A comparison of the 'Maxima' and the modified Ayre's T-piece breathing systems in spontaneously breathing cats

Objective To compare the fresh gas flow requirements of the ‘Maxima’ and Jackson‐Rees modified Ayre's T‐piece (JRMATP) in spontaneously breathing anaesthetized in cats. Study design Prospective randomized clinical study. Animals or sample population Fifteen adult cats (6 male, 9 female, 3.1 ± 0.4 kg [x? ± SD]). Materials & methods After pre‐anaesthetic medication with acepromazine and pethidine, anaesthesia was induced using thiopentone and the trachea was intubated with a cuffed endotracheal tube. This was attached to either a ‘Maxima’ or a JRMATP breathing system; allocation was randomized. Anaesthesia was maintained with halothane delivered in a 1 : 1 oxygen : nitrous oxide mixture. Initial total fresh gas flow (FGF) was set at 600 mL kg^?1 min^?1. After 20 minutes, FGF was reduced in increments of 200 mL min^?1 until rebreathing (inspired CO₂ concentration >0.2%) occurred. At this point, FGF was increased to 600 mL kg^?1 and the process was repeated with the other breathing system. The respiratory rate and airway pressure at the endotracheal tube connector were monitored throughout anaesthesia. Results The mean fresh gas flow that prevented rebreathing with the Maxima system (164 ± 39 mL kg^?1) was significantly less (p < 0.0001) than that required in the modified T‐piece (455 ± 0.77 mL kg^?1). Respiratory rates and airway pressures at the endotracheal tube connector were not significantly affected by breathing system employed. Conclusions In terms of the gas flow requirements that prevent rebreathing, the ‘Maxima’ breathing system is more efficient than the modified Ayre's T‐piece in spontaneously breathing cats anaesthetised with halothane.     

Comparison of the Bain system and Uniflow universal anaesthetic breathing systems in spontaneously breathing young pigs

OBJECTIVE: To compare minimum fresh gas flow (V(min)) requirements and respiratory resistance in the Uniflow and Bain anaesthetic breathing systems used in the Mapleson D mode. Animals Seven pigs, aged 8-12 weeks, anaesthetized for ophthalmic surgery. MATERIALS AND METHODS: Anaesthesia was maintained with halothane delivered in oxygen using a (Mapleson D) Bain breathing system. The V(min) that prevented re-breathing was found, and peak inspiratory (PIP) and peak expiratory (PEP) pressures measured. The fresh gas flow (V(f)) was then increased to V(min) + 50%, then V(min) + 100%, and respiratory pressures re-measured. A heat and moisture exchanger (HME) was inserted at the endotracheal tube and the procedure repeated. The breathing system was then exchanged for a Uniflow and the protocol repeated. After final disconnection from the breathing system, the animals' peak inspiratory and expiratory flows, tidal, and minute volumes (Vm) were measured over five respiratory cycles. RESULTS: The V(min) (L minute(-1); mL kg(-1) minute(-1)) required to prevent rebreathing in the Uniflow system [8.1(mean) +/-1.7 (SD); 332 +/- 94] was significantly greater than the Bain system (6.5 +/- 1.1; 256 +/- 64). At V(min), PEP with the Uniflow (3.5 +/- 0.1 cm H(2)O) was significantly higher than the Bain system (2 +/- 0.7 cm H(2)O), but PIP values did not differ (Uniflow -0.6 +/- 2.1 cm H(2)O; Bain system -0.2 +/- 0.6 cm H(2)O). With both systems, PEP increased significantly (p < 0.001) with each increase in V(f): Uniflow system 4.2 +/- 0.4 (V(min) + 50%) and 5.5 +/- 0.5 cm H(2)O (V(min) + 100%); Bain system 2.8 +/- 0.7 (V(min) + 50%) and 3.5 +/- 0.7 cm H(2)O (V(min) + 100%). Insertion of the HME did not alter pressures. The mean tidal volume was 6.4 +/- 1.6 mL kg(-1); mean Vm was 184.9 +/- 69.8 mL kg(-1) and mean respiratory rate was 28 +/- 5 breaths minute(-1). In one pig breathing with the Uniflow system PEP rose sharply; respiratory and heart rates increased, and ventricular dysrhythmias occurred. When the system was changed and V(f) reduced, physiological variables became normal. CONCLUSION: The study discredited the hypothesis that the two breathing systems behave similarly. Values for V(min) and PEP were higher with the Uniflow system. Increasing V(f) increased PEP with both systems. Insertion of an HME did not affect respiratory pressures. CLINICAL RELEVANCE: The Uniflow used in Mapleson D mode is not suitable for anaesthesia in young spontaneously breathing pigs.     

