Ultrasound-guided and 'blind' sciatic nerve injection techniques: Comparison in rat cadavers

OBJECTIVE

To compare the success rate and extent of sciatic nerve staining with a bupivacaine-dye solution using two injection techniques: 'blind' or ultrasound-guided approach.

STUDY DESIGN

Prospective, experimental, randomized, cadaveric study.

ANIMALS

Adult female Wistar rat cadavers [n = 24, mass 352 g (323-374)].

METHODS

Each sciatic nerve was randomly allocated to one of two groups: 'blind' (group B) or ultrasound-guided approach (group US) to injection. Following injection of bupivacaine-dye solution (0.1 mL), gross anatomical dissection was performed to visualize nerve staining, categorizing it as either positive or negative. The length of nerve staining was then measured and visual inspection conducted to identify potential nerve damage. Fisher's exact test was used to compare positive or negative nerve staining, and the Wilcoxon signed rank test used to compare the length of nerve staining between groups.

RESULTS

In group B, the bupivacaine-dye solution stained 16/24 sciatic nerves (67% success). In group US, staining was successfully observed in all 24 nerves (100% success, p < 0.004). The length of nerve staining [median (interquartile range)] was 2 (2-3) mm in group B and 5 (4-6) mm in group US (p < 0.001). One sciatic nerve in group B had injectate distributed over 16 mm, suggestive of an intraneural injection. No signs of laceration or nerve damage were visible under 6× magnification in either group.

CONCLUSIONS AND CLINICAL RELEVANCE

The ultrasound-guided approach for sciatic nerve injection demonstrated a higher success rate with superior injectate distribution when compared with the 'blind' approach. Ultrasound guidance is recommended over a 'blind' approach for sciatic nerve block in rats when possible.

Comparison of atlantoaxial and lumbosacral cerebrospinal fluid centesis techniques in South American camelids

BACKGROUND

Iatrogenic blood contamination during cerebrospinal fluid (CSF) centesis is common, which can limit the diagnostic usefulness of the sample. A novel ultrasound-guided CSF collection technique is described in horses, by which CSF is obtained from the atlantoaxial (AA) space.

HYPOTHESIS/OBJECTIVES

To compare ultrasound-guided AA centesis with lumbosacral (LS) centesis in South American camelids (SAC). The hypotheses were that AA centesis would yield samples with less blood contamination although being technically more challenging than LS centesis.

ANIMALS

Eight clinically healthy adult SAC from a university-owned teaching herd.

METHODS

Single-blinded, randomized, 4-way, 4-period crossover study in which 2 veterinarians each performed both centesis techniques on each animal once. Cytological sample analysis was performed, and the technical difficulty of sample acquisition was assessed.

RESULTS

The CSF was collected successfully and without complications by either technique during all collection attempts. Aspects of technical difficulty and concentrations of CSF analytes did not vary significantly between techniques. Median total nucleated cell and red blood cell counts were 1/μL and 0.5/μL and 167.5/μL and 155/μL for AA and LS techniques, respectively. The median total protein concentration was 32.9 mg/dL and 38 mg/dL for AA and LS centeses. A median of 1 attempt was necessary for both centesis techniques and the median number of needle repositioning events was 1 for AA and 0 for LS.

CONCLUSION AND CLINICAL IMPORTANCE

Depending on clinical circumstances, ultrasound-guided AA centesis appears to be an acceptable alternative to other techniques for collection of CSF from SAC.

Effect of a single intravenous injection of branched chain amino acids on body temperature of cats undergoing general anesthesia

OBJECTIVE

To evaluate the effect of a single intravenous injection of branched chain amino acids (BCAAs) on body temperature in cats undergoing general anesthesia.

STUDY DESIGN

Prospective, blinded, randomized, crossover, experimental study.

ANIMALS

A total of 10 healthy adult cats (five female and five male).

METHODS

Cats were anesthetized three times with three different treatments in a random order: 3 mL kg-1 lactated Ringer's solution (LRS), 100 mg kg-1 BCAAs (B100) or 200 mg kg-1 BCAAs (B200) solution immediately before induction of anesthesia. After induction, rectal temperature was measured every 5 minutes. Blood samples were collected for the measurement of blood glucose (BG) just before induction, at the end of the 90 minute period of anesthesia, and 24 hours after anesthesia induction. The differences between baseline and each subsequent rectal temperature, and BG measurements were analyzed. Areas under the curve (AUCs) for temperature differences were calculated for each animal for the anesthetic period (AUCT0-90). Parametric or nonparametric data were analyzed by one-way repeated measures anova or Friedman test. A value of p < 0.05 was considered significant.

RESULTS

There were no significant differences in AUCT0-90 between groups: 41.6 ± 7.7 for LRS, 43.4 ± 6.9 for B100 and 42.9 ± 7.5 for B200 (p = 0.368). No significant differences were observed in BG between groups at 90 minutes and 24 hours after anesthesia induction (p = 0.283 and p = 0.089, respectively). The incidence of hypoglycemia [BG ≤ 3.17 mmol L-1 (57 mg dL-1)] after anesthesia tended to be higher in both B100 (4/10 cats) and B200 groups (3/10 cats) than in LRS group (1/10 cats).

CONCLUSIONS AND CLINICAL RELEVANCE

A single, preanesthetic intravenous injection of BCAAs did not attenuate heat loss during anesthesia. More cats were hypoglycemic in the BCAA groups than in the LRS group.

Patient safety culture is needed in veterinary medicine

Studies in human medicine indicate that between 22,000 and 400,000 people die every year as a direct result of medical errors. In veterinary medicine, 42% of human-caused incidents caused harm to the patient, including 5% resulting in death. In a university veterinary teaching hospital, there were 5.3 errors/1,000 patient visits, and 4 of these resulted in death. Veterinary medicine falls far behind other safety-critical industries in adopting a culture of patient safety. Organizations should respond in a just and effective way when errors occur. Psychological safety for team members to identify and speak up about areas of concern must be created and the results of improvements made based on these concerns shared within the professional group. If veterinary medicine is going to embrace patient safety culture, it needs to be included in the curriculum. Accrediting and licensing bodies need to require the teaching and application of principles of patient safety culture. Faculty must be trained to deliver patient safety-oriented care. Experts in human systems engineering should be brought in to educate veterinarians on how the systems we work in impact patient outcomes. If we are going to fulfill the promise of the Veterinarian's Oath, we must embrace patient safety culture and all the difficult changes it requires of our professional culture.

The effect of age on the induction dose of propofol for general anesthesia in dogs

OBJECTIVE

In people, the dose of propofol (DOP) required for procedural sedation and anesthesia decreases significantly with age. The objective of this study was to determine if the DOP required to perform endotracheal intubation decreases with age in dogs.

STUDY DESIGN

Retrospective case series.

ANIMALS

1397 dogs.

METHODS

Data from dogs anesthetized at referral center (2017-2020) were analyzed with three multivariate linear regression models with backward elimination using a combination of either absolute age, physiologic age, or life expectancy (ratio between age at the time of anesthetic event and expected age of death for each breed obtained from previous literature) as well as other factors as independent variables, and DOP as the dependent variable. The DOP for each quartile of life expectancy (<25%, 25-50%, 50-75%, 75-100%, >100%) was compared using one-way ANOVA. Significance was set at alpha = 0.025.

RESULTS

Mean age was 7.2 ± 4.1 years, life expectancy 59.8 ± 33%, weight 19 ± 14 kg, and DOP 3.76 ± 1.8 mg kg-1. Among age models, only life expectancy was a predictor of DOP (-0.37 mg kg-1; P = 0.013) but of minimal clinical importance. The DOP by life age expectancy quartile was 3.9 ± 2.3, 3.8 ± 1.8, 3.6 ± 1.8, 3.7 ± 1.7, and 3.4 ± 1.6 mg kg-1, respectively (P = 0.20). Yorkshire Terrier, Chihuahua, Maltese, mixed breed dogs under 10 kg, and Shih Tzu required higher DOP. Status of neutered male, ASA E, and Boxer, Labrador and Golden Retriever breeds decreased DOP, along with certain premedication drugs.

