SummaryReasons for performing study: Infections are common complications in post operative colic patients. It is the impression of some surgeons that pyrexia in the early post operative period is a sign of infection and appropriate timing of perioperative antimicrobials will decrease the incidence of post operative infection. Objective: To determine the association between 1) post operative pyrexia and development of infection and 2) perioperative antimicrobial drug use and infection rate in post operative colic patients. Methods: Medical records of patients undergoing surgical treatment for colic were reviewed. Horses recovering from surgery and surviving >48 h were included. Data relating to case details, duration of surgery, post operative infection, peri-and post operative antimicrobial administration, presence, intensity and duration of pyrexia, were recorded. Data were analysed using standard statistical methods for simple comparisons between groups and by logistic regression for more complex comparisons. Results: One-hundred-and-thirteen horses were included in the final analyses, 48 (43%) of which were diagnosed with a post operative infection. Duration of surgery and anaesthesia were associated with post operative infection. Eighty-five percent of horses (n = 96) exhibited pyrexia (rectal temperature >38.3°C) post operatively. Peak temperature >39.2°C, time post surgery to peak temperature >48 h and duration of pyrexia >48 h were significantly associated with infection. In a combined model, time to first pyrexic >48 h post surgery, peak temperature and time to peak >48 h were equally weighted and the model's positive predictive value for post operative infection was 72%. Timing and dose rate of preoperative antimicrobials were not associated with infection but duration of post operative antimicrobial drug use was. Conclusion and clinical relevance: Slight to mild pyrexia (38-39.4°C) in the early post operative period is not necessarily associated with impending bacterial infection in colic patients and the use of antimicrobials in these patients may be costly and unnecessary.

Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.

We do not recommend adding clonidine (2 microg.kg(-1)) to a bupivacaine (0.125%) caudal block in children undergoing surgery.

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Background: Monitored Anesthesia Care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA for TAVR at a single center Veterans Affairs Medical Center. Methods: A single-center retrospective review of 349 patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from January 2014 to December 2019 was performed. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS) and cost, total LOS, hospital cost, total cost, and complication rates were collected. Propensity matching was performed and resulted in 83 matched pairs. Results: In the unmatched TAVR cohort, MAC TAVR was associated with reduced OR time (146 vs. 198 minutes, P < .0001), ICU LOS (1.4 vs. 1.8 days, P < 0.0001), total hospital LOS (3.4 vs. 5.4 days, P < .0001), and lower index total cost ($81,3000 vs. $85,400, P = .010). After propensity matching, MAC TAVR patients had reduced OR time (146 vs. 196 minutes, P < 0.05), ICU LOS (1.2 vs. 1.7 days, P = .006), total LOS (3.5 vs. 5.1 days, P = .001), and 180-day mortality (2.4% vs. 12%, P < 0.03). There was no difference in total hospitalization cost or total cost. Conclusions: In propensity matched groups, TAVR utilizing MAC is associated with improved OR time efficiency, decreased LOS, and a reduction in 180-day mortality, but no significant difference in cost.