Relationships between urethrovesical angles and urinary incontinence due to urethral sphincter mechanism incompetence in bitches

In women, the posterior urethrovesical angle is thought to be an important factor in the aetiology of stress urinary incontinence. This form of incontinence has many similarities to urethral sphincter mechanism incompetence (SMI) in the bitch. The role of the ventral and dorsal urethrovesical angles in the aetiology of SMI in the incontinent bitch has yet to be established. Positive-contrast retrograde vagino-urethrograms from 30 incontinent bitches with a diagnosis of SMI and 30 continent bitches were retrieved and the angles between the urethra and dorsal and ventral bladder walls were measured. No relationship was shown to exist between the dorsal urethrovesical angle (the equivalent of the posterior urethrovesical angle in women) and urinary incontinence due to SMI in bitches. Differences in ventral urethrovesical angles were considered to be associated with differences in bladder neck position between the two groups of bitches.     

Isolation and partial characterization of chromoprotein from the larval hemolymph of the Japanese oak silkworm (Antheraea yamamai)

OBJECTIVES: To investigate by urodynamic study position-related changes in uroflowmetry and postvoid residual urine volume (PVR) in men because altered bladder function in the supine position may be a predisposing factor for urinary tract infections in the institutionalized elderly. METHODS: Two healthy men, 34 and 59 years of age and living at home, and 53 nursing home residents (mean age 71.8 years, range 46 to 92) were evaluated with uroflowmetry in the standing and recumbent positions (lying on the left or right side); corresponding PVRs were measured by transabdominal ultrasonic bladder scanning. The two healthy men were monitored longitudinally with multiple recordings in both voiding positions, and the nursing home residents were subjected to two observations: one measurement of the variable parameters in either position. Differences were considered to be significant at P < 0.05. RESULTS: The 34-year-old man performed 51 3 flows (368 standing and 145 recumbent). The mean of all the peak flow rates in the upright (28.2 +/- 4.2 mL/s) versus the recumbent (16.8 +/- 4.1 mL/s) position revealed a highly significant difference (P = 0.0001). Sixteen urinary flows and corresponding PVRs were completed by this subject in either voiding position. The difference between PVRs in the standing (13.1 +/- 14.7 mL) versus recumbent (15.3 +/- 17.5 mL) position was not statistically significant. The 59-year-old man completed 156 flows (128 standing and 28 recumbent). A highly significant difference was noted between the mean of all peak flows in the upright (18.9 +/- 4.1 mL/s) versus recumbent (12.6 +/- 2.0 mL/s) position (P = 0.0001). Thirty-seven urinary flows and corresponding PVRs were completed by this individual (10 PVRs were determined after voiding in the standing and 27 after voiding in the recumbent position). No significant difference was noted between PVRs in the standing (24.6 +/- 34.4 mL) versus recumbent (16.5 +/- 60.0 mL) position. In the nursing home residents, the difference between the mean peak flow rates in the standing (14.5 +/- 8.6 mL/s) versus recumbent (12.4 +/- 6.7 mL/s) position also reached statistical significance (P = 0.0084). The difference between PVRs in the standing (60.5 +/- 125.6 mL) versus recumbent (84.8 +/- 186.2 mL) position barely reached statistical significance (P = 0.0497). CONCLUSIONS: The urinary flow rate decreases in the recumbent position. Bedridden residents may be predisposed to urinary tract infections because of alterations in voiding dynamics in the supine position. This area needs further study.     

Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence?

OBJECTIVE: To assess the contribution of constitutional factors, as demonstrated by antenatal bladder neck mobility, in the development of postpartum urinary stress incontinence. DESIGN: A prospective investigational study. SETTING: General district hospital. POPULATION: One hundred and three primigravid women with no pre-existing urinary incontinence or neurological disorder. METHODS: Antenatal and postnatal measurement of bladder neck mobility using perineal ultrasound. MAIN OUTCOME MEASURE: Urinary stress incontinence at 10-14 weeks postpartum. RESULTS: Women with postpartum urinary stress incontinence have significantly greater antenatal bladder neck mobility than those women continent postpartum. There were no significant differences in any labour or delivery variables, including mode of delivery, between the postpartum continent and incontinent women. CONCLUSIONS: There is evidence for a constitutional risk factor (eg, defective pelvic floor connective tissue in the development of postpartum stress incontinence).     

