Advertisement

Comparison of single-breath continuous positive airway pressure manoeuvre to inhaled salbutamol to improve oxygenation in horses anaesthetized for laparotomy

  • Julien Dupont
    Correspondence
    Corresponding author. Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Quartier Vallée 2, Avenue de Cureghem 3, Bâtiment B41, Sart-Tilman, 4000 Liège, Belgium.
    Affiliations
    Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
    Search for articles by this author
  • Alexandra Gougnard
    Affiliations
    Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
    Search for articles by this author
  • Alexandra Salciccia
    Affiliations
    Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
    Search for articles by this author
  • Johann Detilleux
    Affiliations
    Quantitative Genetics Group, Department of Veterinary Management of Animal Resources, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
    Search for articles by this author
  • Didier Serteyn
    Affiliations
    Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
    Search for articles by this author
  • Charlotte Sandersen
    Affiliations
    Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
    Search for articles by this author
Published:October 20, 2021DOI:https://doi.org/10.1016/j.vaa.2021.06.018

      Abstract

      Objective

      To compare the efficacy of single-breath continuous positive airway pressure manoeuvre (CPAP-M) with inhaled salbutamol, and a combination of both.

      Study design

      Randomized, clinical study.

      Animals

      A total of 62 client-owned horses (American Society of Anesthesiologists status III to V) anaesthetized for laparotomy.

      Methods

      Horses were premedicated with intravenous (IV) xylazine (0.4 to 0.6 mg kg-1), anaesthesia was induced with midazolam (0.06 mg kg-1 IV) and ketamine (2.2 mg kg-1 IV) and maintained with isoflurane in oxygen using volume-controlled ventilation without positive end-expiratory pressure. If PaO2 was < 100 mmHg (13.3 kPa), either a CPAP-M (50 cmH2O for 45 seconds) or salbutamol (0.002 mg kg-1) was administered. The intervention was considered successful if PaO2 reached 100 mmHg (13.3 kPa). If PaO2 remained < 100 mmHg (13.3 kPa), treatments were switched. PaO2/FIO2 ratio and estimated shunt fraction (F-shunt) were derived from data obtained from arterial blood gas measurements. Dynamic compliance (Cdyn) was calculated from variables recorded at the moment of arterial blood analysis. Fisher’s exact tests compared success rates between treatments and linear models were performed to test whether the treatment modified the values of the measurements. p < 0.05.

      Results

      Salbutamol was the first intervention in 28 horses and was effective in 22 horses. CPAP-M was the first intervention in 34 horses and was effective in 26 horses. CPAP-M after salbutamol was performed in six horses, with four responders, and salbutamol after CPAP-M was administered to eight horses, with one responder. Salbutamol, but not CPAP-M, significantly decreased F-shunt. Both salbutamol and CPAP-M significantly increased Cdyn.

