Detomidine-Butorphanol-Propofol for Carotid Artery Translocation and Castration or Ovariectomy in Goats

Objective—To determine the safety and efficacy of propofol, after detomidine-butorphanol premedication, for induction and anesthetic maintenance for carotid artery translocation and castration or ovariectomy in goats. Study Design—Case series. Animals—Nine 4-month-old Spanish goats (17.1 ± 2.6 kg) were used to evaluate propofol anesthesia for carotid artery translocation and castration or ovariectomy. Methods—Goats were premedicated with detomidine (10 μg/kg intramuscularly [IM]) and butorphanol (0.1 mg/kg IM) and induced with an initial bolus of propofol (3 to 4 mg/kg intravenously [IV]). If necessary for intubation, additional propofol was given in 5-mg (IV) increments. Propofol infusion (0.3 mg/kg/min IV) was used to maintain anesthesia, and oxygen was insufflated (5 L/min). The infusion rate was adjusted to maintain an acceptable anesthetic plane as determined by movement, muscle relaxation, ocular signs, response to surgery, and cardiopulmonary responses. Systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures, heart rate (HR), ECG, respiratory rate (RR), Spo₂, and rectal temperature (T) were recorded every 5 minutes postinduction; arterial blood gas samples were collected every 15 minutes. Normally distributed data are represented as mean ± SD; other data are medians (range). Results—Propofol (4.3 ± 0.9 mg/kg IV) produced smooth, rapid (15.2 ± 6 sec) sternal recumbency. Propofol infusion (0.52 ± 0.11 mg/kg/min IV) maintained anesthesia. Mean anesthesia time was 83 ± 15 minutes. Muscle relaxation was good; eye signs indicated surgical anesthesia; two goats moved before surgery began; one goat moved twice during laparotomy. Means are reported over the course of the data collection period. Means during the anesthesia for pH_a (arterial PH), P_aco₂, P_ao₂, HCO₃, and BE (base excess) ranged from 7.233 ± 0.067 to 7.319 ± 0.026, 54.1 ± 4.6 to 65.3 ± 12.0 mm Hg, 133.1 ± 45.4 to 183.8 ± 75.1 mm Hg, 26.9 ± 2.6 to 28.2 ± 2.1 mEq/L, and -0.8 ± 2.9 to 1.4 ± 2.2 mEq/L. Means over time for MAP were 53 ± 12 to 85 ± 21 mm Hg. Mean HR varied over time from 81 ± 6 to 91 ± 11 beats/minute; mean RR, from 9 ± 8 to 15 ± 5 breaths/minute; S_po₂, from 97 ± 3% to 98 ± 3%; mean T, from 36.0 ± 0.6±C to 39.1 ± 0.7±C. Over time, S_po₂ and S_ao₂ did not change significantly; HR, RR, T, and P_aco₂ decreased significantly; SAP, DAP, MAP, pH_a, P_ao₂, and BE increased significantly. HCO₃ concentrations increased significantly, peaking at 45 minutes. Recoveries were smooth and rapid; the time from the end of propofol infusion to extubation was 7.3 ± 3 minutes, to sternal was 9.2 ± 5 minutes, and to standing was 17.7 ± 4 minutes. Median number of attempts to stand was two (range of one to four). Postoperative pain was mild to moderate. Conclusions—Detomidine-butorphanol-propofol provided good anesthesia for carotid artery translocation and neutering in goats. Clinical Relevance—Detomidine-butorphanol-propofol anesthesia with oxygen insufflation may be safely used for surgical intervention in healthy goats.     

