Amanda L. Abelson

Use of wound soaker catheters for the administration of local anesthetic for post-operative analgesia: 56 cases

OBJECTIVE To describe the administration of local anesthetic through wound soaker catheters for post-operative veterinary patients and to characterize complications. STUDY DESIGN Retrospective study of hospital records. ANIMALS Records of patients in which a wound soaker catheter was placed post-operatively between November 1, 2004 and July 1, 2006 at a veterinary teaching hospital. Records in which a limb amputation was performed between January 1, 2002 and August 1, 2007 and in which a wound soaker catheter was not placed were reviewed for historic control. RESULTS A total of 56 cases were identified in which a wound soaker catheter was placed post-operatively including 52 dogs, 2 cats, and 2 goats. Twenty canine cases were identified in which limb amputation was performed and no wound soaker catheter was placed. The majority of surgical procedures for which a wound soaker catheter was placed included thoracic limb amputation (46.4%) and pelvic limb amputation (35.7%). Wound soaker catheters remained in place for an average of 1.6 +/- 0.5 days. Feline and caprine patients received intermittent bupivacaine boluses every 6 hours. Canine patients received continuous lidocaine infusions. Complications included disconnection of the catheter from the infusion (7.7%), one seroma, and one suspected lidocaine neurotoxicity. Incisional infections were noted in 3/56 (5.3%) limb amputations with wound soaker catheters placed which was not higher than the incisional infection rate found in the historic control cases 3/20 (15%). CONCLUSION AND CLINICAL RELEVANCE Use of the wound soaker catheter was a viable means of providing local analgesia in post-operative veterinary patients. Studies are needed to evaluate efficacy of pain management, and to further investigate techniques for catheter placement and maintenance which may help to optimize the analgesia achieved using this technique.

Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs

OBJECTIVE To describe the use of IV and oral mycophenolate mofetil (MMF) as adjunctive therapy in 3 dogs with severe generalized myasthenia gravis. CASE SERIES SUMMARY Three dogs suffering from severe generalized myasthenia gravis as confirmed by acetylcholine antibody titers were treated with MMF as part of their treatment regimens. All 3 dogs had radiographic evidence of megaesophagus and suffered from severe regurgitation. Each dog was initially treated with pyridostigmine and supportive agents. When clinical remission was not achieved, IV MMF was administered to all dogs. Signs of clinical remission were apparent within 48 hours and all dogs were later maintained on oral MMF following resolution of regurgitation. NEW OR UNIQUE INFORMATION PROVIDED This is the first report of the use of IV MMF as adjunctive treatment in dogs with severe generalized myasthenia gravis. Outcome was favorable in all 3 dogs and no adverse effects were noted from the MMF.

A comparison of epidural morphine with low dose bupivacaine versus epidural morphine alone on motor and respiratory function in dogs following splenectomy.

OBJECTIVE To compare post-operative motor function in dogs that received epidural morphine and low dose bupivacaine versus epidural morphine alone following splenectomy. STUDY DESIGN Prospective, randomized study. ANIMALS 16 client owned dogs undergoing routine splenectomy. METHODS Following splenectomy dogs were randomly allocated into one of two groups. The morphine group (MOR) was administered epidural morphine (0.1 mg kg(-1)); the morphine-bupivacaine group (MORB) received epidural morphine (0.1 mg kg(-1)) and low dose bupivacaine [0.25 mg kg(-1), (0.167%)]. The adjusted final volume was 0.15 mL kg(-1) in both groups. Motor function and pain assessment were performed at pre-determined times using a simple numerical motor score and the University of Melbourne Pain Scale (UMPS) respectively. An arterial blood gas was performed 2 hours following epidural administration to check for respiratory compromise. If patients scored >7 on the UMPS or were deemed painful by the observer they were administered hydromorphone intravenously and dose and time of rescue analgesia were recorded. RESULTS There were no statistically significant differences in motor scores, pain scores, amount of rescue analgesia administered or PaCO2 between treatment groups. No dogs demonstrated respiratory depression or profound motor dysfunction at any time point during the study. 9/16 (56%) dogs did not require rescue analgesia during the first 18 hours following splenectomy. CONCLUSIONS AND CLINICAL RELEVANCE The combination of low dose bupivacaine (0.25 mg kg(-1)) and morphine (0.1 mg kg(-1)) when administered epidurally has little effect on post-operative motor function. This combination can be used without concern of motor paralysis in healthy animals.