A clinical evaluation of the 'mini parallel Lack' breathing system in cats and comparison with a modified Ayre's T-piece

OBJECTIVE: To evaluate the suitability of a 'mini parallel Lack' (MPL) breathing system for use in spontaneously breathing cats and to compare the fresh gas flow requirement with that of a modified Ayre's T-piece (MATP). ANIMALS: Twenty client-owned cats, ASA I and II, presented for elective procedures requiring anaesthesia. MATERIALS AND METHODS: Pre-anaesthetic medication and induction of anaesthesia were carried out using several techniques commonly used in our teaching hospital. Anaesthesia was maintained with halothane or isoflurane vaporized in either oxygen or with a mixture of oxygen and nitrous oxide. Both breathing systems were evaluated in each cat, with the order of use randomized. Initial fresh gas flows were 300 mL kg(-1) minute(-1) for the MPL and 500 mL kg(- 1) minute(-1) for the MATP. After a 20-minute stabilization period, fresh gas flow was reduced by 200 mL minute(-1) every 5 minutes until re-breathing--defined as an increase in the inspired partial pressure of carbon dioxide to 0.3 kPa (2 mm Hg)--was detected. The fresh gas flow was then increased in 100 mL minute(-1) increments until re-breathing was no longer detectable, and this value was recorded as the minimum fresh gas flow requirement for the breathing system in use. The procedure was then repeated for the second breathing system. Minimum fresh gas flow requirements were compared using a paired Students t-test. Cardiopulmonary variables were compared using anova. Valve opening pressure was measured in the MPL using a manometer. RESULTS: The mean (+/-SD) fresh gas flow that prevented re-breathing with the MPL (510 +/- 170 mL minute(-1); equivalent to 142 +/- 47 mL kg(-1) minute(-1)) was significantly lower than that required for the MATP (1430 +/- 560 mL minute(-1); equivalent to 397 +/-155 mL kg(-1) minute(-1)). There were no significant differences in cardiopulmonary variables attributable to the use of the two breathing systems. The MPL valve opening pressure was 1.1 cm H2O. CONCLUSIONS: The MPL breathing system used lower gas flows than the MATP without affecting cardiovascular or respiratory function. Clinical relevance In spontaneously breathing cats, the MPL offers the advantages of a reduction in cost and atmospheric pollution because less volatile agent is vaporized.     

A comparison between the v‐gel supraglottic airway device and the cuffed endotracheal tube for airway management in spontaneously breathing cats during isoflurane anaesthesia

ObjectiveTo compare airway management using the v-gel supraglottic airway device (v-gel SGAD) to that using an endotracheal tube (ETT), with respect to practicability, leakage of volatile anaesthetics and upper airway discomfort in cats.Study designProspective, randomized clinical trial.AnimalsTwenty European Shorthair cats (9 males, 11 females), weighing 3.3 ± 0.7 kg.MethodsCats were randomly allocated to one of two groups, in which the airway was managed by either the v-gel SGAD or a cuffed ETT, and anaesthetized for neutering procedures. The dose of propofol necessary to insert the ETT or v-gel SGAD; time from the first injection of propofol to the first clinically acceptable reading on the capnograph; leakage of isoflurane around the airway device; and upper airway discomfort scores during recovery and during the first 24 hours after anaesthesia were recorded. Continuous and discrete variables were analyzed with the Mann–Whitney U-test and the Pearson chi-squared test, respectively. Results were considered statistically significant if p < 0.05.ResultsTime from the first injection of propofol to the first clinically acceptable reading on the capnograph was significantly shorter in the v-gel group. The ETT group showed significantly more stridor during recovery. No other significant differences were found.Conclusions and clinical relevanceAirway management with the v-gel SGAD is a sound and practicable alternative to endotracheal intubation with an ETT. However, larger prospective trials will be needed to draw firm conclusions on the benefits and/or drawbacks of the use of v-gel SGAD for airway management in cats.     

