Partial endotracheal tube obstruction by a blood clot in 2 dogs

Case 1: A seven-year-old lurcher presented after an episode of severe respiratory distress and collapse, which had been treated by the referring veterinary surgeon with a tracheostomy tube placement. Laryngeal paralysis was diagnosed, and the dog was scheduled to undergo left-sided laryngoplasty. During anaesthesia, the dog developed marked hypercapnia and respiratory acidosis during spontaneous ventilation. Initiation of manual ventilation and endotracheal suctioning did not improve the ventilation. On extubation, a blood clot was discovered, occluding approximately two-third of the endotracheal tube (ETT) lumen. Case 2: A two-month-old Jack Russell terrier was presented for ligation of a patent ductus arteriosus. Intraoperatively, the dog developed sudden severe hypercapnia and hypoxaemia. Manual ventilation was initiated, and two attempts of recruiting the lung were made, which initially improved the ventilation. Postoperatively, before extubation, a second episode of severe hypercapnia and resistance to ventilation was noted. On extubation, a blood clot occluding 60 per cent of the ETT lumen was detected

Tips for presenting and lecturing

This article, the last in a series aimed at providing tips and tools to enhance teaching and learning for veterinary staff and students, considers how to give lectures and presentations in an effective manner, enhancing your audience's engagement and understanding

For horses undergoing general anaesthesia, are rope recoveries or free recoveries better?

PICO question: In horses undergoing general anaesthesia, does assistance with ropes result in better recoveries when compared to no assistance (‘free’ recovery)? Clinical bottom line: Category of research question: Treatment The number and type of study designs reviewed: One randomised, non-blinded controlled trial and two retrospective cohort studies Strength of evidence: Weak Outcomes reported: The three studies reviewed arrive at different conclusions regarding the utility of rope assistance in recovery from general anaesthesia in horses, but examine very different populations. The randomised controlled trial provides weak evidence that rope assistance can shorten recovery and improve recovery quality in healthy (American Society of Anesthesiologists (ASA) I–II) horses. One retrospective cohort study provides weak evidence that rope assistance confers a reduction in fatality in both healthy and sick horses. The other retrospective cohort study provides weak evidence that rope assistance confers no benefit to horses undergoing emergency colic surgery. Both assisted and unassisted groups in each study had fatalities and all studies reported complications related to the rope recovery system Conclusion: Insufficient evidence is available to permit a full recommendation regarding rope assistance during recovery from general anaesthesia in horses. Rope assistance may improve recovery time and quality in some horses. The decision to perform a rope-assisted recovery must be made considering individual patient, team and clinic factors. Rope assistance cannot prevent fatalities in recovery How to apply this evidence in practice: The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care

How do we learn?

Catriona Bell – ORCID: 0000-0001-8501-1697 https://orcid.org/0000-0001-8501-1697Item not available in this repository.Item previously deposited in University of Bristol repository at: https://research-information.bris.ac.uk/en/publications/6a792657-431c-442b-b834-d90e07944877Almost all veterinary surgeons teach, yet very little training is provided to vets on how to teach effectively. This article forms the first in a series aimed at providing veterinary staff and students with tips and tools to enhance the teaching opportunities that arise in practice.https://doi.org/10.1136/inp.g160836pubpub

Retrospective computed tomography analysis of endotracheal tube constriction & mispositioning in cats & dogs

