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Objective: To evaluate the feasibility of an ultrasound-guided technique targeting the medial branches of the dorsal ramus of the spinal nerves (DRSN) by injecting a dye solution at the caudal aspect of the base of lumbar mammillary processes [i.e. the retromammillary (RM) space]., Study Design: Feasibility, descriptive, anatomical study., Animals: Eleven canine cadavers., Methods: Using anatomical dissections, the relationship between the mammillary processes and the branches of the DRSN of the thoracolumbar and lumbar spine was studied in two cadavers. Subsequently, ultrasound-guided RM injections were administered in nine cadavers, randomly assigned to low volume (LV; 0.01 mL kg -1 ) of a dye solution at multiple points from L3 to L6 on one side, and high volume (HV; 0.4 mL kg -1 ) at a single L4 point on the contralateral side. Gross anatomical dissections were immediately performed after the injections. The RM injections were feasible if ultrasonographic landmarks were identifiable in at least 80% of cases, and 80% of LV injections showed medial branch staining. A one-sample binomial test was used for testing feasibility., Results: The medial branches emerged shortly after the DRSN exited the intervertebral foramen and traveled towards the caudal aspect of the base of the mammillary process, which served as the target injection point. With LV, 36 out of 36 (100%) injected medial branches were stained, meeting the criteria of feasibility (p < 0.001). The median (range) number of stained medial branches per cadaver were 4 (4-4) and 2 (1-3), with LV and HV, respectively. Although no lateral branches were stained with LV, 1 (0-2) was stained with HV. Neither ventral branch staining nor epidural spread was noted in any cadaver., Conclusions and Clinical Relevance: Ultrasound-guided RM injections are feasible and allow for selective staining of the medial branch of the DRSN in canine cadavers at the lumbar spine., (Copyright © 2024 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare perioperative opioid consumption in dogs undergoing pelvic limb surgeries and receiving a lumbosacral plexus block by combining a lumbar [lateral pre-iliac (LPI)] block with a lumbosacral trunk [i.e. parasacral (PS group) or greater ischiatic notch plane (GIN group)] block. Study design Retrospective, descriptive, exploratory, noninferiority cohort study., Methods: Medical records of 37 client-owned dogs were analyzed. Intraoperative (primary outcome) and postoperative (24 hours) opioid use, 24 hour cumulative pain scores and prevalence of complications were compared between the two groups. Opioid use was quantified in morphine equivalents (ME, mg kg -1 ). The noninferiority limit for intraoperative opioid consumption was set at 0.05 ME kg -1 hour -1 . Demographic data, procedure duration, surgery type and perioperative dexmedetomidine and ketamine use were also collected. A t-test or Wilcoxon rank-sum test, a Fisher's exact test and multivariable linear regression were used. Significance was set at p < 0.05., Results: The GIN and PS groups comprised 17 and 20 dogs, respectively. Total intraoperative ME consumption was 0.17 (0.11-0.21) and 0.22 (0.16-0.30) mg kg -1 hour -1 for the GIN and PS groups, respectively (p = 0.077). The noninferiority analysis adjusted by surgery type and body mass revealed that the mean difference between the groups (GIN - PS) was -0.039 (95% CI -0.11-0.03, p = 0.247) ME mg kg -1 hour -1 , indicating that the GIN group was not inferior to the PS group regarding intraoperative ME consumption. Dexmedetomidine and ketamine use, postoperative ME consumption and pain scores were similar between groups., Conclusions and Clinical Relevance: This retrospective study and preliminary observations support the clinical use of the GIN plane block, demonstrating its noninferiority to the PS block when combined with the LPI block for multimodal perioperative analgesia in dogs undergoing pelvic limb surgeries., (Copyright © 2024 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To describe the gross and ultrasound anatomy of the parasacral region and an ultrasound-guided greater ischiatic notch (GIN) plane approach aimed at staining the lumbosacral trunk (LST) in canine cadavers. To evaluate if the ultrasound-guided GIN plane approach is non-inferior to the previously described ultrasound-guided parasacral approach at staining the LST., Study Design: Prospective, randomized, non-inferiority experimental anatomic study., Animals: A total of 17 (23.9 ± 5.2 kg) mesocephalic canine cadavers., Methods: Anatomic and echographic landmarks, and the feasibility of performing a GIN plane technique were evaluated using two canine cadavers. The remaining 15 cadavers had each hemipelvis randomly assigned to be administered either parasacral or GIN plane injection of 0.15 mL kg -1 dye solution. The parasacral region was dissected after injections to assess the staining of LST, cranial gluteal