Closed system anaesthesia in dogs using liquid sevoflurane injection; evaluation of the square-root-of-time model and the influence of CO2 absorbent

Objective To determine whether predictable alveolar concentrations of sevoflurane are reliably produced in dogs when liquid sevoflurane is injected into closed circuit breathing systems, as calculated by Lowe's square‐root‐of‐time anaesthetic uptake model, and to confirm the validity of the model using soda lime and calcium hydroxide lime. Study design Prospective clinical study. Animals Eleven healthy dogs with a mean body mass of 34 ± 9 kg scheduled for pelvic limb orthopaedic surgery. Materials and methods Following pre‐anaesthetic medication, anaesthesia was induced with propofol and maintained with sevoflurane in a closed circle system. Epidural anaesthesia was performed with morphine and bupivacaine. Liquid sevoflurane was injected into the circuit by syringe, using dosages and time intervals derived from Lowe's square‐root‐of‐time anaesthetic uptake model. The target alveolar concentration chosen was 1.1 × MAC (2.6% end‐tidal sevoflurane). Either soda lime (group S; n = 6) or calcium hydroxide lime (Amsorb; group A; n = 5) were used for CO₂ absorption. Sevoflurane concentration and the respiratory gas composition were measured with an infrared gas analyser. Results End‐tidal sevoflurane concentrations were close to the predicted value of 2.6% at 9 minutes (2.53 ± 0.1% group S; 2.60 ± 0.26% group A) and 16 minutes (2.55 ± 0.30 group S; 2.52 ± 0.28% group A) but declined thereafter to reach 50% (group S) and 64% (group A) of the predicted value at 121 minutes. There was a constant trend towards higher end‐tidal sevoflurane concentrations in group A but the difference was not statistically significant. Conclusions The square‐root‐of‐time model leads to significantly lower alveolar concentrations than expected, suggesting that the rate of sevoflurane uptake in dogs declines less rapidly than predicted. The use of Amsorb tends to reduce the deviation from predicted concentrations. Clinical relevance The model used in this study provided only an approximate guide to the volume of liquid sevoflurane required. Consequently, the definitive dose schedule must be based on measured anaesthetic concentrations and clinical monitoring.     

ACVIM consensus statement on the diagnosis of immune‐mediated hemolytic anemia in dogs and cats

Immune‐mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune‐mediated erythrocyte destruction, and adverse consequences of long‐term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence‐based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.     

A prospective evaluation of the impact of second‐opinion histopathology on diagnostic testing,cost and treatment in dogs and cats with cancer

Second‐opinion histopathology is a common practice in human medicine to avoid unnecessary procedures, costs and to optimize therapy. Histopathology review has been recommended in veterinary oncology as well. In this prospective evaluation of 52 tumours over a 1‐year period, there was diagnostic agreement between first and second opinions in 52% of cases. Twenty‐nine percent of cases had partial diagnostic disagreement, most often a change in grade, tumour subtype or margin status. Nineteen percent had complete diagnostic disagreement, including a change in cell of origin or a change from benign to malignant. Minor disagreements, which would not affect treatment or prognosis, were present in 21% of cases. Major disagreements, which would affect either treatment or prognosis, were present in 37% of cases. Costs of ideal staging and treatment recommendations were considerably different between first and second opinions.     

An evidence‐based medicine approach to small animal anaesthetic mortality in a referral practice: the influence of initiating three recommendations on subsequent anaesthetic deaths

