Management of intraoperative and postoperative anesthetic complications in ruminants and swine

Complications that can occur during and following anesthesia in ruminants and swine are discussed. Because many of these complications can be life-threatening, they must be avoided to allow provision of safe general anesthesia. Emphasis is placed on prevention and recognition of these complications and the institution of therapy when they do occur.     

Complications of external fixation. A problem-oriented approach

External fixation is an effective method of stabilizing many fractures in veterinary orthopedics, however, it is not foolproof. Although careful attention to the principles of fixator selection and application is the optimal way to minimize complications, they do still occur. Prompt recognition of these complications and appropriate treatment, however, will minimize their effects and result in the successful outcome of fracture healing and normal limb function.     

Common complications of fracture repair

Complications are a reality of fracture repair. Many can be avoided or minimized by being aware of their pathophysiology and predisposing factors. Others are unavoidable but their resolution may be aided by early diagnosis and appropriate treatment. Major complications of fracture repair include osteomyelitis, delayed union, nonunion, malunion, premature physeal closure, and fracture associated sarcoma. Consideration of these complications should factor into presurgical patient evaluation as well as postoperative management. This discussion focuses on how to avoid, recognize, and treat these complications.     

Renal biopsy of dogs and cats

Renal diseases are common in dogs and cats. Renal biopsy may be required during the evaluation of the patient to establish a definitive diagnosis, determine the severity of the lesion and formulate an optimal treatment plan. Renal biopsy specimens can be collected via several methods. Percutaneous techniques are performed with ultrasound guidance in both dogs and cats or blindly in cats. If ultrasound guidance is not available, the keyhole technique can be used in dogs. Biopsy can also be performed using laparoscopy or surgery. While complications can arise with any of these techniques, complications are less frequent when an experienced operator uses proper technique. Renal biopsy specimens must be processed and evaluated appropriately if consistent and accurate diagnoses are to be rendered. The article summarizes patient selection and evaluation, renal biopsy techniques, expected complications of renal biopsy, and appropriate processing and evaluation of the renal biopsy specimen.     

Permethrin toxicity in cats: a retrospective study of 20 cases

OBJECTIVE: Permethrin is a synthetic pyrethroid widely used in flea control products for small animals. Accidental toxicity can occur with off-label usage, and cats are particularly susceptible. METHODS: Retrospective study of 20 cases of permethrin toxicity in cats treated at an emergency clinic in Brisbane, Queensland from October 2004 to June 2005. RESULTS: The diagnosis of permethrin toxicity was made on the basis of a history of exposure and characteristic clinical signs, including seizures, muscle fasciculations, and tremors. Decontamination and appropriate seizure or muscle fasciculation control were the basis of treatment. The outcome was good after rapid intervention and 19 of the 20 cats were successfully treated, with the only death occurring in a kitten for which treatment was delayed for 24 h. No long-term complications were reported by the cats' owners at 4-month follow-up after discharge from hospital. CONCLUSIONS: Owner education, together with more appropriate product labelling, may help eliminate this problem in the future.     

Preventing and managing complications of enteral nutritional support

Complications of enteral nutritional support include mechanical problems related to the feeding device, gastrointestinal side effects, metabolic disturbances, and infectious complications. Although the sickest patients are often the ones that we feel will most likely benefit from nutritional support, they are generally more challenging to feed and least likely to tolerate complications arising from assisted feeding. Many of the problems that can occur with enteral nutritional support can be anticipated, which may allow them to be avoided or possibly aid in early detection and thereby minimize consequences to the patient. Therefore, knowledge of the types of complications that can occur with enteral nutritional support will aid in the process of deciding whether and how a patient should receive assisted feeding, and what parameters to monitor while a patient is receiving nutritional support.     