nerve, pararectal fossa and pelvic cavity. The stained LST were removed and processed for histological evaluation of intraneural injections. A one-sided z-test for non-inferiority (non-inferiority margin -14%) was used to statistically evaluate the success of the GIN plane versus the parasacral approach. Data were considered statistically significant when p < 0.05., Results: The GIN plane and parasacral approach stained the LST in 100% and 93.3% of the injections, respectively. The success rate difference between treatments was 6.7% [95% confidence interval, -0.6 to 19.0%; p < 0.001 for non-inferiority]. The GIN plane and parasacral injections stained the LST for 32.7 ± 16.8 mm and 43.1 ± 24.3 mm, respectively (p = 0.18). No evidence of intraneural injection was found., Conclusions and Clinical Relevance: The ultrasound-guided GIN plane technique resulted in nerve staining that was non-inferior to the parasacral technique and may be considered an alternative to the parasacral approach to block the LST in dogs., (Copyright © 2023 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the impact of a 30% end-inspiratory pause (EIP) on alveolar tidal volume (V Talv ), airway (V Daw ) and physiological (V Dphys ) dead spaces in mechanically ventilated horses using volumetric capnography, and to evaluate the effect of EIP on carbon dioxide (CO 2 ) elimination per breath (Vco 2 br -1 ), PaCO 2, and the ratio of PaO 2 -to-fractional inspired oxygen (PaO 2 :FiO 2 )., Study Design: Prospective research study., Animals: A group of eight healthy research horses undergoing laparotomy., Methods: Anesthetized horses were mechanically ventilated as follows: 6 breaths minute -1 , tidal volume (V T ) 13 mL kg -1 , inspiratory-to-expiratory time ratio 1:2, positive end-expiratory pressure 5 cmH 2 O and EIP 0%. Vco 2 br -1 and expired tidal volume (V TE ) of 10 consecutive breaths were recorded 30 minutes after induction, after adding 30% EIP and upon EIP removal to construct volumetric capnograms. A stabilization period of 15 minutes was allowed between phases. Data were analyzed using a mixed-effect linear model. Significance was set at p < 0.05., Results: The EIP decreased V Daw from 6.6 (6.1-6.7) to 5.5 (5.3-6.1) mL kg -1 (p < 0.001) and increased V Talv from 7.7 ± 0.7 to 8.6 ± 0.6 mL kg -1 (p = 0.002) without changing the V TE . The V Dphys to V TE ratio decreased from 51.0% to 45.5% (p < 0.001) with EIP. The EIP also increased PaO 2 :FiO 2 from 393.3 ± 160.7 to 450.5 ± 182.5 mmHg (52.5 ± 21.4 to 60.0 ± 24.3 kPa; p < 0.001) and Vco 2 br -1 from 0.49 (0.45-0.50) to 0.59 (0.45-0.61) mL kg -1 (p = 0.008) without reducing PaCO 2 ., Conclusions and Clinical Relevance: The EIP improved oxygenation and reduced V Daw and V Dphys , without reductions in PaCO 2 . Future studies should evaluate the impact of different EIP in healthy and pathological equine populations under anesthesia., (Copyright © 2023 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To define the morbidity and mortality rates in goats undergoing general anesthesia at a large animal teaching hospital., Study Design: Retrospective, single-cohort, observational study., Animals: Records of 193 client-owned goats., Methods: Data were collected from 218 medical records on 193 goats undergoing general anesthesia between January 2017 and December 2021. Demographic data, anesthetic management, recovery period and perianesthetic complications were recorded. Perianesthetic death was defined as anesthesia-related or anesthesia-contributory death occurring within 72 hours after recovery. Records of goats that were euthanized were reviewed to ascertain the cause of euthanasia. Each explanatory variable was individually investigated by univariable penalized maximum likelihood logistic regression, followed by multivariable analysis. Statistical significance was set at p < 0.05., Results: Perianesthetic mortality was 7.3%, but was 3.4% when considering only goats undergoing elective procedures. Multivariable analysis showed that gastrointestinal surgeries [odds ratio (OR) 19.17, standard error (SE) 12.99, 95% confidence interval (CI) 5.08-72.33; p < 0.01] and requirement for perianesthetic norepinephrine infusion (OR 10.85, SE 8.82, 95% CI 2.21-53.33; p < 0.01) were associated with increased mortality. Maintaining other variables equal, the use of perianesthetic ketamine infusion was associated with decreased mortality (OR 0.09, SE 0.09, 95% CI 0.01-0.73; p = 0.02). Anesthesia-related or anesthesia-contributory complications included hypothermia (52.4%), bradycardia (38.1%), hypotension (35.3%), hypoxemia (14.8%), regurgitation/aspiration (7.3%), azotemia/acute renal failure (4.6%), myopathies/neuropathies (4.1%) and fever of unknown origin (2.7%)., Conclusions and Clinical Relevance: In this population, gastrointestinal surgeries and the requirement for perianesthetic norepinephrine infusion were associated with increased mortality in goats undergoing general anesthesia, while ketamine infusion