Medication errors in veterinary anesthesia: a literature review.

OBJECTIVE: To provide an overview of medication errors (MEs) in veterinary medicine, with a focus on the perianesthetic period; to compare MEs in veterinary medicine with human anesthesia practice, and to describe factors contributing to the risk of MEs and strategies for error reduction. DATABASES USED: PubMed and CAB abstracts; search terms: [("patient safety" or "medication error∗") AND veterin∗]. CONCLUSIONS: Human anesthesia is recognized as having a relatively high risk of MEs. In veterinary medicine, MEs were among the most commonly reported medical error. Predisposing factors for MEs in human and veterinary anesthesia include general (e.g. distraction, fatigue, workload, supervision) and specific factors (e.g. requirement for dose calculations when dosing for body mass, using several medications within a short time period and preparing syringes ahead of time). Data on MEs are most commonly collected in self-reporting systems, which very likely underestimate the true incidence, a problem acknowledged in human medicine. Case reports have described a variety of MEs in the perianesthetic period, including prescription, preparation and administration errors. Dogs and cats were the most frequently reported species, with MEs in cats more commonly associated with harmful outcomes compared with dogs. In addition to education and raising awareness, other strategies described for reducing the risk of MEs include behavioral, communication, identification, organizational, engineering and cognitive aids.

Veterinary students' attitudes toward anesthesiology as a specialty.

OBJECTIVE: To identify the perceptions of veterinary students interested in specialization regarding veterinary anesthesiology. STUDY DESIGN: Cross-sectional, multi-institutional, voluntary, anonymous, nonrandomized survey. POPULATION: Veterinary students (303 of 557 total respondents) from 10 veterinary schools. METHODS: Quantitative data were obtained via 5-point Likert scale questions about anesthesia-related topics. Open-ended questions were used to obtain qualitative data. A multivariate logistic regression model assessed the likelihood of choosing a career as an anesthesiologist. Spearman's rank correlation coefficient was used to assess the relationship between 'anesthesia is interesting' and other variables. RESULTS: Of the respondents, 14 (6%) indicated veterinary anesthesia as their chosen specialty. There was a significant positive relationship between 'anesthesia is interesting' and the following variables: age, enjoyment in anesthesia class, belief in the importance of anesthesia for their career, belief in the importance of analgesia for their career, belief that anesthesia and analgesia have a large impact on patient care, interest in pharmacology, interest in physiology, interest in learning technical skills, belief that anesthesiologists are respected by their colleagues and belief that anesthesiologists are an important part of the health care team. More weeks on the anesthesia clinical rotation was positively and significantly associated with increased rotation enjoyment. Enjoyment in the anesthesia class [p = 0.001, Exp(ß) = 2.1, 95% confidence interval (CI): 1.3-3.4] and belief that anesthesia is interesting [p = 0.013, Exp(ß) = 2.6, 95% CI: 1.2-5.4] were predictors that respondents would be more likely to consider a career as a veterinary anesthesiologist. CONCLUSIONS: Those veterinary students with an interest in pharmacology and who enjoyed their anesthesia course were more likely to consider a career as a veterinary anesthesiologist. If students indicated no interest in specializing in veterinary anesthesia, they appreciated the value the specialty brings to animal care and believed that veterinary anesthesiologists are respected by their peers.

Nerve stimulator-guided mandibular block in an alpaca undergoing dental extraction.

General anesthesia of a 2-year-old castrated male alpaca undergoing mandibular tooth extraction was successfully managed via a mandibular nerve block with bupivacaine, using nerve stimulation to confirm correct needle placement. The local block was effective, with no cardiovascular or respiratory responses to surgical stimulation observed. Key clinical message: Use of a locoregional technique in dentistry confers anesthetic stability, blocks nociceptive responses to surgery, and promotes a smooth recovery and comfortable postoperative period.

Bloc du nerf mandibulaire confirmé en utilisant la stimulation nerveuse chez un alpaga subissant une extraction dentaire. L'anesthésie générale d'un alpaga mâle castré de 2 ans subissant une extraction de dent mandibulaire a été gérée avec succès par un bloc du nerf mandibulaire avec de la bupivacaïne en utilisant la stimulation nerveuse. Aucune réaction contre la stimulation chirurgicale, y compris une augmentation de la fréquence cardiaque et de la pression artérielle, n'a été observée pendant l'opération.Message clinique clé :L'utilisation d'une technique locorégionale en dentisterie confère une stabilité anesthésique, bloque les réactions nociceptives à la chirurgie et favorise un rétablissement en douceur et une période postopératoire confortable.(Traduit par les auteurs).

A prospective survey of veterinary anesthesia equipment in Alberta, Canada, using a standardized checkout procedure.

