Evaluation of the performance of three pulse oximeters at different probe positions in awake rabbits

In rabbits, pulse oximetry plays a crucial role in monitoring oxygen saturation (SpO2) and pulse rate (PR), but it can be challenging due to their small size, variable anatomy, limited measurement sites, and potential motion artifacts during measurements. This prospective randomized study aimed to assess the reliability of three pulse oximeters on the forelimb and tail of fifty awake, healthy European rabbits. Two pulse oximeters, the Masimo Rad-5 (device 1) and the Edan VE-H100B, were tested, with the latter using both a Y-clip (device 2) and the Nellcor OxiMax adhesive finger sensor (device 3). Reliable values of SpO2 and PR were considered ≥ 95% and ≥ 151 bpm, respectively, which are normal values in a healthy rabbit. Success rates of the devices were calculated as the ratio of reliable to unreliable/missing values and compared using χ2 tests. Correlation and agreement between PR and clinically measured heart rate (cHR) were assessed using the Pearson correlation coefficient (r) and Bland-Altman analysis, respectively. Success rates differed significantly among devices (p < 0.001). The SpO2 success rates were 46%, 95.6%, and 94.4% for devices 1, 2, and 3, respectively. The PR success rates were 54.6%, 63%, and 72.8% for devices 1, 2, and 3, respectively. Success rates were higher on the forelimb (>66%) than on the tail (>26%) across devices. Correlation between PR and cHR was stronger on forelimb (r > 0.80) than on tail (r < 0.70). Agreement between PR and cHR was similar among devices, with a mean bias ranging from -6.6 to 6.7 bpm, and limits of agreement from -33.8 to 41.5 bpm. The Edan devices showed superior ability to detect reliable values of SpO2 and PR compared to the Masimo in rabbits. The forelimb appears to be a more reliable site for pulse oximetry in rabbits than the tail.

Risk factors associated with increased mortality within 14 days of general anesthesia in specialty veterinary dentistry and oral surgery practices

OBJECTIVE

To investigate the overall mortality rate and risk factors associated with mortality in dogs within 2 weeks of general anesthesia in a specialty veterinary dentistry and oral surgery practice.

STUDY DESIGN

Retrospective cohort study.

ANIMALS

A total of 3210 dogs were anesthetized for advanced imaging and/or oral surgery.

METHODS

Electronic medical records of four clinics were examined for dogs that had undergone advanced imaging and/or oral surgery requiring general anesthesia over a 2 year period (2021-2023). Data were collected on patient demographics, procedural and anesthetic details, and mortality status 2 weeks after anesthesia. Univariate analyses and multivariable logistic regression were used to identify risk factors associated with anesthetic death.

RESULTS

The mortality rate of the study population of dogs was 0.37%. Median age at death was statistically higher than that of dogs alive 2 weeks after anesthesia following univariate analysis (12 and 7 years, respectively). Median anesthetic duration was statistically longer in dogs that died than those that were alive following univariate analysis (177.5 minutes and 141 minutes, respectively). Following multivariate analysis, however, only older age remained a significant risk factor (odds ratio 1.364). Weight, sex, and American Society of Anesthesiologists physical status classification were not statistically significant risk factors for anesthetic death.

CONCLUSIONS AND CLINICAL RELEVANCE

Data from this study may facilitate risk discussions with clients, especially owners of older dogs undergoing anesthesia in veterinary dental practices.

Veterinary Enhanced Recovery After Surgery (Vet-ERAS) Program in Dogs Undergoing Emergency Laparotomy

This study aimed to assess the efficacy of a veterinary enhanced recovery after surgery (Vet-ERAS) protocol in dogs undergoing emergency laparotomy (EL). The protocol, adapted from human medicine, encompassed a multidisciplinary approach and interventions such as early goal-directed fluid resuscitation, antibiotic prophylaxis, anti-emetic therapy, multimodal analgesia, and early enteral nutrition. A prospective observational study compared outcomes between dogs managed with the Vet-ERAS protocol (n = 59) and historical controls (n = 82). Implementation of the Vet-ERAS protocol resulted in a significant reduction in perioperative complication rates (p = 0.003) and 15-day mortality (5% vs. 20.7%). Intraoperative complications, including tachycardia and hypothermia, were significantly lower in the Vet-ERAS group. Compliance with the protocol improved over time (p = 0.01). These findings suggest that integrating the Vet-ERAS protocol into perioperative management can improve outcomes in dogs undergoing EL.

Inter-observer agreement in classifying anesthetic deaths in cats and dogs

Determining the cause of death in studies assessing mortality during small animal anesthesia poses challenges due to varying definitions of anesthetic death, limited information, and differences in evaluators' interpretations. This study aims to establish the interobserver agreement in classifying the cause of death in anesthetized animals. The observational, retrospective, multicenter study analyzed 432 deaths (83 cats and 349 dogs). Data were collected from a database of 55,022 anesthetized dogs and 14,962 anesthetized cats, created to investigate anesthetic-related mortality in these species. Three highly qualified veterinary anesthesiologists independently assessed whether the deaths were related to anesthesia, using their professional judgment. Data were collected from questionnaires that included the animal's signalment, reason for anesthesia, ASA status, drugs, anesthetic procedures, and comments from the submitting veterinarian. Light's Kappa and the intraclass correlation coefficient (ICC) measured interrater agreement among the three evaluators, while Cohen's Kappa assessed interrater reliability between pairs of observers (p < 0.05). Evaluators A, B, and C classified 296/432 (68.5%), 264/432 (61.1%), and 54/432 (12.5%) of the cases as anesthesia-related deaths, respectively. Agreement among the three evaluators was 128/432 (29.6%) [Light's Kappa: 0.17, p = 0.00026; ICC: 0.06, p-value = 0.0167]. The three evaluators agreed on classifying a death as anesthetic-related in 14.1% of cases (50 out of 354 cases where at least one evaluator classified the death as anesthetic-related). Similarly, for non-anesthetic-related deaths, the three evaluators reached an agreement in 20.4% of cases (78 out of 382 cases where at least one evaluator classified the death as non-anesthetic-related). Overall, agreement between two out of three evaluators was 304/432 (70.4%). Evaluators A and B had a 65.7% agreement [Cohen's Kappa: 0.25, p < 0.00001], A and C had a 46.6% agreement [Cohen's Kappa: 0.10, p < 0.00001], and B and C had a 50.9% agreement [Cohen's Kappa: 0.16, p < 0.00001]. In conclusion, the evaluators' agreement was weak, highlighting the need for a consensus on defining anesthetic mortality in dogs and cats.

Error management in large data sets: A critical component of data collection in veterinary medicine

OBJECTIVE

To assess the usefulness of a webpage incorporating a real-time error management system for the Confidential Enquiry into Perioperative Equine Fatalities 4 (CEPEF4).

