Pulsed delivery of inhaled nitric oxide counteracts hypoxaemia during 2.5 hours of inhalation anaesthesia in dorsally recumbent horses

Nyman, Görel; Grubb, Tamara; Heinonen, Erkki; Frendin, J.; Edner, Anna; Malavasi, Lais M; Frostell, Claes; Högman, Marieann

doi:10.1111/j.1467-2995.2012.00740.x

Cited by 26 publications

(51 citation statements)

References 27 publications

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“…), aerosolized salbutamol (Robertson & Bailey ), pulsed application of nitric oxide (NO) (Nyman et al. ), and spontaneous ventilation with PEEP (sPEEP) (Beadle et al. ; Hall & Trim ).…”

Section: Introductionmentioning

confidence: 99%

Continuous positive airway pressure (CPAP) decreases pulmonary shunt in anaesthetized horses

Mosing

MacFarlane

Bardell

et al. 2016

Veterinary Anaesthesia and Analgesia

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“…), aerosolized salbutamol (Robertson & Bailey ), pulsed application of nitric oxide (NO) (Nyman et al. ), and spontaneous ventilation with PEEP (sPEEP) (Beadle et al. ; Hall & Trim ).…”

Section: Introductionmentioning

confidence: 99%

Continuous positive airway pressure (CPAP) decreases pulmonary shunt in anaesthetized horses

Mosing

MacFarlane

Bardell

et al. 2016

Veterinary Anaesthesia and Analgesia

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“…Although continuous delivery of iNO over the entire inspiratory phase of ventilation did not improve arterial oxygenation in a previous study 23 of halothane-anesthetized horses, PiNO administration during the early phase of inspiration did counteract hypoxemia and Qs/Qt formation in dorsally recumbent 13,15 and laterally recumbent 11,12 isoflurane-anesthetized horses. It appears that pulsing iNO in the first 30% to 45% of the inspiratory phase, as was done in the present study, is the most effective method to improve oxygenation in anesthetized horses.…”

Section: Discussionmentioning

confidence: 53%

“…It appears that pulsing iNO in the first 30% to 45% of the inspiratory phase, as was done in the present study, is the most effective method to improve oxygenation in anesthetized horses. 12,13,23 However, the pulse dose can be too small to be effective, and PiNO administration in only 20% of the inspiratory phase can result in minimal or no improvement. 12 Administration of PiNO at 45% of the inspiratory phase in a horse with a small tidal volume, as for 1 horse in this study, can result in less improvement than when a full dose is delivered.…”

Section: Discussionmentioning

confidence: 97%

“…11 Inhaled NO preferentially reaches only areas of adequate alveolar ventilation, and the subsequent vasodilation redistributes perfusion to these ventilated alveoli, thereby improving V A /Q matching and PaO 2 . Nitric oxide pulsed into the early phase of inhalation has been used to improve PaO 2 and V A /Q matching while decreasing Qs/Qt in recumbent isoflurane-anesthetized horses, [12][13][14][15] but the intrapulmonary location of redistribution of perfusion induced by PiNO administration is not known. Redistribution could occur at individual alveoli scattered throughout the lungs or by mass movement of blood flow away from discrete dependent atelectatic areas.…”

Section: Dapmentioning

confidence: 99%

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Effects of pulse-delivered inhaled nitric oxide administration on pulmonary perfusion and arterial oxygenation in dorsally recumbent isoflurane-anesthetized horses

Grubb

Lord²,

Berger³

et al. 2014

ajvr

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Administration of PiNO in anesthetized dorsally recumbent horses resulted in redistribution of pulmonary blood flow from dependent atelectatic lung regions to nondependent aerated lung regions. Because hypoxemia is commonly the result of atelectasis in anesthetized dorsally recumbent horses, the addition of nitric oxide to inhaled gases could be used clinically to alleviate hypoxemia in horses during anesthesia.

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“…Using this technique, hypoxaemia is treated by redirecting blood flow, or pulmonary perfusion, to the ventilated regions of the lung rather than by changing ventilation of the lung . However, PiNO does not affect ventilation and hypercarbia developed in all or most horses in previous studies . These findings were also confirmed in a clinical study where spontaneously breathing horses undergoing colic surgery treated with PiNO remained hypercarbic despite improved arterial oxygenation .…”

Section: Introductionmentioning

confidence: 77%

Effects of pulsed inhaled nitric oxide on arterial oxygenation during mechanical ventilation in anaesthetised horses undergoing elective arthroscopy or emergency colic surgery

Wiklund

Kellgren

Wulcan

et al. 2019

Equine Veterinary Journal

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Summary Background Administration of pulsed inhaled nitric oxide (PiNO) improves arterial oxygenation in spontaneously breathing anaesthetised healthy horses and in horses undergoing colic surgery. However, because hypoventilation commonly occurs, horses are often mechanically ventilated to prevent hypercarbia. Objectives To evaluate the effects of PiNO on arterial oxygenation during anaesthesia in mechanically ventilated healthy horses and horses undergoing colic surgery. Study design Prospective nonblinded clinical trial. Methods Fifty horses undergoing elective arthroscopy (Group A) and 30 horses undergoing colic surgery (Group C) in dorsal recumbency were included in the study. Every second horse in each group received PiNO (A‐INO, C‐INO), the others served as controls (A‐CN, C‐CN). All horses were mechanically ventilated and anaesthesia was maintained with isoflurane. PiNO was mechanically delivered at the proximal end of the endotracheal tube as a pulse during the first part of each inspiration. Data were collected at the start (baseline, before PiNO) and at the end of inhalation anaesthesia. The Tukey method was used to compare baseline and end values for each parameter. Results Arterial oxygen tension (PaO2) increased from (median [IQR]) 13.6 (9.3, 30.1) at baseline to 24.2 (18.6, 37.0) kPa at the end of anaesthesia in A‐INO (P = 0.005) and from 7.7 (6.4, 8.5) to 15.5 (9.9, 26.9) kPa in C‐INO (P = 0.007). Mean (95% CI) difference in F‐shunt between baseline and end were −6 (−10; −1) and −11 (−22; −1) % in A‐INO (P = 0.005) and C‐INO (P = 0.04) respectively. There was no change in PaO2 or F‐shunt from baseline to end of anaesthesia in A‐CN or C‐CN. Main limitations Cardiac output was not measured, thus O2 delivery could not be calculated. Conclusions The combination of mechanical ventilation and PiNO improved pulmonary gas exchange during anaesthesia by a simultaneous decrease in F‐shunt and improved alveolar ventilation.

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Pulsed delivery of inhaled nitric oxide counteracts hypoxaemia during 2.5 hours of inhalation anaesthesia in dorsally recumbent horses

Cited by 26 publications

References 27 publications

Continuous positive airway pressure (CPAP) decreases pulmonary shunt in anaesthetized horses

Continuous positive airway pressure (CPAP) decreases pulmonary shunt in anaesthetized horses

Effects of pulse-delivered inhaled nitric oxide administration on pulmonary perfusion and arterial oxygenation in dorsally recumbent isoflurane-anesthetized horses

Effects of pulsed inhaled nitric oxide on arterial oxygenation during mechanical ventilation in anaesthetised horses undergoing elective arthroscopy or emergency colic surgery

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