Acid-base imbalances and the association of blood-gas variables, electrolytes, and biochemical analytes with outcome in hospitalized calves undergoing abdominal surgery.

BACKGROUND: Surgical abdominal emergencies in calves are associated with a guarded prognosis and have the potential for complex metabolic derangements including acid-base imbalances. OBJECTIVES: To perform a comprehensive analysis of acid-base status and to assess the prognostic relevance of preoperative clinicopathologic variables in calves undergoing abdominal surgery. ANIMALS: Hospital-based study samples of 535 (dataset 1; DS1) and 83 calves (dataset 2; DS2). METHODS: Retrospective (DS1) and prospective (DS2) case series. RESULTS: In DS1, acidemia (pH <7.33) was present in 49.9%, whereas alkalemia (pH >7.37) was present in 30.7% of calves. Plasma L-lactate, chloride, and serum inorganic phosphorus concentration accounted for 51.9%, 11.6% and 9.4% of the variation of venous blood pH, respectively. Classification tree analysis indicated that a negative outcome (death or euthanasia during hospitalization) was associated with venous pO2 ≤33.6 mm Hg, anion gap >18.3 and >22.9 mEq/L, serum albumin concentration ≤36.5 and ≤29.4 g/L, serum urea concentration >4.4 mmol/L, and plasma ionized calcium concentration ≤1.26 mmol/L. The area under the receiver operating characteristic curve of this model was 0.85 (95% CI: 0.82-0.89, P < .001) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.5 was 89.8% and 65.7%, respectively. In DS2 the model had a similar sensitivity and specificity of 90.5% and 70%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinicopathologic imbalances and associated changes of acid-base status are common in calves with surgical abdominal emergencies and have clinical utility for the prediction of a negative postoperative outcome.

Evaluation of presentation, treatment and outcome in hypertensive emergency in dogs and cats: 15 cases (2003-2019).

OBJECTIVES: Hypertensive emergency is well recognised in human medicine, yet there is limited veterinary evidence. This study aimed to determine the presentation, treatment and outcome in dogs and cats with hypertensive emergency. MATERIALS AND METHODS: A retrospective case series of dogs and cats with hypertensive emergency identified as follows: acute history with non-invasive Doppler systolic blood pressure greater than 180 mmHg and target organ damage including acute onset seizures, altered mentation with or without lateral recumbency or blindness. Data collected included signalment, history, physical examination and clinicopathological findings, systolic blood pressure, antihypertensive treatment and outcome. RESULTS: Seven dogs and eight cats were included presenting with seizures (n=9), blindness (n=4), altered mentation with (n=2) or without (n=2) lateral recumbency. Median age was 9 years (range 1 to 15) and duration of clinical signs before presentation was 1.5 days (range 1 to 15). Median systolic blood pressure on presentation was 230 mmHg (range 190 to 300). Amlodipine was the most common first-line agent (n=10), followed by hydralazine (n=4) and hypertonic saline (n=1). Aetiology of hypertensive emergency was acute kidney injury (n=9), idiopathic hypertension (n=3), hyperthyroidism (n=1), lymphoma (n=1) and suspected cutaneous and renal glomerular vasculopathy (n=1). Five cats and three dogs survived to discharge with an overall survival of 53.3%. CLINICAL SIGNIFICANCE: Hypertensive emergencies had various presenting signs in this series. AKI was considered to be the cause of hypertension in the majority of patients. Further evaluation of treatment for hypertensive emergencies is warranted, considering almost half of the cases did not survive to discharge.

Effect of anesthesia duration on the quality of recovery in horses undergoing elective and emergency surgeries using the same anesthetic protocol.

The objective of this study was to investigate the effect of anesthesia duration on the quality of recovery in horses. The medical records of horses that were anesthetized and underwent surgery for elective and emergency soft tissue and orthopedic conditions from 2013 to 2019 were reviewed. Horses included in the study (N = 305) fulfilled the following requirements: all had the same premedication/induction protocol and the same balanced anesthesia for maintenance and were anesthetized by the same, experienced Board-certified anesthesiologist. A standardized anesthetic recovery score was completed for all horses to evaluate their recovery and the following interactions were assessed: age, body weight, breed, sex, American Society of Anesthesiologists status, type of surgical procedure, occurrence of hypotension, use of dobutamine, number of additional doses of xylazine/ketamine after isoflurane discontinuation, anesthesia duration, post-anesthetic sedation, and end-tidal isoflurane concentration during maintenance and at the time of transfer to the recovery room. These interactions were assessed based on the quality of recovery score using logistic regression. Duration of anesthesia (P = 0.021) and age (P = 0.003) negatively affected the quality of recovery. The odds of a worse recovery score were increased by 1.20-fold (1.03, 1.41; lower and upper limits) for every additional 30 min of anesthesia duration, while the odds of a worse recovery score were increased by 1.09-fold (1.03, 1.16) for every additional 1 y of age. In conclusion, the results of this retrospective study indicate that increasing the anesthesia duration negatively affects the quality of recovery in horses undergoing routine and emergency surgical procedures.

