Veterinary Surgery最新文献

Objective: To evaluate the effect of continuous positive airway pressure (CPAP) on respiratory function in the early postoperative period of brachycephalic dogs.

Study design: Prospective, randomized clinical trial.

Animals: A total of 32 dogs.

Methods: Dogs were assigned to recover with or without CPAP (control) and assessed at specific time points over 1 h. Treatment was discontinued for dogs with a CPAP tolerance score of 3 or more (from a range of 0-4). The primary outcome was pulse oximetry (SpO₂). Secondary outcomes were arterial O₂ pressure (PaO₂)/FiO₂ ratio (PaO₂/FiO₂), arterial CO₂ pressure (PaCO₂), and rectal temperature. For dogs that reached a CPAP tolerance score of 3 or more, only the data collected up to the time point before discontinuation were included in the analysis. The treatment effect (β) was analyzed using random effects models and the results were reported with 95% confidence intervals.

Results: Dogs were assigned randomly to each protocol. Baseline characteristics in both groups were comparable. Arterial blood gases were obtained in seven control group dogs and nine CPAP group dogs. Treatment did not affect SpO₂ (β = -0.1, -2.1 to 2.0) but affected the PaO₂/FiO₂ ratio (β = 58.1, 2.6 to 113.6), with no effects on PaCO₂ (β = -4.3, -10.5 to 1.9) or temperature (β = 0.4, -0.8 to 1.6).

Conclusion: In postoperative brachycephalic dogs, CPAP had no effect on SpO₂ but improved the PaO₂/FiO₂ ratio in brachycephalic dogs postoperatively.

Clinical significance: Continuous positive airway pressure offers a valuable solution to improve gas exchange efficiency, a prevalent concern in postoperative brachycephalic dogs, with the potential to enhance overall outcomes.

Objective: To describe, in detail, the relevant anatomy and surgical approach to access the paracondylar process (PCP) and report its application in a clinical case of headshaking.

Animal: A seven-year-old, mixed breed mare.

Study design: Experimental study/case report.

Methods: A seven-year-old mixed breed mare was presented for investigation of acute onset progressing violent headshaking, resulting in the horse falling on multiple occasions. The horse was highly reactive to palpation over the right PCP. Standing computed tomographic (CT) investigation and ultrasonographic examination of the head detected a fracture of the right PCP. Five equine heads of mixed breeds and sizes were dissected to demonstrate the relevant anatomy surrounding the PCP with regard to surgical access. A modified hyovertebrotomy approach was used to remove the fracture fragment under general anesthesia.

Results: The anatomy surrounding the PCP was described. The fragment was successfully removed resulting in gradual resolution of clinical signs. The horse recovered well postoperatively and was back into light levels of work with no signs of headshaking present two and a half years following surgery.

Conclusion: The caudal meningeal artery and vein as well as the glossopharyngeal and hypoglossal nerves are adjacent to the PCP and must be avoided during dissections. The modified hyovertebrotomy approach allows safe surgical access to the PCP. Surgical excision of a PCP fragment can result in complete resolution of clinical signs of headshaking. Computed tomography and ultrasonography are valuable diagnostic tools to identify a fracture of the PCP.

Objective: To report the outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning (FGNMP).

Study design: Retrospective case series.

Animals: A total of 15 client owned dogs and two cats with 57 metabone fractures.

Methods: Description of FGNMP and reporting of the following data: signalment, pre- and postoperative radiographs, intramedullary pin diameter used, anesthesia, surgery and coaptation times, duration to normal weightbearing and bone union, postoperative care and complications.

Results: Median surgery time was 54 min (range: 26-99), median duration of coaptation was 14 days (range: 1-5 weeks), median time to normal weightbearing was 16 days (range: 2-45) and median time to bone union was 6 weeks (range: 4-12). All cases had at least 12 months of post-surgical follow-up with a median follow-up of 18 months (range: 12-70). No major complications occurred. Mild radiographic changes associated with subchondral bone sclerosis were noted on follow-up radiographs in 13/57 fractures. All cases returned to normal gait and full (15) or acceptable (2) function.

