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OBJECTIVE To determine the dose of alfaxalone for IM administration combined with dexmedetomidine and hydromorphone that would allow endoscopic-guided orotracheal intubation in rabbits without causing a decrease in respiratory rate or apnea. ANIMALS 15 sexually intact (9 females and 6 males) healthy Miniature Lop rabbits weighing a mean ± SD of 2.3 ± 0.3 kg and ranging in age from 4 to 9 months. PROCEDURES In a randomized, controlled clinical trial, rabbits received 0.1 mg of hydro-morphone/kg and 0.005 mg of dexmedetomidine/kg, plus alfaxalone at either 2 mg/kg (5 rabbits), 5 mg/kg (5 rabbits), or 7 mg/kg (5 rabbits). Drugs were mixed in a single syringe and administered IM. Semiquantitative rating scales were used to evaluate quality of anesthesia and intubation. Orotracheal intubation was attempted with endoscopy and confirmed by capnography. RESULTS The number of successful intubations was 0, 3, and 4 in rabbits receiving 2, 5, and 7 mg of alfaxalone/kg, respectively. Median (range) anesthesia quality scores (scale, 0 to 12; 12 = deepest anesthesia) were 3 (2 to 5), 6 (5 to 6), and 6 (4 to 9) for rabbits receiving 2, 5, and 7 mg of alfaxalone/kg, respectively. The median (range) intubation quality scores (scale, 0 to 3 [ie, intubation not possible to easiest intubation]) were 0 (0 to 0), 2 (0 to 3), and 2 (0 to 3) for rabbits receiving 2, 5, and 7 mg of alfaxalone/kg, respectively. None of the rabbits experienced a decrease in respiratory rate or apnea. CONCLUSIONS AND CLINICAL RELEVANCE Increasing doses of alfaxalone combined with hydromorphone and dexmedetomidine increased the success rate of endoscopic-guided orotracheal intubation. Increasing the dose of alfaxalone had no effect on respiratory rate.

To compare blind and endoscopic-guided techniques for orotracheal intubation in rabbits and the number of intubation attempts with laryngeal/tracheal damage.Prospective, randomized experimental study.A total of 24 healthy, intact female New Zealand White rabbits, weighing 2.2 ± 0.2 kg (mean ± standard deviation).Rabbits were randomly assigned to blind (group B) or endoscopic-guided (group E) orotracheal intubation with a 2.0 mm internal diameter uncuffed tube. Intramuscular (IM) alfaxalone (7 mg kgMedian (range) intubation attempts were 2 (1-8) and 1 (1-3) for groups B and E, respectively. More rabbits in group E (91.6%) required additional alfaxalone and dexmedetomidine than in group B (16.7%). Median (range) cumulative histopathology scores were 6 (3-10) and 6 (2-9) for groups B and E, respectively. Scores were highest in the cranial trachea, but there was no difference between groups and no correlation between laryngeal/tracheal damage and the number of intubation attempts.Both orotracheal intubation techniques were associated with laryngeal/tracheal damage. Although blind orotracheal intubation was associated with a higher number of attempts, the tissue damage was similar between groups.

OBJECTIVE To compare results of a commercially available device for oscillometrically measured blood pressure (OBP) with invasively measured blood pressure (IBP) in awake and anesthetized dogs. ANIMALS 19 adult dogs (mean ± SD body weight, 17.8 ± 7.5 kg). PROCEDURES Blood pressures were measured in dogs while they were awake and anesthetized with isoflurane. The OBP was recorded on a thoracic limb, and IBP was simultaneously recorded from the median caudal artery. Agreement between OBP and IBP was evaluated with the Bland-Altman method. Guidelines of the American College of Veterinary Internal Medicine (ACVIM) were used for validation of the oscillometric device. RESULTS In awake dogs, mean bias of the oscillometric device was −11.12 mm Hg (95% limits of agreement [LOA], −61.14 to 38.90 mm Hg) for systolic arterial blood pressure (SAP), 9.39 mm Hg (LOA, −28.26 to 47.04 mm Hg) for diastolic arterial blood pressure (DAP), and −0.85 mm Hg (LOA, −40.54 to 38.84 mm Hg) for mean arterial blood pressure (MAP). In anesthetized dogs, mean bias was −12.27 mm Hg (LOA, −47.36 to 22.82 mm Hg) for SAP, −3.92 mm Hg (LOA, −25.28 to 17.44 mm Hg) for DAP, and −7.89 mm Hg (LOA, −32.31 to 16.53 mm Hg) for MAP. The oscillometric device did not fulfill ACVIM guidelines for the validation of such devices. CONCLUSIONS AND CLINICAL RELEVANCE Agreement between OBP and IBP results for awake and anesthetized dogs was poor. The oscillometric blood pressure device did not fulfill ACVIM guidelines for validation. Therefore, clinical use of this device cannot be recommended.

Objective To investigate the median effective dose 50 (ED50) of midazolam required for endotracheal intubation when used for co-induction of anesthesia with a low dose of alfaxalone in sedated cats. Study design Randomized up-and-down study. Animals A group of 14 mixed-breed cats (eight males, six females), aged 5–12 years and weighing 4.4–6.8 kg. Methods The cats were randomly assigned in a sequential allocation numbers from one to 14. Cats were sedated with dexmedetomidine (3 μg kg–1) and methadone (0.3 mg kg–1) intramuscularly. After 15 minutes, the quality of sedation was subjectively evaluated. Anesthesia induction was performed by intravenous (IV) administration of alfaxalone (0.25 mg kg–1) over a 60 second interval, followed by another 60 second interval, and then an IV dose of midazolam was administered over a 5 second interval. The initial midazolam dose was 0.3 mg kg–1; then, the midazolam dose was adjusted by ±0.1 mg kg–1 for each consecutive cat based on successful or unsuccessful endotracheal intubation of the previous animal following an up-and-down method. This sequence was followed until six nonsequential crossovers were observed. Crossover was defined as two opposite outcomes in two sequential animals. Data were analyzed using isotonic regression with bootstrapping for determination of midazolam ED50 and logistic regression for correlations (p Results Overall, six independent crossovers were found, and ED50 of midazolam was 0.08 ± 0.04 mg kg–1. Sedation score and successful tracheal intubation had a strong positive correlation (p = 0.02). Conclusions and clinical relevance This study determined that 0.08 ± 0.04 mg kg–1 of midazolam co-administered with 0.25 mg kg–1 of alfaxalone IV allowed smooth endotracheal intubation in half of the cats sedated with methadone and dexmedetomidine at the doses used in this study.

