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Redondo JI, Martínez-Taboada F, Viscasillas J, Doménech L, Marti-Scharfhausen R, Hernández-Magaña EZ, Otero PE. Anaesthetic mortality in cats: A worldwide analysis and risk assessment. Vet Rec 2024:e4147. [PMID: 38959210 DOI: 10.1002/vetr.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Patient safety is essential in small animal anaesthesia. This study aimed to assess anaesthesia-related deaths in cats worldwide, identify risk and protective factors and provide insights for clinical practice. METHODS A prospective multicentre cohort study of 14,962 cats from 198 veterinary centres across different countries was conducted. Data on anaesthesia-related deaths, from premedication up to 48 hours postextubation, were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs. RESULTS The anaesthesia-related mortality was 0.63%, with 74.5% of deaths occurring postoperatively. Cats with cachexia, a higher ASA status or who underwent abdominal, orthopaedic/neurosurgical or thoracic procedures exhibited elevated mortality. Mechanical ventilation use was associated with increased mortality. Mortality odds were reduced by the use of alpha2-agonist sedatives, pure opioids in premedication and locoregional techniques. LIMITATIONS Limitations include non-randomised sampling, potential biases, unquantified response rates, subjective death cause classification and limited variable analysis. CONCLUSIONS Anaesthetic mortality in cats is significant, predominantly postoperative. Risk factors include cachexia, higher ASA status, specific procedures and mechanical ventilation. Protective factors include alpha2-agonist sedatives, pure opioids and locoregional techniques. These findings can help improve anaesthesia safety and outcomes. However, further research is required to improve protocols, enhance data quality and minimise risks.
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Affiliation(s)
- José I Redondo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Fernando Martínez-Taboada
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- 3A Animal Anaesthesia and Analgesia, Victoria, Australia
| | | | - Luis Doménech
- Departamento de Matemáticas, Física y Ciencias Tecnológicas, Escuela Superior de Enseñanzas Técnicas, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | | | - Eva Z Hernández-Magaña
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Pablo E Otero
- Department of Anaesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
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Balsa IM, Culp WTN, Palm CA, Hopper K, Hardy BT, Ben-Aderet DG, Mayhew PD, Drobatz KJ. Factors associated with postobstructive diuresis following decompressive surgery with placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats: 37 cases (2010-2014). J Am Vet Med Assoc 2020; 254:944-952. [PMID: 30938617 DOI: 10.2460/javma.254.8.944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe postobstructive diuresis (POD) in cats undergoing surgical placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats and to identify factors associated with duration and maximum severity of POD. DESIGN Retrospective case series. ANIMALS 37 client-owned cats with ureteral obstruction treated between August 2010 and December 2014. PROCEDURES Medical records were reviewed, and data extracted included signalment, history, results from physical examinations and clinical laboratory analyses, treatment, urine output, and outcome. Data were evaluated to identify factors associated with POD duration and maximum severity, alone or in combination. RESULTS Serum concentrations of creatinine, potassium, phosphorus, and BUN before surgery positively correlated with duration and maximum severity of POD. Absolute changes in serum concentrations of creatinine, potassium, and BUN from before surgery to after surgery positively correlated with POD duration. Cats with anuria before surgery had longer POD than did other cats; however, there was no difference in POD duration or maximum severity with unilateral versus bilateral ureteral obstruction. Thirty-four of 37 (92%) cats survived to hospital discharge, which was not associated with whether ureteral obstruction was unilateral or bilateral. Azotemia resolved in 17 of the 34 (50%) cats that survived to hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE Results of the present study indicated that several factors were associated with POD duration and maximum severity, alone or in combination, and that with intensive management of fluid and electrolyte derangements, regardless of the extent of the original azotemia, a high percentage of cats survived to hospital discharge.
