PeerJ Preprints: Anesthesiology and Pain Managementhttps://peerj.com/preprints/index.atom?journal=peerj&subject=3300Anesthesiology and Pain Management articles published in PeerJ PreprintsThe influence of rater training on inter-and intra-rater reliability when using the rat grimace scalehttps://peerj.com/preprints/267212018-04-162018-04-16Emily ZhangVivian LeungDaniel SJ Pang
Rodent grimace scales facilitate assessment of spontaneous pain and can identify a range of acute pain levels. Reported rater training in using these scales varies considerably and may contribute to observed variability in inter-rater reliability. This study evaluated the effect of training on inter-rater reliability with the Rat Grimace Scale (RGS). Two training sets, of 42 and 150 images, were prepared from several acute pain models. Four trainee raters progressed through 2 rounds of training, first scoring 42 images (S1) followed by 150 images (S2a). After each round, trainees reviewed the RGS and any problematic images with an experienced rater. The 150 images were then re-scored (S2b). Four years after training, all trainees re-scored the 150 images (S2c). Inter- and intra-rater reliability was evaluated using the intra-class correlation coefficient (ICC) and ICCs compared with a Feldt test. Inter-rater reliability increased from moderate (0.58 [95%CI: 0.43-0.72]) to very good (0.85 [0.81-0.88]) between S1 and S2b (p < 0.01) and also increased between S2a and S2b (p < 0.01). The action units with the highest and lowest ICCs at S2b were orbital tightening (0.84 [0.80-0.87]) and whiskers (0.63 [0.57-0.70]), respectively. In comparison to an experienced rater the ICCs for all trainees improved, ranging from 0.88 to 0.91 at S2b. Four years later, very good inter-rater reliability was retained (0.82 [0.76-0.84]) and intra-rater reliability was good or very good (0.78-0.87). Training improves inter-rater reliability between trainees, with an associated reduction in 95%CI. Additionally, training resulted in improved inter-rater reliability alongside an experienced rater. Performance was retained after several years. The beneficial effects of training potentially reduce data variability and improve experimental animal welfare.
Rodent grimace scales facilitate assessment of spontaneous pain and can identify a range of acute pain levels. Reported rater training in using these scales varies considerably and may contribute to observed variability in inter-rater reliability. This study evaluated the effect of training on inter-rater reliability with the Rat Grimace Scale (RGS). Two training sets, of 42 and 150 images, were prepared from several acute pain models. Four trainee raters progressed through 2 rounds of training, first scoring 42 images (S1) followed by 150 images (S2a). After each round, trainees reviewed the RGS and any problematic images with an experienced rater. The 150 images were then re-scored (S2b). Four years after training, all trainees re-scored the 150 images (S2c). Inter- and intra-rater reliability was evaluated using the intra-class correlation coefficient (ICC) and ICCs compared with a Feldt test. Inter-rater reliability increased from moderate (0.58 [95%CI: 0.43-0.72]) to very good (0.85 [0.81-0.88]) between S1 and S2b (p < 0.01) and also increased between S2a and S2b (p < 0.01). The action units with the highest and lowest ICCs at S2b were orbital tightening (0.84 [0.80-0.87]) and whiskers (0.63 [0.57-0.70]), respectively. In comparison to an experienced rater the ICCs for all trainees improved, ranging from 0.88 to 0.91 at S2b. Four years later, very good inter-rater reliability was retained (0.82 [0.76-0.84]) and intra-rater reliability was good or very good (0.78-0.87). Training improves inter-rater reliability between trainees, with an associated reduction in 95%CI. Additionally, training resulted in improved inter-rater reliability alongside an experienced rater. Performance was retained after several years. The beneficial effects of training potentially reduce data variability and improve experimental animal welfare.Immunohistochemical characterization of spinal cord dorsal horn microglia and astrocytes in horseshttps://peerj.com/preprints/30662017-07-012017-07-01Constanza Stefania MenesesHeine Yacob MüllerDaniel Eduardo HerzbergBenjamín UbertiHedie Almagro BustamanteMarianne Patricia Werner
