Michielsen, Anneleen

Schauvliege, Stijn

English

Ghent University Academic Bibliography

Letter to the Editorwas recommended, because congenital methaemoglobinaemiais reported in Pomeranian dogs (Shino et al 2018). Unfortu-nately, this was declined by the owner.To the authors’ knowledge, this is the ﬁrst report of a pulse co-oximeter being used to detect methaemoglobinaemia in a dog. Inthis case, conventional two-wave-length pulse oximetry showedlow SpO2 but could not determine the underlying cause (Barkeret al 1989). The use of the multiple wave-length pulse co-oximeter identiﬁed a low SpO2 and detected meth-aemoglobinaemia, as reported in human medicine (Barker &Badal 2008). This monitor may be used during anaesthesia orhospitalisation or both as it is noninvasive and shows real-timevalues, unlike blood tests, which may require several days forprocessing. This report highlights the advantages of using amultiple wave-length pulse co-oximeter versus a conventionaltwo-wave-length pulse oximeter in the early detection ofmethaemoglobinaemia, when an animal exhibits cyanosiswithout apparent pulmonary or cardiovascular causes.Authors’ contributionsIS: preparation of manuscript. FM: preparation of manuscript.AL: preparation of manuscript. PB: preparation of manuscript.Conﬂict of interest statementThe authors declare no conﬂict of interest.Ignacio Sandeza,c, Felipe Marquezb, Ana Lopezc &Pierantonio Battiatoda Mobile Anaesthesia Service, Sinergia Veterinaria, Puerta,Galapagar, Spainb Dick White Referrals, Six Mile Bottom, UKc Vetsia Veterinary Hospital, Leganes, Spaind Puchol Veterinary Hospital, Madrid, SpainE-mail: anestesia@sinergiaveterinaria.es (I Sandez)ReferencesBarker SJ, Badal JJ (2008) The measurement of dyshemoglobinsand total hemoglobin by pulse oximetry. Curr Opin Anaesthesiol21, 805e810.Barker SJ, Tremper KK, Hyatt J (1989) Effects of methemoglobi-nemia on pulse oximetry and mixed venous oximetry. Anesthe-siology 70, 112e117.Haskins S, Pascoe PJ, Ilkiw JE et al. (2005) Reference cardiopul-monary values in normal dogs. Comp Med 55, 156e161.Kules J, Mayer I, Rafaj RB et al. (2011) Co-oximetry in clinicallyhealthy dogs and effects of time of post sampling on measure-ments. J Small Anim Pract 52, 628e631.Shino H, Otsuka-Yamasaki Y, Sato T et al. (2018) Familialcongenital methemoglobinemia in Pomeranian dogs caused by amissense variant in the NADH-cytochrome B5 reductase gene.J Vet Intern Med 32, 165e171.710Wright RO, Lewander WJ, Woolf AD (1999) Methemoglobinemia:etiology, pharmacology and clinical management. Ann EmergMed 34, 646e656.Received 5 November 2018; accepted 4 April 2019.Available online 8 June 2019https://doi.org/10.1016/j.vaa.2019.04.005© 2019 Association of Veterinary Anaesthetists and AmericanCollege of Veterinary Anesthesia and Analgesia. Published byElsevier Ltd. All rights reserved.Plexus brachialis block as partof balanced analgesia in asheep undergoing arthrodesisof the carpusThe plexus brachialis block (PBB) is a well-described and reli-able technique for painful surgical procedures below the elbowin small animals and humans (Duke-Novakovski 2016).Ghadirian & Vesal (2013) described its use in experimentalsheep, but little is known about its application under clinicalcircumstances in sheep. Only Rodrigo-Mocholí & Schauvliege(2015) described the paravertebral PBB as part of balancedanaesthesia in a sheep undergoing thoracic limb amputation.A 2 year old Zwartbles sheep (51 kg) was presented forarthrodesis of the left carpus after a chronic infection. Thepreanaesthetic examination did not reveal anomalies asidefrom clear lameness, swelling and varus deformation. Afterpremedication with 0.4 mg kge1 diazepam (Ziapam; Ecuphar,Belgium) and 0.1 mg kge1 methadone (Comfortan; EurovetAnimal Health BV, The Netherlands) intravenously (IV),anaesthesia was induced with 4 mg kge1 propofol (PropoVetMultidose; Zoetis, Belgium) IV and maintained for 195 minuteswith isoﬂurane (IsoFlo; Aesica Queenborough Limited, UK) inoxygen, using a semiclosed circle system (Dr€ager-AV1;Dr€agerwerk AG, Germany). The animal was mechanicallyventilated throughout the anaesthesia period and lactatedRinger’s solution (Vetivex 5000 mL; Dechra Limited, UK) wasinfused at 5 mL kge1 houre1. Meloxicam 0.5 mg kge1 (Met-acam 20 mg mLe1; Boehringer Ingelheim, Germany) wasadministered subcutaneously 30 minutes after induction.After aseptic preparation, a left PBB was performed in rightlateral recumbency 15 minutes after induction of anaesthesia,46, 707e715Letter to the Editorwith the limb retracted in a slightly caudal position (45 angle).A nerve stimulator needle (Stimuplex Ultra 0.7  100 mm 22gauge 30 200; BraunMelsungen AG, Germany), attached to anerve stimulator (TOF-Watch; Organon Teknika BV, TheNetherlands), was used to verify correct needle placement. In aﬁrst attempt, the needle was inserted as described by Mahler &Adogwa (2008) in dogs. The needle was inserted cranially tothe acromion, perpendicular to an