Heparinized Saline Solution vs. Saline Solution (0.9% Sodium Chloride) for the Maintenance of Dorsal Pedal Arterial Catheter Patency in Dogs Undergoing General Anesthesia: A Pilot Study
“…Lactated Ringer's solution (Lactec; Otsuka Pharmaceutical Factory, Nihon Kohden, Tokyo, Japan) to measure AP (Figure 2). The transducer was placed at the level of the right atrium as a reference point for zero pressure (22,23). Heparinized saline solution (4 IU•mL −1 ) was used to flush the arterial catheter, and infusion was commenced at a rate of 3 mL•h −1 with 300 mm Hg pressure applied to the infuser bag (22,23).…”
Section: Preparationmentioning
confidence: 99%
“…The transducer was placed at the level of the right atrium as a reference point for zero pressure (22,23). Heparinized saline solution (4 IU•mL −1 ) was used to flush the arterial catheter, and infusion was commenced at a rate of 3 mL•h −1 with 300 mm Hg pressure applied to the infuser bag (22,23). Surface ECG was recorded to monitor the heart rate (HR).…”
IntroductionIntra-operative hypotension is a common complication of surgery under general anesthesia in dogs and humans. Computer-controlled closed-loop infusion systems of norepinephrine (NE) have been developed and clinically applied for automated optimization of arterial pressure (AP) and prevention of intra-operative hypotension in humans. This study aimed to develop a simple computer-controlled closed-loop infusion system of NE for the automated control of the mean arterial pressure (MAP) in dogs with isoflurane-induced hypotension and to validate the control of MAP by the developed system.MethodsNE was administered via the cephalic vein, whereas MAP was measured invasively by placing a catheter in the dorsal pedal artery. The proportional-integral-derivative (PID) controller in the negative feedback loop of the developed system titrated the infusion rate of NE to maintain the MAP at the target value of 60 mmHg. The titration was updated every 2 s. The performance of the developed system was evaluated in six laboratory Beagle dogs under general anesthesia with isoflurane.ResultsIn the six dogs, when the concentration [median (interquartile range)] of inhaled isoflurane was increased from 1.5 (1.5–1.5)% to 4 (4–4)% without activating the system, the MAP was lowered from 95 (91–99) to 41 (37–42) mmHg. In contrast, when the concentration was increased from 1.5 (1.0–1.5)% to 4 (4–4.8)% for a 30-min period and the system was simultaneously activated, the MAP was temporarily lowered from 92 (89–95) to 47 (43–49) mmHg but recovered to 58 (57–58) mmHg owing to the system-controlled infusion of NE. If the acceptable target range for MAP was defined as target MAP ±5 mmHg (55 ≤ MAP ≤65 mmHg), the percentage of time wherein the MAP was maintained within the acceptable range was 96 (89–100)% in the six dogs during the second half of the 30-min period (from 15 to 30 min after system activation). The median performance error, median absolute performance error, wobble, and divergence were − 2.9 (−4.7 to 1.9)%, 2.9 (2.0–4.7)%, 1.3 (0.8–1.8)%, and − 0.24 (−0.34 to −0.11)%·min−1, respectively. No adverse events were observed during the study period, and all dogs were extubated uneventfully.ConclusionThis system was able to titrate the NE infusion rates in an accurate and stable manner to maintain the MAP within the predetermined target range in dogs with isoflurane-induced hypotension. This system can be a potential tool in daily clinical practice for the care of companion dogs.