Opinions of veterinarians about the age at which kittens should be neutered

The mean age recommended by veterinary practices for neutering kittens is 22.6 weeks, with only 28 per cent of veterinarians considering it appropriate to neuter 12- to 16-week-old kittens. Multivariable logistic regression was used to identify variables associated with veterinarians' opinion that 12 to 16 weeks is an appropriate age at which to neuter kittens. Significant risk factors included time since graduation, perception of the problem of there being too many unwanted domestic cats and their practice's policy on the recommended neutering age. Veterinarians who thought that neutering eight- to 11-week-old rescue kittens before homing was justified and veterinarians who had neutered 12- to 16-week-old domestic kittens within the previous year were more likely to consider that neutering 12- to 16-week-old kittens was appropriate. Veterinarians who thought that surgical complications, anaesthetic complications and lower urinary tract disease were, or might be, more likely to occur in kittens neutered at 12 to 16 weeks than in those neutered at six months of age, were significantly less likely to think that neutering 12- to 16-week-old kittens was appropriate.     

Use of reversed periosteal flaps in the repair of large nasocutaneous fistulas in two horses

Head injuries occur frequently in horses and a successful outcome after repair depends upon the severity of the initial trauma, the anatomical structures involved and the extent of tissue loss. Often these injuries involve facial bones and enter into the nasal passages or paranasal sinus system. When these injuries occur in conjunction with substantial tissue loss, the resulting defect may be difficult to close and naso/sinocutaneous fistulae can develop. These defects can be challenging and time consuming to repair and an appropriate reconstructive technique must be selected. We describe the use of reverse periosteal flaps as a technique in repairing large nasocutaneous fistulae in 2 horses after previous attempts to close the defects by other means had failed.     

Monitoring techniques for diabetes mellitus in the dog and the cat

One of the keys to achieving glycemic control in animals with diabetes mellitus is the appropriate selection and interpretation of analytic monitoring tests. Diabetic animals are subject to many of the same problems described in human diabetics. Diabetics are more susceptible to infection, and wound healing is often impaired. Decreased insulin promotes lipolysis and moderate hyperlipidemia, which can lead to falsely lowered fructosamine levels, impaired renal circulation, and atherosclerosis. Hyperglycemic, hypoinsulinemic animals continue to lose weight despite an increased appetite and an increased intake because they are not able to use glucose. Many unregulated diabetic animals will present with vomiting and diarrhea that can exacerbate electrolyte abnormalities seen with the osmotic diuresis present in an uncontrolled state. Canine diabetics are prone to cataract formation secondary to sorbitol accumulation in the lens. Cats, on the other hand, can present with diabetic distal neuropathy, which may be reversible with appropriate treatment. With all of these potential complications, it is important to monitor these animals regularly; this is the only way that glycemic control can be properly maintained over time. This article reviews the monitoring parameters available to the modern practitioner and outlines the benefits of each test, as well as caveats, in their interpretation.     

Axillary wounds in horses and the development of subcutaneous emphysema,pneumomediastinum and pneumothorax

Equine axillary wounds are common in horses. Severe and potentially life‐threatening complications that can result from axillary wounds include subcutaneous emphysema, pneumomediastinum and pneumothorax. This report describes the occurrence of these complications and appropriate treatment. Case records of 7 horses after sustaining an axillary wound are reviewed. Of these cases, all 7 developed subcutaneous emphysema, 5 developed a pneumomediastinum and 4 developed a pneumothorax. The time between the wound occurrence and the development of subcutaneous emphysema was able to be determined in 5 of the 7 cases. The mean ± s.d. time for the development of subcutaneous emphysema following initial injury was 3.2 ± 0.84 days (range 2–4 days). Resolution of subcutaneous emphysema was not achieved until the treatment included packing the wound to stop it from acting as a one‐way valve. Horses with a pneumothorax in respiratory distress were managed with thoracocentesis or placement of thoracic drains. Horses with a pneumothorax but without respiratory distress were treated with conservative management. All horses survived to discharge.     

