Publications by authors named "Alessio Vigani"

21 Publications

  • Page 1 of 1

Ultrasound-guided paravertebral perineural glucocorticoid injection for signs of refractory cervical pain associated with foraminal intervertebral disk protrusion in four dogs.

J Am Vet Med Assoc 2021 May;258(9):999-1006

Case Description: 4 dogs, 7.5 to 10 years of age, were presented for evaluation of signs of chronic cervical pain and forelimb lameness secondary to cervical foraminal intervertebral disk protrusion (IVDP). All dogs were refractory to ≥ 2 weeks of conservative management including strict rest and pain management with anti-inflammatory drugs, methocarbamol, and gabapentin.

Clinical Findings: The MRI findings included left foraminal IVDP at C2-3 causing mild C3 nerve root compression (dog 1), multifocal degenerative disk disease with mild focal left-sided disk protrusion at C6-7 without associated spinal cord or nerve root compression (dog 2), left foraminal C6-7 IVDP with suspected focal spinal cord atrophy or mild compression (dog 3), and right foraminal C6-7 IVDP and multifocal cervical intervertebral disk degeneration with annulus fibrosus protrusion (dog 4).

Treatment And Outcome: Ultrasound-guided paravertebral perineural injections with methylprednisolone acetate (1 mg/kg [0.45 mg/lb]) at the C3 nerve root in dog 1 and at the C7 nerve root in the other 3 dogs were performed. Injections were repeated at intervals of 4 weeks to 3 months on the basis of clinical response. None of the dogs had any complications from the procedures. For dogs 1 and 4, there was complete resolution of lameness and signs of cervical pain following perineural injections, and for dog 3, there was complete resolution of lameness and only minimal residual cervical pain. Dog 2 did not have long-lasting improvement.

Clinical Relevance: Findings indicated that ultrasound-guided paravertebral perineural injection can be an effective treatment of cervical foraminal IVDP for some dogs. Additional studies to determine appropriate case selection and better assess the overall success rate and risks associated with this technique are warranted.
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http://dx.doi.org/10.2460/javma.258.9.999DOI Listing
May 2021

Striate Artery Infarct After Bilateral Carotid Artery Ligation (BCAL) in a Dog: A Multimodal MRI Study.

Front Vet Sci 2020 18;7:580256. Epub 2020 Sep 18.

Department of Neurology, Small Animal Clinic, Vetsuisse Faculty Zurich, University of Zurich, Zurich, Switzerland.

Bilateral carotid artery ligation has been reported as a lifesaving procedure to control severe hemorrhage. However, reports are sparse and little information is available regarding the potential risks associated with this procedure. We report an ischemic brain infarct as a complication after vascular surgery. A 3-year old, male intact border collie was presented for acute onset of forebrain signs 5 days after bilateral carotid artery ligation. Multimodal brain MRI including morphologic sequences, MR angiography, diffusion- and perfusion-weighted images were performed. MRI revealed a well-defined intra-axial lesion of the left caudate nucleus, with increased T2 and decreased T1 signal intensity and moderate heterogeneous peripheral contrast enhancement. The cerebral blood flow was reduced relative to the contralateral caudate nucleus. Images were consistent with a subacute lacunar ischemic infarct of the left striate artery. Additionally, multiple arterio-arterial anastomosis arising from the vertebral arteries were visible in the angiography sequences. Ischemic infarct due to thromboembolism should be considered as a possible complication associated with bilateral carotid artery ligation. Collateral blood supply can develop as early as 5 days after surgery.
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http://dx.doi.org/10.3389/fvets.2020.580256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533532PMC
September 2020

Efficacy of a single session in-series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs.

J Vet Emerg Crit Care (San Antonio) 2020 Mar 4;30(2):226-231. Epub 2020 Mar 4.

Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC.

Objective: To describe the efficacy of in-series hemoperfusion and hemodialysis in 2 dogs with carprofen overdose.

