Use of low-flow and closed-system anesthesia.
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Biomedical subjects
Publications and source records attributed to A E Wagner.
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Examined the impact of recurrent otitis media in the first 3 years of life on verbal abilities of 3- to 4-year-old children and the potential for parental verbal stimulation to buffer the negative effects of intermittent hearing loss. Fathers and mothers of 56 children with variable histories of otitis media participated in videotaped parent-child interactions that were used to code level of parental verbal stimulation. Measures of the children's verbal abilities were the McCarthy Verbal Scale Index and a score for the child's verbalizations with each parent. Active and engaging parental verbalizations appeared to buffer the child's developing verbal abilities from the deleterious effects of recurrent otitis. Post hoc analyses examined the implications of task structure and parent sex on parent verbal stimulation. Discussion addresses the importance of paternal involvement for the home language environment and implications for intervention.
Assessed relationship between children's minor illnesses during the first 3 years of life and parenting stress in the 4th year. Also examined whether a good parenting alliance would compensate for or moderate this relationship. Parents of 56 3- to 4-year-olds completed parenting alliance and stress questionnaires. Child morbidity, assessed from medical records, was directly related to mothers' but not fathers' feelings of stress. The parenting alliance was more strongly related to parenting stress for fathers than for mothers. However, child morbidity and parenting alliance interacted in predicting child-related paternal stresses. While fathers in a poor alliance reported more stress, stress was unrelated to their children's illnesses; for fathers in a moderate to strong alliance, illness and stress were positively correlated. Even minor child illnesses appear to be a source of stress for parents.
The cardiovascular effects of xylazine and detomidine in horses were studied. Six horses were given each of the following 5 treatments, at 1-week intervals: xylazine, 1.1 mg/kg, IV; xylazine, 2.2 mg/kg, IM; detomidine, 0.01 mg/kg, IV; detomidine, 0.02 mg/kg, IV; and detomidine, 0.04 mg/kg, IM. All treatments resulted in significantly decreased heart rate, increased incidence of atrioventricular block, and decreased cardiac output and cardiac index; cardiac output and cardiac index were lowest following IV administration of 0.02 mg of detomidine/kg. Mean arterial pressure was significantly reduced for various periods with all treatments; however, IV administration of 0.02 mg of detomidine/kg caused hypertension initially. Systemic vascular resistance was increased by all treatments. Indices of ventricular contractility and relaxation, +dP/dt and -dP/dt, were significantly depressed by all treatments. Significant changes were not detected in stroke volume or ejection fraction. The PCV was significantly reduced by all treatments. Respiratory rate was significantly decreased with all treatments, but arterial carbon dioxide tension did not change. Arterial oxygen tension was significantly decreased briefly with the 3 IV treatments only.
The hemodynamic effects of high arterial carbon dioxide pressure (PaCO2) during anesthesia in horses were studied. Eight horses were anesthetized with xylazine, guaifenesin, and thiamylal, and were maintained with halothane in oxygen (end-tidal halothane concentration = 1.15%). Baseline data were collected while the horses were breathing spontaneously; then the horses were subjected to intermittent positive-pressure ventilation, and data were collected during normocapnia (PaCO2, 35 to 45 mm of Hg), moderate hypercapnia (PaCO2, 60 to 70 mm of Hg), and severe hypercapnia (PaCO2, 75 to 85 mm of Hg). Hypercapnia was induced by adding carbon dioxide to the inspired gas mixture. Moderate and severe hypercapnia were associated with significant (P less than 0.05) increases in aortic blood pressure, left ventricular systolic pressure, cardiac output, stroke volume, maximal rate of increase and decrease in left ventricular pressure (positive and negative dP/dtmax, respectively), and median arterial blood flow, and decreased time constant for ventricular relaxation. These hemodynamic changes were accompanied by increased plasma epinephrine and norepinephrine concentrations. Administration of the beta-blocking drug, propranolol hydrochloride, markedly depressed the response to hypercapnia. This study confirmed that in horses, hypercapnia is associated with augmentation of cardiovascular function.
