Efrat Kelmer

Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitalization time in dogs with gastric dilatation volvulus.

OBJECTIVE To assess the efficacy of IV lidocaine in decreasing complication rate and improving the outcome in dogs with gastric dilatation volvulus (GDV). DESIGN Prospective non-controlled study of 83 lidocaine-treated dogs with GDV compared to 47 untreated historical controls with GDV. SETTING University veterinary teaching hospital. ANIMALS One hundred and thirty client-owned dogs with naturally occurring GDV. INTERVENTIONS Study group dogs were treated at presentation with lidocaine (2 mg/kg, IV bolus) followed by constant rate infusion (CRI) of 0.05 mg/kg/min for 24 h. Historical control dogs did not receive any lidocaine. MEASUREMENTS AND MAIN RESULTS There were no group differences in age, body weight, time lag from onset of clinical signs to presentation, rectal temperature and pulse rate at presentation, and proportion of gastric wall necrosis. The proportions of cardiac arrhythmias and acute kidney injury (AKI) were significantly (P< 0.001 and P = 0.045, respectively) lower in the lidocaine group (10/83 [12%] versus 18/47 [38.3%] and 3/83 [3.6] versus 0/47). Median hospitalization time period was shorter (P = 0.05) in the lidocaine group compared to the controls (median 48 h; range 24-360 h versus median 72 h; range 24-144 h, respectively). CONCLUSION AND CLINICAL RELEVANCE Early treatment with IV lidocaine bolus, followed by CRI of lidocaine for 24 h post presentation decreased the occurrence of cardiac arrhythmias, AKI and hospitalization time period significantly in lidocaine-treated dogs with GDV compared to untreated historical controls. Due to the nonblinded, placebo-uncontrolled, nonrandomized nature of the current study, further evaluation of the efficacy of lidocaine in dogs with GDV is warranted.Objective To assess the efficacy of IV lidocaine in decreasing complication rate and improving the outcome in dogs with gastric dilatation volvulus (GDV). Design Prospective non-controlled study of 83 lidocaine-treated dogs with GDV compared to 47 untreated historical controls with GDV. Setting University veterinary teaching hospital. Animals One hundred and thirty client-owned dogs with naturally occurring GDV. Interventions Study group dogs were treated at presentation with lidocaine (2 mg/kg, IV bolus) followed by constant rate infusion (CRI) of 0.05 mg/kg/min for 24 h. Historical control dogs did not receive any lidocaine. Measurements and Main Results There were no group differences in age, body weight, time lag from onset of clinical signs to presentation, rectal temperature and pulse rate at presentation, and proportion of gastric wall necrosis. The proportions of cardiac arrhythmias and acute kidney injury (AKI) were significantly (P< 0.001 and P = 0.045, respectively) lower in the lidocaine group (10/83 [12%] versus 18/47 [38.3%] and 3/83 [3.6] versus 0/47). Median hospitalization time period was shorter (P = 0.05) in the lidocaine group compared to the controls (median 48 h; range 24–360 h versus median 72 h; range 24–144 h, respectively). Conclusion and Clinical Relevance Early treatment with IV lidocaine bolus, followed by CRI of lidocaine for 24 h post presentation decreased the occurrence of cardiac arrhythmias, AKI and hospitalization time period significantly in lidocaine-treated dogs with GDV compared to untreated historical controls. Due to the nonblinded, placebo-uncontrolled, nonrandomized nature of the current study, further evaluation of the efficacy of lidocaine in dogs with GDV is warranted.

Axial Pattern Flap Based on a Cutaneous Branch of the Facial Artery in Cats

OBJECTIVE To describe the cutaneous portion of the facial artery in cats and an axial pattern flap based on a branch of this artery. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Cat cadavers (n=12). METHODS The common carotid artery was identified, cannulated, and infused with methylene blue to assist in the identification of the facial artery, which was subsequently cannulated and selectively infused with methylene blue. The main trunk of the artery and its branches were dissected. The extent of blue coloration of the skin was evaluated on the contralateral side of the same specimen after infusing methylene blue into the facial artery. In 4 specimens, the flap was raised along previously defined borders and adequacy of perfusion was evaluated. RESULTS The area of skin perfused by the facial artery extended from the lower eyelid dorsally, to the angularis oris cranially, and the wing of the atlas caudally. Borders of the skin flap were defined on the basis of the anatomic dissection and skin coloration after selective infusion of the facial artery with methylene blue. A skin flap of 6 cm × 3.4 cm, based on the first caudally directed cutaneous branch of the facial artery was shown to be well perfused. The viability of this flap was confirmed in a clinical case. CONCLUSION The facial artery flap is useful for repair of skin defects of the head in cats.