Case Summary: This report describes the treatment of 2 dogs following accidental carprofen overdoses who underwent a single in-series hemoperfusion and hemodialysis session. Serial serum carprofen concentrations were measured before, during, and after the session. The first patient's session lasted 5 hours, with the largest decrease in serum carprofen concentrations occurring during the first hour of treatment. The carprofen clearance during the following 4 hours of treatment decreased substantially compared to the first hour and was not different from the patient's intrinsic clearance of carprofen after the session was completed. Based on the findings from the first case, the second patient was treated with a 1 hour single hemoperfusion and hemodialysis session. Our results support the hypothesis that carprofen is not effectively removed by conventional hemodialysis and the efficacy of hemoperfusion is short lived due to rapid saturation of the charcoal filter. Once filter saturation occurs, the extracorporeal session is no longer efficacious. Using in-series hemoperfusion and hemodialysis is of benefit to correct the side effects seen with hemoperfusion alone, and hourly charcoal filter replacement may extend the efficacy of treatment in removing carprofen.

New Or Unique Information Provided: This is the first published report of in-series hemoperfusion and hemodialysis being used to treat carprofen overdose in a dog. In these 2 cases, the intrinsic clearances of the patients were shown to be equivalent to that of standard hemodialysis alone, indicating that hemodialysis does not produce any advantage in carprofen clearance. In this limited report, we suggest that the efficacy of hemoperfusion in removing carprofen is short-lived, and extending the treatment beyond the first hour does not produce any therapeutic benefit. In order to extend the efficacy of hemoperfusion, hourly replacement of the charcoal filter should be considered.
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http://dx.doi.org/10.1111/vec.12931DOI Listing
March 2020

Successful management of clinical signs associated with hepatic encephalopathy with manual therapeutic plasma exchange in a dog.

J Vet Emerg Crit Care (San Antonio) 2020 May 20;30(3):312-317. Epub 2020 Feb 20.

North Carolina State University, College of Veterinary Medicine, Raleigh, NC.

Objective: To describe the use of manual therapeutic plasma exchange (TPE) to manage hepatic encephalopathy (HE) in a dog.

Case Summary: A 9-year-old neutered female Dachshund presented for HE secondary to a previously diagnosed portosystemic shunt. The hyperammonemia and severe clinical signs of HE persisted despite extensive medical management. Therapeutic plasma exchange was performed for stabilization prior to surgical shunt ligation. A total of 1 plasma volume was processed during a single manual TPE session. The ammonia immediately prior to TPE was 235 μmol/L (reference interval, 10-30 μmol/L) and decreased to 117 μmol/L by the end of the session. The dog showed significant improvement in clinical signs shortly after the session and remained stable thereafter. Shunt ligation was performed 5 days later with no complications observed with TPE or postoperatively. The dog was discharged 3 days after surgery with no neurological signs and was doing well 100 days after surgery.

New Or Unique Information Provided: To the authors' knowledge, this is the first published report of manual TPE to manage HE in veterinary medicine. Therapeutic plasma exchange should be further investigated as a possible strategy to manage clinical signs of HE in patients that are refractory to medical management. Achieving this with manual TPE may be considered in patients that are too small for conventional TPE due to extracorporeal volume or in situations where conventional TPE is not available.
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http://dx.doi.org/10.1111/vec.12940DOI Listing
May 2020

Treatment of phenobarbital intoxication using hemodialysis in two dogs.

J Vet Emerg Crit Care (San Antonio) 2020 Mar 23;30(2):221-225. Epub 2020 Jan 23.

Emergency and Critical Care Service, North Carolina State Veterinary Hospital, Raleigh, NC.

Objective: To describe the use of hemodialysis in 2 dogs with severe clinical signs from phenobarbital intoxication.

Series Summary: Two dogs ingested a toxic dose of phenobarbital, leading to severe neurological dysfunction and a comatose state. Both dogs received a 3-hour session of hemodialysis with complete resolution of clinical signs and returned to normal mentation by the end of the therapy. No negative side effects occurred and phenobarbital concentrations returned to therapeutic range during treatment.