may have a protective effect., (Copyright © 2023 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To describe an ultrasound-guided lateral pre-iliac (LPI) and parasacral (PS) approach in feline cadavers (phase I) and compare the perioperative analgesic use and complications in cats administered LPI and PS blocks (group PNB) or epidural anesthesia (group EPI) for pelvic limb surgery (phase II)., Study Design: Experimental uncontrolled, anatomic and retrospective cohort study., Animals: A group of eight feline cadavers and 52 medical records., Methods: Bilateral LPI and PS approaches with 0.1 mL kg -1 of dye to stain the femoral and obturator nerves and the lumbosacral trunk, respectively, were performed on each cadaver. Nerve staining effect was evaluated upon dissections (phase I). Perioperative analgesics use, and complication rates were retrospectively compared between groups PNB and EPI (phase II). Continuous data were compared using the Mann-Whitney U test and the prevalence of events with Fisher's exact test. Differences were considered significant when p < 0.05., Results: Dissections revealed that the LPI approach stained 94% and 75% of the femoral and obturator nerves, respectively. The PS approach stained 100% of the lumbosacral trunks. Cats enrolled in group PNB (n = 23) were administered lower doses of intraoperative opioids than those in group EPI (n = 25) (p = 0.006). Intraoperative rescue analgesia was required in 60% and 17.4% of cats enrolled in groups EPI and PNB, respectively (p = 0.003). Group PNB required more intraoperative anticholinergics than group EPI (p = 0.02). There were no differences in postoperative pain scores, analgesic use and complication rates., Conclusions and Clinical Relevance: The ultrasound-guided LPI and PS approach stained the femoral/obturator nerves and the lumbosacral trunk, respectively, in feline cadavers. Furthermore, PNB was associated with lower intraoperative opioid use and similar postoperative pain and analgesic use compared with epidural anesthesia in a cohort of cats undergoing surgery of the pelvic limb., (Copyright © 2023 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To develop an ultrasound-guided interfascial plane technique for injection of the pudendal nerve near its sacral origin in cats., Study Design: Prospective, randomized, anatomical study., Animals: A group of 12 feline cadavers., Methods: Gross and ultrasound anatomy of the ischiorectal fossa, the pudendal nerve relationship with parasacral structures, and the interfascial plane were described. Computed tomography was employed to describe a cranial transgluteal approach to the pudendal nerve. Bilateral ultrasound-guided injections were performed in eight cadavers using low [(LV) 0.1 mL kg -1 ] or high volume [(HV) 0.2 mL kg -1 ] of ropivacaine-dye solution. Dissections were performed to determine successful staining of the pudendal nerve (>1 cm) and inadvertent staining of the sciatic nerve, and any rectal, urethral, or intravascular puncture. Pudendal nerve staining in groups LV and HV were compared using Fisher's exact and Wilcoxon rank-sum test as appropriate (p = 0.05)., Results: The pudendal nerve and its rectal perineal and sensory branches coursed through the ischiorectal fossa, dorsomedial to the ischiatic spine. The pudendal nerve was not identified ultrasonographically, but the target plane was identified between the sacral transverse process, the ischiatic spine, the pelvic fascia and the rectum, and it was filled with dye solution. Both branches of the pudendal nerve were completely stained 75% and 87.5% in groups LV and HV, respectively (p = 1.00). The dorsal aspect of the sciatic nerve was partially stained in 37% of injections in group HV. Rectal or urethral puncture and intravascular injection were not observed., Conclusions and Clinical Relevance: In cats, ultrasound-guided cranial transgluteal injection successfully stained the pudendal nerve in at least 75% of attempts, regardless of injectate volume. Group HV had a greater probability of sciatic nerve staining., (Published by Elsevier Ltd.)

Objective: To develop a comprehensive formula for calculating the volume of local anaesthetic solution used for retrobulbar anaesthesia in dogs with different skull morphologies., Study Design: Retrospective cohort imaging study., Animals: Skull computed tomography (CT) images of 188 dogs of different breeds collected between January 2009 and December 2017., Methods: Anatomical integrity of the orbit and adjacent structures, presenting complaint, clinical signs and CT findings were verified to exclude ocular abnormalities. The volume of the retrobulbar cone of 376 eyes was calculated using CT scans of the dogs' skulls. Additional data recorded included morphology of the skull, body weight, sex and size of the dogs, all of which were matched for possible association to the retrobulbar cone volume through univariable and multivariable linear regression models. Results of linear regression