Effect of intravenous lidocaine on heart rate, systolic arterial blood pressure and cough responses to endotracheal intubation in propofol-anaesthetized dogs

OBJECTIVE: To evaluate the effect of intravenous lidocaine on coughing and variations in heart rate (HR) and systolic arterial pressure (SAP) at endotracheal intubation in propofol-anaesthetized dogs. STUDY DESIGN: Prospective, randomized, blinded clinical study. ANIMALS: Eighty dogs, ASA grades I/II. METHODS: Dogs were randomly assigned to one of two treatments, with dogs in the lidocaine group receiving 1 mg kg(-1) lidocaine intravenously and those in the saline group receiving 0.05 mL kg(-1) saline intravenously before induction of anaesthesia with up to 6.5 mg kg(-1) propofol intravenously. An electrocardiogram was recorded continuously. Heart rate was calculated and SAP (using Doppler ultrasonic flow detection) was recorded at the following time points: pre-treatment, following lidocaine or saline administration, before and after intubation. The occurrence, number and strength of coughs were recorded. Systolic arterial pressure and HR were compared using one-sample t-tests to examine whether SAP and HR changed with test drug administration or following intubation. The number of coughs was compared between groups using t-tests. A cross tabulation and chi-square or Fisher's exact test was used to compare proportions of dogs that coughed and intensity of coughing in each group. The level of significance was set at p < 0.05. RESULTS: Heart rate did not change in either group. Systolic arterial blood pressure increased following intubation in both the lidocaine (p = 0.003) and saline groups (p = 0.001). There was no difference in the increase in SAP or in the number or intensity of coughs at intubation between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Intravenous lidocaine had no effect on the occurrence or intensity of coughing or on changes in SAP at endotracheal intubation in dogs anaesthetized with propofol. The use of 1 mg kg(-1) lidocaine intravenously before intubation in dogs to attenuate cough and the pressor response was not supported.     

Laryngeal mask airway insertion requires less propofol than endotracheal intubation in dogs

OBJECTIVE: To compare the doses of propofol required for insertion of the laryngeal mask airway (LMA) with those for endotracheal intubation in sedated dogs. STUDY DESIGN: Randomized prospective clinical study. Animals Sixty healthy dogs aged 0.33-8.5 (3.0 +/- 2.3, mean +/- SD) years, weighing 2.2-59.0 (23.4 +/- 13.6, mean +/- SD) kg, presented for elective surgery requiring inhalation anaesthesia. METHODS: Animals were randomly assigned to receive either a LMA or an endotracheal tube. Pre-anaesthetic medication was intravenous (IV) glycopyrrolate (0.01 mg kg(-1)) medetomidine (10 microg kg(-1)) and butorphanol (0.2 mg kg(-1)). Repeated IV propofol injections (1 mg kg(-1) in 30 seconds) were given until LMA insertion or endotracheal intubation was achieved, when the presence or absence of laryngospasm, the respiratory rate (fr) and the total dose of propofol used were recorded. RESULTS: The total propofol dose (mean +/- SD) required for LMA insertion (0.53 +/- 0.51 mg kg(-1)) was significantly lower than for endotracheal intubation (1.43 +/- 0.57 mg kg(-1)). The LMA could be inserted without propofol in 47% of dogs; the remainder needed a single 1 mg kg(-1) bolus (n = 30). Endotracheal intubation was possible without propofol in 3.3% of the dogs, 47% needed one bolus and 50% required two injections (n = 30). The f(r) (mean +/- SD) was 18 +/- 6 and 15 +/- 7 minute(-1) after LMA insertion and intubation, respectively. CONCLUSION AND CLINICAL RELEVANCE: Laryngeal mask airway insertion requires less propofol than endotracheal intubation in sedated dogs therefore propofol-induced cardiorespiratory depression is likely to be less severe. The LMA is well tolerated and offers a less invasive means of securing the upper airway.     

