Pain management for the pregnant, lactating, and neonatal to pediatric cat and dog

A systematic review of mammary gland inflammations in queens (Felis catus)

Mastitis is a rare condition that can be diagnosed in female cats of all breeds and ages. It is usually caused by bacterial agents and is frequently encountered secondarily in feline mammary fibroepithelial hyperplasia (FEH). If left untreated, it can peril both the queen and her kittens. Therefore, a reliable and quick diagnosis is the primary key to successful treatment. Conventional diagnosis consists of a clinical and ultrasound evaluation of the queen's mammary glands. However, there is a lack of literature specifically focused on mastitis in queens. Consequently, the present review brings forth the existing knowledge regarding mammary gland inflammations in cats, with the goal of improving current clinical evaluation and treatment plans.

[Use of drugs in pregnant dogs and puppies - what should be considered from a pharmacological point of view?]

The administration of drugs to pregnant bitches may not only pose a potential danger to the bitch but also to the fetuses. In this context, the extent of the risk also depends on the stage of gestation. Although a number of agents are known to have a fetotoxic and/or teratogenic potential, insufficient knowledge concerning their potential risk to the embryo/fetus is available for the majority of drugs.Arranged in groups of active substances, a selection of drugs that are assumed to be safe according to the current state of knowledge is provided. Drugs for which there is insufficient knowledge or which are clearly contraindicated are also mentioned.The second part of this overview covers the use of medicines in puppies. The physiology of a puppy does not simply correspond to that of a small dog. Only very few drugs posess valid pharmacological data for use in puppies. However, a subset of restrictions on the use of pharmacologic agents may be derived from the specifics of puppy physiology.The recommendations made do not claim to be complete and no guarantee for accuracy is provided, as these have been compiled from a literature review. In certain cases, the recommendations are even contradictory.Veterinarians are therefore encouraged to report all adverse events associated with treatments of pregnant bitches and puppies within the framework of pharmacovigilance. This is the only way to close gaps in knowledge about the treatment of these special patients.

Factors influencing ease of whelping and its relationship with maternal behaviour and puppy perinatal mortality in commercially bred dogs

For dog breeders, parturition is a critical stage in the reproductive cycle of the dam. Evidence in other mammals suggests that a difficult labour can influence maternal behaviour and offspring viability during the first hours postpartum. However, the effect of whelping difficulty on the onset of maternal behaviour has not yet been investigated in domestic dogs. Here we developed an ease of whelping (EoW) index in dams maintained within a Commercial dog Breeding Establishment (CBE) environment and investigated the relationship between intrinsic and extrinsic factors (breed group according to size/weight, litter size, parity, whelping season and origin of the dam), EoW, early maternal behaviour and puppy perinatal mortality. The behaviour of 30 dams was observed throughout the whelping process, starting 24 h before delivery of the first puppy until birth of the last puppy. Parturition duration, birth interval, and behaviours indicative of distress, restlessness, and general activity were scored and included in a Principal Component Analysis to construct the EoW index. Subsequently, mother-pup interactions and puppy perinatal mortality were recorded during the first 24 and 72 h postpartum respectively. Results showed that EoW was significantly affected by whelping season, litter size and origin of the dam (whether she was born and raised within the CBE or brought in). Furthermore, mothers that experienced more difficult parturitions (higher EoW score) spent more time lying in contact with their puppies during the first 24 h postpartum. Time in contact with puppies was also significantly affected by breed group. Nursing duration was significantly affected by breed group and origin of the dam. Additionally, medium-size breed (10-20 kg) puppies were significantly less likely to experience perinatal mortality than large breeds (> 20 kg). These findings are particularly relevant for the welfare of breeding dams maintained in large-scale CBEs where the staff-to-dog ratio might be insufficient to adequately manage multiple simultaneous parturitions.

Parturition in Mammals: Animal Models, Pain and Distress

Parturition is a complex physiological process and involves many hormonal, morphological, physiological, and behavioural changes. Labour is a crucial moment for numerous species and is usually the most painful experience in females. Contrary to the extensive research in humans, there are limited pain studies associated with the birth process in domestic animals. Nonetheless, awareness of parturition has increased among the public, owners, and the scientific community during recent years. Dystocia is a significant factor that increases the level of parturition pain. It is considered less common in polytocous species because newborns' number and small size might lead to the belief that the parturition process is less painful than in monotocous animal species and humans. This review aims to provide elements of the current knowledge about human labour pain (monotocous species), the relevant contribution of the rat model to human labour pain, and the current clinical and experimental knowledge of parturition pain mechanisms in domestic animals that support the fact that domestic polytocous species also experience pain. Moreover, both for women and domestic animal species, parturition's pain represents a potential welfare concern, and information on pain indicators and the appropriate analgesic therapy are discussed.

