Comparison of subarachnoid administration of low-dose bupivacaine and lidocaine in healthy goats.

OBJECTIVE: This study aimed to compare the effects of low-dose subarachnoid injections of 2% lidocaine (LIDO) and 0.5% bupivacaine (BUPI) in goats. ANIMALS: 6 healthy, privately owned female goats. METHODS: In this randomized blind crossover clinical trial, each goat received 0.05 mL/kg-1 of LIDO, BUPI, or sterile saline solution into the lumbosacral subarachnoid space, with a seven-day washout. Cardiorespiratory variables, rectal temperature, and somatosensory (pinprick) and motor (ataxia) functions were recorded at baseline (time 0) and 2, 5, 10, 15, and 30 minutes after injection, then every 20 minutes until the goat was standing and able to walk. Time to regain somatosensory and motor functions was compared between treatments using Kaplan-Meier survival curves and the Cox proportional hazards model. Linear mixed-effects models were used to compare cardiorespiratory variables between treatments and over time. A P value ≤ .05 was considered significant. RESULTS: Somatosensory recovery was longer with BUPI, though not statistically significant. The median time to stand was 50 (50, 67) minutes after LIDO injection and 104 (101, 156) minutes after BUPI injection (P = .031). The median time to walk was 72 (54, 85) minutes after LIDO versus 225 (220, 245) minutes after BUPI injection (P = .031). Cardiovascular and respiratory variables showed no significant differences between treatments. CLINICAL RELEVANCE: Despite prolonged ataxia with BUPI, pinprick sensation recovery did not differ. At reduced doses, both LIDO and BUPI are deemed acceptable for short procedures of the flank, pelvic limb, or tail in healthy goats.

Lumbosacral intrathecal lidocaine provides adequate analgesia for cesarean sections in goats: 7 cases (2020-2021).

OBJECTIVE: To evaluate the analgesic efficacy of lumbosacral intrathecal administration of 2% lidocaine in goats undergoing cesarean sections (C-sections). ANIMALS: 7 client-owned goats. PROCEDURES: Medical records were retrospectively reviewed to identify records of goats undergoing C-sections between January 2020 and November 2021 with intrathecal administration of lidocaine as the primary method of analgesia. Effect of analgesia, American Society of Anesthesiologists status, quality of surgery (determined based on lack of patient movement), mean surgical time, time to stand, and anesthetic complications were recorded. RESULTS: Intrathecal administration of preservative-free 2% lidocaine (1 mg/kg) at the lumbosacral space with the use of a 20-gauge 3.5-inch (0.9 X 90-mm) spinal needle under aseptic technique achieved effective analgesia in sedated goats by time of skin incision. Adequacy of analgesia was complete (failure to respond to needle-prick of skin or skin incision) in 6 of the 7 goats and moderate in 1 goat. Quality of surgery was adequate in all goats. Mean surgical time was 96 ± 20 minutes, and mean time to stand was 182 ± 61 minutes from the time of intrathecal administration. Complications included ruminal tympany, hypothermia, and partial blockade in 1 goat each. CLINICAL RELEVANCE: Results indicated that intrathecal administration of lidocaine as described in the present report provided adequate analgesia for C-sections in goats, with minimal complications, and quicker return to hindlimb motor function postoperatively than historically reported for epidurals.

The effect of erector spinae plane block on perioperative analgesic consumption and complications in dogs undergoing hemilaminectomy surgery: a retrospective cohort study.

OBJECTIVE: To compare the perioperative use of analgesics and complication rates in dogs administered an erector spinae plane (ESP) block or a traditional opioid-based (OP) treatment as part of analgesic management during hemilaminectomy. STUDY DESIGN: Retrospective cohort study. ANIMALS: Medical records of 114 client-owned dogs. METHODS: General data included demographics, duration of procedure, number of laminae fenestrated, perioperative use of steroid and non-steroidal anti-inflammatory drugs. Intra- and postoperative analgesics used in 48 hours and complications rates were compared between groups. Opioid use was expressed in morphine equivalents [ME (mg kg-1)]. Continuous data were compared using the Mann-Whitney U test and incidence of events with a Fisher's exact tests. Multiple linear regression was used to evaluate association between perioperative ME consumption (dependent variable) with other independent variables. Data are presented as median (range). Differences were considered significant when p < 0.05. RESULTS: Group ESP comprised 42 dogs and group OP 72 dogs. No differences were observed in the general data. Intraoperative ME was 0.65 (0.20-3.74) and 0.79 (0.19-5.60) mg kg-1 in groups ESP and OP, respectively (p = 0.03). Intraoperative infusion of lidocaine was administered intravenously (IV) to 23.8% and 68% of groups ESP and OP, respectively (p < 0.0001). Intraoperative infusion of ketamine was administered IV to 21% and 40% of groups ESP and OP, respectively (p = 0.04). Regression analysis revealed the ESP block as the only independent variable affecting the perioperative ME consumption. Pharmacological intervention to treat cardiovascular complications was administered to 21.4% and 47.2% of dogs in groups ESP and OP, respectively (p = 0.008). There were no differences in postoperative complication rates. CONCLUSIONS AND CLINICAL RELEVANCE: ESP block was associated with reduced perioperative opioid consumption, intraoperative adjuvant analgesic use and incidence of pharmacological interventions to treat cardiovascular complications in dogs undergoing hemilaminectomy.