Neuromuscular Effects of Doxacurium Chloride in Isoflurane-Anesthetized Dogs

Objective—To determine the neuromuscular effects of doxacurium chloride and to construct a dose-response curve for the drug in isoflurane-anesthetized dogs. Design—Randomized, controlled trial. Animals—Six healthy, adult, mixed-breed dogs (five female, one male) weighing 24.8 ° 2.8 kg. Methods—Anesthesia was induced with isoflurane in oxygen and maintained with 1.9% to 2.3% end-tidal isoflurane concentration. Paco₂ was maintained between 35 and 45 mm Hg with mechanical ventilation. Mechanomyography was used to quantitate the evoked twitch response of the paw after supramaximal train-of-four stimulation of the superficial peroneal nerve. After baseline values were recorded, the dogs received one of three doses of doxacurium (2.0, 3.5, 4.5 μg/kg of body weight) or a saline placebo intravenously in random order. All dogs received all treatments with at least 7 days between studies. After drug administration, the degree of maximal first twitch depression compared with baseline (T,%) was recorded. Dose-response relations of doxacurium were plotted in log dose-probit format and analyzed by linear regression to determine effective dose (ED₅₀ and ED₉₀) values for doxacurium. Results—The median log dose-probit response curve showed good data correlation (r= .999) with estimates of the ED₅₀ (2.1 μg/kg) and ED₉₀ (3.5 μg/kg) for doxacurium in isoflurane-anesthetized dogs. Mean ± SD values for T₁% (first twitch tension compared with baseline) at maximal depression after drug administration, onset (time from drug administration to maximal depression of T₁%), duration (time from maximal depression of T₁% to 25% recovery of T₁%), and recovery (time from 25% to 75% recovery of T₁%) times were 92%± 4%, 40 ± 5 minutes, 108 ± 31 minutes, and 42 ± 11 minutes for dogs treated with 3.5 μg/kg of doxacurium and 94%± 7%, 41 ± 8 minutes, 111 ± 33 minutes, and 37 ± 10 minutes for dogs treated with 4.5 μg/kg of doxacurium. Conclusion and Clinical Relevance—We conclude that doxacurium is a long-acting neuromuscular blocking agent with a slow onset of action. Doxacurium can be used to provide muscle relaxation for long surgical procedures in isoflurane-anesthetized dogs. Interpatient variability, particularly of duration of drug action, may exist in the neuromuscular response to the administration of doxacurium in dogs.     

Comparison of High Performance Liquid Chromatography and Immunoassay Methods for Measurement of Cyclosporine A Blood Concentrations After Feline Kidney Transplantation

Objective —To compare two methods of whole blood cyclosporine A (CsA) measurement in cats.
Study Design —Whole blood samples were analyzed for CsA concentrations with use of high performance liquid chromatography (HPLC) and monoclonal immunoassay methods.
Animals —Blood (n = 36 samples) was obtained from six cats after renal transplantation.
Methods —Results were compared by linear regression analysis using both pooled and individual patient data. Eight samples were off-scale on the immunoassay and were excluded.
Results —There was significant correlation between CsA measured using HPLC and immunoassay methods ( P < .001; r = .942; r²= .887). However, individuals varied nonrandomly from the mean pooled patient data. Correlation between the assay methods was higher for individual patients using data only from that specific individual (mean r value = .976; r²= .955). Clinical utility of the immunoassay (ie, results would prompt an appropriate CsA dosage adjustment) was good when based on individually derived conversion factors (27 of 28 [96.5%] of decision events).
Conclusion—HPLC is superior for measurement of blood CsA concentrations in cats after kidney transplantation. However, an immunoassay may provide reliable information for CsA management if a comparative database (HPLC v immunoassay) has been previously determined in a specific patient.
Clinical Relevance —Locally available monitoring of CsA by immunoassay in cats may provide significant advantages when shipping of blood samples to distant locations is required to obtain analysis by HPLC. These advantages may include cost and timeliness of results in circumstances where daily blood CsA concentrations may be desired, such as when managing an acute rejection reaction.     