The cardiopulmonary effects of 4 positions (standing, right lateral, left lateral, and dorsal recumbency) were evaluated in conscious cattle in which no sedatives or anesthetic drugs were given. Each position was maintained for 30 minutes, during which time there were no significant changes in heart rate, respiratory rate, mean arterial blood pressure, arterial pH, PaCO2, arterial base excess, or venous blood gas values. Significant decreases in PaO2 developed when cattle were in lateral positions and dorsal recumbency. Cardiac index was unchanged in all positions, except in dorsal recumbency at 30 minutes, when it was significantly decreased.
This study investigated 54 children (37 boys and 17 girls) with cross-situational attention deficit hyperactivity disorder (ADHD) to determine whether there are sex differences in the expression of either the primary or secondary symptomatology of ADHD. Results indicated that the male and female ADHD groups were strikingly similar on all measures of primary (impulsivity, inattention, and overactivity) and secondary (learning problems, externalizing symptoms, internalizing symptoms, peer relationship difficulties, and self-perceptions) symptomatology included in this study. The lack of significant sex differences conflicts with prior reports in the literature, and these conflicting results are discussed in terms of differences in inclusion criteria. Implications for understanding the long-term outcome of ADHD in girls are also discussed.
Creatine kinase (CK) and lactate dehydrogenase (LD) enzyme activities and isoenzymes were determined for synovial fluid, synovial membrane, and articular cartilage from 24 clinically normal equine tarsocrural (tibiotarsal) and femoropatellar joints. All 3 tissues contained LD isoenzymes LD1 to LD5, and CK isoenzymes BB and MM. The CK isoenzyme MB was not found. The similarities in isoenzyme composition of these 3 tissues made differentiation of the source of LD and CK impossible by isoenzyme pattern alone. Reference values for the total enzyme activities of specific joint tissues also had wide variations. The wide variation in activities, as determined by the enzymatic analysis of synovial fluid and a lack of tissue specificity in clinically normal equine joint tissue, indicated that those values were not predictive for the extent and type of tissue damage in equine joint disease. This hypothesis was confirmed when synovial fluids from 22 abnormal joints were analyzed for LD isoenzymes and total enzyme activity. The various causes of the joint problems were not distinguishable.
Eighteen clinically normal horses were used to study the characteristics of normal thoracic fluid. Thoracic fluid was obtained from each horse and was found to be similar to equine abdominal fluid. Total leukocytes averaged 3994/ul, total protein 1.8 g/dl, and specific gravity 1.015. Analysis of thoracic fluid from 16 horses with clinical signs of thoracic disease showed abnormalities in every case. Thoracic fluid analysis alone determined a specific diagnosis in 50% of the cases.
Serum amylase and lipase were measured in 32 healthy dogs and in 55 dogs with serum urea nitrogen values greater than 40 mg/dl, using a nephelometric analyzer (Coleman analyzer model 91). Mean serum amylase and lipase values in normal dogs were 1,085.48 units and 3.98 units, respectively. In dogs with azotemia, the mean serum amylase and lipase values were 1,822.79 units and 12.57 units, respectively. Serum urea nitrogen values could not be correlated with amylase or lipase values.
Orgotein was injected into the right intercarpal joint of each of 8 horses; the corresponding left joint was left alone (not injected) or was given an injection of normal saline solution. Injection with orgotein caused a transient, marked inflammatory response, evidenced by clinical signs and by increased leukocytes and total protein in the synovia (synovial fluid). Leukocyte numbers and total protein concentration were increased (P less than 0.010) in the orgotein-injected joints within 24 hours. However, saline solution alone also elicited a marked inflammatory response, manifested by increased leukocyte count and total protein concentration. By 7 days, leukocyte and total protein values had returned to approximately base line in all joints.
