The effect of prophylactic treatment with levetiracetam on the incidence of post-attenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts

Objectives: To report (1) the incidence of post-attenuation seizures (PAS) in dogs that underwent single congenital extrahepatic portosystemic shunt (cEHPSS) attenuation and (2) to compare incidence of PAS in dogs that either did or did not receive prophylactic treatment with levetiracetam (LEV).Study Design: Multi-institutional retrospective study.Sample Population: Nine-hundred-and-forty dogs.Methods: Medical records were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 2005 through July 2017 and developed PAS within seven days postoperatively. Dogs were divided into three groups: no LEV (LEV-); LEV at >15mg/kg TID for >24 hours or a 60mg/kg intravenous loading dose preoperatively, followed by >15mg/kg TID postoperatively (LEV1); ); and LEV at less than 15mg/kg TID, for less than 24 hours preoperatively, or continued at less than 15mg/kg TID postoperatively (LEV2).Results: Nine-hundred-and-forty dogs were included. Seventy-five (8.0%) developed PAS. Incidence of PAS was 35/523 (6.7%), 21/188 (11.2%) and 19/228 (8.3%) in groups LEV-, LEV1 and LEV2, respectively. This difference was not statistically significant (p=0.14). No significant differences between groups of dogs that seized with respect to variables investigated were identified.Conclusions: The overall incidence of PAS was low (8%). Prophylactic treatment with LEV according to the protocols investigated in our study was not associated with a reduced incidence of PAS.Clinical Significance: Prophylactic treatment with LEV does not afford protection against development of PAS. Surgically treated dogs should continue to be monitored closely during the first seven days postoperatively for seizures

Prognostic factors for short‐term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005‐2018)

© 2020 The American College of Veterinary Surgeons Objective: To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS). Study design: Multi-institutional retrospective study. Sample population: Ninety-three client-owned dogs. Methods: Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS. Results: Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P =.004) and development of focal PAS only (P =.0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures. Conclusion: Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival. Clinical significance: The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons

Effectiveness of chlorhexidine diacetate and povidone‐iodine in antiseptic preparation of the canine external ear canal prior to total ear canal ablation with bulla osteotomy procedure: A preliminary study

Abstract Objective This article is a preliminary study to compare the ability of 0.05% chlorhexidine diacetate (CD) and 1% povidone‐iodine (PI) solutions to reduce bacterial contamination on the canine external ear canal during initial patient preparation and comparison of the incidence of immediate tissue reactions. Study design The study is a multi‐institutional, randomised, clinical prospective study. Animals or sample population Dogs (n = 19) undergoing total ear canal ablation with bulla osteotomy (TECABO). Methods The external ear of each dog was cleaned with the assigned antiseptic solution. Culture of the ear was performed by standard techniques to semi‐quantitatively evaluate bacterial growth and to identify bacterial organisms pre‐ and post‐antiseptic use. Results Both antiseptic groups showed a significant reduction in bacterial growth score (BGS) between pre‐ and post‐antiseptic use (CD p = 0.009, PI p = 0.005). There was no difference in the reduction of BGS between CD and PI solutions (p = 0.53). Minor adverse skin reactions occurred in 25% of cases. There was no significant difference in the occurrence of adverse skin reactions between antiseptics (p = 0.63). Conclusion CD and PI were similarly able to decrease the number of bacteria on the external ear following initial preparation. No difference in the incidence of adverse tissue reactions was found. Clinical significance Properly diluted aqueous formulations of either antiseptic may be used for safe preparation limited to the external ear canal of dogs. Additional studies evaluating outcomes such as duration of bacterial inhibition and incidence of surgical site infections are needed to fully elucidate differences between CD and PI antiseptics prior to TECABO

Comparison of remote and in‐person respiratory function grading of brachycephalic dogs

Publication status: PublishedAbstractObjectiveTo compare the reliability of respiratory function grading (RFG) scores assigned in‐person and remotely via video and electronic stethoscope recordings, evaluated by novice and expert graders.Study designProspective study.Sample populationFifty‐seven brachycephalic dogs.MethodsDogs were evaluated in person by expert graders and RFG scores were assigned. Audio and video recordings were made during the in‐person evaluations. Four expert and four novice graders evaluated the recordings and assigned an RFG score to each dog. Agreement between in‐person and remote RFG scores was assessed using Cohen's kappa statistic. Interobserver reliability was assessed using Fleiss’ kappa statistic.ResultsThe median RFG score from the in‐person assessment was 1 (range, 0–3). Distribution of RFG scores included 12 grade 0 scores, 19 grade 1 scores, 25 grade 2 scores, and 1 grade 3 score.The raw percentage agreements between remote and in‐person scores were 68.4%, 59.6%, 64.9%, and 61.4% for the four experts, and 52.6%, 64.9%, 50.9%, and 42.1% for the four novices. Reliability between remote and in‐person RFG scores was poor to moderate both for the experts (Cohen's kappa: .48, .37, .46, .41) and novices (Cohen's kappa: .28, .47, .28, .21). Interobserver reliability was moderate among the experts (Fleiss’ kappa: .59) and poor among the novices (Fleiss’ kappa: .39).ConclusionRemote RFG scores had poor to moderate interassessment and interobserver reliability. Novice evaluators performed worse than experts for remote or in‐person RFG evaluations.Clinical significanceRemote RFG, as measured in this study, is not reliable for assigning RFG scores. Modifications could be made to remote evaluation to improve reliability. Based upon the performance of novice evaluators, training of evaluators is justified.</jats:sec

Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts

Abstract Objective To report the incidence of postattenuation seizures (PAS) in dogs that underwent single congenital extrahepatic portosystemic shunt (cEHPSS) attenuation and to compare incidence of PAS in dogs that either did or did not receive prophylactic treatment with levetiracetam (LEV). Study design Multi‐institutional retrospective study. Population Nine hundred forty dogs. Methods Medical records were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 2005 through July 2017 and developed PAS within 7 days postoperatively. Dogs were divided into 3 groups: no LEV (LEV−); LEV at ≥15 mg/kg every 8 hours for ≥24 hours preoperatively or a 60 mg/kg intravenous loading dose perioperatively, followed by ≥15 mg/kg every 8 hours postoperatively (LEV1); and LEV at <15 mg/kg every 8 hours, for <24 hours preoperatively, or continued at <15 mg/kg every 8 hours postoperatively (LEV2). Results Seventy‐five (8.0%) dogs developed PAS. Incidence of PAS was 35 of 523 (6.7%), 21 of 188 (11.2%), and 19 of 228 (8.3%) in groups LEV‐, LEV1, and LEV2, respectively. This difference was not statistically significant (P = .14). No differences between groups of dogs that seized with respect to investigated variables were identified. Conclusion The overall incidence of PAS was low (8%). Prophylactic treatment with LEV according to the protocols that were investigated in our study was not associated with a reduced incidence of PAS. Clinical significance Prophylactic treatment with LEV does not afford protection against development of PAS. Surgically treated dogs should continue to be monitored closely during the first 7 days postoperatively for seizures