Comparison of viscoelastic coagulation analysis and standard coagulation profiles in critically ill neonatal foals to outcome

Objective – To determine if changes in viscoelastic variables are associated with abnormalities observed in the standard coagulation profile and patient outcome in foals with suspected septicemia. Design – Prospective clinical trial during 2003 and 2004 foal season. Setting – Neonatal intensive care unit at a veterinary teaching hospital. Animals – Thirty critically ill foals <72‐hour‐old admitted sequentially meeting criteria for systemic inflammatory response associated with infection. Interventions – Hemostatic evaluation, using standard coagulation testing and viscoelastic analysis, was performed at admission, 24 hours following admission, and 48 hours following admission in critically ill foals. Standard coagulation tests included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin(ogen) degradation products, and antithrombin. Data collected from viscoelastic analysis included time to initial clot formation (ACT), clot rate, and platelet function. Signalment, blood culture results, clinicopathologic data, and outcome were collected from medical records. Equality of populations test was used to determine associations between coagulation tests and blood culture status/outcome, as well as between viscoelastic parameters and coagulopathy, blood culture status, and outcome. Logistic regression was used to quantify associations. A significance level of P<0.05 was used. Measurements and Main Results – Foals with decreasing clot rate (CR) over the sample period were more likely to be euthanized or die (P=0.02). Foals with prolonged ACT (P=0.03), and decreased CR at admission (P=0.047), were more commonly coagulopathic. Identification of coagulopathy on admission (P=0.02), or persistence of hemostatic dysfunction 48 hours later (P=0.04), was associated with death. Conclusions – Viscoelastic coagulation evaluation could be used in a neonatal intensive care unit setting to further characterize coagulopathy, and identify foals at higher risk for poor outcome.     

A comparison of auricular, rectal and pulmonary artery thermometry in dogs with anesthesia-induced hypothermia

Objective: To determine if a correlation exists among auricular, rectal and pulmonary artery (PA) temperatures in hypothermic dogs. Design: Prospective study. Setting: Angiography suite at a college of veterinary medicine. Animals: Sexually intact female research hounds (13.9–25.4 kg; n=8). Measurements and main results: Dogs were anesthetized for instrumentation with a percutaneously placed, thermistor‐tipped, PA catheter. Anesthesia was maintained until the core body temperature decreased to 36.6°C (97.8°F). Anesthesia was discontinued, and auricular and rectal temperatures were obtained every 15 minutes until the PA temperature reached 38.3°C (100.9°F). A strong correlation was noted among the 3 methods of temperature measurement (P<0.001; R≥0.846). No statistical difference was detected among measurement methods at baseline, the minimum temperature attained, nor the median temperature attained. However, at the maximum temperature attained, auricular measurements (37.7±0.4°C or 99.8±0.7°F) were lower than either the rectal (38.3±0.3°C or 100.9±0.5°F) or PA (38.3±0.3°C or 100.9±0.5°F) temperature measurements (P=0.001). Conclusion: There is a strong correlation among rectal, auricular and PA temperatures. Auricular temperature may be used to monitor core body temperature during postoperative rewarming; however, it might be slightly lower than core temperature as normothermia is reached.     

Evaluation of age and American Society of Anesthesiologists (ASA) physical status as risk factors for perianesthetic morbidity and mortality in the cat

Objective: To evaluate age and American Society of Anesthesiologists (ASA) physical status as risk factors for perianesthetic morbidity/mortality in cats. Design: Prospective cohort study. Setting: Institution teaching hospital. Animals: 138 cats ≥ 6 months of age that received inhalation anesthesia for ≥ 30 min Interventions: Observations were made during the 24 h post‐anesthetic period. Measurements and main results: Sixty‐one females and 77 males were included. Serious perianesthetic complications occurred in 15 cats (15/138; 11%), including cardiopulmonary arrest in 3 cats (3/138; 2%), and death or euthanasia in 7 cats (7/138; 5%). Age was not a factor in establishing risk for developing serious or minor perianesthetic complications in the cats in this study. However, ASA status was a risk factor. Cats having an ASA status of 3 or more were nearly 4 times as likely to develop serious perianesthetic complications, even when accounting for the significant confounding effects of anesthesia duration. Conclusions: ASA status, but not age, was a risk factor for the development of serious or minor perianesthetic complications in the 138 cats included in this study.     

Central venous access to the cranial vena cava via the omobrachial vein in the dog

Background– The omobrachial vein is a superficial vein that crosses the brachial region of the dog. It terminates in the cranial vena cava, offering a novel site for central venous catheterization into the cranial thorax. Case Summary– The omobrachial vein served as a point of access to the cranial vena cava for treatment and monitoring of a critical canine patient in this report. The omobrachial vein was catheterized using the modified‐Seldinger technique due to contamination of or lack of availability of commonly used central venous catheter insertion sites. Conclusion– Access to the cranial vena cava via the omobrachial vein was easily achieved, and the catheter was maintained without complication for 10 days. Although the site was successfully used in the patient in this report, omobrachial vein anatomy is not consistent in all dogs.