OBJECTIVE: To assess the analgesic efficacy of an IV constant rate infusion (CRI) of a morphine-lidocaine-ketamine (MLK) combination in calves undergoing umbilical herniorrhaphy. ANIMALS: 20 weaned Holstein calves with umbilical hernias. PROCEDURES: Calves were randomly assigned to receive a CRI of an MLK solution (0.11 mL/kg/h; morphine, 4.8 μg/kg/h; lidocaine, 2.1 mg/kg/h; and ketamine, 0.42 mg/kg/h) for 24 hours (MLK group) or 2 doses of flunixin meglumine (1.1 mg/kg, IV, q 24 h) and a CRI of saline (0.9% NaCl) solution (0.11 mL/kg/h) for 24 hours (control group). The assigned CRI was begun after anesthesia induction. A pain-scoring system and incisional algometry were used to assess pain, and blood samples were obtained to measure serum cortisol concentration at predetermined times for 120 hours after CRI initiation. RESULTS: Mean pain scores did not differ significantly between the MLK and control groups at any time. Mean algometry score for the MLK group was significantly greater (calves were less responsive to pressure) than that for the control group at 4 hours after CRI initiation. Mean cortisol concentration decreased over time for both groups and was significantly greater for the MLK group than the control group at 1, 4, and 18 hours after CRI initiation. CONCLUSIONS AND CLINICAL RELEVANCE: A CRI of MLK provided adequate postoperative analgesia to calves that underwent umbilical herniorrhaphy. However, the technical support required for CRI administration limits its use to hospital settings. Kinetic analyses of MLK infusions in cattle are necessary to establish optimal dosing protocols and withdrawal intervals.

Objective—To evaluate whether the application of steam to a variety of surface types in a veterinary hospital would effectively reduce the number of bacteria. Sample—5 surface types.Procedures—Steam was applied as a surface treatment for disinfection to 18 test sites of 5 surface types in a veterinary hospital. A pretreatment sample was obtained by collection of a swab specimen from the left side of each defined test surface. Steam disinfection was performed on the right side of each test surface, and a posttreatment sample was then collected in the same manner from the treated (right) side of each test surface. Total bacteria for pretreatment and posttreatment samples were quantified by heterotrophic plate counts and for Staphylococcus aureus, Pseudomonas spp, and total coliforms by counts on selective media. Results—Significant reductions were observed in heterotrophic plate counts after steam application to dog runs and dog kennel floors. A significant reduction in counts of Pseudomonas spp was observed after steam application to tub sinks. Bacterial counts were reduced, but not significantly, on most other test surfaces that had adequate pretreatment counts for quantification. Conclusions and Clinical Relevance—Development of health-care–associated infections is of increasing concern in human and veterinary medicine. The application of steam significantly reduced bacterial numbers on a variety of surfaces within a veterinary facility. Steam disinfection may prove to be an alternative or adjunct to chemical disinfection within veterinary practices.

A relation exists between colloid osmotic pressure and serum total protein concentration; equations describing this relation have been used to determine a calculated value for colloid osmotic pressure. However, the relation between total protein concentration and colloid osmotic pressure is altered by the method used to measure protein and by changes in the ratio of concentrations of albumin (A) to globulin (G). We developed nomograms for estimating colloid osmotic pressure from A and G concentrations, using samples obtained from clinically normal animals and compared the accuracy of these nomograms with that of previously described equations relating colloid osmotic pressure to total protein concentration. For comparison, serum samples from canine (n = 106), equine (n = 79), feline (n = 24), and bovine (n = 27) patients admitted to the University of Georgia Veterinary Medical Teaching Hospital were used. Results indicated that nomograms based on protein concentration estimated by a refractometer generally were the least reliable. Although predictive nomograms, using total protein concentration determined by the biuret method, provided better results for serum samples, there was considerable variation between measured and calculated values for colloid osmotic pressure in all species studied. Calculated values for colloid osmotic pressure derived from A and G concentrations were most closely related to measured values for colloid osmotic pressure in dogs, horses, and cats. However, calculated values for colloid osmotic pressure differed from measured values by as much as 5 mm of Hg for some samples by each of the methods of estimation. These results indicate that, although calculated values for colloid osmotic pressure may be most accurate when variations in the A-to-G ratio are accounted for in the nomogram, none of the calculation methods provided a consistently accurate estimate of colloid osmotic pressure. For clinical patients, colloid osmotic pressure based on these nomograms cannot replace direct measurement.

