Attitudes and perceptions of veterinary paraprofessionals in New Zealand to postoperative pain in dogs and cats

AIM: To survey the attitudes and perceptions of veterinary paraprofessionals in New Zealand to postoperative pain in dogs and cats.

METHODS: In December 2011, veterinary paraprofessionals (VP) from throughout New Zealand were invited to participate in an online survey. Eleven questions, which were divided into five sections, were used to determine demographic information, the respondents’ assessment of pain after commonly performed surgeries in dogs and cats, their opinions on provision of analgesia, who had responsibility for pain monitoring and the use of any formal pain scoring system in the practice.

RESULTS: Data from 165 respondents were able to be used, and 162 (98%) respondents to the survey were female. According to the respondents’ estimates, fracture repair in dogs and repair of diaphragmatic hernias in cats had the highest pain score following surgery. Neutering procedures involving dogs were scored higher than for cats (p<0.01). All respondents agreed that animals benefit from perioperative analgesia. The veterinary nurse was reported to be predominantly responsible for monitoring pain in animals postoperatively by 116/165 (70.3%) respondents. Of 165 respondents, 154 (93%) considered that their knowledge of pain and assessment of pain could be enhanced.

CONCLUSIONS: This survey reflects the attitudes and perceptions of a sample of VP in New Zealand to postoperative pain in dogs and cats. The results indicate that all respondents believe that surgery results in sufficient pain to warrant analgesic therapy. Routine neutering surgeries were considered to be more painful in dogs than in cats. The current survey also provides information to educators on potential areas of focus, given that 93% of respondents felt that their knowledge of pain and assessment of pain could be enhanced.     

动物腹腔手术后粘连的成因及防制概述

就术后粘连发生的诱因、发生机理进行了阐述,并结合动物粘连模型的试验研究结果及临床研究结果,对预防腹腔手术后粘连的药物和方法进行了综述。     

右美托咪定复合舒芬太尼用于老年患者术后自控静脉镇痛的效果观察

目的观察盐酸右美托咪定复合舒芬太尼用于老年患者术后自控静脉镇痛（PCIA）的有效性和安全性．方法所有患者手术均采用咪达唑仑、顺式阿曲库铵、丙泊酚、芬太尼行麻醉诱导,顺式阿曲库铵、芬太尼与丙泊酚维持麻醉,术后患者随机分为A,B,C3组,使用PCA泵镇痛;分别记录苏醒后（T0）,术后4h（T1）,8h（T2）,12h（T3）,24h（T4）VAS评分;Ramsay镇静评分;术后不同时点PCA按压次数;24h舒芬太尼累计用量;镇痛期间低血压等不良反应的发生情况．结果术后24h内VAS评分A,B组高于C组（P〈0．05）;Ramsay镇静评分：A,B组低于C组（P〈0．05）;24h镇痛泵的总按压次数A组高于B组（P〈0．05）,B组高于c组（P〈0．05）;与术前相比,A组术后血压、心率变化不明显,而B,C两组术后血压、心率下降（P〈0．05）;3组患者术后均无呼吸抑制和镇静过度等不良反应（P〉0．05）,恶心的不良反应发生率B,C组明显少于A组（P〈0．05）．结论盐酸右美托咪定复合舒芬太尼用于老年患者术后自控静脉镇痛安全、有效．     

Intraocular pressure development after cataract surgery: a prospective study in 50 dogs (1998-2000)

