Objective—To determine and compare levels of
sedation achieved by IM administration of diphenhydramine,
saline (0.9% NaCl) solution, and acepromazine
Design—Prospective randomized study.
Procedure—Dogs were randomly assigned to
receive diphenhydramine at 2, 4, or 8 mg/kg (0.9, 1.8,
or 3.6 mg/lb, respectively) IM; acepromazine at 0.1
mg/kg (0.05 mg/lb) IM; or saline solution at 0.05
mL/kg (0.02 mL/lb) IM. Sedation was assessed by
use of a 6-category descriptive system based on
observation and interaction.
Results—Dogs in the acepromazine group had significantly
higher sedation scores than did dogs in the
saline solution or diphenhydramine groups at 30 minutes.
Dogs in the diphenhydramine groups did not
have significantly different sedation scores from dogs
in the saline solution group at any time point.
Conclusions and Clinical Relevance—Diphenhydramine
did not cause clinically appreciable sedation in
healthy dogs. Diphenhydramine is not suitable as a sole
sedative prior to general anesthesia in dogs. (J Am Vet
Med Assoc 2005;226:1092–1094)
OBJECTIVE To determine the bias, sensitivity, and specificity of Doppler ultrasonic flow detector measurement of blood pressure (DBPM) to detect hypotension in dogs with various disease states and to determine whether patient characteristics could affect accuracy of DBPM in dogs.
DESIGN Prospective cross-sectional study.
ANIMALS 146 client-owned dogs undergoing general anesthesia at a veterinary teaching hospital between April 2007 and August 2010.
PROCEDURES Data collected for each dog were breed, limb conformation, sex, American Society of Anesthesiologists physical status classification, anesthetic protocol, surgical procedure, arterial catheter size and location, and DBPM location. Doppler and invasive blood pressure measurements (IBPMs; criterion standard) were simultaneously recorded every 5 minutes throughout anesthesia. Hypotension was defined as mean arterial blood pressure < 60 mm Hg or DBPM < 90 mm Hg. Repeated-measures Bland-Altman analysis was performed to determine bias between DBPMs and IBPMs. Overall sensitivity and specificity of DBPM to detect hypotension were calculated with 2 methods, and values were recalculated for specific patient groups and compared.
RESULTS Bias of DBPM was 2.8 mm Hg with wide 95% limits of agreement (−46.4 to 51.9 mm Hg). For the 2 calculation methods, sensitivity of DBPM to detect hypotension was 69.2% and 66.7% and specificity was 82.2% and 86.8%. No significant differences in sensitivity or specificity were identified regarding limb conformation, gauge of catheter (20 vs 22) used for IBPM, or side (ipsilateral or contralateral) of paired measurements.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that in dogs of the present study, DBPM was unreliable for detecting hypotension.
Studies in human medicine indicate that between 22,000 and 400,000 people die every year as a direct result of medical errors. In veterinary medicine, 42% of human-caused incidents caused harm to the patient, including 5% resulting in death. In a university veterinary teaching hospital, there were 5.3 errors/1,000 patient visits, and 4 of these resulted in death. Veterinary medicine falls far behind other safety-critical industries in adopting a culture of patient safety. Organizations should respond in a just and effective way when errors occur. Psychological safety for team members to identify and speak up about areas of concern must be created and the results of improvements made based on these concerns shared within the professional group. If veterinary medicine is going to embrace patient safety culture, it needs to be included in the curriculum. Accrediting and licensing bodies need to require the teaching and application of principles of patient safety culture. Faculty must be trained to deliver patient safety–oriented care. Experts in human systems engineering should be brought in to educate veterinarians on how the systems we work in impact patient outcomes. If we are going to fulfill the promise of the Veterinarian’s Oath, we must embrace patient safety culture and all the difficult changes it requires of our professional culture.
Objective—To determine the relationship between different body positions during recumbency on the cranial migration of epidurally injected methylene blue in canine cadavers.
Sample Population—21 fresh cadavers of clinically normal adult female mixed-breed dogs.
Procedure—Dogs were randomly assigned to the following 3 groups: dogs remaining in right lateral recumbency (n = 7), dogs rotated from left to right lateral recumbency (7), and dogs rotated from dorsal to right lateral recumbency (7). Each dog received an epidural injection of 0.05% methylene blue (0.1 mL/kg) at the lumbosacral space. A dorsal laminectomy of the vertebral column was made, and cranial extent of methylene blue in 4 quadrants (right lateral, left lateral, ventral, and dorsal) was determined by examining dura mater staining.
Results—No significant difference was found among groups in regard to body weight or body condition score. Epidural cranial migration of methylene blue in the right lateral quadrant was significantly greater in dogs that remained in right lateral recumbency than in dogs that were rotated from left to right lateral recumbency. No significant difference was found within groups for epidural cranial migration of methylene blue between each quadrant. No significant relationship was found between body weight or body condition score and epidural cranial migration of methylene blue.
Conclusions and Clinical Relevance—Body positioning and amount of recumbency time influence cranial migration of epidurally injected methylene blue. If greater cranial migration of an epidurally administered drug is desired, placing the patient in lateral recumbency with the surgical site on the dependent side may precede surgery.
OBJECTIVE To determine the outcome in birds undergoing inhalation anesthesia and identify patient or procedure variables associated with an increased likelihood of anesthesia-related death.
DESIGN Retrospective case series.
ANIMALS 352 birds that underwent inhalation anesthesia.
PROCEDURES Medical records of birds that underwent inhalation anesthesia from January 1, 2004, through December 31, 2014, at a single veterinary referral hospital were reviewed. Data collected included date of visit, age, species, sex, type (pet, free ranging, or wild kept in captivity), body weight, body condition score, diagnosis, procedure, American Society of Anesthesiologists status, premedication used for anesthesia, drug for anesthetic induction, type of maintenance anesthesia, route and type of fluid administration, volumes of crystalloid and colloid fluids administered, intraoperative events, estimated blood loss, duration of anesthesia, surgery duration, recovery time, recovery notes, whether birds survived to hospital discharge, time of death, total cost of hospitalization, cost of anesthesia, and nadir and peak values for heart rate, end-tidal partial pressure of carbon dioxide, concentration of inhaled anesthetic, and body temperature. Comparisons were made between birds that did and did not survive to hospital discharge.
RESULTS Of 352 birds, 303 (86%) were alive at hospital discharge, 12 (3.4%) died during anesthesia, 15 (4.3%) died in the intensive care unit after anesthesia, and 22 (6.3%) were euthanatized after anesthesia. Overall, none of the variables studied were associated with survival to hospital discharge versus not surviving to hospital discharge.
CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed previous findings that indicated birds have a high mortality rate during and after anesthesia, compared with mortality rates published for dogs and cats.