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Effects of an alveolar recruitment maneuver on cardiovascular and respiratory parameters during total intravenous anesthesia in ponies.
Abstract: To evaluate pulmonary and cardiovascular effects of a recruitment maneuver (RM) combined with positive end-expiratory pressure (PEEP) during total intravenous anesthesia in ponies. Methods: 6 healthy adult Shetland ponies. Methods: After premedication with detomidine (10 microg/kg, IV), anesthesia was induced with climazolam (0.06 mg/kg, IV) and ketamine (2.2 mg/kg, IV) and maintained with a constant rate infusion of detomidine (0.024 mg/kg/h), climazolam (0.036 mg/kg/h), and ketamine (2.4 mg/kg/h). The RM was preceded by an incremental PEEP titration and followed by a decremental PEEP titration, both at a constant airway pressure difference (deltaP) of 20 cm H2O. The RM consisted of a stepwise increase in deltaP by 25, 30, and 35 cm H2O obtained by increasing peak inspiratory pressure (PIP) to 45, 50, and 55 cm H2O, while maintaining PEEP at 20 cm H2O. Hemodynamic and pulmonary variables were analyzed at every step of the PEEP titration-RM. Results: During the PEEP titration-RM, there was a significant increase in PaO 2 (+12%), dynamic compliance (+ 62%), and heart rate (+17%) and a decrease in shunt (-19%) and mean arterial blood pressure (-21%) was recorded. Cardiac output remained stable. Conclusions: Although baseline oxygenation was high, Pa(O2) and dynamic compliance further increased during the RM. Despite the use of high PIP and PEEP and a high tidal volume, limited cardiovascular compromise was detected. A PEEP titration-RM may be used to improve oxygenation in anesthetized ponies. During stable hemodynamic conditions, PEEP titration-RM can be performed with acceptable adverse cardiovascular effects.
Publication Date: 2006-01-24 PubMed ID: 16426225DOI: 10.2460/ajvr.67.1.152Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Comparative Study
- Journal Article
Summary
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The study investigates the impacts of a recruitment maneuver (a technique to open collapsed areas of the lung) on the cardiovascular and respiratory systems of ponies while under total intravenous anesthesia. The findings suggest that the maneuver may increase oxygen levels and lung responsiveness, while causing mild cardiovascular complications, making it a potentially beneficial strategy for enhancing oxygenation in anesthetized ponies.
Methods
- The study involved 6 healthy adult Shetland ponies, which were prepared for anesthesia with premedication.
- Anesthesia was both initiated and maintained using a mix of drugs including detomidine, climazolam, and ketamine.
- The recruitment maneuver was performed using an incremental and decremental positive end-expiratory pressure (PEEP) titration method. This involves managing the air pressure within the ponies’ airways with specific increments, and then reducing them in a similar manner.
- The recruitment maneuver consisted of a gradual increase in the pressure difference between peak inspiratory pressure and PEEP (deltaP) by 25, 30, and 35 cm H2O.
Results
- Throughout the process of PEEP titration and the recruitment maneuver, notable changes occurred in the respiratory and cardiovascular parameters.
- Oxygen levels (PaO2) in the blood increased by 12% and lung dynamic compliance (a measure of the lungs’ ability to stretch and expand) improved by 62%.
- There was a 19% decrease in shunt (the mixing of oxygenated and deoxygenated blood), and mean arterial blood pressure lowered by 21%. Heart rate increased by 17% while cardiac output remained stable.
Conclusions
- Baseline oxygenation was already high in the ponies, but more oxygen and an improved dynamic compliance were recorded during the recruitment maneuver.
- Despite using high PEEP, peak inspiratory pressure, and a high volume of air entering the lungs (tidal volume), the negative effects on the cardiovascular system were limited.
- Overall, these findings suggest that a PEEP titration-recruitment maneuver could be used to enhance oxygenation abilities in ponies under anesthesia. This procedure can be performed with minimal adverse cardiovascular effects during stable hemodynamic conditions.
Cite This Article
APA
Wettstein D, Moens Y, Jaeggin-Schmucker N, Böhm SH, Rothen HU, Mosing M, Kästner SB, Schatzmann U.
(2006).
Effects of an alveolar recruitment maneuver on cardiovascular and respiratory parameters during total intravenous anesthesia in ponies.
Am J Vet Res, 67(1), 152-159.
https://doi.org/10.2460/ajvr.67.1.152 Publication
Researcher Affiliations
- Division of Anaesthesiology, Department of Clinical Veterinary Studies, Vetsuisse Faculty University of Berne, Länggassstrasse 124, 3012 Bern, Switzerland.
MeSH Terms
- Anesthesia, Intravenous / veterinary
- Animals
- Benzodiazepines
- Catheterization, Peripheral / veterinary
- Horse Diseases / prevention & control
- Horses
- Hypoxia / prevention & control
- Hypoxia / veterinary
- Intermittent Positive-Pressure Breathing / methods
- Intermittent Positive-Pressure Breathing / veterinary
- Ketamine
- Midazolam / analogs & derivatives
- Positive-Pressure Respiration / methods
- Positive-Pressure Respiration / veterinary
- Pulmonary Alveoli / physiology
- Pulmonary Atelectasis / prevention & control
- Pulmonary Atelectasis / veterinary
- Spirometry / veterinary
Citations
This article has been cited 8 times.- Brandly JE, Midon M, Douglas HF, Hopster K. Flow-controlled expiration reduces positive end-expiratory pressure requirement in dorsally recumbent, anesthetized horses. Front Vet Sci 2023;10:1135452.
- Andrade FSRM, Ambrósio AM, Rodrigues RR, Faccó LL, Gonçalves LA, Garcia Filho SG, Dos Santos RT, Rossetto TC, Pereira MAA, Fantoni DT. The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses. Front Vet Sci 2022;9:1024088.
- Ambrósio AM, Sanchez AF, Pereira MAA, Andrade FSRM, Rodrigues RR, Vitorasso RL, Moriya HT, Fantoni DT. Assessment of Regional Ventilation During Recruitment Maneuver by Electrical Impedance Tomography in Dogs. Front Vet Sci 2021;8:815048.
- Kozłowska N, Wierzbicka M, Jasiński T, Domino M. Advances in the Diagnosis of Equine Respiratory Diseases: A Review of Novel Imaging and Functional Techniques. Animals (Basel) 2022 Feb 4;12(3).
- Dupont J, Serteyn D, Sandersen C. Prolonged Recovery From General Anesthesia Possibly Related to Persistent Hypoxemia in a Draft Horse. Front Vet Sci 2018;5:235.
- Karrasch NM, Hubbell JA, Aarnes TK, Bednarski RM, Lerche P. Comparison of cardiorespiratory variables in dorsally recumbent horses anesthetized with guaifenesin-ketamine-xylazine spontaneously breathing 50% or maximal oxygen concentrations. Can Vet J 2015 Apr;56(4):387-92.
- Hubbell JA, Aarnes TK, Bednarski RM, Lerche P, Muir WW. Effect of 50% and maximal inspired oxygen concentrations on respiratory variables in isoflurane-anesthetized horses. BMC Vet Res 2011 Jun 3;7:23.
- Bukoski A, Downs J, Hodgson DS, Le-Bert CR, Thomen R, Flors L, Thombs L, Bailey J. Cardiopulmonary effects of apneustic anesthesia ventilation in anesthetized pigs: a new mode of ventilation for anesthetized veterinary species. Front Vet Sci 2024;11:1378617.
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