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Topic:Anesthesia

Anesthesia in horses involves the administration of drugs to induce a temporary loss of sensation or consciousness, facilitating surgical procedures and other medical interventions. This complex process requires a deep understanding of equine physiology and pharmacology to ensure the safety and well-being of the animal. Anesthesia in horses can be challenging due to their size, temperament, and unique anatomical and physiological characteristics. Common anesthetic agents used in equine practice include inhalants like isoflurane and sevoflurane, as well as injectable drugs such as ketamine and xylazine. The management of anesthesia in horses also involves careful monitoring of vital signs and the use of supportive measures to prevent complications such as hypotension, hypoventilation, and post-anesthetic myopathy. This page compiles peer-reviewed research studies and scholarly articles that explore the techniques, advancements, and clinical outcomes associated with anesthesia in equine medicine.
Short- and long-term survival and prevalence of postoperative ileus after small intestinal surgery in the horse.
Equine veterinary journal. Supplement    February 24, 2001   Issue 32 42-51 doi: 10.1111/j.2042-3306.2000.tb05333.x
Freeman DE, Hammock P, Baker GJ, Goetz T, Foreman JH, Schaeffer DJ, Richter RA, Inoue O, Magid JH.The records of 74 horses that recovered from anaesthesia after surgery for a small intestinal lesion from 1994 to 1999 were reviewed. Sixty-three horses (85%) had a strangulating lesion and 43 of these (68%) had a resection and anastomosis. Four of 11 horses (36%) without a strangulating lesion had a resection and anastomosis. Sixty-three horses (85%) survived to discharge, with a survival rate of 53/63 in horses with a strangulating lesion (84%) and 10/11 (91%) in others. For all lesions, short-term survival for all end-to-end anastomoses (91%; 21/23) and for no resection (92%; 23/25) were su...
Evaluation of the analgesic effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and U50488H in horses.
American journal of veterinary research    December 29, 2000   Volume 61, Issue 12 1579-1586 doi: 10.2460/ajvr.2000.61.1579
Natalini CC, Robinson EP.To evaluate and compare effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and U50488H on avoidance threshold to noxious electrical stimulation over the dermatomes of the perineal, sacral, lumbar, and thoracic regions in horses. Methods: 5 healthy adult horses. Methods: Using a Latin square complete repeated-measures design, horses were randomly assigned to receive 1 of 6 treatments (morphine, alfentanil, butorphanol, tramadol, U50488H, or sterile water) at intervals of at least 7 days. Agents were injected epidurally at the first intercoccygeal epidural space, and...
Anesthetic, cardiorespiratory, and metabolic effects of four intravenous anesthetic regimens induced in horses immediately after maximal exercise.
American journal of veterinary research    December 29, 2000   Volume 61, Issue 12 1545-1552 doi: 10.2460/ajvr.2000.61.1545
Hubbell JA, Hinchcliff KW, Schmall LM, Muir WW, Robertson JT, Sams RA.To determine the anesthetic, cardiorespiratory, and metabolic effects of 4 IV anesthetic regimens in Thoroughbred horses recuperating from a brief period of maximal exercise. Methods: 6 adult Thoroughbreds. Methods: Horses were preconditioned by exercising them on a treadmill. Each horse ran 4 simulated races, with a minimum of 14 days between races. Races were run at a treadmill speed that caused horses to exercise at 120% of their maximal oxygen consumption. Horses ran until fatigued or for a maximum of 2 minutes. Two minutes after exercise, horses received a combination of xylazine hydrochl...
Investigation of romifidine and detomidine for the clinical sedation of horses.
The Veterinary record    December 8, 2000   Volume 147, Issue 18 507-511 doi: 10.1136/vr.147.18.507
Freeman SL, England GC.The effects of two intravenous doses of romifidine (80 and 120 microg/kg) and one dose of detomidine (20 microg/kg) were compared in a blinded study in 30 horses requiring to be sedated for routine dental treatment. Several physiological parameters were assessed before and for two hours after the administration of the drugs, and the horses' teeth were rasped 30 minutes after they were administered. Romifidine produced a dose-dependent effect on most parameters. Detomidine at 20 microg/kg was similar to romifidine at 120 microg/kg in the magnitude of its sedative effects, but was similar to rom...
Survey of anesthesia techniques and concerns in private veterinary practice.