SURGICAL MANAGEMENT OF APPENDICULAR LONG-BONE FRACTURES IN FREE-RANGING FLORIDA PANTHERS ( PUMA CONCOLOR CORYI): SIX CASES (2000-2014).

The clinical outcomes of six free-ranging Florida panthers ( Puma concolor coryi) that underwent surgical stabilization of appendicular long-bone fractures (three femoral fractures, one tibial and one tibial and fibular fracture and two radial and ulnar fractures) were evaluated. These panthers presented to the University of Florida from 2000-2014. Estimated age of the panthers ranged from 0.5 to 4.5 yr, and weights ranged from 22 to 65 kg. Causes of injuries were vehicular collision ( n = 4) and capture related ( n = 2). All panthers underwent open reduction and fracture stabilization. Fixation failure necessitated three subsequent surgeries in one panther. Five panthers survived the immediate postoperative period, and all of these panthers' fractures obtained radiographic union (range, 8-36 [mean, 22] wk). The five surviving panthers underwent convalescence for 7-14 mo at White Oak Conservation Center before being released back into the wild; however, one panther was killed when hit by a car 3 days after release. The remaining four panthers were tracked for up to 106 mo in the wild and successfully integrated back into the native population. Surgical stabilization of appendicular long-bone fractures in free-ranging Florida panthers can be successful, but must take into account the stress that a large, undomesticated felid will place on the stabilized limb during convalescence as well as the difficulties involved in rehabilitating a wild panther in captivity.

Effects of anesthetic induction with a benzodiazepine plus ketamine hydrochloride or propofol on hypothermia in dogs undergoing ovariohysterectomy.

OBJECTIVE: To assess the effect of anesthetic induction with a benzodiazepine plus ketamine or propofol on hypothermia in dogs undergoing ovariohysterectomy without heat support. ANIMALS: 23 adult sexually intact female dogs undergoing ovariohysterectomy. PROCEDURES: Baseline rectal temperature, heart rate, and respiratory rate were recorded prior to premedication with buprenorphine (0.02 mg/kg, IM) and acepromazine (0.05 mg/kg, IM). Anesthesia was induced with midazolam or diazepam (0.25 mg/kg, IV) plus ketamine (5 mg/kg, IV; n = 11) or propofol (4 mg/kg, IV; 12) and maintained with isoflurane in oxygen. Rectal temperature was measured at hospital intake, prior to premedication, immediately after anesthetic induction, and every 5 minutes after anesthetic induction. Esophageal temperature was measured every 5 minutes during anesthesia, beginning 30 minutes after anesthetic induction. After anesthesia, dogs were covered with a warm-air blanket and rectal temperature was measured every 10 minutes until normothermia (37°C) was achieved. RESULTS: Dogs in both treatment groups had lower rectal temperatures within 5 minutes after anesthetic induction and throughout anesthesia. Compared with dogs that received a benzodiazepine plus ketamine, dogs that received a benzodiazepine plus propofol had significantly lower rectal temperatures and the interval from discontinuation of anesthesia to achievement of normothermia was significantly longer. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs in which anesthesia was induced with a benzodiazepine plus propofol or ketamine became hypothermic; the extent of hypothermia was more profound for the propofol combination. Dogs should be provided with adequate heat support after induction of anesthesia, particularly when a propofol-benzodiazepine combination is administered.

Effects of premedication with sustained-release buprenorphine hydrochloride and anesthetic induction with ketamine hydrochloride or propofol in combination with diazepam on intraocular pressure in healthy sheep.