STUDY DESIGN

An observational, descriptive, retrospective, longitudinal study.

ANIMALS

Data sets from 48,075 general anaesthetics and 12,453 standing sedations.

METHODS

Comparison of three consecutive phases of data collection [phase I: personal document file (PDF) by e-mail, manual revision; phase II: PDF by e-mail, automatic revision; phase III: web system, automatic correction] objectively (number of e-mails sent and received by the data managers related to data correction; number of detected errors by phase) and subjectively (16 questions in Likert format; one open-ended question).

RESULTS

Objectively, the average number of e-mails sent per day was reduced from phase I (3.6) and II (3.9) to 1.7 in phase III. The ratio of e-mails per 100 cases received was reduced from phase I (5.8) and II (4.0) to 2.4 in phase III. Errors remained below 2,000 during phase I, reaching a peak of 5,430 in phase 2 owing to a strengthened error detection strategy. During phase III, errors were reduced from 3,200 to 423 within 94 days. Subjectively, questions evaluating the PDF system indicated that users overall agree/strongly agree (54-84%) with its comfort level versus the (89-99%) of the web system. When compared, users found the web system more comfortable than the PDF system (86-95%).

CONCLUSIONS AND CLINICAL RELEVANCE

The transition to a real-time error management system in phase III led to considerably fewer e-mails sent and received plus fewer errors. Users also found the website preferable to the PDF system. Our findings highlight the importance of implementing an error management system to minimize data inaccuracies and to improve the overall efficiency and ease of use of large data set collection in veterinary medicine.

Anaesthetic mortality in cats: A worldwide analysis and risk assessment

BACKGROUND

Patient safety is essential in small animal anaesthesia. This study aimed to assess anaesthesia-related deaths in cats worldwide, identify risk and protective factors and provide insights for clinical practice.

METHODS

A prospective multicentre cohort study of 14,962 cats from 198 veterinary centres across different countries was conducted. Data on anaesthesia-related deaths, from premedication up to 48 hours postextubation, were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs.

RESULTS

The anaesthesia-related mortality was 0.63%, with 74.5% of deaths occurring postoperatively. Cats with cachexia, a higher ASA status or who underwent abdominal, orthopaedic/neurosurgical or thoracic procedures exhibited elevated mortality. Mechanical ventilation use was associated with increased mortality. Mortality odds were reduced by the use of alpha2-agonist sedatives, pure opioids in premedication and locoregional techniques.

LIMITATIONS

Limitations include non-randomised sampling, potential biases, unquantified response rates, subjective death cause classification and limited variable analysis.

CONCLUSIONS

Anaesthetic mortality in cats is significant, predominantly postoperative. Risk factors include cachexia, higher ASA status, specific procedures and mechanical ventilation. Protective factors include alpha2-agonist sedatives, pure opioids and locoregional techniques. These findings can help improve anaesthesia safety and outcomes. However, further research is required to improve protocols, enhance data quality and minimise risks.

Anaesthetic mortality in dogs: A worldwide analysis and risk assessment

BACKGROUND

Ensuring patient safety during small animal anaesthesia is crucial. This study aimed to assess anaesthetic-related deaths in dogs globally, identify risks and protective factors and inform clinical practice.

METHODS

This prospective cohort multicentric study involved 55,022 dogs from 405 veterinary centres across various countries. Data on anaesthesia-related deaths from premedication to 48 hours post-extubation were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs used.

RESULTS

Anaesthetic-related mortality was 0.69%. Most deaths occurred postoperatively (81%). Age, obesity and a higher ASA classification score were associated with increased mortality. Urgent procedures, non-urgent but unscheduled anaesthesias and short procedures also had higher mortality. Some sedatives, systemic analgesics, hypnotics and the use of locoregional anaesthesia were linked to a decrease in mortality.

LIMITATIONS

The limitations of the study include the non-randomised sample, potential selection bias, lack of response rate quantification, variable data quality control, subjectivity in classifying causes of death and limited analysis of variables.

CONCLUSION

Careful patient evaluation, drug selection and monitoring can be associated with reduced mortality. These findings can be used to develop guidelines and strategies to improve patient safety and outcomes. Further research is needed to refine protocols, enhance data quality systems and explore additional risk mitigation measures.

Surgical management of primary and idiopathic internal hydrocephalus in dogs and cats

Ventriculoperitoneal shunt placement is an effective method to treat internal hydrocephalus in dogs and cats. Although it has a long history in veterinary medicine, the technique continues to evolve. Despite continuing attempts to reduce the incidence of associated complications, shunt failure remains a major problem, and often leads to multiple hospital admissions. This review gives an overview about current knowledge of ventriculoperitoneal shunting techniques in animals, applicable shunt hardware as well as shunt-associated complications and their prevention and treatment.

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

OBJECTIVE

To systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps.

DESIGN

Standardized, systematic evaluation of literature pertinent to peri-CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.

SETTING

Transdisciplinary, international collaboration in university, specialty, and emergency practice.

RESULTS

Thirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end-tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.

CONCLUSIONS

The Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re-arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra-arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome-relevant interventions.

Quantifying refractive error in companion dogs with and without nuclear sclerosis: 229 eyes from 118 dogs

OBJECTIVE

To evaluate the relationship between nuclear sclerosis (NS) and refractive error in companion dogs.

ANIMALS STUDIED

One hundred and eighteen companion dogs.

PROCEDURES

Dogs were examined and found to be free of significant ocular abnormalities aside from NS. NS was graded from 0 (absent) to 3 (severe) using a scale developed by the investigators. Manual refraction was performed. The effect of NS grade on refractive error was measured using a linear mixed effects analysis adjusted for age. The proportion of eyes with >1.5 D myopia in each NS grade was evaluated using a chi-square test. Visual impairment score (VIS) was obtained for a subset of dogs and compared against age, refractive error, and NS grade.

RESULTS

Age was strongly correlated with NS grade (p < .0001). Age-adjusted analysis of NS grade relative to refraction showed a mild but not statistically significant increase in myopia with increasing NS grade, with eyes with grade 3 NS averaging 0.58-0.88 D greater myopia than eyes without NS. However, the myopia of >1.5 D was documented in 4/58 (6.9%) eyes with grade 0 NS, 12/91 (13.2%) eyes with grade 1 NS, 13/57 (22.8%) eyes with grade 2 NS, and 7/23 (30.4%) eyes with grade 3 NS. Risk of myopia >1.5 D was significantly associated with increasing NS grade (p = .02). VIS was associated weakly with refractive error, moderately with age, and significantly with NS grade.