Lactation-related mammary gland pathologies-A neglected emergency in the bitch

Mastitis is a common reproductive disorder in bitches, reaching a prevalence of 0.71%. Mastitis has a wide range of forms, from asymptomatic to severe gangrenous mastitis that can lead to septic shock and death of the bitch and nurslings. However, most of the time it is overlooked, undiagnosed or mistreated. The present systematic review was performed to revise and summarize the existing knowledge related to this disorder, including diagnosis, treatment and prevention.

Curtailing parturition observation and performing preparturient cesarean section in bitches

Properly planned elective cesarean section (CS) in bitches is considered safe and justified for some breeds. Therefore, planning a scheduled (fixed date and time) preparturient CS in bitches belonging to a subpopulation where a CS is unavoidable, seems justified. The first day of cytological diestrus (D0) was used to predict the date of parturition. The aims of this study were to (1) compare the mortality of puppies delivered by preparturient CS to those delivered by parturient CS, (2) determine the extent to which a preparturient CS (performed at 08:00 on D57, while the cervix is closed) would shorten gestation, (3) compare the level of progesterone at the time of preparturient CS to that at the time of parturient CS, (4) compare the change in hematocrit before and after CS for parturient- and preparturient CSs. Out of 99 gestations for which D0 was known and a preparturient CS planned, the CS was performed at the scheduled time in 61%, before the scheduled time because cervical dilatation had started in 32% and before the scheduled time in 7% because the bitches had started showing signs of impending parturition, although their cervices were still closed. This study showed high neonatal survival ratios and good Apgar scores after preparturient CS with 99% of puppies delivered by preparturient CS born alive and 98.8% surviving to 2 h. Performing preparturient CSs shortened gestation by four to 52 h. Progesterone level was significantly higher at the time of preparturient CSs than at the time of parturient CSs. Further studies are required to determine whether preparturient CSs on D57 are routinely safe in all breeds, does not affect long term survival of the puppies and to timeously identify bitches in which parturition starts prior to the date and time for the scheduled elective preparturient CS.

Puppy survival and vigor associated with the use of low dose medetomidine premedication, propofol induction and maintenance of anesthesia using sevoflurane gas-inhalation for cesarean section in the bitch

The safety of an anesthetic protocol consisting of medetomidine hydrochloride (7 μg/kg iv) as premedicant, propofol, (1-2 mg/kg iv) as induction agent and sevoflurane, at 2% in oxygen for maintenance of anesthesia was studied in 292 cesarean sections (CSs) and 2232 puppies delivered. Medetomidine effects were reversed using atipamezole hydrochloride at 50 μg/puppy sc immediately following delivery and in the bitch iv immediately following surgery. The protocol's safety for puppies was expressed using survival immediately, 2 h and 7 d after delivery, and Apgar scores (measurement starting 15 min after delivery of the last puppy). The maternal survival rate was established immediately, 2 h and 7 d after cesarean section (CS). The CSs included 148 on Boerboel, 84 on English bulldog and 60 on other purebred bitches, which resulted in 1378, 541 and 313 puppies, respectively. Boerboel, English bulldog and other purebred bitches yielded 97.39%, 96.67% and 91.69% live puppies at delivery, 95.43%, 88.35% and 89.78% alive by 2 h and 89.19%, 79.11% and 84.03% alive by 7 d. Sixteen (1.16%), 32 (5.59%) and 4 (1.28%) malformed Boerboel, English bulldog and other purebred puppies were euthanized. Thirty five, 18 and 26, Boerboel, English bulldog and other purebred puppies were stillborn respectively, of which 12, 9 and 15, respectively had been discovered dead upon ultrasound examination immediately before CS. After correction for fetuses found dead on ultrasound examination and malformed euthanized puppies, 98.21%, 95.60% and 94.30% of Boerboel, English bulldog and other purebred puppies survived until 2 h and 91.78%, 87.17% and 88.26% until 7 d. Two-hour survival rates are negatively correlated to the proportion of puppies in a litter with scores of 8 or below (r = 0.14, P = 0.01, n = 292 litters) and tends to be positively correlated to the lowest Apgar score in a litter (r = 0.11, P = 0.05, n = 292 litters). This study shows that medetomidine hydrochloride in the protocol used is a safe premedicant in bitches prior to cesarean section and is associated with good puppy vigor as well as 2 h and 7 d puppy survival rates. The use of medetomidine as premedicant permitted use of less than half the dose of propofol usually required as induction agent.

