Endogenous serum insulin concentration in dogs with diabetic ketoacidosis

Objective: To determine endogenous serum insulin concentration in dogs with diabetic ketoacidosis (DKA), and to compare it to endogenous serum insulin concentration in diabetic dogs with ketonuria but no acidosis (KDM), diabetic dogs with uncomplicated diabetes mellitus (DM) that did not have ketonuria or acidosis, and dogs with non‐pancreatic disease (NP). Design: Prospective study. Setting: Veterinary Hospital of the University of Pennsylvania. Animals: Forty‐four client‐owned dogs; 20 dogs with newly diagnosed diabetes mellitus (7 dogs with DKA, 6 dogs with KDM, and 7 dogs with DM) and 24 dogs with non‐pancreatic disease. Interventions: Blood and urine samples were obtained at the time of admission to the hospital. Measurements and main results: Signalment, clinical signs, physical examination findings, and concurrent disease were recorded for all dogs. Blood glucose concentration, venous blood pH, venous blood HCO3^? concentration, urinalysis, and endogenous serum insulin concentration were determined in all dogs. Dogs with DKA have significantly decreased endogenous serum insulin concentrations compared to dogs with DM (P = 0.03) and dogs with non‐pancreatic disease (P = 0.0002), but not compared to dogs with KDM (P = 0.2). Five of 7 dogs with DKA had detectable endogenous serum insulin concentrations, and 2 of these dogs had endogenous serum insulin concentration within the normal range. Conclusions: Diabetic dogs with ketoacidosis have significantly decreased endogenous serum insulin concentration compared to dogs with uncomplicated diabetes mellitus. However, most dogs with DKA have detectable endogenous serum insulin concentrations, and some dogs with DKA have endogenous serum insulin concentrations within the normal range.     

A comparison of anesthetic complications between diabetic and nondiabetic dogs undergoing phacoemulsification cataract surgery: a retrospective study

Objective To compare the incidence of anesthetic complications in diabetic and nondiabetic dogs undergoing general anesthesia and phacoemulsification cataract surgery. Procedure The medical and anesthetic records of all dogs undergoing phacoemulsification cataract surgery at Davies Veterinary Specialists between 2005 and 2008 were reviewed. Anesthetic records were evaluated by an ECVAA Diplomate. Dogs for which records were incomplete were excluded. The anesthetic technique, including all drugs administered in the perioperative period, was recorded. The anesthetic complications investigated included hypotension (MAP (mmHg): ≥55 none/mild; ≤54 moderate/severe), bradycardia (<60 bpm associated with hypotension) and hypothermia (esophageal temperature <36.7 °C). Where hypotension was present, the method of and response to treatment was recorded. The incidence of severe hyperglycemia (blood glucose >13.75 mmol/L (250 mg/dL)) in the diabetic group was also assessed. Results 66 diabetic and 64 nondiabetic dogs were included in the study. Diabetic dogs were more likely to develop moderate and severe intraoperative hypotension than nondiabetic dogs. Forty‐four percent of diabetic dogs had at least one episode of severe hyperglycemia whilst anesthetized. Conclusions Diabetic dogs undergoing phacoemulsification are more likely to suffer the anesthetic complications of moderate and severe hypotension than nondiabetic dogs. The increased incidence and severity of hypotension in diabetic dogs may be explained by hypovolemia secondary to hyperglycemia and resultant osmotic diuresis.     

Posterior capsular opacification in diabetic and nondiabetic canine patients following cataract surgery

