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in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine whether critically ill hypotensive dogs without hyperlactatemia have the same prognosis as critically ill hypotensive dogs with hyperlactatemia.

Design—Retrospective case series.

Animals—67 critically ill dogs with hypotension.

Procedures—Medical records were searched from January 2006 through December 2011 for dogs that were hospitalized in the intensive care unit and that had hypotension and measurement of blood lactate concentration. Blood lactate concentration, systolic blood pressure, and survival rate were compared between hypotensive dogs with and without hyperlactatemia.

Results—19 of 67 (28%) dogs survived and were discharged from the hospital. Hypotensive dogs without hyperlactatemia had a significantly higher systolic blood pressure and were 3.23 (95% confidence interval, 1.04 to 9.43) times as likely to survive, compared with hypotensive dogs with hyperlactatemia. Age, weight, severity of clinical illness, and duration of hospitalization did not differ significantly between hypotensive dogs with and without hyperlactatemia.

Conclusions and Clinical Relevance—Results suggested that hypotensive dogs without hyperlactatemia had a better prognosis and chance of surviving to hospital discharge than did hypotensive dogs with hyperlactatemia. Because blood lactate concentration was negatively associated with systolic blood pressure and survival probability, it may be a useful metric for determining the prognosis of hypotensive dogs.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To examine the association between blood lactate concentration and survival to hospital discharge in critically ill hypotensive cats.

DESIGN Retrospective case series.

ANIMALS 39 cats admitted to an intensive care unit of a university veterinary hospital between January 2005 and December 2011 for which blood lactate concentration was recorded ≤ 1 hour before or after a Doppler-derived arterial blood pressure measurement ≤ 90 mm Hg (ie, hypotension) was obtained.

PROCEDURES Medical records of each cat were reviewed to assess survival to hospital discharge, illness severity, duration of hospitalization, age, body weight, and PCV. Results were compared between hypotensive cats with and without hyperlactatemia (blood lactate concentration ≥ 2.5 mmol/L).

RESULTS 6 of 39 (15%) hypotensive cats survived to hospital discharge. Twelve (31%) cats were normolactatemic (blood lactate concentration < 2.5 mmol/L), and 27 (69%) were hyperlactatemic. Hypotensive cats with normolactatemia had a higher blood pressure and higher survival rate than hypotensive cats with hyperlactatemia. Five-day Kaplan-Meier survival rates were 57% for normolactatemic cats and 17% for hyperlactatemic cats. Age, body weight, duration of hospitalization, PCV, and illness severity did not differ significantly between hypotensive cats with and without hyperlactatemia.

CONCLUSIONS AND CLINICAL RELEVANCE Hypotensive, normolactatemic cats in an intensive care unit had a significantly greater chance of survival to hospital discharge than their hyperlactatemic counterparts. Blood lactate concentration may be a useful prognostic indicator for this patient population when used in conjunction with other clinical and laboratory findings.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To assess the microcirculatory effects of IV fluid administration in healthy anesthetized dogs undergoing elective ovariohysterectomy.

Animals—49 client-owned dogs.

Procedures—Dogs were sedated, and anesthesia was induced with propofol and diazepam and maintained with isoflurane in oxygen. Dogs received lactated Ringer's solution (LRS) IV at rates of 0, 10, or 20 mL/kg/h. Videomicroscopy was used to assess and record effects of LRS administration on microcirculation in the buccal mucosa. Measurements of microcirculatory (total vessel density, proportion of perfused vessels, microcirculatory flow index, and perfused vessel density by vessel size [< 20 μm, ≥ 20 μm, and all diameters]) and other physiologic variables (heart rate, Doppler-measured blood pressure, oxygen saturation as measured by pulse oximetry, capillary refill time, and body temperature) were compared among groups at baseline (immediately after anesthetic induction), 30 and 60 minutes afterward, and overall.

