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.     

Canine anaesthetic death in Spain: a multicentre prospective cohort study of 2012 cases

ObjectiveTo study current perianaesthetic mortality in dogs in Spain and to identify the main risk factors predisposing to perianaesthetic mortality in our country.Study designA multicentre prospective cohort study.Animal populationDogs anaesthetised for different surgical and diagnostic procedures at 39 Spanish veterinary clinics between February 2007 and March 2008.MethodsData of patients, procedures and anaesthetic management were recorded. Anaesthetic death was defined as perioperative death within 24 hours of the procedure end. A multivariate study evaluated perinanaesthetic death using logistic binary regression models with the Wald technique.Results2012 animals were included in the analyses. Twenty‐six dogs died. The global mortality rate was 1.29% (95% Confidence interval (95% CI): 0.88–1.89%). ASA I‐II was 0.33% (95 CI: 0.14–0.78%); ASA III‐V was 4.06% (95% CI: 2.67–6.13%). Most deaths occurred during the post‐operative period (20 dogs, 77%). The multivariate analysis revealed that high ASA grade was associated with an increased risk of mortality. The use of opioids plus NSAIDs during anaesthesia was related with a decrease of the risk.ConclusionsPerianaesthetic mortality in dogs in Spain was 1.29% (95% CI: 0.88–1.89%). ASA grade was the main prognostic factor of likelihood of death. The use of some analgesics (opioids and NSAIDs) in the perioperative period was associated with reduced odds of death and may be protective.Clinical relevanceEvaluation and stabilisation of patients before interventions may help lower risk of death during the anaesthesia. In addition to their use for welfare purposes, analgesics may be beneficial in reducing anaesthetic‐related deaths.     

The risk of death: the confidential enquiry into perioperative small animal fatalities

Objective To estimate the risks of anaesthetic and sedation‐related mortality in companion animals in the UK. (The Confidential Enquiry into Perioperative Small Animal Fatalities, CEPSAF). Study design A prospective cohort study with nested case–control study. Animal population All small animals anaesthetized and sedated at participating centres between June 2002 and June 2004. Methods Patient outcomes at 48 hours (alive, dead and killed) were recorded. Anaesthetic and sedation‐related death was defined as death where surgical or pre‐existing medical causes did not solely cause death. Species‐specific risks of anaesthetic‐related death and 95% confidence intervals (95% CI) were calculated. Risks were also estimated in the sub‐sets of dogs, cats and rabbits that were either healthy or sick (ASA 1–2 and 3–5, respectively). Results One hundred and seventeen veterinary practices participated in the study and 98 036 dogs, 79 178 cats and 8209 rabbits were anaesthetized and sedated. Overall risks of anaesthetic and sedation‐related death in dogs were 0.17% (1 in 601, 95% CI 0.14–0.19%), in cats 0.24% (1 in 419, 95% CI 0.20–0.27%) and in rabbits 1.39% (1 in 72, 95% CI 1.14–1.64%) within 48 hours of the procedure. In healthy dogs, cats and rabbits, the risks were estimated to be 0.05% (1 in 1849, 95% CI 0.04–0.07%), 0.11%, (1 in 895, 95% CI 0.09–0.14%) and 0.73% (1 in 137, 95% CI 0.54–0.93%), respectively. In sick dogs, cats and rabbits, the risks were 1.33%, (1 in 75, 95% CI 1.07–1.60%), 1.40% (1 in 71, 95% CI 1.12–1.68%) and 7.37% (1 in 14, 95% CI 5.20–9.54%), respectively. Postoperative deaths accounted for 47% of deaths in dogs, 61% in cats and 64% in rabbits. Most other small animal species had higher mortality risks. Conclusions and clinical relevance Small animal anaesthesia appears to be increasingly safe. Greater patient care in the postoperative period could reduce fatalities.     

Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats: a case-control study

Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats were investigated in an unmatched case-control study. A total of 197 animals from 150 veterinary practices across the United Kingdom was enrolled, including 105 MRSA cases and 92 controls with methicillin-susceptible S. aureus (MSSA) infection. The association of owners and veterinarian staff with the human healthcare sector (HCS) and animal-related characteristics such as signalment, antimicrobial and immunosuppressive therapy, and surgery were evaluated as putative risk factors using logistic regression. We found that significant risk factors for MRSA infection were the number of antimicrobial courses (p = 0.005), number of days admitted to veterinary clinics (p = 0.003) and having received surgical implants (p = 0.001). In addition, the odds of contact with humans which had been ill and admitted to hospital (p = 0.062) were higher in MRSA infected pets than in MSSA controls. The risk factors identified in this study highlight the need to increase vigilance towards identification of companion animal groups at risk and to advocate responsible and judicious use of antimicrobials in small animal practice.     

