Medetomidine/propofol anaesthesia for gastroduodenal endoscopy in dogs

This study was performed to evaluate clinically the level of analgesia obtained during fibre optic gastroduodenal examination with an anaesthetic regimen consisting of 1000 μg/m²b.s.a. medetomidine premedica-tion (equivalent to 30–50 μg/kg b.w, IM) followed by induction and maintenance of anaesthesia with propofol (1–2 mg/kg, IV), with spontaneous respiration of room air. Following premedication, all the dogs (n=20) were connected to an E.C.G. monitor (lead II) and a femoral artery catheter was placed for continuous recording of blood pressure and to allow sampling for arterial blood gas analysis. The mean values for heart rate and arterial blood pressure following medetomidine administration were 55 b.p.m. and 121 mm Hg, respectively, and these values remained unchanged during the procedure. Blood gas data all remained within physiological limits. Fibre optic gastroduodenoscopy could be performed without the occurrence of “pain” responses. In all but one dog, the pyloric sphincter was relaxed and it was easy to pass the endoscope into the duodenum. All the dogs recovered rapidly and smoothly from anaesthesia, following administration of atipamezole 2500 μg/m² b.s.a. (equivalent to 75–125 μg/kg b.w.) IM to reverse the effects of the medetomidine.     

Evaluation of mega-voltage CT images for completed radiotherapy treatments for dogs and cats reveals uncommon but potentially consequential dose deviation in thoracic and abdominal tumors

As advanced delivery techniques such as intensity-modulated radiation therapy (IMRT) become conventional in veterinary radiotherapy, highly modulated radiation delivery helps to decrease dose to normal tissues. However, IMRT is only effective if patient setup and anatomy are accurately replicated for each treatment. Numerous techniques have been implemented to decrease patient setup error, however tumor shrinkage, variations in the patient's contour and weight loss continue to be hard to control and can result in clinically relevant dose deviation in radiotherapy plans. Adaptive radiotherapy (ART) is often the most effective means to account for gradual changes such as tumor shrinkage and weight loss, however it is often unclear when adaption is necessary. The goal of this retrospective, observational study was to review dose delivery in dogs and cats who received helical radiotherapy at University of Wisconsin, using detector dose data (D2%, D50%, D98%) and daily megavoltage computed tomography (MVCT) images, and to determine whether ART should be considered more frequently than it currently is. A total of 52 treatment plans were evaluated and included cancers of the head and neck, thorax, and abdomen. After evaluation, 6% of the radiotherapy plan delivered had clinically relevant dose deviations in dose delivery. Dose deviations were more common in thoracic and abdominal targets. While adaptation may have been considered in these cases, the decision to adapt can be complex and all factors, such as treatment delay, cost, and imaging modality, must be considered when adaptation is to be pursued.     

The effects of nitrous oxide on recovery from isoflurane anaesthesia in dogs

O bjectives : To assess rate and quality of recovery from anaesthesia where isoflurane was delivered in oxygen or oxygen/nitrous oxide.
M ethods : Dogs anaesthetised with propofol were randomly allocated to receive isoflurane maintenance in either 100 per cent oxygen (group 1) or 66 per cent nitrous oxide (N₂O)/34 per cent oxygen (group 2). Time from end of anaesthesia to achieving sternal recumbency was recorded. Incidence of adverse behaviours (vocalisation, uncontrolled head movement and restlessness) were assessed. Recovery quality was recorded on a visual analogue scale (VAS) (anchored at 0 with "best possible" recovery and "did not recover" at 100 mm). Age, weight, gender, anaesthetic duration, mean vaporiser setting, VAS scores, recovery times, postoperative temperature and behavioural scores were compared (chi-squared test, Mann-Whitney U test or t -test as appropriate, significance P≤0·05).
R esults : Objective data from 54 dogs were analysed, only VAS data where the observer was unaware of treatment group were used (n=33). Recovery was faster in group 2 dogs (median 10 min [range 4 to 31] compared with 14 minutes [3 to 43] in group 1, P=0·049) with less restlessness (0 [0 to 4] compared with 2 [0 to 4] in group 1, P=0·013) and uncontrolled head movement (0 [0 to 4] compared with 1 [0 to 3] in group 1, P<0·001). However, VAS scores were not statistically different between groups (group 1: mean 39·4 mm [s.d. 24·0)]; group 2: 30·1 mm [25·9]; P=0·303).
C linical S ignificance : Addition of N₂O to isoflurane anaesthesia results in a lower incidence of adverse behaviour (for example restlessness) and marginally faster recovery.     

