Clinical methemoglobinemia secondary to administration of hydroxyurea at therapeutic doses in a dog.

Methemoglobinemia secondary to administration of hydroxyurea is only reported in veterinary medicine as a result of accidental ingestion of high doses, and once at therapeutic dose in human medicine. A 2.5-year-old female spayed mixed breed dog was presented for acute signs of neurologic disease and diagnosed with severe erythrocytosis without an identified underlying cause, leading to suspicion of polycythemia vera. The dog was managed with phlebotomies, supportive care, and administration of hydroxyurea. Within 2 h of administration of hydroxyurea (37 mg/kg) administration, respiratory distress with cyanosis, and methemoglobinemia developed. Signs resolved within 24 h but recurred after a second administration of lower dosage of hydroxyurea (17 mg/kg) 20 days later. The dog remained asymptomatic except for mild cyanosis but was humanely euthanized for lack of relevant improvement of signs of neurologic disease. This case report documents the repeated occurrence of methemoglobinemia in a dog after administration of hydroxyurea at therapeutic doses.

Validation of 3-dimensional mathematical computation of feline bladder volume using orthogonal ultrasonographic bladder images.

Urine output measurement is critical for the management of hospitalized cats and their underlying conditions. Ultrasound-guided estimation of urinary bladder volume (UBV) is a non-invasive surrogate measurement that can provide important clinical information. The purpose of this study was to validate the accuracy of a novel 3D computation method in estimating UBV using 2D point-of-care ultrasonographic images. Bladder volume estimation was performed using coordinates from bladder circumference tracings on paired longitudinal and transverse ultrasonographic images (n = 359) aligned in 3D space for mathematical algorithmic computation. Ultrasonographic images were obtained by 2 different observers at 18 different time points on 10 healthy, purpose-bred male cats under general anesthesia in sternal recumbency. Actual urine volumes were measured via urinary catheterization and compared to UBV estimations using Lin's concordance correlation coefficient and Bland-Altman analysis. Estimation of UBV using the 3D computational bladder circumference tracing method showed moderate strength-of-agreement with actual bladder volume (ρc = 0.94 to 0.95) with clinically insignificant bias (3D computation-derived minus actual volume) of -1.96 mL (IQR = -3.89 to -0.57 mL, P < 0.001) and -2.42 mL (IQR = -4.64 to -0.66 mL, P < 0.001) for the 2 observers, respectively. Our study demonstrated acceptable accuracy of 3D computation method for UBV estimation in healthy cats. This method may provide a bridging alternative until 3D ultrasound becomes more readily accessible.

La mesure de la diurèse est critique pour la gestion de chats hospitalisés ainsi que de leurs conditions sous-jacentes. L'estimation échoguidée du volume vésical (UBV) est une mesure de substitution non-invasive qui peut fournir d'importantes informations cliniques. L'objectif de cette étude fut de valider la précision d'une nouvelle méthode de calcul 3D dans l'estimation du volume vésical à l'aide d'images 2D obtenues par échographie au point d'intervention. L'estimation du volume vésical a été réalisée à l'aide de coordonnées des tracés de la circonférence de la vessie sur des images échographiques longitudinales et transversales appariées (n = 359), alignées dans l'espace 3D pour le calcul algorithmique mathématique. Des images échographiques ont été obtenues par deux observateurs différents à 18 moments différents sur 10 chats mâles sains et élevés à cette fin, sous anesthésie générale en décubitus sternal. Les volumes d'urine réels ont été mesurés par cathétérisme urinaire et comparés aux estimations de volume vésical à l'aide du coefficient de corrélation de concordance de Lin et de l'analyse de Bland-Altman. L'estimation du volume vésical à l'aide de la méthode 3D de traçage de la circonférence de la vessie a démontré un degré d'accord modérée avec le volume réel de la vessie (ρc = 0,94 to 0,95) avec un biais cliniquement insignifiant (calcul 3D moins volume réel) de −1,96 mL (écart interquartile = −3,89 à −0,57 mL, P < 0,001) et de −2,42 mL (écart interquartile = −4,64 à −0,66 mL, P < 0,001) pour les deux observateurs respectivement. Notre étude a démontré une précision acceptable de la méthode de calcul 3D pour l'estimation du volume vésical chez des chats en bonne santé. Cette méthode peut fournir une alternative de transition jusqu'à ce que l'échographie 3D devienne plus facilement accessible.(Traduit par Docteur Sabrina Ayoub).

