Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance.

This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.

Sedation with dexmedetomidine decreases skin perfusion in cats.

OBJECTIVE: To evaluate skin perfusion in cats receiving dexmedetomidine compared to a placebo. ANIMALS: 9 healthy adult research cats. METHODS: A randomized, blinded, placebo-controlled study design was used. Two sites, the dorsal metatarsus (site: limb) and lateral flank (site: flank), were evaluated with laser speckle contrast imaging (LSCI) at baseline and following administration of dexmedetomidine (1, 3, or 5 mcg/kg, IV) or a placebo (0.9% saline, IV). Mean speckle contrast (MSC), a surrogate for perfusion, was obtained from LSCI and compared between treatments. Heart rate, sedation score, and body temperature were recorded. Skin perfusion to the flank and limb, reported as MSC, was assessed via LSCI at baseline and at 5, 10, and 15 minutes posttreatment. RESULTS: There was a significant decrease in heart rate (P < .001) in cats receiving 1, 3, and 5 mcg/kg dexmedetomidine compared to placebo. There was a significant increase in median sedation score at all time points postsedation compared to baseline (P < .018). Changes in MSC for the metatarsus were not significantly different between treatments at any time point (P = .12). For the flank, MSC was significantly higher for cats treated with dexmedetomidine compared to baseline (P ≤ .01). Skin perfusion to the flank decreased as early as 5 minutes posttreatment with dexmedetomidine and persisted for at least 15 minutes, regardless of dexmedetomidine dose. CLINICAL RELEVANCE: Dexmedetomidine decreased skin perfusion in cats, even at low doses. Veterinarians may elect for an alternative sedative medication when decreased skin perfusion is a concern.

Staphylectomy in nonbrachycephalic dogs: A retrospective study of 27 cases.

Objective: To report the outcomes and complications associated with staphylectomy in nonbrachycephalic dogs. Animal: Twenty-seven nonbrachycephalic dogs with elongated soft palates and undergoing staphylectomy. Procedure: Retrospective study. Results: Increased upper airway noise (70.4%) and dyspnea (44.4%) were the most common presenting clinical signs. Concurrent upper airway abnormalities found in the study population included laryngeal collapse (25.9%) and laryngeal paralysis (14.8%). The most common staphylectomy technique used in this study was sharp excision (66.7%) with sutured oral and nasal mucosal apposition. The dogs in this study had an overall minor postoperative complication rate of 33.3%, with regurgitation/vomiting (11.1%) and coughing (11.1%) occurring most commonly. No dog required supplemental oxygen therapy or temporary tracheostomy. Conclusion: Staphylectomy was well-tolerated in nonbrachycephalic dogs and was associated with a relatively low rate of complications. Concurrent airway abnormalities were common among nonbrachycephalic dogs with elongated soft palates, similar to brachycephalic dogs. Clinical relevance: Clinicians should be aware that elongated soft palate can occur in nonbrachycephalic dogs, and surgical correction can be achieved with rare major or catastrophic complications.

Staphylectomie chez des chiens non-brachycéphales : une étude rétrospective de 27 cas. Objectif: Rapporter les résultats et les complications associés à la staphylectomie chez des chiens non-brachycéphales. Animal: Vingt-sept chiens non-brachycéphales au palais mou allongé et subissant une staphylectomie. Procédure: Étude rétrospective. Résultats: L'augmentation du bruit des voies respiratoires supérieures (70,4 %) et la dyspnée (44,4 %) étaient les signes cliniques les plus fréquents. Les anomalies concomitantes des voies respiratoires supérieures trouvées dans la population étudiée comprenaient un collapsus laryngé (25,9 %) et une paralysie laryngée (14,8 %). La technique de staphylectomie la plus couramment utilisée dans cette étude était l'exérèse fine (66,7 %) avec apposition suturée des muqueuses buccale et nasale. Les chiens de cette étude présentaient un taux global de complications postopératoires mineures de 33,3 %, les régurgitations/vomissements (11,1 %) et la toux (11,1 %) étant les plus fréquents. Aucun chien n'a eu besoin d'une oxygénothérapie supplémentaire ou d'une trachéotomie temporaire. Conclusion: La staphylectomie a été bien tolérée chez les chiens non-brachycéphales et a été associée à un taux relativement faible de complications. Les anomalies concomitantes des voies respiratoires étaient courantes chez les chiens nonbrachycéphales avec des palais mous allongés, semblables aux chiens brachycéphales. Pertinence clinique: Les cliniciens doivent être conscients qu'un palais mou allongé peut survenir chez les chiens non-brachycéphales et qu'une correction chirurgicale peut être obtenue avec de rares complications majeures ou catastrophiques.(Traduit par Dr Serge Messier).

