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The Effect of Premedication on the Incidence of Gastroesophageal Reflux in 270 Dogs Undergoing General Anesthesia. Animals (Basel) 2022; 12:ani12192667. [PMID: 36230408 PMCID: PMC9559275 DOI: 10.3390/ani12192667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this prospective, non-randomized study was to evaluate the effect of nine different premedication medications on the incidence of gastroesophageal reflux (GOR) in anesthetized dogs. Two hundred and seventy dogs undergoing non-intrathoracic, non-intrabdominal elective surgeries or invasive diagnostic procedures were included in the study, and were allocated into nine groups (30 dogs/group) defined by the type of premedication administered. Premedication consisted of dexmedetomidine with either morphine, pethidine or butorphanol, acepromazine with either one of the three opioids or midazolam with one of the above-mentioned opioids. Anesthesia was induced with propofol and maintained with isoflurane in oxygen. Esophageal pH was measured with the use of a pH-meter electrode and a pH-value less than 4 and over 7.5 was considered to be GOR. The study revealed that 119/270 (44.1%) dogs experienced a reflux episode during anesthesia. The incidence of reflux did not differ among groups (p = 0.117). In group AB the dogs refluxed within 10 min of the beginning of pH-measurements, in comparison with group DB in which dogs refluxed within 30 min (p = 0.029). Invasive diagnostic procedures had a lower incidence of GOR in comparison to castrations (p = 0.09). The outcome of the study suggests that none of the opioids used increased the incidence of GOR in anesthetized dogs.
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Lotti F, Boscan P, Warrit K, Twedt DC. Strongly acidic gastroesophageal reflux and esophageal lumen pH before and after esophageal lavage with water or two bicarbonate concentrations in anesthetized dogs. Am J Vet Res 2022; 83:1-5. [PMID: 36074745 DOI: 10.2460/ajvr.22.05.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To increase acidic esophageal lumen pH in dogs that developed gastroesophageal reflux (GER) during anesthesia. We compared water and 2 different bicarbonate concentrations. ANIMALS 112 healthy, nonbrachycephalic dogs presented for ovariectomy. PROCEDURES Following standard anesthesia and surgery protocols for ovariectomy in all dogs, esophageal lumen impedance and pH were monitored using a dedicated probe. Esophageal impedance indicates the presence of GER whereas pH indicates the acidity level. Dogs with strongly acidic GER and an esophageal lumen pH value < 4.0 were included in the study, and lavage was performed with either tap water, bicarbonate 1%, or bicarbonate 2% until the pH increased to > 4.0. The effect of lavage on esophageal pH was compared using the Kruskal-Wallis and Wilcoxon 2 sample tests. Associations between lavage and pH changes were determined. RESULTS Of 48/112 dogs with strongly acidic GER, 33% neutralized their esophageal pH during surgery. For the 32 dogs that maintained an esophageal lumen pH value < 4, esophageal lavage with water increased the lumen pH to > 4 in 78.6% of dogs, whereas both bicarbonate concentrations increased it in 100% of the dogs to a more neutral pH (P < .0001). The dogs in the water group were more likely to regurgitate after anesthesia (36% vs 0% in both bicarbonate groups, P = .028). CLINICAL RELEVANCE Bicarbonate 1% and 2% increased esophageal lumen pH to more than 4 after strongly acidic GER. Lavage with water was mildly effective, but required large volumes and predisposed to further regurgitation after anesthesia.
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Factors Affecting Intraoperative Gastro-Oesophageal Reflux in Dogs and Cats. Animals (Basel) 2022; 12:ani12030247. [PMID: 35158572 PMCID: PMC8833530 DOI: 10.3390/ani12030247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Gastro-oesophageal reflux (GOR) is an anaesthetic complication that causes oesophageal inflammation and stricture in animals. The aim of this systematic review is to systematically identify the effect of preoperative fasting duration and drugs (anaesthetic and nonanaesthetic agents) on GOR in dogs and cats during anaesthesia. Seven studies were included in the meta-analysis. Many factors seem to affect the development of GOR in dogs and cats. However, there is a limited number of studies investigating these factors, and as the level of evidence is low-to-medium, no reliable conclusions can be extracted. Abstract In animals, gastro-oesophageal reflux (GOR) may occur during anaesthesia, and it can lead to severe consequences such as oesophagitis and oesophageal stricture. This systematic review investigates the effect of fasting duration and anaesthetic and nonanaesthetic drugs on GOR in dogs and cats during general anaesthesia. Fifteen clinical studies met the inclusion criteria in this systematic review. In thirteen studies the population was dogs, while in two studies the population was cats. In the meta-analysis, seven studies were included. Four studies on the effect of fasting duration on GOR in dogs were included in the meta-analysis. In total, 191 dogs had a fasting duration less than 5 h, while 311 dogs had a fasting duration more than 5 h. The heterogeneity of the studies was high and statistically significant (p = 0.0002, I2 = 85%), but the overall effect was statistically nonsignificant (p = 0.82, odds ratio = 0.81, 95% CI 0.15, 4.26), in favour of the low fasting duration (<5 h). Concerning the effect of antacids on GOR, three studies were included in the meta-analysis. The heterogeneity of the studies was low and nonsignificant (p = 0.13, I2 = 52%) and the overall effect was statistically nonsignificant (p = 0.24). The low number of studies and the diverse factors affecting the incidence of reflux prevented us from reaching valuable conclusions on the risk factors for GOR.
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Abstract
Esophagitis in cats and dogs is a consequence of increased exposure of the esophageal mucosa to gastroduodenal reflux. Causes can include anesthesia-related reflux, frequent vomiting, or lodged foreign bodies. An exception is eosinophilic esophagitis, an emerging primary inflammatory disease of the esophagus with a presumed allergic etiology. Reflux esophagitis owing to lower esophageal sphincter incompetence is often suspected; a tentative diagnosis can be made by endoscopic assessment, wireless esophageal pH-monitoring, or histologic examination. Because it can be difficult to distinguish diet-responsive upper gastrointestinal disease from esophagitis, response to treatment with gastric acid suppressants is needed to confirm the tentative diagnosis.
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Affiliation(s)
- Peter Hendrik Kook
- Department of Small Animals, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, Zurich 8057, Switzerland.
