A 4-year-old 490-kg (1,080-lb) American Saddlebred gelding was referred to the University of Georgia Veterinary Teaching hospital for treatment of colic of approximately 24 hours' duration. The horse had initially been treated with flunixin meglumine, acepromazine, and probiotics by the trainer; the referring veterinarian, who examined the horse the following day because it still had signs of pains, administered detomidine and flunixin meglumine. Rectal examination at this time revealed distension of the large colon, and the horse was referred to the Veterinary Teaching Hospital because of ongoing signs of pain.
On initial physical examination, the horse's heart rate was
A 5-year-old spayed female mixed-breed dog weighing 15 kg (33 lb) was brought to the University of Georgia Small Animal Veterinary Teaching Hospital for fixation of a traumatic fracture of the right femur. Physical examination and preanesthetic hematologic evaluation revealed no other abnormalities, and the dog was deemed a suitable candidate for surgery to repair the fracture. The dog was premedicated with glycopyrrolate (0.005 mg/kg [0.002 mg/lb]), hydromorphone (0.05 mg/kg [0.023 mg/lb]), and midazolam (0.2 mg/kg [0.09 mg/lb]) administered SC. Anesthesia was induced via IV administration of ketamine (5 mg/kg [2.3 mg/lb]) and diazepam (0.25 mg/kg [0.11 mg/lb]) and
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)
A 5-year-old castrated male Labrador Retriever weighing 25 kg (55 lb) was brought to the University of Georgia Small Animal Hospital for emergency care after being hit by a car. The dog was physically examined and determined to have a fracture in the right humerus and the right tibia. The dog was stabilized and, days later, was scheduled to be anesthetized for radiographic examination and surgery to repair both fractures. When the dog was returned to the hospital, physical examination and diagnostic imaging revealed no cardiovascular or respiratory abnormalities, and no injuries were evident except for the fractures. Glycopyrrolate
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.
Objective—To determine the effect of an intervention (educational campaign) on hand hygiene (HH) and health-care workers' (HCWs') perceptions of HH.
Design—Prospective observational study and cross-sectional survey.
Sample—Observed opportunities for HH performed by HCWs before (n = 222) and after (249) intervention, measures of HH product usage, and surveys distributed to 300 HCWs.
Procedures—Data were collected by means of direct observation, measurement of HH product consumption, and surveys of HCWs.
Results—Adherence rates of HCWs for HH practices before and after the intervention were 27% (61/222 observations) and 29% (73/249 observations), respectively. Combined HH and glove use adherence rates before and after the intervention were 84% (186/222 observations) and 81% (201/249 observations), respectively. Before intervention, the highest combined HH and glove use adherence rate was detected for technicians (90% [57/63 observations]) and for opportunities after exposure to a patient's bodily fluids (100% [5/5 opportunities]). Rate of use of alcohol-based antimicrobial hand rubs (AHRs) and amount of HH products used did not significantly change during the study. Survey response rates were 41% (122) and 21% (62) before and after the intervention, respectively. Availability of AHRs and role modeling of HH (performance of HH each time it is warranted) were considered the factors most likely to increase HH adherence rates by survey respondents.
Conclusions and Clinical Relevance—Results indicated the intervention did not increase HH adherence or use of AHRs. High rates of glove use before the start of the study may have been a confounding factor. Future educational campaigns should indicate that glove use should not supersede HH.
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.
Objective—To identify and critically evaluate the quality of evidence of the most commonly used pharmacologic, nutraceutical, and purported slow-acting drugs of osteoarthritis for the management of osteoarthritis in dogs by use of the FDA's evidence-based medicine scoring system.
Sample Population—16 clinical trials.
Procedures—A broad bibliographic search was performed prior to May 2006. Inclusion criteria focused on prospective trials evaluating commonly used medical treatment interventions for the management of osteoarthritis in dogs and published in peer-reviewed journals. The analysis consisted of the following: study design rating, quality factor rating, quantity rating, consistency rating, relevance to disease risk reduction rating, and cumulative strength of evidence ranking.
Results—4 trials evaluating meloxicam were rated as type I.Three trials evaluating carprofen were rated as type I, and 2 trials were rated as type III. One trial evaluating each of the following agents was rated as type 1: etodolac; P54FP; polysulfated glycosaminoglycan; and a combination of chondroitin sulfate, glucosamine hydrochloride, and manganese ascorbate. Two trials evaluating pentosan polysulphate and 2 trails evaluating green-lipped mussels were rated as type I. One trial evaluating hyaluronan was rated as type III.
Conclusions and Clinical Relevance—A high level of comfort exists for meloxicam that the claimed relationship is scientifically valid and that its use is clinically efficacious for the treatment of osteoarthritis in dogs.A moderate level of comfort exists for carprofen; etodolac; pentosan polysulphate; green-lipped mussels; P54FP; polysulfated glycosaminoglycans; and a combination of chondroitin sulfate, glucosamine hydrochloride, and manganese ascorbate. An extremely low level of comfort exists for hyaluronan.