Suspected brainstem anesthesia following retrobulbar block in a cat

A 10‐year‐old, male, neutered, domestic shorthair cat was anesthetised for enucleation of a perforated left globe. A retrobulbar injection of local anesthetic (lidocaine/bupivacaine) was performed prior to surgery to provide intra‐ and postoperative analgesia. Following administration of the injection, the cat developed apnea and heart rate increased. Mechanical ventilation was initiated and surgery went ahead as planned. At the conclusion of surgery, the cat remained apnoeic requiring positive pressure ventilation until spontaneous ventilatory effort resumed. Upon recovery, the cat demonstrated neurological signs including tremors, nystagmus and absent dazzle reflex. These signs were attributed to brainstem anesthesia from the retrobulbar block and fully resolved within 3 h. This is the first report of suspected intrathecal spread of local anesthetic following retrobulbar block in a cat to the authors’ knowledge.     

Myasthenia gravis associated with thymic neoplasia in a cat

Objective: To describe acute myasthenia gravis (MG) in the postoperative period following removal of a thymoma in an adult cat. Case summary: A 6‐year‐old spayed female domestic short haired cat weighing 6.4 kg was referred for workup and treatment of a cranial mediastinal mass. Thoracoscopic biopsies confirmed the diagnosis of thymoma. Median sternotomy was performed and approximately 95% of the mass was surgically excised. Postoperatively the cat became remarkably weak and hypercapneic. A presumptive diagnosis of MG was made following a positive response to edrophonium injection (Tensilon test). An elevated serum acetylcholine receptor antibody level was consistent with a diagnosis of MG. Initial treatment consisted of neostigmine, followed by corticosteroids and pyridostigmine. The cat responded well to therapy. New or unique information provided: This report describes a rare syndrome of postoperative weakness due to development of MG following incomplete removal of a thymoma. Post‐thymectomy weakness associated with MG has been reported in dogs and is not well described in cats.     

Combined spinal-epidural anesthesia in a dog

OBJECTIVE: To report use of combined spinal epidural anesthesia for tail resection and surgical exploration of the pelvic canal and the perineal-pararectal area in a dog. ANIMAL: A 4-month-old, 13 kg male Collie dog. METHODS: Under inhalant anesthesia, an epidural catheter was threaded through a Tuohy needle at L5-L6. Then using a Whitacre spinal needle bupivacaine and fentanyl were administered in the subarachnoid space at L6-L7 level. Fifteen minutes later, morphine was administered epidurally. Bupivacaine and morphine were administered epidurally 4 hours after the subarachnoid injection. RESULTS: No cardiorespiratory response to surgical stimulation was observed. Postoperative analgesia was satisfactory, and the catheter was removed 30 hours later. No complications or neurologic sequelae occurred before discharge or were noted 10 days later. CONCLUSION: Combined spinal-epidural anesthesia provided excellent intraoperative anesthesia and perioperative analgesia in a dog undergoing surgery involving the pelvic canal. CLINICAL RELEVANCE: Combined spinal-epidural anesthesia can be performed in dogs, and its use should be considered in major surgeries caudal to the diaphragm, as the epidural catheter allows cranial extension of the block, providing excellent intraoperative anesthesia and perioperative analgesia.     

Evaluation of medetomidine, ketamine and buprenorphine for neutering feral cats

A combination of medetomidine (M, 100 μg/kg), ketamine (K, 10 mg/kg) and buprenorphine (B, 10 μg/kg), administered by intramuscular injection, was evaluated for spaying and castration (neutering) of feral cats (n = 101). Eleven animals (11%) required supplemental anesthesia (isoflurane by mask) to maintain an adequate plane of surgical anesthesia. Atipamezole (A, 125 μg/kg) was administered subcutaneously at the completion of surgery. All cats recovered from surgery and were released the following day. A hemoglobin saturation (SpO(2)) value of < 95% was recorded at least once during anesthesia in all cats. This MKB combination can be used in a feral cat sterilization clinic, but isoflurane supplementation may be necessary. Further research is indicated to determine the clinical significance of the low SpO(2) values associated with this anesthetic regimen.     

