Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP).

In the last 30 years, the use of long-term central venous catheters (CVC) is increased especially for children with hemato-oncological disorders. However, the use of CVC is associated to complications, as mechanical accidents, thrombosis, and infections that can determine a prolongation of hospital stay, an increase of costs, and sometimes life-threatening conditions that require urgent systemic treatment or CVC removal. CVC removal may be troublesome especially in neonates, infants, or any other "highly needed CVC patients"; in these selected cases, the prevention and treatment of CVC-related complications play a pivotal role and specific surveillance programs are crucial. While extensive literature is focused on CVC management in adults, no guidelines are available for children. To this aim, the first recommendations for the management of CVC infectious complication in pediatric age have been written after pediatric and adult literature review and collegial discussion among members of Supportive Therapy working group of Italian Association of Pediatric Hematology and Oncology. Compared to the adult age, the necessity of peripheral vein cultures for the diagnosis of CVC-related infection remains controversial in children because of the poorer venous asset and a conservative, pharmacologically focused management through CVC remains mandatory, with CVC removal to be performed only in selected cases.

Anaesthesia with medetomidine-ketamine-isoflurane with and without midazolam, in eight captive chimpanzees (Pan troglodytes) premedicated with oral zuclopenthixol.

In 8 captive adult chimpanzees of various ages premedicated with oral zuclopenthixol anaesthesia was induced intramuscularly with a combination of medetomidine and ketamine (40 or 50 µg/kg and 5 mg/kg, IM, respectively), with and without midazolam (0.05 mg/kg), and maintained with isoflurane in oxygen. At the end of the procedure, sedation was reversed with atipamezole (0.25 mg/kg, IM) and sarmazenil (0.005 mg/kg, IM) when midazolam had been administered. Oral zuclopenthixol resulted in tranquillization of the whole group and only one animal required a second dart injection to achieve adequately deep anaesthesia. Effective and reliable anaesthesia was achieved in all apes; the depth of hypnosis was stable and sudden arousal did not occur. Physiological parameters remained within normal ranges in the majority of the animals; however, manageable anaesthesia-related complications, namely apnoea after darting, hypotension, hypoventilation, hypoxemia and prolonged recovery, occurred in 6 out of 8 animals. The use of monitoring devices was essential to guarantee adequate management of these complications.

Huit chimpanzés adultes d'un zoo, d'âges différents, ont été anesthésiés, après prémédication orale au zuclopenthixol, avec une combinaison de médétomidine (40 ou 50 µg/kg, IM) et de kétamine (5 mg/kg, IM), avec ou sans ajout de midazolam. La narcose a ensuite été poursuivie par administration d'isoflurane/oxygène. A la fin de l'anesthésie, la sédation a été antagonisée avec de l'atipamézol (0.25 mg/kg, IM) et, lorsqu'on avait utilisé du midazolam, avec en outre du sarmazenil (0.005 mg/kg, IM). L'administration orale de zuclopenthixol amenait une tranquillisation du groupe entier et seul un animal a nécessité une seconde injection par sarbacane pour atteindre une profondeur de narcose suffisante. La profondeur de narcose était constante et on a constaté aucun réveil soudain. La majorité des animaux présentaient des paramètres physiologiques dans les normes mais il s'est produit diverses complications d'anesthésie, comme arrêt respiratoire peu après la télé-injection, hypotension, hypoventilation, hypoxie et réveil retardé chez 6 des 8 animaux. Les outils de surveillance utilisés s'avèrent essentiels pour une gestion adaptée des complications qui peuvent se produire.

Influence of surgical approach on the efficacy of the intervertebral disk fenestration: a cadaveric study.

OBJECTIVES: To investigate the influence of different approach angles on the amount of nucleus pulposus removed during intervertebral disc fenestration in dogs. METHODS: Twenty cadavers of beagle dogs were randomly divided into four groups: a control group and three treatment groups in which intervertebral fenestration was performed using either a dorsal, dorsolateral or lateral approach between the 12th thoracic and second lumbar spaces. The volume of nucleus pulposus, the weight of the residual nucleus pulposus and the angle of the working sector were measured. The ratio of the residual nucleus pulposus weight to the nucleus pulposus volume was used to evaluate the efficacy of the performed fenestration. Data were analysed with Kruskal-Wallis analysis of variance between groups on ranks with correction for ties and Bonferroni correction for multiple comparisons. Correlation between ratio and working angle was calculated using a Spearman's rank test (P<0.05). RESULTS: The calculated ratio of nuclear weight to volume was significantly less in the lateral approach group than that in the other groups. The working sector was widest in the dorsolateral approach group, but this did not correlate with efficient fenestration. CLINICAL SIGNIFICANCE: Using the lateral approach for intervertebral disc fenestration may increase the efficiency of the fenestration procedure.

Two cases of intraoperative herniation of the endotracheal tube cuff.

During anaesthesia for elective procedures, 2 dogs developed acute airway obstruction caused by herniation of the endotracheal cuff. This is an uncommon but potentially fatal complication especially when minimal monitoring of the patient leads to late recognition of the condition. The most typical symptoms are decreased thoracic excursions and tidal volume, absence of gas flow through the endotracheal tube, change in the capnographic waves morphology and increased airway pressures. In both cases desaturation of haemoglobin (measured by pulse oximetry) occurred in-between 6 and 8 minutes after cuff herniation. All signs normalised following partial deflation of the cuff. Careful management of cuff pressures especially when nitrous oxide is used, awareness of the condition and monitoring of the patient can prevent fatal consequences.