Role of glial cells in pain modulation has recently gathered attention. The objective of this study was to determine healthy spinal microglia and astrocyte morphology and disposition in equine spinal cord dorsal horns using Iba-1 and GFAP/Cx-43 immunofluorescence labeling, respectively. 5 adult horses without visible wounds or gait alterations were selected. Spinal cord segments were obtained post-mortem for immunohistochemical and immunocolocalization assays. Immunodetection of spinal cord dorsal horn astrocytes was done using a polyclonal goat antibody raised against Glial Fibrillary Acidic Protein (GFAP) and a polyclonal rabbit antibody against Connexin 43 (Cx-43). For immunodetection of spinal cord dorsal horn microglia, a polyclonal rabbit antibody against a synthetic peptide corresponding to the C-terminus of ionized calcium-binding adaptor molecule 1 (Iba-1) was used. Epifluorescence and confocal images were obtained for the morphological and organizational analysis. Evaluation of shape, area, cell diameter, cell process length and thickness was performed on dorsal horn microglia and astrocyte. Morphologically, an amoeboid o spherical shape with a mean cell area of 92.4 + 34 μm2 (in lamina I, II and III) was found in horse microglial cells, located primarily in laminae I, II and III. Astrocyte primary stem branches (and cellular bodies to a much lesser extent) are mainly detected using GFAP. Thus, double GFAP/Cx- immunostaining was needed in order to accurately characterize the morphology, dimension and cell density of astrocytes in horses. Horse and rodent astrocytes seem to have similar dimensions and localization. Horse astrocyte cells have an average diameter of 56 + 14 μm, with a main process length of 28 + 8 μm, and thickness of 1.4 + 0.3 μm, mainly situated in laminae I, II and III. Additionally, a close association between end-point astrocyte processes and microglial cell bodies was found. These results are the first characterization of cell morphology and organizational aspects of horse spinal glia. Iba-1 and GFAP/Cx-43 can successfully stain microglia and astrocytes respectively in horse spinal cords, and thus reveal cell morphology and corresponding distribution within the dorsal horn laminae of healthy horses. The conventional hyper-ramified shape that is normally visible in resting microglial cells was not found in horses. Instead, horse microglial cells had an amoeboid o spherical shape. Horse protoplasmic astroglia is significantly smaller and structurally less complex than human astrocytes, with fewer main GFAP processes. Instead, horse astrocytes tend to be similar to those found in rodent’s model, with small somas and large cell processes. Microglia and astrocytes were found in the more superficial regions of the dorsal horn, similarly to that previously observed in humans and rodents. Further studies are needed to demonstrate the molecular mechanisms involved in the neuron-glia interaction in horses.
Role of glial cells in pain modulation has recently gathered attention. The objective of this study was to determine healthy spinal microglia and astrocyte morphology and disposition in equine spinal cord dorsal horns using Iba-1 and GFAP/Cx-43 immunofluorescence labeling, respectively. 