Pilot clinical trial: propidium monoazide PCR quantifies reduction of the viable bacterial load after antiseptic preparation of canine oral mucosa.

OBJECTIVE: A pilot clinical study to evaluate the use of propidium monoazide PCR (PMA-PCR) in quantifying a reduction of bacterial load after antiseptic use on the canine oral mucosa and skin, comparison of quantitative PCR (qPCR) to PMA-PCR, and comparison of patterns seen between PCR methods and bacterial culture. ANIMALS: Client-owned dogs (n = 10) undergoing general anesthesia and intravenous catheter placement. PROCEDURES: The oral mucosa and antebrachial skin of each dog underwent swabs for culture, qPCR, and PMA-PCR before and after antiseptic preparation of each site. Reduction in bacterial load between sampling times was evaluated for each quantification method. RESULTS: All testing methods found a significant decrease in bacterial load from oral mucosa after antiseptic preparation (culture P = .0020, qPCR P = .0039, PMA-PCR P = .0039). PMA-PCR had a significantly greater reduction of bacterial load after preparation than qPCR (P = .0494). Only culture detected a significant reduction after preparation of the skin (culture P = .0039, qPCR P = .3125, PMA-PCR P = .0703). CLINICAL RELEVANCE: PMA-PCR was able to quantify a reduction of bacterial load after antiseptic preparation of the high-bacterial load environment, with a pattern similar to that of culture, and was more specific than qPCR for detecting viable bacterial load. The results of this study support the use of PMA-PCR for antiseptic effectiveness studies performed on a high-bacterial load environment, such as canine oral mucosa.

Influence of closed glove exchange on bacterial contamination of the hands of the surgical team.

OBJECTIVE: To determine if closed glove exchange (CGE) increases hand contamination. STUDY DESIGN: Prospective experimental study. SAMPLE POPULATION: Surgical teams participating in 65 individual surgical procedures were included, resulting in 200 individual enrollments. METHODS: At the completion of surgery, gloves were removed and hands were swabbed. The inside of the gown cuff was swabbed. Each participant regloved, using a closed gloving technique. The new gloves were removed, and hands were swabbed for culture a second time. Swabs underwent standard bacterial culture. RESULTS: Before glove exchange, or baseline, contamination was found on 17/200 dominant hands and 13/200 nondominant hands. After performing CGE, contamination was found on 14/200 and 15/200 dominant and nondominant hands, respectively. No difference was detected between the number of CFUs cultured from a surgeon's hands before CGE and the number of CFUs cultured from a surgeon's hands post-CGE (one sided sign test, p = .61). Twelve (12) different bacterial species were identified, the most common were Staphylococcus spp. (97/154; 63%). CONCLUSION: Closed glove exchange did not increase bacterial hand contamination over baseline levels. CLINICAL SIGNIFICANCE: We found no evidence to support discontinuing CGE.

In vitro elution of amikacin from four hydrogel preparations: A pilot study.

