ARTICLES

The effect of carotid artery occlusion on lingual

arterial blood pressure in dogs
David L. Holmberg, Glenn R. Pettifer

Abstract Although temporary occlusion of the carotid arteries is commonly done to reduce blood
loss during nasal surgery in the dog, data supporting its use are mostly anecdotal and subjective. Twelve
dogs were placed under general inhalation anesthesia and mechanically ventilated to maintain
normocapnea and an end-tidal halothane concentration equivalent to 1.3 times the minimum alve-
olar concentration. Tourniquets were placed around both carotid arteries of each dog. Both lingual
arteries were cannulated in each dog and their heart rate and blood pressure were measured bilaterally.
During unilateral carotid artery occlusion, the blood pressures in the ipsilateral lingual artery
were significantly (P < 0.05) lower than the preocclusion control pressures and pressures recorded
in the contralateral vessel. Bilateral carotid artery occlusion resulted in a further significant (P < 0.05)
fall in all lingual arterial pressures. The recorded heart rates only varied significantly from preocclusion
control values when they increased during bilateral carotid occlusion (P < 0.05). The results of this
study confirm that carotid artery occlusion has the potential to reduce intraoperative blood loss during
oronasal surgery in the dog.

Resume L'influence de l'occlusion de I'artere carotide sur la pression arterielle linguale

chez les chiens. Bien que l'occlusion temporaire des arteres carotides est couramment faite pour reduire
la perte sanguine pendant une chirurgie nasale chez le chien, les donnees qui appuient cette
methode sont pour la plupart anecdotiques et subjectives. Douze chiens ont ete mis sous anesthesique
gazeux et ventilation artificielle de maniere a maintenir la normocapnie et une concentration
d'halothane equivalente 'a 1,3 fois la concentration alveolaire minimale. Des garrots ont ete disposes
sur les deux arteres carotides de chaque chien. Des canules ont ete introduites dans les deux
arteres linguales et la pression arterielle a ete evaluee par mesure bilaterale. Pendant l'occlusion uni-
lateral de l'artere carotide, la pression arterielle de l'artere linguale ipsilaterale etait significative-
ment inferieure (P < 0,05) aux pressions de contr8le preocclusion et aux pressions enregistrees pour
le vaisseau controlateral. L'occlusion bilaterale de l'artere carotide a entraine une autre baisse sig-
nificative (P < 0,05) des pressions arterielles linguales. Les frequences cardiaques enregistrees n'ont
variees de fa,on significative de celles de contr6le preocclusion que lorsqu'elles ont augmente pendant
l'occlusion bilateral de la carotide (P < 0,05). Les resultats de cette etude confirment que l'occlu-
sion de l'artere carotide a le potentiel de reduire la perte sanguine peroperatoire pendant une
chirurgie bucco-nasale chez le chien.
(Traduit par Helene Petitclerc)
Can Vet J 1997; 38: 629-631

Introduction that often accompanies tumors of the nasal cavity (3).

Temporary occlusion of the carotid arteries has been
recommended (1), and is commonly performed (2) to
reduce blood loss during nasal surgery in the dog.
Permanent ligation of 1 or both carotid arteries has
been described as a means of reducing the epistaxis
Department of Clinical Studies, Ontario Veterinary College,
University of Guelph, Guelph, Ontario N I G 2W 1.
This work was supported by the Ontario Veterinary College's
Pet Trust Fund.
No reprints available.
Can Vet J Volume 38,
38, October 1997
1997629
Either technique can be used in the dog without obvious
detrimental effects (4,5), and the eventual development
of a collateral blood supply after occlusion has been well
documented (6,7). Although the use of temporary carotid
artery occlusion is widely accepted, data supporting
its use are anecdotal and subjective. A review of our own
medical records suggests that the use of intra-operative
blood transfusions during nasal surgery has not been
affected by the placement of carotid artery tourniquets (8).
The purpose of this study was to document the blood
pressure changes that occur in the lingual branches of
the carotid artery during ipsilateral, contralateral, and
629
 Table 1. Mean heart rate and blood pressures recorded in the lingual arteries of 12 dogs
during occlusion of 1 or both of their common carotid arteries
Control (n = 144) Contralateral (n = 72) Ipsilateral (n = 72) Bilateral (n = 72)
Heart rate 95.2 (s = 14.5) 94.5 (s = 15.8) 94.5 (s = 15.7) 112.9 (s = 26.9)b
Systolic BP 104.6 (s = 9.6) 109.0 (s = 13.6) 66.0 (s = 9.4)a 55.1 (s = I 1.2)b
Diastolic BP 75.7 (s = 11.8) 80.4 (s = 12.9) 57.7 (s = 8.6)a 50.7 (s = 1 .O)b
Mean BP 87.1 (s = 9.4) 92.1 (s = 12.6) 62.0 (s = 8.7)a 53.0 (s = 10.6)b
Heart rate measured in beats per minute
BP = Blood pressure recorded in mmHg
Control = Pressures recorded in the lingual arteries without carotid artery occlusion
Contralateral = Pressures recorded in the lingual artery contralateral to the carotid artery occlusion
Ipsilateral = Pressures recorded in the lingual artery ispilateral to the carotid artery occlusion
Bilateral = Pressures recorded in the lingual arteries during bilateral carotid artery occlusion
aStatistically different from control and contralateral values (P < 0.05)
bStatistically different from ipsilateral and control values (P < 0.05)