“…Lactated Ringer's solution (Lactec; Otsuka Pharmaceutical Factory, Nihon Kohden, Tokyo, Japan) to measure AP (Figure 2). The transducer was placed at the level of the right atrium as a reference point for zero pressure (22,23). Heparinized saline solution (4 IU•mL −1 ) was used to flush the arterial catheter, and infusion was commenced at a rate of 3 mL•h −1 with 300 mm Hg pressure applied to the infuser bag (22,23).…”
Section: Preparationmentioning
confidence: 99%
“…The transducer was placed at the level of the right atrium as a reference point for zero pressure (22,23). Heparinized saline solution (4 IU•mL −1 ) was used to flush the arterial catheter, and infusion was commenced at a rate of 3 mL•h −1 with 300 mm Hg pressure applied to the infuser bag (22,23). Surface ECG was recorded to monitor the heart rate (HR).…”
IntroductionIntra-operative hypotension is a common complication of surgery under general anesthesia in dogs and humans. Computer-controlled closed-loop infusion systems of norepinephrine (NE) have been developed and clinically applied for automated optimization of arterial pressure (AP) and prevention of intra-operative hypotension in humans. This study aimed to develop a simple computer-controlled closed-loop infusion system of NE for the automated control of the mean arterial pressure (MAP) in dogs with isoflurane-induced hypotension and to validate the control of MAP by the developed system.MethodsNE was administered via the cephalic vein, whereas MAP was measured invasively by placing a catheter in the dorsal pedal artery. The proportional-integral-derivative (PID) controller in the negative feedback loop of the developed system titrated the infusion rate of NE to maintain the MAP at the target value of 60 mmHg. The titration was updated every 2 s. The performance of the developed system was evaluated in six laboratory Beagle dogs under general anesthesia with isoflurane.ResultsIn the six dogs, when the concentration [median (interquartile range)] of inhaled isoflurane was increased from 1.5 (1.5–1.5)% to 4 (4–4)% without activating the system, the MAP was lowered from 95 (91–99) to 41 (37–42) mmHg. In contrast, when the concentration was increased from 1.5 (1.0–1.5)% to 4 (4–4.8)% for a 30-min period and the system was simultaneously activated, the MAP was temporarily lowered from 92 (89–95) to 47 (43–49) mmHg but recovered to 58 (57–58) mmHg owing to the system-controlled infusion of NE. If the acceptable target range for MAP was defined as target MAP ±5 mmHg (55 ≤ MAP ≤65 mmHg), the percentage of time wherein the MAP was maintained within the acceptable range was 96 (89–100)% in the six dogs during the second half of the 30-min period (from 15 to 30 min after system activation). The median performance error, median absolute performance error, wobble, and divergence were − 2.9 (−4.7 to 1.9)%, 2.9 (2.0–4.7)%, 1.3 (0.8–1.8)%, and − 0.24 (−0.34 to −0.11)%·min−1, respectively. No adverse events were observed during the study period, and all dogs were extubated uneventfully.ConclusionThis system was able to titrate the NE infusion rates in an accurate and stable manner to maintain the MAP within the predetermined target range in dogs with isoflurane-induced hypotension. This system can be a potential tool in daily clinical practice for the care of companion dogs.
“…Four studies (LOE 5, fair) were identified that evaluated the function of arterial catheters in dogs and reported subsequent complications such as thrombosis 308–311 . None of these reports included a relevant control population (dogs without arterial catheters); hence, all 4 studies were considered neutral to the PECO question.…”
“…Four studies (LOE 5, fair) were identified that evaluated the function of arterial catheters in dogs and reported subsequent complications such as thrombosis. [308][309][310][311] None of these reports included a relevant control population (dogs without arterial catheters); hence, all 4 studies were considered neutral to the PECO question. Additionally, the complication defined as 'catheter occlusion' was not characterized in all cases to distinguish potential causes such as intraluminal thrombosis, catheter kinking, arterial spasm or thromboembolism.…”
Section: Evidence Summarymentioning
confidence: 99%
“…In 2 studies, arterial catheters were in place only during anesthetic procedures, 310,311 while in the 2 remaining studies, some catheters remained in place postoperatively. 308,309 The association between catheter dwell-time and complication rates was partially explored in 2 studies.…”
Objectives: To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. Design: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).Results: Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism.
Conclusions:Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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