R. Reid Hanson

Effects of intravenous lidocaine overdose on cardiac electrical activity and blood pressure in the horse

This study aimed to identify blood serum lidocaine concentrations in the horse which resulted in clinical signs of intoxication, and to document the effects of toxic levels on the cardiovascular and cardiopulmonary systems. Nineteen clinically normal mature horses of mixed breed, age and sex were observed. Lidocaine administration was initiated in each subject with an i.v. loading dose of 1.5 mg/kg bwt and followed by continuous infusion of 0.3 mg/kg bwt/min until clinical signs of intoxication were observed. Intoxication was defined as the development of skeletal muscle tremors. Prior to administration of lidocaine, blood samples for lidocaine analysis, heart rate, mean arterial blood pressure, systolic blood pressure, diastolic blood pressure, respiratory rate and electrocardiographic (ECG) data were collected. After recording baseline data, repeat data were collected at 5 min intervals until signs of intoxication were observed. The range of serum lidocaine concentrations at which the clinical signs of intoxication were observed was 1.85-4.53 microg/ml (mean +/- s.d. 3.24 +/- 0.74 microg/ml). Statistically significant changes in P wave duration, P-R interval, R-R interval and Q-T interval were observed in comparison to control values, as a result of lidocaine administration. These changes in ECG values did not fall outside published normal values and were not clinically significant. Heart rate, blood pressures and respiratory rates were unchanged from control values. This study establishes toxic serum lidocaine levels in the horse, and demonstrates that there were no clinically significant cardiovascular effects with serum lidocaine concentrations less than those required to produce signs of toxicity.

Comparison of direct and indirect methods of intra-abdominal pressure measurement in normal horses.

OBJECTIVES To develop a direct method for measuring intra-abdominal pressures in the standing horse, identify a reference interval for direct intra-abdominal pressures, compare these pressures to indirect intra-abdominal pressures measured from the bladder, and determine the optimal bladder infusion volume for indirect pressure measurement. DESIGN Prospective, experimental study. SETTING A university-based equine research facility. ANIMALS Ten healthy adult horses, 5 males and 5 females. INTERVENTIONS Direct intra-abdominal pressures were measured through an intraperitoneal cannula and zeroed at the height midway between the height of the tuber ishii and point of the shoulder. Indirect measurements of intra-abdominal pressure were performed by measuring intravesicular pressures through a transurethral catheter zeroed at the tuber ishii. MEASUREMENTS AND MAIN RESULTS Direct pressure measurements obtained in the standing horse were subatmospheric (mean, -1.80 cm H(2)O; SD, 1.61 cm H(2)O; 95% CI, -2.80 to -0.80) and were shown to decrease as the horses weight increased (Pearsons r=-0.67, P=0.04), with no effect of head position (P=0.15). Mean baseline indirect pressure measurements (mean, -8.63 cm H(2)O; SD, 4.37 cm H(2)O; 95% CI, -13.05 to -4.21) were significantly different from the pressures measured directly from the abdomen (P<0.001). Indirect pressure measurements were noted to increase with increasing volumes infused into the bladder, and were statistically different at a volume of 100 mL (P=0.004). There was low to moderate correlation between direct and indirect pressure measurements of intra-abdominal pressure over a range of fluid volumes infused into the bladder (Pearsons correlation range -0.38 to 0.58). CONCLUSION Pressures measured directly in the standing horse were subatmospheric, and increased as the horses weight increased. Indirect pressures measured were altered by increasing volumes infused in the bladder. There was no significant correlation between the 2 methods of intra-abdominal pressure measurement.

Complications of Equine Wound Management and Dermatologic Surgery

Complications of wounds and cosmetic surgery can be accurately managed with a combination of timely surgical and medical intervention to ensure the best possible outcome. The lack of soft tissue protection and a large quantity of susceptible synovial, tendon, ligament, and neurovascular structures make early and meticulous evaluation of limb wounds critical. Skin grafting is usually used following a period of open wound management and after healthy granulation tissue formation. Penetrating wounds of the abdomen or thorax have a guarded prognosis resulting from the ensuing potential for infection and pneumothorax. Gunshot wounds limited to the skeletal muscles have a good prognosis, whereas injuries that involve vital organs decreased survivability.