Positive impact of an emergency department protocol on time to antimicrobial administration in dogs with septic peritonitis.

Objective To determine whether the development of a specific antimicrobial protocol for the treatment of canine intra-abdominal sepsis would improve time to appropriate antimicrobial administration following diagnosis of bacterial peritonitis. Design Case controlled observational study. Setting A tertiary referral small animal teaching hospital. Animals Twenty dogs undergoing surgery for septic peritonitis prior to the deployment of the abdominal sepsis protocol served as a case control population and 40 dogs identified as having septic peritonitis after deployment of the protocol served as the study population. Interventions None. Measurements and Main Results Median time from diagnosis of septic peritonitis to antimicrobial administration was 6 hours (range 1–10 h) in the preprotocol group (PRE), and 1 hour (range 1–2 h) in the postprotocol group (POST) (P = 0.001). Five of 20 (25%) culture and sensitivity results yielded negative cultures in the PRE versus 6 of 34 (17.6%) in the POST. Inappropriate empirical antimicrobials were selected 3 of 20 times (15%) in the PRE and 3 of 34 times (8.8%) in the POST. The overall survival to discharge was 60% in the PRE and 70% in the POST (P = 0.425). Conclusions The development of an emergency department antimicrobial protocol significantly decreased time to antimicrobial administration following identification of septic peritonitis in dogs.OBJECTIVE To determine whether the development of a specific antimicrobial protocol for the treatment of canine intra-abdominal sepsis would improve time to appropriate antimicrobial administration following diagnosis of bacterial peritonitis. DESIGN Case controlled observational study. SETTING A tertiary referral small animal teaching hospital. ANIMALS Twenty dogs undergoing surgery for septic peritonitis prior to the deployment of the abdominal sepsis protocol served as a case control population and 40 dogs identified as having septic peritonitis after deployment of the protocol served as the study population. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Median time from diagnosis of septic peritonitis to antimicrobial administration was 6 hours (range 1-10 h) in the preprotocol group (PRE), and 1 hour (range 1-2 h) in the postprotocol group (POST) (P = 0.001). Five of 20 (25%) culture and sensitivity results yielded negative cultures in the PRE versus 6 of 34 (17.6%) in the POST. Inappropriate empirical antimicrobials were selected 3 of 20 times (15%) in the PRE and 3 of 34 times (8.8%) in the POST. The overall survival to discharge was 60% in the PRE and 70% in the POST (P = 0.425). CONCLUSIONS The development of an emergency department antimicrobial protocol significantly decreased time to antimicrobial administration following identification of septic peritonitis in dogs.

The effect of storage on ammonia, cytokine, and chemokine concentrations in feline whole blood