Effects of age and reproductive status on postoperative pain after routine ovariohysterectomy in cats

A prospective clinical trial to compare the effects of age and reproductive status on postoperative pain was conducted in 145 female cats undergoing ovariohysterectomy using injectable anaesthesia. The cats were grouped appropriately: 60 kittens <4 months old (K), 85 adults >4 months old (A) and, within the adult group, 57 normal adults (nA) and 28 adults who were either pregnant or in oestrus (rA). Pain was assessed using a simple descriptive scale (SDS; 0-3), a dynamic and interactive visual scale (DIVAS; 0-100 mm) and mechanical nociceptive thresholds (MNT; N, 2 mm diameter probe) pre-operatively and at 4 and 24 h postoperatively. Kittens had lower DIVAS areas under the time curve and SDS than adults (P <0.05), but similar MNT (K: 3.3 ± 2.6, A: 4.3 ± 2.5 N at 4 h, P >0.05). Data from nA and rA were not different (P >0.05). Kittens had similar wound tenderness, but less affective pain than adults, and reproductive status had no effect.

Veterinary attitudes towards pre-pubertal gonadectomy of cats: a comparison of samples from New Zealand, Australia and the United Kingdom

AIM

To compare the attitudes and practices of a sample of veterinarians in New Zealand, Australia and the United Kingdom (UK) towards pre-pubertal gonadectomy of cats.

METHODS

Respondents' demographics were gathered using an electronic questionnaire distributed via professional veterinary associations in the target countries, as were minimum age at gonadectomy and typical age of puberty. Desirability of prepubertal gonadectomy was gauged using three response categories ('yes', 'no' or 'sometimes'), respondents were then able to justify the response given. Two-way Analyses of Variance (ANOVA) followed by post hoc Tukey HSD tests were used to test whether there were differences in minimum ages for gonadectomy within and between countries and between providers and non-providers of services to pounds (or animal welfare centres). Views on the desirability of prepubertal gonadectomy relative to demographics were explored using a Likelihood Ratio Test.

RESULTS

The survey received 717 responses. Most respondents believed pre-pubertal gonadectomy was either entirely or 'sometimes' desirable (556/621), few thought it was undesirable (65/621). Minimum age at gonadectomy was significantly affected by country surveyed and provision or non-provision of services for pounds. Post hoc Tukey HSD analysis indicated the mean age of both spaying and castration (4.3 months) in the UK was significantly different from both Australia (spaying: 3.4 months, castration: 3.2 months) and New Zealand (spaying: 3.4 months, castration: 3.2 months) (all p<0.001). Mean ages at spaying and castration were also significantly different (p= 0.008; p= 0.019, respectively) for non-providers (spaying: 3.9 months, castration: 3.8 months) of services to pounds when compared to providers (spaying and castration: both 3.6 months). Likelihood Ratio Tests indicated significant effects amongst countries and between genders relative to the desirability of pre- pubertal gonadectomy. Respondents from the UK were more likely to answer 'no' (p = 0.004) or 'sometimes' (p = 0.050) as compared to those from New Zealand or Australia. Females were more likely to respond with 'sometimes' as opposed to 'yes' than males. Reasons for considering pre-pubertal gonadectomy desirable or sometimes desirable focussed on reducing unwanted pregnancies and improving population control, as well as improving rates of adoption, owner compliance and cat behaviour and health.

CONCLUSIONS AND CLINICAL RELEVANCE

In general, pre-pubertal gonadectomy is considered a desirable procedure by those practitioners that responded to the survey. However age at which any such procedure occurs differs depending upon a number of factors. Differences among countries may relate to the specific veterinary association's guidelines or possibly differences in social discourse which affect perception of cats. There is substantial overlap between the reported minimum age of gonadectomy and the age at which cats can enter early puberty, allowing a window for unintentional pregnancy when pre-pubertal gonadectomy does not occur.

Anaesthetic Management of a 1-Month-Old Puppy Undergoing Lateral Thoracotomy for Vascular Ring Anomaly Correction

A 1-month-old male flat-coated retriever was anaesthetized for correction of oesophageal constriction caused by a vascular ring anomaly. Anaesthesia was uneventfully induced with intravenous fentanyl, diazepam, and propofol and maintained with isoflurane in oxygen and air. An intercostal block with bupivacaine and lidocaine was performed, and additional analgesia with an infusion of fentanyl was provided. Fluid therapy consisted in 5% glucose in lactated Ringer’s solution and hetastarch 6%, which proved adequate to maintain normoglycemia and normovolemia. A lateral thoracotomy was performed, and the ligamentum arteriosum was ligated. Intraoperatively, heart rate (HR) varied between 120 and 180 beats min−1without accompanying changes in blood pressure. No arrhythmias were observed or bleeding occurred. The dog recovered uneventfully. Postoperative analgesia consisted in fentanyl infusion adjusted to the patient's requirement and metamizol. This paper describes for the first time the use of balanced anaesthesia and multimodal analgesia in a paediatric dog undergoing thoracotomy.