A Retrospective Study of Factors Influencing Survival Following Surgery for Gastric Dilatation-Volvulus Syndrome in 306 Dogs

Inflammatory biomarker concentrations in dogs with gastric dilatation volvulus with and without 24-h intravenous lidocaine

Background

Canine gastric dilatation volvulus (GDV) is characterized by tissue ischemia, reperfusion, and systemic inflammation. Evidence exists that lidocaine exerts anti-inflammatory properties and potentially improves outcome.

Design and setting

Prospective, randomized observational cohort study in client-owned dogs with GDV.

Objective

The primary objective of the study was the determination of pro- and anti-inflammatory biomarker concentrations in dogs with GDV with and without intravenous (IV) lidocaine therapy. The second objective was the evaluation of side effects of lidocaine.

Methods

Of 35 dogs included in the study, 20 dogs were assigned to receive lidocaine (LIDO) (2 mg/kg initially, followed by a continuous infusion at a rate of 50 μg/kg/min over 24 h) and 15 dogs not to receive lidocaine (NO-LIDO). Plasma concentrations of cytokines interleukin (IL)-6, IL-7, IL-8, IL-10, IL-15, IL-18, interferon gamma, keratinocyte chemotactic-like, monocyte chemotactic protein, and C-reactive protein (CRP) were measured at admission (prior any therapeutic intervention, T0), immediately after surgery (T1), at 24 h (T24), and at 48 h (T48) post-surgery.

Results

No significant differences in concentrations of any cytokines were found between the LIDO- and the NO-LIDO group. Significant lower CRP concentrations (median [range]) were found in dogs with lidocaine compared to dogs without at T24 (97.5 pg/mL [46.3-161.7] vs. 127.9 pg/mL [26.9-182.0]; p = 0.046) and T48 (73.7 pg/mL [18.4-169.4] vs. 116.3 pg/mL [71.4-176.8]; p = 0.002). Dogs receiving lidocaine exhibited significantly impaired mentation, a prolonged period of anorexia, and longer hospitalization compared to dogs without lidocaine.

Conclusion

Lidocaine administration had no impact on the plasma levels of cytokines during the 48-h study period, but significantly lower CRP concentrations were found at T24 and T48. Lidocaine's potential side effects require careful decision making regarding its use.

Outcomes and complications of prophylactic incisional gastropexy in 766 dogs (2009-2019)

OBJECTIVE

To report the outcomes and complications associated with prophylactic incisional gastropexy performed in dog breeds at risk for GDV.

RESULTS

Seven hundred and sixty-six dogs underwent prophylactic incisional gastropexy of which 61 were electively performed at the time of castration or spay and 705 were adjunctively performed at the time of emergency abdominal surgery. All dogs had short-term follow-up, and 446 dogs (58.2%) had additional follow-up with a median long-term follow-up time of 876 days (range 58-4450). Only 3 dogs (0.4%) had a direct complication associated with the gastropexy site including hemorrhage causing hemoabdomen (2) and infection with partial dehiscence (1). No dogs with long-term follow-up experienced gastric dilatation (GD), gastric dilatation volvulus (GDV), or persistent GI signs following gastropexy. Results of this study found that complications directly associated with prophylactic gastropexy were rare and limited to hemorrhage causing hemoabdomen and infection with partial dehiscence. Transient postoperative GI signs may occur. Gastropexy malpositioning and bowel entrapment were not encountered. There was no occurrence of GD or GDV.

Protein C activity in dogs with gastric dilatation and volvulus

Protein C activity, a novel prognostic marker, was evaluated in patients with gastric dilatation and volvulus in relation to mortality and severity of the disease. Data on the mortality, duration of clinical signs, degree of gastric torsion, gastric necrosis, splenectomy and occurrence of disseminated intravascular coagulopathy were recorded. Blood samples were obtained at selected time periods: T0 = no longer than 30 min before surgery; T1 = first day after surgery; T2 = second day after surgery. In addition to protein C activity assessment, haematological and haemostaseological analysis was also performed. The mean protein C activity was the lowest at T1 and the highest at T2. No significant relationship between protein C activity and mortality, duration of clinical signs, degree of gastric torsion, gastric necrosis, splenectomy and disseminated intravascular coagulopathy was found in patients with gastric dilatation and volvulus. All patients that died during hospitalisation after surgery were patients with decreased protein C activity at T1. Although protein C activity was not found to be a reliable preoperative prognostic marker in patients with gastric dilatation and volvulus, the study results show it might be a promising marker in postoperative monitoring of these patients.

Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization

OBJECTIVE

To compare the outcomes of dogs surgically treated for gastric dilatation volvulus (GDV) after rapid versus prolonged medical stabilization.

STUDY DESIGN

Prospective cohort study, monoinstitutional.

SAMPLE POPULATION

One hundred and sixty-two dogs with GDV.

METHODS

Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses.

RESULTS

Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively.

CONCLUSION

No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization.

CLINICAL SIGNIFICANCE

The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.

Pet health insurance reduces the likelihood of pre-surgical euthanasia of dogs with gastric dilatation-volvulus in the emergency room of an Australian referral hospital

AIMS

To determine the association between the presence of pet health insurance and the risk of euthanasia at the time of diagnosis for dogs with gastric dilatation-volvulus (GDV).

METHODS

Insurance status at the time of GDV diagnosis was sought for a cohort of 147 non-referred, confirmed cases of GDV that presented to the emergency department of a university-based veterinary hospital in Australia between 2008 and 2017. Insurance status was obtained from the medical record (n=18) or after contacting the owners by phone using a standardised questionnaire (n=129). Animal, clinical and outcome data was retrospectively compiled in a research database. The primary outcome measure was whether or not the dog was euthanised before surgery. The Mantel-Haenszel procedure was used to quantify the association between the presence of pet health insurance and the risk of euthanasia at the time of diagnosis for dogs with GDV, adjusting for the confounding effect of age at the time of presentation using Bayesian methods.

RESULTS

Of the 69 dogs for which insurance information could be obtained, 10 (14%) cases were insured at the time of the GDV event and 59 (86%) cases were not. The majority of non-insured dogs (37/59; 63 (95% CI=50-74)%) were euthanised before surgery, while none (0 (95% CI=0-28)%) of the insured dogs were euthanised at that time (p<0.001). Of the 32 insured and non-insured dogs that underwent surgery, four dogs (13 (95% CI=5-28)%) did not survive to hospital discharge. Three dogs (9%) were euthanised during or after surgery and one dog (3%) experienced cardiopulmonary arrest during treatment. The majority of dogs for which insurance status was known did not survive to hospital discharge (41/69; 59%), and 90 (95% CI=7-96)% of deaths were caused by euthanasia prior to surgery. Uninsured dogs were 5.0 (95% credible interval=1.8-26) times more likely to undergo presurgical euthanasia compared with insured dogs.

CONCLUSIONS

Euthanasia prior to treatment was most common cause of death in non-referred dogs with GDV; such euthanasia was entirely absent in the cohort of dogs that were insured.

CLINICAL RELEVANCE

Financial considerations significantly contribute to mortality of dogs with GDV presented to an emergency room. Financial instruments to reduce the out-of-pocket expense for pet owners confronted with unexpected veterinary expenses have potential to reduce pet mortality.

Evaluation of a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus in dogs

OBJECTIVE

To evaluate a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus (GDV) in dogs.

ANIMALS

41 client-owned dogs with confirmed GDV from 2012 through 2016.

PROCEDURES

Medical record data were collected regarding patient signalment, diagnostic test results, gastric lavage findings, surgical findings, and short-term survival status. For all dogs, gastric decompression was performed by orogastric intubation and gastric lavage in the same anesthetic episode. If this stage was successful, subsequent corrective surgery (laparotomy and gastropexy) was delayed and performed in a second anesthetic episode.

RESULTS

6 dogs underwent corrective surgery in the same anesthetic session as for decompression and stabilization, 2 of which had gastric necrosis. Thirty-five dogs underwent corrective surgery in a second anesthetic episode a mean of 22.3 hours (range, 5.25 to 69.75 hours) after presentation, during which gastric necrosis was identified in 2 dogs. The mortality rate for delayed-surgery patients was 9% (3/35). Time from presentation to surgery was not associated with surgeon subjective assessment of gastric health status or mortality rate. Intraoperative identification of gastric necrosis was associated with nonsurvival. Single plasma lactate concentrations and percentage change in serial lactate concentrations were associated with intraoperative gastric health status and mortality rate.

