Acupuncture for the Treatment of Animal Pain.

Acupuncture is recognized to induce multifactorial changes in the neuroregulatory aspects of pain physiology. Many aspects overlap with known receptor interactions of commonly used analgesic drugs, and acupuncture can increase the efficacy or replace the use of these pharmacologic pain treatments. This article discusses the currently recognized components of the pain pathways that are modified by acupuncture. It introduces the role of fibroblasts and fascia in mechanotransduction and discusses the ways in which this provides a link between the acupuncture needle and the nervous system and is a conduit for extracellular fluid movement, lymphatics, and the immune system.

Validation of the English version of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats.

BACKGROUND: A scale validated in one language is not automatically valid in another language or culture. The purpose of this study was to validate the English version of the UNESP-Botucatu multidimensional composite pain scale (MCPS) to assess postoperative pain in cats. The English version was developed using translation, back-translation, and review by individuals with expertise in feline pain management. In sequence, validity and reliability tests were performed. RESULTS: Of the three domains identified by factor analysis, the internal consistency was excellent for 'pain expression' and 'psychomotor change' (0.86 and 0.87) but not for 'physiological variables' (0.28). Relevant changes in pain scores at clinically distinct time points (e.g., post-surgery, post-analgesic therapy), confirmed the construct validity and responsiveness (Wilcoxon test, p < 0.001). Favorable correlation with the IVAS scores (p < 0.001) and moderate to very good agreement between blinded observers and 'gold standard' evaluations, supported criterion validity. The cut-off point for rescue analgesia was > 7 (range 0-30 points) with 96.5% sensitivity and 99.5% specificity. CONCLUSIONS: The English version of the UNESP-Botucatu-MCPS is a valid, reliable and responsive instrument for assessing acute pain in cats undergoing ovariohysterectomy, when used by anesthesiologists or anesthesia technicians. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy.

Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction.

OBJECTIVE: To describe the technique for performing a coccygeal epidural injection of local anesthetic to facilitate catheterization in male cats with urethral obstructions using low-dose sedation. SIGNIFICANCE: Prompt diagnosis and relief of urethral obstructions is important as many cats may have developed marked metabolic abnormalities at the time of presentation. General anesthesia in these patients may be associated with significant risk for complications. Pain management is also an essential treatment goal, and this technique relieves urethral and penile pain during the unblocking process. CONCLUSION: Coccygeal epidurals can be used safely to provide analgesia to the penis and urethra and to the authors' knowledge, is a novel treatment modality to aid in the relief of urethral obstructions in male cats.

A multimodal approach to management of suspected neuropathic pain in a prairie falcon (Falco mexicanus).

An adult male prairie falcon (Falco mexicanus) was presented for evaluation and treatment of self-inflicted wounds along the right proximal patagium. The bird had started self-traumatizing approximately 1 month after fracturing the right metacarpus, although the fracture had stabilized, surface wounds had healed completely, and treatment with a nonsteroidal antiinflammatory drug had been administered. The bird was treated with gabapentin (11 mg/kg p.o. q12h), ketamine (0.5 mg/kg i.m. q24h), and low level laser therapy (LLLT) (<5 mW, 630-680 nm, 5-second application per site) for 3 weeks, but, despite initial improvement, new self-inflicted wounds appeared at the same site. Approximately 1.5 months later, a radial and medianoulnar nerve block was performed by using bupivacaine (2 mg/kg) and medetomidine (0.5 microg/kg). In addition, the dosing interval of ketamine was increased to q12h, and the dose of gabapentin was increased 7.5-fold. A higher energy and wavelength of LLLT (1040 mW, 830 nm, 2 J/cm2) was applied once to the injured region and fracture site, then the original LLLT protocol was applied once daily. After 2.5 months, the wounds healed completely and no further mutilation took place. Once deemed ready for release, the falcon was returned to the wild after 181 days in captivity. This is the first reported application of successful multimodal analgesia in a raptor with uncontrolled neuropathic pain.

Successful biphasic transthoracic defibrillation of a dog with prolonged, refractory ventricular fibrillation.

