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Objective: To assess sedation following intramuscular (IM) administration of medetomidine versus medetomidine-vatinoxan in bearded dragons., Study Design: Prospective, randomized, experimental, crossover study., Animals: A group of 10 (five males and five females) bearded dragons (mean mass ± standard deviation 172 ± 28 g)., Methods: All animals were administered both medetomidine (0.2 mg kg -1 ) (MED) and medetomidine (0.2 mg kg -1 )-vatinoxan (4 mg kg -1 ) (MED-VAT) IM, with a 14-16 day washout period between treatments. Sedation was assessed using an adapted version of a sedation scale for bearded dragons (scale range 0-12) before (T0), and every 5 minutes from 10 to 45 minutes after treatment administration (T10-T45). Sedation scores were compared: 1) between time points (within treatments) using a Friedman test and Dunn's post hoc test; and 2) between treatments at each time point using a Wilcoxon paired test. Heart rate and respiratory rate (f R ) were analyzed descriptively. At T45, atipamezole was administered IM., Results: Compared with T0, sedation scores were significantly higher at most time points for both treatments. Highest median (range) scores occurred at T30 for MED [T0, 0 (0-0); T30, 2.5 (1-5); p = 0.0001] and at T35 and T40 for MED-VAT [T0, 0 (0-0); T35, 2 (1-5); p = 0.002; T40, 2 (1-5); p = 0.001]. No significant differences in sedation scores were identified between treatments at any time point. The two protocols caused bradycardia and reduction in f R . All animals were active and ate 1 hour after reversal administration., Conclusions and Clinical Relevance: Both medetomidine and medetomidine-vatinoxan caused similar mild sedation in bearded dragons (median < 3/12). Inclusion of vatinoxan did not enhance sedation in this species., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Perianesthetic death or sedation death in companion animals is an infrequent but devastating complication. Few studies have investigated the pathology associated with these deaths., Objective: To determine clinical features and postmortem findings for submissions to multiple Canadian diagnostic laboratories from perianesthetic/sedation deaths in dogs and cats., Animals and Procedure: Laboratory Information Management Systems were retrospectively reviewed for cases of perianesthetic/sedation death in dogs and cats. Inclusion criteria were: i) whole-body submissions and ii) death within 7 d after the procedure., Results: Pathology reports determined the cause of death in 43% of dogs (73/168) and 34% of cats (50/147). Spay/neuter surgeries were the most common procedure for which animals were submitted (dogs: n = 72, 31%; cats: n = 111, 58%). The American Society of Anesthesiologists physical status in these animals was low (ASA status I or II) in 94% of dogs (68/72) and 93% of cats (103/111). Clinical history was considered incomplete in 60.3% of cases (242/401)., Conclusion and Clinical Relevance: These results had similar trends to those in previous studies that identified an important proportion of submissions for perianesthetic/sedation deaths lacked significant lesions to explain the cause of death. This study also identified spay/neuter procedures were involved in the largest proportion of submissions, despite their low pre-anesthetic/sedation risk., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Grimace scales have been used to assess pain in various animal species. This study aimed to develop the calf grimace scale (CGS), evaluate its responsiveness and the effect of external factors (change of environment and dam separation, and restraint) on CGS. Sixty-nine Angus calves, 6-8 weeks old, were randomly allocated into castrated (n = 34) and sham castrated (n = 35) groups. Images were extracted from videos pre- (M1-M4), during- (M5), and post-castration/sham castration (M6, M7). Six facial action units (FAUs) were identified: ear position, orbital tightening, tension above the eye, nostril dilation, straining of chewing muscle, and mouth opening. Final CGS median scores increased after castration (P < 0.001) for both non-restrained (M7 versus M2) and restrained (M6 versus M3) calves, indicating scale responsiveness. Final CGS median scores increased (P < 0.001) when calves were subjected to external factors before castration (M1 [baseline] versus M2 and M3). However, there was no difference (P > 0.05) in CGS median scores before and after sham castration, regardless of restraint (M3 versus M6, and M2 versus M7), indicating that the external factors may have reached a maximum effect. The CGS is composed of six FAUs, responsive to acute pain and can identify stress unrelated to pain., (© 2024. The Author(s).)

Objective: To identify the perceptions of veterinary students interested in specialization regarding veterinary anesthesiology., Study Design: Cross-sectional, multi-institutional, voluntary, anonymous, nonrandomized survey., Population: Veterinary students (303 of 557 total respondents) from 10 veterinary schools., Methods: Quantitative data were obtained via 5-point Likert scale questions about anesthesia-related topics. Open-ended questions were used to obtain qualitative data. A multivariate logistic regression model assessed the likelihood of choosing a career as an anesthesiologist. Spearman's rank correlation coefficient was used to assess the relationship between 'anesthesia is interesting' and other variables., Results: Of the respondents, 14 (6%) indicated veterinary anesthesia as their chosen specialty. There was a significant positive relationship between 'anesthesia is interesting' and the following variables: age, enjoyment in anesthesia class, belief in the importance of anesthesia for their career, belief in the importance of analgesia for their career, belief that anesthesia and analgesia have a large impact on patient care, interest in pharmacology, interest in physiology, interest in learning technical skills, belief that anesthesiologists are respected by their colleagues and belief that anesthesiologists are an important part of the health care team. More weeks on the anesthesia clinical rotation was positively and significantly associated with increased rotation enjoyment. Enjoyment in the anesthesia class [p = 0.001, Exp(β) = 2.1, 95% confidence interval (CI): 1.3-3.4] and belief that anesthesia is interesting [p = 0.013, Exp(β) = 2.6, 95% CI: 1.2-5.4] were predictors that respondents would be more likely to consider a career as a veterinary anesthesiologist., Conclusions: Those veterinary students with an interest in pharmacology and who enjoyed their anesthesia course were more likely to consider a career as a veterinary anesthesiologist. If students indicated no interest in specializing in veterinary anesthesia, they appreciated the value the specialty brings to animal care and believed that veterinary anesthesiologists are respected by their peers., (Copyright © 2024 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To collect medication error (ME) data during the perianesthetic period from small animal clinics., Sample: 6 small animal general practice veterinary clinics., Methods: Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing., Results: A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education., Clinical Relevance: These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.

