Vets on the Balkans - an online journal for veterinarians from the Balkans

WSAVA Alerts to Emerging ‘Canine Welfare Crisis’ Caused by the Popularity of Short-Nosed Breeds

January 29, 2023

Veterinarians around the world are warning about an emerging canine welfare crisis caused by the rapidly increasing number of short-nosed (brachycephalic) dogs. These dogs can have exaggerated anatomical features that can seriously affect their health and well-being. The most concerning of the health issues they face is Brachycephalic Obstructive Airway Syndrome (BOAS).

The Hereditary Disease Committee (HDC) of the World Small Animal Veterinary Association (WSAVA) has produced an educational video highlighting the problems that BOAS can cause in brachycephalic breeds, including French bulldogs, English bulldogs, and pugs. During the video, members of the WSAVA HDC and other experts explain how the appearance of short-nosed breeds has been affected by breeding for extreme and exaggerated anatomical conformation. While dogs which snore or pant are considered cute by some, the experts point out that these traits are not normal and that the dogs are, in fact, struggling to breathe. Many short-nosed dogs require surgery to survive and have a significantly shorter lifespan than other dogs.

Speaking during the video, Dr Peter Sandøe, Director of the Centre for Companion Animal Welfare at the University of Copenhagen, says: “With French bulldogs now the most popular breed in many countries and with English bulldogs and pugs also very popular, the number of affected dogs is increasing dramatically. Selective breeding for an exaggerated short nose has created dogs whose health, in many cases, is compromised for the sake of perceived ‘cuteness’. It is simply unethical to breed dogs which struggle to breathe.”

The WSAVA Hereditary Disease Committee is calling on all stakeholders – breeders, owners, veterinarians, media, regulators, and others – to work together to improve the welfare of these breeds going forward, and change perceptions of what ‘healthy’ looks like in these dogs.

It urges them to work together on health-focused breeding initiatives to produce dogs with less exaggerated anatomical features so that BOAS and other related health issues are not passed on. The selective breeding which caused these problems in the first place, can return these breeds to better respiratory health by selecting for more moderate anatomical conformation and for normal breathing. Many kennel clubs have instituted Respiratory Function Grading (RFG) to screen prospective breeding dogs against BOAS. If RFG screening is not available, prospective breeding dogs should be able to go on a brisk three-minute walk without laboring to breathe. If they cannot do this, they should not be used for breeding.

The need for a united approach is reinforced by WSAVA HDC member Dr Monique Megens, who contributes to the video explaining that brachycephalic dogs are bred – legally and illegally – around the world and transported across borders so a global approach is the only way to make progress.

The 17-minute video, available in several languages, also features contributions from:

Dr Jerold Bell, Chair of the WSAVA HDC, Cummings School of Veterinary Medicine, Tufts University, USA
Dr Åke Hedhammar, WSAVA HDC member, Senior Professor in Internal Medicine at the University of Agricultural Sciences, Uppsala, Sweden
Dr Jane Ladlow, Clinical Lead of the BOAS Research Group, Cambridge University, UK

Dr Bell said: “Breeders did not purposefully select for dogs with impaired breathing but there is no doubt that breeding to create dogs with ever shorter muzzles has created serious health issues in these breeds.

“We hope our video will help educate breeders, owners, and all of those involved in or influencing the breeding and care of short-nosed dogs. We also hope it will give them useful advice on the steps they can take to help as we work together to resolve a serious welfare issue. All dogs deserve to live healthy lives. We must not let them down.”

The video can be seen here: https://bit.ly/3HmL5fk

The WSAVA represents more than 200,000 veterinarians worldwide through its 115 member associations and works to enhance standards of clinical care for companion animals. Its core activities include the development of WSAVA Global Guidelines in key areas of veterinary practice, including pain management, nutrition and vaccination, together with lobbying on important issues affecting companion animal care worldwide.

The WSAVA Hereditary Disease Committee aims to facilitate clinician diagnoses, treatment and control of hereditary diseases and genetic predispositions in dogs and cats, thereby improving the health of patients now and in future generations.

Latest WSAVA Global Pain Management Guidelines Launched

November 7, 2022

Updated recommendations and resources for pain assessment and management to support veterinary teams now available

An updated set of Global Guidelines for the Recognition, Assessment and Treatment of Pain, which incorporate advances in knowledge and novel evidence, have been launched by the World Small Animal Veterinary Association’s (WSAVA’s) Global Pain Council (GPC) during its annual World Congress in Lima, Peru. WSAVA association member representatives gave enthusiastic support to the new Guidelines, with many signing up to support the GPC’s pledge to improve pain management in companion animals.

Following peer-review, the new Guidelines have been published by the Journal of Small Animal Practice (JSAP), the WSAVA’s official scientific journal, and are available for free download from the WSAVA website and from the JSAP website.

A key feature of the Guidelines is an emphasis on the use of pain scales for the assessment of acute and chronic pain in companion animals. They provide guidance, for instance, on selecting the most effective pain assessment tool based on the condition of the patient and scientific evidence, with links to relevant tools also provided.

In terms of pain management, the Guidelines take into account novel evidence regarding the efficacy and safety of both drug and non-drug therapies. For example, they evaluate the performance of new pharmaceuticals, including monoclonal antibodies, or those with new delivery systems, and evidence regarding the use of cannabinoids for chronic pain. They also discuss the use of non-drug therapies, including acupuncture – evidence of efficacy of which has increased in certain pain conditions. The Guidelines also stress that euthanasia should always be considered in cases where pain cannot be effectively managed and quality of life is poor.

Greater attention is paid to the role of emotions on the perception of pain in the Guidelines. It is now recognized that fear and stress can increase the perception of pain in animals so the document includes recommendations as to how to improve the experience of hospitalized patients, as well as giving advice to support the welfare of animals living with chronic pain and primarily managed by their caregivers at home.

The format of the Guidelines has been enhanced for this version to increase the accessibility of information with an increased use of visuals and graphics. Links to recommended tools are provided, as well as links to videos and additional resources for those wanting to further their knowledge.

A priority for the WSAVA is to provide Guidelines that are globally relevant. For the GPC, this means supporting veterinarians in regions with restricted access to analgesic drugs in working around the limitations they face. To help them, the Guidelines offer tiered protocols and highlight the role of local anesthetic techniques that don’t require additional training, together with the role of non-drug therapies to manage pain such as cold/ice therapy and the provision of a comfortable and safe environment to patients. They also discuss the importance of nursing and supportive care.

The Guidelines are currently available in English with translation into Spanish, Portuguese, Chinese and other languages underway.

Commenting on the launch of the updated Global Guidelines for the Recognition, Assessment and Treatment of Pain, Dr Bea Monteiro, GPC Chair, said: “Pain management is an area of veterinary medicine in which knowledge and understanding has expanded dramatically in recent years. Members of the GPC have worked tirelessly to pull together these latest WSAVA Guidelines, which now provide the most comprehensive and state-of-the-art resource available to support veterinary professionals, wherever in the world they are in practice.

“With animal sentience now legally recognized in many countries and jurisdictions, veterinary health professionals have a medical and ethical duty to mitigate suffering to the best of our ability. Despite the advances in pain management, pain still occurs more commonly than it is treated. We hope that these Guidelines will help colleagues understand the importance of pain management for patient health and welfare and that they will commit to:

Frequently assess pain in every patient
Taking measures to prevent pain and other negative emotions (such as fear and anxiety)
Treat pain using drug or non-drug therapies.”

