Development and assessment of a pictorial guide to improve accuracy of visual estimation of blood loss of small animals.

OBJECTIVE: To investigate the accuracy of visual blood loss estimation from small animals among veterinary staff and final-year veterinary students, and the development and utility of a pictorial guide to improve estimation, in a veterinary hospital. STUDY DESIGN: Online anonymous voluntary survey. METHODS: A two-part online survey was circulated to voluntary participants at the University Veterinary Teaching Hospital Sydney, The University of Sydney, including students, nurses, interns, residents, general practitioners and specialists. The survey consisted of visual and brief descriptive depictions of blood loss scenarios involving small animals, principally including images of common surgical items and receptacles containing a bloodlike substance. Each participant estimated the blood volume (in millilitres) for each scenario two times, initially [Pre-Guide (PGD)] and then with the aid of a pictorial guide [With-Guide (WGD)]. The pictorial guide used similar images labelled with corresponding volumes. Data were analysed for normality with the Shapiro-Wilk test, corrected to absolute error and compared for statistical significance using the Wilcoxon signed-rank test or the Kruskal-Wallis test as appropriate (p < 0.05). RESULTS: A total of 59 participants provided 288 responses. The raw median PGD error was -16 mL (range -105 to 443 mL), indicating a tendency towards underestimation of the actual volume. The WGD median error was 18 mL (range -91 to 191 mL), indicating a tendency towards overestimation when using a pictorial guide (p < 0.0001). Data corrected to absolute error showed a PGD median error of 34 mL (range 0-443 mL) and WGD median error of 23 mL (range 0-191 mL; p < 0.0001). There were differences between the participant roles in the PGD phase but not when using the pictorial guide. CONCLUSIONS: and clinical relevance Participants generally underestimated surgical blood loss, with a wide variation, when visually estimating scenarios involving small animals. A pictorial guide improved estimation by reducing the absolute median error and narrowing the range.

Rehabilitation of companion animals following orthopaedic surgery.

Physical therapy and rehabilitation following orthopaedic surgery in companion animals have become more common and new advancements in this field have been made in recent years. Surgery alone may not return the animal to its previous physical activity or work-related tasks, whether due to concurrent soft tissue trauma, arthrogenic muscle inhibition or osteoarthritis. Rehabilitation therapies following surgery can restore function as well as strength, coordination and balance. Many simple techniques such as cryotherapy and passive range of motion exercises have been shown to improve outcomes following musculoskeletal procedures and may help restore function as well as reduce pain and facilitate healing. Some techniques are more useful during different stages in order to achieve optimum tissue healing and recovery of function. During the first 72 hours, rehabilitation should focus on reduction of inflammation and pain, maintaining joint nutrition and range of motion, and stimulating vascularisation and healing; and may include cryotherapy, passive range of motion exercises, massage and therapeutic exercises. Following the initial recovery period, the goals of rehabilitation also include restoring strength, balance and normal gait patterns, as well as recovery of function. During this period the focus of therapy may shift toward therapeutic exercises, aquatic therapy and increasing activity in the animal. Therapeutic modalities such as neuromuscular electrical stimulation, photobiomodulation (laser therapy), therapeutic ultrasound and extracorporeal shock wave therapy have been reported to reduce pain and inflammation, enhance healing and reduce recovery time in the early and late stages following orthopaedic surgery.

Mechanical analysis of suture attachment methods in toggle suture constructs.

