Postoperative pulmonary complications in dogs undergoing laparotomy: frequency, characterization and disease-related risk factors

Objective: To determine the frequency of postoperative pulmonary complications (PPCs) in dogs following laparotomy, characterize the nature of PPCs, and identify disease‐related risk factors for PPCs in dogs. Design: Retrospective clinical study. Setting: University‐affiliated small animal teaching hospital. Animals: One hundred and sixty‐two dogs without preoperative pulmonary pathology that underwent laparotomy surgery. Interventions: None. Measurements and main results: Cases were evaluated for factors including patient signalment, preexisting disease, primary and ancillary surgical procedure(s), development of postoperative pulmonary disease, characteristics of perioperative hospitalization and therapy, and survival. Twenty‐two percent of dogs in the study developed PPCs. PPCs included respiratory arrest (n=4), acute respiratory distress syndrome (ARDS) (n=3), pneumonia (n=8), hypoventilation (n=13), and transient hypoxemia (n=8). Dogs that developed PPCs had a significantly longer duration of oxygen therapy, longer duration of stay in intensive care unit (ICU), and decreased survival. Dogs with perioperative vomiting or regurgitation were more likely to develop PPCs. Animals that underwent exploratory laparotomy for biliary or septic peritonitis were also more likely to develop PPCs. Conclusions: PPCs occur in dogs following laparotomy and contribute significantly to the morbidity and mortality of these surgical patients. In this patient population, animals with vomiting, regurgitation, or peritonitis may be at a higher risk of developing PPCs. Animals with the identified risk factors should be monitored carefully postoperatively for development of pulmonary complications.     

Perioperative hypothermia

Objective: To review the pathophysiology and management of perioperative hypothermia in dogs and cats. Data sources: Current veterinary and human literature regarding hypothermia was reviewed for this paper. Sources included but were not limited to the following: review articles, clinical trials, and experimental studies. Summary: Perioperative hypothermia is a common, treatable complication of general anesthesia. Homeostatic derangements in thermoregulation from anesthesia and abnormal vasoconstriction can produce alterations in hepatic function, coagulation, cardiac function, renal function, humoral and cellular immunity, and wound healing. Conclusion: Management of perioperative hypothermia includes passive and active surface rewarming along with active core rewarming. Measures to correct hypothermia will diminish the complications of altered mentation, immunity, cardiac function, and wound healing. Simple measures such as monitoring intraoperative temperature continuously, using circulating warm water blankets, forced air warming devices, and warm isotonic lavage fluids will aid in the correction of the hypothermic patient.     

Preliminary evaluation of hemostasis in neonatal foals using a viscoelastic coagulation and platelet function analyzer

Objectives – To compare coagulation and platelet function parameters measured using a viscoelastic analyzer in 3 groups: foals presenting to a neonatal intensive care unit with presumed sepsis, normal foals, and adult horses. Design – Preliminary prospective trial. Setting – Veterinary teaching hospital. Animals – Ten clinically healthy foals, 13 clinically healthy adult horses, and 17 foals sequentially admitted for suspected sepsis. Intervention – A single citrated (3.8%) blood sample collected at admission was submitted for coagulation evaluation using a viscoelastic analyzer. Measurements and Main Results – Time to initial clot formation (ACT), clot rate (CR), platelet function, and time to peak parameters were collected from the signature generated with the associated software. Peak clot strength was collected manually from signature tracings. Signalment, presenting complaint, blood culture results, clinical progression, and outcome were collected from the medical record. Kruskal‐Wallis testing was used to determine differences in coagulation parameters between groups, as well as to identify any associations between coagulation variables, foal variables, and outcome. Normal foals were more likely to have increased platelet function (P=0.04) compared with normal adult horses. Prolonged ACT (P=0.004) and decreased CR (P=0.03) were associated with foals with positive blood culture. There was a trend toward prolonged ACT and increased likelihood of death (P=0.06). Conclusions – Healthy foals differ in values measured by the viscoelastic coagulation and platelet function analyzer compared with healthy adult horses. ACT and CR abnormalities were more likely to be observed in foals with positive blood cultures. The viscoelastic coagulation and platelet function analyzer may be useful in identifying early hemostasic and platelet dysfunction in critically ill foals, particularly those that are septic.     

Assessment and management of the severely polytraumatized small animal patient

Objective: To review the current recommendations for the care of the seriously injured polytraumatized small animal patient, including team organization and facility readiness; scene assessment and care; transport; and hospital assessment and care. Data sources: Original research articles, scientific reviews, book chapters, and clinical experience. Human data synthesis: The care of the seriously injured patient is demanding and requires adequate preparation, rapid access to organized resources and equipment, and skilled personnel. Second in urgency only to stabilization of the airway and breathing is shock. In many, surgical intervention to provide improved and continued stability is required. Evidence is provided by data published comparing survival for humans with high injury scores being cared for at level I trauma centers compared with small rural hospitals. Personal experience as a member of an emergency medical team in the care of multiple injured human patients in both level I trauma centers and small hospitals is also used in this review. Veterinary data synthesis: Publications reporting large clinical series of seriously injured dogs and cats are minimal. Experimental animal models of shock caused by blood loss and the study of various organ injuries and their management are numerous. These and 35 years of the author's experience in managing severely injured dogs and cats (estimated to be >750) is also used in this review for generation of guidelines. Conclusions: Guidelines for care of severe multiple injury patients are presented and are recommended to be used in clinical veterinary medical practice to improve outcome.