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OBJECTIVE Use a referral dental clinic model to study how to calculate accurate 95% upper confidence limits for probabilities of workloads (total case duration, including turnover time) exceeding allocated times. ANIMALS Dogs and cats undergoing dental treatments. METHODS Managerial data (procedure date and duration) collected over 44 consecutive operative workdays were used to calculate the daily anesthetist workload. Workloads were compared with a normal distribution using the Shapiro-Wilk test, serial correlation was examined by runs test, and comparisons among weekdays were made using the KruskalWallis test. The 95% confidence limits for normally distributed workloads exceeding allocated times were estimated with a generalized pivotal quantity. The impact of a number of procedures was assessed with scatterplots, Pearson linear correlation coefficients, and multivariable linear regression. RESULTS Mean anesthetist’s workload was normally distributed (Shapiro-Wilk P = .25), without serial correlation (P = .45), and without significant differences among weekdays (P = .52). Daily workload, mean 9.39 hours and SD 3.06 hours, had 95% upper confidence limit of 4.47% for the probability that exceeding 16 hours (ie, 8 hours per each of 2 tables). There was a strong positive correlation between daily workload and the end of the workday (r = .85), significantly larger than the correlation between the end of the workday and the number of procedures (r = .64, P < .0001). CLINICAL RELEVANCE There are multiple managerial applications in veterinary anesthesia wherein the problem is to estimate risks of exceeding thresholds of workload, including the costs of hiring a locum, scheduling unplanned add-on cases, planning for late discharge of surgical patients to owners, and coordinating anesthetist breaks. [ABSTRACT FROM AUTHOR]

Simple Summary: Pain in animals is assessed by behavioral alterations presented on scales. We aimed to validate the CMPS-SF according to the COSMIN and GRADE guidelines, used to assess the validity and reliability of health instruments. Four trained evaluators assessed 208 videos in four periods (pre-operative, peak of pain, 1 h after peak of pain and analgesia, and 24 h after surgery) of 52 dogs, divided into negative control (animals without pain), soft tissue surgeries, and orthopedic surgeries. The videos were evaluated in two stages, with intervals of 21 days. The CMPS-SF is a unidimensional scale with good reliability both intra-observer and between different observers, and it showed a strong correlation with other scales. Pain scores were higher after than before surgery, reduced after analgesia, and reduced even further after 24 h, which demonstrates its responsiveness. Postoperative pain scores were higher in dogs undergoing surgery versus controls. The scale is homogeneous, and there is a good interrelationship between its items. The detection values for dogs truly with and without pain were 74–83% and 78–87%, respectively. The score for indicating analgesia was ≥5 and the GRADE classification was high, confirming the validity of the scale. We aimed to validate the CMPS-SF according to COSMIN and GRADE guidelines. Four trained evaluators assessed 208 videos (pre-operative-M1, peak of pain-M2, 1 h after the peak of pain and analgesia (rescue)-M3, and 24 h post-extubation-M4) of 52 dogs, divided into negative controls (n = 10), soft tissue surgeries (n = 22), and orthopedic surgeries (n = 20). The videos were randomized and blinded as to when they were filmed, and were evaluated in two stages, 21 days apart. According to confirmatory analysis, the CMPS-SF is a unidimensional scale. Intra-observer reliability was between 0.80 and 0.99 and inter-observer reliability between 0.73 and 0.86. Criterion validity was confirmed by the correlation between the CMPS-SF and other unidimensional scales (≥0.7). The differences between the scores were M2 ≥ M3 > M4 > M1 (responsiveness), and the scale presented construct validity (higher postoperative pain scores in dogs undergoing surgery versus control). Internal consistency was 0.7 (Cronbach's α) and 0.77 (McDonald's ω), and the item-total correlation was between 0.3 and 0.7, except for "A(ii)—Attention to wound". Specificity and sensitivity were 78–87% and 74–83%, respectively. The cut-off point for rescue analgesia was ≥5 or ≥4 excluding item B(iii) mobility, and the GRADE classification was high, confirming the validity of the scale. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess pulmonary hemodynamics and alveolar oxygenation in dogs anesthetized with propofol or isoflurane during one-lung ventilation (OLV) in a closed-thoracic experimental model. ANIMALS 6 healthy Beagles. PROCEDURES Dogs were anesthetized with each of 3 protocols (constant rate IV infusion of propofol [0.4 to 1.0 mg/kg/min], isoflurane at the minimum alveolar concentration [MAC], and isoflurane 1.5 MAC), with a 7-day washout period between anesthetic sessions. During each session, dogs were intubated with a double-lumen endotracheal tube, positioned in right lateral recumbency, and administered atracurium (0.1 to 0.2 mg/kg, IV, q 30 min) to allow mechanical ventilation throughout a 2-hour observation period. Dogs underwent two-lung ventilation for 30 minutes, OLV of the right lung for I hour, and two-lung ventilation for another 30 minutes. Pulmonary hemodynamic and blood gas variables were evaluated at predetermined times and compared among protocols and over time within each protocol. RESULTS Alveolar oxygenation was not impaired, and mean heart rate and pulmonary artery pressure and occlusion pressure were similar among the 3 protocols. One-lung ventilation caused a significant increase in the arteriovenous shunt fraction only when dogs were anesthetized with isoflurane at 1.5 MAC. Dogs developed respiratory acidosis, which was exacerbated by OLV, during all anesthetic sessions. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated pulmonary hemodynamics and alveolar oxygenation during OLV in a closed-thoracic model were similar regardless of whether dogs were anesthetized with propofol or isoflurane. One-lung ventilation can be successfully performed in dogs by use of a double-lumen endotracheal tube and either propofol or isoflurane. [ABSTRACT FROM AUTHOR]

Objective: To collect medication error (ME) data during the perianesthetic period from small animal clinics., Sample: 6 small animal general practice veterinary clinics., Methods: Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing., Results: A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education., Clinical Relevance: These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.

The goal of this study was to evaluate the effect of a human observer on Rabbit Grimace Scale (RbtGS) scores. The study scored video footage taken of 28 rabbits before and after orthopedic surgery, as follows: 24 h before surgery ( baseline ), 1 h after surgery ( pain ), 3 h after analgesia administration ( analgesia ), and 24 h after surgery ( 24h ) in the presence and absence of an observer. Videos were assessed twice in random order by 3 evaluators who were blind to the collection time and the presence or absence of an observer. Responses to pain and analgesia were evaluated by comparing the 4 time points using the Friedman test, followed by the Dunn test. The influence of the presence or absence of the observer at each time point was evaluated using the Wilcoxon test. Intra- and interrater reliabilities were estimated using the intraclass correlation coefficient. The scale was responsive to pain, as the scores increased after surgery and had decreased by 24 h after surgery. The presence of the observer reduced significantly the RbtGS scores (median and range) at pain (present, 0.75, 0 to 1.75; absent, 1, 0 to 2) and increased the scores at baseline (present, 0.2, 0 to 2; absent, 0, 0 to 2) and 24h after surgery (present, 0.33, 0 to 1.75; absent, 0.2, 0 to 1.5). The intrarater reliability was good (0.69) to very good (0.82) and interrater reliability was moderate (0.49) to good (0.67). Thus, the RbtGS appeared to detect pain when scored from video footage of rabbits before and after orthopedic surgery. In the presence of the observer, the pain scores were underestimated at the time considered to be associated with the greatest pain and overestimated at the times of little or no pain.