OBJECTIVE To evaluate the prognostic value of measuring heart rate variability (HRV) in horses with colic at the time of admission to a referral hospital. ANIMALS 51 horses > 1 year of age with colic (41 that survived [survivors] and 10 that died or were euthanized [nonsurvivors]). PROCEDURES HRV was recorded within 1 hour after admission by use of heart rate sensors with horses restrained in stocks. A 5-minute recording period was analyzed to obtain HRV measurements (eg, SD of R-R intervals [SDRR], root mean square of successive differences between R-R intervals [RMSSD], and geometric SDs determined from Poincaré plots [SD1 and SD2]). Variables associated with outcome (survival vs nonsurvival) were identified. Measurements were compared among diagnostic categories for colic (obstructive, inflammatory, or ischemic). RESULTS SDRR and RMSSD were significantly higher in survivors (median [25th to 75th percentile], 91.0 milliseconds [78.9 to 114.6 milliseconds] and 64.8 milliseconds [40.9 to 78.4 milliseconds], respectively) than in nonsurvivors (50.7 milliseconds [29.1 to 69.2 milliseconds] and 33.4 milliseconds [12.6 to 47.9 milliseconds], respectively). Similarly, SD1 and SD2 were significantly higher in survivors (48.3 milliseconds [28.9 to 60.9 milliseconds] and 111.3 milliseconds [93.0 to 146.6 milliseconds], respectively) than in nonsurvivors (23.7 milliseconds [8.9 to 33.9 milliseconds] and 65.1 milliseconds [33.7 to 91.9 milliseconds], respectively). The SDRR and SD2 were significantly higher for horses with obstructive colic than for horses with ischemic colic. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of HRV in horses with colic may provide information on the underlying cause and be helpful in identifying horses less likely to survive.

OBJECTIVE To evaluate use of serum amyloid A (SAA) and haptoglobin concentrations as prognostic indicators for horses with inflammatory disease in regard to euthanasia, complications, and hospitalization duration and cost. ANIMALS 20 clinically normal horses and 53 horses with inflammatory disease. PROCEDURES Total WBC count, neutrophil count, and fibrinogen, SAA, and haptoglobin concentrations were determined for clinically normal horses and horses with suspected inflammatory disease. Clinicopathologic values at admission were compared to test the use of SAA and haptoglobin concentrations in predicting euthanasia, complications, and hospitalization duration and cost. Haptoglobin and SAA concentrations of 22 horses were monitored during hospitalization to test the use of serial measurements in predicting survival and complications. RESULTS Neutrophil count and SAA and haptoglobin concentrations were significantly different at admission for horses with inflammatory disease, compared with those for clinically normal horses. Horses with colitis and peritonitis had significantly higher SAA and haptoglobin concentrations than clinically normal horses. A moderate positive correlation (r = 0.355) between hospitalization duration and haptoglobin concentration was identified. Horses with an increase in SAA concentration between 24 and 72 hours after admission, compared with admission SAA concentration, were significantly more likely (OR, 7.0; 95% confidence interval, 1.1 to 45.9) to be euthanized or develop complications. CONCLUSIONS AND CLINICAL RELEVANCE Concentrations of SAA and haptoglobin at admission were not significantly correlated with outcome in horses with inflammatory conditions. Acute-phase proteins likely have more utility in serial analysis rather than testing at a single time point for horses with inflammatory conditions.

In a case-control study of risk factors associated with an episode of nosocomial Salmonella krefeld infection in dogs at the veterinary medical teaching hospital, data on 20 case dogs and 75 control dogs were obtained by review of hospital records. Univariate and multivariate statistical analyses were carried out for possible risk factors for infection to obtain odds of Salmonella krefeld isolation, given exposure to each risk factor of interest. Compared with control dogs, case dogs were 11.9 times more likely to have been fed rice, 7 times more likely to have had radiography done, 10.2 times more likely to have been a resident in ward 2, 5.6 times more likely to have been given antimicrobial agents orally, 11.3 times more likely to have been given antimicrobial agents parenterally, and 37.9 times more likely to have been given antimicrobial agents orally and parenterally (P less than 0.05).

