Report of the Pathogenesis and Pathophysiology of Lyme Disease Subcommittee of the HHS Tick Borne Disease Working Group.

An understanding of the pathogenesis and pathophysiology of Lyme disease is key to the ultimate care of patients with Lyme disease. To better understand the various mechanisms underlying the infection caused by Borrelia burgdorferi, the Pathogenesis and Pathophysiology of Lyme Disease Subcommittee was formed to review what is currently known about the pathogenesis and pathophysiology of Lyme disease, from its inception, but also especially about its ability to persist in the host. To that end, the authors of this report were assembled to update our knowledge about the infectious process, identify the gaps that exist in our understanding of the process, and provide recommendations as to how to best approach solutions that could lead to a better means to manage patients with persistent Lyme disease.

cis-Atracurium in dogs with and without porto-systemic shunts.

OBJECTIVE: To evaluate the non-depolarizing neuromuscular blocking drug cis-atracurium in dogs with porto-systemic shunts, and to compare it in clinically normal animals. ANIMALS: Thirteen dogs of mixed breed and sex, aged between 3 and 31 months old, weighing 2.2-25.5 kg, with ASA physical status II-IV, and undergoing surgical attenuation of porto-systemic shunt. A control group of 11 bitches of mixed breed, between 8 and 60 months old, and weighing 4.5-41.0 kg, all ASA physical status I, undergoing routine ovarohysterectomy were also studied. MATERIALS AND METHODS: Pre-anaesthetic medication was an opioid analgesic, given either alone or in combination with acepromazine. Following induction of general anaesthesia with intravenous (IV) propofol and oro-tracheal intubation, anaesthesia was maintained using isoflurane in either oxygen or oxygen and nitrous oxide. Ventilation was controlled. The train of four (TOF) technique was used to monitor neuromuscular blockade. An initial dose of 0.1 mg kg(-1)cis-atracurium was given IV and additional doses of 0.03 mg kg(-1)cis-atracurium were administered when at least one twitch of the TOF was present. RESULTS: Except for one dog that was killed during surgery because its anomaly was inoperable, all animals recovered satisfactorily from anaesthesia and surgery. In dogs with porto-systemic shunt, onset of neuromuscular blockade was 3.1 +/- 1.1 minutes (mean +/- SD) and in control dogs was 3.4 +/- 0.7 minutes (not significantly different). Neuromuscular blockade lasted 34 +/- 13 minutes in dogs with porto-systemic shunt and 29 +/- 17 minutes in control dogs (not significantly different). CONCLUSIONS: The presence of porto-systemic shunt did not affect the rate of onset or duration of action of cis-atracurium. CLINICAL RELEVANCE: cis-Atracurium may have a use in veterinary anaesthesia for producing neuromuscular blockade in dogs with hepatic insufficiency, including those with porto-systemic shunt.

Comparison of two thiopental infusion rates for the induction of anaesthesia in dogs.

OBJECTIVE: To compare the induction dose requirements of thiopental using two different infusion rates for induction of anaesthesia in dogs. STUDY DESIGN: Prospective, randomized study. ANIMALS: Fifty, healthy (ASA I or II) client-owned dogs with a mean age of 4.1 years and a mean mass of 20.4 kg undergoing elective surgery. MATERIALS AND METHODS: Animals were randomly assigned to receive an infusion of 2.5% thiopental at a rate of either 0.1 ml kg(-1) minute(-1) or 0.4 ml kg(-1)minute(-1), 30-40 minutes after pre-anaesthetic medication with intramuscular acepromazine (0.025 mg kg(-1)) and pethidine (3.5 mg kg(-1)). Thiopental administration was controlled by a precision syringe driver. Statistical analyses of the results, using the outcome 'mg kg(-1) required for induction' (log-transformed) included unpaired t-tests for all categorical data (thiopental infusion rate, breed, sex, obesity, sedation quality) and univariable linear regression for continuous variables (mass, age). All variables were then considered in a multivariable linear regression model. The quality of induction with the two different infusion rates was also assessed. RESULTS: After controlling for quality of sedation, the thiopental induction dose requirement was significantly less (p < 0.001) with the slower infusion rate (median = 7.5 mg kg(-1); range 4.9-13.7) compared with the faster infusion rate (median =11.0 mg kg(-1); range 6.6-18.0). The quality of sedation also affected the dose required (p = 0.03). The slower infusion rate was associated with a significantly poorer induction quality (p = 0.03) [corrected] CONCLUSIONS: Slow thiopental infusion (0.1 ml kg(-1) minute(-1)) for anaesthesia induction after acepromazine/pethidine pre-anaesthetic medication reduced the induction dose requirement, although the quality of induction was inferior. CLINICAL RELEVANCE: The induction dose of thiopental was reduced with a slower administration rate and so slow administration is recommended in thiopental-sensitive animals.

