Effect of preoperative ondansetron on postoperative nausea in healthy dogs undergoing laparoscopic gastropexy and castration.

OBJECTIVE: To investigate if preoperative ondansetron reduces postoperative nausea associated with laparoscopic gastropexy and castration in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Twenty client-owned, healthy male dogs. METHODS: Dogs were premedicated with dexmedetomidine (2-5 mcg kg-1) and methadone (0.2-0.5 mg kg-1) intramuscularly. General anesthesia was induced with propofol and maintained with an inhalant anesthetic agent. Dogs were randomized into group S (saline 0.1 mL kg-1, intravenously) or group O (ondansetron 0.2 mg kg-1, intravenously). Plasma and serum were collected before premedication and 3 hours postextubation to measure arginine vasopressin (AVP) and cortisol concentrations. Nausea scoring occurred before and 10 minutes after premedication, immediately after extubation, and at 1, 2 and 3 hours postextubation. Data were analyzed by mixed and split-plot anova with Bonferroni adjustment for the number of group comparisons. Significance was set at p < 0.05. RESULTS: Nausea scores increased over time at 1 (p = 0.01) and 2 (p < 0.001) hours postextubation in both groups compared with before premedication. Median nausea score (0-100 mm) for groups S and O before premedication were 2.5 and 0.5 mm, respectively. At 1 and 2 hours postextubation, group S scored 7.5 and 4.0 mm and group O scored 6.0 and 5.0 mm, respectively. No significant differences in nausea scores within or between groups were observed before premedication and 3 hours postextubation. Cortisol concentrations increased significantly 3 hours postextubation in both groups (p < 0.001) compared with before premedication, with no differences between groups. AVP concentrations showed no significant differences within or between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative intravenous administration of ondansetron (0.2 mg kg-1) did not impact postoperative nausea after laparoscopic gastropexy and castration. Investigation of higher doses of ondansetron on the incidence of postoperative nausea and vomiting in dogs after surgery is warranted.

Preoperative management and postoperative complications in 9 dogs undergoing surgical treatment of thymic-associated myasthenia gravis.

Objective: Thymoma-associated paraneoplastic syndromes in dogs and cats include myasthenia gravis, hypercalcemia, exfoliative dermatitis, erythema multiforme, T-cell lymphocytosis, myocarditis, anemia, and polymyositis. Paraneoplastic myasthenia gravis (MG) is the most commonly reported paraneoplastic syndrome in dogs with thymic epithelial tumors. The objective of this study was to examine cases of canine thymic-associated MG treated surgically, with the specific objective of providing an updated clinical picture of the preoperative management, postoperative complications, and outcomes of these cases. Animals: Nine dogs with paraneoplastic MG underwent surgical removal of a thymic epithelial tumor. Procedure: Medical records of dogs with MG that received surgical treatment of a thymic epithelial tumor between January 1, 2012 and October 1, 2022 were obtained from 4 veterinary teaching hospitals. Descriptions of perioperative MG management, complications, and outcomes were reported. Results: Six of the 9 dogs received medical therapy for MG, with either a cholinesterase inhibitor (4 dogs) or a cholinesterase inhibitor and immunosuppressive agent (2 dogs), before surgery. The median duration of medical therapy for MG before surgery was 7.5 d (range: 2 to 60 d). Three of 9 dogs experienced immediate postoperative complications and were euthanized. Six of 9 dogs (66.6%) survived to discharge and 3 of 6 dogs that survived to discharge were alive at the time of writing. At the time of writing, 3 of 6 dogs had complete resolution of clinical signs attributable to MG and 2 of 6 had partial resolution. The median time from surgery to resolution of clinical signs of MG in these dogs was 63 d (range: 2 to 515 d). Conclusion: Dogs with thymic epithelial tumors and paraneoplastic MG are at a high risk for perioperative complications. Clinical relevance: The findings of this study corroborate previous literature stating that paraneoplastic MG is a poor prognostic indicator for dogs with thymic epithelial tumors, while also highlighting the variation in approaches to clinical management of thymic-associated MG in veterinary medicine and the lack of established protocols guiding perioperative management.

