Anaesthetic problems caused by diaphragmatic hernia in the horse: a review of four cases

Verwendung eines neuen Ventilationsmodus genannt “Kontinuierlicher positiver Atemwegsdruck” bei einem Pferd mit Zwerchfellruptur

“…Diaphragmatic hernia is a condition associated with a high anaesthetic mortality rate related to impaired ventilation and hypoxaemia (Clutton et al 1992). Hypoxaemia was also noted in the case described here 15 minutes after induction.…”

“…The "panting respiration" and "fighting the ventilator" seen in our horse has been described by Clutton et al (1992). The reason for this phenomenon is unclear.…”

“…The use of IPPV in horses suffering from diaphragmatic hernia has been associated with better outcome compared to spontaneous ventilation (Clutton et al 1992). The "panting respiration" and "fighting the ventilator" seen in our horse has been described by Clutton et al (1992).…”

“…Anaesthetised healthy horses have values for D(Aa)O 2 of approximately 26 kPa when placed in dorsal recumbency (Nyman et al 1990, Wilson andSoma 1990). The massive lung collapse in this case described here was likely caused by decreased functional residual capacity due to the herniated viscera and presence of blood in the thorax, and the absence of transpulmonary pressure to oppose the elastic recoil force of the lung (Clutton et al 1992). Hypoventilation and possible diffusion impairment caused by lung tissue inflammation due to the underlying disease might have enhanced hypoxaemia (Brigham 1982).…”

“…During anaesthesia the compression of the lungs by the herniated organs plus the absence of subatmospheric intrapleural pressure results in a massive alveolar collapse and decrease in functional residual capacity (FRC). This on top of the rapid occurrence of atelectasis after induction of anaesthesia and resulting high intrapulmonary shunting reported in healthy horses (Nyman et al 1990) can lead to severe hypoxaemia, impaired ventilation and high intraoperative mortality in these patients (Clutton et al 1992, Pearson et al 1977.…”