CONCLUSIONS

NS is associated with visual deficits in some dogs but is only weakly associated with myopia. More work is needed to characterize vision in aging dogs.

Association between body mass and hypotension in dogs under general anaesthesia

OBJECTIVES

To investigate the association between body mass and hypotension during general anaesthesia in dogs undergoing surgical and diagnostic procedures within a referral hospital.

MATERIALS AND METHODS

Retrospective evaluation of the anaesthetic records of 1789 dogs was performed. Data on signalment, anaesthetic protocol and physiological variables, including mean arterial pressure, were collected. A multivariable generalised linear model was used to identify associations between explanatory variables, including body mass, and hypotension.

RESULTS

In the population studied, increasing body mass (per 10 kg) was significantly associated with decreasing odds of hypotension (odds ratio 0.68; 95% confidence interval: 0.60 to 0.77). Additional variables associated with a decreased odds of hypotension were pre-anaesthetic medication with alpha-2 agonists (odds ratio 0.63; 95% confidence interval 0.48 to 0.82) and increased body temperature (per 1°C) during general anaesthesia (odds ratio 0.77; 95% confidence interval 0.67 to 0.88). Brachycephaly (odds ratio 1.72; 95% confidence interval 1.25 to 2.38), ASA physical status classification >3 (odds ratio 2.03; 95% confidence interval 1.16 to 3.56), undergoing a surgical procedure (versus diagnostic) (odds ratio 1.57; 95% confidence interval 1.10 to 2.23) and bradycardia (odds ratio 1.37; 95% confidence interval 1.05 to 1.80) were independently associated with increased odds of hypotension.

CLINICAL SIGNIFICANCE

Dogs of lower body mass and brachycephalic breeds may be at higher risk of hypotension during general anaesthesia or alternatively represent subpopulations in which accurate blood pressure measurement presents a greater challenge. Monitoring blood pressure accurately in these groups requires particular attention and provisions for treating hypotension should be readily accessible.

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.

Risk factors for unilateral cranial cruciate ligament rupture diagnosis and for clinical management in dogs under primary veterinary care in the UK

This study aimed to evaluate demographic risk factors associated with unilateral cranial cruciate ligament (CCL) rupture diagnosis and to explore demographic and clinical risk factors associated with management of unilateral CCL rupture in dogs under primary veterinary care in the UK. A retrospective cohort study design was used. Clinical records were automatically searched and manually verified for incident cases of unilateral CCL rupture during 2019 and additional clinical management information extracted. Multivariable logistic regression modelling was used to evaluate associations between risk factors and: (1) CCL rupture diagnosis; and (2) clinical management (surgical or non-surgical). The analysis included 1000 unilateral CCL rupture cases and a random selection of 500,000 non-cases. After accounting for confounding factors, dogs aged 6 to < 9 years, male neutered and female neutered dogs, insured dogs, and Rottweiler, Bichon Frise, and West Highland White terrier breeds, in particular, had increased odds of unilateral CCL rupture diagnosis. Insured dogs and dogs ≥ 20 kg had increased odds of surgical management, while dogs ≥ 9 years and dogs with one non-orthopaedic comorbidity at diagnosis with CCL rupture had reduced odds. These findings inform identification of at-risk dogs, with Rottweilers and Bichon Frise particularly predisposed. Additionally, they contribute to a greater understanding of the clinical rationales used in primary-care veterinary practices to decide between surgical or non-surgical management of unilateral CCL rupture.

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.

Extradural anaesthesia-analgesia in dogs undergoing cholecystectomy: A single centre retrospective study

Objectives

To assess the effects of extradural anaesthesia-analgesia (EAA) in dogs undergoing cholecystectomy.

Materials and methods

Medical records of dogs undergoing cholecystectomy between 2011 and 2019 were retrieved and allocated to two groups depending if analgesia was provided systemically (group SA) or extradurally (EAA). Preoperative data, intraoperative antinociceptive medications, postoperative analgesia, perioperative complications, and food intake were compared.

Results

Overall 41 medical records were included in the study: 19 and 22 dogs were allocated to groups SA and EAA, respectively. In group EAA, an extradural catheter was placed preoperatively in 8 dogs; in the remaining, it was placed postoperatively but an extradural injection was performed preoperatively. The extradural catheter tip was between the 4th lumbar and the 10th thoracic vertebrae. Intraoperatively, nociception was more likely to occur in group SA [OR 55.42 (2.97–1,035.06)]. During the first 24 and 48 h postoperatively, more dogs in group SA required methadone [OR 24 (2.81–268.4) and OR 11.56 (2.37–45.06), respectively] and additional analgesic drugs [OR 25 (3.47–281.9) and OR 35.29 (1.86–668.2), respectively] compared to group EAA. Voluntary postoperative food intake was also significantly higher in group EAA.

Clinical significance

Compared to systemic analgesia, the use of extradural anaesthesia-analgesia reduced perioperative analgesic requirement and promoted postoperative food intake in dogs undergoing cholecystectomy.

Designing and Equipping a Modern Dentistry and Oral Surgery Suite

Veterinary practices should consider designing and equipping a dedicated space to provide companion animal dental and oral surgical care. A single or multi-table dental suite design will allow organized and efficient delivery of dental care. Each workstation should be equipped with a procedural table that will allow for drainage, shadow-free procedural lighting, an anesthetic machine with monitoring, thermal support, anesthetic scavenger system, dental radiographic equipment, and an air-driven dental delivery system. Lift tables, dental-specific seating, swivel handpieces, and headlamp/surgical loupe lighting should also be considered to improve ergonomics.

Psittacine Sedation and Anesthesia

Successful management of sedation/anesthesia of psittacine species relies on familiarity with their specific anatomy and physiology, and detailed knowledge of the recent advancements in applied pharmacology of the anesthetics and perianesthetic monitoring of cardiovascular and respiratory functions. Each sedation/anesthetic plan should be patient-specific, developed based on preexisting conditions, size, species, age, and estimated risk. Other key factors to improve safety, quality of perioperative care, and client satisfaction are anticipation of complications, extension of close monitoring to the recovery phase, multimodal analgesic approach, stress prevention/reduction, and transparent communication with the owner.

Dystocia and cesarean section in a free-ranging ocelot (Leopardus pardalis) after traumatic spinal cord injury resulting from dog (Canis familiaris) attack

Background:

Ex situ breeding programs are essential to establish genetic resource banks and produce offspring to strengthen the in situ conservation of endangered species. However, many programs fail to maintain viable ex situ populations due to reproductive problems, including dystocia in pregnant females. Dystocia encompasses different emergency obstetric situations for the lives of dams and fetuses that require urgent intervention. This condition has been studied in domesticated species but published records in wildlife, specifically in felines species, are scarce.

