MC 5902
Palo Alto, CA 94304
Fax: (650) 497-8041
University of Southern California Keck School of Medicine, Los Angeles, CA, 06/01/1990
Santa Clara Valley Medical Center Internal Medicine Residency, San Jose, CA, 06/30/1991
Stanford University Anesthesiology Residency, Stanford, CA, 06/30/1994
Anesthesia, American Board of Anesthesiology
Pediatric Anesthesia, American Board of Anesthesiology
Hypotension is a common adverse effect of general anesthesia that has historically been difficult to measure in pinniped species due to technical challenges. A retrospective case review found seven pinniped cases that demonstrated anesthesia-associated hypotension diagnosed by direct blood pressure measurements during general anesthesia at The Marine Mammal Center (Sausalito, CA) between 2017 and 2019. Cases included five California sea lions (CSL: Zalophus californianus), one Hawaiian monk seal (HMS: Neomonachus schauinslandi), and one northern elephant seal (NES: Mirounga angustirostris). Patients were induced using injectable opioids, benzodiazepines, and anesthetics including propofol and alfaxalone. Excluding the HMS, all patients required supplemental isoflurane with a mask to achieve an anesthetic plane allowing for intubation. Each patient was maintained with inhalant isoflurane in oxygen for the duration of the anesthetic event. Each patient was concurrently administered continuous IV fluids and four patients received fluid boluses prior to administration of ephedrine. All hypotensive anesthetized patients were treated with IV ephedrine (0.05-0.2 mg/kg). The average initial systolic (SAP) and mean (MAP) arterial blood pressures for the CSL prior to ephedrine administration were 71 14 mmHg and 48 12 mmHg respectively. The average SAP and MAP for the CSL increased to 119 32 mmHg and 90 34 mmHg respectively within 5 m of ephedrine administration. The NES initial blood pressure measurement was 59/43 (50) (SAP/diastolic [MAP]) mmHg and increased to 80/51 (62) mmHg within 5 m. The initial HMS blood pressure was 79/68 (73) mmHg and increased to 99/78 (85) mmHg within 5 m following ephedrine administration. All patients recovered from anesthesia. These results support the efficacy of IV ephedrine for the treatment of anesthesia-associated hypotension in pinnipeds.
View details for DOI 10.1638/2020-0219
View details for PubMedID 34687524
View details for DOI 10.1016/j.bja.2020.06.009
View details for PubMedID 32600805