mechanically ventilated by a volume-controlled ventilator differed from the volume set on the ventilator (V_TSET) at three fresh gas flow (FGF) rates. To determine if V_TDEL could be accurately predicted by an FGF-based mathematical model.

STUDY DESIGN

Prospective proof-of-concept study.

ANIMALS

A total of 23 adult client-owned dogs undergoing elective orthopedic surgery.

METHODS

Dogs were anesthetized and ventilated with a volume-controlled mechanical ventilator with constant respiratory rate (f_R) of 10 breaths minute^-1, inspiratory-to-expiratory ratio of 1:2 [fraction of inspiratory time (T_I) in one respiratory cycle (T_tot) 1:3], and V_TSET as body weight (kg) × 15 (mL kg^-1). V_TDEL was measured in 20 dogs at three FGF (500, 1000 and 4000 mL minute^-1). A mathematical model was used to calculate predicted volume (V_TPRED) for each animal at each FGF: V_TSET + {FGF × [(T_I/T_tot)/f_R]}. Linear repeated measures models were fit comparing V_TDEL to V_TSET and to V_TPRED by FGF.

RESULTS

V_TDEL was significantly higher than V_TSET at every FGF (p < 0.05), and differences were larger at higher FGF (p < 0.001). There were no statistically significant differences between V_TDEL and V_TPRED at FGF rates of 500 and 4000 mL minute^-1 and, although the mean V_TDEL was statistically significantly higher than V_TPRED at FGF 1000 mL minute^-1 (p = 0.017), the mean difference of 9 mL was not clinically significant.

CONCLUSIONS AND CLINICAL RELEVANCE

Dogs on volume-controlled ventilators may be ventilated at a higher V_TDEL than intended depending on the FGF settings. Ventilation of small animals at high FGF could inadvertently induce pulmonary damage. A mathematical equation can be used to achieve a desired V_TDEL by adjusting V_TSET values based on FGF, f_R and T_I/T_tot.

Flow-controlled expiration reduces positive end-expiratory pressure requirement in dorsally recumbent, anesthetized horses

Introduction

Equine peri-anesthetic mortality is higher than that for other commonly anesthetized veterinary species. Unique equine pulmonary pathophysiologic aspects are believed to contribute to this mortality due to impairment of gas exchange and subsequent hypoxemia. No consistently reliable solution for the treatment of peri-anesthetic gas exchange impairment is available. Flow-controlled expiration (FLEX) is a ventilatory mode that linearizes gas flow throughout the expiratory phase, reducing the rate of lung emptying and alveolar collapse. FLEX has been shown to improve gas exchange and pulmonary mechanics in anesthetized horses. This study further evaluated FLEX ventilation in anesthetized horses positioned in dorsal recumbency, hypothesizing that after alveolar recruitment, horses ventilated using FLEX would require a lower positive end-expiratory pressure (PEEP) to prevent alveolar closure than horses conventionally ventilated.

Methods

Twelve adult horses were used in this prospective, randomized study. Horses were assigned either to conventional volume-controlled ventilation (VCV) or to FLEX. Following induction of general anesthesia, horses were placed in dorsal recumbency mechanically ventilated for a total of approximately 6.5 hours. Thirty-minutes after starting ventilation with VCV or FLEX, a PEEP-titration alveolar recruitment maneuver was performed at the end of which the PEEP was reduced in decrements of 3 cmH₂O until the alveolar closure pressure was determined. The PEEP was then increased to the previous level and maintained for additional three hours. During this time, the mean arterial blood pressure, pulmonary arterial pressure, central venous blood pressure, cardiac output (CO), dynamic respiratory system compliance and arterial blood gas values were measured.

Results

The alveolar closure pressure was significantly lower (6.5 ± 1.2 vs 11.0 ± 1.5 cmH₂O) and significantly less PEEP was required to prevent alveolar closure (9.5 ± 1.2 vs 14.0 ± 1.5 cmH₂O) for horses ventilated using FLEX compared with VCV. The CO was significantly higher in the horses ventilated with FLEX (37.5 ± 4 vs 30 ± 6 l/min).

Discussion

We concluded that FLEX ventilation was associated with a lower PEEP requirement due to a more homogenous distribution of ventilation in the lungs during expiration. This lower PEEP requirement led to more stable and improved cardiovascular conditions in horses ventilated with FLEX.

Risk factors associated with hypoxaemia in horses undergoing general anaesthesia: A retrospective study

BACKGROUND

Hypoxaemia is a common concern during equine general anaesthesia. The prevalence and predictors of hypoxaemia in horses undergoing elective anaesthesia in particular are poorly documented.

OBJECTIVES

To determine and compare the prevalence of hypoxaemia (defined as PaO₂  ≤ 80 mm Hg, on the lowest value recorded) in horses undergoing anaesthesia for exploratory laparotomy and elective procedures, and to identify risk factors in both subpopulations.

STUDY DESIGN

Retrospective cohort study.

METHODS

Data were collected from 774 records of 708 horses undergoing general anaesthesia between April 2017 and August 2020. Potential predictors of hypoxaemia in horses undergoing anaesthesia for exploratory laparotomy or elective procedures were investigated separately by univariable penalised maximum likelihood logistic regression, followed by multivariable analysis. The lowest recorded PaO₂ was used as a single data point for the determination of hypoxaemia and arterial oxygen partial pressure to fractional inspired oxygen ratio analysis.

RESULTS

Hypoxaemia was recorded in 23% horses undergoing exploratory laparotomy compared with 3.8% horses undergoing elective anaesthesia (P < .001). Multivariable analysis showed that weight above 550 kg, large intestinal lesions, and peak inspiratory pressure (PIP) above 30 cmH₂ O were significantly associated with hypoxaemia in horses undergoing exploratory laparotomy. Soft tissue procedures and PIP >30 cmH₂ O were significantly associated with hypoxaemia during elective anaesthesia.

MAIN LIMITATIONS

This study only considered the minimum PaO₂ recorded during anaesthesia. Duration and treatment of hypoxaemia were not considered.

CONCLUSIONS

Based on the lowest PaO₂ value during anaesthesia, in our population, horses undergoing anaesthesia for exploratory laparotomy were over six times more likely to become hypoxaemic than horses undergoing elective procedures. Bodyweight, type of procedure, and high PIP were predictors of hypoxaemia.