Survey on small animal anaesthesia

OBJECTIVE: To ascertain anaesthetic practices currently for dogs and cats in Australia. METHODS: A questionnaire was distributed to 4,800 veterinarians throughout Australia, seeking data on numbers of dogs and cats anaesthetised per week; drug preferences for anaesthetic premedication, induction and maintenance; use of tracheal intubation, supplemental nitrous oxide and anaesthetic antagonists; and types of vaporisers, breathing systems and anaesthetic monitoring devices used or available. Additional questions concerned proportions of different animal types seen in the practice, and the respondent's university and year of graduation. RESULTS: The response rate was 19%; 95% of respondents graduated from Australian universities, about half since 1985. Most responses (79%) came from mainly small animal practices. On average 16 dogs and 12 cats were anaesthetised each week. Premedication was used more often in dogs than cats, with acepromazine and atropine most favoured in both species. For anaesthetic induction, thiopentone was most preferred in dogs and alphaxalone/alphadolone in cats. Inhaled agents, especially halothane, were preferred for maintenance in both species. Most respondents usually employed tracheal intubation when using inhalational anaesthetic maintenance, but intubation rates were lower during injectable anaesthetic maintenance and a minority of respondents provided supplemental O2. Nitrous oxide was administered regularly by 13% of respondents. The agents most frequently used to speed recovery from anaesthesia were doxapram and yohimbine. The most widely used vaporisers were the Fluotec Mark III and the Stephens machine. Most (95%) respondents used a rebreathing circuit for large dogs and a non-rebreathing system was used for small dogs by 68% of respondents. Most respondents (93%) indicated some form of aid was available to monitor general anaesthesia: the three most mentioned were an apnoea alarm, oesophageal stethoscope and electrocardiogram. CONCLUSION: Diverse approaches were evident, but there appeared to be less variation in anaesthetising dogs: premedication was more frequent and less varied in type, while thiobarbituates dominated for induction and inhalants for maintenance. Injectable maintenance techniques had substantial use in cats, but little in dogs. Evident disparity between vaporisers available and circuits used suggested either confusion in terminology or incorrect use of some vaporisers in-circuit. While most respondents used monitoring equipment or a dedicated observer to invigilate anaesthesia, the common reliance on apnoea alarms is of concern, because of unproven reliability and accuracy.     

Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK

Responsible use of antimicrobials by veterinarians is essential to contain antimicrobial resistance in pathogens relevant to public health. Inappropriate antimicrobial use has been previously described in practice. However, there is scarce information on factors influencing antimicrobial usage in dogs and cats. We investigated intrinsic and extrinsic factors influencing decision-making of antimicrobial usage in first opinion small animal practices in the UK through the application of qualitative research methods.     

Avian anaesthesia related mortality and the associated risk factors in a UK zoological collection

ObjectiveTo analyse avian anaesthesia-related mortality in a UK zoological collection over a 5-year period and identify risk factors for mortality.Study designRetrospective cohort study.AnimalsA total of 135 individual birds across 37 species, anaesthetized during 206 events in a UK zoological collection between 1 January 2014 and 30 June 2019 (inclusive).MethodsAnaesthesia records were reviewed and variables such as age, body condition, weight, sex, duration of anaesthesia and health status were collated. Anaesthesia-related mortality was defined as those deaths occurring during anaesthesia and up to 7 days postanaesthesia. Outcome was analysed using multivariable conditional logistic regression. Overall mortality was defined and included birds euthanised during anaesthesia for non-anaesthesia related reasons. Data were summarised as median (range). A value of p < 0.05 was considered significant. Relative risks and 95% confidence intervals (95% CI) were calculated for the association between risk factors and anaesthetic death where a statistically significant difference was found.ResultsThe overall mortality rate was 10.19% (95% CI = 6.06–14.3%), while anaesthesia-related mortality was 3.88% (95% CI = 1.69–7.51%). Birds with an abnormal health status had a 15.53-fold (95% CI = 1.95–123.63) increased risk of death compared with those with a normal health status. The duration of anaesthesia was also a statistically significant risk factor (p = 0.021) in the univariable analysis, but not when combined with health status. No other variables were associated with anaesthesia-related mortality.Conclusions and clinical relevanceAbnormal health status and longer anaesthetic procedures were associated with a significantly increased risk of anaesthesia-related death in this population of birds. It is recommended that anaesthetic duration is minimized, and pre-existing diseases are diagnosed where possible prior to general anaesthesia of birds. Anaesthetizing healthy birds was associated with a low risk of mortality.     