CONCLUSIONS AND CLINICAL RELEVANCE

In contrast to what is observed in people, an age cut-off predictive of DOP does not exist. Percentage of elapsed life expectancy along with other factors such as breed, premedication drug, emergency procedure, and reproductive status significantly alter DOP. In older dogs, the dose of propofol can be adjusted based on their elapsed life expectancy.

Resident Selection Criteria in Veterinary Medicine

With the continued rise of interest and need for veterinary specialists, information regarding optimal selection criteria for successful residency candidates has been lacking in veterinary medicine. A 28-question online survey was developed to determine prioritized resident selection criteria, the importance of formal interviews, and residency supervisor satisfaction with the current selection process. This survey was sent to all programs listed by the Veterinary Internship and Residency Matching Program (VIRMP) for the 2019-2020 program year. Overall, the most important aspects of the residency application process were (1) letters of recommendation, (2) performance during the interview, (3) personal contact/recommendation from a colleague, (4) personal statement, and (5) demonstrated interest in the residency specialty. While measures of academic performance including GPA and veterinary class rank may play a role in sorting of candidates in more competitive specialties, this does not necessarily exclude them from the ranking process. This information should be helpful to candidates and program directors alike in understanding the success of the current residency candidate selection process.

Specifications Grading in a Cardiovascular Systems Course: Student and Course Coordinator Perspectives on the Impacts on Student Achievement

This study investigated students' and a course coordinator's perceptions about specifications (spec) grading in a cardiovascular systems course and assessed its effects on student performance. Spec grading was hypothesized to result in lower perceived student stress about the course, improved student performance, and less work for the course coordinator. The study used a mixed methods approach consisting of student pre-, peri-, and post-course surveys; student focus group interviews; analysis of student course evaluations; and course coordinator reflection. Participants were from a cross-section of one course in the veterinary professional curriculum. Results demonstrated significantly more A grades assigned to students than in the previous year's course, where traditional grading was used (p = .024). The focus group produced two primary themes: pros and cons. Pros included flexibility, student control over grades, generally lower perceived stress, opportunities to resubmit assignments, and more motivation to learn. Cons included confusion about the process, some disorganization, perceived higher workload for the professor, and communication concerns. The course coordinator's positive perceptions included students being less combative about grades than with the traditional system, students appreciating opportunities to resubmit assignments, and students demonstrating improved learning outcomes. Negative course coordinator perceptions were that reduced student stress was inconsistently achieved and that there was increased time commitment compared with traditional grading. Course evaluation themes included skepticism about spec grading in the beginning, varying stress experiences, improved learning, and increased workload. In conclusion, spec grading variably reduced student stress and did not result in less work for the course coordinator.

Effect of Romanowsky-Stained Concentrated Preparations versus Direct Smears on Veterinary Students' Ability to Identify Bacterial Sepsis in Fluid Cytology Samples from Dogs, Cats, and Horses

Veterinary students' accuracy, confidence, and time required to diagnose bacterial sepsis in fluid cytology samples was evaluated using two different slide preparation methods: direct smears and cytocentrifuged concentrated preparations. We hypothesized veterinary students would diagnose fluids as septic on concentrated preparations more accurately and quickly than on direct smears. Thirty third- and fourth-year students who had previously participated in a clinical pathology course completed a survey regarding general cytology experience and reviewed 40 randomized Romanowsky-stained slides via microscopy. Slides consisted of 10 septic and 10 non-septic samples with matched direct and concentrated slides, prepared from fluids from dogs, cats, and a horse. Participants' slide evaluation time, diagnosis, confidence, and slide photographs of areas considered septic were recorded. No difference in diagnostic accuracy between direct and concentrated samples was identified (area under the curve: 57% for both preparations, p = 0.77), although students agreed with pathologist-determined diagnoses more often when viewing concentrated samples (M = 63%, SD = 11% for concentrated; M = 56%, SD = 21% for direct, p = .012). A positive relationship existed between accuracy of diagnosis (R² = .59) and senior status (p = .002), comfort interpreting cytology slides (p < .03), and if the student had taken the senior pathology rotation (p = .02). Only 38% (121/319) of participant photographs correctly identified sepsis. Under experimental conditions, concentrated preparations did not increase the accuracy of veterinary students' bacterial sepsis diagnosis; however, since accuracy did increase with cytology experience and comfort level, additional pre-clinical and clinical cytology training may benefit students before entering practice.

Post-operative Pain Assessment Following Tooth Extraction Using Liposomal Encapsulated Bupivacaine as a Local Anesthetic in Dogs

The objective of this study was to evaluate owner assessment of appetite, demeanor, and mouth soreness following dental extractions in dogs receiving either bupivacaine hydrochloride (BH) or liposomal encapsulated bupivacaine (LEB) for dental blocks. Thirty healthy, adult dogs requiring dental extractions were enrolled in the study. All procedures were completed with dogs under general anesthesia. A non-steroidal anti-inflammatory drug was administered subcutaneously in the preoperative period. Dogs were randomly assigned to receive BH or LEB. An owner assessment to evaluate appetite, demeanor, and soreness of mouth was completed at the end of both the first and second day after discharge from the hospital. The total of the owner assessments for day 1 and both days combined was significantly lower for dogs receiving LEB (P = .007). There were no differences in the number of extractions (P = .21), time from block to evaluations (P = .07), in-hospital pain assessments (P = .99), or number of dogs requiring rescue analgesia (P = .99). This study concluded, dogs that received LEB for dental blocks had improved appetite and demeanor, and reduced soreness of mouth, as evaluated by the owner two days postoperatively, when compared to dogs who received BH.

Specifications Grading for Veterinary Medicine

Assigning grades in a traditional manner is often problematic: grades may or may not reflect actual student achievement, and students may base their self-worth on grades. Specifications (spec) grading claims to remedy these through a novel grading scheme. The scheme also purports to uphold high academic standards, reflect student learning, motivate students to focus on learning (rather than a grade), discourage cheating, reduce student stress, give students control over their grade, minimize conflict between students and faculty, save faculty time, make expectations clear, and facilitate higher-order learning. In spec grading, students must achieve 80% or higher to pass selected assignments, which include exams and quizzes, with the number and nature of assignments dictating the student's final letter grade for the course. Students may resubmit assignments until they pass. Implementing spec grading requires creating assignments, determining assignment bundles, and communicating the new scheme to students to set clear expectations. The purpose of this tip is to describe how to develop a course using spec grading for didactic and clinical applications.

Effects of tiletamine-zolazepam vs. propofol on peri-induction intraocular pressure in dogs: A randomized, masked crossover study

Introduction

Anesthesia induction agents have the potential to cause severe ocular side effects, resulting in lasting damage to the eye.

Objectives

The purpose of this study is to determine the effects of tiletamine-zolazepam on IOP compared to propofol when they are used as an induction agent in normal healthy dogs.

Methods

Twenty healthy adult client owned dogs weighing 22.2 ± 7.6 kg were selected for the study. In a randomized order, all dogs received tiletamine-zolazepam 5 mg/kg IV or propofol 8 mg/kg IV titrated to effect without premedication. Washout between each treatment was at least seven days. IOP measurements were obtained at four time points: baseline, post-induction, post-intubation, and after recovery using applanation tonometry. No additional procedures were performed. After normality of the data was determined, a linear mixed model was built with time, eye, treatment and all interactions of those variables as fixed effects and subject as a random effect.

Results

There was no significant difference for age, body weight, drug dose, baseline IOP, and recovery IOP between treatments. Average IOP measurements remained within the normal range of 15-25 mmHg at these time points. However, IOP was significantly less elevated by the tiletamine-zolazepam treatment vs. propofol at the post-induction (mean difference: -4.7 ± 4.6 [95%CI -6.8 to -2.5]) and the post-intubation (mean difference: -4.4 ± 4.6 [95%CI -6.5 to -2.2]) time points.