The work of the GPC is generously supported by Zoetis.

“At Zoetis, we are committed to ongoing innovation, and we have long history of providing medications, tools/resources and educational initiatives to help veterinarians diagnose and manage pain in pets more effectively,” said Dr Mike McFarland, chief medical officer at Zoetis. “Pain has broad negative impacts on an animal’s health, causes suffering and lowers quality of life. Because we know that pain can lower quality of life and disrupt the important human-animal bond which benefits people and the pets they love, it’s important to ensure veterinarians around the world have access to solutions that can help better diagnose and alleviate pain in animals.”

The goal of the WSAVA Global Pain Council, comprising a team of global experts, is to create a global environment for companion animals in which pain is considered as the fourth vital sign and addressed appropriately. Its first Global Guidelines were published in JSAP in 2014 and have been downloaded from its website 53,000 times.

West Nile Virus detection in Ural owl

October 16, 2022

Dr Plamen Kirov

(case report)

Dr. Plamen M. Kirov, DVM,

Anamaria Manolea, A.S.P.A.D.A. Timisoara – Romania

Introduction

West Nile Virus (WNV) is a single strained RNA virus from the genus Flavivirus. It was discovered for the first time in 1937 in Uganda, causing zoonotic West Nile fever in affected animals and humans. The natural host for the virus are birds, mostly corvids(crows, ravens, and blue jays) and raptors. The disease is vector-borne and distributed by mosquitoes. It is discovered that 80% of the cases are asymptomatic, 20% become symptomatic, and mortality in birds could reach between 20 and 60%. It is agreed that the disease is a considerable factor in corvids population reduction. The mosquitoes transmit the virus by feeding infected blood and then transiting it to uninfected ones. Raptors can get infected by consuming infected chicks or birds. Between humans, the virus can be transmitted by blood or organ transfer, vertically, but not via direct contact.

Clinical signs can vary widely from non to death, with a high dependency on the species affected. Of the mammals only humans and horses show clinical signs – WNV was detected in many domestic and wild mammals, but no cases of the disease were registered. Birds with WNV demonstrate neurological signs – tremors, weakness, loss of coordination, head tilt, lethargy, blindness, and characteristic position of the legs at death.

Balkan countries by having long periods of hot weather and the presence of a lot of water sources (rivers, lakes, marshes, etc.) are the perfect environments for mosquitoes from Aedes(incl. Tiger mosquito) and Calex spp.

Clinical case

An adult Ural owl (Strix uralensis) was found by people in a passing car on rural road in Lugoj area (Timis county). The bird was in lethargic state, with difficult breathing and incoordination of movements of legs and wings.

Physical examination

During the physical examination no feather or tegument abnormalities or signs of trauma were found. Body temperature was elevated to +42oC. The bird was lethargic with difficulties to walk. The appetite appeared to be normal. Clinical diagnostic tests From the bird were taken a venous blood sample from the brachial vein, fecal, and nasopharyngeal probes. Using a panel of tests, bacterial and parasitic diseases were excluded. Since cases of WNV are detected annually in Romania and neighboring countries (Serbia and Hungary), the virological panel included West Nile Virus testing. The results obtained using epitome-binding ELISA, with a sensitivity rate of 98% for WNV antigen, are shown in Table 1.

Table 1

From the obtained results we concluded that the bird is in acute state of West Nile fewer. After consulting with the local veterinary authority, the bird was kept in enclosed environment and treated with Meloxicam per os. We did a second test after a week and another one week later. The third test went negative by showing an absence of viral antigen in the three samples – nasopharyngeal, fecal, and blood. Besides the negative results and complete recovery of the bird, it was transferred to a sanctuary where will remain for a few months and eventually released back into nature in 2023

One Medicine, One Love, One Hope

September 7, 2022

Dr Denica Djodjeva

Blue Cross Veterinary Clinic

Sofia, Bulgaria

I was extremely impressed with my visit to Fitzpatrick Referrals , UK. I initially visited the Soft Tissue Surgery and Oncology Hospital in Guilford. My colleague from Bulgaria, Ivan Kalmukov, who is a graduating resident in surgery and a great guy, had informed everyone about my visit. I am extremely grateful to him, for that, because otherwise without his help my visit would not have taken place.

On the first day, I was greeted by the surgical specialists, who showed me around the hospital and helped me going deeper in the working environment there. They introduced me to a large part of the team. Since my main professional interests are anesthesiology and critical care, I was also introduced to the head of anaesthesia – Daisy. She is a very nice young lady and immediately engaged me with blood gas analysis problems to solve. From day one, I was already aboard. Unfortunately, there were not so many procedures and operations, but for me it was perfect, because I had time to orient myself in the environment and get to know the team. In the following days, the things continued in another direction and I was able to feel the workload of the clinic. In between the many duties and busy workload, everyone talks calmly, without unnecessary emotions and fulfills their duties. In general, a pleasant working atmosphere. I was left with the impression of a great team in which everyone helps each other and has each other’s back. Needless to say, the professionalism with which all operations and procedures are performed.

The attitude they have towards the animals is great and my question “Don’t the dogs bite here?” was completely unnecessary. Collars and other protective devices were only used for very aggressive animals. Each one of them was spoken to calmly and there was always a person next to him to reduce the stress of the unfamiliar environment and people. In the postoperative period, each patient is strictly monitored and waited until is completely recovered from anaesthesia. After that, it is accompanied to thd e waror goes to see the owners, who are already waiting for him in one of the consult rooms.

In my last days, I was able to visit and the other referral centre, for Orthopedics and Neurosurgery in Godalming. I participated in every procedure closely related to my interests in anesthesia and there was always someone to explain everything about it to me. Unfortinately I was not allowed to practice, because I am not a licensed veterinarian in the UK. In my last days, I attended many operations during which I saw some innovative practices, one of which was on a cat with fractured vertebrae. My colleague Ivan was one of the surgeons. The next day, the animal was already walking.

Although there were inexperienced colleagues, they always found support in dealing with daily tasks and everyone celebrated their small victories.

During this one week, I learned a lot, I saw the high level of medicine that is being worked on, and I hope I will be able to apply this to my work in Bulgaria or at least some part of it. I am extremely happy for this opportunity and am very grateful to Ivan for helping to make this happen. My experience at both hospitals was a once in a lifetime. I hope I am wrong and have the opportunity to visit them again.

Management of chronic non-healing wounds over the calcaneal tuberosity in a Sphinx cat

July 2, 2022

Diana Anghelescu DVM

Georgiana Ciochina DVM

Florin Cristian Delureanu DVM, MRCVS, OCQ(V)

February 2022

Abstract

Wounds that fail to heal through the normal healing phases in a routine timely manner are classed as chronic wounds. Factors like improper nutrition, hypovolemia, anemia, infection, excessive motion and endocrinopathies contribute to delay wound healing. The patient presented with chronic bilateral wounds over the calcaneal extremities without progression after approximately two months of conservative management consisting of local bandaging techniques. Therefore, a surgical approach was used to close both defects. In order to achieve closure of these particular lesions, a single releasing incision was utilized. After surgery the patient was hospitalized for 10 days and a “donut type” bandage was used to minimize the local trauma. The sutures were removed at 21 days after surgical intervention.