Validation of a commercial human ELISA to measure hyaluronic acid concentration in feline plasma.

Our goal was to validate a human hyaluronic acid (HA) ELISA (Hyaluronic acid plus ELISA; TECOmedical Group) for use in feline plasma. Plasma from 5 healthy cats and 5 critically ill cats was used for validation of the assay. Validation methods performed included intra- and inter-assay variability, spike-and-recovery, and dilutional linearity. All measurements were performed in duplicate. The precision study revealed good intra-assay CV of 7.4-8.9%; inter-assay CV was 3.4-4.2%. Extraction efficiency via spiking tests yielded mean recovery of 89.6%. The assay met criteria for acceptable linearity using 3 serial dilutions. Our results demonstrate that this commercial HA ELISA had acceptable analytical performance using feline plasma and could be a useful tool in the veterinary clinical research setting.

Use of serum hyaluronic acid as a biomarker of endothelial glycocalyx degradation in dogs with septic peritonitis.

OBJECTIVE: To describe daily changes in serum concentrations of hyaluronic acid (HA), a biomarker of endothelial glycocalyx degradation, in dogs with septic peritonitis and to determine whether relationships exist among serum concentrations of HA and biomarkers of inflammation and patient fluid status. ANIMALS: 8 client-owned dogs. PROCEDURES: Serum samples that had been collected for a previous study and stored at -80°C were used. Blood samples were collected at admission and daily thereafter during hospitalization and were analyzed for concentrations of HA and interleukins 6, 8, and 10. Patient data including acute patient physiologic and laboratory evaluation score, type and amount of fluids administered daily, and daily CBC and lactate concentration results were recorded. To determine the significant predictors of HA concentration, a general linear mixed model for repeated measures was developed. RESULTS: All dogs survived to discharge. Concentrations of HA ranged from 18 to 1,050 ng/mL (interquartile [25th to 75th percentile] range, 49 to 119 ng/mL) throughout hospitalization. Interleukin-6 concentration was a significant predictor of HA concentration as was total administered daily fluid volume when accounting for interleukin-6 concentration. When fluid volume was analyzed independent of inflammatory status, fluid volume was not a significant predictor. Concentrations of HA did not significantly change over time but tended to increase on day 2 or 3 of hospitalization. CONCLUSIONS AND CLINICAL RELEVANCE: Results supported the theory that inflammation is associated with endothelial glycocalyx degradation. Dogs recovering from septic peritonitis may become more susceptible to further endothelial glycocalyx damage as increasing fluid volumes are administered.

Evaluation of the Distribution and Elimination of Balanced Isotonic Crystalloid, 5% Hypertonic Saline, and 6% Tetrastarch 130/0.4 Using Volume Kinetic Modeling and Analysis in Healthy Conscious Cats.

This prospective, randomized, blinded, interventional cross-over study investigated the distribution, elimination, plasma volume expansion, half-life, comparative potency, and ideal fluid prescription of three commonly prescribed intravenous (IV) fluids in 10 healthy conscious cats using volume kinetic analysis that is novel to veterinary medicine. Each cat received 20 mL/kg of balanced isotonic crystalloid (PLA), 3.3 mL/kg of 5% hypertonic saline (HS), and 5 mL/kg of 6% tetrastarch 130/0.4 (HES) over 15 min on separate occasions. Hemoglobin concentration, red blood cell count, hematocrit, heart rate, and blood pressure were measured at baseline, 5, 10, 15, 20, 30, 40, 50, 60, and every 15 min until 180 min. Urine output was estimated every 30 min using point-of-care bladder ultrasonography. Plasma dilution derived from serial hemoglobin concentration and red blood cell count served as input variables for group and individual fluid volume kinetic analyses using a non-linear mixed effects model. In general, the distribution of all IV fluids was rapid, while elimination was slow. The half-lives of PLA, HS, and HES were 49, 319, and 104 min, respectively. The prescribed fluid doses for PLA, HS, and HES resulted in similar peak plasma volume expansion of 27-30%. The potency of HS was 6 times higher than PLA and 1.7 times greater than HES, while HES was 3.5 times more potent than PLA. Simulation of ideal fluid prescriptions to achieve and maintain 15 or 30% plasma volume expansion revealed the importance of a substantial reduction in infusion rates following initial IV fluid bolus. In conclusion, volume kinetic analysis is a feasible research tool that can provide data on IV fluid kinetics and body water physiology in cats. The rapid distribution but slow elimination of IV fluids in healthy conscious cats is consistent with anecdotal reports of fluid overload susceptibility in cats and warrants further investigation.