Anesthetic consideration in dogs with traumatic myocarditis

The trauma patient is commonly encountered in veterinary practice. Traumatic myocarditis has often been overlooked due to its delayed onset and preoccupation with other traumatic problems. The traumatic heart is very sensitive and in itself can cause death. Often a trauma patient requires surgery and a proper anesthetic protocol must be used which does not increase the incidence of cardiac arrhythmias. A review of anesthetic management including preanesthetic medications, induction drugs and techniques and maintenance with inhalation anesthesia reveals the need for careful selection of medications. Isoflurane was shown to be beneficial in reducing the incidence of undesirable responses of these patients.     

Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair

Objective— To compare analgesic efficacy of preoperative versus postoperative administration of carprofen and to determine, if preincisional mepivacaine epidural anesthesia improves postoperative analgesia in dogs treated with carprofen. Study Design— Blind, randomized clinical study. Animals— Dogs with femoral (n=18) or pelvic (27) fractures. Methods— Dogs were grouped by restricted randomization into 4 groups: group 1=carprofen (4 mg/kg subcutaneously) immediately before induction of anesthesia, no epidural anesthesia; group 2=carprofen immediately after extubation, no epidural anesthesia; group 3=carprofen immediately before induction, mepivacaine epidural block 15 minutes before surgical incision; and group 4=mepivacaine epidural block 15 minutes before surgical incision, carprofen after extubation. All dogs were administered carprofen (4 mg/kg, subcutaneously, once daily) for 4 days after surgery. Physiologic variables, nociceptive threshold, lameness score, pain, and sedation (numerical rating scale [NRS], visual analog scale [VAS]), plasma glucose and cortisol concentration, renal function, and hemostatic variables were measured preoperatively and at various times after surgery. Dogs with VAS pain scores >30 were administered rescue analgesia. Results— Group 3 and 4 dogs had significantly lower pain scores and amount of rescue analgesia compared with groups 1 and 2. VAS and NRS pain scores were not significantly different among groups 1 and 2 or among groups 3 and 4. There was no treatment effect on renal function and hemostatic variables. Conclusions— Preoperative carprofen combined with mepivacaine epidural anesthesia had superior postoperative analgesia compared with preoperative carprofen alone. When preoperative epidural anesthesia was performed, preoperative administration of carprofen did not improve postoperative analgesia compared with postoperative administration of carprofen. Clinical Relevance— Preoperative administration of systemic opioid agonists in combination with regional anesthesia and postoperative administration of carprofen provides safe and effective pain relieve in canine fracture repair.     

Sparing effect of a low dose of intrathecal morphine on fentanyl requirements during spinal surgery: a preliminary clinical investigation in dogs

Objective— To evaluate the effect of preoperative intrathecal administration of a low dose of morphine on intraoperative fentanyl requirements in dogs undergoing cervical and thoracolumbar spinal surgery.
Study Design— Prospective randomized clinical study.
Animals— Dogs (n=18) matched by surgical procedure administered intrathecal morphine (MG) or no-treatment (control group, CG).
Methods— After premedication with romifidine (4 μg/kg, intravenously) and induction with propofol, anesthesia was maintained with sevoflurane in oxygen. Intrathecal morphine 0.03 (0.023–0.034) mg/kg was administered at lumbar level 41 (25–65) minutes before surgery in MG. Ketamine (0.5 mg/kg) was administered hourly, starting before incision. Fentanyl infusion (1.2 and 4.2 μg/kg/h in MG and CG, respectively) was administered after a loading dose (5 and 10 μg/kg in MG and CG, respectively), and boluses were given if an increase >20% in heart rate and arterial blood pressure was observed. Total amount of fentanyl administered was recorded, to calculate hourly requirements and predict plasma concentration using a computer simulation.
Results— Hourly fentanyl consumption and predicted plasma concentrations at the time of response to surgery were significantly lower in MG compared with CG.
Conclusions— Preoperative administration of a low dose of intrathecal morphine has a sparing effect on intraoperative fentanyl requirements.
Clinical Relevance— Preoperative intrathecal administration of a low dose of morphine at the lumbar level represented a safe and effective mean of providing intraoperative analgesia in dogs undergoing cervical and thoracolumbar spinal surgery.     

