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Vet Anaesth Analg [journal]
- An evidence-based medicine approach to small animal anaesthetic mortality in a referral practice: the influence of initiating three recommendations on subsequent anaesthetic deaths. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Dec 18.
To evaluate anaesthetic death after implementation of recommendations and its risk factors in a small animal practice.Observational cohort study.All cats and dogs anaesthetized at the Centre Hospitalier Vétérinaire des Cordeliers during two periods, from April 15th, 2008 to April 15th, 2010 (period 1) and from June 15th, 2010 to August 24th, 2011 (period 2).Death occurring during or before full recovery from anaesthesia was recorded. At the end of period 1, a logistic regression model was generated to describe anaesthetic death and identify risk factors. Potential risk factors in our practice setting were identified, and three recommendations, relating to improving physical status and anaesthetic/analgesic regimen implemented for period 2. The relationship between anaesthetic death and recorded variables were analyzed, and where relevant, compared between periods.Six thousand two hundred and thirty-one animals underwent general anaesthesia. The overall death rate during period 1 was 1.35% (48 in 3546, 95% CI [1.0-1.7%]) and during period 2 was 0.8% (21 in 2685, 95% CI [0.6-1.2%]). For sick animals (ASA status 3 and over), the overall death rate was 4.8% (45 of 944 95% [CI 3.5-6.4%]) during period 1 and 2.2% (18 of 834 95% CI [1.3-3.5%]) during period 2; this represented a significant decrease in death rate in period 2 (p = 0.002). In period 2, the main factors associated with an increased odds ratio of anaesthetic death were poor health status (ASA physical status classification) and old age. Species, gender, anaesthetic regimen, the nature and urgency of the procedure were not associated with risk.Following evidence based recommendations, the death rate related to anaesthesia was significantly decreased during period 2 compared to period 1. Application of evidence-based medicine may contribute to an effective approach to decrease death rates. Other factors, not monitored in this study, may also have had an impact.
- Cardiovascular effects of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Dec 18.
To assess the cardiovascular changes of a continuous rate infusion of lidocaine in calves anesthetized with xylazine, midazolam, ketamine and isoflurane during mechanical ventilation.Prospective, randomized, cross-over, experimental trial.A total of eight, healthy, male Holstein calves, aged 10 ± 1 months and weighing 114 ± 11 kg were included in the study.Calves were administered xylazine followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane (1.3%) using mechanical ventilation. Forty minutes after induction, lidocaine (2 mg kg(-1) bolus) or an equivalent volume of saline (0.9%) was administered IV followed by a continuous rate infusion (100 μg kg(-1) minute(-1) ) of lidocaine (treatment L) or saline (treatment C). Heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP and MAP), central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), pulmonary arterial occlusion pressure (PAOP), cardiac output, end-tidal carbon dioxide (Pe'CO2 ) and core temperature (CT) were recorded before lidocaine or saline administration (Baseline) and at 20-minute intervals (T20-T80). Plasma concentrations of lidocaine were measured in treatment L.The HR was significantly lower in treatment L compared with treatment C. There was no difference between the treatments with regards to SAP, DAP, MAP and SVRI. CI was significantly lower at T60 in treatment L when compared with treatment C. PAOP and CVP increased significantly at all times compared with Baseline in treatment L. There was no significant difference between times within each treatment and between treatments with regards to other measured variables. Plasma concentrations of lidocaine ranged from 1.85 to 2.06 μg mL(-1) during the CRI.At the studied rate, lidocaine causes a decrease in heart rate which is unlikely to be of clinical significance in healthy animals, but could be a concern in compromised animals.
- Abstracts. [Journal Article]
- Vet Anaesth Analg 2014 Jan; 41(1):A1-A24.
- Current attitudes regarding the use of perioperative analgesics in dogs and cats by Brazilian veterinarians. [Journal Article]
- Vet Anaesth Analg 2014 Jan; 41(1):82-9.