Background: In both human and veterinary medicine, it is recommended that an anesthetic machine checkout procedure (preuse check) be performed daily, with some items tested before each case, to confirm safe function and the check results recorded. Objective: The objective of this prospective study was to evaluate anesthetic machines in private veterinary clinics in Alberta (Canada) using a standardized checkout procedure. Animals and procedures: One-hundred consecutive anesthetic machines were assessed. For each item of the checkout procedure, a "pass," "fail," or "not applicable" score was awarded. "Not applicable" indicated an item that could not be evaluated. Results: Few machines (10%) evaluated had a secondary oxygen supply, no machines had an oxygen supply pressure alarm, and leaks were identified in 31 and 17% of rebreathing and non-rebreathing systems, respectively. Thirty-nine percent of machines did not have a high-pressure circuit alarm, 86% of machines were attached to an active scavenging system, although it was improperly connected in 56% of cases, and only 2% of machines were accompanied by a checkout log. Conclusion and clinical relevance: There was widespread variation in anesthetic machine standards and function, highlighting the value of performing a regular machine checkout procedure in creating a foundation for safe anesthetic practice.

Une enquête prospective sur l'équipement d'anesthésie vétérinaire en Alberta, au Canada, à l'aide d'une procédure de vérification normalisée. Historique: En médecine humaine et vétérinaire, il est recommandé qu'une procédure de vérification de la machine d'anesthésie (vérification avant utilisation) soit effectuée quotidiennement, avec certains éléments testés avant chaque cas, pour confirmer le fonctionnement sécuritaire et les résultats de la vérification enregistrés. Objectif: L'objectif de cette étude prospective était d'évaluer les machines d'anesthésie dans les cliniques vétérinaires privées de l'Alberta (Canada) en utilisant une procédure de contrôle standardisée. Animaux et procédures: Cent machines d'anesthésie consécutives ont été évaluées. Pour chaque élément de la procédure de vérification, une note « réussite ¼, « échec ¼ ou « non applicable ¼ a été attribuée. « Sans objet ¼ indique un élément qui n'a pas pu être évalué. Résultats: Peu de machines (10 %) évaluées avaient une alimentation secondaire en oxygène, aucune machine n'avait d'alarme de pression d'alimentation en oxygène, et des fuites ont été identifiées dans 31 et 17 % des systèmes de ré-inhalation et sans ré-inhalation, respectivement. Trente-neuf pourcents des machines n'avaient pas d'alarme de circuit haute pression, 86 % des machines étaient rattachées à un système de balayage actif, bien qu'il soit mal raccordé dans 56 % des cas, et seulement 2 % des machines étaient accompagnées d'un journal de sortie. Conclusion et pertinence clinique: Il y avait une grande variation dans les normes et le fonctionnement des machines d'anesthésie, soulignant l'importance d'effectuer une procédure de vérification régulière de la machine pour créer une base pour une pratique anesthésique sûre.(Traduit par Dr Serge Messier).

Successful blood transfusion in a Holstein cow experiencing hemorrhagic shock under general anesthesia.

A 2-year-old Holstein cow weighing 530 kg at 2 mo gestation was scheduled for a paracostal laparotomy and abomasotomy following diagnosis of a reticular foreign body causing obstruction and abomasal impaction. Hemorrhagic shock occurred during surgery, with a rapid, approximately 60% decrease in arterial blood pressure, and reflex tachycardia with a 2-fold increase in heart rate. Following identification of hemorrhagic shock, arterial blood pressure was supported by reducing the inhalant anesthetic requirement, positive inotropic support (IV dobutamine infusion), and IV fluid therapy. Hypertonic saline was administered IV for initial resuscitation of arterial blood pressure, followed by a whole blood transfusion to replenish red blood cells, support oxygencarrying capacity, and provide intravascular volume to maintain cardiac output and tissue perfusion. A gradual increase in arterial blood pressure and a decrease in heart rate were observed in response to treatment. This case report demonstrates the physiologic compensatory response to hemorrhagic shock and the treatment to stabilize cardiovascular parameters in an anesthetized cow. Key clinical message: This case illustrates the physiological reponses to acute hemorrhage under general anesthesia and the effects of various treatment interventions.