OBJECTIVE To investigate the effects of a priming dose of alfaxalone on the total anesthetic induction dose for and cardiorespiratory function of sedated healthy cats. ANIMALS 8 healthy adult cats. PROCEDURES For this crossover study, cats were sedated with dexmedetomidine and methadone administered IM. Cats next received a priming induction dose of alfaxalone (0.25 mg/kg, IV) or saline (0.9% NaCl) solution (0.025 mL/kg, IV) over 60 seconds and then an induction dose of alfaxalone (0.5 mg/kg/min, IV) until orotracheal intubation was achieved. Cardiorespiratory variables were recorded at baseline (immediately prior to priming agent administration), immediately after priming agent administration, after orotracheal intubation, and every 2 minutes until extubation. The total induction dose of alfaxalone was compared between the 2 priming agents. RESULTS Mean ± SD total anesthetic induction dose of alfaxalone was significantly lower when cats received a priming dose of alfaxalone (0.98 ± 0.28 mg/kg), compared with when cats received a priming dose of saline solution (1.41 ± 0.17 mg/kg). Mean arterial blood pressure was significantly higher when alfaxalone was used as the priming dose. No cats became apneic or had a hemoglobin oxygen saturation of < 90%. Expired volume per minute was not significantly different between the 2 priming agents. CONCLUSIONS AND CLINICAL RELEVANCE Administration of a priming dose of alfaxalone to healthy sedated cats reduced the total dose of alfaxalone needed to achieve orotracheal intubation, maintained mean arterial blood pressure, and did not adversely impact the measured respiratory variables.

OBJECTIVE To examine the effect of 24 hours of refrigeration on urine samples collected from dogs with signs of urinary tract infection (UTI). DESIGN Prospective cross-sectional study. ANIMALS 104 dogs with signs consistent with UTI that had a urine sample collected via cystocentesis as part of their diagnostic workup. PROCEDURES A 1-mL aliquot of each urine sample was refrigerated at 5°C for 24 hours in a plain glass tube, then processed for quantitative bacterial culture (QBC). A 0.5-mL aliquot was added to 3 mL of tryptic soy broth (TSB) and refrigerated at 5°C for 24 hours, then processed for QBC. The remaining portion was immediately processed for QBC, with results reported as numbers of bacterial colony–forming units (CFUs). Sensitivity of the QBC for detection of bacteria (and therefore UTI) was determined for sample refrigeration in the 2 conditions, compared with immediate processing (reference standard). RESULTS Bacterial growth was identified in 35.6% (n = 37), 33.7% (35), and 31.7% (33) of the immediately processed, refrigerated, and refrigerated-in-TSB urine samples, respectively. Sample refrigeration without TSB resulted in no significant difference in CFU counts relative to immediate processing; however, the sensitivity of this method was 95% (35/37). Sample refrigeration with TSB resulted in significantly lower CFU counts, and sensitivity was only 89% (33/37). CONCLUSIONS AND CLINICAL RELEVANCE Canine urine samples collected for bacterial culture should be immediately submitted for testing. Although CFU counts for refrigerated and immediately processed samples were statistically similar in this study, sample refrigeration in enrichment broth resulted in imperfect sensitivity for UTI detection and is not recommended.

Serratia marcescens has emerged as an important opportunistic pathogen responsible for nosocomial and severe infections. Here, we determined phenotypic and molecular characteristics of 54 S. marcescens isolates obtained from patient samples from intensive-care-unit (ICU) and neonatal intensive-care-unit (NIUC) of a Brazilian tertiary hospital. All isolates were resistant to beta-lactam group antibiotics, and 92.6% (50/54) were not susceptible to tigecycline. Furthermore, 96.3% showed intrinsic resistance to polymyxin E (colistin), a last-resort antibiotic for the treatment of infections caused by MDR (multidrug-resistant) Gram-negative bacteria. In contrast, high susceptibility to other antibiotics such as fluoroquinolones (81.5%), and to aminoglycosides (as gentamicin 81.5%, and amikacin 85.2%) was found. Of all isolates, 24.1% were classified as MDR. The presence of resistance and virulence genes were examined by PCR and sequencing. All isolates carried KPC-carbapenemase (blaKPC) and extended spectrum beta-lactamase blaTEM genes, 14.8% carried blaOXA–1, and 16.7% carried blaCTX–M–1group genes, suggesting that bacterial resistance to β-lactam antibiotics found may be associated with these genes. The genes SdeB/HasF and SdeY/HasF that are associated with efflux pump mediated drug extrusion to fluoroquinolones and tigecycline, respectively, were found in 88.9%. The aac(6′)-Ib-cr variant gene that can simultaneously induce resistance to aminoglycoside and fluoroquinolone was present in 24.1% of the isolates. Notably, the virulence genes to (i) pore-forming toxin (ShlA); (ii) phospholipase with hemolytic and cytolytic activities (PhlA); (iii) flagellar transcriptional regulator (FlhD); and (iv) positive regulator of prodigiosin and serratamolide production (PigP) were present in 98.2%. The genetic relationship among the isolates determined by ERIC-PCR demonstrated that the vast majority of isolates were grouped in a single cluster with 86.4% genetic similarity. In addition, many isolates showed 100% genetic similarity to each other, suggesting that the S. marcescens that circulate in this ICU are closely related. Our results suggest that the antimicrobial resistance to many drugs currently used to treat ICU and NIUC patients, associated with the high frequency of resistance and virulence genes is a worrisome phenomenon. Our findings emphasize the importance of active surveillance plans for infection control and to prevent dissemination of these strains.

