Repeated bolus injections of bupivacaine for continuous bilateral transversus thoracis plane block undergoing median sternotomy in a dog: A case report.

An 8-year-old, 6.5 kg, neutered female Shih-Tzu dog was presented for surgical resection of a mediastinal mass. A median sternotomy and left cranial lung lobectomy were performed. Intraoperatively, with the patient under general anaesthesia, a bilateral transversus thoracis plane (TTP) block was performed by injecting 0.5% bupivacaine (0.2 ml/kg) per side using real-time ultrasound guidance. After surgery, indwelling catheters for repeated bolus injections of bupivacaine in TTP were placed as follows: the fifth sternebra was palpated in dorsal recumbency, and the transducer was placed in the longitudinal plane lateral to the sternal border. A 16 gauge over-the-needle catheter was inserted caudo-cranially using an in-plane technique and located in the TTP. An intermittent bolus of bupivacaine (0.1 ml/kg) per side was injected via the indwelling catheter every 8 h for 3 days, with a constant rate infusion of an intravenous fentanyl (1 µg/kg/h) and ketamine (0.12 mg/kg/h) combination. Post-operative pain was evaluated using the Glasgow composite measure pain scale and the score was 4-5/24 on the day of surgery and gradually decreased over time. Additional rescue analgesia was not required. Repeated boluses of bupivacaine for a continuous bilateral TTP block may be a useful adjuvant for perioperative pain management strategies, including median sternotomy, in dogs.

CT and radiographic evaluation of bronchial collapsibility at forced expiration in asymptomatic brachycephalic dogs.

Bronchial collapse due to bronchomalacia is an important cause of chronic coughing in dogs. Radiographic and CT evidence of bronchial collapse has previously been reported in healthy Beagle dogs under forced expiration. However, published studies in brachycephalic dog breeds that are prone to bronchial collapse are currently lacking. In the present prospective analytical experimental study, CT and radiography were used to measure the bronchial diameter and collapsibility of each pulmonary bronchus during end-expiratory, 5 mL/kg forced-expiratory, and 10 mL/kg forced-expiratory phases in 17 asymptomatic brachycephalic dogs and six healthy Beagle dogs. Bronchial collapsibility was significantly greater during forced expiration, than that at the end of expiration in both groups (P < .001). Bronchial collapsibility measurements of the left lung lobes and the right cranial, middle, and accessory lobes were significantly higher in asymptomatic brachycephalic dogs than those in healthy Beagle dogs, during all expiratory phases (P < .05). The higher bronchial collapsibility of brachycephalic dogs was also supported using CT multiplanar reconstruction images and radiography. In conclusion, radiographic and CT measures of bronchial collapsibility in asymptomatic brachycephalic dogs are higher than measures in healthy Beagle dogs. Therefore, measures of bronchial collapse in brachycephalic dogs should not be evaluated using the same baseline measures as those used for healthy Beagle dogs.

Evaluation of the radiographic liver length/11th thoracic vertebral length ratio as a method for quantifying liver size in cats.

Abdominal radiography is a standard diagnostic test for cats with suspected liver disease, however, absolute measurements of radiographic liver size can be affected by other factors such as positioning, radiographic technique, and obesity. This prospective and retrospective, analytical, cross-sectional study evaluated the liver length/11th thoracic vertebral length (LL/T11) ratio as a method for minimizing these outside effects. In a prospectively recruited sample of 25 clinically healthy cats, measurements of radiographic LL/T11 ratio were compared with CT measurements of liver volume. Effects of radiographic technical factors (body posture, recumbency state, and beam center to LL/T11 ratio) and observer were also tested. In a retrospectively recruited sample of 324 cats with no evidence of liver disease, radiographic measurements of the LL/T11 ratio were performed using right lateral radiographs and compared among signalment groups (age, sex, body weight, and body condition score). There was a strong significant correlation between the LL/T11 ratio and CT liver volume (P < .001), and this ratio was not affected by radiographic technical factors. The reference value of the LL/T11 ratio was 4.22 ± 0.54 and the LL/T11 ratio did not differ among signalment groups. Findings supported the use of the LL/T11 ratio as a novel quantitative index of radiographic liver size in cats. Future studies in clinically affected cats are needed to further validate this method.

Three-dimensional volumetric magnetic resonance imaging (MRI) analysis of the soft palate and nasopharynx in brachycephalic and non-brachycephalic dog breeds.

The purpose of this study was to use magnetic resonance imaging (MRI) to compare the volumes and three-dimensional configurations of the soft palate and nasopharynx in non-brachycephalic and brachycephalic dogs with different body weights, and infer which factors influence nasopharyngeal volume. This was a retrospective observational study. The brain MRI medical records of all dogs referred to the Veterinary Medical Center, Chungbuk National University, between 2013 and 2016, for evaluation of intracranial disease were reviewed. There was a significant difference in the two-dimensional parameters including soft palate length/skull length ratio (P<0.01) and maximum soft palate thickness (P<0.01), and three-dimensional parameters which included soft palate volume (P<0.01), nasopharyngeal volume (P<0.01), soft palate/total upper airway volume ratio (P<0.01), and nasopharyngeal volume/total upper airway volume ratio (P<0.01), between brachycephalic and non-brachycephalic dog breeds. Nasopharyngeal volume correlated positively with the maximum soft palate thickness and body weight in all breeds. The three-dimensional morphologic grades of soft palate were significantly different between the two groups. In brachycephalic breeds, Grade 3 was observed in 33% of cases but was absent in non-brachycephalic breeds, where Grade 1 was present in 85% of the cases. We can conclude that three-dimensional morphology and upper airway volume are significantly different between brachycephalic and non-brachycephalic breeds, and body weight and maximum soft palate thickness are the key factors associated with a decreased nasopharyngeal volume.

Computed tomographic and radiographic bronchial collapse may be a normal characteristic of forced expiration in dogs.

Tracheobronchomalacia has been diagnosed using radiography or bronchoscopy to confirm bronchial changes in luminal diameter during the respiratory cycle. However, studies in healthy humans suggest that some degree of bronchial collapse may be observed during the normal respiratory cycle. In this analytical study, the luminal diameter of the bronchus to each of the six pulmonary lobes and the mean percentage of expiratory collapse from end inspiratory, end expiratory, and two forced expiratory phases (10 and 15 ml/kg) were determined via computed tomography (CT) and radiography in 22 healthy Beagle dogs. The bronchial collapsibility was significantly greater during the forced expiration than the end expiration (P < 0.001); the same results were observed in dorsal and sagittal CT images and radiographs (P < 0.001). Median collapsibility values associated with 15 ml/kg forced expiratory collapse determined via cross-sectional CT images were measured as 16.6-45.5% and differed according to the pulmonary lobe. Median collapsibilities on radiography with 15 ml/kg forced expiration were 57.8% and 62.1% in the right cranial lobe and right caudal lobe, respectively. In conclusion, bronchial diameter may change during the respiratory cycle, and some degree of reduction in bronchial diameter may be an incidental finding in healthy dogs. More rigorous criteria are needed with regards to bronchial collapsibility during normal respiration for the diagnosis of bronchomalacia in order to avoid false-positive diagnoses.