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Abstract

Enhanced Recovery After Surgery (ERAS) is a new and emerging concept in human medicine that involves rethinking the preoperative, intraoperative, and postoperative periods. The ultimate, overarching aim is to improve patient outcome following surgery and, thus, return to a normal daily routine as soon as possible. The development and implementation of locoregional anesthetic techniques in humans is one of the key elements driving these protocols. In veterinary medicine, we are no exception: the rapidly growing interest, development, and refinement of these techniques in our veterinary species is changing the way we think of anesthesia and analgesia. The potential real benefits are yet to be determined, as this concept is implemented into our veterinary hospitals in general, and our surgical patients in particular, in a more systematic and routine way. In this article, we will introduce the reader to the concept of ERAS protocols and the role of regional anesthesia in some common surgical procedures.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To investigate use of a candidate maxillary nerve block in rabbits.

ANIMALS

13 healthy New Zealand White rabbits (Oryctolagus cuniculus).

PROCEDURES

In phase 1, the maxillary nerve block procedure was performed in 7 sedated rabbits with 2 volumes (0.25 and 0.5 mL) of a saline (0.9% NaCl)-tissue marker dye solution (1 injection/side by random assignment). Rabbits were euthanized and dissected; numeric scales were used to rate injection accuracy and extent of staining. In phase 2, the nerve block was performed with articaine hydrochloride-epinephrine solution (0.5 mL) on a randomly assigned side in 6 sedated rabbits, with the contralateral side used as a control. Sensory function of the relevant dermatome was tested in triplicate with an algesiometer 0, 30, and 90 minutes after recovery from sedation. Statistical methods were used to compare results between injection volumes (phase 1) and between treated and control sides (phase 2).

RESULTS

In phase 1, dye was in contact with the targeted nerve after 13 of 14 injections. Accuracy and extent of staining did not differ significantly between volumes. In phase 2, algesiometer-applied force tolerance differed significantly between treated and control sides 30 minutes after recovery from sedation (56 to 145 minutes after the nerve block procedure). No adverse effects were detected in either study phase.

CONCLUSIONS AND CLINICAL RELEVANCE

The described technique for a maxillary nerve block was accurate and effective for desensitization of the relevant dermatome as assessed by algesiometry in healthy rabbits. Additional studies are needed to assess use of this procedure in rabbits of other breeds and its efficacy for clinical use. (Am J Vet Res 2020;81:843-848)

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To evaluate the cardiovascular effects of atipamezole administered at half the volume or the same volume as dexmedetomidine to isoflurane-anesthetized cats.

ANIMALS

6 adult (1 to 2 years old) domestic shorthair cats (body weight, 3 to 6 kg).

PROCEDURES

Each cat was anesthetized with isoflurane and rocuronium 3 times; there was a 1-week washout period between successive anesthetic procedures. For each anesthetic procedure, dexmedetomidine (5 μg/kg) was administered IV. Five minutes after dexmedetomidine was administered, atipamezole (25 or 50 μg/kg) or saline (0.9% NaCl) solution was administered IM. Pulse rate, mean arterial blood pressure (MAP), cardiac output (CO), and systemic vascular resistance (SVR) were measured during anesthesia before dexmedetomidine administration (baseline), after dexmedetomidine administration, and 15, 30, 60, and 120 minutes after administration of atipamezole or saline solution. Pulse rate and MAP were also recorded when MAP was at its lowest value. Hemodynamic variables were compared among treatments at baseline, after dexmedetomidine administration, and after administration of atipamezole or saline solution. Effects of treatment and time on all variables were assessed with mixed-effects models.

RESULTS

Both doses of atipamezole resulted in a significantly lower MAP than did saline solution. Pulse rate, CO, and SVR were not significantly different among treatments after atipamezole or saline solution were administered.

CONCLUSIONS AND CLINICAL RELEVANCE

Atipamezole administered IM at half the volume or the same volume as dexmedetomidine was ineffective at increasing pulse rate or CO in anesthetized cats that received dexmedetomidine. However, atipamezole caused short-lasting but severe arterial hypotension.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE To evaluate the potency of vecuronium and duration of vecuronium-induced neuromuscular blockade in dogs with centronuclear myopathy (CNM).

ANIMALS 6 Labrador Retrievers with autosomal-recessive CNM and 5 age- and weight-matched control dogs.

PROCEDURES Dogs were anesthetized on 2 occasions (1-week interval) with propofol, dexmedetomidine, and isoflurane. Neuromuscular function was monitored with acceleromyography and train-of-four (TOF) stimulation. In an initial experiment, potency of vecuronium was evaluated by a cumulative-dose method, where 2 submaximal doses of vecuronium (10 μg/kg each) were administered IV sequentially. For the TOF's first twitch (T1), baseline twitch amplitude and maximal posttreatment depression of twitch amplitude were measured. In the second experiment, dogs received vecuronium (50 μg/kg, IV) and the time of spontaneous recovery to a TOF ratio (ie, amplitude of TOF's fourth twitch divided by amplitude of T1) ≥ 0.9 and recovery index (interval between return of T1 amplitude to 25% and 75% of baseline) were measured.

