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The effect of anesthetic drug choice on accuracy of high-definition oscillometry in laterally recumbent horses

Duke-Novakovski, Tanya, Ambros, Barbara, Feng, Cindy, Carr, Anthony P.
Veterinary anaesthesia and analgesia 2017 v.44 no.3 pp. 589-593
anesthesia, blood pressure, breathing, heart rate, horses, isoflurane, models, tail, xylazine
To determine the accuracy of high-definition oscillometry (HDO) for arterial pressure measurement during injectable or inhalation anesthesia in horses.Prospective, clinical study.Twenty-four horses anesthetized for procedures requiring lateral recumbency.Horses were premedicated with xylazine, and anesthesia induced with diazepam–ketamine. Anesthesia was maintained with xylazine–ketamine–guaifenesin combination [TripleDrip (TD; n = 12) or isoflurane (ISO; n = 12)]. HDO was used to obtain systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures, and heart rate (HR) using an 8-cm-wide cuff around the proximal tail. Invasive blood pressure (IBP), SAP, MAP, DAP and HR were recorded during HDO cycling. Bland–Altman analysis for repeated measures was used to compare HDO and IBP for all measurements. The generalized additive model was used to determine if means in the differences between HDO and IBP were similar between anesthetic protocols for all measurements.There were >110 paired samples for each variable. There was no effect of anesthetic choice on HDO performance, but more variability was present in TD compared with ISO. Skewed data required log-transformation for statistical comparison. Using raw data and standard Bland–Altman analysis, HDO overestimated SAP (TD, 3.8 ± 28.3 mmHg; ISO, 3.5 ± 13.6 mmHg), MAP (TD, 4.0 ± 23.3 mmHg; ISO, 6.3 ± 10.0 mmHg) and DAP (TD, 4.0 ± 21.2 mmHg; ISO, 7.8 ± 13.6 mmHg). In TD, 26–40% HDO measurements were within 10 mmHg of IBP, compared with 60–74% in ISO. Differences between HDO and IBP for all measurements were similar between anesthetic protocols. The numerical difference between IBP and HDO measurements for SAP, MAP and DAP significantly decreased as cuff width:tail girth ratio increased toward 40%.More variability in HDO occurred during TD. The cuff width:tail girth ratio is important for accuracy of HDO.