Molly K. Shepard

A comparison of cardiopulmonary and anesthetic effects of an induction dose of alfaxalone or propofol in dogs

OBJECTIVE To compare the physiological parameters, arterial blood gas values, induction quality, and recovery quality after IV injection of alfaxalone or propofol in dogs. STUDY DESIGN Prospective, randomized, blinded crossover. ANIMALS Eight random-source adult female mixed-breed dogs weighing 18.7 ± 4.5 kg. METHODS Dogs were assigned to receive up to 8 mg kg(-1) propofol or 4 mg kg(-1) alfaxalone, administered to effect, at 10% of the calculated dose every 10 seconds. They then received the alternate drug after a 6-day washout. Temperature, pulse rate, respiratory rate, direct blood pressure, and arterial blood gases were measured before induction, immediately post-induction, and at 5-minute intervals until extubation. Quality of induction, recovery, and ataxia were scored by a single blinded investigator. Duration of anesthesia and recovery, and adverse events were recorded. RESULTS The mean doses required for induction were 2.6 ± 0.4 mg kg(-1) alfaxalone and 5.2 ± 0.8 mg kg(-1) propofol. After alfaxalone, temperature, respiration, and pH were significantly lower, and PaCO2 significantly higher post-induction compared to baseline (p < 0.03). After propofol, pH, PaO2 , and SaO2 were significantly lower, and PaCO2 , HCO3 , and PA-aO2 gradient significantly higher post-induction compared to baseline (p < 0.03). Post-induction and 5-minute physiologic and blood gas values were not significantly different between alfaxalone and propofol. Alfaxalone resulted in significantly longer times to achieve sternal recumbency (p = 0.0003) and standing (p = 0.0004) compared to propofol. Subjective scores for induction, recovery, and ataxia were not significantly different between treatments; however, dogs undergoing alfaxalone anesthesia were more likely to have ≥ 1 adverse event (p = 0.041). There were no serious adverse events in either treatment. CONCLUSIONS AND CLINICAL RELEVANCE There were no clinically significant differences in cardiopulmonary effects between propofol and alfaxalone. A single bolus of propofol resulted in shorter recovery times and fewer adverse events than a single bolus of alfaxalone.

Effect of duration and type of anesthetic on tear production in dogs

OBJECTIVE To determine effects of duration and type of anesthetic on tear production in dogs. ANIMALS 8 female Beagles. PROCEDURES Each dog was randomly allocated into 1 of 4 groups according to a Latin square design to receive anesthesia as follows: 1 hour with isoflurane, 1 hour with desflurane, 4 hours with isoflurane, and 4 hours with desflurane. Each dog was anesthetized with the selected inhalant 4 times during a 4-week period, with at least 5 days separating anesthetic episodes. Aqueous tear production was measured via the Schirmer I tear test at baseline and 10 minutes, 30 minutes, and 1 hour after induction of anesthesia as well as 2, 3, and 4 hours after induction for the 4-hour groups. Tear production was also measured after the dogs were standing after recovery from anesthesia and 2, 10, and 22 hours after recovery from anesthesia. RESULTS Aqueous tear production was significantly reduced in dogs during anesthesia and returned to baseline values immediately after recovery and until 10 hours after anesthesia in all treatment groups. Inhalant type and duration had no significant effect. Neither lateral recumbency nor left versus right eyes had a significant effect. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that inhalant anesthetics did not reduce tear production after anesthesia and that longer-duration anesthesia did not cause decreased tear production, compared with shorter-duration anesthesia.

Effects of acepromazine maleate or morphine on tear production before, during, and after sevoflurane anesthesia in dogs.

OBJECTIVE To investigate the effects of acepromazine maleate and morphine on aqueous tear production before, during, and after sevoflurane anesthesia in dogs. ANIMALS 6 mixed-breed dogs. PROCEDURES In a Latin square study design, dogs underwent i.m. administration of morphine (1 mg/kg), acepromazine (0.05 mg/kg), or saline (0.9% NaCl) solution (0.05 mL/kg), followed by induction and maintenance of anesthesia with sevoflurane for 30 minutes. The protocol was repeated until all dogs had received all treatments, with a minimum of 7 days between anesthetic episodes. Aqueous tear production was measured via Schirmer tear test I before treatment (baseline); before anesthetic induction; 5, 10, 20, and 30 minutes after anesthetic induction; immediately once dogs recovered from anesthesia; and 2 and 10 hours after recovery. RESULTS Aqueous tear production for all treatments was significantly lower 10, 20, and 30 minutes (but not 5 minutes) after anesthetic induction than at baseline, before anesthetic induction, at recovery, and 2 and 10 hours after recovery. Aqueous tear production was significantly higher after saline solution administration than after morphine administration at the preinduction measurement point and 2 hours after recovery. No other differences were detected among the 3 treatments. CONCLUSIONS AND CLINICAL RELEVANCE Aqueous tear production after anesthesia did not differ significantly from baseline values after any treatment following 30 minutes of sevoflurane anesthesia, suggesting premedication with morphine or acepromazine does not contribute to a decrease in lacrimation in these circumstances.