Understanding Volume Kinetics: The Role of Pharmacokinetic Modeling and Analysis in Fluid Therapy.

Fluid therapy is a rapidly evolving yet imprecise clinical practice based upon broad assumptions, species-to-species extrapolations, obsolete experimental evidence, and individual preferences. Although widely recognized as a mainstay therapy in human and veterinary medicine, fluid therapy is not always benign and can cause significant harm through fluid overload, which increases patient morbidity and mortality. As with other pharmaceutical substances, fluids exert physiological effects when introduced into the body and therefore should be considered as "drugs." In human medicine, an innovative adaptation of pharmacokinetic analysis for intravenous fluids known as volume kinetics using serial hemoglobin dilution and urine output has been developed, refined, and investigated extensively for over two decades. Intravenous fluids can now be studied like pharmaceutical drugs, leading to improved understanding of their distribution, elimination, volume effect, efficacy, and half-life (duration of effect) under various physiologic conditions, making evidence-based approaches to fluid therapy possible. This review article introduces the basic concepts of volume kinetics, its current use in human and animal research, as well as its potential and limitations as a research tool for fluid therapy research in veterinary medicine. With limited evidence to support our current fluid administration practices in veterinary medicine, a greater understanding of volume kinetics and body water physiology in veterinary species would ideally provide some evidence-based support for safer and more effective intravenous fluid prescriptions in veterinary patients.

High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation.

OBJECTIVE: To determine the effect of high-flow nasal cannula (HFNC) oxygen therapy on cardiorespiratory variables and outcome in dogs with acute hypoxemic respiratory failure. DESIGN: Prospective, sequential clinical trial. SETTING: University veterinary teaching hospital. ANIMALS: Twenty-two client-owned dogs that failed to respond to traditional oxygen support. INTERVENTIONS: Initiation of HFNC therapy after traditional oxygen supplementation failed to increase Spo2 > 96% and Pao2 > 75 mm Hg or improve respiratory rate/effort. MEASUREMENTS AND MAIN RESULTS: Physiological variables, blood gas analyses, and dyspnea/sedation/tolerance scores were collected prior to HFNC initiation (on traditional oxygen support [time 0 or T0]), and subsequently during HFNC oxygen administration at time 30 minutes, 60 minutes, and 7 ± 1 hours. Relative to T0, use of HFNC resulted in a decreased respiratory rate at 1 hour (P = 0.022) and 7 hours (P = 0.012), a decrease in dyspnea score at all times (P < 0.01), and an increase in Spo2 at all times (P < 0.01). There was no difference in arterial/venous Pco2 relative to T0, although Paco2 was correlated with flow rate. Based on respiratory assessment, 60% of dogs responded to HFNC use by 30 minutes, and 45% ultimately responded to HFNC use and survived. No clinical air-leak syndromes were observed. CONCLUSIONS: HFNC use improved oxygenation and work of breathing relative to traditional oxygen therapies, without impairing ventilation. HFNC use appears to be a beneficial oxygen support modality to bridge the gap between standard oxygen supplementation and mechanical ventilation.

Preliminary evaluation of the use of high-flow nasal cannula oxygen therapy during recovery from general anesthesia in dogs with obstructive upper airway breathing.