Prise en charge préopératoire et complications postopératoires chez 9 chiens subissant un traitement chirurgical de la myasthénie grave associée au thymus. Objectif: Les syndromes paranéoplasiques associés au thymome chez le chien et le chat comprennent la myasthénie grave, l'hypercalcémie, la dermatite exfoliative, l'érythème polymorphe, la lymphocytose à cellules T, la myocardite, l'anémie et la polymyosite. La myasthénie paranéoplasique (MG) est le syndrome paranéoplasique le plus fréquemment rapporté chez les chiens atteints de tumeurs épithéliales thymiques. L'objectif de cette étude était d'examiner les cas de MG canine associée au thymus traités chirurgicalement, dans le but spécifique de fournir un tableau clinique actualisé de la prise en charge préopératoire, des complications postopératoires et des résultats de ces cas. Animaux: Neuf chiens atteints de MG paranéoplasique ont subi l'ablation chirurgicale d'une tumeur épithéliale thymique. Procédure: Les dossiers médicaux des chiens atteints de MG ayant reçu un traitement chirurgical d'une tumeur épithéliale thymique entre le 1er janvier 2012 et le 1er octobre 2022 ont été obtenues auprès de 4 hôpitaux universitaires vétérinaires. Des descriptions de la prise en charge péri-opératoire de la MG, des complications et des résultats ont été rapportées. Résultats: Six des 9 chiens ont reçu un traitement médical pour la MG, avec soit un inhibiteur de la cholinestérase (4 chiens), soit un inhibiteur de la cholinestérase et un agent immunosuppresseur (2 chiens), avant la chirurgie. La durée médiane du traitement médical de la MG avant la chirurgie était de 7,5 jours (plage : 2 à 60 jours). Trois des neuf chiens ont présenté des complications postopératoires immédiates et ont été euthanasiés. Six des 9 chiens (66,6 %) ont survécu jusqu'à leur sortie et 3 des 6 chiens qui ont survécu jusqu'à leur sortie étaient en vie au moment de la rédaction. Au moment de la rédaction de cet article, 3 chiens sur 6 présentaient une résolution complète des signes cliniques attribuables à la MG et 2 chiens sur 6 présentaient une résolution partielle. Le délai médian entre l'intervention chirurgicale et la résolution des signes cliniques de MG chez ces chiens était de 63 jours (plage : 2 à 515 jours). Conclusion: Les chiens atteints de tumeurs épithéliales thymiques et de MG paranéoplasique présentent un risque élevé de complications périopératoires. Pertinence clinique: Les résultats de cette étude corroborent la littérature antérieure indiquant que la MG paranéoplasique est un indicateur de mauvais pronostic pour les chiens atteints de tumeurs épithéliales thymiques, tout en soulignant également la variation des approches de prise en charge clinique de la MG associée au thymus en médecine vétérinaire et le manque de protocoles établis de gestion guidant les interventions périopératoires.(Traduit par Dr Serge Messier).

Preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery: A systematic review and meta-analysis.

OBJECTIVE: To provide a systematic assessment of the efficacy of preoperative skin asepsis using chlorhexidine versus povidone-iodine based protocols for surgical site infection (SSI) prevention in veterinary surgery. STUDY DESIGN: Systematic meta-analytical review according to PRISMA-P guidelines. SAMPLE POPULATION: Studies comparing preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery identified by systematic search between 1990 and 2020. METHODS: A search using MEDLINE/Pubmed, Web of Science and CAB Abstracts was performed, followed by secondary searches of Google Scholar, Proquest Dissertation and Theses, and relevant bibliographic articles. Primary and secondary outcome measures were the efficacy of skin asepsis protocols using chlorhexidine versus povidone-iodine on SSI incidence and skin bacterial colonization, respectively. A meta-analysis was performed with a random-effect model, with effect size calculated as risk ratio (RR) or mean standard deviation (MSD) with 95% CI. Statistical significance was set at P < .05. RESULTS: Among 1067 publications that met the initial search criteria, 9 relevant studies were eligible for analysis. No difference in the incidence of postoperative SSI or skin bacterial colonization between preoperative asepsis protocols using chlorhexidine versus povidone-iodine was found. Insufficient information and detail were frequent among studies and precluded a clear assessment of bias. CONCLUSION: This study showed that asepsis protocols using chlorhexidine were comparable to povidone-iodine in preventing postoperative SSI and reducing skin bacterial colonization. CLINICAL SIGNIFICANCE: Given the limitations of the studies that were included in terms of both quality and quantity, more high-quality randomized controlled trials are needed to confirm these conclusions.

Comparison of imaging techniques to detect migrating foreign bodies. Relevance of preoperative and intraoperative ultrasonography for diagnosis and surgical removal.