5 adult horses without visible wounds or gait alterations were selected. Spinal cord segments were obtained post-mortem for immunohistochemical and immunocolocalization assays. Immunodetection of spinal cord dorsal horn astrocytes was done using a polyclonal goat antibody raised against Glial Fibrillary Acidic Protein (GFAP) and a polyclonal rabbit antibody against Connexin 43 (Cx-43). For immunodetection of spinal cord dorsal horn microglia, a polyclonal rabbit antibody against a synthetic peptide corresponding to the C-terminus of ionized calcium-binding adaptor molecule 1 (Iba-1) was used. Epifluorescence and confocal images were obtained for the morphological and organizational analysis. Evaluation of shape, area, cell diameter, cell process length and thickness was performed on dorsal horn microglia and astrocyte. Morphologically, an amoeboid o spherical shape with a mean cell area of 92.4 + 34 μm2 (in lamina I, II and III) was found in horse microglial cells, located primarily in laminae I, II and III. Astrocyte primary stem branches (and cellular bodies to a much lesser extent) are mainly detected using GFAP. Thus, double GFAP/Cx- immunostaining was needed in order to accurately characterize the morphology, dimension and cell density of astrocytes in horses. Horse and rodent astrocytes seem to have similar dimensions and localization. Horse astrocyte cells have an average diameter of 56 + 14 μm, with a main process length of 28 + 8 μm, and thickness of 1.4 + 0.3 μm, mainly situated in laminae I, II and III. Additionally, a close association between end-point astrocyte processes and microglial cell bodies was found. These results are the first characterization of cell morphology and organizational aspects of horse spinal glia. Iba-1 and GFAP/Cx-43 can successfully stain microglia and astrocytes respectively in horse spinal cords, and thus reveal cell morphology and corresponding distribution within the dorsal horn laminae of healthy horses. The conventional hyper-ramified shape that is normally visible in resting microglial cells was not found in horses. Instead, horse microglial cells had an amoeboid o spherical shape. Horse protoplasmic astroglia is significantly smaller and structurally less complex than human astrocytes, with fewer main GFAP processes. Instead, horse astrocytes tend to be similar to those found in rodent’s model, with small somas and large cell processes. Microglia and astrocytes were found in the more superficial regions of the dorsal horn, similarly to that previously observed in humans and rodents. Further studies are needed to demonstrate the molecular mechanisms involved in the neuron-glia interaction in horses.Evaluation of “being healthy, being away from chronic diseases” public service advertisement in Chongqing, China: A cross-sectional studyhttps://peerj.com/preprints/29852017-05-202017-05-20Ping HuTing ting WuCheng bin WuHao HuangZhirong FuLei DuXiang long XuZumin ShiYong Zhao
Background: Chronic diseases have become a global public health issue, and mass media campaigns are often used to encourage and sustain positive behavior change. Our aim was to evaluate the effect of public service advertising on the awareness of Chongqing citizens.
Methods: The theme of the public service advertisement launched in Chongqing was “being healthy, being away from chronic diseases.” A self-designed questionnaire was used in an outdoor intercept survey to collect information about the perception of citizens toward the effect of the advertisement on cognitive situations.
Results: A total of 985 valid questionnaires were received. Respondents had good understanding of chronic disease (23.6±4.1, total score: 30), but only 58.4% of participants thought cancer is one type of chronic disease. The awareness of cancer as a chronic disease among the group who had seen this advertisement (63.6%) was higher than that of the group who had not seen the advertisement (56.5%) (p=0.046). After watching the advertisement, approximately 77.4% of participants attempted to remind their family and friends to prevent chronic diseases, roughly 78.2% tried to persuade their family and friends to change their unhealthy lifestyle habits, and 73.2% of participants reported that it increased the possibility of their own lifestyle change. Logistic regression analysis indicates that occupation, educational level, watching the advertising through TV, watching the advertising through indoor LED screen, and watching the advertising through mobile TV affected the three post-viewing behavior changes
Conclusion : The public service advertisement achieved a certain knowledge propaganda effect. It may help change awareness and improve health behavior of the public.