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Lotti F, Twedt D, Warrit K, Bryan S, Vaca C, Krause L, Fukushima K, Boscan P. Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs. J Small Anim Pract 2021; 62:677-682. [PMID: 33769569 DOI: 10.1111/jsap.13328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Gastroesophageal reflux can occur during anaesthesia and may lead to esophagitis and occasionally oesophageal stricture formation. The aim of the study is to assess two omeprazole protocols on gastroesophageal reflux incidence and pH in anaesthetised dogs. MATERIALS AND METHODS Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1 mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1 mg/kg orally the evening and 3 hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs). An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia. RESULTS Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups. Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH < 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively. CLINICAL SIGNIFICANCE Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.
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Affiliation(s)
- F Lotti
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - D Twedt
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - K Warrit
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - S Bryan
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - C Vaca
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - L Krause
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - K Fukushima
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - P Boscan
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
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A Systematic Review of the Methods of Assessment of Gastro-Oesophageal Reflux in Anaesthetized Dogs. Animals (Basel) 2021; 11:ani11030852. [PMID: 33803871 PMCID: PMC8003202 DOI: 10.3390/ani11030852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Regurgitation and gastro-oesophageal reflux (GOR) are common complications in dogs under anaesthesia. We reviewed the definitions and methods of GOR assessment in anaesthetized dogs published in 22 scientific papers to assess if studies were comparable (i.e., looking at the same thing). The definition of GOR implied the presence of fluids not reaching the mouth or nose in the oesophagus in all studies. Most studies measured the acidity in the oesophagus to state if fluids were present or not. The probes were not always placed in the same location and definitions varied. This means that it is complicated to compare findings of the different studies. Abstract We reviewed the definitions and methods of assessment of gastro-oesophageal reflux (GOR) in anaesthetized dogs. Three databases were used. Titles and abstracts were screened by two of the authors independently. A total of 22 studies was included in the analysis. The definition of GOR implied the presence of fluids not reaching the mouth or nose in the oesophagus in all studies. Most studies considered a change in pH using oesophageal pH meters as the sole method of assessment. Calibration of the pH probe was inconsistently reported. The position of the tip of the oesophageal probe was inconsistent and not always precisely described. The correct positioning in the intended location was verified in a limited number of studies. Some studies considered that GOR had happened for changes in pH below 4.0 or above 7.5 while others considered that GOR had happened when the pH dropped below 4.0 only. Some studies stated that the pH change had to be sustained for a minimum period of time (20 or 30 s) whereas others did not mention any duration. The variability of definitions and methods of assessment of GOR in anaesthetized dogs precludes meaningful comparison of the findings. Re-evaluation and uniformization of the methods appear necessary.
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Costa RS, Abelson AL, Lindsey JC, Wetmore LA. Postoperative regurgitation and respiratory complications in brachycephalic dogs undergoing airway surgery before and after implementation of a standardized perianesthetic protocol. J Am Vet Med Assoc 2020; 256:899-905. [PMID: 32223703 DOI: 10.2460/javma.256.8.899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether implementation of a standardized perianesthetic protocol was associated with reduced incidence of postoperative regurgitation, pneumonia, and respiratory distress in brachycephalic dogs undergoing general anesthesia for airway surgery. ANIMALS 84 client-owned dogs. PROCEDURES A perianesthetic protocol that included preoperative administration of metoclopramide and famotidine, restrictive use of opioids, and recovery of patients in the intensive care unit was fully implemented for brachycephalic dogs in July 2014. Medical records of brachycephalic dogs (specifically Boston Terriers, French Bulldogs, English Bulldogs, and Pugs) undergoing anesthesia for airway surgery before (group A) and after (group B) protocol implementation were reviewed. Patient characteristics, administration of medications described in the protocol, surgical procedures performed, anesthesia duration, recovery location, and postoperative development of regurgitation, pneumonia, and respiratory distress were recorded. Data were compared between groups. RESULTS The proportion of dogs with postoperative regurgitation in group B (4/44 [9%]) was significantly lower than that in group A (14/40 [35%]). No intergroup differences in patient characteristics (including history of regurgitation), procedures performed, or anesthesia duration were found. Rates of development of postoperative pneumonia and respiratory distress did not differ between groups. A history of regurgitation was associated with development of postoperative regurgitation. CONCLUSIONS AND CLINICAL RELEVANCE Implementation of the described protocol was associated with decreased incidence of postoperative regurgitation in brachycephalic dogs undergoing anesthesia. Prospective studies are warranted to elucidate specific causes of this finding.
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Jones CT, Fransson BA. Evaluation of the effectiveness of preoperative administration of maropitant citrate and metoclopramide hydrochloride in preventing postoperative clinical gastroesophageal reflux in dogs. J Am Vet Med Assoc 2020; 255:437-445. [PMID: 31355727 DOI: 10.2460/javma.255.4.437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the prophylactic effectiveness of preoperative administration of maropitant citrate and metoclopramide hydrochloride in preventing postoperative clinical gastroesophageal reflux (GER) in dogs and to identify risk factors for clinical postoperative GER in dogs. ANIMALS 93 client-owned dogs undergoing surgery at the Washington State University Veterinary Teaching Hospital between March 2016 and February 2017. PROCEDURES Dogs were randomly assigned to either the intervention group (preoperatively received maropitant and metoclopramide) or the control group (did not preoperatively receive maropitant and metoclopramide). After surgery, all dogs were recovered and monitored, and occurrences of GER were noted. The prophylactic effectiveness of maropitant and metoclopramide was evaluated, and univariate and multivariate logistic regression analyses were performed to identify variables associated with postoperative clinical GER in dogs. RESULTS No meaningful difference in the incidence of clinical GER during the postoperative period was detected between the control and intervention groups. Results indicated that variables associated with significantly increased odds of postoperative clinical GER included the male sex (OR, 9.2; 95% confidence interval [CI], 1.26 to 195.0), an overweight BCS (OR, 12.3; 95% CI, 2.1 to 135.1), gastrointestinal surgery (OR, 30.5; 95% CI, 3.0 to 786.9), and requirement for a dexmedetomidine constant rate infusion after surgery (OR, 9.6; 95% CI, 1.3 to 212.5). CONCLUSIONS AND CLINICAL RELEVANCE Findings indicated that incidence of clinical GER during the postoperative period was not lower for dogs that received preoperative prophylactic administration of metoclopramide and maropitant, compared with incidence dogs that did not receive the prophylactic treatment. Further research is required into alternative measures to prevent postoperative clinical GER in dogs.