OBJECTIVE: To report the relative sensitivity of different diagnostic imaging (DI) techniques to detect migrating foreign bodies (FB) in subcutaneous and underlying soft tissue structures of dogs and evaluate the value of intraoperative ultrasonography (intraop-US). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Forty-one dogs. METHODS: Medical records (2007-2019) of dogs that underwent surgery for a chronic abscess or draining tract were included when preoperative US (preop-US), computed tomography (preop-CT), or preop-MRI, and at least 6 months of follow-up information were available. Collected data included the DI techniques used, DI findings, and surgical findings. The relative sensitivity of each preoperative DI (preop-DI) technique was calculated. Dogs were divided into two groups, dogs that underwent only a preop-DI examination (group A) and dogs that underwent an additional intraop-US (group B). The success rates for FB surgical removal were compared between groups. RESULTS: The relative sensitivity of preop-US and preop-CT/MRI was 88% (95% CI, 70%-95.8%) and 57.1% (95% CI, 32.6%-78.6%), respectively. The success rate for FB removal was higher in group B (89.5%) than in group A (59.1%; P = .038). Clinical resolution occurred in 90.2% of dogs for a median duration of follow-up of 4.2 years (6 months to 9.3 years). CONCLUSION: Preoperative US seems more suitable than preop-CT/MRI for detection of migrating FB in subcutaneous and underlying soft tissue structures. The use of intraop-US increases the success rate for FB surgical removal. CLINICAL SIGNIFICANCE: Intraoperative US should be used in combination with preop-US to increase the likelihood of migrating FB surgical removal in dogs.

Influence of clipping on bacterial contamination of canine arthrocentesis sites before and after skin preparation.

OBJECTIVE: To determine the influence of hair removal as part of the aseptic skin preparation of canine arthrocentesis sites and to characterize the bacterial flora remaining after aseptic skin preparation. STUDY DESIGN: Randomized controlled trial. STUDY POPULATION: Thirteen shorthaired beagle-cross dogs. METHODS: A coin toss was used to randomly determine to have one carpus, elbow, tarsus, and stifle clipped. The contralateral side was left unclipped. Aseptic skin preparation was performed on all sites with 4% chlorhexidine followed by 70% isopropyl alcohol. The skin of each site was sampled for aerobic and anaerobic bacterial cultures before and after aseptic skin preparation. Bacterial cultures were submitted for laboratory testing to determine the colony-forming units (CFU) of bacteria and bacterial species isolated for each site. RESULTS: Each group (clipped and unclipped) included 52 sites. Aseptic skin preparation reduced bacterial CFU in both groups. There was no association between values for CFU per milliliter after skin preparation of dogs and side (P = .07), joint (P = .71), pre-aseptic skin preparation CFU (P = .94), or clipping (P = .42). Staphylococcus spp were the most common of the bacterial species cultured. CONCLUSION: In clean shorthaired dogs without visible evidence of dermatological disease, leaving arthrocentesis sites unclipped rather than performing traditional surgical clipping did not result in increased bacterial skin counts after aseptic skin preparation. CLINICAL SIGNIFICANCE: In this study we did not find evidence to support that clipping of canine arthrocentesis sites is required for effective aseptic skin preparation. A prospective clinical trial is required to determine whether a change in practice would be associated with increased morbidity.

Impact of preanaesthetic echocardiography on the planned anaesthetic management of cats.

OBJECTIVE: To assess the impact of preanaesthetic echocardiography on the subsequent intended anaesthetic management plan in cats with incidental clinical findings that may indicate cardiac disease. STUDY DESIGN: Clinical study involving cats undergoing echocardiography and subsequent anaesthesia. ANIMALS: A total of 40 client-owned cats. METHODS: Echocardiography was performed in conscious cats and the information was used to plan anaesthesia or sedation. An information sheet including relevant history, temperament, body condition score, clinical examination findings, current medication and results of any relevant tests such as haematology, biochemistry or Doppler blood pressure measurement was sent to three specialist anaesthetists and virtual case management plans were designed for each cat in two steps: step 1) anaesthetists were unaware of echocardiography results; and step 2) anaesthetists were aware of echocardiography results. In the second step the anaesthetists documented any changes to their original management plan, as either 'step-up' or 'step-down'. RESULTS: Of the 40 cats, 26 had murmurs, four had a gallop rhythm, four had both findings and six had other findings. Pathology of potential haemodynamic significance was found on echocardiography in 23 cats, 17 of which anaesthetists had correctly identified as having disease before echocardiography. A proportion of cats with murmurs were subsequently deemed to have no significant pathology after echocardiography. Echocardiography findings in these cases were: dynamic left ventricular outflow tract obstruction (DLVOTO) without hypertrophy; DLVOTO without hypertrophy + dynamic right ventricular outflow tract obstruction (DRVOTO); DRVOTO; valvular dysplasia; normal. In a median of 26/40 (range 16-38) of cases, the anaesthetic plan was changed after provision of further information; in 15/40 (8-20) cases, this was a 'step-up' in care and in eight/40 (6-23) it was a 'step-down' in care. In cases with atrial enlargement (left atrium to aortic ratio of >1.6) and deemed at risk of cardiac failure, alpha-2 agonist use changed considerably with availability of echocardiography findings. CONCLUSION: and clinical relevance Where there are abnormal cardiac findings on clinical examination in cats, echocardiography is required to accurately assess anaesthetic risk . The availability of echocardiographic information positively influences anaesthetic management.