ObjectiveTo evaluate anaesthetic death after implementation of recommendations and its risk factors in a small animal practice.Study designObservational cohort study.AnimalsAll cats and dogs anaesthetized at the Centre Hospitalier Vétérinaire des Cordeliers during two periods, from April 15th, 2008 to April 15th, 2010 (period 1) and from June 15th, 2010 to August 24th, 2011 (period 2).MethodsDeath occurring during or before full recovery from anaesthesia was recorded. At the end of period 1, a logistic regression model was generated to describe anaesthetic death and identify risk factors. Potential risk factors in our practice setting were identified, and three recommendations, relating to improving physical status and anaesthetic/analgesic regimen implemented for period 2. The relationship between anaesthetic death and recorded variables were analyzed, and where relevant, compared between periods.ResultsSix thousand two hundred and thirty-one animals underwent general anaesthesia. The overall death rate during period 1 was 1.35% (48 in 3546, 95% CI [1.0–1.7%]) and during period 2 was 0.8% (21 in 2685, 95% CI [0.6–1.2%]). For sick animals (ASA status 3 and over), the overall death rate was 4.8% (45 of 944 95% [CI 3.5–6.4%]) during period 1 and 2.2% (18 of 834 95% CI [1.3–3.5%]) during period 2; this represented a significant decrease in death rate in period 2 (p = 0.002). In period 2, the main factors associated with an increased odds ratio of anaesthetic death were poor health status (ASA physical status classification) and old age. Species, gender, anaesthetic regimen, the nature and urgency of the procedure were not associated with risk.Conclusion and clinical relevanceFollowing evidence based recommendations, the death rate related to anaesthesia was significantly decreased during period 2 compared to period 1. Application of evidence-based medicine may contribute to an effective approach to decrease death rates. Other factors, not monitored in this study, may also have had an impact.     

Validation of the Sysmex XT‐2000iV hematology system for dogs,cats, and horses. II. Differential leukocyte counts

Background: The Sysmex XT‐2000iV is a laser‐based, flow cytometric hematology system that stains nucleic acids in leukocytes with a fluorescent dye. A 4‐part differential is obtained using side fluorescence light and laser side scatter. Objective: The purpose of this study was to validate the Sysmex XT‐2000iV for determining differential leukocyte counts in blood from ill dogs, cats, and horses. Methods: Blood samples from diseased animals (133 dogs, 65 cats, and 73 horses) were analyzed with the Sysmex XT‐2000iV (Auto‐diff) and the CELL‐DYN 3500. Manual differentials were obtained by counting 100 leukocytes in Wright‐stained blood smears. Results: Leukocyte populations in the Sysmex DIFF scattergram were usually well separated in equine samples, but were not as well separated in canine and feline samples. Correlation among the Sysmex XT‐2000iV, CELL‐DYN 3500, and manual counts was excellent for neutrophil counts (r ≥.97) and good for lymphocyte counts (r ≥.87) for all three species. Systematic differences between the 3 methods were seen for lymphocyte and monocyte counts. The Sysmex reported incomplete differential counts on 18% of feline, 13% of canine, and 3% of equine samples, often when a marked left shift (>10% bands) and/or toxic neutrophils were present. Eosinophils were readily identified in cytograms from all 3 species. Neither the Sysmex nor the CELL‐DYN detected basophils in the 7 dogs and 5 cats with basophilia. Conclusions: The Sysmex XT‐2000iV automated differential leukocyte count performed well with most samples from diseased dogs, cats, and horses. Basophils were not detected. Immature neutrophils or prominent toxic changes often induced errors in samples from cats and dogs.     

The effect of the stage of the ovarian cycle (anoestrus or dioestrus) and of pregnancy on the incidence of gastro‐oesophageal reflux in dogs undergoing ovariohysterectomy

ObjectiveTo investigate the potential association of increased blood progesterone (P₄) concentrations and/or late pregnancy with the incidence of gastro-oesophageal reflux (GOR), in healthy bitches undergoing ovariohysterectomy under general anaesthesia during anoestrus or dioestrus or during the second half of pregnancy.Study designProspective observational study.AnimalsNinety-four healthy, female, dogs, aged 1–8 years presented for elective ovariohysterectomy.MethodsNon-pregnant animals were classified into group A (anoestrus) (n = 35) if blood P₄ concentration was sufficiently low or group D (dioestrus) (n = 26) if blood P₄ concentration was sufficiently high. All animals in the second half of pregnancy were classified into group P (n = 33). Acepromazine (0.05 mg kg⁻¹) was administered intramuscularly as preanaesthetic medication, and sodium thiopental (10 mg kg⁻¹, with additional doses if needed) was administered intravenously (IV) for induction of anaesthesia. After endotracheal intubation, halothane (1.1–1.3% end-tidal concentration) in oxygen was used for maintenance of anaesthesia. Lower oesophageal pH was monitored continuously throughout surgery using a pH-measuring probe. Reflux was considered to have occurred whenever pH values of >7.5 (alkaline reflux) or <4 (acid reflux) were recorded. On completion of surgery, carprofen (4 mg kg⁻¹) was administered IV. Further administration of analgesics post-operatively was dictated by visual analogue scale pain scoring.ResultAcid GOR was observed in five of 26 dogs in group D, six of 35 group A, and 12 of 33 group P (p = 0.152). The incidence of GOR in group P approached statistical significance and was higher than the incidence in the combined group A + D (one sided p = 0.044, two sided p = 0.077).ConclusionsIn dogs undergoing ovariohysterectomy, GOR during anaesthesia occurs with a high incidence in dogs in the second half of pregnancy compared to non-pregnant animals during anoestrus or dioestrus.Clinical relevanceMeasures could be taken in such cases to avoid the consequences of potential reflux.     

