TABLE 4.

Troubleshooting table.

Step	Problem	Possible reason	Solution
3	Difficult intubation	Laryngospasm and fluid accumulation in the pharyngeal region are common when too large of an endotracheal tube (ET) is selected, when too much force is used when passing the ET tube through the vocal cords, or when improper technique is used	Consider anticholinergics, such as atropine 0.02–0.05 mg kg−1, to reduce secretions. Xylocaine spray or lidocaine given topically can alleviate laryngospasm. Smaller ET tubes and proper placement of the laryngoscope can alleviate further complications
17	Difficulty accessing the artery	The arteries will spasm with manipulation. If the artery is not properly exposed, the fascia surrounding it can cause the needle to miss the vessel lumen	Bath the artery in 2% (wt/vol) lidocaine to dilate it. Be sure to expose the adventia by dissecting away the fascia covering the artery to ensure proper placement of the needle into the vessel lumen. Proper proximal control of the vessel with vessel loops will allow light tension to be placed on the artery to help the needlepoint pierce the vessel (Fig. 6c)
17A(i)	Swine has ipsilateral eyelid ptosis, pupil miosis and facial anhy-drosis after surgery	Cervical ganglia in the swine are located within the carotid sheath and can be easily damaged during carotid sheath surgery	Carefully dissect the carotid artery within the carotid sheath and be mindful of the cranial cervical sympathetic ganglion that are located within the carotid sheath41
23	Problems obtaining quality invasive pressure-volume loops	Improper setup or calibration, improper place-ment; anesthesia too deep; animal too cold or hot; animal dehydrated	Follow the manufacturer’s recommendations for proper setup and calibration. Ensure the proper depth of anesthesia and maintain the animal’s hydration and body temperature. Refer to Pacher et al.12 for further information on pressure-volume loop collection and analysis in laboratory animals
29	Problems identify-ing the first diagonal branch for proper bal-loon placement	Ramus intermedius can be confused with the first diagonal of LAD; the right coronary artery or septal branches can obscure or compli-cate diagonal identification in right anterior oblique 30° projection	Swine have highly variable coronary distribution and structure, but overall they follow standard human anatomy. Start with a right anterior oblique 30° projection of the heart to identify the LAD and associated branches. Other projec-tions can be used to properly identify the origin and orientation of all coronary anatomy and ensure proper PTCA balloon placement distal to the first diagonal of the LAD. Refer to Scanlon et al.42 as well as Alderman and Stadius43 for further information on standardized coronary anatomy descriptions and naming conventions for humans that can be translated into the swine model
30	Cardiac dysrhythmia	Cardiac dysrhythmia is an expected side effect of LAD occlusion causing myocardial ischemia; however, irreversible arrhythmia can be caused by partial or full occlusion of the first diago-nal, complete occlusion of the left main ostia, too large a PTCA balloon or an overinflated PTCA balloon	Prophylactic lidocaine can be administered by a 2.0–4.0 mg kg−1 bolus followed by a 50 µg kg−1 min−1 infusion to lower the incidence of prema-ture ventricular contractions (PVCs), ventricular tachycardia (VT) and ventricular fibrillation (VF). High-quality chest compressions and rapid defi-brillation should return heart to a sinus rhythm for VT and VF. In cases of VF or VT resistant to defibrillation, consider higher voltage defibrillation and epinephrine, 30 µg kg−1. For bradycardia or asystole, administer chest compressions and epinephrine and/or atropine, 0.05 mg kg−1. If arrhythmia is reversible, check for correct place-ment and ensure that the appropriate-sized PTCA balloon was selected and not overinflated
29, 31	Coronary vasospasm	The coronary arteries can spasm from excessive manipulation of catheters inside the vessels or during reperfusion	Intracoronary nitroglycerin (200 µg) given via slow intracoronary infusion (diluted in 2 ml of saline) can be given to dilate the artery
36 and Box 2	Difficult recovery	If the swine has become hypothermic, hypo-tensive or hypovolemic during the procedure, it can lead to prolonged recovery	Maintain swine homeostasis and monitor vital signs closely throughout procedure. Forced warm air blankets are easy and safe to use to help maintain proper temperature. Isotonic fluids should be administered at 10–15 ml kg−1 h−1 to maintain proper hydration throughout the proce-dure. Weaning anesthesia slowly while closing the surgical access site can reduce recovery times, and slowly weaning from ventilator support can quicken the return to spontaneous respiration
Boxes 1 and 2	Ventricular arrhythmia during injections	PVCs during needle engagement or injections are an indication of viable muscle at injec-tion site. However, VT or VF can be caused by excessive delivery volume, too-rapid delivery or improper needle placement and engagement	Ensure adequate volume and rate for injection sites. Avoid coronary vasculature, conduction pathways or the basal aspect of the heart dur-ing injections. Properly plan injection sites to adequately target desired areas of interest