This article reviews the previous reports of post-anaesthetic spinal cord myelomalacia (PSCM) in horses and summarises the speculated pathogenesis, potential risk factors, clinical signs, differential diagnosis, histopathology findings, treatment and prognosis of this post-anaesthetic complication. Furthermore, a clinical case of suspected PSCM is presented.
Background Erector spinae plane block (ESPB) is an ultrasound-guided interfascial plane block used to provide analgesia in dogs undergoing hemilaminectomy. The aim of this study is to compare the analgesic efficacy of a bilateral ESPB with a fentanyl constant rate infusion (CRI) in dogs undergoing hemilaminectomy. Methods This is a retrospective cohort study. Anaesthetic records of client-owned dogs undergoing hemilaminectomy (June 2019–August 2020), and in which a bilateral ESPB was performed (group ESPB), were retrieved and compared to a cohort of 39 dogs that underwent hemilaminectomy (September 2014 – June 2017) and in which a fentanyl CRI (2 μg/kg bolus followed by 5 μg/kg/hour) was used as a primary intraoperative analgesia (group CRI). The prevalence of dogs in which intraoperative rescue fentanyl boluses were administered, the total dose of rescue fentanyl boluses administered, the postoperative methadone requirement and anaesthetic complications during the first 24 postoperative hours were evaluated. Univariate statistical analysis was used. Results Group ESPB comprised of 93 dogs. The bilateral ESPB was performed using a median (range) levobupivacaine volume of 1 (0.5–1.7) mL/kg per side, at a concentration of 0.125% (0.12–0.25). At least one rescue fentanyl bolus was administered in 54.8% and in 56.4% of dogs in group ESPB and CRI, respectively (p > 0.99). The number of rescue fentanyl boluses was higher in group CRI (p = 0.006), especially during lumbar hemilaminectomy. Rescue fentanyl boluses were more frequently administered from skin incision to end of vertebral lamina drilling in group CRI (p = 0.001), and from end of vertebral lamina drilling to end of surgery in group ESPB (p = 0.0002). During the first 6 (p = 0.0035) and 6–12 (p = 0.0005) postoperative hours, the number of dogs that required at least one dose of methadone was higher in group CRI. In group ESPB, dogs were more likely to become hypothermic (p = 0.04). One dog, not included in the study, developed sinus arrest after performing a caudal thoracic ESPB. Conclusions Under the conditions of this study, a bilateral ESPB was associated with a lower number of rescue fentanyl boluses administered in dogs undergoing hemilaminectomy, especially between skin incision to end of vertebral lamina drilling. Despite ESPB being associated with a reduced opioid consumption during the first 12 hours postoperatively, differences in the postoperative management precluded any firm conclusion regarding its postoperative effect.
Objective The aim of this study was to retrospectively evaluate the success rate and perioperative complications of lumbosacral extradural anaesthesia in dogs undergoing total hip replacement. Study Design Records of dogs undergoing total hip replacement in which lumbosacral extradural anaesthesia with 0.5% levo- or bupivacaine combined with either morphine or buprenorphine were retrieved. Success rate was defined as intraoperative fentanyl consumption <1 μg/kg/h with no intravenous infusion of other analgesic drugs and no additional morphine/methadone within the first 3 hours from premedication. Prevalence of intraoperative anaesthetic and postoperative surgical complications was calculated. Results Overall, 206 dogs were included in the study. Success rate was 88.7%. Hypercapnia (75.2%), hypotension (46.1%), hypothermia (27.7%) and regurgitation (6.3%) were recorded during anaesthesia. Within 24 hours post-surgery, urinary retention (17.8%), vomiting/regurgitation/diarrhea (8.2%) and sciatic neurapraxia of the operated limb (5.8%) were recorded. Luxation of the operated hip occurred at 48 and 72 hours after surgery in two dogs and one dog respectively. One dog had cardiopulmonary arrest at 52 hours after surgery. Conclusion While hypercapnia, hypotension and hypothermia might develop intraoperatively, the high success rate and the relatively low prevalence of postoperative surgical complications directly associated with lumbosacral extradural anaesthesia justify its use in dogs undergoing total hip replacement.
An 11-year-old, 22 kg, male neutered English Staffordshire Bull Terrier, in which a pheochromocytoma was removed from the left retroperitoneal space, was referred to investigate the regrowth of a mass in the same region. A neuroendocrine tumour, compatible with pheochromocytoma, was cytologically diagnosed after ultrasound-guided fine-needle aspirates, and the dog underwent explorative celiotomy. A combination of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion was used intraoperatively to control nociception and potential haemodynamic changes caused by sudden catecholamines release. Postoperative analgesia was provided by administering 0.12% levobupivacaine through the thoracic epidural catheter and oral paracetamol and gabapentin. Postoperative methadone was administered twice during the first 24 postoperative hours only. Two days after the surgery, the dog was anaemic and packed red blood cells were administered. No other complications occurred, and the dog was discharged from the hospital 5 days following surgery. INVESTIGATIONSAbnormalities found on blood analysis are reported in Table 1. Prothrombin time was 6.0 seconds [reference interval (r.i.), 7.0-12.0], activated partial thromboplastin time was 16.0 seconds (r.i., 15.0-25.0). The blood type was dog erythrocyte antigen (DEA) 1.1-negative. In addition to CT findings, an abdominal ultrasound (US) showed nodular hepatopathy, bilateral chronic nephropathy, left mild hydronephrosis. The mass was
A 6‐month‐old, 4 kg, male pomeranian, was referred for investigations of a heart murmur found during a routine clinical examination. A severe valvular pulmonic stenosis was diagnosed and medical management with atenolol was started. One month later, the dog underwent percutaneous balloon valvuloplasty. Anaesthesia was maintained with propofol‐dexmedetomidine continuous infusion, and a minimally invasive cardiac output monitor was used to assess haemodynamic variations. Intraoperatively, lidocaine was started because the frequency of the premature ventricular complexes increased before ballooning. A reduction in pressure gradient across the pulmonic valve was achieved. No other intraoperative complications were recorded. Recovery from general anaesthesia was uneventful, and the dog was discharged from the hospital 26 hours following the procedure.
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