L'objectif de cette étude était d'étudier l'effet de la durée de l'anesthésie sur la qualité de la récupération chez les chevaux. Les dossiers médicaux des chevaux qui ont été anesthésiés et ont subi une intervention chirurgicale élective et d'urgence des tissus mous et orthopédique de 2013 à 2019 ont été examinés. Les chevaux inclus dans l'étude (N = 305) remplissaient les conditions suivantes : tous avaient le même protocole de prémédication/d'induction et la même anesthésie équilibrée pour l'entretien et ont été anesthésiés par le même anesthésiste expérimenté et certifié par le Board. Un score de récupération anesthésique standardisé a été réalisé pour tous les chevaux afin d'évaluer leur récupération et les interactions suivantes ont été évaluées : âge, poids corporel, race, sexe, statut American Society of Anesthesiologists, type d'intervention chirurgicale, survenue d'hypotension, utilisation de dobutamine, nombre de doses supplémentaires de xylazine/kétamine après l'arrêt de l'isoflurane, la durée de l'anesthésie, la sédation post-anesthésique et la concentration d'isoflurane en fin d'expiration pendant l'entretien et au moment du transfert en salle de réveil. Ces interactions ont été évaluées sur la base de la qualité du score de récupération en utilisant la régression logistique. La durée de l'anesthésie (P = 0,021) et l'âge (P = 0,003) ont affecté négativement la qualité de la récupération. Les probabilités d'un pire score de récupération ont été multipliées par 1,20 (1,03, 1,41; limites inférieure et supérieure) pour chaque 30 min supplémentaire de durée d'anesthésie, tandis que les chances d'un pire score de récupération ont été multipliées par 1,09 (1,03, 1,16) pour chaque année d'âge supplémentaire. En conclusion, les résultats de cette étude rétrospective indiquent que l'augmentation de la durée de l'anesthésie affecte négativement la qualité de la récupération chez les chevaux subissant des interventions chirurgicales de routine et d'urgence.(Traduit par Docteur Serge Messier).

Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies.

In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.

A pilot study comparing bone marrow aspirates and venous blood for emergency point-of-care blood parameters in healthy dogs.

OBJECTIVE: To compare intravenous and intraosseous blood aspirates using point-of-care diagnostic equipment available in veterinary hospitals. DESIGN: Prospective study. SETTING: Private referral hospital. ANIMALS: Dogs undergoing a tibial plateau leveling osteotomy or extracapsular anterior cruciate ligament stabilization procedure were enrolled. METHODS: Under general anesthesia, simultaneous 0.5 mL intravenous and intraosseous blood samples were collected from the jugular vein and proximal tibia, respectively. Samples were evaluated in duplicate within 10 minutes of collection and averaged for each of the following parameters: blood urea nitrogen (BUN), glucose, packed cell volume, total plasma protein (TPP), plasma lactate, sodium, potassium, chloride, urea, glucose, pH, anion gap, pO2, and pCO2 . Normalcy was tested with Kolmogorov-Smirnov test. A Student's t-test and Bland-Altman plot were used to compare intravenous and intraosseous samples. RESULTS: Twelve dogs were recruited into the study. There were statistically significant differences between intravenous and intraosseous samples for sodium (P = 0.0216), chloride (P = 0.0225), BUN (P = 0.014), and potassium (P < 0.0001), respectively. No significant differences were detected for the other parameters evaluated. DISCUSSION: The intraosseous space provides an easily accessible, noncollapsible alternative for assessing blood parameters. Omitting potassium, the statistically significant differences noted between sites was not felt to be clinically significant. Although statistically insignificant, the large difference in hematocrit values indicates that the samples should not be used interchangeably. CONCLUSION: Intraosseous aspirates, excluding potassium and hematocrit, appear to be a reliable alternative for assessing most point-of-care analytes in healthy dogs, although a larger sample size should be investigated. The application of these data in shock patients is unknown.

