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To characterize the extent of the impact of the COVID-19 pandemic on aspects of the anesthesia residency experience from the perspective of American College of Veterinary Anesthesia and Analgesia (ACVAA) mentors and trainees. This includes the residency interview process, didactic training and availability and variety of clinical cases for resident learning. Cross-sectional, online, anonymous voluntary survey. A total of 58 respondents, representing 30 residency program mentors and 28 residents. Surveys were distributed by email to 94 residency program mentors and 70 residents, representing programs and residents registered with the ACVAA during the years of 2019–2021. Anonymous links to an online survey were provided via a link embedded in the email. Questions included perceived impacts (–5 to +5 scale) on didactic and clinical training, case distribution, workload, residency application and selection process, and mental health. Responses were summarized with descriptive statistics [median (IQR) or mean ± SD]. The overall survey response rate was 31.9% (30/94) and 40.0% (28/70) for resident program mentors and residents, respectively. There was a negative perceived impact on overall residency training reported: –1.0 (IQR –2.0 to 0) for program mentors and –1.5 ± 1.5 for residents. The reported perceived impact of travel limitations on case log completion was –2.0 (IQR –4.0 to –1.0) for program mentors and –2.4 ± 2.0 for residents. Program mentors and residents had incongruent feelings on the impact of the pandemic on work hours, with residents reporting a perceived increase in work hours [+2.1 ± 2.1 versus 0 (IQR –1.0 to 0)]. Residency program mentors and residents generally agreed that the COVID-19 pandemic had negatively impacted multiple aspects of residency interview and training process. A broader, objective analysis of veterinary anesthesia training programs is required to fully elucidate the scale of the impact on veterinary anesthesia training. [ABSTRACT FROM AUTHOR]

To survey anaesthetic practices and attitudes towards veterinary patient safety in Australia. This was a cross-sectional sample population from Australian veterinary practices, including first opinion small animal, mixed animal and referral small animal practices. The survey included practices' anaesthetic management, monitoring equipment and topics regarding patient safety. Responses were obtained from 310/1700 (18%) veterinary practices, with 208 respondents from small animal practices (67%), 71 mixed animal practices (23%) and 31 referral small animal centres (10%). Overall, 61% of respondents reported always having a dedicated staff member monitoring the anaesthetic, who was most commonly a certified veterinary nurse (89%). In 22% of the practices, some of the staff monitoring an anaesthetic did not have any qualification. Completion of anaesthetic plans for each animal prior to an anaesthetic was reported by 24.5% of respondents and labelling of syringes was completed in 80% of practices. Pulse oximetry (98%) and temperature (88%) were the most common clinical variables monitored. The use of capnography (46%) or an electrocardiogram (48%) was also reported by the respondents. Emergency drugs, airway and ventilation equipment are available in 96%, 88% and 59% of practices, respectively. A defibrillator was available in 11% of practices with only 54% respondents being confident in using it. Of the respondents 60% were aware of anaesthesia safety interventions and clinical guidelines regarding patient safety during anaesthesia. Despite practices showing a relative improvement over the years in the standard of anaesthesia care, most of them are still not meeting international guidelines. Areas where changes could lead to improved safety practices could include: a trained person dedicated to monitor anaesthesia, pain scoring evaluation in patients recovering from anaesthesia, an increased use of standardised handover checklists, record keeping and an increase in open discussion of adverse events by the veterinary team. [ABSTRACT FROM AUTHOR]

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

Simple Summary: The purpose of this study was to evaluate the efficacy of using the pleth variability index (PVi) to guide fluid therapy in dogs undergoing surgery under general anesthesia compared to conventional fixed-fluid-rate administration. Twenty-seven dogs meeting specific criteria were randomly assigned to either a conventional fluid management (CFM) group or a PVi-guided (PVi) group. The CFM group received a fixed rate of fluid, while the PVi group had their fluid rate adjusted based on their PVi values. Results showed that dogs in the PVi group received less total fluid and experienced fewer hypotensive episodes compared to the CFM group. In addition, the mean arterial pressure (MAP) was significantly higher in the PVi group during surgery. These findings suggest that PVi-guided fluid therapy may result in more targeted fluid administration and improve the hemodynamic stability in anesthetized dogs. However, further studies with larger sample sizes are needed to confirm these results and explore the broader applicability of the PVi in veterinary anesthesia. The aim of this prospective, randomized clinical trial was to evaluate the use of the pleth variability index (PVi) to guide the rate of intraoperative fluid therapy compared to a traditional fixed-fluid-rate approach in ASA 1–2 dogs undergoing surgery. Twenty-seven dogs met the inclusion criteria and were randomly assigned to the conventional fluid management group (CFM, n = 12) or the PVi-guided group (PVi, n = 15). The CFM group received a fixed rate of 5 mL kg−1 h−1 of crystalloid solution, while in the PVi group the rate was continuously adjusted based on the PVi: PVi < 14% = 3 mL kg−1 h−1; 14% ≤ PVi ≥ 20% = 10 mL kg−1 h−1; and PVi > 20% = 15 mL kg−1 h−1. Hypotension (MAP < 65 mmHg) in the CFM was treated with a maximum of two fluid boluses (5 mL kg−1 in 10 min) and in the case of no response, dobutamine (1–3 mcg kg−1 min−1) was administered. In the PVi group, the treatment of hypotension was similar, except when the PVi > 14%, when dobutamine was started directly. Total fluid volume was significantly lower in the PVI group (0.056 ± 0.027 mL kg−1 min−1) compared to the CFM group (0.132 ± 0.115 mL kg−1 min−1), and the incidence of hypotension was lower (p = 0.023) in the PVi group (0%) compared to the CFM group (41%). The mean arterial pressure (MAP) was significantly higher in the PVi group during surgery. Dobutamine was never administered in either group. Preliminary data suggest that the PVi may be considered as a potential target to guide fluid therapy in dogs; larger studies are needed, especially in cases of cardiovascular instability. [ABSTRACT FROM AUTHOR]