Clinical significance

Dogs receiving tiletamine-zolazepam for anesthetic induction had a significantly less elevated IOP at induction and intubation compared to dogs receiving propofol.

Examination of Motivational Influences on Clinical-Year Veterinary Students' Career Decisions

The purpose of this study was to identify motivations for fourth-year veterinary students to choose future career paths based on post-graduation employment or post-graduation education. Approximately 500 students from four institutions were invited to participate in an online survey. Surveys were based on the cognitive evaluation theory, a minitheory within the self-determination macrotheory framework developed by Deci and Ryan. Intrinsic motivational factors were categorized by autonomy, competence, and relatedness, and extrinsic motivators were categorized by environmental and interpersonal factors. Students pursuing post-graduation education have intrinsic motivators that aligned with competence and were extrinsically motivated by a mentor, while students interested in post-graduation employment had intrinsic motivators that were more focused on autonomy with extrinsic motivational influences of debt/finances and geographic location.

Single instead of triplicate intraocular pressure measurements in dogs do not substantially lower accuracy and precision but do slightly reduce statistical power

OBJECTIVE

To compare single and triplicate applanation tonometry values across previous intraocular pressure (IOP) studies in dogs.

ANIMALS

116 ophthalmologically normal dogs.

PROCEDURES

Triplicate IOP readings (n = 1432) from studies evaluating effect of anesthetic protocols were analyzed to estimate a range of probable differences between averaged triplicate and first, averaged and lowest, and first and lowest IOPs. The decrease in variability with triplicate measurements and the magnitude of effects on statistical power were quantified.

RESULTS

The 2.5th to 97.5th interpercentile range for differences of averaged triplicate values minus first IOP readings was –3 to 2.7 mm Hg; for averaged minus lowest: 0 to 3.7 mm Hg; for first minus lowest: 0 to 5 mm Hg. The 95% prediction interval for differences in study group means (n = 160 groups, n = 5 to 11 eyes per group) based on averaged minus first measurements was –1.0 to 0.9 mm Hg with associated SDs reduced by 4% on average. Analysis of previous studies using averaged instead of first IOP values resulted in minimal decreases in SEs of 3–9% (0.03 to 0.09 mm Hg). Of 11 comparisons found significant with averaged data, 2 (18%) were found nonsignificant with first measurements. Of 96 comparisons found nonsignificant with averaged data, 3 (3%) were found significant with first measurements.

CLINICAL RELEVANCE

With applanation tonometry in ophthalmologically normal dogs, no clinically meaningful difference was found between the first, lowest, or averaged triplicate IOP measurements, but the first reading has a larger variance and hence will result in lower statistical power.

Comparison of 2 blind approaches to the paravertebral brachial plexus regional block in canine cadavers

The paravertebral brachial plexus block (PVB) provides thoracic limb analgesia. The objective was to describe a blind craniocaudal (CC) approach to the PVB and compare its accuracy, time, and difficulty of performance with a blind dorsoventral (DV) approach. The operator was initially trained by experienced clinicians to perform both approaches on 5 cadavers. Next, a CC or DV approach to the PVB was performed on both thoracic limbs of 20 cadavers (20 for each approach). Methylene blue dye was equally divided into 4 aliquots to stain the ventral branches of the sixth to eighth cervical and first thoracic spinal nerves. Successfully stained (stain ≥ 1 cm) spinal nerves were counted. The time to perform each approach was recorded and ease of performance was scored using a numerical scale (1 "easy" to 4 "difficult"). The phrenic nerve was checked for stain. A Wilcoxon signed-rank test was used to compare approaches. The data are presented as median (interquartile range; minimum to maximum range). The number of stained nerves with the CC approach 3 (1; 2 to 4), was higher than the DV approach 2 (2; 0 to 4) (P = 0.002). The time (in seconds) to perform the CC approach 125 (79; 70 to 194), was not different from the DV approach 142 (54; 101 to 232) (P = 0.084). The CC approach 2 (2; 1 to 4) was easier to perform than the DV approach 3 (1; 2 to 4) (P = 0.024). No phrenic nerve staining was observed with either approach. The CC approach is an alternative to the DV approach for performing the PVB in dogs.

Educational Research Report Correlation between Student Self-Assessment and Proctor Evaluation in a Veterinary Surgical Laboratory

Self-assessment has been shown to facilitate learning, goal setting, and professional development. We sought to evaluate whether veterinary students in a surgical curriculum would have self-assessments that differed from proctor evaluations and whether high-performing students would differ from low-performing students in self-assessment characteristics. Student and proctor assessments were compared for 8 weeks of a spay/neuter surgical laboratory taking place in the second year of the curriculum. Eight students were classified as high-performing, and 10 students were classified as low-performing. A quantitative evaluation of the scores and a qualitative assessment of written comments were completed. Proctors assigned higher scores to high-performing students compared to low-performing students, but no difference was observed overall in self-assessment scores assigned by students. When only anesthesia students were evaluated, we found a difference in self-assessment scores for high- versus low-performers, but this was not true for surgery students. Differences between proctor and student assessment scores diminished over time for all students and for anesthesia students, but not for surgery students. High-performing student anesthetists self-assessed and received proctor assessments with higher scores in technical skills. Comments from high-performing students tended to be less reflective and more positive. Low-performing students were more defensive and more likely to use I-statements in their comments. Overall, quantitative analysis did not reveal a difference in self-assessment between high-performers and low-performers; however, specific differences existed in qualitative characteristics, surgery versus anesthesia students, and proctor assessments. The differences in self-assessment between high- and low-performing students suggest areas of further investigation for the use of reflection in education.

Scoping review of quality of anesthetic induction and recovery scales used for dogs

OBJECTIVE

To compare, describe and assess the level of validation of all instruments measuring quality of induction and recovery from anesthesia in dogs.

DATABASES USED

A search was performed using the electronic database PubMed to find articles containing an induction quality scale, a recovery quality scale or both in dogs. Articles not directly accessible through PubMed were obtained through the Auburn University Library website and Google Scholar. The phrases 'induction scoring systems dogs', 'recovery scoring systems dogs', 'anesthetic induction score dogs', and 'anesthetic recovery score dogs' were used for searches using the 'best match search' function. The time frame searched was from 1980 to May 2020. The search was conducted from March 2020 to May 2020.

CONCLUSIONS

A thoroughly tested and validated scale for measuring the quality of induction and recovery does not exist in the current veterinary literature. A large disagreement exists between studies on the use of induction and recovery scales, and many have reported inconsistent results with current instruments. It is recommended that an induction and recovery scale intended for wide-scale use be constructed and tested extensively for psychometric validation and reliability.

A survey of emergency and critical care veterinarians regarding IV fluid bolus therapy and monitoring practices in small animals

OBJECTIVE

To determine how veterinary emergency and critical care clinicians define IV fluid bolus therapy (FBT) and what constitutes a positive response to a fluid bolus.

DESIGN

Online survey of 222 emergency and critical care veterinarians between December 17, 2018, and March 1, 2019.

INTERVENTIONS

An online survey was provided to diplomates of the American College of Veterinary Emergency and Critical Care (ACVECC), residents of ACVECC-approved training programs, as well as house officers and emergency clinicians of a corporate multicenter emergency and specialty care veterinary hospital. The survey investigated the administration of various crystalloid, colloid, and blood products for FBT, as well as expected physiological responses.