Overdose during chemical restraint in a black rhinoceros (Diceros bicornis).

A juvenile female black rhinoceros (Diceros bicornis) was successfully treated after overdose of drugs used for chemical restraint. Subsequent general anaesthesia for surgical reduction of a recurrent rectal prolapse was uneventful. Over a 25-minute period before transportation to the veterinary hospital, the animal received a total dose of 1.225 mg etorphine, 30 mg acepromazine and 30 mg detomidine. Based on an estimated mass of 200 kg, these corresponded to doses of 6.1 microg kg(-1) etorphine, 150 microg kg(-1) acepromazine, and 150 microg kg(-1) detomidine which constitutes considerable overdose for each drug given separately, notwithstanding the synergy that probably resulted when the three drugs were present concurrently. The estimated body mass may have substantially overestimated the actual body mass and exacerbated overdosage. The animal was recumbent and apnoeic on arrival at the hospital. Heart sounds were auscultated and a weak peripheral pulse was palpated; no pulse deficits were detected, although the heart rate was low. The trachea was intubated, inspired breath was enriched with oxygen and the lungs ventilated manually. Diprenorphine (1.5 mg) was given intravenously and spontaneous breathing resumed 11 minutes later. After induction of general anaesthesia using isoflurane, emergency surgery for correction of rectal prolapse was performed, from which the animal recovered uneventfully. The case highlights some of the practical problems that may be encountered in dealing with dangerous and unfamiliar species.

Acid-base, blood gas, and physiologic parameters during laparoscopy in the head-down position in white-tailed deer (Odocoileus virginianus).

The objective of this project was to evaluate the acid-base, blood gas, and physiologic parameters of white-tailed deer (Odocoileus virginianus) during laparoscopy in the head-down position. Eleven white-tailed does were captured and then immobilized with xylazine (6 mg/kg i.m.) and ketamine (7 mg/kg i.m.). The deer were intubated orotracheally and maintained with isoflurane in oxygen. The deer were positioned in dorsal recumbency and positive pressure ventilated. Heart rate (HR), arterial blood pressure, end-tidal carbon dioxide concentration (FE/CO2), and CO2 insufflation pressure were recorded every 5 min. Respiratory parameters, plasma electrolytes, and peak inspiratory pressure were measured immediately before tilting deer in the head-down position (45-55 degrees), 5 min after tilting, and immediately before the end of the procedure (while tilted). Butorphanol (0.05 mg/kg i.m.) was administered at the end of the procedure and yohimbine (0.2 mg/kg i.v.) administered before release. The deer weighed 52 kg (28-70 kg) [median (minimum-maximum)]. The peak inspiratory pressure in dorsal recumbency while still horizontal was 25 cm H2O (16-28 cm H2O), which increased to 29 cm H2O (18-46 cm H2O) after tilting (P = 0.02). PaO2, PaCO2, FE/CO2, and pH did not change after tilting in the head-down position or after insufflation. HR did not change during the anesthetic period. Mean arterial pressure did not change after tilting or abdominal insufflation, but decreased by the end of the anesthetic period (approximately 1 hr). Time from intubation to extubation was 117 min (72-170 min) (n = 5) and surgery time was 31 min (17-60 min; n = 10). We conclude that captured white-tailed deer have minimal derangements to acid-base, blood gas, or physiologic parameters during laparoscopy in the head-down position with abdominal insufflation, and thus this procedure may be performed safely in ventilated white-tailed deer.