Balanced anesthesia and ventilation strategies for an alpaca (Lama pacos) with an increased anesthetic-risk

We report the use of a balanced anesthetic technique in a three-year-old, female Huacaya alpaca with an increased anesthetic risk that underwent an extensive dental surgery. Anesthesia was provided with an infusion of midazolam, fentanyl, S-ketamine and low concentrations of isoflurane in oxygen. The mandibular alveolar nerve was desensitized with a lidocaine-bupivacaine combination. The alpaca showed signs of hypoxemia fifteen minutes after anesthesia induction and arterial blood gases confirmed severe venous admixture. Application of positive end expiratory pressure (PEEP) of 6-9 cm H2O improved the arterial oxygenation. Other cardiopulmonary variables remained within the normal range. At the end of surgery, sarmazenil was administered to antagonize the effects of midazolam and emergence from anesthesia was smooth and uneventful. Flunixine meglumine and a transdermal delivery system for fentanyl were administered for post-operative analgesia. This method of balanced anesthesia allowed for an adequate anesthetic plane and a safe recovery, however, special ventilation strategies (PEEP) had to be applied.     

Immune‐mediated myasthenia gravis in a methimazole‐treated cat

A 12‐year‐old female neutered ragdoll crossbred cat was presented for investigation of generalised weakness and regurgitation. The cat was being treated with transdermal methimazole for hyper‐thyroidism, which had been diagnosed 10 weeks previously. An acetylcholine receptor antibody titre was consistent with acquired myasthenia gravis. Withdrawal of methimazole and treatment with pyridostigmine was followed by resolution of clinical signs and reduction of the acetylcholine ‐receptor antibody titre. Medical control of hyperthyroidism was subsequently achieved with carbimazole, administered in conjunction with pyridostigmine, and no recurrence of clinical signs was observed. Myasthenia gravis is an uncommon but clinically significant adverse effect of methimazole therapy in cats, and may be caused by immunomodulatory properties of this drug. An adverse drug reaction should be considered in cats receiving methimazole that develop myasthenia gravis, and potentially also other immune‐mediated disorders.     

Thymectomy in a cat with myasthenia gravis: a case report focusing on perianaesthetic management

An 8 years old male persian cat with a diagnosis of myasthenia gravis was scheduled for transternal thoracotomy. An anterior mediastinal mass, suspected to be a thymoma, had to be resected. Progressive paraparesis and reduced ocular reflexes and menace response were the main clinical features. At the preoperative examination the cat appeared free of significant myocardial or respiratory diseases. The possibility of compromised respiratory function due to muscle weakness was addressed by the choice of a balanced anesthesia protocol without the use of muscle-relaxants. Intravenous induction was followed by intubation, administration of isoflurane in oxygen and ventilatory support. Thorough cardiorespiratory monitoring was performed during anaesthesia. Epidural morphin was given to reduce the amount of inhalation agent required to maintain anaesthesia and supplemental intravenous analgesia was given. At the end of the surgery, intrapleural bupivacaine was administered to help controlling poststernotomy pain, while reducing the need for systemic analgesics. Although rapid returning of swallowing reflex and spontaneous breathing followed the disconnection from the anaesthetic circuit, the cat needed to breath oxygen enriched air to maintain a normal hemoglobin saturation in the early postoperative phase.     

