Why You Should Wake up to the Realities of AnesthesiaOctober 6, 2014Originally published in the October 2014 issue of Veterinary Practice News When she wanted to offer one crystal-clear message to veterinarians about anesthesia best practices, Christina Braun, Dr. Med. Vet, Dipl. ACVAA, offered one of her favorite quotes from J.W. von Goethe: “You only see what you know.” It’s unlikely the German writer and statesman was referring to anesthesia, but Dr. Braun thinks it’s a good point nonetheless. “Monitoring is the first step to improve anesthetic outcome,” said Braun, a professor in anesthesiology and perioperative intensive care medicine at the University of Veterinary Medicine in Vienna, Austria. She encourages general practice veterinarians to reach out to the American College of Veterinary Anesthesia and Analgesia (ACVAA) if they have questions or concerns, and pet owners may be referred to the group’s website for more information. “For example, I know of old cats and dogs that had such terrible teeth that they wouldn’t eat anymore,” Braun said. “Because they were old, the fear of anesthesia was so high that the owner didn’t want the general veterinarian to perform a dental cleaning —which, in pets, absolutely [requires] general anesthesia. “Contacting a diplomate of the ACVAA can help in learning about good ways to …
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12 Ways to Avoid Surgical MistakesSeptember 22, 2014 What follows might very well become my most controversial surgical column. This list of 12 surgical mistakes is hardly exhaustive. It is, however, meant to start a reflection, rather than to offend anybody. 1) Skills The challenge with surgery is that a seemingly straightforward procedure can suddenly become much more complicated. Having the necessary skills set is the whole dilemma. Examples include the “routine” cystotomy, canine or feline, which in fact required a urethrostomy; the “routine” splenic mass, which in fact was a hepatic mass; the “routine” enterotomy, which in fact turned into a resection and anastomosis of three feet of jejunum. Could you handle any of these situations? 2) Indications Just because you have a hammer, even if you are a hammer expert, does not mean that every problem is a nail. Not all fractures can be pinned; some require a plate and screws. Not all cases of otitis externa can be treated by a Zepp procedure; many require a total ear canal ablation. Not all ACL tears can be treated with lateral nylon sutures; some patients require fancier procedures, such as a tibial plateau leveling osteotomy or a tibial …
Veterinarian Wins High Praise for Saving GoldfishSeptember 16, 2014 George the goldfish is back in his home pond after an Australian veterinarian successfully removed a brain tumor. The 45-minute operation on an uncommon veterinary patient cost the owners a couple of hundred dollars, according to Lort Smith Animal Hospital, and brought admiration from around the world as news and photographs of the surgery went viral. “Thanks for treating fish with the respect they deserve,” one Facebook user wrote on the clinic’s page. “That might be the coolest thing I’ve ever seen,” another wrote. “And to those that question the use of financial resources for a goldfish, some varieties can fetch amazingly high prices. Some are treasured pets. Who are we to judge?” The International Brain Tumor Alliance weighed in as well, stating, “We have heard of dogs and cats having brain tumors removed, but this is the first time we have heard of a fish undergoing brain surgery. Way to go, George!” The doctor was Tristan Rich, BVSc, who heads exotics and wildlife medicine at the Melbourne hospital. “The fish was having trouble eating, getting around and he was getting bullied by other fish,” Dr. Rich told The Telegraph newspaper. …
How the Laparoscopic-Assisted Spay EvolvedAugust 26, 2014 Published in the August 2014 issue of Veterinary Practice News. When Ray Cox, DVM, first took laparoscopy courses in the 1980s, some veterinarians were already performing laparoscopic-assisted ovariohysterectomies. But the procedure took two to three people operating through three ports, and even the best surgeons needed 2.5 hours to complete a spay, so the modality wasn’t practical compared to the traditional spay. But today, Dr. Cox said, even surgeons who take the longest to do a lap-assisted spay need less than 20 minutes. They can also look around inside the animal, basically doing a mini-exploratory during every procedure. In little more than a decade, the lap-assisted spay has become a procedure that can be used often enough for the general practitioner to develop a skill set in rigid endoscopy and make the equipment a practical addition to a clinic. Rigid endoscopy can be used for liver biopsy, prophylactic gastropexy, cryptorchid surgery and cystoscopy, among other procedures, all of which can add to the return on investment. Intrigued by those early courses, Cox began working to refine the procedure. He didn’t know it then, but he would become one of the pioneers of …
Vets Say Why they Use Laser TherapyAugust 20, 2014 Veterinarians are adopting and implementing therapeutic lasers at practices across the country. The therapy's effectiveness is still debated in some quarters — though less so than in the past — so why have they taken the plunge? The consensus among practitioners interviewed for this story is that the results speak for themselves—the lasers are effective at treating injuries and speeding healing with little to no side effects. And with a relatively gentle learning curve and quick return on investment, they say lasers are a no-brainer for their practices. Tales from Veterinarians On the Fence Linda Baty, DVM, of East Brook Animal Clinic in Waverly, Tenn., began offering laser therapy as a low-cost alternative to surgery for such injuries as ligament tears and back problems. “We were faced with keeping dogs on painkillers for the rest of their lives or even putting them down,” she said. “So we were looking for therapy that would relieve the pain and put them back to some function without going through major surgery [such as ACL repairs] if [the client] couldn’t afford that.” Though she had done a fair amount of research, Dr. Baty was still hesitant. “It wasn’t until …
