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This clinical review summarises the pharmacological and anaesthetic properties of alfaxalone in the dog. Available pharmacokinetic‐pharmacodynamic data and factors affecting the induction dose have been reported. Furthermore, quality of induction and recovery after alfaxalone administration, the use of alfaxalone for total intravenous anaesthesia, and its effects on the cardio‐respiratory system, on laryngeal motion, on intraocular pressure and tear production have been evaluated. Finally, the use of alfaxalone in dogs undergoing caesarean section and the effect of intramuscular alfaxalone administration have been considered. [ABSTRACT FROM AUTHOR]

Objectives: To describe the prevalence, clinical findings and predictors of disease in dogs with cervical hyperaesthesia. Materials and Methods: Medical records of dogs referred for neurological investigation of cervical hyperaesthesia between 2009 and 2013 were retrospectively reviewed. Dogs were assigned to one of the following groups according to the final diagnosis: Non‐Neurologic, Brain, Cervical Spine, Multifocal, and Chiari‐like Malformation/Syringomyelia. Demographic data, clinical and neurological signs and laboratory findings were compared between groups using univariate analysis; predictors of disease location were assessed by multivariate analysis. Results: Final diagnostic allocations of the 185 records included in the study were as follows: 2.7% Non‐Neurologic, 2.2% Brain, 63.2% Cervical Spine, 22.2% Multifocal and 9.7% Chiari Malformation/Syringomyelia. Intervertebral disc extrusion and steroid‐responsive meningitis arteritis were the most common diseases. Compared to Multifocal dogs, those allocated a Cervical Spine diagnosis were older, heavier, more frequently ataxic and lame on a thoracic limb; furthermore, they were less frequently depressed or hyperthermic at presentation. Leucocytosis, neutrophilia and monocytosis were more frequent in dogs allocated a Multifocal diagnosis. Dogs with cervical hyperaesthesia older than 36 months and non‐hyperthermic at presentation were more likely to have a lesion of the cervical region rather than a multi‐focal disease. Clinical Significance: Although non‐specific, these results may be useful to guide clinicians in management of dogs presenting with cervical hyperaesthesia. Animal age and body temperature may support the suspicion of either focal or multi‐focal cervical spinal disease. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of 5% lidocaine patches on postoperative analgesia in dogs undergoing hemilaminectomy. Materials and Methods: Client‐owned dogs undergoing hemilaminectomy for a single acute intervertebral thoracolumbar disc extrusion were enrolled in this prospective, randomised, blinded clinical trial. Following methadone administration, anaesthesia was induced with propofol, and maintained with isoflurane in oxygen and fentanyl infusion, in both groups. After skin closure, two 1∙5 cm wide 5% lidocaine patch strips were attached along both sides of the wound in dogs allocated to Group L. In Group C, the two lidocaine patch strips were applied but the transparent isolating liner was not removed. Postoperatively, all dogs received a non‐steroidal anti‐inflammatory drug, gabapentin and diazepam. Methadone was administered according to the short form of Glasgow Composite Pain Scale with pain assessed every 2 hours for 48 hours by observers unaware of the treatment. Results: Thirty‐nine dogs completed the study. Demographic data, end‐expiratory fraction of isoflurane, fentanyl consumption, anaesthesia and surgical times were similar between groups. The number of dogs requiring postoperative methadone and the number of doses of methadone administered were not different between groups. No macroscopic skin reaction was noticed once the patches were removed. Clinical Significance: In this setting, 5% lidocaine patches did not provide additional postoperative analgesia in dogs undergoing hemilaminectomy. [ABSTRACT FROM AUTHOR]

Objectives To compare the lateral pre-iliac approach to the lumbar plexus combined with lumbar paravertebral sciatic nerve block, and the dorsal paravertebral approach to the lumbar plexus combined with sciatic nerve block in dogs. Methods Retrospective examination of case records of dogs that received the blocks and underwent pelvic limb orthopaedic surgery between 2010 and 2012. Success rate (intraoperative fentanyl consumption <2·1 µg/kg/hour), type and dose of local anaesthetic used, multiple of minimum alveolar concentration of volatile anaesthetic agent administered, incidence of intraoperative hypotension, postoperative methadone administration, postoperative contralateral limb paralysis and neurological complication at 6 weeks re-examination were analysed. Results Ninety-six and 95 records were retrieved in which lateral pre-iliac - lumbar paravertebral sciatic nerve and dorsal paravertebral - sciatic nerve were used, respectively. Success rates were 82·3% in lateral pre-iliac - lumbar paravertebral sciatic nerve and 74·7% in dorsal paravertebral - sciatic nerve groups. Bupivacaine, levobupivacaine and ropivacaine were used. Total local anaesthetic doses, intraoperative hypotension and postoperative methadone administered were similar between groups; minimum alveolar concentration multiple was significantly (P<0·001) lower in lateral pre-iliac - lumbar paravertebral sciatic nerve group. No neurological complications were noted. Clinical Significance Although success rates and perioperative analgesic requirements were not significantly different, the different exposure to anaesthetic agents suggests that the two techniques may not be equivalent. [ABSTRACT FROM AUTHOR]