CONCLUSIONS AND CLINICAL RELEVANCE

The observed mortality rate for delayed-surgery patients was comparable to rates reported for other GDV treatment techniques. Results suggested that delaying corrective surgery is possible for certain dogs, but careful case selection would be important and no reliable preoperative case selection criteria were identified. Additional research is needed to further investigate the potential risks and benefits of staged versus immediate surgical treatment of GDV in dogs.

The Effect of Pet Insurance on Presurgical Euthanasia of Dogs With Gastric Dilatation-Volvulus: A Novel Approach to Quantifying Economic Euthanasia in Veterinary Emergency Medicine

Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs (n = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs (p < 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; p = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge (p < 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.

Evaluation of a novel technique involving ultrasound-guided, temporary, percutaneous gastropexy and gastrostomy catheter placement for providing sustained gastric decompression in dogs with gastric dilatation-volvulus

OBJECTIVE

To evaluate the feasibility of ultrasound-guided, temporary, percutaneous T-fastener gastropexy (TG) and gastrostomy catheter (GC) placement for providing sustained gastric decompression in dogs with acute gastric dilatation-volvulus (GDV) and to compare findings with those of trocarization.

ANIMALS

16 dogs with GDV.

PROCEDURES

Dogs were randomly assigned to undergo gastric decompression by means of percutaneous trocarization (trocar group; n = 8) or temporary TG and GC placement (TTG+GC group; 8) with ultrasound guidance. The gastric volvulus was then surgically corrected, and the decompression sites were examined. Outcomes were compared between groups.

RESULTS

The proportion of dogs with successful decompression did not differ significantly between the TTG+GC (6/8) and trocar (7/8) groups; median procedure duration was 3.3 and 3.7 minutes, respectively. After the failed attempts in the TTG+GC group, the procedure was modified to include ultrasound guidance during T-fastener placement. The decrease in intragastric pressure by 5 minutes after trocar or GC insertion was similar between groups. For dogs in the TTG+GC group, no significant difference in intragastric pressure was identified between 5 and 60 minutes after GC insertion. Complications included inadvertent splenic or jejunal placement in 2 dogs (TTG+GC group) and malpositioned and ineffective trocar placement in 1 dog (trocar group). All dogs survived for at least 2 weeks.

CONCLUSIONS AND CLINICAL RELEVANCE

Ultrasound-guided, temporary, percutaneous TG and GC placement was safe and effective at providing sustained gastric decompression in dogs with GDV, suggesting that this technique would be ideal for dogs in which surgical delays are anticipated or unavoidable.

Retrospective analysis of 736 cases of canine gastric dilatation volvulus

OBJECTIVE

To identify factors influencing the survival of confirmed gastric dilatation volvulus (GDV) cases presented to a specialist referral and emergency hospital.

METHODS

Clinical records of confirmed GDV cases admitted to two specialist referral and emergency centres in Sydney (Animal Referral Hospital (ARH) Homebush and ARH Baulkham Hills) between July 1999 and July 2019 were searched.

RESULTS

A total of 736 GDV cases were reviewed, of which 460 dogs were surgically treated and 276 dogs were humanely killed. The survival rates of patients operated on by general surgeons and specialists were 81.7% and 88.7%, respectively. Both incisional gastropexy and belt-loop gastropexy were clinically effective in treating GDV, with no significant difference in survival rates. Intraoperative mortality rates for general surgeons and specialists were 7.0% and 2.9%, respectively. The odds of mortality in dogs operated on by general surgeons were 2.03 times those operated on by specialist surgeons. The odds of mortality in dogs presented between 3:00 and 9:00 am were 3.57 times those of dogs presented between 9:00 am and 9:00 pm. The odds of mortality in dogs where the duration from presentation to completion of surgery was more than 3 h were 2.53 times those of dogs where time lapsed was equal or less than 3 h.

CONCLUSION

The results suggested that admission time was statistically significantly related to the survival rate. Dogs operated on by specialist surgeons had a significantly higher survival rate compared to those operated on by general surgeons. Clinicians should aim to stabilise and complete surgical correction of GDV as soon as possible to decrease the mortality.