Short duration anaesthesia for minor procedures in dogs

Anaesthesia was maintained with 4 different techniques in each of 12 dogs of ASA grades I or 11 undergoing 4 treatment sessions of mega-voltage x-ray therapy at weekly intervals. After induction of anaesthesia with propofol, these dogs received either: i) continiious pi-opofol iv infusion together with nitrous oxide/oxygen by inhalation: ii) halothane in nitrous oxiddoxygen; iii) entluraiie in nitrous oxide/oxygen; or iv) isollurane in nitrous oxide/oxygen. Anaesthesia dways enabled irradiation to be performed but stable anaesthesia was achieved more easily when enflurnne was used. The incidence of undesirable effects during anaesthesia wiis low. Recovery from the end of anaesthesia to swallowing was fastest Lifter enfluraiie (2.2 min median) but the recovery times to walking were similar (medians: halothane 12.5 min; entlurane 12.0 min; isoflurane 12.5 min; propofol I3 min). Personal preferences. local facilities and cost are likely to be the deciding factors in choice of any one of these techniques for dogs undergoing short procedures unussociatcd with surgical stimulation.     

A comparative study of medetomidine/ketamine and xylazine/ketamine anaesthesia in dogs

The anaesthetic and physiological effects of a combination of 40 micrograms medetomidine with 2.5 ketamine, 5.0 or 7.5 mg/kg administered intramuscularly were compared with the effects of a combination of 1 mg/kg xylazine and 15 mg/kg ketamine. All the combinations rapidly induced an anaesthetic state that permitted endotracheal intubation, with the absence of the pedal reflex and with good muscle relaxation, and induced bradycardia that was less pronounced as the dose of ketamine was increased. All the combinations produced a decrease in respiratory rate. Increasing the dose of ketamine combined with medetomidine resulted in a very significant prolongation of the duration of anaesthesia, the duration of muscle relaxation and the arousal time. The duration of the anaesthetic effects of 40 micrograms/kg medetomidine with 5 mg/kg ketamine was comparable to that provided by the recommended xylazine/ketamine combination but the period of muscle relaxation was significantly longer. The recovery from medetomidine/ketamine took longer than recovery from xylazine/ketamine but there were fewer side effects.     

Blood gas and acid-base status during tiletamine/zolazepam anaesthesia in dogs

OBJECTIVE: To evaluate the effect of the tiletamine/zolazepam (TZ) combination (Zoletil 100; Virbac, Carros, France) with and without atropine on blood gas values and acid-base status in dogs. STUDY DESIGN: Randomized cross-over experimental study. ANIMALS: Six healthy adult cross-bred dogs, weighing 11.0-18.5 kg. MATERIALS AND METHODS: Each dog received four different drug treatments at intervals of at least 15 days: (i) 5 mg kg(-1) intravenous (IV) TZ (TZ.IV); (ii) 10 mg kg(-1) intramuscular (IM) TZ (TZ.IM); (iii) atropine, 20 microg kg(-1) IV, followed 5 minutes later by 5 mg kg(-1) TZ IV (A.TZ.IV); and (IV) atropine (same dose) given 5 minutes before 10 mg kg(-1) TZ IM (A.TZ.IM). Arterial blood samples were collected from each dog before drug administration (baseline) at induction of anaesthesia (time 0) and 2, 5, 10 and 30 minutes thereafter. RESULTS: Transient hypoxaemia and respiratory acidosis were observed just after induction. PaO(2) and SaO(2) dropped, while H(+) concentration and PaCO(2) rose significantly above baseline values. In groups TZ.IV and A.TZ.IV, PaO(2) values as low as 6.0-6.4 kPa (45-48 mm Hg) were recorded. However, there was no significant difference in blood gas variables among the groups encountered during the evaluation period. The overall change in [HCO(3) (-)] and base excess (BE) was not significant among groups. Atropine did not affect the above variables. CONCLUSIONS AND CLINICAL RELEVANCE: Tiletamine/zolazepam injection may induce transient hypoxaemia and respiratory acidosis, but acid-base status changes are clinically unimportant. Particularly, close observation of dogs is recommended during the first 5-10 minutes after induction with TZ, especially in animals with cardiopulmonary disease. TZ should perhaps not be used in animals intolerant of tachycardia.     

Four fraction palliative radiotherapy for osteosarcoma in 24 dogs

Twenty-four dogs underwent palliative radiotherapy consisting of four 8 gray (Gy) fractions of 60Co radiation on days 0, 7, 14, and 21 at 26 sites for axial (n=11) or appendicular (n=15) osteosarcoma. Response was noted in 92% of sites treated. Seventeen dogs were euthanized due to local or metastatic disease, one dog died of metastatic disease, five dogs died of unrelated causes, and one dog is alive. The four fraction protocol is effective for palliation of clinical signs associated with axial or appendicular osteosarcoma and may result in a higher response rate and longer survival time than three fraction palliative protocols.     