New Information Provided: This is the first report on the utility and safety of using hemodialysis for phenobarbital intoxication in dogs.
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http://dx.doi.org/10.1111/vec.12908DOI Listing
March 2020

Trauma-induced primary hypoparathyroidism following severe bite wound injury to the neck in a dog.

J Vet Emerg Crit Care (San Antonio) 2020 May 15;30(3):331-335. Epub 2020 Jan 15.

University of Florida Small Animal Hospital, Gainesville, FL.

Objective: To describe the clinical presentation and outcome of a dog with primary hypoparathyroidism secondary to cervical bite wounds.

Case Summary: A 3-year-old male intact Chihuahua presented after being attacked by a large breed dog. The dog sustained severe cervical lacerations, exposing the trachea and jugular veins. A portion of the right thyroid gland was missing. The dog was stabilized before wound debridement and closure. Ionized calcium concentrations were within reference range at the time of presentation. Forty-eight hours after the initial trauma, the dog was presented in lateral recumbency with signs of hypovolemic shock, muscle tremors, and hyperthermia. Bloodwork showed severe ionized hypocalcemia with low normal parathyroid hormone concentration consistent with acute primary hypoparathyroidism. The dog was managed initially with IV calcium gluconate and calcitriol, then long-term oral calcium carbonate and vitamin D3. After 6 months, the dog was successfully weaned off calcium supplementation.

New Or Unique Information Provided: This is the first described case of traumatic primary hypoparathyroidism after a bite injury to the neck in a dog.
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http://dx.doi.org/10.1111/vec.12923DOI Listing
May 2020

Successful treatment of a severe cannabinoid toxicity using extracorporeal therapy in a dog.

J Vet Emerg Crit Care (San Antonio) 2019 Nov 22;29(6):674-679. Epub 2019 Oct 22.

Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina.

Objective: To describe the use of extracorporeal therapy (ECT) to treat severe cannabinoid intoxication in a dog with severe hyperlipidemia.

Case Summary: A 7-month-old female intact Labrador Retriever presented with seizures and severe hyperesthesia that were refractory to multiple anticonvulsant medications and required induction of general anesthesia with propofol and mechanical ventilation. The dog's urine yielded a strong positive signal for delta-9-tetrahydrocannabinol (THC) on urine drug test and exposure to THC oil was confirmed by the owner. Bloodwork revealed severe hyperlipidemia such that IV lipid emulsion was considered contraindicated. The dog was treated with a 3-hour ECT session, using charcoal hemoperfusion and hemodialysis in series. Neurologic signs improved during the session and mechanical ventilation was discontinued. Immediately after the session, the dog's mentation was significantly improved and seizures and hyperesthesia had ceased, although the dog remained moderately ataxic. The dog was hospitalized for 36 hours following the ECT session for continued monitoring. The dog fully recovered and was successfully discharged.

New Or Unique Information Provided: To the authors' knowledge, this is the first published report to document ECT to treat THC intoxication in veterinary medicine. ECT may be considered as a treatment option for severe THC intoxication that is refractory to standard therapy or where severe hyperlipidemia precludes use of IV lipid emulsions.
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http://dx.doi.org/10.1111/vec.12899DOI Listing
November 2019

Clinical Application of Apheresis in Very Small Dogs Weighing <8 kg to Pediatric Patients.

Ther Apher Dial 2019 Aug 22. Epub 2019 Aug 22.

Department of Clinical Sciences, North Carolina State University, Raleigh, NC, USA.