OBJECTIVE: To determine the effect of the method used to attach OrthoFiber #5 to a 1/8-in Securos toggle rod on the mechanical properties of the resulting construct. STUDY DESIGN: Prospective bench top mechanical analysis. SAMPLE POPULATION: One hundred twenty-eight OrthoFiber #5-toggle rod suture constructs. METHODS: Toggle-suture constructs (groups A-H) were prepared by using 8 methods to attach OrthoFiber #5 to a 1/8-in toggle rod (n = 16 constructs/group). A servohydraulic materials-testing machine was used to test each toggle-suture construct in tension. Mean load to failure, cycles to failure, construct stiffness, and suture elongation under static and cyclic loading were compared among types of constructs. RESULTS: Mean load to failure was greatest (>500 N) for constructs D (P ≤ .048) and G (P ≤ .048). Mean construct stiffness of D (53.52 N/mm) and E (53.6 N/mm) was greater than that of the 6 other constructs (P ≤ .040). Construct A sustained the most elongation in acute (23.47 mm; P < .001) and cyclic (18.53 mm; P < .003) loading. Cycles to failure was greater for construct C (622 cycles) compared with constructs A, B, and H (P = .008, P = .009, and P = .010, respectively). CONCLUSION: The method used to attach OrthoFiber #5 to a 1/8-in toggle rod influenced the mechanical properties of the construct. No one construct outperformed other groups in all areas of testing, but construct D was superior when mean load to failure and construct stiffness were considered. CLINICAL IMPACT: Construct D, with OrthoFiber #5, passed straight through the toggle rod eyelet, may provide superior stability and resistance to fatigue failure to toggle-in repairs of coxofemoral luxations.

Veterinary trials and tribulations.

Dog owner Jodi Ware makes the case for transparency in companion animal research.

Tail Docking and Ear Cropping Dogs: Public Awareness and Perceptions.

Tail docking and ear cropping are two surgical procedures commonly performed on many dog breeds. These procedures are classified as medically unnecessary surgeries whose purpose is primarily cosmetic. Available attitude research surrounding these controversial practices has been limited to surveys of veterinarians and dog breeders familiar with both practices. The aim of this project was to: 1) assess public awareness of tail docking and ear cropping, 2) determine whether physical alteration of a dog affects how the dog, and 3) owner are perceived. In Experiment 1 awareness was measured using a combination of both explicit and implicit measures. We found that 42% of participants (n = 810) were unable to correctly explain the reason why tail docked and ear cropped dogs had short ears and tails. Similarly, an implicit measure of awareness ('nature vs nurture task'), found that the majority of participants believed short tails and erect ears were a consequence of genetics rather than something the owner or breeder had done. The results obtained in Experiment 2 (n = 392) provide evidence that ear cropped and tail docked dogs are perceived differently than an identical dog in its 'natural' state. Modified dogs were perceived as being more aggressive, more dominant, less playful and less attractive than natural dogs. Experiment 3 (n = 410) is the first evidence that owners of modified dogs are perceived as being more aggressive, more narcissistic, less playful, less talkative and less warm compared to owners of natural dogs. Taken together, these results suggest that although a significant proportion of subjects appear unaware of the practices of tail docking and ear cropping in dogs, these procedures have significant impacts on how modified dogs and their owners are perceived by others.

Advances in Urinary Tract Endoscopy.

The use of endoscopy in veterinary medicine has become the mainstay of diagnosis and treatment in the subspecialty of small animal urology over the past decade. This subspecialty is termed endourology. With the common incidence of urinary tract obstructions, stones disease, renal disease, and urothelial malignancies, combined with the recognized invasiveness and morbidity associated with traditional surgical techniques, the use of endoscopic-assisted alternatives using interventional endoscopic techniques has become appealing to both owners and clinicians. This article provides a brief overview of some of the most common urologic procedures being performed in veterinary medicine.

Advances in Equipment and Instrumentation in Laparoscopic Surgery.

The practice of veterinary laparoscopic surgery has grown in the past decade. Surgical devices routinely used in human laparoscopy have become available to the veterinary surgeon, at a cost the veterinary market can bear. This includes electrosurgical generators, access ports, stapling devices, tissue dissectors, and a wide array of laparoscopic handpieces. With the development of the laparoscopic clip applier in the 1990s, laparoscopic cholecystectomy came to be commonly performed in people. During this time, numerous training programs were developed to rapidly bring human surgeons up to speed.

Advances in Laparoscopic Surgery.