Objective To determine if the concentrations of ammonia and inflammatory mediators in feline stored whole blood (SWB) increase with duration of storage. Design Prospective ex vivo study. Setting University Teaching Hospital. Animals Thirteen cats, recruited from the hospital feline donor pool, deemed healthy based on the predonation donor screening process. Interventions One unit (30 mL) of whole blood was collected from 13 unique blood donor cats, anticoagulated with citrate-phosphate-dextrose, and stored at 4°C. Concentrations of ammonia, interleukin (IL) 6, and IL-10 were measured in 5 units weekly for 4 weeks. Presence of chemokine ligand (CXCL) 8 was measured weekly in 8 other units in the same manner. Measurements and Main Results The ammonia concentration increased nonlinearly with duration of storage, from a median of 48 μmol/L (range 25–74 μmol/L) on day 0 and 417 μmol/L (324–457 μmol/L) on day 28. IL-6 and IL-10 concentrations were below the lower limits of detection of the assay used (IL-6 < 31.2 pg/mL and IL-10 < 125 pg/mL). CXCL-8 was detected in 4 of 8 SWB units at all time points. Conclusions and Clinical Importance Ammonia concentration increases with storage time in feline SWB. The clinical significance of this finding is yet to be determined. The presence of the proinflammatory chemokine CXCL-8 in feline SWB warrants further research to determine whether it can incite an inflammatory response in the recipient. Further research evaluating the epidemiology of transfusion reactions in cats should evaluate the effect of unit age, and should include the possible impact of the presence of CXCL-8.OBJECTIVE To determine if the concentrations of ammonia and inflammatory mediators in feline stored whole blood (SWB) increase with duration of storage. DESIGN Prospective ex vivo study. SETTING University Teaching Hospital. ANIMALS Thirteen cats, recruited from the hospital feline donor pool, deemed healthy based on the predonation donor screening process. INTERVENTIONS One unit (30 mL) of whole blood was collected from 13 unique blood donor cats, anticoagulated with citrate-phosphate-dextrose, and stored at 4°C. Concentrations of ammonia, interleukin (IL) 6, and IL-10 were measured in 5 units weekly for 4 weeks. Presence of chemokine ligand (CXCL) 8 was measured weekly in 8 other units in the same manner. MEASUREMENTS AND MAIN RESULTS The ammonia concentration increased nonlinearly with duration of storage, from a median of 48 μmol/L (range 25-74 μmol/L) on day 0 and 417 μmol/L (324-457 μmol/L) on day 28. IL-6 and IL-10 concentrations were below the lower limits of detection of the assay used (IL-6 < 31.2 pg/mL and IL-10 < 125 pg/mL). CXCL-8 was detected in 4 of 8 SWB units at all time points. CONCLUSIONS AND CLINICAL IMPORTANCE Ammonia concentration increases with storage time in feline SWB. The clinical significance of this finding is yet to be determined. The presence of the proinflammatory chemokine CXCL-8 in feline SWB warrants further research to determine whether it can incite an inflammatory response in the recipient. Further research evaluating the epidemiology of transfusion reactions in cats should evaluate the effect of unit age, and should include the possible impact of the presence of CXCL-8.

Comparison of time to obtain intraosseous versus jugular venous catheterization on canine cadavers