Key words: Public service advertisement , Chronic diseases, Health; Awareness, Behavior
Background: Chronic diseases have become a global public health issue, andmass media campaigns are often used to encourage and sustain positive behavior change. Our aim was to evaluate the effect of public service advertising on the awareness of Chongqing citizens.Methods: The theme of the public service advertisement launched in Chongqing was “being healthy, being away from chronic diseases.” A self-designed questionnaire was used in an outdoor intercept survey to collect information about the perception of citizens toward the effect of the advertisement on cognitive situations.Results: A total of 985 valid questionnaires were received. Respondents had good understanding of chronic disease (23.6±4.1, total score: 30), but only 58.4% of participants thought cancer is one type of chronic disease. The awareness of cancer as a chronic disease among the group who had seen this advertisement (63.6%) was higher than that of the group who had not seen the advertisement (56.5%) (p=0.046). After watching the advertisement, approximately 77.4% of participants attempted to remind their family and friends to prevent chronic diseases, roughly 78.2% tried to persuade their family and friends to change their unhealthy lifestyle habits, and 73.2% of participants reported that it increased the possibility of their own lifestyle change. Logistic regression analysis indicates that occupation, educational level, watching the advertising through TV, watching the advertising through indoor LED screen, and watching the advertising through mobile TV affected the three post-viewing behavior changes Conclusion : The public service advertisement achieved a certain knowledge propaganda effect. It may help change awareness and improve health behavior of the public.Key words: Public service advertisement , Chronic diseases, Health; Awareness, BehaviorFactors influencing healthcare provider respondent fatigue answering a globally administered in-app surveyhttps://peerj.com/preprints/29392017-04-212017-04-21Vikas N O'Reilly-Shah
Background: Respondent fatigue, also known as survey fatigue, is a common problem in the collection of survey data. Factors that are known to influence respondent fatigue include survey length, survey topic, question complexity, and open-ended question type. There is a great deal of interest in understanding the drivers of physician survey responsiveness due to the value of information received from these practitioners. With the recent explosion of mobile smartphone technology 7, it has been possible to obtain survey data from users of mobile applications (apps) on a question-by-question basis. We obtained basic demographic survey data as well as survey data related to an anesthesiology-specific drug called sugammadex and leveraged nonresponse rates to examine factors that influenced respondent fatigue.
Methods: Primary data were collected between December 2015 and February 2017. Surveys and in-app analytics were collected from global users of a mobile anesthesia calculator app. Key independent variables were user country, healthcare provider role, rating of importance of the app to personal practice, length of time in practice, and frequency of app use. Key dependent variable was the metric of respondent fatigue.
Results: Provider role and World Bank country income level were predictive of the rate of respondent fatigue for this in-app survey. Importance of the app to the provider and length of time in practice were moderately associated with fatigue. Frequency of app use was not associated. This study focused on a survey with a topic closely related to the subject area of the app. Respondent fatigue rates will likely change dramatically if the topic does not align closely,
Discussion: Although apps may serve as powerful platforms for data collection, responses rates to in-app surveys may differ on the basis of important respondent characteristics. Studies should be carefully designed to mitigate fatigue as well as powered with the understanding of the respondent characteristics that may have higher rates of respondent fatigue.
Background: Respondent fatigue, also known as survey fatigue, is a common problem in the collection of survey data. Factors that are known to influence respondent fatigue include survey length, survey topic, question complexity, and open-ended question type. There is a great deal of interest in understanding the drivers of physician survey responsiveness due to the value of information received from these practitioners. With the recent explosion of mobile smartphone technology 7, it has been possible to obtain survey data from users of mobile applications (apps) on a question-by-question basis. We obtained basic demographic survey data as well as survey data related to an anesthesiology-specific drug called sugammadex and leveraged nonresponse rates to examine factors that influenced respondent fatigue.Methods: Primary data were collected between December 2015 and February 2017. Surveys and in-app analytics were collected from global users of a mobile anesthesia calculator app. Key independent variables were user country, healthcare provider role, rating of importance of the app to personal practice, length of time in practice, and frequency of app use. Key dependent variable was the metric of respondent fatigue.Results: Provider role and World Bank country income level were predictive of the rate of respondent fatigue for this in-app survey. Importance of the app to the provider and length of time