Validation of a low-dose ACTH stimulation test in healthy adult horses

OBJECTIVE To determine the lowest ACTH dose that would induce a maximum increase in serum cortisol concentration in healthy adult horses and identify the time to peak cortisol concentration. DESIGN Evaluation study. ANIMALS 8 healthy adult horses. PROCEDURES Saline (0.9% NaCl) solution or 1 of 4 doses (0.02, 0.1, 0.25, and 0.5 μg/kg [0.009, 0.045, 0.114, and 0.227 μg/lb]) of cosyntropin (synthetic ACTH) were administered IV (5 treatments/horse). Serum cortisol concentrations were measured before and 30, 60, 90, 120, 180, and 240 minutes after injection of cosyntropin or saline solution; CBCs were performed before and 30, 60, 120, and 240 minutes after injection. RESULTS For all 4 doses, serum cortisol concentration was significantly increased, compared with the baseline value, by 30 minutes after administration of cosyntropin; no significant differences were detected among maximum serum cortisol concentrations obtained in response to administration of doses of 0.1, 0.25, and 0.5 μg/kg. Serum cortisol concentration peaked 30 minutes after administration of cosyntropin at a dose of 0.02 or 0.1 μg/kg, with peak concentrations 1.5 and 1.9 times, respectively, the baseline concentration. Serum cortisol concentration peaked 90 minutes after administration of cosyntropin at a dose of 0.25 or 0.5 μg/kg, with peak concentrations 2.0 and 2.3 times, respectively, the baseline concentration. Cosyntropin administration significantly affected WBC, neutrophil, and eosinophil counts and the neutrophil-to-lymphocyte ratio. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in healthy horses, administration of cosyntropin at a dose of 0.1 μg/kg resulted in maximum adrenal stimulation, with peak cortisol concentration 30 minutes after cosyntropin administration.

Comparison of equine articular cartilage thickness in various joints

Abstract Purpose: Thicknesses of fresh equine articular cartilage surfaces from the fetlock, carpal and stifle joints were measured employing a needle probe test. Materials and methods: Eighty-seven samples used in measurement were cultivated from fetlock, carpal and stifle joints of 12 deceased within 4 h of death. After approximately three minutes of exposure to air during dissection, all cartilage samples were preserved in a saline solution to keep the articular cartilage hydrated for testing. The thickness was measured on five different spots on the same sample. The thicknesses of the fetlock, carpus and stifle were compared. Results: The articular cartilage of the stifle was thicker than the fetlock and carpus, while the fetlock and the carpus had similar thickness values. The average thickness of the fetlock, carpal and stifle joint are 0.86, 0.87 and 2.1 mm, respectively. They were statistically compared using the Student t-test. The differences on the articular cartilage thicknesses between the fetlock and stifle, and carpus and stifle were “very highly significant” (p < 0.001). This indicates that the articular cartilage thickness of the stifle is significantly different from that of the fetlock and carpus. Four different surfaces in the fetlock and four in the carpal joint were also compared. Significant differences between each set of the four surfaces were not observed. In the carpus, the difference in thickness between the distal radius and proximal third carpal bone articular cartilage surfaces as well as the proximal radial carpal bone and distal radial carpal bone articular cartilage surfaces were statistically significant.

The average roughness and fractal dimension of articular cartilage during drying

Cartilage is a unique material in part because of it biphasic properties. The structure of cartilage is a porous matrix of collagen fibers, permeated with synovial fluid which creates a gliding and near frictionless motion in articulating joints. However, during in vitro testing or surgery, there exists potential for cartilage to dehydrate, or dry out. The effects of this drying can influence experimental results. It is likely that drying also changes joint performance in vivo. In in vitro testing of equine cartilage explants exposed to open air, the average roughness of cartilage changes from 1.85 ± 0.78 to 3.66 ± 1.41 µm SD in a 5-h period. Significant changes in roughness in individual samples are seen within 10 min of exposure to open air. However, the multi-scale nature of cartilage, characterized by the fractal dimension, does not significantly change during the same period. The current study attempts to quantify the magnitude of error that is introduced when cartilage is removed from its native environment.

A Surface Roughness Comparison of Cartilage in Different Types of Synovial Joints

The naturally occurring structure of articular cartilage has proven to be an effective means for the facilitation of motion and load support in equine and other animal joints. For this reason, cartilage has been extensively studied for many years. Although the roughness of cartilage has been determined from atomic force microscopy (AFM) and other methods in multiple studies, a comparison of roughness to joint function has not be completed. It is hypothesized that various joint types with different motions and regimes of lubrication have altered demands on the articular surface that may affect cartilage surface properties. Micro- and nanoscale stylus profilometry was performed on the carpal cartilage harvested from 16 equine forelimbs. Eighty cartilage surface samples taken from three different functioning joint types (radiocarpal, midcarpal, and carpometacarpal) were measured by a Veeco Dektak 150 Stylus Surface Profilometer. The average surface roughness measurements were statistically different for each joint. This indicates that the structure of cartilage is adapted to, or worn by, its operating environment. Knowledge of cartilage micro- and nanoscale roughness will assist the future development and design of treatments for intra- articular substances or surfaces to preserve joint integrity and reduce limitations or loss of joint performance.

