Histopathological changes and mRNA expression in lungs of horses after inhalation anaesthesia with different ventilation strategies

Hopster, Klaus; Jacobson, Benjamin; Hopster‐Iversen, Charlotte; Rohn, Karl; Kästner, Sabine

doi:10.1016/j.rvsc.2016.04.008

Cited by 11 publications

(9 citation statements)

References 41 publications

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“…In humans, low tidal volume ventilation and adequate PEEP levels have been shown to be important factors to prevent VILI during anaesthesia . In horses, CMV was associated with increases in several key proinflammatory cytokines, which have been associated with inflammatory lung diseases . Highest changes in these biomarkers were seen after high airway pressures were applied during a recruitment manoeuvre, while no differences were observed between awake horses and those breathing spontaneously during anaesthesia.…”

Section: Part 2: Pulmonary Ventilation and Controlled Ventilationmentioning

confidence: 99%

“…Most importantly one has to be aware of the possible impact on cardiovascular system and has to abandon the RM when the cardiovascular status deteriorates. The high airway pressures applied during RM can cause lung tissue damage and inflammation . Furthermore, these pressures over‐distend alveolar structures causing an increase in alveolar dead space during RM .…”

Section: Mechanical Ventilation During Anaesthesiamentioning

confidence: 99%

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Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation

Mosing

Senior

2018

Equine Veterinary Journal

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SummaryIn the first edition of this journal, Barbara Weaver wrote a review titled 'Equine Anaesthesia', stating that, at that time, it was quickly becoming accepted practice that many horses were being anaesthetised 'by essentially similar procedures, i.e. premedication, induction and then maintenance by controlled inhalation'. To celebrate the 50th anniversary of the first edition of this journal, this review covers the development of understanding and practice of inhalational anaesthesia and controlled ventilation in horses over the last 50 years. We review how the perceived benefits of halothane led to its widespread use, but subsequently better understanding of halothane's effects led to changes in equine anaesthetic practice and the utilisation of different inhalation agents (e.g. isoflurane and sevoflurane). We discuss how more recently, better understanding of the effects of the 'newer' inhalation agents' effects has led to yet more changes in equine anaesthetic practice, and while, further new inhalation agents are unlikely to appear in the near future, further enhancements to anaesthetic practice may still lead to improved outcomes. We review advances in our understanding of the anatomy and pathophysiology of the equine lung as well of the effects of anaesthesia on lung function and how these predispose to some of the common problems of gas exchange and ventilation during anaesthesia. We identify the aims of optimal mechanical ventilation for anaesthetic management and whether the various methods of ventilatory support during equine anaesthesia achieve them. We also highlight that further developments in equipment and optimal ventilator modes are likely in the near future.

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Section: Part 2: Pulmonary Ventilation and Controlled Ventilationmentioning

confidence: 99%

Section: Mechanical Ventilation During Anaesthesiamentioning

confidence: 99%

Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation

Mosing

Senior

2018

Equine Veterinary Journal

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“…Ventilator induced lung injury (VILI), as has been described in humans, was suspected to occur in horses just recently by Hopster et al (2016 c) who reported early signs of possible lung injury in equine patients. This study group was able to demonstrate a higher degree of atelectasis in horses breathing spontaneously and being mechanically ventilated without PEEP, compared to horses receiving IPPV combined with PEEP and ARM.…”

Section: Introductionmentioning

confidence: 99%

“…This method has been implemented successfully in ponies by Wettstein et al (2006) and Hopster et al (2016 c).…”

Section: Introductionmentioning

confidence: 99%

The use of positive end-expiratory pressure (PEEP) and alveolar recruitment manoeuvre (ARM) in equine anaesthesia – a review

Küls¹,

Braun²,

Moens³

2016

PHK

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Summary: Impairment of gas exchange and arterial oxygenation during general anaesthesia and recumbency of the horse are a common and well-known problem. Often these alterations are poorly responsive to intermittent positive pressure ventilation (IPPV) and increasing levels of supplemental oxygen. Over the last decades the understanding of the underlying pathophysiology developed more and more, recognizing that a decrease in functional residual capacity (FRC), lung collapse and atelectasis, and ultimately ventilation/perfusion mismatch lead to poor oxygenation. Accordingly, new ventilation strategies arose over the course of time including alveolar recruitment manoeuvres (ARMs) and positive end expiratory pressure (PEEP). In 1992 Burkhard Lachmann presented his idea of an 'open lung' concept using high peak inspiratory pressures to reopen atelectatic lung regions followed by sufficiently high PEEP to keep the recruited lung areas open. In equine anaesthesia, early attempts with continuous positive pressure in spontaneously breathing horses yielded rather disappointing results. In combination with IPPV the use of PEEP resulted in unreliable improvements in the partial pressure of oxygen in arterial blood (PaO 2 ). Once the pre-treatment with an ARM prior to PEEP was introduced, improvement in PaO 2 could be seen to be more reliable. Despite these promising results, there is a risk of adverse effects with the use of PEEP and ARM in horses due to the high pressures that are necessary to achieve an effect. A reduction in cardiac output proportional to the increase in intrathoracic pressure has been observed and may compromise peripheral blood flow as well as gastrointestinal perfusion once a certain pressure threshold is reached. Similar, an increase in right to left shunt due to forcing blood into already collapsed lung areas can compromise the desired effect. Finally, early signs of ventilator induced lung injury have been detected in horses and it remains to be seen how future ventilation strategies will succeed in finding the optimal balance for each individual horse. This review presents the development and use of ARMs and PEEP in horses and its potential effect and side effects.

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“…Atualmente sabe-se que somente a instituição da PEEP não é suficiente para abrir os alvéolos atelectasicos; tem-se que se associar uma manobra de recrutamento afim de se otimizar os valores de PaO 2 , complacência e diminuir a ocorrência de shunt intrapulmonar durante a ventilação mecânica (MOENS et al, 1998;NYMAN et al, 2012;GRUBB et al, 2014). Diversas maneiras de se fazer a manobra de recrutamento alveolar vêm sendo estudadas na anestesia Revisão de Literatura Lara L. Facó de equinos, dentre elas a titulação crescente e decrescente da PEEP (WETTSTEIN et al, 2006;AMBRÓSIO et al, 2013;HOPSTER et al, 2016a O protocolo experimental foi submetido e aprovado pela Comissão de Ética e Uso de Animais (CEUA) da mesma instituição.…”

Section: Introductionunclassified

<b>Avaliação de diferentes protocolos de recrutamento alveolar durante a ventilação mecânica em equinos submetidos a laparotomia</b>

Mott¹

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Histopathological changes and mRNA expression in lungs of horses after inhalation anaesthesia with different ventilation strategies

Cited by 11 publications

References 41 publications

Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation

Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation

The use of positive end-expiratory pressure (PEEP) and alveolar recruitment manoeuvre (ARM) in equine anaesthesia – a review

<b>Avaliação de diferentes protocolos de recrutamento alveolar durante a ventilação mecânica em equinos submetidos a laparotomia</b>

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