Sedation and Anesthesia in Rodents.

Sedation and anesthesia in rodent species are complex due to their wide species variation, small size, and metabolism. This review article covers recent advances in sedation and anesthesia as well as an updated drug formulary for sedation protocols. Setup, equipment, monitoring, maintenance, and recovery are reviewed as well as species-specific anatomy.

Myoclonus and hypersensitivity of the hind limbs and tail with urinary retention following neuraxial administration of morphine in a cat.

An adult female domestic shorthair cat developed myoclonus, muscle rigidity, and hypersensitivity of the hind limbs and tail with urinary retention following neuraxial administration of morphine. Myoclonic contractions resolved following treatment with midazolam and a urinary catheter was placed until normal micturition returned. The cat was clinically normal 36 hours after neuraxial morphine injection. The cat underwent a second surgery without neuraxial morphine and control of postoperative pain required more intervention. Key clinical message: Neuraxial morphine may cause myoclonus and urinary retention. The response to pharmacological treatment of myoclonus is varied, but a benzodiazepine drug may be effective.

Myoclonie et hypersensibilité des membres postérieurs et de la queue avec rétention urinaire après administration neuraxiale de morphine chez un chat. Une chatte domestique à poils courts adulte a développé une myoclonie, une rigidité musculaire et une hypersensibilité des membres postérieurs et de la queue avec rétention urinaire après l'administration neuraxiale de morphine. Les contractions myocloniques se sont résolues après un traitement avec du midazolam et un cathéter urinaire a été placé jusqu'à ce que les mictions normales reviennent. Le chat était cliniquement normal 36 heures après l'injection neuraxiale de morphine. Le chat a subi une deuxième intervention chirurgicale sans morphine neuraxiale et le contrôle de la douleur postopératoire a nécessité plus d'intervention.Message clinique clé:La morphine neuraxiale peut provoquer une myoclonie et une rétention urinaire. La réponse au traitement pharmacologique de la myoclonie est variée, mais un médicament à base de benzodiazépine peut être efficace.(Traduit par Dr Serge Messier).

Successful cardiopulmonary resuscitation following cardiac arrest in a hypoglycemic cat.

This case highlights the successful recovery to discharge of a hypothermic cat in cardiac arrest, with minimal lasting clinical signs. Immediately after resuscitation, the cat was blind and non-ambulatory paraparetic. Within 4 days, the cat became fully ambulatory, but vision loss remains. We believe that the cat's hypothermia likely contributed to this successful outcome. Other factors which may have played a role in the cat's recovery were the administration of mannitol and anti-seizure medications. Key clinical message: We share learning points regarding re-warming rates for hypothermic patients and the use of Doxapram for stimulation of the central respiratory center.

Ressuscitation cardio-pulmonaire réussie suivant un arrêt cardiaque chez un chat hypoglycémique. Le présent cas souligne le succès de la guérison jusqu'au congé d'un chat hypothermique en arrêt cardiaque, avec des signes cliniques permanents minimes. Immédiatement après la ressuscitation, le chat était aveugle et paraparétique non-ambulant. À l'intérieur d'un délai de 4 jours le chat est devenu complètement ambulatoire, mais la perte de vision persistait. Nous sommes d'avis que l'hypothermie du chat aurait contribué à cette conclusion positive. D'autres facteurs qui pourraient avoir joué un rôle dans la guérison du chat étaient l'administration de mannitol et de médicaments anti-convulsions.Message clinique clé :Nous partageons des notions d'apprentissage concernant les vitesses de réchauffement pour les patients hypothermiques et l'utilisation de Doxapram pour la stimulation du centre central de la respiration.(Traduit par Dr Serge Messier).

Adverse reactions to fentanyl transdermal patches in calves: a preliminary clinical and pharmacokinetic study.

