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See R, Rollet M, Elsom J, Tayari H. Accidental epidural morphine overdose in a cat. Vet Anaesth Analg 2024; 51:580-582. [PMID: 39138054 DOI: 10.1016/j.vaa.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Regina See
- Southern Counties Veterinary Specialists, Ringwood, UK
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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; 195:e4147. [PMID: 38959210 DOI: 10.1002/vetr.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Torruella X, Potter J, Huuskonen V. Sacrococcygeal epidural administration of 0.5% bupivacaine in seven cats undergoing pelvic or hind limb orthopaedic procedures. Ir Vet J 2023; 76:1. [PMID: 36726137 PMCID: PMC9893688 DOI: 10.1186/s13620-023-00231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Epidural administration of local anaesthetic agents provides good intraoperative antinociception for orthopaedic procedures of the pelvis and the pelvic limb. However, in cats the spinal cord extends approximately to the level of the first sacrococcygeal vertebra, and therefore the sacrococcygeal epidural could be a safer alternative to the lumbosacral epidural in cats. This case series describes perioperative analgesia and the haemodynamic status of seven client-owned cats that received sacrococcygeal epidural injection of 0.5% bupivacaine and underwent orthopaedic hind leg or pelvic surgeries under general anaesthesia. CASE PRESENTATION Each cat received either 0.2 or 0.3 mL/kg of 0.5% bupivacaine with or without 0.2 mg/kg of morphine in the sacrococcygeal epidural space. Intraoperative antinociceptive response to surgical stimulus and haemodynamic changes were monitored and reported. CONCLUSION In these seven anaesthetised cats, 0.2 or 0.3 mL/kg of 0.5% bupivacaine, administered alone or in combination with morphine into the sacrococcygeal epidural space, enhanced antinociception so that intraoperative rescue analgesia was unnecessary in all but one cat. It also reduced the anticipated requirement for postoperative opioid use. However, a high incidence of hypotension was observed in the cats in this report, and hence intraoperative blood pressure monitoring should be considered mandatory in anaesthetised cats following epidural injection of local anaesthetic agents, regardless of injection site.
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Affiliation(s)
- Xavier Torruella
- grid.7886.10000 0001 0768 2743UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6 Ireland
| | - Joanna Potter
- grid.7886.10000 0001 0768 2743UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6 Ireland
| | - Vilhelmiina Huuskonen
- grid.7886.10000 0001 0768 2743UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6 Ireland
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Perrucci J, Walton R, Zorn C, Yuan L, Mochel JP, Blong A. Retrospective evaluation of the effect of inhalant anesthesia on complications and recurrence rates in feline urethral obstruction. J Feline Med Surg 2023; 25:1098612X221149348. [PMID: 36745058 PMCID: PMC10812080 DOI: 10.1177/1098612x221149348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the use of inhalant anesthesia vs sedation for urinary catheter placement in male cats with urethral obstruction. The primary outcome measures were the incidence of complications related to catheterization, the incidence of recurrent urethral obstruction (rUO; both during hospitalization and within 1 year) and survival. The secondary aim of this study was to evaluate the association between baseline serum biochemical concentrations and antispasmodic medications with complications and short-term rUO. METHODS We carried out a retrospective review of records from a university teaching hospital from 2009 to 2020. Cats were included if diagnosed with a urinary obstruction, based on the presence of a large, painful and non-expressible bladder, a urinary catheter was placed and hospitalization occurred for a minimum of 24 h. Collected baseline data included age, breed, weight, serum biochemical concentrations and if cats underwent sedation or inhalant anesthesia for urethral catheterization. For the comparison of inhalant anesthesia or sedation, univariate logistic regression was used. RESULTS There was no statistically significant difference in complications or the recurrence of obstruction in cats with urethral obstruction that underwent inhalant anesthesia compared with sedation. All serum biochemical concentrations were significantly associated with survival. Decreased serum ionized calcium was found to be statistically significantly associated with higher complication rates (P = 0.0086), as well as short-term recurrence of obstruction (P = 0.004). Increased serum potassium concentrations were found to be statistically significantly associated with the risk of short-term recurrent urethral obstruction (P = 0.0345). No significant difference was found between the use of antispasmodic medications with short-term recurrence. CONCLUSIONS AND RELEVANCE No significant difference was found between complications or recurrence rates when comparing the use of inhalant anesthesia to sedation protocols. Baseline serum biochemical data were significantly associated with complications, survival and short-term recurrence rates.
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Affiliation(s)
- Jessica Perrucci
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Chelsea Zorn
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - April Blong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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Breheny C, Blacklock KB, Gunn‐Moore D. Approach to urethral obstruction in cats. Part 2: catheterising and postobstruction management. IN PRACTICE 2022. [DOI: 10.1002/inpr.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. J Feline Med Surg 2022; 24:4-30. [PMID: 34937455 PMCID: PMC10845386 DOI: 10.1177/1098612x211066268] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PRACTICAL RELEVANCE Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. CLINICAL CHALLENGES Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. EVIDENCE BASE These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors' experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.
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Affiliation(s)
- Paulo V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Universite de Montréal, Saint-Hyacinthe, Canada; and Department of Veterinary Clinical Sciences and Centre for Companion Animal Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | | | - Bradley Simon
- Department of Small Animal Clinical Sciences, Texas A&M College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Leon N Warne
- Veterinary Anaesthesia & Pain Management Australia, Perth, Western Australia; and Veterinary Cannabis Medicines Australia, Perth, Western Australia, Australia
| | - Yael Shilo-Benjamini
- Koret School of Veterinary Medicine, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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Reineke EL, Cooper ES, Takacs JD, Suran JN, Drobatz KJ. Multicenter evaluation of decompressive cystocentesis in the treatment of cats with urethral obstruction. J Am Vet Med Assoc 2021; 258:483-492. [PMID: 33620246 DOI: 10.2460/javma.258.5.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO). ANIMALS 88 male cats with UO. PROCEDURES Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded. RESULTS No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, -5 to 12) and DC group cats (range, -4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, -1; range, -9 to 5) and DC group cats (score, -1; range, -7 to 5). CONCLUSIONS AND CLINICAL RELEVANCE DC did not improve time to place the urinary catheter or ease of UC in cats with UO.
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