Review of oncological emergencies in small animal patients.

Oncological emergencies can occur at any time during the course of a malignancy and need to be recognized promptly to maximize successful outcomes. Emergencies are characterized as chemotherapy-induced, paraneoplastic syndromes, or directly related to the neoplasm. Prompt identification with treatment of these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This review aims to educate the reader on the pathophysiology, clinical presentation and treatment of some of these emergencies, and to review the current veterinary literature to help educate veterinarians in primary and tertiary facilities to know how to diagnose and treat these serious conditions.

Measurement of plasma cell-free DNA concentrations in dogs with sepsis, trauma, and neoplasia.

OBJECTIVES: To determine if cell-free DNA (cfDNA) was identifiable in canine plasma, to evaluate 3 techniques for the measurement of plasma cfDNA concentrations in dogs presented to an emergency service, and to compare the plasma cfDNA concentrations of healthy dogs to those with sepsis, trauma, and neoplasia. DESIGN: Retrospective study of banked canine plasma samples collected between May 2014 and December 2014. SETTING: Dogs presented to the emergency service of a university veterinary teaching hospital. ANIMALS: Plasma cfDNA was measured on residual plasma samples obtained from 15 dogs with sepsis, 15 dogs with moderate-severe trauma, 15 dogs diagnosed with a sarcoma. Plasma cfDNA was also measured in 15 healthy dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Assay linearity, repeatability, and reproducibility were evaluated. Quantification of cfDNA was performed in duplicate on diluted citrated plasma and following DNA purification using 2 fluorescence assays (SYBR-Gold; Quant-iT) and by ultraviolet absorbance spectroscopy. Fluorescence intensities (FIs) were converted to cfDNA concentrations using standard curves. Median FI values and cfDNA concentrations were compared to healthy controls using the Kruskal-Wallis test, with adjustment for multiple comparisons. Alpha was set at 0.05. Both assays had excellent linearity, and acceptable repeatability and reproducibility. Compared to controls, plasma cfDNA concentrations were significantly increased in dogs with sepsis or moderate-severe trauma with both assays (P ≤ 0.003). Dogs with neoplasia had significantly increased cfDNA concentrations with the Quant-iT assay only (P = 0.003). When measurements were performed on purified DNA, only dogs with moderate-severe trauma had significantly increased cfDNA concentrations (P < 0.001; SYBR-Gold assay). CONCLUSIONS: cfDNA can be readily identified in canine plasma using 2 fluorescence assays. DNA extraction offers no advantage over direct measurement. Compared to healthy controls, dogs with sepsis or moderate-severe trauma have significantly increased plasma cfDNA concentrations.

Medical and Surgical Emergencies in Ferrets.

In the last few years, significant improvement in diagnosis and treatment of ferret emergencies has occurred. Scientific advances demonstrated the need of specific practices when dealing with emergencies in ferrets. The risk of overdiagnosis of hypoglycemia with human portable blood glucose meters is a clear example. The purpose of this article is to describe the current approach to common medical and surgical emergencies in ferrets.

Hyphema: Considerations in the Small Animal Patient.

Classification, diagnosis, and treatment of hemorrhage into the anterior chamber of the eye, or hyphema, can be a challenging and frustrating process for many practitioners, especially in emergency situations. This review outlines an inclusive list of causes, diagnostics, and treatments for traumatic and nontraumatic hyphema in both canine and feline patients. The review is tailored to small animal practitioners, especially in emergency practice, and is designed to provide concise but thorough descriptions on investigating underlying causes of hyphema and treating accordingly.

Management of Orbital Diseases.

Orbital diseases are common in dogs and cats and can present on emergency due to the acute onset of many of these issues. The difficulty with diagnosis and therapy of orbital disease is that the location of the problem is not readily visible. The focus of this article is on recognizing classical clinical presentations of orbital disease, which are typically exophthalmos, strabismus, enophthalmos, proptosis, or intraconal swelling. After the orbital disease is confirmed, certain characteristics such as pain on opening the mouth, acute vs. chronic swelling, and involvement of nearby structures can be helpful in determining the underlying cause. Abscesses, cellulitis, sialoceles, neoplasia (primary or secondary), foreign bodies, and immune-mediated diseases can all lead to exophthalmos, but it can be difficult to determine the cause of disease without advanced diagnostic imaging, such as ultrasound, magnetic resonance imaging, or computed tomography scan. Fine-needle aspirates and biopsies of the retrobulbar space can also be performed.