RESULTS Depression of T1 after each submaximal dose of vecuronium was not different between groups. Median time to a TOF ratio ≥ 0.9 was 76.7 minutes (interquartile range [IQR; 25th to 75th percentile], 66.7 to 99.4 minutes) for dogs with CNM and 75.0 minutes (IQR, 47.8 to 96.5 minutes) for controls. Median recovery index was 18.0 minutes (IQR, 9.7 to 23.5 minutes) for dogs with CNM and 20.2 minutes (IQR, 8 to 25.1 minutes) for controls.

CONCLUSIONS AND CLINICAL RELEVANCE For the study dogs, neither potency nor duration of vecuronium-induced neuromuscular blockade was altered by CNM. Vecuronium can be used to induce neuromuscular blockade in dogs with autosomal-recessive CNM.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To create a model of transient unilateral laryngeal paralysis (LP) that will allow the study of cricoarytenoideus dorsalis dysfunction and a method for quantification of varying degrees of LP in dogs.

ANIMALS

5 castrated male research Beagles.

PROCEDURES

Between January and February 2018, dogs were anesthetized and instrumented with a laryngeal mask airway and a flexible endoscope to record the rima glottidis. The left or right recurrent laryngeal nerve (RLn) was localized using ultrasonography and electrical stimulation, then conduction blockade was induced with perineural lidocaine. The normalized glottal gap area (NGGA) was measured before and every 15 minutes after the block. Inspired 10% carbon dioxide (CO2) was administered for 1 minute at each sampling time. The inspiratory increase in NGGA (total and each side) was measured at peak inspiration. The change in hemi-NGGA for the control side versus the anesthetized side was evaluated with a mixed-effect model.

RESULTS

During CO2 stimulation, the increase in inspiratory hemi-NGGA was consistently less (P < .001) for the treated side (–8% to 13%) versus the control side (49% to 82%). A compensatory increase (larger than at baseline) in the control hemi-NGGA was observed. The total NGGA remained unaffected.

CLINICAL RELEVANCE

Unilateral local anesthesia of the RLn produced transient unilateral LP with a compensatory increase in the hemi-NGGA for the contralateral side. This model could facilitate the evaluation of respiratory dynamics, establishment of a grading system, and collection of other important information that is otherwise difficult to obtain in dogs with LP.

Open access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To compare the duration of bupivacaine liposome suspension in the dog with that of bupivacaine and dexmedetomidine following a perineural injection.

ANIMALS

8 healthy Beagles.

PROCEDURES

The left sciatic nerve of each dog was randomly assigned to an ultrasound-guided perineural injection with either bupivacaine liposome suspension (BLS) or with 0.5% bupivacaine with dexmedetomidine (1 µg/mL) (BUP-DEX). The contralateral nerve was assigned to the alternate agent. The sensory, motor, and proprioceptive functions were evaluated before the injection (baseline) and at 4, 10, 24, 48, 72, and 96 hours.

RESULTS

The block in 1 limb in the BLS treatment appeared to have failed (data set excluded). The motor scores of 2 individuals could not be evaluated leaving 5 limbs to evaluate in the BLS treatment and 6 in the BUP-DEX.

A total of 6 out of 7 limbs in the BLS achieved a complete sensory block. In 3 out of 5 treatments with BLS, motor block was only partial and in 2 not apparent at all. Proprioceptive block was partial in 5 out of 7 dogs in the BLS treatment. All functions were still completely obliterated at 10 hours in 6 cases in treatment BUP-DEX. All functions were restored in all cases by 96 and 24 hours after administration of BLS and BUP-DEX, respectively.

CLINICAL RELEVANCE

The blockade characteristics of bupivacaine liposome suspension were effective and long lasting. Motor and proprioceptive deficits may be inconsistent over time.

Open access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To compare the quality of recovery in horses emerging from general anesthesia with or without the assistance of a novel device (recovery-enhancing device [RED]) designed to minimize high-energy falls.

ANIMALS

20 mixed-breed horses, between July 1, 2023, and January 24, 2024.

METHODS

A computer-controlled belay system designed to slow the acceleration of a horse during a fall was evaluated in this study. Horses were randomly assigned to 1 of 2 treatment groups: RED (belay, assisted) or FREE (unassisted). An inertia-measuring unit was fitted to all horses and data were live streamed and recorded onto a computer for further analysis. Recoveries were scored using the composite grading scale (CGS; 0 to 100) by 3 independent observers. Two additional unitless recovery scores (RS and RS’), based on accelerometry values (high accelerations, less desirable), were calculated for each recovery. All the recovery scores were compared between the 2 treatment groups.

RESULTS

Composite grading scale scores were 26 ± 10 and 46 ± 13 in the RED and FREE groups, respectively (P = .001). The RS was 120 ± 79 and 198 ± 34 for the RED and FREE treatment groups, respectively (P = .015). The RS’ was 32 (7 to 50) and 46 (28 to 44) for the RED and FREE treatment groups, respectively (P = .038).

CLINICAL RELEVANCE

The RED improves the recovery scores compared with unassisted recoveries. This device may lead to a potential reduction in the number and severity of injuries in horses and personnel involved during the recovery period.