models were expressed as estimated beta coefficients with the corresponding 95% confidence intervals (95% CIs)., Results: Using univariate analysis, the retrobulbar cone volume was positively associated with weight and male sex. In addition, brachycephalic and dolichocephalic dogs showed a larger retrobulbar cone volume than mesocephalic dogs, while sex was no longer significantly associated with the retrobulbar cone volume. In multivariate analysis, when considering all variables in the model, weight emerged as the strongest predictor (beta coefficient: 0.062 mL kg -1 , 95% CI: 0.056-0.067 mL kg -1 , p < 0.001)., Conclusions: and clinical relevance In the veterinary literature, there is no agreement on the precise volume of local anaesthetic solution that should be used to achieve intraconal retrobulbar anaesthesia in dogs. Here we suggest a formula to calculate the retrobulbar cone volume and, accordingly, the injection volume of local anaesthetic solution for effective retrobulbar anaesthesia., (Copyright © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To describe the gross and microscopic anatomy of the sciatic nerve paraneural sheath and to report an ultrasound (US)-guided subparaneural approach to the sciatic nerve in dogs, comparing two different volumes of injectate., Study Design: Prospective, randomized, anatomical study., Animals: A group of nine middle-sized adult Mongrel canine cadavers (18 limbs)., Methods: The sciatic nerves of three pelvic limbs of two canine cadavers were identified, exposed and isolated between the greater trochanter and the popliteal fossa for gross anatomical and microscopic examination. An additional three pelvic limbs were surgically dissected on the lateral surface of the limb; the sciatic nerves were isolated, and a 26 gauge over-the-needle catheter was inserted through the paraneural sheath under direct visualization. A methylene blue solution was then slowly injected into the subparaneural compartment through the catheter under US visualization using an 8-13 MHz linear-array transducer. Subsequently, 12 pelvic limbs (six cadavers) were randomly allocated to one of two groups; using US-guided percutaneous subparaneural approach, either 0.1 or 0.05 mL kg -1 of a 1:1 solution of methylene blue and 0.5% bupivacaine was injected. The spread of the dye solution and the amount of nerve staining were macroscopically scored. The stained sciatic nerves with their sheaths were then harvested for microscopic examination., Results: The paraneural sciatic nerve sheath was easily identified distinct from the nerve trunk both macroscopically and with US visualization, and microscopically. Complete staining was achieved in five of six (83.3%) sciatic nerves in each group; no difference was found in the amount of staining between the two groups. Microscopically, no signs of sciatic nerve intraneural injection were observed., Conclusions and Clinical Relevance: The US-guided subparaneural injection of 0.05 mL kg -1 of a dye injectate resulted in satisfactory nerve staining without evidence of sciatic nerve intraneural injection., (Copyright © 2020 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare intraocular pressure (IOP) and pupillary diameter (PD) following intravenous (IV) administration of dexmedetomidine and acepromazine in dogs., Study Design: Prospective, randomized experimental trial., Animals: A group of 16 healthy adult dogs aged (mean ± standard deviation) 4.9 ± 3.3 years and weighing 15.7 ± 9.6 kg, without pre-existing ophthalmic disease., Methods: IV dexmedetomidine hydrochloride (0.002 mg kg -1 ; DEX) or acepromazine maleate (0.015 mg kg -1 ; ACE) was administered randomly to 16 dogs (eight per group). The IOP and PD, measured using applanation tonometry and Schirmer's strips mm scale, respectively, and the heart rate (HR), systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures and respiratory rate (f R ) were recorded at baseline, at time of injection, and then 5, 10, 15, 20 and 25 minutes after injection. A single ophthalmologist, unaware of treatment, performed all measurements under consistent light conditions. Values were compared with baseline and among treatments using a multivariate mixed-effects model (p ≤ 0.05)., Results: The IOP was significantly lower in the DEX group compared with the ACE group at 10 (p < 0.01) and 15 minutes (p < 0.01) after drug injection. PD was significantly smaller compared to baseline for the entire duration of the study (p < 0.01) in both groups. Dogs in the DEX group had significant lower HR (p < 0.01) and f R (p < 0.01), higher SAP (p < 0.01) and DAP (p < 0.01) at all time points, and higher MAP (p < 0.01) during the first 15 minutes following drug injection in comparison with the ACE group., Conclusions and Clinical Relevance: Our results suggest that premedication with IV dexmedetomidine temporarily decreases IOP when compared with IV acepromazine. Both drugs cause miosis., (Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)