Transfusion sanguine réussie chez une vache Holstein en état de choc hémorragique sous anesthésie générale. Une vache Holstein de 2 ans pesant 530 kg à 2 mois de gestation devait subir une laparotomie paracostale et une abomasotomie à la suite du diagnostic d'un corps étranger réticulaire provoquant une obstruction et une impaction abomasale. Un choc hémorragique est survenu pendant la chirurgie, avec une diminution rapide d'environ 60 % de la pression artérielle et une tachycardie réflexe avec une augmentation du double de la fréquence cardiaque. À la suite de l'identification d'un choc hémorragique, la pression artérielle a été soutenue en réduisant le besoin d'anesthésique inhalé, un soutien inotrope positif (perfusion de dobutamine IV) et une thérapie avec des fluides IV. Une solution saline hypertonique a été administrée par voie intraveineuse pour la restauration initiale de la pression artérielle, suivie d'une transfusion de sang total pour rétablir la quantité de globules rouges, soutenir la capacité de transport d'oxygène et fournir un volume intravasculaire pour maintenir le débit cardiaque et la perfusion tissulaire. Une augmentation progressive de la pression artérielle et une diminution de la fréquence cardiaque ont été observées en réponse au traitement. Ce rapport de cas démontre la réponse physiologique compensatoire au choc hémorragique et le traitement pour stabiliser les paramètres cardiovasculaires chez une vache anesthésiée.Message clinique clé :Ce cas illustre les réponses physiologiques à une hémorragie aiguë sous anesthésie générale et les effets de diverses interventions thérapeutiques.(Traduit par Dr Serge Messier).

Randomization, blinding, data handling and sample size estimation in papers published in Veterinary Anaesthesia and Analgesia in 2009 and 2019.

OBJECTIVE: To evaluate reporting of items indicative of bias and weak study design. STUDY DESIGN: Literature survey. POPULATION: Papers published in Veterinary Anaesthesia and Analgesia. METHODS: Reporting of randomization, blinding, sample size estimation and data exclusion were compared for papers published separated by a 10 year interval. A reporting rate of more than 95% was considered ideal. The availability of data supporting results in a publicly accessible repository was also assessed. Selected papers were randomized and identifiers removed for review, with data from 59 (57 in 2009, two in 2008) and 56 (52 in 2019, four in 2018) papers analyzed. Items were categorized for completeness of reporting using a previously published operationalized checklist. Two reviewers reviewed all papers independently. RESULTS: Full reporting of randomization increased over time from 13.6% to 85.7% [95% confidence interval (CI), 57.8-86.6%; p < 0.0001], as did sample size estimation (from 0% to 20%; 95% CI, 7.6-32.4%; p = 0.002). Reporting of blinding (49.2% and 50.0%; 95% CI, -18.3% to 20.0%; p = 1.0) and exclusions of samples/animals (39.0% and 50.0%; 95% CI, -8.8% to 30.8%; p = 0.3) did not change significantly. Data availability was low (2008/2009, zero papers; 2018/2019, two papers). None of the items studied exceeded the predetermined ideal reporting rate. CONCLUSIONS AND CLINICAL RELEVANCE: These results indicate that reporting quality remains low, with a risk of bias.

Is training necessary for efficacious use of the Glasgow Feline Composite Measure Pain Scale?

Objective: The Glasgow Feline Composite Measure Pain Scale (CMPS-F) is a validated cat pain assessment tool for clinical use. No research has examined how training impacts use of this tool. Thus, we examined whether seminar-style training improves the identification of cat pain when using the CMPS-F. Veterinarians (n = 17) and non-veterinarian staff (n = 33; N = 50) were recruited to participate. Procedure: Seminars included: i) pre-training use of the CMPS-F to score cat videos with varying degrees of pain; ii) cat pain assessment training; and iii) post-training use of the CMPS-F. Participant CMPS-F ratings were compared to experts' ratings of the same videos. Average CMPS-F scores and analgesic decision ratings were compared pre-and post-training. Results: Most participants were female non-veterinarian staff who had not heard of the CMPS-F. Participant and expert analgesic decision-making did not differ pre- (P = 1.0) and post-training (P = 0.1). In addition, analgesic decision-making was similar between participants and experts for all but 3/20 videos. Conclusion and clinical relevance: Seminar training may not be necessary for efficacious use of the CMPS-F. Further research is needed to explore strategies for improving awareness of cat pain assessment tools and increasing in-clinic use.

Objectif: L'échelle de mesure de la douleur féline composite de Glasgow (CMPS-F) est un outil validé d'évaluation de la douleur chez le chat à usage clinique. Aucune recherche n'a examiné l'impact de la formation sur l'utilisation de cet outil. Ainsi, nous avons examiné si la formation de type séminaire améliore l'identification de la douleur du chat lors de l'utilisation du CMPS-F. Des vétérinaires (n = 17) et du personnel non vétérinaire (n = 33; N = 50) ont été recrutés pour participer. Procédure: Les séminaires comprenaient : i) l'utilisation du CMPS-F avant la formation pour noter des vidéos de chats avec différents degrés de douleur; ii) formation à l'évaluation de la douleur chez le chat; et iii) l'utilisation du CMPS-F après la formation. Les notes CMPS-F des participants ont été comparées aux notes des experts des mêmes vidéos. Les scores CMPS-F moyens et les cotes de décision analgésique ont été comparés avant et après la formation. Résultats: La plupart des participants étaient du personnel féminin non vétérinaire qui n'avait jamais entendu parler du CMPS-F. La prise de décision des participants et des experts en matière d'analgésie ne différait pas avant (P = 1,0) et après la formation (P = 0,1). De plus, la prise de décision analgésique était similaire entre les participants et les experts pour toutes les vidéos sauf 3/20. Conclusion et pertinence clinique: La formation en séminaire peut ne pas être nécessaire pour une utilisation efficace du CMPS-F. Des recherches supplémentaires sont nécessaires pour explorer des stratégies visant à améliorer la sensibilisation aux outils d'évaluation de la douleur chez les chats et à accroître leur utilisation en clinique.(Traduit par Dr Serge Messier).