To correlate the demographic data of Brazilian veterinarians with their use of, attitudes towards, knowledge of and preference for continuing education regarding use of analgesics in small animal practice.Prospective survey.The questionnaire was composed of sections pertaining to demographics, personal data, use of analgesics in general and specific procedures, analgesia used, and attitudes towards the assessment and relief of pain. The descriptive statistics with frequency analysis was performed using sas for Windows 9.1.3. Chi-square for simple comparisons test was used.Questionnaires were obtained from 1298 small animal veterinarians. Women and younger graduates attributed higher pain scores than men and older graduates but the frequency and duration of analgesic treatment did not differ between genders. The most commonly used opioids were tramadol (79%) and morphine (51%). NSAIDs of choice were meloxicam (81%) and ketoprofen (70%). Cats received lower pain scores for laparotomy, orchiectomy and dental procedures than dogs. Practical experience (64%) and national (47%) and regional meetings (43%) were the main sources of information for identifying and treating pain in small animals.Although the number of Brazilian veterinarians believed that their knowledge in the area was lower than in other countries, the focus in pain management was similar or higher than in other countries, showing a good attitude in pain relief in animals.
- Maropitant prevented vomiting but not gastroesophageal reflux in anesthetized dogs premedicated with acepromazine-hydromorphone. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Dec 16.
To evaluate the efficacy of maropitant for prevention of vomiting and gastroesophageal reflux (GER) in dogs following acepromazine-hydromorphone premedication and inhalation anesthesia.Randomized, blinded, prospective clinical study.Twenty-six dogs admitted for elective soft tissue or orthopedic procedures that were 3.1 ±3.1 years of age and weighed 20.5 ± 11.4 kg.Dogs were randomly assigned to one of two groups: Group M received maropitant (1.0 mg kg(-1) ) and Group S received 0.9% saline (0.1 mL kg(-1) ) intravenously 45-60 minutes before premedication with hydromorphone (0.1 mg kg(-1) ) and acepromazine (0.03 mg kg(-1) ) intramuscularly. An observer blinded to treatment documented any retching or vomiting for 20 minutes before induction with propofol (2-6 mg kg(-1) ) and inhalation anesthesia. A pH probe inserted into the distal esophagus was used to detect GER.None of the dogs in Group M retched or vomited (0/13), 6/13 (46%) in Group S were observed to retch or vomit, and the difference between groups was significant (p = 0.015). There were no differences between groups in the number of dogs with GER (Group M: 4/13, Group S: 6/13 dogs) or the number of reflux events. Esophageal pH at the end of anesthesia was significantly lower in both M and S groups in dogs with GER versus dogs without GER (p = 0.004 and 0.011, respectively). Only dogs with GER in Group S had significantly lower pH at the end compared to the beginning of anesthesia (p = 0.004).Intravenous maropitant prevented retching and vomiting associated with acepromazine-hydromorphone premedication. Maropitant did not prevent the occurrence of GER. Fewer dogs in Group M developed GER but further study with a larger number of dogs is necessary to determine if there is a significant difference.
- Comparison of an infrared anaesthetic agent analyser (Datex-Ohmeda) with refractometry for measurement of isoflurane, sevoflurane and desflurane concentrations. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Dec 16.
To assess agreement between infrared (IR) analysers and a refractometer for measurements of isoflurane, sevoflurane and desflurane concentrations and to demonstrate the effect of customized calibration of IR analysers.In vitro experiment.Six IR anaesthetic monitors (Datex-Ohmeda) and a single portable refractometer (Riken).Both devices were calibrated following the manufacturer's recommendations. Gas samples were collected at common gas outlets of anaesthesia machines. A range of agent concentrations was produced by stepwise changes in dial settings: isoflurane (0-5% in 0.5% increments), sevoflurane (0-8% in 1% increments), or desflurane (0-18% in 2% increments). Oxygen flow was 2 L minute(-1) . The orders of testing IR analysers, agents and dial settings were randomized. Duplicate measurements were performed at each setting. The entire procedure was repeated 24 hours later. Bland-Altman analysis was performed. Measurements on day-1 were used to yield calibration equations (IR measurements as dependent and refractometry measurements as independent variables), which were used to modify the IR measurements on day-2.Bias ± limits of agreement for isoflurane, sevoflurane and desflurane were 0.2 ± 0.3, 0.1 ± 0.4 and 0.7 ± 0.9 volume%, respectively. There were significant linear relationships between differences and means for all agents. The IR analysers became less accurate at higher gas concentrations. After customized calibration, the bias became almost zero and the limits of agreement became narrower.If similar IR analysers are used in research studies, they need to be calibrated against a reference method using the agent in question at multiple calibration points overlapping the range of interest.