Pharmacodynamics of alfaxalone after single-dose intramuscular administration in red-eared sliders (Trachemys scripta elegans): a comparison of two different doses at two different ambient temperatures

OBJECTIVE This study compares the pharmacodynamics of two different doses of alfaxalone administered intramuscularly (IM) to red-eared sliders at two ambient temperatures. STUDY DESIGN Prospective blinded crossover experimental study. ANIMALS Nine adult female sliders (Trachemys scripta elegans). METHODS Following a 2-week acclimation at 22-25 °C, nine sliders were randomly assigned to receive alfaxalone, 10 mg kg(-1) (W10), or 20 mg kg(-1) (W20) IM. Each turtle received each dose, with a minimum 7-day washout period. A blinded observer evaluated heart rate (HR), palpebral and corneal reflexes, muscle relaxation, handling, and response to toe pinch at the following points: pre-injection, and 5, 12, 20, 30, 45, 60, and 120 minutes post-injection. Turtles then acclimated to 18-20 °C for 63 days, and the experiment was repeated in this lower-temperature environment, with treatment groups C10 (alfaxalone 10 mg kg(-1)) and C20 (alfaxalone 20 mg kg(-1)) subjected to the same crossover design. RESULTS C10 and C20 groups had significantly lower intraanesthetic HR than W10 or W20, respectively. C10 and W20 were significantly more relaxed and easier to handle than W10. No significant differences were observed in palpebral reflex, nor responsiveness to the toe pinch stimulus. None of the turtles lost corneal reflex. W20 and C20 had prolonged recoveries, compared to low-dose groups within the same temperature environment. Recovery was also longer at C20 and C10 compared to W10. CONCLUSIONS Turtles given 10 mg kg(-1) were more relaxed and easier to handle in cold than warm conditions. Warm turtles were more relaxed and easier to handle when given 20 mg kg(-1) than those given 10 mg kg(-1). Cold conditions correlated with lower HR and longer recovery time for each dose category. CLINICAL RELEVANCE The turtles had dose-dependent and inconsistent responses to alfaxalone. Lower ambient temperature augmented the behavioral effects of this drug.

A survey of the use of arterial catheters in anesthetized dogs and cats: 267 cases

OBJECTIVES To describe the clinical practice of insertion of arterial catheters in anesthetized dogs and cats, to document complications of arterial catheterization, and to determine risk factors associated with the complications. DESIGN Prospective clinical study and retrospective evaluation of medical records. SETTING University teaching hospital. ANIMALS Dogs (n = 251) and 13 cats anesthetized for clinical procedures with arterial catheters inserted for blood pressure monitoring. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Details of the animal and catheter were collected at the time of anesthesia. On the following day, the catheter site was palpated and observed for abnormalities and the medical records of all animals were reviewed retrospectively for complications. Details of catheter placement were available for 216 catheters: 158 catheters in a dorsal pedal artery, 50 catheters in the median caudal (coccygeal) artery, 6 in the median artery, and 1 each in a cranial tibial and lingual artery. Blood pressure was obtained from 200 catheters, and 12 catheters failed before the end of anesthesia. Postoperative observational data obtained from 112 catheters described a palpable arterial pulse at 73 sites and no pulse at 21 sites. No risk factor for arterial occlusion was identified. No complications resulting from arterial catheterization were noted in the medical records. CONCLUSIONS Arterial catheterization resulted in loss of a peripheral pulse postoperatively in 21/94 (22.3%) of animals examined, although no evidence of tissue ischemia was noted in the medical records of any of the patients in this study. These results suggest that insertion of a catheter in the dorsal pedal or coccygeal arteries was not associated with a high risk for complications. However, the course of arterial occlusion postoperatively warrants further investigation.Objectives To describe the clinical practice of insertion of arterial catheters in anesthetized dogs and cats, to document complications of arterial catheterization, and to determine risk factors associated with the complications. Design Prospective clinical study and retrospective evaluation of medical records. Setting University teaching hospital. Animals Dogs (n = 251) and 13 cats anesthetized for clinical procedures with arterial catheters inserted for blood pressure monitoring. Interventions None. Measurements and Main Results Details of the animal and catheter were collected at the time of anesthesia. On the following day, the catheter site was palpated and observed for abnormalities and the medical records of all animals were reviewed retrospectively for complications. Details of catheter placement were available for 216 catheters: 158 catheters in a dorsal pedal artery, 50 catheters in the median caudal (coccygeal) artery, 6 in the median artery, and 1 each in a cranial tibial and lingual artery. Blood pressure was obtained from 200 catheters, and 12 catheters failed before the end of anesthesia. Postoperative observational data obtained from 112 catheters described a palpable arterial pulse at 73 sites and no pulse at 21 sites. No risk factor for arterial occlusion was identified. No complications resulting from arterial catheterization were noted in the medical records. Conclusions Arterial catheterization resulted in loss of a peripheral pulse postoperatively in 21/94 (22.3%) of animals examined, although no evidence of tissue ischemia was noted in the medical records of any of the patients in this study. These results suggest that insertion of a catheter in the dorsal pedal or coccygeal arteries was not associated with a high risk for complications. However, the course of arterial occlusion postoperatively warrants further investigation.

Critical incident technique analysis applied to peri-anesthetic 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.

Updates in Perioperative Care: Ideas from the Human Field

The article focuses mainly on appropriate patient preparation for an anesthetic episode. Special attention is given to evaluate the environmental situation for optimal adjustment to reduce stress before the anesthetic event. During the anesthetic event, special attention must be paid regarding monitoring and, evaluating the patient during and after the anesthetic episode.