Journal of the American Veterinary Medical Association    December 8, 2000   Volume 217, Issue 11 1652-1657 doi: 10.2460/javma.2000.217.1652
Wagner AE, Hellyer PW.No abstract available
Identification of lidocaine and its metabolites in post-administration equine urine by ELISA and MS/MS.
Journal of veterinary pharmacology and therapeutics    December 7, 2000   Volume 23, Issue 4 215-222 
Dirikolu L, Lehner AF, Karpiesiuk W, Harkins JD, Woods WE, Carter WG, Boyles J, Fisher M, Tobin T.Lidocaine is a local anesthetic drug that is widely used in equine medicine. It has the advantage of giving good local anesthesia and a longer duration of action than procaine. Although approved for use in horses in training by the American Association of Equine Practitioners (AAEP), lidocaine is also an Association of Racing Commissioners International (ARCI) Class 2 drug and its detection in forensic samples can result in significant penalties. Lidocaine was observed as a monoprotonated ion at m/z 235 by ESI+ MS/MS (electrospray ionization-positive ion mode) analysis. The base peak ion at m/...
Use of sevoflurane for anesthetic management of horses during thoracotomy.
American journal of veterinary research    December 7, 2000   Volume 61, Issue 11 1430-1437 doi: 10.2460/ajvr.2000.61.1430
Aida H, Steffey EP, Pascoe JR, Yarbrough TB, Takahashi T, Hiraga A, Hobo S, Smith BL, Steffey MA, Jones JH.To evaluate sevoflurane as an inhalation anesthetic for thoracotomy in horses. Methods: 18 horses between 2 and 15 years old. Methods: 4 horses were used to develop surgical techniques and were euthanatized at the end of the procedure. The remaining 14 horses were selected, because they had an episode of bleeding from their lungs during strenuous exercise. General anesthesia was induced with xylazine (1.0 mg/kg of body weight, IV) followed by ketamine (2.0 mg/kg, IV). Anesthesia was maintained with sevoflurane in oxygen delivered via a circle anesthetic breathing circuit. Ventilation was contr...
Cardiopulmonary effects of romifidine and detomidine used as premedicants for ketamine/halothane anaesthesia in ponies.
The Veterinary record    November 30, 2000   Volume 147, Issue 19 535-539 doi: 10.1136/vr.147.19.535
Freeman SL, Bowen IM, Bettschart-Wolfensberger R, England GC.The cardiopulmonary effects of romifidine at 80 microg/kg (R80) or 120 pg/kg (R120), and detomidine at 20 pg/kg (D20) when used as premedicants for ketamine/halothane anaesthesia were investigated in six ponies. Using a blinded crossover design, acepromazine (0-04 mg/kg) was administered followed by the alpha-2 agonist. Anaesthesia was induced with ketamine at 2.2 mg/kg and maintained with halothane (expired concentration 1.0 per cent) in oxygen for three hours. During anaesthesia, arterial blood pressure, cardiac index, PaO2 and PmvO2 decreased, and systemic vascular resistance and PaCO2 incr...
Complications associated with anaesthesia for ocular surgery: a retrospective study 1989-1996.
Equine veterinary journal    November 28, 2000   Volume 32, Issue 6 555-559 doi: 10.2746/042516400777584659
Parviainen AK, Trim CM.This retrospective study was initiated to identify complications of anaesthesia occurring during ocular surgery. Records of 74 horses anaesthetised for eye enucleation, 65 horses anaesthetised for surgery of the eye and adnexa, and 51 horses anaesthetised for splint bone excision were reviewed. Fifty-three percent of the horses anaesthetised for eye enucleation moved during surgery which was significantly more frequent than in the other groups (P = 0.001). The incidence of moving was significantly reduced by use of an anaesthetic gas analyser for monitoring (P = 0.001). Transient hypertension ...
Endoscopic electrosurgical excision of laryngeal granulation tissue in a standing pregnant mare.
The Veterinary record    November 10, 2000   Volume 147, Issue 15 418-420 doi: 10.1136/vr.147.15.418
Booth TM, Hainisch EK, Knottenbelt DC, Edwards GB, Clegg PD, Kelly DF.An 11-year-old, eight-months pregnant mare suddenly developed severe respiratory distress. Endoscopic examination identified intralaryngeal granulation tissue obstructing the airway. In order to avoid general anaesthesia and the problems associated with a permanent tracheostomy, the mass was resected electrosurgically while the mare was standing. Patency was restored to the airway and the mare foaled without complication.