A practical guide to implementing clinical audit.

Clinical audit is a quality improvement tool for evaluating and improving patient care and outcomes. This is achieved by systematically reviewing current practices against explicit criteria and measuring the impact of change(s) introduced to generate improvement. The clinical audit process can be described by "Plan," "Do," "Study," "Act" phases that comprise an audit cycle. The phases are moved through in turn to attempt quality improvement. Clinical audits are widely used in human medicine at both local (individual clinic or hospital) and national (to achieve nationwide improvements in care) levels. Substantial and sustained improvements in patient care have been attributed to the use of clinical audits. Clinical audits have been described in the veterinary literature since the 1990s, but their adoption does not appear widespread. This paper is intended as a practical, "how to" guide to applying clinical audit in veterinary practice.

Un guide pratique pour la mise en place d'un audit clinique. Un audit clinique est un outil d'amélioration de la qualité pour évaluer et améliorer les soins aux patients et les résultats. Ceci est obtenu en révisant systématiquement les pratiques actuelles envers des critères spécifiques et en mesurant l'impact des changements introduits pour générer une amélioration. Le processus d'audit clinique peut être décrit par les phases « Planifier ¼, « Exécuter ¼, « Examiner ¼ et « Agir ¼ qu'incluent un cycle d'audit. Le passage en séquence des phases vise une amélioration de la qualité. Les audits cliniques sont utilisés extensivement en médecine humaine à l'échelle locale (clinique individuelle ou hôpital) et nationale (pour atteindre des améliorations des soins à la grandeur du pays). Des améliorations substantielles et soutenues dans les soins aux patients ont été attribuées à l'utilisation des audits cliniques. Les audits cliniques ont été décrits dans la littérature vétérinaire depuis le début des années 1990, mais l'adhésion ne semble pas être répandue. Cet article se veut un guide pratique sur le « comment faire ¼ pour mettre en application un audit clinique en pratique vétérinaire.(Traduit par Dr Serge Messier).

Reducing length of stay with the direct oral anti-coagulants in low and intermediate risk pulmonary embolism: a single center experience.

Direct oral anti-coagulants (DOACs) reduce hospital length-of-stay (LOS) in patients with acute pulmonary embolism (PE) in clinical trials. There is a paucity of literature describing real world utility of DOACs, particularly in intermediate-risk patients. To evaluate if the utilization of DOACs vs. non-DOACs in acute PE patients, reduces LOS without a difference in safety in patients defined as low and intermediate-risk of mortality by the European Society of Cardiology. This was a retrospective cohort study of prospectively collected data from a single center registry of consecutive adult outpatients diagnosed with acute PE who survived to hospital discharge. Primary outcome was median hospital LOS. Secondary outcomes were 30-day readmission, survival, and incidence of major and minor bleeding. There were 307 outpatients admitted with acute PE 88 (28.7%) low-risk, 213 (69.4%) intermediate-risk, and 6 (2.0%) high-risk. Two hundred and twenty-six (73.6%) received a DOAC. There was a statistically significant shorter median LOS in all patients treated with a DOAC (2.9 days, IQR 1.8-4.7) vs non-DOAC (4.9 days, IQR 3-8.9) (Generalized Linear Model p < 0.001). There was a shorter median LOS between intermediate-risk patients treated with a DOAC (3.6 days, IQR 2-5.8) vs non-DOAC (5, IQR 3-9). There was no difference in 30-day readmission, survival, or bleeding complications in both cohorts. There was a reduction in LOS in low and intermediate risk patients treated with a DOAC without a difference in 30-day safety and efficacy. Treating acute PE patients with DOACs including intermediate-risk patients, compared to conventional anticoagulation, may facilitate early discharge, and potentially reduce hospital costs.

Predicting the duration of surgery and procedures in a veterinary referral center.