Comparative efficacy of three antiseptics as surgical skin preparations in dogs.

OBJECTIVE: To compare the antimicrobial efficacy of a 2% chlorhexidine gluconate and 70% ethanol solution (CG+A) with that of F10 Skin Prep Solution (F10) and electrochemically activated water (EAW) when used as a surgical preparation in canine patients. STUDY DESIGN: Prospective randomized clinical study. SAMPLE POPULATION: One hundred sixteen dogs presented for ovariohysterectomy. METHODS: Dogs were randomly divided into 1 of the 3 antiseptic groups (CG+A, F10, EAW). Skin samples with replicating organism detection and counting plates were taken at 4 different perioperative sites and time intervals (postskin preparation, postskin antisepsis, 2 hours after the second sample, and at the end of surgery) during ovariohysterectomies performed by students. The colony forming unit (CFU) counts from each sample were quantified according to the level of bacterial contamination. Zero CFU was defined as no contamination, 1-12 CFU was defined as low contamination, and greater than 12 CFU was defined as high contamination. The 3 antiseptics were compared with respect to the level of contamination. RESULTS: There was no difference in the level of colonization between the antiseptics at the first sampling time (P = .454). However, the level of contamination for CG+A was lower compared with F10 and EAW at the second, third, and fourth sampling times (P = .001, P = .01, P = .02, respectively). CONCLUSION: CG+A was more effective at achieving a zero CFU count and low levels of contamination compared with F10 and EAW for surgical preparation in dogs undergoing ovariohysterectomy. CLINICAL SIGNIFICANCE: This study does not provide evidence to support the use of F10 and EAW instead of CG+A for the surgical skin preparation of dogs undergoing ovariohysterectomy.

Effect of routine pre-anesthetic laboratory screening on pre-operative anesthesia-related decision-making in healthy dogs.

The usefulness of pre-anesthetic laboratory screening of healthy veterinary patients is controversial and clear evidence-based guidelines do not exist. The purpose of our study was to determine the influence of preanesthetic laboratory screening on peri-anesthetic plans in canine patients undergoing elective surgery. One hundred medical records were randomly selected between the years 2008 and 2013 and patient information was presented to 5 Diplomates of the American College of Veterinary Anesthesia and Analgesia (ACVAA) for review. They were given pre-anesthetic laboratory screening test results for each patient and asked whether the results would change the way they managed the case from an anesthesia perspective. Peri-operative anesthetic management was altered in 79% of patients based on pre-anesthetic screening results; however, the overall agreement among anesthesiologists was weak with 64% of changes made by only a single anesthesiologist. Pre-anesthetic laboratory screening test results may influence pre-operative anesthesia case management but major discrepancies can occur among ACVAA diplomates.

Effet du dépistage de laboratoire pré-anesthésique de routine sur la prise de décisions préopératoires liées à l'anesthésie chez des chiens en santé. L'utilité du dépistage de laboratoire pré-anesthésique des patients vétérinaires en santé est controversée et des lignes directrices claires basées sur des données probantes n'existent pas. Le but de notre étude consistait à déterminer l'influence du dépistage de laboratoire pré-anesthésique pour la péri-anesthésie chez les patients canins subissant une chirurgie non urgente. Cent dossiers médicaux choisis au hasard entre les années 2008 et 2013 et des données sur les patients ont été présentés à cinq diplomates de l'American College of Veterinary Anesthesia and Analgesia (ACVAA) aux fins d'examen. On leur a donné les résultats des tests de dépistage de laboratoire pré-anesthésiques pour chaque patient et on leur a demandé d'évaluer si les résultats auraient modifié la façon dont ils auraient géré le cas du point de vue de l'anesthésie. La gestion anesthésique péri-opératoire a été modifiée chez 79 % des patients en se basant sur les résultats du dépistage préanesthésique. Cependant, le consensus général parmi les anesthésiologistes était faible avec 64 % des changements apportés par seulement un seul anesthésiologiste. Les résultats des tests de dépistage de laboratoire pré-anesthésiques peuvent influencer la gestion des cas d'anesthésie préopératoire mais des écarts majeurs peuvent se produire parmi les diplomates de l'ACVAA.(Traduit par Isabelle Vallières).

