Antinociceptive effects of bupivacaine injected within the internal abdominis rectus sheath in standing healthy horses.

OBJECTIVE: To evaluate a regional anesthetic technique for blocking the abdominal midline in horses. STUDY DESIGN: Anatomical description and prospective, crossover, placebo-controlled, blinded study. ANIMALS: Adult horses; two cadavers, six healthy animals. METHODS: In stage 1, 0.5% methylene blue with 0.25% bupivacaine (0.5 mL kg-1) was injected using ultrasonography into the internal rectus abdominis sheath (RAS) of two cadavers with a one-point or two-point technique. The dye spread was described after the dissection of the abdomens. In stage 2, each horse was injected with 1 mL kg-1 of 0.9% NaCl (treatment PT) or 0.2% bupivacaine (treatment BT) using a two-point technique. The abdominal midline mechanical nociceptive threshold (MNT) was measured with a 1 mm blunted probe tip and results analyzed with mixed-effect anova. Signs of pelvic limb weakness were recorded. RESULTS: The cadaver dissections showed staining of the ventral branches from the eleventh thoracic (T11) to the second lumbar (L2) nerve with the one-point technique and T9-L2 with the two-point technique. Baseline MNTs were, mean ± standard deviation, 12.6 ± 1.6 N and 12.4 ± 2.4 N in treatments PT and BT, respectively. MNT increased to 18.9 ± 5.8 N (p = 0.010) at 30 minutes, and MNT was between 9.4 ± 2.0 and 15.3 ± 3.4 N from 1 to 8 hours (p > 0.521) in treatment PT. MNTs in treatment BT were 21.1 ± 5.9 to 25.0 ± 0.1 N from 30 minutes to 8 hours (p < 0.001). MNTs after the RAS injections were higher in treatment BT than PT (p = 0.007). No pelvic limb weakness was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Antinociception of at least 8 hours without pelvic limb weakness was observed in the abdominal midline in standing horses after the RAS block. Further investigations are necessary to evaluate suitability for ventral celiotomies.

Development of the Auburn Induction Scale for evaluating induction quality in dogs.

OBJECTIVE: To develop and begin establishing evidence for validity of an instrument to assess the quality of induction in dogs. STUDY DESIGN: Cross-sectional survey and video scoring. ANIMALS AND POPULATION: A total of 51 veterinary anesthesia personnel, four board-certified anesthesiologists and videos of induction of anesthesia in 18 dogs. METHODS: In Part 1, an online survey was sent to veterinary anesthesia personnel to solicit expressions and words that they associate with induction of anesthesia. These expressions were evaluated by four anesthesiologists to create a composite scale (Auburn Induction Scale). In Part 2, 18 videos were reviewed by the same four anesthesiologists on two separate occasions. The videos were scored using the Auburn Induction Scale, a simple descriptive scale (SDS) and a visual analog scale (VAS). Intra-rater and inter-rater reliability was measured using an intraclass correlation coefficient (ICC). Significance was set at p < 0.05. RESULTS: The survey yielded 51 responses that were condensed into 133 expressions. The four anesthesiologists created 18 items incorporating the 133 expressions. The mean ± standard deviation intra-rater reliability ICC was 0.81 ± 0.08 for the Auburn Induction Scale, 0.71 ± 0.02 for the SDS and 0.71 ± 0.08 for the VAS for all raters. The mean ± standard deviation inter-rater reliability ICC was 0.69 ± 0.04 for the Auburn Induction Scale, 0.61 ± 0.05 for the SDS and 0.60 ± 0.06 for the VAS. CONCLUSIONS AND CLINICAL RELEVANCE: In a research setting, widespread use of this scale may be helpful in increasing the accuracy of data and improving agreement between studies assessing induction of anesthesia in dogs. The results of this study have yielded a composite scale that is more reliable between and among raters than a unidimensional scale.

Comparison of hydromorphone and butorphanol for management of pain in equine patients undergoing elective arthroscopy: a randomized clinical trial.