Value of transrectal ultrasonography in the assessment of failures of stress urinary incontinence surgery in women

OBJECTIVES: To describe the role of transrectal ultrasonography as an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. METHODS: The means of independent samples of transrectal ultrasound parameters of two groups of patients (group I, patients who were continent after surgery; group II, patients who remained incontinent after surgery) were compared. RESULTS: Patients who were continent after surgery showed scanty caudal and dorsal mobility of the bladder neck and proximal urethra during the periods of increased intraabdominal pressure. The US finding in this group of patients is characterized by a funnel surrounding the bladder neck and the proximal urethra. The existence of an intrinsically incompetent sphincter can also be determined with this technique. CONCLUSIONS: Transrectal ultrasonography constitutes an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. It permitis determining whether incontinence is due to a failed procedure, the existence of an intrinsically incompetent sphincter, or whether other causes of incontinence should be investigated.     

Hepatocyte nuclear factor-4 alpha gene mutations in Japanese non-insulin dependent diabetes mellitus (NIDDM) patients

OBJECTIVE: To assess the effect of pregnancy, maternal position, and cardiac output on intrapulmonary shunting (Qs/Qt) in normotensive nulliparous women near term. METHODS: Ten normotensive nulliparas between 36 and 38 weeks' gestation underwent pulmonary artery catheterization (via the subclavian route) and radial artery canalization. Baseline assessments were made with subjects in the left lateral recumbent position after a 30-minute stabilization period. Measurements were obtained sequentially in the left lateral, right lateral, supine, knee-chest, sitting, and standing positions. Each position change was followed by a 10-minute pre-measurement stabilization period. Cardiac output was measured via the thermodilution technique. Blood samples were obtained simultaneously from the pulmonary and radial arteries and analyzed in duplicate for oxygen content with a blood gas analyzer. Qs/Qt was calculated using the classic shunt equation. Statistical analysis was performed by analysis of variance of repeated measures of Qs/Qt and maternal position. The relationship of Qs/Qt to maternal cardiac output was evaluated by the correlation coefficient. Significance was defined as P < .05. RESULTS: Directly measured Qs/Qt averaged 15.3% in left lateral, 15.2% in right lateral, 13.9% in supine, 12.8% in knee-chest, 13.8% in sitting, and 13.0% in standing positions. There was no statistically significant correlation between Qs/Qt and cardiac output (R2 = 0.11, not significant). CONCLUSION: This is the first report of directly measured Qs/Qt in normal pregnant women in the third trimester. Qs/Qt values reported in pregnancy are higher than those reported in nonpregnant individuals.     

Intraoperative autotransfusion: an underutilized technique

The effect of posture on phase III (alveolar nitrogen plateau) and phase IV (closing capacity) of the single-breath oxygen test was examined in 10 normal people. In part 1 of the study, subjects inspired and expired in the standing, supine, prone, and right lateral decubitus positions; there was no effect of posture on phase IV but slopes of phase III were higher when subjects were in the supine and lateral positions. In part 2, subjects inspired in the standing position and expired in one of the recumbent positions. Phase IV occurred infrequently except in the prone position (6 of 10 subj); slopes of phase III in part 2 were not consistently altered by changing posture. It is difficult to explain the failure of posture to alter phase IV solely on a model requiring a linear gradient of pleural pressure. The slope of phase III appears to depend more on the emptying patterns of small regions with widely varying volume-to-ventilation ratios than on gravity-dependent sequences of emptying. Finally, the data suggest a considerable similarity between the upright and prone positions in terms of lung filling and emptying.     