Apheresis in low body weight children and adolescents is challenging due to a variety of technical and clinical issues including vascular access, low total blood volume, and hypotension. Although dogs have been a valuable preclinical model for apheresis, the procedure can be challenging since many pure-bred dogs are extremely small. Therefore, apheresis in these very small breeds presents very similar challenges as seen when performing the procedure in very low body weight people. We describe apheresis of four very small dogs, weighing from 4.6 to 7.6 kg, using either a COBESpectra and Spectra Optia apheresis system (Terumo BCT, Lakewood, CO, USA). Two dogs underwent large volume leukapheresis to collect mononuclear cells in preparation for hematopoietic stem cell transplantation and two dogs underwent therapeutic plasma exchange to treat an immune-mediated disease. In all cases, a dual-lumen hemodialysis catheter placed in the jugular vein provided adequate machine inlet and return flow rates. Machine priming was necessary to maintain hemodynamic stability during the beginning of the procedure, and rinseback was avoided for the same reason. Anticoagulant citrate dextrose solution, solution A was used for the large volume leukapheresis procedures and a combination of anticoagulant citrate dextrose solution, solution A and heparin was used for the therapeutic plasma exchange procedures. As such, serum iCa levels were regularly monitored and 10% calcium gluconate constant rate infusions were used to prevent citrate toxicity. All dogs completed the aphereses with no life-threatening adverse events. We conclude that aphereses in very small dogs is feasible if close attention is paid to hemodynamic stability and citrate toxicity.
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http://dx.doi.org/10.1111/1744-9987.13432DOI Listing
August 2019

Ultrasound-guided placement of pigtail cystostomy tubes in dogs with urethral obstruction.

J Vet Emerg Crit Care (San Antonio) 2019 May 17;29(3):331-336. Epub 2019 Apr 17.

College of Veterinary Medicine, North Carolina State University, Raleigh, NC.

Background: Circumstances such as the inability to pass a retrograde urinary catheter or a lack of surgeon availability may prevent immediate relief of urethral obstruction in dogs. In such situations, a cystostomy tube may be placed with ultrasound guidance to allow urinary diversion until further treatment is possible.

Key Findings: A case of a 5-year-old male neutered Swiss Mountain dog with an obstructive urolith at the level of the os penis is used to describe the technique. Multiple attempts to pass a urinary catheter under sedation were unsuccessful. A pigtail cystostomy tube was placed with ultrasound guidance to allow urinary diversion. The dog was discharged from the hospital within 2 days after scrotal urethrostomy and the dog made a full recovery. Ultrasound-guided placement of a pigtail cystostomy tube was straightforward and without complications.

Significance: Ultrasound-guided placement of a pigtail cystostomy tube may be beneficial as it is not technically challenging, can be performed rapidly, and may avoid the need for general anesthesia. Additionally, ultrasound is readily available and an inexperienced ultrasonographer can easily locate the urinary bladder. This report serves to provide a detailed technique of ultrasound-guided placement of a pigtail cystostomy tube in dogs for emergency urinary diversion.
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http://dx.doi.org/10.1111/vec.12832DOI Listing
May 2019

Systemic and Local Management of Burn Wounds.

Vet Clin North Am Small Anim Pract 2017 Nov 10;47(6):1149-1163. Epub 2017 Aug 10.

Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC 27607, USA.

Management of severe burn injury (SBI) requires prompt, complex, and aggressive care. Despite major advances in the management of SBI-including patient-targeted resuscitation, management of inhalation injuries, specific nutritional support, enhanced wound therapy, and infection control-the consequences of SBI often result in complex, multiorgan metabolic changes. Consensus guidelines and clinical evidence regarding specific management of small animal burn patients are lacking. This article aims to review updated therapeutic consideration for the systemic and local management of SBI that are proven effective to optimize outcomes in human burn patients and may translate to small animal patients.
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http://dx.doi.org/10.1016/j.cvsm.2017.06.003DOI Listing
November 2017

Maintenance Fluid Therapy: Isotonic Versus Hypotonic Solutions.

Vet Clin North Am Small Anim Pract 2017 Mar 29;47(2):383-395. Epub 2016 Nov 29.

North Carolina State Veterinary Hospital, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA.