O bjectives: To compare the analgesic and sedative effects of butorphanol and pethidine (meperidine) in dogs. M ethods: Twenty-eight female dogs undergoing ovariectomy (20) or ovariohysterectomy (8) were randomly divided into two groups. Pre-anaesthetic medication in group B consisted of 20 μg/kg intramuscular (im) acepromazine and 0·4 mg/kg butorphanol, while group P received 20 μg/kg acepromazine with 5 mg/kg pethidine. The resulting sedation (simple descriptive scale), propofol dose required to induce anaesthesia, several intraoperative cardiorespiratory variables and postoperative pain (Colorado Pain Scoring System) were compared between the two groups. A 0·2 mg/kg meloxicam dose was administered intravenously to all animals at the end of the 4 hours observation period, or earlier if the pain score was more than 13. R esults: Sedation scores, propofol induction doses and intraoperative cardiorespiratory variables were not different between groups. Postoperative pain scores were also similar although one dog in group B required rescue analgesia. Five dogs in group P vomited postoperatively. C linical S ignificance: Either butorphanol and pethidine, combined with acepromazine, produced reliable sedation and analgesia up to 4 hours after intramuscular injection in dogs. [ABSTRACT FROM AUTHOR]

Summary Reason for performing study: The recovery quality scoring systems (RQSSs) in current use have not been critically reviewed for reliability. Objective: To examine reliability (reproducibility) of 4 RQSSs when applied to a ranked series. Methods: A DVD incorporating the recordings of 9 horses recovering from general anaesthesia was evaluated by final year students over 5 days. On Day 1, each evaluator ranked recoveries from 1-9 (1 = best). Over the following 4 days, each evaluator scored the same recoveries using 4 different RQSSs (3 of them in common usage and previously published) applied in random order. The scores from each RQSS were ranked and plotted against the Day 1 ranking of each evaluator to establish the extent of agreement using generalisability theory. The same 9 recoveries were also ranked by 12 experienced equine anaesthetists and the Spearman Rank Correlation coefficient calculated to determine the agreement between experienced and inexperienced evaluators. Results: The recoveries were evaluated by 117 students. All 4 RQSSs were equally reliable with low (<4%) interobserver variability. The main (80%) source of total variation arose from differences between horses. The overall ranking within each RQSS was strongly correlated with Day 1 ranking. There was strong correlation (r = 0.983) between the students' ranking and that established by experienced anaesthetists. Interobserver reliability was similar with all 4 RQSSs. Conclusion: All 4 RQSSs studied were similarly reliable. Potential relevance: The selection of a universally acceptable RQSS from amongst the 4 examined can be based on criteria other than reliability, e.g. ease of use. This will facilitate wider scale multi-centre studies in recovery quality after anaesthesia in horses. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate intraoperative effects, complications, postoperative rescue analgesia requirement and presence of postoperative unilateral blockade after hypobaric spinal anaesthesia in dogs. METHODS Retrospective review of case records of dogs that underwent pelvic limb orthopaedic surgery and received hypobaric spinal anaesthesia. Cases that contained complete information on perioperative analgesia, end tidal anaesthetic agent, arterial blood pressure, postoperative urination, motor function and assessment at the sixth week re-examination were selected. RESULTS Twenty-four of forty-eight records were sufficiently complete to meet the selection criteria. Local anaesthetic dose and volume of the solution administered were 0 · 22 (±0 · 06) mg/kg and 0 · 16 (±0 · 05) mL/kg, respectively. Fentanyl was administered intraoperatively in seven dogs (29%); mean ± sd end-expired isoflurane was 1 · 09 ± 0 · 17%; hypotension was observed in nine dogs (37 · 5%). Unilateral blockade was documented in 18 dogs (75%); 6 dogs (25%) required methadone postoperatively; urinary retention was not observed. One dog developed steroid responsive meningitis arteritis. CLINICAL SIGNIFICANCE Hypobaric spinal anaesthesia achieved unilateral postoperative pelvic limb motor blockade in dogs, although bilateral block occurred in a proportion of animals; intraoperative hypotension was not infrequent. Fentanyl and postoperative methadone might be required to control nociception and pain, despite technical success in performing spinal anaesthesia. [ABSTRACT FROM AUTHOR]

A 4‐year‐old, male, entire Newfoundland was presented for investigation of an acute onset cervical ventroflexion and pyrexia, 4 days following a hip replacement surgery. Neurological examination confirmed prominent cervical ventroflexion characterised by an inability to raise the head, without evidence of cervical hyperaesthesia or associated neurological deficits. Magnetic resonance imaging identified focal, bilaterally symmetrical changes to the semispinalis cervicis musculature, responsible for elevation of the head. The presentation and diagnostic imaging findings appeared analogous to dropped‐head syndrome in humans. Toxoplasma IgG antibodies were found to be mildly elevated, and therefore treatment with clindamycin was initiated. The dog responded well to treatment and was reported to be clinically normal 2 months thereafter. [ABSTRACT FROM AUTHOR]

