John W. Ludders

Distribution of a lidocaine-methylene blue solution staining in brachial plexus, lumbar plexus and sciatic nerve blocks in the dog

OBJECTIVE To determine the influence on the distribution of the volume of a local anaesthetic-methylene blue solution at three different nerve block sites in the dog. STUDY DESIGN Randomized, controlled, blinded experimental trial. ANIMALS 23 hound-cross dogs weighing 16-40 kg and aged 2 +/- 0 years (mean +/- SD). METHODS Dogs were anaesthetized and randomly assigned to three groups of seven or eight dogs each, based on volume administered: low, medium and high volume (L, M and H). Using electrolocation, the injection was performed after a positive response was elicited (flexion of the elbow for the brachial plexus block, quadriceps contractions for the lumbar plexus and dorsiflexion/plantar extension of the foot for the sciatic nerve block). At the brachial plexus site, groups L, M and H received 0.075, 0.15 and 0.3 mL kg(-1), respectively. At the lumbar plexus site, groups L, M and H received 0.1, 0.2 and 0.4 mL kg(-1), respectively. At the proximal sciatic nerve site, groups L, M and H received 0.05, 0.1 and 0.25 mL kg(-1), respectively. Necropsies were performed immediately following euthanasia. Staining of > or =2 cm along the nerve was considered sufficient; the proportions sufficient were compared with Fishers exact test. The volume was recommended when all the relevant nerves were stained sufficiently in all or all but one of the dogs within the group. RESULTS In the brachial plexus, only in group H were all the nerves stained sufficiently. In the lumbar plexus site, no statistical difference was found, but we suggest the H group volume to balance sufficient and excessive staining. At the sciatic nerve site, all volumes tested produced sufficient staining in all (or all but one) dogs. CONCLUSIONS AND CLINICAL RELEVANCE Volumes of 0.3 and 0.05 mL kg(-1) produced sufficient distribution for performing brachial plexus, and sciatic nerve blocks, respectively. Additionally, a volume of 0.4 mL kg(-1) might also be adequate for a lumbar plexus block (no statistical significance was reached).

Perioperative risk factors for puppies delivered by cesarean section in the United States and Canada.

The purpose of this study was to evaluate perioperative risk factors affecting neonatal survival after cesarean section. Data from 807 cesarean-derived litters (3,908 puppies) was submitted by 109 practices in the United States and Canada. Survival rates immediately, two hours, and seven days after delivery were 92% (n=3,127), 87% (n=2,951), and 80% (n=2,641), respectively, for puppies delivered by cesarean section (n=3,410) and were 86% (n=409), 83% (n=366), and 75% (n=283), respectively, for puppies born naturally (n=498). Maternal mortality rate was 1% (n=9). Of 776 surgeries, 453 (58%) were done on an emergency basis. The most common breed of dog was bulldog (n=138; 17%). The most common methods of inducing and maintaining anesthesia were administration of isoflurane for induction and maintenance (n=266; 34%) and administration of propofol for induction followed by administration of isoflurane for maintenance (n=237; 30%). A model of cesarean-derived puppies surviving to birth, between birth and two hours, and between two hours and seven days was designed to relate litter survival to perioperative factors. The following factors increased the likelihood of all puppies being alive: the surgery was not an emergency; the dam was not brachycephalic; there were four puppies or less in the litter; there were no naturally delivered or deformed puppies; all puppies breathed spontaneously at birth; at least one puppy vocalized spontaneously at birth; and neither methoxyflurane nor xylazine was used in the anesthetic protocol.