Objective: To provide an overview of medication errors (MEs) in veterinary medicine, with a focus on the perianesthetic period; to compare MEs in veterinary medicine with human anesthesia practice, and to describe factors contributing to the risk of MEs and strategies for error reduction., Databases Used: PubMed and CAB abstracts; search terms: [("patient safety" or "medication error∗") AND veterin∗]., Conclusions: Human anesthesia is recognized as having a relatively high risk of MEs. In veterinary medicine, MEs were among the most commonly reported medical error. Predisposing factors for MEs in human and veterinary anesthesia include general (e.g. distraction, fatigue, workload, supervision) and specific factors (e.g. requirement for dose calculations when dosing for body mass, using several medications within a short time period and preparing syringes ahead of time). Data on MEs are most commonly collected in self-reporting systems, which very likely underestimate the true incidence, a problem acknowledged in human medicine. Case reports have described a variety of MEs in the perianesthetic period, including prescription, preparation and administration errors. Dogs and cats were the most frequently reported species, with MEs in cats more commonly associated with harmful outcomes compared with dogs. In addition to education and raising awareness, other strategies described for reducing the risk of MEs include behavioral, communication, identification, organizational, engineering and cognitive aids., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Overdose of carbon dioxide gas (CO₂) is a common euthanasia method for rodents; however, CO₂ exposure activates nociceptors in rats at concentrations equal to or greater than 37% and is reported to be painful in humans at concentrations equal to or greater than 32.5%. Exposure of rats to CO₂ could cause pain before loss of consciousness. We used 2 standardized loss of righting reflex (LORR) methods to identify CO₂ concentrations associated with unconsciousness in Wistar, Long???Evans, and Sprague???Dawley rats (n = 28 animals per strain). A rotating, motorized cylinder was used to test LORR while the rat was being exposed to increasing concentrations of CO₂. LORR was defined based on a 15-second observation period. The 2 methods were 1) a 1-Paw assessment (the righting reflex was considered to be present if one or more paws contacted the cylinder after the rat was positioned in dorsal recumbency), and 2) a 4-Paw assessment (the righting reflex was considered to be present if all 4 paws contacted the cylinder after the rat was positioned in dorsal recumbency). Data were analyzed with Probit regression, and dose-response curves were plotted. 1-Paw EC 95 values (CO₂ concentration at which LORR occurred for 95% of the population) were Wistar, 27.2%; Long???Evans, 29.2%; and Sprague???Dawley, 35.0%. 4-Paw EC 95 values were Wistar, 26.2%; Long???Evans, 25.9%, and Sprague???Dawley, 31.1%. Sprague???Dawley EC 95 values were significantly higher in both 1- and 4-Paw tests as compared with Wistar and Long???Evans rats. No differences were detected between sexes for any strain. The 1-Paw EC 95 was significantly higher than the 4-Paw EC 95 only for Sprague-Dawley rats. These results suggest that a low number of individual rats from the strains studied may experience pain during CO₂ euthanasia.

Objective: Use a referral dental clinic model to study how to calculate accurate 95% upper confidence limits for probabilities of workloads (total case duration, including turnover time) exceeding allocated times., Animals: Dogs and cats undergoing dental treatments., Methods: Managerial data (procedure date and duration) collected over 44 consecutive operative workdays were used to calculate the daily anesthetist workload. Workloads were compared with a normal distribution using the Shapiro-Wilk test, serial correlation was examined by runs test, and comparisons among weekdays were made using the Kruskal-Wallis test. The 95% confidence limits for normally distributed workloads exceeding allocated times were estimated with a generalized pivotal quantity. The impact of a number of procedures was assessed with scatterplots, Pearson linear correlation coefficients, and multivariable linear regression., Results: Mean anesthetist's workload was normally distributed (Shapiro-Wilk P = .25), without serial correlation (P = .45), and without significant differences among weekdays (P = .52). Daily workload, mean 9.39 hours and SD 3.06 hours, had 95% upper confidence limit of 4.47% for the probability that exceeding 16 hours (ie, 8 hours per each of 2 tables). There was a strong positive correlation between daily workload and the end of the workday (r = .85), significantly larger than the correlation between the end of the workday and the number of procedures (r = .64, P < .0001)., Clinical Relevance: There are multiple managerial applications in veterinary anesthesia wherein the problem is to estimate risks of exceeding thresholds of workload, including the costs of hiring a locum, scheduling unplanned add-on cases, planning for late discharge of surgical patients to owners, and coordinating anesthetist breaks.

Studies assessing animal pain in veterinary research are often performed primarily for the benefit of animals. Frequently, the goal of these studies is to determine whether the analgesic effect of a novel treatment is clinically meaningful, and therefore has the capacity to improve the welfare of treated animals. To determine the treatment effect of a potential analgesic, control groups are necessary to allow comparison. There are negative control groups (where pain is unattenuated) and positive control groups (where pain is attenuated). Arising out of animal welfare concerns, there is growing reluctance to use negative control groups in pain studies. But for studies where pain is experimentally induced, the absence of a negative control group removes the opportunity to demonstrate that the study methods could differentiate a positive control intervention from doing nothing at all. For studies that are controlled by a single comparison group, the capacity to distinguish treatment effects from experimental noise is more difficult; especially considering that pain studies often involve small sample sizes, small and variable treatment effects, systematic error and use pain assessment measures that are unreliable. Due to these limitations, and with a focus on farm animals, we argue that many pain studies would be enhanced by the simultaneous inclusion of positive and negative control groups. This would help provide study-specific definitions of pain and pain attenuation, thereby permitting more reliable estimates of treatment effects. Adoption of our suggested refinements could improve animal welfare outcomes for millions of animals globally., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hyndman, Bowden, Woodward, Pang and Hampton.)

General anesthesia induces a reversible loss of consciousness (LOC), a state that is characterized by the inability to feel pain. Identifying LOC in animals poses unique challenges, because the method most commonly used in humans, responding to questions, cannot be used in animals. For over a century, loss of righting reflex (LORR) has been used to assess LOC in animals. This is the only animal method that correlates directly with LOC in humans and has become the standard proxy measure used in research. However, the reporting of how LORR is assessed varies extensively. This systematic literature review examined the consistency and completeness of LORR methods used in rats and mice. The terms 'righting reflex,' 'anesthesia,' 'conscious,' 'rats,' 'mice,' and their derivatives were used to search 5 electronic databases. The abstracts of the 985 articles identified were screened for indications that the study assessed LORR in mice or rats. Full texts of selected articles were reviewed for LORR methodological completeness, with reported methods categorized by 1) animal placement method, 2) behavioral presence of righting reflex, 3) duration of LORR testing, 4) behavioral LORR, and 5) animal position for testing LORR. Only 22 papers reported on all 5 methodological categories. Of the 22 papers, 21 used unique LORR methodologies, with descriptions of LORR methods differing in at least one category as compared with all other studies. This variability indicates that even papers that included all 5 categories still had substantial differences in their methodological descriptions. These findings reveal substantial inconsistencies in LORR methodology and reporting in the biomedical literature likely compromising study replicability and data interpretation.

General anesthesia of a 2-year-old castrated male alpaca undergoing mandibular tooth extraction was successfully managed via a mandibular nerve block with bupivacaine, using nerve stimulation to confirm correct needle placement. The local block was effective, with no cardiovascular or respiratory responses to surgical stimulation observed. Key clinical message: Use of a locoregional technique in dentistry confers anesthetic stability, blocks nociceptive responses to surgery, and promotes a smooth recovery and comfortable postoperative period., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Exposure to CO₂ gas is a common rodent euthanasia method. CO₂ activates nociceptors in rats and is painful to humans at concentrations equal to or greater than 32.5% The concentration of CO₂ at which rodents become unconsciousness is inadequately defined. We used loss of righting reflex (LORR) to identify the concentration at which CO₂ caused loss of consciousness in C57Bl/6, CD1 and 129P3J mice (16 females and 16 males per strain). We used a custom built, rotating, motorized cylinder to determine LORR as CO₂ concentrations were increased. Two LORR assessment methods were used: 1) a 1-Paw assessment in which the righting reflex was considered to be present if one or more paws contacted the cylinder after rotation into dorsal recumbency and 2) a 4-Paw assessment in which the righting reflex was considered to be present only if all 4 paws contacted the cylinder. LORR test data were analyzed with Probit regression and dose response curves were plotted. 1-Paw EC 95 values (CO₂ concentration at which LORR occurred for 95% of the population) were: C57Bl/6; 30.7%, CD1; 26.2%, 129P3J; 20.1%. The EC 95 for C57Bl/6 was significantly higher than that of the 129P3J mice, with no significant differences between other strains. Four-Paw EC 95 values were: C57Bl/6; 22.8%, CD1; 25.3%, 129P3J; 20.1%. Values for 129P3J mice were significantly lower than those of CD1 mice), with no significant difference between other strains. The EC 95 varied significantly between 1-Paw and 4-Paw methods only for C57Bl/6 mice. These results suggest a potential for nociception and pain to occur in some individuals of some mouse strains during CO₂ euthanasia.