OBJECTIVE: To compare the effects of hydromorphone and butorphanol in horses undergoing arthroscopy and describe the pharmacokinetics of hydromorphone in anesthetized horses. STUDY DESIGN: Randomized controlled clinical trial. ANIMALS: A total of 40 adult horses admitted for elective arthroscopy. METHODS: Horses were randomly assigned to be administered intravenous hydromorphone (0.04 mg kg-1; group TxH; n = 19) or butorphanol (0.02 mg kg-1; group TxB; n = 21) prior to surgery as part of a standardized anesthetic protocol. Pain was scored by two observers unaware of group assignment using the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) and a composite pain scale (CPS) prior to surgery (baseline), 2 hours (P2) and 4 hours (P4) following recovery from anesthesia. Blood samples were collected at various time points for determination of plasma hydromorphone concentration using liquid chromatography-tandem mass spectrometry. Data were analyzed with a mixed-effect model. RESULTS: Median (range) baseline EQUUS-FAP was 1.2 (0.0-4.0) with no effect of group, time points or interaction. Baseline CPS was similar between groups. Group TxH baseline CPS was 2.5 (0.0-10.0), increased at P2 [4.5 (0-10.0); p = 0.046] and returned to baseline values at P4 [3.0 (0.0-11.0)]. Group TxB baseline CPS was 2.0 (0.0-8.0), increased at P2 [3.5 (0.0-11.0); p = 0.009] and P4 [5.0 (0.0-11.0); p < 0.001]. Pharmacokinetic terminal half-life was 774 ± 82.3 minutes, area under the curve was 1362 ± 314 ng minutes mL-1, clearance was 30.7 ± 7.23 mL minute-1 kg-1 and volume of distribution at steady state was 884 ± 740 mL kg-1. CONCLUSIONS: Hydromorphone, but not butorphanol, decreased CPS back to baseline at P4 after recovery. CLINICAL RELEVANCE: Hydromorphone may provide superior postoperative analgesia compared with butorphanol in horses undergoing arthroscopy.

Influence of doxapram and intermittent 10% carbon dioxide inspiration on cardiovascular and laryngeal functions in anesthetized dogs.

OBJECTIVE: To compare the effects of two doses of doxapram intravenous injection and carbon dioxide inhalation on the cardiovascular and laryngeal functions of anesthetized hounds. STUDY DESIGN: Experimental study. ANIMALS: Six healthy adult dogs. METHODS: In a Latin-square design, the mean arterial blood pressure (MABP) and heart rate (HR) were recorded continuously. The inspiratory normalized glottic gap areas (iNGGA) were measured before and after each stimulation with 0.55 mg/kg of doxapram (L-DOX), 2.2 mg/kg of doxapram (H-DOX), or 90 s of inhalation of 10% carbon dioxide in oxygen (I-CO2 ). The stimulations were tested in duplicate or triplicate. Video clips of the laryngeal movement were scored by board-certified surgeons masked to the treatment. RESULTS: The MABP increased with L-DOX and H-DOX up to 81% (both p < .001 compared to I-CO2 ), and persisted during the other stimulations (both p < .001). An intermittent tachycardic effect of up to 79% increase in HR was observed with doxapram. The HR following H-DOX was higher than L-DOX and I-CO2 (both p < .016). Neither hypertension nor tachycardia was observed with I-CO2 . The iNGGA increased with all treatments (p < .001). The iNGGA was greater with H-DOX than L-DOX and I-CO2 (both p < .007). All treatments received higher scores (all p < .001) with acceptable inter- and intra-observers Krippendorff's alphas. CONCLUSION: All treatments were effective respiratory stimulants in anesthetized dogs; however, doxapram caused hypertension and tachycardia. CLINICAL SIGNIFICANCE: Carbon dioxide inhalation might improve arytenoid motion without cardiovascular effects in dogs during clinical airway examinations.

Pharmacokinetics and pharmacodynamics of meperidine after intramuscular and subcutaneous administration in horses.

