To determine whether serum total thyroxine (TT4) concentration at admission to an intensive care unit (ICU) was associated with mortality rate and duration of hospitalization for critically ill dogs.
166 client-owned dogs that were hospitalized in the ICU of a private veterinary practice from January 2013 through December 2016 and for which serum TT4 concentration had been measured at admission.
Medical records were reviewed to collect data regarding patient signalment, concurrent illnesses, medications, reason for hospitalization, outcome (death, euthanasia, or survival to hospital discharge), duration of hospitalization, and initial serum TT4 concentration.
Mean age of the 166 dogs was 8.6 years (range, 1 to 16 years). Overall mortality rate was 15.7%, with 26 dogs failing to survive to hospital discharge. Of these 26 dogs, 7 died and 19 were euthanized. No significant association was identified between serum TT4 concentration at admission and survival to discharge (yes or no) or duration of hospitalization. Age was significantly associated with survival to discharge, with older dogs less likely to survive than younger dogs. Duration of hospitalization was also associated with survival to discharge, with longer hospital stays associated with a lower likelihood of survival to discharge.
CONCLUSIONS AND CLINICAL RELEVANCE
Findings suggested that serum TT4 concentration at admission to an ICU had no prognostic value in this population of critically ill dogs.
To evaluate a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus (GDV) in dogs.
41 client-owned dogs with confirmed GDV from 2012 through 2016.
Medical record data were collected regarding patient signalment, diagnostic test results, gastric lavage findings, surgical findings, and short-term survival status. For all dogs, gastric decompression was performed by orogastric intubation and gastric lavage in the same anesthetic episode. If this stage was successful, subsequent corrective surgery (laparotomy and gastropexy) was delayed and performed in a second anesthetic episode.
6 dogs underwent corrective surgery in the same anesthetic session as for decompression and stabilization, 2 of which had gastric necrosis. Thirty-five dogs underwent corrective surgery in a second anesthetic episode a mean of 22.3 hours (range, 5.25 to 69.75 hours) after presentation, during which gastric necrosis was identified in 2 dogs. The mortality rate for delayed-surgery patients was 9% (3/35). Time from presentation to surgery was not associated with surgeon subjective assessment of gastric health status or mortality rate. Intraoperative identification of gastric necrosis was associated with nonsurvival. Single plasma lactate concentrations and percentage change in serial lactate concentrations were associated with intraoperative gastric health status and mortality rate.
CONCLUSIONS AND CLINICAL RELEVANCE
The observed mortality rate for delayed-surgery patients was comparable to rates reported for other GDV treatment techniques. Results suggested that delaying corrective surgery is possible for certain dogs, but careful case selection would be important and no reliable preoperative case selection criteria were identified. Additional research is needed to further investigate the potential risks and benefits of staged versus immediate surgical treatment of GDV in dogs.
OBJECTIVE To validate that dogs become hypocoagulable following rattlesnake envenomation and to determine whether thromboelastographic abnormalities are correlated with envenomation severity for dogs bitten by rattlesnakes native to southern California.
ANIMALS 14 dogs with observed or suspected rattlesnake envenomation (envenomated dogs) and 10 healthy control dogs.
PROCEDURES For each dog, a citrate-anticoagulated blood sample underwent kaolin-activated thromboelastography. For each envenomated dog, a snakebite severity score was assigned on the basis of clinical findings, and prothrombin time, activated partial thromboplastin time, and platelet count were determined when the attending clinician deemed it necessary and owner finances allowed.
RESULTS For 12 of 14 envenomated dogs, the thromboelastographically determined clot strength was below the 25th percentile for the clot strength of control dogs, which was indicative of a hypocoagulable state. No envenomated dog had thromboelastographic results indicative of a hypercoagulable state. One envenomated dog had a prolonged prothrombin time, but the activated partial thromboplastin time and all thromboelastographic variables were within the respective reference ranges for that dog. Seven of 13 envenomated dogs were thrombocytopenic (platelet count, ≤ 170,000 platelets/μL). Snakebite severity score was negatively correlated with platelet count but was not correlated with any thromboelastographic variable.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dogs generally become hypocoagulable following rattlesnake envenomation. Thromboelastography might provide an objective measure of the coagulation status of envenomated dogs and aid in the identification of dogs that are in a hypocoagulable state and in need of antivenin treatment prior to the onset of progressive clinical signs.
Objective—To determine whether epidural administration of opioids was associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures.
Design—Retrospective cohort study.