The pattern of mortality in dogs with gastric dilatation and volvulus

INTRODUCTION

The primary study objective was to characterize the pattern of in-hospital mortality in dogs with gastric dilatation and volvulus (GDV), with a focus on preoperative nonsurvival.

MATERIALS AND METHODS

A retrospective review of medical records from a 10-year period was undertaken at a university teaching hospital. Data collected included signalment, physical examination parameters at hospital presentation, blood lactate concentration, and outcome.

RESULTS

A total of 498 dogs were included. Overall, 319 (64.1%) survived to discharge and 179 (35.9%) were nonsurvivors. Of the nonsurvivors, 149 (31.3% of all dogs) were euthanized and 30 (6%) died. Of those dogs euthanized, the majority (n = 116) were euthanized at the time of hospital presentation prior to surgery (ie, without intent to treat). When dogs that were euthanized prior to surgery were excluded, 83.5% of dogs survived to discharge. Median group age was higher in those euthanized than in the group of dogs that survived to discharge.

CONCLUSIONS

Preoperative euthanasia and hence nonsurvival without intent to treat accounted for the majority of GDV mortality in this study. Given the high rate of nonsurvival without intent to treat it is likely that efforts focused at disease prevention will ultimately affect a much greater improvement in overall disease mortality than those focused on improving treatment.

Pre- and post-surgical evaluation of plasma lactate concentration in 45 dogs with gastric dilatation-volvulus: A preliminary study

This preliminary study was designed to contribute to the evaluation of reliability of plasma lactate concentration (PLC) and its clearance as predictive and prognostic factors of gastric necrosis and clinical outcome of dogs affected by gastric dilatation-volvulus (GDV). Main aims of the study were: 1) to evaluate the prognostic reliability of PLC at presentation (T0) in dogs with GDV, 2) to compare the obtained data and considerations with the veterinary literature, and 3) to introduce the possible validity of PLC values at 24 (T24) and 48 (T48) hours after surgery as a predictive factor.

Dogs with GDV were retrospectively evaluated. PLC at T0, T24 and T48 were recorded and correlated to the presence or absence of macroscopic necrosis of the stomach and to outcome.

Forty-five dogs met the inclusion criteria. Significant differences were not detected in the mean values between the initial PLC in dogs with and without necrosis of the gastric wall, as well as between surviving and non-surviving dogs; these values were not associated with higher risk of gastric necrosis or death.

At T24 and T48 no significant differences were recorded between necrosis and non-necrosis, and surviving and non-surviving categories.

A median plasma lactate concentration clearance from arrival to T24 ≥ 50% was identified in both groups (with and without necrosis), and this parameter failed in identifying dogs that survived to discharge.

In conclusion, the results presented here failed to detect PLC at T0 and its clearance at T24 as prognostic factors in this population of dogs with GDV.

Acid-Base, Electrolyte and Lactate Abnormalities as Well as Gastric Necrosis and Survival in Dogs With Gastric Dilation-Volvulus Syndrome. A Retrospective Study in 75 Dogs

Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO₂, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (-8.1 vs. -1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (-1.9 vs. -9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.

Prognostic value of canine pancreatic lipase immunoreactivity and lipase activity in dogs with gastric dilatation-volvulus

This study evaluated the association between a selection of candidate predictor variables, including the elevation of specific pancreatic enzymes, and outcome in dogs with gastric dilatation-volvulus (GDV).

Twenty-two dogs with gastric dilatation-volvulus were included, being classified as survivors or non-survivors based on the final outcome. Dogs with intestinal obstruction (n = 16) were selected for comparison. Blood samples were collected upon admission (T0) and after 24 hours (T1). Serum lipase activity, canine pancreatic lipase immunoreactivity (cPLI) and other variables (plasma lactate concentration and C- reactive protein -CRP- in particular) were evaluated as predictive variables.

T0 cPLI and serum lipase activity were not found to differ significantly between dogs with gastric dilatation-volvulus or intestinal obstruction. Canine pancreatic lipase immunoreactivity values above 400 μg/L were detected in 6/22 dogs with gastric dilatation-volvulus and 4/16 with intestinal obstruction. However, lactate concentration was significantly higher and CRP significantly lower in GDV as compared to IO dogs, and in the GDV group, lipase, cPLI and CRP measured upon admission were significantly associated with a negative outcome. No differences in lipase activity and canine pancreatic lipase immunoreactivity values were detected between T0 and T1.