Fentanyl or midazolam for co-induction of anaesthesia with propofol in dogs

ObjectivePropofol may cause adverse effects (e.g. apnoea, hypotension) at induction of anaesthesia. Co-induction of anaesthesia may reduce propofol requirements. The effect of fentanyl or midazolam on propofol dose requirements and cardiorespiratory parameters was studied.Study designRandomized, controlled, blinded clinical study.AnimalsSixty-six client owned dogs (35 male, 31 female, ASA I-II, age 6–120 months, body mass 4.7–48.0 kg) were selected.MethodsPre-medication with acepromazine (0.025 mg kg⁻¹) and morphine (0.25 mg kg⁻¹) was administered by intramuscular injection. After 30 minutes group fentanyl-propofol (FP) received fentanyl (2 μg kg⁻¹), group midazolam-propofol (MP) midazolam (0.2 mg kg⁻¹) injected over 30 seconds via a cephalic catheter and in a third group, control-propofol (CP), the IV catheter was flushed with an equivalent volume of heparinized saline. Anaesthesia was induced 2 minutes later, with propofol (4 mg kg⁻¹minute⁻¹) administered to effect. After endotracheal intubation anaesthesia was maintained with a standardized anaesthetic protocol. Pulse rate, respiratory rate (RR) and mean arterial pressure (MAP) were recorded before the co-induction agent, before induction, and 0, 2 and 5 minutes after intubation. Apnoea ≥30 seconds was recorded and treated. Sedation after pre-medication, activity after the co-induction agent, quality of anaesthetic induction and endotracheal intubation were scored.ResultsPropofol dose requirement was significantly reduced in FP [2.90 mg kg⁻¹(0.57)] compared to CP [3.51 mg kg⁻¹ (0.74)] and MP [3.58 mg kg⁻¹(0.49)]. Mean pulse rate was higher in MP than in CP or FP (p = 0.003). No statistically significant difference was found between groups in mean RR, MAP or incidence of apnoea. Activity score was significantly higher (i.e. more excited) (p = 0.0001), and quality of induction score was significantly poorer (p = 0.0001) in MP compared to CP or FP. Intubation score was similar in all groups.Conclusions and clinical relevanceFentanyl decreased propofol requirement but did not significantly alter cardiovascular parameters. Midazolam did not reduce propofol requirements and caused excitement in some animals.     

Propofol infusion anaesthesia in dogs pre-medicated with medetomidine

Ten laboratory beagles pre-medicated with medetomidine (40 μg/kg bodyweight [bwt]) were anaesthetised using a rapid injection of propofol, followed by propofol infusion. A loading dose of 4 mg/kg bwt of propofol was administered intravenously (iv) as a bolus and, immediately after, a 60 min iv propofol infusion (150 μg/kg bwt/min) was initiated. After a transient increase, mean arterial blood pressure decreased significantly below the pre-propofol level. However, the lowest values recorded (115 ± 11 mmHg) remained within the physiological limits. Heart rate increased significantly (from 41 ± 7.3 to 58 ± 11 beats/min) after initiation of the propofol infusion. No significant changes were seen in respiratory frequency; pO₂ decreased transiently; minimum values (10 ± 2.3 kPa) recorded 5 mins after initiation of the propofol infusion differed significantly from the starting level. pCO₂ increased significantly and the highest values recorded were 6.1 ± 0.35 kPa. Accordingly, pH decreased reaching the lowest level (pH 7.29) 15 mins after initiation of the propofol infusion. The analgesic effect of the present combination was not studied, but the absence of the palpebral and pedal reflexes suggested a surgical stage of anaesthesia. Therefore, propofol infusion in beagles pre-medicated with medetomidine proved to be a promising anaesthetic regimen but, if used clinically, oxygen-enriched inspired air should be used.     

Nerve stimulator-guided paravertebral lumbar plexus anaesthesia in dogs

Veterinary Research Communications -     

The influence of anaesthesia on bronchography in dogs

The spread of the contrast medium, Dionosil Aqueous (Glaxo),* in the bronchi of three healthy dogs was investigated under a variety of anaesthetic techniques. The most reliable results were obtained when intermittent positive pressure ventilation (IPPV) was applied following anaesthetic techniques incorporating the use of neuromuscular blocking agents. Good results were also obtained using trichloroethylene anaesthesia. The reliability of results obtained using relaxant techniques was confirmed in clinical cases.     