The EMO system in small animal anaesthesia

The EMO System was used to administer ether/air anaesthesia to dogs undergoing clinical surgical procedures. Anaesthesia with spontaneous breathing gave rise to normal oxygen tensions in arterial blood, a slight acidosis and a decrease in arterial carbon dioxide tension. When used with relaxant drugs and intermittent positive pressure ventilation of the lungs it was found that to maintain normal oxygen tensions in the arterial blood it was necessary to hyperventilate to low arterial carbon dioxide tensions. Ether/air anaesthesia with the EMO System was found to meet modern criteria for acceptability in general practice where the veterinary surgeon may be assisted in the operating theatre by a nurse or may be entirely alone.     

Recommended techniques in small animal anaesthesia: An update

A protocol for anaesthesia of healthy small animals (dogs and cats) is described with the emphasis on good technique. The anaesthetic period is considered in stages from pre-operative evaluation through to recovery.     

Perioperative physiology and pharmacology in the obese small animal patient

ObjectiveTo review the available literature concerning the physiologic and pharmacologic alterations induced by obesity in canine and feline patients and their relevance to perioperative care.Study designLiterature review.DatabasesPubmed, CAB, Web of Science.ConclusionsObesity of cats and dogs is a chronic inflammatory condition that is increasingly prevalent. Similar to the situation in humans, small animal obesity may be associated with changes in endocrine, respiratory, and cardiovascular function. In addition, alteration of body composition in obesity can affect pharmacokinetic variables. Modifications in perioperative care may need to be made for obese dogs and cats, including attention to respiratory and cardiovascular supportive care and drug dose adjustments.     

Evaluation of a non-rebreathing circuit for small animal anaesthesia

Several new multi-purpose non-rebreathing anaesthetic systems have been developed for human anaesthesia. This study evaluated a New Zealand designed non-rebreathing circuit, the Palmerston Valve, in anaesthetised spontaneously breathing dogs and compared it to the widely used Lack coaxial circuit. Arterial blood gas measurements 60 minutes after induction demonstrated comparable slight increases in PaCO₂ in nearly all dogs maintained on the Palmerston Valve and Lack coaxial circuit with halothane and oxygen mixtures, and a fresh gas flow rate of 70 ml/kg/min.

Results suggest the Palmerston Valve is at least as efficient as the Lack coaxial circuit, while offering in the same unit the potential for economical controlled ventilation.     

A case-control study of risk factors for brucellosis seropositivity in Portuguese small ruminants herds

A case–control study involving 255 small ruminants herds randomly selected was carried out in Portugal between January and December 2004, to identify risk factors associated with brucellosis seropositivity.

To achieve this objective, two groups of herds selected according their prevalence status were compared: “cases” (farms with seroprevalence higher than 5%, n = 123) and “controls” (farms seronegatives, n = 132). A carefully structured questionnaire was used to collect data from each herd. A statistical analysis to compare “case” versus “control” herds was performed with the variables obtained from the questionnaire and the seroprevalence results. The effects on seroprevalence of several variables such as: individual characteristics; farm management practices; farm characteristics; animal health; knowledge and characteristics of farmers were evaluated. Data were analysed using logistic regression. Univariable analysis was used to screen the variables used in the logistic regression model. Nine variables were associated with brucellosis seropositivity in univariable analysis p < 0.10. These variables were retained for multivariable logistic regression model. Regression model identified five variables as risk factors for seropositivity. The odds of brucellosis were increased: herds with more than 116 animals (OR = 2.99); in herds with no cleaned-watering places (OR = 3.05); in herds with insufficient manure removal and insufficient cleaning of premises (OR = 2.87); in introduction of animals from non-free brucellosis herds or from herds of unknown status (OR = 12.11). In the other hand, farmers’ age (the eldest) was related to decreased odds (OR = 0.4).