Preoperative Differential Diagnosis of Canine Adrenal Tumors Using Triple-Phase Helical Computed Tomography.

OBJECTIVE: To characterize the computed tomography (CT) findings for canine adrenal tumors, including cortical adenoma, cortical adenocarcinoma, and pheochromocytoma, and to evaluate the feasibility and usefulness of preoperative triple-phase helical CT for differentiation of tumor types and surgical planning. STUDY DESIGN: Retrospective study. ANIMALS: Dogs with adrenal tumors (n=36). METHODS: All dogs underwent triple-phase helical CT, followed by adrenalectomy and histopathological diagnosis of the resected mass. Precontrast images, arterial, venous, and delayed phase images were obtained. In all cases, morphological characteristics and CT values and calculations, including the percentage enhancement washout ratio, relative percentage washout, enhancement washin, and enhancement washout, were analyzed and compared among the tumor types. RESULTS: Of the 36 dogs with adrenal masses, cortical adenocarcinoma was most commonly diagnosed (16 dogs), followed by pheochromocytoma (13 dogs), and cortical adenoma (7 dogs). The precontrast minimum CT value and enhancement washout between venous and delayed phases in the cortical adenoma were significantly higher than those in the cortical adenocarcinoma. The maximum CT values of the precontrast image and arterial and venous phases, the enhancement washin and washouts, percentage enhancement washout ratio, and relative percentage washout in the pheochromocytomas were significantly higher than those in cortical adenocarcinoma. CONCLUSION: The differential diagnosis of canine adrenal tumors was feasible based on triple-phase CT findings, including morphological features, CT values, and intratumoral contrast attenuation. Preoperative diagnosis using triple-phase helical CT may be useful for surgical planning in dogs with adrenal tumors.

High-Definition Video Telescope-Assisted Ventral Slot Decompression Surgery for Cervical Intervertebral Disc Herniation in 30 Dogs.

OBJECTIVE: To describe the use of a video telescope operating monitor (VITOM™) for ventral slot decompression and to report its clinical applications using preoperative and postoperative computed tomography (CT) myelography. STUDY DESIGN: Prospective case series. ANIMALS: Consecutive dogs presented with cervical intervertebral disc disease requiring surgical decompression (n = 30). METHODS: Demographic data, preoperative neurological status, localization and lateralization of the compression, total operative time, surgical complications, ventral slot size and orientation, hospitalization time, and postoperative outcome were recorded. Preoperative and postoperative spinal cord area at the compression site and ratios of compressed to normal spinal cord area were calculated by CT myelography. RESULTS: French Bulldogs were the most common breed of dogs (n = 15; 50%) and neck pain was the most common neurological sign (n = 18; 60%). Postoperative CT myelography confirmed that spinal cord decompression, postoperative spinal cord area, and the ratios of compressed to normal spinal cord area improved significantly compared with preoperative measurements (P = .01). Sinus bleeding occurred in 20% of dogs. The mean ratios (± SD) of ventral slot length and width compared with vertebral body length and width were 0.21 ± 0.08 and 0.31 ± 0.07, respectively. The mean postoperative hospitalization time was 3.0 ± 0.6 days and all dogs showed clinical improvement and an excellent outcome. CONCLUSION: The VITOM™ ventral slot decompression technique was fast and easy to perform. It allowed a minimally invasive approach with a small ventral slot while improving spinal cord visualization. The results of this study support the use of the VITOM™ technique in spinal veterinary surgery.

Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids.