Pharmacokinetics of single-dose oral pregabalin administration in normal dogs

OBJECTIVE To describe the pharmacokinetics of pregabalin in normal dogs after a single oral dose. STUDY DESIGN Prospective experiment. ANIMALS Six adult Labrador/Greyhound dogs (four females and two males) aged 2.6 (2.6-5.6) years old (median and range) weighing 33.4 (26.8-42.1) kg. METHODS After jugular vein catheterization, the dogs received a single oral dose of pregabalin ( approximately 4 mg kg(-1)). Blood samples were collected at: 0 (before drug administration), 15 and 30 minutes and at 1, 1.5, 2, 3, 4, 6, 8, 12, 24 and 36 hours after drug administration. Plasma pregabalin concentration was measured by HPLC. Noncompartmental analysis was used to estimate pharmacokinetic variables. RESULTS No adverse effects were observed. The median (range) pharmacokinetic parameters were: Area under the curve from time 0 to 36 hours = 81.8 (56.5-92.1) microg hour mL(-1); absorption half-life = 0.38 (0.25-1.11) hours; elimination half-life = 6.90 (6.21-7.40) hours; time over 2.8 microg mL(-1) (the presumed minimal effective concentration) = 11.11 (6.97-14.47) hours; maximal plasma concentration (C(max)) = 7.15 (4.6-7.9) microg mL(-1); time for C(max) to occur = 1.5 (1.0-4.0) hours. Assuming an 8-hour dosing interval, predicted minimal, average, and maximal steady state plasma concentrations were 6.5 (4.8-8.1), 8.8 (7.3-10.9), and 13.0 (8.8-15.2) microg mL(-1). The corresponding values assuming a 12-hour interval were 3.8 (2.4-4.8), 6.8 (4.9-7.9), and 10.1 (6.6-11.6) microg mL(-1). CONCLUSIONS AND CLINICAL RELEVANCE Pregabalin 4 mg kg(-1) PO produces plasma concentrations within the extrapolated therapeutic range from humans for sufficient time to suggest that a twice daily dosing regime would be adequate. Further study of the drugs safety and efficacy for the treatment of neuropathic pain and seizures in dogs is warranted.

Fecal Corticosterone Reflects Serum Corticosterone in Florida Sandhill Cranes

Florida sandhill cranes (Grus canadensis pratensis) were conditioned to confinement 6 hr/day for 7 days. On day 8, each birds jugular vein was catheterized, blood samples were drawn, and each crane was confined for 6 hr. Using a randomized, restricted cross-over design, cranes were injected intravenously with either 0.9% NaCl solution or ACTH (cosyntropin; Cortrosyn®; 0.25 mg). During the 6 hr of confinement, fecal samples (feces and urine) were collected from each of five cranes immediately after defecation. Individual fecal samples were collected approximately at hourly intervals and assayed for corticosterone. We showed previously that serum corticosterone did not vary significantly following saline injection, but peaked significantly 60 min after ACTH injection. Maximal fecal corticosterone concentrations (ng/g) were greater (P < 0.10; median 1087 ng/g) following ACTH stimulation compared to maximal fecal corticosterone concentrations at the end of acclimation (day 7; median 176) and following saline treatment (median 541). In cranes under controlled conditions, fecal corticosterone concentration reflects serum corticosterone levels.

Procedural sedation combined with locoregional anesthesia for orthopedic surgery of the pelvic limb in 10 dogs: case series

HISTORY Ten dogs weighing 36 (21.4-75) kg [median (min-max)] and aged 3 (1-9) years scheduled for orthopedic surgery involving the stifle and structures distal to it. PHYSICAL EXAMINATION Patients were classified as ASA I or II based on physical examination and basic hematology and biochemistry. MANAGEMENT Each dog was managed using combined femoral and sciatic nerve blocks and procedural sedation with an intravenous infusion of propofol (0.07-0.15 mg kg(-1) minute(-1)) and dexmedetomidine (1 μg kg(-1) hour(-1)). None of the patients required conversion to general anesthesia as a result of response to surgical stimulation. The level of sedation was considered adequate in all patients and was characterized by occasional head lifting, thoracic limb stretching, yawning, lingual movements and swallowing. The eye position ranged from central to partial ventromedial rotation and was accompanied by spontaneous blinking. Intra-operative cardiovascular and ventilatory variables were considered within acceptable limits. Muscle relaxation at the surgical field was adequate and surgical conditions were indistinguishable from those produced by general anesthesia. Intraoperatively, no additional analgesics were considered necessary. The quality of the recoveries was considered excellent in all cases. FOLLOW UP No additional pain relief was required in any of the dogs within the 10 hours following blockade. All dogs ate 5.5 (3.5-12) hours after recovery. Ambulation occurred at 4 (2-6) hours. No evidence of esophagitis or aspiration pneumonitis has been reported during a period of 1 year after the procedures in any of the dogs. CONCLUSION When combined with femoral and sciatic nerve blocks, procedural sedation has the potential of being an alternative to general anesthesia for orthopedic surgery involving the stifle and structures distal to it in the dog.