Presurgical cPLI and lipase activity were frequently increased during gastric dilatation-volvulus and were suggestive of the presence of pancreatic damage; while more extensive studies are required, based on this pilot analysis, cPLI has the potential to be a useful predictive variable for outcome in GDV. Further to this, serum CRP was able to predict outcome in this population of dogs with GDV, while blood lactate was not.

Evaluation of echocardiography and cardiac biomarker concentrations in dogs with gastric dilatation volvulus

OBJECTIVE

To assess abnormalities in concentrations of cardiac troponin I (cTnI), lactate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in relation to arrhythmias, echocardiographic measurements, and survival in dogs with gastric dilatation volvulus (GDV).

DESIGN

Prospective observational study.

SETTING

University hospital.

ANIMALS

Twenty-two dogs with naturally occurring GDV.

SAMPLES

Concentrations of cTnI, plasma lactate, and NT-proBNP were recorded at presentation to the emergency room, the time closest to echocardiography, and the highest recorded concentrations during hospitalization.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Cardiac rhythms were categorized on a 0-4 scale (0 = no ventricular premature complexes [VPCs], 1 = single VPCs, 2 = bigeminy or trigeminy, 3 = couplets or triplets, and 4 = R-on-T phenomenon or ventricular tachycardia). Echocardiography was performed 6-18 hours postoperatively. Fifteen dogs had ventricular arrhythmias during hospitalization (Grade 1 [n = 9], Grade 4 [n = 6]). The highest recorded cTnI concentration was significantly higher in the dogs with Grade 4 (P = 0.002) or Grade 1 (P = 0.001) arrhythmias compared to dogs without arrhythmias. Plasma lactate was significantly correlated with left ventricular internal diameter in diastole (r = -0.52, P = 0.01) and systole (r = -0.57, P = 0.006), left ventricular free wall in diastole (LWDd, r = 0.59, P = 0.004), and interventricular septal thickness in diastole (IVDs, r = 0.65, P = 0.001). Dogs that did not survive to 1 week postdischarge (3/22) had a significantly thicker LVWd (P = 0.04) and IVSd (P = 0.05), and received significantly less fluids in the first 24 (P = 0.02) and 48 hours (P = 0.03) of hospitalization.

CONCLUSIONS

Concentrations of cTnI and NT-proBNP increased during hospitalization, but only cTnI concentrations were significantly higher in dogs with a higher arrhythmia grade. Additional research on the potential role of serial measurement of biomarkers in dogs with GDV is warranted.

Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors and survival

OBJECTIVE

To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs.

METHODS

The study used a cross-sectional design using emergency-care veterinary clinical records from the VetCompass Programme spanning September 1, 2012 to February 28, 2014 and risk factor analysis using multivariable logistic regression modelling.

RESULTS

The study population comprised 77,088 dogs attending 50 Vets Now clinics. Overall, 492 dogs had presumptive gastric dilation-volvulus diagnoses, giving a prevalence of 0·64% (95% Confidence interval: 0·58 to 0·70%). Compared with cross-bred dogs, breeds with the highest odds ratios for the diagnosis of presumptive gastric dilation-volvulus were the great Dane (odds ratio: 114·3, 95% Confidence interval 55·1 to 237·1, P<0·001), akita (odds ratio: 84·4, 95% Confidence interval 33·6 to 211·9, P<0·001) and dogue de Bordeaux (odds ratio: 82·9, 95% Confidence interval 39·0 to 176·3, P<0·001). Odds increased as dogs aged up to 12 years and neutered male dogs had 1·3 (95% Confidence interval 1·0 to 1·8, P=0·041) times the odds compared with entire females. Of the cases that were presented alive, 49·7% survived to discharge overall, but 79·3% of surgical cases survived to discharge.

CLINICAL SIGNIFICANCE

Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed.