Objective: To evaluate the reporting of key items associated with risk of bias and weak study design over a 10-year period., Design: Literature survey., Setting: Not applicable., Animals: Not applicable., Interventions: Papers published in the Journal of Veterinary Emergency and Critical Care between 2009 and 2019 were screened for inclusion. Inclusion criteria consisted of prospective experimental studies describing in vivo or ex vivo research (or both), containing at least 2 comparison groups. Identified papers had identifying information (publication date, volume and issue, authors, affiliations) redacted by an individual not involved with paper selection or review. Two reviewers independently reviewed all papers and applied an operationalized checklist to categorize item reporting as fully reported, partially reported, not reported, or not applicable. Items assessed included randomization, blinding, data handling (inclusions and exclusions), and sample size estimation. Differences in assessment between reviewers were resolved by consensus with a third reviewer. A secondary aim was to document availability of data used to generate study results. Papers were screened for links to access data in the text and supporting information., Measurements and Main Results: After screening, 109 papers were included. Eleven papers were excluded during full-text review, with 98 papers included in the final analysis. Randomization was fully reported in 31.6% of papers (31/98). Blinding was fully reported in 31.6% of papers (31/98). Inclusion criteria were fully reported in all papers. Exclusion criteria were fully reported in 60.2% of papers (59/98). Sample size estimation was fully reported in 8.0% of papers (6/75). No papers (0/99) made data freely available without a requirement to contact study authors., Conclusions: There is substantial room for improvement in reporting of randomization, blinding, data exclusions, and sample size estimations. Evaluation of study quality by readers is limited by the low reporting levels identified, and the risk of bias present indicates a potential for inflated effect sizes., (© Veterinary Emergency and Critical Care Society 2023.)

A 2-year-old Holstein cow weighing 530 kg at 2 mo gestation was scheduled for a paracostal laparotomy and abomasotomy following diagnosis of a reticular foreign body causing obstruction and abomasal impaction. Hemorrhagic shock occurred during surgery, with a rapid, approximately 60% decrease in arterial blood pressure, and reflex tachycardia with a 2-fold increase in heart rate. Following identification of hemorrhagic shock, arterial blood pressure was supported by reducing the inhalant anesthetic requirement, positive inotropic support (IV dobutamine infusion), and IV fluid therapy. Hypertonic saline was administered IV for initial resuscitation of arterial blood pressure, followed by a whole blood transfusion to replenish red blood cells, support oxygencarrying capacity, and provide intravascular volume to maintain cardiac output and tissue perfusion. A gradual increase in arterial blood pressure and a decrease in heart rate were observed in response to treatment. This case report demonstrates the physiologic compensatory response to hemorrhagic shock and the treatment to stabilize cardiovascular parameters in an anesthetized cow. Key clinical message: This case illustrates the physiological reponses to acute hemorrhage under general anesthesia and the effects of various treatment interventions., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Background: In both human and veterinary medicine, it is recommended that an anesthetic machine checkout procedure (preuse check) be performed daily, with some items tested before each case, to confirm safe function and the check results recorded., Objective: The objective of this prospective study was to evaluate anesthetic machines in private veterinary clinics in Alberta (Canada) using a standardized checkout procedure., Animals and Procedures: One-hundred consecutive anesthetic machines were assessed. For each item of the checkout procedure, a "pass," "fail," or "not applicable" score was awarded. "Not applicable" indicated an item that could not be evaluated., Results: Few machines (10%) evaluated had a secondary oxygen supply, no machines had an oxygen supply pressure alarm, and leaks were identified in 31 and 17% of rebreathing and non-rebreathing systems, respectively. Thirty-nine percent of machines did not have a high-pressure circuit alarm, 86% of machines were attached to an active scavenging system, although it was improperly connected in 56% of cases, and only 2% of machines were accompanied by a checkout log., Conclusion and Clinical Relevance: There was widespread variation in anesthetic machine standards and function, highlighting the value of performing a regular machine checkout procedure in creating a foundation for safe anesthetic practice., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Available methods for recognizing and assessing pain in rodents have increased over the last 10 years, including the development of validated pain assessment scales. Much of this work has been driven by the needs of biomedical research, and there are specific challenges to applying these scales in the clinical environment. This article provides an introduction to pain assessment scale validation, reviews current methods of pain assessment, highlighting their strengths and weaknesses, and makes recommendations for assessing pain in a clinical environment., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Pupillometry, the measurement of pupil size and reactivity to a stimulus, has various uses in both human and veterinary medicine. These reflect autonomic tone, with the potential to assess nociception and emotion. Infrared pupillometry reduces inaccuracies that may occur when the pupillary light reflex is determined subjectively by the examiner. To our knowledge, there are no published studies outlining normal reference intervals for automated pupillometry in dogs., Objective: The objective of this study was to develop de novo automated pupillometry reference intervals from 126 healthy canine eyes., Methods: The pupillary light reflex (PLR) was measured with a handheld pupillometer (NeurOptics™ PLR-200™ Pupillometer). Parameters recorded included maximum pupil diameter (MAX), minimum pupil diameter (MIN), percent constriction (CON), latency (LAT), average constriction velocity (ACV), maximum constriction velocity (MCV), average dilation velocity (ADV) and time to 75% pupil diameter recovery (T75). One measurement was obtained for each eye., Results: The following reference intervals were developed: MAX (6.05-11.30 mm), MIN (3.76-9.44 mm), CON (-37.89 to -9.64 %), LAT (0.11-0.30 s), ACV (-6.39 to -2.63 mm/ s), MCV (-8.45 to -3.75 mm/s), ADV (-0.21-1.77 mm/s), and T75 (0.49-3.20 s)., Clinical Significance: The reference intervals developed in this study are an essential first step to facilitate future research exploring pupillometry as a pain assessment method in dogs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mills, Combs-Ramey, Kwong and Pang.)

Objective: The Diabetes Prevention Program (DPP) is the gold standard lifestyle modification program that reduces incident type 2 diabetes mellitus. Patients with prediabetes and patients with non-alcoholic fatty liver disease (NAFLD) often share metabolic features; we hypothesized that the DPP could be adapted and used to improve outcomes in patients with NAFLD., Methods: NAFLD patients were recruited into a 1 year modified DPP. Demographics, medical comorbidities, and clinical laboratory values were collected at baseline, 6 and 12 months. The primary endpoint was change in weight at 12 months. Secondary endpoints were changes in hepatic steatosis, metabolic comorbidities, and liver enzymes (per-protocol basis) and retention at 6 and 12 months., Results: Fourteen NAFLD patients enrolled; three dropped out before 6 months. From baseline to 12 months, hepatic steatosis ( p  = 0.03), alanine aminotransferase ( p  = 0.02), aspartate aminotransferase ( p = 0.02), high-density lipoprotein ( p  = 0.01) and NAFLD fibrosis score ( p  < 0.001) improved, but low-density lipoprotein worsened ( p  = 0.04)., Conclusion: Seventy-nine percent of patients completed the modified DPP. Patients lost weight and had improvements in five out of six indicators of liver injury and lipid metabolism., Clinical Trial Registry Number: NCT04988204., Competing Interests: The authors declare no other conflict of interest., (© 2022 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Objective: To assess the feasibility of a canister-free negative-pressure wound therapy (NPWT) device (PICO™ 1.6, Smith & Nephew Medical Ltd) and evaluate its effect on early phases of wound healing in canine experimental cutaneous wounds., Animals: 5 adult spayed female research Beagles., Procedures: In a pilot experimental study, 1 full-thickness 2-cm X 2-cm cutaneous wound was surgically created on each hemithorax in each dog. Wounds were treated with either NPWT or a conventional wound dressing for 14 days. Bandage changes and wound evaluations were done at 7 time points. First macroscopic appearance of granulation tissue, smoothness of granulation tissue, and percentages of wound contraction and epithelialization were compared between treatments. Wounds were sampled at 3 time points for histopathologic analyses and semiquantitative scoring., Results: NPWT dressings were well tolerated by all dogs. Complete seal of the dressing required the application of adhesive spray, and maintenance of the vacuum lessened over time. Self-limiting skin irritations appeared in all dogs and hampered the attainment of negative pressure. Granulation tissue developed faster and was more abundant in control wounds. Wound contraction, epithelialization, and fibroblast proliferation were greater in control wounds at the end of the study., Clinical Relevance: This canister-free NPWT device is feasible but problematic in maintaining a vacuum, requiring frequent revisions of the dressing. Further studies are necessary to evaluate the effect of this device on early phases of wound healing. Its benefits in wound healing remain unknown.