BACKGROUND: Brachycephalic airway syndrome can pose a risk of complicated recovery from anesthesia as a result of irritation to the excess pharyngeal andlaryngeal tissue present in affected dogs. High-flow nasal cannula (HFNC) oxygen therapy is a respiratory support modality that offers provision of continuous positive airway pressure via high gas flow rates. The HFNC system actively warms and humidifies inspired gases, which improves comfort and facilitates tolerance of the high flow rates in people and dogs. HFNC oxygen therapy was applied to brachycephalic dogs that developed increased work of breathing or hypoxemia in the recovery phase of anesthesia to determine if this device would be tolerable and effective for relief of upper respiratory difficulty. KEY FINDINGS: The HFNC nasal prong interface is well suited to the brachycephalic facial structure. The application of HFNC was found to reduce dyspnea scores in patients with signs of upper airway obstruction after general anesthesia. Aerophagia and changes in PCO2 were noted. SIGNIFICANCE: Application of HFNC in the recovery period may result in improved airflow during times of somnolent obstructive breathing, not unlike the use of continuous positive airway pressure therapy in sleep-disordered breathing in people.

Prescribing patterns and comparison of culture versus empiric-based selection of meropenem in cats and dogs in a veterinary teaching hospital (2011-2018).

The utilization of meropenem in a small animal veterinary teaching hospital over a 7-year period was retrospectively analyzed, and culture (CBD) versus empiric-based decisions (EBD) were compared. Meropenem was infrequently prescribed at a rate of 0.50 prescriptions/1000 admissions in cats and 0.58/1000 in dogs. The most common condition for meropenem prescription in both cats and dogs was septic peritonitis (15/52, 28.8%). Overall 65.4% of meropenem prescriptions were initiated without, or prior to, culture results indicating a need for the drug. Based on retrospective analysis of culture and susceptibility results, only 2.9% of empirical meropenem selections were indicated, while the majority were not indicated (52.9%), or of questionable indication (44.2%).

Patrons d'ordonnance et comparaison de la culture versus le choix empirique de méropénème chez les chats et chiens dans un hôpital d'enseignement vétérinaire (2011­2018). L'utilisation de méropénème dans un hôpital d'enseignement vétérinaire pour animaux de compagnie durant une période de 7 ans fut analysée rétrospectivement, et la culture (CBD) versus la décision empirique (EBD) furent comparées. Le méropénème était prescrit peu fréquemment à une fréquence de 0,50 ordonnances/1000 admissions chez les chats et 0,58/1000 chez les chiens. La condition la plus fréquente pour la prescription de méropénème était la péritonite septique (15/52, 28,8 %). Globalement, 65,4 % des ordonnances de méropénème étaient initiés sans, ou précédent, les résultats de culture indiquant un besoin pour ce médicament. Basé sur l'analyse rétrospective des résultats de culture et de sensibilité, dans seulement 2,9 % des cas le choix empirique de méropénème état indiqué alors que dans la majorité des cas (52,9 %), ce n'était pas indiqué ou c'était une indication discutable.(Traduit par Dr Serge Messier).

Feasibility of a novel 3-dimensional mathematical algorithmic computation of feline bladder volumes using point-of-care longitudinal and transverse cysto-colic ultrasonographic images.

Conventional geometric formulas for estimating bladder volume assume that bladders have a perfectly uniform spheroid geometry. Bladders are often irregularly shaped, however, especially when under-filled or distorted by a full colon, which results in inaccurate ultrasonographic linear measurements and volume estimation. This pilot study investigates the feasibility, inter-observer reliability (reproducibility), robustness, and agreement of a novel 3-dimensional bladder volume computation method using bladder circumference tracing compared to a published feline linear bladder dimension formula. Paired sets of longitudinal and transverse B-mode bladder ultrasound images (n = 228) were acquired by 2 observers with different point-of-care ultrasonography skills using 10 healthy purpose-bred cats positioned in dorsal recumbency at various time points. Using strict criteria for Lin's concordance correlation coefficient, inter-observer agreements (n = 223) were found to be substantial (0.95 to 0.99) with statistically significant but clinically non-significant median differences (biases) of 0.96 mL [interquartile range (IQR): 0.16 to 2.46, P < 0.001] and 0.23 mL (IQR: 0.88 to 1.97, P = 0.006) when bladder circumference tracings were made on similar sets of ultrasound images respectively. Inter-observer agreements improved from substantial (0.95 to 0.99) to almost perfect (> 0.99) strength-of-agreement as the quality of ultrasound images improved. The bladder circumference tracing method showed moderate (0.90 to 0.95) strength-of-agreement with the recently published feline linear bladder dimension formula, with significant additive median differences (biases) of -6.76 mL (IQR: -9.06 to -3.88, P < 0.001) and -6.44 mL (IQR: -11.41 to -3.81, P < 0.001) recorded by each observer (n = 111, n = 83), respectively. Data obtained from orthogonal ultrasonographic bladder circumference tracings justify further investigation into use of this method for estimating bladder volume in cats.