Simple Summary: Pain scoring in dogs can be challenging, particularly in a busy clinical setting and when staff with diverse training and veterinary students are involved. Consequently, concerns about dogs receiving inadequate analgesia were raised at this institution. This study was performed to investigate if veterinary students, veterinary nurses, veterinary surgeons with no specific training in anaesthesia, and diplomates in veterinary anaesthesia and analgesia perform pain scoring using the short form of the canine Glasgow Composite Measure Pain Scale (CMPS-SF) in a similar manner. The results obtained indicated good to excellent pain assessment agreement between groups. Nevertheless, the overall agreement amongst all assessors was poor and the intra-group agreement was poor to moderate, suggesting significant individual differences when pain scoring dogs. Veterinary students tend to pain score higher than more experienced assessors. Several pain scoring systems have been validated to measure pain in dogs. However, pain may not be adequately assessed since these tools are associated with high-level inter-observer variation. The aim of this study is to evaluate the agreement of pain assessment using the CMPS-SF between veterinary students, veterinary nurses, veterinary surgeons, and European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates. Forty-five client-owned dogs presented to a teaching hospital were enrolled in this prospective, observational study. All dogs were pain-scored in vivo, while a video of the assessment was recorded and subsequently evaluated by twenty assessors, with five per group. Mean scores between groups were compared, and agreement within groups and agreement of the average scores between groups were assessed by calculating the intraclass correlation coefficient (ICC). The intervention point at which dogs were deemed to require additional analgesia was also evaluated. Overall agreement of pain assessment was poor (ICC = 0.494). Nurses had the best inter-observer agreement (ICC = 0.656), followed by ECVAA diplomates (ICC = 0.540), veterinary surgeons (ICC = 0.478), and veterinary students (ICC = 0.432). The best inter-group agreement was between veterinary surgeons and nurses (ICC = 0.951) and between ECVAA diplomates and nurses (ICC = 0.951). Students were more likely to determine that additional analgesia was required compared to other groups. Pain assessment is key for animal welfare, and training in this area should be reinforced to improve consistency. [ABSTRACT FROM AUTHOR]

Inhalational anaesthetic agents are routinely used in veterinary anaesthesia practices, yet their consumption contributes significantly to greenhouse gas emissions and environmental impact. We conducted a 55-day observational study at a veterinary teaching hospital in Switzerland, monitoring isoflurane and sevoflurane consumption across small, equine and farm animal clinics and analysed the resulting environmental impact. Results revealed that in total, 9.36 L of isoflurane and 1.27 L of sevoflurane were used to anaesthetise 409 animals across 1,489 h. Consumption rates varied among species, with small and farm animals ranging between 8.7 and 13 mL/h, while equine anaesthesia exhibited a higher rate, 41.2 mL/h. Corresponding to 7.36 tonnes of carbon dioxide equivalent in total environmental emissions or between 2.4 and 31.3 kg of carbon dioxide equivalent per hour. Comparison to human anaesthesia settings showed comparable consumption rates to small animals, suggesting shared environmental implications, albeit on a smaller scale. This research highlights the importance of continued evaluation of veterinary anaesthesia practices to balance patient safety with environmental stewardship; potential mitigation strategies are explored and discussed. [ABSTRACT FROM AUTHOR]

The aim was to study the pharmacokinetics of xylazine as a stable anesthetic in goats. In this study, goats were injected with xylazine at the rate of 0.3 mL·kg-1 intramusculally, and blood samples were collected at 1, 3, 5, 10, 20, 30, 45, 60, 90, 120, 180, and 240 min after administration, respectively. Xylazine was extracted by liquid-liquid extraction and separation method, and blood concentration was determined by high performance liquid chromatography (HPLC). The pharmacokinetic characteristics of xylazine in healthy goats were analyzed by pharmacokinetic software. The results showed that the chromatographic peak time of xylazine chromatography was 9-11 min. The specificity of the method was good. The linear correlation coefficient R² of the standard curve was 0.9982 when the concentration of xylazine was in the range of 10-1x1 000 ng. The pharmacokinetic model of xylazine in goats was a one-chamber model with first-order rate absorption, distribution half-life t1/2Ka was (0.49±0.041) min, elimination half-life t1/2Ke was (23.3±2.5) min, and the peak time (Tp) of the highest concentration was (2.8±0.2) min. The total drug clearance CL/F was (0.00016±0.000016) mg·kg-1·min-1 (ng·mL-1), and the minimum effective blood concentration was 56.6 ng ·mL-1, which was consistent with the clinical anesthetic effect. The results showed that xylazine had the characteristics of rapid absorption, wide distribution, short peak time, slow clearance rate, and long anesthetic time in goats, which could be used as the basic drug for the development of goat complex anesthetic preparation. [ABSTRACT FROM AUTHOR]