Background: Limited recent data exists regarding discospondylitis in dogs. Hypothesis/Objectives: (i) Describe the signalment, clinical and imaging findings, etiologic agents, treatment, and outcome of dogs with discospondylitis, (ii) determine diagnostic agreement between radiographs, CT, and MRI with regard to the presence of discospondylitis and its location, and (iii) determine risk factors for relapse and progressive neurological deterioration. Animals: Three hundred eighty‐six dogs. Methods: Multi‐institutional retrospective study. Data extracted from medical records were: signalment, clinical and examination findings, diagnostic results, treatments, complications, and outcome. Potential risk factors were recorded. Breed distribution was compared to a control group. Agreement between imaging modalities was assessed via Cohen's kappa statistic. Other analyses were performed on categorical data, using cross tabulations with chi‐squared and Fisher's exact tests. Results: Male dogs were overrepresented (236/386 dogs). L7‐S1 (97/386 dogs) was the most common site. Staphylococcus species (23/38 positive blood cultures) were prevalent. There was a fair agreement (κ = 0.22) between radiographs and CT, but a poor agreement (κ = 0.05) between radiographs and MRI with regard to evidence of discospondylitis. There was good agreement between imaging modalities regarding location of disease. Trauma was associated with an increased risk of relapse (P =.01, OR: 9.0, 95% CI: 2.2‐37.0). Prior steroid therapy was associated with an increased risk of progressive neurological dysfunction (P =.04, OR: 4.7, 95% CI: 1.2‐18.6). Conclusions and Clinical Importance: Radiograph and MRI results could be discrepant in dogs with discospondylitis. Prior trauma and corticosteroids could be associated with relapse and progressive neurological dysfunction, respectively. [ABSTRACT FROM AUTHOR]

A 12‐year‐old, neutered, male, domestic shorthair cat presented for investigation of acute‐onset respiratory distress and cough. Computed tomography scan showed bilateral pleural effusion and dorsal elevation of the trachea compatible with a mass effect. A median sternotomy was performed. Anaesthetic protocol consisted of premedication with intravenous methadone (0.2 mg/kg), induction with alfaxalone to effect and maintenance with isoflurane in oxygen. Transversus thoracic muscle plane block was performed injecting 0.4 mL/kg of 0.25% bupivacaine per side. Fentanyl (2 μg/kg) was administered as rescue analgesia once during surgery. The Glasgow Composite Pain Scale was assessed postoperatively. Methadone was given as rescue analgesia postoperatively when Glasgow pain score was greater than 5/20. The first administration of methadone was required at 8 hours after the transversus thoracic muscle plane block was performed. This case showed that the ultrasound‐guided transversus thoracic muscle plane block is a feasible technique in feline patients as part of a multimodal analgesia plan in a cat undergoing sternotomy. [ABSTRACT FROM AUTHOR]

A 3.25‐kg, 1‐year‐old, European shorthair cat was referred for acute respiratory distress. A thoracic computed tomography revealed the presence of multiple pulmonary abscesses, and a median sternotomy for pulmonary lobectomy was scheduled. The cat was premedicated with methadone and dexmedetomidine, anaesthesia was induced with alfaxalone and maintained with isoflurane in 100% oxygen. Ultrasound‐guided parasternal block was performed before surgery with ropivacaine 0.5% (total dose 3 mg/kg). Rescue analgesia was needed only during abscess debridement and lung lobectomy. Postoperative pain was assessed every hour, using the short‐form Glasgow Feline Composite Measure Pain Scale. The cat required rescue analgesia (0.2 mg/kg methadone) 7 hours after the completion of the block. This case report describes the feasibility of ultrasound‐guided parasternal block in a cat undergoing median sternotomy, suggesting that it can usefully be added to a multimodal analgesic plan in the perioperative period. [ABSTRACT FROM AUTHOR]

A 3‐year‐old, crossbreed dog was presented for an acute onset of cervical pain 6 weeks after the initiation of corticosteroid treatment for an immune‐mediated polyarthritis. Except for cervical hyperesthesia, neurological examination was unremarkable. Computed tomography revealed thrombosis of cervical vertebral venous structures and caudal cerebral sinuses. The dural sac containing the cervical spinal cord was moderately to severely compressed. A decrease in antithrombin activity was measured and assumed to be caused by secondary altered production due to corticosteroid therapy as well as important active thrombosis. The hypercoagulable state was most likely caused by chronic corticosteroid administration as a treatment of immune‐mediated polyarthritis. Complete resolution of clinical signs and venous lesions was achieved by tapering off corticosteroids and initiating gabapentin and antithrombotic treatment (clopidogrel and rivaroxaban). [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID‐19 usually deteriorate rapidly and need further intensive care. Aim: We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID‐19 at risk of serious events. Design: We conducted a retrospective single‐centre case‐control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. Methods: The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non‐invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. Results: There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut‐off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC = 0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC = 0.71). Conclusions: NEWS2 has an appropriate ability to triage newly admitted patients with COVID‐19 into three levels of risk: low risk (NEWS2 = 0‐3), medium risk (NEWS2 = 4‐6), and high risk (NEWS2 ≥ 7). Relevance to clinical practice: Using NEWS2 may help nurses in early identification of at‐risk COVID‐19 patients and clinical nursing decision‐making. Using NEWS2 to triage new patients with COVID‐19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety. [ABSTRACT FROM AUTHOR]