Comparison between intravenous lidocaine and fentanyl on cough reflex and sympathetic response during endotracheal intubation in dogs

ObjectiveTo compare the effects of intravenous (IV) lidocaine and fentanyl on the cough reflex and autonomic response during endotracheal intubation in dogs.Study designRandomized, blinded, superiority clinical trial.AnimalsA total of 46 client-owned dogs undergoing magnetic resonance imaging.MethodsAfter intramuscular methadone (0.2 mg kg^–1), dogs were randomized to be administered either IV lidocaine (2 mg kg^–1; group L) or fentanyl (7 μg kg^–1; group F). After 5 minutes, alfaxalone was administered until endotracheal intubation was possible (1 mg kg^–1 IV over 40 seconds followed by 0.4 mg kg^–1 increments to effect). Total dose of alfaxalone was recorded and cough reflex at endotracheal intubation was scored. Heart rate (HR) was continuously recorded, Doppler systolic arterial blood pressure (SAP) was measured every 20 seconds. Vasovagal tonus index (VVTI) and changes (Δ) in HR, SAP and VVTI between pre-intubation and intubation were calculated. Groups were compared using univariate and multivariate analysis. Statistical significance was set as p < 0.05.ResultsGroup F included 22 dogs and group L 24 dogs. The mean (± standard deviation) alfaxalone dose was 1.1 (± 0.2) and 1.35 (± 0.3) mg kg^–1 in groups F and L, respectively (p = 0.0008). At intubation, cough was more likely in group L (odds ratio = 11.3; 95% confidence intervals, 2.1 – 94.2; p = 0.01) and HR increased in 87.5% and 54.5% of groups L and F, respectively (p = 0.02). The median (range) ΔHR between pre-intubation and intubation was higher (13.1%; – 4.3 to + 55.1) in group L (p = 0.0021). Between groups, SAP and VVTI were similar.Conclusion and clinical relevanceAt the stated doses, whilst reducing the alfaxalone dose, fentanyl is superior to lidocaine in suppressing the cough reflex and blunting the increase in HR at endotracheal intubation in dogs premedicated with methadone.     

Policies for the vaccination of cats and dogs in New Zealand veterinary practices

AIMS: To determine current practices and attitudes towards vaccination of dogs and cats of veterinarians in New Zealand; the methods used for informing clients on which vaccines to use, and the preferred site for vaccination of cats.

METHODS: A postal questionnaire was sent to all 483 listed veterinary practices in New Zealand during February 2012. Some questions were specific to pet dogs, cats, or working farm dogs. Responses were categorised according to practice type and geographical region of the respondent. Factors associated with respondent recommendation of annual vaccination with modified live viral (MLV) vaccines were examined using logistic regression analysis. Vaccines that were considered to be essential for every animal were defined as core; those that may be recommended for animals whose location or lifestyle placed them at risk, were defined as non-core.

RESULTS: There were 204 useable returns, equivalent to a response rate of 42.2%, distributed across the country. Annual vaccination with MLV vaccines of dogs was recommended by 54/198 (27.3%) respondents, and of cats by 107/181 (59.1%) respondents. Factors associated with the recommendation of annual administration of MLV vaccines to dogs included being a companion animal practice, a desire for policies on vaccination to be left to individual clinics, and having one veterinarian in the practice. Administration of the final vaccination for puppies was recommended at ≥14 weeks old by 55/185 (29.7%) respondents, and for kittens at ≥13 weeks old by 42/183 (23%) respondents. Of respondents that administered MLV vaccines annually, 62/103 (60.2%) believed reducing the frequency of vaccination would reduce income, and 52/103 (50.5%) considered it would have a negative effect on animal health. Advice to enable clients to decide which non-core vaccines were administered was given by 181/199 (91%) respondents. Factors considered when recommending a vaccine included consideration of risk to individual patients (190/203; 93.6%), requirements of boarding kennels/catteries (165/203; 81.3%) and clinic vaccination policy (142/203; 70%). The preferred site for administering MLV vaccines to cats was the dorsal neck or inter-scapular region (137/198; 69.2%). Amongst respondents, 18 wanted disease surveillance information to allow for truly informed decisions to be made about vaccination.