Posterior capsular opacification (PCO) is the most common postoperative complication of contemporary cataract surgery. Limited information is available regarding PCO formation and factors that influence PCO development in the dog. Two hundred sixty-five eyes (144 from diabetic dogs and 121 from dogs with breed-related cataracts) were prospectively evaluated for PCO formation for up to 12 months postoperatively. The mean age of all dogs in the study was 7.77 years and diabetic dogs were significantly older than dogs with breed-related cataracts. There were 73 males (61 neutered, 12 intact) and 74 females (70 neutered, 4 intact) in the study. Statistical analysis was performed based on age, breed/size, gender, stage of cataract at the time of surgery, PCO score at each time point, breed-related vs. diabetic cataract, right eyes compared to left eyes, and presence/absence of uveitis. Age and gender did not significantly influence PCO formation. Small and medium-sized breeds developed significantly more PCO in comparison to the large/giant breeds at 2 weeks and 2-4 months postoperatively, but the differences were not significant at later time points. There was an overall significant increase in PCO formation in eyes with early immature cataracts when compared to other stages of cataract up to 4 months postoperatively but not at later time points. There were no statistical differences in PCO score at 6 months or at 1 year postoperatively in eyes with breed-related and diabetic cataracts. Right eyes did not differ from left eyes in PCO score. PCO score significantly increased over time in breed-related and diabetic groups and in the overall population. No difference was found in the degree of PCO formation in eyes with inflammation prior to or after surgery compared with those without inflammation. In summary, age, gender, presence of inflammation, and cause of cataract (breed-related vs. diabetes mellitus) do not influence the development of PCO in canine cataract dogs. Small and medium-sized breeds develop significant PCO earlier than larger breeds. It is important to note that all eyes from all dogs in this study developed PCO in a time dependent manner.     

Anesthetic and analgesic techniques used for dogs undergoing ovariohysterectomies in general practice in the United States

ObjectiveTo acquire information about anesthesia and analgesia protocols used by United States (US) veterinarians in primary care practices when performing routine ovariohysterectomy in dogs.Study designCross-sectional survey.PopulationPrimary care veterinarians in the US.MethodsAn online anonymous survey, originally created in New Zealand, was modified with permission and made available to Veterinary Information Network (VIN) members. The survey asked questions about performing ovariohysterectomy in healthy adolescent dogs in the categories of preanesthetic evaluation, premedication and induction protocols, maintenance protocols and monitoring equipment, and postoperative analgesic and sedation protocols and pain assessments.ResultsA total of 1213 US veterinarians completed the survey. Respondents (n; %) reported performing preoperative laboratory tests [packed cell volume (135; 11%), complete blood cell count (889; 73%) and biochemistry panels (1057; 87%)] and preanesthetic examinations on the morning of surgery (1083; 90%). The most commonly administered drugs for premedication were acepromazine (512; 42%), hydromorphone (475; 39%) or butorphanol (463; 38%), with propofol (637; 67%) for induction of anesthesia and isoflurane (882; 73%) for maintenance of anesthesia. Most veterinarians reported placing intravenous catheters (945; 78%), administering electrolyte solutions (747; 67%) and providing heat support (1160; 96%). Perioperative and postoperative analgesia included local anesthetics (545; 45%), opioids (844; 70%) and non-steroidal anti-inflammatory drugs (NSAIDs) (953; 79%); NSAIDs were dispensed for home use (985; 81%). Dogs were most frequently discharged on the day of surgery (1068; 88%) and the owners were contacted (914; 75%) for follow-up within 1–2 days.Conclusions and clinical relevanceAnesthetic management for routine ovariohysterectomy in dogs varies among US veterinary VIN members. Information from this study is useful for all veterinarians for comparison with their practice management and for teachers of veterinary anesthesia to continue to emphasize options for analgesia.     

Comparison of two anesthetic protocols for feline blood donation

Objective To compare hemodynamic variables during, and recovery quality following, anesthesia for feline blood donation using intramuscular ketamine–midazolam–butorphanol (KMB) versus inhaled sevoflurane in oxygen (SEV). Study design Prospective blinded, randomized, crossover study. Animals Twenty healthy, client‐owned, mixed breed cats, aged 4–8 years, weighing 5.2–6.4 kg. Methods Cats were anesthetized with KMB for one donation and SEV for another. Heart rate (HR), respiratory rate (f_R), pulse quality, mucous membrane color, capillary refill time, arterial hemoglobin saturation with oxygen (SpO₂), and noninvasive arterial blood pressure (Doppler) were assessed by a blinded observer every 1 minute during collection. A nonblinded anesthesiologist delivered drugs and responded to hemodynamic changes. Each donation consisted of 55 mL of whole blood drawn via jugular puncture over 5–22 minutes. Donors received 60 mL subcutaneous lactated Ringer’s solution before recovery. Donors were monitored for a minimum of 4 hours post‐donation, before returning home. Owners, unaware of anesthetic protocol, completed a questionnaire regarding their cat’s behavior during the 24 hours following donation. Results Both protocols provided adequate restraint but were complicated by significant hypotension, requiring intervention in 16 (84%) SEV cats, and eight (42%) KMB cats. KMB cats experienced post‐procedure hyperthermia, with body temperatures >103.5°F. All animals responded to symptomatic therapy within 2 hours. Owners noted a significantly faster return to normal behavior at home following SEV. Conclusion All cats experienced hypotension, with many animals requiring intervention. There was no significant difference between protocols in incidence and severity of hypotension. The primary post‐procedure complication was hyperthermia with KMB. Clinical relevance As a result of the potential for hypotension during blood donation, intravenous (IV) access and blood pressure monitoring are recommended for all anesthetized donor cats, regardless of the anesthetic protocol. Post‐procedure hyperthermia is a risk with KMB, so temperature monitoring is recommended. Return to normal behavior is faster with SEV.     