Key words: Chronic wound, “donut-type” bandage, calcaneal extremities.

Signalment and history

A six months old Sphinx cat weighing 2.1 kg was brought for a second opinion in december 2021 because of non-healing wounds at the calcaneal extremities. It was not clear the cause of these lesions but the owner noted a slowly progression of the wounds in approximately one month. At the initial veterinary practice the patient was locally treated with an antibacterial-steroid based ointment which was applied twice a day and a light bandage to cover the wounds. Afterwards, the owner was advised to improve the comfort of the home environment to prevent further trauma. There was no improvement noted after this treatment.

Clinical examination and findings

At the time of presentation, the wounds from both calcaneal extremities were quite similar in appearance. In terms of depth, a full thickness skin defect was present measuring approximately 1cm diameter. The wound from the left side presented mild moisture and small amount of slough was covering the surface while the wound from the right side was covered by a dry crust. There was no local pain and or purulent discharge and no bone exposure. A concurrent parasitic otitis was found during examination.

Treatment

Cytological examination of the lesions revealed a mild superficial bacterial infection along with an inflammatory response. The options of conservative and surgical management were discussed with the owner. Initially the owner opted for second intention healing. The bacterial infection was treated locally using chlorhexidine gluconate solution 0.02% daily for three days followed by application of medical grade Manuka gel covered by a light protective bandage. A recommendation of daily bandage changes was made for the first three days until the first recheck. An Elizabethan collar was recommended to prevent self-trauma but the owner declined. An otic swab confirmed the presence of Otodectes Cynotis and the patient received one dose of lotilaner for the parasitic infection and daily ear cleansing with clorhexidine with TRIS-EDTA for 2 weeks.

Fig.1 Left (A) and right (B) calcaneal lesions. There is no marginal reepithelialisation and the wound margins are not inflamed. The left defect present a chronic pale granulation tissue and the right lesion is covered by a dry crust.

At the first check-up the lesions were considerably larger but also the owner reported that the patient managed to remove the bandages during the night. Moderate amount of slough was present on both defects and mild moisture was present (Figure 2).

Fig.2 Left (A) and right (B) calcaneal wounds. There is an increase in size of both wounds and the wound edges present mild inflammation.

At this moment a “dounut-type” bandage with hydrogel representing the contact layer for the next ten days was recommended (Figure 3). This type of bandage was ment to prevent against any further trauma and the hydrogel to help by wound debridement and keeping a moist environment. The the bandage was changed every three days.

Fig.3 Donut Type bandage. A “donut” pad was made by rolling long strip of cotton in a circular manner and was applied over the bony proeminence. The “donut” was fixed in place with padding gauze and tape.

At the ten days recheck there was no more slough or necrotic areas over the wounds but was no improvement in terms of size or granulation tissue quality. The surgical intervention was recommended at this state and the owner accepted.

Complete blood work, including a CBC and a biochemistry panel, was done before surgery. The results were within reference levels. The patient underwent general anesthesia using dexmedetomidine (4.5mcg/kg IM) and methadone (0.18 mg/kg IM) as premedication followed by induction with propofol (6mg/kg IV) and maintenance with isoflurane and oxygen.

After wound bed preparation, the local skin assessment was performed aiming to obtain a robust and tension free closure. The assessment involved manipulation of the skin that surround the defects but also the skin from the nearby area (Figure 4). More skin was available proximal to the hock, medial and lateral compared with other areas. The options of surgical closure taken in consideration were: undermining, tension-relieving techniques in form of single releasing incision, Z-plasty, V-Y plasty and transposition flap from the lateral or medial aspect of the distal tibia. Initially undermining of the wound edges was performed and closure was attempted but there was too much tension. A single releasing incision was the option used to close these particular wounds.

Fig.4 Caudal view of the right hock. A manual manipulation of the skin that surround the wound is perform.

The following steps were used for both wounds:

Initially the fibrotic thickened wound edge was removed and undermining was performed around in a circular manner (Figure 5). A 2cm parallel incision with the wound was made approximately 2cm dorsally and 1cm medial on the medial aspect of the distal tibia (Figure 6). Undermining was performed in a cranio-caudal direction connecting the incision with the wound bed. The skin was advanced into the defect and 3/0 monofilament in a simple interrupted suture pattern was used for closure (Figure 7).

Fig 5

Fig 6

The medial donor defect was left to heal by second intention. The surgical site was covered by a “donut-type” bandage placed over the hock and a nonadherent dressing over the new defect.

After surgery the patient was hospitalized in a padded room the same “donut” bandage but polyurethane foam was used as a contact layer over the new defects and the closed wound was not covered with any dressings. The bandage was changed every 3 days. The new defects ressolved within 8 days and no complications were noted at the surgical site.

Fig.7 Medio-caudal view of the right hock. The final appearance of the wound after closure.

The cat was discharged after 10 days and was sent home with the same bandage until the suture material was removed. In day 14 and 21 the sutures were removed an Elizabethan collar was appied to prevent self-trauma at home for the next 4 days. At the last recheck both hocks presented with normal scar tissue and no local discomfort. The owner reported that after the collar was removed the cat was not interested in her previously affected areas.

Discussion

The present case report describes the conservative and surgical approach of two symmetric chronic non-healing wounds associated with the calcaneal tuberosity together with the macroscopic description of the lesions.

Fig.8 Caudal view left (A) and right (B) calcaneal extremities four days after suture removal.

The patient was presented with a history of more than four weeks of non-healing wounds at both calcaneal extremities. We treated conservatively with specific dressings and bandaging techniques for another two without improvement. Hence, a surgical intervention was recommended.

To achieve the maximum skin advancement the purposed skin incision was planned to be perpendicular to the wound. The reason why the releasing incision was performed slightly proximally to the defect and not perpendicular to it was to avoid exposure of the medial malleolus of the tibia which was sharp and was not covered by robust soft tissue. Therefore, this extremity could represent another pressure point exposed.

In order to minimise the chances of self-trauma, the patient was hospitalised in a soft padded room. The “donut” type bandage was still used for another 10 days. A follow up recheck four days post suture removal was made to make sure there are no post-operative complications. There was a normal scar tissue formed and no local discomfort present functional deficits (Figure 8).

References:

Michael M. Pavletic– Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth edition, 2018 John Wiley & Sons, Inc;
Nicole J. Buote, DVM, DACVS-SA- Updates in Wound Management and Dressings, Veterinary Clinics of North America: Small Animal Practice 2021 Elsevier Inc;
Theresa Fossum- Small Aminal Surgery 5^th Edition, April 2018, Elsevier Inc;
Steven F. Swaim, Walter C. Renberg, Kathy M. Shike- Small Animal Bandaging, Casting, and Splinting Techniques, Iowa State University Press, United States 2011;
Baranoski, S, Ayello, EA. 2016. Wound Care Essentials: Practice Principles, 4th ed. New York: Wolters Kluwer;
Hunt TK, Williams H. 1997. Wound healing and wound infection. Surg Clin N Am 77:587–606.
Bryant RA, Nix DP. 2016. Acute and Chronic Wounds: Current Management Concepts, 5th ed. St. Louis: Elsevier Inc.

Lateral Flank Approach for Ovariohysterectomy in Cats

March 18, 2022

Vladimir Stojanoski, DVM, Spec. surg. vet.

