Journal Papers: PORV in dogs, Lactate in cats, and 'All in a tangle'

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Davies JA, Fransson BA, Davis AM, et al. Incidence of and risk factors for postoperative regurgitation and vomiting in dogs: 244 cases (2000–2012). J Am Vet Med Assoc 2015. 246(3):327-335.


Objective — To determine the incidence of and risk factors for postoperative regurgitation and vomiting (PORV) in dogs.
Design — Retrospective cohort study.
Animals — 244 client-owned dogs.

Procedures — Dogs referred for nonelective surgery in the first 3 months of 2000 and 2012 were included. Breed; sex; age; weight; body condition score; emergency status; food withholding status; history of vomiting or regurgitation; American Society of Anesthesiologists score; presence of diabetes or hypothyroidism; preoperative PCV and total solids concentration; anesthesia protocol; corticosteroid, opioid, neuromuscular blocking agent, and nitrous oxide usage; anesthesia time; surgery time; type of surgery; and occurrence of vomiting or regurgitation within 24 hours after recovery from anesthesia were recorded. Data were analyzed by means of the Fisher exact test, Wilcoxon rank sum test, and logistic regression.

Results — 30 of 244 (12.3%) dogs meeting study inclusion criteria developed PORV. There was no significant difference in the incidence of PORV between the 2000 (12/111 [10.8%]) and 2012 (18/133 [13.5%]) cohorts, although the incidence of regurgitation was higher in 2012. Univariate logistic regression identified the most significant risk factors as gastrointestinal surgery (OR, 11.15; 95% confidence interval [CI], 3.11 to 40.03), premedication without strong sedatives including either an α2-adrenoceptor agonist or acepromazine (OR, 5.36; 95% CI, 1.89 to 15.17), American Society of Anesthesiologists score of 4 (OR, 5.25; 95% CI, 1.05 to 26.15), history of vomiting or regurgitation (OR, 5.12; 95% CI, 1.83 to 14.31), emergency surgery (OR, 4.08; 95% CI, 1.29 to 12.90), neurologic surgery (OR, 3.18; 95% CI, 1.02 to 9.92), sevoflurane inhalation anesthesia (OR, 2.78; 95% CI, 1.25 to 6.13), and being sexually intact (OR, 2.37; 95% CI, 1.07 to 5.27). Multivariate analysis was not clinically useful owing to the low sensitivity and specificity of the model.

Conclusions and Clinical Relevance — Between 2000 and 2012, there was no change in the incidence of PORV for dogs undergoing neurologic, orthopedic, and soft tissue surgical procedures; however, the proportion of dogs that regurgitated increased significantly in 2012. Preoperative antiemetic prophylaxis should be considered in dogs undergoing gastrointestinal surgery and in those in which other risk factors are present.

Reineke EL, Rees C, Drobatz KJ. Association of blood lactate concentration with physical perfusion variables, blood pressure, and outcome for cats treated at an emergency service. J Am Vet Med Assoc 2015. 247(1):79-84.


Objective —To determine the association of blood lactate concentration with physically assessed perfusion variables, systolic arterial blood pressure (SAP), and outcome in cats evaluated by an emergency service.
Design — Prospective, observational study.
Animals — 111 cats.

Procedures — Initial blood lactate concentration and SAP (prior to any therapeutic interventions) as well as physically assessed perfusion variables (mucous membrane color, capillary refill time, peripheral pulse quality, heart rate, and rectal temperature) were determined. Cats were categorized as having no shock, mild to moderate shock, or severe shock. Outcomes were recorded. Associations between lactate concentration and these variables were assessed.

Results — Median initial blood lactate concentration was 2.7 mmol/L (range, 0.5 to 19.3 mmol/L); cats with white mucous membranes, abnormal peripheral pulse quality, and hypothermia had significantly higher lactate concentration than did cats without these findings. Median lactate concentration for cats with SAP < 90 mm Hg (3.3 mmol/L) was significantly higher than that of cats with SAP ≥ 90 mm Hg (2.35 mmol/L). Cats with severe shock had significantly higher lactate concentration (4.3 mmol/L) than did cats in other shock categories. Median initial lactate concentration at admission did not differ between cats that did (2.45 mmol/L) and did not (3.2 mmol/L) survive to discharge from the hospital. Change in lactate concentration during hospitalization (when applicable) was not associated with outcome.

Conclusions and Clinical Relevance — Findings indicated that blood lactate concentration, together with physical examination findings and SAP, may be a useful tool for identifying abnormalities in tissue oxygen delivery in cats. However, lactate concentrations were not associated with outcome in the present study.

Boveri S, Brearley JC. All in a tangle: a mishap with an oesophagostomy tube in an intubated cat. Vet Anaes Analg 2015. 42(2):227-229.

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