CONCLUSIONS AND CLINICAL RELEVANCE: Veterinarians can now compare their own vaccination practices and attitudes with those of veterinarians nationally, and internationally. There is a need for national surveillance information and for continued education of the public and commercial kennel and cattery owners for optimal vaccination strategies to be developed.     

Tracheal trauma and pneumonia secondary to endotracheal intubation in a horse undergoing general anaesthesia,computerised tomography and myelography

Endotracheal intubation is commonly performed in horses undergoing general anaesthesia to avoid fluid aspiration and provide mechanical ventilation and inhalational anaesthetic agents. Secondary laryngeal and tracheal trauma following intubation is not rare. This case report describes the successful treatment of a horse with laryngeal and tracheal trauma secondary to intubation during myelography. Based on other clinical reports and clinical experience, movement of the endotracheal tube during myelography was considered the most likely cause of the damage. This case underscores the importance of monitoring horses for development of respiratory signs after general anaesthesia for computerised tomography and myelography.     

A low-cost portable simulator of a domestic cat larynx for teaching endotracheal intubation

ObjectiveTo design and construct an affordable simulator of the cat larynx for training intubation maneuvers and to share the designs for its fabrication.Study designResearch and development study.AnimalsA domestic cat.MethodsThe cadaver of a cat, dead by natural causes, was frozen in sternal recumbency with the neck extended and the mouth wide open. A computed tomography image was acquired and used to construct a digital three-dimensional (3D) model of the pharynx and trachea. A digitally adapted model was 3D-printed and used to generate a silicone model of these structures, which was placed within a wooden container. The quality of the simulator was assessed by 46 veterinary anesthesiologists and veterinarians with experience in tracheal intubation maneuvers, and their opinions were obtained through an anonymous questionnaire.ResultsSeveral preliminary prototypes were assessed regarding stability, texture and cost. Finally, a silicone model of a cat larynx (LaryngoCUBE) was produced and encased in a wooden container. Results from the questionnaire showed high scores regarding anatomy, tissue texture and intubation maneuver realism, compared with the real procedure.Conclusionsand clinical relevance Use of LaryngoCUBE as a training tool may improve the skills of students and reduce the use of animals for teaching endotracheal intubation. Blueprints and computational models are provided online so that the simulator can be fully reproduced.     

Effect of intravenous fentanyl on cough reflex and quality of endotracheal intubation in cats

ObjectiveTo assess the effects of intravenous (IV) fentanyl on cough reflex and quality of endotracheal intubation (ETI) in cats.Study designRandomized, blinded, negative controlled clinical trial.AnimalsA total of 30 client-owned cats undergoing general anaesthesia for diagnostic or surgical procedures.MethodsCats were sedated with dexmedetomidine (2 μg kg^–1 IV), and 5 minutes later either fentanyl (3 μg kg^–1, group F) or saline (group C) was administered IV. After alfaxalone (1.5 mg kg^–1 IV) administration and 2% lidocaine application to the larynx, ETI was attempted. If unsuccessful, alfaxalone (1 mg kg^–1 IV) was administered and ETI re-attempted. This process was repeated until successful ETI. Sedation scores, total number of ETI attempts, cough reflex, laryngeal response and quality of ETI were scored. Postinduction apnoea was recorded. Heart rate (HR) was continuously recorded and oscillometric arterial blood pressure (ABP) was measured every minute. Changes (Δ) in HR and ABP between pre-intubation and intubation were calculated. Groups were compared using univariate analysis. Statistical significance was set as p < 0.05.ResultsThe median and 95% confidence interval of alfaxalone dose was 1.5 (1.5–1.5) and 2.5 (1.5–2.5) mg kg^–1 in groups F and C, respectively (p = 0.001). The cough reflex was 2.10 (1.10–4.41) times more likely to occur in group C. The overall quality of ETI was superior in group F (p = 0.001), with lower laryngeal response to ETI (p < 0.0001) and ETI attempts (p = 0.045). No differences in HR, ABP and postinduction apnoea were found.Conclusions and clinical relevanceIn cats sedated with dexmedetomidine, fentanyl could be considered to reduce the alfaxalone induction dose, cough reflex and laryngeal response to ETI and to improve the overall quality of ETI.     