in practice were moderately associated with fatigue. Frequency of app use was not associated. This study focused on a survey with a topic closely related to the subject area of the app. Respondent fatigue rates will likely change dramatically if the topic does not align closely,Discussion: Although apps may serve as powerful platforms for data collection, responses rates to in-app surveys may differ on the basis of important respondent characteristics. Studies should be carefully designed to mitigate fatigue as well as powered with the understanding of the respondent characteristics that may have higher rates of respondent fatigue.A comparison of anesthesia techniques for entomological experimentation: Longevity of the leaf-mining fly pest Scaptomyza flava Fallén (Drosophilidae)https://peerj.com/preprints/28742017-03-152017-03-15Ryan RaylStephen Wratten
Historically, handling insects has usually involved their being killed, but non-lethal approaches are necessary when evaluating the biology of such organisms. Anesthesia has been used as one of these non-lethal approaches. Two common anesthetics used in this way have been carbon dioxide and chilling. These have been used frequently in the literature but have sub-lethal effects on insects that may affect further experimentation. An alternative anesthetic that has potential for experimental use is triethylamine (TEA). This shows promise because of its ease of use and potency as an insect anesthetic, but evidence, if any, of the sub-lethal effects is almost non-existent in the literature. Here, longevity was use as a proxy for fitness as this is a common approach to laboratory work of this type for pests and their natural enemies. A series of experiments were carried out to find the optimal rates for these three selected anesthetics. The organism selected for this work was the fly Scaptomyza flava (Fallén), the larvae of which mine the leaves of commercial brassica crops worldwide. It is a ‘cosmetic’ pest in that damage thresholds for crop rejection are very low and prophylactic use of insecticides is the norm. One way of mitigating the negative environmental aspects of this approach is to enhance biological control. One such way of enhancing biological control is the use of flowering plants, as they can provide alternative resources to natural enemies, which can enhance their ability to control pests. To evaluate these flowering plants, handling of the insects is necessary and anesthesia is used for this purpose. For each anesthetic an optimal rate was found, then these rates were compared to each other in a subsequent experiment. These anesthetics differed markedly in their value in terms of the duration of the anesthesia and other practical considerations. TEA had the longest effect, CO2 and chilling had the shortest. All three were similar in their effects on longevity (i.e. recovery time and mortality rates).
Historically, handling insects has usually involved their being killed, but non-lethal approaches are necessary when evaluating the biology of such organisms. Anesthesia has been used as one of these non-lethal approaches. Two common anesthetics used in this way have been carbon dioxide and chilling. These have been used frequently in the literature but have sub-lethal effects on insects that may affect further experimentation. An alternative anesthetic that has potential for experimental use is triethylamine (TEA). This shows promise because of its ease of use and potency as an insect anesthetic, but evidence, if any, of the sub-lethal effects is almost non-existent in the literature. Here, longevity was use as a proxy for fitness as this is a common approach to laboratory work of this type for pests and their natural enemies. A series of experiments were carried out to find the optimal rates for these three selected anesthetics. The organism selected for this work was the fly Scaptomyza flava (Fallén), the larvae of which mine the leaves of commercial brassica crops worldwide. It is a ‘cosmetic’ pest in that damage thresholds for crop rejection are very low and prophylactic use of insecticides is the norm. One way of mitigating the negative environmental aspects of this approach is to enhance biological control. One such way of enhancing biological control is the use of flowering plants, as they can provide alternative resources to natural enemies, which can enhance their ability to control pests. To evaluate these flowering plants, handling of the insects is necessary and anesthesia is used for this purpose. For each anesthetic an optimal rate was found, then these rates were compared to each other in a subsequent experiment. These anesthetics differed markedly in their value in terms of the duration of the anesthesia and other practical considerations. TEA had the longest effect, CO2 and chilling had the shortest. All three were similar in their effects on longevity (i.e. recovery time and mortality rates).Functional and spinal neuropeptidomic alterations in a new rat surgical model of osteoarthritic pain: A pilot studyhttps://peerj.com/preprints/27042017-01-062017-01-06Julie-Anne GervaisColombe OtisBertrand LussierMartin GuillotFrancis BeaudryEric Troncy