Klebsiella pneumoniae is an important opportunistic pathogen that commonly causes nosocomial infections and contributes to substantial morbidity and mortality. We sought to investigate the antibiotic resistance profile, pathogenic potential and the clonal relationships between K. pneumoniae (n = 25) isolated from patients and sources at a tertiary care hospital’s intensive care units (ICUs) in the northern region of Brazil. Most of K. pneumoniae isolates (n = 21, 84%) were classified as multidrug resistant (MDR) with high-level resistance to β-lactams, aminoglycosides, quinolones, tigecycline, and colistin. All the 25 isolates presented extended-spectrum beta-lactamase-producing (ESBL), including carbapenemase producers, and carried the blaKPC (100%), blaTEM (100%), blaSHV variants (n = 24, 96%), blaOXA-1 group (n = 21, 84%) and blaCTX-M-1 group (n = 18, 72%) genes. The K2 serotype was found in 4% (n = 1) of the isolates, and the K1 was not detected. The virulence-associated genes found among the 25 isolates were mrkD (n = 24, 96%), fimH-1 (n = 22, 88%), entB (100%), iutA (n = 10, 40%), ybtS (n = 15, 60%). The genes related with efflux pumps and outer membrane porins found were AcrAB (100%), tolC (n = 24, 96%), mdtK (n = 22, 88%), OmpK35 (n = 15, 60%), and OmpK36 (n = 7, 28%). ERIC-PCR was employed to determine the clonal relationship between the different isolated strains. The obtained ERIC-PCR patterns revealed that the similarity between isolates was above 70%. To determine the sequence types (STs) a multilocus sequence typing (MLST) assay was used. The results indicated the presence of high-risk international clones among the isolates. In our study, the wide variety of MDR K. pneumoniae harboring β-lactams and virulence genes strongly suggest a necessity for the implementation of effective strategies to prevent and control the spread of antibiotic resistant infections.

The topic of ‘fungal stress’ is central to many important disciplines, including medical mycology, chronobiology, plant and insect pathology, industrial microbiology, material sciences, and astrobiology. The International Symposium on Fungal Stress (ISFUS) brought together researchers, who study fungal stress in a variety of fields. The second ISFUS was held in May 8-11 2017 in Goiania, Goiás, Brazil and hosted by the Instituto de Patologia Tropical e Saúde Pública at the Universidade Federal de Goiás. It was supported by grants from CAPES and FAPEG. Twenty-seven speakers from 15 countries presented their research related to fungal stress biology. The Symposium was divided into seven topics: 1. Fungal biology in extreme environments; 2. Stress mechanisms and responses in fungi: molecular biology, biochemistry, biophysics, and cellular biology; 3. Fungal photobiology in the context of stress; 4. Role of stress in fungal pathogenesis; 5. Fungal stress and bioremediation; 6. Fungal stress in agriculture and forestry; and 7. Fungal stress in industrial applications. This article provides an overview of the science presented and discussed at ISFUS-2017. Sao Paulo Research Foundation (FAPESP) 2010/06374-1, 2013/50518-6, 2014/01229-4 Brazilian National Council for Scientific and Technological Development (CNPq) PQ2 302312/2011-0, PQ1D 308436/2014-8 Coordenação de Aperfeiçoãmento de Pessoal de Nível Superior (CAPES) PAEP 88881.123209/2016-01 Fundação de Amparo à Pesquisa do Estado de Goiás Brazil 201710267000110

A 3-month-old male umbrella cockatoo (Cacatua alba) was presented because of acute non-weight-bearing lameness of the right leg. Marked soft tissue swelling was present around the femorotibiotarsal (stifle) joint, and the radiographic diagnosis was right medial femorotibiotarsal subluxation. Surgical management was elected, and the stifle joint was approached via a lateral parapatellar incision. Joint exploration revealed damage to the lateral meniscus, tendon of origin of the cranial tibial muscle, and cranial cruciate ligament. After debriding the disrupted meniscus, the stifle joint was anatomically reduced. The femorotibiotarsal joint was stabilized by using a lateral extracapsular suture in a modified technique using a self-tapping cortical screw in the lateral femoral condyle and a hole through the proximal tibiotarsus. The bird regained function of the femorotibiotarsal joint for 3 months after surgery, allowing sufficient time for the bird to establish a physiologic perching angle so that ankylosis occurred to maintain functionality of the leg as a unit. This combination of orthopedic techniques adapted from techniques commonly used in small companion-animal species may be considered to provide young birds with femorotibiotarsal luxations and subluxation a good quality of life despite ankylosis of the joint.