Retrospective analysis of nonradiation complications in dogs undergoing radiation therapy

Dogs receiving radiation can develop complications unrelated to the radiation treatment. No study to date has described these complications in clinical patients undergoing multiple radiation therapy treatments. The purpose of this retrospective case‐control study was to characterize the incidence and type of complications that occur in these dogs. A secondary goal was to evaluate whether patient and treatment characteristics could be identified to predict the risk of these complications. Medical records of 268 dogs receiving at least one radiation treatment at a single institution, between September, 2004 and June, 2007 were reviewed. Age, breed, gender, body weight, tumor type, tumor location, number of treatments, pre‐treatment blood work abnormalities, and whether chemotherapy, glucocorticoids, or nonsteroidal anti‐inflammatory drugs were given were collected. Number, type, and severity of nonradiation complications were recorded. Complications attributed to the tumor or to the radiation were excluded. Statistical analyses were performed to determine whether demographic and clinical characteristics were associated with development of a complication. General anesthesia was used for all treatments. Complications occurred in 101 (37%) cases including diarrhea, vomiting, cough, and loss of appetite, which were typically mild. Seventeen dogs (6%) developed severe complications. Eight dogs (3%) died from their complication. Dogs that developed complications were younger, received more treatments, had leukocytosis, received glucocorticoids, and were less likely to have thrombocytopenia. On multivariate analysis, number of treatments and leukocytosis were significantly associated with complications. Findings indicate that nonradiation complications are common in dogs receiving radiotherapy under general anesthesia. In this population, complications were usually mild or self‐limiting.     

External coaptation.

The goal of any method of fracture repair should be the early return of total limb function and the prevention of fracture disease. This can be accomplished through adhering to the basic principles of good patient and fracture assessment, choosing the correct method of fracture repair, and appropriate patient care. The complications of external coaptation can be minimized by appropriate patient and fracture assessment as well as correct cast and splint application. Choosing external coaptation as a method of fracture repair can be rewarding as long as the appropriate steps are taken to ensure success.     

Spotted fever group rickettsiae: a brief review and a Canadian perspective

Spotted fever group rickettsioses (SFGR) are infections caused by established and emerging human pathogens worldwide. These rickettsial agents are transmitted to humans via arthropods and may result in mild to severe and potentially fatal diseases. Spotted fever group rickettsioses are characterized by similar clinical features, including fever, rash, headache and myalgias, with the development of an inoculation eschar in many, but not all cases. Endemic rickettsial infections do occur but are infrequent in Canada, in contrast to the United States, where these infections are far more prevalent. Travel-associated rickettsioses, however, are being diagnosed with increasing frequency in Canadian travellers returning from international trips abroad, in particular in travellers returning from Africa. The diagnosis of rickettsial infections can be challenging owing to the non-specific nature of the clinical symptoms and the requirement for specialized testing. Serology cannot distinguish between the approximately 20 spotted fever group rickettsial species currently known or suspected to be capable of causing human infection. Molecular testing is required to determine the rickettsial species responsible for infection, but requires greater effort on the part of the clinician to collect appropriate samples, including cutaneous skin swabs from under the eschar or skin punch biopsies of the eschar or rash. Infections with spotted fever group rickettsiae likely occur more commonly than currently recognized and should be considered in patients with appropriate symptoms and exposure histories.     

Getting to the point: indications for fine-needle aspiration of internal organs and bone

The technique of fine-needle biopsy (fine-needle aspiration or fine-needle fenestration) for cytologic evaluation can be extended to many sites beyond the traditional lymph node and skin. Intra-abdominal, intrathoracic, and bone lesions can be easily and rapidly evaluated cytologically. Percutaneous fine-needle aspiration and fine-needle fenestration are useful, accurate, and inexpensive techniques with a rapid turnaround time, and outpatient applicability. For most pets, these minimally invasive techniques do not require anesthesia or analgesia. Although risks are inherent with any invasive procedure, complications are uncommon even with visceral and intrathoracic fine-needle biopsy. Attention to appropriate technique and close patient monitoring minimize the morbidity and improve the diagnostic utility. The low cost, low risk, minimal invasiveness, and high diagnostic yield make fine-needle biopsy particularly attractive to clients. In combination with ultrasound guidance and newer staining techniques, these diagnostic procedures are invaluable to the veterinary clinician.     

