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  • Author or Editor: Daniel S. J. Pang x
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Abstract

OBJECTIVE

Use a referral dental clinic model to study how to calculate accurate 95% upper confidence limits for probabilities of workloads (total case duration, including turnover time) exceeding allocated times.

ANIMALS

Dogs and cats undergoing dental treatments.

METHODS

Managerial data (procedure date and duration) collected over 44 consecutive operative workdays were used to calculate the daily anesthetist workload. Workloads were compared with a normal distribution using the Shapiro-Wilk test, serial correlation was examined by runs test, and comparisons among weekdays were made using the Kruskal-Wallis test. The 95% confidence limits for normally distributed workloads exceeding allocated times were estimated with a generalized pivotal quantity. The impact of a number of procedures was assessed with scatterplots, Pearson linear correlation coefficients, and multivariable linear regression.

RESULTS

Mean anesthetist's workload was normally distributed (Shapiro-Wilk P = .25), without serial correlation (P = .45), and without significant differences among weekdays (P = .52). Daily workload, mean 9.39 hours and SD 3.06 hours, had 95% upper confidence limit of 4.47% for the probability that exceeding 16 hours (ie, 8 hours per each of 2 tables). There was a strong positive correlation between daily workload and the end of the workday (r = .85), significantly larger than the correlation between the end of the workday and the number of procedures (r = .64, P < .0001).

CLINICAL RELEVANCE

There are multiple managerial applications in veterinary anesthesia wherein the problem is to estimate risks of exceeding thresholds of workload, including the costs of hiring a locum, scheduling unplanned add-on cases, planning for late discharge of surgical patients to owners, and coordinating anesthetist breaks.

Open access
in American Journal of Veterinary Research

Abstract

Objective—To evaluate the relationship between end-tidal partial pressure of CO2 (ETCO2) and PaCO2 in isoflurane-anesthetized harp seals.

Animals—Three 5-month-old 25- to 47-kg harp seals (Phoca groenlandica).

Procedures—PaCO2 was determined in serial arterial samples from isoflurane-anesthetized seals and compared with concomitant ETCO2 measured with a side-stream microstream capnograph. Twenty-four paired samples were subjected to linear regression analysis and the Bland-Altman method for assessment of clinical suitability of the 2 methods (ie, PaCO2 and ETCO2 determinations). The influence of ventilation rate per minute (VR) on the ETCO2 to PaCO2 difference (P[ET-a] CO2) was examined graphically.

Results—The correlation coefficient between the 2 measurements was 0.94. The level of agreement between ETCO2 and PaCO2 varied considerably. Values of ETCO2 obtained with a VR of < 5 underestimated PaCO2 to a greater degree (mean bias, −4.01 mm Hg) and had wider limits of agreement of −13.10 to 5.07 mm Hg (−4.01 mm Hg ± 1.96 SD), compared with a VR of ≥ 5 (mean bias, −2.24 mm Hg; limits of agreement, −7.79 to 3.30 mm Hg).

Conclusions and Clinical Relevance—These results indicate that a microstream sidestream capnograph provides a noninvasive, sufficiently accurate estimation of PaCO2 with intermittent positive ventilation at a VR ≥ 5 in anesthetized harp seals.

Full access
in American Journal of Veterinary Research
in Journal of the American Veterinary Medical Association

Abstract

Objective—To evaluate the effects of atipamezole hydrochloride on recovery and analgesia following ovariohysterectomy in cats anesthetized with a dexmedetomidine hydrochloride, ketamine hydrochloride, and hydromorphone hydrochloride combination, in accordance with fast-track surgery principles.

Design—Prospective, randomized, clinical trial.

Animals—44 cats.

Procedures—Cats were anesthetized with a combination of dexmedetomidine (15 μg/kg [6.8 μg/lb]), ketamine (5 mg/kg [2.3 mg/lb]), and hydromorphone (0.05 mg/kg [0.023 mg/lb]), IM, supplemented with isoflurane in oxygen. Immediately after ovariohysterectomy, cats received meloxicam (0.2 mg/kg [0.09 mg/lb]) SC and either atipamezole (75 μg/kg [34.1 μg/lb]) or an equivalent volume of saline (0.9% NaCl) solution IM. Pain and sedation were scored at baseline (prior to surgery) and at predetermined intervals after surgery. Time to sternal recumbency was recorded.

Results—The atipamezole group recovered to sternal recumbency faster (median, 15 minutes; range, 5 to 60 minutes) than the saline solution group (median, 60 minutes; range, 15 to 90 minutes]). Pain scores did not differ between groups or at any time, compared with baseline, and were below the intervention threshold for most cats. Sedation scores were significantly greater in the saline solution group (median, 0; range, 0 to 2) at 2 hours after surgery, compared with the atipamezole group (median, 0; range, 0 to 0).

Conclusions and Clinical Relevance—Results indicated that administration of atipamezole, compared with saline solution, allowed for a faster recovery from anesthesia with dexmedetomidine-ketamine-hydromorphone in cats following ovariohysterectomy without compromising analgesia. These findings have implications for the provision of appropriate postoperative analgesia following ovariohysterectomy in cats. (J Am Vet Med Assoc 2015;246:645–653)

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To assess the feasibility of a canister-free negative-pressure wound therapy (NPWT) device (PICO™ 1.6, Smith & Nephew Medical Ltd) and evaluate its effect on early phases of wound healing in canine experimental cutaneous wounds.

ANIMALS

5 adult spayed female research Beagles.

PROCEDURES

In a pilot experimental study, 1 full-thickness 2-cm X 2-cm cutaneous wound was surgically created on each hemithorax in each dog. Wounds were treated with either NPWT or a conventional wound dressing for 14 days. Bandage changes and wound evaluations were done at 7 time points. First macroscopic appearance of granulation tissue, smoothness of granulation tissue, and percentages of wound contraction and epithelialization were compared between treatments. Wounds were sampled at 3 time points for histopathologic analyses and semiquantitative scoring.

RESULTS

NPWT dressings were well tolerated by all dogs. Complete seal of the dressing required the application of adhesive spray, and maintenance of the vacuum lessened over time. Self-limiting skin irritations appeared in all dogs and hampered the attainment of negative pressure. Granulation tissue developed faster and was more abundant in control wounds. Wound contraction, epithelialization, and fibroblast proliferation were greater in control wounds at the end of the study.

CLINICAL RELEVANCE

This canister-free NPWT device is feasible but problematic in maintaining a vacuum, requiring frequent revisions of the dressing. Further studies are necessary to evaluate the effect of this device on early phases of wound healing. Its benefits in wound healing remain unknown.

Open access
in American Journal of Veterinary Research