Hyaluronidase shortens levobupivacaine lumbosacral epidural anaesthesia in dogs

Objectives : The aim of this study was to evaluate the effects of hyaluronidase added to levobupivacaine in lumbosacral epidural blockade in dogs. Methods : Six adult mixed breed dogs (two males and four females) weighing 7 to 14 kg (10·5 ±1·5 kg) and aged two to five years were used. Each dog received both treatments in random order: levobupivacaine alone (LBA; n=6) or levobupivacaine plus hyaluronidase (LBH; n=6) administered in the lumbosacral epidural space. Systemic effects, spread and duration of anaesthesia and motor block were determined before treatment and at predetermined intervals. Results : The duration of local anaesthesia was 90 ±10 minutes (P=0·001) for LBH treatment and 150 ±15 minutes for LBA treatment. In the LBH treatment, anaesthesia reached the T12 to T13 dermatome and in the LBA treatment it reached the T11 to T12 dermatome in all animals in 5 and 15 minutes, respectively. Complete motor blockade was 75 ±12 minutes (P=0·01) and 120 ±15 minutes for LBH and LBA treatments, respectively. Clinical Significance : Hyaluronidase added to levobupivacaine significantly shortens the duration of epidural anaesthesia with the same dermatome spread into the epidural space in dogs.     

Stereotactic radiotherapy outcomes for intraventricular brain tumours in 11 dogs

Published radiotherapy data for canine intraventricular tumours are limited. In this retrospective, longitudinal study (9/2011–2018), 11 dogs with intraventricular masses were treated with stereotactic radiotherapy (SRT). Pathologic diagnosis was available from surgery or necropsy in 6/11 cases, revealing choroid plexus papilloma (3) or carcinoma (2), and ependymoma (1). The remainder were magnetic resonance imaging (MRI)-diagnosed as suspected choroid tumours or ependymomas. Tumours were located in the third or lateral ventricle (8), fourth ventricle (2), and cerebellopontine angle (1). Surgery was performed in three dogs prior to radiotherapy, and all showed gross residual/recurrent disease at treatment. Dogs received 8 Gray × 3 fractions (7), or 15 Gray × 1 fraction (4). Ten dogs were deceased at analysis, and one was living. The estimated median overall survival time (OS) from first SRT treatment was 16.9 months (515 days, 95% CI 33–1593 days). The survival time for two pathology-diagnosed carcinoma dogs were 24 and 133 days, respectively, and survival time for dogs with moderate to marked ventriculomegaly (4/11) ranged from 24 to 113 days. A total of 10/11 showed clinical improvement per owner or clinician, but two had short-lived benefits and were euthanized within 6 weeks of SRT. Limited conclusions on radiation-specific complications are possible due to the small dataset and limited follow-up imaging. This study provides preliminary evidence that radiotherapy outcomes are variable with intraventricular tumours, and some long-term survivors are noted.     

A comparison of propofol infusion and propofol/isoflurane anaesthesia in dexmedetomidine premedicated dogs

The effects of propofol infusion were compared with propofol/isoflurane anaesthesia in six beagles premedicated with 10 microg/kg intramuscular (i.m.) dexmedetomidine. The suitability of a cold pressor test (CPT) as a stress stimulus in dogs was also studied. Each dog received isoflurane (end tidal 1.0%, induction with propofol) with and without CPT; propofol (200 microg/kg/min, induction with propofol) with and without CPT; premedication alone with and without CPT in a randomized block study in six separate sessions. Heart rate and arterial blood pressures and gases were monitored. Plasma catecholamine, beta-endorphin and cortisol concentrations were measured. Recovery profile was observed. Blood pressures stayed within normal reference range but the dogs were bradycardic (mean heart rate < 70 bpm). PaCO2 concentration during anaesthesia was higher in the propofol group (mean > 57 mmHg) when compared with isoflurane (mean < 52 mmHg). Recovery times were longer with propofol than when compared with the other treatments. The mean extubation times were 8 +/- 3.4 and 23 +/- 6.3 min after propofol/isoflurane and propofol anaesthesia, respectively. The endocrine stress response was similar in all treatments except for lower adrenaline level after propofol infusion at the end of the recovery period. Cold pressor test produced variable responses and was not a reliable stress stimulus in the present study. Propofol/isoflurane anaesthesia was considered more useful than propofol infusion because of milder degree of respiratory depression and faster recovery.     

Sarcoma development after radiotherapy in two dogs

Two dogs were treated with a hypofractionated course of radiotherapy following surgical excision of an intermediate grade mast cell tumour and a round cell tumour, respectively. Both dogs developed a sarcoma of the bone, within the irradiated site, several years after the initial radiotherapy treatment. Bone tumours arising within a previously irradiated area are well‐recognized late radiotherapy side‐effect in humans but have been reported infrequently in dogs. These are the first case reports to describe bone sarcomas in the appendicular skeleton at a site, which had been previously treated by a hypofractionated course of radiotherapy for an unrelated tumour.