Assessment of cardiac troponin I and C-reactive protein concentrations associated with anesthetic protocols using sevoflurane or a combination of fentanyl, midazolam, and sevoflurane in dogs

ObjectiveTo report serum cardiac troponin I (cTnI) and C-reactive protein (CRP) concentrations in dogs anesthetized for elective surgery using two anesthetic protocols.Study designProspective, randomized clinical study.AnimalsTwenty client-owned dogs presenting for elective ovariohysterectomy or castration.MethodsThe dogs were randomized into two groups. All dogs were premedicated with glycopyrrolate (0.011 mg kg^?1) and hydromorphone (0.1 mg kg^?1) IM approximately 30 minutes prior to induction of anesthesia. Anesthesia in dogs in group 1 was induced with propofol (6 mg kg^?1) IV to effect and in dogs in group 2 with diazepam (0.2 mg kg^?1) IV followed by etomidate (2 mg kg^?1) IV to effect. For maintenance of anesthesia, group 1 received sevoflurane (adjustable vaporizer setting 0.5–4%) and group 2 received a combination of fentanyl (0.8 μg kg^?1 minute^?1) and midazolam (8.0 μg kg^?1 minute^?1) IV plus sevoflurane (adjustable vaporizer setting 0.5–4%) to maintain anesthesia. Serum cTnI and CRP concentrations were measured at baseline and 6, 18, and 24 hours post-anesthetic induction. Biochemical analysis was performed at baseline. Lactate was obtained at baseline and 6 hours post-anesthetic induction. Heart rate and mean arterial blood pressure were measured intra-operatively.ResultsBaseline serum cTnI and CRP concentrations were comparable between groups. A significant difference in serum cTnI or CRP concentrations was not detected post-operatively between groups at any time point. Serum CRP concentrations were significantly increased post-anesthetic induction in both groups, which was attributed to surgical trauma.Conclusions and clinical relevanceThere was no significant difference in serum cTnI and CRP concentrations between anesthetic protocols. Further investigation in a larger number of dogs is necessary to confirm the current findings.     

Postoperative pulmonary complications in dogs undergoing laparotomy: anesthetic and perioperative factors

Objective: To define the peri‐anesthetic risk factors that are associated with the development of postoperative pulmonary complications (PPCs) in dogs following laparotomy. Study design: Retrospective study. Animals: One hundred and sixty‐two dogs that underwent laparotomy at a veterinary teaching hospital. Methods: Cases were evaluated for factors including signalment, American Society of Anesthesiologists (ASA) physical status (PS) score, duration of fast, duration of anesthesia, anesthetic and analgesic protocols, fluid and blood product therapy, animal positioning, and postoperative temperature. Results: Statistically significant differences between dogs that developed PPCs and those that did not (nPPCs) were identified in the following categories: ASA PS score≥III (P=0.041), emergent surgery (P=0.038), longer duration of anesthesia (P=0.0462), and use of butorphanol or oxymorphone instead of hydromorphone for postoperative medication (P=0.04 and 0.015, respectively). Dogs that received transfusions of stored blood products (fresh frozen plasma or packed red blood cells) during their hospital stay were also more likely to develop PPCs (P=0.035 and 0.005, respectively). Dogs that developed PPCs were also more likely to have received antagonists for potent opiates or benzodiazepines postoperatively and to have recovered in the intensive care unit (ICU) (P=0.03 and 0.009, respectively). Conclusions: Dogs with ASA PS scores≥III, or those requiring longer or emergency anesthesia are at a higher risk of developing PPCs. Additionally, dogs receiving stored blood products in the perioperative period may be at risk for pulmonary complications. Dogs fitting criteria for the above risk factors should be monitored closely postoperatively for development of pulmonary complications.     

Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites

This prospective clinical trial evaluated the effects of epidural anesthesia (EA) placed at the lumbosacral compared to the L5–L6 junction in dogs undergoing hindlimb orthopedic surgery. In all, 98 dogs were randomly assigned to receive injection at either L7–S1 (LS group) or L5–L6 (LL group) at the same local anesthetic regimen (1 mg/kg bupivacaine 0.5% and 0.1 mg/kg morphine 1%). Fentanyl (1 µg/kg) was the intraoperative rescue analgesia (iRA) administered if mean arterial pressure increased by 30% above pre-stimulation value. Procedural failure, iRA, hypotension, motor block resolution, and postoperative side effects were recorded. There were 7/47 (15%) epidural procedural failures in the LS group and 8/51 (16%) (P=1.00) in the LL group; iRA was administered in 21/40 (52%) LS group dogs and in 13/43 (30%) LL group dogs, respectively (P=0.047). The incidence of hypotension was 10/40 (25%) and 16/43 (37%) in the LS group and the LL group, respectively (P=0.25). Proprioceptive residual deficit at 8 hr after EA was recorded in 3/26 (12%) in group LS dogs and in 13/26 (50%) group LL dogs, respectively (P=0.01). The proprioceptive residual deficit at 24 hr in one dog (LL group) resolved within 36 hr. No episodes of postoperative urinary retention, pruritus or neurological damage were recorded. The L5–L6 EA decreased significantly iRA but delays the proprioceptive recovery time. Further studies are needed to determine whether a lower bupivacaine dose reduces the duration of the residual block retaining the same incidence of iRA.     

Comparison of perioperative analgesic protocols for dogs undergoing tibial plateau leveling osteotomy

OBJECTIVE: To compare effects of 3 commonly used perioperative analgesic protocols (epidural injection, intra-articular injection, and intravenous [IV] injection) for management of postoperative pain in dogs after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Prospective, randomized clinical trial. ANIMALS: Fifty-six healthy dogs with naturally occurring cranial cruciate ligament rupture. METHODS: Dogs were premedicated with IV hydromorphone and acepromazine and were randomly assigned to receive either E (preoperative epidural injection with morphine and bupivacaine), IA (pre- and postoperative intra-articular injections of bupivacaine), or C (neither epidural morphine and bupivacaine, nor intra-articular bupivacaine). All dogs were administered hydromorphone (0.05 mg/kg IV) at extubation and as needed to maintain comfort postoperatively. Patients were observed and monitored continuously for 24 hours and discomfort was assessed using visual analog pain scores (VASs), multifactorial pain scores (MPSs), and response to a pressure nociceptive threshold (PNT) measuring device. Time to 1st dose and the total doses of hydromorphone required to achieve adequate comfort for each dog were recorded. RESULTS: No differences in measured indices of postoperative pain were observed between dogs of each treatment group; VAS (P=.190), MPS (P=.371), and PNT (P=.160). Time to 1st analgesic intervention was longer for Group E compared with Group C (P=.005) and longer for Group IA compared with Group C (P=.032). Although time to 1st intervention between Groups E and IA were longer for Group E, differences were not significant. To provide an adequate level of comfort, more analgesic interventions were administered to dogs in Group C compared with dogs in group E (P=.015). On average, more hydromorphone was administered to Group C compared with Group IA (P=.072) and to Group IA compared with Group E (P=.168), but statistical significance was not reached for these data. CONCLUSIONS: In this study population, significant differences were seen in time to 1st hydromorphone dose between Groups E and IA compared with Group C. As well, more supplemental analgesia was administered to Group C compared with Group E to maintain the same level of postoperative comfort. Although differences between Groups E and IA tended to favor the epidural group, differences were minimal and not statistically significant. CLINICAL RELEVANCE: Our results suggest that regardless of analgesic protocol, measured indices of pain in dogs after TPLO can be minimized if dogs are continuously observed and appropriately supplemented with parenteral opioids. However, the frequency of postoperative opioid dosing can be minimized and may be a factor when contemplating supplementary use of epidural or intra-articular injections as part of a balanced analgesic approach.     