The goal of maintenance fluid therapy in small animals is to replace normal ongoing losses of water and salts when oral intake is withheld. Hospitalized dogs and cats may have multiple stimuli for antidiuretic hormone release that disrupt normal osmoregulation and predispose to water retention. Severe illness promotes retention of both sodium and water as edema. Commercially available fluids have electrolyte concentrations that are very different from dietary maintenance requirements, and potential consequences include development of hypoosmolality, edema, or both when excesses of water or sodium are administered. Suggestions for tailoring fluid administration toward specific goals are provided.
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http://dx.doi.org/10.1016/j.cvsm.2016.10.001DOI Listing
March 2017

Severe Pit Viper Envenomation with Extended Clinical Signs and Treatment Complications in a Dog.

J Am Anim Hosp Assoc 2015 Sep-Oct;51(5):329-37

From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL (M.S., G.B., B.C., L.C., A.V., A.E.V., J.C., C.B.); and Lake Veterinary Clinic, Mt. Dora, FL (D.D.).

This manuscript describes the extended clinical abnormalities that can occur in severe snake envenomation and the clinical signs associated with antivenom hypersensitivity in a 3 yr old dog. Treatment consisted of IV fluid therapy, analgesics, a vasopressor, cardiac antiarrhythmia drugs, and polyvalent pit viper antivenom. Following initial response to treatment, relapse of clinical signs occurred. Most interesting was the recrudescence of clinical signs on day 7 that may have been caused by the release of deposited venom during surgical debridement of necrotic skin. The resulting extensive clinical signs required multiple vials of antivenom (22 vials over a 7 day period). Both F(ab')2 antivenom and antivenin (Crotalidae) polyvalent were used in this dog because of availability logistics. It is thought that this large amount of antivenom resulted in type I (anaphylaxis) and type III hypersensitivity (serum sickness) reactions. The dog made a complete clinical recovery. This description of extended, fluctuating clinical abnormalities that were associated with envenomation together with the development of hypersensitivity reactions that were presumably secondary to antivenom administration is information that can be useful for the management of patients afflicted with severe pit viper envenomation.
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http://dx.doi.org/10.5326/JAAHA-MS-6234DOI Listing
August 2016

Comparison of cardiac output determined by an ultrasound velocity dilution cardiac output method and by the lithium dilution cardiac output method in juvenile horses with experimentally induced hypovolemia.

Am J Vet Res 2014 Jun;75(6):565-71

Departments of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32606.

Objective: To assess the accuracy of an ultrasound velocity dilution cardiac output (UDCO) method, compared with that of the lithium dilution cardiac output (LiDCO) method, for determination of cardiac output (CO) in juvenile horses with experimentally induced hypovolemia.

Animals: 12 anesthetized 2- to 6-month-old horses.

Procedures: For each anesthetized horse, CO was determined by the LiDCO and UDCO methods prior to any intervention (baseline state), after withdrawal of approximately 40% of the horse's blood volume (low CO state), after maintenance of hypovolemia and infusion of norepinephrine until mean arterial blood pressure was equal to baseline value (high CO state), and after further infusion of norepinephrine and back-transfusion of withdrawn blood (posttransfusion state). For each of the 4 hemodynamic situations, CO and calculated cardiac index (CI) values were obtained by each method in duplicate (8 pairs of measurements/horse); mean values for each horse and overall mean values across all horses were calculated. Agreement between CI determined by each method (96 paired values) was assessed by Bland-Altman analysis.

Results: For the UDCO method-derived CI measurements among the 12 horses, mean ± SD bias was -4 ± 11.3 mL/kg/min (95% limits of agreement, -26.1 to 18.2 mL/kg/min) and mean relative bias was -10.4 ± 21.5% (95% limits of agreement, -52.6% to 31.8%).

Conclusions And Clinical Relevance: Results indicated that, compared with the LiDCO method, the UDCO method has acceptable clinical usefulness for determination of CO in foals.
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http://dx.doi.org/10.2460/ajvr.75.6.565DOI Listing
June 2014

Anesthesia and analgesia for standing equine surgery.

