The effect of neuraxial morphine on postoperative pain in dogs after extrahepatic portosystemic shunt attenuation.

OBJECTIVE: To investigate the analgesic effect of epidural morphine after surgical extrahepatic portosystemic shunt (EHPSS) attenuation. STUDY DESIGN: Randomized clinical trial. ANIMALS: A total of 20 dogs with a congenital EHPSS. METHODS: Dogs were randomly allocated to be given either a single epidural dose of 0.2 mg kg-1 preservative-free morphine (group M) or not (group C) before surgery. All dogs were administered 0.3 mg kg-1 methadone intravenously (IV) as preanaesthetic medication. Pain scores were determined every 2 hours for the first 24 hours postoperatively using the short-form Glasgow Composite Measure Pain Scale (GCMPS-SF). Dogs with a GCMPS-SF pain score >4/20 or >5/24 received 0.1 mg kg-1 methadone IV as rescue analgesia and were reassessed 30 minutes later. If more than three doses of methadone were administered in a 2 hour period, alternative pain relief was provided and a treatment failure recorded. The GCMPS-SF pain scores and number of rescue analgesia injections were analysed over 24 hours. The last observation carried forward method was applied in case of treatment failure. Food consumption and time to first urination were recorded. Data were analysed using a Mann-Whitney U test and presented as median (minimum-maximum range), with significance set at p < 0.05. RESULTS: Group M showed lower GCMPS-SF pain scores [15 (11-41) versus 31 (11-86); p = 0.023] and lower postoperative methadone requirements [0 (0-0.2) versus 0.25 (0-0.5) mg kg-1; p = 0.029] than group C. There were three treatment failures in group C only. Food consumption and time to first urination did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Epidural morphine reduced the requirement for postoperative analgesia in this study population.

Incidence of perianaesthetic complications experienced during feline bronchoscopy: a retrospective study.

OBJECTIVES: The aim of this study was to report the incidence of anaesthetic complications associated with feline bronchoscopy. METHODS: This was a retrospective analysis of anaesthetic records and electronic case logs of feline bronchoscopies at two university hospitals (centres B and L) between January 2013 and December 2015. A two-tailed Fisher's exact test was used for comparison of variables and outcomes between centres. RESULTS: Seventy-nine cases were included. Desaturation (SpO2 <90%) was the most frequently encountered complication, reported in 24 cats (30.3%); centre B reported significantly less desaturation than centre L (22.4% vs 52.4%; P = 0.014). The use of an endotracheal tube or laryngeal mask airway resulted in a lower incidence of desaturation (22.9% vs 22.2%) than the use of a tracheal catheter through which oxygen was insufflated (48.0%). The latter method was associated with an increased incidence of desaturation (P = 0.034). Patients to which terbutaline was administered had a lower incidence of desaturation (27.5%) than those that did not receive it (35.7%), although this was not statistically significant (P = 0.46). Airway management method and the use of terbutaline differed significantly between centres, as did the profile of complications. Pneumothorax was encountered in two cats (2.5%) and cardiac arrest resulting in the death in one of these cats (1.3%). CONCLUSIONS AND RELEVANCE: Desaturation is a frequently encountered complication during and after bronchoscopy. Airway management method and the use and timing of terbutaline warrant prospective evaluation for their role in decreasing the incidence of desaturation. Bronchoscopy is a high-risk procedure with frequent requirement for post-procedure oxygen supplementation. Pneumothorax and cardiac arrest are potential complications.

Perioperative trends in plasma colloid osmotic pressure in horses undergoing surgery.

OBJECTIVE: To compare perioperative trends in plasma colloid osmotic pressure (COP) between horses undergoing orthopedic and colic surgery. DESIGN: Prospective clinical study September 2009-January 2011. SETTING: Veterinary university teaching hospital. ANIMALS: Thirty-three healthy, client-owned horses presenting for orthopedic surgery (non-GI) and 85 client-owned horses presenting for emergency exploratory celiotomy (GI, gastrointestinal). INTERVENTIONS: None. MEASUREMENTS: Data relating to the horse's parameters on presentation, surgical lesion, post-operative management and survival were extracted from computerized clinical records. Heparinized blood samples were taken on presentation (PreOp, pre-operative), on recovery from anesthesia (T0), at 12 (T12) and 24 (T24) hours post recovery. COP was measured within 4 hours of collection. RESULTS: There was no significant difference in PreOp or T0 COP between groups. Both groups had a significant decrease in COP during anesthesia. When compared to their respective pre-operative values, horses in the non-GI group had significantly increased COP at T12, whereas those in the GI group had significantly reduced COP. This trend was continued at T24. Horses in the GI group placed on intravenous crystalloid isotonic fluids post-operatively had a significantly lower COP at T12 and T24. Horses in the GI group that did not survive had significantly lower post-operative COP values at T24. CONCLUSIONS: Horses undergoing exploratory celiotomy had significantly lower COP post-operatively than those horses undergoing orthopedic surgery. This difference was more marked in those horses receiving isotonic crystalloid intravenous fluid therapy post-operatively and in those that did not survive to discharge. In the non-GI group an increase in COP post-operatively was common.