Effect of a 30-minute infusion of dobutamine hydrochloride on hind limb blood flow and hemodynamics in halothane-anesthetized horses.
American journal of veterinary research    October 20, 2000   Volume 61, Issue 10 1282-1288 doi: 10.2460/ajvr.2000.61.1282
Raisis AL, Young LE, Blissitt KJ, Walsh K, Meire HB, Taylor PM, Lekeux P.To evaluate the hemodynamic effects of dobutamine hydrochloride (0.5 microg/kg of body weight/min) in halothane-anesthetized horses. Methods: 6 adult Thoroughbred horses. Methods: Anesthesia was induced by use of romifidine (100 microg/kg) and ketamine (2.2 mg/kg), IV. Anesthesia was maintained by halothane (end-tidal concentration 0.9 to 1.0%). Aortic, left ventricular, and right atrial pressures were measured, using catheter-mounted strain gauge transducers. Cardiac output (CO), velocity time integral, maximal aortic blood flow velocity and acceleration, and left ventricular preejection peri...
Effects of xylazine hydrochloride during isoflurane-induced anesthesia in horses.
American journal of veterinary research    October 20, 2000   Volume 61, Issue 10 1225-1231 doi: 10.2460/ajvr.2000.61.1225
Steffey EP, Pascoe PJ, Woliner MJ, Berryman ER.To quantitate dose- and time-related anesthetic-sparing effects of xylazine hydrochloride (XYL) during isoflurane-induced anesthesia in horses and to characterize selected physiologic responses of anesthetized horses to administration of XYL. Methods: 6 healthy adult horses. Methods: Horses were anesthetized 2 times to determine the minimum alveolar concentration (MAC) of isoflurane in O2 and to characterize the anesthetic-sparing effect (MAC reduction) after IV administration of XYL (0.5 and 1 mg/kg of body weight, random order). Selected measures of cardiopulmonary function, blood glucose co...
Anesthetic management with sevoflurane and oxygen for orthopedic surgeries in racehorses.
The Journal of veterinary medical science    October 20, 2000   Volume 62, Issue 9 1017-1020 doi: 10.1292/jvms.62.1017
Ohta M, Oku K, Yamanaka T, Mizuno Y.Eighty-five thoroughbred racehorses with various types of fracture were subjected to arthroscopic surgery (44 horses) or internal fixation (41 horses) under sevoflurane anesthesia. The mean end-tidal sevoflurane concentration during anesthesia ranged from 2.5 to 2.8%. PaCO2 was maintained between 50 and 65 mmHg by controlled ventilation. The mean arterial blood pressure was maintained above 65 mmHg by infusion of dobutamine and fluids, however, heart rate significantly increased with time. Recovery from anesthesia was calm and smooth in almost all cases. No apparent complication was observed d...
Comparison of four drug combinations for total intravenous anesthesia of horses undergoing surgical removal of an abdominal testis.
Journal of the American Veterinary Medical Association    September 21, 2000   Volume 217, Issue 6 869-873 doi: 10.2460/javma.2000.217.869
Muir WW, Lerche P, Robertson JT, Hubbell JA, Beard W, Miller T, Badgley B, Bothwell V.To evaluate anesthetic effects of 4 drug combinations used for total intravenous anesthesia of horses undergoing surgical removal of an abdominal testis. Methods: Clinical trial. Methods: 32 healthy cryptorchid horses. Methods: Horses were sedated with xylazine and butorphanol and were randomly assigned to 1 of 4 groups: induction of anesthesia with ketamine and diazepam and maintenance with bolus administration of ketamine and xylazine (KD/KX); induction and maintenance of anesthesia with bolus administration of tiletamine-zolazepam, ketamine, and detomidine (TKD); induction and maintenance o...
Kinematics of the hind limb in trotting horses after induced lameness of the distal intertarsal and tarsometatarsal joints and intra-articular administration of anesthetic.