Histoplasmosis in dogs and cats

Histoplasma capsulatum is endemic throughout most of the United States with a high prevalence of infections in the Midwest and South. Histoplasmosis is the second most common systemic fungal disease in cats that may be more susceptible than dogs. Infection occurs by inhalation of conidia from the mycelial phase, which subsequently convert to the yeast form. Histoplasma capsulatum is phagocytized and harbored by cells of the mononuclear phagocyte system. Infection may be subclinical or cause clinical pulmonary granulomatous disease or dissemination. Disseminated disease predominantly affects the liver, spleen, gastrointestinal tract, bone and bone marrow, integument, and eyes. Primary gastrointestinal histoplasmosis also occurs. Clinical signs of histoplasmosis often are nonspecific, including chronic wasting, fever, anorexia, respiratory signs, and lameness. Gastrointestinal signs (eg, diarrhea with hematochezia or melena) are common in dogs. The definitive diagnosis is made by identification of the yeast in tissue samples. Itraconazole is the treatment of choice.     

A prospective study of postoperative surgical site infections in dogs and cats

OBJECTIVE: To assess postoperative surgical site infection (SSI) rate and to identify associated predictive factors. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs and cats that had surgery (1010 interventions) during 58 weeks from April 1999 to June 2000. METHODS: Data sheets were completed by clinicians. Patients were controlled for clinical evidence of SSI at suture removal. Two definitions of SSI ("infection" and "infection/inflammation") were developed specifically for this study and used for statistical analysis. Logistic regression models were built in order to identify significant predictive factors for SSI. RESULTS: Wounds with "infection/inflammation" occurred in 5.8% and "infected" wounds in 3% of patients. The outcome "infection" was associated with 3 major risk factors (duration of surgery, increasing number of persons in the operating room, dirty surgical site) and 1 protective factor (antimicrobial prophylaxis). The outcome "infection/inflammation" was associated with 6 significant factors (duration of anesthesia, duration of postoperative intensive care unit stay, wound drainage, increasing patient weight, dirty surgical site, and antimicrobial prophylaxis). CONCLUSIONS: SSI frequency in companion animals is comparable with the frequency observed in human surgical patients. Several significant predictive factors for SSI in small animals surgery were identified. CLINICAL RELEVANCE: Baseline information for SSI surveillance in our hospital and for comparison with other studies was defined. The factors identified may help to predict infections in surgical patients and to take adequate preventive measures for patients at risk.     

Primary hyperparathyroidism in dogs and cats

The most common cause of primary hyperparathyroidism in dogs and cats is a solitary adenoma involving an extracapsular parathyroid gland. The prognosis is excellent if the affected parathyroid gland is removed. Nonsurgical methods are discussed, although there are no current data to support any benefit over conventional surgery. The common postoperative complication to consider is hypocalcemia. Hypocalcemia can be successfully managed in these animals if it is anticipated and treated promptly.     

Campylobacter species in cats and dogs in South Australia

BACKGROUND: Campylobacter enteritis was the most frequently notified infectious disease in Australia in 1996 and Campylobacter species have been associated with extra-intestinal infections such as purulent arthritis and Guillian-Barré syndrome. Dogs and cats are known to carry campylobacteria and contact with household pets have been implicated as possible sources of human infection. OBJECTIVE: To provide information on the species of campylobacter carried by cats and dogs in South Australia. METHODS: Faecal samples were collected from stray and owned cats and dogs and feral cats. Campylobacter-like organisms were isolated using selective media and filtration methods. They were then characterised by biochemical tests, antibiotic resistance and growth patterns under various conditions. Husbandry factors that could have influenced the carriage rates were examined both as single variables and in a multivariate logistic regression. RESULTS: Campylobacter upsaliensis and C jejuni were found in 11% and 4% of cats, respectively, whereas 34% dogs carried C upsaliensis, 7% C jejuni and 2% C coli. Intensive housing and open drains were found to be significant risk factors and increased the carriage rate by 2 and 2.6 times, respectively. CONCLUSION: Dogs and cats are a potential reservoir for human enteric infections with campylobacters.     