OBJECTIVE: To describe adverse reactions and measure plasma fentanyl concentrations in calves following administration of a fentanyl transdermal patch (FTP). STUDY DESIGN: Prospective, experimental clinical study. ANIMALS: Six female Holstein calves and one male Angus calf. Four calves were healthy experimental animals and three calves were clinical patients. METHODS: Plasma fentanyl concentrations were measured in blood collected from a jugular vein. FTP 2 µg kg-1 hour-1 and 1 µg kg-1 hour-1 was applied to four and three calves, respectively. Heart rate, respiratory rate, temperature and ataxia were recorded at the same times as blood collection (0, 2, 4, 6, 12, 24, 36, 48, 60, 72, 84 and 96 hours). Substance P concentrations were determined via radioimmunoassay for two calves. RESULTS: After the FTP (2 µg kg-1 hour-1) application, two calves developed tachycardia, hyperthermia, excitement and ataxia within 6 hours; no adverse effect was observed in the other two calves. The three calves administered FTP (1 µg kg-1 hour-1) exhibited tachycardia and excitement, and the FTP were removed at 4 hours. Naloxone was administered to two calves before the adverse clinical signs ceased, while adverse events in the other three calves resolved within 2 hours of FTP removal. Variables returned to previous baseline values by 2-4 hours after FTP removal. Maximum plasma fentanyl concentrations were variable among calves (0.726-6.923 ng mL-1). Substance P concentrations measured in two calves were not consistently depressed during FTP application. Fentanyl concentrations at 4 and 6 hours were significantly associated with the appearance of adverse effects. CONCLUSIONS AND CLINICAL RELEVANCE: FTP (1-2 µg kg-1 hour-1) administered to calves may result in adverse behavioral and cardiovascular effects. Patch removal and treatment with an opioid antagonist may resolve these adverse effects. Additional research is needed to determine optimal FTP dosing for cattle.

On-site management of medical encounters during obstacle adventure course participation.

Obstacle adventure courses (OAC) are increasing in popularity. Although injuries are not uncommon, there is scant medical literature documenting the morbidity and mortality associated with these events. This manuscript describes a case series. Event demographics, medical coverage, and injuries/illnesses documented during four OAC events in British Columbia, Canada, are discussed - Tough Mudder™ (2012 and 2013) and Warrior Dash© (2011 and 2012). The patient presentation rate across all events ranged from 26.53 to 37.40 per 1,000 participants. Ambulance transfer rates were low (range = 0 to 5 per event day, 0% to 1.1% of patients seen). Although some illness presentations and injuries required a higher level of care, the majority of medical issues were related to musculoskeletal injuries of the lower limbs. Advanced knowledge about risks and patient presentations associated with participation in OAC may influence on-site staffing, deployment patterns, rescue equipment, and transfer to hospital planning for diagnostic imaging and definitive treatment.

An analysis of patient presentations at a 2-day mass-participation cycling event: the Ride to Conquer Cancer Case Series, 2010-2012.

OBJECTIVE: To analyze the unique factors involved in providing medical support for a long-distance, cross-border, cycling event, and to describe patient presentations and event characteristics for the British Columbia (BC) Ride to Conquer Cancer from 2010 through 2012. METHODS: This study was a 3-year, descriptive case series report. Medical encounters were documented, prospectively, from 2010-2012 using an online registry. Data for event-related variables also were reported. RESULTS: Providing medical support for participants during the 2-day ride was complicated by communication challenges, weather conditions, and cross-border issues. The total number of participants for the ride increased from 2,252 in 2010 to 2,879 in 2011, and 3,011 in 2012. Patient presentation rates (PPRs) of 125.66, 155.26, and 198.93 (per 1,000 participants) were documented from 2010 through 2012. Over the course of three years, and not included in the PPR, an additional 3,840 encounters for "self-treatment" were documented. CONCLUSIONS: The Ride to Conquer Cancer Series has shown that medical coverage at multi-day, cross-national cycling events must be planned carefully to face a unique set of circumstances, including legislative issues, long-distance communication capabilities, and highly mobile participants. This combination of factors leads to potentially higher PPRs than have been reported for noncycling events. This study also illuminates the additional workload "self-treatment" visits place on the medical team.

An organized medical response for the Vancouver International Marathon (2006-2011): when the rubber hits the road.

OBJECTIVE: We described an organized, on-site medical response for a large-scale urban marathon event and documented illness/injury rates as well as ambulance transfer rates at the Vancouver International Marathon (VIM). METHODS: Case-series report of medical encounters was documented prospectively over a 6-yr period at the VIM. The planning and organization of the on-site medical response is the main focus of this report. RESULTS: A total of 67,402 runners participated in the VIM from 2006 to 2011. Over the 6-yr period, 2,986 patient encounters were documented. The patient presentation rate for the series was 45/1,000, the ambulance transfer rate was 0.09-0.58/1,000, and the medical transfer rate was 0.37-1.09/1,000. CONCLUSION: A coordinated on-site medical team covering the entire event site and race route was deployed to reduce the severity of illness and injury at a long-distance running event.

