Electronic survey investigating UK veterinarians' perceptions of the potential for veterinary prescription medication misuse or abuse.

OBJECTIVE: To investigate veterinarians' experience and perception of the risk of veterinary prescription medication (VPM) misuse and abuse by the public and veterinary professionals and to determine the clinical context in which respondent veterinarians prescribed certain VPMs. STUDY DESIGN: Anonymous online voluntary survey. POPULATION: A total of 361 of 7126 veterinarians registered as practicing in the UK, who provided e-mail contact details to the Royal College of Veterinary Surgeons Knowledge for participation in research. Respondents included general practitioners, with or without further qualifications, and European specialists, covering charity, private or academic small, large or mixed animal practice. METHODS: The anonymous online survey, open from September to December 2021, posed 27 questions regarding personal experience and perception of VPM misuse or abuse, including which VPMs were considered most at risk of abuse by clients or veterinary staff. Thematic analysis was performed on free-text sections. RESULTS: The participation rate was 5% (361/7126), and the completion rate 60% (216/361 respondents). Of these, 88% of respondents somewhat agreed, agreed or strongly agreed that some VPMs were at risk of abuse. A third (29.9%; 107/358) had suspected an owner of taking VPMs, and one fifth (20.1%; 72/358) had suspected veterinary staff. Perceptions regarding the likelihood of public VPM abuse ranged from not suspecting a problem to having first-hand experience. Drugs considered most at risk of owner abuse were opioids, benzodiazepines and gabapentin, and those for veterinary staff were opioids, benzodiazepines and ketamine. Numerous 'red flags' prompting suspicion of VPM abuse were identified alongside ways of mitigating risk. CONCLUSIONS AND CLINICAL RELEVANCE: Veterinarians in the UK reported varied experiences with, awareness of, and attitudes towards VPM abuse by the public and veterinary staff. Although not quantified, the UK veterinary industry could be a source of abusable drugs.

Ethical dilemmas in clinical practice: a perspective on the results of an electronic survey of veterinary anaesthetists.

Medical progress has greatly advanced our ability to manage animals with critical and terminal diseases. We now have the ability to sustain life even in the most dire of circumstances. However, the preservation of life may not be synonymous with providing 'quality of life', and worse, could cause unnecessary suffering. Using the results of an electronic survey, we aim to outline and give examples of ethical dilemmas faced by veterinary anaesthetists dealing with critically ill animals, how the impact of these dilemmas could be mitigated, and what thought processes underlie decision-making in such situations.

Aspects of in vivo endotracheal tube intracuff pressure in cats.

OBJECTIVES: To determine the endotracheal tube cuff pressure produced with two inflation techniques, in two brands of endotracheal tube in cats. To determine the inspiratory pressure which produces an audible leak when the intracuff pressure is 30 cmH2O. STUDY DESIGN: Prospective, clinical, randomized study. ANIMALS: A total of 40 client-owned healthy adult cats. METHODS: Following induction of anaesthesia, endotracheal intubation was performed with a Parker Flex-Tip PFLP (Parker; n = 20) or Flexicare VentiSeal (Flexicare; n = 20) endotracheal tube. For each cat, the endotracheal tube cuff was inflated using two methods, minimum occlusive volume (MOV) and pilot balloon palpation (PBP). Intracuff pressure was recorded. Cuff pressure was then set at 30 cmH2O and the pressure within the breathing system when a manual breath first caused an audible leak was measured. RESULTS: PBP pressure was lower for Parker (36 ± 13 cmH2O) compared with Flexicare (45 ± 13 cmH2O, p = 0.048). MOV pressure was not different between tube types (56 ± 28 versus 66 ± 25 cmH2O for Parker and Flexicare, respectively, p = 0.247). MOV produced a higher pressure than PBP for Parker (56 ± 28 versus 36 ± 13 cmH2O, p = 0.001) and Flexicare (66 ± 25 versus 45 ± 13 cmH2O, p = 0.007). When intracuff pressure was set at 30 cmH2O, 95% of cats did not develop an audible leak until the inspiratory pressure was greater than 10 and 12 cmH2O for Parker and Flexicare tubes, respectively. CONCLUSIONS: PBP produced lower cuff pressures than MOV, although both techniques produced a cuff pressure above that at which mucosal blood flow is believed to be restricted. A cuff pressure of 30 cmH2O may be sufficient to prevent audible leak in most cats if respiratory pressures are kept at 10-12 cmH2O or below. CLINICAL RELEVANCE: To ensure a safe endotracheal tube cuff pressure, use of a specifically designed pressure gauge is recommended.

Systems analysis of voluntary reported anaesthetic safety incidents occurring in a university teaching hospital.