- Predictors of outcome in dogs undergoing thoracic surgery (2002-2011). [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Dec 13.
To evaluate mortality in a canine population undergoing thoracic surgery and identify factors which may be associated with outcome.Retrospective cohort study.286 dogs anaesthetized for thoracic surgery at the Royal Veterinary College between June 2002 - June 2011.Variables examined included: signalment; ASA status; nature of disease; presence of co-morbidities; pre-anaesthetic oxygen requirement; surgical approach; anaesthesia management [anaesthetic agents; requirement for thoracocentesis; central venous pressure measurement; duration of surgery and anaesthesia; use of colloids, blood products, inotropes or neuromuscular blocking agents (NMBA)]. Outcome was defined as either non-survival to 24 hours after surgery or (having survived to 24 hours) to discharge. Univariate and multivariable logistic regressions were performed to identify risk factors associated with non-survival.Overall non-survival (excluding those euthanased) to discharge was 5.9%. Non-survival was 2.2% at 24 hours and 3.6% at time of discharge. Non-survival to 24 hours was associated with pre-anaesthetic oxygen requirement (odds ratio (OR) 12.2 [95% CI 1.8-84.5]) and NMBA use (OR 9.6 [95% CI 1.6-57.9]). Non-survival to discharge was associated with surgical duration, with surgeries >180 minutes having OR 16.9 [95% CI 2.0-144.0] compared to surgeries ≤90 minutes and blood product use (OR 4.6 [95% CI 1.3-14.6]). No association was found between ASA category and non-survival at 24 hours (OR 1.4 [95% CI 0.2-11.7]) or discharge (OR 4.4 [95% CI 0.6-34.3]). Significant associations were found between NMBA use and ASA category (p = 0.046), surgical duration (p = 0.002), use of colloids (p = 0.011), blood products (p = 0.001) and inotropes and/or vasopressors (p < 0.001).Variables significantly associated with non-survival from canine thoracic surgery at 24 hours include NMBA use and pre-anaesthetic oxygen requirement. Blood product use and increasing surgical duration were associated with non-survival to hospital discharge. The associations may relate to the need for such products in the most complicated cases.
- Thermal and mechanical nociceptive threshold testing in pregnant sheep. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Nov 21.
Analgesic regimes were compared in pregnant ewes after laparotomy by measuring thermal (TT) and mechanical (MT) nociceptive thresholds.Prospective randomised experimental study.Pregnant ewes at 121 days gestation underwent laparotomy as part of another research project.Thermal and mechanical thresholds were measured before, and 2, 6, 24 and 48 hours after surgery. Thermal stimuli were delivered to the lateral aspect of the metatarsus via a skin-mounted probe, and mechanical stimuli to the contralateral site via a pneumatically driven 1.5 mm diameter pin. Each test was performed five times, alternating thermal and mechanical stimuli, with ten minutes between thermal stimuli. At the end of surgery ewes received either: 75 μg hour(-1) transdermal fentanyl patch (medial thigh) (group FP) (n = 8), or 3 μg kg(-1 ) hour(-1) intra-peritoneal medetomidine via an osmotic pump (group IPM) (n = 8) inserted immediately prior to closure. Data were analysed using the Kruskal-Wallis RS Test (p < 0.05). Once a significant effect was identified, pairwise comparisons were performed using paired Wilcoxon RS tests. To compensate for multiple hypotheses testing, p < 0.005 was considered significant.Prior to surgery mean ± SD TT was 56.1 ± 5.0 °C (FP) and 55.6 ± 5.0 °C (IPM); MT was 5.3 ± 2.6 N (FP) and 8.0 ± 5.0 N (IPM). In FP there was no significant change in either TT or MT over time. In IPM there was no significant change in MT over time but TT increased at two hours to 59.2 ± 3.0 °C (p = 0.003). Skin temperature (ST) ranged from 33.0 to 34.7 °C and did not change over time. There were no significant differences between groups in TT, MT or ST.Administration of intra-peritoneal medetomidine (3 μg kg(-1 ) hour(-1) ) by an osmotic pump increases the thermal nociceptive threshold in the immediate post operative period in pregnant sheep, suggesting that this agent may have a role in providing post-operative analgesia.
