Paula F. Moon

Perioperative risk factors for puppies delivered by cesarean section in the United States and Canada.

The purpose of this study was to evaluate perioperative risk factors affecting neonatal survival after cesarean section. Data from 807 cesarean-derived litters (3,908 puppies) was submitted by 109 practices in the United States and Canada. Survival rates immediately, two hours, and seven days after delivery were 92% (n=3,127), 87% (n=2,951), and 80% (n=2,641), respectively, for puppies delivered by cesarean section (n=3,410) and were 86% (n=409), 83% (n=366), and 75% (n=283), respectively, for puppies born naturally (n=498). Maternal mortality rate was 1% (n=9). Of 776 surgeries, 453 (58%) were done on an emergency basis. The most common breed of dog was bulldog (n=138; 17%). The most common methods of inducing and maintaining anesthesia were administration of isoflurane for induction and maintenance (n=266; 34%) and administration of propofol for induction followed by administration of isoflurane for maintenance (n=237; 30%). A model of cesarean-derived puppies surviving to birth, between birth and two hours, and between two hours and seven days was designed to relate litter survival to perioperative factors. The following factors increased the likelihood of all puppies being alive: the surgery was not an emergency; the dam was not brachycephalic; there were four puppies or less in the litter; there were no naturally delivered or deformed puppies; all puppies breathed spontaneously at birth; at least one puppy vocalized spontaneously at birth; and neither methoxyflurane nor xylazine was used in the anesthetic protocol.

Neonatal critical care

The first few minutes after a neonates birth may determine the quality of its entire life. Immediate care includes prevention of hypothermia, clearing of nasal and oral passages, stimulation of ventilation and oxygenation, and, in a few cases, advanced life support. Any additional stress during the first weeks of life can also result in neonatal morbidity and mortality. Care of the diseased newborn must focus not only on treatment of the underlying disease but on aggressive supportive care. A safe, warm, clean, proper environment and adequate nutrition are essential.

Effect of Fentanyl on the Minimum Alveolar Concentration of Isoflurane in Swine

Background Fentanyl is used in anesthetic protocols for swine, but there are no reports on its potency in this species. This study measured the extent to which fentanyl reduces the minimum alveolar concentration of isoflurane (MACISO) in swine.

Fetal oxygen content is restored after maternal hemorrhage and fluid replacement with polymerized bovine hemoglobin, but not with hetastarch, in pregnant sheep.

We investigated the ability of hemoglobin-based oxygen carrying solutions (HBOCs) to alleviate fetal hypoxemia from maternal hemorrhage. Fifteen pregnant ewes (132-day gestational age) were hemorrhaged 20 mL/kg over 1 h; they were randomized to receive 20 mL/kg IV of HBOC, hetastarch (HTS), or autologous blood (BLD) (n = 5 each) over 30 min and were monitored for 2 h. Hemorrhage significantly (P ≤ 0.05) decreased maternal mean blood pressure (from 98 to 48 mm Hg, median), arterial oxygen content (from 12.2 to 11.1 mL/dL), and fetal arterial oxygen content (from 8.1 to 3.9 mL/dL). Fluid replacement restored maternal blood pressure in all groups, although maternal oxygen content immediately returned to baseline only after BLD or HBOC. Maternal oxygen saturation decreased after HBOC (from 98% to 88%). Fetal oxygen content rapidly returned to baseline with either BLD (7.1 mL/dL) or HBOC (8.0 mL/dL) but was never restored with HTS (4.7 mL/dL), and, 60 min after fluid replacement, it was higher with HBOC (8.3 mL/dL) than with HTS (4.7 mL/dL). Fetal plasma-free hemoglobin did not change after HBOC. In conclusion, maternal fluid replacement with HBOC or BLD effectively restored fetal oxygenation, primarily by restoring maternal oxygen content, whereas HTS did not.

Fetal exposure to magnesium chloride-adenosine triphosphate (MgCl2-ATP) results in alterations in cerebral blood flow and a metabolic acidosis.

Objective Magnesium chloride-adenosine triphosphate (MgCl2-ATP), advocated as an adjunct treatment in shock resuscitation, might be useful for pregnant women who develop hypovolemia secondary to conditions such as placental abruption. The effects of this treatment on the fetus, however, have never been investigated. This study determined the direct, acute effects of MgCl2-ATP on fetal organ blood flow, hemodynamic measurements, and metabolic parameters before and after maternal hemorrhage. Design Experimental, randomized, nonblinded, control study. Setting Animal laboratory at a university research facility. Subjects This study was performed on 11 chronically instrumented, 123-day gestational age, pregnant ewes (term = 147 days) and their fetuses. Interventions Ewes were randomly allocated to either experimental (Expt, n = 5) or control (Cntl, n = 6) groups. After a 60-min baseline period, Expt fetuses received a 60-min iv infusion of MgCl2-ATP (150 &mgr;mole/hr each of MgCl2 and ATP; at 3 mL/hr), and Cntl fetuses received an equivalent volume of 0.9% NaCl. After this infusion-only period, the infusion was continued, and ewes were intermittently bled over 1 hr for a total blood loss of 20 mL/kg (hemorrhage-plus-infusion period). After this, the infusions were continued, and ewes and fetuses were monitored for 1 additional hr (posthemorrhage period). Measurements At the end of all periods, fetal and maternal blood pressures, blood gases, oxygen saturation, hemoglobin, serum electrolytes, and serum glucose concentrations were measured. At the end of the baseline, infusion-only, and hemorrhage-plus-infusion periods, fetal organ blood flows were determined using a fluorescent microsphere technique. Nonparametric statistics were used for comparisons (2-tailed, p ≤ .05). Main Results Maternal hemorrhage caused maternal hypotension, resulting in a decrease in fetal oxygen content and an increase in fetal hemoglobin and glucose concentrations. The changes were similar in both groups. In both groups, a progressive fetal metabolic acidosis developed during the hemorrhage period and it continued through the posthemorrhage period. This metabolic acidosis was more severe in the Expt fetuses and appeared to have started during the infusion-only period. There were no fetal deaths in either group. In the Cntl fetuses, there were increases from baseline after the hemorrhage-plus-infusion period in fetal adrenal (71%), brain (89%), and thymus (18%) blood flow and a decrease in muscle (−28%) blood flow. In the Expt fetuses, there were increases during the infusion-only period in adrenal (332%), myocardial (142%), and pancreatic (219%) blood flow and decreases in kidney (−25%) and skin (−75%) blood flow. These changes persisted during the hemorrhage-plus-infusion period. Most strikingly, regional cerebral blood flow in the Expt fetuses did not increase from baseline in any of the 10 brain areas sampled during the infusion-only period or following maternal hemorrhage. In Cntl fetuses, however, there was increase in blood flow in all 10 brain areas sampled following maternal hemorrhage. Conclusions In healthy fetuses, direct MgCl2-ATP exposure caused metabolic acidosis and a redistribution of cardiac output to different organs. When the MgCl2-ATP fetuses were then subject to the effects of maternal hemorrhage, the expected increase in cerebral blood flow was not observed. Although an earlier study suggests that ATP may be beneficial to stressed fetuses when administered to mothers in labor, the direct effect of MgCl2-ATP appears to be potentially harmful by producing an acidosis and altering the normal fetal cerebral blood flow response to maternal hemorrhage.