Prospective evaluation of complications associated with jugular venous catheter use in a veterinary hospital

Objectives : To prospectively investigate the incidence of mechanical and infectious complications associated with the use of jugular catheters and risk factors for these complications. Methods : Data was collected over a 6-month period and risk factors associated with the occurrence of mechanical or inflammatory complications were investigated. Results : One hundred catheters were placed over a 6-month period, totalling 393 catheter days. Complications were seen in 39% of catheters with a total of 51 complications. Forty-one of these complications were mechanical. A total of 10 inflammatory or infectious complications were identified in eight catheters (a total of 0·03 infectious complications per catheter day). Complications were more likely to occur in patients requiring more than one attempt for placement and patients that were ASA status 3 to 5. Infectious complications were more likely in patients not having general anaesthesia for placement, those having medical rather than surgical disease and those placed out of theatre. No association was found between the skill of the person placing the catheter and risk of complication. Clinical Significance : Mechanical complications are frequently associated with jugular catheter placement. Identification of risk factors for complications is important and warrants further study.     

Common Peripartum Problems in the Mare

Reproductive problems in the perinatal period can adversely affect a mare's future fertility or, worse, may be life threatening to her or her foal. A number of abnormalities can occur, including uterine torsion, uterine artery or uterine hemorrhage, retained fetal membranes, metritis, rectovaginal injuries, and necrotic vaginitis. Because hemorrhage, retained placenta, metritis, and necrotic vaginitis can happen after a normal delivery or after dystocia, all mares should be monitored closely in the first days after parturition for signs of lethargy, depression, colic, sore feet, or anorexia. Methods for diagnosing, managing, and treating these conditions and the possible complications are discussed.     

Management of hard-to-heal wounds.

Some wounds do not heal normally and present the practitioner with a challenge. These can be thought of as hard-to-heal wounds. There are numerous causes of such wounds, and when they occur, the veterinarian should consider all factors associated with the wound. When diagnostic tests are indicated, they should be performed. Finally, appropriate measures should be taken to correct the underlying cause of the hard-to-heal wound.     

A review of equine laryngoplasty complications

Prosthetic laryngoplasty is a common treatment for equine recurrent laryngeal neuropathy (RLN). Complications of this surgery include immediate post operative problems, such as dysphagia, seroma formation, wound infection and sudden loss of arytenoid abduction. Longer term complications include gradual loss of arytenoid abduction, chronic coughing, arytenoid granulomas and dynamic upper airway collapse unrelated to RLN such as palatal dysfunction, and aryepiglottic fold or vocal fold collapse. However, the benefit of this procedure greatly outweighs these potential post operative complications, especially if appropriate surgical and post operative management practices are employed.     

The management of open joint injuries

The prognosis for returning horses with open joint injuries to athletic function is most closely related to the duration of the injury prior to treatment. Prompt diagnosis and appropriate therapy should yield a favorable result. Delayed diagnosis or inappropriate therapy that allow the wound to progress to an infected state makes the likelihood of return to athletic function poor. Refractory joint infection can occur despite early diagnosis and prompt appropriate therapy. The development of these infections is undoubtedly increased by tissue loss and gross contamination. Appropriate antibiotics given long term probably play the most significant role in resolving joint sepsis. When the refractory nature of the infection is accompanied by cartilage loss and bone proliferation, aggressive treatment by open drainage, synovectomy, and arthrodesis of the joint should be considered.     

Epidural analgesia and anesthesia.

This review describes the beneficial effects of the use of epidural drugs for pre-emptive analgesia, intraoperative analgesia with an inhalant-sparing effect, and prolonged postoperative analgesia. Epidural morphine oxymorphone, or hydromorphone is recommended for use in small animals in combination with a local anesthetic of appropriate duration for procedures involving the hind end, although epidural morphine or hydromorphone may be more appropriate for procedures on the thorax and forelimbs. Side effects are few and can usually be easily managed, with the benefits outweighing any detrimental effects that might occur.