Patient safety culture is needed in veterinary medicine.

Studies in human medicine indicate that between 22,000 and 400,000 people die every year as a direct result of medical errors. In veterinary medicine, 42% of human-caused incidents caused harm to the patient, including 5% resulting in death. In a university veterinary teaching hospital, there were 5.3 errors/1,000 patient visits, and 4 of these resulted in death. Veterinary medicine falls far behind other safety-critical industries in adopting a culture of patient safety. Organizations should respond in a just and effective way when errors occur. Psychological safety for team members to identify and speak up about areas of concern must be created and the results of improvements made based on these concerns shared within the professional group. If veterinary medicine is going to embrace patient safety culture, it needs to be included in the curriculum. Accrediting and licensing bodies need to require the teaching and application of principles of patient safety culture. Faculty must be trained to deliver patient safety-oriented care. Experts in human systems engineering should be brought in to educate veterinarians on how the systems we work in impact patient outcomes. If we are going to fulfill the promise of the Veterinarian's Oath, we must embrace patient safety culture and all the difficult changes it requires of our professional culture.

Comparative growth dynamics of bacterial and fungal contaminants in bupivacaine liposomal injectable suspension, bupivacaine 0.5%, and propofol.

OBJECTIVE: To determine whether bupivacaine liposomal injectable suspension (BLIS) supports microbial growth when artificially inoculated and to evaluate liposomal stability in the face of this extrinsic contamination as evidenced by changes in free bupivacaine concentrations. STUDY DESIGN: A randomized, prospective in vitro study in which three vials of each BLIS, bupivacaine 0.5%, and propofol were individually inoculated with known concentrations of Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans (n = 36) to quantify bacterial and fungal growth was conducted. Over 120 hours, aliquots from contaminated vials were withdrawn, plated, and incubated to determine microbial concentrations. High-pressure liquid chromatography (HPLC) was used to evaluate free bupivacaine concentrations over time in BLIS. Data were analyzed using a mixed effects model with multiple comparisons. SAMPLE POPULATION: Twelve vials of each BLIS, bupivacaine 0.5%, and propofol. RESULTS: BLIS did not support significant growth of Staphylococcus aureus or Candida albicans at any time. BLIS supported significant growth of Escherichia coli and Pseudomonas aeruginosa beginning at the 24 hour time point. Bupivacaine 0.5% did not support significant growth of any organisms. Propofol supported significant growth of all organisms. Free bupivacaine concentrations changed minimally over time. CONCLUSION: Bacterial and fungal contaminant growth in artificially inoculated BLIS is organism dependent. BLIS supports significant growth of Escherichia coli and Pseudomonas aeruginosa. Extra-label handling of BLIS should only be undertaken with caution and with adherence to strict aseptic technique.

Pharmacokinetics of intravenous, oral transmucosal, and intranasal buprenorphine in healthy male dogs.

Effective management of pain in animals is of critical importance but options are limited for treating acute pain in dogs on an outpatient basis. The objective of this study was to compare the plasma concentrations and pharmacokinetics of a concentrated solution of buprenorphine, 1.8 mg/ml (Simbadol™) administered intravenously, intranasally, and via the oral transmucosal (OTM) route in healthy male dogs. Five healthy castrated adult male Beagle-cross dogs were included in this randomized blocked crossover study. The dogs received 0.03 mg/kg body weight buprenorphine intravenously, intranasally, or via the OTM route, with a minimum 72-h washout period between treatments. Blood samples were collected at multiple intervals up to 24 h post administration and buprenorphine plasma concentrations were determined by liquid chromatography tandem mass spectrometry. Non-compartmental pharmacokinetic analysis revealed that the area under the curve of intravenous, intranasal, and OTM routes were 28.0 (15.1-41.3) h × ng/ml, 16.1 (3.4-28.7) h × ng/ml and 10.8 (8.8-11.8) h × ng/ml, respectively. The bioavailability of intranasal and OTM routes were 57.5 (22.7-93.7)% and 41.1 (25.5-69.4)%, respectively. Intranasal and OTM routes of administration of concentrated buprenorphine in dogs may allow for the provision of analgesic care at home.

Risk factors associated with hypoxaemia in horses undergoing general anaesthesia: A retrospective study.

