Efficacy of Three Tourniquet Types for Intravenous Antimicrobial Regional Limb Perfusion in Standing Horses

Abstract

To determine (1) if clinically useful concentrations of amikacin sulfate can be obtained in synovial fluid during regional limb perfusion (RLP) performed above the carpus in standing sedated horses and (2) to determine the efficacy of 3 tourniquet types (narrow rubber [NR], wide rubber [WR], pneumatic [PN]). Horses (n=9). Bilateral forelimb RLP with amikacin sulfate (2.5 g) were administered through the cephalic vein in standing sedated horses. Limbs were randomly assigned to the 3 tourniquet types (NR, WR, PN) applied above the carpus. Metacarpophalangeal synovial fluid was obtained 0.5 hour after perfusion. Amikacin concentration in the synovial fluid was detected using fluorescence polarization immunoassay. Mean synovial concentrations of amikacin in the PN (mean 236 μg/mL; range 23-913 μg/mL) and WR (mean 64.2 μg/mL; range 7-315 μg/mL) were significantly higher (P=.000 and .032, respectively) than the NR tourniquet (mean 2.1 μg/mL; range 0.9-3.3 μg/mL). The PN tourniquet resulted in the highest synovial fluid amikacin concentrations in all horses, although administration with PN and WR tourniquets achieved adequate amikacin concentrations. NR tourniquet is ineffective and should not be used for RLP above the carpus in the standing horse.