imaginary line between theacromion and the greater tuberosity and advanced slowlywith astimulus of 4 mA current, 0.1 ms duration, at a frequency of 1Hz. Only weak muscle contractions appeared, despite reposi-tioning the needle two times and increasing the current to 5mA.Subsequently, a different needle position was chosen, asdescribed by Ghadirian & Vesal (2013) in experimental sheep.The needle was inserted medial to the shoulder joint, parallel tothe vertebral column of the sheep, aiming towards the costo-chondral junctions. Using the same stimulus, strong musclecontractions and clear extension and ﬂexion twitches of thecarpus were observed. The current was decreased, but con-tractions of the ﬂexors of the carpus remained visible at 0.2 mA.To avoid possible intraneural injection, the needle was slightlyrepositioned such that contractions were visible at 0.4, but notat 0.3 mA and subsequently, undiluted mepivacaine 0.8 mgkge1 (Mepidor 20 mg mLe1; Richter Pharma AG, Austria) wasinjected. After slightly retracting the needle, the same procedurewas performed for the extensors of the carpus, with injection of afurther undiluted 0.8 mg kge1 of mepivacaine. Thereafter theneedle was gently withdrawn while injecting a ﬁnal undiluted0.4 mg kge1 mepivacaine. A total volume of 5.1 mL wasinjected. After the block, the sheep was positioned in dorsal re-cumbency for carpal arthrodesis through a dorsal approach,with removal of all articular cartilage by curettage, closure of thesurgical incision and application of a full-limb cast. During sur-gery (120 minutes), no abrupt cardiorespiratory changes wereseen, all vital parameters remained within normal limits and norescue analgesia was required (the average end-tidal isoﬂuranewas 1.18%). The recovery of the animal was uneventful and noclear signs of discomfortwere observed. Assessment of the degreeof lameness was difﬁcult as the animal was not yet used to copewith the cast. Postoperative analgesia was provided by 0.5 mgkge1 meloxicam administered subcutaneously for 5 days.With a successful PBB, selective anaesthesia and relaxationof the limb distal to the elbow joint can be provided (Mahler &Adogwa 2008). Interestingly, the technique described byMahler & Adogwa (2008) in dogs provided insufﬁcient musclecontractions in this case, so the technique described in sheepby Ghadirian & Vesal (2013) and in dogs by Duke-Novakovski(2016) was performed instead. Ghadirian & Vesal (2013) usedthis technique to evaluate the effect of adding epinephrine orxylazine to a lidocaine solution for PBB in experimental sheep,with an overall success rate of about 89%. In the present case,the relatively low concentration of isoﬂurane and the absence46, 707e715of abrupt cardiorespiratory changes suggest that the block wassuccessful, although the inﬂuence of meloxicam and metha-done also need to be considered. Potential complications of thePBB such as puncture of the thoracic cavity or the jugularvein/axillary artery/vein, and nerve trauma, were notencountered in the present case.In conclusion, the PBB as described by Ghadirian & Vesal(2013) can be performed as part of a multimodal plan ofanalgesia in sheep undergoing thoracic limb surgery. No sideeffects were observed in this case.Authors' contributionsAJHCM: design, preparation manuscript. SS: preparationmanuscript.Conﬂict of interest statementAuthors declare no conﬂict of interest.Anneleen JHC Michielsen & Stijn SchauvliegeDepartment of Surgery and Anaesthesia of DomesticAnimals, Facility of Veterinary Medicine, University ofGhent, Merelbeke, BelgiumE-mail: anneleen.michielsen@ugent.be (AJHC Michielsen)ReferencesDuke-Novakovski T (2016) Pain management II: local and regionalanaesthetic techniques. In: BSAVA Manual of Canine and FelineAnaesthesia and Analgesia (3rd edn). Duke-Novakovski T, deVries M, Seymour C (eds). BSAVA, UK. pp. 143e158.Ghadirian S, Vesal N (2013) Brachial plexus block using lidocaine/epinephrine or lidocaine/xylazine in fat-tailed sheep. Vet ResForum 3, 161e167.Mahler SP, Adogwa AD (2008) Anatomical and experimental studiesof brachial plexus, sciatic, and femoral nerve-location using periph-eral nerve stimulation in the dog. Vet Anaesth Analg 35, 80e89.Rodrigo-Mocholí D, Schauvliege S (2015)Paravertebral brachial plexusblockade as part of a balanced anaesthesia in a sheep undergoingthoracic limb amputation. Vet Anaesth Analg 43, 239e240.Received 17 October 2018; accepted 1 April 2019.Available online 27 April 2019https://doi.org/10.1016/j.vaa.2019.04.005© 2019 Association of Veterinary Anaesthetists and AmericanCollege of Veterinary Anesthesia and Analgesia. Published byElsevier Ltd. All rights reserved.711

Plexus brachialis block as part of balanced analgesia in a sheep undergoing arthrodesis of the carpus

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Plexus brachialis block as part of balanced analgesia in a sheep undergoing arthrodesis of the carpus

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