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

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

Historically, xylazine has been utilized in veterinary medicine for decades as an anesthetic and analgesic sedative to facilitate safe handling, diagnostic testing, and surgical procedures in large animals. Currently, xylazine is an emerging threat to human health. It has been detected in the illicit drug supply chain, often as an adulterant. It has been more commonly added to illicit substances, most notably fentanyl, by drugmakers to enhance drug effect. End users are often unaware of its presence. This is alarming given the large number of xylazine-involved overdose deaths while laboratory detections are deficient and reversal agents are absent. Herein, we present the first documented case of xylazine identified via gas chromatography–tandem mass spectrometry at University of California Davis Health despite a peculiarly mild clinical presentation. We hope to increase awareness of this potentially fatal adulterant that is often missed in evaluation and engender further opportunities to study this ongoing issue. [ABSTRACT FROM AUTHOR]

Simple Summary: Anesthetic risk in rabbits is higher than in other species such as dogs and cats and, furthermore, the treatment of their perioperative pain is sometimes inadequate. Loco-regional anesthesia is seeing increasing application in veterinary medicine, as it allows a reduction in the systemic administration of drugs. The block of the transversus abdominis plane (TAP) is an anesthetic technique of great interest for locoregional anesthesia in veterinary practice. This technique is used to desensitize the abdominal wall and consists of injecting a volume of local anesthetic into the TAP with the aim of obtaining its distribution on the branches of the thoracolumbar nerve located in the fascial plane between the internal oblique and transversus abdominis muscles. In both human and veterinary medicine, this technique is considered promising for producing analgesia for surgical procedures performed on the abdominal wall (e.g., laparoscopies, mastectomies, abdominal hernias), representing a valid alternative to epidural analgesia. Different approaches to performing ultrasound-guided TAP block have been described. The preiliac approach is one of the most used; however, it seems to be useful in managing pain in the caudal abdomen, but the cranial diffusion of the local anesthetic does not seem to be sufficient to achieve complete desensitization of the abdominal wall. Alternative approaches, involving further retrocostal and/or subcostal infiltration, have been successfully studied in dogs, cats, calves and ponies to ensure effective desensitization of the cranial abdomen and, in part, also of the thorax; but these techniques do not have yet been described in rabbits. The aim of this study was to describe one-point (preiliac approach) and two-point (preiliac and retrocostal approach) blocks of the Transversus Abdominis Plane (TAP) on a cadaveric model. For this purpose, ultrasound-guided infiltration of the plane between the internal oblique and transversus abdominis muscles was performed and, after dissection of tissues, the areas and percentage of nerve fibers involved were analyzed. Injection into the TAP plexus of a 1 mL/kg solution of 2% lidocaine and 1% methylene blue (1:1) was performed in 30 rabbit cadavers. In fifteen rabbits (group S), the solution was inoculated at the preiliac level. In the other 15 rabbits (group D), the solution was divided into two inoculations (0.5 mL/kg at the retrocostal level and 0.5 mL/kg at the preiliac level). All cadavers were then dissected and stained spinal nerve branches were measured. Moreover, the percentage of length, height and the total area of the stained tissue were calculated. In the S group, T10, T11 and T12 nerve eminences were successfully stained in 18%, 52% and 75% of cases, respectively. Furthermore, L1, L2, L3 and L4 were stained in 95%, 100%, 60% and 40% of cases, respectively. In group D, the ventromedial eminence of T10, T11 and T12 were stained in 68.1%, 100% and 98% of cases, respectively, and L1, L2, L3 and L4 were stained in 88%, 100%, 62% and 31% of cases, respectively. In conclusion, a two-point TAP block is more effective in covering the nerve eminences of the cranial abdomen than the preiliac approach alone. [ABSTRACT FROM AUTHOR]

An 11‐year‐old, 500 kg, healthy mare was admitted for tenovaginoscopy. A jugular venous catheter was inserted to administer detomidine for diagnostic imaging and for anaesthesia‐related drug administration. The horse was premedicated with intramuscular acepromazine and intravenous flunixin. For sedation, 7.5 mL of a solution, presumed to be xylazine 2%, was drawn up in a syringe and labelled with a sticker. Two minutes after injection of 7.5 mL from xylazine‐labelled syringe, the horse showed severe ataxia and fell. Nystagmus and catatonia appeared while one person sat on its neck, to prevent it from rising. After 8 minutes, the horse could not be kept down and took several uncoordinated attempts to stand, still showing nystagmus and ataxia for several minutes. The xylazine‐labelled syringes were analysed. They contained pure ketamine. This case report should raise awareness about clinical errors, a healthy error culture and use of Morbidity and Mortality Rounds to improve patient and personnel care. [ABSTRACT FROM AUTHOR]

