Understanding anesthesia in canine dentistryOctober 17, 2019They also represent a source of fear and concern for pet owners—witness the burgeoning anesthesia-free dental cleaning services that have become popular.
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Decreasing anesthetic riskSeptember 13, 2019Knowing how to recognize risk and respond appropriately can greatly decrease the likelihood of anesthesia-related complications.
Understanding capnography and anesthesiaSeptember 5, 2019Capnography, which is the measurement of carbon dioxide in a patient’s breath, provides a good picture of the respiratory process.
Using feeding tubes in general practiceAugust 15, 2019Nutrition is quite often overlooked in hospitalized patients, which depending on what the patient is being treated for, can worsen the situation.
Four bold questions about hand asepsisMay 24, 2019Hand asepsis is one of the most critical components of surgical asepsis to lower the risk of nosocomial diseases. In this column, we answer four critical and bold questions related to hand asepsis. Could you lose your driver's license by scrubbing in? With the emergence of alcohol-based hand-rub solutions (ABHRS), you may be concerned that with repeated use, you could have enough alcohol in your bloodstream to lose your driver's license. Alcohol is indeed absorbed through the skin, and you inhale plenty of it while scrubbing (or "rubbing"). So could a breathalyzer test be positive? A 2006 Australian study1 looked at 20 health-care workers and their use of ABHRS repeatedly over a short period of time: 30 applications in an hour! Then serum and breath ethanol and isopropanol absorption were assessed. Traces of ethanol were detectable in the breath of 30 percent of subjects at one to two minutes after application and in the serum of 10 percent of them at five to seven minutes postexposure. Serum isopropanol levels were undetectable at all time points. Even though ethanol did have a positive result, whether through cutaneous absorption or inhalation of fumes, neither level would be considered positive during a police-issued …
Cone-beam computed tomography in dentistry and oral surgeryMay 24, 2019Computed tomography (CT) has revolutionized our ability to detect subtle hard and soft tissue abnormalities of the maxillofacial region. Cone-beam computed tomography (CBCT) is creating much buzz amongst veterinary dentists when it comes to dental/maxillofacial diagnostic tools. What is the difference between CBCT and conventional CT? Rather than a collection of thin, closely spaced slices obtained with a fan-shaped beam of conventional CT, CBCT has both an X-ray generator and detector that rotates around the patient, capturing data with a cone-shaped beam. Both modalities can be used to create very helpful 3-D reconstructions of the areas of interest, although CBCT provides increased detail of dentoalveolar structures. One veterinary study compared CBCT's diagnostic image quality with that of 64-multidetector row CT sagittal slices. Four blinded evaluators compared CBCT and 64-multidetector row CT images. Trabecular bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura and "overall impression" were scored. Images captured with CBCT were found to be significantly superior in image quality when compared to images acquired with 64-multidetector CT in all categories.1 Inka, the jaguar My first experience with CBCT was with a patient from the Elmwood Park Zoo in Norristown, Pa. Inka is a five-year-old jaguar that fractured …
How to improve your surgical skillsMay 6, 2019What can you do to improve your surgical skills? Assuming your career path does not include a surgery internship or a residency and board certification, here are some tips to raise the surgical bar. Prerequisites Some traits are self-understanding. In order to perform surgery, you need to have dexterity and think in 3D. You'll also need the following: "Good hands"—no shaking allowed. A keen sense of observation. Observe the patient. Observe the tissue. Observe others perform surgery. Some will teach you what to do, while others will teach you what not to do. Use the correct suture material, the correct needle, and the correct size. Know and apply the seven principles of William Stewart Halsted, MD, our 19th-century forefather (see The basics of surgery). Speaking of forefathers… believe the sayings they crafted: "Measure twice, cut once." "If it's worth taking out, it's worth turning in" (i.e. masses belong in the lab, not the trash). "There are routine surgeries, but there is no routine anesthesia." "Dilution is the solution to pollution." It is critical to thoroughly understand anatomy, indications, and surgical approaches. Reading books to acquire a good understanding of anatomy and a great knowledge of approaches is a must. But …
Declawing cats may soon be illegal in New YorkMay 3, 2019Legislation is currently moving through New York's state assembly in an effort to ban the declawing of cats. Declawing is already banned in several cities in California, as well as many countries around the world, including Switzerland, Israel, and the U.K. If Bill A01303 is passed, it would make New York the first state to ban the practice. "Claws play an important role in various aspects of cats' lives. They use their nails to assist in climbing and maintaining balance, to help them fully stretch, to relieve stress through kneading, and to escape danger," reads a state assembly memorandum memo. The memo goes on to say, "When the claws are removed, the animal tends to shift its gait and where it places most of its weight, causing strain on its leg joints and spine, which can lead to early onset arthritis and prolonged back and joint pain." Should the bill pass, anyone who performs an onychectomy, a partial/complete phlangectomy, or a tendonectomy procedure on a cat faces a fine of up to $1,000. Declawing will be permitted when it is necessary for therapeutic purposes, including: an existing or recurring illness; infection; disease; injury; or an abnormal condition in the …
Brain Teaser: Can you solve this puzzle?March 25, 2019 Presentation You need to cut into the colon to remove a foreign body or take a biopsy. Challenge 1) What is the holding layer of the colon—the one to include in the suture line 2) Which suture material is ideal? Which needle is best? 3) Which suture pattern is recommended? Check the answers on the next page.
Osteosarcoma: Beyond amputation and euthanasiaMarch 12, 2019When a patient is diagnosed with osteosarcoma, we tend to focus on three options: • the "gold standard," i.e. amputation with or without chemotherapy; • what many call palliative care, meaning pain medication and rest; or • euthanasia. But what if amputation is not an option? What if chemotherapy or radiation is out of the owner's financial capabilities? Or a couple of medications are not enough to numb the pain? What if visible metastasis to the lungs is already present? Bob Stein, DVM, pain management guru and founder of the Veterinary Anesthesia & Analgesia Support Group (www.vasg.org), recently shared another valid option.* "With my suggested approach, we can often provide quality of life to even large-breed dogs for six to 12 months and sometimes more than 20." Let's detail Dr. Stein's protocol. Pamidronate Pamidronate, a bisphosphonate, is an injectable drug that is inexpensive and easy to administer (ref: TM Fan et al. JVIM 2007). It helps to reduce pain (in 30 to 50 percent of patients), inhibit bone osteolysis, and has potential cancer-suppression effects by impeding proliferation and inducing apoptosis. The drug has a wide safety margin and can even be used on patients with renal or …
