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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.)

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.)

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.)

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.)

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.)

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.)

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.)

A prospective, observational, cross-sectional study documenting the prevalence of pain in dogs presented to the emergency service of a veterinary teaching hospital and their handling (times to triage, examination, treatment) was conducted. Pain was assessed and compared using a validated and an unvalidated pain assessment scale. Sedation was monitored using a validated scale. A first evaluation was completed in 109 dogs. A second evaluation was completed for 95 dogs: 36 (38%) were identified as painful and 53% (19/36) were provided analgesia in the clinic. The remainder either did not receive analgesia (6/36, 17%) or were prescribed an analgesic for administration at home (11/36, 31%). Of dogs receiving analgesia in the clinic, most showed a decrease in pain score (15/19, 79%). Pain assessment scales were positively correlated ( r = 0.69, P < 0.0001) but the unvalidated scale was insensitive in discriminating changes. Between painful and non-painful dogs, progression did not differ: admission to treatment [ P = 0.96, 95% confidence interval (CI): -23 to 22 minutes] and examination to treatment ( P = 0.73, 95% CI: 14 to 20 minutes). Suboptimal analgesic use suggests focused training in pain assessment and analgesic use guided by a validated pain assessment scale, is warranted., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

The selection of an appropriate endotracheal tube (ET) for orotracheal intubation in dogs is based largely on experience, with no well-established guidelines available. This study examined relationships between several novel and published methods for selecting endotracheal tubes in a heterogenous population of 79 adult dogs. The following measurements were included: left and right nare width, nasal septum width, sum of left and right nares width plus the nasal septum width, total nose width and height, tracheal width, metacarpal and digital footpad width and height, and body mass. Using the Bland and Altman ratio method, the calculation of Cube Root Mass provided the greatest accuracy and precision, predicting actual ET size use within 3 to 4 tube sizes. A simpler to calculate, but less precise method was Width of Nose/3. The majority of published methods for estimating ET size performed poorly, including nasal septum and tracheal width., Competing Interests: The authors declare no conflicts of interest. Funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

A 6-year-old, 3.0 kg, neutered female, Yorkshire terrier was referred for orthopedic surgery. Cardiac arrest followed unsuccessful treatment of bradycardia and systemic arterial hypotension under general anesthesia. Postmortem examination revealed hypertrophic cardiomyopathy. A possible relationship between treatment of bradycardia, systemic arterial hypotension, and sudden cardiac death is described.