Recently, a new platform of abdominal access, called single-port surgery, has emerged in human and veterinary laparoscopy. The single-port platform enables all laparoscopic instruments, including the telescope, to pass individually through the same abdominal incision. Recently, there have been several published reports documenting the efficacy and safety of single-port procedures in veterinary patients. This article discusses the common single-port devices and instrumentation, as well as procedures now routinely offered in veterinary minimally invasive surgery.

Advances in Flexible Endoscopy.

Flexible endoscopy, a minimally invasive diagnostic and potentially therapeutic tool, has become more available over the past decades. A fiberscope is used to visualize the lumen of the area of interest and collect tissue or fluid samples for evaluation. Samples can be submitted for histopathology, cytologic analysis, and bacterial culture. Flexible endoscopy is being investigated. This article provides a brief review of equipment and basic flexible endoscopy followed by an overview of advanced flexible endoscopic procedures that focuses on the gastrointestinal tract. The procedures included here may become more readily available and improve diagnosis and treatment.

Complications and Conversion from Endoscopic to Open Surgery.

Endoscopic surgery is a rapidly expanding modality of diagnosis and treatment of small animal patients. The development of skills, equipment, and minimally invasive means of correcting complications may be of great importance in decreasing the incidence of conversion from endoscopic to open surgery; however, conversion to an open approach should never be seen as a failure. Conversion should be considered at any time that it is of the greatest benefit for the patient. This concept is important enough to warrant discussion with the owner before surgery and acceptance of the need to convert without further consultation during the procedure.

Anesthesia for Endoscopy.

Anesthesia for endoscopic surgery can be challenging depending on surgical manipulations and patient comorbidity. Anesthetists must understand the possible systemic changes and complications that are associated with endoscopic surgery. Pneumoperitoneum induces vasoconstriction, reduces cardiac output, and decreases functional residual capacity in the cardiopulmonary system. Both hypoventilation caused by the thoracoscopic procedure and CO2 insufflation increase Paco2. To prevent the problems associated with high Paco2, monitoring of end-tidal CO2 (ETco2) and capability of positive pressure ventilation are crucial. Sudden changes of ETco2 should be monitored closely. Endoscopic surgery should be a less invasive procedure; however, appropriate analgesia remains necessary.

Laparoscopic-Assisted Surgical Procedures.

Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches.

Advances in Laparoscopic Skills Training and Management.

Veterinarians interested in adding minimally invasive surgery (MIS) to their surgical repertoire need a distinct set of skills. These MIS skills do not transfer from open surgery; they require specific training. Training based solely on practice in live patients becomes limited and inconsistent. In addition, ethical and cost issues arise when advanced procedures are practiced in live patients. This article discusses the Veterinary Applied Laparoscopic Training program, which provides simulation-based training for MIS.

Temporary tracheostomy.

Upper airway obstruction can be due to a variety of causes in small animal patients and is often life threatening if left untreated. Placement of a temporary tracheostomy tube may be necessary in the most severe cases of upper airway obstruction until definitive therapy can be implemented. This paper discusses the indications, technique for placement, maintenance, and complications associated with temporary tracheostomy in dogs and cats.

Nasal hydropulsion.

Intranasal tumors of dogs and cats pose a diagnostic and therapeutic challenge for the small animal practitioner. A simplified flushing technique to biopsy and debulk nasal tumors, that often results in immediate clinical relief for the patient is described. This technique can also be utilized to remove nasal foreign bodies.

Tracheal stent placement for the emergency management of tracheal collapse in dogs.

Dogs with tracheal collapse may present with life-threatening upper airway obstruction. In most instances, a conservative approach to treatment including oxygen support coupled with sedation and cooling measures will relieve respiratory effort and thus relieve airway obstruction. Dogs that fail this conservative approach require endotracheal intubation to ensure a patent airway. This population of patients would benefit from a more definitive, yet palliative treatment option to acutely relieve upper airway obstruction. Placement of a self-expanding metallic stent that spans the affected portion of the trachea will acutely provide the patient with a sustained patent airway and optimize the likelihood of a positive outcome.