Comparison of two insulin protocols for diabetic dogs undergoing cataract surgery

Objective To evaluate the effectiveness of two insulin doses to maintain an acceptable range of blood glucose concentrations (70–200 mg dL^?1) in the peri‐operative period in diabetic dogs. Animals Twenty‐four diabetic dogs with a median weight of 20.6 kg and a median age of 8 years old. Methods The dogs were randomly assigned to receive either 25 or 100% of their normal insulin dose subcutaneously on the morning of surgery. The anesthetic and feeding protocols were standardized. On the day before surgery, venous blood was collected for measurement of β‐hydroxybutyrate, cholesterol, glucose, glycosylated hemoglobin, hematocrit, total plasma protein and urea nitrogen. On the day of surgery, blood glucose concentrations were measured prior to anesthesia, prior to the start of surgery, 1 and 2 hours after beginning of surgery, 1 hour after extubation, at 16 : 00 hours and at 20 : 00 hours. β‐hydroxybutyrate concentrations were measured at 20 : 00 hours that day. At 08 : 00 hours the following day, β‐hydroxybutyrate and glucose concentrations were measured. The significance of differences between groups was tested with Wilcoxon's two‐tailed rank‐sum test, Chi‐square test and Fisher's exact test. Results There were no differences in insulin treatments, clinical signs, concurrent diseases and most clinicopathological parameters between the two groups of dogs at entry to the study. The 25% dose group had blood glucose values of 296 (102–601) mg dL^?1 at 16 : 00 hours and 429 (97–595) mg dL^?1 at 20 : 00 hours on the day of surgery. The 100% insulin dose group had lower corresponding values of 130 (55–375) mg dL^?1 (p = 0.04) and 185 (51–440) mg dL^?1 (p = 0.004). No other differences (p < 0.05) were detected between the two groups. Conclusions The administration of a full dose of insulin is only marginally advantageous for reducing glucose to normal (70–120 mg dL^?1) after anesthesia but neither dose consistently induced glycemic values in an acceptable range (70–200 mg dL^?1) or normoketonemia. Clinical relevance Blood glucose should be measured immediately before anesthesia and periodically throughout the peri‐operative period in all diabetic dogs because presurgical subcutaneous administration of 25 or 100% of the normal insulin dose resulted in unpredictable blood glucose concentrations.     

The clinical use of the neuromuscular blocking agent rocuronium in dogs

Objective The aim of this study was to characterize the onset and duration of action of the aminosteroid muscle relaxant rocuronium in dogs under clinical conditions. Study design Prospective single dose trial. Animals Twenty‐three dogs aged between 6 months and 12 years, weighing between 5.5 and 61.5 kg admitted to the University of Liverpool Small Animal Hospital between January and March 2000, and undergoing elective surgical procedures under general anaesthesia. Materials and methods Following induction of general anaesthesia, neuromuscular function was evaluated using train‐of‐four (TOF) stimulation. An initial dose of 0.4 mg kg^?1 rocuronium was administered intravenously (IV) and neuromuscular blockade was monitored by visually assessing the number of responses (twitches) to TOF stimulation (train‐of‐four count: TOFC). Incremental doses of 0.16 mg kg^?1 rocuronium were administered as indicated, when at least two twitches of the TOFC had returned. Results Rocuronium (0.4 mg kg^?1) abolished all responses to TOF stimulation in all dogs. The mean time to onset of neuromuscular blockade (complete abolition of all twitches) was 98 ± 52 seconds. Neuromuscular blockade (absence of all twitches to return of all four) lasted 32.3 ± 8.2 minutes. Incremental doses of 0.16 mg kg^?1 had a mean duration of action of 20.8 ± 4.9 minutes and up to seven increments were shown to be noncumulative. The effects of rocuronium were readily antagonized with neostigmine and atropine. Small transient increases in arterial blood pressure, which occurred in three dogs after the administration of rocuronium, were the only cardiovascular side‐effects observed. Conclusions Rocuronium is an effective nondepolarizing neuromuscular blocking agent in the dog, with a rapid onset of neuromuscular block after intravenous administration and an intermediate duration of action. Clinical relevance Rocuronium produced a neuromuscular block with similar characteristics to those obtained with vecuronium, thus apparently offering little advantage over vecuronium. However, its availability in aqueous solution and a longer shelf‐life increases convenience.