Les formules géométriques conventionnelles pour estimer le volume de la vessie présument que les vessies ont une géométrie sphéroïde uniforme. Les vessies sont souvent de forme irrégulière, toutefois, spécialement lorsqu'elles ne sont pas remplies complètement ou sont déformées par un côlon rempli, ce qui résulte en des mesures linéaires imprécises par échographie et des estimations erronées de volume. La présente étude pilote a examiné la faisabilité, la fiabilité inter-observateur (reproductibilité), robustesse, et accord d'une nouvelle méthode de computation en 3-D du volume de la vessie en utilisant un traçage de la circonférence de la vessie comparée à une formule publiée utilisant la dimension linéaire de la vessie féline. Des images échographiques en mode B pairées longitudinale et transverse de la vessie (n = 228) furent obtenues par deux observateurs avec des compétences différentes en échographie au point de service en utilisant 10 chats en santé positionnés en décubitus dorsal à différents moments. En utilisant des critères stricts pour le coefficient de corrélation de concordance de Lin, les accords inter-observateurs (n = 223) ont été notés comme substantiels (0,95 à 0,99) avec une différence médiane (biais) statistiquement significative mais cliniquement non-significative de 0,96 mL [écart interquartile (IQR) : 0,16 à 2,46, P < 0,001] et 0,23 mL (IQR : 0,88 à 1,97, P = 0,006) lorsque les traçages de la circonférence de la vessie étaient effectués sur des groupes similaires d'images échographiques respectivement. La force des accords inter-observateurs se sont améliorés de substantiels (0,95 à 0,99) jusqu'à presque parfaits (> 0,99) à mesure que la qualité des images échographiques s'améliorait. La méthode de traçage de la circonférence de la vessie a montré une force d'accord modérée (0,90 à 0,95) avec la formule récemment publiée des dimensions linéaires de la vessie, avec une différence médiane (biais) additive significative de −6,76 mL (IQR : −9,06 à −3,88, P < 0,001) et −6,44 mL (IQR : −11,41 à −3,81, P < 0,001) notée par chaque observateur (n = 111, n = 83), respectivement. Les données obtenues par traçage orthogonal de la circonférence de la vessie justifient des études supplémentaires sur l'utilisation de cette méthode pour estimer le volume de la vessie chez les chats.(Traduit par Docteur Serge Messier).

A pilot study evaluating the effects of prestorage leukoreduction on markers of inflammation in critically ill dogs receiving a blood transfusion.

OBJECTIVES: To compare markers of inflammation after transfusion of leukoreduced (LR) packed RBCs (pRBCs) versus non-LR pRBCs in dogs with critical illness requiring blood transfusion, and to report survival to discharge and rates of transfusion reactions in these dogs. DESIGN: Prospective randomized blinded clinical study June 2014-September 2015. SETTING: University veterinary teaching hospital. ANIMALS: Twenty-three client-owned critically ill dogs, consecutively enrolled. INTERVENTIONS: Dogs requiring a single pRBC transfusion were randomized into the LR or non-LR pRBC group. Exclusion criteria included: requirement for multiple blood products, history of previous blood transfusion, and administration of anti-inflammatory or immunosuppressive medication prior to enrollment. MEASUREMENTS: Blood samples were obtained immediately prior to transfusion, then 2 and 24 hours following transfusion. Parameters measured at each time point included: PCV, WBC count, segmented and band neutrophil counts, fibrinogen, and plasma lactate and C-reactive protein concentrations. Acute patient physiologic and laboratory evaluation fast score was calculated on admission. RESULTS: Eleven dogs were included in the LR group and 12 in the non-LR group; scores of illness severity were not significantly different between groups. Total WBC count was significantly higher in the non-LR versus LR group 24 hours following pRBC transfusion, but this difference was not evident 2 hours following transfusion. No other inflammatory parameters at any time point were significantly different between LR versus non-LR pRBC transfused dogs. Survival rates to discharge for LR and non-LR groups were 8/11 and 9/12, respectively. Acute transfusion reactions were identified in 1/11 and 2/12 dogs in the LR and non-LR group, respectively. All transfused blood was stored ≤12 days. CONCLUSIONS: Most markers of inflammation did not significantly increase following transfusion of LR versus non-LR pRBCs stored ≤12 days in ill dogs. Further prospective, randomized trials are needed in clinically ill dogs to determine the benefit of prestorage leukoreduction.