Conclusion: In this study, FGNMP was an effective and safe technique for metabone fracture repair, requiring only short-term external coaptation in most patients. Time to bone union and return to normal function compared favorably to previously reported techniques.

Clinical relevance: Fluoroscopically guided normograde metabone pinning provides an alternative technique for treatment of metabone fractures.

Objective: To investigate the impact of surgery resident training on surgery duration in tibial plateau leveling osteotomy (TPLO) and evaluate whether surgery duration differs with each year of residency training.

Study design: Retrospective medical record review.

Animals: A total of 256 client-owned dogs underwent TPLO.

Methods: Records of dogs that underwent TPLO between August 2019 and August 2022 were reviewed. The effects of the surgeon (faculty/resident) and the procedure (arthrotomy/arthroscopy) on TPLO surgery duration were examined with an analysis of variance, and geometric least squares means (GLSM) were compared. A linear mixed effects model (LMM) was fitted to quantify fixed and random effects.

Results: Four faculty surgeons performed 74 (29%) TPLOs, while 10 residents performed 182 (71%) TPLOs under the direct supervision of a faculty surgeon. All TPLOs were conducted with arthrotomy (109; 43%) or arthroscopy (147; 57%). Overall, residents (GLSM, 153 min) required 54% more surgery duration than faculty surgeons (GLSM, 99 min). Surgery duration among first-year residents (GLSM, 170 min) was 15% longer than second- (GLSM, 148 min) and third-year (GLSM, 147 min) residents, whereas the duration did not differ statistically between second- and third-year residents. Arthroscopy, meniscal tear treatment, surgery on the right stifle, and increasing patient weight were also associated with longer surgery duration.

Conclusion: The duration of TPLO surgery significantly decreased after the first year of residency, but did not decrease afterward.

Clinical significance: The results will aid with resource allocation, curricula planning, and cost management associated with resident training.

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

Objective: To examine attitudes towards surgical safety checklists (SSCs) among American College of Veterinary Surgeons (ACVS) diplomates and to identify barriers to implementation.

Study design: Qualitative online research survey.

Sample population: A total of 1282 current ACVS diplomates.

Methods: An anonymous online survey was distributed to current ACVS diplomates via email. ACVS diplomates were identified using publicly available data through the ACVS website. A total of 1282 surveys were electronically distributed, and respondents were given 4 weeks to respond. The survey consisted of 34 questions examining (1) demographic information, (2) current use of SSCs, (3) knowledge and attitudes towards SSCs, (4) perceived advantages and disadvantages to use of SSCs, (5) implementation strategies, and (6) potential reasons for noncompletion of SSCs.

Results: Survey response rate was 20% (257/1282). A total of 169 of 249 (67.9%) respondents indicated using SSCs. Respondents generally agreed that SSCs were proven to reduce surgical complications (196/249 [78.7%]) and did not perceive any disadvantages to use (100/138 [75.2%]). Respondents not using SSCs were more likely to perceive them as a waste of time (p < .001). The most common reasons for noncompletion of SSCs were forgetfulness (21/52 [39.6%]) and time constraints (19/52 [36.5%]). Improved training (72/138 [52.2%]) and modifying the SSC based on staff feedback (69/138 [50%]) were suggested as methods to improve SSC uptake.

Conclusion: Respondents currently using SSCs were generally satisfied. Time constraints and memory related issues were common causes for noncompletion of SSCs.

Clinical significance: Efforts to expand the implementation of SSCs in veterinary surgery should focus on improved engagement of relevant stakeholders and modification of the SSC to suit local conditions.

Objective: To compare antimicrobial activity as demonstrated by the zone of inhibition (ZOI) produced by antibiotic-impregnated calcium sulfate (CaSO₄) beads after storage for 0, 3, 6, 9, and 12 months.

Study design: Controlled laboratory study.

Sample population: Three-millimeter diameter CaSO₄ beads impregnated with vancomycin (125 mg/mL), or amikacin (250 mg/mL), or without antibiotic (control).