Vet Clin North Am Equine Pract 2014 Apr 31;30(1):1-17. Epub 2013 Dec 31.

Department of Large Animal Clinical Science, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA.

Morbidity and mortality rate in equine anesthesia is still unacceptably high. Thus it is critical contemplating whether the benefit of general anesthesia for a specific patient and procedure outweighs the risks. Sedative protocols that would allow performing diagnostic and surgical procedures with the patient remaining standing would therefore be ideal. Infusion of short-acting agents allows to rapidly achieve a titratable steady state of sedation. Supplementing sedatives and tranquilizers with systemic analgesic or regional anesthetic techniques (i.e. epidurals) facilitates standing surgical procedures. Multimodal analgesia would also provide superior analgesia with potentially fewer side effects than a single agent approach.
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http://dx.doi.org/10.1016/j.cveq.2013.11.008DOI Listing
April 2014

Computed tomography angiography of coarctation of the aorta in a dog.

J Vet Cardiol 2013 Dec 28;15(4):277-81. Epub 2013 Oct 28.

Department of Surgery, Section of Veterinary Clinical Studies, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Ireland. Electronic address:

Coarctation of the aorta has been described previously as either a post-mortem or angiographic finding in three dogs with clinical signs related to the aortic coarctation. A 10-year-old dog was presented for evaluation of suspected laryngeal paralysis. On physical examination, femoral pulses were absent bilaterally, with an indirect systolic blood pressure difference of 60 mmHg between the ipsilateral thoracic and pelvic limbs. Coarctation of the aorta was detected on a thoracic computed tomographic angiography study. The coarctation was pre-ductal in position, with extensive dilation of the descending thoracic aorta. Characteristic rib changes that are seen in humans with coarctation were not apparent in this dog. 3D reconstructions of the thorax provided high vascular definition with exact localization of the aortic narrowing.
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http://dx.doi.org/10.1016/j.jvc.2013.09.001DOI Listing
December 2013

Single-incision, multicannulated, laparoscopic ovariectomy in two tigers (Panthera tigris).

Vet Q 2013 Jun 14;33(2):108-11. Epub 2013 Apr 14.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL 32608, USA.

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http://dx.doi.org/10.1080/01652176.2013.783951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886627PMC
June 2013

Cardiopulmonary effects of a new inspiratory impedance threshold device in acute hemorrhagic shock in dogs.

J Vet Emerg Crit Care (San Antonio) 2011 Dec 22;21(6):618-24. Epub 2011 Nov 22.

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA.

Objective: To compare cardiovascular and respiratory effects of an inspiratory impedance threshold device (ITD) in dogs before and after induction of acute hemorrhagic shock.

Study Design: Prospective experimental randomized study.

Animals: Eight healthy adult dogs.

Methods: Dogs were anesthetized and maintained on spontaneous ventilation. Tidal volume (V(T)), systolic, mean and diastolic arterial blood pressure (SAP, MAP, DAP), central venous pressure (CVP), gastric P(CO2) (GBF) as an indicator of gastric perfusion, cardiac index (CI), systemic vascular resistance (SVR), oxygen delivery (DO(2)), and plasma lactate were monitored. To monitor respiratory compliance (RC) and respiratory resistance (ResR), animals were briefly placed on mechanical ventilation. Dogs were studied under 4 different conditions: (1) baseline (euvolemic state) (MAP > 60 mm Hg) with and without the ITD and (2) acute hemorrhagic shock (hypovolemic state) (target MAP of 40 mm Hg) with and without ITD. These 4 conditions were performed during one anesthetic period, allowing time for stabilization of parameters for each condition. Data were analyzed by ANOVA for repeated measure mixed models.