Evaluation of laryngeal mask as an alternative to endotracheal intubation in cats anesthetized under spontaneous or controlled ventilation

OBJECTIVE: To compare the cardiorespiratory effects and incidence of gastroesophageal reflux with the use of a laryngeal mask airway (LMA) or endotracheal tube (ET) in anesthetized cats during spontaneous (SV) or controlled ventilation (CV). STUDY DESIGN: Prospective randomized experimental trial. ANIMALS: Thirty-two adult crossbred cats, weighing 2.7 +/- 0.4 kg. METHODS: The cats were sedated with intramuscular (IM) methotrimeprazine (0.5 mg kg(-1)) and buprenorphine (0.005 mg kg(-1)), followed 30 minutes later by induction of anesthesia with intravenous (IV) thiopental (12.5-20 mg kg(-1)). An ET was used in 16 cats and an LMA in the remaining 16 animals. Anesthesia was maintained with 0.5 minimum alveolar concentration (0.6%) of halothane in oxygen using a Mapleson D breathing system. Cats in both groups were further divided into two equal groups (n = 8), undergoing either SV or CV. Neuromuscular blockade with pancuronium (0.06 mg kg(-1)) was used to facilitate CV. Heart and respiratory rates, direct arterial blood pressure, capnometry (PE'CO2) and arterial blood gases were measured. Gastric reflux and possible aspiration was investigated by intragastric administration of 5 mL of radiographic contrast immediately after induction of anesthesia. Cervical and thoracic radiographs were taken at the end of anesthesia. Data were analyzed using anova followed by Student-Newman-Keuls, Kruskal-Wallis or Friedman test where appropriate. RESULTS: Values for PaCO2 and PE'CO2 were higher in spontaneously breathing cats with the LMA when compared with other groups. Values of PaO2 and hemoglobin oxygen saturation did not differ between groups. Gastroesophageal reflux occurred in four of eight and two of eight cats undergoing CV with ET or LMA, respectively. There was no tracheal or pulmonary aspiration in any cases. CONCLUSIONS AND CLINICAL RELEVANCE: The use of an LMA may be used as an alternative to endotracheal intubation in anesthetized cats. Although aspiration was not observed, gastric reflux may occur in mechanically ventilated animals.     

Digestive sensitivity varies according to size of dogs: a review

Field observations on food tolerance have repeatedly shown that when fed an identical diet, large breed (>25 kg) dogs present softer and moister faeces than small breed ones (<15 kg). The purpose of this review is to highlight the findings of four PhD theses, carried out between 1998 and 2013, whose objectives were to investigate the anatomical and physiological peculiarities that would explain, at least in part, this observation, as well as their nutritional implication. This work showed that large breed dogs, in contrast with smaller breeds, present a highly developed caecum and colon, which could explain the relatively longer colonic transit time. A prolonged colonic transit time could explain higher colonic fermentative activity, as supported by higher faecal concentrations of fermentative by‐products. This effect would be reinforced by increased intestinal permeability and reduced sodium net‐absorption. Taken together, these elements could be a possible cause of higher digestive sensitivity in large breed dogs. When prescribing a diet to a small or large breed dog, several aspects of the formulation must be taken into account. For a large breed dog, the general goal is to limit any ingredient that could increase the level of fermentable undigested residues and, in fine, exacerbate colonic fermentation. Highly digestible sources of proteins and starches are therefore strongly recommended to maintain an optimal digestive tolerance. Fermentable fibre sources (i.e. beet pulp and FOS) must also be used in limited quantity in their diet. Conversely, the incorporation of non‐fermentable fibre (i.e. cellulose) appears useful to increase their stool quality. For a small breed dog, the general objective is to minimize any ingredient that could excessively limit colonic fermentation and induce in fine constipation. Purified starches and cellulose are therefore not really suitable for them. In contrast, cereals flours as well as non‐fermentable fibre provided by cereals are recommended.     