OBJECTIVE: To determine in vitro elution of amikacin from poloxamer 407 NF, 1% carboxymethylcellulose (CMC), 3% CMC, 5% CMC, and control (sterile water). STUDY DESIGN: Descriptive in vitro. SAMPLE POPULATION: Triplicate samples from each experimental group. METHODS: Amikacin solution was prepared in poloxamer 407 NF, 1% CMC, 3% CMC, 5% CMC, or sterile water. Then, 1 ml of phosphate-buffered saline (PBS) was added to each of three aliquots per base and the samples were incubated at 37°C. PBS was removed and replaced at 1, 4, 8, 12, 24, 48, 72, 96, 120, 144, 168, 192, 216, and 240 hours and amikacin concentration was measured. RESULTS: The highest median concentration of amikacin in the eluent of poloxamer 407 NF, 3% CMC, and 5% CMC was observed at 48 hours: 3300, 3030, and 2190 µg/ml, respectively. The highest median concentration of amikacin in the eluent of 1% CMC and sterile water were observed at 1 hour: 13300 and 15600 µg/ml, respectively. Median eluent concentration of amikacin exceeded 2000 µg/ml (the reported minimum inhibitory concentration [MIC] of certain biofilm-producing methicillin-resistant Staphylococcus pseudintermedius) from 24 to 96 hours for poloxamer 407 NF, 24-72 hours for 3% CMC, 48-72 hours for 5% CMC, 1-4 hours for 1% CMC, and 1-4 hours for sterile water. CONCLUSION: Amikacin elution from tested substances reached or exceeded target MIC during the 240 hours tested. CLINICAL SIGNIFICANCE: Hydrogel-amikacin solutions may be useful topical treatment options for some infected wounds. In vivo safety and efficacy should be evaluated.

Carotid pseudoaneurysm in a kitten after accidental puncture with a needle.

Case summary: A 3-month-old intact male domestic shorthair kitten's cervical region was inadvertently punctured during routine subcutaneous fluid administration. A swelling rapidly developed on the left lateral neck and continued to grow, despite compression. An emergency facility evaluated the kitten 48 h later and the swelling was determined to be blood. Fine-needle aspiration of the swelling resulted in further swelling of the mass on the neck. The kitten began showing signs of systemic shock, necessitating a blood transfusion. The kitten was referred to a tertiary facility 24 h later for further diagnostics and treatment. CT of the head and neck revealed a large fluid-filled mass with progressive contrast enhancement noted during the filling phase, consistent with active hemorrhage. A carotid pseudoaneurysm was suspected and surgery was recommended. The left carotid artery was ligated proximal to the pseudoaneurysm; hemorrhage continued and the swelling was further explored. A small connection to the carotid artery within the medial aspect of the swelling was identified and ligated. The kitten required autotransfusion and massive allotransfusion during surgery due to blood loss. Recovery was uneventful. A head tilt and Horner's syndrome were noted postoperatively and improved over the following months. Histopathology was consistent with pseudoaneurysm. Relevance and novel information: This is the first reported case of pseudoaneurysm in a kitten that was treated surgically, with massive blood transfusion and minimal complications. Early surgical intervention can result in excellent prognosis. The need for blood product administration should be anticipated.

Surgical ligation of patent ductus arteriosus in dogs: Incidence and risk factors for rupture.

OBJECTIVE: To determine the rates of rupture and mortality associated with surgical ligation of patent ductus arteriosus (PDA) in dogs and to identify risk factors for rupture. STUDY DESIGN: Retrospective cohort. ANIMALS: Two-hundred and eighty-five dogs with PDA undergoing surgical ligation. METHODS: Information regarding signalment, weight, surgical findings, complications, presence of residual flow, and survival was recorded. Age, weight, and presence of residual flow were compared between cases with and without rupture. RESULTS: The initial surgical approach was extrapericardial (144), intrapericardial (46), not reported (94), or Jackson-Henderson (1). Rupture of the PDA occurred in 7.0% of dogs (20/285, 13 extrapericardial, 3 intrapericardial, 4 not reported). No difference in age or weight was found between dogs with and without rupture. Overall mortality was 0.4% (1/285). Additional major complications occurred in 1.4% of dogs, all in the nonrupture group. The overall rate of residual flow after ligation was 9.4%. Dogs with rupture were more likely to have residual flow than those without rupture (P = .012). If ligation was performed after rupture (rather than hemostasis only), no difference in residual flow rates (P = .398) was noted between dogs with rupture and those without. CONCLUSION: The rate of rupture with surgical ligation of PDAs was low. No specific risk factors for rupture were identified. CLINICAL SIGNIFICANCE: Successful treatment of PDA rupture is possible, evidenced by the low mortality rate in this population of dogs. Ligation of the PDA after rupture, either in the concurrent or a subsequent procedure, reduces the odds of residual flow.