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Lindsay B, Cook D, Wetzel JM, Siess S, Moses P. Brachycephalic airway syndrome: management of post-operative respiratory complications in 248 dogs. Aust Vet J 2020; 98:173-180. [PMID: 32037517 DOI: 10.1111/avj.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE As ownership of brachycephalic dog breeds rises, the surgical correction of components of brachycephalic airway syndrome (BAS) is increasingly recommended by veterinarians. This study's objective was to describe the incidence of, and strategies for the management of post-operative respiratory complications in brachycephalic dogs undergoing surgical correction of one or more components of BAS. METHODS Medical records of 248 brachycephalic dogs treated surgically for BAS were retrospectively reviewed for demographic information, procedures performed, post-operative complications and treatment implemented, hospitalisation time, and necessity for further surgery. RESULTS Pugs, Cavalier King Charles Spaniels and British Bulldogs were the most commonly encountered breeds. Dogs which experienced a complication were significantly older (mean was 5.5 years, compared with 4.1 years [P < 0.01]). Fifty-eight dogs (23.4%) had complications which included: dyspnoea managed with supplemental oxygen alone (7.3%, n = 18), dyspnoea requiring anaesthesia and re-intubation (8.9%, n = 22), dyspnoea necessitating treatment with a temporary tracheostomy (8.9%, n = 22), aspiration pneumonia (4%, n = 10), and respiratory or cardiac arrest (2.4%, n = 6). Five of the 22 dogs requiring anaesthesia and re-intubation deteriorated 12 or more hours after post-surgical anaesthetic recovery. The overall mortality rate in this study was 2.4% (n = 6). Age, concurrent airway pathology, and emergency presentation significantly predicted post-operative complications. CONCLUSION Our data show the importance of close monitoring for a minimum of 24 h following surgery by an experienced veterinarian or veterinary technician. Surgical intervention for BAS symptomatic dogs should be considered at an earlier age as an elective procedure, to reduce the risk of post-operative complications.
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Affiliation(s)
- B Lindsay
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - D Cook
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - J-M Wetzel
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - S Siess
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - P Moses
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
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Bruniges N, Rioja E. Intraoperative anaesthetic complications in dogs undergoing general anaesthesia for thoracolumbar hemilaminectomy: a retrospective analysis. Vet Anaesth Analg 2019; 46:720-728. [PMID: 31547961 DOI: 10.1016/j.vaa.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To establish the incidence of intraoperative anaesthetic complications in dogs undergoing general anaesthesia (GA) for thoracolumbar hemilaminectomy (TH), to determine whether GA duration affects incidence of intraoperative complications and to identify associations between intraoperative complications. STUDY DESIGN Retrospective observational study. ANIMALS A total of 224 client-owned dogs of various breeds undergoing TH for intervertebral disc extrusion. METHODS Anaesthetic records of dogs undergoing TH at a university teaching hospital between 2010 and 2016 were analysed. Data recorded included breed, sex, body weight, GA duration, magnetic resonance imaging (MRI) under the same GA, pharmacological intervention to increase heart rate (PIHR), hypotension (mean arterial blood pressure < 60 mmHg for ≥ 10 minutes), mechanical ventilation (MV) for inadequate ventilation, hypothermia (oesophageal temperature < 37 °C), oesophageal temperature ≥ 39 °C (T ≥ 39 °C), temperature trend, regurgitation and use of alpha-2 adrenoreceptor agonists, acepromazine, ketamine or lidocaine. Multivariate logistic regression models were fitted for hypothermia, T ≥ 39 °C, hypotension and PIHR with forced inclusion of GA duration. RESULTS Hypothermia was the most common complication (63.8% incidence), followed by MV implementation (63.4%), hypotension (33.9%), PIHR (24.6%), T ≥ 39 °C (20.5%) and regurgitation (4.9%). Multivariate models revealed that MRI and hypotension were associated with an increased risk of hypothermia, whilst increasing body weight, alpha-2 adrenoreceptor agonists and MV were associated with a reduced risk. Alpha-2 adrenoreceptor agonists and GA duration were associated with an increased risk of T ≥ 39 °C, whilst hypotension was associated with a reduced risk. Hypothermia and PIHR were associated with an increased risk of hypotension, whereas increased body weight was associated with a reduced risk. MV and hypothermia were associated with an increased risk of PIHR, whereas increased body weight was associated with a reduced risk. CONCLUSIONS AND CLINICAL RELEVANCE Increasing GA duration was associated with increased risk of T ≥ 39 °C, but not any other intraoperative complications.
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Affiliation(s)
- Natalie Bruniges
- School of Veterinary Science, Liverpool University, Liverpool, UK.
| | - Eva Rioja
- Optivet Referrals, Havant, Hampshire, UK
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Fawcett A, Barrs V, Awad M, Child G, Brunel L, Mooney E, Martinez-Taboada F, McDonald B, McGreevy P. Consequences and Management of Canine Brachycephaly in Veterinary Practice: Perspectives from Australian Veterinarians and Veterinary Specialists. Animals (Basel) 2018; 9:E3. [PMID: 30577619 PMCID: PMC6356869 DOI: 10.3390/ani9010003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/30/2022] Open
Abstract
This article, written by veterinarians whose caseloads include brachycephalic dogs, argues that there is now widespread evidence documenting a link between extreme brachycephalic phenotypes and chronic disease, which compromises canine welfare. This paper is divided into nine sections exploring the breadth of the impact of brachycephaly on the incidence of disease, as indicated by pet insurance claims data from an Australian pet insurance provider, the stabilization of respiratory distress associated with brachycephalic obstructive airway syndrome (BOAS), challenges associated with sedation and the anaesthesia of patients with BOAS; effects of brachycephaly on the brain and associated neurological conditions, dermatological conditions associated with brachycephalic breeds, and other conditions, including ophthalmic and orthopedic conditions, and behavioural consequences of brachycephaly. In the light of this information, we discuss the ethical challenges that are associated with brachycephalic breeds, and the role of the veterinarian. In summary, dogs with BOAS do not enjoy freedom from discomfort, nor freedom from pain, injury, and disease, and they do not enjoy the freedom to express normal behaviour. According to both deontological and utilitarian ethical frameworks, the breeding of dogs with BOAS cannot be justified, and further, cannot be recommended, and indeed, should be discouraged by veterinarians.