Postoperative Management of Dogs With Gastric Dilatation and Volvulus

The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. Intensive postoperative management of the patients with GDV is essential for survival. Therapy in the postoperative period is focused on maintaining tissue perfusion along with intensive monitoring for prevention and early identification of ischemia-reperfusion injury (IRI) and consequent potential complications such as hypotension, cardiac arrhythmias, acute kidney injury (AKI), gastric ulceration, electrolyte imbalances, and pain. In addition, early identification of patients in need for re-exploration owing to gastric necrosis, abdominal sepsis, or splenic thrombosis is crucial. Therapy with intravenous lidocaine may play a central role in combating IRI and cardiac arrhythmias. The most serious complications of GDV are associated with IRI and consequent systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Other reported complications include hypotension, AKI, disseminated intravascular coagulation, gastric ulceration, and cardiac arrhythmias. Despite appropriate medical and surgical treatment, the reported mortality rate in dogs with GDV is high (10%-28%). Dogs with GDV that are affected with gastric necrosis or develop AKI have higher mortality rates.

Agreement between values for arterial and end-tidal partial pressures of carbon dioxide in spontaneously breathing, critically ill dogs

OBJECTIVE To determine agreement between arterial partial pressures of carbon dioxide (PaCO(2)) and end-tidal partial pressures of carbon dioxide (PETCO(2)) measured with a nasal catheter in spontaneously breathing, critically ill dogs. DESIGN Validation study. ANIMALS 26 client-owned dogs admitted to an intensive care unit for various conditions. PROCEDURES PaCO(2) was measured with a commercial blood gas analyzer, and PETCO(2) was measured with a sidestream capnograph attached to a nasal catheter. Measurements were obtained twice (ie, with and without supplemental oxygen). Paired values were compared by means of the Pearson correlation method. Level of agreement was assessed by means of the Bland-Altman method. RESULTS Mean difference between PaCO(2) and PETCO(2) when dogs did not receive supplemental oxygen (mean +/- SD, 3.95 +/- 4.92 mm Hg) was significantly lower than mean difference when dogs did receive supplemental oxygen (6.87 +/- 6.42 mm Hg). Mean difference in dogs with a condition affecting the respiratory system (8.55 +/- 5.43 mm Hg) was significantly higher than mean difference in dogs without respiratory tract disease (3.28 +/- 3.23 mm Hg). There was a significant linear correlation and good agreement between measured values of PaCO(2) and PETCO(2). Catheter size, ventilatory status, and outcome were not significantly associated with mean difference between PaCO(2) and PETCO(2). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that nasal capnography is a clinically relevant method of estimating PaCO(2) in spontaneously breathing, critically ill dogs, but that values should be interpreted with caution in dogs receiving supplemental oxygen and in dogs with conditions affecting the respiratory system.

Two years of combined high-intensity physical training and heat acclimatization affect lymphocyte and serum HSP70 in purebred military working dogs

Military working dogs in hot countries undergo exercise training at high ambient temperatures for at least 9 mo annually. Physiological adaptations to these harsh conditions have been extensively studied; however, studies focusing on the underlying molecular adaptations are limited. In the current study, military working dogs were chosen as a model to examine the effects of superimposing endurance exercise on seasonal acclimatization to environmental heat stress. The lymphocyte HSP70 profile and extracellular HSP70 were studied in tandem with physiological performance in the dogs from their recruitment for the following 2 yr. Aerobic power and heat shock proteins were measured at the end of each summer, with physical performance tests (PPTs) in an acclimatized room (22°C). The study shows that together with a profound enhancement of aerobic power and physical performance, hsp72 mRNA induction immediately post-PPT and 45 min later, progressively increased throughout the study period (relative change in median lymphocyte hsp72 mRNA first PPT, 4.22 and 12.82; second PPT, 17.19 and 109.05, respectively), whereas induction of HSP72 protein was stable. These responses suggest that cellular/molecular adaptive tools for maintaining HSP72 homeostasis exist. There was also a significant rise in basal and peak median optical density extracellular HSP at the end of each exercise test (first PPT, 0.13 and 0.15; second PPT, 1.04 and 1.52, respectively). The relationship between these enhancements and improved aerobic power capacity is not yet fully understood.