OBJECTIVE: To describe the pharmacokinetics and pharmacodynamics of meperidine after IM and subcutaneous administration in horses. STUDY DESIGN: prospective, randomized, blinded, crossover trial. ANIMALS: Six adult horses weighing 494 ± 33 kg. METHODS: Treatments included meperidine 1 mg/kg IM with saline 6 mL subcutaneously, meperidine 1 mg/kg subcutaneously with saline 6 mL IM, and saline 6 mL subcutaneously and 6 mL IM, with a 7-day washout between treatments. Plasma meperidine concentrations and pharmacodynamic values (thermal and mechanical thresholds, physiological variables, fecal production) were collected at various time points for 24 hours. Accelerometry data were obtained for 8 hours to measure locomotor activity. Data were analyzed with a mixed effects model, and α was set at .05. RESULTS: Meperidine terminal half-life (T1/2 ), maximal plasma concentrations, and time to maximal concentration were 186 ± 59 and 164 ± 56 minutes, 265.7 ± 47.2 and 243.1 ± 80.1 ng/mL at 17 ± 6, and 24 ± 13 minutes for IM at subcutaneous administration, respectively. No effect of treatment or time was observed on thermal or mechanical thresholds, heart rate, respiratory rate, locomotor activity, frequency of defecations, or fecal weight (P > .2 for all). CONCLUSION: Maximum meperidine concentrations were achieved quickly with a short T1/2 in both treatment groups. Neither IM nor subcutaneous meperidine influenced thermal or mechanical threshold or physiological variables. CLINICAL SIGNIFICANCE: The short half-life and lack of detectable antinociceptive effect do not support IM or subcutaneous administration meperidine at 1 mg/kg for analgesia in horses.

Physiologic and blood gas effects of xylazine-ketamine versus xylazine-tiletamine-zolazepam immobilization of white-tailed deer before and after oxygen supplementation: a preliminary study.

OBJECTIVE: To compare oxygenation and ventilation in white-tailed deer (Odocoileus virginianus) anesthetized with two treatments with and without oxygen supplementation. STUDY DESIGN: Randomized, blinded, crossover study. ANIMALS: A total of eight healthy adult white-tailed deer weighing 49-62 kg. METHODS: Each deer was anesthetized twice intramuscularly: 1) treatment XK, xylazine (2 mg kg-1) and ketamine (6 mg kg-1) and 2) treatment XTZ, xylazine (2 mg kg-1) and tiletamine-zolazepam (4 mg kg-1). With the deer in sternal position, arterial and venous blood was collected before and at 30 minutes during administration of oxygen at 1 L minute-1 through a face mask. PaO2 and heart rate (HR) were compared using two-way repeated measures anova. pH, PaCO2 and lactate concentration were analyzed using mixed-effects linear models, p < 0.05. RESULTS: When breathing air, PaO2 was < 80 mmHg (10.7 kPa) in six and seven deer with XK and XTZ, respectively, and of these, PaO2 was < 60 mmHg (8.0 kPa) in three and five deer, respectively. With oxygen supplementation, PaO2 increased to 128 ± 4 and 140 ± 5 mmHg (17.1 ± 0.5 and 18.7 ± 0.7 kPa), mean ± standard error, with XK and XTZ, respectively (p < 0.001). PaO2 was not significantly different between treatments at either time point. HR decreased during oxygen supplementation in both treatments (p < 0.001). Lactate was significantly lower (p = 0.047) with XTZ than with XK (2.2 ± 0.6 versus 3.5 ± 0.6 mmol L-1) and decreased (p < 0.001) with oxygen supplementation (4.1 ± 0.6 versus 1.6 ± 0.6 mmol L-1). PaCO2 increased in XTZ during oxygen breathing. CONCLUSIONS AND CLINICAL RELEVANCE: Treatments XK and XTZ resulted in hypoxemia, which responded to oxygen supplementation. Both treatments are suitable for immobilization of white-tailed deer under the study circumstances.

A retrospective evaluation of the effect of perianesthetic hydromorphone administration on the incidence of postanesthetic signs of colic in horses.

OBJECTIVE: To describe the incidence of postanesthetic signs of colic (PASC) in horses and determine if perianesthetic administration of hydromorphone was associated with an increased risk of PASC. STUDY DESIGN: Retrospective, cohort study. ANIMALS: A total of 409 horses. METHODS: Anesthesia and clinical records of horses admitted for various procedures from July 2018 to September 2019 were reviewed. Signs of colic and interventions were recorded up to 48 hours after anesthesia. A binomial logistic regression model was used to evaluate the association between the type of surgery, administration of hydromorphone, the duration of anesthesia and the incidence of PASC. RESULTS: Overall, 25 (6.1%) horses developed PASC within 48 hours of general anesthesia. Of 60 horses that underwent colic surgery, 16 (26.7%) developed PASC. Of 349 horses that underwent noncolic procedures, nine (2.6%) developed PASC. Thus, the incidence of PASC was higher in horses that underwent colic surgery than in horses that underwent noncolic procedures [odds ratio (OR) = 13.74 (5.73-32.95)]. No effect of hydromorphone on the incidence of PASC was identified [OR = 1.61 (0.71-3.62)]. Longer procedures (>2 hours) were identified as an independent risk factor for PASC [OR = 4.13 (1.52-11.22)]. CONCLUSIONS: No association between hydromorphone and an increase in the incidence of PASC was identified. Anesthesia for colic surgery and duration of anesthesia were associated with an increased risk of PASC. CLINICAL RELEVANCE: Hydromorphone did not increase the incidence of PASC in this population.