OBJECTIVE: To describe (1) preoperative findings and surgical technique, (2) intraoperative difficulties, and (3) postoperative complications and long-term outcome of equine cheek tooth extraction using a minimally invasive transbuccal screw extraction (MITSE) technique. STUDY DESIGN: Retrospective case series. ANIMALS: Fifty-four equids; 50 horses, 3 ponies, and 1 mule. METHODS: Fifty-eight MITSE procedures were performed to extract cheek teeth in 54 equids. Peri- and intraoperative difficulties, as well as short- (<1 month) and long-term (>6 months) postoperative complications were recorded. Followup information was obtained through telephone interviews, making specific inquiries about nasal discharge, facial asymmetry, and findings consistent with surgical site infection. RESULTS: Preoperative findings that prompted exodontia included 50 cheek teeth with apical infections, 48 fractures, 4 neoplasia, 2 displacements, and 1 supernumerary tooth. Previous oral extraction was attempted but had failed in 55/58 (95%) animals because of cheek tooth fracture in 28, or insufficient clinical crown for extraction with forceps in 27. MITSE was successful in removing the entire targeted dental structure in 47/58 (81%) procedures. However, MITSE failed to remove the entire targeted dental structure in 11/58 (19%) procedures and was followed by repulsion in 10/11 (91%). Short-term postoperative complications included bleeding (4/58 procedures, 7%) and transient facial nerve paralysis (4/58 procedures, 7%). Owners were satisfied with the functional and cosmetic outcome for 40/41 (98%) animals with followup. CONCLUSION: MITSE offers an alternate for cheek tooth extraction in equids, where conventional oral extraction is not possible or has failed. Overall, there was low morbidity, which compares favorably with invasive buccotomy or repulsion techniques.

Effect of Presurgical Iodine-Based Disinfection on Bacterial Colonization of the Equine Peripodal Region.

OBJECTIVE: To compare bacterial colonization after diluted iodine tincture or povidone iodine solution for presurgical disinfection of the equine peripodal region. STUDY DESIGN: Complete block design. ANIMALS: Five horses. METHODS: Disinfection protocols using iodine tincture or povidone iodine solutions were tested on 5 pairs (n = 10) equine front feet. Iodine tincture was applied to the left feet and povidone iodine to the right feet. Fixed surfaces of the sole, frog, hoof wall, and peripodal skin were swabbed pre-preparation (T0), after a standard pre-disinfection step (T1), after short disinfection with a 4-minute application of 0.5% iodine tincture or povidone iodine (T2), and after long disinfection with 12-hour soaking in 0.25% iodine tincture or povidone iodine (T3). Quantitative bacteriology was performed on each swab. RESULTS: The frog and sole were the most contaminated sites compared to hoof wall and skin at T0. Bacterial counts were significantly decreased at T2 for both solutions. Bacterial counts did not change significantly with iodine tincture at T3 but increased with povidone iodine compared to T2. Skin abrasions were detected on almost all feet but were subjectively more severe on iodine tincture-treated feet. CONCLUSION: Soaking for 12 hours with either iodine tincture or povidone iodine is not recommended as these solutions damaged the skin and bacterial recolonization was noted with povidone iodine. Four-minute disinfection using either iodine tincture or povidone iodine (0.5% available iodine) is appropriate for presurgical preparation of the equine peripodal region.

Efficacy of Mechanical versus Non-Mechanical Sterile Preoperative Skin Preparation With Chlorhexidine Gluconate 4% Solution.

OBJECTIVE: To compare the efficacy of sterile preoperative skin antisepsis using either a 5-minute mechanical preparation or 5-minute non-mechanical preparation with chlorhexidine gluconate 4% solution. STUDY DESIGN: Matched design, ANOVA. ANIMALS: Healthy adult Thoroughbred horses (n = 30). METHODS: Each horse had both surgical preparation methods randomly assigned to identical sites on the left or right upper thigh. Prepared sites were sampled and cultured for bacteria after each preparation step. RESULTS: Mechanical and non-mechanical preparation techniques significantly reduced bacteria isolated from surface swab samples compared with samples taken from unprepared skin and after the preliminary rough prepared skin (P < 0.05). No difference in the number of skin-associated bacteria was detected between the mechanical and non-mechanical sterile preoperative preparation techniques (P = 0.77). Ten species of bacteria were identified by 16s PCR after final skin preparation. CONCLUSIONS: Pre-surgical skin preparation without repeated mechanical scrubbing using chlorhexidine gluconate 4% solution (total contact time, 225 seconds) is effective in reducing bacterial counts.

Remote conditioning or erythropoietin before surgery primes kidneys to clear ischemia-reperfusion-damaged cells: a renoprotective mechanism?