American journal of veterinary research    September 8, 2000   Volume 61, Issue 9 1031-1036 doi: 10.2460/ajvr.2000.61.1031
Kramer J, Keegan KG, Wilson DA, Smith BK, Wilson DJ.To identify hind limb and pelvic kinematic variables that change in trotting horses after induced lameness of the distal intertarsal and tarsometatarsal joints and after subsequent intra-articular administration of anesthetic. Methods: 8 clinically normal adult horses. Methods: Kinematic measurements were made before and after transient endotoxin-induced lameness of the distal intertarsal and tarsometatarsal joints and after intra-articular administration of anesthetic. Fourteen displacement and joint angle (metatarsophalangeal [fetlock] and tarsal joints) measurements were made on the right h...
A comparison of the haemodynamic effects of isoflurane and halothane anaesthesia in horses.
Equine veterinary journal    August 22, 2000   Volume 32, Issue 4 318-326 doi: 10.2746/042516400777032282
Raisis AL, Young LE, Blissitt KJ, Brearley JC, Meire HB, Taylor PM, Lekeux P.The purpose of this study was to compare the haemodynamic effects of equipotent isoflurane and halothane anaesthesia. Six adult horses were investigated on two separate occasions at least 4 weeks apart. On both occasions anaesthesia was induced by ketamine 2.2 mg/kg bwt given 5 min after i.v. administration 100 microg/kg bwt romifidine. Anaesthesia was maintained either by halothane or isoflurane (end-tidal concentrations 0.9-1.0% and 1.3-1.4%, respectively). Horses were ventilated by intermittent positive pressure to maintain PaCO2 between 40-50 mmHg. Haemodynamic variables were measured usin...
Sternal bone biopsy in standing horses.
Veterinary surgery : VS    August 5, 2000   Volume 29, Issue 4 303-308 doi: 10.1053/jvet.2000.5595
Désévaux C, Laverty S, Doizé B.To develop a technique for sternal bone biopsy in standing horses. Methods: Experimental study. Methods: Five adult horses. Methods: Horses were restrained in a standing stocks and sedated. The sternal biopsy site, identified by ultrasonographic examination, was clipped and prepared for aseptic surgery and infiltrated with local anesthetic. An electric bone biopsy drill (Osteocore; Institut Straumann AG, CH-4437, Waldenburg, Switzerland)), which yielded 4-mm-diameter bone specimens, was used to obtain sternal biopsies through a small skin incision. Sections (7 microm) of the bone specimens wer...
Cardiac output measured by lithium dilution, thermodilution, and transesophageal Doppler echocardiography in anesthetized horses.
American journal of veterinary research    July 15, 2000   Volume 61, Issue 7 731-737 doi: 10.2460/ajvr.2000.61.731
Linton RA, Young LE, Marlin DJ, Blissitt KJ, Brearley JC, Jonas MM, O'Brien TK, Linton NW, Band DM, Hollingworth C, Jones RS.To assess the suitability of lithium dilution as a method for measuring cardiac output in anesthetized horses, compared with thermodilution and transesophageal Doppler echocardiography. Methods: 6 horses (3 Thoroughbreds, 3 crossbreeds). Methods: Cardiac output was measured in 6 anesthetized horses as lithium dilution cardiac output (LiDCO), thermodilution cardiac output (TDCO), and transesophageal Doppler echocardiographic cardiac output (DopplerCO). For the LiDCO measurements, lithium chloride was administered i.v., and cardiac output was derived from the arterial lithium dilution curve. Sod...
Anesthesia case of the month. Diaphragmatic hernia making it difficult to ventilate a horse during anesthesia.
Journal of the American Veterinary Medical Association    June 23, 2000   Volume 216, Issue 12 1918-1919 doi: 10.2460/javma.2000.216.1918
Branson KR, Kramer J.No abstract available
The sedative and analgesic effects of detomidine-butorphanol and detomidine alone in donkeys.
Journal of the South African Veterinary Association    June 14, 2000   Volume 70, Issue 3 112-118 doi: 10.4102/jsava.v70i3.769
Joubert KE, Briggs P, Gerber D, Gottschalk RG.Butorphanol and detomidine constitute an effective combination for sedation and analgesia in horses. This trial was undertaken to assess the effectiveness of this combination in donkeys. The detomidine and butorphanol were given intravenously one after the other. A dose of 10 microg/kg of detomidine and 25 microg/kg of butorphanol was used. Sedation is easily extended by additional doses of butorphanol. The average dose of detomidine was 11.24 microg/kg and that of butorphanol was 28.0 microg/kg. Four donkeys in the detomidine group required additional sedation and analgesia. Detomidine alone ...