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Neilson DM, Viscasillas J, Alibhai HIK, Kenny PJ, Niessen SJM, Sanchis-Mora S. Anaesthetic management and complications during hypophysectomy in 37 cats with acromegaly. J Feline Med Surg 2019; 21:347-352. [PMID: 29848149 PMCID: PMC10814632 DOI: 10.1177/1098612x18778697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES The aim of this study was to describe the anaesthetic management and perianaesthetic complications encountered during hypophysectomy surgery in acromegalic cats. We explored relationships between animal demographic data, the anaesthetic protocol used and presence of perioperative complications. METHODS Cats having undergone hypophysectomy surgery for the treatment of feline acromegaly at a single veterinary referral hospital were identified from hospital records. The anaesthesia records and clinical notes of these animals were retrospectively reviewed. Descriptive statistics were produced and binary logistic regression run to assess for any relationship between patient factors, anaesthetic management and complications during the perioperative period. RESULTS Perianaesthetic complications identified included hypothermia, hypotension, bradycardia and airway obstruction. Mortality at 24 h post-anaesthesia was 8%. The use of alpha (α)2 agonists was associated with a lower incidence of hypotension. Fentanyl infusion was associated with a higher incidence of airway obstruction compared with remifentanil. Subjectively assessed anaesthetic recovery quality had an association with the number of days spent in the intensive care ward postoperatively. CONCLUSIONS AND RELEVANCE The anaesthetic management described seems effective for hypophysectomy surgery in cats. Intraoperative complications were common and, while not apparently associated with 24 h patient outcome, drugs and equipment to manage these complications should be available.
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Affiliation(s)
| | - Jaime Viscasillas
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Hatim IK Alibhai
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Patrick J Kenny
- Small Animal Specialist Hospital, North Ryde, NSW, Australia
| | - Stijn JM Niessen
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Sandra Sanchis-Mora
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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Carvalho ER, Champion T, Vilani RGDC, Freitas GC, Ambrosini F, Silva GA, Gonçalves KS, Fischborn JCJ. Sedative and electrocardiographic effects of low dose dexmedetomidine in healthy cats. PESQUISA VETERINÁRIA BRASILEIRA 2019. [DOI: 10.1590/1678-5150-pvb-5823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT: In feline veterinary practice sedation is often needed to perform diagnostic or minimally invasive procedures, minimize stress, and facilitate handling. The mortality rate of cats undergoing sedation is significantly higher than dogs, so it is fundamental that the sedatives provide good cardiovascular stability. Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist utilized in cats to provide sedation and analgesia, although studies have been utilized high doses, and markedly hemodynamic impairments were reported. The aim of this study was to prospectively investigate how the sedative and electrocardiographic effects of a low dose of DEX performing in cats. Eleven healthy cats were recruited; baseline sedative score, systolic arterial pressure, electrocardiography, and vasovagal tonus index (VVTI) were assessed, and repeated after ten minutes of DEX 5μg/kg intramuscularly (IM). A smooth sedation was noticed, and emesis and sialorrhea were common adverse effects, observed on average seven minutes after IM injection. Furthermore, electrocardiographic effects of a low dose of DEX mainly include decreases on heart rate, and increases on T-wave amplitude. The augmentation on VVTI and appearance of respiratory sinus arrhythmia, as well as sinus bradycardia in some cats, suggesting that DEX enhances parasympathetic tonus in healthy cats, and therefore will be best avoid in patients at risk for bradycardia.
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Portier K, Ida KK. The ASA Physical Status Classification: What Is the Evidence for Recommending Its Use in Veterinary Anesthesia?-A Systematic Review. Front Vet Sci 2018; 5:204. [PMID: 30234133 PMCID: PMC6128170 DOI: 10.3389/fvets.2018.00204] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022] Open
Abstract
Background: The effectiveness of the American Society of Anesthesiologists (ASA) Physical Status (PS) classification to identify the animals at a greater risk of anesthesia-related death and complications is controversial. In this systematic review, we aimed to analyze studies associating the ASA PS scores with the outcome of anesthesia and to verify whether there was any evidence for recommending the use of the ASA PS in veterinary patients. Methods: Research articles found through a systematic literature search were assessed for eligibility, and data were extracted and analyzed using random-effects analysis. Results: A total of 15 observational prospective and retrospective studies including 258,298 dogs, cats, rabbits, and pigs were included. The analysis found consistency between the studies showing that dogs, cats and rabbits with an ASA-PS ≥III had 3.26 times (95% CI = 3.04–3.49), 4.83 times (95% CI = 3.10–7.53), and 11.31 times (95% CI = 2.70–47.39), respectively, the risk of anesthesia-related death within 24 h (dogs) and 72 h (cats and rabbits) after anesthesia compared with those with an ASA PS <III. In addition, the analysis showed that dogs and cats with ASA PS ≥III had 2.34 times the risk of developing severe hypothermia during anesthesia (95% CI = 1.82–3.01). Conclusions: The simple and practical ASA PS was shown to be a valuable prognostic tool and can be recommended to identify an increased risk of anesthetic mortality until 24–72 h after anesthesia, and a greater risk of development severe intraoperative hypothermia.