OBJECTIVE To evaluate agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scores determined by use of a simple descriptive scale (SDS) or a composite grading scale (CGS) for quality of recovery of horses from anesthesia and to investigate use of 3-axis accelerometry (3AA) for objective evaluation of recovery. ANIMALS 12 healthy adult horses. PROCEDURES Horses were fitted with a 3AA device and then were anesthetized. Eight diplomates evaluated recovery by use of an SDS, and 7 other diplomates evaluated recovery by use of a CGS. Agreement was tested with κ and AC1 statistics for the SDS and an ANOVA for the CGS. A library of mathematical models was used to map 3AA data against CGS scores. RESULTS Agreement among diplomates using the SDS was slight (κ = 0.19; AC1 = 0.22). The CGS scores differed significantly among diplomates. Best fit of 3AA data against CGS scores yielded the following equation: RS = 9.998 × SG0.633 × ∑UG0.174, where RS is a horse's recovery score determined with 3AA, SG is acceleration of the successful attempt to stand, and ∑UG is the sum of accelerations of unsuccessful attempts to stand. CONCLUSIONS AND CLINICAL RELEVANCE Subjective scoring of recovery of horses from anesthesia resulted in poor agreement among diplomates. Subjective scoring may lead to differences in conclusions about recovery quality; thus, there is a need for an objective scoring method. The 3AA system removed subjective bias in evaluations of recovery of horses and warrants further study.

Objective—To evaluate physical methods for inducing death during the slaughter of American alligators (Alligator mississippiensis). Animals—24 captive hatched-and-reared American alligators. Procedures—Baseline electroencephalograms (EEGs) were obtained for awake and anesthetized alligators. Corneal reflex, spontaneous blinking, and EEGs were evaluated after severance of the spinal cord, severance of the spinal cord followed by pithing of the brain, application of a penetrating captive bolt, or application of a nonpenetrating captive bolt (6 alligators/group). Results—Overall, alligators subjected to spinal cord severance alone differed from those subjected to the other techniques. Spinal cord severance alone resulted in postprocedure EEG power values greater than those in anesthetized alligators, whereas the postprocedure EEG power values were isoelectric for the other 3 techniques. Corneal reflex and spontaneous blinking were absent in all alligators immediately after application of a penetrating or nonpenetrating captive bolt. One of 6 alligators had a corneal reflex up to 1 minute after pithing, but all others within that group had immediate cessation of reflexes after pithing. Mean time to loss of spontaneous blinking and corneal reflex for alligators subjected to spinal cord severance alone was 18 minutes (range, 2 to 37 minutes) and 54 minutes (range, 34 to 99 minutes), respectively. Conclusions and Clinical Relevance—Spinal cord severance followed by pithing of the brain and application of a penetrating or nonpenetrating captive bolt appeared to be humane and effective techniques for inducing death in American alligators, whereas spinal cord severance alone was not found to be an appropriate method.

Objective To determine if blood pressure measured with an ultrasonic Doppler flow detector (Doppler) is in good agreement with directly measured blood pressures in anesthetized cats. Design Prospective observational study. Setting University veterinary teaching hospital. Animals Thirty-nine cats undergoing routine neutering. Interventions Cats were divided into 2 groups; 19 cats enrolled in Group A had a 24-Ga catheter inserted into a dorsal pedal artery; 20 cats in Group B had a 20-Ga catheter placed in a femoral artery. In both groups, systolic, diastolic, and mean arterial pressures were directly measured using a validated pressure measurement system. Indirect values were compared against direct blood pressure measurements. Results There was no difference between groups. Overall, there was poor agreement with a significant bias observed between Doppler and directly measured blood pressures. For the systolic arterial pressure the bias was −8.8 with limits of agreements (LOA) of −39.3 and 21.7. For the mean arterial pressure, the bias was 14.0 with LOA of −13.9 and 41.9. For the diastolic arterial pressure, the bias was 27.9 with LOA of −4.4 and 60.2. Methodology, weight, sex, and replicates did not have a significant effect on the difference between indirect and direct measurements in any model. Conclusions Results suggest poor agreement between Doppler values and directly measured blood pressures in anesthetized cats. Use of Doppler in cats could be misleading and readings should be interpreted with caution in a clinical context.

Blood pressure monitoring of patients has become increasingly common in companion animal veterinary hospitals, especially during anesthesia, surgical procedures, critical care, and general health assessments. Determining an animal’s blood pressure has become a standard part of the routine diagnostic evaluation for monitoring hypertension in geriatric patients or patients affected with renal insufficiency, cardiac disease, vision loss, or endocrine disorders. To increase the standard of care in exotic and zoological medicine, new diagnostic techniques must be identified and implemented. Blood pressure measurements in avian species are more challenging because only direct blood pressure techniques have been reported to be accurate. Arterial catheterization and interpretation can be daunting without the knowledge of avian physiology and anatomy; however, techniques for placing arterial catheters are not difficult once clinicians have gained sufficient experience. This article describes the techniques, anatomy, and appropriate interpretation of blood pressure results obtained through arterial catheterization in birds.

Metomidate hydrochloride is an imidazole-based, nonbarbiturate hypnotic drug primarily used as an immersion sedation and anesthetic agent in freshwater and marine finfish. To the authors' knowledge, there is no documentation in the literature of its use in amphibians. In this study, 7 male and 4 female leopard frogs (Rana pipiens) were induced with metomidate hydrochloride via immersion bath at a concentration of 30 mg/L for 60 min. The pH of the induction solution ranged from 7.63 to 7.75. Each frog was then removed from the induction solution, rinsed, and recovered in 26.6 degrees C amphibian Ringer's solution. After 210 min in the Ringer's solution, the frogs were transferred to moist paper towels for recovery. Heart rate, gular and abdominal respiration rates, righting reflex, superficial and deep pain withdrawal reflexes, corneal and palpebral reflexes, and escape response were monitored and recorded at defined intervals during both induction and recovery. The average time to loss of righting reflex and escape response was 17.36 min and 17.82 min, respectively. Metomidate produced clinical sedation in all frogs (n = 11). Surgical anesthesia was achieved in only 27% (3/11), with an anesthetic duration that ranged from 9 to 20 min. Recovery times were extremely prolonged and varied, with a range from 313 min to longer than 600 min. The findings of this study indicate that metomidate hydrochloride is unsuitable as a sole anesthetic agent in leopard frogs, and further research is needed to evaluate its suitability in other amphibians.