Comparison of high flow nasal cannula oxygen administration to traditional nasal cannula oxygen therapy in healthy dogs.

OBJECTIVE: To determine the feasibility, degree of respiratory support, and safety of high flow nasal cannula (HFNC) oxygen therapy in sedated and awake healthy dogs, when compared to traditional nasal cannula (TNC) oxygen administration. DESIGN: Randomized experimental crossover study. SETTING: University research facility. ANIMALS: Eight healthy dogs. INTERVENTIONS: Variable flow rates (L/kg/min) were assessed, TNC: 0.1, 0.2, and 0.4 and HFNC: 0.4, 1.0, 2.0, and 2.5. HFNC was assessed in sedated and awake dogs. MEASUREMENTS: Variables measured included: inspiratory/expiratory airway pressures, fraction of inspired oxygen (FiO2 ), end-tidal oxygen (ETO2 ), end-tidal carbon dioxide (ETCO2 ), partial pressure of oxygen (PaO2 ), partial pressure of carbon dioxide (PaCO2 ), temperature, heart/respiratory rate, arterial blood pressure, and pulse oximetry. Sedation status, complications, and predefined tolerance and respiratory scores were recorded. MAIN RESULTS: Using HFNC, continuous positive airway pressure (CPAP) was achieved at 1 and 2 L/kg/min. CPAP was not higher at 2.5 than 2 L/kg/min, with worse tolerance scores. Expiratory airway pressures were increased when sedated (P = 0.006). FiO2 at 0.4 L/kg/min for both methods was 72%. FiO2 with TNC 0.1 L/kg/min was 27% and not different from room air. The FiO2 at all HFNC flow rates ≥1 L/kg/min was 95%. PaO2 for HFNC 0.4 L/kg/min was lower than at other flow rates (P = 0.005). The only noted complication was aerophagia. PaCO2 was increased with sedation and use of HFNC when compared to baseline (P = 0.006; P < 0.01). CONCLUSIONS: Use of HFNC in dogs is feasible and safe, provides predictable oxygen support and provides CPAP, but may cause a mild increase in PaCO2 . Flow rates of 1-2 L/kg/min are recommended. If using TNC, flow rates above 0.1 L/kg/min may attain higher FiO2 .

Comparison of fentanyl and hydromorphone constant rate infusions for pain management in dogs in an intensive care unit.

OBJECTIVE: To compare the efficacy and quality of analgesia provided by constant rate infusions (CRIs) of hydromorphone and fentanyl in dogs in the intensive care unit (ICU). STUDY DESIGN: Prospective, randomized, blinded, clinical trial. ANIMALS: A total of 29 client-owned dogs. METHODS: Dogs prescribed a µ-opioid agonist infusion for postsurgical or medical pain were randomized to be administered either hydromorphone (0.025 or 0.05 mg kg-1 bolus, followed by a 0.03 mg kg-1 hour-1 infusion) or fentanyl (2.5 or 5 µg kg-1 bolus, followed by a 3 µg kg-1 hour-1 infusion). The technical staff and clinicians were blinded as to which drug was administered. Pain scores, using the Colorado State University Canine Acute Pain Scale, sedation scores and nausea scores were assigned at regular intervals and compared between groups. Dose escalation and de-escalation of the study drug were performed according to set protocols. Adverse clinical signs and all other medications administered were recorded and compared between groups. The study drug was discontinued if the animal remained painful despite dose escalations, or if adverse effects were noted. RESULTS: The pain scores were of low magnitude and were not significantly different between groups. The use of concurrent analgesia, sedation/anxiolytic medications and antacid/antiemetic medications was not different between groups. Sedation and nausea scores were not statistically different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Hydromorphone and fentanyl CRIs appear to be equally effective for adequate pain relief in dogs, with no significant differences in adverse effects. Therefore, either drug may be chosen for control of postsurgical or medical pain in an ICU setting.