Retroperitoneal Abscess Associated With a Migrating Grass Awn in a Cat: Treatment With Omentalization and Grass Awn Removal

An 18-month-old domestic short hair male castrated cat presented with a history of fever of unknown origin of 1-year duration. Abdominal ultrasound revealed a mixed echogenicity mass. Cytological examination of the fluid obtained through fine needle aspiration was consistent with a retroperitoneal abscess. The cat underwent a midline celiotomy and the abscess was opened, lavaged, and omentalized. Antibiotics were also administered. Two months after surgery, the cat represented with a fluctuant swelling in the right flank region at the lumbodorsal triangle. Abdominal and mass ultrasound showed a mixed echogenicity swelling in the right flank. Under gas anesthesia, the swelling was surgically explored and a 0.4 cm long grass awn was found and removed. Telephone communication with the owners 6 months after surgery found the cat to be free of clinical signs.     

Pain management and regional anesthesia for the dental patient

Current standards of care in veterinary medicine dictate an adequate level of pain control for our patients. Effective pain control uses a proactive, multimode approach that starts with preoperative medications, includes the anesthetic protocol selected, and continues into the postoperative period. A basic understanding of the physiology of pain assists in selecting those agents and modalities best suited for individual patients. Analgesic drug selection and local anesthesia are both integral parts of pain control when performing surgery in the oral cavity. Local (regional) anesthesia plays an important part in the pain control of oral surgical patients. Regional anesthetic techniques are used for many common oral procedures, including extractions, periodontal flap surgery, treatment of traumatic injuries of the oral cavity, tumor removal, palatal surgery, periodontal therapy, and root canal therapy. This presentation will cover strategies for analgesia and the techniques and materials used in local/regional anesthesia in the oral cavity. Anatomic landmarks and guidelines for effective regional blocks will be covered.     

Advantages and guidelines for using halothane.

Halothane is a frequently used agent. Its cost is inexpensive. Halothane is a safe and effective anesthetic agent if used properly. Proper usage includes adjusting the concentration administered to produce adequate anesthesia for the procedure without excess depression of cardiac, respiratory, and neurologic function. Proper monitoring of the patient indicates the adjustments needed in concentration or needed medications or procedures to increase safe usage. Potent tranquilizers, sedatives, and analgesics used as preanesthetics during halothane anesthesia or the early postanesthetic period may produce profound changes in anesthetic concentrations required or physiologic responses to the combined medications.     

Effects of preanesthetic administration of morphine on gastroesophageal reflux and regurgitation during anesthesia in dogs

OBJECTIVE: To determine the effect of morphine administered prior to anesthesia on the incidence of gastroesophageal reflux (GER) in dogs during the subsequent anesthetic episode. ANIMALS: 90 dogs (30 dogs/group). PROCEDURE: The randomized prospective clinical study included healthy dogs with no history of vomiting. Dogs were scheduled to undergo elective orthopedic surgery. Food was withheld for (mean+/-SD) 17.8+/-4.1 hours prior to induction of anesthesia. The anesthetic protocol included acepromazine maleate, thiopental, and isoflurane. Dogs were randomly selected to receive morphine at various dosages (0, 0.22, or 1.10 mg/kg, IM) concurrent with acepromazine administration prior to induction of anesthesia. A sensor-tipped catheter was used to measure esophageal pH, and GER was defined as a decrease in pH to < 4 or an increase to > 7.5. RESULTS: 40 dogs had acidic reflux, and 1 had biliary reflux. Proportions of dogs with GER were 8 of 30 (27%), 15 of 30 (50%), and 18 of 30 (60%) for morphine dosages of 0, 0.22, and 1.10 mg/kg, respectively. Mean duration of GER was 91.4+/-56.8 minutes. There was no significant association between GER and age, weight, vomiting after preanesthetic medication, administration of antimicrobials, or start of surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Most healthy dogs vomit after a large dose of morphine, but vomiting does not increase the likelihood of GER during the subsequent anesthetic episode. Administration of morphine prior to anesthesia substantially increases the incidence of GER during the subsequent anesthetic episode.     