Sedative and cardiorespiratory effects of dexmedetomidine and buprenorphine administered to cats via oral transmucosal or intramuscular routes

OBJECTIVE To determine if buprenorphine plus dexmedetomidine administered via the oral transmucosal route produces sufficient sedation in cats so that students can insert intravenous catheters. STUDY DESIGN Prospective, randomized, blinded, clinical trial. ANIMALS Eighty-seven shelter-owned female cats aged 4-48 months, weighing 1.1-4.9 kg. METHODS Cats were randomly allocated to two treatment groups based on route of drug administration: oral transmucosal (OTM), or intramuscular (IM). Buprenorphine (20 microg kg(-1)) plus dexmedetomidine (20 microg kg(-1)) were administered as pre-medicants via one of these two routes. Prior to and 20 minutes after drug administration, heart and respiratory rates, systolic arterial pressure, and posture were measured and recorded. Twenty minutes after drug administration the same variables plus each cats response to clipper sound, clipping, and restraint were recorded; higher scores indicated more sedation. RESULTS There were no significant differences between the two groups prior to pre-medication. Within each treatment group heart rate was significantly lower 20 minutes after treatment, but it did not differ significantly between the two groups. Twenty minutes after treatment, respiratory rate was significantly less in the OTM group, but did not differ significantly between the two groups. Systolic arterial pressure did not differ within or between the two groups at either time. Scores for posture increased significantly within both groups, and cats in the IM group had higher scores after treatment. Twenty minutes after treatment, cats in the IM group had higher scores for clipping and restraint than OTM cats. Ketamine (IM) was necessary to facilitate catheterization in 25% and 16% of cats in the OTM and IM groups, respectively, but this was not significantly different. CONCLUSIONS AND CLINICAL RELEVANCE Administration of dexmedetomidine plus buprenorphine by the OTM route is easy to perform, but produces less sedation than the IM route for IV catheterization in cats.

A randomized, blinded, controlled trial of the antiemetic effect of ondansetron on dexmedetomidine-induced emesis in cats

OBJECTIVE To determine the effect of ondansetron on the incidence of vomiting in cats pre-medicated with dexmedetomidine and buprenorphine. STUDY DESIGN Randomized, blinded, controlled trial. ANIMALS Eighty-nine female domestic shorthair cats, aged 3-60 months (median, 12 months) and weighing 1.2-5.1 kg. METHODS Each cat received dexmedetomidine (40 μg kg(-1)) plus buprenorphine (20 μg kg(-1)), intramuscularly as pre-anesthetic medication. Cats were assigned to three treatment groups: ondansetron (0.22 mg kg(-1), intramuscular [IM]), either 30 minutes before the pre-anesthetic medication (ONDA group, n = 31) or with the pre-anesthetic medication (OPM group, n = 30) mixed with the pre-anesthetic medications in the same syringe, or not to receive the antiemetic (control group, n = 28). Emesis was recorded as an all-or-none response. The number of episodes of emesis and the time until onset of the first emetic episode were recorded for each cat. Clinical signs of nausea were recorded whenever they occurred, and a numerical rating scale was used to quantify these signs. Data were analyzed using Kruskal-Wallis and Chi-square test; a Bonferroni correction was made for six comparisons; thus, the two-sided p for significance was 0.05/6 = 0.008. RESULTS There was a significant reduction in the number of cats vomiting, in the episodes of vomiting/cat, the time elapsed between the premedication and the first vomiting and the severity of nausea in the OPM group compared to the ONDA and control groups. CONCLUSIONS AND CLINICAL RELEVANCE In cats, the administration of ondansetron (0.22 mg kg(-1)) ameliorates and reduced the severity of dexmedetomidine-induced nausea and vomiting only when it was administered in association with this drug.