The use of isophane insulin for the control of diabetes mellitus in dogs.

For this study 54 dogs with diabetes mellitus verified by anamnesis, clinical examinations and laboratory analyses were selected in 13 Danish and Swedish small animal clinics. After instruction the owners gave isophane insulin ("Insulin Protaphan Human") injections to the dogs morning and evening followed by a commercial or homemade meal rich in fibers. The veterinarians examined the treated dogs 5 times or more in the 90 day treatment period, preferably in the morning before injection and meal. In all 54 dogs the clinical symptoms disappeared a few days after isophane insulin injections, and 54% of the dogs were clinically healthy within 8 days. Within a month 96% of the dogs were normalized after therapy. Simultaneously the blood glucose levels were normalized in 64% of the dogs within 14 days and in further 21% within 30 days. The urine glucose levels were normalized in 64% of the dogs within 14 days and for further 19% within 30 days. At the end of the study 48 out of the 54 diabetic dogs were clinically healthy, alert and free from symptoms of diabetes. The average dose of isophane insulin was for greater dogs 0.44 units per kg bw twice a day, for small dogs 0.79. Six dogs had been destroyed in the trial period for various reasons. One owner had injection troubles. Another owner was hospitalized and had to get rid of the dog. One dog developed advanced breast cancer, 1 went fierce and 2 developed cataracts. Four dogs had by 1 or 2 occasions shown hypoglycemic symptoms, which quickly disappeared after appropriate adjustments of insulin dosing, feeding schedule and exercise programme.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of intraperitoneal ropivacaine and bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy

Objective

To compare postoperative analgesia following either intraperitoneal (IP) ropivacaine or bupivacaine in dogs undergoing ovariohysterectomy (OVH) in the scope of multimodal analgesia.

Comparison of three ultrasound guided approaches to the lumbar plexus in dogs: a cadaveric study

ObjectiveTo assess the accuracy of contrast material injection and the dispersion of injectate following ultrasound guided injections at the level of L6 and L7, in canine cadavers.Study designProspective, randomized, experimental study.AnimalsTwenty nine mixed breed canine cadavers (28.9 ± 6.0 kg).MethodsThree ultrasound-guided approaches to the lumbar plexus (LP) were compared: 1) a dorsal pre-iliac approach at the level of L6; 2) a lateral paravertebral approach at mid-L6; and 3) a lateral paravertebral approach at mid-L7. An isovolumic mixture of iodine-based contrast with new methylene blue (0.1 mL kg⁻¹) was injected bilaterally in the juxta-foraminal region along the L6 or L7 nerve root. Computed tomography was performed followed by segmentation and 3D reconstruction of the lumbar spine and contrast material volumes using dedicated software. Distances between contrast material and the fifth through seventh lumbar foraminae, and length of femoral (FN) and obturator (ON) nerve staining were measured and compared between approaches (p < 0.05).ResultsInjectate moved cranial and caudal to the site of injection, and dispersed into an ovoid shape between the quadratus lumborum, iliopsoas and psoas minor muscles. Injections at L7 resulted in significantly closer contrast proximity to the L6 and L7 foraminae (p < 0.001). Femoral nerve staining was similar for all approaches, ON staining was more consistent after L7 injections (p < 0.001).Conclusion and clinical relevanceAn ultrasound-guided lateral paravertebral approach to the LP proved very practical and accurate, with easy visualization of the plexus and associated nerves. To ensure that the ON is covered by injectate, an approach at the level of L7 is recommended. Further studies are necessary to determine if this correlates with clinically effective local anesthesia.     

