Sheilah A. Robertson

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

Rationale: The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge. Relevance: Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian–client–patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. Approaches: The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. Evidence base: The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

Retrospective analysis of detomidine infusion for standing chemical restraint in 51 horses

OBJECTIVE To assess the effectiveness of a detomidine infusion technique to provide standing chemical restraint in the horse. DESIGN Retrospective study. ANIMALS Fifty-one adult horses aged 9.5 ± 6.9 years (range 1-23 years) and weighing 575 ± 290.3 kg. METHODS Records of horses presented to our clinic over a 3-year period in which a detomidine infusion was used to provide standing chemical restraint were reviewed. Information relating to the types of procedure performed, duration of infusion, drug dosages and adjunct drugs administered was retrieved. RESULTS Detomidine was administered as an initial bolus loading dose (mean ± SD) of 7.5 ± 1.87 μg kg-1. The initial infusion rate was 0.6 μg kg-1 minute-1, and this was halved every 15 minutes. The duration of the infusion ranged from 20 to 135 minutes. Twenty horses received additional detomidine or butorphanol during the procedure. All horses undergoing surgery received local anesthesia or epidural analgesia in addition to the detomidine infusion. A wide variety of procedures were performed in these horses. CONCLUSIONS Detomidine administered by infusion provides prolonged periods of chemical restraint in standing horses. Supplemental sedatives or analgesics may be needed in horses undergoing surgery. CLINICAL RELEVANCE An effective method that provides prolonged periods of chemical restraint in standing horses is described. The infusion alone did not provide sufficient analgesia for surgery and a significant proportion of animals required supplemental sedatives and analgesics.

Newer Diagnostic and Surgical Techniques and Their Impact on Anesthesia

There are several newer diagnostic and surgical techniques available to veterinarians today. Careful anesthetic management is essential when using these modalities both to avoid accidents and to enable their use. For example, total intravenous anesthetic techniques can be used if the airway is occupied by an endoscope or laser surgery is being performed in the airway. The anesthesiologist must also be aware of the physiological changes that may occur during procedures such as laparoscopy and act to minimize their impact on patients.

Best practice recommendations for prehospital veterinary care of dogs and cats

Objective To examine available evidence on prehospital care in human and veterinary trauma and emergency medicine and develop best practice guidelines for use by both paramedical and nonparamedical personnel in the approach to the prehospital care of dogs and cats. Design Systematic evaluation of the literature gathered via medical databases searches of Medline, CAB abstracts, and Google Scholar. Synthesis From a review and systematic evaluation of the available evidence, consensus guidelines on the approach to prehospital care of dogs and cats in 18 scenarios were developed. Conclusions Due to the lack of current evidence in the veterinary prehospital arena, best practice guidelines were developed as an initial platform. Recommendations were based on a review of pertinent human and available veterinary literature as well as a consensus of the authors’ professional opinions. It is anticipated that evidence-based additions will be made in the future.