Effects of carbon dioxide insufflation combined with changes in body position on blood gas and acid-base status in anesthetized llamas (Llama glama)

OBJECTIVE: To study the combined effects of intra-abdominal CO2 insufflation with changes in body position during laparoscopy in xylazine-ketamine-halothane anesthetized llamas. STUDY DESIGN: Prospective, controlled study. ANIMALS: Nine castrated, male llamas weighing 114 +/- 23 kg, 3 to 13 years old. METHODS: Three llamas (preliminary study [PS] group) were used to study the effect of right, lateral, dorsal, and left lateral recumbency on gas exchange and acid-base status. The other six (experimental study [ES] group) were used to study the combined effects of changes in body position and CO2 insufflation to an intraabdominal pressure of 10 to 12 mm Hg. Heart rate, respiratory rate, and indirect arterial blood pressures (systolic [SAP], mean [MAP], and diastolic [DAP]) were recorded every 5 minutes during anesthesia. Arterial blood gases (PaO2 and PaCO2) and acid-base status (pHa and HCO3-) were measured immediately after induction of anesthesia and before each change of position. RESULTS: In the PS group, significant decreases in SAP, MAP and PaCO2 and increases in PaO2 and pHa were observed when the llamas were turned from right lateral to dorsal recumbency. Values for HCO3- were lower than the postinduction values, but they remained unaffected by the changes in position. In the ES group, values for MAP were significantly lower when the llamas were placed in dorsal and left lateral recumbency than those observed during right lateral recumbency. Arterial O2 tension during right lateral recumbency was lower but returned to preinsufflation values when the llamas were placed in the dorsal position. All llamas recovered uneventfully within 30 minutes after termination of anesthesia. CONCLUSIONS: Insufflation of CO2 and changing body position induce minor and transient changes in cardiovascular and respiratory function. CLINICAL RELEVANCE: Laparoscopy with mild intra-abdominal CO2 insufflation (10 to 12 mm Hg) can be used safely in spontaneously breathing llamas anesthetized with xylazine, ketamine, and halothane.     

The correlation between surface measurement of head and neck posture and the anatomic position of the upper cervical vertebrae

STUDY DESIGN: Repeated measurements were made of surface postural angles registering the relative positions of the head and neck in photographs and of angles of the upper cervical vertebrae recorded in lateral cephalometric radiographs in the same subjects. For all registrations, subjects assumed the natural head rest position. OBJECTIVES: To examine the correlation between external measurement of head and neck posture and the anatomic positions of the upper four cervical vertebrae. SUMMARY OF BACKGROUND DATA: Interpretation of surface cervical posture measurement is confounded by lack of knowledge about the extent of the underlying compensatory adjustments among the upper cervical vertebrae that may accompany variation in head and neck posture. The correlation between surface measurement and postural characteristics of the upper cervical spine has not been reported to date. METHODS: The association between a set of angles describing the anatomic position of the four upper cervical vertebrae on lateral cephalometric radiographs and a surface measurement of head and neck posture, the craniovertebral angle, was studied in 34 young adult women aged between 17.2 and 30.5 years, mean age, 24.5 years. Anatomic positions of the upper four cervical vertebrae were expressed by angles relative to the true vertical or horizontal. Surface angles registering head and neck position for each subject were obtained from photographs recorded on two occasions. RESULTS: No strong correlation could be established between the angles taken from the lateral cephalometric radiographs measuring the extent of upper cervical lordosis, orientation of the atlas, vertebral inclination, or odontoid process tilt and surface angles recording head and neck position. This finding was attributed principally to the much greater positional variability demonstrated within the upper cervical spine when compared with the surface measurements of head and neck position. CONCLUSION: Anatomic alignment of the upper cervical vertebrae cannot be inferred from variation in surface measurement of head and neck posture. This is the case even in those people identified with more extreme head and neck postural tendencies.     