Acute Blindness.

Sudden loss of vision is an ophthalmic emergency with numerous possible causes. Abnormalities may occur at any point within the complex vision pathway, from retina to optic nerve to the visual center in the occipital lobe. This article reviews specific prechiasm (retina and optic nerve) and cerebral cortical diseases that lead to acute blindness. Information regarding specific etiologies, pathophysiology, diagnosis, treatment, and prognosis for vision is discussed.

C-reactive protein and high mobility group box 1 in dogs with gastric dilatation and volvulus.

OBJECTIVE: To (1) measure C-reactive protein (CRP) and high mobility group box 1 (HMGB1) and (2) evaluate their prognostic value and relationship to severity of systemic inflammatory response syndrome, routine hematological and acid-base parameters in dogs with gastric dilatation volvulus (GDV). DESIGN: Prospective observational study from September 2010 to June 2012. SETTING: Veterinary teaching hospital. ANIMALS: Forty-one client-owned dogs with GDV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood was collected before surgery (baseline), postsurgery, 6-10 hours postsurgery, and 18-22 hours postsurgery. CRP and HMGB1 were measured in all samples, and routine hematological, biochemical, and acid-base analyses were performed. Only baseline and postsurgery samples were used from nonsurvivors (n = 10). CRP increased significantly from postsurgery sampling to 18-22 hours postsurgery, while HMGB1 did not change over time. There was a significant difference in HMGB1 between survivors and nonsurvivors over time. Both proteins correlated with systemic inflammatory response syndrome severity, total leukocyte, segmented neutrophils, and band counts. HMGB1 correlated also with acid-base parameters (pH, bicarbonate, base excess). CONCLUSION: HMGB1 and CRP behaved differently in regards to their kinetic patterns, with HMGB1 appearing to better reflect the severity of tissue injury in dogs with GDV than CRP.

Morfologia e morfometria da traqueia da preguiça (bradypus variegatus): conhecimentos para procedimentos de emergência / Morphological and morphometric trachea sloth (bradypus variegatus): knowledge for emergency procedures

Por ser uma espécie pouco estudada, principalmente do ponto de vista morfológico, objetivou-se conhecer a anatomia da traqueia da preguiça (Bradypus variegatus) a fim de fornecer informações para facilitar a eleição de tubo endotraqueal adequado, máscara laríngea ou cânula de traqueostomia para anestesia e procedimentos de emergência, uma vez que a mesma revelou-se possuidora de uma morfologia especial. Foram investigados 11animais jovens de idades diferentes, sendo quatro machos e sete fêmeas, provenientes do Museu Emilio Goeldi e doados a UFRA. Os exemplares foram perfundidos via intramuscular com solução aquosa de formol a 10% para fins de conservação e posteriormente foram dissecados em nível cervico-torácico, por meio de mesoscopia, expondo-se desde a laringe até os brônquios principais direito e esquerdo ao nível do hilo pulmonar. As traqueias foram divididas em cinco regiões (região cervical, região da primeira flexura, região da segunda flexura, região da terceira flexura e região da carina) as quais foram mensuradas altura e largura, assim como o comprimento traqueal total e parte do material foi submetido à técnicas de rotina histológica. Macroscopicamente, destacou-se a presença de sinuosidades acentuadas em porção médio caudal, contemplando a carina. O comprimento médio traqueal foi de 14,6cm. Microscopicamente, a traqueia era constituída por placas separadas de cartilagem hialina constituindo cada anel, sendo revestido por epitélio estratificado ciliado. Apesar da traqueia da preguiça comum apresentar revestimento padrão encontrado na traqueia de outros animais, na literatura não há registros de outras espécies que tenham morfologia macroscópica nas condições descritas, o que nos leva a sugerir, quando necessário acesso para ventilação de emergência, a prática da IOT e não a de traqueostomia.

