Use of continuous positive airway pressure (CRAP) in a horse with diaphragmatic hernia

作者：Mosing Martina^*; Junat Stephane

来源：Pferdeheilkunde, 2011, 27(1): 65-+.

• Anaesthesia
• hypoxaemia
• ventilation mode
• horse
• continuous positive airway pressure
• CPAP

Continuous positive airway pressure (CPAP) is a ventilation mode where airway pressure is kept above ambient during the entire breathing cycle. We describe a case of a diaphragmatic hernia in a horse where CPAP was applied during anaesthesia to treat hypoxaemia. A 15 year-old mare weighing 556 kg was anaesthetised for colic surgery. After induction, hypoxaemia (PaO(2): 8.8 kPa = 66 mmHg) and severe hypotension (mean arterial pressure: 24 mm Hg) were noticed. CPAP at a level of 20 cm H(2)O was applied to the airways. This resulted in a marked increase of PaO(2) to 53.2 kPa (400 mmHg) within 90 minutes after induction of anaesthesia. Treatment of hypotension included dobutamine, ephedrine, phenylephrine and hypertonic saline. Total anaesthesia time was 120 minutes. Surgical examination revealed an impaction of the large colon with no other gastrointestinal abnormality. After disconnecting the horse from the circle system and transferring it with the overhead hoist into the recovery box, it suffered from cardio-respiratory arrest and died. Pathology revealed a diaphragmatic hernia with 25 L of blood and the whole stomach in the thoracic cavity. In this case CPAP appeared to be a reliable technique to treat hypoxaemia during anaesthesia in a horse with a pre-existing pulmonary abnormality. However, its effects on the cardio-vascular system must be closely monitored and adequate support provided.

• 出版日期2011-2