Objective: The Glasgow Feline Composite Measure Pain Scale (CMPS-F) is a validated cat pain assessment tool for clinical use. No research has examined how training impacts use of this tool. Thus, we examined whether seminar-style training improves the identification of cat pain when using the CMPS-F. Veterinarians ( n = 17) and non-veterinarian staff ( n = 33; N = 50) were recruited to participate., Procedure: Seminars included: i) pre-training use of the CMPS-F to score cat videos with varying degrees of pain; ii) cat pain assessment training; and iii) post-training use of the CMPS-F. Participant CMPS-F ratings were compared to experts' ratings of the same videos. Average CMPS-F scores and analgesic decision ratings were compared pre-and post-training., Results: Most participants were female non-veterinarian staff who had not heard of the CMPS-F. Participant and expert analgesic decision-making did not differ pre- ( P = 1.0) and post-training ( P = 0.1). In addition, analgesic decision-making was similar between participants and experts for all but 3/20 videos., Conclusion and Clinical Relevance: Seminar training may not be necessary for efficacious use of the CMPS-F. Further research is needed to explore strategies for improving awareness of cat pain assessment tools and increasing in-clinic use., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

The most commonly accepted method of rat euthanasia in North America is intraperitoneal injection of sodium pentobarbital (PB). However, misinjection can occur, and intraperitoneal PB may cause pain and distress. The objective of this study was to test an alternative method of euthanasia: intrahepatic injection of PB. A pilot study was conducted to develop a method of intrahepatic injections (evaluated using CT scans and test injections), followed by a full study comparing intraperitoneal ( n = 14) and intrahepatic PB injections ( n = 66) in adult rats. Full study outcomes were: 1) time from injection to loss of right- ing reflex (LORR), 2) time from injection to cessation of heartbeat (CHB), 3) number of failed euthanasia attempts, and 4) confirmation of successful intrahepatic injection or misinjection via necropsy. All injections were performed by a veterinary student. CT revealed that intrahepatic injections were feasible. Times (median [range]) to LORR and CHB were faster after successful intrahepatic injections (LORR, 3 s [1 to 5 s]; CHB, 8 s [2 to 242 s]) than after intraperitoneal injections (LORR, 89.5 s [73 to 110 s], CHB: 284.5 s [237 to 423 s]). The misinjection rate was higher with intrahepatic injections (59%) than with intraperitoneal injections (29%), but intrahepatic misinjection still resulted in fast and successful euthanasia (LORR, 29 s [1 to 96 s]; CHB, 216 s [12 to 330 s]), with the injectate distributed between the intraperitoneal and intrahepatic locations. The number of failed euthanasia attempts with intrahepatic injections was low ( n = 2). Intrahepatic injections show potential as an alternative to intraperitoneal injections for rat euthanasia.

Objective: To evaluate reporting of items indicative of bias and weak study design., Study Design: Literature survey., Population: Papers published in Veterinary Anaesthesia and Analgesia., Methods: Reporting of randomization, blinding, sample size estimation and data exclusion were compared for papers published separated by a 10 year interval. A reporting rate of more than 95% was considered ideal. The availability of data supporting results in a publicly accessible repository was also assessed. Selected papers were randomized and identifiers removed for review, with data from 59 (57 in 2009, two in 2008) and 56 (52 in 2019, four in 2018) papers analyzed. Items were categorized for completeness of reporting using a previously published operationalized checklist. Two reviewers reviewed all papers independently., Results: Full reporting of randomization increased over time from 13.6% to 85.7% [95% confidence interval (CI), 57.8-86.6%; p < 0.0001], as did sample size estimation (from 0% to 20%; 95% CI, 7.6-32.4%; p = 0.002). Reporting of blinding (49.2% and 50.0%; 95% CI, -18.3% to 20.0%; p = 1.0) and exclusions of samples/animals (39.0% and 50.0%; 95% CI, -8.8% to 30.8%; p = 0.3) did not change significantly. Data availability was low (2008/2009, zero papers; 2018/2019, two papers). None of the items studied exceeded the predetermined ideal reporting rate., Conclusions and Clinical Relevance: These results indicate that reporting quality remains low, with a risk of bias., (Copyright © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Background: Burkholderia pseudomallei , the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections., Methods: We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016., Results: One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei . The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections., Conclusions: Gentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches., (© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

In biomedical research, rabbits are commonly sedated to facilitate a variety of procedures. Developing a sedation assessment scale enables standardization of levels of sedation and comparisons of sedation protocols, and may help in predicting sedation level requirements for different procedures. The goal of this study was to develop a rabbit sedation assessment scale using a psychometric approach. We hypothesized that the sedation scale would have construct validity, good internal consistency, and reliability. In a prospective, randomized, blinded study design, 15 (8 females, 7 males) healthy 1-y-old New Zealand white rabbits received 3 intramuscular treatments: midazolam (0.5 mg/kg; n = 6); midazolam (1.5 mg/kg)-ketamine (5 mg/kg; n = 7); and alfaxalone (4 mg/kg)-dexmedetomidine (0.1 mg/kg)-midazolam (0.2 mg/kg; n = 3). One rabbit received 2 treatments. A sedation scale was developed by using psychometric methods, with assessment performed by 6 independent raters who were blind to treatment. Final sedation scale items included posture, palpebral reflex, orbital tightening, lateral recumbency, loss of righting reflex, supraglottic airway device placement, toe pinch, and general appearance. The scale showed construct validity, good to very good interrater reliability for individual items (6 raters; intraclass correlation coefficient, 0.671 to 0.940), very good intrarater reliability (5 raters; intraclass correlation coefficient, 0.951 to 0.987), and excellent internal consistency (Cronbach α, 0.947). The sedation scale performed well under the conditions tested, suggesting that it can be applied in a wider range of settings (different populations, raters, sedation protocols).