Animals—179 client-owned dogs undergoing elective surgery for cranial cruciate ligament rupture.
Procedures—Medical records of 179 dogs that underwent surgical correction for cranial cruciate rupture between January 2009 and October 2012 were reviewed; 120 received epidural administration of opioids and 59 did not. Signalment, type of procedure, administration of epidural analgesia, time to first postanesthetic urination, and number of urinations during the first 24 hours were evaluated and compared between groups.
Results—Administration of preservative-free morphine into the epidural space was not significantly associated with time to first urination following anesthetic recovery or the total number of urinations within the first 24 hours of anesthetic recovery. Administration of a hydromorphone bolus IV following surgery was significantly associated with urinary retention, compared with administration of either morphine boluses or fentanyl constant rate infusions following surgery. No other variables were significantly associated with urinary retention.
Conclusions and Clinical Relevance—Administration of preservative-free morphine into the epidural space was not associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. Systemic administration of opioids may be associated with urinary retention.
To retrospectively compare clinical outcomes associated with 3 commercially available antivenom products (2 F[ab']2 products and 1 IgG product) in dogs with crotalid envenomation.
282 dogs with evidence of crotalid envenomation treated with antivenom at a single high-volume private emergency facility in southwestern Arizona from 2014 to 2018.
Data were collected on all dogs regarding signalment, coagulation test results, snakebite characteristics, type and number of units of antivenom received (1 of 3 products), survival to hospital discharge (yes or no), and complications following discharge. Survival rates and other variables were compared among antivenoms by means of bivariable analyses.
271 of 282 (96.1%) dogs survived to discharge; 11 (3.9%) were euthanized or died in the hospital. No significant difference in survival rates was found among the 3 antivenom products. Infusion reaction rates were higher for the IgG product than for each F(ab')2 product. A higher percentage of dogs treated with the IgG product (vs either F[ab']2 product) received only 1 unit of antivenom. Variables associated with a lower probability of survival included older age and lower body weight, thoracic (vs other) location of snakebites, and presence of an antivenom infusion reaction.
CONCLUSIONS AND CLINICAL RELEVANCE
Given that survival rates were high for all 3 antivenom products, clinicians may consider other factors when selecting an antivenom, such as preference for a fractionated versus whole immunoglobulin product, risk of infusion reaction, cost, shelf life, availability, ease of use and administration, species of crotalids used for antivenom production, approval by federal regulatory bodies, and clinical preference.
To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs.
170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016.
Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors.
Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs.
CONCLUSIONS AND CLINICAL RELEVANCE
These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.
Objectives—To determine incidence and identify predisposing
factors for sterile hemorrhagic cystitis (SHC) in
dogs with lymphoma that were treated with cyclophosphamide
and to evaluate whether furosemide administered
IV concurrently with cyclophosphamide decreased
the incidence of SHC.
Animals—216 dogs with lymphoma.
Procedure—Medical records of dogs with lymphoma
that received cyclophosphamide chemotherapy in
accordance with 1 of 2 protocols, with or without concurrent
IV administration of furosemide, were examined.
Data for the 2 groups were analyzed to determine
the incidence and predisposing factors (age, breed, sex,
weight, previous or preexisting disease, previous or preexisting
urinary tract infection, neutropenia, azotemia,
dose, and number of cyclophosphamide treatments) for
Results—Cyclophosphamide-associated SHC developed
in 12 of 133 (9%) dogs that had not received concurrent
administration of furosemide and cyclophosphamide
treatments; of the 83 dogs that had received
furosemide, only 1 (1.2%) developed SHC. Dogs receiving
cyclophosphamide and furosemide concurrently
were significantly less likely to develop SHC than dogs
that did not receive furosemide. Dogs with previous or
preexisting immune-mediated disease were significantly
more likely to develop cyclophosphamide-associated
Conclusions and Clinical Relevance—Analysis of
results suggested an association between IV administration
of furosemide concurrently with cyclophosphamide
and decreased incidence of cyclophosphamide-
associated SHC. Incidence of cyclophosphamide-
associated SHC was similar in treated dogs
that did not receive concurrent furosemide to that
observed for other studies in which cyclophosphamide
was administered orally. Cyclophosphamide-associated
SHC appeared to develop early during the course of
chemotherapy when furosemide was not administered
concurrently with cyclophosphamide. (J Am Vet Med
Objective—To evaluate the safety and efficacy of laparoscopic hepatic biopsy in dogs.