Hemostatic abnormalities in dogs with naturally occurring heatstroke

OBJECTIVE To investigate hemostatic analyte abnormalities and their association with mortality in dogs with naturally occurring heatstroke. DESIGN Prospective observational study. SETTING University teaching hospital. ANIMALS Thirty client-owned dogs with naturally occurring heatstroke. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Citrated and EDTA blood samples were collected at presentation and at 4, 12, 24, 36, and 48 hours postpresentation (PP). Hemostatic tests performed included platelet count, prothrombin and activated partial thromboplastin times (PT and aPTT, respectively), antithrombin activity (ATA), total protein C activity (tPCA), fibrinogen, and D-dimer concentrations. The overall survival rate was 60% (18/30 dogs). Older age, higher heart rate and rectal temperature at presentation, and time from onset of clinical signs to presentation were significantly associated with mortality. Hemostatic analytes at presentation were not associated with mortality. Prolonged PT and aPTT at 12-24 hours PP, lower tPCA at 12 hours PP, and hypofibrinogenemia at 24 hours PP were significantly (P < 0.05) associated with mortality. Increased D-dimer concentration and low ATA were common at all time points, but were not associated with mortality. The frequency of disseminated intravascular coagulation (DIC) increased in nonsurvivors throughout hospitalization, but the development of DIC was not associated with mortality. The number of abnormal coagulation disturbances during the first 24 hours was significantly higher in nonsurvivors (P = 0.04). CONCLUSIONS Hemostatic derangements are common in dogs with naturally occurring heatstroke. Alterations in PT, aPTT, tPCA, and fibrinogen concentrations appear to be associated with the outcome at 12-24 hours PP, exemplifying the need for serial measurement of multiple laboratory hemostatic tests during hospitalization, even when within reference interval on presentation. The development of DIC, as defined in this cohort, was not associated with mortality; however, nonsurvivors had significantly more coagulation abnormalities during the first 24 hours PP.Objective To investigate hemostatic analyte abnormalities and their association with mortality in dogs with naturally occurring heatstroke. Design Prospective observational study. Setting University teaching hospital. Animals Thirty client-owned dogs with naturally occurring heatstroke. Interventions None. Measurements and Main Results Citrated and EDTA blood samples were collected at presentation and at 4, 12, 24, 36, and 48 hours postpresentation (PP). Hemostatic tests performed included platelet count, prothrombin and activated partial thromboplastin times (PT and aPTT, respectively), antithrombin activity (ATA), total protein C activity (tPCA), fibrinogen, and D-dimer concentrations. The overall survival rate was 60% (18/30 dogs). Older age, higher heart rate and rectal temperature at presentation, and time from onset of clinical signs to presentation were significantly associated with mortality. Hemostatic analytes at presentation were not associated with mortality. Prolonged PT and aPTT at 12–24 hours PP, lower tPCA at 12 hours PP, and hypofibrinogenemia at 24 hours PP were significantly (P < 0.05) associated with mortality. Increased D-dimer concentration and low ATA were common at all time points, but were not associated with mortality. The frequency of disseminated intravascular coagulation (DIC) increased in nonsurvivors throughout hospitalization, but the development of DIC was not associated with mortality. The number of abnormal coagulation disturbances during the first 24 hours was significantly higher in nonsurvivors (P = 0.04). Conclusions Hemostatic derangements are common in dogs with naturally occurring heatstroke. Alterations in PT, aPTT, tPCA, and fibrinogen concentrations appear to be associated with the outcome at 12–24 hours PP, exemplifying the need for serial measurement of multiple laboratory hemostatic tests during hospitalization, even when within reference interval on presentation. The development of DIC, as defined in this cohort, was not associated with mortality; however, nonsurvivors had significantly more coagulation abnormalities during the first 24 hours PP.

Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia.

CASE DESCRIPTION A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing. CLINICAL FINDINGS Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, gamma-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity. TREATMENT AND OUTCOME Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood. CONCLUSIONS AND CLINICAL RELEVANCE Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration>5 days) pneumothorax when surgery is not an option.

Peripheral and central venous blood glucose concentrations in dogs and cats with acute arterial thromboembolism.

Background Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging. Hypothesis/Objectives Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval. Animals Client‐owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 cats and 9 dogs); acute limb paralysis secondary to orthopedic or neurologic conditions (nonambulatory controls; 10 cats and 11 dogs); ambulatory animals presented because of various diseases (ambulatory controls; 10 cats and 9 dogs). Methods Prospective observational, clinical study. Systemic and local (affected limb) blood glucose concentrations were measured. Their absolute and relative differences (ΔGlu and %ΔGlu, respectively) were compared among groups. Results ΔGlu and %ΔGlu were significantly higher in the ATE cats and dogs groups, compared to both of their respective controls (P < .0001 and P < .001, respectively). No significant differences were observed between the control groups. Receiver operator characteristics analysis of ΔGlu and %ΔGlu as predictors of ATE had area under the curve of 0.96 and 0.99 in cats, respectively, and 1.00 and 1.00, in dogs, respectively. ΔGlu cutoffs of 30 mg/dL and 16 mg/dL, in cats and dogs, respectively, corresponded to sensitivity and specificity of 100% and 90% in cats, respectively, and 100% in dogs. Conclusions and Clinical Importance ΔGlu and %ΔGlu are accurate, readily available, diagnostic markers of acute ATE in paralyzed cats and dogs.

Effects of intravenous administration of tranexamic acid on hematological, hemostatic, and thromboelastographic analytes in healthy adult dogs.