[Unilateral laparoscopic cryptorchidectomy in a llama]. / Unilaterale laparoskopische Kryptorchidektomie bei einem Lama.

Cryptorchism is an inherited congenital abnormality characterized by the failure of one or both testes to descend into the scrotum. Diagnosis can be difficult if the retained testicular tissue cannot be localized during clinical examination and the history of the animal is unknown, or if the animal shows persistent male behaviour despite the history of successful previous castration. The present case report describes the history of a cryptorchid Lama and the techniques of general anesthesia and laparoscopic cryptorchidectomy advocated.

Evaluation of effectiveness, safety and reliability of intramuscular medetomidine-ketamine for captive great apes.

Twenty great apes (six orangutans, eight chimpanzees and six gorillas) were anaesthetised prior to being transported for undergoing diagnostic and interventional procedures. Anaesthesia was induced with a combination of medetomidine and ketamine administered intramuscularly through a dart syringe. The onset of anaesthesia varied among apes: the mean (±sd) time from darting to recumbency was 12.13 (±1.9), 18.5 (±8.7) and 22.2 (±9.2) minutes in chimpanzees, orangutans and gorillas, respectively. The depth of anaesthesia was sufficient to allow safe removal of the animals from the enclosure, intravenous catheter placement and manipulation; however, the anaesthetic effect was short-acting (20 (±7) minutes in orangutans, 16 (±14) in gorillas, and 10 (±4) minutes in chimpanzees, respectively) and isoflurane administration was necessary in the majority of the apes to prolong the duration of anaesthesia, especially when lengthier procedures were performed. The sedative effect of medetomidine was reversed at the end of each procedure with atipamezole, and recovery was smooth and uneventful for all animals.

Evaluation of peri-operative epidural analgesia with ropivacaine, ropivacaine and sufentanil, and ropivacaine, sufentanil and epinephrine in isoflurane anesthetized dogs undergoing tibial plateau levelling osteotomy.

The purpose of this study was to compare four epidural protocols for peri-operative analgesia in dogs undergoing tibial plateau levelling osteotomy. Forty client-owned dogs were randomly assigned to one of four treatments - groups R0.5 and R1 received 0.5mg/kg and 1mg/kg ropivacaine, respectively. Group SR0.5 received 1 µg/kg sufentanil plus 0.5mg/kg ropivacaine, and group SER0.5 received 1 µg/kg sufentanil, 0.5mg/kg ropivacaine plus 6 µg/kg epinephrine. Dilution, when required, was performed with saline, so that the injected volume was always 0.2 mL/kg. Intra-operatively, nociception assessment was based on the evaluation of changes in heart rate, respiratory rate and mean arterial pressure. Post-operative pain assessment was performed using the Glasgow visual analogue pain scale, and an ad hoc multifactorial pain score. Motor block was evaluated using a modified Bromage score. Intra-operatively, none of the animals was hypotensive. All groups except SER0.5 required rescue intra-operative fentanyl (40%, 30% and 40% of the animals in groups R0.5, R1 and SR0.5, respectively). Group SER0.5 showed lower post-operative pain scores, and group R1 significantly greater motor block, compared to the other treatment groups. None of the dogs had urinary retention. Epidural sufentanil-epinephrine-ropivacaine provided superior peri-operative analgesia compared to the other treatments, without producing clinically relevant side effects.

Blood/gas partition coefficients of halothane, isoflurane and sevoflurane in horse blood.

BACKGROUND: Blood/gas partition coefficients (lambda(b/g)) for volatile agents in horse blood are reported for halothane but not for isoflurane and sevoflurane. We measured the lambda(b/g) of halothane, isoflurane and sevoflurane in the blood of fasted horses. The correlation with age, weight and some haematological and biochemical variables was studied. The temperature correction factor for isoflurane solubility was calculated. METHODS: Twenty-four horses were randomly allocated to halothane (n=8), isoflurane (n=8) or sevoflurane (n=8). Blood samples were taken after 10 h' fasting. Calculation of lambda(b/g) was based on the measurement of anaesthetic partial pressures in blood at 37 degrees C, which was achieved with tonometer equilibration and headspace gas chromatography. RESULTS: Mean lambda(b/g) was 1.66 (SD 0.06) for halothane, 0.92 (0.04) for isoflurane, and 0.47 (0.03) for sevoflurane. The lambda(b/g) values were all significantly lower than in humans (P<0.001). No correlation was found between lambda(b/g) and weight, age, haematocrit, plasma triglycerides, cholesterol or total bilirubin. The change in isoflurane solubility per 1 degrees C temperature increase was -2.63 (0.13)%. CONCLUSION: The lambda(b/g) values of halothane, isoflurane and sevoflurane in fasted horses are significantly lower than those reported in humans. The lambda(b/g) for halothane in this study agrees with values reported in the literature but a positive correlation with plasma triglycerides could not be confirmed. Knowledge of lambda(b/g) can refine models of anaesthetic uptake.