OBJECTIVE: To evaluate the ability of veterinary personnel to predict the duration of surgery and associated procedures in a referral center. STUDY DESIGN: Prospective observational study. SAMPLE POPULATION: Experienced surgeons (ES; n = 2, board certified for 10+ years), inexperienced surgeons (IS; n = 2, residency completed, not board certified), anesthesia animal health technicians (AAHT; n = 3) and surgery animal health technicians (SAHT; n = 2). METHODS: Surgeons and technicians predicted surgery duration (skin incision to final stitch/staple) and total procedure duration (TPD; from induction of anesthesia to extubation). Predictions were compared to actual durations with Bland-Altman plots to assess agreement (accuracy) as indicated by bias (mean of observed differences) and limits of agreement (LOA; bias ±1.96 SD). RESULTS: All groups underestimated TPD. Experienced surgeons predicted their own TPD more accurately (bias -20.1 ± 30.4 minutes [±SD]) and more consistently (narrower LOA) than IS for their own TPD (-40.1 ± 41.0 minutes). Experienced surgeon TPD predictions by AAHT were more accurate than those by ES (bias -16.0 ± 28.9 minutes, LOA 5% narrower). Inexperienced surgeon TPD predictions by AAHT were less consistent (wider LOA) than those by IS. Own surgery duration predictions by surgeons were similar in magnitude (ES surgery duration [ESSD] 8.3 ± 18.3, IS surgery duration [ISSD] surgery duration -7.9 ± 27.2 minutes), with greater consistency by ES (LOA 30% narrower). Anesthesia animal health technician predictions were similar to those of surgeons (ESSD 3.0 ± 19.3, ISSD -9.0 ± 28.7 minutes). Surgery animal health technician predictions were similar to those of AAHT for ESSD but were less accurate for ISSD. CONCLUSION: Surgery duration was more accurately predicted than TPD, which was most accurately predicted by anesthesia technicians. CLINICAL SIGNIFICANCE: Surgical procedure planning should involve personnel best able to predict total procedure durations; in this case, anesthesia technicians. Accurate planning will promote efficient operating room and personnel use.

Hypoventilation following oxygen administration associated with alfaxalone-dexmedetomidine-midazolam anesthesia in New Zealand White rabbits.

OBJECTIVE: To investigate the relationship between oxygen administration and ventilation in rabbits administered intramuscular alfaxalone-dexmedetomidine-midazolam. STUDY DESIGN: Prospective, randomized, blinded study. ANIMALS: A total of 25 New Zealand White rabbits, weighing 3.1-5.9 kg and aged 1 year. METHODS: Rabbits were anesthetized with intramuscular alfaxalone (4 mg kg-1), dexmedetomidine (0.1 mg kg-1) and midazolam (0.2 mg kg-1) and randomized to wait 5 (n = 8) or 10 (n = 8) minutes between drug injection and oxygen (100%) administration (facemask, 1 L minute-1). A control group (n = 9) was administered medical air 10 minutes after drug injection. Immediately before (PREoxy/air5/10) and 2 minutes after oxygen or medical air (POSToxy/air5/10), respiratory rate (fR), pH, PaCO2, PaO2, bicarbonate and base excess were recorded by an investigator blinded to treatment allocation. Data [median (range)] were analyzed with Wilcoxon, Mann-Whitney U and Kruskal-Wallis tests and p < 0.05 considered significant. RESULTS: Hypoxemia (PaO2 < 88 mmHg, 11.7 kPa) was observed at all PRE times: PREoxy5 [71 (61-81) mmHg, 9.5 (8.1-10.8) kPa], PREoxy10 [58 (36-80) mmHg, 7.7 (4.8-10.7) kPa] and PREair10 [48 (32-64) mmHg, 6.4 (4.3-8.5) kPa]. Hypoxemia persisted when breathing air: POSTair10 [49 (33-66) mmHg, 6.5 (4.4-8.8) kPa]. Oxygen administration corrected hypoxemia but was associated with decreased fR (>70%; p = 0.016, both groups) and hypercapnia (p = 0.016, both groups). Two rabbits (one per oxygen treatment group) were apneic (no thoracic movements for 2.0-2.5 minutes) following oxygen administration. fR was unchanged when breathing air (p = 0.5). PaCO2 was higher when breathing oxygen than air (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: Early oxygen administration resolved anesthesia-induced hypoxemia; however, fR decreased and PaCO2 increased indicating that hypoxemic respiratory drive is an important contributor to ventilation using the studied drug combination.

Dynamic prediction of fluid responsiveness during positive pressure ventilation: a review of the physiology underlying heart-lung interactions and a critical interpretation.

