Amalia Agut

Ultrasound-guided block of the sciatic and femoral nerves in dogs: a descriptive study.

Ten canine cadavers were used to investigate the anatomy and ultrasonographic approaches to the sciatic (ScN) and femoral (FN) nerves and to assess the accuracy of an ultrasound (US) guided technique to locate and block these nerves in the dog. The nerves of four sedated dogs were sought using US, blocked with 1% lidocaine and successful location confirmed by peripheral neurostimulation. The ScN was identified by US in all cases whereas the FN was not located in all cases. This study validates the usefulness of the US-guided technique to locate and block the ScN at the midfemoral level but the acoustic window of the inguinal region was less successful for locating and blocking the FN.

Computed tomographic anatomy of the temporomandibular joint in the young horse

REASONS FOR PERFORMING STUDY The equine temporomandibular joint (TMJ) and its surrounding structures can be difficult to investigate in cases with a clinical problem related to the region. Little previous attention has been given either to a computed tomographic (CT) imaging protocol for the joint or an interpretation of the structures displayed in CT images of the normal joint. OBJECTIVES To provide a CT atlas of the normal cross-sectional anatomy of the equine TMJ using frozen and plastinated sections as anatomical reference. METHODS Eight TMJs from 4 immature pure-bred Spanish horses were examined by helical CT. Scans were processed with a detailed algorithm to enhance bony and soft tissue. Transverse CT images were reformatted into sagittal and dorsal planes. Transverse, sagittal and dorsal cryosections were then obtained, photographed and plastinated. Relevant anatomic structures were identified in the CT images and corresponding anatomical sections. RESULTS In the CT images, a bone window provided excellent bone detail, however, the soft tissue components of the TMJ were not as well visualised using a soft tissue window. The articular cartilage was observed as a hyperattenuating stripe over the low attenuated subchondral bone and good delineation was obtained between cortex and medulla. The tympanic and petrous part of the temporal bone (middle and inner ear) and the temporohyoid joint were seen in close proximity to the TMJ. CONCLUSIONS Helical CT provided excellent images of the TMJ bone components to characterise the CT anatomy of the normal joint. POTENTIAL RELEVANCE Detailed information is provided that may be used as a reference by equine veterinarians for the CT investigation of the equine TMJ and serve to assist them in the diagnosis of disorders of the TMJ and related structures (middle and inner ear). The study was performed at an immature stage and further studies of mature individuals are required in order to confirm that the clinical interpretation is not affected by changes occurring with age.

Anatomy of the equine temporomandibular joint: study by gross dissection, vascular injection and section.

REASONS FOR PERFORMING STUDY The minute anatomy of the temporomandibular joint (TMJ) in horses is poorly documented in the literature. OBJECTIVES To examine in detail the anatomy of the normal equine TMJ and the relationship of the joint to adjacent structures. METHODS The anatomy of the TMJ was examined in 12 equidae using dissections, synovial and vascular injections and frozen and plastinated sections. Relevant structures were photographed. RESULTS Rostral and caudal compartments were identified in the dorsal and ventral synovial pouches of the TMJ. Lateral and caudal ligaments were identified and attachments of the masticatory muscles over the TMJ were documented. Direct relationships between the TMJ and components of the ear were found, and the vascular supply described. CONCLUSIONS This joint is related to some components of the ear as in man, and has its own peripheral vascular supply. POTENTIAL RELEVANCE A knowledge of the detailed anatomy of the equine TMJ is a prerequisite to interpreting the imaging techniques, and will enable improved diagnosis of TMJ pathologies.

Ultrasonographic characteristics (cross-sectional area and relative echogenicity) of the digital flexor tendons and ligaments of the metacarpal region in Purebred Spanish horses.