As the sloth (Bradypus variegatus) is a little studied species, especially from a morphological point of view, this research aimed to define the anatomy of its trachea. The information would facilitate the selection of a proper endotracheal tube, laryngeal mask or tracheostomy tube for anesthesia and emergency procedures, since it appeared to have a special morphology. Eleven young animals of different ages were investigated, four males and seven females, obtained from the Emilio Goeldi Museum and donated to UFRA. The specimens were infused intramuscularly with 10% aqueous formaldehyde for preservation and were later dissected at the cervico-thoracic level, by mesoscopia, exposing the area from the larynx to the right and left primary bronchi at the hilum. The tracheae were divided into five regions (cervical, first flexure, second flexure, third flexure, and carina) for which length and width were measured, as well as the total tracheal length. Sharp windings were seen in the middle caudal portion, including the carina. The average tracheal length was 14.6 cm. Microscopically, the trachea was made up of separate plates of hyaline cartilage forming each ring, lined with ciliated epithelium. Despite the trachea of the common sloth displaying the same lining pattern found in other animals, there are no reports in the literature of other species having a macroscopic morphology as described here, which leads us to suggest, where appropriate access to emergency ventilation, the practice of IOT and not tracheostomy.

Manejo e transporte de equinos fraturados / Management and transportation of fractured equine patients / Manejo y transporte de equinos fracturados

O atendimento emergencial e o transporte de equinos fraturados a centros de referência capacitados constituem procedimentos fundamentais para o sucesso de sua recuperação. Após a execução das medidas de estabilização do paciente, manejo das feridas e, se possível, avaliação radiográfica, realiza-se a imobilização externa da fratura de acordo com o local do membro onde esta se encontra, para melhor neutralização das forças atuantes. A imobilização de fraturas do esqueleto apendicular consiste basicamente no emprego de uma bandagem de Robert-Jones, sobreposta por uma ou mais talas posicionada(s) no(s) aspecto(s) dorsal, lateral, medial ou caudal/palmar/plantar. As fraturas cranianas e mandibulares podem ocasionar distúrbios neurológicos e oculares, temporários ou permanentes, e frequentemente acometem a cavidade nasal e os seios paranasais, gerando comprometimento respiratório. O transporte dos pacientes fraturados deve ser efetuado da maneira mais segura possível, com a finalidade de evitar maiores complicações do quadro do paciente. Deste modo, obtêm-se maior possibilidade de recuperação e melhor prognóstico para estes animais.(AU)

The emergency care and transportation of fractured equine patients to trained veterinary hospitals are fundamental procedures for the success of its recovery. After the stabilization procedures, wound management, and, if possible, radiographic evaluation on the patient, external immobilization of the fracture is performed depending on the place where the fracture is located, in order to better neutralize the acting forces. The immobilization of appendicular skeleton fractures consists on basically using Robert-Jones? bandage, overlapped with one or more splints positioned on the dorsal, lateral, medial or caudal/palmar/plantar aspect. Skull fractures may cause neurological and ocular disorders, both temporary or permanent, and frequently affect nasal cavity and paranasal sinuses, leading to respiratory problems. The transportation of fractured patients must be carried out in the safest way as possible, in order to avoid further complication to the patient?s condition. Thus, greater recovery possibility and better prognosis for these animals are obtained.(AU)

El atendimiento de emergencia y el transporte de equinos fracturados a centros de referencia capacitados, constituyen procedimientos fundamentales para el éxito de su recuperación. Tras la ejecución de medidas de estabilización del paciente, manejo de las heridas y, si posible, evaluación radiográfica, se realiza la inmovilización externa de la fractura de acuerdo con el lugar del miembro donde ésta se encuentre, para mejor neutralización de las fuerzas actuantes. La inmovilización de fracturas del esqueleto apendicular consiste en utilizar un vendaje de Robert-Jones, sobrepuesto por una o más férulas posicionadas de forma dorsal, lateral, medial o caudal/palmar/plantar. Las fracturas craneanas y mandibulares pueden causar disturbios neurológicos y oculares, temporarios o permanentes, y frecuentemente acometen la cavidad nasal y los senos paranasales, generando comprometimiento respiratorio. El transporte de los pacientes fracturados debe ser efectuado de la manera más segura posible, con el fin de evitar mayores complicaciones en el cuadro del paciente. De este modo se obtiene mayor posibilidad de recuperación y mejor pronostico para estos animales.(AU)

Evaluation of L-lactate and cardiac troponin I in horses undergoing emergency abdominal surgery.