Case Description:

An adult female ocelot (Leopardus pardalis) was referred to the wildlife hospital of the Universidad San Francisco de Quito after being attacked by dogs (Canis familiaris). Neurological tests revealed traumatic spinal cord injury at a thoracolumbar level. Complementary tests (laboratory exams, radiographs, and ultrasound) revealed a full-term pregnancy, failure in the labor progress, and critical fetal stress. A cesarean section was performed, and the newborns received resuscitation care after assessing their viability using the Apgar score system. The neonate with the lowest Apgar score died within the first hour after birth, while the second one showed an increase in Apgar score after resuscitation care and survived the procedure.

Conclusion:

We provide new obstetric data that could be relevant to save the lives of dams and newborns in related cases for ocelots and other species of wild felids. Furthermore, this study confirms the adverse effects that domestic dogs have on wildlife species.

[Common veterinary practice in small animal anesthesia - an online survey among small animal practitioners in Europe]

OBJECTIVES

Survey concerning the situation of small animal anesthesia in Europe and assessment of the compliance with the guidelines of the AVA (American Society of Anesthesiologists) and the DVG specialty group VAINS (Veterinary Anesthesia, Intensive Care, Emergency Medicine, and Pain Management).

MATERIAL AND METHODS

A link to an online survey with questions concerning anesthesia management (topics include demographics, equipment, monitoring, thermal management, pre-anesthetic examination, anesthetic protocol, and others) was sent to small animal practitioners in several countries.

RESULTS

A total of 767 evaluable questionnaires came from Germany (n = 343), Austria (n = 216), Switzerland (n = 83), the United Kingdom (n = 38), France (n = 25), Hungary (n = 25), Scandinavia (n = 23), and "other countries" (n = 11). On average, 91 % of respondents complied with the AVA guideline and 58 % complied with the VAINS specialty group guideline even before its publication. Practices/clinics with higher staff possessed superior equipment, and practices/clinics performing higher numbers of anesthesias per week were more likely to implement "good preliminary examination."

CONCLUSION AND CLINICAL RELEVANCE

Although the guidelines were found to be implemented to a certain degree, the presented study reveals a potential for optimization of the anesthesia regime in many practices/clinics, e. g. by improving the equipment or allowing for better use of present apparatus.

Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018-2020)

Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterising the outcome of these surgeries as a single group in dogs. The aim of the study was to characterise the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was a gastrointestinal foreign body. Overall, the 15-day mortality rate was 20.7% (17/82). The median (range) length of hospitalisation was 3 (0.5-15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) developed minor complications. Perioperative factors significantly associated with death included tachycardia (p < 0.001), hypothermia (p < 0.001), lactate acidosis (p < 0.001), shock index > 1 (p < 0.001), leukopenia (p < 0.001) and thrombocytopenia (p < 0.001) at admission, as well as intraoperative hypotension (p < 0.001) and perioperative use of blood products (p < 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.

Intratumoural Treatment of 18 Cytologically Diagnosed Canine High-Grade Mast Cell Tumours With Tigilanol Tiglate

Canine high-grade mast cell tumours (HGMCT) are associated with a poor prognosis, are inherently more invasive, and have higher rates of local recurrence. The primary aim of this retrospective study was to assess the efficacy of intratumoural tigilanol tiglate (TT) as a local treatment option. Eighteen dogs with mast cell tumours (MCT) cytologically diagnosed by veterinary pathologists as either high-grade or suspected high-grade MCT were treated with TT. The TT dose was based on tumour volume (0.5 mg TT/cm³ tumour volume) and delivered intratumourally using a Luer lock syringe and a fanning technique to maximise distribution throughout the tumour mass. Efficacy was assessed on the presence/absence of a complete response (CR) to therapy at days 28 and 84 using response evaluation criteria in solid tumours (RECIST). For dogs not achieving a CR after 28 days, the protocol was repeated with a second intratumoural TT injection. Ten out of 18 dogs (56%) in this study achieved and maintained a CR to at least 84 days after their first or second treatment. Six patients were alive and available for evaluation at 2 years, three of those were recurrence free, and a further three patients were recurrence free following a second treatment cycle. Tigilanol tiglate shows efficacy for local treatment of HGMCT, with higher efficacy noted with a second injection if a CR was not achieved following the first treatment. In the event of treatment site recurrence (TSR), the tumour may be controlled with additional treatment cycles. Tigilanol tiglate provides an alternative local treatment approach to dogs with HGMCT that would either pose an unacceptable anaesthetic risk or the tumour location provides a challenge when attempting surgical excision.

Mouse Anesthesia: The Art and Science

There is an art and science to performing mouse anesthesia, which is a significant component to animal research. Frequently, anesthesia is one vital step of many over the course of a research project spanning weeks, months, or beyond. It is critical to perform anesthesia according to the approved research protocol using appropriately handled and administered pharmaceutical-grade compounds whenever possible. Sufficient documentation of the anesthetic event and procedure should also be performed to meet the legal, ethical, and research reproducibility obligations. However, this regulatory and documentation process may lead to the use of a few possibly oversimplified anesthetic protocols used for mouse procedures and anesthesia. Although a frequently used anesthetic protocol may work perfectly for each mouse anesthetized, sometimes unexpected complications will arise, and quick adjustments to the anesthetic depth and support provided will be required. As an old saying goes, anesthesia is 99% boredom and 1% sheer terror. The purpose of this review article is to discuss the science of mouse anesthesia together with the art of applying these anesthetic techniques to provide readers with the knowledge needed for successful anesthetic procedures. The authors include experiences in mouse inhalant and injectable anesthesia, peri-anesthetic monitoring, specific procedures, and treating common complications. This article utilizes key points for easy access of important messages and authors’ recommendation based on the authors’ clinical experiences.

Pre-anaesthetic clinical examination influences anaesthetic protocol in dogs undergoing general anaesthesia and sedation

OBJECTIVES

Identify whether pre-anaesthetic clinical examination influences anaesthetic and analgesic agents and techniques protocol in dogs presented for general anaesthesia and sedation at a large referral hospital.

MATERIALS AND METHODS

In this prospective clinical audit, 554 dogs, undergoing general anaesthesia or sedation for surgical, diagnostic or imaging procedures were included. Multiple attending anaesthetists completed a questionnaire divided into four sections (American Society of Anesthesiologists physical status classification, anaesthetic and analgesic agents and techniques protocol, pre-anaesthetic clinical examination findings and changes made to the anaesthetic protocol). The attending anaesthetist was able to review the patient's history before planning the anaesthetic and analgesic agents and techniques protocol. The patients were examined and changes in American Society of Anesthesiologists physical status classification or anaesthetic protocol were recorded.