The objectives of this study were to establish normal values for relative echogenicity (RE) and cross-sectional area (CSA) of the flexor tendons and ligaments of the metacarpal region of Purebred Spanish horses (PBSH), and to determine the effect of body mass index (BMI), age, sex and forelimb on these variables. Transverse ultrasonographic images were obtained using 20 normal PBSH (10 females, 10 males; 2-25 years of age; BMI 132.04-152.25; not in training). The images were digitised and values for CSA and RE were determined for each structure. The suspensory ligament was the most echogenic and the largest structure, and the superficial digital flexor tendon was the least echogenic and smallest of the tissues examined. The tendons and ligaments of the metacarpal region in PBSH showed similar RE but smaller CSAs when compared to other breeds.

Clinical and radiographic study of bone and joint lesions in 26 dogs with leishmaniasis.

Twenty-six dogs with parasitologically confirmed leishmaniasis and abnormalities of gait were studied to determine the most common radiological patterns of bone and joint lesions. The clinical findings included either lameness, joint pain and crepitation, soft tissue swelling and/or muscle atrophy. Bone lesions were observed radiographically in 12 of the 26 dogs; the radius and ulna were affected in seven, the tibia in six and the femur in six. Joint lesions were observed radiographically in 15 of the 26 dogs; the carpus and stifle were affected in all 15, and the tarsus in nine. There was a tendency for the bones and joints to be affected bilaterally. The radiographic patterns observed were different in the long bones and the joints. In the long bones, the most common pattern was periosteal and intramedullary proliferation, involving the diaphyses and related to the nutrient foramen; in the joints, two patterns, either non-erosive or erosive polyarthritis with soft-tissue swelling, were observed. The changes observed in the synovial fluid were associated in most cases with osteolytic lesions. However, Leishmania organisms were identified in the synovial fluid from joints without bony radiographic changes.

Ventral ultrasound-guided suprainguinal approach to block the femoral nerve in the dog.

This prospective study assessed a ventral ultrasound-guided suprainguinal approach to block the femoral nerve (FN) in dogs. The anatomical features of the FN were evaluated in four canine cadavers. In another five cadavers, the FN was located by ultrasound-guidance and the accuracy of this technique was evaluated by injection of black ink and posterior evaluation of the degree of staining of the nerves. In five live dogs, the FN was blocked with 2% lidocaine. The distribution of lidocaine around the nerve and the presence of motor deficit were evaluated. The FN was easily located and accurately blocked in all cases. This new ultrasound-guided approach was reliable for blocking the FN and might be a suitable alternative to the traditional approaches described to block the FN in the dog.

Ultrasound-guided 'two-in-one' femoral and obturator nerve block in the dog: an anatomical study.

OBJECTIVE To evaluate the dye extent and distribution at the lumbar plexus (LP) of three volumes of local anaesthetic-methylene-blue solution administered close to the femoral nerve (FN) by the use of a ventral ultrasound (US)-guided suprainguinal approach (SIA). STUDY DESIGN Prospective experimental trial. ANIMALS Twenty mongrel canine cadavers weighing 17.7 ± 3.8 kg (mean ± SD). METHODS The left and right LP of two cadavers were dissected to identify the FN, obturator nerve (ON) and lateral femoral cutaneous nerve (LFCN). The extent and distribution of dye at the LP of each of three volumes of injectate of 0.2, 0.4 and 0.6 mL kg(-1) administered close to the FN by a ventral US-guided SIA then were studied in a further 18 dog cadavers (n = 6 per group). Staining of ≥2 cm along the target nerves was indicative of sufficient spread to produce a nerve block. RESULTS The ventral US-guided SIA allowed the observation of the FN within the iliopsoas muscle (IPM) in a total of 17 cadavers. The assessment of the dye extent and distribution revealed a similar pattern regardless of the injected volume. From the injection site, the spreading of injectate occurred in cranial, lateral and caudal directions. The FN and ON were effectively stained in all the cases. The LFCN was not effectively stained in any case. CONCLUSIONS AND CLINICAL RELEVANCE A volume of 0.2 mL kg(-1) administered close to the FN by a ventral US-guided SIA produced a sufficient distribution of the injectate within the IPM to produce effective staining of the FN and ON. This US-guided technique may be an appropriate alternative to previously reported techniques based on electrolocation to block the FN and ON in the dog.