Objectives: To discover the prevalence of endotracheal tube (ETT) constriction and rostral and caudal mispositioning in anaesthetised cats and dogs, and to identify associated risk factors. Study Design: Retrospective analysis. Animal population: A total of 146 cats, 670 dogs. Methods: Computed tomography images of the head/neck/thorax from orotracheally intubated cats and dogs were visually assessed for constriction or mispositioning of the ETT. If constriction was present, measurements of the cross-sectional area (CSA) of the ETT lumen at constricted and un-constricted locations were compared. Location and cause of constriction were noted and the expected increase in resistance to gas flow was calculated. Animal information was collected from clinical records. Normality of continuous variables was assessed via the Shapiro-Wilk test. Chi square tests examined associations between variables. Kendall’s tau-b test was performed between measured ETT size and degree of constriction. Results: The ETT extended rostrally beyond incisors in 52% of cases; the connector was within the oral cavity in 19% of cases. The ETT extended beyond the first rib in 25.5% of cases. The prevalence of ETT constriction was 22.7%. Median reduction in CSA was 7.68% (0.14–64.19%). Median increase in resistance assuming laminar and turbulent flow was 16.5% (0.3–680%) and 21% (0.3–1200%), respectively. The most common cause of constriction was the presence of a radiotherapy mouth gag. Significant associations existed between presence of constriction and rostral mispositioning, and caudal mispositioning and extreme brachycephaly. Increased severity of constriction was more likely in smaller ETT. Conclusions: And clinical relevance Constriction and mispositioning of ETT occurred very commonly in this population. Checking the ETT within the oral cavity for constriction and mispositioning is recommended. Radiotherapy mouth gags increase the risk of ETT compression. Smaller ETT are at greater risk of severe constriction. Brachycephalic dogs are at particular risk of caudal mispositioning

Suspected severe post-anaesthetic myopathy or myelopathy in a Clydesdale horse resulting in euthanasia

This case report describes suspected myopathy or myelopathy in a 5-year-old Clydesdale gelding following general anaesthesia for sarcoid removal. The lowest mean arterial pressure was 67 mm Hg. Hyperlactataemia and tachycardia were observed during anaesthesia prompting abortion of surgery. The horse was unable to stand with assistance from a specialised sling. Azotaemia and hyperkalaemia developed in recovery and worsened despite therapeutic interventions. Euthanasia was performed given the grave prognosis. Post-mortem examination was not carried out but could have provided a definitive diagnosis. Specific factors have been identified in the prevention of post-anaesthetic myopathy, including maintenance of adequate tissue perfusion and oxygenation and careful positioning. Potential improvements in the anaesthetic management of this case in relation to these factors are discussed

A comparison of two ketamine doses for field anaesthesia in horses undergoing castration

Background: Ketamine at 2.2 mg/kg given i.v. is often used to induce anaesthesia for surgical procedures in horses under field conditions. Commonly, additional doses are needed to complete the surgery. We hypothesised that surgical conditions would be improved when 5 mg/kg of ketamine was used to induce anaesthesia, while induction and recovery qualities would not differ from those when 2.2 mg/kg ketamine was used. Objective: To compare the anaesthetic effects of two ketamine doses (5 and 2.2 mg/kg) during field anaesthesia for castration of horses. Study design: Prospective, randomised, blinded, clinical study. Method: Seventy-seven client-owned Icelandic horses presented for castration under field conditions were studied. Pre-anaesthetic medication was xylazine (0.7 mg/kg) butorphanol (25 μg/kg) and acepromazine (50 μg/kg) injected i.v. Anaesthesia was induced with either 2.2 mg/kg (K2.2) or 5 mg/kg (K5) i.v. of ketamine mixed with diazepam (30 μg/kg). The quality of induction, surgical conditions and recovery were compared using subjective and objective measures, and the number of additional ketamine doses recorded. Results: Ketamine 5 mg/kg provided better surgical conditions and a more rapid induction. Recovery quality was subjectively better in K2.2. Five horses in K2.2 and two in K5 required additional ketamine doses. Main limitations: While the pre-anaesthetic sedation and benzodiazepine doses were consistent among horses, the level of sedation and muscle relaxation achieved differed. Conclusion: A ketamine dose of 5 mg/kg can be used to improve the quality of field anaesthesia for castration in Icelandic horses. Although recovery quality is subjectively better when using 2.2 mg/kg, no adverse events were observed during recovery with either dos

Manual of Clinical Procedures in Dogs, Cats, Rabbits and Rodents, 3rd edn

Steven E. Crow, Sally O. Walshaw, and Jennifer E. Boyle, 408 pages, softback, £29.99. Wiley-Blackwell. 2009. ISBN 978 0 81381304 2

Manual of Clinical Procedures in Dogs, Cats, Rabbits and Rodents, 3rd edn

Steven E. Crow, Sally O. Walshaw, and Jennifer E. Boyle, 408 pages, softback, £29.99. Wiley-Blackwell. 2009. ISBN 978 0 81381304 2

Delayed dyspnoea in pigs possibly associated with endotracheal intubation

No abstract available