Open access
in American Journal of Veterinary Research

Abstract

OBJECTIVE To evaluate the efficacy of each of 3 incremental doses of MK-467 for alleviation of dexmedetomidine-induced hemodynamic depression in isoflurane-anesthetized cats.

ANIMALS 6 healthy adult domestic shorthair cats.

PROCEDURES Each cat was anesthetized with isoflurane and received a target-controlled infusion of dexmedetomidine estimated to maintain the plasma dexmedetomidine concentration at 10 ng/mL throughout the experiment. Heart rate (HR) and direct arterial pressures were measured at baseline (isoflurane administration only), during dexmedetomidine infusion, and before and after IV administration of each of 3 serially increasing doses (15, 30, and 60 μg/kg) of MK-467. Cardiac index (CI) and systemic vascular resistance (SVR) were recorded at baseline, during dexmedetomidine infusion, and at the mean arterial pressure nadir after administration of the 30- and 60-μg/kg doses of MK-467.

RESULTS Compared with baseline values, the dexmedetomidine infusion significantly decreased HR and increased arterial pressures. Each dose of MK-467 caused a significant decrease in arterial pressures and a significant, albeit clinically irrelevant, increase in HR (≤ 10%). Following administration of the 30- and 60-μg/kg doses of MK-467, all cats developed clinical hypotension (mean arterial pressure, < 60 mm Hg) even though CI and SVR returned to baseline values.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated administration of small doses of MK-467 to isoflurane-anesthetized cats receiving dexmedetomidine restored CI and SVR, but caused a substantial decrease in arterial pressures and only a marginal increase in HR. Therefore, caution should be used when MK-467 is administered to alleviate dexmedetomidine-induced hemodynamic depression in isoflurane-anesthetized cats.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To compare the thermoregulatory and analgesic effects of high-dose buprenorphine versus morphine in cats undergoing ovariohysterectomy.

ANIMALS

94 client-owned cats.

PROCEDURES

Cats were randomized to receive either buprenorphine 0.24 mg/kg or morphine 0.1 mg/kg subcutaneously (SC) during recovery from ovariohysterectomy. Body temperature measurements were obtained before anesthesia, during anesthesia (averaged), at extubation, and 2, 4, and 16 to 20 hours postoperatively. Signs of pain were assessed, and demographic characteristics were compared between groups. The effects of treatment and time on body temperature, point prevalence of hyperthermia (> 39.2 °C), and pain scores were compared with linear or generalized mixed-effect models.

RESULTS

Cats receiving morphine (vs. buprenorphine) were older and heavier (both, P ≤ 0.005). Other group characteristics did not differ between treatments. Cats receiving buprenorphine (vs. morphine) had higher postoperative temperatures (P = 0.03). At 2, 4, and 16 to 20 hours after extubation, the point prevalence of hyperthermia was greater (P = 0.001) for cats receiving buprenorphine (55% [26/47], 44% [21/47], and 62% [27/43], respectively) versus morphine (28% [13/46], 13% [6/46], and 47% [21/44], respectively). There were no differences in pain scores between groups or over time. Five cats receiving buprenorphine and 6 receiving morphine required rescue analgesia within the 24-hour period.

CLINICAL RELEVANCE

Administration of buprenorphine (0.24 mg/kg SC), compared with morphine (0.1 mg/kg SC), resulted in higher body temperatures without an apparent advantage with regard to analgesia during the first 20 postoperative hours than morphine. Opioid-induced postoperative hyperthermia could confound the diagnosis of fever from different sources.

Open access
in American Journal of Veterinary Research

Abstract

OBJECTIVE To evaluate the effects of 2 fractions of inspired oxygen (Fio 2s) during anesthesia on postanesthesia Pao 2 and other measures of oxygen exchange.

ANIMALS 22 healthy adult sexually intact female dogs undergoing ovariohysterectomy by ventral midline celiotomy.

PROCEDURES Dogs were randomly assigned to receive either oxygen (Fio 2 > 0.9 [100% oxygen]; n = 11; control group) or a mixture of nitrogen and oxygen (Fio 2 = 0.4; 11; 40% oxygen group) as the carrier gas for isoflurane while anesthetized. All dogs were allowed to breathe spontaneously while anesthetized. For each dog, the Pao 2, Paco 2, other indices of oxygenation, and extent of sedation were monitored at predetermined times during and for 1 hour after anesthesia. Measured variables were compared between the 2 treatment groups and over time within each treatment group.

RESULTS None of the measured variables differed significantly between the control and 40% oxygen groups at any time during the postanesthesia period. Within each treatment group, the Paco 2 and extent of sedation decreased over time during the postanesthesia period.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that indices of oxygenation did not differ significantly between healthy dogs in which the Fio 2 was maintained at > 0.9 and those in which the Fio 2 was maintained at 0.4 while anesthetized for ovariohysterectomy. Thus, the addition of nitrogen to the carrier gas for an inhalant anesthetic conferred neither an advantage nor disadvantage in regard to oxygenation during the first hour of anesthesia recovery.

Full access
in American Journal of Veterinary Research