Objective To study the course of intraocular pressure (IOP) after cataract surgery in 50 dogs. Design Prospective study. Animals Fifty dogs without preoperative ocular hypertension were selected for cataract surgery. Methods All dogs underwent cataract surgery: 25 by manual extracapsular extraction and 25 by phacoemulsification. For each dog, intraocular pressure was measured before surgery, and 1, 3, 5, 18 h, 1 week and 1 month post surgery. Results No significant difference of mean intraocular pressure between the two surgical methods was observed for each time measurement. Nine dogs had postoperative hypertension (IOP > 25 mmHg) during the first 5 hours post surgery. Incidence of postoperative hypertension was not significantly different with manual extracapsular extraction (16%) vs. phacoemulsification (20%). A decrease of mean IOP was observed 1 h after surgery (8.49 mmHg vs. 10.91 mmHg), then an increase 3 and 5 h post surgery (12.3 and 13.32 mmHg, respectively). At 18 h, 1 week and 1 month post surgery, mean IOP decreased. Mean IOP was 10.38, 10.38 and 8.84 mmHg, respectively. Conclusion In this study incidence of POH is not high. However, a follow‐up of IOP in the first hours after cataract surgery is required to avoid complications of the retina and optic nerve and to administer hypotensive treatment if necessary.     

腹腔镜胆囊切除术及其并发症的预防（附30例报告）

用腹腔镜行胆囊切除术３０例。术前均经Ｂ超检查确诊为胆囊结石者２４例和胆囊息肉６例。３０例中有２９例获手术成功，１例因胆囊萎缩在术中转为开腹术，出现并发症者４例，其中１例因胆素床出血转为开腹后发现出血已停，另３例术后出现皮下气肿。手术时间最短１５ｍｉｎ，最长８７ｍｉｎ，平均２８ｍｉｎ。住院时间最短４天，最长１１天，平均６．５天。     

Factors associated with mortality and morbidity in small intestinal volvulus in horses

OBJECTIVE: To determine historical, physical, and clinical factors that may affect morbidity and mortality in horses with small intestinal volvulus unrelated to other causes (e.g., incarceration, lipoma, etc.). STUDY DESIGN: Retrospective study. ANIMALS: Client-owned horses (115), aged 1 month to 21 years. Methods: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction. RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery. CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors. CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.     

The pre-emptive effect of epidural ketamine on wound sensitivity in horses tested by using von Frey filaments

Objective To evaluate the pre‐emptive analgesic effect of pre‐incisional epidural ketamine. Study Design A blinded, randomized experimental study. Animals Sixteen mixed breed mares, 7.6 ± 2.8 years old, weighing 352 ± 32 kg. Methods In a pilot study, an incision was made on one lateral thigh using a lidocaine block and no further analgesics, and it was verified that the nociceptive threshold was lower on the incised side than nonincised side (p ≤ 0.05), and that von Frey filaments evoked a pain response. The 16 animals were divided into group A (ketamine, n = 9) and B (saline, n = 7). An epidural catheter was inserted 24 hours before the trials. The thigh was shaved bilaterally, and the right side was blocked (incised side) using lidocaine. Twenty‐five minutes later, ketamine (A) or saline (B) was administered epidurally. Five minutes later, a 10‐cm skin incision was made on the right side, and then sutured. Nociceptive threshold was determined with von Frey filaments at 1, 3, and 5 cm around the incision at 15‐minute intervals for 2 hours, then at 4, 6, and 8 hours. Behavioral alterations, heart and respiratory rates were recorded. Nociceptive thresholds from these points were averaged to obtain mean values at each time, converted to a logarithmic scale, and submitted to a nonparametric analysis (Mann–Whitney and one‐way repeated measures anova test, p ≤ 0.05). Results After 8 hours, the global range score revealed reduced hyperalgesia (p < 0.01) around the incision in 92% (4.65–4.27) of evaluated intervals in group A (ketamine). There were no significant changes in behavior, heart and respiratory rates. Conclusions It was concluded that pre‐emptive epidural ketamine reduced post‐incisional pain in the horse, and that von Frey filaments were able to quantify cutaneous sensitivity after tissue damage. Clinical relevance Epidural ketamine injection can reduce post‐incisional sensitivity in the horse.     