Background. Osteoarthritis is the leading cause of chronic joint pain, causing important productivity and economic losses. It is believed that peripheral and centralized sensitization play a role in the creation and maintenance of a chronic painful state. Different animal models have been employed for the investigation of pain mechanisms and evaluation of potential treatments, but none of them are ideal in terms of reproducibly, reliability and translational value. Methods. In the search for better animal model, this pilot study was performed with the goal of evaluating pain functional outcomes and spinal biomarkers between three surgical rat models of osteoarthritic pain, i.e. destabilization of the medial meniscus, cranial cruciate ligament transection and the combination of both, and comparing those results to the intra-articular injection of monosodium iodoacetate. Six rats were assigned to each model group and a Sham group. Static weight bearing, punctate tactile paw withdrawal threshold, and spinal neuropeptides (substance P, calcitonin gene-related peptide, bradykinin, and somatostatin) were evaluated for each group. Results. Both the monosodium iodoacetate and combination models induced functional alterations in static weight bearing and punctate tactile paw withdrawal threshold, the changes being more persistent in the combination group. Both also produced an increased release of pro-nociceptive and anti-nociceptive neuropeptides at different time-points. When surgical models were compared, the cranial cruciate ligament transection and destabilization of the medial meniscus models were less interesting, with temporary functional alterations, and no significant change in neuropeptides. Discussion. The surgical induction of osteoarthritis was accompanied by quantifiable neurophysiologic changes relating to non-physiologic pain. Comparison with the monosodium iodoacetate model showed that the interest of a surgical model, especially the combination of destabilization of the medial meniscus and cranial cruciate ligament transection, might reside in more persistent and progressive changes, a model that may represent better the human post-traumatic osteoarthritis.
Background. Osteoarthritis is the leading cause of chronic joint pain, causing important productivity and economic losses. It is believed that peripheral and centralized sensitization play a role in the creation and maintenance of a chronic painful state. Different animal models have been employed for the investigation of pain mechanisms and evaluation of potential treatments, but none of them are ideal in terms of reproducibly, reliability and translational value. Methods. In the search for better animal model, this pilot study was performed with the goal of evaluating pain functional outcomes and spinal biomarkers between three surgical rat models of osteoarthritic pain, i.e. destabilization of the medial meniscus, cranial cruciate ligament transection and the combination of both, and comparing those results to the intra-articular injection of monosodium iodoacetate. Six rats were assigned to each model group and a Sham group. Static weight bearing, punctate tactile paw withdrawal threshold, and spinal neuropeptides (substance P, calcitonin gene-related peptide, bradykinin, and somatostatin) were evaluated for each group. Results. Both the monosodium iodoacetate and combination models induced functional alterations in static weight bearing and punctate tactile paw withdrawal threshold, the changes being more persistent in the combination group. Both also produced an increased release of pro-nociceptive and anti-nociceptive neuropeptides at different time-points. When surgical models were compared, the cranial cruciate ligament transection and destabilization of the medial meniscus models were less interesting, with temporary functional alterations, and no significant change in neuropeptides. Discussion. The surgical induction of osteoarthritis was accompanied by quantifiable neurophysiologic changes relating to non-physiologic pain. Comparison with the monosodium iodoacetate model showed that the interest of a surgical model, especially the combination of destabilization of the medial meniscus and cranial cruciate ligament transection, might reside in more persistent and progressive changes, a model that may represent better the human post-traumatic osteoarthritis.A comparison of anesthesia techniques for entomological experimentation: Longevity of the leaf-mining fly pest Scaptomyza flava Fallén (Drosophilidae)https://peerj.com/preprints/25712016-11-032016-11-03Ryan J RaylSteve D Wratten
Historically, handling insects usually involved their being killed as early studies used these organisms for work on genetics, physiology and/or pesticide bioassays. With the advancement of these research topics, the development of behavioral studies and the sensitivity of culturally important, threatened or endangered species, approaches that focus on non-lethal preparation of the insects for experimentation have become important. Anesthesia has been used as one of these non-lethal approaches to provide researchers flexibility when designing experiments. Two common anesthetics used for insect experimentation are carbon dioxide and chilling. These anesthetics have been used frequently in the literature but their sub-lethal effects on insects are poorly studied. Another that has potential for experimental use is triethylamine (TEA). This chemical shows promise because of its ease of use and potency as an insect anesthetic, but evidence, if any, of the sub-lethal effects is almost non-existent in the literature. A series of experiments was carried out to find the optimal exposure times and/or concentrations for each of these three approaches. Once an optimal treatment was found for each approach, these were compared to each other in a subsequent experiment. It was found that TEA is a far superior anesthetic when recording/observing fly longevity.