Objective To compare palpation-guided with ultrasound-guided brachial plexus blockade in Hispaniolan Amazon parrots. Study design Prospective randomized experimental trial. Animals Eighteen adult Hispaniolan Amazon parrots (Amazona ventralis) weighing 252–295 g. Methods After induction of anesthesia with isoflurane, parrots received an injection of lidocaine (2 mg kg−1) in a total volume of 0.3 mL at the axillary region. The birds were randomly assigned to equal groups using either palpation or ultrasound as a guide for the brachial plexus block. Nerve evoked muscle potentials (NEMP) were used to monitor effectiveness of brachial plexus block. The palpation-guided group received the local anesthetic at the space between the pectoral muscle, triceps, and supracoracoideus aticimus muscle, at the insertion of the tendons of the caudal coracobrachial muscle, and the caudal scapulohumeral muscle. For the ultrasound-guided group, the brachial plexus and the adjacent vessels were located with B-mode ultrasonography using a 7–15 MHz linear probe. After location, an 8-5 MHz convex transducer was used to guide injections. General anesthesia was discontinued 20 minutes after lidocaine injection and the birds recovered in a padded cage. Results Both techniques decreased the amplitude of NEMP. Statistically significant differences in NEMP amplitudes, were observed within the ultrasound-guided group at 5, 10, 15, and 20 minutes after injection and within the palpation-guided group at 10, 15, and 20 minutes after injection. There was no statistically significant difference between the two groups. No effect on motor function, muscle relaxation or wing droop was observed after brachial plexus block. Conclusions and clinical relevance The onset of the brachial plexus block tended to be faster when ultrasonography was used. Brachial plexus injection can be performed in Hispaniolan Amazon parrots and nerve evoked muscle potentials were useful to monitor the effects on nerve conduction in this avian species. Neither technique produced an effective block at the doses of lidocaine used and further study is necessary to develop a useful block for surgical analgesia.

Objective To determine if an oscillometric device optimized for use in dogs produces systolic, diastolic, and mean arterial pressures (MAPs) measurements that are in good agreement with directly obtained pressures Design Prospective study. Setting University teaching hospital. Animals Twenty-one dogs under general anesthesia for surgical procedures. Interventions A 20-Ga catheter was placed into the dorsal pedal artery and systolic, diastolic, and MAPs were directly measured using a validated blood pressure measurement system. Indirect blood pressure measurements were collected using a widely available veterinary oscillometric blood pressure unit. Results obtained by the 2 methods were then compared. Measurements and Main Results Agreement between the directly and indirectly measured pressure demonstrated a bias of 9.9 mm Hg and limits of agreement (LOA) 73.7 to −53.9, a bias of −8.9 mm Hg and LOA 23.3 to −41.2, and a bias of −6.3 mm Hg and LOA 28.2 to −40.8 for systolic, diastolic, and MAP, respectively. Conclusions There was poor agreement between the direct and indirect measured blood pressure measurement systems. Therefore, use of the oscillometric blood pressure unit evaluated in this study for monitoring patients under anesthesia cannot be recommended at this time.

Objectives 1) To determine which peripheral artery commonly used for invasive arterial blood pressure (IBP) monitoring yields the least bias when compared with noninvasive blood pressure (NIBP) values obtained at the antebrachium of the dog, and 2) to identify and describe differences in systolic (SAP), mean (MAP) and diastolic arterial pressures (DAP) among different anatomical locations. Study design Prospective experimental study. Animals Twenty adult hound dogs weighing 24.5 ± 1.1 kg (mean ± standard deviation). Methods Four peripheral arteries—dorsal pedal, median caudal, intermediate auricular and superficial palmar arteries—were catheterized with 20 gauge, 3.8 cm catheters. One NIBP cuff was placed in the middle third of the antebrachium. Four sets of IBP and NIBP measurements were simultaneously collected every 2 minutes. A linear mixed model was performed to analyze the collected data. Results IBP values varied depending on the arterial catheterization site. The difference was greater for SAP. NIBP measured at the antebrachium had the best agreement with IBP measured at the median caudal artery. Conclusion and clinical relevance IBP varies among anatomical locations. The smallest bias and narrowest limits of agreement were obtained at the median caudal artery, providing the best overall agreement with the equipment studied. The median caudal artery may be the preferable anatomical location for clinical comparison studies between IBP and NIBP in dogs when the cuff is on the antebrachium.

Objective—To assess the effects of dopamine and dobutamine on the blood pressure of isoflurane-anesthetized Hispaniolan Amazon parrots (Amazona ventralis). Animals—8 Hispaniolan Amazon parrots. Procedures—A randomized crossover study was conducted. Each bird was anesthetized (anesthesia maintained by administration of 2.5% isoflurane in oxygen) and received 3 doses of each drug during a treatment period of 20 min/dose. Treatments were constant rate infusions (CRIs) of dobutamine (5, 10, and 15 μg/kg/min) and dopamine (5, 7, and 10 μg/kg/min). Direct systolic, diastolic, and mean arterial pressure measurements, heart rate, esophageal temperature, and end-tidal partial pressure of CO2 were recorded throughout the treatment periods. Results—Mean ± SD of the systolic, mean, and diastolic arterial blood pressures at time 0 (initiation of a CRI) were 132.9 ± 22.1 mm Hg, 116.9 ± 20.5 mm Hg, and 101.9 ± 22.0 mm Hg, respectively. Dopamine resulted in significantly higher values than did dobutamine for the measured variables, except for end-tidal partial pressure of CO2. Post hoc multiple comparisons revealed that the changes in arterial blood pressure were significantly different 4 to 7 minutes after initiation of a CRI. Overall, dopamine at rates of 7 and 10 μg/kg/min and dobutamine at a rate of 15 μg/kg/min caused the greatest increases in arterial blood pressure. Conclusions and Clinical Relevance—Dobutamine CRI at 5, 10, and 15 μg/kg/min and dopamine CRI at 5, 7, and 10 μg/kg/min may be useful in correcting severe hypotension in Hispaniolan Amazon parrots caused by anesthesia maintained with 2.5% isoflurane.