Short- and long-term survival after adrenalectomy in 53 dogs with pheochromocytomas with or without alpha-blocker therapy.

OBJECTIVE: To report data related to the short- and long-term survival of dogs undergoing adrenalectomy for pheochromocytoma, and to determine the influence of preoperative alpha-blocker therapy. STUDY DESIGN: Retrospective. ANIMALS: Fifty-three dogs. METHODS: Medical records were reviewed for dogs diagnosed with pheochromocytoma and treated with adrenalectomy between 2010 and 2020. Preoperative management, imaging studies, intraoperative cardiovascular instability, complications, and procedural information were recorded. When applicable, duration of survival and cause of death, time to recurrence or metastasis, and postoperative complications were recorded. RESULTS: During anesthesia, a hypertensive episode was documented in 46/53 dogs and arrhythmias were recorded in 16/53 dogs. Of these, 37/46 hypertensive dogs and 11/16 dogs with arrhythmias were treated with an alpha-blocker before surgery. Intraoperative systolic blood pressures reached higher levels by a magnitude of nearly 20% in dogs that were treated preoperatively with an alpha-blocker (P = .01). All dogs survived surgery and 44 survived to discharge. Follow up ranged from 6 to 1653 days (median 450 days). Median survival time for dogs discharged from the hospital was 1169 days (3.2 years). Recurrence and metastasis were suspected in 3 and 8 dogs, respectively. CONCLUSION: Most dogs survived the immediate postoperative period and achieved long-term survival with a low reported incidence of tumor recurrence or metastasis. Preoperative alpha-blocker therapy was not associated with increased survival. CLINICAL SIGNIFICANCE: The favorable outcomes reported in this study should be taken into consideration when discussing treatment options for dogs with pheochromocytomas. This study provides no evidence to support preoperative alpha-blocker therapy.

The effect of a smoke-evacuation unit on ultrafine particle concentrations in the operating room during approach to the proximal tibia for tibial plateau-leveling osteotomy surgery in dogs.

OBJECTIVE: To evaluate the effectiveness of a smoke-evacuation unit on reducing ultrafine particle concentration in the operating room (OR) during the approach to the proximal tibia for tibial plateau-leveling osteotomy (TPLO). STUDY DESIGN: Prospective, randomized, controlled clinical trial. SAMPLE POPULATION: Twenty-nine client-owned dogs undergoing unilateral TPLO at a single institution were assigned to either smoke-evacuator groups (SE; n = 15) or non-smoke-evacuator groups (NSE; n = 14). METHODS: Dogs were randomly assigned to the SE group or the NSE group. An airborne particle measuring device measured and recorded baseline and intraoperative particles per cm3 (ppc) during the approach to the proximal tibia during which electrosurgery was used to provide hemostasis, dissect subcutis, transect and elevate fascia. The mean ppc, maximum ppc, and baseline ppc were compared between groups. Mean ppc was also compared to the baseline ppc within each group. RESULTS: During surgery, mean ppc (1352) and maximum ppc (62 450) for the NSE group were higher in than mean ppc (763) and maximum ppc (10 100) for the SE group (P < .0001, P < .0001, respectively). Mean ppc was higher in both SE (mean ppc = 763; P < .0001) and NSE (mean ppc = 1352; P = .0001) than their respective baseline ppc (213 and 240). CONCLUSION: The use of a smoke evacuator decreased particle concentrations 56.4% during the approach to the proximal tibia. Performing the approach to the proximal tibia resulted in higher particle concentrations than the baseline, regardless of smoke-evacuator use. CLINICAL SIGNIFICANCE: Surgeons should be aware of smoke produced by electrosurgery, potential health consequences, and methods of smoke mitigation (smoke evacuation).