The pharmacokinetics and pharmacodynamics of intravenous hydromorphone in horses.

OBJECTIVE: Describe the pharmacokinetics and pharmacodynamics of intravenous hydromorphone in healthy horses. STUDY DESIGN: Masked, randomized, cross-over, Latin square design. ANIMALS: A group of eight healthy adult horses METHODS: Horses were administered each of four treatments with an 8 day washout. Treatments groups included intravenous hydromorphone 0.02 mg kg-1 (LD), 0.04 mg kg-1 (MD), 0.08 mg kg-1 (HD) and saline (P). Blood samples for hydromorphone analysis were obtained for 24 hours after treatment. Plasma hydromorphone was quantified and pharmacokinetic parameters were determined using non-compartmental analysis. Pharmacodynamic data collected for 24 hours after treatment included thermal nociceptive threshold, heart rate (HR), respiratory rate (fR) and rectal temperature, and analyzed using mixed-effects linear models. RESULTS: Mean (± standard deviation) hydromorphone terminal half-life (t1/2), systemic clearance and apparent volume of distribution at steady state (Vdss) were 18.1 ± 18.6, 34.0 ± 12.8, and 41.3 ± 32.5 minutes, 66.6 ± 5.3, 550.0 ± 76.4, and 92.7 ± 13.9 mL kg-1 minute-1, and 1118 ± 369, 1460 ± 325 and 2242 ± 950 mL kg-1 for treatments LD, MD and HD, respectively. Thermal threshold increased significantly compared to baseline for all treatments for up to 12 hours. HR was elevated above baseline in treatments LD, MD and HD, extending to 30, 15 and 105 minutes after treatment, respectively. Respiratory rate was elevated above baseline in treatments MD and HD from 30 to 195 minutes and from 45 to 480 minutes after treatment, respectively. Temperature was elevated above baseline in treatment HD until 255 minutes after treatment. CONCLUSIONS: Hydromorphone exhibited a short t1/2, rapid clearance and large Vdss in horses. It also provided a dose-dependent increase in thermal threshold with associated increases in HR, fR and rectal temperature. CLINICAL RELEVANCE: Hydromorphone 0.04 mg kg-1 provided clinically relevant thermal antinociception with minimal adverse effects.

Critical incident technique analysis applied to perianesthetic cardiac arrests at a university teaching hospital.

OBJECTIVE: To apply the critical incident technique (CIT) methodology to a series of perianesthetic cardiac arrest events at a university teaching hospital to describe the factors that contributed to cardiac arrest. STUDY DESIGN: CIT qualitative analysis of a case series. ANIMALS: A group of 16 dogs and cats that suffered a perioperative cardiac arrest between November 2013 and November 2016. METHODS: If an arrest occurred, the event was discussed among the anesthesiologists. The discussion included a description of the case, a description of the sequence of events leading up to the arrest and a discussion of what could have been done to affect the outcome. A written description of the case and the event including animal signalment and a timeline of events was provided by the supervising anesthesiologist following discussion among the anesthesiologists. Only dogs or cats were included. After the data collection period, information from the medical record was collected. A qualitative document analysis was performed on the summaries provided about each case by the supervising anesthesiologist, the medical record and any supporting documents. Each case was then classified into one or more of the following: animal, human, equipment, drug and procedural factors for cardiac arrest. RESULTS: The most common factor was animal (n=14), followed by human (n=12), procedural (n=4), drugs (n=1) and equipment (n=1). The majority (n=11) of animals had multiple factors identified. CONCLUSIONS AND CLINICAL RELEVANCE: Cardiac arrests during anesthesia at a referral teaching hospital were primarily a result of animal and human factors. Arrests because of procedural, drug and equipment factors were uncommon. Most animals experienced more than one factor and two animals arrested after a change in recumbency. Future work should focus on root cause analysis and interventions designed to minimize all factors, particularly human ones.