Postoperative comparison of four perioperative analgesia protocols in dogs undergoing stifle joint surgery.

OBJECTIVE: To compare 4 analgesic protocols in dogs undergoing stifle joint surgery. DESIGN: Randomized, blinded, prospective clinical trial. Animals-48 client-owned dogs that underwent stifle joint surgery. PROCEDURES: Dogs undergoing tibial plateau leveling osteotomy were randomly assigned to receive a constant rate infusion of a combination of morphine, lidocaine, and ketamine; a lumbosacral epidural with morphine and ropivacaine; both treatments (ie, constant rate infusion and lumbosacral epidural); or only IM premedication with morphine. Indices of cardiorespiratory function and isoflurane requirement were recorded at 5-minute intervals during anesthesia. A validated sedation scoring system and the modified Glasgow composite measure pain score were used to assess comfort and sedation after surgery and anesthesia once the swallowing reflex returned and a body temperature of ≥ 36.7°C (98.1°F) was attained. Pain and sedation scores were acquired at 60-minute intervals for 4 hours, then at 4-hour intervals for 24 hours. Dogs with a postoperative pain score > 5 of 24 were given morphine as rescue analgesia. RESULTS: No differences in heart rate, respiratory rate, systolic arterial blood pressure, end-tidal Pco2, end-tidal isoflurane concentration, and vaporizer setting were detected among groups. No differences in pain score, sedation score, rescue analgesia requirement, or time to first rescue analgesia after surgery were detected. CONCLUSIONS AND CLINICAL RELEVANCE: Pain scores were similar among groups, and all 4 groups had similar rescue analgesia requirements and similar times to first administration of rescue analgesia. All 4 analgesic protocols provided acceptable analgesia for 24 hours after stifle joint surgery.

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial.

OBJECTIVES: Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections. METHODS: A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age ≥ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (α  =  0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction. RESULTS: Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days, p  =  0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and < 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively). Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED. CONCLUSIONS: PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive.

Text messaging as a strategy to address the limits of audio-based communication during mass-gathering events with high ambient noise.

INTRODUCTION: The provision of medical care in environments with high levels of ambient noise (HLAN), such as concerts or sporting events, presents unique communication challenges. Audio transmissions can be incomprehensible to the receivers. Text-based communications may be a valuable primary and/or secondary means of communication in this type of setting. OBJECTIVES: To evaluate the usability of text-based communications in parallel with standard two-way radio communications during mass-gathering (MG) events in the context of HLAN. METHODS: This Canadian study used outcome survey methods to evaluate the performance of communication devices during MG events. Ten standard commercially available handheld smart phones loaded with basic voice and data plans were assigned to health care providers (HCPs) for use as an adjunct to the medical team's typical radio-based communication. Common text messaging and chat platforms were trialed. Both efficacy and provider satisfaction were evaluated. RESULTS: During a 23-month period, the smart phones were deployed at 17 events with HLAN for a total of 40 event days or approximately 460 hours of active use. Survey responses from health care providers (177) and dispatchers (26) were analyzed. The response rate was unknown due to the method of recruitment. Of the 155 HCP responses to the question measuring difficulty of communication in environments with HLAN, 68.4% agreed that they "occasionally" or "frequently" found it difficult to clearly understand voice communications via two-way radio. Similarly, of the 23 dispatcher responses to the same item, 65.2% of the responses indicated that "occasionally" or "frequently" HLAN negatively affected the ability to communicate clearly with team members. Of the 168 HCP responses to the item assessing whether text-based communication improved the ability to understand and respond to calls when compared to radio alone, 86.3% "agreed" or "strongly agreed" that this was the case. The dispatcher responses (n = 21) to the same item also "agreed" or "strongly agreed" that this was the case 95.5% of the time. CONCLUSION The use of smart phone technology for text-based communications is a practical and feasible tool for MG events and should be explored further. Multiple, reliable, discrete forms of communication technology are pivotal to executing effective on-site medical and disaster responses.

Mass-gathering medicine: creation of an online event and patient registry.