Animal models have been invaluable in the identification of molecular events occurring in and contributing to intervertebral disc (IVD) degeneration and important therapeutic targets have been identified. Some outstanding animal models (murine, ovine, chondrodystrophoid canine) have been identified with their own strengths and weaknesses. The llama/alpaca, horse and kangaroo have emerged as new large species for IVD studies, and only time will tell if they will surpass the utility of existing models. The complexity of IVD degeneration poses difficulties in the selection of the most appropriate molecular target of many potential candidates, to focus on in the formulation of strategies to effect disc repair and regeneration. It may well be that many therapeutic objectives should be targeted simultaneously to effect a favorable outcome in human IVD degeneration. Use of animal models in isolation will not allow resolution of this complex issue and a paradigm shift and adoption of new methodologies is required to provide the next step forward in the determination of an effective repairative strategy for the IVD. AI has improved the accuracy and assessment of spinal imaging supporting clinical diagnostics and research efforts to better understand IVD degeneration and its treatment. Implementation of AI in the evaluation of histology data has improved the usefulness of a popular murine IVD model and could also be used in an ovine histopathological grading scheme that has been used to quantify degenerative IVD changes and stem cell mediated regeneration. These models are also attractive candidates for the evaluation of novel anti‐oxidant compounds that counter inflammatory conditions in degenerate IVDs and promote IVD regeneration. Some of these compounds also have pain‐relieving properties. AI has facilitated development of facial recognition pain assessment in animal IVD models offering the possibility of correlating the potential pain alleviating properties of some of these compounds with IVD regeneration. [ABSTRACT FROM AUTHOR]

A 4.5‐year‐old dog was anaesthetised to undergo a partial pancreatectomy for insulinoma removal, an insulin‐secreting pancreatic tumour causing hypoglycaemia. The patient was premedicated with dexmedetomidine (2 μg/kg) and maropitant (1 mg/kg) intravenously. Anaesthesia was induced with alfaxalone (0.5 mg/kg) and diazepam (0.2 mg/kg) intravenously and maintained with a dexmedetomidine constant‐rate infusion of 1 μg/kg/h and isoflurane in 70% oxygen. A bilateral transversus abdominis plane block was performed with ropivacaine (0.3% 1 ml/kg) divided into four points. Additional intraoperative analgesia included ketamine, fentanyl and methadone intravenously. Lactated Ringer's solution was administered, and glucose supplementation was adjusted based on glycaemia. Postoperatively, the patient was comfortable and required no analgesia for the 48‐hour hospitalisation period, but presented mild hyperglycaemia. This case reports the successful management of an insulinoma with a dexmedetomidine constant‐rate infusion and opioid‐sparing multimodal analgesia. [ABSTRACT FROM AUTHOR]

Multimodal analgesia is the foundation of opioid‐sparing analgesia protocols in major surgery, being locoregional anaesthesia their keystone. Its aim is to provide adequate analgesia while minimising opioid requirements, and thus opioid‐related adverse effects. The blossoming of ultrasound‐guided fascial plane blocks offers a new spectrum of safer and simpler alternatives to traditional locoregional anaesthesia techniques. This report describes the anaesthetic management of a dog and a cat that underwent bilateral thoracotomy for treatment of chylothorax. The multimodal analgesia protocol consisted of preoperative methadone, ultrasound‐guided serratus plane and erector spinae plane blocks, and epidural catheter for postoperative analgesia management. The combination of these techniques allowed for a reduction of perioperative opioid requirements, good‐quality recovery and opioid‐free analgesia in the postoperative period. [ABSTRACT FROM AUTHOR]

A 13.9 kg, 4‐year‐old, male cocker spaniel dog was scheduled for cystotomy. Premedication consisted of intravenous medetomidine (5 µg/kg), induction with propofol (1 mg/kg, intravenous) and anaesthesia maintenance with isoflurane in O2 100%. A medetomidine constant‐rate infusion (1 µg/kg/h) was administered throughout. A bilateral quadratus lumborum block with 3 ml of 0.5% bupivacaine (each side) was performed, and intermittent positive‐pressure ventilation was initiated. At the end of the surgery, medetomidine constant‐rate infusion and intermittent positive‐pressure ventilation ceased. The patient remained in apnoea and developed severe hypercapnia (end‐tidal carbon dioxide: 12 kPa). Thirty minutes after isoflurane discontinuation, respiratory muscles movement started. Three days before, the dog underwent a mini‐hemilaminectomy (similar anaesthetic protocol) without complications. Epidural/spinal migration from the right quadratus lumborum block was suspected, although the definitive cause of transient respiratory arrest after bilateral quadratus lumborum block could not be ascertained. We advise caution when performing quadratus lumborum if previous neighbouring spinal surgery was performed. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar intervertebral disc extrusion (TL‐IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking. Objectives: To summarize the current literature as it relates to diagnosis and management of acute TL‐IVDE in dogs, and to formulate clinically relevant evidence‐based recommendations. Animals: None. Methods: A panel of 8 experts was convened to assess and summarize evidence from the peer‐reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported. Results: The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies. Conclusions and Clinical Importance: Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL‐IVDE. [ABSTRACT FROM AUTHOR]