Triple‐phased mesenteric CT angiography using a test bolus technique for evaluation of the mesenteric vasculature and small intestinal wall contrast enhancement in dogs

Computed tomography angiography is widely used for the assessment of various mesenteric vascular and bowel diseases in humans. However, there are only few studies that describe CT angiography application to mesenteric vessels in dogs. In this prospective, experimental, exploratory study, the mesenteric vasculature and enhancement pattern of the intestinal wall were evaluated on triple‐phase CT angiography, and improvement of the visibility of vasculature was assessed on multiplanar reformation, maximum intensity projection, and volume rendering technique. After test bolus scanning at the level of the cranial mesenteric artery arising from the aorta, mesenteric CT angiography was performed in 10 healthy, male, Beagle dogs. Scan delay was set based on time‐to‐attenuation curves, drawn by placing the regions of interest over the aorta, intestinal wall, and cranial mesenteric vein. Visualization and enhancement of mesenteric arteries and veins were evaluated with multiplanar reformation, maximum intensity projection, and volume rendering techniques. The degree of intestinal wall enhancement was assessed on the transverse images in precontrast, arterial, intestinal, and venous phases. Pure arterial images were obtained in the arterial phase. Venous phase images allowed good portal vascular mapping. All CT angiography images were of high quality, allowing for excellent visualization of the anatomy of mesenteric vasculature including the small branches, particularly on maximum intensity projection and volume rendering technique. Distinct contrast enhancement of the intestinal wall was observed in both intestinal and venous phases. Findings indicated that this technique is feasible for the evaluation of mesenteric circulation in dogs.     

Validation of the Sysmex XT‐2000iV hematology system for dogs,cats, and horses. I. Erythrocytes,platelets, and total leukocyte counts

Background: The Sysmex XT‐2000iV is a laser‐based, flow cytometric hematology system that has been introduced for use in large and referral veterinary laboratories. Objective: The purpose of this study was to validate the Sysmex XT‐2000iV for counting erythrocytes, reticulocytes, platelets, and total leukocytes in blood from ill dogs, cats, and horses. Methods: Blood samples from diseased animals (133 dogs, 65 cats, and 73 horses) were analyzed with the Sysmex XT‐2000iV and the CELL‐DYN 3500. Manual reticulocyte counts were done on an additional 98 canine and 14 feline samples and manual platelet counts were done on an additional 73 feline and 55 canine samples, and compared with automated Sysmex results. Results: Hemoglobin concentration, RBC counts, and total WBC counts on the Sysmex were highly correlated with those from the CELL‐DYN (r≥0.98). Systematic differences occurred for MCV and HCT. MCHC was poorly correlated in all species (r=0.33–0.67). The Sysmex impedance platelet count in dogs was highly correlated with both the impedance count from the CELL‐DYN (r=0.99) and the optical platelet count from the Sysmex (r=0.98). The Sysmex optical platelet count included large platelets, such that in samples from cats, the results agreed better with manual platelet counts than with impedance platelet counts on the Sysmex. Canine reticulocyte counts on the Sysmex correlated well (r=0.90) with manual reticulocyte counts. Feline reticulocyte counts on the Sysmex correlated well with aggregate (r=0.86) but not punctate (r=0.50) reticulocyte counts. Conclusion: The Sysmex XT‐2000iV performed as well as the CELL‐DYN on blood samples from dogs, cats, and horses with a variety of hematologic abnormalities. In addition, the Sysmex detected large platelets and provided accurate reticulocyte counts.