Limb Salvage Surgery for Osteosarcoma of the Proximal Humerus: Outcome in 17 Dogs

Objective —To describe function and identify factors that affect outcome in dogs undergoing limb salvage surgery for osteosarcoma (OS) of the proximal humerus.
Study Design —A retrospective study of dogs in which OS of the proximal humerus was treated with limb salvage surgery.
Animals —17 client-owned dogs.
Methods: Records were analyzed for functional outcome, recurrence, metastasis, and survival.
Results —Outcome was good to excellent in 12% of dogs. Recurrence, metastasis, and survival were significantly affected by completeness of surgical margins. Double plating of the distal allograft-host junction significantly reduced frequency of biomechanical failure.
Conclusions —Limb salvage surgery for OS of the proximal humerus did not result in acceptable function and was fraught with postoperative complications. Outcome was significantly affected by completeness of surgical margins.
Clinical Relevance —Limb salvage surgery for OS of the proximal humerus in dogs cannot be recommended until improvement in functional outcome and reduction in postoperative complications can be achieved. The dependence of outcome on completeness of surgical margins supports aggressive en bloc resection and marking and evaluating surgical margins.     

Biomechanical Comparison of the Trocar Tip Point and the Hollow Ground Tip Point for Smooth External Skeletal Fixation Pins

Objective —To compare the insertional characteristics of external fixator pins with hollow ground (HG), modified HG, and trocar (T) points.
Study Design —An acute, in vitro biomechanical evaluation.
Sample Population—Thirteen radii from canine cadavers.
Methods —A total of 16 T-tipped and 16 HG-tipped pins were inserted into 8 canine radii. Ten pins of each modification of the HG tip (length of the cutting edge reduced by 0.127 mm and 0.254 mm, respectively) were inserted into another five radii. All pins were inserted with low-speed power drilling and 80 N drilling load. Differences between peak tip temperature, drilling energy, and pullout force were determined for each pin type at both diaphyseal and metaphyseal locations.
Results —HG-tipped pins showed a 40% lower tip temperature in diaphyseal bone, a 25% reduction in drilling energy in diaphyseal bone, and a reduction of pullout force in both diaphyseal (65%) and metaphyseal (50%) bone compared with T-tipped pins. HG 0.254-mm pins generated higher tip temperatures and had greater pullout than HG pins in diaphyseal bone.
Conclusions —The HG tip was a more efficient design; however, the reduction in pullout force suggests that, because a better hole was drilled, radial preload is reduced. Reduction of the cutting edge by 0.254 mm increased the pullout force but also increased the temperatures.
Clinical Relevance —Thermal and microstructural damage are reduced by the HG tip, but pin-bone interface stability is also compromised. The use of a tip with 0.254 mm reduction in the cutting edge may optimize the biological and mechanical factors at the pin-bone interface.     

Biomechanical Comparison of the Herbert and AO Cortical Bone Screws for Compression of an Equine Third Carpal Bone Dorsal Plane Slab Osteotomy

Objective—To assess feasibility of insertion of 4.5-mm Herbert cannulated bone screws (HS) using fluoroscopic guidance and compare the mechanical shear strength of these HS and 4.5-mm AO cortical bone screws (AO) for fixation of dorsal plane slab osteotomies in equine cadaver third carpal bones (C3).
Animals or Sample Population—Eight equine cadavers.
Methods—Bone mineral composition and density of contralateral C3 were confirmed to be equivalent using dual-energy x-ray absorptiometry. A standard 10-mm C3 slab osteotomy was reduced using HS or AO instrumentation under fluoroscopic guidance. Specimens were loaded in shear until failure, using a materials testing apparatus.
Results—HS and AO instrumentation allowed accurate reconstruction of the osteotomy, but there was difficulty encountered seating the HS proximal self-tapping threads. There was no significant difference in maximal load to failure, stiffness, or mode of failure of constructs created with the HS and AO screws.
Conclusions —Use of 4.5-mm HS for repair of C3 radial facet, dorsal plane slab fractures may result in a mechanically comparable fixation to a repair using a 4.5-mm AO. Equine dorsal C3 may be too dense, however, to allow placement of the proximal self-tapping threads of the HS without potentially excessive application of torque to the screw itself.
Clinical Relevance —Dorsal plane, radial facet slab fractures of the equine C3 are a significant clinical problem. Accurate reconstruction and stabilization are necessary for return to athletic function.     