Arthroscopic removal of patellar fracture fragments in horses: five cases (1989-1998).
Journal of the American Veterinary Medical Association    June 9, 2000   Volume 216, Issue 11 1799-1801 doi: 10.2460/javma.2000.216.1799
Marble GP, Sullins KE.To evaluate the use of arthroscopy as the primary method for removal of large patellar fracture fragments. Methods: Retrospective study. Methods: 5 performance horses of various breeds with patellar fractures. Methods: Clinical signs of lameness, external evidence of injury, and radiography were used to diagnose and determine fracture orientation. Arthroscopy of the stifle joint was performed on the affected limb with the horse positioned in dorsal recumbency and under general anesthesia. Progress after surgery was determined by evaluating medical records and via telephone conversations with o...
Repeatability of Doppler ultrasound measurements of hindlimb blood flow in halothane anaesthetised horses.
Equine veterinary journal    June 3, 2000   Volume 32, Issue 3 239-246 doi: 10.2746/042516400776563662
Raisis AL, Young LE, Meire H, Walsh K, Taylor PM, Lekeux P.The purpose of this study was to determine the repeatability of femoral blood flow recorded using Doppler ultrasound in anaesthetised horses. Doppler ultrasound of the femoral artery and vein was performed in 6 horses anaesthetised with halothane and positioned in left lateral recumbency. Velocity spectra, recorded using low pulse repetition frequency, were used to calculate time-averaged mean velocity (TAV), velocity of component a (TaVa), velocity of component b (TaVb), volumetric flow, early diastolic deceleration slope (EDDS) and pulsatility index (PI). Within-patient variability was deter...
Laparoscopic intra-abdominal ligation of the testicular artery following castration in a horse.
Journal of the American Veterinary Medical Association    May 29, 2000   Volume 216, Issue 10 1596-1569 doi: 10.2460/javma.2000.216.1596
Trumble TN, Ingle-Fehr J, Hendrickson DA.A 364-kg (800-lb) 1-year-old mixed-breed horse was admitted for treatment of uncontrolled bleeding after castration. Multiple attempts to ligate the testicular artery through the scrotal incisions prior to referral had been unsuccessful. Because of the owner's concerns about cost, an attempt was made to control the bleeding by applying pressure to the inguinal region and administering formalin IV. However, hemorrhage continued. A decision was made to use laparoscopy to ligate the testicular artery. The horse was anesthetized and positioned in dorsal recumbency, and a routine ventral laparoscop...
Resection of the common digital extensor tendon in a gelding.
The Veterinary record    May 10, 2000   Volume 146, Issue 13 373-376 doi: 10.1136/vr.146.13.373
Booth TM, Clegg PD, Singer ER, Cheeseman MT.A four-year-old gelding was lame owing to a chronic septic common digital extensor tendon and sheath. The horse had been treated by open surgical lavage but the sepsis had recurred after three months. Physical, ultrasonographic, cytological and histological examinations confirmed chronic septic tenosynovitis and tendonitis. The entire intrathecal component of the common digital extensor tendon was resected under general anaesthesia and the synovial lining of the sheath was ablated. Postoperatively the horse regained good limb function and became sound.
Effect of inhaled nitric oxide on experimentally induced pulmonary hypertension in neonatal foals.
American journal of veterinary research    May 3, 2000   Volume 60, Issue 10 1207-1212 
Lester GD, DeMarco VG, Norman WM.To evaluate the efficacy of inhaled nitric oxide (NO) in anesthetized healthy newborn foals with experimentally induced pulmonary hypertension. Methods: Five 1- to 3-day-old foals. Methods: Anesthesia was induced and maintained with propofol, and foals were intubated and mechanically ventilated. Systemic pressure and pulmonary arterial pressure (P(PA)) were recorded every 30 seconds. Hypertension was induced via a hypoxic gas mixture or chemical vasoconstriction, using the thromboxane mimetic U46619. Nitric oxide was added at a concentration of 80 parts per million (ppm) for 6 minutes under ba...