Potential risk factors identified in this study were consistent factors associated with brucellosis seropositivity and support current recommendations for the control of brucellosis. Considering the paucity of epidemiological reports on brucellosis in the Northeast of Portugal and the absence of any data concerning factors related to either the prevention or the spread of the disease, our results could make a useful contribution towards the prevention of small ruminants brucellosis in the area.     

Doppler blood pressure measurement in pigs during anaesthesia

To determine the accuracy of Doppler blood pressure measurement in anaesthetised pigs eight large white pigs (Sus scrofa) were anaesthetised with zolazepam and tiletamine as Zoletil 100 (4 mg/kg) and xylazine (2 mg/kg) by intramuscular injection followed by isoflurane in 100% oxygen. Blood pressure measurements were recorded using a Doppler probe on the radial artery and a catheter in the femoral artery connected to a transducer. The sample mean of the Doppler measurements were compared with the sample mean of the invasive systolic arterial blood pressure while accounting for the heart rate, end-tidal CO₂ and temperature. The predicted error of the Doppler was greatest when pigs were hypotensive and normothermic: 11 mmHg (CI: 6–15). Doppler measurements should be interpreted with caution in anaesthetised pigs that are hypotensive and normothermic.     

Clinical evaluation of the Lack coaxial breathing circuit in small animal anaesthesia

The performance of the Lack co-axial breathing circuit was evaluated in 25 anaesthetized dogs breathing spontaneously. Fresh gas flows were adjusted until rebreathing started to occur as judged by capnography. Thus a critical fresh gas flow rate was determined for small (10–15 kg) and larger (15 + kg) dogs. These were 130.5 ± 31.2 and 95.9 ± 13-1 ml/kg/min respectively. In a further twenty dogs weighing over 15 kg a fresh gas flow rate of 120 ml/kg/min was used and was found to be sufficient to prevent rebreathing in all cases. In 11 dogs a direct comparison was made between the Lack and the Magill circuits with fresh gas flows of 120 ml/kg/min and it was found by capnography that while there was minimal or no rebreathing with the Lack system there was substantial rebreathing with the Magill.     

In vitro validation of a Pitot-based flow meter for the measurement of respiratory volume and flow in large animal anaesthesia

Objective  To remodel and validate commercially available monitors and their Pitot tube-based flow sensors for use in large animals, using in vitro techniques.
Study design  Prospective, in vitro experiment.
Methods  Both the original and the remodelled sensor were studied with a reference flow generator. Measurements were taken of the static flow-pressure relationship and linearity of the flow signal. Sensor airway resistance was calculated. Following recalibration of the host monitor, volumes ranging from 1 to 7 L were generated by a calibration syringe, and bias and precision of spirometric volume was determined. Where manual recalibration was not available, a conversion factor for volume measurement was determined. The influence of gas composition mixture and peak flow on the conversion factor was studied.
Results  Both the original and the remodelled sensor showed similar static flow–pressure relationships and linearity of the flow signal. Mean bias (%) of displayed values compared with the reference volume of 3, 5 and 7 L varied between −0.4% and +2.4%, and this was significantly smaller than that for 1 L (4.8% to +5.0%). Conversion factors for 3, 5 and 7 L were very similar (mean 6.00 ± 0.2, range 5.91–6.06) and were not significantly influenced by the gas mixture used. Increasing peak flow caused a small decrease in the conversion factor. Volume measurement error and conversion factors for inspiration and expiration were close to identity.
Conclusion  The combination of the host monitor with the remodelled flow sensor allowed accurate in vitro measurement of flows and volumes in a range expected during large animal anaesthesia.
Clinical relevance  This combination has potential as a reliable spirometric monitor for use during large animal anaesthesia.     