OBJECTIVE: To identify factors contributing to the development of anaesthetic safety incidents. STUDY DESIGN: Prospective, descriptive, voluntary reporting audit of safety incidents with subsequent systems analysis. ANIMALS: All animals anaesthetized in a multispecies veterinary teaching hospital from November 2014 to October 2016. METHODS: Peri-anaesthetic incidents that risked or caused unnecessary harm to an animal were reported by anaesthetists alongside animal morbidity and mortality data. A modified systems analysis framework was used to identify contributing factors from the following categories: Animal and Owner, Task and Technology, Individual, Team, Work Environmental, and Organizational and Management. The outcome was graded using a simple descriptive scale. Data were analysed using Pearson's Chi-Square test for association and univariable and multivariable logistic regression analysis. RESULTS: Totally, 3379 anaesthetics were performed during the audit period. Of these, 174 incident reports were analysed, 163 of which impacted safe veterinary care and 26 incidents were considered to have had major or catastrophic outcomes. Incident outcome was believed to have been limited by anaesthetist intervention in 104 (63.8%) cases. Various factors were identified as: Individual in 123 (70.7%), Team in 108 (62.1%), Organizational and Management in 94 (54.0%), Task and Technology in 80 (46.0%), Work Environmental in 53 (30.5%) and Animal and Owner in 36 (20.7%) incidents. Individual factors were rarely seen in isolation. Significant associations were identified between Experience and Supervision, X2 (1, n=174)=54177, p=0.001, Failure to follow a standard operating procedure and Task Management, X2 (2, n=174)=11318, p=0.001, and Staffing and Poor Scheduling, X2 (1, n=174)=36742, p=0.001. Animal Condition [odds ratio (OR)=16210, 95% confidence interval (CI)=5573-47147)] and anaesthetist Decision Making (OR=3437, 95% CI=1184-9974) were risk factors for catastrophic and major outcomes. CONCLUSIONS AND CLINICAL RELEVANCE: Individual factors contribute to many safety incidents but tend to occur concurrently with other factors. Anaesthetist intervention limits the consequences of incidents for most animals.

Immersion and branchial/transcutaneous irrigation anaesthesia with alfaxalone in a Mexican axolotl.

INTRODUCTION: Immersion anaesthetic techniques are commonly used in amphibian species. Alfaxalone has been reported as an immersion anaesthetic in fish but not amphibians. CASE HISTORY AND EXAMINATION: A Mexican 56 g axolotl was presented with a 3-day history of anorexia. Anaesthesia was required for the surgical retrieval of two gastric foreign bodies. Prior to anaesthesia, on visual inspection the axolotl was bright and active. Branchial and gular respiratory movements occurred at approximately 24 respirations minute(-1) and heart rate was approximately 52 beats minute(-1) . MANAGEMENT: The axolotl was exposed to increasing concentrations (up to 5 mg L(-1) ) of alfaxalone (Alfaxan; Vetóquinol, UK) in a water bath. After becoming sedated the axolotl was removed from the water bath. Anaesthesia was induced and maintained with alfaxalone (5 mg L(-1) ) via continuous irrigation of the gills (branchial) and skin (cutaneous) with additional 30 µL drops of alfaxalone (10 mg mL(-1) ) administered branchially as required. Endoscopy and surgery were performed to remove two gastric foreign bodies. Branchial and gular respiratory movements persisted at what was considered an appropriate anaesthetic depth. Anaesthetic depth could be rapidly deepened by branchial irrigation of alfaxalone solutions and lightened by irrigation using fresh water. Anaesthesia lasted approximately 1 hour and recovery was rapid (within 15 minutes). Recovery was assisted through branchial and cutaneous irrigation with fresh water. FOLLOW-UP: No obvious adverse effects of anaesthesia were observed immediately post-anaesthesia or, according to the owner, in the following week. Conclusions Axolotls can be anaesthetized using alfaxalone administered via immersion and branchial/transcutaneous irrigation offering an alternative technique for anaesthetising axolotls for clinical and research purposes.

Effect of body position on the arterial partial pressures of oxygen and carbon dioxide in spontaneously breathing, conscious dogs in an intensive care unit.

OBJECTIVE: To evaluate the effect of body position on the arterial partial pressures of oxygen and carbon dioxide (PaO(2), PaCO(2)), and the efficiency of pulmonary oxygen uptake as estimated by alveolar-arterial oxygen difference (A-a difference). DESIGN: Prospective, randomized, crossover study. SETTING: University teaching hospital, intensive care unit. ANIMALS: Twenty-one spontaneously breathing, conscious, canine patients with arterial catheters placed as part of their management strategy. INTERVENTIONS: Patients were placed randomly into lateral or sternal recumbency. PaO(2) and PaCO(2) were measured after 15 minutes in this position. Patients were then repositioned into the opposite position and after 15 minutes the parameters were remeasured. MEASUREMENTS AND MAIN RESULTS: Results presented as median (interquartile range). PaO(2) was significantly higher (P=0.001) when patients were positioned in sternal, 91.2 mm Hg (86.0-96.1 mm Hg), compared with lateral recumbency, 86.4 mm Hg (73.9-90.9 mm Hg). The median change was 5.4 mm Hg (1.1-17.9 mm Hg). All 7 dogs with a PaO(2)<80 mm Hg in lateral recumbency had improved arterial oxygenation in sternal recumbency, median increase 17.4 mm Hg with a range of 3.8-29.7 mm Hg. PaCO(2) levels when patients were in sternal recumbency, 30.5 mm Hg (27.3-32.7 mm Hg) were not significantly different from those in lateral recumbency, 32.2 mm Hg (28.3-36.0 mm Hg) (P=0.07). The median change was -1.9 mm Hg (-3.6-0.77 mm Hg). A-a differences were significantly lower (P=0.005) when patients were positioned in sternal recumbency, 21.7 mm Hg (17.3-27.7 mm Hg), compared with lateral recumbency, 24.6 mm Hg (20.4-36.3 mm Hg). The median change was -3.1 mm Hg (-14.6-0.9 mm Hg). CONCLUSIONS: PaO(2) was significantly higher when animals were positioned in sternal recumbency compared with lateral recumbency, predominantly due to improved pulmonary oxygen uptake (decreased A-a difference) rather than increased alveolar ventilation (decreased PaCO(2)). Patients with hypoxemia (defined as PaO(2)<80 mm Hg) in lateral recumbency may benefit from being placed in sternal recumbency. Sternal recumbency is recommended to improve oxygenation in hypoxemic patients.