Comparison of postoperative pain and inflammation reaction in dogs undergoing preventive laparoscopic-assisted and incisional gastropexy

This study compared the effects of postoperative pain and inflammation reaction after preventive laparoscopic-assisted gastropexy (LAG) and incisional gastropexy (IG) in 10 clinically normal Beagles. Surgical time, incision length, visual analog scale (VAS) score, University of Melbourne Pain Scale (UMPS) score, and plasma C-reactive protein (CRP), plasma cortisol (COR), and serum interleukin-6 (IL-6) levels were evaluated. The VAS and UMPS scores and COR and IL-6 levels were recorded at 0.5, 1, 2, 4, 8, 12, 18 and 24 hr after surgery. CRP level was recorded at 12, 24 and 48 hr after surgery. The VAS and UMPS scores showed no significant intergroup differences. Compared to IG, LAG had significantly lower surgical time (45 ± 9.91 min vs 64 ± 5.30 min; P<0.05), incision length (46 ± 8.21 mm vs 129 ± 19.49 mm; P<0.05), CRP level (12 hr after surgery; 4.58 ± 1.58 mg/dl vs 12.4 ± 1.34 mg/dl; P<0.01), and COR level (1 hr after surgery; 10.79 ± 3.07 µg/dl vs 15.9 ± 3.77 µg/dl; P<0.05). IL-6 levels showed no significant intergroup differences at any time point. However, LAG resulted in lower IL-6 levels than did IG at all postoperative time points. Neither procedure resulted in significant surgical complications. LAG produced lower surgical stress than did IG, suggesting that LAG is a safe, minimally invasive, and highly useful technique for preventing canine gastric dilatation-volvulus. Nevertheless, since this study used experimental models, its usefulness should be evaluated in future cases.

Temporary percutaneous T-fastener gastropexy and continuous decompressive gastrostomy in dogs with experimentally induced gastric dilatation

OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter. ANIMALS 6 healthy male large-breed dogs. PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours. RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery. CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.

Advances in Laparoscopic Surgery

Recently, a new platform of abdominal access, called single-port surgery, has emerged in human and veterinary laparoscopy. The single-port platform enables all laparoscopic instruments, including the telescope, to pass individually through the same abdominal incision. Recently, there have been several published reports documenting the efficacy and safety of single-port procedures in veterinary patients. This article discusses the common single-port devices and instrumentation, as well as procedures now routinely offered in veterinary minimally invasive surgery.

Hemostatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus

OBJECTIVE

Prospective characterization of hemostastatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus (GDV).

MATERIAL AND METHODS

Coagulation variables (platelets, prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen, antithrombin [AT], protein C [PC], protein S [PS], D-dimers), plasma lactate concentration and inflammatory biomarkers (C-reactive protein, white blood cell [WBC] count, lymphocyte and neutrophil numbers) were assessed in 20 dogs with GDV presented between 2011 and 2012. Blood was taken preoperatively and at days 1 and 3 postoperatively. The prognostic value of these variables before and after surgery was evaluated as well as the behavior of variables during the study.

RESULTS

Overall, 7/20 (35%) dogs did not survive; two dogs (29%) were euthanized during surgery due to severe gastric necrosis and 5 (71%) dogs after surgery due to sepsis and disseminated intravascular coagulopathy. Prior to surgery, median plasma lactate concentration was significantly (p = 0.01) lower in survivors (6.2 mmol/l, range 1.9-9.7 mmol/l) when compared to non-survivors (11.8 mmol/l, range 7.5-16.2 mmol/l). In dogs dying after surgery, significantly higher plasma lactate concentration, coagulation times and D-dimer concentration were present as well as lower fibrinogen concentration and activity of PC and AT compared to survivors. At discharge, activity of AT, PC and PS were markedly below the reference interval in 6/13 (46%), 11/13 (85%), and 8/13 (62%) dogs, respectively.

CLINICAL RELEVANCE

Only lactate plasma concentration was of preoperative prognostic value. After surgery, severe abnormalities of coagulation variables, especially the endogenous anticoagulants were present in most of the dogs. The severity of the abnormalities was associated with survival.

Perioperative Monitoring of Heart Rate and Rhythm

Perioperative disorders of heart rate and rhythm are common and can contribute to patient morbidity and mortality. Management of perioperative arrhythmias is facilitated by understanding the basic mechanisms of arrhythmia formation and the role of transient imbalances. The decisions of when and how to treat perioperative arrhythmias are based on whether or not hemodynamic signs are present and the assumed risk of sudden arrhythmic death. Perioperative arrhythmias warrant careful monitoring and consideration of potential complications associated with antiarrhythmic therapy.

