Disseminated candidiasis secondary to fungal and bacterial peritonitis in a young dog

Objective – To describe a severe case of bacterial sepsis and disseminated candidiasis in a previously healthy dog.
Case Summary – Fungal sepsis was identified in a 2-year-old dog following intestinal dehiscence 4 days after abdominal surgery. Septic peritonitis was identified at admission and evidence of dehiscence at the previous enterotomy site was found during an exploratory laparotomy. Both gram-positive cocci and Candida albicans were cultured from the abdominal cavity. Candida sp. was also subsequently cultured from a central venous catheter. Euthanasia was performed due to failure to respond to therapy. Fungal organisms, morphologically consistent with Candida spp., were found in the lungs and kidney on postmortem histopathologic examination indicating disseminated candidiasis.
New or Unique Information Provided – Candida peritonitis is a well-recognized entity in humans and contributes to morbidity and mortality in critically ill patients. Abdominal surgery, intestinal perforation, presence of central venous catheters, and administration of broad-spectrum antibiotics are all considered to be suspected risk factors. This report describes the first known case of systemic candidiasis occurring secondary to Candida peritonitis and bacterial sepsis in a critically ill dog.     

The effect of volatile anaesthetics on the relative sensitivity of facial and distal thoracic limb muscles to vecuronium in dogs

ObjectiveTo compare n. facialis-m. nasolabialis (nF-mNL) and n. ulnar-mm. carpi flexorii (nU-mCF) sensitivity to vecuronium during halothane or isoflurane anaesthesia.Study designRandomized, prospective, experimental study.AnimalsForty-four client-owned dogs (19 male, 25 female) undergoing surgery; mean age: 5.0 years; mean body mass: 24.7 kg.MethodsThirty minutes after acepromazine (0.05 mg kg^?1) and morphine (0.5 mg kg^?1), anaesthesia was induced with intravenous (IV) thiopental and maintained with either halothane (n = 22) or isoflurane (randomly allocated) in oxygen. The lungs were mechanically ventilated and end-tidal inhaled anaesthetic (Fe’_IAA) maintained at 1.2 × MAC values. Neuromuscular transmission at nF-uNL and nU-mCF was monitored using the train of four count. Vecuronium (50 μg kg^?1 IV) was injected (t = 0) after 15 trains, 50-60 minutes after inhalational anaesthesia began, when Fe’_IAA had been constant for >15 minutes. Times of the disappearance (-) and reappearance (+) of the fourth (T4) and first twitch (T1) were recorded allowing the calculation of: latent (t = 0 to T4-) and manifest onset times (t = 0 to T1-) duration of blockade (T1- to T1+) and drug effect (T4- to T4+) and recovery time (T1+-T4+). Student’s paired t-test was used to compare simultaneous responses at nF-uNL and nU-mCF. An unpaired t-test was used to compare anaesthetic effects.ResultsLatent and manifest onset times were significantly (p < 0.05) briefer, blockade and drug effects were significantly longer and recovery from blockade were significantly slower in the nF-mNL unit in both halothane and isoflurane recipients. Profound block duration and drug action were significantly longer and recovery from blockade were significantly slower in halothane recipients at both nerve-muscle units.Conclusion and clinical relevanceThe nF-mNL was more sensitive than nU-mCF to vecuronium, particularly in halothane-anaesthetized dogs.     

The use of lingual venous blood to determine the acid‐base and blood‐gas status of dogs under anesthesia

