Adverse event surveillance in small animal anaesthesia: an intervention-based, voluntary reporting audit

McMillan, Matt; Darcy, Hannah

doi:10.1111/vaa.12309

Cited by 30 publications

(21 citation statements)

References 23 publications

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“…The incidence of peri-operative hypotension in dogs undergoing cholecystectomy in this study population was 53.4%. Whilst this is higher than the rate of 7-10.3% reported in general small animal anaesthesia (Gaynor et al 1999, Mcmillan & Darcy 2016, it is much lower than previously reported rates of hypotension in dogs undergoing cholecystectomy, which reached 74% in one study (Burns et al 2014). The reasons a patient may develop hypotension during anaesthesia are often complex and multifactorial.…”

Section: Discussionmentioning

confidence: 52%

Impact of intra‐operative hypotension on mortality rates and post‐operative complications in dogs undergoing cholecystectomy

Hattersley¹,

Downing²,

Demetriou³

et al. 2020

J of Small Animal Practice

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To report the mortality rate within a cohort of dogs undergoing cholecystectomy and investigate the impact of intra-operative hypotension on mortality. Materials and MethOds: Clinical records at five UK referral centres were reviewed for dogs undergoing cholecystectomy. Data collected included presenting signs, pre-operative blood test results, intra-operative data including frequency and duration of hypotension and the incidence and type of post-operative complications. results: Data from 119 dogs were included. Sixteen dogs (13%) died before discharge and by 28 days after surgery the total mortality was 19 dogs (17%). Hypotension lasting over 10 minutes during general anaesthesia occurred in 65 dogs (54.6%), with a mean ± sd duration of 36.1 ± 30.0 minutes. Intra-operative hypotension or the number of hypotensive episodes did not appear to be associated with in-hospital or 28-day mortality. American Society of Anaesthesiologists grade (of fitness for surgery) was significantly associated with both in-hospital and 28-day mortality on univariable analysis, as were post-operative hypoproteinaemia, ileus and pancreatitis. However on multivariable analysis, only ileus and pancreatitis were found to significantly impact mortality.

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Section: Discussionmentioning

confidence: 52%

Impact of intra‐operative hypotension on mortality rates and post‐operative complications in dogs undergoing cholecystectomy

Hattersley¹,

Downing²,

Demetriou³

et al. 2020

J of Small Animal Practice

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“…This approach has been used for decades in audits of livestock slaughter through reporting of parameters such as the proportion of cattle that are not rendered immediately insensible via stunning [20–22]. Monitoring of adverse event data is also used in veterinary medicine to assess the safety and efficacy of registered therapeutic chemicals [23] and anaesthetic procedures [24]. Reporting such data allows identification of techniques that produce favourable animal welfare outcomes when compared with those that do not and can facilitate the development of evidence-based ‘best practice’ guidelines [25].…”

Section: Introductionmentioning

confidence: 99%

How many to sample? Statistical guidelines for monitoring animal welfare outcomes

2019

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There is increasing scrutiny of the animal welfare impacts of all animal use activities, including agriculture, the keeping of companion animals, racing and entertainment, research and laboratory use, and wildlife management programs. A common objective of animal welfare monitoring is to quantify the frequency of adverse animal events (e.g., injuries or mortalities). The frequency of such events can be used to provide pass/fail grades for animal use activities relative to a defined threshold and to identify areas for improvement through research. A critical question in these situations is how many animals should be sampled? There are, however, few guidelines available for data collection or analysis, and consequently sample sizes can be highly variable. To address this question, we first evaluated the effect of sample size on precision and statistical power in reporting the frequency of adverse animal welfare outcomes. We next used these findings to assess the precision of published animal welfare investigations for a range of contentious animal use activities, including livestock transport, horse racing, and wildlife harvesting and capture. Finally, we evaluated the sample sizes required for comparing observed outcomes with specified standards through hypothesis testing. Our simulations revealed that the sample sizes required for reasonable levels of precision (i.e., proportional distance to the upper confidence interval limit (δ) of ≤ 0.50) are greater than those that have been commonly used for animal welfare assessments (i.e., >300). Larger sample sizes are required for adverse events with low frequency (i.e., <5%). For comparison with a required threshold standard, even larger samples sizes are required. We present guidelines, and an online calculator, for minimum sample sizes for use in future animal welfare assessments of animal management and research programs.