Agreement among anesthesiologists regarding postoperative pain assessment in dogs.

OBJECTIVE: To establish evidence for the validity and reliability of three commonly used pain scales in dogs when assessed by video by specialists in anesthesia. STUDY DESIGN: Mixed-method test-retest observational study. SUBJECTS: A group of six American College of Veterinary Anesthesia and Analgesia board-certified specialists and 31 postoperative dogs. METHODS: The evaluators scored 31 dogs using a visual analogue scale (VAS), numeric rating scale (NRS), and Glasgow pain scale (GPS). The evaluators individually scored the dogs using all three scales together and subsequently, at 3 month intervals, using each of the scales apart. Then, all evaluators in one room reviewed 23 of the videos. A camera was positioned for video and audio recording of discussion about the videos. Intra- and interobserver reliability was determined using a two-way random model intra-class correlation coefficient (ICC). RESULTS: Linear regression indicated a strong correlation among all scales when assigned together (VAS versus NRS, p < 0.0001, R2 = 0.93; VAS versus GPS, p < 0.0001, R2 = 0.59; and NRS versus GPS, p < 0.0001, R2 = 0.61) and apart (VAS versus NRS, p < 0.0001, R2 = 0.68; VAS versus GPS, p < 0.0001, R2 = 0.40; and NRS versus GPS, p < 0.0001, R2 = 0.47). Posture, appearance, vocalization, stiffness, interaction between the animal and a person and response to palpation were identified as important variables for assessing pain. Intra-observer reliability produced average ICC values of 0.90 for VAS, 0.89 for NRS and 0.85 for GPS. Interobserver reliability produced average ICC values when scores were assigned together (VAS: 0.93, NRS: 0.93 and GPS: 0.93) and when done separately (VAS: 0.91, NRS: 0.93 and GPS: 0.95). CONCLUSIONS AND CLINICAL RELEVANCE: The preferred use of the VAS and NRS over the use of the GPS should be cautiously considered for research applications when experts are observers. Revisions of the GPS to clarify descriptors and remove or modify items that may not be associated with pain in dogs should be considered.

Effect of routine pre-anesthetic laboratory screening on pre-operative anesthesia-related decision-making in healthy dogs.

The usefulness of pre-anesthetic laboratory screening of healthy veterinary patients is controversial and clear evidence-based guidelines do not exist. The purpose of our study was to determine the influence of preanesthetic laboratory screening on peri-anesthetic plans in canine patients undergoing elective surgery. One hundred medical records were randomly selected between the years 2008 and 2013 and patient information was presented to 5 Diplomates of the American College of Veterinary Anesthesia and Analgesia (ACVAA) for review. They were given pre-anesthetic laboratory screening test results for each patient and asked whether the results would change the way they managed the case from an anesthesia perspective. Peri-operative anesthetic management was altered in 79% of patients based on pre-anesthetic screening results; however, the overall agreement among anesthesiologists was weak with 64% of changes made by only a single anesthesiologist. Pre-anesthetic laboratory screening test results may influence pre-operative anesthesia case management but major discrepancies can occur among ACVAA diplomates.

Effet du dépistage de laboratoire pré-anesthésique de routine sur la prise de décisions préopératoires liées à l'anesthésie chez des chiens en santé. L'utilité du dépistage de laboratoire pré-anesthésique des patients vétérinaires en santé est controversée et des lignes directrices claires basées sur des données probantes n'existent pas. Le but de notre étude consistait à déterminer l'influence du dépistage de laboratoire pré-anesthésique pour la péri-anesthésie chez les patients canins subissant une chirurgie non urgente. Cent dossiers médicaux choisis au hasard entre les années 2008 et 2013 et des données sur les patients ont été présentés à cinq diplomates de l'American College of Veterinary Anesthesia and Analgesia (ACVAA) aux fins d'examen. On leur a donné les résultats des tests de dépistage de laboratoire pré-anesthésiques pour chaque patient et on leur a demandé d'évaluer si les résultats auraient modifié la façon dont ils auraient géré le cas du point de vue de l'anesthésie. La gestion anesthésique péri-opératoire a été modifiée chez 79 % des patients en se basant sur les résultats du dépistage préanesthésique. Cependant, le consensus général parmi les anesthésiologistes était faible avec 64 % des changements apportés par seulement un seul anesthésiologiste. Les résultats des tests de dépistage de laboratoire pré-anesthésiques peuvent influencer la gestion des cas d'anesthésie préopératoire mais des écarts majeurs peuvent se produire parmi les diplomates de l'ACVAA.(Traduit par Isabelle Vallières).