ObjectiveTo assess the suitability of lingual venous blood (LBG) as an alternative to arterial blood (ABG) samples in determining acid–base balance and blood–gas status in dogs anesthetized for elective procedures and with medetomidine and isoflurane administration under experimental conditions.Study designProspective, randomized clinical and experimental study.AnimalsClinical population of 18 ASA I/II dogs for elective surgery and five healthy Beagles (3 females and 2 males) for the experimental study.MethodsBlood sampling was simultaneously performed at dorsal pedal arterial and lingual venous sites, generating paired data. Two paired samples were collected from each dog in the clinical part and four from each dog in the experimental part (two during isoflurane anesthesia and two during isoflurane plus medetomidine). A modified Bland and Altman method was used to examine data from the clinical part and the experimental data were subjected to a paired sign's test following transformation where appropriate.ResultsThe pH of LBG overestimated ABG, with limits of agreement of (?0.01, 0.02). The partial pressure of carbon dioxide (PCO₂) of LBG overestimated ABG by 0.6 mmHg [0.1 kPa], with limits of agreement of (?3.5, 4.6) mmHg [?0.5, 0.6 kPa]. The partial pressure of oxygen (PO₂) of LBG underestimated ABG by 86.3 mmHg [?11.5 kPa], with limits of agreement of (?199.8, 27.3) mmHg [?26.6, 3.6 kPa]. During medetomidine administration values for PO₂ (p = 0.03) and lactate (p = 0.03) were lower for LBG when compared with ABG. The LBG value of PO₂ was lower (p = 0.03) during medetomidine and isoflurane administration versus isoflurane alone.Conclusions and clinical relevanceThe pH and PCO₂ of LBG samples provide clinically acceptable substitutes of ABG samples in the dog population studied. The wider limits of agreement for PO₂ render it less reliable as a substitute for ABG. The difference in PO₂ identified between LBG and ABG during medetomidine administration may not preclude the use of LBG as substitutes for ABG samples.     

Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs

Objective – To describe the use of IV and oral mycophenolate mofetil (MMF) as adjunctive therapy in 3 dogs with severe generalized myasthenia gravis.
Case Series Summary – Three dogs suffering from severe generalized myasthenia gravis as confirmed by acetylcholine antibody titers were treated with MMF as part of their treatment regimens. All 3 dogs had radiographic evidence of megaesophagus and suffered from severe regurgitation. Each dog was initially treated with pyridostigmine and supportive agents. When clinical remission was not achieved, IV MMF was administered to all dogs. Signs of clinical remission were apparent within 48 hours and all dogs were later maintained on oral MMF following resolution of regurgitation.
New or Unique Information Provided – This is the first report of the use of IV MMF as adjunctive treatment in dogs with severe generalized myasthenia gravis. Outcome was favorable in all 3 dogs and no adverse effects were noted from the MMF.     

Brown recluse spider (Loxosceles reclusa) envenomation in small animals

Objective – To provide a comprehensive review of relevant literature regarding the brown recluse spider (BRS) and to define those criteria that must be satisfied before making a diagnosis of brown recluse envenomation.
Etiology – The complex venom of the BRS contains sphingomyelinase D, which is capable of producing all the clinical signs in the human and some animal models.
Diagnosis – There is no current commercially available test. In humans there are many proposed guidelines to achieve a definitive diagnosis; however, there are no established guidelines for veterinary patients.
Therapy – Currently, no consensus exists for treatment of BRS envenomation other than supportive care, which includes rest, thorough cleaning of the site, ice, compression, and elevation.
Prognosis – Prognosis varies based on severity of clinical signs and response to supportive care.     

Assessment of cardiac troponin I and C-reactive protein concentrations associated with anesthetic protocols using sevoflurane or a combination of fentanyl, midazolam, and sevoflurane in dogs

ObjectiveTo report serum cardiac troponin I (cTnI) and C-reactive protein (CRP) concentrations in dogs anesthetized for elective surgery using two anesthetic protocols.Study designProspective, randomized clinical study.AnimalsTwenty client-owned dogs presenting for elective ovariohysterectomy or castration.MethodsThe dogs were randomized into two groups. All dogs were premedicated with glycopyrrolate (0.011 mg kg^?1) and hydromorphone (0.1 mg kg^?1) IM approximately 30 minutes prior to induction of anesthesia. Anesthesia in dogs in group 1 was induced with propofol (6 mg kg^?1) IV to effect and in dogs in group 2 with diazepam (0.2 mg kg^?1) IV followed by etomidate (2 mg kg^?1) IV to effect. For maintenance of anesthesia, group 1 received sevoflurane (adjustable vaporizer setting 0.5–4%) and group 2 received a combination of fentanyl (0.8 μg kg^?1 minute^?1) and midazolam (8.0 μg kg^?1 minute^?1) IV plus sevoflurane (adjustable vaporizer setting 0.5–4%) to maintain anesthesia. Serum cTnI and CRP concentrations were measured at baseline and 6, 18, and 24 hours post-anesthetic induction. Biochemical analysis was performed at baseline. Lactate was obtained at baseline and 6 hours post-anesthetic induction. Heart rate and mean arterial blood pressure were measured intra-operatively.ResultsBaseline serum cTnI and CRP concentrations were comparable between groups. A significant difference in serum cTnI or CRP concentrations was not detected post-operatively between groups at any time point. Serum CRP concentrations were significantly increased post-anesthetic induction in both groups, which was attributed to surgical trauma.Conclusions and clinical relevanceThere was no significant difference in serum cTnI and CRP concentrations between anesthetic protocols. Further investigation in a larger number of dogs is necessary to confirm the current findings.     