The aim of this study was to introduce a novel intraoral technique for performing mandibular nerve blocks in dromedary camels (Camelus dromedarius). In this study, 18 adult camel skulls of varying ages and breeds were examined to determine the position of the mandibular foramen. Using a Vernier caliper, three dimensions in millimeters were measured: (1) the distance between the mandibular foramen (MF) and the caudal edge of the third molar tooth at the occlusal surface level, (2) the distance between the MF and the rostral edge border of the mandible's ramus (RER) at the occlusal surface level, and (3) the distance between the MF and the ventral margin border of the mandible (VM). The technique was evaluated using five intact camel cadaver heads (n = 5), and a total of ten mandibular nerve blocks were described. An 18-gauge 80-mm Tuohy needle was inserted into the mouth commissure and advanced caudally while injecting a saline-methylene blue solution. The accuracy of the injection was confirmed through the infiltration of the contrast dye into the target area using computed tomography (CT) and post procedural dissection. Anatomical study of the mandibular nerve site was performed to aid the blind insertion of the needle. The findings contribute to the development of veterinary anesthesia techniques and provide anatomical considerations for clinicians performing oral surgeries in sedated camels. The results demonstrated the successful implementation of the intraoral technique, highlighting its efficacy and reliability in achieving local anesthesia for oral surgeries involving the lower jaw and teeth in sedated camels. Further research studies are needed to evaluate the long-term efficacy and safety of the technique and to compare it with existing approaches. [ABSTRACT FROM AUTHOR]

The patellar tendon (PT) is crucial for maintaining stability and facilitating movement in the stifle joint. Elastography has been recognized as a prominent method for evaluating PT properties in humans and dogs. The utilization of oscillation methods in canine studies remains limited despite their extensive documentation in human studies. Our study represents the first effort to quantitatively assess and compare the effects of muscle relaxant on the biomechanical and viscoelastic characteristics of the PT at varying stifle angles in living dogs. Five healthy female beagles were used in this study. Biomechanical (tone, stiffness, and decrement) and viscoelastic (relaxation time and creep) properties of the PT were measured using MyotonPRO (Myoton Ltd, Estonia) prior to and following administration of rocuronium (0.5 mg/kg/body weight) at normal, extended, and flexed positions. Rocuronium was selected for its safety, controllability, and widespread clinical use in veterinary anesthesia. Two-way analysis of variance showed that tone, stiffness, and decrement were significantly higher (P < 0.001) in the control group than in the muscle relaxation group. At the same time, relaxation time and creep were significantly lower (P < 0.001) in the control group than in the muscle relaxation group. The findings indicate that stifle angle position and muscle rexalant administration fundamentally alter the biomechanical loading conditions of the PT, leading to changes in its viscoelastic properties. Therefore, this novel quantitative data could benefit clinical settings that necessitate accurate and objective methods for risk identification and monitoring PT biomechanics in dogs. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to characterize the level of concern among Spanish veterinarians regarding acute pain in companion animals. Additionally, it sought to determine whether this concern correlates with the utilization of optimal assessment tools. Methods: A survey was conducted to explore Spanish veterinarians' attitudes toward pain and its assessment. The survey was distributed through two most prominent small animal veterinary associations, the Spanish association for veterinary anesthesia and analgesia, as well as key industry players committed to proactive pain management. Descriptive analysis of the collected data was performed using Excel and SPSS. Results: A total of 292 veterinarians participated in the study. A high level of concern regarding pain in dogs and cats was determined where 44% of surveyed veterinarians assessed pain in all patients. Despite an awareness of validated pain scales, only 28% used them. The preferred scales were the Glasgow CMPS for dogs (94%) and the Feline Grimace Scale for cats (93%). Among respondents who do not use these validated tools, there was a considerable interest in incorporating these scales into practice (85%) and considered lack of training was the most relevant issue (32%). Other challenges to scale utilization were identified, including constraints related to time, staffing, and the need to establish a habit. Conclusions and relevance: Spanish small animal veterinarians demonstrated a strong awareness to pain in their patients and employed various methods for pain assessment. However, a limited use of validated tools was identified and likely attributed to challenges such as a lack of established routine, time constraints, insufficient personnel, and, notably, a knowledge gap among veterinarians who do not employ pain assessment scales. The most commonly used scales were the Glasgow CMPS for dogs and the FGS for cats. Overall, these results suggest a window of opportunity for the implementation of training programs in small animal pain assessment at a national level. [ABSTRACT FROM AUTHOR]