OBJECTIVE: Cardiovascular responses to hypovolemia and hypotension are depressed during general anesthesia. A considerable number of anesthetized and critically ill animals may not benefit hemodynamically from a fluid bolus; therefore, it is important to have measures for accurate prediction of fluid responsiveness. Static measures of preload, such as central venous pressure, do not provide accurate prediction of fluid responsiveness, whereas dynamic measures of cardiovascular function, obtained during positive pressure ventilation, are highly predictive. This review describes key physiological concepts behind heart-lung interactions during positive pressure ventilation, factors that can modify this relationship and provides the basis for a rational interpretation of the information obtained from dynamic measurements, with a focus on pulse pressure variation (PPV). DATABASE USED: PubMed. Search items used were: heart-lung interaction, positive pressure ventilation, pulse pressure variation, dynamic index of fluid therapy, goal-directed hemodynamic therapy, dogs, cats, pigs, horses and rabbits. CONCLUSIONS: The veterinary literature suggests that targeting specific PPV thresholds should guide fluid therapy in lieu of conventional assessments. Understanding the physiology of heart-lung interactions during intermittent positive pressure ventilation provides a rational basis for interpreting the literature on dynamic indices of fluid responsiveness, including PPV. Clinical trials are needed to evaluate whether goal-directed fluid therapy based on PPV results in improved outcomes in veterinary patient populations.

Agreement between invasive and oscillometric arterial blood pressure measurements using the LifeWindow multiparameter monitor and two cuff sizes in anesthetized adult horses.

OBJECTIVE: To assess agreement between oscillometric noninvasive blood pressure (NIBP) measurements using LifeWindow monitors (LW9xVet and LW6000V) and invasive blood pressure (IBP). To assess the agreement of NIBP readings using a ratio of cuff width to mid-cannon circumference of 25% and 40%. STUDY DESIGN: Prospective, randomized clinical study. ANIMALS: A total of 43 adult horses undergoing general anesthesia in dorsal recumbency for different procedures. METHODS: Anesthetic protocols varied according to clinician preference. IBP measurement was achieved after cannulation of the facial artery and connection to an appropriately positioned transducer connected to one of two LifeWindow multiparameter monitors (models: LW6000V and LW9xVet). Accuracy of monitors was checked daily using a mercury manometer. For each horse, NIBP was measured with two cuff widths (corresponding to 25% or 40% of mid-cannon bone circumference), both connected to the same monitor, and six paired IBP/NIBP readings were recorded (at least 3 minutes between readings). NIBP values were corrected to the relative level of the xiphoid process. A Bland-Altman analysis for repeated measures was used to assess bias (NIBP-IBP) and limits of agreement (LOAs). RESULTS: The 40% cuff width systolic arterial pressure [SAP; bias 7.9 mmHg, LOA -26.6 to 42.3; mean arterial pressure (MAP): bias 4.9 mmHg, LOA -28.2 to 38.0; diastolic arterial pressure (DAP): bias 4.2 mmHg, LOA -31.4 to 39.7)] performed better than the 25% cuff width (SAP: bias 26.4 mmHg, LOA -21.0 to 73.9; MAP: bias 15.7 mmHg, LOA -23.8 to 55.2; DAP: bias 10.9 mmHg, LOA -33.2 to 54.9). CONCLUSIONS AND CLINICAL RELEVANCE: Using the LifeWindow multiparameter monitor in anesthetized horses, the 40% cuff width provided better agreement with IBP; however, both cuff sizes and both monitor models failed to meet American College of Veterinary Internal Medicine Consensus Statement Guidelines.

Impact of preanaesthetic echocardiography on the planned anaesthetic management of cats.

OBJECTIVE: To assess the impact of preanaesthetic echocardiography on the subsequent intended anaesthetic management plan in cats with incidental clinical findings that may indicate cardiac disease. STUDY DESIGN: Clinical study involving cats undergoing echocardiography and subsequent anaesthesia. ANIMALS: A total of 40 client-owned cats. METHODS: Echocardiography was performed in conscious cats and the information was used to plan anaesthesia or sedation. An information sheet including relevant history, temperament, body condition score, clinical examination findings, current medication and results of any relevant tests such as haematology, biochemistry or Doppler blood pressure measurement was sent to three specialist anaesthetists and virtual case management plans were designed for each cat in two steps: step 1) anaesthetists were unaware of echocardiography results; and step 2) anaesthetists were aware of echocardiography results. In the second step the anaesthetists documented any changes to their original management plan, as either 'step-up' or 'step-down'. RESULTS: Of the 40 cats, 26 had murmurs, four had a gallop rhythm, four had both findings and six had other findings. Pathology of potential haemodynamic significance was found on echocardiography in 23 cats, 17 of which anaesthetists had correctly identified as having disease before echocardiography. A proportion of cats with murmurs were subsequently deemed to have no significant pathology after echocardiography. Echocardiography findings in these cases were: dynamic left ventricular outflow tract obstruction (DLVOTO) without hypertrophy; DLVOTO without hypertrophy + dynamic right ventricular outflow tract obstruction (DRVOTO); DRVOTO; valvular dysplasia; normal. In a median of 26/40 (range 16-38) of cases, the anaesthetic plan was changed after provision of further information; in 15/40 (8-20) cases, this was a 'step-up' in care and in eight/40 (6-23) it was a 'step-down' in care. In cases with atrial enlargement (left atrium to aortic ratio of >1.6) and deemed at risk of cardiac failure, alpha-2 agonist use changed considerably with availability of echocardiography findings. CONCLUSION: and clinical relevance Where there are abnormal cardiac findings on clinical examination in cats, echocardiography is required to accurately assess anaesthetic risk . The availability of echocardiographic information positively influences anaesthetic management.

