Lidocaine-saturated cotton tip applicator used for laryngeal desensitization resulting in an iatrogenic tracheobronchial foreign body in two cats.

Case series summary: Two cats were referred to a veterinary teaching hospital with a cotton tip applicator (CTA) tracheobronchial foreign body (FB) after induction of anesthesia for an elective dental cleaning. In both cases, a lidocaine-saturated CTA, utilized to desensitize the larynx before endotracheal (ET) intubation, broke when introduced into the oropharynx and was subsequently aspirated into the tracheobronchial tree. Both CTAs were successfully removed bronchoscopically, and the cats survived with no short- or long-term complications noted. Relevance and novel information: Utilizing a lidocaine-saturated CTA to facilitate ET intubation in cats is not well described, and information on the relative risks and benefits of this specific method for laryngeal desensitization is lacking. This retrospective case series is the first to describe a complication of this technique and successful treatment. These cases highlight the risk inherent to using a CTA to desensitize the feline larynx.

A liposomal bupivacaine infiltrative block reduces rescue analgesia administration compared to a bupivacaine splash block after canine ovariohysterectomy in a teaching laboratory.

OBJECTIVE: This study aimed to determine whether an infiltrative block with liposomal bupivacaine was associated with less rescue analgesia administration and lower pain scores than a bupivacaine splash block after ovariohysterectomy in dogs. ANIMALS: Eligible dogs included those that were spayed as part of a veterinary teaching laboratory. Dogs were up to 7 years old and otherwise healthy. A total of 136 dogs were analyzed. METHODS: All dogs underwent ovariohysterectomy performed by veterinary students. Dogs received hydromorphone and acepromazine premedication, propofol induction, isoflurane maintenance, and an NSAID. Dogs were randomly allocated to receive either a splash block with standard bupivacaine or an infiltrative block with liposomal bupivacaine for incisional analgesia. Postoperatively, all dogs were assessed by a blinded evaluator using the Colorado State University-Canine Acute Pain Scale (CSU-CAPS) and Glasgow Composite Measures Pain Scale-Short Form (GCPS-SF). Dogs received rescue analgesia with buprenorphine if they scored ≥ 2 on the CSU-CAPS scale. RESULTS: Dogs that received liposomal bupivacaine had a significantly lower incidence of (P = .04) and longer time to (P = .03) administration of rescue analgesia. There was an overall time-averaged significant difference between groups for CSU-CAPS (P = .049) and GCPS-SF scores (P = .015), with dogs in the bupivacaine group being more likely to have an elevated pain score at some point for both scales. CLINICAL RELEVANCE: The use of liposomal bupivacaine in an infiltrative block may decrease the need for rescue analgesia in dogs undergoing ovariohysterectomy compared to a bupivacaine splash block.

Sedative effects of alfaxalone and hydromorphone with or without midazolam in cats: a pilot study.

OBJECTIVES: The aim of this pilot study was to compare the quality of sedation and ease of intravenous (IV) catheter placement following sedation using two intramuscular (IM) sedation protocols in cats: hydromorphone, alfaxalone and midazolam vs hydromorphone and alfaxalone. METHODS: This was a prospective, randomized and blinded study. Cats were randomly assigned to receive an IM injection of hydromorphone (0.1 mg/kg), alfaxalone (1.5 mg/kg) and midazolam (0.2 mg/kg; HAM group), or hydromorphone (0.1 mg/kg) and alfaxalone (1.5 mg/kg; HA group). Sedation scoring (0-9, where 9 indicated maximum sedation) was performed at 0, 5, 10, 15 and 20 mins from the time of injection. At 20 mins, an IV catheter placement score (0-10, where 10 indicated least resistance) was performed. RESULTS: Twenty-one client-owned adult cats were included in this study. Sedation and IV catheter placement scores were compared between groups using Wilcoxon rank sum tests. Peak sedation was significantly higher (P = 0.002) in the HAM group (median 9; range 7-9) than in the HA group (median 7; range 3-9), and IV catheter placement scores were significantly higher (P = 0.001) in the HAM group (median 9.5; range 7-10) compared with the HA group (median 7; range 4-9). Spearman correlations were calculated between IV catheter placement score and sedation scores. There was a significant positive correlation of average sedation over time (correlation 0.83; P <0.001) and sedation at 20 mins (correlation 0.76; P <0.001) with a higher, more favorable IV catheter placement score. CONCLUSIONS AND RELEVANCE: These preliminary results suggest that the addition of midazolam to IM alfaxalone and hydromorphone produced more profound sedation and greater ease of IV catheter placement than IM alfaxalone and hydromorphone alone.