MEASUREMENTS AND MAIN RESULTS

The majority of respondents considered balanced isotonic crystalloids appropriate for FBT (220/222 [99.1%]). Respondents showed greater variability in acceptance of 0.9% sodium chloride (105/222 [47.30%]), hypertonic (3-7%) sodium chloride (131/222 [59.01%]), and hydroxyethyl starch solutions (90/222 [40.54%]). Most respondents did not consider physiological plasma (44/222 [19.82%]) an appropriate choice. The most commonly used parameters for monitoring FBT responses were heart rate (220/222 [99.10%]), blood pressure (217/222 [97.75%]), capillary refill time (192/222 [86.49%]), lactate (181/222 [81.53%]), pulse pressure (151/222 [68.02%]), and rectal temperature (145/222 [65.32%]). The majority of respondents perceived that 0-20% (165/222 [74.32%]) of hypotensive patients are nonresponsive to FBT.

CONCLUSIONS

Small animal emergency and critical care clinicians favored balanced isotonic electrolyte solutions and hypertonic sodium chloride solutions for FBT over other options. When monitoring responses to FBT, heart rate, blood pressure, capillary refill time, and plasma lactate were among the most commonly monitored parameters, and there was a lack of familiarity with others. Despite the widespread use of FBT, these findings outline the need for further prospective clinical trials regarding the ideal fluid type and rate, as well as the appropriate responses to FBT.

Descriptive assessment of adverse events associated with midazolam-etomidate versus saline-etomidate in healthy hydromorphone premedicated dogs

OBJECTIVES

To determine the frequency, severity and duration of adverse events including myoclonus, pain on injection, hypersalivation, regurgitation and apnoea after administration of midazolam or saline followed by etomidate in hydromorphone premedicated dogs.

MATERIALS AND METHODS

Dogs undergoing elective dental prophylaxis or soft tissue surgeries were enrolled in this randomised trial. Dogs were premedicated with hydromorphone 0.1 mg/kg IV. Sixty seconds later, midazolam 0.3 mg/kg or saline at an equivalent volume was administered IV. Sixty seconds after that, etomidate 1.5 mg/kg IV was administered over 60 seconds. Additional doses of 0.5 mg/kg etomidate were administered until endotracheal intubation was successful. Observers were blinded to the treatment. Frequency, duration and a severity score of 0 to 3 were recorded for myoclonus, pain on injection, hypersalivation and regurgitation. Duration of apnoea and frequency of any additional complications was recorded.

RESULTS

Forty variable breed healthy dogs were enrolled in the study. Myoclonus, pain on injection, regurgitation, hypersalivation, gagging, tachypnoea and pigmenturia occurred, respectively, in 10%, 40%, 0%, 15%, 35%, 25% and 5% of dogs in the saline group and 0%, 65%, 0%, 10%, 45%, 15% and 5% of dogs in the midazolam group. Apnoea occurred for 115 seconds (range 0 to 660 seconds) and 160 seconds (range 0 to 600 seconds) in the saline and midazolam groups, respectively. Two dogs developed pigmenturia. The trial was stopped early due to the occurrence of pigmenturia.

CLINICAL SIGNIFICANCE

Due to early stopping of the trial, the predefined sample size was not reached. Further investigation is needed to determine if midazolam reduced the incidence of adverse events or improved the induction quality when combined with hydromorphone and etomidate.

Nonparticipant Student Observation of Faculty Classroom Teaching

Student evaluations are commonly used to evaluate teaching effectiveness. Nonparticipant observation uses individuals who are not a part of the learning process but rather are observers who can formulate observations about the teaching encounter, possibly with less bias than student evaluators. The purpose of this article is to analyze reports by inexperienced nonparticipant observers of faculty classroom teaching episodes. The hypothesis was that veterinary faculty have common characteristics in their classroom teaching that are observable by nonparticipant observers and that these are similar to characteristics observed historically by student evaluators. This study is a qualitative document analysis of written observations made by senior veterinary students attending pre-clinical classroom lectures by a faculty member. Each written report was analyzed using thematic concept analysis, and the researchers met multiple times throughout the process to discuss the analysis and develop conclusions about themes that were encountered consistently among observations. Common emergent themes included information formats, PowerPoint presentations, timing, organization, student engagement, and delivery. Nonparticipant observers may contribute valuable data that may enhance faculty development in pedagogy. Observations may serve to augment data from student evaluations, self-reflection, and peer assessment.

Full-Time Employment or Post-Graduate Education: A Means-Ends Investigation of Fourth-Year Veterinary Students

The purpose of this article is to identify the motivations for fourth-year veterinary students to pursue either full-time employment or post-graduate education. Twenty-one fourth-year veterinary students were interviewed using a means-ends investigation style. Interviews were analyzed using a qualitative method in the context of the self-determination theory pillars of intrinsic motivation (autonomy, competence, and relatedness). Students interested in full-time employment had more statements that were categorized as demonstrating an interest in autonomy. Students who were interested in post-graduate education had more statements that were categorized as demonstrating an interest in developing competence. Both groups of students indicated that relatedness was important. Understanding the beliefs and motivations that influence students' post-graduation career decisions is important in framing their decision-making process.

Influence of osteochondrosis on the longevity and racing performance of standardbred trotters and pacers

OBJECTIVE

To determine the influence of clinical osteochondrosis (OC) on the short-term (2, 3, and 4-year-old) and long-term racing performance and longevity of standardbred racehorses.

STUDY DESIGN

Retrospective case-control study.

SAMPLE POPULATION

Standardbred racehorses from a single breeding farm born between 2009 and 2017 that survived to racing age (n = 2711). Three hundred eighty-two (14%) horses were OC-affected (829 lesions confirmed arthroscopically during surgical treatment), and 2329 (86%) horses were nonaffected.

METHODS

Racing performance data were obtained from an online database and evaluated with multiple linear regression models.

RESULTS

Trotters were more likely than pacers to be affected by OC (odds ratio [OR] = 1.4, 95% CI = 1.1-1.9, P = .006). Compared with nonaffected horses, long-term OC-affected horses had 8.8 fewer starts (95% CI = -14.4 to -3.2, P = .002), 1.0 fewer wins (95% CI = -1.9 to -0.1, P = .030), and 3.8 fewer total number of first through third place finishes (95% CI = -6.2 to -1.4, P < .0001). Nonaffected horses had longer careers compared with OC-affected horses, racing 0.32 years longer (95% CI = -0.52 to -0.12, P = .002). Osteochondrosis had no impact on short-term racing performance. Horses with lesions at the distal intermediate ridge of the tibia or lateral trochlear ridge of the talus had decreased performance compared with horses without these lesions.

CONCLUSION

Pacers were less likely than trotters to be affected by OC. Affected horses had fewer starts and shorter careers, despite early surgical intervention.

CLINICAL SIGNIFICANCE

Osteochondrosis decreases long-term racing performance in racing standardbreds.

Faculty Perspectives Regarding Day One-Ready Examination Items

The objective of this mixed-methods, cross-sectional study was to evaluate faculty perspectives regarding Day One-Ready (DOR) content on examination questions given to students at a veterinary medical college and to elucidate whether differing viewpoints on what information constitutes DOR knowledge exist among different veterinary disciplines. Twelve faculty members at a veterinary medical college from three different disciplines (small animal internal medicine, surgery, and primary care) reviewed examination questions given to veterinary students, answered the questions, and stated whether they tested DOR information. After elimination of items not answered by all respondents and after reviewing for question quality, 103 questions remained for analysis. An evaluator from each discipline participated in a discussion about DOR content. Of the questions, 30% were unanimously considered to assess DOR information. No association was found between type of question (medicine, surgery, uncategorized) and whether it was considered DOR. Primary care doctors assessed more questions as testing DOR information than either type of specialist. Questions answered correctly were more likely to be assessed as DOR. During discussion, themes identified with DOR information included common conditions, practical diagnostics, critical knowledge, and discriminating between differential diagnoses. Specialists and primary care doctors differed in their assessment of DOR questions. Veterinary faculty should carefully consider whether examination questions contain DOR information and are appropriate for testing knowledge of the entry-level veterinarian.

Evaluation of the time to desensitization of the larynx of cats following topical lidocaine application

OBJECTIVES

The objective of this study was to evaluate the time to decreased reactivity of the arytenoid cartilages in cats after application of topical lidocaine.