Suspected epidural morphine analgesia induced chronic urinary and bowel dysfunction in a cat

A 12-year-old male castrated domestic shorthair developed chronic urinary retention, constipation and a decreased perineal reflex following a single lumbo-sacral epidural injection of morphine during general anesthesia. Similar adverse effects have been reported in humans following epidural analgesia, but this is the first reported case of both urinary and bowel dysfunction in a cat purportedly from an epidural. The cat was medically managed with manual bladder expressions, intermittent enemas, and various medications including bethanechol, cisapride and stool softeners. The cat continues to have long-term neurologic dysfunction 15 months post-onset. This case report describes a rare but serious potential risk of lumbo-sacral epidural injections in cats.     

Cost comparison of anesthetic regimens in the dog and cat

Comparative costs of anesthetic regimens for the dog and cat were calculated. Various combinations of currently popular sedatives, tranquilizers, and anti-muscarinics (preanesthetic drugs), and anesthetic induction and maintenance drugs were studied. The preanesthetic drug affected overall anesthetic cost through its own cost, its effect on the amount of anesthetic drug necessary for intubation, and its effect on the amount of anesthetic necessary to maintain anesthesia. The combination of acetylpromazine-thiamylal-halothane was the least expensive regimen for both the dog and cat, whereas drug combinations that included isoflurane as the maintenance drug were the most expensive. In the cat, induction of anesthesia by use of N2O, O2, and halothane in a plexiglas chamber was more expensive than by the use of thiamylal.     

Sclerosing Encapsulating Peritonitis in Four Dogs and a Cat

Sclerosing encapsulating peritonitis (SEP) was diagnosed in four dogs and one cat. Clinical signs included vomiting, abdominal pain, palpable abdominal mass, and ascites. The abdominal fluid was red-tinged and contained large numbers of red blood cells, macrophages, mixed inflammatory cells, reactive mesothelial cells, and fibroblasts. At surgery, the typical appearance was of multiple surfaces covered with granulation tissue or fibrous tissue or both. Multiple adhesions were often present. Causes of SEP included steatitis, fiberglass ingestion, and bacterial infection. Treatment included administration of antibiotic, corticosteroid, and diuretic medications. The major long-term management problems were chronic weight loss, ascites, and progression of concurrent disease.     

Anesthesia and Analgesia in Rabbits and Rodents

Rabbits and rodents are popular pets and are often presented to veterinarians for evaluation and medical treatment. Anesthesia in exotic pets is required for many diagnostic and surgical procedures and is associated with a higher perioperative risk in rabbits and rodents when compared with dogs and cats. Inhalation anesthetic agents are commonly used as the sole source of anesthesia in small rodents, whereas injectable agents in combination with inhalation anesthesia are often used for rabbits and larger rodents. Analgesia is an important component of exotic pet medicine. Although it may be difficult to recognize signs of pain in companion exotic mammals, adequate pain management should always be provided. Opioid and nonsteroidal antiinflammatory drugs are the analgesic medications of choice, but others should be considered (e.g., local anesthetic agents). This article provides an update of the current literature regarding anesthesia and analgesia in rabbits and rodents.     

Myasthenia Gravis in the Cat

Myasthenia gravis (MG) was diagnosed in four cats--one had an apparently congenital form and three had the acquired autoimmune form. All four cats were examined because of episodes of weakness including gait abnormalities, voice change, neck ventroflexion, and regurgitation. Palpebral reflexes were absent in all cats. Administration of edrophonium chloride resulted in transient resolution of clinical signs in all four cats. Three cats were tested for the presence of serum autoantibodies against acetylcholine receptor (AChR) by radioimmunoassay. Two cats with acquired MG had anti-AChR antibody titers of 10.5 and 96.8 nmol/l (normal, less than or equal to 0.03 nmol/l). Antibodies were not detected in the cat with presumptive congenital MG. All four cats were treated with pyridostigmine bromide. Two cats with acquired MG were euthanatized because of clinical deterioration. The third cat with acquired MG has been asymptomatic since 2 months after diagnosis. The cat with presumed congenital MG is alive 3 years after diagnosis.     

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.