OBJECTIVE To characterize antimicrobial prescribing patterns of clinicians and clinical services at a large animal veterinary teaching hospital and identify factors associated with antimicrobial prescribing. ANIMALS All large animals (ie, equids, bovids, sheep, goats, camelids, swine, and cervids) evaluated at the New Bolton Center hospital at the University of Pennsylvania from 2013 through 2018. PROCEDURES In a cross-sectional study design, data on antimicrobial use by clinicians and clinical services were collected from administrative and billing records. Multivariable regression modeling was performed to identify factors associated with antimicrobial prescribing patterns. RESULTS Antimicrobials and critically important antimicrobials of the highest priority were dispensed in 42.1% (9,853/23,428) and 24.0% (2,360/9,853) of visits, respectively, and these proportions differed significantly among clinicians. Per visit, the median (interquartile [25th to 75th percentile] range) number of animal-defined daily doses dispensed was 3.6 (0.8 to 11.1) and the mean (SD) number of antimicrobial classes dispensed was 2.0 (1.3). Patient species, age, affected body system, and duration of hospitalization as well as submission of specimens for bacterial culture were significantly associated with prescribing patterns. CONCLUSIONS AND CLINICAL RELEVANCE The frequency and quantity of antimicrobials prescribed differed significantly among clinicians within and across services, even for animals with clinical signs affecting the same body system. Patient- and visit-level factors explained some but not all of the heterogeneity in prescribing patterns, suggesting that other clinician-specific factors drove such practices. More research is needed to better understand antimicrobial prescribing patterns of clinicians, particularly in situations for which no antimicrobial use guidelines have been established.

OBJECTIVE To determine the prognostic value of CD44 variant isoform expression in dogs with multicentric high-grade B-cell lymphoma (BCL). ANIMALS 45 dogs with multicentric BCL and 10 healthy control Beagles. PROCEDURES The medical record database of a veterinary teaching hospital was searched to identify dogs with BCL that were treated between November 2005 and April 2015. Information regarding overall response to chemotherapy, progression-free survival (PFS) time, and overall survival time was extracted from each record. Archived lymph node aspirate specimens from dogs with BCL and lymph node aspirate specimens from the 10 control dogs underwent real-time PCR analysis to determine mRNA expression of CD44 variant isoforms of exons 3, 6, and 7 and the CD44 whole isoform. For each isoform, mRNA expression was compared between dogs with BCL and control dogs. The mean relative expression of each isoform was used to classify dogs with BCL into either a high- or low-expression group, and overall response rate, PFS time, and overall survival time (ie, indices of prognosis) were compared between the 2 groups. RESULTS For all isoforms evaluated, mean relative mRNA expression for dogs with BCL was numerically lower than that for control dogs. Dogs with BCL and high CD44 isoform expression had a lower overall response rate, median PFS time, and median overall survival time, compared with dogs with BCL and low CD44 isoform expression. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that, for dogs with BCL, high expression of exons 3, 6, and 7 was associated with a poor prognosis.

OBJECTIVE To assess the effect of anesthetic induction with a benzodiazepine plus ketamine or propofol on hypothermia in dogs undergoing ovariohysterectomy without heat support. ANIMALS 23 adult sexually intact female dogs undergoing ovariohysterectomy. PROCEDURES Baseline rectal temperature, heart rate, and respiratory rate were recorded prior to premedication with buprenorphine (0.02 mg/kg, IM) and acepromazine (0.05 mg/kg, IM). Anesthesia was induced with midazolam or diazepam (0.25 mg/kg, IV) plus ketamine (5 mg/kg, IV; n = 11) or propofol (4 mg/kg, IV; 12) and maintained with isoflurane in oxygen. Rectal temperature was measured at hospital intake, prior to premedication, immediately after anesthetic induction, and every 5 minutes after anesthetic induction. Esophageal temperature was measured every 5 minutes during anesthesia, beginning 30 minutes after anesthetic induction. After anesthesia, dogs were covered with a warm-air blanket and rectal temperature was measured every 10 minutes until normothermia (37°C) was achieved. RESULTS Dogs in both treatment groups had lower rectal temperatures within 5 minutes after anesthetic induction and throughout anesthesia. Compared with dogs that received a benzodiazepine plus ketamine, dogs that received a benzodiazepine plus propofol had significantly lower rectal temperatures and the interval from discontinuation of anesthesia to achievement of normothermia was significantly longer. CONCLUSIONS AND CLINICAL RELEVANCE Dogs in which anesthesia was induced with a benzodiazepine plus propofol or ketamine became hypothermic; the extent of hypothermia was more profound for the propofol combination. Dogs should be provided with adequate heat support after induction of anesthesia, particularly when a propofol-benzodiazepine combination is administered.