Irena Mandevska, DVM.

Animal Care Clinic, Clinic for surgery, oftalmology andstomatology, Bitola, Macedonia

ABSTRACT

The ovariohysterectomy is a routine procedure which is recommended primary for control of the population of cats. Until now there are various access techniques that are described in the literature for the ovariohysterectomy(OVH) at cats. In this study of ovariohysterectomy, 500 adult female cats at the age of 6 months to 9 years with bodyweight of 2,5-5 kg, were covered. In OVH a small lateral accessed cut is made which minimizes the presence of bleeding during incision, easy access and extraction of the ovaries and the horns of the uterus is obtained during the procedure, also minimization of postoperative complication, shorten the time of the surgical procedure (give or take 20 minutes per intervention), also the healing of the wound and the pain threshold postoperative, all this examined by Feline grimace scale fact sheet(Evanelista at all 2019) are significantly smaller. 96% of the clinics in the USA apply the “Flank” lateral access for OVH at cats, but in our region this technique is still not well known though the benefits of it are greater, in contrast to other techniques of OVH at cats.

INTRODUCTION

The managing of the population of domestic cats is a global issue which raises the question of the individual wellbeing of the cats (Roberts et all, 2015). OVH is a routine procedure that is recommended as the best method in controlling the population of cats (Levy et all, 2003). Traditionally, OVH is made by medial ventral or lateral “Flank” access which in the world and also our region is still not accepted as a routine everyday technique. Because of the positive feedback, the lateral “Flank” access for OVH at cats is more and more applied in the world.

The left side of incision was preferred in the start of applying the lateral “Flank” access (McGarthet all, 2004) and also many incisions were applied in horizontal and vertical direction of the abdominal oblique muscles in OVH at cats (Hogue, 1991). Generally, at the start of the application of this technique, the length of the incision was 2-3cm м (McGrath et all, 2004; Coe et all, 2006; Rana, 2007; Kiani et all, 2014). In comparative studies Ghanawat and Mantri (1996), Shuttleworth and Smythe (2000), Coe et all, (2006) and Rana (2007) reported significantly smaller incision with the lateral “Flank” access 1-1,5 cm compared to the medial ventral access. Examining the technique and comparing the suturing of the skin with skin and intradermal sutures a conclusion was gained that the healing of the wound with intradermal suture is way quicker and the discomfort of the patient is greatly reduced. Also by applying this technique the time needed for wound healing is shortened, the trauma of the abdominal muscles is way smaller because the incision is lateral, the pressure over the wound and the incision is greatly reduced.

MATERIAL AND METHODS

In this study were covered 500 female adult cats, the youngest older than 6 months and the oldest younger than 9 months. All patients undergone: general clinical examination, blood test and ultrasonography for confirmation of pregnancy. Every cat that did not showed deviations in the clinical examination, blood test also were not pregnant was included in this study. Every cat was preoperatively deprived of food 12-24h and water 6h. At all patients a venous path was established, a venous anesthesia was applied, also intubated and a breathing monitoring was used thanks to a Breathe Safe Respiratory Monitor. During the procedure a NaCl0.9% infusion was applied in dose of 20ml/kg/h. The surgical field was shaved by a shaving machine with No. 40F knife, and also disinfected by 4% chlorhexidine. Also the surgical field was covered by surgical covers (sheets) with dimensions of 45-45cm, a surgical knife 10 was used and as a surgical thread we used monofilament Monosyn 3-0. We used the general surgical set for sterilization (with spay hook), sterilized by the method of dry sterilization. Postoperatively as an analgesic a single dose of NSAID – meloxicam 0.2mk/kg i/v was applied.

INDICATIONS

One of the most common indication for implementing this access is sterilizing of breastfeeding cats and also sterilizing cats with hyperplasia of the mammary glands. When the OVH is made during lactation it’s a better choice to use the lateral “Flank” access rather than the medial ventral access because the occurrence of dermal and subdermal heamorrhagia is very rare almost unnoticeable, also swelling, infection and discharge of the mammary gland are absent. Besides that, by using the lateral “Flank” access in cats during lactation, there is no disorder in the function of the mammary gland, so these patients can continue the breastfeeding postoperative the next day.

The mammary hyperplasia, also known as fibro adenomatous hyperplasia or mammary hypertrophy -fibroadenomal complex (Dolly Parton Syndrome) – image 1, represents a benign formation during estrous cycle or breastfeeding at cats that characterizes with fast abnormal growth of one or more mammary complexes (Hayden at all, 1981). As a choice of treatment its recommended to use ovariectomy or ovariohysterectomy, that results with regression of the mammary hyperplasia within a time period of 3-4 weeks (Wehrend and all, 2001). The use of this technique during lactation eliminates the occurrence of rupture of the mammary complexes triggered by a wound infection that appears as a complication by using the medial access of OVH.

ADVANTAGES

The advantages of the lateral “Flank” access to OVH at cats includes the possibility to over watch the surgical wound from distance and reducing the potential to eviscerate due to dehiscence of the wound sutures (Dorn & AS, 1975; Krzaczynski, 1974; Miller &Zawistowski, 2012). These advantages are very important while working with wild, feral and homeless, scared animals or animals whose owner is not always capable to transport the patient back to the clinic/ambulance. The capability for these animals to be brought back for routine control postoperative is very limited, thus very often, observing from distance is necessary.

The lateral “Flank” access allows visual assessment of the wound without manipulating with the patient, which is not the case by using the ventral-medial access.

Evisceration of the abdominal organs or dehiscence of the sutures are very uncommon because the forces of gravity using the lateral “Flank’ access are weaker than using the ventral-medial access (Dorn & AS, 1975; Krzaczynski, 1974; Miller &Zawistowski, 2012; Janssens&Janssens, 1991). In addition, the overlapping of the oblique abdominal muscles helps keeping the integrity of the abdominal wall, which makes the possibility of such complications to occur very small.

With the lateral access, the ipsilateral ovary and the horn of the uterus is spotted right under the incision, which makes them very easy to locate. This shortens the time, normally needed to locate the ovary during the ventral-medial access, thus shortens the time needed for the whole operation.

CONTRAINDICATIONS

Contraindications of the lateral “Flank” access includes: distension of the uterus respectively gravity or pyometra, overweight or patient younger than 12 weeks (Dorn & AS, 1975; Krzaczynski, 1974; Janssens&Janssen,s 1991; Dorn &Swist, 1977). Some authors describe the risk of visual scar or imperfections of the color and fur growth of the operation field (Janssens&Janssens, 1991). At patient that are highly gravid or have a uterine distension/pyometra, the lateral “Flank” access is not recommended because we do not have a clear access to manipulate with the uterus. If the gravity or pyometraare identified by accident, the lateral “Flank” access is extended for relieved extraction of the uterus. However, extending the incision can increase the risk of muscle trauma or potential bleeding, undermining the primary advantages of the lateral “Flank” access during OVH (Salmeri at all, 1991).

DISADVANTAGES

The primal disadvantage of the lateral “Flank” access is the limited visual exposure in occurrence of possible complications (Dorn & AS 1975; Krzaczynski, 1974; Janssens&Janssens, 1991; Dorn &Swist, 1977).