Determination of plasma lysosomal enzyme activity and its relationship to severity of injury following blunt vehicular trauma in dogs

Objective: To determine plasma β‐d ‐glucuronidase (βG) activity in the first 4 hours following injury in dogs struck by a motor vehicle, and to evaluate whether the degree of enzyme activity is correlated with the severity of injury. Design: A prospective clinical study. Setting: Veterinary Medical Teaching Hospital. Animals: Thirteen client‐owned dogs that were presented to the Veterinary Hospital of the University of Pennsylvania between June and August 1999 for blunt vehicular trauma. Ten healthy student and staff‐owned dogs served as controls. Interventions: None. Measurements: Plasma was analyzed for βG enzyme activity at the time of presentation (n=13), and 1 and 4 hours (n=7) following presentation to the Emergency Service for blunt vehicular trauma. The results were compared with enzyme activity from healthy controls evaluated serially over 4 hours. Fluorometric analysis using 96‐well microtiter plates was used to perform the enzyme assays. The relationships between presentation (n=13) and 4 hours (n=7) of enzyme activity and 3 indices of metabolic and physical disturbance (serum pH, serum lactate and Animal Trauma Triage (ATT) score) at the time of presentation were also investigated. Main results: Of the 13 dogs, 7 fulfilled the inclusion criteria for comparison of enzyme activity of the trauma over time. A statistically significant difference in βG activity was found in the trauma group (mean 75.6±10.4 U) at 4 hours following presentation compared with controls (mean 48.0±6.4 U). This difference was suggested by 1 hour following presentation (trauma group, mean 70.4±10.9 U; control group, mean 49.8±5.5 U), although it did not reach statistical significance. Thirteen dogs fulfilled the inclusion criteria for comparison of only presentation enzyme activity with trauma severity score, serum lactate, and serum pH. No statistically significant relationship was found between the βd ‐glucuronidase activity and the presenting ATT score, serum lactate concentration, or serum pH at either presentation or 4 hours, although the power of these analyses was low. Conclusions: These results demonstrate that the activity of βG, a lysosomal enzyme, increases significantly in the systemic circulation in dogs 4 hours following blunt trauma. Additional research to include more severely injured dogs, a larger number of dogs, and to follow the course of injury for a longer period of time would be beneficial to further characterize βG activity following blunt trauma.     

Comparison of isoflurane and propofol for maintenance of anesthesia in dogs with intracranial disease undergoing magnetic resonance imaging

ObjectiveTo compare isoflurane and propofol for maintenance of anesthesia and quality of recovery in client-owned dogs with intracranial disease undergoing magnetic resonance imaging (MRI).Study designProspective, randomized, clinical trial.AnimalsTwenty-five client-owned dogs with intracranial pathology, 13 females and 12 males, ages 11 months to 13 years, weighing between 3.0 and 48.0 kg.MethodsEach dog was randomly assigned to receive propofol or isoflurane for maintenance of anesthesia. All dogs were not premedicated, were administered propofol intravenously to effect for induction, intubated and mechanically ventilated to maintain an end-tidal carbon dioxide tension 30–35 mmHg (4.0–4.7 kPa). Temperature and cardiac output were measured pre- and post-MRI. Scores for mentation, neurological status, ease of maintenance, and recovery were obtained pre- and post-anesthesia. Pulse oximetry, end-tidal gases, arterial blood pressure, heart rate (HR) and requirements for dopamine administration to maintain mean arterial pressure (MAP) >60 mmHg were recorded throughout anesthesia.ResultsEnd-tidal isoflurane concentration was 0.73 ± 0.35% and propofol infusion rate was 292 ± 119 μg kg^?1 minute^?1. Cardiac index was higher, while HR was lower, with propofol than isoflurane in dogs younger than 5 years, but not in older dogs. Dogs maintained with isoflurane were 14.7 times more likely to require dopamine than propofol dogs. Mentation and maintenance scores and temperature were not different. MAP and diastolic arterial pressure were higher in the propofol group. Recovery scores were better with propofol, although times to extubation were similar. Change in neurological score from pre- to post-anesthesia was not different between treatments.ConclusionsDogs maintained with propofol during MRI had higher arterial pressures, decreased requirements for dopamine, and better recovery scores, compared to dogs maintained with isoflurane.Clinical relevancePropofol anesthesia offered cardiovascular and recovery advantages over isoflurane during MRI in dogs with intracranial disease in this study.