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Affiliation(s)
- Karine Portier
- Univ Lyon, VetAgro Sup, GREAT, Marcy l'Etoile, France.,Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Keila Kazue Ida
- Anesthésiologie et Réanimation Vétérinaires, Département de Clinique des Animaux de Compagnie et des Équidés, Université de Liège, Liège, Belgium
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Phillips H, Ellison GW, Mathews KG, Aronson LR, Schmiedt CW, Robello G, Selmic LE, Gregory CR. Validation of a model of feline ureteral obstruction as a tool for teaching microsurgery to veterinary surgeons. Vet Surg 2018; 47:357-366. [DOI: 10.1111/vsu.12769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 10/01/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Heidi Phillips
- Department of Veterinary Clinical Medicine; University of Illinois at Urbana-Champaign; Urbana Illinois
| | - Gary W. Ellison
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville Florida
| | - Kyle G. Mathews
- Department of Clinical Sciences; North Carolina State University; Raleigh North Carolina
| | - Lillian R. Aronson
- Department of Clinical Studies; University of Pennsylvania; Philadelphia Pennsylvania
| | - Chad W. Schmiedt
- Department of Small Animal Medicine and Surgery; University of Georgia; Athens Georgia
| | - Gil Robello
- PetCare Veterinary Hospital; Santa Rosa California
| | - Laura E. Selmic
- Department of Veterinary Clinical Medicine; University of Illinois at Urbana-Champaign; Urbana Illinois
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Goggs R, De Rosa S, Fletcher DJ. Multivariable analysis of the association between electrolyte disturbances and mortality in cats. J Feline Med Surg 2017; 20:1072-1081. [PMID: 29206071 PMCID: PMC6259255 DOI: 10.1177/1098612x17743564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Electrolyte disorders have been individually associated with mortality in small populations of cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in cats. METHODS An electronic database containing 7064 electrolyte profiles was constructed to assess the association between disorders of sodium, potassium, corrected-chloride and ionized calcium concentrations with non-survival by multivariable modelling. A second database containing 2388 records was used to validate the models constructed from the first database. RESULTS All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (area under the receiver operator characteristic curve [AUROC] 0.689) or death (AUROC 0.750). CONCLUSIONS AND RELEVANCE Multivariable modelling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. The present study suggests that measurement of electrolyte concentrations is an important component of the assessment of cats in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
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Affiliation(s)
- Robert Goggs
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Sage De Rosa
- 2 Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - Daniel J Fletcher
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Goggs R, De Rosa S, Fletcher DJ. Electrolyte Disturbances Are Associated with Non-Survival in Dogs-A Multivariable Analysis. Front Vet Sci 2017; 4:135. [PMID: 28868302 PMCID: PMC5563317 DOI: 10.3389/fvets.2017.00135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/04/2017] [Indexed: 11/13/2022] Open
Abstract
Electrolyte disorders have been individually associated with mortality in small populations of dogs and cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium, and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in dogs. An electronic database containing 33,117 electrolyte profiles was constructed to retrospectively assess the association between disorders of sodium, potassium, corrected chloride, and ionized calcium concentrations with non-survival and with death excluding euthanasia by multivariable modeling. A second database containing 11,249 records was used to validate the models constructed from the first database. All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (AUROC 0.624) or death (AUROC 0.678). Multivariable modeling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. This study suggests that measurement of electrolyte concentrations is an important component of the assessment of dogs in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Sage De Rosa