RESULTS

The initial anaesthetic and analgesic agents and techniques protocol was altered in 23.3% (n=129/554) of cases following a pre-anaesthetic clinical examination, but American Society of Anesthesiologists physical status reclassification occurred in only 8.0% (n=37/464) of cases. Multivariable logistic regression analysis showed that pre-anaesthetic clinical examination performed by European College of Veterinary Anaesthesia and Analgesia diplomates (odds ratio 5.8, 95% confidence interval 2.0 to 17.2), compared to anaesthesia interns, and the presence of an audible heart murmur (odds ratio 2.4, 95% confidence interval 1.4 to 4.4) were factors linked to changes in anaesthetic and analgesic agents and techniques protocol, whereas for each one kilogram increase in patient's weight, the odds of a change in anaesthetic and analgesic agents and techniques protocol to occur decreased by 1.7% (odds ratio 0.98, 95% confidence interval 0.97 to 1.0).

CLINICAL SIGNIFICANCE

Pre-anaesthetic clinical examination has impact on American Society of Anesthesiologists physical status classification, therefore estimation of patient's anaesthetic risk, and influences anaesthetic and analgesic agents and techniques protocol choice.

Repeatability and accuracy of fingertip pulse oximeters for measurement of hemoglobin oxygen saturation in arterial blood and pulse rate in anesthetized dogs breathing 100% oxygen

OBJECTIVE

To evaluate the repeatability and accuracy of fingertip pulse oximeters (FPO) for measurement of hemoglobin oxygen saturation in arterial blood and pulse rate (PR) in anesthetized dogs breathing 100% O₂.

ANIMALS

29 healthy client-owned anesthetized dogs undergoing various surgical procedures.

PROCEDURES

In randomized order, each of 7 FPOs or a reference pulse oximeter (PO) was applied to the tongue of each intubated anesthetized dog breathing 100% O₂. Duplicate measurements of oxygen saturation (Spo₂) and PR were obtained within 60 seconds of applying an FPO or PO. A nonparametric version of Bland-Altman analysis was used. Coefficient of repeatability was the interval between the 5th and 95th percentiles of the differences between duplicate measurements. Bias was the median difference, and the limits of agreement were the 5th and 95th percentiles of the differences between each FPO and the PO. Acceptable values for the coefficient of repeatability of Spo₂ were ≤ 6%. Agreements were accepted if the limits of agreement had an absolute difference of ≤ ± 3% in Spo₂ and relative difference of ≤ ± 10% in PR.

RESULTS

Coefficient of repeatability for Spo₂ was acceptable for 5 FPOs, but the limits of agreement for Spo₂ were unacceptable for all FPOs. The limits of agreement for PR were acceptable for 2 FPOs.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that some FPOs may be suitable for accurately monitoring PRs of healthy anesthetized dogs breathing 100% O₂, but mild underestimation of Spo₂ was common.

2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats

Risk for complications and even death is inherent to anesthesia. However, the use of guidelines, checklists, and training can decrease the risk of anesthesia-related adverse events. These tools should be used not only during the time the patient is unconscious but also before and after this phase. The framework for safe anesthesia delivered as a continuum of care from home to hospital and back to home is presented in these guidelines. The critical importance of client communication and staff training have been highlighted. The role of perioperative analgesia, anxiolytics, and proper handling of fractious/fearful/aggressive patients as components of anesthetic safety are stressed. Anesthesia equipment selection and care is detailed. The objective of these guidelines is to make the anesthesia period as safe as possible for dogs and cats while providing a practical framework for delivering anesthesia care. To meet this goal, tables, algorithms, figures, and "tip" boxes with critical information are included in the manuscript and an in-depth online resource center is available at aaha.org/anesthesia.

Feline procedural sedation and analgesia: When, why and how

PRACTICAL RELEVANCE

Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA.

CLINICAL CHALLENGES

Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat's health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized.

AIMS

This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.

Anesthetic effects of ketamine-medetomidine-hydromorphone in dogs during high-quality, high-volume surgical sterilization program under field conditions

OBJECTIVE

To describe the anesthetic and adverse effects of an injectable anesthetic protocol in dogs as part of a high-volume sterilization program under field conditions in Belize.

STUDY DESIGN

Prospective, observational, field study.

ANIMALS

A total of 23 female and eight male dogs (14.2 ± 7.7 kg; age ≥ 8 weeks).

METHODS

Using a volume per kg-based dose chart, dogs were administered ketamine (4.5 mg kg^-1), medetomidine (0.04 mg kg^-1) and hydromorphone (0.09 mg kg^-1) intramuscularly. After induction of anesthesia, an endotracheal tube was inserted and dogs were allowed spontaneous breathing in room air. Monitoring included peripheral oxygen saturation (SpO₂), mean arterial pressure (MAP), heart rate (HR), respiratory rate, rectal temperature and end-tidal carbon dioxide (Pe'CO₂). Meloxicam (0.2 mg kg^-1) was administered subcutaneously after surgery. Data were analyzed with linear models and chi-square tests (p < 0.05).

RESULTS

Onset of lateral recumbency (3.4 ± 2 minutes) was rapid. Desaturation (SpO₂ < 90%) was observed at least once in 64.5% of dogs and was more frequent in large dogs (p = 0.019). Hypercapnia (Pe'CO₂ ≥ 50 mmHg; 6.7 kPa) was observed in 48.4% of dogs. MAP was 111 ± 19 mmHg, mean ± standard deviation. Hypertension (MAP ≥ 120 mmHg), bradycardia (HR ≤ 60 beats minute^-1) and tachycardia (HR ≥ 140 beats minute^-1) were observed in 45.2%, 16.1% and 3.3% of dogs, respectively. Hypotension and hypothermia were not observed. Sex was not significantly associated with any complication. Return of swallowing reflex and time to standing were 71 ± 23 and 152 ± 50 minutes after injection, respectively. Return of swallowing was significantly longer in large dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

At the doses used, ketamine-medetomidine-hydromorphone was effective in dogs for high-volume sterilization. In this field setting, adverse effects included hypoventilation, hypoxemia and prolonged recovery.

Impact of a Topical Anaesthesia Wound Management Formulation on Pain, Inflammation and Reduction of Secondary Infections after Tail Docking in Lambs

Simple Summary

Tail docking is routinely conducted in sheep husbandry around the world, often without anaesthesia or analgesia despite recognition that it is a painful process. Several methods are used, although the Council of Europe states that surgical methods with anaesthesia should be used to dock the tail, with these recommendations copied into national legislation by most European countries. However, no studies have been documented comparing the use of general anaesthesia and stitching. This study compared different surgical approaches with and without general anaesthesia, and with and without surgical stitching, plus examined the efficacy of applying a commercially available wound gel spray containing topical anaesthetics and an antiseptic, immediately on tail amputation. Results demonstrated that lambs display more pain when the surgery included stitching and these wounds became more readily infected, potentially requiring antibiotic therapy. As the generation of potential antimicrobial resistance and drug residues issues in food-producing animals from over-use of antibiotics is an emerging one health consideration, the availability of a topical anaesthetic formulation that provides pain relief and contains an antiseptic that reduces secondary infections and hasten wound healing, is of potential importance for improving husbandry procedures such as tail docking.