Background: Alfaxalone is commonly used in veterinary anesthesia for the induction of general anesthesia (GA) in dogs. However, it has been associated with dose-dependent cardiovascular depression. Therefore, the administration of liposoluble, intravenous (IV)-administered injectable induction agents, such as alfaxalone, is recommended to be based on the dog's lean body mass (LBM). Aim: To determine the influence of body condition score (BCS) on IV alfaxalone dose requirements to achieve endotracheal intubation in dogs. Methods: Prospective clinical study. A group of 34 dogs undergoing GA for diagnostic and/or surgical procedures, body weight (BW) > 4 kg, BCS > 2, age 1-14 years, American Society of Anesthesiologists (ASAs) classification I-III. Dogs were allocated to two different groups according to their BCS: non-overweight group (NOW) BCS: 3-5 and over-weight group (OW) BCS: 6-9. All dogs were premedicated IV with methadone 0.2 mg kg-1, and anesthesia was induced by a slow IV infusion of alfaxalone at 1 mg kg-1 minute-1, delivered with a syringe driver, until loss of jaw tone and no/minimal gagging reflex sufficient to allow endotracheal intubation was achieved. The total dose of alfaxalone and the occurrence of post-induction apnoea were recorded. The Shapiro-Wilk test was performed to test for normality. A Chi-square test was performed to compare the incidence of post-induction apnoea between groups, and the Mann-Whitney U test was performed to compare the induction dose of alfaxalone between groups. A p-value < 0.05 was considered statistically significant. Results: The mean dose ± standard deviation of alfaxalone in NOW was 2.18 ± 0.59 mg kg-1, and in OW, it was 1.63 ± 0.26 mg kg-1 (p = 0.002). The sedation score did not differ between groups. Postinduction apnoea (PIA) occurred in 6 of 17 animals in NOW and 15 of 17 in OW (p = 0.002). Conclusion: The dose of IV alfaxalone per kg of total body mass required to achieve endotracheal intubation was lower in overweight dogs, suggesting that LBM should be considered when calculating IV anesthetic doses. The incidence of post-induction apnoea was higher in overweight/obese dogs with alfaxalone administered at a rate of 1 mg kg-1 minute-1. [ABSTRACT FROM AUTHOR]

Summary: Difficulty to extubate any patient is not a problem commonly thought of during general anaesthesia. This case report describes some of the factors that lead to this predicament and the successful surgical removal of the endotracheal tube via a tracheostomy. This case report also highlights some of the deficiencies in the clinical practice of veterinary anaesthesia. Further research is required for the selection size criteria of endotracheal tubes in all species and the monitoring of cuff pressures during general anaesthesia. [ABSTRACT FROM AUTHOR]

Simple Summary: Anaesthesia plays an important role in diagnosis procedures and the treatment and pain management of oncological patients. However, studies suggest that anaesthetic drugs may increase the risk of tumour dissemination in the perioperative period by directly and indirectly suppressing the immune system, which is primarily responsible for controlling tumour growth. Science faces the challenge of understanding their influence on the immune system to develop anaesthetic strategies that assure greater immune stability in patients with cancer or other immune-compromising diseases. Throughout the course of oncological disease, the majority of patients require surgical, anaesthetic and analgesic intervention. However, during the perioperative period, anaesthetic agents and techniques, surgical tissue trauma, adjuvant drugs for local pain and inflammation and other non-pharmacological factors, such as blood transfusions, hydration, temperature and nutrition, may influence the prognosis of the disease. These factors significantly impact the oncologic patient's immune response, which is the primary barrier to tumour progress, promoting a window of vulnerability for its dissemination and recurrence. More research is required to ascertain which anaesthetics and techniques have immunoprotective and anti-tumour effects, which will contribute to developing novel anaesthetic strategies in veterinary medicine. [ABSTRACT FROM AUTHOR]

To evaluate the accuracy with which veterinary anaesthetists and nurses of different experience draw up small volumes of liquid. Prospective blinded randomized study. A group of seven European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates, six ECVAA residents and six anaesthesia nurses participated in the study. For each participant, five target volumes between 0.01 and 1.0 mL were randomly allocated. They were drawn up 20 times in random order using a 1 mL syringe attached to a 23 gauge needle. A total of 1900 measurements were analysed. An investigator filled the syringe and needle dead space with water for injection before each experiment. The change in mass of the syringe once filled to the target volume was used to calculate the actual volume of liquid drawn up. Large errors were made with measurements < 0.04 mL, so they were excluded from the statistical analysis. There was a significant effect of the target volume (p < 0.001) and of the order (p < 0.01). For each mL increase in the target volume, the absolute error decreased by 4% and from the first to the hundredth withdrawal each participant's absolute error decreased by 1%. The target volume was underestimated in 52.3% of measurements, 42% were overestimated and 5.7% were on target. None of the between-subject predictor variables approached significance. Accuracy of veterinary anaesthetists and nurses in drawing up medications decreases as the target volume becomes smaller. Small veterinary patients receive small volumes of anaesthetic drugs with higher risks of overdosing compared with larger dogs. Years of experience and staff grade are not associated with greater accuracy. Large percentage errors may be seen with target volumes less than 0.04 mL. Dilutions are recommended for volumes > 0.19 mL in 1 mL syringe. [ABSTRACT FROM AUTHOR]