Flumazenil, a competitive GABA A receptor antagonist, is commonly used in rabbits to shorten sedation or postanesthetic recovery after benzodiazepine administration. However, no combined pharmacokinetic (PK) and pharmacodynamic (PD) data are available to guide its administration in this species. In a prospective, randomized, blinded, crossover study design, the efficacy of IV flumazenil (FLU; 0.05 mg/kg) or saline control (SAL; equal volume) to reverse the loss of righting reflex (LORR) induced by IV midazolam (1.2 mg/kg) was investigated in 15 New Zealand white rabbits (2.73 to 4.65 kg, 1 y old). Rabbits were instrumented with arterial (central auricular artery) and venous (marginal auricular vein) catheters. After baseline blood sampling, IV midazolam was injected (T0). Flumazenil or saline (FLU/SAL) was injected 30 s after LORR. Arterial blood samples were collected at 1 and 3 min after midazolam injection, and at 1, 3, 6, 10, 15, 21, 28, 36, 45 and 60 min after injection with flumazenil. Plasma samples for midazolam, 1-OH-midazolam and flumazenil were analyzed using high performance liquid chromatography-high-resolution mass spectrometry and the time to return of righting reflex (ReRR) was compared between groups (Wilcoxon test). FLU terminal half-life, plasma clearance and volume of distribution were 26.3 min [95%CI: 23.3 to 29.3], 18.74 mL/min/kg [16.47 to 21.00] and 0.63 L/kg [0.55 to 0.71], respectively. ReRR was 25 times faster in rabbits treated with FLU (23 [8 to 44] s) compared with SAL (576 [130 to 1141] s; 95%CI [425 to 914 s]). Return of sedation (lateral recumbency) occurred in both groups (7/13 in FLU; 12/13 in SAL) with return of LORR in a few animals (4/13 in FLU; 7/13 in SAL) at 1540 [858 to 2328] s. In the population and anesthesia protocol studied, flumazenil quickly and reliably reversed sedation induced by midazolam injection. However, the potential return of sedation after flumazenil administration warrants careful monitoring in the recovery period.

In humans and other mammals, general anesthesia impairs thermoregulation, leading to warm core blood redistributing to the periphery. This redistribution is an important contributor to hypothermia that can be reduced with pre-warming before anesthesia. Additionally, sedation following premedication has been associated with hypothermia in dogs. In a prospective, randomized, cross-over study, 8 adult male and female rats (weighing 388 to 755 g) were sedated with intramuscular ketamine-midazolam-hydromorphone, then placed in an unwarmed cage or warmed box for 14 minutes, followed by 30 minutes of isoflurane anesthesia with active warming. Core body temperature was monitored throughout. After sedation, warmed rats gained 0.28°C ± 0.13°C and unwarmed rats lost 0.19°C ± 0.43°C, a significant difference between groups ( P = 0.004). After anesthesia, warmed rats maintained higher core temperatures ( P < 0.0001) with 2/8 and 6/8 of warmed and unwarmed rats becoming hypothermic, respectively. Pre-warming during sedation and active warming during general anesthesia is effective in minimizing hypothermia., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Based on human surgical guidelines, intravenous antimicrobials are recommended to be administered within 60 min of surgical incision. Achieving this target in horses is reportedly challenging and influenced by hospital policies. The objectives of this study were to evaluate and improve: (1) the timing of antimicrobial administration to surgical incision (tAB-INC), (2) contributions of anesthesia pre-induction (tPRI) and surgical preparation (tPREP) periods to tAB-INC, and the (3) completeness of antimicrobial recording. Two clinical audits were conducted before and after the policy changes (patient preparation and anesthesia record keeping). tPRI, tPREP, and tAB-INC were calculated and compared for elective arthroscopies and emergency laparotomies within and between the audits. The percentage of procedures with a tAB-INC <60 min was calculated. Antimicrobial recording was classified as complete or incomplete. A median tAB-INC <60 min was achieved in laparotomies (audit 1; 45 min, audit 2; 53 min) with a shorter tPREP than arthroscopies ( p < 0.0001, both audits). The percentage of procedures with tAB-INC <60 min, tAB-INC, tPRI, and tPREP durations did not improve between the audits. There was a positive correlation between the number of operated joints and tPREP (audit 1, p <0.001, r = 0.77; audit 2, p < 0.001, r = 0.59). Between audits, antimicrobial recording significantly improved for elective arthroscopies (82-97%, p = 0.008) but not emergency laparotomies (76-88%, p = 0.2). Clinical audits successfully quantified the impact of introduced changes and their adherence to antimicrobial prophylaxis guidelines. Antimicrobial recording was improved but further policy changes are required to achieve a tAB-INC <60 min for arthroscopies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ceriotti, Westerfeld, Bonilla and Pang.)

Clinical audit is a quality improvement tool for evaluating and improving patient care and outcomes. This is achieved by systematically reviewing current practices against explicit criteria and measuring the impact of change(s) introduced to generate improvement. The clinical audit process can be described by "Plan," "Do," "Study," "Act" phases that comprise an audit cycle. The phases are moved through in turn to attempt quality improvement. Clinical audits are widely used in human medicine at both local (individual clinic or hospital) and national (to achieve nationwide improvements in care) levels. Substantial and sustained improvements in patient care have been attributed to the use of clinical audits. Clinical audits have been described in the veterinary literature since the 1990s, but their adoption does not appear widespread. This paper is intended as a practical, "how to" guide to applying clinical audit in veterinary practice., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

von Frey (vF) monofilaments are used to quantify mechanical hypersensitivity and nociception in rodents; however, this method of testing has been criticized due to inconsistencies in testing methods, filament properties, and nonlinearity. This study compared withdrawal thresholds measured by using vF monofilaments with those of a novel mechanical threshold testing device currently in development (RatMet) in a carrageenan inflammatory model in 9- to 11-wk-old male Wistar rats. Rats were randomly assigned to assessment of mechanical hypersensitivity after intraplantar carrageenan injection by using either vF monofilaments ( n = 10) or the RatMet device equipped with 3 sizes of probe tips (0.9 mm [RM0.9], n = 15; 0.5 mm [RM0.5], n = 11; and 0.09 mm [RM0.09], n = 11). All RatMet probe sizes and vF monofilaments identified a reduction in withdrawal threshold after treatment. Systematic differences in threshold were identified between vF and both RM0.9 and RM0.5 groups; RM0.09 did not differ from vF. Withdrawal thresholds showed linear relationships with probe diameter, square root of probe diameter, and area of the RatMet probes. In contrast, exponential relationships were observed with the vF monofilaments. Furthermore, none of the RatMet probe results differed in accuracy when comparing a single test with the averages of 3 or 5 tests per time point. Overall, the RatMet device measurements have construct validity even when the number of testing replicates is low. These data indicate that the RatMet device produces data comparable with those from vF monofilaments, with the potential for a shortened testing period without a decrease in accuracy.

Accurate pain assessment methods are necessary to ensure animal welfare and reliable data collection in animal research. The Rat Grimace Scale (RGS), a facial expression pain scale, allows effective identification of pain. However, the potential confounds of this method remain mostly unexplored. General anesthesia, which is used in many laboratory procedures, suppresses thermoregulation and results in hypothermia. We investigated the effects of isoflurane-induced hypothermia on RGS scores. Twenty (10 male and 10 female) Sprague-Dawley rats each received 30 min of anesthesia, followed by 30 min of observation after the return of sternal recumbency. Rats were randomized to receive warming with an electric heating pad or no warming during both periods. Unwarmed rats became hypothermic within 15 min after isoflurane exposure began and returned to normothermia within 15 min after returning to sternal recumbency. Warmed rats did not deviate from the normothermic range. The RGS scores of unwarmed rats were significantly higher than baseline levels for 3 h after anesthesia and were higher than those of warmed rats at 5 and 180 min after anesthesia. Hypothermia resulted in a larger proportion of rats crossing a predetermined analgesic intervention threshold. Our findings show that hypothermia induced by isoflurane anesthesia presents a confound to accurate RGS scoring. These results emphasize the importance of maintaining normothermia to avoid inflated pain scores and to obtain accurate pain assessment.