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Affiliation(s)
- Anne Fawcett
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Vanessa Barrs
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Magdoline Awad
- PetSure, 465 Victoria Avenue, Chatswood, NSW 2067, Australia.
| | - Georgina Child
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Laurencie Brunel
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Erin Mooney
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Fernando Martinez-Taboada
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Beth McDonald
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Paul McGreevy
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
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Marks SL, Kook PH, Papich MG, Tolbert MK, Willard MD. ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. J Vet Intern Med 2018; 32:1823-1840. [PMID: 30378711 PMCID: PMC6271318 DOI: 10.1111/jvim.15337] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
The gastrointestinal (GI) mucosal barrier is continuously exposed to noxious toxins, reactive oxygen species, microbes, and drugs, leading to the development of inflammatory, erosive, and ultimately ulcerative lesions. This report offers a consensus opinion on the rational administration of GI protectants to dogs and cats, with an emphasis on proton pump inhibitors (PPIs), histamine type-2 receptor antagonists (H2 RAs), misoprostol, and sucralfate. These medications decrease gastric acidity or promote mucosal protective mechanisms, transforming the management of dyspepsia, peptic ulceration, and gastroesophageal reflux disease. In contrast to guidelines that have been established in people for the optimal treatment of gastroduodenal ulcers and gastroesophageal reflux disease, effective clinical dosages of antisecretory drugs have not been well established in the dog and cat to date. Similar to the situation in human medicine, practice of inappropriate prescription of acid suppressants is also commonplace in veterinary medicine. This report challenges the dogma and clinical practice of administering GI protectants for the routine management of gastritis, pancreatitis, hepatic disease, and renal disease in dogs and cats lacking additional risk factors for ulceration or concerns for GI bleeding. Judicious use of acid suppressants is warranted considering recent studies that have documented adverse effects of long-term supplementation of PPIs in people and animals.
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Affiliation(s)
- Stanley L. Marks
- Department of Medicine & EpidemiologySchool of Veterinary Medicine, University of California, DavisDavisCalifornia
| | - Peter H. Kook
- Vetsuisse Faculty, Clinic for Small Animal Internal Medicine, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Mark G. Papich
- Department of Molecular Biomedical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth Carolina
| | - M. K. Tolbert
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, Texas A & M UniversityCollege StationTexas
| | - Michael D. Willard
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, Texas A & M UniversityCollege StationTexas
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Reid K. Perioperative gastrointestinal reflux in dogs. IN PRACTICE 2018. [DOI: 10.1136/inp.k4353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Ogden J, Ovbey D, Saile K. Effects of preoperative cisapride on postoperative aspiration pneumonia in dogs with laryngeal paralysis. J Small Anim Pract 2018; 60:183-190. [DOI: 10.1111/jsap.12940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/13/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Ogden
- Pittsburgh Veterinary Specialty and Emergency Center; Pittsburgh Pennsylvania 15237 USA
| | - D. Ovbey
- Southeast Veterinary Anesthesia Services; Charleston South Carolina 29416 USA
| | - K. Saile
- Pittsburgh Veterinary Specialty and Emergency Center; Pittsburgh Pennsylvania 15237 USA
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Baetge C, Cummings KJ, Deveau M. Reduced risk of pneumonia after changes in anesthetic procedures for dogs receiving repeated anesthesia for radiation treatment. Vet Radiol Ultrasound 2018; 60:241-245. [PMID: 30375098 DOI: 10.1111/vru.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022] Open
Abstract
Radiation therapy requires repeated anesthetic administration to patients who often have multiple comorbidities contributing to an increased rate of anesthetic complications such as pneumonia. This is a retrospective observational study in which data were collected from 146 medical records of dogs receiving repeat anesthesia for radiation treatment from prior to management changes and compared to data from 149 cases treated after completion of management changes. The objective was to determine if changes in case management protocol that were put in place decreased the risk of pneumonia development among these patients. Management changes that were made included the following: decrease in anticholinergic and pure-mu opioid use, change in positioning during intubation and recovery, prophylactic treatment of nausea, timing of cuff inflation and deflation, and aseptic handling of intubation equipment. There was a significant association between diagnosis of pneumonia and the following: pre- vs. post-changes to protocol, presence of a neurologic tumor, presence of respiratory disease, presence of megaesophagus, and number of radiation fractions completed. Diagnosis of pneumonia did not vary significantly by age group, body weight category, or sex. In a multivariable logistic regression model that controlled for the effects of the three concurrent diseases and fractions completed, the odds of being diagnosed with pneumonia were approximately 10 times greater among dogs anesthetized prior to management changes (odds ratio = 9.9, 95% CI = 2.0-48.7, P = 0.005).