Incidence, survival time, and surgical treatment of parathyroid carcinomas in dogs: 100 cases (2010-2019).

OBJECTIVE: To evaluate outcomes of dogs with parathyroid carcinoma (PTC) treated by surgical excision and to describe the incidence of postoperative hypocalcemia, degree of hypocalcemia, duration of hospitalization, duration of calcium supplementation, and survival time. ANIMALS: 100 client-owned dogs with PTC admitted to academic, referral veterinary institutions. PROCEDURES: In a retrospective multi-institutional study, medical records of dogs undergoing surgical excision of PTC between 2010 to 2019 were reviewed. Signalment, relevant medical history, clinical signs, clinicopathologic testing, imaging, surgical findings, intraoperative complications, histologic examination, and survival time were recorded. RESULTS: 100 dogs with PTC were included, and 96 dogs had clinical or incidental hypercalcemia. Common clinical signs included polyuria (44%), polydipsia (43%), hind limb paresis (22%), lethargy (21%), and hyporexia (20%). Cervical ultrasonography detected a parathyroid nodule in 91 of 91 dogs, with a single nodule in 70.3% (64/91), 2 nodules in 25.3% (23/91), and ≥ 3 nodules in 4 (4/91)% of dogs. Hypercalcemia resolved in 89 of 96 dogs within 7 days after surgery. Thirty-four percent of dogs developed hypocalcemia, on the basis of individual analyzer ranges, within 1 week after surgery. One dog had metastatic PTC to the prescapular lymph node, and 3 dogs were euthanized for refractory postoperative hypocalcemia. Estimated 1-, 2-, and 3-year survival rates were 84%, 65%, and 51% respectively, with a median survival time of 2 years. CONCLUSIONS AND CLINICAL RELEVANCE: Excision of PTC results in resolution of hypercalcemia and excellent long-term tumor control. Surgical excision of PTC is recommended because of resolution of hypercalcemia and a good long-term prognosis. Future prospective studies and long-term follow-up are needed to further assess primary tumor recurrence, metastasis, and incidence of postoperative hypocalcemia.

Comparison of bacteriologic culture results for skin wound swabs and skin wound biopsy specimens.

OBJECTIVE: To compare bacteriologic culture results for superficial swab and tissue biopsy specimens obtained from dogs with open skin wounds. ANIMALS: 52 client-owned dogs. PROCEDURES: For each dog, 1 wound underwent routine preparation prior to collection of 2 specimens, 1 by superficial swab (Levine) technique and 1 by tissue biopsy. Specimens were processed for bacteriologic culture. Two observers determined whether any detected difference in culture results for the 2 types of specimen would have resulted in differing treatment plans. RESULTS: Culture results of swab and tissue biopsy specimens were identical in 11/52 (21.2%) cases. Tissue biopsy specimen and swab cultures yielded positive results for 44 (84.6%) and 40 (76.9%) wounds, respectively. With regard to mean recovery rates of bacteria from wounds with positive culture results, both the biopsy specimens and swabs yielded 3.4 bacterial species/wound. All wounds for which swab cultures yielded no growth also had negative culture results for biopsy specimens. Biopsy specimen and swab culture results were in agreement with regard to the most common bacteria cultured. In 7/52 (13%) wounds, the observers would have treated the patient differently on the basis of the results of the 2 cultures. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that culture of a swab collected by the Levine technique is an appropriate noninvasive alternative to culture of a tissue biopsy specimen. A negative result obtained from culture of a swab is likely to be reliable. Disagreement between the results of swab and tissue biopsy specimen cultures is likely of low clinical importance.