bilateral carotid artery occlusion. Because the lingual
artery and branches of the maxillary artery that supply
the nasal cavity and oral palate have a similar topo-
graphic relationship with the common carotid artery, vari-
ations in their blood pressure should occur simultane-
ously. Based on these findings, the utility of carotid
artery occlusion as a means of lowering regional blood
pressure and reducing hemorrhage during oronasal
surgery should be objectively ascertained.
Materials and Methods
Twelve dogs already under general inhalation anesthe-
sia for another unrelated project and scheduled for
euthanasia were mechanically ventilated to maintain
normocapnea (PaCO235 to 45 mmHg). The end-tidal
halothane concentration was maintained at 1.2%
throughout the investigation. This concentration is
equivalent to 1.3 times the minimum alveolar concen-
tration (MAC) reported for halothane in dogs (9). A
balanced electrolyte solution (Plasma-Lyte 148, Baxter
Corporation, Toronto, Ontario) was administered IV
at a rate of 10 mL/kg body weight (BW)/h. The animals'
body temperatures were monitored electronically using
a rectal probe and maintained between 36°C and 38°C.
Lingual arterial blood pressures were measured directly,
using a transducer (DTX Pressure Transducer System,
Viggo-Spectgramed, Oxnard, California, USA) con-
nected to a 20 gauge catheter (Cathlon IV, Critikon
Canada, Markham, Ontario) placed in each lingual
artery. End-tidal CO2' halothane concentrations and
lingual artery pressures were recorded on a monitor
(Criticare 1 100 Patient Monitor, Wauesha, Wisconsin,
USA). The common carotid arteries of each dog were
surgically exposed through a ventral midline cervical
incision, just caudal to the larynx. Rumel type tourniquets
were placed loosely around each artery, with care being
taken not to damage or encircle the associated vagosym-
pathetic trunk.
Blood pressure was recorded in both lingual arteries
of all dogs: without carotid arterial occlusion, following
right unilateral carotid artery occlusion, following left
unilateral carotid artery occlusion, and following bilat-
eral carotid occlusion. Nonoccluded control pressures
were also measured following re-establishment of bilat-
eral carotid arterial blood flow between each change in
occlusion and at the end of the study. The order of the
arterial occlusion was randomly assigned such that 4 of
630
the dogs started with the right carotid artery, 4 started
with the left carotid artery, and 4 started with bilateral
carotid artery occlusion. Heart rate and systolic, diastolic,
and mean arterial blood pressures were recorded every
S min during the experiment. The animals were allowed
to stabilize for 15 min (3 readings) between each change
in occlusion. Following the experiment the dogs were
euthanized by an IV overdose of barbiturate (Euthansol,
Pentobarbital, Schering-Plough, Pointe Claire, Quebec).
Changes in the heart rate and arterial blood pressure
were analysed using a repeated measures analysis of vari-
ance with a post hoc, Duncan's multiple-range test.
Differences were considered significant when P < 0.05.
Results
The 3 lingual arterial blood pressure measurements
taken after each change in carotid artery occlusion did
not vary significantly within each dog. There were like-
wise no significant differences between the nonoc-
cluded control pressures and the slightly elevated pres-
sures within the contralateral lingual vessels following
unilateral carotid artery occlusion (Table 1). Right and
left side lingual artery blood pressures fell by the same
amount during unilateral right and left carotid artery
occlusion, respectively, and were combined for statistical
analysis. The ispilateral pressures were significantly
lower than the control and contralateral pressures during
unilateral carotid artery occlusion (Table 1). Bilateral
carotid occlusion resulted in a further significant fall in
the blood pressures recorded in both lingual arteries.
There were no differences between the pressures mea-
sured in the right and left lingual arteries during bilateral
occlusion, so these values were combined for statistical
analysis (Table 1). More variation in heart rate than in
blood pressure was observed during each of the stabi-
lization periods. Heart rate was significantly increased
during bilateral carotid occlusion (Table 1).
Discussion
The dog (5), unlike the cat (10), has a vertebral artery
blood supply, which can adequately maintain cerebral
function during bilateral carotid artery occlusion.
Anastomotic branches occur between the dog's vertebral
and maxillary arteries via the occipital and ethmoidal
arteries. This collateral arterial supply is likely respon-
sible for maintaining the reduced but stable lingual
Can Vet J Volume 38, October 1997
blood pressure measured in this study during bilateral
carotid occlusion.
Direct measurement of arterial pressures within the
nasal cavity has not been reported, nor can intranasal
blood pressure be monitored noninvasively. There is,
however, very little resistance to blood flow between
communicating arteries, and pulse pressures are trans-
mitted rapidly with little decrease in strength (11).
Although a pressure gradient must exist to maintain
flow between the proximal and distal portions of intact
vessels, we are not aware of any anatomic or physiologic
explanation why the blood pressure recorded within
the lingual arteries would not be indicative of changes
occurring within the arteries of the nasal cavity.
The increased heart rate recorded during bilateral
carotid artery occlusion is probably the result of reduced
inhibitory feedback from the baroreceptors in the carotid
sinuses (12). Although not measured in this study, a com-
pensatory rise in the systemic blood pressure would
also likely occur during bilateral carotid occlusion.
During a surgical procedure, factors such as the eti-
ology and invasiveness of the disease process, integrity
of the patient's clotting mechanisms, and skill of the sur-
geon will all affect the volume of blood that is lost
during a surgical procedure and may outweigh the effect
of local blood pressure (8). However, based on the
relationship (11): Flow = Pressure . Resistance, the
results of this study support the previous subjective
impression of some authors (1) that carotid artery occlu-
sion has the potential to reduce intraoperative blood
loss by reducing the regional arterial blood pressure
to the head, thereby slowing nasal hemorrhage. cv.
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Can Vet J Volume 38, October 1997
References
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