Historically, handling insects usually involved their being killed as early studies used these organisms for work on genetics, physiology and/or pesticide bioassays. With the advancement of these research topics, the development of behavioral studies and the sensitivity of culturally important, threatened or endangered species, approaches that focus on non-lethal preparation of the insects for experimentation have become important. Anesthesia has been used as one of these non-lethal approaches to provide researchers flexibility when designing experiments. Two common anesthetics used for insect experimentation are carbon dioxide and chilling. These anesthetics have been used frequently in the literature but their sub-lethal effects on insects are poorly studied. Another that has potential for experimental use is triethylamine (TEA). This chemical shows promise because of its ease of use and potency as an insect anesthetic, but evidence, if any, of the sub-lethal effects is almost non-existent in the literature. A series of experiments was carried out to find the optimal exposure times and/or concentrations for each of these three approaches. Once an optimal treatment was found for each approach, these were compared to each other in a subsequent experiment. It was found that TEA is a far superior anesthetic when recording/observing fly longevity.A clinical audit cycle of post-operative hypothermia in dogshttps://peerj.com/preprints/23502016-08-112016-08-11Nicole RoseGrace PS KwongDaniel SJ Pang
Objectives: Use of clinical audits to assess and improve perioperative hypothermia management in client-owned dogs. Methods: Two clinical audits were performed. Audit 1: data were collected to determine the incidence and duration of perioperative hypothermia (defined rectal temperatures < 37.5˚C). The results from Audit 1 were presented to clinic staff and a consensus reached on changes to be implemented to improve temperature management. Following one month with the changes in place, Audit 2 was performed to assess performance. Results: Audit 1 revealed a high incidence of post-operative hypothermia (88.9%) and prolonged time periods for animals to reach normothermia. Following discussion, a consensus was reached to: 1. measure rectal temperatures hourly post-operatively until a temperature ≥ 37.5˚C was achieved and 2. use a forced air warmer on all dogs until rectal temperature was ≥ 37˚5. After one month with the implemented changes, Audit 2 identified a significant reduction in the time to achieve a rectal temperature of ≥ 37.5˚C, with 75% of dogs achieving this goal by 3.5 hours (7.5 hours for Audit 1, p = 0.01). The incidence of hypothermia at extubation remained high in Audit 2 (97.3% with a rectal temperature < 37.5˚C). Clinical significance: Post-operative hypothermia was improved through simple changes in practice, showing that clinical audit is a useful tool for monitoring post-operative hypothermia and improving patient care. Overall management of perioperative hypothermia could be further improved with earlier intervention.
Objectives: Use of clinical audits to assess and improve perioperative hypothermia management in client-owned dogs. Methods: Two clinical audits were performed. Audit 1: data were collected to determine the incidence and duration of perioperative hypothermia (defined rectal temperatures < 37.5˚C). The results from Audit 1 were presented to clinic staff and a consensus reached on changes to be implemented to improve temperature management. Following one month with the changes in place, Audit 2 was performed to assess performance. Results: Audit 1 revealed a high incidence of post-operative hypothermia (88.9%) and prolonged time periods for animals to reach normothermia. Following discussion, a consensus was reached to: 1. measure rectal temperatures hourly post-operatively until a temperature ≥ 37.5˚C was achieved and 2. use a forced air warmer on all dogs until rectal temperature was ≥ 37˚5. After one month with the implemented changes, Audit 2 identified a significant reduction in the time to achieve a rectal temperature of ≥ 37.5˚C, with 75% of dogs achieving this goal by 3.5 hours (7.5 hours for Audit 1, p = 0.01). The incidence of hypothermia at extubation remained high in Audit 2 (97.3% with a rectal temperature < 37.5˚C). Clinical significance: Post-operative hypothermia was improved through simple changes in practice, showing that clinical audit is a useful tool for monitoring post-operative hypothermia and improving patient care. Overall management of perioperative hypothermia could be further improved with earlier intervention.Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a doghttps://peerj.com/preprints/22752016-07-112016-07-11Melanie PrebbleDaniel SJ Pang
A 6-year-old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiologic parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after completion of an intravenous injection of cefazolin, the audible signal from the Doppler ultrasound unit stopped. A rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous epinephrine (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second line therapy and delay in administering epinephrine, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.