HLA-DRB1 alleles and beta 2 glycoprotein I-dependent anticardiolipin antibodies in Japanese patients with systemic lupus erythematosus

PURPOSE: This study was designed to evaluate the anatomic and functional consequences of lateral internal sphincterotomy in patients who developed anal incontinence and in matched controls. METHODS: The study includes 13 patients with anal incontinence after lateral internal sphincterotomy and 13 controls who underwent the same operation and were continent and satisfied with the results of the procedure. Patients underwent clinical evaluation, anorectal manometry, pudendal nerve terminal motor latency testing, and endoanal ultrasonography. RESULTS: Sphincterotomies were longer in incontinent patients (75 vs. 57 percent), but the resting pressure and length of the high-pressure zone were not different between groups. Surprisingly, maximum voluntary contraction was higher in incontinent patients than in continent controls (136 vs. 100 mmHg). Rectal sensation and pudendal nerve terminal motor latency were similar in both groups. The defect in the internal sphincter was wider in incontinent patients than in continent controls (17.3 vs. 14.4 mm), but these differences were not statistically significant. The thickness of the internal sphincter measured by endoanal ultrasound was identical in both groups, but the external sphincter was thinner in incontinent patients both at the site of the sphincterotomy (6.8 vs. 8.1 mm) and in the posterior midline (7.1 vs. 8.6 mm). CONCLUSIONS: Anal incontinence after lateral internal sphincterotomy is directly related to the length of the sphincterotomy. Whether secondary to preoperative sphincter abnormality or the result of lateral internal sphincterotomy, the external sphincter is thinner in incontinent patients than in continent controls.     

Utility and safety of parotid gland biopsy in Sj?gren''s syndrome

OBJECTIVE: To review the results of bladder-neck reconstruction in patients with repaired bladder exstrophy and pubic diastasis. PATIENTS AND METHODS: Nine girls (mean age 7 years, range 4-17) and four boys (mean age 9 years, range 5-15) underwent a modified Young-Dees-Leadbetter bladder-neck reconstruction with augmentation cystoplasty (YDL-C). The patients were reviewed retrospectively (follow-up, 1-6 years) to assess continence, particularly in relation to the degree of pubic diastasis measured on an appropriate abdominal radiograph. RESULTS: Ten patients were continent; seven girls and one boy are managed by clean intermittent catheterization (CIC) and one girl and one boy void normally. One girl who would not allow CIC and one boy in whom CIC was not possible are incontinent and are scheduled for construction of a continent diversion. One incontinent boy who also would not allow CIC was lost to follow-up. Public diastasis had no bearing on the surgical results, the 10 continent patients having diastasis ranging from 4 to 9 cm (mean 5.5 cm) and the incontinent patients a diastasis of 3.4 and 6.5 cm (mean 4.5 cm). CONCLUSION: Young-Dees-Leadbetter bladder-neck reconstruction with augmentation cystoplasty is a satisfactory operation in patients with bladder exstrophy. We believe that the rate of continence reflected a competent tubularization with an adequate bladder capacity and assured bladder emptying. A closed pelvis with approximated public bones is not necessary to achieve this objective.     

Incidence of patent Toxocara canis infection in bitches during the oestrous cycle

The incidence of patent Toxocara canis infection as result of reactivation of somatic larvae with subsequent tracheal migration was investigated by faecal examination during 23 oestrous cycles of 15 bitches. Blood samples were collected for determination of total and differential leukocyte counts, prolactin concentration, and Toxocara titre. Five pregnant dogs were used as controls. In the cyclic dogs there were no alterations in white blood cell counts or prolactin concentration, in contrast with the pregnant dogs, in which both variables increased, starting 10 days after onset of the luteal phase. The difference was significant at day 40 and day 60 (both p < 0.005). No significant differences were observed in the number of eosinophils or in the Toxocara antibody titre. T. canis eggs were only found in the faeces of three 1-year-old, cyclic dogs at 1, 60, and 140 days, respectively, after the onset of the luteal phase. It is concluded that cyclic beagle bitches, in which prolactin levels increase in the second half of the luteal phase, are unlikely to be at higher risk for patent T. canis infection than in other phases.     