METHODS

One hundred and ten mixed-breed cats were randomly assigned to one of five groups based on the time between application of lidocaine and stimulation of the larynx: 5 (T5), 15 (T15), 30 (T30), 45 (T45) or 60 (T60) s. Cats were premedicated with dexmedetomidine, ketamine and buprenorphine. Anesthesia was induced with propofol to effect. Lidocaine 2% (2 mg/kg) was applied topically to the vocal cords using a catheter attached to a syringe under direct laryngoscopy. After lidocaine application, the designated time elapsed and the vocal cords were stimulated with the patient end of an endotracheal tube. Severity of reaction was reported as none, mild, moderate or severe. All cats were intubated after the reactivity score was recorded. Anesthesia was maintained with isoflurane and 100% oxygen while cats were spayed or castrated. Cats were monitored in recovery for signs of respiratory complications and pain.

RESULTS

There was a significant difference in overall reactivity score between T5 and T45 (P = 0.0038). Also, there was a significant difference in the number of cats with no reaction compared with cats with any reaction between T5 and T30 (P = 0.03), as well as between T5 and T45 (P = 0.0028). No cat had a severe reactivity score at T45 or T60. All cats were successfully intubated. There were no complications during intubation, maintenance of anesthesia or recovery.

CONCLUSIONS AND RELEVANCE

As the lowest overall reactivity score occurred at T45, it is recommended to wait at least 45 s after application of topical lidocaine before attempting tracheal intubation.

Arterial oxygenation in anesthetized horses placed in a 5-degree reverse Trendelenburg position

Low arterial oxygen is a common complication in anesthetized horses and placing the animal in reverse Trendelenburg (RT) position may treat hypoxemia. The objective of this study was to assess the arterial partial pressure of oxygen (PaO₂) in horses placed in a 5-degree RT compared to horizontal (H) position. Client-owned healthy horses (n = 60) undergoing elective surgeries were enrolled in a randomized controlled clinical study. Horses were sedated with butorphanol, an α₂-adrenoceptor agonist, ± acepromazine and induced with ketamine combined with a benzodiazepine, propofol, or guaifenesin. Anesthesia was maintained with isoflurane in oxygen with mechanical ventilation. Each group (RT and H) included 30 horses, 10 in each recumbency (dorsal, right and left lateral). Arterial blood gas analyses (aBG) were performed following arterial catheter placement then hourly. Time first-to-last aBG, changes in PaO₂, dynamic compliance (C_dyn), estimated pulmonary shunt fraction (F-shunt), and alveolar dead space to tidal volume ratio (V_D/V_T) were evaluated with a 2-way analysis of variance. Statistical significance was set at p < .05. Overall, PaO₂ increased in all groups; however no significant difference was found between recumbencies (dorsal, right and left lateral) and RT versus H in changes over time for PaO₂ (p = .064 and p = .070, respectively), C_dyn (p = .721 and p = .672, respectively), F-shunt (p = .055 and p = .054, respectively), or V_D/V_T (p = .616 and p = .064, respectively). In healthy anesthetized horses, 5-degree RT did not affect changes in PaO₂ as compared to H position.

Perception of small animal cardiopulmonary resuscitation of owners presenting to a small animal teaching clinic including a large first opinion service

OBJECTIVE

To gather information from veterinary clients to better understand and gauge the knowledge level and perception of small animal cardiopulmonary resuscitation (CPR) in an academic veterinary hospital.

DESIGN

Prospective cross-sectional survey.

SETTING

A veterinary teaching hospital including a large first opinion service.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

An anonymous survey was developed to gauge the knowledge of veterinary clients on a variety of CPR related topics at a university veterinary hospital. Surveys were randomly distributed to a convenience sample of clients in the waiting room through the client services staff between October 2017 and March 2018. Of the 451 surveys distributed, 296 were used for the statistical analysis. The majority of respondents (92%) knew the appropriate definition of CPR but only 11% knew how to perform CPR on a dog or cat. Most respondents (82%) wanted to discuss their pet's CPR status at a veterinary visit. The mean ± SD estimate of rate of discharge from hospital after cardiac arrest was 39.4 ± 25.6% and the majority of respondents (202 [68%]) got their estimate from an educated guess. The respondents who elected CPR that day provided an estimated cost of 257 ± 365 USD while the respondents who elected not to have CPR provided an estimated cost of 491 ± 875 USD; P = 0.019. The respondents that watched television medical dramas estimated a higher rate of survival to discharge at 42 ± 25%, while people who did not watch television medical dramas provided an estimated survival rate of 35 ± 26%; P = 0.034.

CONCLUSIONS

Inaccurate perceptions regarding CPR and survival rates exist among the general public; however, respondents are interested in becoming better informed.

Retention of basic suturing skills with brief or extended practice in veterinary students

OBJECTIVE

To evaluate the effect of practice duration on accuracy, retention, and confidence when learning how to tie basic surgical knots.

STUDY DESIGN

Prospective study.

SAMPLE POPULATION

Fifteen first-year veterinary students.

METHODS

Students were randomly assigned to a 2-week practice (TWP) or an 8-week practice (EWP) to learn how to tie surgeon's, strangle, and miller's knots. Students' knot-tying accuracy and confidence were evaluated immediately after training, at an intermediate time point (2-6 weeks postpractice), and at 12 weeks postpractice.

RESULTS

Students who had been trained during an extended period tied the strangle knot correctly more often at all assessments (P = .025). The ability of students trained for 2 weeks to tie the strangle knot correctly decreased over time (P = .028). These students lost some confidence (P = .03) and repositioned suture more frequently (P = .03) while constructing the strangle knot at the final time point compared with students trained for 8 weeks. Students who completed TWP felt more confident at placing surgeon's knots than friction knots at the final assessment period (P = .0164 miller's knot, P = .0056 strangle knot), whereas confidence did not differ between knot types for students who completed EWP. All students felt less confident with their knot-tying skills at 12 weeks postpractice.

CONCLUSION

Training for 8 weeks rather than for 2 weeks resulted in superior knot tying skills. Students' confidence decreased 12 weeks after training.

CLINICAL SIGNIFICANCE

Prolonged distributed practice is recommended to train students for more complex tasks such as placement of a strangle knot.

Effect on urine specific gravity of the addition of glucose to urine samples of dogs and cats

OBJECTIVE

To evaluate effects of the addition of glucose to dog and cat urine on urine specific gravity (USG) and determine whether glucosuria affects assessment of renal concentrating ability.

SAMPLE

Urine samples from 102 dogs and 59 cats.

PROCEDURES

Urine for each species was pooled to create samples with various USGs. Glucose was added to an aliquot of each USG pool (final concentration, 2,400 mg/dL), and serial dilutions of the glucose-containing aliquot were created for each pool. The USG then was measured in all samples. The difference in USG attributable to addition of glucose was calculated by subtracting the USG of the unaltered sample from the USG of the sample after the addition of glucose. The relationship between the difference in USG and the USG of the unaltered, undiluted sample was evaluated by the use of linear regression analysis.

RESULTS

Addition of glucose to urine samples increased the USG. There was a significant relationship between USG of the undiluted sample and the difference in USG when glucose was added to obtain concentrations of 300, 600, 1,200, and 2,400 mg/dL in canine urine and concentrations of 600, 1,200, and 2,400 mg/dL in feline urine. The more concentrated the urine before the addition of glucose, the less change there was in the USG. Changes in USG attributable to addition of glucose were not clinically important.

CONCLUSIONS AND CLINICAL RELEVANCE

Substantial glucosuria resulted in minimal alterations in specific gravity of canine and feline urine samples. Thus, USG can be used to assess renal concentrating ability even in samples with glucosuria.