As a result of the various restrictions associated with the current COVID-19 pandemic, the practice of veterinary telehealth is likely to grow substantially. One area in which high quality care can be maintained while respecting physical distancing is teleconsulting, which describes the relationship between an attending and off-site consulting veterinarian. This guide uses a dentistry case to illustrate the provision of real-time anesthesia consulting, with a focus on the technological considerations central to facilitating live, 2-way video-communication. Case selection, teamwork, and patient safety are also discussed., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Objective: To assess the impact of preanaesthetic echocardiography on the subsequent intended anaesthetic management plan in cats with incidental clinical findings that may indicate cardiac disease., Study Design: Clinical study involving cats undergoing echocardiography and subsequent anaesthesia., Animals: A total of 40 client-owned cats., Methods: Echocardiography was performed in conscious cats and the information was used to plan anaesthesia or sedation. An information sheet including relevant history, temperament, body condition score, clinical examination findings, current medication and results of any relevant tests such as haematology, biochemistry or Doppler blood pressure measurement was sent to three specialist anaesthetists and virtual case management plans were designed for each cat in two steps: step 1) anaesthetists were unaware of echocardiography results; and step 2) anaesthetists were aware of echocardiography results. In the second step the anaesthetists documented any changes to their original management plan, as either 'step-up' or 'step-down'., Results: Of the 40 cats, 26 had murmurs, four had a gallop rhythm, four had both findings and six had other findings. Pathology of potential haemodynamic significance was found on echocardiography in 23 cats, 17 of which anaesthetists had correctly identified as having disease before echocardiography. A proportion of cats with murmurs were subsequently deemed to have no significant pathology after echocardiography. Echocardiography findings in these cases were: dynamic left ventricular outflow tract obstruction (DLVOTO) without hypertrophy; DLVOTO without hypertrophy + dynamic right ventricular outflow tract obstruction (DRVOTO); DRVOTO; valvular dysplasia; normal. In a median of 26/40 (range 16-38) of cases, the anaesthetic plan was changed after provision of further information; in 15/40 (8-20) cases, this was a 'step-up' in care and in eight/40 (6-23) it was a 'step-down' in care. In cases with atrial enlargement (left atrium to aortic ratio of >1.6) and deemed at risk of cardiac failure, alpha-2 agonist use changed considerably with availability of echocardiography findings., Conclusion: and clinical relevance Where there are abnormal cardiac findings on clinical examination in cats, echocardiography is required to accurately assess anaesthetic risk . The availability of echocardiographic information positively influences anaesthetic management., (Copyright © 2020 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

The measurement of pain in animals is surprisingly complex, and remains a critical issue in veterinary care and biomedical research. Based on the known utility of pain measurement via facial expression in verbal and especially non-verbal human populations, "grimace scales" were first developed a decade ago for use in rodents and now exist for 10 different mammalian species. This review details the background context, historical development, features (including duration), psychometric properties, modulatory factors, and impact of animal grimace scales for pain., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To investigate the relationship between oxygen administration and ventilation in rabbits administered intramuscular alfaxalone-dexmedetomidine-midazolam., Study Design: Prospective, randomized, blinded study., Animals: A total of 25 New Zealand White rabbits, weighing 3.1-5.9 kg and aged 1 year., Methods: Rabbits were anesthetized with intramuscular alfaxalone (4 mg kg -1 ), dexmedetomidine (0.1 mg kg -1 ) and midazolam (0.2 mg kg -1 ) and randomized to wait 5 (n = 8) or 10 (n = 8) minutes between drug injection and oxygen (100%) administration (facemask, 1 L minute -1 ). A control group (n = 9) was administered medical air 10 minutes after drug injection. Immediately before (PRE oxy/air 5/10) and 2 minutes after oxygen or medical air (POST oxy/air 5/10), respiratory rate (f R ), pH, PaCO 2 , PaO 2 , bicarbonate and base excess were recorded by an investigator blinded to treatment allocation. Data [median (range)] were analyzed with Wilcoxon, Mann-Whitney U and Kruskal-Wallis tests and p < 0.05 considered significant., Results: Hypoxemia (PaO 2 < 88 mmHg, 11.7 kPa) was observed at all PRE times: PRE oxy 5 [71 (61-81) mmHg, 9.5 (8.1-10.8) kPa], PRE oxy 10 [58 (36-80) mmHg, 7.7 (4.8-10.7) kPa] and PRE air 10 [48 (32-64) mmHg, 6.4 (4.3-8.5) kPa]. Hypoxemia persisted when breathing air: POST air 10 [49 (33-66) mmHg, 6.5 (4.4-8.8) kPa]. Oxygen administration corrected hypoxemia but was associated with decreased f R (>70%; p = 0.016, both groups) and hypercapnia (p = 0.016, both groups). Two rabbits (one per oxygen treatment group) were apneic (no thoracic movements for 2.0-2.5 minutes) following oxygen administration. f R was unchanged when breathing air (p = 0.5). PaCO 2 was higher when breathing oxygen than air (p < 0.001)., Conclusions and Clinical Relevance: Early oxygen administration resolved anesthesia-induced hypoxemia; however, f R decreased and PaCO 2 increased indicating that hypoxemic respiratory drive is an important contributor to ventilation using the studied drug combination., (Copyright © 2020. Published by Elsevier Ltd.)

Objectives: The aim of this study was to compare the effects of butorphanol and buprenorphine, as part of a multimodal analgesic protocol, on recovery and analgesia in cats undergoing orchiectomy., Methods: In a prospective, randomized, blind clinical trial, 47 adult male cats were randomly assigned to receive either butorphanol (0.3 mg/kg, n = 24) or buprenorphine (0.02 mg/kg, n = 23) in combination with dexmedetomidine (25 μg/kg) and alfaxalone (2 mg/kg) as a single intramuscular injection for the induction of general anesthesia. Isoflurane carried in oxygen was supplemented as needed during orchiectomy. All cats received lidocaine (2 mg/kg intratesticular), meloxicam (0.3 mg/kg SC) and atipamezole (125 μg/kg IM) postoperatively. Pain and sedation scales were applied at baseline, and 2, 4 and 6 h postoperatively. Time to achieve sternal recumbency and to begin eating were also recorded., Results: Pain scale scores were low and showed no difference between the treatment groups at all time points ( P ⩾0.99, all time points). Four cats exceeded the analgesia intervention threshold for rescue analgesia (butorphanol, n = 3; buprenorphine, n = 1). There was no difference in sedation scores between groups at any time point ( P >0.99, all time points). Significantly more cats in the buprenorphine group (n = 12) required isoflurane than in the butorphanol group (n = 2) ( P  = 0.0013; relative risk 6.3, 95% confidence interval [CI] 1.8-23.5). There was no significant difference in time to achieve sternal recumbency ( P  = 0.96, 95% CI -20 to 20) between groups or in return to eating ( P  = 0.48, 95% CI -92.0 to 113.5), with most cats eating within 1 h of surgery (butorphanol, 79%; buprenorphine, 83%)., Conclusions and Relevance: There were no significant differences in analgesia or recovery between butorphanol and buprenorphine treatment groups as part of a multimodal injectable anesthetic protocol. Butorphanol is associated with superior depth of anesthesia, facilitating injectable anesthesia.

