Development and implementation of veterinary anesthesia medical quality standards for primary care

Data-driven safety limits for assessing perianesthetic mortality risk in dogs and cats undergoing elective procedures

OBJECTIVE

To create data-driven clinical pathology thresholds for routine blood tests to assess perianesthetic mortality risk in dogs and cats undergoing elective procedures.

STUDY DESIGN

Retrospective analysis.

ANIMALS

Data from dogs and cats visiting Banfield hospitals between January 2019 and March 2023.

METHODS

Using routinely collected veterinary data from dogs and cats undergoing elective procedures at primary care veterinary practices, data-driven clinical pathology thresholds were calculated to identify perianesthetic mortality risk. This process involved simulation from a generalized additive model that estimated perianesthetic mortality risk, based on signalment data, procedure type, physical status classification and blood analyte values, with data collected between January 2019 and March 2023. The simulated data was used to test 400 potential thresholds. Optimal thresholds were chosen to maximize sensitivity (proportion of deaths correctly predicted) subject to limits on false positive rate (number of non-deaths incorrectly identified). These optimal limits were evaluated on observed data.

RESULTS

Two levels of data-driven clinical pathology thresholds were determined, 'stop' and 'critical stop', with the latter more stringent. For the 'stop' limits, the overall median sensitivity on observed data was 7.16% (interquartile range 4.29%-9.88%) and 11.80% (11.00%-14.60%) for dogs and cats, respectively, and the overall median false positive rate was 2.65% (2.40%-3.31%) and 8.25% (6.86%-9.66%) for dogs and cats, respectively. Albumin, hematocrit, neutrophils and white blood cells were identified as having strong evidence for their utility in creating thresholds for dogs. Neutrophils showed strong evidence for thresholds for cats. These new data-driven thresholds offer more consistent and quantifiable false positive rates and increased sensitivities compared with existing limits. However, weaker evidence resulted in fewer useful thresholds for cats owing to lower data availability.

CONCLUSIONS AND CLINICAL RELEVANCE

It is possible to use routinely collected data to create data-driven clinical pathology thresholds for blood tests to identify animals at increased risk of perianesthetic mortality.

Periodontal Pocket Therapy Using a Class IV Dental Diode Laser in Dogs: A Retrospective Analysis

Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series evaluates the use of Class IV dental diode laser therapy for abnormal periodontal pockets in a specialty veterinary dental practice. A hypothesis that the Class IV diode dental laser is a useful adjuvant modality in canine periodontal pocket therapy in the reduction of clinical pocket depth was made. This article discusses and demonstrates diode laser use in periodontal pocket therapy in a specialty veterinary dental practice and reviews the current literature. Inclusion in this study was limited to client-owned dogs with noted periodontal pocketing on any tooth type between 3 and 6 mm, which were treated with closed root planing (RP/C) and laser therapy who returned in 6 to 7 months for recheck of the pockets from the years 2017 to 2020. Twelve patients met the inclusion criteria. A total of 128 periodontal pockets were included in the study. Each periodontal pocket was a case receiving therapy. The mean periodontal pocket depth before the treatment is measured as 3.35 mm. The mean pocket depth of the periodontal pockets following treatment was 0.59 mm. The mean improvement in periodontal pocket depths after diode laser therapy when considering patient and tooth number using linear mixed-effects modeling was 2.63 mm (95% confidence interval [CI]: 1.81-3.46, P < .0001). No statistically significant results were observed for pocket type, as P values were greater than .05.

A Retrospective Study on Canine and Feline Mortality during Anaesthesia at a University Clinic in Greece

This retrospective cohort study investigated the mortality rate during anaesthesia and possible contributing factors in canine and feline population in an academic institution in Greece. Data on 1187 dogs and 250 cats which underwent general anaesthesia from 1 January 2018 to 31 December 2019 at the Veterinary Faculty of the Aristotle University of Thessaloniki were analysed regarding cardiac arrest and mortality. In dogs, the rate of cardiac arrest was 1.1% and the rate of death was 0.6%. In cats, these rates were 2.8% and 0.8%, respectively. The mortality rate in healthy/mild disease (ASA I-II) dogs was 0.1% and in cats was 0.5%. Sick (ASA III-V) dogs exhibited a death rate of 2.6%, while sick cats had a rate of 2.2%. In dogs, ASA status had a positive association with cardiac arrest and mortality, with sick dogs being 23 times more likely to suffer cardiac arrest and 24.5 times more likely to die than healthy/mild disease ones. Other factors associated with cardiac arrest and mortality were the anaesthetic protocol and the use of inotropes. In cats, premedication and inotropic support were related to cardiac arrest and death. Feline anaesthesia involves higher risk, and requires greater vigilance in peri-anaesthetic management than dogs.

Use of ketamine and xylazine anesthesia in dogs: A retrospective cohort study of 3,413 cases

The information regarding the risk of anesthesia-related death in veterinary medicine is scarce, and little is known about the mortality risk of specific anesthetics. The study conducted during 2019 at University of Sarajevo, Veterinary faculty, aimed to estimate the mortality risk of intermittent injectable ketamine-xylazine anesthesia in dogs and to investigate the potential relationship between mortality rate and anesthesiologists’ experience. Anesthetic records, where ketamine and xylazine combination was used for anesthesia induction and maintenance, were reviewed and divided into two groups: inexperienced (AN1) and experienced anesthesiologists (AN2). Inexperienced anesthesiologists were constantly supervised by experienced ones, whose corrective interventions were recorded. Overall detected mortality rate was 0.15%, with 0.18% and 0.11% in the AN1 and AN2 groups, respectively. A statistically significant difference was not found. Records of the AN1 group revealed interventions of experienced anesthesiologist in 92% of cases. Detected mortality rate was within the values previously established for inhalant anesthesia indicating high safety in usage of investigated protocol, if performed by experienced anesthesiologists. The high percentage of interventions of a senior anesthesiologist suggests that supervised upskilling of inexperienced anesthesiologists before their independent work could result in a better outcome.