OBJECTIVE: To evaluate changes in plasma cardiac troponin I (cTnI) and L-lactate (LLt) as prognostic indicators in horses undergoing emergency abdominal surgery. DESIGN: Prospective observational study. SETTING: Veterinary teaching hospital. ANIMALS: Thirty-four horses undergoing emergency abdominal surgery. INTERVENTIONS: Serial blood sampling during various times during hospitalization (hospital admission, and 12, 24, 48, and 72 h postoperatively) evaluating cTnI and LLt concentrations. MEASUREMENTS AND MAIN RESULTS: All horses required surgery for correction of a strangulating (n = 29) or nonstrangulating obstruction (n = 5) of the small or large intestine. Twenty-seven horses survived to discharge; 7 were euthanized either during (n = 1) or after (n = 6) surgery due to disease severity or systemic complications associated with the primary gastrointestinal lesion. Preoperative cTnI concentrations were increased above the normal reference interval in 24% of horses (8/34, median = 0.01 ng/mL, range = 0-12.23 ng/mL), whereas LLt concentrations were increased above the normal reference interval in 88% of horses (30/34, median = 3.37 mmol/L, range = 0.77-13.26 mmol/L). The LLt concentration was significantly higher (P < 0.05) in nonsurviving compared with surviving horses at admission, and at 24 and 72 hours postoperatively. No significant difference in the cTnI concentration was detected between groups at admission. However, the cTnI concentration was significantly higher (P<0.05) in nonsurviving compared with surviving horses at all time points postoperatively. CONCLUSIONS: Measurement of both LLt and cTnI concentrations may provide information for prognostication in surgical colic horses. Marked increases in admission concentrations of LLt (median 7.56 mmol/L) and even moderate postoperative increases in cTnI concentration (median 0.97 ng/mL) may both indicate a poor prognosis in critically ill horses following abdominal surgery.

Emergency and therapeutic vaccination--is stimulating innate immunity an option?

There is increasing evidence that activation of innate immunity, in animals and man, by live vaccines, sub-unit vaccines or synthetic or non-synthetic stimulants can induce a profound and rapidly induced resistance to pathogens, including infectious agents that are unrelated to the stimulating antigen or agent. We review the evidence for this phenomenon and present the proposition that this approach might be used to stimulate immunity during the life of the animal when susceptibility to infection is high and when normal vaccination procedures may be inappropriate.

Anaesthetic management of a 10-month-old white rhinoceros (Ceratotherium simum) calf for emergency exploratory celiotomy.

A 10-month-old, 580 kg, hand-reared white rhinoceros (Ceratotherium simum) calf was presented for emergency exploratory celiotomy. Anaesthesia was safely induced with three successive intravenous (IV) boluses of diazepam (10 mg) and ketamine (100 mg) until the trachea could be intubated. Anaesthesia was adequately maintained with isoflurane-inoxygen (mean end-tidal isoflurane concentration of 1.1% ± 0.2%) on a circle anaesthetic machine with carbon dioxide absorption and an intravenous infusion of ketamine and medetomidine at a mean rate of 0.02 mg/kg/min and 0.02 µg/kg/min, respectively. Mean values recorded during anaesthesia and surgery were heart rate (56.9 ± 11 beats/min), mean arterial blood pressure (6.16 kPa ± 1.75 kPa), end-tidal carbon dioxide concentration (6.23 kPa ± 0.30 kPa). Abdominal gas distension contributed to hypoventilation that resulted in hypercapnoea, confirmed by arterial blood gas analysis (PaCO2 14.69 kPa), which required controlled ventilation for correction. Blood volume was maintained with the intravenous infusion of a balanced electrolyte solution at 10 mL/kg/h and blood pressure supported with a continuous infusion of dobutamine and phenylephrine. Duration of anaesthesia was 3.5 h. It was concluded that anaesthesia was safely induced in a compromised white rhinoceros calf with a combination of diazepam and ketamine. A constant-rate infusion of medetomidine and ketamine allowed for a reduction in the dose of isoflurane required during maintenance of anaesthesia and improved intra-operative blood pressure management.

Adipose tissue-derived adiponectin expression is significantly associated with increased post operative mortality in horses undergoing emergency abdominal surgery.