The effects of extubation with an inflated versus deflated endotracheal tube cuff on endotracheal fluid volume in the dog

Objective The purpose of this study was to investigate the effect of extubation with the endotracheal tube (ETT) cuff inflated versus deflated on endotracheal fluid volume in normal canine cadavers. Study Design Prospective randomized blinded controlled cadaver study. Animals Sixteen adult Beagle cadavers weighing 10.7 ± 1.7 kg (mean ± SD) and <2 years of age. Methods Cadavers were orotracheally intubated in lateral recumbency, and the ETT cuffs were inflated to a closing pressure of 20 cm H₂O before barium was introduced orad to the cuff. The dogs were randomly assigned to an ETT cuff extubation condition of deflated or unchanged from the original closing pressure. After extubation, lateral thoracic radiographs of the cadavers were obtained and scored by three independent blinded reviewers. Each reviewer ordered all 16 lateral radiographs from most to least intratracheal contrast and also estimated residual intratracheal contrast volume. Results Dogs extubated with a deflated ETT cuff had a median rank of 13 and dogs extubated with an inflated ETT cuff had a median rank of 4.5 (p < 0.0001). Dogs extubated with a deflated ETT cuff had an estimated intratracheal volume of fluid of 1.8 mL ± 0.7 mL (mean ± SD) and dogs extubated with an inflated ETT cuff had an estimated volume of 0.9 mL ± 0.5 mL (p < 0.0001). Fleiss Kappa for agreement among evaluators was 0.875. Conclusions and clinical relevance Extubation with the cuff inflated removed more liquid contents from the trachea than extubation with the cuff deflated and may assist in the prevention of pulmonary aspiration when fluid is present in the proximal trachea. The technique did not remove all fluid so the potential for pulmonary damage remains.     

The determination of dark adaptation time using electroretinography in conscious Miniature Schnauzer dogs

The optimal dark adaptation time of electroretinograms (ERG''s) performed on conscious dogs were determined using a commercially available ERG unit with a contact lens electrode and a built-in light source (LED-electrode). The ERG recordings were performed on nine healthy Miniature Schnauzer dogs. The bilateral ERG''s at seven different dark adaptation times at an intensity of 2.5 cd·s/m² was performed. Signal averaging (4 flashes of light stimuli) was adopted to reduce electrophysiologic noise. As the dark adaptation time increased, a significant increase in the mean a-wave amplitudes was observed in comparison to base-line levels up to 10 min (p < 0.05). Thereafter, no significant differences in amplitude occured over the dark adaptation time. Moreover, at this time the mean amplitude was 60.30 ± 18.47 µV. However, no significant changes were observed for the implicit times of the a-wave. The implicit times and amplitude of the b-wave increased significantly up to 20 min of dark adaptation (p < 0.05). Beyond this time, the mean b-wave amplitudes was 132.92 ± 17.79 µV. The results of the present study demonstrate that, the optimal dark adaptation time when performing ERG''s, should be at least 20 min in conscious Miniature Schnauzer dogs.     

Laparoscopic ovariectomy in dogs: comparison between laparoendoscopic single-site and three-portal access

This study was conducted to evaluate the feasibility and therapeutic safety of laparoendoscopic single-site ovariectomy (LESS-OVE) and 3-portal laparoscopic ovariectomy (Lap-OVE) in dogs. Ten female mixed breed dogs were included in the study. Dogs were divided into group 1 (LESS-OVE; n = 5) and group 2 (Lap-OVE; n = 5). All procedures were performed by laparoscopic-skilled surgeons, and the anesthetic protocol was the same for all patients. In both groups, the ovarian vascular pedicle and ligaments were transected using a bipolar vessel sealer/divider device. The mean total surgical time was slightly longer in LESS-OVE (36.6 ± 3.5 min) than Lap-OVE (32.0 ± 3.0 min); however, the differences were not significant. Perioperative complications were not reported in any group. Both laparoscopic techniques were shown to be equally feasible and safe for patients. However, surgeons found LESS-OVE to require more skill than Lap-OVE. Therefore, additional studies should be conducted to evaluate this novel approach in clinical veterinary practice, and a proper laparoscopic training program for veterinary surgeons should be developed.     