UNLABELLED: INTRODUCTION/PROBLEM: A review of the mass-gathering medicine literature confirms that the research community currently lacks a standardized approach to data collection and reporting in relation to large-scale community events. This lack of consistency, particularly with regard to event characteristics, patient characteristics, acuity determination, and reporting of illness and injury rates makes comparisons between and across events difficult. In addition, a lack of access to good data across events makes planning medical support on-site, for transport, and at receiving hospitals, challenging. This report describes the development of an Internet-hosted, secure registry for event and patient data in relation to mass gatherings. METHODS: Descriptive; development and pilot testing of a Web-based event and patient registry. RESULTS: Several iterations of the registry have resulted in a cross-event platform for standardized data collection at a variety of events. Registry and reporting field descriptions, successes, and challenges are discussed based on pilot testing and early implementation over two years of event enrollment. CONCLUSION: The Mass-Gathering Medicine Event and Patient Registry provides an effective tool for recording and reporting both event and patient-related variables in the context of mass-gathering events. Standardizing data collection will serve researchers and policy makers well. The structure of the database permits numerous queries to be written to generate standardized reports of similar and dissimilar events, which supports hypothesis generation and the development of theoretical foundations in mass-gathering medicine.

An assessment of gum-based environmental enrichment for captive gummivorous primates.

In the wild, many primates consume gums exuded from trees, and many species are gum specialists. In spite of this, few data exist concerning gum feeding in captivity. Using a web-based survey of 46 zoos in 12 countries, we evaluated the extent to which zoos feed gum to primates. We found that although callitrichids and galagos receive gum-based enrichment, cercopithecines generally do not. Environmental enrichment is important for stimulating naturalistic behavior to promote the psychological wellbeing of animals. Thus, gum-based enrichment is important for captive gummivores. Our study highlights the need to improve environmental enrichment for captive gummivores, in particular that of cercopithecines. This is most striking for the patas monkey (Erythrocebus patas), an obligate gummivore. The exchange of ecological data between field research and captive settings is crucial, and is just one way primate caretakers can contribute to the conservation and welfare of some of our closest living relatives.

Amygdala size and hypothalamus size predict social play frequency in nonhuman primates: a comparative analysis using independent contrasts.

The amygdala and hypothalamus become sexually differentiated by gonadal hormones giving rise to sexually differentiated behaviors, which include play behavior. Phylogenetic comparative analyses test for relationships between social play and brain structure volumes. Relative volume of the amygdala and hypothalamus correlated with social play, but not nonsocial play, even after controlling for the size of other brain structures. The authors propose that behaviors such as social assessment, recognizing and responding to facial expression, and social response appropriateness, which are mediated by the amygdala, are developed through social play. Additionally, the hypothalamus may regulate the motivation to engage in play through positive reinforcement of pleasurable activity. Thus, the instinctive socio-emotive aspects of play in primates appear to be those regulated by the amygdala and hypothalamus.

Analog number representations in mongoose lemurs (Eulemur mongoz): evidence from a search task.

A wealth of data demonstrating that monkeys and apes represent number have been interpreted as suggesting that sensitivity to number emerged early in primate evolution, if not before. Here we examine the numerical capacities of the mongoose lemur (Eulemur mongoz), a member of the prosimian suborder of primates that split from the common ancestor of monkeys, apes and humans approximately 47-54 million years ago. Subjects observed as an experimenter sequentially placed grapes into an opaque bucket. On half of the trials the experimenter placed a subset of the grapes into a false bottom such that they were inaccessible to the lemur. The critical question was whether lemurs would spend more time searching the bucket when food should have remained in the bucket, compared to when they had retrieved all of the food. We found that the amount of time lemurs spent searching was indicative of whether grapes should have remained in the bucket, and furthermore that lemur search time reliably differentiated numerosities that differed by a 1:2 ratio, but not those that differed by a 2:3 or 3:4 ratio. Finally, two control conditions determined that lemurs represented the number of food items, and neither the odor of the grapes, nor the amount of grape (e.g., area) in the bucket. These results suggest that mongoose lemurs have numerical representations that are modulated by Weber's Law.

Playing for keeps : Evolutionary relationships between social play and the cerebellum in nonhuman primates.

The hypothesis that play behavior is more prevalent in larger-brained animals has recently been challenged. It may be, for example, that only certain brain structures are related to play. Here, we analyze social play behavior with regards to the cerebellum: a structure strongly implicated in motor-development, and possibly also in cognitive skills. We present an evolutionary analysis of social play and the cerebellum, using a phylogenetic comparative method. Social play frequency and relative cerebellum size are positively correlated. Hence, there appears to be a link between the evolutionary elaboration of social play and the cerebellum.