The second important concern is that when a cat is brought, but it’s unknown if the same cat has undergone a OVH, the surgical scar is small and the point of incision is not always typical to be made at the same location, even if it’s made on the same side of the previous incision, in contrast to the medial ventral access where the incision is typically spotted on exact location respectively under the umbilicus along the linea alba (Miller &Zawistowski, 2012). This could lead to an unnecessary surgical intervention if the surgeon is not aware of the possibility that the lateral “Flank” access might have been used for OVH. Therefore, when the lateral “Flank” access is used, it is necessary to mark the cat that is operated, like tattooing of the umbilicus or linea alba along the abdomen, or by incising the tip of the left ear at the homeless or feral cats (Miller &Zawistowski, 2012).

SURGICAL INTERVENTION

Anesthesia of the patient

Ovariohysterectomy is a routine surgical procedure by which in this study is used an intravenous anesthesia.

Sedation/anesthesia in combination with midazolam:

Dexmeditomidin10 µg/kg i/m
Midazolam2mg/kg i/v and
Ketamine 2mg/kg i/v – slowly applicate till effect is achieved
- For maintenance of anesthesia if needed Propofol is administered like a bolus of – 0,4mg/kg
- Intubation and monitoring of breathing with Breathe Safe Respiratory Monitor (image 2).
  Image 2 – Breathe Safe Respiratory Monitor
  
  Instruments that are used for the procedure
  
  Standard set for sterilization: surgical gloves, surgical sterile sheet, surgical tweezers – Adison tissue, scalpel – No. 10, needle holder – Mayo Hager, hook (spay hook) for ovariohysterectomy, four surgical forceps – Mosquito forceps, surgical scissors – mayo scissor curved, four Backhaus towel clamps, surgical knife – No. 10, monofilament (Monosyn 3-0) resorptive threat, sterile gauze (image 3).
  
  Image 3 – Ovariohysterectomy kit
  
  Position of the patient
  
  By using the lateral “flank” access the patient could be positioned in right or left dorsal recumbence depending of the surgeons opinion. The access at the right side is preferred by some surgeons because it provides better access to more cranially anatomically placed ovary and because the omentum covers the viscera when it’s used a left sided access (Dorn &Swist, 1977). From our experience there aren’t any advantages whether a left or right sided access is used, but the left side is better because the dominant hand is used for easy manipulation with the suspensory ligament. The animal is placed in lateral position by fixing the limbs in their extension (Krzaczynski, 1974) – image 4.
  
  Image 4 – Lateral position with limbs fixed in extension
  
  Surgical preparation
  
  The surgical field is being shaved by starting cranially from the last rib all the way down to the iliac bone in cranial-caudal direction and the transversal processes of the lumbar vertebrae, all the way down to the mammary complex in dorsal-ventral projection.
  
  Marking the incision
  
  The carving of the incision may be placed in dorsal-ventral or cranial-caudal direction, however by our experience we use the technique of cranial-caudal incision by which the incision is placed in one conceived central line, two fingers from the last rib, one finger from the transversal processes and two fingers from the iliac bone in diameter of 1-1,5 cm (image 5) depending on the size of the cat, estrus phase, or the presence of other possible complication factors.
  
  Image 5 – Ready surgical field and appropriate location of incision for a left lateral access (left dashed line: location of the last rib; right dashed line: location of the iliac crest
  
  Surgical technique
  
  The incision of the skin for the lateral “Flank” access can made in cranial caudal direction paying attention for avoiding the superficial blood vessels. The subdermal tissue must be cut with separating scissors (image 6). The abdominal muscles should be separated from the subdermal tissue and by using a forceps or scissors an incision must be made separately on every layer of the lateral abdominal muscles. When the abdomen is opened its important to fixate the abdominal muscle with a forceps, or the thumb, to maintain the control over the abdominal wall. The ovary or the uterine horn should be placed right under the incision.
  
  Image 6 – Subcutaneous separation
  
  The horn is pulled out by using (image 7 top).
  
  Image 7 – Spay hook (top) and extraction of the horn of the uterus (bottom)
  
  After the extraction of the horn and sighting the ovary, with the help of a forceps the ovary is fixated with the suspensory ligament (image 7 bottom). At older and obese cats the ovary is surrounded by adipose tissue, which requires prolonging the incision of the abdominal wall to achieve better visibility of the surgical field. After fixating the ovary/ligament the blood vessel is being ligated by placing two ligatures also used at the medial ventral access. The wide ligament (including the surrounding ligament) should be blindly separated parallel to the uterine artery at the level of the bifurcation of the uterus. After that, the uterine horn should be lifted to reveal the bifurcation and the contra lateral horn of the uterus, after which by using the hook the horn is lifted to a level of visibility of the contra lateral ovary, which is fixated with a forceps to the suspensory ligament. Because this ligament is on the opposite side it is harder to pull it out, and because it is shorter, it should be torn bluntly or be cut by scissors, and the rest of the procedure is the same as the other ovary. Then the both horns are pulled out until the bifurcation is visible. The both horns are being ligated twice near the bifurcation and are cut off 0,5 cm over the second ligature.
  
  The visualization of the contra lateral ovary and horn of the uterus could be difficult to acquire through the small incision, but because the ipsilateral ovary is spotted right beneath the incision, by pulling out the horn all the way to the bifurcation, the contra lateral horn is pulled out by a hook, so is the contra lateral ovary. For easy visualization of the contra lateral ovary, the duodenum (left lateral “Flank” access) or the descendent colon (right lateral “Flank” access) are used to push dorsally the small intestine with the spay hook, simultaneously we pull the abdominal wall ventrally, and by doing so the visibility of the contra lateral ovary is bigger (image 8).
  
  Image 8 – Extraction of the ovaries
  
  To visualize the bifurcation of the uterus, by using the spay hook the small intestine and the bladder should be pulled in cranial and ventral direction simultaneously pulling the abdominal wall caudally, by doing so the uterine body lies dorsally of the bladders neck (image 9).
  
  The abdominal wall at cats is closed by using a continuous suture, embracing the three layers of abdominal muscles. The skin is closed with a routine intra dermal suture, and by doing so, the extraction of the suture threads postoperatively is unnecessary (image 10).
  
  Image 10 – Closing the skin wound by placing an intradermal suture
  
  Postoperative care and analgesia
  
  The postoperative care by using the lateral “Flank” access is nothing special, nor is necessary stationary observing postoperatively, so the patient could be checked out the very same day. The observation is done from distance and there is no need of bringing the patient back for a control. We used a single dose of NSAIL analgesic – meloxicam 0,2 mg/kg i/v.
  
  RESULTS AND DISCUSION
  
  In this study for ovariohysterectomy were involved 500 adult female cats at the age of 6 months to 9 years, with bodyweight of 2,5-5 kg. (Domestic and feral) which were electively brought to the clinic, which covers all the world known high standards of working in veterinary medicine.
  
  The owners and volunteers in charge were informed of the whole process both verbally and in writing detailed description of the procedures and in this publication, their personal data isn’t mentioned and they remained completely anonymous.
  
  The choice of anesthetic protocol and the analgesia in the postoperative period, depends on the procedure and the health status of the patient, including both acute and chronic diseases.
  
  Even though there is no standard surgical access to ovariohysterectomy at cats, generally the ventral medial access dominates, in contrast to the lateral “Flank” access, which technique is less preferred (Bartels, 1998; Slatter, 2003).
  
