Anesthesia for Patients with Renal/Hepatic Disease

[A multifactorial risk index for evaluation of anesthetic risk in dogs: the LeiV-Risk-Index]

OBJECTIVE

The Leipzig Veterinary Risk-Index - "LeiV-Risk-Index" is a multifactorial risk index developed to enable an improved objective assessment of the anesthetic risk in dogs. The scoring system is based on 10 risk factors affecting perioperative mortality. The aim of this study was to evaluate the applicability of the LeiV-Risk-Index and its risk factors as well as to perform a direct comparison with the ASA-classification.

MATERIAL AND METHODS

An online survey was conducted among veterinarians working in small animal medicine throughout Germany. Participants received a questionnaire containing information on 15 selected patients. They were asked to classify the patients according to the LeiV-Risk-Index and ASA-classification and to answer several questions concerning their professional background. The results were statistically analyzed considering the consistency among veterinarians of rating the different patients by using Fleiss'-Kappa. The correlation of LeiV-Risk-Index and ASA-classification was calculated.

RESULTS

The consistency of all assigned LeiV-risk classes between participants was moderate (κ = 0.55) and higher than classification by ASA (κ = 0.33). On average, 3 different LeiV-risk classes and 4 different ASA-classes were assigned for one patient. There was a positive correlation between LeiV-risk class and increasing ASA-class. No effect of gender or clinical experience of the veterinarian could be demonstrated on ranking patients. There was also no effect of how confident veterinarians felt in applying the LeiV-Risk-Index.

CONCLUSION UND CLINICAL RELEVANCE

The LeiV-Risk-Index is the first index available in veterinary medicine for assessing anesthetic risk that is based on objective risk criteria and whose objectivity exceeds that of the ASA classification. Anesthetic patients can thus be evaluated more consistently in veterinary medicine as well. Utility and practicability were positively received by 95 % of the participants. Further revision of individual risk criteria needs to be reconsidered.

Effects of thoracolumbar epidural anesthesia with lidocaine on the systemic hemodynamics and hepatic blood flow in propofol anesthetized dogs

General anesthesia reduces hepatic blood flow (HBF) from circulatory depression. Total intravenous anesthesia (TIVA) is associated with decreased circulatory depression compared to inhalation anesthesia, and epidural anesthesia using local anesthetics increases blood flow by blocking the sympathetic nerves and expanding blood vessels. We investigated the effects of thoracolumbar epidural anesthesia with TIVA on HBF in dogs. Six Beagle dogs had epidural catheters placed between T13 and L1 and were anesthetized with propofol and vecuronium. Physiological saline (control) or 2% lidocaine (0.2 ml/kg, followed by 0.2 ml/kg/hr) was administered at 1-2 weeks intervals. Heart rate (HR), cardiac index (CI), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI) were recorded at 10-min intervals from before epidural injections (T0) to 110 min. Indocyanine green test was used to measure HBF during the awake state and until 90 min after epidural injections. HR and CI did not differ between treatments. MAP and SVRI after lidocaine were significantly lower than those of controls, and the lowest MAP value was 65 ± 11 mmHg at T10. Compared to T0, after lidocaine treatment, HBF was significantly higher at T30, T60 and T90 (P<0.05); while, after control treatment, no significant change was evident at any time point. Despite a decrease in MAP by this technique, HBF was either maintained at pre-anesthetic levels or increased in comparison to controls, probably due to vasodilation of the hepatic artery induced by the selective blockade sympathetic ganglia.

EVALUATION OF TWO DOSES OF BUTORPHANOL-MEDETOMIDINE-MIDAZOLAM FOR THE IMMOBILIZATION OF WILD VERSUS CAPTIVE BLACK-FOOTED CATS (FELIS NIGRIPES)

The efficacy, safety, physiologic effects, and reversibility of butorphanol-medetomidine-midazolam (BMM) immobilization were evaluated in black-footed cats (Felis nigripes) and compared between captive and wild animals. Nine captive and 14 wild black-footed cats were hand injected into an accessible hind limb muscle group with the BMM combination. The captive cats (captive group) received a lower dose of the combination (butorphanol, 0.25 ± 0.03 mg/kg; medetomidine, 0.06 ± 0.01 mg/kg; midazolam, 0.13 ± 0.02 mg/kg), whereas the wild cats received a higher dose (butorphanol, 0.53 ± 0.11 mg/kg, medetomidine, 0.13 ± 0.03 mg/kg, midazolam, 0.27 ± 0.05 mg/kg). Two capture methods were required to restrain the wild cats; previously collared cats were tracked and excavated out of their burrows during daylight hours (excavated group), whereas uncollared cats were randomly located using spotlights and pursued by a vehicle at night (pursued group). Inductions were rapid and no spontaneous arousals occurred. Mean arterial blood pressure in all cats was within normal limits for domestic cats. Initial rectal temperatures varied greatly among the groups, but decreased in all groups as the immobilization progressed. In the pursued animals, heart rates and respiratory rates were initially elevated. All cats had moderate hypoxemia, hypocapnia, and metabolic acidosis. Intramuscular administration of naltrexone, atipamezole, and flumazenil resulted in rapid, uncomplicated recoveries. BMM is thus a safe, effective immobilizing drug combination for both captive and wild black-footed cats, but higher doses are required in wild animals. The capture methods exerted a greater influence on the physiology of the immobilized animals than did the doses of the drugs used. Although this drug combination can be used safely to immobilize black-footed cats, supplemental oxygen should always be available for use, especially in pursued animals due to hypoxia.

Perioperative urinary heat shock protein 72 as an early marker of acute kidney injury in dogs

OBJECTIVE

Acute kidney injury (AKI) may be a complication in dogs undergoing surgery. Urinary heat shock protein 72 (uHSP72) is a sensitive biomarker of canine AKI. To assess the occurrence of perioperative AKI, based on uHSP72 compared with serum creatinine (sCr), and whether its occurrence is associated with the American Society of Anesthesiology physical status (ASA status).

STUDY DESIGN

Clinical prospective study.

ANIMALS

A total of 80 client-owned and shelter dogs.

METHODS

Dogs scheduled for elective or emergency surgery were assigned ASA status (ASA I-IV). Preoperative and 24 hour postoperative serum and urine samples were collected. sCr, uHSP72 and urinary creatinine (uCr) were measured.

RESULTS

Postoperative uHSP72/uCr concentration [median (range)] of all dogs undergoing surgery [2.40 (0.14-252) ng mg^-1] was significantly increased compared with preoperative uHSP72/uCr [1.30 (0.11-142) ng mg^-1] concentration (p < 0.001). Conversely, postoperative sCr concentration of all dogs [0.88 (0.3-1.6) mg dL^-1] significantly decreased compared with preoperative sCr concentration [0.8 (0.2-5.0) mg dL^-1; p = 0.001]. Median uHSP72/uCr concentration differed both preoperatively (p = 0.007) and postoperatively (p = 0.019) among the ASA status groups. Increased uHSP/uCr was measured in 20 dogs preoperatively and 33 dogs postoperatively, whereas only five dogs fulfilled the criteria of AKI based on sCr.

CONCLUSIONS

The occurrence of increased uHSP72/uCr perioperatively suggests that the proportion of dogs with AKI is considerably higher than perceived.

CLINICAL RELEVANCE

Dogs undergoing surgery should be closely monitored for AKI before and after anesthesia, using currently available markers (e.g., sCr) and more sensitive markers.