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Affiliation(s)
- Courtney Baetge
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, 77346
| | - Kevin J Cummings
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, 14853
| | - Michael Deveau
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, 77346
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17
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Brioschi FA, Gioeni D, Jacchetti A, Carotenuto AM. Effect of metoclopramide on nausea and emesis in dogs premedicated with morphine and dexmedetomidine. Vet Anaesth Analg 2018; 45:190-194. [PMID: 29409803 DOI: 10.1016/j.vaa.2017.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/16/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate whether subcutaneous (SC) metoclopramide (0.2 mg kg-1) administered 30 minutes prior to (T30) or simultaneously with (T0) intramuscular (IM) morphine (0.2 mg kg-1) and dexmedetomidine (0.003 mg kg-1) reduces the incidence of nausea and emesis in healthy dogs. STUDY DESIGN Prospective, randomized and blinded study. ANIMALS A total of 45 dogs scheduled for elective procedures. METHODS Dogs were assigned randomly to three groups to be administered SC metoclopramide (0.2 mg kg-1) 30 minutes before (group M30) or simultaneously (group M0) to IM morphine (0.2 mg kg-1) and dexmedetomidine (0.003 mg kg-1). Dogs in the control group (group C) were administered SC saline at T30 and T0. Dogs were observed for 30 minutes after premedication to evaluate signs of nausea (continuous lip-licking and sialorrhoea) and emesis. Signs of pain or discomfort caused by SC injections were also recorded. RESULTS There were no statistical differences amongst groups for age, body weight and sex. More dogs developed continuous lip-licking in group C (12/15, 80.0%) compared to dogs in group M30 (1/15, 6.7%) and dogs in group M0 (5/15, 33.3%; p = 0.0001 and p = 0.01, respectively). More dogs developed sialorrhoea in group M0 (8/15, 53.3%) and in group C (10/15, 66.7%) compared to dogs in group M30 (2/15, 13.3%; p = 0.03 and p = 0.004, respectively). More dogs vomited in group M0 (4/15, 26.7%) and in group C (9/15, 60.0%) compared to dogs in group M30 (0/15, 0.0%; p = 0.05 and p = 0.0003, respectively). None of the dogs demonstrated signs of pain or discomfort during SC metoclopramide injection. CONCLUSIONS AND CLINICAL RELEVANCE Subcutaneous metoclopramide at 0.2 mg kg-1 may reduce IM morphine and dexmedetomidine-induced nausea and emesis if administered 30 minutes in advance. It is effective in reducing lip-licking even when administered concurrently with IM morphine-dexmedetomidine.
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Simon BT, Scallan EM, Carroll G, Steagall PV. The lack of analgesic use (oligoanalgesia) in small animal practice. J Small Anim Pract 2017; 58:543-554. [PMID: 28763103 DOI: 10.1111/jsap.12717] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 03/03/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
Oligoanalgesia is defined as failure to provide analgesia in patients with acute pain. Treatment of pain in emergencies, critical care and perioperatively may influence patient outcomes: the harmful practice of withholding analgesics occurs in teaching hospitals and private practices and results in severe physiological consequences. This article discusses the prevalence, primary causes, species and regional differences and ways to avoid oligoanalgesia in small animal practice. Oligoanalgesia may be addressed by improving education on pain management in the veterinary curriculum, providing continuing education to veterinarians and implementing pain scales.
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Affiliation(s)
- B T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - E M Scallan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - G Carroll
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - P V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, 3200 Rue Sicotte, Saint-Hyacinthe, Quebec, J2S2M2, Canada
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Sherman R, Karagiannis M. Aspiration Pneumonia in the Dog: A Review. Top Companion Anim Med 2017; 32:1-7. [PMID: 28750782 DOI: 10.1053/j.tcam.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the human and veterinary literature pertaining to aspiration pneumonitis and pneumonia. MATERIAL AND METHODS Data sources included scientific reviews and original research publications from the human and veterinary literature. All reviews and studies that added to the understanding of aspiration pneumonia were included. RESULTS Compared to human medicine, aspiration pneumonia can be difficult to diagnose in the canine patient and is often a diagnosis of presumption. Multiple risk factors exist increasing the likelihood of aspiration pneumonia and a thorough understanding of these can aid in prevention. Treatment recommendations center primarily on supportive care, oxygen therapy and antibiotic administration. CLINCIAL SIGNIFICANCE Aspiration pneumonia is a common finding in the canine patient and a thorough understanding of the disease will lead to better treatment outcomes. Further studies on treatment and prevention in veterinary medicine are warranted.
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Anagnostou TL, Kazakos GM, Savvas I, Kostakis C, Papadopoulou P. Gastro-oesophageal reflux in large-sized, deep-chested versus small-sized, barrel-chested dogs undergoing spinal surgery in sternal recumbency. Vet Anaesth Analg 2017; 44:35-41. [PMID: 27388495 DOI: 10.1111/vaa.12404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether an increased frequency of gastro-oesophageal reflux (GOR) is more common in large-sized, deep-chested dogs undergoing spinal surgery in sternal recumbency than in small-sized, barrelchested dogs. STUDY DESIGN Prospective, cohort study. ANIMALS Nineteen small-sized, barrel-chested dogs (group B) and 26 large-sized, deep-chested dogs (group D). METHODS All animals were premedicated with intramuscular (IM) acepromazine (0.05 mg kg-1) and pethidine (3 mg kg-1) IM. Anaesthesia was induced with intravenous sodium thiopental and maintained with halothane in oxygen. Lower oesophageal pH was monitored continuously after induction of anaesthesia. Gastro-oesophageal reflux was considered to have occurred whenever pH values > 7.5 or < 4 were recorded. If GOR was detected during anaesthesia, measures were taken to avoid aspiration of gastric contents into the lungs and to prevent the development of oesophagitis/oesophageal stricture. RESULTS The frequency of GOR during anaesthesia was significantly higher in group D (6/26 dogs; 23.07%) than in group B (0/19 dogs; 0%) (p = 0.032). Signs indicative of aspiration pneumonia, oesophagitis or oesophageal stricture were not reported in any of the GOR cases. CONCLUSIONS AND CLINICAL RELEVANCE In large-sized, deep-chested dogs undergoing spinal surgery in sternal recumbency, it would seem prudent to consider measures aimed at preventing GOR and its potentially devastating consequences (oesophagitis/oesophageal stricture, aspiration pneumonia).
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Affiliation(s)
- Tilemahos L Anagnostou
- Anaesthesia and Intensive Care Unit, Faculty of Health Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George M Kazakos
- Anaesthesia and Intensive Care Unit, Faculty of Health Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Savvas
- Anaesthesia and Intensive Care Unit, Faculty of Health Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Charalampos Kostakis
- Anaesthesia and Intensive Care Unit, Faculty of Health Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paraskevi Papadopoulou
- Diagnostic Imaging Unit, Faculty of Health Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Krentz T, Allen S. Bacterial translocation in critical illness. J Small Anim Pract 2017; 58:191-198. [PMID: 28186322 DOI: 10.1111/jsap.12626] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 12/19/2022]
Abstract
Bacterial translocation involves the passage of intestinal bacteria to extraintestinal sites and has been shown to increase morbidity and mortality in critical illness. This review outlines the pathophysiology of bacterial translocation, host defence mechanisms, and reviews the evidence for the clinical management of critically ill patients in order to minimise the negative outcomes associated with bacterial translocation.