BACKGROUND: Hypoxaemia is a common concern during equine general anaesthesia. The prevalence and predictors of hypoxaemia in horses undergoing elective anaesthesia in particular are poorly documented. OBJECTIVES: To determine and compare the prevalence of hypoxaemia (defined as PaO2  ≤ 80 mm Hg, on the lowest value recorded) in horses undergoing anaesthesia for exploratory laparotomy and elective procedures, and to identify risk factors in both subpopulations. STUDY DESIGN: Retrospective cohort study. METHODS: Data were collected from 774 records of 708 horses undergoing general anaesthesia between April 2017 and August 2020. Potential predictors of hypoxaemia in horses undergoing anaesthesia for exploratory laparotomy or elective procedures were investigated separately by univariable penalised maximum likelihood logistic regression, followed by multivariable analysis. The lowest recorded PaO2 was used as a single data point for the determination of hypoxaemia and arterial oxygen partial pressure to fractional inspired oxygen ratio analysis. RESULTS: Hypoxaemia was recorded in 23% horses undergoing exploratory laparotomy compared with 3.8% horses undergoing elective anaesthesia (P < .001). Multivariable analysis showed that weight above 550 kg, large intestinal lesions, and peak inspiratory pressure (PIP) above 30 cmH2 O were significantly associated with hypoxaemia in horses undergoing exploratory laparotomy. Soft tissue procedures and PIP >30 cmH2 O were significantly associated with hypoxaemia during elective anaesthesia. MAIN LIMITATIONS: This study only considered the minimum PaO2 recorded during anaesthesia. Duration and treatment of hypoxaemia were not considered. CONCLUSIONS: Based on the lowest PaO2 value during anaesthesia, in our population, horses undergoing anaesthesia for exploratory laparotomy were over six times more likely to become hypoxaemic than horses undergoing elective procedures. Bodyweight, type of procedure, and high PIP were predictors of hypoxaemia.

Assessment of Safety Culture at a Veterinary Teaching Hospital in the United States.

This study assessed the fidelity of an existing questionnaire regarding attitudes toward safety culture in an academic veterinary hospital setting and gathered baseline data on these attitudes in a local population. A cross-sectional study design was used to evaluate perceptions held by veterinary teaching hospital employees. An established veterinary safety culture survey was modified and administered as a confidential online survey to faculty, house officers, and professional staff of a veterinary teaching hospital in the United States. Confirmatory and exploratory factor analysis were conducted to compare the adapted survey to the established version. Descriptive statistics were used to characterize baseline safety culture. The adapted survey exhibited factor groupings that were mostly in agreement with, but slightly different from, the original instrument. In general, survey respondents outlined positive attitudes toward the various domains of safety culture, though we identified opportunities for improvement in some areas. An adapted veterinary safety culture survey can be applied to a veterinary teaching hospital in the United States to assess baseline data surrounding the culture of safety and to identify opportunities for focused improvement efforts.

Perioperative physiology and pharmacology in the obese small animal patient.

OBJECTIVE: To review the available literature concerning the physiologic and pharmacologic alterations induced by obesity in canine and feline patients and their relevance to perioperative care. STUDY DESIGN: Literature review. DATABASES: PubMed, CAB, Web of Science. CONCLUSIONS: Obesity of cats and dogs is a chronic inflammatory condition that is increasingly prevalent. Similar to the situation in humans, small animal obesity may be associated with changes in endocrine, respiratory, and cardiovascular function. In addition, alteration of body composition in obesity can affect pharmacokinetic variables. Modifications in perioperative care may need to be made for obese dogs and cats, including attention to respiratory and cardiovascular supportive care and drug dose adjustments.

The effect of nitrous oxide on the minimum alveolar concentration (MAC) and MAC derivatives of isoflurane in dogs.

This study investigated the effects of 70% nitrous oxide (N2O) on the minimum alveolar concentration (MAC) of isoflurane (ISO) that prevents purposeful movement, the MAC of ISO at which there is no motor movement (MACNM), and the MAC of ISO at which autonomic responses are blocked (MACBAR) in dogs. Six adult, healthy, mixed-breed, intact male dogs were anesthetized with ISO delivered via mask. Baseline MAC, MACNM, and MACBAR of ISO were determined for each dog using a supra-maximal electrical stimulus (50 V, 50 Hz, 10 ms). Nitrous oxide (70%) was then administered and MAC and its derivatives (N2O-MAC, N2O-MACNM, and N2O-MACBAR) were determined using the same methodology. The values for baseline MAC, MACNM, and MACBAR were 1.39 ± 0.14, 1.59 ± 0.10, and 1.72 ± 0.16, respectively. The addition of 70% N2O decreased MAC, MACNM, and MACBAR by 32%, 15%, and 25%, respectively.

Cette étude avait comme objectif d'évaluer chez des chiens les effets de 70 % d'oxyde nitreux (N2O) sur la concentration alvéolaire minimum (MAC) d'isoflurane (ISO) qui empêche les mouvements volontaires, la MAC d'ISO à laquelle il n'y a pas de mouvement moteur (MACNM), et la MAC d'ISO à laquelle les réponses autonomes sont bloquées (MACBAR).Six chiens mâles intacts adultes de race mélangée ont été anesthésiés avec de l'ISO administré via un masque. Les valeurs de base de MAC, MACNM et de MACBAR d'ISO ont été déterminées pour chaque chien à l'aide d'un stimulus électrique supra-maximal (50 V, 50 Hz, 10 ms). De l'oxyde nitreux (70 %) fut ensuite administré et la MAC et ses dérivées (N2O-MAC, N2O-MACNM et N2O-MACBAR) déterminées à l'aide de la même méthodologie. Les valeurs des données de base de MAC, MACNM et MACBAR étaient respectivement 1,39 ± 0,14, 1,59 ± 0,10 et 1,72 ± 0,16. L'ajout de 70 % de N2O a entrainé des diminutions de MAC, MACNM et MACBAR de 32 %, 15 % et 25 %, respectivement.(Traduit par Docteur Serge Messier).