Postoperative ultrasonographic appearance of uncomplicated enterotomy or enterectomy sites in dogs

The ultrasonographic findings in 20 dogs with 25 healing enterotomy and enterectomy sites resulting from the removal of foreign material or correction of intussusceptions are presented. In this prospective study, dogs had preoperative abdominal ultrasound examinations followed by sequential sonographic examinations on the first, third, sixth, and 10th days postenterotomy or enterectomy with an additional sonographic examination after 20 days postoperatively. Documented sonographic features included length and maximal intestinal wall thickness of the enterotomy or enterectomy sites, echogenicity of omental/mesenteric fat, amount of free gas and abdominal effusion, and gastrointestinal motility. Sonographically, 57% of enterotomies and 100% of enterectomies were visualized. Pneumoperitoneum, hyperechoic omental/mesenteric fat, and abdominal effusion did not appreciably hamper evaluation of the intestinal surgical site. Absent wall layering at the surgical site was noted in 96% of dogs at day 1 postoperatively. At the final sonographic examination, wall layering remained altered to absent in 100% of dogs and normal thickness was noted in only 20% of dogs. The median maximal wall thickness was 7 and 8 mm for enterotomies and enterectomies respectively, which occurred between days 1 and 3 and days 3 and 6 postoperatively. Effusion and increased echogenicity of omental/mesenteric fat localized to the surgical site were noted in 42% and 60% of dogs respectively at day 1 postoperatively, with resolution noted between days 3 and 10 postoperatively in 92% and 80% of dogs. Generalized abdominal effusion and pneumoperitoneum were seen in 100% of dogs immediately postoperatively and resolved in 80% by day 10.     

益气解毒法对胃癌术后辅助化疗患者生存质量的影响

目的 观察益气解毒法对胃癌术后辅助化疗患者生存质量的影响。方法 50例胃癌术后采用替吉奥和奥利沙铂（SOX方案）进行辅助化疗患者（观察组）,配以益气解毒法中医治疗2个化疗周期,观察化疗药物的毒副反应、Karnofsky评分和QLQ-30评分,并与50例胃癌术后单用SOX方案进行辅助化疗患者（对照组）进行比较。结果 毒副反应：在贫血、恶心呕吐、周围神经毒性、口腔黏膜损害和肝功能损害方面,观察组级别明显低于对照组（P<0.05）;Karnofsky评分：观察组Karnofsky评分优于对照组（P<0.05）;QLQ-30评分：对照组治疗前后疲乏无力、恶心呕吐和食欲减退的评分较治疗前显著升高（P<0.05）,观察组治疗后情绪功能和整体生活质量评分较治疗前显著升高（P<0.05）,其余各项目治疗前后评分差异无统计学意义（P>0.05）。结论 益气解毒法可减轻胃癌术后辅助化疗毒副反应,提高患者生存质量。     

Evaluation of low-molecular-weight heparin for the prevention of equine laminitis after colic surgery

Objectives – The aim of this study is to describe the prevalence of postoperative laminitis in colic cases and to determine if low-molecular-weight heparin (LMWH) is effective in preventing this complication.
Design – Retrospective clinical study.
Animals – Client-owned horses.
Interventions – SC administration of enoxaparin during the postoperative period.
Measurements and Main Results – Medical records of 360 horses undergoing surgery for colic and surviving at least 3 days were evaluated. Fifty-six horses admitted before 1995 did not receive LMWH (control group) and 304 admitted after 1995 received LMWH as a prophylaxis for laminitis (treatment group). Three grades of severity were defined for laminitis. Prevalence and severity of laminitis were compared between the 2 groups. Several parameters recorded on admission (sex, age, breed, site and nature of the disease, heart rate, PCV, gravity score, and shock score) and the administration of LMWH were tested as risk factors in the development of laminitis in a logistic regression procedure. Prevalence and grade of laminitis were significantly lower in the treatment group. Only the absence of LMWH was recognized as a significant risk factor in the logistic regression model.
Conclusions – The administration of LMWH appears to be effective in the prophylaxis of laminitis following colic surgery and may be useful in the postoperative management of these horses.