Methods: Calcium sulfate beads were created at the onset of the study. Individual beads were separated in sterile containers and stored in a closed cabinet at room temperature and humidity for 0, 3, 6, 9, or 12 months until testing. The ZOI against methicillin-resistant Staphylococcus pseudintermedius, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa was recorded with serial replating on a fresh lawn of bacteria every 24 h until beads failed to produce a ZOI. The ZOIs and their changes were compared with mixed-effects linear models. Eluted concentrations of vancomycin measured with high-performance liquid chromatography were reported.

Results: At 24 h, ZOIs were comparable regardless of time since formulation, except vancomycin against P. aeruginosa, which failed to generate a ZOI. The daily changes of ZOI and duration of activity of antibiotics did not vary between storage length (p > .05). There was no consistent change in eluted drug concentration between storage length of beads.

Conclusion: Light protected storage at room temperature for up to 12 months did not impair the in vitro activity of antibiotic-impregnated CaSO₄ beads, as demonstrated through ZOIs.

Clinical significance: When stored correctly, antibiotic-impregnated CaSO₄ beads can be used at least up to 12 months after formulation.

Objective: To document the utilization and training of laparoscopic and thoracoscopic minimally invasive surgery (MIS) techniques within the American, European, Australian and New Zealand Colleges of Small Animal Veterinary Surgeons (ACVS, ECVS, and ANZCVS) in 2020.

Study design: Observational study.

Sample population: Diplomates and residents of the ACVS, ECVS, and FANZCVS.

Methods: An electronic survey was sent using veterinary list servers. Questions were organized into categories evaluating (1) the demographics of the study population and the caseload, (2) comfort level with specific procedures, (3) motivating factors and limitations, and (4) surgical training and the role of the governing bodies.

Results: Respondents included 111 practicing surgeons and 28 residents. Respondents' soft-tissue MIS caseloads had increased since they first started performing MIS; however, most respondents were only comfortable performing basic laparoscopy. Over half of the respondents agreed on the patient benefits and high standard of care provided by MIS. Perceived adequate soft-tissue training in MIS during residency was strongly associated with perceived proficiency at the time of survey response. Most respondents agreed that the specialty colleges should take a more active role in developing standards for soft-tissue MIS, with residents agreeing that a required standardized course would be beneficial.

Conclusion: Soft-tissue MIS is widely performed by diplomates and residents. Perceived adequate soft-tissue MIS training was strongly associated with perceived proficiency.

Clinical significance: There is substantial underutilization of advanced MIS techniques in veterinary specialty surgical practice, which might be improved by a stronger focus on MIS training during residency.

Objective: To determine the outcome of tenoscopically guided palmar/plantar annular ligament (PAL) desmotomy to treat PAL constriction without concurrent intrathecal soft-tissue injury, notably of the digital flexor tendons and manica flexoria.

Study design: Retrospective multicenter cohort study.

Animals: Sixty-five horses.

Methods: Horses from four UK equine hospitals, with digital flexor tendon sheath (DFTS) tenosynovitis, which underwent tenoscopically guided PAL desmotomy for treatment of PAL constriction between 2017 and 2022 were included. All horses had lameness isolated to the DFTS/PAL, and PAL constriction was diagnosed tenoscopically when there was difficulty maneuvering the endoscope into or through the fetlock canal. Horses with tearing of the digital flexor tendons and/or manica flexoria, or any other intrathecal pathology, were excluded. Follow up was via structured telephone questionnaire.

Results: Follow up (median 25 months) was available for 61 horses with cobs and ponies predominating. Forty-two returned to their previous level of work, or a higher level, postoperatively and 50 owners were satisfied with the outcome of surgery. Eleven horses returned to lower level exercise, and six were retired/euthanized as they did not regain soundness. Fifty-two horses achieved soundness (median 3 months postoperatively).

Conclusion: Tenoscopically guided PAL desmotomy for the treatment of PAL constriction in the absence of intrathecal soft tissue injury had a good prognosis for return to previous levels of exercise in a UK horse population.

Clinical significance: The prognosis for horses undergoing tenoscopically guided PAL desmotomy to treat PAL constriction in the absence of intrathecal injury is better than previously described. Cobs and ponies seem to be predisposed to PAL constriction in agreement with the previous literature.