On the surveillance for animal diseases in small herds

Small herds may present a problem in surveillance for infectious animal diseases because typical levels of a within-herd design prevalence are not directly applicable. We suggest a definition of small herds as those smaller than 2/(within-herd design prevalence) on the basis that such herds would be expected to have less than two (i.e. only one) infected animals. Consequently, the probability of detecting small herds cannot be improved by choosing a larger sample size within the herd. We derive necessary sample sizes of herds and the probability (“confidence”) of detecting disease within a stratum of small herds, given the among-herd design prevalence and test diagnostic sensitivity. Both a binomial model and a Poisson model can be used to establish the confidence for a given sample size of herds (and vice versa). The results of a simulation study suggest that the Poisson model provides more conservative (lower) estimates of the confidence for a given sample size and should therefore be preferred.     

Carriage of methicillin-resistant Staphylococcus pseudintermedius in small animal veterinarians: indirect evidence of zoonotic transmission

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is increasingly reported in small animals and cases of human infections have already been described despite its recent emergence in veterinary practice. We investigated the prevalence of MRSP and methicillin-resistant Staphylococcus aureus (MRSA) among small animal dermatologists attending a national veterinary conference in Italy. Nasal swabs were obtained from 128 veterinarians, seven of which harboured MRSP (n = 5; 3.9%) or MRSA (n = 2; 1.6%). A follow-up study of two carriers revealed that MRSP persisted for at least 1 month in the nasal cavity. Methicillin-susceptible S. aureus (MSSA) was isolated from 32 (25%) conference participants, whereas methicillin-susceptible S. pseudintermedius (MSSP) was not detected, suggesting that MRSP may have a particular ability to colonize humans compared to MSSP. All isolates were characterized by spa typing. Methicillin-resistant isolates were further typed by antimicrobial susceptibility testing, SCCmec and multi-locus sequence typing. Two lineages previously associated with pets were identified among the five MRSP isolates; the European epidemic clone ST71-SCCmec II-III and ST106-SCCmec IV. One of the two MRSA isolates displayed a genotype (ST22- SCCmecIV) frequently reported in dogs and cats. MRSP isolates were resistant to more antimicrobial agents compared with MRSA isolates and displayed the typical multidrug resistance patterns of MRSP in pets. The 32 MSSA isolates belonged to 20 spa types and the most frequent types (t12, t15 and t166) were associated with common S. aureus lineages in humans (CC30 and CC45). Although low, the 3.9% MRSP carriage rate found among small animal dermatologists was surprising in consideration of the rare occurrence of S. pseudintermedius in humans, the lack of MSSP detection and the recent appearance of MRSP in Europe. As cases of human MRSP infection have been linked with pets, veterinarians should be aware of this zoonotic risk and proper preventative measures should be taken to avoid MRSP transmission from animal patients.     

A survey of anaesthesia in small animal practice: AVA/BSAVA report

Over 150 veterinary surgeons from 53 small animal practices collaborated in a prospective survey of anaesthetic accidents and emergencies by recording all anaesthetics administered and detailing the problems they encountered. From these records it is estimated that 1 in 679 of the healthy dogs and cats died primarily as a result of anaesthesia; many of these deaths apparently occurred at a time when the animal was not under close observation. Anaesthetics involving the use of xylazine seemed to result in an exceptionally high mortality rate. Complications following endotracheal intubation appeared to be associated with several deaths in cats. The death rate in cats and dogs with pathological but not immediately life-threatening conditions was estimated to be 1 in 31. There was no evidence to suggest that some breeds (with the possible exception of the Pekingese) were more likely than others to die under anaesthesia.     