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OBJECTIVE: To determine the minimum alveolar concentration (MAC) of isoflurane (ISO) in llamas. STUDY DESIGN: Prospective study. ANIMALS: Eight adult neutered male llamas (9 +/- 1 years [x +/- SD], 177 +/- 29 kg). METHODS: Anesthesia was induced and maintained in otherwise unmedicated llamas with a mixture of ISO in oxygen administered through a standard small-animal, semi-closed circle system using an out-of-circle, agent-specific vaporizer. The time from mask placement to intubation was recorded. Inspired and end-tidal (ET) ISO was sampled continuously. At each anesthetic concentration, a constant ET ISO was maintained for at least 20 minutes before application of a noxious electrical stimulus (50 volts, 5 Hz, 10 ms for up to 1 minute). A positive or negative response to the stimulus was recorded, and ET ISO then increased (if positive response) or decreased (if negative response) by 10% to 20%. Individual MAC was the average of multiple determinations. Body temperature was maintained at 37 +/- 1 degrees C. Selected cardiopulmonary variables (heart rate [HR], respiratory rate [RR], arterial blood pressure [ABP]) and ET ISO were recorded at hourly intervals from first ISO. Arterial blood was collected for pH, PCO2, PO2 analysis and measurement of packed cell volume (PCV) and total protein (TP) at 2 hour intervals. Following MAC determination, the anesthetic was discontinued and llamas were allowed to recover. Duration and quality of recovery were noted. RESULTS: The time from start of induction by mask to completion of intubation took 19.1 +/- 4.8 minutes. The MAC of ISO corrected to one atmosphere at sea level (barometric pressure 760 mm Hg) in these llamas was 1.05 +/- 0.17%. Mean ABP increased from 70 +/- 26 mm Hg at the end of the first hour of anesthesia to 102 +/- 7 mm Hg measured at the end of the sixth hour of anesthesia. ET ISO decreased from 2.06 +/- 0.10% to 1.27 +/- 0.07% over the same time period, but MAC did not change with time. The duration from first ISO to discontinuation of ISO averaged 6.19 +/- 0.9 hours. Animals were able to support their heads in a sternal posture at 23 +/- 10 minutes, and stood 62 +/- 26 minutes following discontinuation of the anesthetic. CONCLUSION: The MAC for ISO is similar to, but slightly lower than, values reported for other species. CLINICAL RELEVANCE: Knowledge of MAC may facilitate appropriate clinical use and provide the basis for future investigation of ISO in llamas.
The effects of increasing respiratory rates on arterial pH, PaCO2, HCO3, and potassium (K) were measured in normal anesthetized dogs. Hyperventilation resulted in increased pH, decreased PaCO2, decreased HCO3, and decreased K compared with those parameters in spontaneously breathing dogs. The changes were related quantitatively: each 10 mmHg decrease in PaCO2 was associated with a pH increase of 0.1, a HCO3 decrease of 2.0 mEq/L, and a K decrease of 0.4 mEq/L. There were no cardiac arrhythmias or clinical signs of hypokalemia. After termination of hyperventilation, serum K was slower to return to control values than PaCO2. The ratio of the duration of hyperventilation to the time required for return of serum K to control was 0.67.
Nine horses were premediated with acepromazine, and anesthesia was induced with guaifenesin and thiamylal. Anesthesia was maintained in four horses with halothane in oxygen, and in five horses with halothane in oxygen plus a constant dose infusion of detomidine. Both maintenance regimens produced a MAC equivalent of 1.4 at the ambient barometric pressure. Hemodynamic and respiratory measurements were made after the horses were anesthetized, during surgical manipulations involving skin or tissues other than nerves, during manipulation and transection of digital nerves, and after surgery while the limbs were being bandaged. Heart rate was significantly higher in horses anesthetized with halothane only than in horses that also received detomidine; there were no other differences in hemodynamic function or recovery characteristics. Respiratory rate was significantly higher than baseline during soft tissue and nerve manipulations; arterial blood pressure was significantly higher after surgery began and highest during neurectomy; cardiac output and cardiac index were significantly decreased during surgery; systemic vascular resistance was significantly increased during neurectomy and bandaging and highest during neurectomy. The data suggest that the increase in blood pressure often associated with surgical stimulation is caused by increased vascular resistance and may be accompanied by a decrease in cardiac output.