Abstract

We examined several procedures for surgical tail docking; with and without general anaesthesia (GA), including the use of a topical wound gel formulation to provide pain relief (PR) and improve healing after surgery, containing local anaesthetics lignocaine and bupivacaine, with cetrimide and adrenalin. Forty-four lambs were recruited into four equal cohorts: Groups A and C, the tail was excised with a scalpel without anaesthesia or stitches; Groups B and D, the tail was surgically excised and stitched under GA; Groups C and D wounds were immediately sprayed with PR. Behavioural observations identified that Groups A and C displayed significantly less pain-related behaviours than Groups B and D shortly after the procedure, especially if treated with PR. Similarly, the mean of days when animals showed no signs of wound infection was longer in the groups not undergoing stitching. Finally, treatment with PR appeared to reduce the cortisol response and avoided the elevation of serum amyloid A in lambs where the tail was excised without general anaesthesia. In conclusion, surgical tail-docking without GA but where wounds are immediately sprayed with PR, appears as an affordable and more welfare-appropriate method for conducting tail docking in lambs.

Investigation of associations between preoperative acepromazine or dexmedetomidine administration and development of arterial hypotension or bradycardia in dogs undergoing ovariohysterectomy

OBJECTIVE To evaluate potential associations between preanesthetic administration of acepromazine or dexmedetomidine and development of arterial hypotension or bradycardia in isoflurane-anesthetized dogs undergoing ovariohysterectomy. ANIMALS 341 dogs. PROCEDURES Medical records were searched to identify dogs that underwent ovariohysterectomy between January 2009 and December 2010 and received hydromorphone with acepromazine or dexmedetomidine as preanesthetic agents. Demographic data, sedative and anesthetic drugs, duration of anesthesia, average vaporizer setting, positive pressure ventilation, occurrence of hypotension (mean arterial pressure < 60 mm Hg) or bradycardia (> 50% reduction in heart rate, compared with the preanesthetic value), time to first occurrence and duration of hypotension, and treatment with dopamine or anticholinergic agents were recorded. Data were compared between dogs that received acepromazine and dexmedetomidine. Logistic regression was used to investigate associations between the treatments of interest (and other putative risk factors) and development of hypotension or bradycardia. RESULTS For dogs that received acepromazine, the odds of developing hypotension were 2.61 times those for dogs that received dexmedetomidine. Hypotension occurred earlier and lasted longer in dogs that received acepromazine, and this group was treated with dopamine more frequently than the group that received dexmedetomidine. Lower body weight was associated with increased odds of hypotension. Odds of developing bradycardia were greater for dogs sedated with dexmedetomidine (vs acepromazine) and for dogs that underwent anesthetic induction with propofol or a ketamine-benzodiazepine combination (vs thiopental). CONCLUSIONS AND CLINICAL RELEVANCE Anesthetic complications differed between isoflurane-anesthetized dogs undergoing ovariohysterectomy after premedication with acepromazine or dexmedetomidine in this study; future prospective investigations are warranted to investigate these effects in other, less homogenous populations of dogs.

Evaluation of various carbon dioxide laser settings on the time and number of laser beam passes required to make a full-thickness skin incision and amount of laser-induced tissue artifact

OBJECTIVE

To evaluate the time and number of laser beam passes required to make full-thickness skin incisions and extent of laser-induced tissue artifacts following use of a CO₂ laser at various settings.

SAMPLE

24 skin specimens from six 5-month-old porcine carcasses.

PROCEDURES

4 full-thickness skin specimens were harvested from the flank regions of each carcass within 30 minutes after euthanasia and randomly assigned to 4 treatment groups. Three 5-cm-long incisions were made in each specimen with a CO₂ laser (beam diameter, 0.4 mm) set to deliver a continuous wave of energy alone (groups 1 and 2) or in superpulse mode (groups 3 and 4) at 10 (groups 1 and 3) or 20 (groups 2 and 4) W of power. The time and number of passes required to achieve a full-thickness incision were recorded, and extent of laser-induced tissue artifact (as determined by histologic evaluation) was compared among the 4 groups.

RESULTS

Mean time required to make a full-thickness skin incision for groups 2 and 4 (power, 20 W) was significantly less than that for groups 1 and 3 (power, 10 W). Mean number of passes was lowest for group 2 (continuous wave at 20 W). Extent of laser-induced tissue artifact was greatest for group 4 (superpulse mode at 20 W).

CONCLUSIONS AND CLINICAL RELEVANCE

Results provided preliminary information regarding use of CO₂ lasers to make skin incisions in veterinary patients. In vivo studies are necessary to evaluate the effect of various CO₂ laser settings on tissue healing and patient outcome.

Randomized controlled clinical study evaluating the efficacy and safety of intratumoral treatment of canine mast cell tumors with tigilanol tiglate (EBC-46)

Objective

To evaluate the efficacy and safety of tigilanol tiglate (TT) for local intratumoral treatment of mast cell tumors (MCTs) in dogs.

Methods

A randomized controlled clinical study in 2 phases involving 123 dogs with cytologically diagnosed MCT. Phase 1 compared 81 TT‐treated dogs with 42 control dogs; phase 2 allowed TT treatment of control dogs and retreatment of dogs that failed to achieve tumor resolution after TT treatment in phase 1. Tigilanol tiglate (1 mg/mL) was injected intratumorally with dose based on tumor volume. Concomitant medications were used to minimize potential for MCT degranulation. Modified response evaluation criteria in solid tumors were used to evaluate treatment response at 28 and 84 days. Adverse events and quality of life were also assessed.

Results

A single TT treatment resulted in 75% complete response (CR) (95% confidence interval [CI] = 61‐86) by 28 days, with no recurrence in 93% (95% CI = 82‐97) of dogs by 84 days. Eight TT‐treated dogs that did not achieve CR in phase 1 achieved CR after retreatment, increasing the overall CR to 88% (95% CI = 77‐93). Control dogs had 5% CR (95% CI = 1‐17) at 28 days. Wound formation after tumor slough and wound size relative to tumor volume were strongly associated with efficacy. Adverse events typically were low grade, transient, and directly associated with TT's mode of action.