Anorectal function in patients with complete rectal prolapse. Differences between continent and incontinent individuals

AIMS: A study is made of the alterations in anorectal physiology among rectal prolapse patients, evaluating the differences between fecal continent and incontinent individuals. PATIENTS AND METHODS: Eighteen patients with complete rectal prolapse were divided into two groups: Group A (8 continent individuals) and Group B (10 incontinent women), while 22 healthy women were used as controls (Group C). Clinical exploration and perineal level measurements were performed, along with anorectal manometry, electrophysiology, and anorectal sensitivity to electrical stimuli. RESULTS: The main antecedents of the continent subjects were excess straining efforts, while the incontinent women presented excess straining and complex deliveries. Pathological perineal descent was a frequent finding in both groups, with a hypotonic anal canal at rest (p < 0.001 vs controls) and at voluntary squeezing (p < 0.001 vs controls). In turn, the incontinent patients exhibited a significantly lower anal canal pressure at rest than the continent women (p < 0.05). There were no significant differences between Groups A and C in terms of pudendal motor latency, though latency was significantly longer in Group B than in the controls (p < 0.01). Moreover, pudendal neuropathy was more common, severe and often bilateral in Group B. There were no differences in rectal sensation to distention or in terms of the volumes required to relax the internal anal sphincter. In turn, both prolapse groups exhibited diminished anal canal and rectal sensitivity to electrical stimuli. CONCLUSIONS: Patients with rectal prolapse exhibit a hypotonic anal canal at rest, regardless of whether they are continent to feces or not. Continent patients have less pudendal neuropathy and therefore less pressure alterations at voluntary sphincter squeeze than incontinent individuals.     

Mentoring in the context of a training programme for young unemployed adults with physical disability

We describe a modified method for antegrade placement of periurethral collagen in incontinent men. In this technique, a flexible cystoscope is used to guide the placement of a specially designed needle into the bladder neck and external sphincter region via an antegrade transvesical approach. The 19-gauge, 28-cm long needle is passed suprapubically without a sheath. The procedure may be performed with local anesthesia and intravenous sedation only and takes less than 30 minutes.     

The effect of position on autonomic nervous activity in late pregnancy

We investigated the effect of three different recumbent positions on autonomic nervous activity in late pregnancy. Thirty pregnant and 24 nonpregnant aged-matched women were studied, and measures of heart rate variability in both time and frequency domains were compared using supine, right and left lateral decubitus positions. In the nonpregnant women, the normalised high-frequency power was greatest in the right lateral decubitus position. In the pregnant women, the normalised high-frequency power was lowest and the low/high-frequency power ratio was greatest in the supine position. Both the percentage decrease of normalised high-frequency power and the percentage increase of low/high-frequency power ratio in the supine and right lateral positions were greater than those in the left lateral position. For women in late pregnancy, the left lateral decubitus position may be beneficial because cardiac vagal activity is least suppressed and cardiac sympathetic activity is least enhanced. Aortocaval compression might be the mechanism underlying the change in cardiac autonomic nervous activity when supine and right lateral decubitus positions are assumed in late pregnancy.     

Birth order in homosexual versus heterosexual sex offenders against children, pubescents, and adults