OBJECTIVE: To describe a case of spontaneous ventricular fibrillation in a dog in which biphasic defibrillation was life saving. CASE SUMMARY: Ventricular fibrillation occurred in a 7-year-old female Australian Heeler during recovery from anesthesia following pacemaker implantation. Resuscitative efforts including immediate delivery of transthoracic monophasic defibrillation shocks of escalating energy and administration of vasopressors were unsuccessful. However, a single biphasic shock restored sinus rhythm despite prolonged duration of the arrhythmia. NEW OR UNIQUE INFORMATION PROVIDED: This case suggests greater efficacy of biphasic defibrillation compared with traditional monophasic defibrillation. In this dog the newer, biphasic technology was life saving after monophasic shocks failed repeatedly to terminate ventricular fibrillation.

Changes in colloid osmotic pressure as a function of anesthesia and surgery in the presence and absence of isotonic fluid administration in dogs.

OBJECTIVE: To determine how a combination of anesthetic drugs; including pre-medication, induction agents and inhalational agents; affect colloid osmotic pressure (COP) in the presence and absence of isotonic fluid administration. Secondarily, to determine if changes in total plasma protein (TPP) correlate with COP in anesthetized patients. STUDY DESIGN: Prospective, randomized clinical study. ANIMALS: Ten female dogs, 4 months to 4 years of age and >8 kg undergoing elective ovariohysterectomy. METHODS: All dogs were anesthetized in a similar fashion. After induction, five dogs received lactated ringer's solution (LRS) at 10 mL kg(-1) hour(-1) and five dogs received no fluid therapy during anesthesia. Blood samples were collected prior to pre-medication, prior to induction, immediately post-induction/prior to the inhalational agent, 30 minutes post-induction, at the time of recovery and 45 minutes post-discontinuation of inhalant. TPP and COP were measured from each sample. RESULTS: Administration of fluids resulted in a decrease in COP and TPP over time that did not return to baseline by 45 minutes after recovery. Anesthesia without the administration of fluids also resulted in a significant decrease in COP over time, that was rebounding by recovery (but still significantly less than baseline). TPP had variable correlation with COP at different time points with or without fluid administration. CONCLUSIONS AND CLINICAL RELEVANCE: Anesthetic drugs alter COP similarly in the presence and absence of isotonic fluids. These changes in COP did not have a simple relationship to TPP and so the latter could not be used to predict COP in this patient population.

Heterotopic implantation of a porcine bioprosthetic heart valve in a dog with aortic valve endocarditis.

CASE DESCRIPTION: A 5-year-old male German Shepherd Dog was evaluated because of a 5-month history of progressive lethargy, weight loss, and heart failure. CLINICAL FINDINGS: On physical examination, bounding femoral pulses and systolic and diastolic murmurs were detected. Echocardiography revealed severe aortic valve insufficiency (AVI) and a large vegetative lesion on the aortic valve consistent with aortic valve endocarditis. The AVI velocity profile half-time was 130 milliseconds; the calculated peak systolic pressure gradient across the aortic valve was 64 mm Hg. Left ventricular diameter during diastole was 63.6 mm (predicted range, 40.2 to 42 mm) and during systole was 42.9 mm (predicted range, 25.4 to 27 mm). Systolic, diastolic, and mean arterial blood pressures were 120, 43, and 65 mm Hg, respectively. TREATMENT AND OUTCOME: To palliate severe AVI, the descending aorta was occluded (duration, 16.75 minutes) and heterotopic implantation of a porcine bioprosthetic heart valve in that vessel was performed. After surgery, systolic, diastolic, and mean arterial blood pressures were 115, 30, and 61 mm Hg, respectively, in the forelimb and 110, 62, and 77 mm Hg, respectively, in the hind limb. Within 6 months, the AVI velocity profile half-time had increased to 210 milliseconds, indicating diminished severity of AVI. After 24 months, the dog was able to engage in vigorous exercise; no pulmonary edema had developed since surgery. CLINICAL RELEVANCE: Heterotopic bioprosthetic heart valve implantation into the descending aorta during brief aortic occlusion appears feasible in dogs and may provide substantial palliation for dogs with severe AVI.

Pharmacokinetics and anesthetic and cardiopulmonary effects of propofol in red-tailed hawks (Buteo jamaicensis) and great horned owls (Bubo virginianus).