OBJECTIVE: To determine the effects of diazepam combined with ketamine hydrochloride or propofol for induction of anesthesia (IOA) following premedication with sustained-release buprenorphine hydrochloride (SRB) on intraocular pressure (IOP) in sheep. ANIMALS: 20 healthy adult sheep. PROCEDURES: Diazepam with ketamine or propofol was given IV to each of 10 sheep after premedication with SRB (0.01 mg/kg, SC); after > 4 weeks, each sheep received the other induction combination with no premedication. For both eyes, IOPs were measured before premedication (if given), 10 minutes prior to (baseline) and immediately following administration of ketamine or propofol (time of IOA), after endotracheal intubation, and 5 minutes after IOA. Peak end-tidal P(CO2), globe position, and pupillary diameter were also analyzed. RESULTS: Data were not available for all sheep for all anesthetic episodes. Propofol-diazepam administration alone had no significant effect on IOP, whereas there was a significant decrease in IOP immediately following ketamine-diazepam administration alone. At 5 minutes after ketamine-diazepam administration, SRB-premedicated sheep had significantly higher IOP than unpremedicated sheep. Intraocular pressure was significantly higher at baseline, at intubation, and 5 minutes after IOA in SRB-premedicated sheep receiving propofol-diazepam, compared with unpremedicated sheep. Peak end-tidal P(CO2) at intubation was significantly higher in SRB-premedicated sheep. For sheep receiving either anesthetic treatment, IOPs did not differ significantly with or without SRB premedication. Globe position or pupillary diameter and IOP were not significantly related at any time point. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that both ketamine-diazepam and propofol-diazepam combinations were suitable for IOA without increasing IOP in sheep. The use of SRB should be avoided in sheep when increases in IOP are undesirable.

Evaluation of an indirect oscillometric blood pressure monitor in normotensive and hypotensive anesthetized dogs.

OBJECTIVE: To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs. DESIGN: Prospective observational study. SETTING: University teaching hospital. ANIMALS: Eight crossbred adult dogs. INTERVENTIONS: Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end-tidal isoflurane concentration at 1.2+/-0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia. MEASUREMENTS AND MAIN RESULTS: Agreement between the direct and indirect BP measurements was determined by the Bland-Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were -14.7 mm Hg (15.5 mm Hg), -16.4 mm Hg (12.1 mm Hg), and -14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were -32 mm Hg (22.6 mm Hg), -24.2 mm Hg (19.5 mm Hg), and -16.8 mm Hg (17.2 mm Hg), respectively. CONCLUSION: The oscillometric device was not reliably predictive of intra-arterial BP during hypotension associated with acute hemorrhage.

Comparison of time to desaturation between preoxygenated and nonpreoxygenated dogs following sedation with acepromazine maleate and morphine and induction of anesthesia with propofol.

OBJECTIVE: To compare the time to desaturation in healthy dogs that breathed oxygen or room air for 3 minutes before induction of anesthesia. ANIMALS: 20 healthy dogs. PROCEDURES: Dogs were sedated with morphine and acepromazine maleate. Dogs received a 3-minute treatment of room air or oxygen (100 mL/kg/min) via face mask. Arterial blood samples were collected before and after treatment to determine PaCO(2), PaO(2), pH, and SaO(2); propofol (6 mg/kg, IV) was injected during a 7-second period, and the dogs were intubated. A lingual pulse oximeter probe was placed. Dogs remained disconnected from the breathing circuit until SpO(2) equaled 90% (desaturation point) and then connected and ventilated until the SpO(2) was >or= 97%. Arterial blood samples were collected and SpO(2) was recorded every 30 seconds for 4 minutes and then every minute until the desaturation point. Times to first breath and the desaturation point were recorded. Data were collected at 0, 5, 30, 60, 90, 120, and 150 seconds. RESULTS: Mean +/- SEM time to desaturation differed significantly between dogs treated with room air (69.6 +/- 10.6 seconds) and oxygen (297.8 +/- 42.0 seconds). Lowest mean PaO(2) and SaO(2) when dogs were breathing room air were 62 +/- 6.3 mm Hg and 82.3 +/- 4%, respectively, at 30 seconds. CONCLUSIONS AND CLINICAL RELEVANCE: Preoxygenation for 3 minutes increased the time to desaturation in healthy dogs sedated with acepromazine and morphine in which anesthesia was induced with propofol.

Comparison between analgesic effects of buprenorphine, carprofen, and buprenorphine with carprofen for canine ovariohysterectomy.