Plasma lactate concentration as a prognostic biomarker in dogs with gastric dilation and volvulus

Initial and serial plasma lactate concentrations can be used to guide decision making in individual dogs with GDV but care is necessary in phrasing conversations with owners. Published data suggests that survival is more likely and the chance of complications less in dogs with an initial plasma lactate of <4 mmol/L. An initial lactate >6 mmol/L makes gastric necrosis and greater expense more likely. However, because of the overlap between groups and the good overall survival rates, exploratory laparotomy should always be recommended irrespective of the plasma lactate concentration. Falls in plasma lactate of greater than ~40% after fluid resuscitation are likely to indicate better survival. If the initial plasma lactate concentration is moderately to severely increased (5->10 mmol/L) and a sustained increase in plasma lactate occurs after fluid resuscitation, the cause should be aggressively pursued. Many dogs with persistent hyperlactatemia over 24-48 hours do not survive.

Cardiovascular and systemic effects of gastric dilatation and volvulus in dogs

Gastric dilatation and volvulus (GDV) is a common emergency condition in large and giant breed dogs that is associated with high morbidity and mortality. Dogs with GDV classically fulfill the criteria for the systemic inflammatory response syndrome (SIRS) and can go on to develop multiple organ dysfunction syndrome (MODS). Previously reported organ dysfunctions in dogs with GDV include cardiovascular, respiratory, gastrointestinal, coagulation and renal dysfunction. Cardiovascular manifestations of GDV include shock, cardiac arrhythmias and myocardial dysfunction. Respiratory dysfunction is also multifactorial, with contributory factors including decreased respiratory excursion due to gastric dilatation, decreased pulmonary perfusion and aspiration pneumonia. Gastrointestinal dysfunction includes gastric necrosis and post-operative gastrointestinal upset such as regurgitation, vomiting, and ileus. Coagulation dysfunction is another common feature of MODS in dogs with GDV. Disseminated intravascular coagulation can occur, putting them at risk of complications associated with thrombosis in the early hypercoagulable state and hemorrhage in the subsequent hypocoagulable state. Acute kidney injury, acid-base and electrolyte disturbances are also reported in dogs with GDV. Understanding the potential for systemic effects of GDV allows the clinician to monitor patients astutely and detect such complications early, facilitating early intervention to maximize the chance of successful management.

An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs

OBJECTIVE

To evaluate risk factors for gastric dilatation-volvulus (GDV) in a large number of privately owned dogs across a wide geographic area.

DESIGN

Internet-based, cross-sectional study.

ANIMALS

2,551 privately owned dogs.

PROCEDURES

A questionnaire addressed dog-specific, management, environmental, and personality-associated risk factors for GDV in dogs. Respondents were recruited through the posting of the electronic link to the questionnaire on websites for dog owners; the information was also disseminated at meetings of dog owners and via newsletters, e-mail lists for dog owners and breeders, owner-oriented dog publications, and e-mails forwarded by participants. Descriptive statistics and logistic regression analysis were performed.

RESULTS

Factors significantly associated with an increased risk of GDV were being fed dry kibble, anxiety, residence in the United Kingdom, being born in the 1990s, being a family pet, and spending at least 5 hours a day with the owner. Factors associated with a decreased risk of GDV were playing with other dogs and running the fence after meals, fish and egg dietary supplements, and spending equal time indoors and outdoors. A significant interaction between sex and neuter status was observed, with sexually intact females having the highest risk for GDV.

CONCLUSIONS AND CLINICAL RELEVANCE

In dogs with a high risk of GDV, regular moderate daily and postprandial activity appeared to be beneficial. Feeding only commercial dry dog food may not be the best choice for dogs at risk; however, supplements with fish or eggs may reduced this risk. The effect of neuter status on GDV risk requires further characterization.

Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitalization time in dogs with gastric dilatation volvulus

OBJECTIVE

To assess the efficacy of IV lidocaine in decreasing complication rate and improving the outcome in dogs with gastric dilatation volvulus (GDV).