Assessment of ketamine/medetomidine anaesthesia in the New Zealand White rabbit

Objective To compare the characteristics of anaesthesia induced with four dose combinations of ketamine/medetomidine. Design Prospective randomized study. Animals Five female New Zealand White (NZW) rabbits of approximately 2.3 kg. Methods Rabbits were given one of four drug combinations (25/0.25; 15/0.5; 15/0.25 and 10/0.5 mg kg^?1 IM) on four successive occasions with a four day interval. Response to injection and then arterial blood gas and cardiovascular parameters were recorded at predetermined time points. Toe and ear pinch reflexes gave measures of total duration of surgical anaesthesia and total sleep time. Analyses used repeated measures analysis of variance. Results Induction was smooth with little reaction to injection and intubation achieved easily. Two combinations (15/0.25, 10/0.5) produced moderate hypoxaemia (mean pO₂ < 8.0 kPa) and two (25/0.25, 15/0.5) very marked hypoxaemia (mean pO₂ < 5.3 kPa). This was reversed within 15 minutes of oxygen administration and all rabbits recovered uneventfully. Heart rates fell in all cases, with only minimal effects on arterial blood pressure and no cardiac arrhythmias. Mean duration of surgical anaesthesia was significantly longer for dose groups 25/0.25 (57 ± 12 minutes) and 15/0.5 (59 ± 17 minutes, p = 0.01) compared to dose group 15/0.25 (27 ± 8 minutes). Only three animals in the 10/0.5 mg kg^?1 group achieved surgical anaesthesia. Mean duration of loss of the ear pinch reflex was similar between doses, being, respectively, 64 ± 13, 81 ± 7, 60 ± 22 and 62 ± 24 minutes. Sleep time was significantly longer for the 15/0.5 dose (112 ± 10 minutes) compared to 15/0.25 (86 ± 22 minutes, p = 0.04). Sleep times for the 25/0.25 and 10/0.5 mg kg^?1 doses were, respectively, 103 ± 23 and 108 ± 12 minutes. Conclusions Ketamine/medetomidine reliably produces smooth induction and recovery in the NZW rabbit, but due to the degree of hypoxaemia produced, should only be used with simultaneous provision of oxygen. Clinical relevance Currently recommended dose rates of ketamine/medetomidine for minor procedures such as ovariohysterectomy in rabbits (25 mg/0.5 mg kg^?1) are unnecessarily high; a dose of 15/0.25 mg kg^?1 should be adequate for 15–30 minutes of surgical anaesthesia.     

A model to investigate hepatic extraction of oxygen during anaesthesia in the dog

Measurement of hepatic oxygen extraction was performed on six healthy Greyhound dogs over a two hour period. The Greyhounds were anaesthetised and a right subcostal surgical incision performed. Ultrasonic flow transducers were used to measure flow rate in the hepatic artery and the portal vein. The blood oxygen tensions in arterial blood and in the portal and hepatic veins were also measured. Hepatic oxygen extraction remained stable throughout the study, despite a steady decline in arterial blood pressure. The methodology described in this study provides a direct measure of oxygen uptake by the liver in the dog and could readily be used to investigate hepatic uptake of drugs.     

Risk factors for lamb mortality on UK sheep farms

Data on neonatal-lamb mortality and flock history were recorded by veterinary students working on 108 sheep farms in the UK in Spring 1997. The mean reported mortality incidence risk was 10.0% (median 9%; inter-quartile range 5.9–12.3%). The outcomes were incidence risks of stillbirth, perinatal (within 24 h of birth) mortality and postnatal (>24 h after birth) mortality. Exposures were screened for univariable associations with mortality risk. Logistic binomial multiple regressions adjusted for confounding, with farm as a random effect. This study has raised hypotheses for management factors associated with lamb mortality that warrant further study. Intensive rearing systems appear to be associated with increased perinatal and postnatal mortality, although housing ewes at lambing was associated with a decreased risk of stillbirth. High perinatal mortality also was associated with poor mothering-pen hygiene, flocks that foster more lambs, and failure to provide appropriate nursing for sick lambs. Larger flocks, poor ewe condition at breeding, and flocks with higher ewe-replacement rates were associated with higher postnatal mortality.