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Luca GC, Monteiro BP, Dunn M, Steagall PVM. A retrospective study of anesthesia for subcutaneous ureteral bypass placement in cats: 27 cases. J Vet Med Sci 2017; 79:992-998. [PMID: 28428483 PMCID: PMC5487804 DOI: 10.1292/jvms.16-0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The goals of this retrospective clinical case series study were to describe the management of anesthesia, and to report perioperative complications in cats undergoing subcutaneous ureteral bypass (SUB) placement due to ureteral obstruction. Medical records of client-owned cats with ureteral obstruction and anesthetized for SUB placement between 2012 and 2015 in a veterinary teaching hospital were reviewed. Twenty-seven cases were identified. Duration of anesthesia and surgery (mean ± standard deviation) were 215 ± 42 min and 148 ± 36 min, respectively. Hypothermia was the most common intraoperative complication. Hypotension, hypocapnia, hypertension and bradycardia were also frequently observed. Out of 22 cats who experienced intraoperative hypotension, 17 received inotropes and vasopressors. There was a significant decrease in creatinine (P=0.008) and total solids (P=0.007) after SUB placement when compared with baseline values. Postoperative complications included pain, anorexia, nausea, hypertension, and urinary tract-related problems. No death occurred in the postoperative period. Successful management of anesthesia for SUB placement involves rigorous anesthetic monitoring and immediate treatment of complications. Perioperative complications appear to be common. This study could not identify risk factors associated with this procedure.
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Affiliation(s)
- Geneviève C Luca
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Beatriz P Monteiro
- Department of Biomedical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Marilyn Dunn
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Paulo V M Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
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Smith MD, Barletta M, Young CN, Hofmeister EH. Retrospective study of intra-anesthetic predictors of prolonged hospitalization, increased cost of care and mortality for canine patients at a veterinary teaching hospital. Vet Anaesth Analg 2017; 44:1321-1331. [PMID: 29174211 DOI: 10.1016/j.vaa.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/22/2017] [Accepted: 04/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of intraoperative anesthetic variables on the length of hospitalization, cost of care and mortality in dogs. STUDY DESIGN Retrospective, observational study. ANIMALS A total of 235 dogs undergoing general anesthesia. METHODS Medical records of dogs undergoing general anesthesia between 2007 and 2014 at the University of Georgia Veterinary Teaching Hospital were reviewed. Data collected included demographic data, American Society of Anesthesiologists (ASA) physical status, type and duration of anesthesia, hemodynamic variables, temperature, ventilation, fluid therapy and adjunctive drugs administered. Outcome variables were length of hospitalization in the intensive care unit (ICU), hospital charges and survival to discharge. RESULTS The only factor significantly associated with duration of ICU care was higher ASA status (p<0.0001). Factors associated with increased cost of hospitalization were ICU duration (p<0.0001), anesthesia duration (p<0.0001), hemorrhage amount (p<0.0001), colloid use (p=0.0081), increased age (p=0.0253), increased weight (p = 0.0293) and presence of hypertension (p=0.0179). Overall mortality rate was 5.1%. The only factors negatively associated with survival were the administration of colloids (p<0.0008) and ASA status (p=0.0314). CONCLUSIONS AND CLINICAL RELEVANCE Several intrinsic patient factors and intraoperative hemodynamic variables were significantly associated with postoperative morbidity and mortality in dogs. These factors might have prognostic value in conjunction with preoperative risk assessment, and patient outcome may be improved by stricter intraoperative control of these variables.
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Affiliation(s)
- Melissa D Smith
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
| | - Michele Barletta
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Courtni N Young
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Erik H Hofmeister
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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Vedrine B. Perioperative Occlusion of a Subcutaneous Ureteral Bypass Secondary to a Severe Pyonephrosis in a Birman Cat. Top Companion Anim Med 2017; 32:58-60. [DOI: 10.1053/j.tcam.2017.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/10/2017] [Indexed: 11/11/2022]
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