Management of a severe peripartum hemorrhage following cesarean section in a dog.

This report describes the intensive blood pressure management and transfusion of a peripartum intrauterine hemorrhage following a cesarean section in a dog. The impact of pregnancy-associated physiologic changes and anesthesia on hemodynamic parameters along with potential alternate management techniques are discussed.

Gestion d'une hémorragie péri-partum sévère à la suite d'une césarienne chez une chienne. Ce rapport décrit la gestion intensive de la pression sanguine et des transfusions lors d'une hémorragie intra-utérine péri-partum à la suite d'une césarienne chez une chienne. L'impact des changements physiologiques associés à la gestation et à l'anesthésie sur les paramètres hémodynamiques ainsi que des techniques de gestion alternatives sont discutés.(Traduit par Dr Serge Messier).

Prevalence and management of pain in dogs in the emergency service of a veterinary teaching hospital.

A prospective, observational, cross-sectional study documenting the prevalence of pain in dogs presented to the emergency service of a veterinary teaching hospital and their handling (times to triage, examination, treatment) was conducted. Pain was assessed and compared using a validated and an unvalidated pain assessment scale. Sedation was monitored using a validated scale. A first evaluation was completed in 109 dogs. A second evaluation was completed for 95 dogs: 36 (38%) were identified as painful and 53% (19/36) were provided analgesia in the clinic. The remainder either did not receive analgesia (6/36, 17%) or were prescribed an analgesic for administration at home (11/36, 31%). Of dogs receiving analgesia in the clinic, most showed a decrease in pain score (15/19, 79%). Pain assessment scales were positively correlated (r = 0.69, P < 0.0001) but the unvalidated scale was insensitive in discriminating changes. Between painful and non-painful dogs, progression did not differ: admission to treatment [P = 0.96, 95% confidence interval (CI): -23 to 22 minutes] and examination to treatment (P = 0.73, 95% CI: 14 to 20 minutes). Suboptimal analgesic use suggests focused training in pain assessment and analgesic use guided by a validated pain assessment scale, is warranted.

Prévalence et gestion de la douleur chez des chiens présentés au service d'urgence d'un hôpital d'enseignement vétérinaire. Une étude prospective, observationnelle et transversale a été réalisée pour documenter la prévalence de la douleur chez les chiens présentés au service d'urgence d'un hôpital universitaire vétérinaire ainsi que leur gestion (délai pour le triage, examen et traitement). Une échelle validée d'évaluation de la douleur a été utilisée pour évaluer la douleur à l'admission et suivant le traitement en clinique. A titre de comparaison, une échelle non validée d'évaluation de la douleur a également été utilisé et le degré de sédation a été documenté à l'aide d'une échelle de sédation validée. Une première évaluation a été complétée chez 109 chiens. Sur les 95 chiens pour lesquels une deuxième évaluation a été complétée, 36 (38 %) ont été identifiés comme étant en douleur et 53 % (19/36) ont reçu de l'analgésie en clinique. Les chiens restants n'ont soit pas reçu d'analgésie (6/36, 17 %) ou ont reçu une prescription pour un traitement analgésique à la maison (11/36, 31 %). Pour les chiens ayant reçu un traitement analgésique en clinique, la grande majorité ont démontré une diminution de leur score de douleur (15/19, 79 %). Une corrélation positive entre les deux échelles d'évaluation de la douleur était présente (r = 0,69, P < 0,0001), mais l'échelle non validée n'était pas sensible pour distinguer les changements de score de douleur. Il n'y avait pas de différence significative entre les chiens en douleur et non en douleur concernant le délai entre l'admission et le traitement (P = 0,96, 95 % CI : ­23 à 22 minutes) ou entre l'examen et le traitement (P = 0,73, 95 % CI : 14 à 20 minutes). L'administration d'analgésie était suboptimal dans la population étudiée, suggérant qu'un entraînement ciblé pour reconnaître et traiter la douleur à l'aide d'une échelle validée est recommandé.(Traduit par Dr Frédérik Rousseau-Blass).

Teleconsulting in the time of a global pandemic: Application to anesthesia and technological considerations.

As a result of the various restrictions associated with the current COVID-19 pandemic, the practice of veterinary telehealth is likely to grow substantially. One area in which high quality care can be maintained while respecting physical distancing is teleconsulting, which describes the relationship between an attending and off-site consulting veterinarian. This guide uses a dentistry case to illustrate the provision of real-time anesthesia consulting, with a focus on the technological considerations central to facilitating live, 2-way video-communication. Case selection, teamwork, and patient safety are also discussed.