OBJECTIVE: To compare the analgesic effects of buprenorphine, carprofen, and their combination in dogs undergoing ovariohysterectomy. STUDY DESIGN: Prospective, randomized blinded clinical study. ANIMALS: 60 dogs. METHODS: Treatments were buprenorphine 0.02 mg kg(-1), intramuscularly (IM) (group B); carprofen 4 mg kg(-1), subcutaneously (SC) (group C); or a combination of both (group CB). Anesthesia was induced with propofol and maintained with isoflurane. A Dynamic Interactive Visual Analog Scale (DIVAS, 0-100 mm) and the Glasgow Composite Pain Scale (GCMPS, 0-24) were used to evaluate comfort and sedation at baseline, 2, 4, 6, and 24 hours after extubation. Rescue analgesia was provided with buprenorphine (0.02 mg kg(-1)). Wound swelling measurements (WM) and a visual inflammation score (VIS) of the incision were made after surgery and 2, 4, 6, and 24 hours later. p < 0.05 was considered significant. RESULTS: Group C required more propofol (5.0 +/- 1.4 mg kg(-1)) compared with B (3.3 +/- 1.1 mg kg(-1)) and CB (3.2 +/- 0.7 mg kg(-1)); respectively, p = 0.0002 and 0.0001. Rescue analgesia was required in nine dogs. B had a higher GCMPS and DIVAS III score at 6 hours (2.6 +/- 2.5) and (23 +/- 22.5 mm) compared with C (1.0 +/- 1.3, 6 +/- 7.3 mm) and CB (1.5 +/- 1.4, 8 +/- 10.7 mm); respectively, p = 0.02 and 0.006. Group C had a lower sedation score at 2 hours (43 +/- 23.6 mm) compared with B (68 +/- 32.1 mm) and BC (69 +/- 22.1 mm); respectively, p = 0.03 and 0.004. Group B had a higher WM score at 2 hours (3 +/- 0.8 mm) compared with C (2 +/- 0.6 mm) p = 0.01 and at 6 hours (3 +/- 1 mm) compared with C (2 +/- 0.8 mm) and CB (2 +/- 0.8 mm); respectively, p = 0.01 and 0.008. VIS was not different between groups. CONCLUSION AND CLINICAL RELEVANCE: All treatments provided satisfactory analgesia for the first 6 hours and at 24 hours. C and CB pain score and WS were superior to B at 6 hours. No superior analgesic effect was noted when the drugs were combined.

Evaluation of intravenous administration of meloxicam for perioperative pain management following stifle joint surgery in dogs.

OBJECTIVE: To compare preoperative administration of meloxicam and butorphanol to perioperative administration of butorphanol alone for control of postoperative signs of pain in dogs. ANIMALS: 40 client-owned dogs scheduled for surgical repair of a cranial cruciate ligament rupture. PROCEDURE: Group-1 dogs received butorphanol (0.2 mg/kg, IV) and meloxicam (0.2 mg/kg, IV) just prior to surgery. Group-2 dogs received butorphanol just prior to surgery (0.2 mg/kg, IV) and at incision closure (0.1 mg/kg, IV). Pain assessment began 1 to 2 hours before surgery and from extubation until 24 hours after surgery by obtaining the following measurements: the visual analog scale (VAS) score, cumulative pain score (CPS), adjusted cumulative pain score, modified cumulative pain score, and the adjusted modified cumulative pain score (AMCPS). Serum cortisol concentration was measured between 12 to 24 and between 1 to 2 hours prior to surgery, and at 30 minutes, and 1, 2, 4, 8, 18, and 24 hours after extubation. RESULTS: No significant differences between treatment groups were observed in CPS or VAS score. At 8, 9, 10, and 11 hours after extubation, meloxicam-butorphanol-treated dogs had a significantly lower AMCPS, compared with butorphanol-alone-treated dogs. Total serum cortisol concentration (area under the curve) during the measurement period was significantly lower in meloxicam-butorphanol-treated dogs, compared with butorphanol-alone treated dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative single dose administration of meloxicam-butorphanol is equivalent to or slightly better than the administration of 2 perioperative doses of butorphanol for the control of postoperative signs of pain in dogs.

Using the human patient simulator to educate students of veterinary medicine.

INTRODUCTION: The human patient simulator has proved to be an effective educational device for teaching physicians and paramedical personnel. METHODOLOGY: To determine whether veterinary medicine students would benefit from similar educational sessions, 90 students each took a turn being the patient's clinician as real-life scenarios were played out on the simulator. The students induced and maintained anesthesia on their patient and monitored vital signs. Several critical events were presented for the students to diagnose and treat as they occurred. All students submitted a written evaluation of the course upon completion. The last 40 students were randomly divided into two groups of 20 students each. The students in Group I experienced the simulator before their clerkship examination, and those in Group II took the examination before their simulator experience. RESULTS: The students rapidly gained confidence in treating their simulated patient. This carried over to the clinical setting, where they appeared to be more confident when anesthetizing live patients. The simulator experience brought together much of the previous didactic material that they had been exposed to so they could appreciate its clinical relevance. The overwhelming response to the simulator experience was positive. The students in Group I had a significantly higher score on the clerkship examination dealing with concepts reviewed by simulation than those in Group II, who engaged in self-study instead of the simulation exercise (p < 0.001). CONCLUSION: We conclude that the human patient simulator was a valuable learning tool for students of veterinary medicine. It was exciting for the students to work with, made them deal with "real-life" scenarios, permitted them to learn without subjecting live patients to complications, enabled them to retrace their steps when their therapy did not correct the simulated patient's problems, and facilitated correlation of their basic science knowledge with clinical data, thus accelerating their ability to handle complex clinical problems in healthy and diseased patients.