OBJECTIVE: The selection of patients amenable to treatment with a bladder neck sling remains a controversy. In this paper we review our experience with this technique and describe our patient selection criteria. METHODS: Since 1991, 30 patients (24 females and 6 males) aged 4 to 20 years (mean 10) received a bladder neck sling as part of the surgical treatment for their urinary incontinence. The cause of incontinence was neurogenic in 28 of the 30 patients. The 6 male patients were prepuberal. All patients had a preoperative video urodynamic study. The criteria for increasing cervico-urethral resistance included a passive leak point pressure of < 50 cm H2O, stress leak point pressure of < 100 cm H2O, radiological evidence of an open bladder neck and stress incontinence regardless of the other urodynamic and radiologic parameters. The technical aspects of the procedure are described in detail. Augmentation cystoplasty was performed concomitantly in 29 patients. RESULTS: Patient follow-up ranged from 2 to 70 months (mean 37.6). Twenty-eight patients (93%) were continent postoperatively. Two female patients remained incontinent at low leak point pressures. All patients emptied the bladder by intermittent catheterization. Twelve patients perform catheterization through the urethra without difficulty. CONCLUSION: The rectus fascia sling has several advantages over other surgical methods for increasing the cervico-urethral resistance. It is simple, effective, low-cost and has a low complication rate. In our view, the sling is the technique of choice for increasing cervico-urethral resistance in female and prepuberal male patients requiring a cystoplasty concomitantly.     

Experience with the use of cystometry and simultaneous cystometry and urethrometry to clarify urinary incontinence in women (author's transl)

Cystometry and simultaneous cystometry and urethrometry were conducted in 81 incontinent female patients (46 Grade I, 35 Grade II, according to the Ingelman-Sundberg Scale). The tonometric criteria for stress incontinence were presented and discussed by statistically comparing the pressure parameters for continent and incontinent patients. The results of both examinations indicated that, in almost all cases, the cause of incontinence (bladder, bladder obstruction or combination of both) can be determined with certainty. This method is well suited as a routine procedure to clarify urinary incontinence in women.     

Comparisons of intravaginal and intrauterine insemination of bitches with fresh or frozen semen

To compare the importance of the route of insemination when using fresh or frozen semen, six groups of five bitches were inseminated either into the uterus (groups 4, 5 and 6) or the vagina (groups 1, 2 and 3) with fresh (groups 1 and 4) or frozen semen (groups 2, 3, 5 and 6). The fresh semen was collected when needed from the same dog. The frozen semen used in groups 2 and 5 was obtained from seven dogs on the same day, and pooled and processed simultaneously so that the groups were inseminated with exactly the same semen. The frozen semen used in groups 3 and 6 was obtained from different dogs and processed independently to evaluate not only the effect of the route of insemination but also the potential effect of the dog. The mean concentration of the fresh semen was 310 x 10(6) spermatozoa/ml, its motility was greater than 80 per cent and the percentage of normal live spermatozoa was 80 to 92 per cent. The mean spermatozoal concentration of the frozen semen was 200 x 10(6) spermatozoa/ml, its motility was greater than 60 per cent and the percentage of normal live spermatozoa was 80 per cent. In all the groups there were fewer than 15 per cent abnormal spermatozoa. The animals inseminated with fresh semen received significantly more spermatozoa than the others. The bitches were inseminated twice, three and five days after the estimated peak of luteinising hormone, with a total volume of 5 ml for the vaginal inseminations and 2 ml for the intrauterine inseminations. Sixty per cent of the bitches inseminated with frozen semen and 100 per cent of the bitches inseminated with fresh semen became pregnant, irrespective of the insemination technique used.     

Immediate management of posterior urethral disruptions due to pelvic fracture: therapeutic alternatives