Téléconsultation en temps de pandémie globale : application à l'anesthésie et considérations technologiques. Comme résultats des différentes restrictions associées à la présente pandémie de COVID-19, la pratique de télésanté vétérinaire est appelée à croître considérablement. Un domaine dans lequel des soins de haute qualité peuvent être maintenus tout en respectant la distanciation physique est la téléconsultation, qui décrit la relation entre un vétérinaire traitant et un vétérinaire consultant hors-site. Ce guide utilise un cas de dentisterie pour illustrer les exigences de consultation en temps réel pour l'anesthésie, avec une emphase sur les considérations technologiques essentielles pour faciliter une communication vidéo bidirectionnelle en direct. La sélection de cas, le travail d'équipe et la sécurité du patient sont également discutés.(Traduit par Dr Serge Messier).

Misconceptions surrounding the relationship between journal impact factor and citation distribution in veterinary medicine.

OBJECTIVE: To define the relationship between journal impact factor (JIF) and citation distribution in veterinary journals. Citation distribution is a summary of the number of citations of individual papers published in a defined period, and JIF is said to represent the mean number of citations received by a paper published in a given journal. JIF is criticized for promoting unimportant differences between journals, exaggerating small differences in journal citation distributions by misrepresenting a skewed citation distribution. The hypothesis was that veterinary journals have a skewed citation distribution and that median citation rates between journals would be smaller than that indicated by JIF. STUDY DESIGN: Bibliometric study. ANIMALS: None. METHODS: A published method was used to generate journal citation reports from a commercial database, with search limits set for document ('article' and 'review') and the 2 year citation window of interest. Citation distributions [median (range)] and cumulative citations were calculated for Veterinary Anaesthesia and Analgesia (Vet Anaesth Analg, 2007-2017), 11 preselected subject- and species-specific and general veterinary journals (2016) and veterinary journals from the top (n = 10) and bottom (n = 10) of the Veterinary Sciences category ranking (2016) with a 10 year publication record. RESULTS: Citation distributions were right-skewed for all journals, with 15-20% of papers contributing approximately 50% of citations. For Vet Anaesth Analg, the median citation distribution [1 (0-2)] did not change despite JIF ranging from 1.044 to 2.064 between 2007 and 2017. Calculated median citation rates revealed minimal differences between journals, with only three groups identified: bottom (median citation 0), preselected (median citation 1) and top (median citation 2) journals. These groups represent over 100 places in the JIF (0.316-3.148) ranking. CONCLUSIONS: Ranking veterinary journals according to JIF is misleading, exaggerating differences while concealing minimally different citation distributions.

Investigating novel anatomical predictors for endotracheal tube selection in dogs.

The selection of an appropriate endotracheal tube (ET) for orotracheal intubation in dogs is based largely on experience, with no well-established guidelines available. This study examined relationships between several novel and published methods for selecting endotracheal tubes in a heterogenous population of 79 adult dogs. The following measurements were included: left and right nare width, nasal septum width, sum of left and right nares width plus the nasal septum width, total nose width and height, tracheal width, metacarpal and digital footpad width and height, and body mass. Using the Bland and Altman ratio method, the calculation of Cube Root Mass provided the greatest accuracy and precision, predicting actual ET size use within 3 to 4 tube sizes. A simpler to calculate, but less precise method was Width of Nose/3. The majority of published methods for estimating ET size performed poorly, including nasal septum and tracheal width.

Résumé ­Étude de nouveaux prédicateurs anatomiques pour la sélection de tube endotrachéal chez les chiens. La sélection d'un tube endotrachéal (TE) approprié pour intubation orotrachéale chez les chiens est basée largement sur l'expérience, sans qu'il n'y ait de directives bien établies de disponibles. La présente étude a examiné les relations entre plusieurs méthodes nouvelles et publiées pour sélectionner les tubes endotrachéaux dans une population hétérogène de 79 chiens adultes. Les mesures suivantes étaient incluses : largeur des narines droite et gauche, largeur du septum nasal, somme de la largeur des narines droite et gauche plus la largeur du septum nasal, largeur totale du nez et hauteur, largeur de la trachée, largeur et hauteur des coussinets plantaires métacarpiens et digitaux, et masse corporelle. Utilisant la méthode de ratio de Bland et Altman, le calcul de la racine cubique de la masse a fourni la meilleure exactitude et précision, prédisant la dimension actuelle du TE utilisé à l'intérieur de trois à quatre dimensions de tubes. Une méthode de calcul plus simple, mais moins précise, était Largeur du Nez/3. La majorité des méthodes publiées pour estimer la dimension du TE performait pauvrement, incluant celles utilisant la largeur du septum nasal et la largeur de la trachée.(Traduit par Dr Serge Messier).