Effect of Omentectomy on Adhesion Formation in Horses

Objective —To determine if omentectomy would decrease the frequency of postoperative intraabdominal adhesions. Study Design —Retrospective study. Animals or Sample Population—44 horses that had either two ventral median celiotomies or a ventral median celiotomy and a necropsy more than 4 days later; 19 of these horses had their omentum removed at the initial surgery. Methods —Data retrieved from the records included location and type of intraabdominal adhesions; location of the surgical lesion; relationship of adhesions to the surgical lesion; surgical procedures; duration of initial surgery; time interval between procedures; age, gender, and breed of the horse; and clinical outcome. Fisher's exact test was used to evaluate the association between categorical explanatory and outcome variables. The effect of potential risk factors on the incidence rate of adhesion formation was estimated using a proportional hazards regression model. Results —Of 25 horses in the nonomentectomy group, 15 (60%) had postoperative adhesions that resulted in the need for a second surgical intervention, whereas of 19 horses that had omentectomy initially, only 4 (21%) had postoperative adhesions that required a second procedure. Rate of adhesion formation was higher in horses that did not have omentectomy initially (incidence ratio rate [IRR], 0.46; 90% confidence interval [CI], 0.18 to 1.19). At initial surgery, 24 horses had a small intestinal lesion, and 20 horses had a large intestinal lesion. Fifteen horses (63%) with small intestinal lesions subsequently developed adhesions compared with four horses (20%) with an initial large intestinal lesion (P= .006). At the second procedure, small intestine lesions were identified in 32 horses and large intestine lesions in 12 horses (1 horse had both small and large intestine lesions), and 1 horse had a gastric lesion. Adhesions were identified as the cause of colic signs in 19 (61%) horses with small intestinal lesions and in none of the horses with large intestine lesions. The frequency of adhesion development leading to colic associated with only the small intestine at the second surgery or necropsy was significantly greater (P= .001) than the frequency only in the large intestine. Conclusions —Omentectomy reduced the rate of postoperative adhesion formation. Adhesions are more likely to occur after small intestinal surgery and if they do occur likely involve the small intestine. Clinical Relevance —Omentectomy is a safe procedure and should be considered prophylactically for reduction of adhesion formation after abdominal surgery in horses.     

THE DURAL TAIL SIGN IN THE DIAGNOSIS OF MENINGIOMAS

In humans the dural tail is a sign seen on contrast enhanced T1 weighted magnetic resonance images. This finding is considered specific for meningioma. The purpose of this study was to determine how often the dural tail occurs in cats and dogs and whether it is a specific sign for meningiomas in these species. MR examinations for eighteen dogs and four cats with proven diagnoses were reviewed. Diagnoses included ten meningiomas (seven dogs and three cats), three gliomas, two pituitary tumors, single examples of two other tumor types and five patients with mass lesions due to inflammatory disease. Contrast enhanced T1 weighted images were evaluated independently by three of the authors for the presence of a dural tail, without knowledge of the diagnoses. The results were compared to the diagnosis for each patient and the performance of individual reviewers compared. When their results were averaged, the reviewers reported the presence of a dural tail in 6 of 10 (60%) meningiomas, although detection varied between observers from 40% to 80%. Each reviewer had one false positive result, two reported a dural tail with a chromophobe adenocarcinoma and one with a toxoplasma meningoencephalitis. When a dural tail is seen an associated mass is most likely a meningioma. It is uncertain whether the dural tail represents neoplastic infiltration beyond the margins of the meningioma. This should be considered when planning treatment.