Direct oral anti-coagulants (DOACs) reduce hospital length-of-stay (LOS) in patients with acute pulmonary embolism (PE) in clinical trials. There is a paucity of literature describing real world utility of DOACs, particularly in intermediate-risk patients. To evaluate if the utilization of DOACs vs. non-DOACs in acute PE patients, reduces LOS without a difference in safety in patients defined as low and intermediate-risk of mortality by the European Society of Cardiology. This was a retrospective cohort study of prospectively collected data from a single center registry of consecutive adult outpatients diagnosed with acute PE who survived to hospital discharge. Primary outcome was median hospital LOS. Secondary outcomes were 30-day readmission, survival, and incidence of major and minor bleeding. There were 307 outpatients admitted with acute PE 88 (28.7%) low-risk, 213 (69.4%) intermediate-risk, and 6 (2.0%) high-risk. Two hundred and twenty-six (73.6%) received a DOAC. There was a statistically significant shorter median LOS in all patients treated with a DOAC (2.9 days, IQR 1.8-4.7) vs non-DOAC (4.9 days, IQR 3-8.9) (Generalized Linear Model p < 0.001). There was a shorter median LOS between intermediate-risk patients treated with a DOAC (3.6 days, IQR 2-5.8) vs non-DOAC (5, IQR 3-9). There was no difference in 30-day readmission, survival, or bleeding complications in both cohorts. There was a reduction in LOS in low and intermediate risk patients treated with a DOAC without a difference in 30-day safety and efficacy. Treating acute PE patients with DOACs including intermediate-risk patients, compared to conventional anticoagulation, may facilitate early discharge, and potentially reduce hospital costs.

General anesthesia is a common procedure in laboratory rats; however, it impairs thermoregulation, rapidly leading to hypothermia as warm core blood is distributed to the cooler periphery. The protective strategy of prewarming before the onset of anesthesia delays hypothermia, but only for a short period. This prospective, randomized, cross-over, experimental study in adult male and female SD rats ( n = 8) was designed to compare passive (fleece blanket) and active (temperature controlled heating pad) warming. Initial treatment order was randomized, with a cross-over after a minimum 5 d washout period. Both groups underwent a period of prewarming in a warming box to increase core temperature by 1% (median 0.4 °C). At completion of prewarming, general anesthesia was induced and maintained for 30 min with isoflurane carried in oxygen. Core temperature was monitored for a further 30 min after anesthesia. Active warming resulted in higher core temperatures during anesthesia. During passive warming, hypothermia occurred after approximately 30 min of anesthesia and continued into recovery. In contrast, active warming prevented hypothermia. Prewarming followed by passive warming delayed hypothermia for approximately 30 min, but active warming was more effective at maintaining normothermia both during and after general anesthesia.

This report describes the intensive blood pressure management and transfusion of a peripartum intrauterine hemorrhage following a cesarean section in a dog. The impact of pregnancy-associated physiologic changes and anesthesia on hemodynamic parameters along with potential alternate management techniques are discussed., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Carbon dioxide and isoflurane are widely used for killing rats, yet may not truly achieve "euthanasia", because they elicit aversion. The inhalant anesthetic desflurane is faster acting than isoflurane, representing a potential refinement. Using an aversion-avoidance paradigm, 24 rats were exposed to isoflurane or desflurane ( n = 12 per group) at initial exposure. Fourteen rats were then re-exposed to isoflurane or desflurane ( n = 7 per group), after a 7 days washout period. Initial exposure: time to recumbency was faster for desflurane than isoflurane ( p = 0.0008, 95% CI [-12.9 to 32.6 s]), with 9/12 and 6/12 rats becoming recumbent, respectively. At initial exposure, there was no difference between groups in time to withdrawal ( p = 0.714). At re-exposure, all rats withdrew and no rats became recumbent. Time to withdrawal at re-exposure did not differ between treatment groups ( p = 0.083). Compared to initial exposure, time to withdrawal during re-exposure was similar for isoflurane ( p = 0.228) and faster with desflurane ( p = 0.012, 95% CI [19.1 to 49.5 s]). Isoflurane and desflurane are similarly aversive, with aversion increasing at re-exposure. The shorter time from exposure to recumbency with desflurane indicates that any distress is of a shorter duration when compared with isoflurane.

Intraperitoneal (IP) injection of sodium pentobarbital (PB) is an accepted method of euthanasia for mice. However, this method has important drawbacks, including the potential for pain or misinjection. The objective of this prospective, randomized, blinded study was to determine whether intrahepatic (IH) injection of PB is more effective than IP delivery for mouse euthanasia. Secondary objectives were to: 1) determine whether IP ethanol (ET) is a suitable alternative to PB and 2) study the effect of isoflurane anesthesia on euthanasia with either PB or ET. Eighty adult CD1 mice were randomly assigned to 6 different treatment groups, were euthanized by using IP or IH injections of either PB or ET, and were either anesthetized or conscious before injection. Variables of interest were: 1) misinjection rates (based on necropsy evaluation), 2) time from injection to apnea and 3) time to cessation of heartbeat (CHB). The misinjection rate for IH injections was 93% (28/30). Two successful IH injections resulted in death within 4 s, but this method cannot be recommended due to the possibility for intrathoracic injection ( n = 4). In nonanesthetized mice, time to apnea and CHB was significantly shorter with IP ET (apnea: 72.5 s [median], CHB: 115 s) than with IP PB (apnea: 136 s, CHB: 176 s). Anesthesia at time of injection was associated with a shorter CHB time for IP PB. These data show the difficulty in achieving successful IH injections in mice, but confirm that IP ET is a viable and potentially superior alternative to IP PB. Lastly, anesthesia can shorten time to death after IP injection of PB.

Euthanasia is one of the most commonly performed procedures in biomedical research, involving tens of millions of animals in North America and Europe every year. The use of sodium pentobarbital, injected intraperitoneally, for killing rodents is described as an acceptable technique by the AVMA and CCAC euthanasia guidelines. This drug and route are recommended over inhalant anesthetics, carbon dioxide, and physical methods for ethical and aesthetic reasons as well as efficiency. However, a growing body of evidence challenges the efficacy and utility of intraperitoneal pentobarbital. This methodology has been described as inconsistent and may induce pain and stress. With these considerations in mind, a review of the literature is needed to assess the evidence surrounding this killing method, the associated welfare implications, and potential for refinement.