Effect of Catheter Gauge on the Success of Intravenous Catheter Placement by Veterinary Students.

The purposes of this study were to determine if senior veterinary students find it easier to place a smaller-bore catheter, and to relate patient variables with student success in catheter placement. For dogs between 10 kg and 20 kg, the catheter size options were 20 gauge or 22 gauge. For dogs larger than 20 kg, the catheter size options were 18 gauge or 20 gauge. Variables recorded included time for catheter placement, number of catheterization attempts, number of catheters used, number of legs used, difficulty of catheterization, student success, and patient characteristics including signalment, weight, body condition score, premedication drugs given, tentative diagnosis, and procedure. If the student could not place an IV catheter after three attempts, it was graded as a student catheter placement failure. For the 55 students participating in the study over 28 months, we recorded 192 individual catheterization attempts. In small patients, students were successful in 19/20 attempts with 22-gauge catheters and in 24/30 with 20-gauge catheters. In large patients, students were successful in 59/68 attempts with 20-gauge catheters and 61/74 with 18-gauge catheters. The overall success rate was 164/192 (85%). Students were more likely to be successful when attempting placement in those dogs receiving acepromazine than in those not receiving acepromazine (p=.02). There were no significant differences among any of the other variables for difficulty, placement time, number of attempts, or student success. Clinicians and educators may select a size catheter for the patient without concern for the effects on student catheter placement success.

Reliability of video recordings to evaluate quality of anesthesia recovery in dogs.

OBJECTIVE: To assess the reliability of using video recordings to evaluate anesthesia recovery in dogs. STUDY DESIGN: Prospective study. ANIMALS: A total of 30 dogs undergoing surgery. METHODS: Recovery monitoring and video recording lasted from extubation until 1 hour later. Scoring was done in real time at the end of the hour by a graduate student using three systems: a simple descriptive scale, visual analog scale and numeric rating scale. Videos were distributed to three American College of Veterinary Anesthesia and Analgesia board-certified anesthesiologist raters as well as the original rater to score. These videos were revisited 4 months later, and the recoveries were scored again. To assess reliability, Cohen's and Fleiss' kappa values evaluated the agreement between sessions. Wilcoxon signed-rank tests were run comparing each observer's two sessions. Recoveries were classified as 'good' or 'bad' according to the cut-off values for each system. RESULTS: Correlation values among raters ranged from 0.50 to 0.82 and from 0.26 to 0.60 in the first and second session, respectively. Bland-Altman plots revealed biases between 0.133 and 1.633 points for each of the three scoring systems. Cohen's kappa had agreement ranging from 0.29 to 0.79 during the first viewing and from 0.17 to 0.44 during the second. Fleiss' kappa values were 0.06, 0.16, 0.22 and 0.26 for various data combinations. Considering overall recovery, Fleiss' kappa showed agreement ranging from 0.54 to 0.71 and from 0.13 to 0.49 for the first and second session, respectively. Of the 12 Wilcoxon tests run, seven found significantly different scores between the two scoring sessions. The recoveries given an overall good or bad were the same on both occasions that they were reviewed. CONCLUSIONS AND CLINICAL RELEVANCE: The use of a video to evaluate recovery in dogs should be used with caution. Individual raters' agreement for specific scores was poor, but evaluating recovery overall had perfect agreement.

Agreement between veterinary students and anesthesiologists regarding postoperative pain assessment in dogs.

OBJECTIVE: To determine the levels of agreement among first- and second-year veterinary students and experienced anesthesiologists in assessing postoperative pain in dogs from video-recordings. STUDY DESIGN: Cross-sectional study. SUBJECTS: Twenty-seven veterinary students, five anesthesiologists and 13 canine clinical patients. METHODS: Prior to their enrolment in a core anesthesia course, veterinary students volunteered to watch 13 90 second videos of dogs. Dogs were hospitalized in an intensive care unit after a variety of surgical procedures. Students were asked to score the level of the dogs' pain using the Dynamic Interactive Visual Analog Scale and the Short Form of the Glasgow Composite-Measure Pain Scale. The same videotapes were scored by five board-certified anesthesiologists. The differences and agreement between the ratings of anesthesiologists and students, and first- and second-year students were determined with Mann-Whitney U-tests and Fleiss' or Cohen's kappa, respectively. RESULTS: Pain scores assigned by students and anesthesiologists differed significantly (p < 0.01). Students assigned higher pain scores to dogs that were given low pain scores by anesthesiologists, and lower pain scores to dogs deemed to be in more pain by anesthesiologists. On average, students assigned higher scores on both scales. CONCLUSIONS AND CLINICAL RELEVANCE: Veterinary students early in their training assigned pain scores to dogs that differed from scores assigned by experienced anesthesiologists.