Determination of the minimum alveolar concentration of sevoflurane that blunts adrenergic responses and the effect of a constant rate infusion of ketamine in sheep

Minimizing sympathetic stimulation under anesthesia prevents activation of the neuroendocrine stress response. The minimum alveolar concentration blunting adrenergic responses in 50% of the population when exposed to a noxious stimulus is defined as MAC-BAR. The purpose of this study was to determine the MAC-BAR of sevoflurane (MAC-BAR_sevo) in sheep and the MAC-BAR sparing effects of ketamine. Thirteen healthy Dorset-cross adult ewes, 4 ± 1 year old and weighing 74 ± 9 kg, were enrolled in a randomized blinded crossover study design. Ewes were anesthetized twice for MAC-BAR_sevo determination. After face mask induction with sevoflurane, sheep received intravenous ketamine at 1.5 mg/kg and a constant rate infusion of 1.5 mg/kg/h or an equivalent volume of saline (placebo). After 8 day washout, the other treatment was administered. A bracketing technique was used for MAC-BAR_sevo determination and values were collected in duplicate. The mechanical stimulus (sponge forceps) was applied at the coronary band for 1 min and blood was collected for ketamine plasma concentrations. The MAC-BAR_sevo values of each treatment were compared using a paired t-test. Mean MAC-BAR_sevo of the ketamine and placebo were 2.73 ± 0.23% and 2.77 ± 0.31%, respectively and no significant difference was found (p = .638). Average ketamine plasma concentrations was 1.54 ± 0.18 μg/mL maintained through the study. Ketamine at 1.5 mg/kg, followed by 1.5 mg/kg/h, did not decrease the MAC-BAR_sevo in sheep. Further studies to determine the effect of higher doses of ketamine on inhalational anesthetic agents and their potential adverse effects are warranted.

A systematic review of the effects of injectable sedative and anesthetic drugs and inhalant anesthetics on intraocular pressure in the dog

OBJECTIVE

The purpose of this systematic review was to summarize the results of studies that have determined the effect of injectable and inhalant drugs used in anesthesia on intraocular pressure (IOP) in dogs.

DATABASES USED

A comprehensive search of research literature was performed without language restriction. The search utilized the PubMed, CAB Abstracts and the University of Georgia's Galileo electronic databases using a combination of free text terms 'Ophthalmology', 'Intraocular Pressure', 'Anesthetic', 'Anesthesia', 'Canine' or 'Dog'. The time frame searched was from 1970 to October 2018. Any published research paper that dealt with sedatives or anesthetics administered systemically and the canine eye was evaluated.

CONCLUSIONS

The effects of many anesthetic drugs in dogs with ocular pathology are largely unknown. Many anesthetic drugs do not induce clinically relevant changes in IOP in dogs with normal eyes, although some studies demonstrated results with statistically significant changes. The dose, route of administration, experimental conditions, drug combinations, timing of measurements, measurement technology and setting or individual animal characteristics may all produce some heterogeneity in results from multiple studies.

Veterinarians' attitudes towards use of nutraceuticals

The objective of this study was to assess veterinarians' understanding of nutraceutical use in humans and companion animals and their motivation and circumstances for recommending nutraceuticals to clients. We administered a cross-sectional survey to veterinarians attending continuing education sessions at the University of Georgia (USA) College of Veterinary Medicine from 2012 to 2015 (N = 126). Information regarding veterinarians' age, year of graduation, practice focus, and typical approaches to nutraceutical use was compiled from the returned surveys. The results indicated that veterinarians are more familiar with nutraceutical use in animals than in humans and primarily recommend nutraceuticals to their clients for preventative purposes and/or due to client interest. Veterinarians believed that nutraceuticals were most useful for osteoarthritis and therefore use omega-3 fatty acid and glucosamine/chondroitin products more often than other products for both their patients and their own pets. Safety and efficacy were the most important considerations when deciding which nutraceuticals to recommend to clients. The survey results show that veterinarians are familiar with nutraceuticals and open to their use in patients when they perceive these products to be safe and efficacious.

The effect of induction with propofol or ketamine and diazepam on quality of anaesthetic recovery in dogs

OBJECTIVE

To evaluate the quality of recovery in dogs undergoing elective orthopaedic surgery induced with either propofol or a combination of ketamine and diazepam.

MATERIALS AND METHODS

Sixty client-owned dogs undergoing single-limb elective orthopaedic procedures were enrolled. Dogs were randomly assigned to receive induction with propofol (4 mg/kg) (group P) or ketamine (5 mg/kg) with diazepam (0.25 mg/kg) (group KD) to which all scorers were blinded. The recovery monitoring period lasted for 1 hour following extubation. The recovery period was video-recorded for blinded scoring at a later time. Scoring for quality of recovery was carried out using three different systems (lower numbers=better quality): a simple descriptive scale (1 to 5), a visual analogue scale (0 to 10 cm) and a numeric rating scale (0 to 10). Videos were reviewed by three ACVAA board-certified anaesthesiologist raters.

RESULTS

Five dogs were deemed to be ineligible. The mean (±SD) duration of anaesthesia was 260.4 ±57.84 minutes in group KD and 261.1 ±51.83 minutes in group P. There was no difference between groups for time to extubation, head lift or sternal recumbency. The number of dogs having a recovery that was scored overall as bad (mean simple descriptive scale > 4, mean visual analogue scale or numeric rating scale > 5) was not different between groups. Dogs in group KD had significantly lower scores than group P dogs (simple descriptive scale P=0.01, numeric rating scale P=0.03, visual analogue scale P=0.03).

CLINICAL SIGNIFICANCE

Induction with ketamine and diazepam resulted in a smoother recovery from anaesthesia than induction with propofol.

Use of nalbuphine as a substitute for butorphanol in combination with dexmedetomidine and tiletamine/zolazepam: a randomized non-inferiority trial

OBJECTIVES

The goal of this study was to determine whether a drug combination using nalbuphine with dexmedetomidine and tiletamine/zolazepam is non-inferior to one that uses butorphanol.

METHODS

All healthy cats presenting solely for gonadectomy to two trap-neuter-return mobile clinic days were randomly assigned to induction with a combination of tiletamine/zolazepam 3 mg/kg, dexmedetomidine 7.5 µg/kg and either butorphanol or nalbuphine at 0.15 mg/kg. All participants were blinded to the identity of the combinations. The primary endpoint was clinician satisfaction, comprised of the mean of four satisfaction ratings on a 7-point Likert scale (highly dissatisfied through to highly satisfied) recorded for induction, maintenance of anesthesia, surgery and recovery. Exploratory endpoints included each individual score, number of injections, duration of induction, duration of recovery and need for reversal agent. To assess non-inferiority for the primary endpoint and individual scores, the difference and 95% confidence intervals (CIs) of the difference between the mean clinical scores for the nalbuphine and butorphanol-based combinations were calculated and compared with a prespecified non-inferiority margin of 20% (1.4 points).

RESULTS

Seventy-two cats were enrolled, 36 in each group. The mean ± SD composite score for the combination with nalbuphine was 6.06 ± 0.59 (95% CI 5.86-6.25) points, while the combination with butorphanol was 6.22 ± 0.62 (95% CI 6.01-6.43). The difference between mean scores was 0.17 (-0.12 to 0.45), which did not exceed the prespecified boundary of 1.4, establishing the non-inferiority of nalbuphine. No individual clinical score for nalbuphine was inferior to butorphanol, and there were no significant differences for any secondary endpoints.

CONCLUSIONS AND RELEVANCE

The clinical experience of the nalbuphine-based combination was non-inferior to the butorphanol-based combination. Nalbuphine is an effective substitute for butorphanol, providing another option if butorphanol is unavailable due to shortage, controlled status or cost, without requiring a change in anesthetic workflow.