Perioperative analgesic use by Ontario veterinarians, 2012.

The objectives of this study were to describe the routine use of analgesics by Ontario veterinarians for common surgeries in dogs and cats, and to compare routine use of analgesics between species and surgeries, using Chi-square analyses. In total, 239 veterinarians responded to the questionnaires; a response rate of 13.1%. Fifty-two percent to 79% of veterinarians used meloxicam for both species and all surgeries. Approximately 9% of veterinarians did not use analgesics for dog ovariohysterectomy and castration, while 16% to 22% did not use analgesics for these surgeries in cats. Veterinarians used and dispensed analgesics to dogs more often than to cats (P < 0.05). Many (60% or more) veterinarians administered analgesics pre-emptively to both dogs and cats for all surgeries. Continuing education for veterinarians needs to focus on understanding of pre-emptive analgesia, preventive analgesia, and the importance of dispensing analgesic drugs after surgery for all surgeries.

Utilisation de l'analgésie péri-opératoire par les vétérinaires de l'Ontario, 2012. Les objectifs de cette étude consistaient à décrire l'utilisation routinière de l'analgésie par les vétérinaires de l'Ontario pour les chirurgies courantes chez les chiens et les chats et à comparer l'utilisation routinière de l'analgésie entre les espèces et les chirurgies en utilisant des analyses du chi-carré. Au total, 239 vétérinaires ont répondu aux questionnaires, pour un taux de réponse de 13,1 %. De cinquante-deux à 79 % des vétérinaires avaient recours au méloxicam pour les deux espèces et toutes les chirurgies. Environ 9 % des vétérinaires n'ont pas utilisé d'analgésie pour l'ovario-hystérectomie et la castration canines, tandis que de 16 % à 22 % n'ont pas eu recours à l'analgésie pour ces chirurgies chez les chats. Les vétérinaires utilisaient et distribuaient des analgésiques aux chiens plus souvent qu'aux chats (P < 0,05). Plusieurs vétérinaires (60 % ou plus) ont administré des analgésiques de manière préventive aux chiens et aux chats pour toutes les chirurgies. La formation continue des vétérinaires doit continuer de se concentrer sur la compréhension de l'analgésie préventive et sur l'importance d'administrer des analgésiques après la chirurgie pour toutes les chirurgies.(Traduit par Isabelle Vallières).

A Quick Reference on Magnesium.

This article serves as a quick reference on the distribution, handling, and supplementation of magnesium. It also lists the manifestations and causes of magnesium deficit and provides criteria for the diagnosis of a magnesium deficit.

Using focus groups to engage veterinary students in course redesign and development.

Students' perceptions about the quality of teaching have been shown to influence their approaches to learning and studying. The literature suggests that understanding student perceptions is critical to making informed decisions about curriculum development so that courses meet objectives, enhance engagement, and, ultimately, improve learning. However, the assessment of students' perceptions of their courses and the quality of teaching is frequently limited to an end-of-term course evaluation survey. While these course evaluations may be useful in providing a summative assessment, they do not typically provide insight into the reasons and influences that underlie student ratings. Achieving this type of understanding can be accomplished through qualitative methodology, which is a process of investigation used to reveal the depth, complexity, and nuances of perceptions and experiences. In the current article, we report the use of focus groups as a method of gaining in-depth understanding of student perceptions for course redesign. We present the redesign of the Art of Veterinary Medicine II course, a second-year core offering within the Doctor of Veterinary Medicine curriculum at the Ontario Veterinary College in Guelph, Canada. A series of student focus groups were held to gain greater insight into student perceptions of the course objectives, format, and content. Findings were then considered in the redevelopment of the course to better engage students and their various learning styles. Summative course evaluations as well as informal feedback before and after the focus groups indicate a notable improvement in student experiences and perceptions of the course format and content following the focus-group informed course redesign.