Liposuction For Pets: Procedure Becoming Increasingly PopularJuly 31, 2014 Follow Veterinary Practice News on Twitter at @vetpetnews. Our society is a bit obsessed with appearance. Countless ads pop up on radio, television and in magazines promoting breast augmentations, anti-aging creams and countless ways to lose weight (through exercise, weight-loss programs, special diets, medications and surgeries). One such option is liposuction. The ad may show a woman with a not-so-flat belly next to a picture of one with a toned stomach, telling people that liposuction was the answer. So when I saw in the news that liposuction was now available for pets, I thought our society had gone too far. But, like everything else, you have to read the fine print. Although referred to as liposuction, when the procedure is performed on pets it is not cosmetic (even if your client’s pet is hoping for a svelte figure). It’s actually used to improve the health of the pet. The non-invasive procedure removes the fat from lipomas in overweight and senior dogs. If gone untreated, they can grow quite large and impede the dog’s movement. “They can be really big,” Rebecca Pentecost, DVM, told Fox 8 Cleveland. …
C-Sections: Anesthesia And SurgeryJuly 25, 2014 This article first appeared in the August 2013 issue of Veterinary Practice News. We continue describing our steps for a happy C-section. [See Part 1 here]. In this article, we focus on anesthesia and surgery. Our goals: safety and speed. 5) Anesthesia Melissa Goodman, DVM, board-qualified in the American College of Theriogenologists at Veterinary Reproductive Services in West Chester, Pa., skips premedication, and prefers masking patients down. She uses the smallest possible dose of propofol only if needed, e.g. in brachycephalic and fractious patients. When giving drugs to the dam, you are indirectly giving them to the babies. Many drugs are rapidly carried through the placental barrier and consequently affect the offspring. This may make resuscitation efforts more difficult. For example, acepromazine, ketamine and atropine can flow through the placenta, so they should be avoided. Glycopyrrolate, if needed, is a better choice than atropine. Choosing an anesthesia protocol that is safe for a caesarean patient is tricky at best. Because hypoxia is a concern for the patient and the neonates, pre-oxygenation for five to 10 minutes is an important precaution. Patients are then intubated and placed on isoflurane or sevoflurane and oxygen. …
Pet C-Section ChecklistJuly 25, 2014 This article first appeared in the July 2013 issue of Veterinary Practice News. Read the first part here. Secrets To A Happy C-Section Be prepared and work quickly. Preparation and speed count. Correct hypotension and any acid-base and electrolyte imbalances. Create two or three teams: surgery/anesthesia and “baby resuscitators.” Withhold analgesia until after babies have been delivered. C-section Risk Factors A large study found seven factors that negatively affect survival of canine neonates. They are: emergency (as opposed to elective) surgery brachycephalic breed more than four puppies a few puppies had a natural delivery some puppies were malformed xylazine was used some puppies had difficulty breathing spontaneously or didn’t cry at birth Factors that improved the outcome included using propofol and not using halothane. C-section Checklist An experienced team will gather as many supplies as possible before a C-section. Here is a non-exhaustive checklist. Anesthesia Team Paperwork (records, forms) Complete list of pre-calculated drug dosages Various syringes and needles Various endotracheal tubes Laryngoscope Surgery Team Surgical blades Scrubbing supplies Extra gauze squares and lap sponges Sterile towels Suction (machine, hose and tip) Warm irrigation fluids Towels on the floor to help cleaning up Suture material …
4 Steps To A Safer Pet C-SectionJuly 25, 2014 This article first appeared in the July 2013 issue of Veterinary Practice News A C-section can be a stressful and chaotic nightmare, or it can be a wonderful and uplifting experience. In this article, part one of three, we will share 10 steps to become better equipped for your next C-section. Our goal is to save the offspring—and of course keep the dam safe. 1) Preparation & Teamwork A successful C-section requires teamwork at its best. This should include pet owners, who should be educated during any pregnancy —especially those at risk — so they know what to expect and when veterinary assistance might be needed. What is normal? What is abnormal? When might a C-section be necessary? When should they call if they think a C-section is required, so you can be ready? Many late night or early morning emergency C-sections could be avoided if more time were spent educating clients. Understanding the client’s wishes is a critical part of the discussion. Does he want the pet spayed? Can she afford another C-section? Can he properly care for another 12 puppies while working two jobs? Does the world really need more hydrocephalic Chihuahuas …
Scrub in or rub in?January 30, 2014 Dr. John Smith is getting ready for his first surgery of the day. He puts on his cap and mask, adjusts them methodically, and starts to rigorously prepare his hands for surgery. He grabs a brush soaked with chlorhexidine scrub and goes to work, as if it were a ritual: First his fingers, then the palm of each hand, then the back, then his wrists, then his forearms, for a full five minutes, just like he has been doing for the past 15 years as a surgeon. Sounds perfectly acceptable, doesn't it? What Dr. Smith doesn't know is that his surgical scrub routine is actually detrimental to the health of his hands, increases the likelihood of contamination, and puts him at risk of developing occupational dermatitis. Meanwhile, Dr. Denis Verwilghen of Copenhagen, Denmark, is getting ready for his first surgery of the day. He puts on his cap and mask, adjusts them methodically, and starts to rigorously prepare his hands for surgery. He first gently washes his hands with a mild, non-medicated soap, dries them with a non-sterile paper towel, and then meticulously rubs a hydroalcoholic solution on his hands and arms for a couple of minutes — until they are …