  The complexity to identify the subcutaneous adipose tissue and the internal and external oblique muscle and the peritoneum, during this access did not showed as a problem, so did the identification of the anatomical position of the ovaries and the uterus.
  
  The risk of remaining ovarian tissue is rather often complication during ovariohysterectomy at cats, so is loosening of the ovarian ligatures during operation, which however doesn’t result with significant loss of blood (James at all, 2021). These intra operational complications didn’t showed as a problem with the application of the “Flank” lateral access in this study, considering the high level of competence and experience of the main surgeon, as is the use of modern materials for ligation and the use of modern surgical techniques as for ligating the ovaries and the
  
  uterus and as for the fascia of mm. rectus abdominis.
  
  By choosing the lateral “Flank” access to ovariohysterectomy at cats, there is lower degree of licking the wound, swelling and lower incidence of complications: bleeding of wound 0,5%, dehiscence of the wound 2%, infections of the wound 2,5% in the postoperative period (image 11).
  
  Even though there is no general opinion for which procedure is better and it’s not used as a routine procedure, the lateral “Flank” access to ovariohysterectomy at cats in this study provede positive effect in veterinary surgeons during the intra and postoperative process, lower costs of material, so is the greater satisfaction of the owners and the comfort of the patients in the healing period.
  
  Also the tress hold of pain during the lateral “Flank” access is very low, examined by Feline grimace scale fact sheet (Evanelista at all, 2019) by which a single dose of NSAID – meloxicam 0,2 mg/kg i/v is enough.
  
  CONCLUSION
  
  The lateral access in this study showed as better by the personnel that took place in the operations and the owners/fosters of patients because of the shorter operation time (
  
  generally the difference is 10-15 minutes quicker), smaller surgical incision (1-1,5 cm), eased anatomical locating of the ovaries and uterus, quicker healing of the wound (2-4 days), smaller degree of wound opening (2%), together with the better response of the patient during awakening from anesthesia and in the postoperative period.
  
  Saving the amount of time for the procedure (around 20 minutes per procedure), the minimal incision for performing the procedure, the shortened time for wound healing in contrast to the standard medial ovariohysterectomy, the tress hold of pain postoperatively is way lower in contrast to the standard medial technique, the postoperative complications are very rare (infection of the wound, dehiscence of the sutures, postoperative bleeding and pain at the animal itself.

If you are ucranian vet you can be supported by vets from whole Europe!

March 6, 2022

Please check here: https://vetsforukraine.com/?fbclid=IwAR1xVUFbh_0AR9c548ZbJwgWUFlkNtY-PanSj3BoqOxKLsJ1qq0J_uOw2tA

First list:

Here we are with the opportunities for Ukrainian vets

1. Hemodiavet and Dr Vitalaru Bogdan Alexandru-6 persons, Bucharest, Romania

2. Alessia Matia-2 persons,Milan, Italy

3. Linda Werme-1 person, Sweden, lwerme88@gmail.com

4. Larisa Fedotova- 2 persons ,Darlington,UK

5. Natalie Franiek-Krijt-1-2 persons, Austria , vet-vertretung@gmx.at

6. Federica Fogli -1 person, UK , fefy25@gmail.com

7. Aleksandra Pikarevska- 2 persons, Brighton,UK, apikarevska@gmail.com

8. Calorina Delabre- vet family and work for them, North France

9. Elisabeth Buchinger -2-6 persons, Lower Austria

10. Karena Bonte- a family, Belgium 003292537063

11. Julieta Pedernera-1 person, Frankfurt,Germany

12. Lisa Beffort -live in Germany next to Limburg 65558. We can help organizing train tickets.Phone 0049 176 96 15 46 24

13. Diana Lehner-2 persons, South Germany, about an hour south of Stuttgart

WhatsApp is the best way +436509800071

14. Nadia Kostadinova- a family and job for them in the clinic. Plovdiv,Bulgaria, +359887775165

15. Elisabeth Muller-4 persons , +491714265645 for contact

16. Cristian Cristea-4-6 persons, Bucharest, Romania +40723683806 whatsapp or sms and will call you back.

17. Bojana Mircheva- a family, Gorna Oryahovitsa, Bulgaria, also a job for them , +359885468665

Boryana Vankova- a family and work for veterinarian. Troyan, Bulgaria,email boby_van@abv.bg

Phone +359888578783

18. Mila Bobadova- a family, and work for vets,Sofia, Bulgaria , +359888359102

19. Karen Welkenhuyesen- 1 person with kids, Belgium (Diepenbeek)

20. Dr. Michael Greshake-3 persons, Grevener Damm 184, 48282 Emsdetten,

21. Dany Holmes- help in Ireland , holmes veterinary@gmail.com

22. Ann Criel –help in Belgium ann.criel@gmail.com

23. Veerle Guffens- 3 persons, Hoogstaten,Belgium –veerle.guffens@telenet.be

24. Sofia Matias 2 persons , Walton,Uk, sofia.matias@gmail.com

25. Kristein Henckaerts-1 person, Hasselt,Belgium, kristeinhenckaerts@hotmail.com

Second list:

1. Charlotte McGivney

We have a single bedroom available near Newcastle in the UK. Lottieherdan@gmail.com

2. Regina Sassenrath

We are a small animal practice in Ober Olm 12km from Mainz, close to Frankfurt. We can offer a job as vetetinarian and help with accommodation. Please contact us.

Kontakt@tierarztpraxis-ober-olm.de or use messenger.

3.Petra Geisser

Hello from Bavaria,

We could accommodate 1-2 persons. Children and pets are also welcome. Please contact me by Messenger or Mail

petra.geisser@tierarzt-immenstadt.de

4. Ana Cardoso

Hello from Portugal, I can acomodate how much will be needed in one room, and arrange a way for pets if needed, and can help with a job. Please send email for cvet.anaeosbichos@gmail.com

5. Laura Thirtle Mills

Family home in Cornwall, UK, two spare bedrooms available for small family. Please message if we can help.

6. Emma Morris

copthorne vets in the uk, shrewsbury can host a vet and their family and employ one vet www.shrewsburyvets.com do get in touch

7. Annie Koldeweij

Annie et Ben Koldeweij, center of France 58, can host a family of four, lend a vehicle and eventually employ one vet . acaskol@hotmail.com for more details

8. Naas Anastasia

We are small animal practice Dyreklinikk Mo AS in Nittedal 25km from Oslo, Norway. We can hire 1 Ukrainian small/equine veterinarian as veterinary assistant and help with local accommodation in our beautiful area:) help with every tasks to introduce our new colleague to Norwegian life and regulation system. http://www.modyreklinikk.no/ . We will assist with language course as well. Please, contact us post@modyreklinikk.no

9. Maria Ledunger Thulin

Hello from Stockholm Sweden

We can offer a position at our clinics Sollentuna Djurklinik and Vallentuna Djurklinik. For 2-3 ukrainian vets and nurses. Housing can also be solved for up to three adults with 1-2 children, also pets.

maria.ledunger.thulin@sollentunadjurklinik.se

10. Bambi Be

Hy I am from Vienna, we can host one person with a child, pm me for details please!

11. Patrick Govart

I can offer accomodaton for up to 2 persons(couple) with young kids and pet in a studio. We are in paris suburb. Contact us via messenger.