      Conclusions and clinical relevance

      Salbutamol and CPAP-M were comparably effective in improving oxygenation and Cdyn in anaesthetized horses with PaO2 < 100 mmHg (13.3 kPa). Whether combining both treatments might be beneficial needs to be confirmed on a larger number of horses.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Araos J.D.
        • Larenza M.P.
        • Boston R.C.
        • et al.
        Use of the oxygen content-based index, Fshunt, as an indicator of pulmonary venous admixture at various inspired oxygen fractions in anesthetized sheep.
        Am J Vet Res. 2012; 73: 2013-2020
        • Araos J.
        • Lacitignola L.
        • Stripoli T.
        • et al.
        Effects of positive end-expiratory pressure alone or an open-lung approach of recruited lung volumes and respiratory mechanics of mechanically ventilated horses.
        Vet Anaesth Analg. 2019; 46: 780-788
        • Arroyo M.G.
        • Couëtil L.L.
        • Nogradi N.
        • et al.
        Efficacy of inhaled levalbuterol compared to albuterol in horses with recurrent airway obstruction.
        J Vet Intern Med. 2016; 30: 1333-1337
        • Auckburally A.
        • Nyman G.
        Review of hypoxemia in anaesthetised horses: predisposing factors, consequences and management.
        Vet Anaesth Analg. 2017; 44: 397-408
        • Benator S.R.
        • Hewlett A.M.
        • Nunn J.F.
        The use of iso-shunt lines for control of oxygen therapy.
        Br J Anaesth. 1973; 45: 711-718
        • Briganti A.
        • Portela D.A.
        • Grasso S.
        • et al.
        Accuracy of different oxygenation indices in estimating intrapulmonary shunting at increasing rates of dobutamine in horses under general anaesthesia.
        Vet J. 2015; 204: 351-356
        • Bringewatt T.
        • Hopster K.
        • Kästner S.B.R.
        • et al.
        Influence of modified open lung concept ventilation on the cardiovascular and pulmonary function of horses during total intravenous anaesthesia.
        Vet Rec. 2010; 167: 1002-1006
        • Casoni D.
        • Spadavecchia C.
        • Adami C.
        Cardiovascular changes after administration of aerosolized salbutamol in horses: five cases.
        Acta Vet Scand. 2014; 56: 49
        • Derksen F.J.
        • Olszewski M.A.
        • Robinson N.E.
        • et al.
        Aerosolized albuterol sulfate used as a bronchodilator in horses with recurrent airway obstruction.
        Am J Vet Res. 1999; 60: 689-693
        • Hopster K.
        • Kästner S.
        • Rohn K.
        • et al.
        Intermittent positive pressure ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvre during inhalation anesthesia in horses undergoing surgery for colic, and its influence on the early recovery period.
        Vet Anaesth Analg. 2011; 38: 169-177
        • Hopster K.
        • Wogatzki A.
        • Geburek F.
        • et al.
        Effects of positive end-expiratory pressure titration on intestinal oxygenation and perfusion in isoflurane anaesthetised horses.
        Equine Vet J. 2016; 49: 250-256
        • Hopster K.
        • Jacobson B.
        • Hopster-Iversen C.
        • et al.
        Histopathological changes in mRNA expression in lungs of horses after inhalation anaesthesia with different ventilation strategies.
        Res Vet Sci. 2016; 107: 8-15
        • Hopster K.
        • Rohn K.
        • Ohnesorge B.
        • et al.
        Controlled mechanical ventilation with constant positive end-expiratory pressure and alveolar recruitment manoeuvres during anaesthesia in laterally or dorsally recumbent horses.
        Vet Anaesth Analg. 2017; 44: 121-126
        • Lachmann B.
        Open up the lung and keep the lung open.
        Intens Care Med. 1992; 18: 319-321
        • Mansel J.C.
        • Clutton R.E.
        The influence of body mass and thoracic dimensions on arterial oxygenation in anesthetized horses and ponies.
        Vet Anaesth Analg. 2008; 35: 392-399
        • Moens Y.
        • Schramel J.P.
        • Tusman G.
        • et al.
        Variety of non-invasive continuous monitoring methodologies including electrical impedance tomography provides novel insights into the physiology of lung collapse and recruitment – case report of an anaesthetized horse.
        Vet Anaesth Analg. 2014; 41: 196-204
        • Nyman G.
        • Hedenstierna G.
        Ventilation-perfusion relationships in the anaesthetised horse.
        Equine Vet J. 1989; 21: 274-281
        • Nyman G.
        • Funkquist B.
        • Kvart C.
        • et al.
        Atelectasis causes gas exchange impairment in the anaesthetised horse.
        Equine Vet J. 1990; 22: 317-324
        • Patschova M.
        • Kabes R.
        • Krisova S.
        The effect of inhalation salbutamol administration on systemic and pulmonary hemodynamic, pulmonary mechanics and oxygen balance during general anaesthesia in the horse.
        Vet Med (Praha). 2010; 9: 445-456
        • Robertson S.A.
        • Bailey J.E.
        Aerosolized salbutamol (albuterol) improves PaO2 in hypoxaemic anaesthetized horses – a prospective clinical trial in 81 horses.
        Vet Anaesth Analg. 2002; 29: 212-218
        • Santos M.
        • Ibancovichi J.A.
        • Lopez-Sanroman F.J.
        • et al.
        Effects of single hyperinflation using a sustained high pressure manœuvre during inhalation anaesthesia in horses.
        Vet J. 2013; 197: 892-895
        • Soni N.
        • Williams P.
        Positive pressure ventilation: what is the real cost?.
        Br J Anaesth. 2008; 101: 446-457
        • Törneke K.
        β-adrenoceptors in equine trachea and heart.
        Vet Res Commun. 1999; 23: 41-51
        • Wandrup J.H.
        Quantifying pulmonary oxygen transfer deficits in critically ill patients.
        Acta Anaesthesiol Scand Suppl. 1995; 107: 37-44
        • Wettstein D.
        • Moens Y.
        • Jaeggin-Schmucker N.
        • et al.
        Effects of an alveolar recruitment maneuver on cardiovascular and respiratory parameters during total intravenous anesthesia in ponies.
        Am J Vet Res. 2006; 67: 152-159