PURPOSE: We retrospectively reviewed the results of 3 types of initial management of pelvic fracture urethral disruption in children. MATERIALS AND METHODS: From 1980 to 1994, 35 boys 2 to 15 years old (mean age 8.1) with prostatomembranous urethral disruption were treated, including 17 who also had associated injuries. Immediate treatment included suprapubic cystostomy and delayed urethroplasty in 19 patients (group 1), urethral catheter alignment without traction and concomitant suprapubic cystostomy in 10 (group 2), and primary retropubic anastomotic urethroplasty in 6 (group 3). RESULTS: In all patients in groups 1 and 2 severe urethral obliteration developed. Four group 3 patients (66%) had a stricture at the site of anastomotic repair. After delayed urethroplasty 16 group 1 (84%) and all 10 group 2 patients were continent. However, only 3 group 3 patients (50%) achieved continence. Retrospectively associated bladder neck injury occurred in 5 of the 6 incontinent boys. Erections were observed before and after treatment in all but 3 children. Unstable pelvic ring fractures (type IV) comprised 28% of all pelvic fractures with a high rate of associated injuries. CONCLUSIONS: As described, urethral alignment was not beneficial for avoiding urethral obliteration. Therefore we recommend suprapublic cystostomy as the only form of initial treatment in these cases. Urinary incontinence seems more likely related to associated bladder neck rupture and the severity of pelvic fracture rather than to initial treatment or delayed urethral repair. Consequently, when associated bladder neck injury is present, we advocate immediate surgical repair.     

Acquired urinary incontinence in bitches: its incidence and relationship to neutering practices

A five-year cohort study was conducted on bitches chosen by a sample of 233 randomly selected practising veterinary surgeons in the UK, to estimate the incidence of acquired urinary incontinence (AUI) in neutered and entire animals, and to investigate possible risk factors associated with neutering practices. Information was collected using questionnaires, and data on 809 bitches, of which 22 developed AUI, were obtained. The estimated incidence rates in neutered and entire animals were 0.0174 and 0.0022 per animal-year, respectively (95 per cent confidence intervals: 0.0110, 0.0275 and 0.0009, 0.0058, respectively). The relative risk, neutered vs entire, was 7.8 (95 per cent confidence interval: 2.6, 31.5). The attributable proportion(exposed) and population attributable proportion were 87.1 per cent and 63.1 per cent (95 per cent confidence intervals: 61.9 per cent, 95.6 per cent, and 28.3 percent, 88.5 per cent, respectively). An increased risk, significant at the conventional 5 per cent level, was not demonstrated in animals neutered before, vs after, first heat (relative risk: 3.9, 95 per cent confidence interval: 0.8, 10.4), although the result was significant at the 10 per cent level. Removal of the cervix was not shown to be a risk factor in neutered dogs.     

Anesthetic and cardiorespiratory effects of tiletamine-zolazepam-medetomidine in cheetahs

OBJECTIVE: To evaluate anesthetic and cardiorespiratory effects of an intramuscular injection of a tiletamine-zolazepam-medetomidine combination in cheetahs. DESIGN: Prospective study. ANIMALS: 17 adult captive cheetahs. PROCEDURE: The anesthetic combination was administered intramuscularly via a dart. Induction quality, duration of lateral recumbency, duration of recovery, and quality of anesthetic reversal with atipamezole were assessed. Cardiorespiratory variables (arterial blood gas partial pressures, arterial blood pressure, heart and respiratory rates, end-tidal CO2, oxygen saturation, and rectal temperature) were measured during anesthesia. RESULTS: Sedation and lateral recumbency developed within 1.9 +/- 1.0 (mean +/- SD) and 4.3 +/- 2.0 minutes of drug administration, respectively. Clinically acceptable cardiorespiratory and blood gas values were recorded for at least 87 minutes after drug administration in all but 1 cheetah. Hypoxemia and arrhythmias developed in 1 cheetah breathing room air but resolved after treatment with oxygen. Hypertension developed in all cheetahs. Significant differences in heart and respiratory rates, mean arterial blood pressure, arterial pH, partial pressure of oxygen, and hemoglobin saturation were found between cheetahs that did and did not receive oxygen supplementation. After administration of atipamezole, sternal recumbency and mobility returned within 6.9 +/- 5.8 and 47.5 +/- 102.2 minutes, respectively. Postreversal sedation, which lasted approximately 4 hours, developed in 4 cheetahs. CLINICAL IMPLICATIONS: Tiletamine-zolazepam-medetomidine delivered via a dart provided an alternative method for induction and maintenance of anesthesia in cheetahs. Atipamezole at the dose used was effective for reversal of this combination in the initial phase of anesthesia.