12. Riëtte Kok

Assen, the Netherlands, AniCura Dierenkliniek Assen, can host 1 family. We are a small animal practise (mostly cats and dogs).

13. Emily Thomas

Hello from Cambridgeshire in the UK. I am so very sorry that our government is being unhelpful with visas. Please know that many people here are lobbying them to change this. But if you can get to the UK, I can host 1-2 people +/- a child. ek_thomas@hotmail.com

14. Nathalie Axelsson

Hi, from Sweden (southern part, close to malmö)

We can host 1-2 (+/- a Child) people and pets are welcome.

Nathalie.axelsson@gmail.com

15. Holger Volk

If you are small animal vet or a scientist, we at the vet school in Hannover want to help. Need a place to work in a small animal clinic and potentially live close by, please write an email to Kleintierklinik@tiho-hannover.de. On a personal note, we can host at our own home one Ukrainian vet +/- partner +/- kid +/- dog.

16. Zsolt Szeghő

We are a small equine clinic at northeast Hungary, about 200 km from the ukrainian border. We can offer accomodation and hosting for a vet or a vet student evacuated from Ukraine. We can speak hungarian, english, slovak and romanian language.

Contact email: logyogyasz@logyogyasz.hu

17. Susanna Käppeli

Hello from Interlaken, Switzerland! we can host 1 person (vet or vet student) in a shared Apartement and help in our small animal clinic. please contact me per messenger or +41 33 822 21 41. we help if possible with the travel. info@tierklinik-interlaken.ch

18. Amélie Desvars

Hi from Austria, we have a room for 1 person with 1 kid. Cats welcome. amel.desvars@gmail.com

19. Flamme Martine

Hi, in Belgium (Chimay), we have a place for 2 adults and a young kid, and of course animals.

20. Caro Stolpe

C.Stolpe, Hessen, Germany.

4-6 people, dogs and cats welcome

Contact by FB-Messenger

21. Christiana Ober

We would be happy to have a family (and pets) or anyone in need. Wiltshire, UK christianaober@gmail.com. Please feel free to get in touch

22. Svein Henriksen

Hello from south west Sweden., We can host one family and pets in apartment on our small farm. We also need help in our small animal clinic. Please contact me boigetinge@gmail.com

23. Berit Blomstrand

Hi, I can house 1-2 families in need, animals welcome (Mid-Norway). beritblomstrand@gmail.com, +4797535891

24. Veterinary practice Kay offers accommodation and a job for Ukrainian veterinarians. We are a family business and treat small animals and horses. The practice is located between Stuttgart and Munich. Gladly WhatsApp +49 151 22672554

25.Eleonora Piseddu

Hi, I am italian vet located in Bergamo. I got two rooms (one double and one single) available for Ukraine colleagues and their animals. My email is eleonora-piseddu@idexx.com. Best regards, Eleonora

26.Stephanie Sanderson

We would be happy to host a 3 people ( 1-2 adults +1-2 kids) in north west UK (near liverpool).

steph.sandesron@gmail.com

27.Ledewij Wiersma

Hi there, Great initiative to host Ukranian vets! My husband and I, our 3 year old, our soon to be born second son and our 6 animals have an independent house that can host up to 4 people comfortably, more if needed. We live in the countryside north of Rome. Children and animals welcome. No veterinary jobs but always enough to do around the property (compensated). I prefer not to share

my phone number and email address directly on the facebook site but for your records: lidewij_w@hotmail.com 00393899481311

languages: english, french, italian, spanish, dutch and a little german

28. It is an independent studio, for a couple with a young child, and dogs or cats.

You can reach Martine Flamme with the e-mail in copy of this email: mflamme01@gmail.com.

Hope this will help.

We stand with you.

Martine Martin

10334323_1650417485231859_7490271749546982451_n

ABCD & Boehringer Ingelheim invite applications for the 2022 Young Scientist Award

February 11, 2022

The European Advisory Board on Cat Diseases (ABCD) invites applications for the 2022 ABCD & Boehringer Ingelheim Award, which aims to reward innovative and outstanding work by promising young professionals in the field of feline infectious diseases and/or applied immunology.

Candidates should have made an original contribution to the field of feline infectious diseases and/or immunology, which has been published or accepted for publication in a referenced journal or accepted by another assessing body in 2020 or later.

Candidates should be based in Europe, have completed a veterinary or biomedical curriculum, and ideally be under 35 years of age at the time of application.

Applications should be made in English in an electronic format and include a short abstract (max. 500 words) of the work the applicant wishes to submit, as well as a short curriculum vitae and two personal references. Any relevant publications and/or dissertation on the topic should be included. The deadline for submission is 15 April 2022.

The 2022 award (1000€) is funded by Boehringer Ingelheim and will be presented by the ABCD at the congress of the International Society of Feline Medicine, to be held from 30 June to 3 July in Rhodes. The award winner will receive a complimentary registration to this congress. Return travel expenses and accommodation will also be covered to allow the laureate to attend the event. The winner is expected to give a short presentation or present a poster of his/her findings at this event.

The Young Scientist Award was created in 2008 jointly by Boehringer Ingelheim (then Merial) and the ABCD.

The 2021 recipients of the Award were Julia Klaus (Zurich) and Yasmina Parr (Glasgow)

Application forms and detailed rules can be downloaded from the ABCD web site (www.abcdcatsvets.org)

For further information, please contact Karin de Lange, ABCD secretary, kdelange@invivo.edu

BSAVA Congress 2022 is going hybrid!

February 8, 2022

20 January – Registration for Europe’s largest small animal veterinary event is now open! The British Small Animal Veterinary Association (BSAVA) Congress will be held from 24-26 March in Manchester for an exciting programme packed with 100+ hours of world-class CPD delivered by over 50 world-class speakers from around the globe.

Hybrid and virtual possibilities

The live event is due to be held in Manchester, with the opportunity for delegates to attend online through an interactive virtual platform which will run alongside the live event (‘hybrid’ format). This means you can get the chance to catch up with your peers and experience a live event while not missing out on sessions with the option to catch up on demand.

And of course, if you can’t travel to Manchester, you’ll still be able to attend the event, as the congress can also be followed at a distance (‘virtual format’).

Long-form lectures are out, immersive experience is in

“Last year’s online event proved top CPD can be delivered remotely in a highly interactive and engaging way. Returning to a face-to-face format enables us to take that even further and provide delegates with a truly immersive experience,” says Sarah Fitzpatrick, BSAVA Head of Partnerships and Events.

Many sessions at this year’s event feature two speakers delivering different perspectives on a topic, followed by a Q&A. With just 15-20 minutes to get into the detail, lectures will get straight to the point, be fast-paced and rich in content. “A day in the life of….”, a new feature for the 2022 event, will see actors play out scenarios, with experts and the audience invited to discuss the options before returning to the actors to play out the scene.

Meet-the-speakers and free drop-in practicals

Manchester has a proud history in science, as well as politics, music, arts and sports. The Manchester Central convention centre is an award-winning venue in the heart of the city. The size of the iconic building has enabled the organisers to bring the whole of Congress under one roof.

Alongside industry partner stands’, delegates will be able to drop-in to practical sessions and perfect a technique such as undertaking cytological examination, reading radiographs and even performing endoscopy in as little as 15 minutes. For the first time, the practical sessions will be included within the ticket price. There’s also the opportunity to meet the speakers in a dedicated space in the exhibition during lecture breaks.