A 6-year-old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiologic parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after completion of an intravenous injection of cefazolin, the audible signal from the Doppler ultrasound unit stopped. A rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous epinephrine (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second line therapy and delay in administering epinephrine, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.Gene expression profile of sodium channel subunits in the anterior cingulate cortex during experimental paclitaxel-induced neuropathic pain in micehttps://peerj.com/preprints/19362016-04-072016-04-07Willias Masocha
Paclitaxel, a chemotherapeutic agent, causes neuropathic pain whose supraspinal pathophysiology is not fully understood. Dysregulation of sodium channel expression, studied mainly in the periphery and spinal cord level, contributes to the pathogenesis of neuropathic pain. We examined gene expression of sodium channel subunits by real time PCR in the anterior cingulate cortex (ACC) at day 7 post first administration of paclitaxel, when mice had developed paclitaxel-induced thermal hyperalgesia. The ACC was chosen because increased activity in the ACC has been observed during neuropathic pain. In the ACC of control animals the Ct values for Nav1.4, Nav1.5, Nav1.7, Nav1.8 and Nav1.9 were above 30 and/or not detectable in some samples. Thus, comparison in mRNA expression between control and paclitaxel treated animals was done for Nav1.1, Nav1.2, Nav1.3, Nav1.6, Nax as well as Navβ1-Navβ4. Paclitaxel treatment significantly increased the mRNA expression of Nav1.1, Nav1.2, Nav1.6 and Nax, but not Nav1.3, sodium channel alpha subunits compared to vehicle-treated controls. Amongst the sodium channel beta subunits treatment with paclitaxel significantly increased the expression of Navβ1 and Navβ3, but not Navβ2 and Navβ4, compared to vehicle-treated controls. These findings suggest that during PINP there is differential upregulation of sodium channels in the ACC, which might contribute to the increased neuronal activity observed in the area during neuropathic pain.
Paclitaxel, a chemotherapeutic agent, causes neuropathic pain whose supraspinal pathophysiology is not fully understood. Dysregulation of sodium channel expression, studied mainly in the periphery and spinal cord level, contributes to the pathogenesis of neuropathic pain. We examined gene expression of sodium channel subunits by real time PCR in the anterior cingulate cortex (ACC) at day 7 post first administration of paclitaxel, when mice had developed paclitaxel-induced thermal hyperalgesia. The ACC was chosen because increased activity in the ACC has been observed during neuropathic pain. In the ACC of control animals the Ct values for Nav1.4, Nav1.5, Nav1.7, Nav1.8 and Nav1.9 were above 30 and/or not detectable in some samples. Thus, comparison in mRNA expression between control and paclitaxel treated animals was done for Nav1.1, Nav1.2, Nav1.3, Nav1.6, Nax as well as Navβ1-Navβ4. Paclitaxel treatment significantly increased the mRNA expression of Nav1.1, Nav1.2, Nav1.6 and Nax, but not Nav1.3, sodium channel alpha subunits compared to vehicle-treated controls. Amongst the sodium channel beta subunits treatment with paclitaxel significantly increased the expression of Navβ1 and Navβ3, but not Navβ2 and Navβ4, compared to vehicle-treated controls. These findings suggest that during PINP there is differential upregulation of sodium channels in the ACC, which might contribute to the increased neuronal activity observed in the area during neuropathic pain.