Opiates have a long history of medical use as effective analgesics associated with well‐described side effects, including euphoria, respiratory depression, constipation, bradycardia, and histamine release, among others. The search for opiate analogs that retain effective analgesic qualities without detrimental side effects has yielded numerous compounds, including buprenorphine. Early studies of buprenorphine demonstrated analgesic effectiveness with a favorable safety profile, leading to the approval of formulations for use in humans. Since then, advances in receptor theory and molecular cloning of opioid receptors have led to a deeper understanding of buprenorphine pharmacology. More recent studies of receptor affinity and intrinsic activity have shown that buprenorphine is a μ‐ and κ‐opioid receptor agonist, a nociceptin orphanin peptide agonist, and a δ‐opioid receptor antagonist. Buprenorphine appears to have a primary spinal analgesic mechanism with complex supraspinal actions. It is considered a full agonist for pain but a partial agonist for other clinical endpoints such as respiratory depression. In feline medicine, buprenorphine is approved as low‐ and high‐concentration injectable solutions, in addition to the most recently introduced long‐acting transdermal formulation. Several investigational and compounded formulations have also been evaluated. There are contrasting differentiable features that include pharmacokinetics, onsets‐ and durations‐of‐action, routes of administration, and formulation constituents. Available buprenorphine formulations allow clinicians to select a formulation based on the anticipated duration of pain associated with various surgical procedures, and to provide interventions as needed. In light of the newly approved transdermal buprenorphine solution in cats and progress in buprenorphine pharmacology, the objective of this review is to examine the history and pharmacology of buprenorphine relative to full opioid agonists, where appropriate, integrating these insights into advances within feline medicine. [ABSTRACT FROM AUTHOR]

Two adult medium‐sized dogs presented with generalised tonic‐clonic seizures associated with meningiomas, one affecting the right parietal lobe and the other both frontal and olfactory lobes. Both underwent craniotomy and received multimodal anaesthetic protocols, including a peripheral nerve scalp block (frontal, zygomaticotemporal and major occipital nerves) based on a previous cadaveric study. For one dog, an intraoperative magnetic resonance imaging was performed; the bupivacaine block wore off after 280 minutes and was repeated with good effect before surgery resumed. The second dog had dexmedetomidine added to bupivacaine at the outset. The block lasted, as judged by pain assessment, at least 6 hours. We found that regional anaesthesia of the scalp was manageable to perform in a timely manner, showed good perioperative clinical effect and was likely prolonged by the addition of dexmedetomidine. [ABSTRACT FROM AUTHOR]

The beneficial effects of performing regional anaesthesia techniques as part of a pre‐emptive analgesic strategy are to improve perioperative analgesia and reduce opioid and general anaesthetic drug requirements. In prey species, an early recovery of voluntary motor function, especially after a regional anaesthesia, is essential for the animal's health and welfare. To reduce motor paralysis, a low volume and concentration of local anaesthetic should be administered close to the targeted nerve. This is the first report of an ultrasound (14 MHz linear probe)‐ and nerve stimulation (0.2 mA; 0.3 second; 2 Hz)‐guided saphenous and sciatic nerve blocks using bupivacaine (0.125%; 0.2 mL/kg per nerve) in a rabbit. Drug consumption, physiological response to surgery and postoperative pain scoring were used to determine block success. The ultrasound‐ and nerve stimulation‐guided sciatic and saphenous nerve blocks could be recommended as part of multimodal pain management in rabbits undergoing appropriate pelvic limb orthopaedic surgeries. [ABSTRACT FROM AUTHOR]

Background: In equine anaesthesia, the recovery period is a time of considerable risk and has been the focus of prolific research. Risk factors, including age, type and duration of procedure or temperament may influence recovery quality. Unfortunately, the anaesthetist is unable to control for these factors, therefore various pharmacological interventions and recovery methods have been developed with the objective of improving recovery quality. However, no consensus among anaesthetists has been reached for many of these interventions and their implications for recovery‐related mortality and morbidity. Objectives: To conduct a systematic review of the published evidence relating to risk factors and interventions in the recovery period which may influence recovery quality from equine general anaesthesia (GA). Study design: A systematic evaluation of the equine veterinary literature using the GRADE framework. Methods: A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub‐topic was assessed using the GRADE framework. Results: Thirty‐nine studies were identified which directly assessed the impact of risk factors and recovery interventions on recovery quality after equine GA. There was evidence to support that peri‐anaesthetic risk factors such as anaesthesia duration, American Society of Anesthesiologists (ASA) physical status and surgical procedure influenced recovery quality. We also identified sufficient evidence that administration of α‐2 adrenoreceptor agonists immediately prior to recovery, improves recovery quality. Main limitations: The validity of the results of some studies may have been compromised by missing data and small sample sizes. Conclusions: Recovery quality is influenced by factors including: anaesthesia duration, ASA physical status and surgical procedure. Recovery quality can be improved by the administration of an α‐2 adrenoreceptor agonist immediately prior to recovery. [ABSTRACT FROM AUTHOR]

A 4‐year 9‐month‐old beagle was presented for a 2‐week history of acute onset of lowered tail carriage and faecal incontinence. Neurological examination was unremarkable except for an absent perineal reflex, there was no history of trauma. Blood work was unremarkable. Lumbosacral and coccygeal CT pre‐ and post‐intravenous contrast revealed a large sacrococcygeal disc extrusion with mineralised material extending from the level of S2 and to midbody of Cd1. A dorsal laminectomy was performed from the cranial margin of S2 to the caudal margin of Cd1. A large volume of mineralised disc material was removed. The material was confirmed on histopathology to be consistent with extruded nucleus pulposus. The patient regained faecal continence within 3 days of hospital discharge. Based on a literature search this is the first report of a sacrococcygeal disc extrusion resulting in faecal incontinence, with successful surgical management. [ABSTRACT FROM AUTHOR]