Acute kidney injury is common, serious with no specific treatment. Ischemia-reperfusion is a common cause of acute kidney injury (AKI). Clinical trials suggest that preoperative erythropoietin (EPO) or remote ischemic preconditioning may have a renoprotective effect. Using a porcine model of warm ischemia-reperfusion-induced AKI (40-min bilateral cross-clamping of renal arteries, 48-h reperfusion), we examined the renoprotective efficacy of EPO (1,000 iu/kg iv.) or remote ischemic preconditioning (3 cycles, 5-min inflation/deflation to 200 mmHg of a hindlimb sphygmomanometer cuff). Ischemia-reperfusion induced significant kidney injury at 24 and 48 h (χ(2), 1 degree of freedom, >10 for 6/7 histopathological features). At 2 h, a panel of biomarkers including plasma creatinine, neutrophil gelatinase-associated lipocalin, and IL-1ß, and urinary albumin:creatinine could be used to predict histopathological injury. Ischemia-reperfusion increased cell proliferation and apoptosis in the renal cortex but, for pretreated groups, the apoptotic cells were predominantly intratubular rather than interstitial. At 48-h reperfusion, plasma IL-1ß and the number of subcapsular cells in G2-M arrest were reduced after preoperative EPO, but not after remote ischemic preconditioning. These data suggest an intrarenal mechanism acting within cortical cells that may underpin a renoprotective function for preoperative EPO and, to a limited extent, remote ischemic preconditioning. Despite equivocal longer-term outcomes in clinical studies investigating EPO as a renoprotective agent in AKI, optimal clinical dosing and administration have not been established. Our data suggest further clinical studies on the potential renoprotective effect of EPO and remote ischemic preconditioning are justified.

The effect of preoperative planning method on recommended tibial tuberosity advancement cage size.

OBJECTIVE: To determine if use of various commonly practiced tibial tuberosity advancement (TTA) preoperative planning methods leads to variable TTA cage size recommendations. STUDY DESIGN: Radiographic study. ANIMALS: Dogs (n = 14) with naturally occurring cranial cruciate ligament disease. METHODS: TTA was planned by a single observer on mediolateral stifle radiographs of each dog using 2 sets of tibial plateau landmarks (anatomic [A] vs. femorotibial common tangent [T]) and 2 advancement measurement techniques (transparent overlay [O] vs. simulated TTA using imaging software [S]) for 4 different planning methods (AO, AS, TO, TS). Cage size recommendations for each stifle were tabulated for each of the 4 planning methods. Mean advancement (mm) required to obtain patellar tendon angle (PTA) = 90° for each of the 4 planning methods were statistically compared. RESULTS: In the 14 stifles studied, the 4 planning methods evaluated led to 4 different cage size recommendations in 1 stifle, 3 different recommendations in 8 stifles, 2 different recommendations in 3 stifles, and 1 recommendation in only 2 stifles. There was a significant difference in the mean advancement measurement between the 4 planning methods (P < .0001); the AS technique was the largest whereas TO resulted in the smallest measurement. Overall, larger advancement was associated with use of anatomic landmarks (vs. common tangent) and imaging software to simulate TTA (vs. overlays). CONCLUSION: Currently practiced methods for TTA pre-planning led to variable cage size recommendations in 86% of the stifles evaluated and may be a source of inconsistent functional outcomes.

Comparison of two surgical site protocols for cattle in a field setting.

OBJECTIVE: To compare 2 preoperative surgical site protocols for standing laparotomy in cattle in a field setting. STUDY DESIGN: Cohort study. ANIMALS: Dairy cows (n = 73) undergoing a clean standing laparotomy (no visceral perforation during surgery). METHODS: Cows were randomly assigned to 1 of 2 preoperative skin-preparations protocols with chlorhexidine used as an antiseptic. A standard protocol (3 minutes [min] cleansing scrub, tap water rinse, 3 minutes surgical scrub with a sterile one-use chlorhexidine scrub and alternate passage of alcohol and 2% chlorhexidine solution (7 minutes; n = 32) was compared with a 3 minutes abbreviated preoperative protocol, consisting of two 90 seconds period of cleansing scrub and 3 passages of 0.5% chlorhexidine gluconate in 70% in isopropyl alcohol solution (4 minutes; n = 32). Pre- and postoperative skin bacterial counts and clinical assessment of wounds 10-15 days after surgery, as well as standardized interview with the producers focused on wound infection 30 days after the surgery were used to compare both protocols. RESULTS: There was no difference between protocols for absolute colony forming units (CFU) and percentage CFU reduction perioperatively as well as for surgical wound clinical score 10-15 days after the surgery. The infection rate at 30 days was 10.5% (6/57) but no significant difference was observed between protocols 10% (3/30) versus 11.5% (3/27). CONCLUSIONS: An abbreviated preoperative protocol using nonsterile reusable material can be as effective as a standard protocol using sterile one-use brush in reducing skin microflora and preventing surgical wound infection.

Anesthesia for the horse with colic.