The impact of a surgical checklist on surgical outcomes in an academic institution.

OBJECTIVE: To determine the influence of a surgical checklist (SC) on morbidities and compliance with safety measures. STUDY DESIGN: Before-and-after-intervention study. SAMPLE POPULATION: Three thousand two hundred eighty-six dogs: 1375 dogs pre-SC and 1911 post-SC. METHODS: Completion of safety measures and occurrence of morbidity and/or mortality during hospitalization and up to death or 30-days postoperatively were recorded. RESULTS: Safety measures were more frequently completed post-SC, including oral confirmation of patient identity (467/1177 [40%] vs. 1911/1911 [100%]) and oral confirmation of surgical site (568/1175 [48%] vs. 1911/1911 [100%]). In addition, duration of anesthesia decreased from 241 to 232 min (t = 2.824; p = .005); a greater proportion of animals that were intended to receive antibiotics did so prior to incision (1142/1316 [86.8%] vs. 1656/1845 [89.8%] [χ2 = 6.70, p = .01]); and fewer dogs had unplanned return to the OR (32/1065 [3.0%], vs. 21/1472 [1.4%]) (χ2 = 7.52, p = .006). No difference in surgical site infection (adjusted odds ratio 1.02 [95%CI: 0.63-1.66]); morbidity, (adjusted odds ratio 1.00 [95%CI: 0.77-1.29]); or death within 30 days (adjusted odds ratio 1.15 [95%CI: 0.72-1.83]) was detected on multivariable logistic regression analysis. The checklist prevented one wrong-site surgery. CONCLUSION: Implementation of the checklist at our institution led to a decrease in anesthesia duration, increased administration of planned perioperative antibiotics before incision, increased completion of safety measures, and decreased unexpected return to the OR. IMPACT: Despite the lack of effect on morbidities, the use of SC is recommended to improve compliance with safety measures and potentially prevent rare catastrophic events.

Adaptation of a hands-on veterinary surgical training course from a traditionally taught laboratory to a remotely taught laboratory during a global pandemic.

OBJECTIVE: The goal of this study was to evaluate and report details of a remotely taught surgical laboratory. STUDY DESIGN: Observational. SAMPLE POPULATION: Second-year veterinary students (n = 143) enrolled in a surgical laboratory; 9 weeks were taught traditionally, and 6 weeks were taught remotely. METHODS: Because of the global pandemic, remote laboratories were developed and delivered. Students performed surgical procedures in model organs remotely while being observed by and receiving feedback from instructors on an internet-based video platform. Methods for remote surgical teaching were explored, and successes and challenges were detailed. Surveys were administered to the students and faculty to gather perspectives on their experience and subsequent confidence. RESULTS: Surveys were completed by 81 of 143 (57%) students and seven of seven (100%) instructors. The mean overall student satisfaction score (1 not at all satisfied, 10 very satisfied) for in-person instruction was 8.2, and the mean score for remote instruction was 6.2 (P < .001). Overall, the instructors had a mean satisfaction score of 8 for in-person laboratories and a mean satisfaction score of 6 for remotely taught laboratories. Most students had a perception of greater one-on-one instructor attention in remote laboratories. Students reported similar confidence levels for three surgical procedures. CONCLUSION: The described remote teaching method resulted in the perception of greater instructor attention given to students. Student and instructor satisfaction was lower with remote teaching than with in-person teaching. IMPACT: The described method of remote teaching may be applied to teaching surgical students in settings when face-to-face instruction cannot be achieved and may be developed further to create an experience equivalent to face-to-face instruction.

Randomized, controlled clinical trial to assess the effect of antimicrobial-impregnated suture on the incidence of surgical site infections in dogs and cats.