Duplex-ultrasonographic evaluation of the common carotid artery in the resting, sedated and anesthetized horse. Schmucker N, Schatzmann U, Budde K, Gundel M, Jäggin CE, Meier H.The aim of this study was to determine the blood flow in the carotid artery during halothane anaesthesia by means of duplex-sonography. Seventeen warm blood horses were evaluated in dorsal and lateral recumbency and the results were compared with the values of the same horses resting and under sedation. The cross sectional area of the vessels, the time-averaged maximal blood velocity, time-averaged maximal blood flow and the resistance index were determined and the flow profile was evaluated. During halothane anesthesia the total blood flow shows a significant increase which is not dependent o...
Combination of continuous intravenous infusion using a mixture of guaifenesin-ketamine-medetomidine and sevoflurane anesthesia in horses.
The Journal of veterinary medical science    April 19, 2000   Volume 62, Issue 3 229-235 doi: 10.1292/jvms.62.229
Yamashita K, Satoh M, Umikawa A, Tsuda A, Yajima Y, Tsubakishita S, Seno T, Katoh S, Izumisawa Y, Kotani T.The anesthetic and cardiovascular effects of a combination of continuous intravenous infusion using a mixture of 100 g/L guaifenesin-4 g/L ketamine-5 mg/L medetomidine (0.25 ml/kg/hr) and oxygen-sevoflurane (OS) anesthesia (GKM-OS anesthesia) in horses were evaluated. The right carotid artery of each of 12 horses was raised surgically into a subcutaneous position under GKM-OS anesthesia (n=6) or OS anesthesia (n=6). The end-tidal concentration of sevoflurane (EtSEV) required to maintain surgical anesthesia was around 1.5% in GKM-OS and 3.0% in OS anesthesia. Mean arterial blood pressure (MABP)...
Variability of Doppler ultrasound measurements of hindlimb blood flow in conscious horses.
Equine veterinary journal    April 1, 2000   Volume 32, Issue 2 125-132 doi: 10.2746/042516400777591561
Raisis AL, Young LE, Meire HB, Taylor PM, Walsh K, Lekeux P.Ultrasonography of the left and right femoral artery and vein was performed in 5 conscious horses. Velocity waveforms, recorded using low pulse repetition frequency, were used to calculate time-averaged mean velocity (TAV), velocity of component a (TaVa), velocity of component b (TaVb) and volumetric flow. Waveform analysis included calculation of early diastolic deceleration slope (EDDS) and pulsatility index (PI) and subjective description of the waveform. Measurements were recorded at monthly intervals for 6 months. The repeated measurements were used to determine the within-horse variation...
The effect of changing the mode of ventilation on the arterial-to-end-tidal CO2 difference and physiological dead space in laterally and dorsally recumbent horses during halothane anesthesia.
Veterinary surgery : VS    March 24, 2000   Volume 29, Issue 2 200-205 doi: 10.1111/j.1532-950x.2000.00200.x
Neto FJ, Luna SP, Massone F, Thomassian A, Vargas JL, Junior JR, D'Utra Vaz BB, Crocci AJ.To evaluate the effect of changing the mode of ventilation from spontaneous to controlled on the arterial-to-end-tidal CO2 difference [P(a-ET)CO2] and physiological dead space (VD(phys)/VT) in laterally and dorsally recumbent halothane-anesthetized horses. STUDY DESIGN; Prospective, experimental, nonrandomized trial. Methods: Seven mixed breed adult horses (1 male and 6 female) weighing 320 +/- 11 kg. Methods: Horses were anesthetized in 2 positions-right lateral and dorsal recumbency-with a minimum interval of 1 month. Anesthesia was maintained with halothane in oxygen for 180 minutes. Sponta...
Paranasal sinus surgery through a frontonasal flap in sedated, standing horses.
Veterinary surgery : VS    March 24, 2000   Volume 29, Issue 2 173-177 doi: 10.1111/j.1532-950x.2000.00173.x
Schumacher J, Dutton DM, Murphy DJ, Hague BA, Taylor TS.To report experience with paranasal sinus surgery through a frontonasal flap in sedated, standing horses. Methods: Treatment of 10 horses with naturally occurring paranasal sinus disease through a frontonasal bone flap created with the horses standing. Methods: Ten adult horses. Methods: After restraint and sedation, local anesthetic was injected subcutaneously along the proposed incision line over the conchofrontal sinus and was instilled into the sinuses through a small hole created in the frontal bone. A 3-sided, rectangular, cutaneous incision that extended through the periosteum was creat...
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