Purpose: To determine the anesthetic effect and related indicators following concurrent administration of remifentanil and propofol in cerebral hemorrhage surgery patients. Methods: A total of 88 cerebral hemorrhage patients admitted in Lishui People’s District Hospital, Nanjing, China, from December 2019 to December 2020, were assigned to two groups, viz, control group which received fentanyl and propofol for anesthesia, while study group was administered remientanil combined with propofol for anesthesia There were 44 patients in each group. Hemodynamic index, brain injury marker index, stress response index, awakening condition, propofol dosage, anesthetic effect, and adverse reactions were assessed and recorded. Results: Heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) at T2 and T3 of the two groups were less than those at T1. At T3, the study group’s HR, DBP, and SBP were substantially higher than those of control group (p < 0.05); At 12 and 24 h after operation, brain injury markers and stress response indices in study group were significantly lower compared to control group (p < 0.05), while in comparison to control group (79.55 %), the degree of anesthesia in the study group was higher (95.45 %; p < 0.05). The incidence of adverse reactions in the study group (15.91 %) was lower than in control group (43.18 %; p < 0.05). Conclusion: Remifentanil, when combined with propofol anesthesia, stabilizes hemodynamics, protects against brain injury, and reduces stress reactions in patients undergoing cerebral hemorrhage surgery. The combination is also highly effective and safe. However, validation of these findings in larger clinical trials is required. [ABSTRACT FROM AUTHOR]

Simple Summary: Anaesthesia-related mortality is a critical topic in the field of medicine that should occasionally be reassessed, as it provides information on the quality of anaesthesia care and can be used as an indicator of safety. On top of this, various critical points in the peri-anaesthetic management of the patient can be determined to improve standard of care and avoid future complications. This study investigated cardiac arrest and death rates in dogs and cats during anaesthesia, in a Greek veterinary academic institution and assessed certain factors that may contribute to a higher mortality rate. It was concluded that cats have a higher risk of death than dogs with the current anaesthesia practices, and that more caution must be taken in the peri-anaesthetic management of this species. This retrospective cohort study investigated the mortality rate during anaesthesia and possible contributing factors in canine and feline population in an academic institution in Greece. Data on 1187 dogs and 250 cats which underwent general anaesthesia from 1 January 2018 to 31 December 2019 at the Veterinary Faculty of the Aristotle University of Thessaloniki were analysed regarding cardiac arrest and mortality. In dogs, the rate of cardiac arrest was 1.1% and the rate of death was 0.6%. In cats, these rates were 2.8% and 0.8%, respectively. The mortality rate in healthy/mild disease (ASA I-II) dogs was 0.1% and in cats was 0.5%. Sick (ASA III-V) dogs exhibited a death rate of 2.6%, while sick cats had a rate of 2.2%. In dogs, ASA status had a positive association with cardiac arrest and mortality, with sick dogs being 23 times more likely to suffer cardiac arrest and 24.5 times more likely to die than healthy/mild disease ones. Other factors associated with cardiac arrest and mortality were the anaesthetic protocol and the use of inotropes. In cats, premedication and inotropic support were related to cardiac arrest and death. Feline anaesthesia involves higher risk, and requires greater vigilance in peri-anaesthetic management than dogs. [ABSTRACT FROM AUTHOR]

To investigate risk, risk factors and effects on adherence to adequate clinical standards, of burnout and depression in veterinary anaesthesia residents. Closed online cross-sectional survey study. A sample of 89 residents registered to the European and/or the American Colleges of Veterinary An (ae)sthesia and Analgesia out of a total of 185. A link to access an online questionnaire, which included the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the Harvard National Depression Screening Day Scale (HANDS) and 28 questions developed to assess adherence to adequate clinical standards, was sent by email to 185 residents. The three components of the MBI-HSS namely emotional exhaustion (EE), depersonalization and reduced personal accomplishment were analysed separately. Analysis of proportions and two-step regression statistical modelling were used for data analysis, and p values < 0.05 were considered statistically significant. The response rate was 48%. Based on HANDS and MBI-HSS scores, 49% of the residents were at high risk of both depression and burnout. These residents expressed greater concern of delivering inadequate animal care (p < 0.001), of decreased quality of supervision during COVID-19 (p = 0.038) and of negative impact of the pandemic on their training programme (p = 0.002) than residents at low-to-moderate risk. Working in a clinical environment for ≥ 60 hours/week was a risk factor for both depression (p = 0.016) and EE (p = 0.022), while female sex was a risk factor for EE only (p = 0.018). A large proportion of residents is at high risk of depression and burnout, a scenario likely worsened by the pandemic. The findings of this study suggest that reducing the clinical workload and increasing the level of support and supervision may help to improve residents' mental health. [ABSTRACT FROM AUTHOR]