Design—Retrospective case series.
Animals—80 client-owned dogs.
Procedures—Medical records of dogs that underwent laparoscopic hepatic biopsy between 2004 and 2009 because of suspected hepatic disease were reviewed to obtain information on signalment, intraoperative and postoperative complications, and histologic diagnosis. Follow-up information was obtained through medical records and telephone conversations with owners.
Results—76 of the 80 (95%) dogs survived to hospital discharge. Three (4%) dogs required conversion to laparotomy, but in none of the dogs was conversion to laparotomy needed to control hemorrhage associated with the laparoscopic biopsy procedure. Another 3 (4%) dogs required a blood transfusion; all 3 had been anemic prior to surgery. All laparoscopic biopsy samples were considered to be of sufficient size and to contain a sufficient number of portal triads to obtain a histologic diagnosis. However, disagreements in histologic diagnoses were identified for 7 of the 49 (14%) dogs for which multiple slides were available for review.
Conclusions and Clinical Relevance—Results suggested that laparoscopic hepatic biopsy is a safe procedure in dogs, with low morbidity and mortality rates, that typically yields sufficient samples for histologic examination. However, because of the possibility of disagreement among histologic diagnoses, multiple samples should be obtained.
To determine the incidence of and potential risk factors for postoperative regurgitation and vomiting (PORV), postoperative nausea and vomiting (PONV), and aspiration pneumonia in geriatric dogs using premedication with maropitant and famotidine, intraoperative fentanyl, and postoperative fentanyl as part of an anesthetic protocol.
105 client-owned geriatric dogs that underwent general anesthesia for a major surgical procedure between January 2019 and March 2020.
Medical records were reviewed to collect data on signalment, historical gastrointestinal signs, American Society of Anesthesiologists (ASA) score, indication for surgery, duration of anesthesia and surgery, patient position during surgery, mode of ventilation, and perioperative administration of maropitant, famotidine, anticholinergics, opioids, colloidal support, NSAID, corticosteroids, and appetite stimulants. The incidence of postoperative regurgitation, vomiting, nausea, and aspiration pneumonia was calculated, and variables were each analyzed for their association with these outcomes.
2 of 105 (1.9%) dogs regurgitated, 1 of 105 (1.0%) dogs developed aspiration pneumonia, 4 of 105 (3.8%) dogs exhibited nausea, and no dogs vomited. Identified possible risk factors included older age (≥ 13 years old) for postoperative regurgitation, regurgitation for postoperative aspiration pneumonia, and high ASA score (≥ 4) for both regurgitation and aspiration pneumonia.
CONCLUSIONS AND CLINICAL RELEVANCE
The use of an antiemetic protocol including maropitant, famotidine, and fentanyl in geriatric dogs resulted in very low incidences of PORV, PONV, and aspiration pneumonia. Future prospective studies are warranted to further evaluate and mitigate postoperative risks.
Objective—To evaluate complications and outcomes associated with surgical placement of gastrojejunostomy feeding tubes in dogs with naturally occurring disease.
Procedures—Multiple preoperative, intraoperative, and postoperative variables were evaluated. Daily postoperative abdominal radiographic examinations were performed to determine the presence of the following mechanical tube complications: kinking, coiling, knotting, and migration. Tube stoma abnormalities (erythema, cellulitis, and discharge) were observed daily and recorded by use of a standardized visual analog grading scale. Additionally, presence of complications was compared with median survival times.
Results—The most common indication for gastrojejunostomy tube placement was gastrointestinal disease (n = 11), with confirmed septic peritonitis in 8 of 11 dogs. Other indications for gastrojejunostomy tube placement included extrahepatic biliary surgery (n = 6) and pancreatic disease (9). Mean ± SD surgical time required for tube placement was 26 ± 14 minutes. Overall, mechanical tube complication rate was 46% (12/26), including coiling (7), migration (4), and kinking (2). Overall minor tube stoma complication rate was 77% (20/26) and included erythema (16), cellulitis (13), and discharge (17). Dislodgement or self-induced tube trauma resulted in accidental tube removal in 2 of 26 dogs, and inadvertent tube damage necessitated premature removal by the clinician in 1 of 26 dogs. Kaplan-Meier median survival time was 39 days with 13 of 26 dogs still alive.
Conclusions and Clinical Relevance—Gastrojejunostomy tube placement affords flexibility in the postoperative nutritional regimen by allowing for postgastric feeding with simultaneous access to the stomach.