The clinical use of the neuromuscular blocking agent rocuronium in dogs.

OBJECTIVE: The aim of this study was to characterize the onset and duration of action of the aminosteroid muscle relaxant rocuronium in dogs under clinical conditions. STUDY DESIGN: Prospective single dose trial. ANIMALS: Twenty-three dogs aged between 6 months and 12 years, weighing between 5.5 and 61.5 kg admitted to the University of Liverpool Small Animal Hospital between January and March 2000, and undergoing elective surgical procedures under general anaesthesia. MATERIALS AND METHODS: Following induction of general anaesthesia, neuromuscular function was evaluated using train-of-four (TOF) stimulation. An initial dose of 0.4 mg kg-1 rocuronium was administered intravenously (IV) and neuromuscular blockade was monitored by visually assessing the number of responses (twitches) to TOF stimulation (train-of-four count: TOFC). Incremental doses of 0.16 mg kg-1 rocuronium were administered as indicated, when at least two twitches of the TOFC had returned. RESULTS: Rocuronium (0.4 mg kg-1) abolished all responses to TOF stimulation in all dogs. The mean time to onset of neuromuscular blockade (complete abolition of all twitches) was 98 ± 52 seconds. Neuromuscular blockade (absence of all twitches to return of all four) lasted 32.3 ± 8.2 minutes. Incremental doses of 0.16 mg kg-1 had a mean duration of action of 20.8 ± 4.9 minutes and up to seven increments were shown to be noncumulative. The effects of rocuronium were readily antagonized with neostigmine and atropine. Small transient increases in arterial blood pressure, which occurred in three dogs after the administration of rocuronium, were the only cardiovascular side-effects observed. CONCLUSIONS: Rocuronium is an effective nondepolarizing neuromuscular blocking agent in the dog, with a rapid onset of neuromuscular block after intravenous administration and an intermediate duration of action. CLINICAL RELEVANCE: Rocuronium produced a neuromuscular block with similar characteristics to those obtained with vecuronium, thus apparently offering little advantage over vecuronium. However, its availability in aqueous solution and a longer shelf-life increases convenience.

The use of the nondepolarizing neuromuscular blocking drug cis-atracurium in dogs.

Objective This clinical trial attempted to evaluate the potency, onset and duration of action of cis-atracurium in dogs. Animals Twenty dogs aged between 1 and 15 years and weighing between 15 and 85 kg admitted for a variety of elective, surgical procedures under general anaesthesia. Materials and methods Following induction of general anaesthesia, the effects of an intravenous loading dose of cis-atracurium (0.1 mg kg-1) were evaluated by counting visual responses to train of four (TOF) nerve stimulation. Incremental doses of 0.02 or 0.04 mg kg-1 cis-atracurium were administered when the first of four responses to TOF stimulation was present. Results An initial dose of 0.1 mg kg-1 eliminated all four TOF responses in 18 out of 20 dogs. The same dose, repeated 10 minutes later in two animals in which blockade was incomplete, abolished all responses. In dogs receiving 0.1 mg kg-1 cis-atracurium neuromuscular blockade lasted 27.2 ± 9.3 minutes. Up to six incremental doses were given in individual animals; incremental doses appeared to be noncumulative. No untoward side-effects were observed with the use of this drug. There was considerable variation between individuals in response to cis-atracurium. Conclusions Cis-atracurium is an effective neuromuscular blocking agent in the dog, although its potency varies. Clinical Relevance Further studies are required to determine whether observed differences in potency are related to age, breed or sex. Cis-atracurium may prove useful in dogs with impaired renal and or hepatic function.