Objective – To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs. Design – Prospective observational study. Setting – University teaching hospital. Animals – Eight crossbred adult dogs. Interventions – Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end-tidal isoflurane concentration at 1.2±0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia. Measurements and Main Results – Agreement between the direct and indirect BP measurements was determined by the Bland-Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were −14.7 mm Hg (15.5 mm Hg), −16.4 mm Hg (12.1 mm Hg), and −14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were −32 mm Hg (22.6 mm Hg), −24.2 mm Hg (19.5 mm Hg), and −16.8 mm Hg (17.2 mm Hg), respectively. Conclusion – The oscillometric device was not reliably predictive of intra-arterial BP during hypotension associated with acute hemorrhage.

Objective—To determine the level of agreement between direct and indirect blood pressure measurements obtained from healthy Hispaniolan Amazon parrots (Amazona ventralis) anesthetized with isoflurane. Design—Validation study. Animals—16 healthy adult Hispaniolan Amazon parrots. Procedures—Parrots were anesthetized, and a 26-gauge, 19-mm catheter was placed percutaneously in the superficial ulnar artery for direct measurement of systolic, mean, and diastolic arterial pressures. Indirect blood pressure measurements were obtained with a Doppler ultrasonic flow detector and an oscillometric unit. The Bland-Altman method was used to compare direct and indirect blood pressure values. Results—There was substantial disagreement between direct systolic arterial blood pressure and indirect blood pressure measurements obtained with the Doppler detector from the wing (bias, 24 mm Hg; limits of agreement, −37 to 85 mm Hg) and from the leg (bias, 14 mm Hg; limits of agreement, −14 to 42 mm Hg). Attempts to obtain indirect blood pressure measurements with the oscillometric unit were unsuccessful. Conclusions and Clinical Relevance—Results suggested that there was substantial disagreement between indirect blood pressure measurements obtained with a Doppler ultrasonic flow detector in anesthetized Hispaniolan Amazon parrots and directly measured systolic arterial blood pressure.

OBJECTIVE To compare blood pressure measured noninvasively with an oscillometric device that involved use of a novel conical cuff and a traditional cylindrical blood pressure cuff. ANIMALS 17 adult hound-type dogs. PROCEDURES Dogs were anesthetized, and a 20-gauge, 1.5-inch catheter was inserted in the median sacral artery. The catheter was attached to a pressure transducer via fluid-filled noncompliant tubing, and direct blood pressure was recorded with a multifunction monitor. A specially fabricated conical cuff was placed on the antebrachium. Four sets of direct and indirect blood pressure measurements were simultaneously collected every 2 minutes. Four sets of measurements were then obtained by use of a cylindrical cuff. RESULTS The cylindrical cuff met American College of Veterinary Internal Medicine consensus guidelines for validation of indirect blood pressure measurements for mean arterial blood pressure (MAP), systolic arterial blood pressure (SAP), and diastolic arterial blood pressure (DAP). The conical cuff met the consensus guidelines for difference of paired measurements, SD, and percentages of measurements within 10 and 20 mm Hg of the value for the reference method, but it failed a correlation analysis. In addition, although bias for the conical cuff was less than that for the cylindrical cuff for SAP, MAP, and DAP measurements, the limits of agreement for the conical cuff were wider than those for the cylindrical cuff for SAP and MAP measurements. CONCLUSIONS AND CLINICAL RELEVANCE On the basis of results of this study, use of a conical cuff for oscillometric blood pressure measurement cannot be recommended.

To determine the median effective dose (EDRandomized up-and-down study.A total of 14 Ross-708 broiler chickens (Gallus gallus domesticus) weighing 1.70-2.75 kg.Anesthesia was induced and maintained with isoflurane. Monitoring included the electrocardiogram and invasive arterial pressures. Chickens were administered bupivacaine IV over 2 minutes using a dose based on the response of the previous animal. Dose was decreased when HR and/or MAP in the previous animal increased or decreased ≥30% after bupivacaine administration, or increased when HR or MAP changed30%. The EDThe IV EDThese results suggest that 1.33 and 1.96 mg kg

This study evaluated the effects of the Biosilicate

OBJECTIVE To use CT-derived measurements to create a ferret-specific formula for body surface area (BSA) to improve chemotherapeutic dosing. ANIMALS 25 adult ferrets (19 live and 6 cadavers). PROCEDURES Live subjects were weighed, and body measurements were obtained by each of 3 observers while ferrets were awake and anesthetized. Computed tomography was performed, and a 3-D surface model was constructed with open-source imaging software, from which BSA was estimated. The CT-derived values were compared with BSA calculated on the basis of the traditional tape method for 6 cadavers. To further validate CT analysis software, 11 geometric shapes were scanned and their CT-derived values compared with those calculated directly via geometric formulas. Agreement between methods of surface area estimation was assessed with linear regression. Ferret-specific formulas for BSA were determined with nonlinear regression models. RESULTS Repeatability among the 3 observers was good for all measurements, but some measurements differed significantly between awake and anesthetized ferrets. Excellent agreement was found between measured versus CT-derived surface area of shapes, traditional tape– versus CT-derived BSA of ferret cadavers, and CT-derived BSA of cadavers with and without monitoring equipment. All surface area formulas performed relatively similarly. CONCLUSIONS AND CLINICAL RELEVANCE CT-derived BSA measurements of ferrets obtained via open-source imaging software were reliable. On the basis of study results, the recommended formula for BSA in ferrets would be 9.94 × (body weight)2/3; however, this represented a relatively minor difference from the feline-derived formula currently used by most practitioners and would result in little practical change in drug doses.