OBJECTIVE To compare the time required and the success rate of personnel with 4 different levels of experience to place a humeral intraosseous (IO) catheter versus a jugular venous catheter (IV) in cadaver dogs. DESIGN Prospective study. SETTING Veterinary university teaching hospital. INTERVENTIONS Canine cadavers from recently euthanized dogs were obtained from the cadaver donation program between May and December 2014. Catheter placers (CPs) with varying clinical experience, including a first year emergency and critical care resident, a senior emergency veterinary technician (VTS certified), a final year veterinary student, and an ACVECC diplomate, participated in the study. Each CP catheterized a total of 6 dogs so that there was a total of 6 IO and 6 IV catheters placed, by automatic rotary insertion device (with an EZ-IO gun) and vascular cut-down technique, respectively, for each CP. Time for IO catheterization and IV catheterization was recorded and compared. The success of IO catheterization and IV catheterization was verified by visualization of an injection of iodinated contrast material under fluoroscopy within the medullary cavity or vessel. ANIMALS Twenty-four canine cadavers. MEASUREMENTS AND MAIN RESULTS Outcomes were analyzed using the Wilcoxon rank-sum test and the Kruskal-Wallis one-way analysis of variance. The median time for all IO catheterization operators was faster at 55.4 seconds (range 15.0-153.0 s) compared to the median time for all IV catherization operators at 217.3 seconds (range 55.6-614 s). The success rate for IO and IV was equal at 87.5%. CONCLUSION IO catheterization using an automatic rotary insertion device was performed more rapidly and successfully than jugular venous catheterization using a cut-down technique in canine cadaver. These findings suggest IO catheterization may be more efficient for gaining vascular access in the appropriate emergency clinical situations when preexisting IV access does not exist.Objective To compare the time required and the success rate of personnel with 4 different levels of experience to place a humeral intraosseous (IO) catheter versus a jugular venous catheter (IV) in cadaver dogs. Design Prospective study. Setting Veterinary university teaching hospital. Interventions Canine cadavers from recently euthanized dogs were obtained from the cadaver donation program between May and December 2014. Catheter placers (CPs) with varying clinical experience, including a first year emergency and critical care resident, a senior emergency veterinary technician (VTS certified), a final year veterinary student, and an ACVECC diplomate, participated in the study. Each CP catheterized a total of 6 dogs so that there was a total of 6 IO and 6 IV catheters placed, by automatic rotary insertion device (with an EZ-IO gun) and vascular cut-down technique, respectively, for each CP. Time for IO catheterization and IV catheterization was recorded and compared. The success of IO catheterization and IV catheterization was verified by visualization of an injection of iodinated contrast material under fluoroscopy within the medullary cavity or vessel. Animals Twenty-four canine cadavers. Measurements and Main Results Outcomes were analyzed using the Wilcoxon rank-sum test and the Kruskal–Wallis one-way analysis of variance. The median time for all IO catheterization operators was faster at 55.4 seconds (range 15.0–153.0 s) compared to the median time for all IV catherization operators at 217.3 seconds (range 55.6–614 s). The success rate for IO and IV was equal at 87.5%. Conclusion IO catheterization using an automatic rotary insertion device was performed more rapidly and successfully than jugular venous catheterization using a cut-down technique in canine cadaver. These findings suggest IO catheterization may be more efficient for gaining vascular access in the appropriate emergency clinical situations when preexisting IV access does not exist.

Comparison of two intramuscular sedation protocols on sedation, recovery and ease of venepuncture for cats undergoing blood donation:

Objectives The aim of this study was to compare the quality of sedation and recovery, and ease of venipuncture following sedation for feline blood donation using two intramuscular (IM) sedation protocols: alfaxalone/butorphanol (AB) and dexmedetomidine/butorphanol (DB). Methods This was an experimental randomized, blinded, crossover study. Ten client-owned healthy cats were recruited to participate in the study. Cats were sedated with AB (alfaxalone 2 mg/kg and butorphanol 0.2 mg/kg) for one donation and DB (dexmedetomidine 10 μg/kg and butorphanol 0.2 mg/kg) for another. Reaction to injection, quality of sedation and quality of recovery were assessed by a blinded observer. Time to lateral recumbency, number of venipuncture attempts, time required for blood collection and time to return to sternal recumbency were recorded. Cats were monitored for evidence of gastrointestinal distress. Each donation consisted of a maximum of 53 ml whole blood drawn over 3–22 mins. Donors received 100 ml subcutaneous lactated Ringer’s solution in recovery. Owners, unaware of sedation protocol, were asked to complete a questionnaire evaluating their cat’s behavior following sedation. Results IM injections were well tolerated by both treatment groups. There was no significant difference between treatment groups in sedation scores for posture (P = 0.30) or behavior (P = 0.06). Cats sedated with DB had significantly higher muscle relaxation scores (P = 0.03) compared with AB. There was no significant difference between treatment groups in time to lateral recumbency (P = 0.12), number of venipuncture attempts (P = 0.91) and time for blood draw (P = 0.29). There was no difference in quality of recoveries between treatment groups based on simple descriptive scores (P = 0.18) and owner evaluation 24 h following sedation. One cat vomited following administration of DB. Conclusions and relevance Alfaxalone is a suitable alternative to dexmedetomidine when combined with butorphanol and used as part of an IM sedation protocol for cats undergoing blood donation.