Tramadol improved the efficacy of ketamine–xylazine anaesthesia in young pigs

ObjectiveTo evaluate the influence of premedication with tramadol on xylazine–ketamine anaesthesia in young pigs.Study designProspective, randomized, blinded cross-over study.AnimalsTen young Niger hybrid pigs: mean weight 6.1 ± 0.6 kg.MethodsPigs were anaesthetized twice. Xylazine (2.5 mg kg^?1), ketamine (25 mg kg^?1) and atropine (0.04 mg kg^?1) were administered by intramuscular (IM) injection, 5 minutes after either tramadol (5 mg kg^?1)) (treatment XKT) or saline (treatment XKS). Time to loss of righting reflex (TLRR), duration of antinociception, duration of recumbency (DR) and recovery times (RCT) were recorded. Quality of induction of anaesthesia including ease of endotracheal intubation was assessed using a subjective ordinal rating score of 1 (worst) to 4 (best). Heart, pulse and respiratory rates, arterial oxygen saturations and rectal temperatures were determined over 60 minutes. Antinociception was assessed by the pigs’ response to artery forceps applied at the interdigital space. Data were compared with Student's t-test, Mann–Whitney's test or analysis of variance (anova) for repeated measures as appropriate and are presented as mean ± standard deviation.ResultsThe quality of anaesthetic induction was significantly better and duration of antinociception significantly longer (p < 0.05) in treatment XKT (3.1 ± 0.7 score; 43.7 ± 15.5 minutes) than in treatment XKS (2.8 ± 0.6 score; 32.0 ± 13.3 minutes). TLRR, DR and RCT did not differ significantly (p > 0.05) between treatment XKT (2.1 ± 0.8, 65.8 ± 17.0 and 13.2 ± 6.7 minutes) and treatment XKS (2.1 ± 1.3, 58.0 ± 14.8 and 10.3 ± 5.6 minutes). Physiological measurements did not differ between the treatments.Conclusion and clinical relevanceTramadol improved the quality of anaesthetic induction and increased the duration of antinociception in xylazine–ketamine anaesthetized young pigs without increasing duration of anaesthesia, nor causing additional depression of the physiological parameters measured.     

Anaesthetic and cardiorespiratory effects of romifidine/ketamine combinations in cats

ObjectiveTo study the anaesthetic and cardiorespiratory effects of intramuscular (IM) administration of different combinations of romifidine and ketamine in cats.Study designProspective, randomized, cross-over experiment.AnimalsSeven healthy adult cats weighing (mean ± SD) 3.4 ± 0.7 kg and aged 4.6 ± 3.2 years.MethodsAnimals received romifidine 100 μg kg^?1 with ketamine 7.5 (R100/K7.5) and 10 mg kg^?1 (R100/K10), romifidine 200 μg kg^?1 with ketamine 5 (R200/K5), 7.5 (R200/K7.5) and 10 mg kg^?1 (R200/K10) by IM injection. The time required to perform orotracheal intubation (IT) was measured and the ease of intubation assessed. The onset of anaesthesia (OA), duration of anaesthesia (DA) and anaesthesia recovery times (AR) were measured. Analgesia and muscle relaxation scores were recorded every 5 minutes for 60 minutes after OA. Heart rate, systolic arterial pressure, arterial haemoglobin saturation, respiratory rate, end-tidal carbon dioxide and oesophageal temperature were also measured.ResultsThe IT, OA and DA were not significantly different between the treatments. The analgesia and muscle relaxation scores were similar between all treatments at most time points. The cardiorespiratory variables were not significantly different between the treatments in most cases. The adverse effects were dose dependent and similar to those previously described for other combinations of α₂-agonists and ketamine.Conclusions and clinical relevanceAnaesthesia produced by the studied combinations of romifidine and ketamine may only be reliable when conducting brief and noninvasive procedures in cats. The OA times were slower and the DA shorter than those reported for other alpha-2 agonists combined with ketamine. A dose-related increase in the intensity of the anaesthetic effects could not be demonstrated in this study.