Evaluation of hyperviscous fluid resuscitation in a canine model of hemorrhagic shock: a randomized, controlled study.

BACKGROUND: Enhancing plasma viscosity during fluid resuscitation results in vasodilation and improved microvascular perfusion in rodents subjected to hemorrhagic shock. We hypothesized that resuscitation with hyperviscous lactated Ringer's solution (hyperLRS) would result in improved tissue oxygenation and acid-base values in hemorrhaged dogs. METHODS: Twelve dogs were anesthetized and splenectomized. Vascular catheterization was performed, and tissue oxygen probes were placed in the jejunal serosa and skeletal muscle to assess macro- and microhemodynamic parameters. Baseline (BL) and posthemorrhage data were obtained. After 1 hour of hemorrhagic shock (mean arterial pressure [MAP] 30-40 mm Hg), treatment groups (n = 6) were administered bolus LRS or hyperLRS, and then received sufficient LRS to achieve and maintain an MAP between 60 mm Hg and 70 mm Hg. Data were obtained at 10, 30, 60, 120, and 180 minutes after fluid resuscitation. RESULTS: There were no significant differences between LRS or hyperLRS groups at BL or posthemorrhage. Blood and plasma viscosity were significantly increased by the administration of hyperLRS at all time points postresuscitation compared with LRS. Significantly more fluid was required to maintain MAP, and vascular hindrance was consistently lower in dogs administered hyperLRS versus LRS, suggesting viscosity-induced vasodilation. Central and mesenteric venous oxygen saturations were significantly decreased, whereas lactate and oxygen extraction ratios were significantly increased after hyperLRS administration compared with LRS. The tissue oxygen tension was similar in dogs administered hyperLRS or LRS. CONCLUSIONS: A hyperviscous balanced electrolyte solution did not improve hemodynamic parameters, tissue oxygen tension, or acid-base values despite evidence for viscosity-induced vasodilation.

Magnesium: a quick reference.

This article serves as a quick reference for the distribution, handling, and supplementation of magnesium. It also lists the manifestations and causes of magnesium deficit and provides criteria for the diagnosis of a magnesium deficit.

Making sense of blood gas results.

Recent technologic advances have allowed the production and marketing of cage-side blood gas analyzers to private practitioners. The widespread use of cage-side portable blood gas analyzers in veterinary practices has increased the need to develop the basic skills of blood gas analysis as part of a tool kit for practicing veterinarians. Rapid expansion of emergency and critical care medicine as a specialty and increased numbers of veterinary emergency and veterinary specialty practices have occurred concurrently with the availability of blood gas analyzers that are affordable for private practitioners. As a result, evaluation of blood gas results is no longer an activity confined to academic institutions and has become a daily part of many practicing veterinarians' activities.

Comparison of the analgesic efficacy of hydromorphone and oxymorphone in dogs and cats: a randomized blinded study.

OBJECTIVE: To determine if oxymorphone and hydromorphone are equally efficacious as analgesics in both dogs and cats and to determine the side-effects of each drug in painful animals. STUDY DESIGN: Randomized, blinded, clinical trial. ANIMALS: 151 animals (28 cats and 123 dogs) admitted to the intensive care unit requiring mu opioid agonist treatment for a variety of painful procedures. METHODS: Animals were randomized into two groups and received either hydromorphone or oxymorphone as their primary mu agonist agent. All staff and clinicians were blinded as to which drug was administered. Pain scores, side-effects, dose and duration were recorded for each drug dose administered. The study groups were not revealed until the study had been completed and the ensuing manuscript written. Implementation of reversal and rescue protocols were dependent on pain scores and the judgment of the primary clinician. RESULTS: The groups did not significantly differ at randomization or in the number of study drug doses. There were no statistical differences between the dose of drug or the time between each dose, indicating that potency and efficacy was not different between the two drugs. Significantly more animals that received hydromorphone vomited, but there were no other statistical differences in adverse events, or in requirement for rescue or reversal protocols. CONCLUSIONS AND CLINICAL RELEVANCE: Hydromorphone is significantly less expensive than oxymorphone and the results of this trial indicate that the two drugs have a similar clinical value. Both oxymorphone and hydromorphone can be used as primary mu agonist therapy in veterinary patients.