Conclusions

Tigilanol tiglate is efficacious and well tolerated, providing a new option for the local treatment of MCTs in dogs.

Assessment of a commercially available veterinary blood pressure device used on awake and anesthetized dogs

OBJECTIVE

To compare results of a commercially available device for oscillometrically measured blood pressure (OBP) with invasively measured blood pressure (IBP) in awake and anesthetized dogs.

ANIMALS

19 adult dogs (mean ± SD body weight, 17.8 ± 7.5 kg).

PROCEDURES

Blood pressures were measured in dogs while they were awake and anesthetized with isoflurane. The OBP was recorded on a thoracic limb, and IBP was simultaneously recorded from the median caudal artery. Agreement between OBP and IBP was evaluated with the Bland-Altman method. Guidelines of the American College of Veterinary Internal Medicine (ACVIM) were used for validation of the oscillometric device.

RESULTS

In awake dogs, mean bias of the oscillometric device was -11.12 mm Hg (95% limits of agreement [LOA], -61.14 to 38.90 mm Hg) for systolic arterial blood pressure (SAP), 9.39 mm Hg (LOA, -28.26 to 47.04 mm Hg) for diastolic arterial blood pressure (DAP), and -0.85 mm Hg (LOA, -40.54 to 38.84 mm Hg) for mean arterial blood pressure (MAP). In anesthetized dogs, mean bias was -12.27 mm Hg (LOA, -47.36 to 22.82 mm Hg) for SAP, -3.92 mm Hg (LOA, -25.28 to 17.44 mm Hg) for DAP, and -7.89 mm Hg (LOA, -32.31 to 16.53 mm Hg) for MAP. The oscillometric device did not fulfill ACVIM guidelines for the validation of such devices.

CONCLUSIONS AND CLINICAL RELEVANCE

Agreement between OBP and IBP results for awake and anesthetized dogs was poor. The oscillometric blood pressure device did not fulfill ACVIM guidelines for validation. Therefore, clinical use of this device cannot be recommended.

The Influence of Anaesthetic Drugs on the Laryngeal Motion in Dogs: A Systematic Review

Simple Summary

Laryngeal paralysis is secondary to a loss of normal function of the larynx. Older dogs are particularly affected, with normal breathing becoming difficult. A successful diagnosis typically relies on the visualisation of either, complete, or partially absent, laryngeal movements. The use of anaesthesia drugs to provide sedation and stress relief is most commonly necessary during the diagnosis of laryngeal paralysis. While, the excessive administration of anaesthesia drugs may result in absent movements, the ideal anaesthesia regime remains unknown, and the use of sedation is questionable, given the potential for absent laryngeal movements, even in healthy dogs. In this systematic review, we found a potential benefit from using sedation during the evaluation of laryngeal function when compared to injectable anaesthetics only. The respiratory stimulant doxapram was effective in differentiating normal dogs from dogs with laryngeal paralysis but has associated safety hazards.

Abstract

Anaesthetic drugs are commonly used during the evaluation of laryngeal function in dogs. The aim of this review was to systematically analyse the literature describing the effects of anaesthetic drugs and doxapram on laryngeal motion in dogs and to determine which drug regime provides the best conditions for laryngeal examination. PubMed, Google Scholar, and EMBASE databases were used for the literature search up to November 2019. Relevant search terms included laryngeal motion, anaesthetic drugs and dogs. Studies were scored based on their level of evidence (LoE), according to the Oxford Centre for Evidence-based Medicine, and the quality was assessed using the risk-of-bias tool and SIGN-checklist. In healthy dogs, premedication before laryngeal examination provided better examination conditions and maintained overall adequate laryngeal motion in 83% of the studies. No difference in laryngeal motion between induction drugs was found in 73% of the studies but the effects in dogs with laryngeal paralysis remain largely unknown. Doxapram increased laryngeal motion in healthy dogs without serious side effects, but intubation was necessary for some dogs with laryngeal paralysis. Methodological characteristics varied considerably between studies, including the technique and timing of evaluation, number of assessors, study design, drug dose, combinations, route and speed of administration.

Postoperative oxygenation in healthy dogs following mechanical ventilation with fractions of inspired oxygen of 0.4 or >0.9

OBJECTIVE

To evaluate arterial oxygenation during the first 4 postoperative hours in dogs administered different fractions of inspired oxygen (FiO₂) during general anesthesia with mechanical ventilation.

STUDY DESIGN

Prospective, randomized clinical trial.

ANIMALS

A total of 20 healthy female dogs, weighing >15 kg and body condition scores 3-7/9, admitted for ovariohysterectomy.

METHODS

Dogs were randomized to breathe an FiO₂ >0.9 or 0.4 during isoflurane anesthesia with intermittent positive pressure ventilation. The intraoperative PaO₂:FiO₂ ratio was recorded during closure of the linea alba. Arterial blood was obtained 5, 60 and 240 minutes after extubation for measurement of PaO₂ and PaCO₂ (FiO₂ = 0.21). Demographic characteristics, duration of anesthesia, PaO₂:FiO₂ ratio and anesthetic agents were compared between groups with Wilcoxon tests. The postoperative PaO₂, PaCO₂, rectal temperature, a visual sedation score and events of hypoxemia (PaO₂ < 80 mmHg) were compared between groups with mixed-effects models or generalized linear mixed models.

RESULTS

Groups were indistinguishable by demographic characteristics, duration of anesthesia, anesthetic agents administered and intraoperative PaO₂:FiO₂ ratio (all p > 0.08). Postoperative PaO₂, PaCO₂, rectal temperature or sedation score were not different between groups (all p > 0.07). During the first 4 postoperative hours, hypoxemia occurred in three and seven dogs that breathed FiO₂ >0.9 or 0.4 during anesthesia, respectively (p = 0.04).

CONCLUSIONS AND CLINICAL RELEVANCE

The results identified no advantage to decreasing FiO₂ to 0.4 during anesthesia with mechanical ventilation with respect to postoperative oxygenation. Moreover, the incidence of hypoxemia in the first 4 hours after anesthesia was higher in these dogs than in dogs breathing FiO₂ >0.9.

Management of veterinary anaesthesia in small animals: A survey of current practice in Quebec

OBJECTIVE

To describe how small animal anaesthesia is performed in French-speaking Eastern Canada, and the variations between practices, in particular based on practice type, veterinarian gender and experience.

DESIGN

Observational study, survey.

SAMPLE

156 respondents.