OBJECTIVE: To evaluate the prophylactic efficacy of triclosan-coated (TC) suture in preventing surgical site infections (SSIs) in dogs and cats undergoing surgical procedures. ANIMALS: 862 animals (794 dogs and 68 cats). PROCEDURES: Incidences of SSI of surgical wounds closed with TC suture and surgical wounds closed with non-TC suture occurring between the time of surgery and 1 month postoperatively were compared. Animals were randomly assigned to TC or non-TC suture groups. When TC suture was assigned, all suture available as TC material was used rather than non-TC suture. Presence of an SSI was determined by an owner questionnaire or direct examination. RESULTS: Overall, 50 of 862 (5.8%) animals developed SSIs. Incidence of SSI was 6% (24/428) in the non-TC suture group and 6% (26/434) in the TC suture group. No significant difference was found in the incidence of SSI between groups. No significant difference was detected in the incidence of incisional problems (eg, redness, dehiscence, and seroma formation) between animals in which TC suture was used and those in which non-TC suture was used. On multivariable analysis, other factors were associated with increased SSI rates, including an incision length > 10 cm, surgery performed by the soft tissue surgery department, and anesthesia duration of > 240 minutes. CONCLUSIONS AND CLINICAL RELEVANCE: No significant difference in incidence of SSI was detected between animals undergoing surgical procedures performed with non-TC versus TC suture.

Prognostic factors for short-term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018).

OBJECTIVE: To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS). STUDY DESIGN: Multi-institutional retrospective study. SAMPLE POPULATION: Ninety-three client-owned dogs. METHODS: Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS. RESULTS: Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P = .004) and development of focal PAS only (P = .0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures. CONCLUSION: Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival. CLINICAL SIGNIFICANCE: The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons.

Influence of a cell salvage washing system and leukocyte reduction filtration on bacterial contamination of canine whole blood ex vivo.

OBJECTIVE: To determine the ability of cell salvage washing and leukoreduction filtration to remove bacterial contamination from canine whole blood. STUDY DESIGN: Ex vivo nested cohort study. SAMPLE POPULATION: Commercially purchased fresh canine whole blood (n = 33 units). METHODS: Commercially obtained canine whole blood was inoculated with known concentrations of one of three species of bacteria, Escherichia coli (ATCC 25922), Staphylococcus pseudintermedius (quality control strain; Texas A&M University), or Pseudomonas aeruginosa (ATCC 27853). Negative controls were inoculated with sterile saline. The inoculated blood was processed through a cell salvage system and filtered through a series of two leukocyte reduction filters. Samples were aseptically collected at five points during processing (inoculum, prewash, postwash, post-first filtration, and post-second filtration) for bacterial enumeration. RESULTS: Bacterial concentrations were reduced by 85.2%, 91.5%, and 93.9% for E coli, S pseudintermedius, and P aeruginosa, respectively, after washing (P < .0001), and bacterial concentrations were reduced by 99.9%, 100%, and 100%, respectively, after the first filtration (P < .0001). After the second filtration, none of the three species of bacteria could be isolated (100% reduction). No bacterial growth was obtained from negative controls throughout the study. The type of bacteria (P = .29) did not allow prediction of bacterial reduction. CONCLUSION: Cell salvage washing combined with leukoreduction filtration eliminated bacterial contamination of whole dog blood (P < .0001). CLINICAL SIGNIFICANCE: Cell salvage washing and leukoreduction filtration could be applied to intraoperative autotransfusion in clinical animals, especially those treated for trauma or hemorrhage with concurrent bacterial contamination.

Norwich terriers possess a greater vertebral heart scale than the canine reference value.