Objective: To assess agreement between oscillometric noninvasive blood pressure (NIBP) measurements using LifeWindow monitors (LW9xVet and LW6000V) and invasive blood pressure (IBP). To assess the agreement of NIBP readings using a ratio of cuff width to mid-cannon circumference of 25% and 40%., Study Design: Prospective, randomized clinical study., Animals: A total of 43 adult horses undergoing general anesthesia in dorsal recumbency for different procedures., Methods: Anesthetic protocols varied according to clinician preference. IBP measurement was achieved after cannulation of the facial artery and connection to an appropriately positioned transducer connected to one of two LifeWindow multiparameter monitors (models: LW6000V and LW9xVet). Accuracy of monitors was checked daily using a mercury manometer. For each horse, NIBP was measured with two cuff widths (corresponding to 25% or 40% of mid-cannon bone circumference), both connected to the same monitor, and six paired IBP/NIBP readings were recorded (at least 3 minutes between readings). NIBP values were corrected to the relative level of the xiphoid process. A Bland-Altman analysis for repeated measures was used to assess bias (NIBP-IBP) and limits of agreement (LOAs)., Results: The 40% cuff width systolic arterial pressure [SAP; bias 7.9 mmHg, LOA -26.6 to 42.3; mean arterial pressure (MAP): bias 4.9 mmHg, LOA -28.2 to 38.0; diastolic arterial pressure (DAP): bias 4.2 mmHg, LOA -31.4 to 39.7)] performed better than the 25% cuff width (SAP: bias 26.4 mmHg, LOA -21.0 to 73.9; MAP: bias 15.7 mmHg, LOA -23.8 to 55.2; DAP: bias 10.9 mmHg, LOA -33.2 to 54.9)., Conclusions and Clinical Relevance: Using the LifeWindow multiparameter monitor in anesthetized horses, the 40% cuff width provided better agreement with IBP; however, both cuff sizes and both monitor models failed to meet American College of Veterinary Internal Medicine Consensus Statement Guidelines., (Copyright © 2020 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Background: The Feline Grimace Scale (FGS) is a facial expression-based scoring system for acute pain assessment in cats with reported validity using image assessment. The aims of this study were to investigate the clinical applicability of the FGS in real-time when compared with image assessment, and to evaluate the influence of sedation and surgery on FGS scores in cats., Methods: Sixty-five female cats (age: 1.37 ± 0.9 years and body weight: 2.85 ± 0.76 kg) were included in a prospective, randomized, clinical trial. Cats were sedated with intramuscular acepromazine and buprenorphine. Following induction with propofol, anesthesia was maintained with isoflurane and cats underwent ovariohysterectomy (OVH). Pain was evaluated at baseline, 15 min after sedation, and at 0.5, 1, 2, 3, 4, 6, 8, 12 and 24 h after extubation using the FGS in real-time (FGS-RT). Cats were video-recorded simultaneously at baseline, 15 min after sedation, and at 2, 6, 12, and 24 h after extubation for subsequent image assessment (FGS-IMG), which was performed six months later by the same observer. The agreement between FGS-RT and FGS-IMG scores was calculated using the Bland & Altman method for repeated measures. The effects of sedation (baseline versus 15 min) and OVH (baseline versus 24 h) were assessed using linear mixed models. Responsiveness to the administration of rescue analgesia (FGS scores before versus one hour after) was assessed using paired t -tests., Results: Minimal bias (-0.057) and narrow limits of agreement (-0.351 to 0.237) were observed between the FGS-IMG and FGS-RT. Scores at baseline (FGS-RT: 0.16 ± 0.13 and FGS-IMG: 0.14 ± 0.13) were not different after sedation (FGS-RT: 0.2 ± 0.15, p = 0.39 and FGS-IMG: 0.16 ± 0.15, p = 0.99) nor at 24 h after extubation (FGS-RT: 0.16 ± 0.12, p = 0.99 and FGS-IMG: 0.12 ± 0.12, p = 0.96). Thirteen cats required rescue analgesia; their FGS scores were lower one hour after analgesic administration (FGS-RT: 0.21 ± 0.18 and FGS-IMG: 0.18 ± 0.17) than before (FGS-RT: 0.47 ± 0.24, p = 0.0005 and FGS-IMG: 0.45 ± 0.19, p = 0.015)., Conclusions: Real-time assessment slightly overestimates image scoring; however, with minimal clinical impact. Sedation with acepromazine-buprenorphine and ovariohysterectomy using a balanced anesthetic protocol did not influence the FGS scores. Responsiveness to analgesic administration was observed with both the FGS-RT and FGS-IMG., Competing Interests: Beatriz Monteiro and Paulo Steagall have provided consultancy services for Zoetis. This does not alter the authors’ adherence to PeerJ policies on sharing data and materials., (©2020 Evangelista et al.)

Objective: To evaluate the ability of veterinary personnel to predict the duration of surgery and associated procedures in a referral center., Study Design: Prospective observational study., Sample Population: Experienced surgeons (ES; n = 2, board certified for 10+ years), inexperienced surgeons (IS; n = 2, residency completed, not board certified), anesthesia animal health technicians (AAHT; n = 3) and surgery animal health technicians (SAHT; n = 2)., Methods: Surgeons and technicians predicted surgery duration (skin incision to final stitch/staple) and total procedure duration (TPD; from induction of anesthesia to extubation). Predictions were compared to actual durations with Bland-Altman plots to assess agreement (accuracy) as indicated by bias (mean of observed differences) and limits of agreement (LOA; bias ±1.96 SD)., Results: All groups underestimated TPD. Experienced surgeons predicted their own TPD more accurately (bias -20.1 ± 30.4 minutes [±SD]) and more consistently (narrower LOA) than IS for their own TPD (-40.1 ± 41.0 minutes). Experienced surgeon TPD predictions by AAHT were more accurate than those by ES (bias -16.0 ± 28.9 minutes, LOA 5% narrower). Inexperienced surgeon TPD predictions by AAHT were less consistent (wider LOA) than those by IS. Own surgery duration predictions by surgeons were similar in magnitude (ES surgery duration [ESSD] 8.3 ± 18.3, IS surgery duration [ISSD] surgery duration -7.9 ± 27.2 minutes), with greater consistency by ES (LOA 30% narrower). Anesthesia animal health technician predictions were similar to those of surgeons (ESSD 3.0 ± 19.3, ISSD -9.0 ± 28.7 minutes). Surgery animal health technician predictions were similar to those of AAHT for ESSD but were less accurate for ISSD., Conclusion: Surgery duration was more accurately predicted than TPD, which was most accurately predicted by anesthesia technicians., Clinical Significance: Surgical procedure planning should involve personnel best able to predict total procedure durations; in this case, anesthesia technicians. Accurate planning will promote efficient operating room and personnel use., (© 2020 The American College of Veterinary Surgeons.)

General anesthesia causes hypothermia by impairing normal thermoregulatory mechanisms. When using inhalational anesthetic agents, Redistribution of warm blood from the core to the periphery is the primary mechanism in the development of hypothermia and begins following induction of anesthesia. Raising skin temperature before anesthesia reduces the temperature gradient between core and periphery, decreasing the transfer of heat. This prospective, crossover study (n = 17 adult male and female SD rats) compared three treatment groups: PW1% (pre-warming to increase core temperature 1% over baseline), PW40 (pre-warming to increase core temperature to 40°C) and NW (no warming). The PW1% group was completed first to ensure tolerance of pre-warming. Treatment order was then randomized and alternated after a washout period. Once target temperature was achieved, anesthesia was induced and maintained with isoflurane in oxygen without further external temperature support. Pre-warming was effective at delaying the onset of hypothermia, with a significant difference between PW1% (12.4 minutes) and PW40 (19.3 minutes, p = 0.0044 (95%CI -12 to -2.2), PW40 and NW (7.1 minutes, p < 0.0001 (95%CI 8.1 to 16.0) and PW1% and NW (p = 0.003, 95%CI 1.8 to 8.7). The rate of heat loss in the pre-warmed groups exceed that of the NW group: PW1% versus NW (p = 0.005, 95%CI 0.004 to 0.027), PW40 versus NW (p < 0.0001, 95%CI 0.014 to 0.036) and PW1% versus PW40 (p = 0.07, 95%CI -0.021 to 0.00066). Pre-warming alone confers a protective effect against hypothermia during volatile anesthesia; however, longer duration procedures would require additional heating support., Competing Interests: The authors have read the journal's policy and have the following conflicts: Author KS is a director at Vetronic Services Ltd., the company that designed and built the heating unit. There are no patents, products in development, or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.