A 2‐year‐old female intact huacaya alpaca weighing 66.6 kg presented for the removal of a bone sequestrum from the distal femur. Nerve stimulator‐guided femoral and sciatic nerve blocks were applied to provide analgesia for distal femoral surgery. The blocks were simple to perform using existing equipment and current techniques translated from small animals. The techniques reported here for both femoral and sciatic nerve blocks in an alpaca can be used as an alternative to an ultrasound‐guided approach, especially in field situations where additional expensive equipment may not be available or desirable. [ABSTRACT FROM AUTHOR]

An 11‐year‐old, 22 kg, male neutered English Staffordshire Bull Terrier, in which a pheochromocytoma was removed from the left retroperitoneal space, was referred to investigate the regrowth of a mass in the same region. A neuroendocrine tumour, compatible with pheochromocytoma, was cytologically diagnosed after ultrasound‐guided fine‐needle aspirates, and the dog underwent explorative celiotomy. A combination of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion was used intraoperatively to control nociception and potential haemodynamic changes caused by sudden catecholamines release. Postoperative analgesia was provided by administering 0.12% levobupivacaine through the thoracic epidural catheter and oral paracetamol and gabapentin. Postoperative methadone was administered twice during the first 24 postoperative hours only. Two days after the surgery, the dog was anaemic and packed red blood cells were administered. No other complications occurred, and the dog was discharged from the hospital 5 days following surgery. [ABSTRACT FROM AUTHOR]

Background: Flumazenil antagonises the actions of benzodiazepines. There has been no prior research specifically investigating this anaesthetic reversal agent for horses. Objectives: To determine the effects of flumazenil administration in horses on (a) ventilatory parameters after midazolam‐ketamine induction and maintenance with isoflurane in oxygen and on (b) the characteristics of recovery from general anaesthesia. Study design: Blinded, randomised, crossover experiment. Methods: Six horses were randomly assigned to receive high‐dose flumazenil (Fhigh, 20 µg/kg), low‐dose flumazenil (Flow, 10 µg/kg) and saline (control). Cardioventilatory parameters were monitored. After 90 minutes of isoflurane anaesthesia, a bolus of Fhigh, Flow or saline was administered i.v. The horses were recovered using head and tail rope assistance. The times to first movement, to achievement of sternal recumbency, to the first attempt to stand and the total recovery time were determined. The recovery quality was evaluated using a 115‐point recovery scoring system. The cardioventilatory parameters and recovery times were analysed using mixed‐effects regression analyses. Intraclass correlation (ICC) analysis was used to evaluate the recovery scores. A Mann‐Whitney U test assessed the relationship between recovery score and flumazenil administration. Results: A significant difference with flumazenil administration was found for SpO2, mean arterial pressure, I:E ratio, minute volume of ventilation (MV) and peak inspiratory pressure. There was a significant difference with flumazenil administration for the time to sternal recumbency, the time to the first attempt to rise and the total recovery time. There was no significant difference in total recovery score with flumazenil administration. Main limitations: Plasma levels of midazolam and flumazenil were not obtained. Conclusions: Flumazenil has a dose‐dependent effect on MV and recovery time, which may make it useful in cases for which a prolonged anaesthetic recovery is undesirable. [ABSTRACT FROM AUTHOR]

In this article, dexmedetomidine (Dex) was used to prevent neurological disorders in patients anesthetized with sevoflurane and the effect was analyzed using ultrasound images based on the restoration algorithm of the linear system model. Children injected with Dex were in the experimental group, while children injected with normal saline were in the control group. The mean arterial pressure (MAP), arterial oxygen saturation (SpO2), heart rate (HR), Pediatric anesthesia agitation scale (PAED) score, Face, Legs, Activity, Cry, Consolability (FLACC) score, and adverse drug event (ADE) in the two groups were compared before the injection (T1), at 5 min (T2), 10 min (T3), and 20 min (T4) after the injection, and when the patient came to himself (T5). It was found that in contrast with the control group, the MAP in the experimental group at T2, T3, and T4 periods was lower, while it was higher at T5 period and its HR at T2, T3, T4, and T5 periods was higher (P < 0.05); the PAED and FLACC scores were lower (P < 0.05), and the incidence of ADE (10.53%) was lower than that in the control group (31.58%) (P < 0.05). However, SpO2 at different periods showed no obvious differences between the two groups (P > 0.05). In conclusion, the restoration algorithm-based ultrasound images had high quality, and they demonstrated good application value in evaluating the effect of Dex to prevent neurological disorders in patients anesthetized by sevoflurane. [ABSTRACT FROM AUTHOR]

A cockerel (Gallus gallus domesticus) was presented for lameness investigation. A CT scan of the left leg and a bone marrow biopsy were planned. Both procedures were performed under general anaesthesia and, before the biopsy was performed, a sciatic nerve block was achieved with levobupivacaine 0.5% (0.75 mg/kg), aided by an electrical nerve locator. The nerve was located through a lateral approach, with a motor response to stimulation similar to that described in mammals. The efficacy of the block was assessed as satisfactory during the procedure. Postoperatively, the pain was subjectively assessed, but no pain scales were employed, as none are validated for birds. No iatrogenic complications occurred; therefore, this nerve block could be considered as a part of a multimodal approach to perioperative pain management. [ABSTRACT FROM AUTHOR]