The primary objective was to evaluate the effect of a bupivacaine mandibular nerve block on intraoperative blood pressure (BP) and heart rate (HR) in response to surgical stimulation and the need for systemic analgesics postoperatively. We hypothesized that a mandibular nerve block would decrease the need for systemic analgesics both intraoperatively and postoperatively.Fourteen adult male Yucatan pigs were purchased. Pigs were chemically restrained with ketamine, midazolam, and dexmedetomidine and anesthesia was maintained with isoflurane inhalant anesthesia. Pigs were randomized to receive a mandibular block with either bupivacaine (bupivacaine group) or saline (control group). A nerve stimulator was used for administration of the block with observation of masseter muscle twitch to indicate the injection site. Invasive BP and HR were measured with the aid of an arterial catheter in eight pigs. A rescue analgesic protocol consisting of fentanyl and lidocaine was administered if HR or BP values increased 20% from baseline. Postoperative pain was quantified with a customized ethogram. HR and BP were evaluated at base line, pre-rescue, 10 and 20 min post-rescue.Pre-rescue mean BP was significantly increased (p = .001) for the bupivacaine group. Mean intraoperative HR was significantly lower (p = .044) in the bupivacaine versus saline group. All other parameters were not significant.Addition of a mandibular nerve block to the anesthetic regimen in the miniature pig condylectomy model may improve variations in intraoperative BP and HR. This study establishes the foundation for future studies with larger animal numbers to confirm these preliminary findings.

To determine the cardiovascular effects of lidocaine infused intravenously (IV) in broiler chickens.Two phase study: Phase 1, randomized up-and-down study to determine effective dose 50 (ED50) for lidocaine; Phase 2, prospective randomized study to determine the cardiovascular effects of lidocaine.Seventeen Ross-708 broiler chickens (Gallus gallus domesticus) [11 chickens (Phase 1) and 6 chickens (Phase 2)], weighing 2.6-4.3 kg.After induction of anesthesia with isoflurane and placement of monitoring equipment including invasive blood pressure, chickens were administered lidocaine IV. During Phase 1, using an up-and-down design, each animal received a variable dose selected based on the response of the previous animal. During Phase 2, each animal was administered 6 mg kg(-1) of lidocaine IV over 2 minutes. Clinically irrelevant cardiovascular effects were defined as a relative decrease of heart rate (HR) and mean blood pressure (MAP)30% subsequent to IV lidocaine administration. The ED50 was defined as the dose rate that would cause clinically irrelevant cardiovascular depression in 50% of the population.During Phase 1, using an up-and-down study design (n = 11), the ED50 of lidocaine was determined to be 6.30 mg kg(-1) and 6.22 mg kg(-1) (95% confidence interval, 5.30-7.13 mg kg(-1)), when calculated by Dixon's up-and-down method, and logistic regression, respectively. During Phase 2, following infusion of lidocaine (6 mg kg(-1)), no clinically relevant effects on HR or MAP were detected in any animal.Previous reports state that the dose of lidocaine used in birds should be ≤4 mg kg(-1). In this study, 6 mg kg(-1) of lidocaine injected IV was not associated with adverse cardiovascular effects. These results suggest that the dose of 4 mg kg(-1) can be exceeded, at least in chickens, and opens the possibility of other therapeutic uses for lidocaine in birds.

Objective—To assess the accuracy of an ultrasound velocity dilution cardiac output (UDCO) method, compared with that of the lithium dilution cardiac output (LiDCO) method, for determination of cardiac output (CO) in juvenile horses with experimentally induced hypovolemia. Animals—12 anesthetized 2- to 6-month-old horses. Procedures—For each anesthetized horse, CO was determined by the LiDCO and UDCO methods prior to any intervention (baseline state), after withdrawal of approximately 40% of the horse's blood volume (low CO state), after maintenance of hypovolemia and infusion of norepinephrine until mean arterial blood pressure was equal to baseline value (high CO state), and after further infusion of norepinephrine and back-transfusion of withdrawn blood (posttransfusion state). For each of the 4 hemodynamic situations, CO and calculated cardiac index (CI) values were obtained by each method in duplicate (8 pairs of measurements/horse); mean values for each horse and overall mean values across all horses were calculated. Agreement between CI determined by each method (96 paired values) was assessed by Bland-Altman analysis. Results—For the UDCO method–derived CI measurements among the 12 horses, mean ± SD bias was −4 ± 11.3 mL/kg/min (95% limits of agreement, −26.1 to 18.2 mL/kg/min) and mean relative bias was −10.4 ± 21.5% (95% limits of agreement, −52.6% to 31.8%). Conclusions and Clinical Relevance—Results indicated that, compared with the LiDCO method, the UDCO method has acceptable clinical usefulness for determination of CO in foals.

To determine if blood pressure measured with an ultrasonic Doppler flow detector (Doppler) is in good agreement with directly measured blood pressures in anesthetized cats.Prospective observational study.University veterinary teaching hospital.Thirty-nine cats undergoing routine neutering.Cats were divided into 2 groups; 19 cats enrolled in Group A had a 24-Ga catheter inserted into a dorsal pedal artery; 20 cats in Group B had a 20-Ga catheter placed in a femoral artery. In both groups, systolic, diastolic, and mean arterial pressures were directly measured using a validated pressure measurement system. Indirect values were compared against direct blood pressure measurements.There was no difference between groups. Overall, there was poor agreement with a significant bias observed between Doppler and directly measured blood pressures. For the systolic arterial pressure the bias was -8.8 with limits of agreements (LOA) of -39.3 and 21.7. For the mean arterial pressure, the bias was 14.0 with LOA of -13.9 and 41.9. For the diastolic arterial pressure, the bias was 27.9 with LOA of -4.4 and 60.2. Methodology, weight, sex, and replicates did not have a significant effect on the difference between indirect and direct measurements in any model.Results suggest poor agreement between Doppler values and directly measured blood pressures in anesthetized cats. Use of Doppler in cats could be misleading and readings should be interpreted with caution in a clinical context.