This article discusses anesthesia for horses with colic from acute gastrointestinal disease. Emphasis is placed on new developments in pre-, intra-, and immediate postoperative management over the last decade, including early goal-directed therapy (EGDT) in the resuscitation of septic patients, the controversy over the optimal fluid type to administer, and the management of complications, such as cardiovascular depression, hypoventilation and hypoxemia, and decreased colloid oncotic pressure (COP). An update on analgesia is also provided; older drugs such as ketamine and lidocaine are increasingly being recognized both for their analgesic properties and other potentially beneficial effects in endotoxemic horses.

Effectiveness of chlorhexidine diacetate and povidone-iodine in antiseptic preparation of the canine external ear canal prior to total ear canal ablation with bulla osteotomy procedure: A preliminary study.

OBJECTIVE: This article is a preliminary study to compare the ability of 0.05% chlorhexidine diacetate (CD) and 1% povidone-iodine (PI) solutions to reduce bacterial contamination on the canine external ear canal during initial patient preparation and comparison of the incidence of immediate tissue reactions. STUDY DESIGN: The study is a multi-institutional, randomised, clinical prospective study. ANIMALS OR SAMPLE POPULATION: Dogs (n = 19) undergoing total ear canal ablation with bulla osteotomy (TECABO). METHODS: The external ear of each dog was cleaned with the assigned antiseptic solution. Culture of the ear was performed by standard techniques to semi-quantitatively evaluate bacterial growth and to identify bacterial organisms pre- and post-antiseptic use. RESULTS: Both antiseptic groups showed a significant reduction in bacterial growth score (BGS) between pre- and post-antiseptic use (CD p = 0.009, PI p = 0.005). There was no difference in the reduction of BGS between CD and PI solutions (p = 0.53). Minor adverse skin reactions occurred in 25% of cases. There was no significant difference in the occurrence of adverse skin reactions between antiseptics (p = 0.63). CONCLUSION: CD and PI were similarly able to decrease the number of bacteria on the external ear following initial preparation. No difference in the incidence of adverse tissue reactions was found. CLINICAL SIGNIFICANCE: Properly diluted aqueous formulations of either antiseptic may be used for safe preparation limited to the external ear canal of dogs. Additional studies evaluating outcomes such as duration of bacterial inhibition and incidence of surgical site infections are needed to fully elucidate differences between CD and PI antiseptics prior to TECABO.

Ultrasonographic and laboratory screening in clinically normal mature golden retriever dogs.

Wellness and pre-anesthetic screening of blood and urine of geriatric companion animals are routinely recommended. In addition, there are occasional references to the use of imaging in clinically normal geriatric patients. However, the utility of wellness testing is not known, and there is limited information regarding the value of pre-anesthetic testing. Wellness testing, including complete blood cell count, biochemical profile, urinalysis, and abdominal ultrasound, was performed on 53 clinically normal, mature golden retriever dogs. Laboratory analysis revealed abnormalities in 54.7% (29/53) of the dogs. Abdominal ultrasound screening demonstrated abnormalities in 64.2% (34/53) of the dogs. As only a small number of dogs had follow-up diagnostic testing available, the significance of these abnormalities is unknown. Further study involving a larger cohort of animals and analysis of follow-up data is necessary to determine the utility of laboratory and imaging studies in clinically normal geriatric patients.

The Use of Waterless Alcohol-based Antiseptic for Surgical Skin Preparation in Rhesus Macaques (Macaca mulatta).

Ensuring asepsis of the surgical site before surgery is an essential component of safe surgical practices to reduce the incidence of surgical site infections in veterinary medicine. The current accepted method of skin preparation is a multistep process that alternates either a povidone-iodine or chlorhexidine soap scrub with a 70% alcohol rinse. After cleansing, the site is left to dry before draping. The goal of this study was to assess the effectiveness of a waterless alcohol-based (WAB) antiseptic as part of a 2-step procedure after the soap scrub. WAB antiseptics are commonly used as a presurgical hand scrub for the surgeon as they evaporate quickly and provide effective antisepsis. Previous studies have examined the WAB antiseptics in small animal surgeries. We tested this approach in large animal surgery. Twenty-four rhesus macaques were divided into 4 groups that received one of the following treatments: saline and alcohol, iodine-alcohol-iodine, soap scrub/WAB, and chlorhexidine-alcohol-chlorhexidine. The surgical site was swabbed before and after treatment and plated to assess sterility. Overall, no colonies were recovered from skin treated with WAB antiseptic, establishing it as an effective alternative to the current standard protocol. This method will simplify the current 3-step procedure and reduce animal handling, the use of materials, and the time necessary for surgical preparation.