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 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)
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 quality and speed of recovery from anesthesia with isoflurane, sevoflurane, or desflurane and determine end-tidal inhalant concentration at certain events during recovery in healthy dogs.
Animals—11 healthy dogs.
Procedures—Anesthesia was induced with propofol (IV), and dogs were assigned by use of a crossover design to receive isoflurane at 2.0%, sevoflurane at 3.2%, or desflurane at 11% end-tidal concentrations. Direct blood pressure was monitored throughout the 120 minutes of anesthesia. At the end of anesthesia, the circuit was flushed with oxygen, and the time to specific events in recovery and overall quality of recovery were assessed. Blood gas concentrations were measured prior to anesthesia and after recovery.
Results—Dogs in the desflurane group had the shortest time to standing (11.7 ± 5.1 minutes), followed by dogs in the sevoflurane group (18.6 ± 7.5 minutes) and dogs in the isoflurane group (26.3 ± 7.2 minutes). There was no difference for recovery quality among groups. Arterial blood pressure was higher in the sevoflurane group than in the desflurane group at 10 and 15 minutes and in the isoflurane group at 10, 15, 30, 45, 60, 75, 105, and 120 minutes. There were no significant differences among groups with respect to blood gas concentrations.
Conclusions and Clinical Relevance—Results suggested that in dogs for which a short interval to standing is desired, desflurane is the best selection, followed by sevoflurane.
Objective—To determine the association among signalment, health status, other clinical variables, and treatments and events during cardiopulmonary cerebral resuscitation (CPCR) with the return of spontaneous circulation (ROSC) for animals with cardiopulmonary arrest (CPA) in a veterinary teaching hospital.
Animals—161 dogs and 43 cats with CPA.
Procedures—Data were gathered during a 60-month period on animals that had CPA and underwent CPCR. Logistic regression was used to evaluate effects of multiple predictors for ROSC.
Results—56 (35%) dogs and 19 (44%) cats had successful CPCR. Twelve (6%) animals (9 dogs and 3 cats) were discharged from the hospital. Successfully resuscitated dogs were significantly more likely to have been treated with mannitol, lidocaine, fluids, dopamine, corticosteroids, or vasopressin; had CPA while anesthetized; received chest compressions while positioned in lateral recumbency; and had a suspected cause of CPA other than hemorrhage or anemia, shock, hypoxemia, multiple organ dysfunction syndrome, cerebral trauma, malignant arrhythmia, or an anaphylactoid reaction and were less likely to have been treated with multiple doses of epinephrine, had a longer duration of CPA, or had multiple disease conditions, compared with findings in dogs that were not successfully resuscitated. Successfully resuscitated cats were significantly more likely to have had more people participate in CPCR and less likely to have had shock as the suspected cause of CPA, compared with findings in cats that were not successfully resuscitated.
Conclusions and Clinical Relevance—The prognosis was grave for animals with CPA, except for those that had CPA while anesthetized.