Objective—To determine whether veterinary-specific oscillometric blood pressure units yield measurements that are in good agreement with directly measured blood pressures in cats. Design—Evaluation study. Animals—21 cats undergoing routine spaying or neutering. Procedures—A 24-gauge catheter was inserted in a dorsal pedal artery, and systolic, diastolic, and mean arterial pressures were directly measured with a validated pressure measurement system. Values were compared with indirect blood pressure measurements obtained with 3 veterinary-specific oscillometric blood pressure units. Results—There was poor agreement between indirectly and directly measured blood pressures. For unit 1, bias between indirectly and directly measured values was −14.9 mm Hg (95% limits of agreement [LOA], −52.2 to 22.4 mm Hg), 4.4 mm Hg (95% LOA, −26.0 to 34.8 mm Hg), and −1.3 mm Hg (95% LOA, −26.7 to 24.1 mm Hg) for systolic, diastolic, and mean arterial pressures, respectively. For unit 2, bias was −10.3 mm Hg (95% LOA, −52.9 to 32.2 mm Hg), 13.0 mm Hg (95% LOA, −32.1 to 58.0 mm Hg), and 9.1 mm Hg (95% LOA, −32.9 to 51.2 mm Hg) for systolic, diastolic, and mean arterial pressures, respectively. For unit 3, bias was −13.4 mm Hg (95% LOA, −51.8 to 25.1 mm Hg), 8.0 mm Hg (95% LOA, −25.5 to 41.6 mm Hg), and −3.6 mm Hg (95% LOA, −31.6 to 24.5 mm Hg) for systolic, diastolic, and mean arterial pressures, respectively. Conclusions and Clinical Relevance—Results suggested that none of the 3 veterinary-specific oscillometric blood pressure units could be recommended for indirect measurement of blood pressure in cats.

Case Description—A healthy 6-year-old 28.5-kg (62.7-lb) spayed female Boxer undergoing surgical repair of a ruptured cranial cruciate ligament was inadvertently administered an overdose of morphine (1.3 mg/kg [0.59 mg/lb]) via subarachnoid injection. Clinical Findings—50 minutes after administration of the overdose, mild multifocal myoclonic contractions became apparent at the level of the tail; the contractions migrated cranially and progressively increased in intensity and frequency during completion of the surgery. Treatment and Outcome—The myoclonic contractions were refractory to treatment with midazolam, naloxone, phenobarbital, and pentobarbital; only atracurium (0.1 mg/kg [0.045 mg/lb], IV) was effective in controlling the movements. The dog developed hypertension, dysphoria, hyperthermia, and hypercapnia. The dog remained anesthetized and ventilated mechanically; treatments included continuous rate IV infusions of propofol (1 mg/kg/h [0.45 mg/lb/h]), diazepam (0.25 mg/kg/h [0.11 mg/lb/h]), atracurium (0.1 to 0.3 mg/kg/h [0.045 to 0.14 mg/lb/h]), and naloxone (0.02 mg/kg/h [0.009 mg/lb/h]). Twenty-two hours after the overdose, the myoclonus was no longer present, and the dog was able to ventilate without mechanical assistance. The dog remained sedated until 60 hours after the overdose, at which time its mentation improved, including recognition of caregivers and response to voice commands. No neurologic abnormalities were detectable at discharge (approx 68 hours after the overdose) or at a recheck evaluation 1 week later. Clinical Relevance—Although intrathecal administration of an overdose of morphine can be associated with major and potentially fatal complications, it is possible that affected dogs can completely recover with immediate treatment and extensive supportive care.

Objectives To compare two commonly used oscillometric technologies for obtaining noninvasive blood pressure (NIBP) measurements and to determine if there is a difference in agreement between these systems and invasive blood pressure (IBP) measurements. Study design Prospective, experimental study. Animals Twenty adult laboratory dogs. Methods Each dog was anesthetized and its median caudal artery catheterized for IBP monitoring. An NIBP cuff was placed in the middle third of the antebrachium and attached to either monitor-1 or monitor-2. Four pairs of concurrent NIBP and IBP measurements were recorded with each monitor. Agreement between IBP and NIBP measurements was explored using Bland–Altman analysis, as well as the American College of Veterinary Internal Medicine (ACVIM) and Association for the Advancement of Medical Instrumentation (AAMI) guidelines for the validation of NIBP devices. Results Both NIBP technologies produced results that met the ACVIM and AAMI guidelines for the validation of NIBP devices. For monitor-1, analyses of agreement showed biases of 0.2 mmHg [95% limits of agreement (LoA) -11.8 to 12.3 mmHg] in systolic arterial pressure (SAP) values, -2.6 mmHg (95% LoA -14.4 to 9.1 mmHg) in diastolic arterial pressure (DAP) values, and -2.5 mmHg (95% LoA -12.7 to 7.3 mmHg) in mean arterial pressure (MAP) values. For monitor-2, analyses of agreement showed biases of 3.4 mmHg (95% LoA -8.7 to 15.5 mmHg) in SAP values, 2.2 mmHg (95% LoA -6.6 to 10.9 mmHg) in DAP values, and 1.6 mmHg (95% LoA -5.9 to 8.9 mmHg) in MAP values. Conclusions and clinical relevance Multi-function monitors can contain components from various manufacturers. Clinicians should consider whether these have been validated in the species to be monitored. Both of the technologies studied here seem appropriate for use in dogs.