Results: No cardiovascular changes were detected between groups with and without use of ITD during euvolemic states. During acute hemorrhagic hypovolemic state, CI and DO(2) were higher with the ITD (2.9 ± 0.6 L/min/m(2)) and (326.5 ± 86.8 mL/min) compared with no ITD (1.8 ± 0.6 L/min/m(2)) and (191.3 ± 58.1 mL/min), respectively. The use of ITD during hypovolemia also increased SAP and MAP. There was an increase in ResR and decreased RC with the ITD in both euvolemic and hypovolemic states.

Conclusion And Clinical Relevance: The use of an ITD in dogs during acute hemorrhagic hypovolemic shock improved cardiovascular parameters but had negative effects on RC and ResR.
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http://dx.doi.org/10.1111/j.1476-4431.2011.00692.xDOI Listing
December 2011

Quantitative response of volumetric variables measured by a new ultrasound dilution method in a juvenile model of hemorrhagic shock and resuscitation.

Resuscitation 2012 Aug 25;83(8):1031-7. Epub 2012 Jan 25.

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.

Objective: New volumetric variables of preload, such as total end-diastolic volume index (TEDVI) and active circulation volume index (ACVI) and central blood volume index (CBVI), may represent good indicators of preload and predictors of fluid responsiveness. During acute changes of intravascular volume these variables would allow a more accurate intervention.

Aim: The aim of the present study was to investigate the changes in TEDVI, ACVI, CBVI in a juvenile model of hemorrhagic shock and resuscitation.

Methods: Twelve anaesthetized ponies (3-8 months of age) were studied at normovolaemia (BASE), after blood withdrawal to mean arterial pressure (MAP) of 40 mmHg (HEMO), after infusion of norepinephrine to reach a MAP of ± 10% of baseline (HE-NE), and after retransfusion of shed blood (RESU). TEDVI, ACVI, CBVI were measured by Ultrasound Dilution (UD) technology with CoStatus device. Data were analyzed using 1-way (ANOVA) followed by Bonferroni's multiple pairwise comparisons. Evaluation of dependence between CoStatus volumetric variables and stroke volume index (SVI) were performed using the linear regression analysis and calculating the r(2) coefficient of determination.

Results: TEDVI and ACVI changed significantly during HEMO and RESU status. NE administration induced MAP and CVP significant changes, whereas TEDVI and ACVI remained unchanged. CBVI showed high variability and seemed to be inconsistent on the identification of the volume status. In the correlation analysis, only TEDVI consistently correlated with SVI and volume induced SVI changes.

Conclusions: In this animal model, TEDVI and ACVI were superior to CBVI in consistently reflecting hemorrhage. TEDVI but not ACVI and CBVI correlated with volume-induced changes in SVI. NE administration did not affect this correlation.
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http://dx.doi.org/10.1016/j.resuscitation.2012.01.014DOI Listing
August 2012

Determination of cardiac output by ultrasound velocity dilution in normovolemia and hypovolemia in dogs.

Vet Anaesth Analg 2011 Jul 1;38(4):279-85. Epub 2011 Jun 1.

Department of Large Animal Clinical Sciences, University of Florida College Veterinary Medicine, Gainesville, FL 32610-0136, USA.

Objective: The purpose of this study was to compare CO measured by use of lithium dilution (LiDCO) and ultrasound velocity dilution (UDCO) in a canine model of acute hemorrhage.

Study Design: Prospective descriptive evaluation.

Animals: Twelve dogs (15-34 kg).

Methods: Dogs were anesthetized and instrumented to measure direct blood pressure, heart rate, arterial blood gases and CO. The CO was measured by use of LiDCO and UDCO techniques. Measurements were obtained from each animal at baseline and during a low CO state (hemorrhagic state). Measurements were converted to cardiac index (CI = CO/BSA) values for statistical analysis. To measure CO using UDCO, a 20 mL bolus of 0.9% sodium chloride was administered and CO was calculated from the transient dilution of blood proteins created by the injection bolus. Hypovolemia was induced by withdrawing 40% of the blood volume until the mean arterial blood pressure (MAP) was stable at 40 mmHg for 10 minutes. Agreement was determined using Bland & Altman analysis and concordance correlation coefficients.

