Suspected fatal venous air embolism during anaesthesia in a Pomeranian dog with pulmonary calcification

CASE HISTORY: Death occurred in a 1.25 kg, 9-month-old female Pomeranian dog undergoing anaesthesia for surgical repair of partially healed fractures of the radius and ulna.

CLINICAL FINDINGS: Following sedation, anaesthesia was induced using thiopentone and maintained with halothane in oxygen. An acute decrease in the dog's end-tidal carbon dioxide (EtCO₂) measurements was noted approximately 50 min after induction, immediately following delivery of a 5-ml bolus of lactated Ringer's solution (LRS) administered to flush a small (0.06 ml) volume of fentanyl via a pre-placed intravenous (I/V) catheter. Venous air embolism (VAE) was suspected and the dog died despite interventive therapy. On post-mortem examination, several air bubbles were noted when the right ventricle was opened under water. Histologically, the kidneys appeared abnormal with immature glomeruli, and the lungs appeared diffusely mineralised. The origin of the air was probably small bubbles and microbubbles that may have been present in the extension set and 20 ml syringe used for the administration of fentanyl and I/V fluids to the dog.

DIAGNOSIS: Renal dysplasia and diffuse pulmonary calcification, with VAE as the probable cause of death.

CLINICAL RELEVANCE: In this case of VAE-associated anaesthetic death, it is further speculated that underlying pulmonary disease, in the form of pulmonary calcification, may have contributed to an increased sensitivity to the adverse effects of VAE.     

MRI of a split cord malformation in a german shepherd dog

A 9 yr old spayed female German shepherd dog was referred for MRI of the thoracic and lumbar spine because she had clinical signs of chronic neurogenic bladder dysfunction of an unknown cause. Transverse T2-weighted images identified a type II split cord malformation (i.e., diastematomyelia) in the thoracic spine. Split cord malformations are forms of spinal dysraphism where the abnormal development of spinal cord results in sagittal splitting of a portion of the cord into two hemicords. The location of the lesion in the thoracic spine was consistent with the dog's clinical signs of an upper motor neuron bladder. Split cord malformations that occur in humans have similar MRI characteristics and can result in similar clinical signs as those identified in the dog described in this report.     

Peripheral metabolism of thyroid hormones and iodide in healthy and hyperthyroid cats

The metabolic clearance rate, volume of distribution, and fractional clearance rate of thyroxine (T4), triiodothyronine (T3), and iodide were calculated for 6 healthy and 7 hyperthyroid cats, using single-compartmental and noncompartmental methods of analysis. The mean T4 volume of distribution of the hyperthyroid cats was 32.0% less than that of the healthy cats; it was the only variable that was significantly different (P less than 0.05) between these 2 groups of cats. The mean fractional clearance rate of T4 in the hyperthyroid cats was 53.2% greater than that in the healthy cats, but this difference was not significant. Hyperthyroid cats had no significant differences in T3 or iodide kinetic variables when compared with those in healthy cats. Single-compartmental analysis significantly overestimated T4 kinetic variables of healthy cats and T4, T3, and iodide kinetic variables of hyperthyroid cats when compared with the noncompartmental method of analysis.     

Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review

The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.     

Validation of Forest Condition Monitoring Programme (ICP-Forests, level 1) cone index scores by measuring cone density using a field-of-view method

A measure of annual cone production is needed for evaluatingpotential seed crops and for the study of population changesof seed-eating species, but is rarely available in long timeseries or over extensive areas. The Forest Condition Monitoring(FCM) programme, which contributes to the International Co-operativeProgramme on Assessment and Monitoring of Air Pollution Effectson Forests (ICP-Forests), has been collecting coning data forScots pine, Norway spruce and Sitka spruce since 1989, fromplots located throughout Britain. A visual assessment systemis used to measure a coning index at four levels of abundanceas part of the overall crown health assessment. This study testedwhether the FCM abundance assessment was related to coning density,and therefore its potential for wider use in future research.Data from the survey have been compared with a field-of-viewmethod that assesses cone density, and the cone production representedby the FCM index has thus been determined. A direct relationshipbetween increased cone index and increased cone density wasfound; the use of a four-level scoring system allows differentcone densities to be distinguished with some reliability. Allocationof cone scores by surveyors from year to year was shown to beconsistent except in the case of abundantly coning Sitka spruce.These findings indicate that the FCM programme scoring methoddoes reflect cone production levels and that the data can beused to assess variation in coning between sites and betweenyears. The resolution of the coning data is adequate for assessingthe potential for natural regeneration of woodlands but notfor selecting stands for seed collections. It is also appropriatefor use as a measure of food resource to relate to populationchanges in seed-eating birds and mammals, and the long-termand Britain-wide nature of these data are of particular value.There is potential for the field-of-view method to be used morewidely to evaluate the quality of cone data collected at ICP-Forestsites throughout Europe where the same cone index method hasbeen employed.     

Gastric dilatation-volvulus in dogs

Gastric dilatation-volvulus (GDV) is a disease in which there is gross distension of the stomach with fluid or gas and gastric malpositioning. It causes pathology of multiple organ systems and is rapidly fatal. It is common in large- and giant-breed dogs. The disease appears to have a familial predisposition. Thoracic depth/width ratio also appears to predispose dogs to GDV. Implicated dietary factors include dietary particle size, frequency of feeding, speed of eating, aerophagia and an elevated feed bowl. A fearful temperament and stressful events may also predispose dogs to GDV. Abdominal distension, non-productive retching, restlessness, signs of shock, tachypnoea and dyspnoea are possible clinical signs. Initial treatment includes treatment of shock and gastric decompression. Surgical treatment should be performed promptly. There are no studies comparing the use of different anaesthetic agents in the anaesthetic management of GDV. Pre-medication with an opioid/benzodiazepine combination has been recommended. Induction agents that cause minimal cardiovascular changes such as opioids, neuroactive steroidal agents and etomidate are recommended. Anaesthesia should be maintained with an inhalational agent. Surgical therapy involves decompression, correction of gastric malpositioning, debridement of necrotic tissue, and gastropexy. Options for gastropexy include incisional, tube, circumcostal, belt-loop, incorporating, and laparoscopic gastropexy. Expected mortality with surgical therapy is 15–24%. Prognostic factors include mental status on presentation, presence of gastric necrosis, presence of cardiac arrhythmia and plasma lactate levels. Prophylactic gastropexy should be considered in dogs identified as being at high risk.