Colour and pulsed Doppler ultrasonographic study of the canine testis.

This study was performed to characterize the normal blood flow of the canine testis and to measure the peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) of testicular arteries weekly during a period of 6 months in five healthy Beagle dogs and to evaluate whether there were any change along this time. The ultrasonographic exams were made with an 11 MHz linear transducer. The vessels of the testes were subdivided into three categories: supratesticular arteries, marginal artery and intratesticular vessels. At the supratesticular arteries, two measurements were recorded at the cranial and the looping parts. No significant differences in any of the parameters studied were observed for the 6 months that the study was performed. The cranial part of the supratesticular artery showed a flow pattern of high-resistive vessel, whereas in the looping part of the supratesticular artery, marginal and intratesticular arteries, the flow showed a low-resistance pattern. PSV, RI and PI values were higher at the cranial part of the supratesticular artery, followed by the looping part of the supratesticular artery, marginal and intratesticular vessels. EDV measurements were higher in the looping part of the supratesticular artery.

Effects of altering the sequence of midazolam and propofol during co‐induction of anaesthesia

OBJECTIVE To assess the effects of varying the sequence of midazolam and propofol administration on the quality of induction, cardiorespiratory parameters and propofol requirements in dogs. STUDY DESIGN Randomized, controlled, clinical study. ANIMALS Thirty-three client owned dogs (ASA I-III, 0.5-10 years, 5-30 kg). METHODS Dogs were premedicated with acepromazine (0.02 mg kg(-1) ) and morphine (0.4 mg kg(-1) ) intramuscularly. After 30 minutes, group midazolam-propofol (MP) received midazolam (0.25 mg kg(-1) ) intravenously (IV) before propofol (1 mg kg(-1) ) IV, group propofol-midazolam (PM) received propofol before midazolam IV at the same doses, and control group (CP) received saline IV, instead of midazolam, before propofol. Supplementary boluses of propofol (0.5 mg kg(-1) ) were administered to effect to all groups until orotracheal intubation was completed. Behaviour after midazolam administration, quality of sedation and induction, and ease of intubation were scored. Heart rate (HR), respiratory rate, and systolic arterial blood pressure were recorded before premedication, post-premedication, after midazolam or saline administration, and at 0, 2, 5, and 10 minutes post-intubation. End-tidal CO2 and arterial oxygen haemoglobin saturation were recorded at 2, 5 and 10 minutes post-intubation. RESULTS Quality of sedation and induction, and ease of intubation were similar in all groups. Incidence of excitement was higher in the MP compared to CP (p = 0.014) and PM (p = 0.026) groups. Propofol requirements were decreased in MP and PM groups with respect to CP (p < 0.001), and in PM compared to MP (p = 0.022). The HR decreased after premedication in all groups, and increased after midazolam and subsequent times in MP (p = 0.019) and PM (p = 0.001) groups. Incidence of apnoea and paddling was higher in CP (p = 0.005) and MP (p = 0.031) groups than in PM. CONCLUSIONS AND CLINICAL RELEVANCE Administration of midazolam before propofol reduced propofol requirements although caused mild excitement in some dogs. Administration of propofol before midazolam resulted in less excitatory phenomena and greater reduction of propofol requirements.

Ultrasound-guided block of the feline sciatic nerve

This study was conducted to validate an ultrasound-guided technique to block the sciatic nerve in cats. An anatomical study was first carried out in four feline cadavers to evaluate the feasibility of the glutea (cranial and caudal), femoris and poplitea ultrasonographical approaches for the sciatic nerve block. The results showed that the femoris approach was optimal because the region was free of vascular and bony structures, and the needle was easily visualised in-plane. Then, the efficacy of the femoris ultrasonographical approach to block the sciatic nerve was tested in six healthy adult experimental cats. A dose of 2 mg/kg lidocaine 2% diluted in saline to a final volume of 1 ml was administered in all cats. The blockade was successful in all cases and the cats recovered uneventfully. This study shows the usefulness of the femoris approach in performing an ultrasound-guided blockade of the sciatic nerve in cats.