Seven horses, which were part of an investigation of the effect of endotoxin administration on vascular reactivity, were anesthetized on two separate occasions for surgical excision of 4-cm sections of palmar digital artery and vein. On the first occasion, the horses were given an infusion of 1 L 0.9% NaCl solution intravenously (i.v.) just before induction of anesthesia (control); on the second occasion, the horses received an infusion of 1 L 0.9% NaCl containing Escherichia coli endotoxin, 0.1 microgram/kg (endotoxin). On both occasions, anesthesia was induced with xylazine, guaifenesin, and ketamine, and maintained with halothane in oxygen. Hemodynamic measurements were made with the horses under anesthesia immediately before beginning surgery (period 1), during skin incision (period 2), during dissection and excision of the vessels (period 3), during skin suturing (period 4), and after completion of surgery during bandaging (period 5). Hemoglobin concentration and mixed venous oxygen content were greater at all periods in horses that received endotoxin. Otherwise, there were no significant differences in hemodynamic parameters between control horses and horses administered endotoxin before beginning surgery (period 1). During surgery and bandaging, horses administered endotoxin had significantly higher heart rate (periods 3, 4, and 5), cardiac index (periods 3, 4, and 5), and oxygen delivery (periods 2, 3, 4, and 5) than did control horses, and mean arterial blood pressure (period 2) and systemic vascular resistance (periods 2, 3, 4, and 5) were less than in control horses. Compared with period 1, surgical stimulation in control horses was associated with increased mean arterial blood pressure and systemic vascular resistance (periods 2, 3, 4, and 5), but cardiac index and oxygen delivery were decreased (periods 3, 4, and 5).(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of morphine (M), 0.1 mg/kg, administered into the lumbosacral subarachnoid space of sheep used for experimental stifle surgery, were investigated. In a pilot study, preservative-free morphine was administered to three sheep, morphine containing preservatives to two sheep, and saline (S) to one sheep. After recovery from anesthesia, all five sheep administered M displayed rear limb weakness. One sheep, which had received morphine containing preservatives, also licked and chewed incessantly at its flank and hindquarters during recovery. A group of 24 sheep was used to study the effects of morphine containing preservatives, injected intrathecally, on recovery from general anesthesia and hindlimb orthopedic surgery. Eight sheep received M, eight sheep received S, and eight sheep had a needle placed in the subarachnoid space without any injection (N). Times from end of anesthesia to standing varied greatly and did not differ significantly among groups (P = .73), with M sheep averaging 119 minutes; S sheep, 87 minutes; and N sheep, 83 minutes. One sheep administered M licked and chewed at its hindquarters during recovery. Another group of 24 sheep was used to study the effects of morphine containing preservatives, injected intrathecally, on postoperative lameness. Treatments were as described previously. Sheep were videotaped intermittently for 36 hours after surgery, and each sheep was scored as follows: 0 = not lame; 1 = slightly lame; and 2 = very lame. The average lameness scores, which did not differ significantly among groups (P = .21), were: M sheep, 1.07; S sheep, 0.81; and N sheep, 0.68. One sheep administered M displayed extensor spasms of the hindlimbs, and could not stand until several hours after surgery. We conclude that subarachnoid morphine at the dosage used produces no apparent benefit in sheep which have had stifle surgery, and in fact may cause detrimental side effects, such as hindlimb weakness, and pruritus or irritation of the hindquarters.
The complications and mortality associated with anesthesia of dogs and cats in a university teaching hospital were determined. During one year, 2,556 dogs and 683 cats were anesthetized by the anesthesia service. Hypotension occurred in 179 (7%) dogs and 58 (8.5%) cats. Cardiac dysrhythmias occurred in 64 (2.5%) dogs and 12 (1.8%) cats. Transfusions were required in 31 (1.2%) dogs. Hypercapnea occurred in 33 (1.3%) dogs and one (less than 1%) cat. Hypoxemia occurred in 14 (0.5%) dogs. Anesthetic complications, as defined, occurred in 12.0% of dogs and 10.5% of cats, while deaths associated with the perianesthetic period occurred in 0.43% of dogs and 0.43% of cats.