Results: Twenty-four comparisons were made. Lithium determinations of CI ranged between 7.5 and 1.3 L minute(-1) m(-2), and the mean overall difference between the two methods was -0.40 L minute(-1) m(-2). The mean relative bias was -17 ± 21% (limits of agreements: -59% to 25%). There was no significant effect of state of CI on bias or relative bias (p = 0.24 and p = 0.10, respectively). The concordance correlation coefficient between LiDCO and UDCO as 0.88 (p < 0.0001).

Conclusions: When compared to lithium dilution, the UDCO technique is a viable method for measuring cardiac output in a model of normovolemia and hypovolemia in dogs.
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http://dx.doi.org/10.1111/j.1467-2995.2011.00604.xDOI Listing
July 2011

Evaluation of an indirect oscillometric blood pressure monitor in normotensive and hypotensive anesthetized dogs.

J Vet Emerg Crit Care (San Antonio) 2010 Jun;20(3):313-8

Departments of Large Animal Clinical Science, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA.

Objective: To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs.

Design: Prospective observational study.

Setting: University teaching hospital.

Animals: Eight crossbred adult dogs.

Interventions: Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end-tidal isoflurane concentration at 1.2+/-0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia.

Measurements And Main Results: Agreement between the direct and indirect BP measurements was determined by the Bland-Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were -14.7 mm Hg (15.5 mm Hg), -16.4 mm Hg (12.1 mm Hg), and -14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were -32 mm Hg (22.6 mm Hg), -24.2 mm Hg (19.5 mm Hg), and -16.8 mm Hg (17.2 mm Hg), respectively.

Conclusion: The oscillometric device was not reliably predictive of intra-arterial BP during hypotension associated with acute hemorrhage.
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http://dx.doi.org/10.1111/j.1476-4431.2010.00536.xDOI Listing
June 2010

Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs.

Vet Anaesth Analg 2010 May 10;37(3):215-21. Epub 2010 Mar 10.

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA.

Objective: To compare the hemodynamic and respiratory effects of an inspiratory impedance threshold device (ITD) in anesthetized normotensive and hypotensive dogs.

Study Design: Prospective randomized study.

Animals: Ten adult dogs.

Methods: Dogs were anesthetized with propofol followed by isoflurane. During spontaneous ventilation, tidal volume (.VT), systolic (SAP), mean (MAP) and diastolic arterial blood pressure, central venous pressure, gastric PCO(2) as an indicator of gastric perfusion, subcutaneous oxygen tension, subcutaneous blood flow, cardiac index (CI), systemic vascular resistance and blood lactate were monitored. To monitor respiratory compliance (RC) and resistance (ResR), animals were briefly placed on mechanical ventilation. Dogs were studied under four different conditions: 1) normotension (MAP > 60 mmHg) with and without the ITD and 2) hypotension (target MAP = 40 mmHg) with and without ITD. These four conditions were performed during one anesthetic period, allowing for stabilization of parameters for each condition. Data were analyzed by anova repeated measure mixed models.

Results: No cardiovascular changes were detected between no ITD and ITD in the normotensive state. During hypotension, CI was higher with the ITD (5 +/- 1.0 L minute(-1) m(-2)) compared with no ITD (4 +/- 1.3 L minute(-1) m(-2)). During hypotension, SAP was increased with ITD (80 +/- 14 mmHg) versus without ITD (67 +/- 13 mmHg). There was an increase in ResR and decreased RC with the ITD in both normotensive and hypotensive state.

Conclusion And Clinical Relevance: Impedance threshold device in dogs during isoflurane-induced hypotension improved CI and SAP but had negative effects on RC and ResR.
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http://dx.doi.org/10.1111/j.1467-2995.2009.00524.xDOI Listing
May 2010