Biochemical Variables in Free-ranging White-tailed Deer (Odocoileus virginianus) after Chemical Immobilization in Clover Traps or Via Ground-darting

Abstract The objective of this prospective observational cohort study in free-ranging female white-tailed deer (Odocoileus virginianus) was to compare the physiologic effects of two methods of anesthetic drug administration: hand-injection in Clover traps and remote injection by dart after ground-stalking. Six trapped and 14 darted female deer were injected with a median (minimum, maximum) of 590 µg/kg butorphanol (401, 1070 µg/kg), plus 235 µg/kg medetomidine (160, 429 µg/kg) intramuscularly. In the trap, the deer struggled when approached and were restrained for injection. Darted deer sprinted away after injection. Once immobilized, deer were transported to a veterinary hospital where blood was collected and vital signs were measured on admission. Admission data from a subset of deer in which measurements were taken within 40 min of trapping (n  =  6) or darting (n  =  5) were analyzed. After salpingectomy under isoflurane and while still anesthetized, another blood sample was collected from all 20 deer. Body weight and immobilization drug doses were not different between groups. On admission, most deer from both groups were hypoxemic, although the darted deer were significantly more hypoxemic. The median rectal temperature in trapped deer was higher than in darted deer, and temperatures higher than 39°C only occurred in trapped deer. The median heart rate in trapped deer was more than twice that in darted deer. Trapped deer had lower median pH and base excess; in trapped deer, the median plasma lactate concentration was more than fivefold higher than in darted deer. After surgery, the median serum creatine kinase concentration was nearly 10-fold higher in trapped deer, and the median cardiac troponin I concentration was higher in trapped deer but undetectable in 10 of 14 darted deer. The white-tailed deer immobilized by hand-injection in Clover traps experienced more severe physiologic perturbations than deer remotely injected by dart after ground-stalking. These perturbations might be sufficient to cause myocardial damage.

Comparison between acceleromyography and visual assessment of train‐of‐four for monitoring neuromuscular blockade in horses undergoing surgery

OBJECTIVE To compare acceleromyography (AMG) with visual assessment of train-of-four (TOF) for monitoring neuromuscular blockade and detecting residual muscle paralysis in horses receiving atracurium. STUDY DESIGN Prospective, controlled clinical study. ANIMALS Nine adult, client-owned horses weighing 577 (436, 727) kg (median, minimum, maximum) and ASA physical status I-II, admitted for surgery. METHODS An electrical nerve stimulator was used to stimulate the peroneal nerve with TOFs at 1 minute intervals. Before and after atracurium administration (0.15 mg kg(-1), IV), the number of twitches observed (TOF count, or TOFc) was assessed visually. When four twitches were seen (i.e., TOFc = 4) presence or absence of fade by visual assessment was recorded. Simultaneously, the response to each TOF was assessed by AMG; this measured TOFc, and twitch fade using TOF ratio (TOFR; ratio of fourth to first twitch). The anesthetist performing the visual evaluation was blinded to the AMG readings. Recovery from neuromuscular blockade was defined as the absence of fade by visual inspection or a TOFR > or =90% by AMG. RESULTS During onset of action of the drug, fade was first detected 4 (1, 8) minutes earlier by AMG (p = 0.008). Maximal blockade started at 6 (3, 17) minutes by visual assessment and 9 (3, 25) minutes by AMG (not significantly different). Only four horses achieved complete neuromuscular blockade (TOFc of zero by both methods); in those four horses AMG did not detect the start of the return of neuromuscular transmission before visual assessment. Visual assessment indicated the return of four twitches with no fade 12 (8, 42) minutes before AMG gave a TOFR of > or =90% (p = 0.004). CONCLUSION AND CLINICAL RELEVANCE There was no substantial advantage for AMG in detecting the onset of atracurium-induced neuromuscular blockade. However, AMG detected residual blockade when visual assessment of TOF did not. Application of AMG is likely to reduce the incidence of residual blockade.

Inhalant anesthetics and inspired oxygen: implications for anesthesia in birds

A number of factors cause respiratory depression in anesthetized birds. Hypoventilation can be due to anesthetic-induced depression of the central nervous system, muscular relaxation of the muscles of respiration, and effects on central and peripheral chemoreceptors. Compared to mammals, respiratory function in birds may be more sensitive to the effects of inhalant anesthetics because of their effect on unique carbon dioxide (CO2)-sensitive intrapulmonary chemoreceptors located within the avian lung. High fractions of inspired oxygen also contribute to hypoventilation, possibly by depressing oxygen-sensitive chemoreceptors. This article is a review of the factors that cause respiratory depression in anesthetized birds.