Analysis of Small Animal Rotating Internship Applicants' Personal Statements

The primary purpose of this study was to identify themes that are consistent across veterinary internship applicants' personal statements and that are correlated with the statements' perceived overall quality. A secondary purpose was to investigate the reliability in personal statement quality scoring among six experienced internship candidate evaluators. One hundred applications to the University of Georgia Small Animal Rotating Internship program were evaluated. Each evaluator wrote a description of what he or she values in personal statements and his or her beliefs about content and presentation in high- and low-quality statements. After statement de-identification, each evaluator reviewed 15 randomly selected personal statements from internship applicants and assigned each a score ranging from 1 to 4 according to the following criteria: 1 = would not rank for an internship; 2 = would rank in the bottom third; 3 = would rank in the middle third; and 4 = would rank in the top third. A subset of these scored personal statements was chosen for qualitative analysis. A qualitative document analysis using grounded theory was performed for both the evaluators' descriptions of preferences in personal statements and the subset of personal statements. Agreement among evaluators' assigned scores was slight (Fleiss's κ = 0.11). Analysis of the evaluator statements and the scored candidate statements indicated that important factors in a personal statement include the applicant's ability to articulate experiences, to convey maturity, to demonstrate understanding of what an internship entails, and to describe reasons for pursuing an internship.

Evaluation of a point-of-care blood glucose monitor in healthy goats

OBJECTIVE

To assess agreement between a point-of-care glucometer (POCG) and a laboratory chemistry analyzer for blood glucose measurements in goats.

DESIGN

Prospective study.

SETTING

University teaching hospital.

ANIMALS

Eighteen healthy adult goats.

INVESTIGATIONS

Whole blood samples were obtained via jugular venipuncture prior to premedication with xylazine and butorphanol (T0), following premedication (T20), and after 1 hour of inhalant anesthesia (T60). Each sample was tested with a POCG and a laboratory analyzer (HITA). Agreement was assessed using concordance correlation coefficients and calculation of bias and 95% limits of agreement.

MEASUREMENTS AND MAIN RESULTS

Mean blood glucose concentration at T0 was 3.9 ± 0.6 mmol/L (70 ± 10 mg/dL; POCG) and 2.9 ± 0.4 mmol/dL (53 ± 8 mg/dL; HITA). Glucose concentrations at T20 were 6.7 ± 2.4 mmol/L (121 ± 43 mg/dL) and 5.4 ± 2.1 mmol/L (97 ± 37 mg/dL) and at T60 were 5.7 ± 1.7 mmol/L (102 ± 31 mg/dL) and 4.7 ± 1.3 mmol/L (85 ± 24 mg/dL) when measured with the POCG and HITA, respectively. The POCG overestimated blood glucose compared to the HITA. The bias ± SD was 1.08 ± 0.53 mmol/L (19.4 ± 9.5 mg/dL) (95% LOA 0.04 to 2.11 mmol/L [0.7 to 38.0 mg/dL]) and the concordance correlation coefficient was 0.82. After correcting the results of the POCG using a mixed-effects linear model, the bias was 0.0 ± 0.38 mmol/L (0.0 ± 6.8 mg/dL) (95% LOA ± 0.74 mmol/L [± 13.4 mg/dL]) and the concordance correlation coefficient was 0.98.

CONCLUSIONS

The POCG overestimated blood glucose concentrations in goats, compared to the HITA, but when the POCG concentrations were corrected, the agreement was excellent.

Agreement among anesthesiologists regarding postoperative pain assessment in dogs

OBJECTIVE

To establish evidence for the validity and reliability of three commonly used pain scales in dogs when assessed by video by specialists in anesthesia.

STUDY DESIGN

Mixed-method test-retest observational study.

SUBJECTS

A group of six American College of Veterinary Anesthesia and Analgesia board-certified specialists and 31 postoperative dogs.

METHODS

The evaluators scored 31 dogs using a visual analogue scale (VAS), numeric rating scale (NRS), and Glasgow pain scale (GPS). The evaluators individually scored the dogs using all three scales together and subsequently, at 3 month intervals, using each of the scales apart. Then, all evaluators in one room reviewed 23 of the videos. A camera was positioned for video and audio recording of discussion about the videos. Intra- and interobserver reliability was determined using a two-way random model intra-class correlation coefficient (ICC).

RESULTS

Linear regression indicated a strong correlation among all scales when assigned together (VAS versus NRS, p < 0.0001, R² = 0.93; VAS versus GPS, p < 0.0001, R² = 0.59; and NRS versus GPS, p < 0.0001, R² = 0.61) and apart (VAS versus NRS, p < 0.0001, R² = 0.68; VAS versus GPS, p < 0.0001, R² = 0.40; and NRS versus GPS, p < 0.0001, R² = 0.47). Posture, appearance, vocalization, stiffness, interaction between the animal and a person and response to palpation were identified as important variables for assessing pain. Intra-observer reliability produced average ICC values of 0.90 for VAS, 0.89 for NRS and 0.85 for GPS. Interobserver reliability produced average ICC values when scores were assigned together (VAS: 0.93, NRS: 0.93 and GPS: 0.93) and when done separately (VAS: 0.91, NRS: 0.93 and GPS: 0.95).

CONCLUSIONS AND CLINICAL RELEVANCE

The preferred use of the VAS and NRS over the use of the GPS should be cautiously considered for research applications when experts are observers. Revisions of the GPS to clarify descriptors and remove or modify items that may not be associated with pain in dogs should be considered.

Evaluation of a laparoscopically assisted ovariectomy technique in cats

OBJECTIVE

To describe a laparoscopically assisted ovariectomy (LAO) technique in the cat with a bipolar vessel sealing device (BVSD) or suture ligation and to compare the outcomes to open ovariohysterectomy (OO).

STUDY DESIGN

Randomized prospective study ANIMALS: Healthy, adult, sexually intact female cats (n = 30).

METHODS

Ten cats were assigned to each group: LAO with BVSD (group A), LAO with ligation (group B), and OO with ligation (group C). Surgical times and complications were assessed. Serum glucose and cortisol were measured prior to surgery and at 1, 2, 4, 6, 12, and 24 hours after surgery. Pain was scored by using an interactive visual analog scale (IVAS) at 0, 1, 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours after surgery. Rescue analgesia was provided when IVAS score was 4 or more. Physiological and serum values and IVAS scores were compared among groups with area under the curve (AUC) by using a 1-way ANOVA.

RESULTS

Surgical time was shortest for group C (19.1 ± 5.2 minutes; P < .0002); there was no significant difference between groups A (27.7 ± 6.6 minutes) and B (33.2 ± 8.2 minutes). All procedures were completed successfully. No significant differences among groups were found in IVAS scores (P = .36), rescue analgesia (P = .22), glucose AUC (P = .53), or cortisol AUC (P = .27).

CONCLUSION

The LAO technique was accomplished as described in all cats with no complications or failures. Pain scores were not different from cats undergoing OO. LAO can be performed efficiently to maximize the benefits of minimally invasive surgery and is amenable to clinical practice.

Influence of sedation on onset and quality of euthanasia in sheep

The purpose of this study was to determine if dexmedetomidine administered IV prior to euthanasia in sheep affected the speed or quality of euthanasia. Twenty clinically healthy Dorset-cross adult ewes between 1 and 3years of age were enrolled in a randomized blinded experimental trial. The subjects were randomly assigned to receive dexmedetomidine 5μg/kg IV or an equivalent volume of saline. Five minutes later, euthanasia was accomplished with a pentobarbital/phenytoin overdose given IV. The time to apnea, asystole, cessation of audible heartbeat, and absence of corneal reflex were recorded by two blinded investigators. If any muscle spasms, contractions, vocalization, and/or dysrhythmias were noted, the time was recorded and type of ECG abnormality was described. An overall score of the euthanasia event was assigned using a numeric rating scale (NRS) after the animal was declared dead. The time to loss of corneal reflex was significantly longer in sheep given dexmedetomidine compared with those who received saline (P=0.03). Although vocalization was observed only in some animals premedicated with dexmedetomidine, no significance was found for this event and no other significant differences between groups were noted. Dexmedetomidine at 5μg/kg IV 5min prior to injection of pentobarbital/phenytoin for euthanasia did not substantially affect the progress of euthanasia. Dexmedetomidine may be given to sedate sheep prior to euthanasia without concern for it adversely affecting the progress of euthanasia, however vocalization may occur.

