2. Universidad Cardenal Herrera-CEU

Background: Patient safety is essential in small animal anaesthesia. Thisstudy aimed to assess anaesthesia-related deaths in cats worldwide, identifyrisk and protective factors and provide insights for clinical practice.Methods: A prospective multicentre cohort study of 14,962 cats from198 veterinary centres across different countries was conducted. Data onanaesthesia-related deaths, from premedication up to 48 hours postex-tubation, were collected. Logistic regression was used to analyse patientdemographics, American Society of Anesthesiologists (ASA) classification,procedure type and anaesthetic drugs.Results: The anaesthesia-related mortality was 0.63%, with 74.5% of deathsoccurring postoperatively. Cats with cachexia, a higher ASA status or whounderwent abdominal, orthopaedic/neurosurgical or thoracic proceduresexhibited elevated mortality. Mechanical ventilation use was associated withincreased mortality. Mortality odds were reduced by the use of alpha2 -agonistsedatives, pure opioids in premedication and locoregional techniques.Limitations: Limitations include non-randomised sampling, potentialbiases, unquantified response rates, subjective death cause classification andlimited variable analysis.Conclusions: Anaesthetic mortality in cats is significant, predominantlypostoperative. Risk factors include cachexia, higher ASA status, specificprocedures and mechanical ventilation. Protective factors include alpha2 -agonist sedatives, pure opioids and locoregional techniques. These findingscan help improve anaesthesia safety and outcomes. However, further researchis required to improve protocols, enhance data quality and minimise risks.

Background:Ensuring patient safety during small animal anaesthesia is cru-cial. This study aimed to assess anaesthetic-related deaths in dogs globally,identify risks and protective factors and inform clinical practice.Methods:This prospective cohort multicentric study involved 55,022 dogsfrom 405 veterinary centres across various countries. Data on anaesthesia-related deaths from premedication to 48 hours post-extubation werecollected. Logistic regression was used to analyse patient demographics,American Society of Anesthesiologists (ASA) classification, procedure typeand anaesthetic drugs used.Results:Anaesthetic-related mortality was 0.69%. Most deaths occurred post-operatively (81%). Age, obesity and a higher ASA classification score wereassociated with increased mortality. Urgent procedures, non-urgent butunscheduled anaesthesias and short procedures also had higher mortality.Some sedatives, systemic analgesics, hypnotics and the use of locoregionalanaesthesia were linked to a decrease in mortality.Limitations:The limitations of the study include the non-randomised sam-ple, potential selection bias, lack of response rate quantification, variable dataquality control, subjectivity in classifying causes of death and limited analysisof variables.Conclusion:Careful patient evaluation, drug selection and monitoring canbe associated with reduced mortality. These findings can be used to developguidelines and strategies to improve patient safety and outcomes. Furtherresearch is needed to refine protocols, enhance data quality systems andexplore additional risk mitigation measures.

Objectives: To evaluate the use of 0.7 mA as a fixed electrical current to indicate epidural needle placement and to confirm that 0.7 mA is greater than the upper limit of the minimal electrical threshold (MET) for sacrococcygeal epidural needle placement in dogs. Study design: Prospective clinical study. Animals: A group of 20 client-owned dogs. Methods: During general anaesthesia and with standard monitoring, the presence of the 3patellar reflex was confirmed in all dogs. An insulated needle was inserted through the sacrococcygeal intervertebral junction and absence of tail movement was confirmed when a fixed electrical current of 0.7 mA was applied. Then, the needle was further advanced towards the epidural space until the expected motor response was obtained – the 'nerve stimulation test' (NST). The NST was considered positive when a motor response of the muscles of the tail was elicited but not the perineal muscles, whereas it was considered negative when no movement of the tail was evoked. The electrical current was turned to 0 mA and then increased by 0.01 mA increments until tail movement was evoked, this was recorded as the MET. In the positive NST cases, 0.05 mL cm-1 occipitococcygeal length of 2% lidocaine or 0.25-0.5% bupivacaine was administered. Epidural blockade was confirmed by the loss of patellar reflex. Descriptive statistics were used to present data. Results: Sacrococcygeal epidural needle placement, corroborated by loss of the patellar reflex, was correctly predicted in 89.5% (95% confidence interval: 68.6%-97.1%) of the cases. The MET was 0.22 mA (0.11-0.36). Conclusions and clinical relevance: A current of 0.7 mA is approximately twice the upper limit of the MET for epidural placement. Therefore, this study demonstrates, with a success rate of 89.5%, the adequacy of using 0.7 mA as the fixed electrical current to detect sacrococcygeal epidural needle placement in dogs.

The study aimed to compare bupivacaine onset time when administered via epidural anaesthesia injecting both at the lumbosacral and sacrococcygeal spaces, spinal anaesthesia, and DPE in clinical dogs. A total of 41 dogs requiring neuraxial anaesthesia as part of their anaesthetic protocol were recruited. They were randomly allocated to receive an epidural injection in the sacrococcygeal space aided by the nerve stimulator (SCO), an epidural injection in the lumbosacral (LS), a subarachnoid injection (SPI), or a DPE. The onset of anaesthesia was assessed every 30 s after the injection by testing the presence of patellar ligament reflex. The number of attempts and time to perform the technique were also recorded. Data were analysed using a one-way ANOVA for trimmed means with post hoc Lincoln test and a Kaplan–Meier curve. The significance level was set at p < 0.05, and the results are presented in absolute values and median (range). There was no difference in the number of attempts required to complete the techniques between groups (p = 0.97). Epidural injections (LS and SCO) tended to be shorter than SPI and DPE techniques, but there was no statistically significant difference (p = 0.071). The time to the disappearance of patellar ligament reflex (Westphal’s sign) in the SCO group was longer than in any other group. In conclusion, all techniques provided a rapid block of the patellar reflex. The SCO technique was the slowest in onset, while the other groups (SPI, DPE, and LS) were faster and almost indistinguishable.

Objective The aim of the study was to develop a multifactorial tool for assessment of sedation in dogs. Methods Following a modified Delphi method, thirty-eight veterinary anaesthetists were contacted to describe the following levels of awareness: no-sedation, light, moderate, profound sedation and excitation. The answers were summarized in descriptors for each level. A questionnaire was created with all the variables obtained from the descriptors. The questionnaire was returned to the panel of anaesthetists to be used before and after real sedations in conjunction with the previous 5-point categorical scale. Data obtained were analysed using the classification-tree and random-forest methods. Results Twenty-three anaesthetists (60%) replied with descriptions. The descriptors and study variables were grouped in categories: state-of-mind, posture, movements, stimuli-response, behaviour, response-to-restraint, muscle tone, physiological data, facial-expression, eye position, eyelids, pupils, vocalization and feasibility-to-perform-intended-procedure. The anaesthetists returned 205 completed questionnaires. The levels of awareness reported by the anaesthetists were: no sedation in 92, mild (26), moderate (37) and profound in 50 cases. The classification-tree detected 6 main classifying variables: change in posture, response-to-restraint, head-elevation, response-to-toe-pinching, response-to-name, and movements. The random-forest found that the following variables: change in posture, response-to-restraint, head-elevation, response-to-name, movements, posture, response-to-toe-pinching, demeanour, righting-reflex and response-to-handclap, were classified correctly in 100% awake, 62% mild, 70% moderate and 86% of profound sedation cases. Discussion and conclusion The questionnaire and methods developed here classified correctly the level of sedation in most cases. Further studies are needed to evaluate the validity of this tool in the clinical and research setting.