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“…Indeed, the adverse events associated with anesthetizing animals, although similar to those reported in humans, are far more common than reported for humans ( 1 – 4 ). A recent study investigating adverse events associated with anesthesia in dogs and cats suggested that approximately 40% of animals had at least one adverse event and as many as 1% had up to six adverse events ( 5 ). Anesthetic death is reported to occur in approximately 0.5, 1.0, and 10 in every 1,000 anesthetic episodes in otherwise healthy dogs, cats, and horses, respectively ( 6 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…Species differences aside, the incidence of adverse events, including intraoperative cardiac arrest, is considerably greater in animals than in humans ( 2 , 8 , 9 , 11 ). Reemergence from anesthesia, breakthrough pain, hypoventilation, respiratory arrest, airway complications, and hypotension are comparatively common adverse events reported in dogs, cats, and horses ( 5 , 8 , 10 , 11 ). Anesthesia-associated hypotension is frequently attributed to a decrease in ventricular contractile performance, arterial vasodilation, or both ( 5 , 10 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…Reemergence from anesthesia, breakthrough pain, hypoventilation, respiratory arrest, airway complications, and hypotension are comparatively common adverse events reported in dogs, cats, and horses ( 5 , 8 , 10 , 11 ). Anesthesia-associated hypotension is frequently attributed to a decrease in ventricular contractile performance, arterial vasodilation, or both ( 5 , 10 – 14 ). Far less emphasis has been placed upon alterations in venous physiology or the effects of anesthetic drugs on the venous system’s contribution to cardiac output (CO).…”

Section: Introductionmentioning

confidence: 99%

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Anesthesia-Associated Relative Hypovolemia: Mechanisms, Monitoring, and Treatment Considerations

Noel-Morgan

Muir

2018

Front. Vet. Sci.

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Although the utility and benefits of anesthesia and analgesia are irrefutable, their practice is not void of risks. Almost all drugs that produce anesthesia endanger cardiovascular stability by producing dose-dependent impairment of cardiac function, vascular reactivity, and compensatory autoregulatory responses. Whereas anesthesia-related depression of cardiac performance and arterial vasodilation are well recognized adverse effects contributing to anesthetic risk, far less emphasis has been placed on effects impacting venous physiology and venous return. The venous circulation, containing about 65–70% of the total blood volume, is a pivotal contributor to stroke volume and cardiac output. Vasodilation, particularly venodilation, is the primary cause of relative hypovolemia produced by anesthetic drugs and is often associated with increased venous compliance, decreased venous return, and reduced response to vasoactive substances. Depending on factors such as patient status and monitoring, a state of relative hypovolemia may remain clinically undetected, with impending consequences owing to impaired oxygen delivery and tissue perfusion. Concurrent processes related to comorbidities, hypothermia, inflammation, trauma, sepsis, or other causes of hemodynamic or metabolic compromise, may further exacerbate the condition. Despite scientific and technological advances, clinical monitoring and treatment of relative hypovolemia still pose relevant challenges to the anesthesiologist. This short perspective seeks to define relative hypovolemia, describe the venous system’s role in supporting normal cardiovascular function, characterize effects of anesthetic drugs on venous physiology, and address current considerations and challenges for monitoring and treatment of relative hypovolemia, with focus on insights for future therapies.

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Adverse event surveillance in small animal anaesthesia: an intervention-based, voluntary reporting audit

Cited by 30 publications

References 23 publications

Impact of intra‐operative hypotension on mortality rates and post‐operative complications in dogs undergoing cholecystectomy

Impact of intra‐operative hypotension on mortality rates and post‐operative complications in dogs undergoing cholecystectomy

How many to sample? Statistical guidelines for monitoring animal welfare outcomes

Anesthesia-Associated Relative Hypovolemia: Mechanisms, Monitoring, and Treatment Considerations

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