Successful treatment of acute respiratory distress syndrome in 2 dogs.

Acute respiratory distress syndrome (ARDS) was diagnosed in 2 dogs with acute dyspnea. Short-term positive pressure ventilation and intense critical and nursing care were provided. Both dogs improved and were discharged. Few reports describe successful recovery from ARDS. Due to advances in positive pressure ventilation and improvement in the supportive care of critically ill veterinary patients, the prognosis for ARDS may improve.

The effect of ketamine on the MACBAR of sevoflurane in dogs.

OBJECTIVE: To determine the effect of intravenous ketamine on the minimum alveolar concentration of sevoflurane needed to block autonomic response (MAC(BAR)) to a noxious stimulus in dogs. STUDY DESIGN: Randomized, crossover, prospective design. ANIMALS: Eight, healthy, adult male, mixed-breed dogs, weighing 11.2-16.1 kg. METHODS: Dogs were anesthetized with sevoflurane on two occasions, 1 week apart, and baseline MAC(BAR) (B-MAC(BAR)) was determined on each occasion. MAC(BAR) was defined as the mean of the end-tidal sevoflurane concentrations that prevented and allowed an increase (≥15%) in heart rate or invasive mean arterial pressure in response to a noxious electrical stimulus (50 V, 50 Hz, 10 ms). Dogs then randomly received either a low-dose (LDS) or high-dose series (HDS) of ketamine, and treatment MAC(BAR) (T-MAC(BAR)) was determined. The LDS had an initial loading dose (LD) of 0.5 mg kg(-1) and constant rate infusion (CRI) at 6.25 µg kg(-1) minute(-1), followed, after T-MAC(BAR) determination, by a second LD (1 mg kg(-1)) and CRI (12.5 µg kg(-1) minute(-1)). The HDS had an initial LD (2 mg kg(-1)) and CRI (25 µg kg(-1) minute(-1)) followed by a second LD (3 mg kg(-1)) and CRI (50 µg kg(-1) minute(-1)). Data were analyzed with a mixed-model anova and are presented as LSM ± SEM. RESULTS: The B-MAC(BAR) was not significantly different between treatments. Ketamine at 12.5, 25, and 50 µg kg(-1) minute(-1) decreased sevoflurane MAC(BAR), and the maximal decrease (22%) occurred at 12.5 µg kg(-1) minute(-1). The percentage change in MAC(BAR) was not correlated with either the log plasma ketamine or norketamine concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Ketamine at clinically relevant doses of 12.5, 25, and 50 µg kg(-1) minute(-1) decreased sevoflurane MAC(BAR), although the reduction was neither dose-dependent nor linear.

Agreement between values for arterial and end-tidal partial pressures of carbon dioxide in spontaneously breathing, critically ill dogs.

OBJECTIVE: To determine agreement between arterial partial pressures of carbon dioxide (PaCO(2)) and end-tidal partial pressures of carbon dioxide (PETCO(2)) measured with a nasal catheter in spontaneously breathing, critically ill dogs. DESIGN: Validation study. ANIMALS: 26 client-owned dogs admitted to an intensive care unit for various conditions. PROCEDURES: PaCO(2) was measured with a commercial blood gas analyzer, and PETCO(2) was measured with a sidestream capnograph attached to a nasal catheter. Measurements were obtained twice (ie, with and without supplemental oxygen). Paired values were compared by means of the Pearson correlation method. Level of agreement was assessed by means of the Bland-Altman method. RESULTS: Mean difference between PaCO(2) and PETCO(2) when dogs did not receive supplemental oxygen (mean +/- SD, 3.95 +/- 4.92 mm Hg) was significantly lower than mean difference when dogs did receive supplemental oxygen (6.87 +/- 6.42 mm Hg). Mean difference in dogs with a condition affecting the respiratory system (8.55 +/- 5.43 mm Hg) was significantly higher than mean difference in dogs without respiratory tract disease (3.28 +/- 3.23 mm Hg). There was a significant linear correlation and good agreement between measured values of PaCO(2) and PETCO(2). Catheter size, ventilatory status, and outcome were not significantly associated with mean difference between PaCO(2) and PETCO(2). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that nasal capnography is a clinically relevant method of estimating PaCO(2) in spontaneously breathing, critically ill dogs, but that values should be interpreted with caution in dogs receiving supplemental oxygen and in dogs with conditions affecting the respiratory system.