To evaluate the sleep quality, prevalence of fatigue and depressive symptoms in veterinary anaesthesia personnel. Anonymous online voluntary survey. Sleep quality, fatigue, depressive symptoms and self-perceived burnout were scored using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Patient Health Questionnaire-9 (PHQ-9) and single-item burnout measure, respectively. Demographic data and questions about work-related fatigue, out-of-hours duty, transport and rest periods were included. PSQI, FSS and PHQ-9 scores were compared using Spearman rank correlation tests. Responses from 393 participants were obtained from an estimated population of 1374 including diplomates of the American and European Colleges of Veterinary An(a)esthesia and Analgesia (43.9%), residency-trained veterinarians (15.6%), residents-in-training (13.8%) and veterinary technicians and nurses (12.0%), from 32 countries. Most were employed in clinical university teaching hospitals (54.2%) or clinical private practice (41.5%). PSQI scores > 5 were reported by 71.2% of respondents, with 52.4% reporting insufficient sleep to meet their job demands. Many showed high or borderline fatigue (56.4%), and 74.7% reported mistakes due to work-related fatigue. Major depressive symptoms (PHQ-9 score ≥ 10) were found in 42.7%, with 19.2% reporting they had thought about suicide or self-harm in the previous 2 weeks. Over half (54.8%) met the criteria for burnout and more veterinary nurses and technicians suffered from burnout than other roles, with 79.6% of this group affected (p < 0.001). Scores for PSQI and FSS [ r (388) = 0.40, p < 0.001]; PSQI and PHQ-9 [ r (389) = 0.23, p < 0.001]; and FSS and PHQ-9 [ r (387) = 0.24, p < 0.001] were all positively correlated. This survey demonstrates a high prevalence of poor sleep, fatigue, depressive symptoms and burnout in veterinary anaesthesia personnel, and more should be done to improve the health of those in the profession. [ABSTRACT FROM AUTHOR]

The case report by Aßmann et al. ([1]) in this issue reported the surgical management of an accessory carpal bone fracture, repaired under standing sedation. As the authors mention, recovery from general anaesthesia can be particularly challenging for a patient undergoing fracture repair surgery, and it has been shown that these patients are at an increased risk of recovery-related fatalities when compared to other surgical groups (Johnston et al., [18], [17]; Laurenza et al., [19]; Mee et al., [25]). As expected, the incidence of standing sedation-related fatalities seems lower than that of general anaesthesia, supporting the fact that standing sedation removes the risk of mortality imposed by recovery from general anaesthesia. [Extracted from the article]

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

In China, dezocine is commonly employed as a partial agonist of mu/kappa opioid receptors during anesthesia induction for surgical patients, yet evidence supporting its causal association with emergence delirium is limited. The objective of this investigation was to evaluate the impact of intravenous dezocine administered during anesthesia induction on emergence delirium. The retrospective studied existing data containing medical records of patients undergoing an elective laparoscopy procedure and the study was conducted with ethics-board approval. The primary outcome was the incidence of emergence delirium. Secondary outcomes included the VAS in the PACU and 24 h after surgery, the RASS score in the PACU, postoperative MMSE, hospital stay, and ICU stay. A total of 681 patients were analyzed, after being propensity score-matched, the dezocine and non-dezocine group each had 245 patients. Emergence delirium occurred in 26/245 (10.6%) of patients who received dezocine and 41/245 (16.7%) of patients did not receive dezocine. Patients on whom dezocine was used were associated with a significantly lower incidence of emergence delirium (absolute risk difference, −6.1%, 95% CI, −12% to −0.2%; relative risk [RR], 0.63; 95% CI, 0.18–0.74). All secondary outcome measures and adverse outcomes were not significantly different. The use of dezocine during anesthesia induction was associated with a decreased incidence of emergence delirium after elective laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

To report anesthetic-related complications and determine risks associated with anesthesia in draft horses. Retrospective study. A total of 401 anesthetic records for draft horse breeds that underwent general anesthesia from January 2010 through December 2020 were reviewed; horses euthanized during general anesthesia were excluded. Demographics, perioperative drugs used, procedure type and duration, time to extubation, number of attempts to stand, use of sling in recovery and perioperative morbidity and mortality were investigated. Morbidity and mortality statistical evaluation included univariable logistic regression analysis and ordinal regression analysis. American Society of Anesthesiologists (ASA) status I–II, ASA III–V and total mortality rate for all cases was 0.69% (2/288), 6.19% (7/113) and 2.24% (9/401), respectively, with Belgian horses being overrepresented (6/9). Cardiac arrest occurred in six out of nine horses that died without euthanasia, and five out of six of these horses underwent colic surgery. Factors associated with increased mortality risk included ASA status of III–V, increased body weight, emergency status and horses presenting for colic. Hypotension, hypercarbia and hypoxemia occurred in 56% (224/401), 46% (186/401) and 14% (58/401) of horses, respectively. During recovery from anesthesia, lighter horses and horses undergoing shorter anesthetic procedures were more likely to be successful on the first or second attempt to stand and were less likely to require a sling in recovery. Draft horses undergoing general anesthesia had a higher mortality rate than previously reported for all types and breeds of horses. [ABSTRACT FROM AUTHOR]