OBJECTIVE: To determine induction doses, anesthetic constant rate infusions (CRI), and cardiopulmonary effects of propofol in red-tailed hawks and great horned owls and propofol pharmacokinetics in the owls during CRI. ANIMALS: 6 red-tailed hawks and 6 great horned owls. PROCEDURE: The CRI dose necessary for a loss of withdrawal reflex was determined via specific stimuli. Anesthesia was induced by IV administration of propofol (1 mg/kg/min) and maintained by CRI at the predetermined dose for 30 minutes. Heart and respiratory rates, arterial blood pressures, and blood gas tensions were obtained in awake birds and at various times after induction. End-tidal CO2 (ETCO2) concentration and esophageal temperature were obtained after induction. Propofol plasma concentrations were obtained after induction and after completion of the CRI in the owls. Recovery times were recorded. RESULTS: Mean +/- SD doses for induction and CRI were 4.48 +/- 1.09 mg/kg and 0.48 +/- 0.06 mg/kg/min, respectively, for hawks and 3.36 +/- 0.71 mg/kg and 0.56 +/- 0.15 mg/kg/min, respectively, for owls. Significant increases in PaCO2, HCO3, and ETCO2 in hawks and owls and significant decreases in arterial pH in hawks were detected. A 2-compartment model best described the owl pharmacodynamic data. Recovery times after infusion were prolonged and varied widely. Central nervous system excitatory signs were observed during recovery. CONCLUSIONS AND CLINICAL RELEVANCE: Effects on blood pressure were minimal, but effective ventilation was reduced, suggesting the need for careful monitoring during anesthesia. Prolonged recovery periods with moderate-to-severe excitatory CNS signs may occur in these species at these doses.

Clinical pain management techniques for cats.

Although pain management is an emerging and popular topic in veterinary medicine, use of analgesics in cats has received little attention relative to their canine counterparts. Some of the difficulty lies in assessment of whether or not a cat is in pain. Simple observation of a cat in a cage relies upon overt expression of pain, and is often inaccurate. Pain scales have been developed that allow a semiquantitative evaluation of the degree of pain an animal may be experiencing. However, treating pain based upon observation of the painful state is less effective than anticipating and preemptively treating pain. This article reviews specific methods for preemptively treating and alleviating pain in the cat. The traditional approach to pain management involves drug administration. Specific categories of agents used in cats include opioids, nonsteroidal anti-inflammatories, or alpha-2 agonists. Other modalities of pain management, which are also reviewed, include use of local anesthetic drugs for local and regional analgesia, as well as acupuncture.

An evaluation of apnea or spontaneous ventilation in early recovery following mechanical ventilation in the anesthetized horse.

OBJECTIVE: To compare arterial oxygen and carbon dioxide tensions in apneic and spontaneously ventilating horses recovering from anesthesia. STUDY DESIGN: Randomized clinical trial. ANIMAL POPULATION: Forty-two healthy horses averaging 466 ± 106 kg and 6 ± 5 years of age. METHODS: Anesthetized horses undergoing a variety of surgical procedures and receiving positive pressure ventilation (IPPV) were divided into two equal groups. One group was allowed to return to spontaneous ventilation prior to disconnection from the anesthetic circuit (weaned). The other group remained apneic during transport to a recovery stall. Arterial blood gas data were collected at five time points: 20 minutes before moving to a recovery stall (t = - 20); at the time the anesthetic circuit was disconncted (t = 0); at 3 and 5 minutes post-disconnection (t = 3 and t = 5) and at the time of the first spontaneous breath (t = sv). The data were analyzed using an anova method for repeated measures and paired, two-tailed t-tests. Significance was assumed when p < 0.05. RESULTS: The apneic group took a mean of 5 minutes 18 seconds (± 135 seconds) before starting spontaneous ventilation. This group maintained significantly higher PaO2 levels at intermediate time points (t = 0 and t = 3) but no difference was noted after 5 minutes. PaCO2 levels were higher in the weaned group at time 0 minutes, returning to a comparable level to the apneic group at t = 3 minutes. CONCLUSIONS AND CLINICAL RELEVANCE: Horses can survive a short period of apnea during transport from the surgery suite to recovery stall and may benefit from a reduced incidence of transient hypoxemia compared with spontaneously ventilating horses. This information has practical implications for the anesthetist evaluating the options for discontinuing IPPV when horses are moved to a recovery stall.