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Affiliation(s)
- T Krentz
- Department of Emergency and Critical Care, Massachusetts Veterinary Referral Hospital, Woburn, MA, 01801, USA
| | - S Allen
- Department of Emergency and Critical Care, Massachusetts Veterinary Referral Hospital, Woburn, MA, 01801, USA
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22
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Viskjer S, Sjöström L. Effect of the duration of food withholding prior to anesthesia on gastroesophageal reflux and regurgitation in healthy dogs undergoing elective orthopedic surgery. Am J Vet Res 2017; 78:144-150. [DOI: 10.2460/ajvr.78.2.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Milovancev M, Townsend K, Spina J, Hurley C, Ralphs SC, Trumpatori B, Seguin B, Jermyn K. Effect of Metoclopramide on the Incidence of Early Postoperative Aspiration Pneumonia in Dogs with Acquired Idiopathic Laryngeal Paralysis. Vet Surg 2016; 45:577-81. [DOI: 10.1111/vsu.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Milan Milovancev
- Department of Clinical Sciences; College of Veterinary Medicine, Oregon State University; Corvallis Oregon
| | - Katy Townsend
- Department of Clinical Sciences; College of Veterinary Medicine, Oregon State University; Corvallis Oregon
| | - Jason Spina
- Department of Clinical Sciences; College of Veterinary Medicine, Oregon State University; Corvallis Oregon
| | - Connie Hurley
- Wisconsin Veterinary Referral Center; Waukesha Wisconsin
| | | | - Brian Trumpatori
- Veterinary Specialty Hospital of the Carolinas; Cary North Carolina
| | - Bernard Seguin
- Department of Clinical Sciences; College of Veterinary Medicine, Oregon State University; Corvallis Oregon
| | - Kieri Jermyn
- Department of Clinical Sciences; College of Veterinary Medicine, North Carolina State University; Raleigh North Carolina
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Whitehead K, Cortes Y, Eirmann L. Gastrointestinal dysmotility disorders in critically ill dogs and cats. J Vet Emerg Crit Care (San Antonio) 2016; 26:234-53. [PMID: 26822390 DOI: 10.1111/vec.12449] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 07/21/2015] [Accepted: 08/30/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the human and veterinary literature regarding gastrointestinal (GI) dysmotility disorders in respect to pathogenesis, patient risk factors, and treatment options in critically ill dogs and cats. ETIOLOGY GI dysmotility is a common sequela of critical illness in people and small animals. The most common GI motility disorders in critically ill people and small animals include esophageal dysmotility, delayed gastric emptying, functional intestinal obstruction (ie, ileus), and colonic motility abnormalities. Medical conditions associated with the highest risk of GI dysmotility include mechanical ventilation, sepsis, shock, trauma, systemic inflammatory response syndrome, and multiple organ failure. The incidence and pathophysiology of GI dysmotility in critically ill small animals is incompletely understood. DIAGNOSIS A presumptive diagnosis of GI dysmotility is often made in high-risk patient populations following detection of persistent regurgitation, vomiting, lack of tolerance of enteral nutrition, abdominal pain, and constipation. Definitive diagnosis is established via radioscintigraphy; however, this diagnostic tool is not readily available and is difficult to perform on small animals. Other diagnostic modalities that have been evaluated include abdominal ultrasonography, radiographic contrast, and tracer studies. THERAPY Therapy is centered at optimizing GI perfusion, enhancement of GI motility, and early enteral nutrition. Pharmacological interventions are instituted to promote gastric emptying and effective intestinal motility and prevention of complications. Promotility agents, including ranitidine/nizatidine, metoclopramide, erythromycin, and cisapride are the mainstays of therapy in small animals. PROGNOSIS The development of complications related to GI dysmotility (eg, gastroesophageal reflux and aspiration) have been associated with increased mortality risk. Institution of prophylaxic therapy is recommended in high-risk patients, however, no consensus exists regarding optimal timing of initiating prophylaxic measures, preference of treatment, or duration of therapy. The prognosis for affected small animal patients remains unknown.
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Affiliation(s)
- KimMi Whitehead
- Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452
| | - Yonaira Cortes
- Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452
| | - Laura Eirmann
- the Nutrition Department (Eirmann), Oradell Animal Hospital, Paramus, NJ, 07452
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25
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Wilson D, Monnet E. Risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis: 232 cases (1987–2012). J Am Vet Med Assoc 2016; 248:188-94. [DOI: 10.2460/javma.248.2.188] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rodríguez-Alarcón CA, Beristain-Ruiz DM, Rivera-Barreno R, Díaz G, Usón-Casaús JM, García-Herrera R, Pérez-Merino EM. Gastroesophageal reflux in anesthetized dogs: a review. REV COLOMB CIENC PEC 2015. [DOI: 10.17533/udea.rccp.v28n2a03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kempf J, Lewis F, Reusch CE, Kook PH. High-resolution manometric evaluation of the effects of cisapride and metoclopramide hydrochloride administered orally on lower esophageal sphincter pressure in awake dogs. Am J Vet Res 2014; 75:361-6. [DOI: 10.2460/ajvr.75.4.361] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ovbey DH, Wilson DV, Bednarski RM, Hauptman JG, Stanley BJ, Radlinsky MG, Larenza MP, Pypendop BH, Rezende ML. Prevalence and risk factors for canine post-anesthetic aspiration pneumonia (1999–2009): a multicenter study. Vet Anaesth Analg 2014; 41:127-36. [DOI: 10.1111/vaa.12110] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 10/13/2012] [Indexed: 01/10/2023]
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Evaluation of metoclopramide and ranitidine on the prevention of gastroesophageal reflux episodes in anesthetized dogs. Res Vet Sci 2012; 93:466-7. [DOI: 10.1016/j.rvsc.2011.07.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/28/2011] [Accepted: 07/24/2011] [Indexed: 11/17/2022]