Results—Neither the proportion of perfused vessels nor microcirculatory flow index varied among treatment groups at any time point, regardless of vessel size. For vessels < 20 μm in diameter and for all vessels combined, total and perfused vessel density were similar among groups. For vessels ≥ 20 μm in diameter, total vessel density was significantly greater in the 20 mL/kg/h group than in other groups, and perfused vessel density was significantly greater in the 20 mL/kg/h group than in the 0 mL/kg/h group, when all time points were considered. Other physiologic variables were similar among groups.

Conclusions and Clinical Relevance—Total and perfused vessel density of vessels ≥ 20 μm in diameter (mostly venules) were greatest in dogs that received 20 mL of LRS/kg/h. Further research is required to evaluate clinical importance of these findings.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE To compare the effect of blood collection by a push-pull technique from an indwelling IV catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol to dogs.

DESIGN Prospective randomized clinical study.

ANIMALS 30 healthy client-owned dogs that weighed ≥ 10 kg (22 lb) and were anesthetized for elective surgical procedures.

PROCEDURES All dogs were premedicated with methadone (0.5 mg/kg [0.2 mg/lb], IM), and 20 to 30 minutes later, anesthesia was induced with either alfaxalone (1 to 3 mg/kg [0.5 to 1.4 mg/lb], IV to effect; n = 15) or propofol (2 to 6 mg/kg [0.9 to 2.7 mg/lb], IV to effect; 15). Immediately prior to premedication and after anesthesia induction, paired blood samples were collected from the cephalic veins; 1 by direct venipuncture and 1 by use of a push-pull technique from a 20-gauge catheter. All blood samples underwent venous blood gas analysis immediately after collection. Results were compared between sample collection techniques before and after anesthesia induction and between anesthesia induction protocols.

RESULTS All results were within established reference ranges. For many variables, statistically significant but clinically irrelevant differences were detected between samples collected by direct venipuncture and those collected by the push-pull technique but not between the 2 anesthesia induction protocols.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated the push-pull technique was an acceptable method for collection of blood samples from dogs for venous blood gas analysis that could be used instead of direct venipuncture for patients with patent IV catheters.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To evaluate the relationship between Doppler blood pressure (DBP) and survival or response to treatment in critically ill cats.

Design—Retrospective case series.

Animals—83 cats.

Procedures—Medical records from cats admitted to the intensive care unit with at least 2 recorded DBP measurements were included in the study. Hypotension was defined as 1 or more DBP measurements d 90 mm Hg. Change in blood pressure, survival to hospital discharge, heart rate, rectal temperature, PCV, plasma pH, serum ionized calcium concentration, disease process, body weight, age, duration of hospitalization, and catecholamine treatment were also evaluated.

Results—39 cats were included in the hypotensive group, and 44 were consistently normotensive. Overall survival rate was 53% (44/83), with a significantly higher mortality rate in the hypotensive group (64% vs 32%). Among other variables, only low rectal temperature and low PCV were significantly associated with hypotension. Hypotensive cats with an increase in blood pressure of ≥ 20 mm Hg during hospitalization were more likely to survive to discharge (mortality rate, 69% vs 17%).

Conclusions and Clinical Relevance—Hypotensive cats had increased mortality rate with lower rectal temperatures and lower PCV, compared with normotensive critically ill cats. The implications of these findings with regard to treatment remain to be elucidated, but addressing these abnormalities may be appropriate.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To compare effectiveness of maropitant and ondansetron in preventing preoperative vomiting and nausea in healthy dogs premedicated with a combination of hydromorphone, acepromazine, and glycopyrrolate.

ANIMALS

88 dogs owned by rescue organizations.

PROCEDURES

Dogs received maropitant (n = 29) or ondansetron (28) PO 2 hours prior to premedication or did not receive an antiemetic (31; control). Dogs were evaluated for vomiting, nausea, and severity of nausea (scored for 6 signs) for 15 minutes following premedication with hydromorphone, acepromazine, and glycopyrrolate.

