title: Cardiopulmonary, blood and peritoneal fluid alterations associated with abdominal insufflation of carbon dioxide in standing horses.
abstract: BACKGROUND
  Abdominal insufflation is performed routinely during laparoscopy in horses to improve visualisation and facilitate instrument and visceral manipulations during surgery. It has been shown that high-pressure pneumoperitoneum with carbon dioxide (CO2) has deleterious cardiopulmonary effects in dorsally recumbent, mechanically ventilated, halothane-anaesthetised horses. There is no information on the effects of CO2 pneumoperitoneum on cardiopulmonary function and haematology, plasma chemistry and peritoneal fluid (PF) variables in standing sedated horses during laparoscopic surgery.
  
  
  OBJECTIVE
  To determine the effects of high pressure CO2 pneumoperitoneum in standing sedated horses on cardiopulmonary function, blood gas, haematology, plasma chemistry and PF variables.
  
  
  METHODS
  Six healthy, mature horses were sedated with an i.v. bolus of detomidine (0.02 mg/kg bwt) and butorphanol (0.02 mg/kg bwt) and instrumented to determine the changes in cardiopulmonary function, haematology, serum chemistry and PF values during and after pneumoperitoneum with CO2 to 15 mmHg pressure for standing laparoscopy. Each horse was assigned at random to either a standing left flank exploratory laparoscopy (LFL) with CO2 pneumoperitoneum or sham procedure (SLFL) without insufflation, and instrumented for measurement of cardiopulmonary variables. Each horse underwent a second procedure in crossover fashion one month later so that all 6 horses had both an LFL and SLFL performed. Cardiopulmonary variables and blood gas analyses were obtained 5 mins after sedation and every 15 mins during 60 mins baseline (BL), insufflation (15 mmHg) and desufflation. Haematology, serum chemistry analysis and PF analysis were performed at BL, insufflation and desufflation, and 24 h after the conclusion of each procedure.
  
  
  RESULTS
  Significant decreases in heart rate, cardiac output and cardiac index and significant increases in mean right atrial pressure, systemic vascular resistance and pulmonary vascular resistance were recorded immediately after and during sedation in both groups of horses. Pneumoperitoneum with CO2 at 15 mmHg had no significant effect on cardiopulmonary function during surgery. There were no significant differences in blood gas, haematology or plasma chemistry values within or between groups at any time interval during the study. There was a significant increase in the PF total nucleated cell count 24 h following LFL compared to baseline values for LFL or SLFL at 24 h. There were no differences in PF protein concentrations within or between groups at any time interval.
  
  
  CONCLUSIONS
  Pneumoperitoneum with CO2 during standing laparoscopy in healthy horses does not cause adverse alterations in cardiopulmonary, haematology or plasma chemistry variables, but does induce a mild inflammatory response within the peritoneal cavity.
  
  
  CONCLUSIONS
  High pressure (15 mmHg) pneumoperitoneum in standing sedated mature horses for laparoscopic surgery can be performed safely without any short-term or cumulative adverse effects on haemodynamic or cardiopulmonary function.
authors.affiliation: Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana 70803, USA.
authors.forename: F G
authors.initials: FG
authors.lastname: Latimer
authors.forename: S C
authors.initials: SC
authors.lastname: Eades
authors.forename: G
authors.initials: G
authors.lastname: Pettifer
authors.forename: J
authors.initials: J
authors.lastname: Tetens
authors.forename: G
authors.initials: G
authors.lastname: Hosgood
authors.forename: R M
authors.initials: RM
authors.lastname: Moore
mesh_terms: D000818:Animals; D001202:Ascitic Fluid / Q000737:chemistry / Q000166:cytology / Q000662:veterinary*; D001784:Blood Gas Analysis / Q000662:veterinary; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects*; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D016292:Procedural Sedation / Q000662:veterinary; D018592:Cross-Over Studies; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006706:Homeostasis / Q000187:drug effects* / Q000502:physiology; D006736:Horses / Q000502:physiology*; D007327:Insufflation / Q000009:adverse effects / Q000379:methods / Q000662:veterinary*; D010535:Laparoscopy / Q000662:veterinary; D008297:Male; D010529:Peritoneal Cavity / Q000473:pathology; D011027:Pneumoperitoneum / Q000139:chemically induced / Q000503:physiopathology / Q000662:veterinary*; D011897:Random Allocation; D012119:Respiration
chemical_list: D002245:Carbon Dioxide