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Zacuto AC, Marks SL, Osborn J, Douthitt KL, Hollingshead KL, Hayashi K, Kapatkin AS, Pypendop BH, Belafsky PC. The influence of esomeprazole and cisapride on gastroesophageal reflux during anesthesia in dogs. J Vet Intern Med 2012; 26:518-25. [PMID: 22489656 DOI: 10.1111/j.1939-1676.2012.00929.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/21/2012] [Accepted: 03/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux (GER) is common in anesthetized dogs and can cause esophagitis, esophageal stricture, and aspiration pneumonia. OBJECTIVE To determine whether preanesthetic IV administration of esomeprazole alone or esomeprazole and cisapride increases esophageal pH and decreases the frequency of GER in anesthetized dogs using combined multichannel impedance and pH monitoring. ANIMALS Sixty-one healthy dogs undergoing elective orthopedic surgery procedures. METHODS Prospective, randomized, placebo-controlled study. Dogs were randomized to receive IV saline (0.9% NaCl), esomeprazole (1 mg/kg) alone, or a combination of esomeprazole (1 mg/kg) and cisapride (1 mg/kg) 12-18 hours and 1-1.5 hours before anesthetic induction. An esophageal pH/impedance probe was utilized to measure esophageal pH and detect GER. RESULTS Eight of 21 dogs in the placebo group (38.1%), 8 of 22 dogs in the esomeprazole group (36%), and 2 of 18 dogs in the combined esomeprazole and cisapride group (11%) had ≥ 1 episode of GER on impedance testing during anesthesia (P < .05). Esomeprazole was associated with a significant increase in gastric and esophageal pH (P = .001), but the drug did not significantly decrease the frequency of GER (P = .955). Concurrent administration of cisapride was associated with a significant decrease in the number of reflux events (RE) compared to the placebo and esomeprazole groups (P < .05). CONCLUSIONS AND CLINICAL RELEVANCE Preanesthetic administration of cisapride and esomeprazole decreases the number of RE in anesthetized dogs, but administration of esomeprazole alone was associated with nonacid and weakly acidic reflux in all but 1 dog.
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Affiliation(s)
- A C Zacuto
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Sacramento, CA 95616, USA
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Mercurio A. Complications of Upper Airway Surgery in Companion Animals. Vet Clin North Am Small Anim Pract 2011; 41:969-80, vi-vii. [DOI: 10.1016/j.cvsm.2011.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Favarato ES, de Souza MV, Costa PRDS, Pompermayer LG, Favarato LSC, Ribeiro Júnior JI. Ambulatory esophageal pHmetry in healthy dogs with and without the influence of general anesthesia. Vet Res Commun 2011; 35:271-82. [PMID: 21461644 DOI: 10.1007/s11259-011-9471-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2011] [Indexed: 12/20/2022]
Abstract
This research aimed to determine the value of esophageal pH in awake and anesthetized dogs, to evaluate the esophageal pH value in awake dogs, in different body positions, as well as to study the occurrence of gastroesophageal reflux episodes in these positions. Thus, 40 healthy male and female adult dogs with mean body weight of 15.5 ± 4.6 kg were used. Esophageal pHmetry was conducted by inserting a catheter through the oropharynx in 30 dogs (stage 1) anesthetized with acepromazine, propofol and isoflurane, submitted to elective ovariosalpingohysterectomy. In addition, 8-h esophageal pHmetry was carried out transnasally in 10 awake dogs (stage 2), allowed to move and change body positions (lateral and sternal decubitus, and standing position), which were recorded. The mean esophageal pH value was lower (p < 0.01) in the anesthetized dogs (7.3 ± 0.82) than in the awake dogs (8.2 ± 0.3). Only four anesthetized dogs (13.33%) suffered reflux episodes. Reflux was not observed in the awake dogs and no esophageal pH differences were found between the body positions studied. Compared to the alert state, general anesthesia in dogs submitted to the previously mentioned anesthesia protocol causes esophageal pH reduction and predisposes to the occurrence of gastroesophageal reflux episodes. Transnasal pHmetry of 8 h in healthy awake dogs reveals that the esophageal pH value is alkaline and does not vary according to body position. In these animals, decubitus position is not a determining factor for reflux episodes to occur.
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Affiliation(s)
- Evandro Silva Favarato
- Department of Veterinary Medicine, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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Elwood C, Devauchelle P, Elliott J, Freiche V, German AJ, Gualtieri M, Hall E, den Hertog E, Neiger R, Peeters D, Roura X, Savary-Bataille K. Emesis in dogs: a review. J Small Anim Pract 2010; 51:4-22. [PMID: 20137004 PMCID: PMC7167204 DOI: 10.1111/j.1748-5827.2009.00820.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2009] [Indexed: 11/26/2022]
Abstract
Emesis is a common presenting sign in small animal practice. It requires a rational approach to management that is based upon a sound understanding of pathophysiology combined with logical decision making. This review, which assesses the weight of available evidence, outlines the physiology of the vomiting reflex, causes of emesis, the consequences of emesis and the approach to clinical management of the vomiting dog. The applicability of diagnostic testing modalities and the merit of traditional approaches to management, such as dietary changes, are discussed. The role and usefulness of both traditional and novel anti-emetic drugs is examined, including in specific circumstances such as following cytotoxic drug treatment. The review also examines areas in which common clinical practice is not necessarily supported by objective evidence and, as such, highlights questions worthy of further clinical research.
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Affiliation(s)
- C Elwood
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, Hertfordshire SG5 3HR
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Panti A, Bennett R, Corletto F, Brearley J, Jeffrey N, Mellanby R. The effect of omeprazole on oesophageal pH in dogs during anaesthesia. J Small Anim Pract 2009; 50:540-4. [DOI: 10.1111/j.1748-5827.2009.00818.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
5-Hydroxytryptamine, or serotonin, is a biogenic amine most noted for its role as a neurotransmitter. Manipulation of serotonin in animal models was used as a tool for studying its role in humans. Through such research serotonin has been shown to modulate gastrointestinal motility, peripheral vascular tone, cerebral vascular tone, and platelet function and has been implicated in the pathophysiology of mood disorders, emesis, migraine, irritable bowel syndrome (IBS), and pulmonary and systemic hypertension. The knowledge gained is being directly applied back to animals in research on drugs that manipulate the serotonergic system in dogs and cats. Increasing use and availability of drugs that manipulate the serotonergic system has created a circumstance through which a novel toxicity was discovered in both humans and animals. Serotonin Syndrome describes the clinical picture seen in humans and animals with serotonin toxicity. This paper provides a review the physiology of serotonin and its involvement in the pathophysiologic mechanisms of various conditions, including the Serotonin Syndrome.