A dog with a large abdominal mass underwent coeliotomy. Before surgery, the dog was anaemic, hypoalbuminaemic and had a grade III out of VI left sided holosystolic heart murmur; no signs related to heart failure were detected on thoracic radiographs. After intramuscular administration of methadone, anaesthesia was induced intravenously (IV) with fentanyl and propofol and maintained with isoflurane in oxygen. Lungs were mechanically ventilated using a volume‐controlled setting. To manage ventilation asynchrony, atracurium was administered IV. Concurrent hypotension did not respond to lowering the isoflurane concentration, crystalloid and colloid boluses administration, and dobutamine infusion. Surgery lasted 40 minutes, and the mass was easily removed. At end of surgery, neostigmine was administered IV slowly, and a progressive improvement of arterial blood pressure was recorded. The animal was then allowed to breathe spontaneously, and isoflurane was discontinued. Recovery from general anaesthesia was uneventful. [ABSTRACT FROM AUTHOR]

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un‐ and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three‐tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well‐being of our patients, and how this equates to an animal welfare issue, is discussed. [ABSTRACT FROM AUTHOR]

Pain management in veterinary patients is a crucial component of appropriate patient care. Multimodal analgesia that includes both systemically and locally/regionally administered drugs is generally the most effective approach to providing pain relief. Local anaesthetic drugs used in local and regional blockade are unique in that they can completely block the transmission of pain (in conscious patients) or nociceptive (in anaesthetized patients) signals, thereby providing profound analgesia. In addition, local and regional administration of drugs, when compared with systemic bolus administration, generally results in a lower incidence of dose‐related adverse effects. Due to the potential to provide profound analgesia and the high safety margin (when used correctly) of this drug class, local anaesthetics are recommended as part of the analgesic protocol in the majority of patients undergoing surgical procedures or suffering traumatic injuries. This manuscript, Part 1 of a two‐part instalment, emphasizes the importance of using local and regional anaesthesia as a component of multimodal analgesia, provides a review of the basic pharmacokinetics/pharmacodynamics of local anaesthetic drugs in general, lists information on commonly used local anaesthetic drugs for local and regional blockade in dogs and cats, and briefly introduces the novel liposome‐encapsulated bupivacaine (NOCITA®). Part 2 is a review of local and regional anaesthetic techniques used in dogs and cats (Grubb & Lobprise, 2020). [ABSTRACT FROM AUTHOR]

Aim of the Study. To evaluate the ability of the prehospital National Early Warning Score 2 scale (NEWS2) to predict early mortality (within 48 hours) after the index event based on the triage priority assigned for any cause in the emergency department. Methods. This is a multicenter longitudinal observational cohort study on patients attending Advanced Life Support units and transferred to the emergency department of their reference hospital. We collected demographic, physiological, and clinical variables, main diagnosis, and hospital triage level as well as mortality. The main outcome variable was mortality from any cause within two days of the index event. Results. Between April 1 and November 30, 2018, a total of 1054 patients were included in our study. Early mortality within the first 48 hours after the index event affected 55 patients (5.2%), of which 23 cases (41.8%) had causes of cardiovascular origin. In the stratification by triage levels, the AUC of the NEWS2 obtained for short-term mortality varied between 0.77 (95% CI: 0.65-0.89) for level I and 0.94 (95% CI: 0.79-1) for level III. Conclusions. The Prehospital Emergency Medical Services should evaluate the implementation of the NEWS2 as a routine evaluation, which, together with the structured hospital triage system, effectively serves to predict early mortality and detect high-risk patients. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no information directly comparing midazolam with guaifenesin when used in combination with an alpha‐2 agonist and ketamine to maintain anaesthesia via i.v. infusion in horses. Objectives: To compare ketamine–medetomidine–guaifenesin with ketamine–medetomidine–midazolam for total intravenous anaesthesia (TIVA) in young horses anaesthetised for computerised tomography. Study design: Prospective, randomised, blinded, crossover trial. Methods: Fourteen weanlings received medetomidine 7 μg/kg bwt i.v. and anaesthesia was induced with ketamine 2.2 mg/kg bwt i.v. On two separate occasions horses each received infusions of ketamine 3 mg/kg bwt/h, medetomidine 5 μg/kg bwt/h, guaifenesin 100 mg/kg bwt/h (KMG) or ketamine 3 mg/kg bwt/h, medetomidine 5 μg/kg bwt/h, midazolam 0.1 mg/kg bwt/h (KMM) for 50 min. Cardiorespiratory variables and anaesthetic depth were assessed every 5–10 min. Recovery times after the infusions ceased were recorded and recovery quality was assessed using a composite score system (CSS), simple descriptive scale (SDS) and visual analogue scale (VAS). Multivariable models were used to generate mean recovery scores for each treatment and each recovery score system and provide P‐values comparing treatment groups. Results: Anaesthesia was uneventful with no difference in additional anaesthetic requirements and little clinically relevant differences in cardiopulmonary variables between groups. All horses recovered without incident with no significant difference in recovery times. Quality of the anaesthetic recovery was significantly better for the KMM group compared with the KMG group using the CSS (P<0.001), SDS (P<0.001) and VAS (P<0.001). Main limitations: No surgical stimulus was applied and study animals may not represent general horse population. Conclusion: Midazolam is a suitable alternative to guaifenesin when co‐infused with ketamine and medetomidine for anaesthesia in young horses undergoing noninvasive procedures. Both infusions produce a clinically comparable quality of anaesthesia; however, recovery from anaesthesia is of a better quality following an infusion of ketamine–medetomidine–midazolam. [ABSTRACT FROM AUTHOR]