Previous studies have demonstrated evidence that normal reference ranges for radiographic vertebral heart scale values can vary among dog breeds. The purpose of this retrospective, observational study was to determine whether the normal vertebral heart scale values published by Buchanan and Bücheler for lateral radiographs are applicable to the Norwich terrier. Secondary objectives were to determine if clinical signs of respiratory disease, age, sex, weight, body condition score, recumbency, or thoracic depth-to-width ratio had any influence on vertebral heart scale measurements in this breed. The electronic medical record systems of two universities were reviewed and Norwich terriers were included in the study if they had orthogonal thoracic radiographs performed and no historical or radiographic evidence of cardiopulmonary disease. A vertebral heart scale was calculated for each patient. Sixty-one client-owned, Norwich terrier dogs with no clinical signs of cardiovascular disease were evaluated. The vertebral heart scale for Norwich terriers without evidence of cardiac disease (10.6 ± 0.6) was found to be significantly greater than the canine reference value of 9.7 ± 0.5 initially established by Buchanan and Bücheler. No significant correlation was found between clinical signs of respiratory disease, sex, age, thoracic depth-to-width ratio or lateral recumbency, and vertebral heart scale. Norwich terriers with a body condition score ≥6 had a significantly higher vertebral heart scale than those with a body condition score ≤5. Breed-specific ranges and body condition scores need to be considered when interpreting vertebral heart scale values for Norwich terriers.

Intestinal incisional dehiscence rate following enterotomy for foreign body removal in 247 dogs.

OBJECTIVE: To report the intestinal incisional dehiscence rate following enterotomy for foreign body removal in dogs. ANIMALS: 247 client-owned dogs with intestinal foreign bodies treated with enterotomy between November 2001 and September 2017. PROCEDURES: Medical records were reviewed, and data were collected regarding signalment, history, surgery, clinicopathologic findings, hospitalization, intestinal incisional dehiscence, and survival to hospital discharge. Dogs were grouped according to whether intestinal incisional dehiscence occurred (dehiscence group) or did not occur (nondehiscence group) following enterotomy, and the rate of dehiscence for the total number of enterotomies during the study period was calculated. Univariable analysis was performed to identify variables associated with intestinal incisional dehiscence. RESULTS: 8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge. Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge. Duration of hospitalization was longer for dogs in the dehiscence group than for dogs in the nondehiscence group. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that enterotomy for intestinal foreign body removal had a lower rate of dehiscence in dogs during the study period, compared with rates previously reported; however, the low rate should not be used as a reason to perform an enterotomy rather than an enterectomy when needed. Surgeons should thoroughly evaluate the bowel and perform an enterotomy only when indicated.

Long-term outcome and risk factors associated with death or the need for revision surgery in dogs with permanent tracheostomies.

OBJECTIVE: To evaluate long-term outcomes and identify factors associated with death or the need for revision surgery in dogs with permanent tracheostomies (PTs). DESIGN: Retrospective cohort study. ANIMALS: 69 client-owned dogs that received a PT between January 2002 and June 2016 at 1 of 4 veterinary teaching hospitals. PROCEDURES: Medical records were reviewed, and data extracted included signalment, history, clinical signs, radiographic and laryngeal examination findings, presence of esophageal abnormalities, date and reason for receiving a PT, postoperative complications, cause of death, and survival time. Dogs surviving < 2 weeks after receiving a PT were excluded. RESULTS: Major complications occurred in 42 of 69 (61%) dogs, with aspiration pneumonia (13 [19%]), skinfold occlusion (13 [19%]), and stoma stenosis (12 [17%]) being most common. Revision surgery was performed in 24 of 69 (35%) dogs, most commonly because of stoma stenosis or skinfold occlusion (9/24 [38%] each). Brachycephalic dogs were more likely (OR, 3.5; 95% confidence interval, 1.2 to 10.2) to require revision surgery than were nonbrachycephalic dogs. The overall median survival time was 1,825 days, and dogs that received corticosteroids before receiving a PT, had tracheal collapse, or were older had shorter survival times. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study indicated that creation of a PT was a viable treatment option for obstructive upper airway diseases in dogs and that long-term survival after receiving a PT was possible; however, a PT may not reduce the risk of aspiration pneumonia in dogs.