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Affiliation(s)
- L F Mohammad-Zadeh
- Southern Arizona Veterinary Specialty and Emergency Center, Tucson, AZ 85705, USA.
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Abstract
OBJECTIVE To determine the effect of suction, lavage and instillation of sodium bicarbonate solution on esophageal pH during acidic gastro-esophageal reflux (GER) in anesthetized dogs. STUDY DESIGN Prospective, clinical trial. ANIMALS Ten healthy dogs, 4.8 +/- 2.4 years old, and weighing 37.1 +/- 7.9 kg. METHODS Dogs were admitted to the study if they were under general anesthesia and regurgitation occurred. A sensor-tipped catheter was used to measure esophageal pH. On study entry the esophagus was suctioned. After an interval of at least 5 minutes, if the esophageal pH was still less than 4 the esophagus was lavaged with tap water and again suctioned. In 6 dogs 20 mL of dilute bicarbonate solution was instilled into the esophageal lumen. RESULTS Suctioning fluid from the esophagus did not change the pH significantly. Lavage with tap water caused the pH to increase above 4 in four dogs, with the average pH increasing from 1.2 +/- 0.5 to 3.5 +/- 4.9. In all dogs where dilute bicarbonate solution was instilled, esophageal pH increased to above 6 for up to 180 (mean +/- SD, 89 +/- 81) minutes. CONCLUSIONS AND CLINICAL RELEVANCE Suctioning refluxate from the esophagus does not change the pH of the esophageal lumen. Instillation of a small volume of bicarbonate solution predictably increased the pH above 4 following an episode of acidic GER. Care must be taken that fluid is instilled into the lumen of the esophagus, and not into the trachea.
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Affiliation(s)
- Deborah V Wilson
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48867, USA.
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Wilson DV, Boruta DT, Evans AT. Influence of halothane, isoflurane, and sevoflurane on gastroesophageal reflux during anesthesia in dogs. Am J Vet Res 2007; 67:1821-5. [PMID: 17078741 DOI: 10.2460/ajvr.67.11.1821] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether maintenance of anesthesia with halothane or sevoflurane is associated with a lower incidence of gastroesophageal reflux (GER) than the use of isoflurane in dogs undergoing orthopedic surgery. ANIMALS 90 dogs. PROCEDURES Dogs were evaluated during elective orthopedic surgery. Dogs with a history of vomiting or that had received any drugs that would alter gastrointestinal tract function were excluded from the study. The anesthetic protocol used was standardized to include administration of acepromazine maleate and morphine prior to induction of anesthesia with thiopental. Dogs were allocated to receive halothane, isoflurane, or sevoflurane to maintain anesthesia. A sensor-tipped catheter was placed to measure esophageal pH during anesthesia. Gastroesophageal reflux was defined as an esophageal pH < 4 or > 7.5. RESULTS 51 dogs had 1 or more episodes of acidic GER during anesthesia. Reflux was detected in 14 dogs receiving isoflurane, 19 dogs receiving halothane, and 18 dogs receiving sevoflurane. In dogs with GER, mean +/- SD time from probe placement to onset of GER was 36 +/- 65 minutes and esophageal pH remained < 4 for a mean of 64% of the measurement period. There was no significant association between GER and start of surgery or moving a dog on or off the surgery table. Dogs that developed GER soon after induction of anesthesia were more likely to regurgitate. CONCLUSIONS AND CLINICAL RELEVANCE Maintenance of anesthesia with any of the 3 commonly used inhalant agents is associated with a similar risk for development of GER in dogs.
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Affiliation(s)
- Deborah V Wilson
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
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Wilson DV, Tom Evans A, Mauer WA. Pre-anesthetic meperidine: associated vomiting and gastroesophageal reflux during the subsequent anesthetic in dogs. Vet Anaesth Analg 2007; 34:15-22. [PMID: 17238958 DOI: 10.1111/j.1467-2995.2006.00295.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effect of meperidine administered prior to anesthesia on the incidence of vomiting before, and gastroesophageal reflux (GER) and regurgitation during, the subsequent period of anesthesia in dogs. STUDY DESIGN Randomized, controlled trial. ANIMALS A total of 60 healthy dogs, 4.3 +/- 2.3 years old, and weighing 35.5 +/- 13.1 kg. METHODS Dogs were admitted to the study if they were healthy, had no history of vomiting, and were scheduled to undergo elective orthopedic surgery. The anesthetic protocol used was standardized to include thiopental and isoflurane in oxygen. Dogs were randomly selected to receive one of the following pre-medications: morphine (0.66 mg kg(-1) IM) with acepromazine (0.044 mg kg(-1) IM), meperidine (8.8 mg kg(-1) IM) with acepromazine (0.044 mg kg(-1) IM) or meperidine alone (8.8 mg kg(-1) IM). A sensor-tipped catheter was placed to measure esophageal pH during anesthesia. Gastro-esophageal reflux was judged to have occurred if there was a decrease in esophageal pH below four or an increase above 7.5. RESULTS No dogs vomited after the administration of meperidine, but 50% of dogs vomited after the administration of morphine. When compared with morphine, treatment with meperidine alone or combined with acepromazine before anesthesia was associated with a 55% and 27% reduction in absolute risk of developing GER, respectively. Dogs receiving meperidine alone were significantly less sedate than other dogs in the study, and required more thiopental to induce anesthesia. Arterial blood pressure and heart rate were not significantly different between groups at the start of the measurement period. Cutaneous erythema and swelling were evident in four dogs receiving meperidine. CONCLUSIONS AND CLINICAL RELEVANCE Administration of meperidine to healthy dogs prior to anesthesia was not associated with vomiting and tended to reduce the occurrence of GER, but produced less sedation when compared with morphine. Meperidine is not a useful addition to the anesthetic protocol if prevention of GER is desired.
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Affiliation(s)
- Deborah V Wilson
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI 48864, USA.
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