Biomimetic Model of Articular Cartilage Based on In Vitro Experiments

Articular cartilage is a complicated material to model for a variety of reasons: its biphasic/triphasic properties, heterogeneous structure, compressibility, unique geometry, and variance between samples. However, the applications for a biomimetic, cartilage-like material are numerous and include: porous bearings, viscous dampers, robotic linkages, artificial joints, etc. This work reports experimental results on the stress-relaxation of equine articular cartilage in unconfined compression. The response is consistent with simple spring and damper systems, and gives a storage and loss moduli. This model is proposed for use in evaluating biomimetic materials, and can be incorporated into large-scale dynamic analyses to account for motion or impact. The proposed characterization is suited for high-level analysis of multi-phase materials, where separating the contribution of each phase is not desired.

Use of a Barbed Knotless Suture for Laparoscopic Ablation of the Nephrosplenic Space in 8 Horses

OBJECTIVE To evaluate use of a knotless suture for laparoscopic closure of the equine nephrosplenic space. STUDY DESIGN Experimental in vivo study. ANIMALS Normal horses without previous history of abdominal surgery (n=8). METHODS The nephrosplenic space was closed under laparoscopic visualization using a unidirectional, barbed 0 metric absorbable suture (copolymer of glycolic acid and trimethylene carbonate). Intracorporeal suturing of the nephrosplenic space was performed in a cranial-to-caudal direction in a simple continuous fashion. Repeat evaluation was performed laparoscopically in 2 horses and by necropsy in 6 horses. The length of closure was measured and nature of the healed tissue was evaluate grossly. RESULTS Total surgery time was 65-167 minutes (mean ± SD, 89.6 ± 22.6). Suturing time was 30-65 minutes (40.4 ± 16.3). Second laparoscopy in 2 horses was performed at days 198 and 227. Necropsy was performed at day 69-229 postoperatively (132.7 ± 63.0) in 6 horses. The closure measured 12-14 cm in length (13 ± 1) and consisted of mature fibrous tissue bridging the splenic capsule and the nephrosplenic ligament. No residual suture material was identified grossly in any horses. The procedure was easily performed; extracorporeal suture management to hold it taut was unnecessary since the barbs had excellent purchase in the apposed tissues, and intracorporeal knot tying was not required. CONCLUSION The barbed knotless suture appears to be a valid alternative to facilitate laparoscopic closure of the nephrosplenic space in normal horses; however, further work is necessary to investigate its suitability in clinically affected horses.

In Vitro Evaluation of the Aberdeen Knot for Continuous Suture Patterns with Large Gauge Suture

OBJECTIVE To evaluate the strength, size, and holding capacity of the Aberdeen knot compared to surgeons and square knots using large gauge suture. STUDY DESIGN In vitro mechanical study. STUDY POPULATION Knotted suture. METHODS Aberdeen, surgeons, and square knots were tested using 2 and 3 USP polyglactin 910 and 2 USP polydioxanone under linear tension on a universal testing machine. Mode of failure and knot holding capacity (KHC) were recorded and relative knot security (RKS) was calculated as a percentage of KHC. Knot volume and weight were quantified by a digital micrometer and balance, respectively. Strength between number of throws, suture, suture size, and knot type were compared by ANOVA and post hoc testing. P≤.05 was considered significant. RESULTS Aberdeen knots had higher KHC and RKS than surgeons or square knots for all suture types and number of throws (P<.001). For all suture materials, none of the Aberdeen knots unraveled, but a portion of square and surgeons knots with <7 throws did unravel (P=.101). Aberdeen knots had a smaller volume and weight than both surgeons and square knots with equal numbers of throws (P<.001). The knot with the combined highest RKS and smallest size and weight was an Aberdeen knot with 4 throws using 3 USP polyglactin 910. CONCLUSION The Aberdeen knots were stronger, more secure, and smaller than surgeons and square knots for ending a continuous suture pattern. Clinically, the Aberdeen knot may be a useful alternative for completion of continuous patterns using large gauge suture, without sacrificing knot integrity.