OBJECTIVE To assess the effects of tranexamic acid (TA) on hematological, hemostatic, and thromboelastographic analytes in healthy adult dogs. DESIGN Prospective study. SETTING University teaching hospital. ANIMALS Eleven healthy, staff-owned, adult dogs. MEASUREMENTS AND MAIN RESULTS Dogs were administered TA as an IV bolus, followed by a 3-hour constant rate infusion (CRI). Complete blood count, prothrombin time, activated partial thromboplastin time, D-dimer, antithrombin, fibrinogen, and thromboelastography (TEG) were measured prior to, and immediately after TA administration. Vomiting occurred transiently in the first 2 treated dogs, immediately after 20 and 15 mg/kg IV boluses, but not during the CRI. In all other dogs the TA IV bolus dose was reduced to 10 mg/kg, and administered slower, and vomiting did not occur. All measured hemostatic and hematological analytes remained within their reference intervals, however, following TA treatment, significant decreases were recorded in prothrombin time, TEG R and A30 values, Hct, and hemoglobin concentration, while the TEG LY30 significantly increased. CONCLUSIONS Administration of TA as a slow IV bolus at 10 mg/kg, followed by a 10 mg/kg/h CRI over 3 hours to healthy dogs is safe; however, its effect on TEG A30, A60, LY30, and LY60 values was inconsistent with its expected anti-fibrinolytic properties.

A retrospective evaluation of Vipera palaestinae envenomation in 18 cats: (2006–2011)

OBJECTIVE To describe the clinical signs, clinicopathologic abnormalities, treatment, complications and outcome, and to identify risk factors for death in cats envenomed by Vipera palaestinae (Vp). DESIGN Retrospective study. SETTING Veterinary teaching hospital. ANIMALS Eighteen client-owned cats envenomed by Vp. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All envenomations occurred during the hot season (May to October), mostly in young (<4 years, 66%) domestic shorthair, outdoor or indoor-outdoor cats. Clinical signs included tachypnea (>40/min, 100%), lameness (78%), depression (71%), fang penetration marks (55%), hypothermia (<37.5°C, 43%), hematoma at the envenomation site (27%), tachycardia (>220/min, 20%), and bradycardia (<140/min, 20%). Hematologic abnormalities included thrombocytopenia (89%), hemoconcentration (33%), and leukocytosis (33%). The activated partial thromboplastin and prothrombin times were prolonged in 100% and in 93% of the cats at presentation to a veterinarian, and remained prolonged 12-24 hours later in 92% and in 77% of the cats, respectively. Cats displayed increased serum creatine kinase activity (100%) and hyperglycemia (89%). Four cats (22%) did not survive. Median hospitalization time was 2 days. Variables associated with death included lower body weight (P = 0.01), lower initial rectal temperature (P = 0.02), lower initial hematocrit (P < 0.001) and 12-24 hours later (P = 0.001), and lower total plasma protein at 12-24 hours following presentation (P = 0.001). There was no association between death and administration of antivenom (10 mL/cat), fresh frozen plasma, or corticosteroids. CONCLUSIONS Cats are at least as susceptible as dogs to Vp envenomation. Lower body weight, rectal temperature, and hematocrit at presentation were associated with nonsurvival.Objective To describe the clinical signs, clinicopathologic abnormalities, treatment, complications and outcome, and to identify risk factors for death in cats envenomed by Vipera palaestinae (Vp). Design Retrospective study. Setting Veterinary teaching hospital. Animals Eighteen client-owned cats envenomed by Vp. Interventions None. Measurements and Main Results All envenomations occurred during the hot season (May to October), mostly in young ( 40/min, 100%), lameness (78%), depression (71%), fang penetration marks (55%), hypothermia ( 220/min, 20%), and bradycardia (<140/min, 20%). Hematologic abnormalities included thrombocytopenia (89%), hemoconcentration (33%), and leukocytosis (33%). The activated partial thromboplastin and prothrombin times were prolonged in 100% and in 93% of the cats at presentation to a veterinarian, and remained prolonged 12–24 hours later in 92% and in 77% of the cats, respectively. Cats displayed increased serum creatine kinase activity (100%) and hyperglycemia (89%). Four cats (22%) did not survive. Median hospitalization time was 2 days. Variables associated with death included lower body weight (P = 0.01), lower initial rectal temperature (P = 0.02), lower initial hematocrit (P < 0.001) and 12–24 hours later (P = 0.001), and lower total plasma protein at 12–24 hours following presentation (P = 0.001). There was no association between death and administration of antivenom (10 mL/cat), fresh frozen plasma, or corticosteroids. Conclusions Cats are at least as susceptible as dogs to Vp envenomation. Lower body weight, rectal temperature, and hematocrit at presentation were associated with nonsurvival.