Effect of Catheter Gauge on the Success of Intravenous Catheter Placement by Veterinary Students

The purposes of this study were to determine if senior veterinary students find it easier to place a smaller-bore catheter, and to relate patient variables with student success in catheter placement. For dogs between 10 kg and 20 kg, the catheter size options were 20 gauge or 22 gauge. For dogs larger than 20 kg, the catheter size options were 18 gauge or 20 gauge. Variables recorded included time for catheter placement, number of catheterization attempts, number of catheters used, number of legs used, difficulty of catheterization, student success, and patient characteristics including signalment, weight, body condition score, premedication drugs given, tentative diagnosis, and procedure. If the student could not place an IV catheter after three attempts, it was graded as a student catheter placement failure. For the 55 students participating in the study over 28 months, we recorded 192 individual catheterization attempts. In small patients, students were successful in 19/20 attempts with 22-gauge catheters and in 24/30 with 20-gauge catheters. In large patients, students were successful in 59/68 attempts with 20-gauge catheters and 61/74 with 18-gauge catheters. The overall success rate was 164/192 (85%). Students were more likely to be successful when attempting placement in those dogs receiving acepromazine than in those not receiving acepromazine (p=.02). There were no significant differences among any of the other variables for difficulty, placement time, number of attempts, or student success. Clinicians and educators may select a size catheter for the patient without concern for the effects on student catheter placement success.

Assessment of agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scoring the recovery of horses from anesthesia by use of subjective grading scales and development of a system for evaluation of the recovery of horses from anesthesia by use of accelerometry

OBJECTIVE To evaluate agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scores determined by use of a simple descriptive scale (SDS) or a composite grading scale (CGS) for quality of recovery of horses from anesthesia and to investigate use of 3-axis accelerometry (3AA) for objective evaluation of recovery. ANIMALS 12 healthy adult horses. PROCEDURES Horses were fitted with a 3AA device and then were anesthetized. Eight diplomates evaluated recovery by use of an SDS, and 7 other diplomates evaluated recovery by use of a CGS. Agreement was tested with κ and AC1 statistics for the SDS and an ANOVA for the CGS. A library of mathematical models was used to map 3AA data against CGS scores. RESULTS Agreement among diplomates using the SDS was slight (κ = 0.19; AC1 = 0.22). The CGS scores differed significantly among diplomates. Best fit of 3AA data against CGS scores yielded the following equation: RS = 9.998 × SG^0.633 × ∑UG^0.174, where RS is a horse's recovery score determined with 3AA, SG is acceleration of the successful attempt to stand, and ∑UG is the sum of accelerations of unsuccessful attempts to stand. CONCLUSIONS AND CLINICAL RELEVANCE Subjective scoring of recovery of horses from anesthesia resulted in poor agreement among diplomates. Subjective scoring may lead to differences in conclusions about recovery quality; thus, there is a need for an objective scoring method. The 3AA system removed subjective bias in evaluations of recovery of horses and warrants further study.

A Natural Experiment on the Effect of Time Given for Quizzes on Veterinary Student Performance in a Required Principles of Anesthesia Course

Assessments can cause significant distress in veterinary students and are listed as some of the greatest causes of academic stress. The purpose of this natural experiment was to determine if there is a relationship between amount of time given to complete quizzes and the students' score on the quiz. The Principles of Anesthesia course is required of all students. Quizzes are administered at the start of a class period and spaced throughout the course to cover 2-4 lectures per quiz. Once the allotted time has passed (3-6 minutes), students are notified they have 2 minutes to return the quiz to the instructor. To complete the quiz, students had 3 minutes in 2012 and 2013, 4 minutes in 2014, 5 minutes in 2015, and 6 minutes in 2016. The average quiz score was significantly lower with 3 minutes than with 4 or 6 minutes. Students in the bottom quartile scored significantly higher with 4, 5, or 6 minutes than with 3 minutes. Students in the upper quartile scored significantly higher with 4 minutes than with 3 minutes and with 4 minutes than with 5 minutes. The time provided for students to complete a free-response quiz was not associated with student performance once a certain minimum time (4 minutes) was provided. Providing students an appropriate, but not excessive, amount of time to complete assessments will allow for appropriately applied assessments and preserve time dedicated to instruction.

Retrospective study of intra-anesthetic predictors of prolonged hospitalization, increased cost of care and mortality for canine patients at a veterinary teaching hospital

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.

Reliability of video recordings to evaluate quality of anesthesia recovery in dogs

OBJECTIVE

To assess the reliability of using video recordings to evaluate anesthesia recovery in dogs.

STUDY DESIGN

Prospective study.

ANIMALS

A total of 30 dogs undergoing surgery.

METHODS

Recovery monitoring and video recording lasted from extubation until 1 hour later. Scoring was done in real time at the end of the hour by a graduate student using three systems: a simple descriptive scale, visual analog scale and numeric rating scale. Videos were distributed to three American College of Veterinary Anesthesia and Analgesia board-certified anesthesiologist raters as well as the original rater to score. These videos were revisited 4 months later, and the recoveries were scored again. To assess reliability, Cohen's and Fleiss' kappa values evaluated the agreement between sessions. Wilcoxon signed-rank tests were run comparing each observer's two sessions. Recoveries were classified as 'good' or 'bad' according to the cut-off values for each system.

RESULTS

Correlation values among raters ranged from 0.50 to 0.82 and from 0.26 to 0.60 in the first and second session, respectively. Bland-Altman plots revealed biases between 0.133 and 1.633 points for each of the three scoring systems. Cohen's kappa had agreement ranging from 0.29 to 0.79 during the first viewing and from 0.17 to 0.44 during the second. Fleiss' kappa values were 0.06, 0.16, 0.22 and 0.26 for various data combinations. Considering overall recovery, Fleiss' kappa showed agreement ranging from 0.54 to 0.71 and from 0.13 to 0.49 for the first and second session, respectively. Of the 12 Wilcoxon tests run, seven found significantly different scores between the two scoring sessions. The recoveries given an overall good or bad were the same on both occasions that they were reviewed.

CONCLUSIONS AND CLINICAL RELEVANCE

The use of a video to evaluate recovery in dogs should be used with caution. Individual raters' agreement for specific scores was poor, but evaluating recovery overall had perfect agreement.

A survey of the use of arterial catheters in anesthetized dogs and cats: 267 cases

OBJECTIVES

To describe the clinical practice of insertion of arterial catheters in anesthetized dogs and cats, to document complications of arterial catheterization, and to determine risk factors associated with the complications.

DESIGN

Prospective clinical study and retrospective evaluation of medical records.

SETTING

University teaching hospital.

ANIMALS

Dogs (n = 251) and 13 cats anesthetized for clinical procedures with arterial catheters inserted for blood pressure monitoring.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Details of the animal and catheter were collected at the time of anesthesia. On the following day, the catheter site was palpated and observed for abnormalities and the medical records of all animals were reviewed retrospectively for complications. Details of catheter placement were available for 216 catheters: 158 catheters in a dorsal pedal artery, 50 catheters in the median caudal (coccygeal) artery, 6 in the median artery, and 1 each in a cranial tibial and lingual artery. Blood pressure was obtained from 200 catheters, and 12 catheters failed before the end of anesthesia. Postoperative observational data obtained from 112 catheters described a palpable arterial pulse at 73 sites and no pulse at 21 sites. No risk factor for arterial occlusion was identified. No complications resulting from arterial catheterization were noted in the medical records.

CONCLUSIONS

Arterial catheterization resulted in loss of a peripheral pulse postoperatively in 21/94 (22.3%) of animals examined, although no evidence of tissue ischemia was noted in the medical records of any of the patients in this study. These results suggest that insertion of a catheter in the dorsal pedal or coccygeal arteries was not associated with a high risk for complications. However, the course of arterial occlusion postoperatively warrants further investigation.