DESIGN

Prospective non-controlled study of 83 lidocaine-treated dogs with GDV compared to 47 untreated historical controls with GDV.

SETTING

University veterinary teaching hospital.

ANIMALS

One hundred and thirty client-owned dogs with naturally occurring GDV.

INTERVENTIONS

Study group dogs were treated at presentation with lidocaine (2 mg/kg, IV bolus) followed by constant rate infusion (CRI) of 0.05 mg/kg/min for 24 h. Historical control dogs did not receive any lidocaine.

MEASUREMENTS AND MAIN RESULTS

There were no group differences in age, body weight, time lag from onset of clinical signs to presentation, rectal temperature and pulse rate at presentation, and proportion of gastric wall necrosis. The proportions of cardiac arrhythmias and acute kidney injury (AKI) were significantly (P< 0.001 and P = 0.045, respectively) lower in the lidocaine group (10/83 [12%] versus 18/47 [38.3%] and 3/83 [3.6] versus 0/47). Median hospitalization time period was shorter (P = 0.05) in the lidocaine group compared to the controls (median 48 h; range 24-360 h versus median 72 h; range 24-144 h, respectively).

CONCLUSION AND CLINICAL RELEVANCE

Early treatment with IV lidocaine bolus, followed by CRI of lidocaine for 24 h post presentation decreased the occurrence of cardiac arrhythmias, AKI and hospitalization time period significantly in lidocaine-treated dogs with GDV compared to untreated historical controls. Due to the nonblinded, placebo-uncontrolled, nonrandomized nature of the current study, further evaluation of the efficacy of lidocaine in dogs with GDV is warranted.

Serum pepsinogen-A, canine pancreatic lipase immunoreactivity, and C-reactive protein as prognostic markers in dogs with gastric dilatation-volvulus

BACKGROUND

Pepsinogens are proenzymes secreted by gastric chief cells. In humans, their serum concentrations reflect gastric mucosal morphological and functional status.

OBJECTIVES

To evaluate serum canine pepsinogen-A (cPG-A), C-reactive protein (CRP), and canine pancreatic lipase immunoreactivity (cPLI) concentrations in dogs with gastric dilatation-volvulus (GDV).

ANIMALS

Sixty-six dogs presented with GDV and 79 healthy controls.

METHODS

Blood was collected prospectively, and records retrospectively reviewed.

RESULTS

Median cPG-A concentration was higher in GDV dogs (median, 397 μg/L; range, 37-5,410) compared to controls (median, cPG-A 304 μg/L; range, 18-848; P = .07). Mortality rate in GDV dogs was 22.7%. In nonsurvivors of GDV, median cPG-A was higher compared to survivors (median, 746 μg/L; range, 128-5,409 versus median, 346; range, 36-1,575, respectively; P = .003). The proportion of dogs with increased cPG-A increased with gastric wall damage score (P = .007). An ROC analysis of cPG-A as a predictor of death showed an area under the curve (AUC) of 0.75, higher than lactate (AUC 0.66), and corresponded to a sensitivity and specificity of 53% and 88%, respectively. CRP was increased in 48 dogs (75%), cPLI was >200 μg/L in 26 dogs (39.4%) and >400 μg/L in 12 dogs (18.2%) but both analytes had no association with outcome.

CONCLUSIONS

Presurgical cPG-A concentration was positively and significantly associated with gastric wall lesion severity, but, based on ROC analysis, it was only a moderate outcome predictor. CRP and cPLI were commonly increased in dogs with GDV.

Chronic gastric instability and presumed incomplete volvulus in dogs

Chronic gastric volvulus in dogs results in long-standing gastrointestinal signs unlike those of acute gastric dilatation and volvulus. This report describes chronic gastric volvulus in seven dogs. The majority of dogs presented with weight loss, chronic vomiting, lethargy and abdominal pain. A combination of radiographic, ultrasonographic and endoscopic imaging indicated altered positioning of gastric landmarks. Dynamic changes were identified in some cases. Exploratory coeliotomy and surgical gastropexy were performed in all dogs. Clinical signs improved or resolved in six of seven dogs postoperatively. Chronic gastric volvulus is an uncommon condition in dogs, but should be considered as a differential in cases presenting with the above clinical signs.