Longitudinal study of veterinary students and veterinarians: the first 20 years

OBJECTIVE: To describe the career paths of veterinary graduates from the University of Queensland during the first 15 years after they graduated, paying particular attention to the fifteenth year. PROCEDURE: Longitudinal study. Questionnaires were completed by 154 first year veterinary students in 1985 and 1986, then while they were in fifth year, and after 1, 5, 10 and 15 years after they graduated. This paper describes findings from the most recent questionnaire but includes comparisons with previous ones. RESULTS: Completed questionnaires were received from 134 of the 137 graduates. They were spread widely, but 58% were in Queensland and 20% in New South Wales; 17% were overseas. Most (85%) were in private practice, and 56% of them were part or sole owners; 58% were working in cities with > 100,000 people, and 28% in centres with < 10,000 people. Overall 80% of the workload of the group was with dogs and cats, 8% with horses and 11% with farm animals. Most felt that their income was too low. Of those doing less than half-time or no veterinary work, 44% were at home with family, 8% in another business, 11% another profession, and the rest in a wide variety of occupations. Changed interests, need for greater challenges, poor remuneration, loss of interest in veterinary work, and caring for family were, in order, the top five (of 15) reasons for leaving veterinary work. Three-quarters (78%) of all those doing veterinary work, but 52% of those no longer doing veterinary work agreed that their career had lived up to their expectations. CONCLUSION: After 15 years 77% were still doing veterinary work, 85% in private practice, and 80% of their work was with dogs and cats. Almost all were either very glad or generally glad that they had done the veterinary course, though most (78%) felt that their income was too low.     

Effect of anaesthetic maintenance with isoflurane or propofol on ease of endoscopic duodenal intubation in dogs

ObjectiveTo compare the ease of endoscopic duodenal intubation (EDI) in dogs during maintenance of general anaesthesia with isoflurane or propofol infusion.Study designProspective, randomized, partially blinded clinical trial.AnimalsA total of 22 dogs undergoing upper gastrointestinal tract endoscopy to include EDI were recruited.MethodsDogs were randomly assigned isoflurane (ISO; n = 10) or propofol (PROP; n = 11) for maintenance of general anaesthesia. Following anaesthetic premedication with intramuscular medetomidine (0.005 mg kg^–1) and butorphanol (0.2 mg kg^–1), general anaesthesia was induced with propofol, to effect, maintained with 1.5% (vaporizer setting) isoflurane in 100% oxygen or 0.2 mg kg^–1 minute^–1 propofol. The dose of both agents was adjusted to maintain general anaesthesia adequate for the procedure. Degree of sedation 20 minutes post-anaesthetic premedication, propofol induction dose, anaesthetist and endoscopist training grade, animal’s response to endoscopy, presence of gastro-oesophageal and duodenal-gastric reflux, spontaneous opening of the lower oesophageal and pyloric sphincters, antral movement and time to achieve EDI were recorded. EDI was scored 1 (immediate entry with minimal manoeuvring) to 4 (no entry after 120 seconds) by the endoscopist, blinded to the agent in use. Data were tested for normality (Shapiro-Wilk test) and differences between groups analysed using independent t test, Mann-Whitney U test and Fisher’s exact test as appropriate.ResultsThere were no significant differences between groups for EDI score [median (interquartile range): 2 (3) ISO, 2 (3) PROP] or time to achieve EDI [mean ± standard deviation: 52.50 ± 107.00 seconds (ISO), 70.00 ± 196.00 seconds (PROP)]. Significantly more dogs responded to passage of the endoscope into the oesophagus in group PROP compared with group ISO (p = 0.01).Conclusions and clinical relevanceMaintenance of general anaesthesia with either isoflurane or propofol did not affect EDI score or time to achieve EDI.