The use of equine surfactant and positive pressure ventilation to treat a premature alpaca cria with severe hypoventilation and hypercapnia.

A 5-hour-old, premature alpaca cria was presented with failure to nurse, weakness, hypoglycemia, hypercapnia, and respiratory distress. The cria was treated with 3 doses of fresh, crude equine surfactant, positive pressure ventilation, and supplemental intranasal oxygen. Recovery to discharge was uneventful, and the cria regained apparently normal respiratory function. Three years after hospital discharge, the alpaca was a healthy adult.

Utilisation du surfactant équin et de la ventilation à pression positive pour traiter un jeune alpaga atteint d'hypoventilation grave et d'hypercapnie. Un jeune alpaga né prématurément et âgé de 5 heures a été présenté pour une absence d'allaitement, une faiblesse, l'hypoglycémie, l'hypercapnie et la détresse respiratoire. Le jeune a été traité à l'aide de 3 doses de surfactant équin frais et brut, une ventilation à pression positive et de l'oxygène intranasal supplémentaire. Le rétablissement et le congé se sont bien passés et la fonction respiratoire normale du jeune s'est apparemment rétablie. Trois ans après le congé de l'hôpital, l'alpaga était un adulte en santé.(Traduit par Isabelle Vallières).

Comparison of tensile strength and early healing of acute repeat celiotomy through a ventral median or a right ventral paramedian approach.

OBJECTIVE: To compare tensile strength, failure location, and histologic features after acute repeat celiotomy through a ventral median (RVM) or a right ventral paramedian (RVP) celiotomy in horses. STUDY DESIGN: Ex vivo experimental study. ANIMALS: Adult horses (N = 18). METHODS: Twelve adult horses had original ventral median (OVM) celiotomy. Repeat celiotomy was performed 72 hours postoperatively through the original ventral median (RVM, N = 6) or a RVP (N = 6) celiotomy. Celiotomies were scored daily for edema, drainage, and dehiscence. Fourteen days after repeat celiotomy, horses were euthanatized and abdominal wall containing celiotomy(ies) were collected for biomechanical and histological evaluation. The abdominal wall of control horses (N = 6; no celiotomy) was collected for biomechanical testing. Vital sign variables, incisional edema, and histologic scores were compared using a Wilcoxon signed-rank test. Incisional fibrotic depth and tensile strength per unit length (N/cm) was compared using repeated measures ANOVA. RESULTS: RVM and RVP horses had significantly less tensile strength compared to control horses, but no differences were observed between RVM and RVP horses. No differences in healing, inflammation, infection, or necrosis of repeat celiotomies was observed, but RVP horses accumulated more fibrin and hemorrhage within the incision. RVP horses had significantly greater incisional edema scores, but incisional drainage was more frequent in RVM horses. CONCLUSIONS: Acute repeat celiotomy through a RVM incision results in similar incisional healing and tensile strength compared with repeat celiotomy through a RVP incision.

Development, implementation and impact of simple patient safety interventions in a university teaching hospital.

OBJECTIVE: To determine the incidence of anesthesia patient safety incidents at a university teaching hospital, develop interventions to address the most common incidents, and determine the effectiveness of these interventions. STUDY DESIGN: Pre-post intervention observational. ANIMALS: Four thousand, one hundred forty dogs and cats anesthetized by the anesthesia service. METHODS: The study was divided into two 11.5 month periods. During each period, incidents were logged (e.g. closed adjustable pressure limiting (APL) valve, esophageal intubation, and medication error). At the end of the first period, four countermeasures were incorporated into the service's protocols: 1) prior to any drug injection, the individual would read out aloud the drug name, patient name, and route of administration; 2) use of a uniquely colored occlusive wrap over arterial catheters; 3) a check box on the anesthesia record labeled "Technician Confirmed Intubation"; 4) a check box on the anesthesia record labeled "Technician Checked OR (operating room)". The number of patient safety incidents during period 1 and period 2 were compared using Fisher's Exact Test. RESULTS: During Period 1, there were 74 incidents documented in 2028 patients (3.6%) including 25 medication errors, 20 closed APL valves, and 16 of esophageal intubation. During Period 2, there were 30 incidents documented in 2112 patients (1.4%) including 14 medication errors, 5 closed APL valves, and 4 of esophageal intubation. The proportion of events during Period 2 was significantly smaller than during Period 1 (p < 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE: Implementation of four simple interventions was associated with a significant decrease in the number of incidents.