Surgical repair of deep melting ulcers with porcine small intestinal submucosa (SIS) graft in dogs and cats

PURPOSE: To evaluate the efficacy of using a porcine small intestinal submucosa (SIS) graft for the surgical repair of deep melting ulcers in dogs and cats. METHODS: Two cats and five dogs presented with deep and large melting ulcers of the cornea. In each case, the necrotic and collagenolytic tissue of the cornea was removed by keratectomy. A SIS graft, 1 mm greater than the corneal defect, was rehydrated in sterile saline and sutured to the edges of the ulcer with a simple interrupted pattern of 9/0 polyglactin 910. A nictitating membrane flap was utilized in two cats and four dogs for 2 weeks. All cases were treated postoperatively with topical and systemic antibiotics, a systemic anti-inflammatory drug and topical atropine. All animals were re-evaluated 15 days, 4 weeks, 35-45 days, 2-3 months and 6 months postsurgery. RESULTS: At 15 days postsurgery, a superficial intense corneal neovascularization surrounded the SIS graft. No ocular discomfort was present and fluorescein staining was negative in all cases. At 4 weeks the SIS graft was thick and opaque in all cases, although in one cat the SIS graft had partially detached. Between 35 and 45 days, SIS graft integration was evident in all eyes, and corneal neovascularization had decreased progressively. All eyes healed without complications and retained corneal transparency. This occurred even in the presence of corneal perforation in two cases: one prior to and one during surgery. CONCLUSION: Results of our study suggest the SIS graft may be an effective alternative surgical treatment to the traditional conjunctival grafts commonly used to repair melting ulcers in dogs and cats. The advantages of using a SIS graft include good corneal transparency, preservation of corneal integrity and maintenance of vision.     

Iridociliary epithelial tumors in 100 dogs and 17 cats: a morphological study

The morphological features of iridociliary epithelial tumors in 100 dogs and 17 cats were reviewed. Twenty-seven cases were in either Golden Retrievers or Labrador Retrievers. Affected globes were stained for light microscopy with alcian blue, periodic acid Schiff (PAS) and hematoxylin and eosin stains. Selected tissues were examined by immunohistochemistry for vimentin, desmin, cytokeratin, S-100, neuron-specific enolase (NSE), and glial fibrillary acid protein (GFAP). The presence or absence of hyaluronic acid was recorded by staining with alcian blue before and after digestion of the tissue with hyaluronidase. Canine tumors were divided into papillary and solid tumors based on the pattern of growth. Twenty-eight of 57 papillary tumors exhibited invasive behavior including eight of the 57 which showed infiltration of the sclera. Twenty-nine of 43 solid tumors were invasive including 13 of 43 with scleral invasion. Tumors with scleral invasion were designated adenocarcinoma. Tumors of both types could be pigmented or nonpigmented and often contained smooth basement membranes reminiscent of the inner membrane of the nonpigmented ciliary body epithelial cell. All of the feline tumors were nonpigmented and 14 of 16 feline tumors were solid and two of the tumors were papillary. Eighteen of 20 canine tumors and three of four feline tumors stained positive for vimentin. Cytokeratin stain was positive only in a few of the highly aggressive tumors. The finding of pigmented epithelial cells, thick, smooth basement membrane structures, positive staining for vimentin, S-100, and NSE as well as hyaluronic acid deposition were considered to be features which define iridociliary epithelial tumors in dogs. The positive staining for vimentin and NSE are highly specific markers which help to characterize iridociliary epithelium and distinguish this tumor from metastatic epithelial tumors. The finding of solid nonpigmented tumors with small epithelial cells packeted by thin PAS-positive membranes staining positive for vimentin were considered significant features defining iridociliary epithelial tumors in cats. Follow-up information on survival and cause of death was obtained on 43 canine cases and only two feline cases. The average follow-up interval in dogs was 25 months and only two dogs died with lesions that could have been due to metastasis although neither was confirmed. We concluded that neither iridociliary adenomas nor adenocarcinomas is likely to metastasize.     

Practical application of holter monitoring in dogs and cats

Holter monitoring is a valuable noninvasive tool for the monitoring of the cardiac rhythm over a prolonged period during normal daily activities. The advent of this diagnostic test has demonstrated that the incidence of serious arrhythmias is much greater than previously determined using routine electrocardiography. A resting electrocardiogram is typically recorded for several seconds to several minutes and is likely to miss or underestimate the underlying arrhythmia. This article will present the clinical indications, equipment, technical application, and assessment of holter monitoring.     