- Anesthetic complications in dogs undergoing hepatic surgery: cholecystectomy versus non-cholecystectomy. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Nov 21.
To determine if dogs that undergo laparotomy for cholecystectomy suffer from a greater number or magnitude of perianesthetic complications, including hypotension, hypothermia, longer recovery time, and lower survival rate, than dogs that undergo laparotomy for hepatic surgery without cholecystectomy.Retrospective cohort study.One hundred and three dogs, anesthetised between January 2007 and October 2011.The variables collected from the medical record included age, weight, gender, surgical procedure, pre-operative bloodwork, American Society of Anesthesiologists (ASA) status, emergency status, total bilirubin concentration, anesthetic agents administered, body temperature nadir, final body temperature, hypotension, duration of hypotension, blood pressure nadir, intraoperative drugs, anesthesia duration, surgery duration, time to extubation, final diagnosis, days spent in the intensive care unit (ICU), total bill, survival to discharge, and survival to follow-up.No significant difference in body temperature nadir, final temperature, presence of hypotension, duration of hypotension, blood pressure nadir, the use of inotropes, or final outcome was found between dogs undergoing cholecystectomy and dogs undergoing exploratory laparotomy for other hepatic disease. Dogs that had cholecystectomy had longer anesthesia durations and longer surgery durations than dogs that did not have cholecystectomy. No significant differences existed for temperature nadir (34.8 versus 35.3 °C; non-cholecystectomy versus cholecystectomy), final temperature (35.6 versus 35.9 °C), time to extubation (30 versus 49 minutes), duration of hypotension (27 versus 21 minutes), or MAP nadir (56 versus 55 mmHg). Hypotension occurred in 66% and 74% and inotropes were used in 64% and 53%, for non-cholecystectomy and cholecystectomy patients, respectively.Dogs that underwent cholecystectomies did not suffer a greater number of anesthesia complications than did dogs undergoing hepatic surgery without cholecystectomies.
- Comparison of invasive and oscillometric blood pressure measurement techniques in anesthetized sheep, goats, and cattle. [JOURNAL ARTICLE]
- Vet Anaesth Analg 2013 Nov 14.
To determine the level of agreement between an oscillometric (O-NIBP) and an invasive method (IBP) of monitoring arterial blood pressure (ABP) in anesthetized sheep, goats, and cattle.Prospective clinical study.Twenty sheep and goats, 20 cattle weighing <150 kg body weight, and 20 cattle weighing >150 kg body weight.Animals were anesthetized and systolic ABP (SABP), mean ABP (MABP), and diastolic ABP (DABP) were measured using IBP and O-NIBP. Differences between IBP and O-NIBP, and 95% limits of agreement (LOA) between SABP, MABP, and DABP values were assessed by the Bland-Altman method.Mean difference ± standard deviation (range) between SABP, DABP, and MABP measurements in sheep and goats was 0 ± 16 (-57 to 38) mmHg, 13 ± 16 (-37 to 70) mmHg, and 8 ± 13 (-34 to 54) mmHg, respectively. Mean difference between SABP, DABP, and MABP measurements in small cattle was 0 ± 19 (-37 to 37) mmHg, 6 ± 18 (-77 to 48) mmHg, and 4 ± 16 (-73 to 48) mmHg, respectively. Mean difference between SABP, DABP, and MABP measurements in large cattle was -18 ± 32 (-107 to 71) mmHg, 7 ± 29 (-112 to 63) mmHg, and -5 ± 28 (-110 to 60) mmHg, respectively. The 95% LOAs for SABP, DABP, and MABP were -31 to +31, -19 to +44, and -19 to +34 mmHg, respectively in sheep and goats; were -37 to +37, -19 to +44, and -19 to +34 mmHg, respectively in small cattle; and were -81 to +45, -50 to +63, and -59 to +50 mmHg, respectively in large cattle.Agreement was poor between O-NIBP and IBP monitoring techniques.Arterial BP should be monitored in anesthetized sheep, goats, and cattle using IBP.