Evaluation of serial venous and arterial lactate concentrations in healthy anesthetized sheep undergoing ovariectomy.

OBJECTIVE: To determine if lactate concentrations in jugular venous and auricular arterial blood differ in anesthetized sheep. STUDY DESIGN: Prospective, controlled experimental study. ANIMALS: Twelve healthy adult ewes, 4-7 years and weighing 62-77 kg. METHODS: Jugular venous blood was collected before anesthesia (PreOv ) for measurement of lactate concentration, packed cell volume and total protein. Ewes were administered a standard anesthesia protocol. Jugular venous (IntraOv ) and auricular arterial (IntraOa ) blood samples were obtained 40 minutes after induction of anesthesia, and again in recovery (PostOv and PostOa ). An additional blood sample was drawn 6 weeks post-operatively from non-fasted sheep (NF_Lact). Lactate concentrations were compared among PreOv , IntraOv and IntraOa , PostOv and PostOa , and between PreOv and NF_Lact with paired t-test and repeated measure analyses of variance (anova) with PreOv as a covariate (p ≤ 0.05). RESULTS: IntraOv lactate concentration had decreased from PreOv There were significant differences between arterial and venous IntraO and PostO lactate concentrations. There was no significant difference between IntraO and PostO, or PreOv and NF_Lact. CONCLUSIONS AND CLINICAL RELEVANCE: Lactate concentrations were significantly lower in anesthetized sheep compared to non-anesthetized sheep. Lactate concentrations in venous blood were higher than in arterial blood. Therefore, anesthetic status and sampling site should be considered when interpreting lactate concentrations, and the sampling site should be consistent for repeated measurements.

Anesthesia for the dog with heartworm disease: a brief, practical review.

Dogs with heartworm disease may present for procedures that require anesthesia. This article is a brief, practical review of anesthetic techniques for dogs with heartworm. Dogs with heartworm, such as in a shelter that undergo spay and neuter procedures, may be safely anesthetized prior to heartworm treatment. The dog presenting with caval syndrome may require emergent anesthesia for extraction of the heartworms; anesthetic drugs and potential adverse effects are discussed. The anesthetic agents that have been used are discussed.

Retrospective assessment of general anesthesia-related challenges, morbidity, and death in snakes: 139 cases (2000-2022).

OBJECTIVE: To summarize the anesthetic events of snakes seen at a large university hospital, identify challenges with record keeping, and assess patient and anesthesia-related morbidity and death. SAMPLE: 139 anesthetic events were performed; only 106 cases had detailed anesthetic reports available for further analyses. PROCEDURES: Medical records of snakes that underwent general anesthesia between October 2000 and January 2022 were retrospectively reviewed. Only cases with complete anesthesia records were used to assess anesthetic parameters. Collected data included general patient details, diagnoses, procedures, premedication, induction, maintenance, monitoring, and recovery. RESULTS: A thorough review of the records identified issues or scenarios that resulted in poor record management as well as highlighted the most frequently used anesthetics in snakes. For premedication this was alfaxalone, butorphanol, and hydromorphone, whereas isoflurane, alfaxalone, or propofol were the most common with induction. Lastly, with maintenance, isoflurane was the most popular choice. Of the 139 cases performed, 127 animals recovered, 8 were euthanatized due to poor prognosis, and 4 failed to recover. All snakes that failed to recover had preexisting disease identified pre-, peri-, or postoperatively at necropsy. CLINICAL RELEVANCE: General anesthesia can be reliably and safely undertaken in snakes without severe preexisting disease. Efforts should be directed at identifying preexisting disease and maintaining and completing anesthesia records, and we recommend an auditing system to identify and correct issues as they arise.