PROCEDURE

A questionnaire was designed to assess current small animal anaesthesia practices in French-speaking Eastern Canada, mainly in the province of Quebec. The questionnaire was available through SurveyMonkey, and consisted of four parts: demographic information about the veterinarians surveyed, evaluation and management of anaesthetic risk, anaesthesia procedure, monitoring and safety. Gender, year of graduation, and type of practice were tested as potential risk factors. Chi-square exact test was used to study relations between each risk factor, and the effect of the selected risk factor on each response of the survey. For ordinal data, the Cochran-Mantel-Haenszel test was used to maximize power.

RESULTS

Response rate over a period of 3 months was 20.85% (156 respondents). Overall, the way anaesthesia is performed by most respondents does not meet international guidelines, such as patient preparation and evaluation prior to anaesthesia, not using individualised protocols (for 41%), not obtaining intravenous access (12.4% use it for all their anaesthesia in cats, and 30.6% in dogs), lack of patient monitoring at certain intervals for 55% of the responses, and client prompted optional analgesia (for 29% of respondents). Some practices are more compliant than others. Among them, referral centres generally offer better care than general practices.

CONCLUSIONS AND CLINICAL RELEVANCE

The level of care in anaesthesia and analgesia in practices in French-speaking Eastern Canada is concerning, highlighting the need for more sustained continuing education.

Survey on conduct of anaesthetic monitoring in small animal practice in the UK

BACKGROUND

An online survey was used to investigate current anaesthetic monitoring practices and the confidence level of personnel monitoring anaesthetics in small animal practices within the UK.

METHODS

Veterinary surgeons (VSs), registered veterinary nurses (RVNs) and student veterinary nurses (SVNs) working in the UK were invited to participate in an anonymous, internet-based survey. To gather data, the questions used free text, multiple choice or scales measuring respondent attitude or opinion. No questions were mandatory and data were analysed with descriptive statistics or inductive thematic analysis.

RESULTS

524 valid surveys were completed and included in the data analysis (VS n=136, RVN n=307, SVN n=81). The results indicated mainly RVNs perform pre-anaesthetic monitoring equipment checks, set-up the monitoring equipment and monitor anaesthesia and are more confident than VSs monitoring anaesthetics. VSs, RVNs and SVNs were all recognised to interpret and address changes in parameters monitored. Critical tasks pertaining to anaesthetic monitoring are being performed by personnel other than a VS, RVN or SVN. Respondents recognised the importance of monitoring in relation to patient outcome; however, a considerable proportion of respondents indicated that improving standards of monitoring was not a priority in their practice. Most respondents felt that standards of monitoring could be improved and that financial constraints were the major factor limiting improvement. Most respondents felt they would benefit from further training in anaesthetic monitoring.

CONCLUSION

Variability exists in how anaesthetic monitoring is conducted. Workplace pressures afflicting veterinary staff can influence the conduct of anaesthetic monitoring and initiating change within a veterinary practice can be difficult.

Throwing the Baby Out With the Bath Water: Could Widespread Neutering of Companion Dogs Cause Problems at a Population Level?

In many countries where companion dogs are popular, owners are strongly encouraged to neuter their dogs. Consequently, millions of dogs are neutered each year. In recent times considerable attention has been paid to the possible effects of such procedures on canine health and welfare. Less scrutinized are the potential ramifications of widespread neutering on the breeding of dogs and their continued success as human companions. This paper summarizes research investigating factors influencing the breeding and rearing of dogs most suited to companionship roles in contemporary, typically high-density, communities, and briefly reviews current breeder practices. It then argues that a fundamental shift to promote inclusion of “proven” companion dogs in the gene pool, as opposed to dogs meeting conformation or working/sporting standards, is required to successfully meet the needs of modern urban dog owners. A new model is proposed, whereby responsible owners and breeders work together to produce dogs most suited for life as human companions.

Disorders of Bulldogs under primary veterinary care in the UK in 2013

The Bulldog is a popular companion breed in the UK despite widely reported disease predispositions. This study aimed to characterise the demography, mortality and common disorders of Bulldogs under veterinary care in the UK during 2013. VetCompass collates anonymised clinical data from UK primary-care veterinary practices for epidemiological research. The clinical records of all Bulldogs available in the VetCompass study dataset were reviewed manually in detail to extract the most definitive diagnoses recorded for all disorders that existed during 2013 and for all deaths. Bulldogs comprised 1621 (0.36%) of 445,557 study dogs. Bulldogs increased from 0.35% of the 2009 birth cohort to 0.60% in 2013. Median longevity was 7.2 years, which was lower in males (6.7 years) than females (7.9 years) (P = 0.021). The most prevalent fine-level precision disorders recorded were otitis externa (n = 206, prevalence 12.7%, 95% CI: 11.1–14.4), pyoderma (142, 8.8%, 95% CI: 7.4–10.2) and overweight/obesity (141, 8.7%, 95% CI: 7.4–10.2). The most prevalent disorder groups were cutaneous (n = 463, prevalence: 28.6%, 95% CI: 26.4–30.8), ophthalmological (292, 18.0%, 95% CI: 16.2–20.0), aural (211, 13.0%, 95% CI: 11.4–14.8), enteropathy (188, 11.6%, 95% CI: 10.1–13.3) and upper respiratory tract (171, 10.5%, 95% CI: 9.1–12.1). Provision of an evidence base on the most common disorders and causes of mortality within breeds can support owners, breeders and the veterinary profession to improve health and welfare within these breed.

Canine dystocia in 50 UK first-opinion emergency care veterinary practices: clinical management and outcomes

Canine dystocia is a relatively common veterinary presentation. First opinion emergency care clinical data from 50 Vets Now clinics across the UK were used to explore dystocia management and outcomes in bitches. Caesarean section (CS) was performed on 341/701 (48.6 per cent (95 per cent CI 44.9 to 52.4)) of dystocia cases. The bulldog (OR 7.60, 95 per cent CI 1.51 to 38.26, P=0.014), Border terrier (OR 4.89, 95 per cent CI 0.92 to 25.97, P=0.063) and golden retriever (OR 4.07, 95 per cent CI 0.97 to 17.07, P=0.055) had the highest odds of CS among dystocic bitches compared with crossbreds. Brachycephalic dystocic bitches had 1.54 (95 per cent CI 1.05 to 2.28, P=0.028) times the odds of CS compared with non-brachycephalics. Oxytocin was administered to 380/701 (54.2 per cent) and calcium gluconate was administered to 82/701 (11.7 per cent) of dystocic bitches. 12 of 701 dystocia cases (1.7 per cent) died during emergency care. These results can help veterinary surgeons to provide better evidence on the risks to owners who may be contemplating breeding from their bitches. In addition, the results on the management and clinical trajectory of dystocia can facilitate clinical benchmarking and encourage clinical audit within primary care veterinary practice.

Consequences and Management of Canine Brachycephaly in Veterinary Practice: Perspectives from Australian Veterinarians and Veterinary Specialists

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.