The effects of two intramuscular sedation protocols on echocardiographic variables in cats following sedation and blood donation

was adjusted to reach the MACBAR-ketamine or MACBAR-alone values previously established for that specific subject. Sheep received 1.5 mg kg 1 IV ketamine and a CRI of 1.5 mg kg 1 hour 1 or an equivalent volume of saline solution. Heart rate (HR), invasive systolic (SBP), mean (MBP) and diastolic (DBP) blood pressure, and cardiac output (CO) via NICO were compared with paired t test. Results: Mean ± SD HR, SBP, MBP, DBP, CO, of the ketamine and saline treatments were 81 ± 17 and 78 ± 15 beats minute 1 (p1⁄4 0.55), 98 ± 11 and 90 ± 11 mmHg (p1⁄4 0.05), 79 ± 17 and 73 ± 13 mmHg (p1⁄4 0.09), 70 ± 14 and 64 ± 13 mmHg (p1⁄4 0.13), 61.1 ± 16.4 and 58.9 ± 14.1 mL kg 1 minute 1 (p1⁄4 0.64), respectively. No significant difference was found for any of these variables between the 2 treatments. Conclusion: Ketamine at 1.5 mg kg 1 IV, followed by 1.5 mg kg 1 hour 1 did not affect the hemodynamics of healthy sheep anesthetized with sevoflurane. Further studies with higher doses of ketamine are warranted. http://dx.doi.org/10.1016/j.vaa.2017.09.026 Effect of propofol and ketamineediazepam on intraocular pressure in healthy premedicated dogs M Smith, M Barletta, K Diehl, E Hofmeister & S Franklin The University of Georgia College of Veterinary Medicine,

Severe brachycephalic obstructive airway syndrome is associated with hypercoagulability in dogs

We evaluated whether dogs with severe brachycephalic obstructive airway syndrome (BOAS) developed a hypercoagulable state similar to people with obstructive sleep apnea. Five dogs with grade 3 BOAS were included as well as 5 healthy control Labrador Retrievers. Venous blood samples were collected from each dog for performance of thromboelastography and determination of hematocrit and platelet count. Groups were compared using a t-test, with p < 0.05 considered significant. Thromboelastography results identified that all BOAS dogs were hypercoagulable compared to the Labradors, having significantly shortened clotting time with increased angle, maximal amplitude, and clot rigidity. BOAS dogs also had evidence of delayed fibrinolysis. These results are consistent with, but more severe than, those previously documented in apparently healthy Bulldogs. Together, these findings support the presence of a hypercoagulable state in brachycephalic dogs, and suggest that this state is amplified by increasing severity of BOAS.

Evaluation of red blood cell distribution width as a prognostic indicator in cats with acquired heart disease, with and without congestive heart failure:

Objectives Congestive heart failure secondary to cardiomyopathy is a common manifestation of cardiac disease in cats, carrying a variable prognosis. The objective of this retrospective study was to evaluate the relationship between red blood cell distribution width (RDW) and survival time in feline patients with acquired heart disease with and without congestive heart failure (CHF). Methods Three hundred and forty-nine client-owned cats with echocardiograms and complete blood count, including RDW measurement, performed between March 2006 and December 2011, were included in the study. Patient characteristics, including signalment, hematocrit, RDW, echocardiographic parameters and survival, were recorded. Comparisons between RDW in cats with asymptomatic acquired heart disease and those with CHF were made. Survival was documented and compared at 30 days and 6 months. Results CHF was present in 80 cats and absent in 269 cats. Cats with CHF had an increase in mortality compared with cats without CHF at 30 days and 6 months (P = 0.007 and P = 0.04, respectively). RDW was not significantly associated with survival in cats with or without CHF at 30 days or 6 months. A significant difference was found between median RDW values in cats with CHF vs cats without CHF (16.3% vs 15.8%; P = 0.02). The median RDW value was significantly higher in cats with unclassified cardiomyopathy compared with cats with other types of cardiomyopathy (16.3% vs 15.8%; P = 0.03). Conclusions and relevance Single RDW values did not predict mortality in cats with acquired heart disease but may be useful in determining if cats have decompensated heart disease and CHF. Human studies indicate that incremental increases in serial RDW measurements are associated with decreased survival; serial RDW measurements in cats may be an area of future study.