Brachycephalic breeds of dog have grown in popularity in the UK and so form an increasing proportion of cases requiring anaesthesia. These breeds are predisposed to several conditions, notably brachycephalic obstructive airway syndrome and gastro‐oesophageal reflux, that have important implications for anaesthetic management and carry high risk for complications. This review incorporates peer‐reviewed veterinary literature with clinical experience in a discussion on perioperative management of brachycephalic dogs. We focus on preoperative identification of common concurrent conditions, practical strategies for reducing anaesthetic risk and improving postoperative management. Comparisons of brachycephalic obstructive airway syndrome with the human condition of obstructive sleep apnoea are included where appropriate. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims and objectives: Early warning score systems (EWS‐S) have been shown to be valuable tools to recognize otherwise unnoticed clinical deterioration (CDET) of patients. They have been associated with fewer unplanned transfers to the intensive care unit (UTICU) and lower in‐hospital mortality. Little is known about their current usage in Switzerland and about the attitudes towards such tools among chief physicians. We aimed to assess the use of EWS‐S in Switzerland and the attitudes of chief physicians towards EWS‐S depending on previously experienced CDET followed by UTICU, reanimation, or death. Methods: Chief physicians of medical and surgical departments from all acute care hospitals in Switzerland were asked to participate within a project that aims to develop recommendations for the use of EWS‐S in Switzerland (n = 118). The explorative study assessed perceived CDET, which led to UTICU, reanimation, or death of a patient, the knowledge and usage about different EWS‐S and attitudes towards EWS‐S in a written questionnaire. Means and percentages were used, and differences were assessed with independent t tests, chi‐square, or Fisher exact test, as appropriate. Results: Adverse events based on CDET were reported frequently, and awareness among chief physicians was high. Less than half of the chief physicians knew tools that systematically assess CDET with one‐fifth of responders reporting using tools at their department. Previous experiences of UTICU, reanimation, or death after due to CDET were associated with more positive attitudes towards EWS‐S. Conclusions: Adverse events based on CDET of patients are frequent and the awareness of this problem is high among chief physicians. Positive attitudes were more common with previous experiences of adverse events due to CDET. Our results strengthen the argumentation that the recommendation and future implementation of EWS‐S in Switzerland would be meaningful. [ABSTRACT FROM AUTHOR]

Background Although rare, 70% of equine fatalities during recovery from general anaesthesia ( GA) are due to catastrophic fractures from poor recovery quality. Objective To determine the effect of repeated GA recovery on GA recovery quality. Study design Experimental blinded trial. Methods Eight adult horses underwent six GA events on sevoflurane for distal limb MRI examination over a 14-week period. Prior to GA recovery, xylazine was administered. Randomly ordered video-recorded GA recoveries were scored by three blinded board certified veterinary anaesthesiologists, unaware of patient identity or GA event number, for nine parameters using a 100 mm visual analogue scale ( VAS) where 0 = worst and 100 = best. The number of attempts to stand, duration of lateral and sternal recumbency, total recovery duration and physiologic parameters during each GA event were recorded. Repeated measures ANOVA were used to detect differences. Agreement between observer VAS scores was determined via inter-rater reliability using an intraclass correlation. Results With GA recovery experience, VAS scores for balance and coordination, knuckling, and overall quality of recovery were improved and the duration of lateral recumbency was increased. There were no differences in total recovery duration, number of attempts to stand, physiologic parameters other than heart rate during GA, or VAS scores for activity in lateral recumbency, move to sternal, move to stand, or strength. Main limitations Each GA event was relatively short and there was no surgical stimulation. The same results may not occur if there was surgical stimulation and pain during each GA event. Conclusion Recovery from GA improves with multiple anaesthetic episodes in horses. Clinicians can advise clients that horses are likely to have better GA recovery on repeated GA recovery due to improved balance and coordination and reduced knuckling. Additionally, there is no change in anaesthetic morbidity with six repeated GA events over a 14-week period. [ABSTRACT FROM AUTHOR]

Oligoanalgesia is defined as failure to provide analgesia in patients with acute pain. Treatment of pain in emergencies, critical care and perioperatively may influence patient outcomes: the harmful practice of withholding analgesics occurs in teaching hospitals and private practices and results in severe physiological consequences. This article discusses the prevalence, primary causes, species and regional differences and ways to avoid oligoanalgesia in small animal practice. Oligoanalgesia may be addressed by improving education on pain management in the veterinary curriculum, providing continuing education to veterinarians and implementing pain scales. [ABSTRACT FROM AUTHOR]

Opioids are the cornerstone for the treatment of acute pain in small animal patients. This is primarily because of their remarkable safety profile, high efficacy, and benefit of reversibility. There have been some significant advances in our knowledge on opioid pharmacology and clinical usage in companion animal medicine. This review discusses the progression of opioid use in small animal practice providing current misconceptions and controversies in light of routes of administration. Potential targets for research and drug development and novel therapies are discussed in addition to the concepts of glial cell modulators, individual variability, and opioid tolerance and hyperalgesia. The future brings an interesting perspective with the application of pharmacogenetics and individualized pain management in canine and feline practice. [ABSTRACT FROM AUTHOR]