Squamous cell carcinoma of the nasal planum in cats and dogs

The purpose of this article is to review the therapeutic options available for the treatment of squamous cell carcinoma of the nasal planum in cats and dogs. The techniques of complete and partial nasal planum resection in the cat are described in detail. Surgical treatment offers the greatest chance of cure, although several options are available for early, less invasive lesions.     

Correlation of cytologic and histopathologic findings with perinodal echogenicity of abdominal lymph nodes in dogs and cats

Abdominal lymphadenopathy in dogs and cats is routinely investigated with ultrasound. As the determination between benign and neoplastic etiologies of lymphadenopathy affects patient management, specific sonographic characteristics associated with both benign and neoplastic lymph nodes have been suggested. However, a significant overlap between these characteristics exists, necessitating a cytologic or histopathologic diagnosis in most instances. The objectives of this retrospective, cross‐sectional study were to evaluate whether echogenicity of perinodal fat could be a discriminator between benign and neoplastic abdominal lymphadenopathy and to assess if additional sonographic features associated with malignancy could be identified in lymph nodes with hyperechoic perinodal fat. Small animal patients (257 dogs and 117 cats) with sonographic evidence of abdominal lymphadenopathy and a cytological or histopathological diagnosis were evaluated for differences in the proportions of sonographic features between benign and neoplastic groups. Greater maximum long axis diameter (in dogs and cats) and a greater number of abnormal lymph nodes (in cats) were associated with malignancy in lymph nodes with hyperechoic perinodal fat. Canine lymph nodes with round cell neoplasia were significantly more likely to have hyperechoic perinodal fat. Lymph nodes affected with other neoplasia or with lymphadenitis were equally likely to have normal or hyperechoic perinodal fat. Reactive lymph nodes were significantly less likely to have hyperechoic perinodal fat in both species. These results suggest that though echogenicity of perinodal fat is a nonspecific finding, abdominal lymph nodes with hyperechoic perinodal fat are less likely to be reactive and sampling of these lymph nodes may be indicated.     

Scleral rupture in dogs, cats, and horses

OBJECTIVES: The aim of this retrospective study was to summarize the most frequent clinical signs, ultrasonographic, and histological findings accompanying scleral rupture as a result of blunt trauma in dogs, cats, and horses. ANIMALS STUDIED AND PROCEDURES: Thirty small animals and three horses diagnosed with scleral rupture resulting from blunt trauma. B-mode ultrasonography was performed on 20 animals. Histopathology was carried out on 18 enucleated globes. RESULTS: In small animals, 80% presented hyphema, 60% subconjunctival hemorrhage, and 53% eyelid and conjunctival swelling. In horses, 100% presented eyelid and conjunctival swelling, 67% hyphema, subconjunctival hemorrhage, and collapsed anterior chamber. Ultrasonographic findings were an area with ill-defined scleral margins (90%), echoic/hyperechoic contents in the anterior and posterior chamber (55%) and in the vitreous (80%). In small animals, scleral rupture location noted on gross examination was: at the posterior pole (4), close to the optic nerve (3), near the limbus (2), and in the dorsal aspect of the globe (1). In horses, the lesion was located at the limbus (3). In small animals, histopathology showed presence of hemorrhage in the anterior, posterior chamber, and vitreous (94%), retinal detachment (94%), choroidal edema and hemorrhages (88%), and choroidal detachment as a result of suprachoroidal hemorrhage (88%). The same lesions were found in the globes of two horses. In small animals, rupture location noted on histopathology was: at the posterior pole (8), close to the optic nerve (4), near the limbus (1), near the ciliary body (1). CONCLUSIONS: The most frequent clinical signs observed were hyphema, subconjunctival hemorrhage, and eyelid and conjunctival swelling. Ultrasonographic findings suggestive for scleral rupture were ill-defined scleral borders and/or echoic/hyperechoic material in the cavities of the globe. On histopathology, lesions severely altering the anatomy of the eye structures were: hemorrhage into the chambers of the globe, subretinal and suprachoroidal hemorrhage leading to retinal and choroidal detachment, respectively. In small animals, the most frequent locations for scleral rupture were the posterior pole and close to the optic nerve, whereas in horses it was the limbus.