REASONS FOR PERFORMING STUDY: Adipose tissue is an important source of inflammatory cytokines (adipokines) and adiposity has been identified as having a significant effect on human morbidity and mortality. Obesity is also an emerging welfare problem in the UK horse population, but the role that it plays in secondary diseases is unclear. OBJECTIVES: To examine the expression of inflammation-related adipokine genes in retroperitoneal adipose tissue of horses undergoing emergency abdominal surgery and to explore associations with adiposity and post operative survival. METHODS: Retroperitoneal adipose tissue samples were obtained from 76 horses undergoing emergency abdominal surgery. Real-time PCR was used to measure gene expression for leptin, adiponectin, tumour necrosis factor-alpha, macrophage chemoattractant protein-1, macrophage inhibitory factor, serum amyloid A, haptoglobin and interleukin-1. Multivariate patterns of adipokine expression were explored with principal component analysis (PCA), whilst univariable associations with post operative survival were tested in a Cox proportional hazards model. RESULTS: Leptin gene expression was higher in overweight and obese horses than in lean animals. Expression of mRNA encoding adiponectin mRNA in visceral adipose tissue was positively associated with increased post operative mortality (hazard ratio 1.31, 95% CI 1.05-1.65). However, PCA did not demonstrate multivariable patterns of adipokine gene expression from visceral adipose tissue associated with body mass index or with survival. CONCLUSIONS: In horses presented with acute intestinal disease, increased adiponectin gene expression from retroperitoneal adipose tissue is associated with an increased risk of mortality. Obesity assessed by BMI had no association with increased post operative mortality in horses with primary gastrointestinal disease. POTENTIAL RELEVANCE: Further study is warranted on the expression and effects of adipokines, particularly adiponectin, and correlation with postoperative outcome.

Histamine: metabolism, physiology, and pathophysiology with applications in veterinary medicine.

OBJECTIVE: To review the human and veterinary literature on histamine physiology and pathophysiology and potential applications for clinical use in veterinary critical care. DATA SOURCES: Human and veterinary clinical studies, reviews, texts, and recent research in histamine receptor and antagonist therapy. HUMAN DATA SYNTHESIS: Recent progress in molecular biology has led to a more complete understanding of the enzymes involved in histamine metabolism and histamine receptor physiology. The past decade of research has confirmed the role of histamine in the classical functions (contraction of smooth muscle, increase in vascular permeability, and stimulation of gastric acid secretion) and has also elucidated newer ones that are now under investigation. Data on the roles of histamine in angiogenesis, circadian rhythm, bone marrow regeneration, bacterial eradication, and cancer are emerging in the literature. Newer histamine antagonists are currently in drug trials and are expected to advance the clinical field in treatment of allergic, gastrointestinal, and cognitive disorders. VETERINARY DATA SYNTHESIS: Veterinary histamine research is directed at identifying the effects of certain pharmacological agents on blood histamine concentrations and establishing the relevance in clinical disease states. Research demonstrates important species differences in regards to histamine receptor physiology and tissue response. Studies in the area of trauma, sepsis, anaphylaxis, allergy, and gastrointestinal disorders have direct applications to clinical veterinary medicine. CONCLUSIONS: Histamine plays a key role in the morbidity and mortality associated with allergy, asthma, gastric ulcers, anaphylaxis, sepsis, hemorrhagic shock, anesthesia, surgery, cardiovascular disease, cancer, CNS disorders, and immune-mediated disease. Histamine antagonism has been in common use to block its adverse effects. With recent advances in the understanding of histamine receptor physiology, pharmaceutical agents targeting these receptors have increased the therapeutic options.

Adverse events associated with pericardiocentesis in dogs: 85 cases (1999-2006).

OBJECTIVE: To quantify the frequency of adverse events occurring during or post pericardiocentesis and to determine if adverse events are related to the cause of the pericardial effusion or frequency of pericardiocentesis. DESIGN: Retrospective study. SETTING: Referral hospital. ANIMALS, INTERVENTION AND MEASUREMENTS: Medical records of 85 dogs that underwent 112 episodes of pericardiocentesis were reviewed. Any adverse events during pericardiocentesis and in the 48 hours post pericardiocentesis were noted. The frequency of adverse events was compared between dogs with a suspected neoplastic cause and a suspected nonneoplastic cause of their pericardial effusion and also between the first and subsequent pericardiocenteses. MAIN RESULTS: The incidence of adverse events was 10.7% within 1 hour of pericardiocentesis and 15.2% within 48 hours. There was no significant difference in the frequency of adverse events between the groups. Most adverse events identified were dysrhythmias. Forty-one percent of those dogs with adverse events were euthanized or died within 48 hours. CONCLUSION: The incidence of adverse events seen within 48 hours of pericardiocentesis was 15.2%.