RESULTS

A significantly lower percentage of dogs vomited after receiving maropitant (3/29 [10%]), compared with control dogs (19/31 [62%]) and dogs that received ondansetron (15/28 [54%]). A significantly lower percentage of dogs appeared nauseated after receiving maropitant (3/29 [10%]), compared with control dogs (27/31 [87%]) and dogs that received ondansetron (14/28 [50%]), and a significantly lower percentage of dogs appeared nauseated after receiving ondansetron, compared with control dogs. Nausea severity scores for hypersalivation, lip licking, hard swallowing, and hunched posture were significantly lower for dogs that received maropitant than for control dogs, and scores for hypersalivation, lip licking, and hard swallowing were significantly lower for dogs that received ondansetron than for control dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Oral administration of maropitant 2 hours prior to premedication with hydromorphone reduced the incidence of vomiting and the incidence and severity of nausea in healthy dogs. Oral administration of ondansetron reduced the incidence and severity of nausea but not the incidence of vomiting.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

Compare changes in intra-abdominal pressure (IAP), abdominal perfusion pressure (APP), hemodynamics, and clinicopathological variables in nonpregnant and late-term pregnant queens undergoing elective ovariohysterectomy (OHE) and evaluate the effect of patient positioning on IAP and APP measurements.

ANIMALS

18 late-term pregnant queens and 25 nonpregnant controls.

PROCEDURES

Temperature, heart rate (HR), Doppler blood pressure (DBP), IAP (dorsal and right lateral), PCV, total protein (TP), and lactate were recorded preoperatively, at abdominal wall closure (dorsal IAP only), and postoperatively under general anesthesia. Uterine weight, blood loss, and surgical duration were recorded. Abdominal perfusion pressure was calculated as DBP minus IAP.

RESULTS

Pre- and postoperatively, pregnant queens had lower DBP, APP, and PCV compared to controls (P < 0.001). IAP was higher in pregnant queens preoperatively (P < 0.001). Controls had a decrease in HR and increase in IAP, while both groups had a decrease in body temperature, DBP, APP, and lactate over time (P < 0.05). Pregnant queens had a decrease (P = 0.029), and controls had an increase in TP (P = 0.001). Blood loss and surgical time were greater for pregnant queens (P < 0.001). Dorsal IAP and APP were higher and lower than right lateral measurements (P < 0.001), respectively, and correlation was strong.

CLINICAL RELEVANCE

Hemodynamics and APP are impaired in late-term pregnant queens undergoing OHE, and increased monitoring is warranted. Although strongly correlated, feline IAP and APP measurements in dorsal and right lateral recumbency are not interchangeable.

Open access
in American Journal of Veterinary Research

Abstract

Objective—To determine whether multiple organ dysfunction syndrome (MODS) could be identified in dogs with sepsis secondary to gastrointestinal tract leakage, and whether the number of affected organ systems was significantly associated with mortality rate.

Design—Multicenter retrospective case series.

Animals—114 dogs.

Procedures—Medical records for dogs treated surgically because of sepsis secondary to gastrointestinal tract leakage between 2003 and 2007 were reviewed. Sepsis was diagnosed on the basis of results of bacterial culture of peritoneal fluid, gross evidence of gastrointestinal tract leakage at surgery, or both. Renal dysfunction was defined as a ≥ 0.5 mg/dL increase in serum creatinine concentration after surgery. Cardiovascular dysfunction was defined as hypotension requiring vasopressor treatment. Respiratory dysfunction was defined as a need for supplemental oxygen administration or mechanical ventilation. Hepatic dysfunction was defined as a serum bilirubin concentration > 0.5 mg/dL. Dysfunction of coagulation was defined as prolonged prothrombin time, prolonged partial thromboplastin time, or platelet count ≤ 100,000/μL.

Results—89 (78%) dogs had dysfunction of 1 or more organ systems, and 57 (50%) dogs had MODS. Mortality rate increased as the number of dysfunctional organ systems increased. Mortality rate was 70% (40/57) for dogs with MODS and 25% (14/57) for dogs without.

Conclusions and Clinical Relevance—Results indicated that MODS, defined as dysfunction of at least 2 organ systems, can be identified in dogs with sepsis and that organ system dysfunction increased the odds of death.

Restricted access
in Journal of the American Veterinary Medical Association