Early bird discounts apply until 17 February

To register, simply go online on www.bsavaevents.com! Early bird rates apply until 17 February. Virtual-only rates are £203 + VAT and Hybrid (in-person & virtual) rates are £405 + VAT for BSAVA* and FECAVA**-members. Reduced rates also apply for WSAVA*** members, veterinary nurses and students.

Accreditations from RACE, the New Zealand Veterinary Association and the Swiss Veterinary Association (GST/SVS) are pending. All participants will have 60 days access to all virtual and on-demand content after the event.

* For information on how to become a BSAVA member please visit: www.bsava.com/Membership

** As FECAVA member, proof of membership of one of FECAVA’s member associations may be required. To check, please visit www.fecava.org/associations.

*** Veterinarians who are members of WSAVA through their national organisation can claim a 10% discount on the BSAVA non-member rate.

Basic anaesthesia of brachycefalic dog

January 16, 2022

Dr Denica Djodjeva

Blue Cross Veterinary Clinic

Sofia, Bulgaria

Quite often in our practice we have to sedate or keep under anaesthesia brachycephalic dogs and cats. This is associated with some stress for us, given the peculiarities of the breed. In this article I will try to briefly present the main key points in the anesthesia of brachycephalic breeds, which has gained great popularity in recent years. Will pay attention to their anatomical and physiological features, which are a prerequisite for complications during anesthesia, and how to avoid them and reduce the risk.

The main specificity of them is the so-called brachycephalic syndrome ( BOAS). It may include narrowed nostrils, a long soft palate, a hypoplastic trachea, or an inverted laryngeal sac. It can be re-applied and used for prolonged trauma to the pharyngeal soft tissues and trachea, which can cause soft tissue outflow or tracheal collapse. This trauma most often occurs when the animal is intubated. Gastroesophageal reflux should not be forgotten, also high vagal tone.

In severe cases of BOAS, airway obstruction may benefit from the development of pulmonary edema. The pathophysiology of post-obstructive pulmonary edema includes the effect of negative intrathoracic pressure on fluid distribution and subsequent hypoxia. High negative intrathoracic pressure causes an increase in venous return to the right atrium, which increases the pulmonary artery, while left ventricular function is reduced and afterload is increased. The end result is increased hydrostatic pressure, which aids in the movement of fluids from the capillaries in the interstitium and thus causes pulmonary outflow. Rapid recognition of this condition and taking temporary measures, such as maintaining airway patency, adequate oxygen supply and, if necessary, PPV administration. Diuretics may also be used, but it should be anticipated that hypovolaemia and hypoperfusion may occur during anesthesia and clinical delivery should be considered. And because of the risk of soft tisuue and pulmonary oedema, it’s beneficial to add an corticosteroid in low dose, as prevention. Unless there are a serious contraindications. There are different anaesthesia protocols with dexamethason or methylprednisolon, it’s a matter of personal choice.

Deep sedation in these patients is performed with excessive relaxation of the pectoral muscles and aggravation of airway obstruction. Even if the patient is aggressive, it is good to adhere to lower doses of premedication. The most commonly used combination is of a sedative component, for example an alpha-2-agonist and an opioid. A tranquilizer such as acepromazine and benzodiazepines such as diazepam or midazolam may also be used. Accordingly, the doses are at the discretion and according to the desired effect and treatment. In the table below I quote some of the most commonly used pre- anaesthetic drugs with the value of the dose. There are no restrictions and contraindications to the use of narcotic drugs in this breed. For induction you can use a different combinations, as benzodiazepine+ propofol or benzodiazepine+ ketamine. Your choice mainly depends on what the end result you whant. In brachycefalic breeds it is recommended the induction to be smooth and fast, so the most suitable drug in this case is propofol.

Given the peculiarity of the birth, it is very important to monitor the brachycephalic patient during the pre-aesthetic period, as relaxation of the pectoral muscles further complicates breathing, reduces the number of respiratory movements and the appropriate patient does not fall into hypoxia. It is recommended that the patient be preoxygenated during the pre-anesthetic period. The administration of 100% oxygen before induction of anesthesia prolongs the time to the onset of arterial hypoxemia.

When intubating a brachycephalic patient, prepare several tube sizes, apparently up to two sizes smaller than you think would be appropriate. It will be useful if you use a laryngoscope, especially when your patient has a long soft palate, as it will help ensure good visibility to the airways.

It is common practice to maintain the patient under inhalation anesthesia during the operation. Isoflurane is most commonly used for this purpose. It should be borne in mind that, like other inhaled anesthetics, it produces a dose-dependent reduction in myocardial contractility, systemic vascular resistance and cardiac preload, followed by a reduction in mean arterial pressure (MAP) and cardiac output in a dose-dependent manner; therefore, the evaporator settings should be kept as low as possible while maintaining an adequate depth of anesthesia.

In brachycephalic breeds, there is a very strong vasovagal tone, which can cause bradycardia, which in turn can lead to AV block or even cardiac arrest. The most common reason for increased vagal tone is severe pain. Advice on this reason for good pain relief of this breed is extremely important. However, if the patient develops severe bradycardia, a use of anticholinergic in an appropriate emergency dose is indicated.

As mentioned earlier, another common complication is gastroesophageal reflux, which can occur at any stage of anesthesia. This can lead to airway obstruction and aspiration pneumonia. Advice for this reason is recommended in the anesthesia protocol to include antiemetics, unless there are serious contraindications. It is recomended to be applied proton pump inhibitors as omeprasole, 4 hours before the planed anaesthesia.

The recovery period is also not to be underestimated. Here it is important to constantly monitor the patient and be extubated, when we are sure that all reflexes have returned. Especially the swallowing one. The best time to extubate is when our patient has muscle tone in the lower jaw and tries to cough up the endotracheal tubus itself or even better if the patient is tring to chews it. It is important to be positioned in a sternal position with appropriate continuous monitoring.

The anaesthesia of these specific breeds is not so complicated, if know their features and for what to watch out for. With more carefulness and knowinge there is nothing to be afraid of.

Tabl. Most commonly used pre- anaesthetic drugs

Drug	Benefit	Side effects	Peak onset/duration of action	IM dose
Dexmedetomidine, Medetomidine	Profound sedation, reversible, some analgesic properties, drug sparing (reduction in induction drugs needed)	Dose dependent bradycardia	5-15 min IM 2- 3 min IV	Dexmedetomidine 5-15 µg/ kg Medetomidine 3- 10 µg/ kg
Butorphanol	Mild analgesia, good sedation	Poor analgesia and should not be used for surgical patients	10–15min/lasts for 60–90min	0.1–0.4mg/kg
Buprenorphine	Moderate analgesia, mild sedation	Moderate analgesia	10- 15 min IV 15-30min IM /can be given q 6–8 h	0.01–0.04mg/kg
Methadone	Good analgesia	If given too fast, IV can cause bradycardia and respiratory depression	30min/can be given q 4 – 6 h	0.1–0.4mg/kg
Acepromazine	Good anxiolytic, sedation improved when administered with an opioid	Hypotension, unreliable sedation when used alone, not reversible	35–40min IM 10- 15 IV /can be given q 4–6h	0.01–0.05mg/kg