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To explore the satisfaction and well-being experienced by anaesthesia residents during their training, and to investigate factors that may have influenced their experiences. Cross-sectional online anonymous voluntary survey. A total of 150 (of approximately 600 canvassed) former veterinary anaesthesia residents. Participants were invited to complete an internet-based survey regarding the satisfaction and well-being experienced during their residency. Multiple choice, categorical, dichotomous, Likert-type rating scales and slider questions were used to investigate five domains (demographic, working conditions, educational environment, training satisfaction, well-being). Sampling adequacy, questionnaire reliability and participant responses were investigated by Kaiser-Meyer-Olkin (KMO) indices, Cronbach's α and standard statistical techniques, respectively (p < 0.05). The questionnaire demonstrated good sampling adequacy (median KMO index 0.74; range 0.51–0.89) and high item 'reliability' (α = 0.82–0.94). Of the 150 responders, (25% participation rate) 62% were satisfied, 14% were neutral and 24% were dissatisfied with their residency training; 60.6% would do the residency again, 39.3% would not or were unsure. Sex and age did not correlate with training satisfaction (p > 0.05). Salary/stipend was considered inadequate by 70% of responders; 66% received no on-call supplement. Greater supervisory input, a good working environment and extra income when on-call were positively correlated with training satisfaction (p < 0.01). The majority (94.6%) of trainees suffered from at least one medical condition during their residency, with fatigue, sleep disturbance or anxiety reported by > 62%. Although a quarter of responders were dissatisfied with their residency, several modifiable factors were identified, particularly with respect to supervisors' input, working environment and pay, which could inform improvements for future residency programmes. Most trainees experienced negative health impacts; however, this parallels the general situation in both the medical and veterinary professions, which requires greater attention from the supervisors, trainees and colleges. [ABSTRACT FROM AUTHOR]

Descriptions of measures taken to optimize animal welfare are often absent from scientific reports of animal experiments. One reason may be that journal guidelines inadequately compel authors to provide such information. In this study, online English language versions of the 'Guidelines to authors' (GTAs) from 54 national biomedical journals were examined for neutral (unrelated to welfare) and non-neutral keywords referring to: animal welfare; the '3Rs'; the ARRIVE (2010) guidelines, and regulations pertaining to animal experimentation. Journals were selected from nine countries (UK, US, China, Canada, India, Brazil, Germany, Japan and Australia) and seven biomedical specialties (oncology, rheumatology, surgery, pharmacology, medicine, anaesthesia and veterinary medicine). Total GTA word counts varied from 1137 to 31,609. The keyword count identified per category were expressed per myriad (10,000) of total word count. One-way analyses of variance followed by post hoc Tukey pairwise comparisons revealed greater non-neutral per myriad word counts for (a) veterinary GTAs compared with medicine, oncology, rheumatology or surgery; (b) British, compared with Australian, Canadian, German and Japanese GTAs; and (c) no differences between non-neutral categories. The English language versions of GTAs of British and veterinary medical journals contain more words associated with animal welfare, the 3Rs and the ARRIVE guidelines than those from eight other countries and six other medical specialities. The exclusion of 'national' language versions from analysis precludes attempts to identify national differences in attitudes to laboratory animal welfare. [ABSTRACT FROM AUTHOR]

Background: Squeezing the reservoir bag on the anaesthetic breathing system to inflate the lungs (colloquially known as bagging) is a technique commonly used during general anaesthesia in veterinary practice. Despite being straightforward to perform, the physiological implications are important to understand. Furthermore, catastrophic consequences can occur and staff must be vigilant and trained correctly when using this technique to manage ventilation during anaesthesia. Aim of the article: This article provides an overview of the indications and contraindications of manual bagging, and reviews relevant literature from human medicine. [ABSTRACT FROM AUTHOR]

Abstract Background Many veterinarians consider English Bulldogs to have a greater perianesthetic mortality risk. The aims of this study were to 1) determine total and anesthesia-related, perianesthetic mortality (PAM) rates in English Bulldogs (EB), 2) identify potential risk factors associated with mortality in EB, and 3) determine the difference in the perianesthetic mortality rates between EB, other-brachycephalic breeds (OB), and non-brachycephalic breeds (NB). Records from EB that were anesthetized between 2010 and 2017, were investigated. OB and NB were enrolled to match with each EB based on a procedure and age from the study period. Data collected in EB included: age, ASA status, weight, procedure types, anesthetic and analgesic management, anesthetic duration, anesthetic recovery location, and cause of death. Age and cause of death were determined from OB and NB. Fisher’s exact test was used to compare PAM rate and age in EB, OB, and NB. Mann–Whitney U test was used to compare EB survivor and EB non-survivor. Logistic regression models were used to identify factors and odds ratio (OR) associated with PAM in EB. Result Two hundred twenty nine EB, 218 OB, and 229 NB were identified. The total and anesthesia-related PAM rates in EB were 6.6 and 3.9%, respectively. EB had a greater total PAM rate compared with OB (p = 0.007). ASA status was different between survivors and non-survivors in EB (p

The European Veterinary Emergency and Critical Care Society (EVECCS) and the European College of Veterinary Emergency and Critical Care (ECVECC) announce the passing of Fabio Viganó, a highly respected member and leader in the field of veterinary emergency and critical care. Fabio, who battled illness for over six years, was known for his positive attitude and dedication to his work. He was a founding member and president of several veterinary societies in Italy, and his expertise and passion for education made him a key figure in the European veterinary community. Fabio's colleagues remember him as a mentor and a friend, and he will be greatly missed. He is survived by his wife and children. [Extracted from the article]