To view this site you must be a
veterinarian surgeon or nurse.
Are you a Veterinary Surgeon or Veterinary Nurse?

No

Under Pressure: Practical blood pressure assessment and management.

Blood pressure monitoring is a vital part of patient care, unfortunately, many veterinary practices still don’t routinely monitor blood pressure and if they do they don’t have an in-house protocol to treat their findings. It is the veterinary nurse who needs to drive its routine use forwards to improve patient care and outcomes.

Blood pressure monitoring and hypotension during anaesthesia

General anaesthesia is a common procedure, performed on a daily basis in general small animal practice. During anaesthesia our aim should be to maintain our patients as close to their physiological normal as possible.

 Hypotension is reportedly one of the most common complications associated with general anaesthesia in dogs and cats occurring in about 22% of anaesthetised cats and 33% of anaesthetised dogs (Wagner2006).

Too frequently, however, hypotension, hypoperfusion, and potential end-organ damage are not recognised in anesthetised patients as a result of the unavailability or underutilisation of monitoring equipment, improper use of that equipment, or failure to recognise limitations in its technology.

Blood pressure monitoring is now far more achievable with the wide variety of monitoring systems available.  Making sure values are accurate and knowing what the numbers mean will enable the veterinary team to assess hypotension during the intraoperative phase; prevent it occurring or worsening and treating as necessary.

What is blood pressure?

Blood Pressure (BP) is the pressure exerted by blood on the wall of a blood vessel. BP is made up of a systolic and diastolic component. Systolic pressure is created at the end of the cardiac cycle when the ventricles are contracting and the pressure in the arteries are at its highest. Diastolic pressure is when the ventricles are relaxing and the pressure is at its lowest at the beginning of each cardiac cycle.

Arterial blood pressure is the product of systemic vascular resistance (SVR) and cardiac output (CO) (Ettinger and Feldman, 2005) and this is the driving force behind tissue oxygenation.  By multiplying the SVR and CO together you get an estimation of BP.

Systemic vascular resistance (SVR) is the resistance that blood "sees" as it travels throughout the circulatory system of the body and reflects the degree of peripheral resistance by assessing the degree of dilation (vasodilation) or constriction (vasoconstriction) of the systemic blood vessels.

Cardiac output (CO) is the amount of blood pumped by the heart over a given time period and is the product of two separate components:

  • Stroke volume (SV) - the amount of blood pumped by the left ventricle of the heart in one contraction.
  • Heart rate (HR) - the number of heartbeats occurring within a minute

As the stroke volume increases, so does the cardiac output. Over time if the heart has been required to work harder for a longer period of time a plateau is reached and further increases in HR will result in a decrease in CO (Ettinger and Feldman, 2005) 

The components of blood pressure

When we break down the components that make up blood pressure we can see that stroke volume (SV) is made up of three parts:

  1. Cardiac preload – the force acting to stretch the ventricle fibres at the end of diastole and is estimated to be the volume of blood in the ventricle at the end of diastole and therefore represents the blood volume remaining in the heart after contraction.
  2. Cardiac contractility – the strength or ability of the heart to contract.
  3. Cardiac afterload – is the resistance against the vasculature which the left ventricle must overcome for blood to leave the heart during contraction.

Cardiac output not only represents the amount of blood pumped by the heart over a given time period but is also a specific component to how oxygen is delivered to tissues. The delivery of oxygen to the tissues is determined by the cardiac output and how much oxygen is in the arteries. 

Defects in any of the components of blood pressure can lead to a reduction in overall BP, decreased systemic oxygen to the tissues (hypoxia) and systemic hypoperfusion.

Why monitor blood pressure under anaesthesia?

Hypotension during anaesthesia can occur in any anaesthetised patient, no matter what the age, health status or drugs used.

Arterial blood pressure gives us information on our patient’s cardiac output and tissue perfusion. During anaesthesia we should monitor trends in a graphical format. Regular BP monitoring throughout the whole anaesthetic process can indicate anaesthetic depth, give us information on volume status and pain response.

What is hypotension?

Blood pressure is measured in millimetres of mercury (mmHg).  Normal arterial blood pressure is approximately 120/80 mmHg, with the normal mean arterial pressure between 70-90 mmHg.

Hypotension is defined as a systolic blood pressure (SBP) less than 90mmHg or a mean arterial pressure (MAP) less than 60mmHg. General opinion suggests that during anaesthesia, systolic arterial pressure should be maintained above 90mmHg and mean above 60 mmHg in order to ensure sufficient tissue perfusion for the brain, kidneys and heart.

Causes of hypotension

During anaesthesia, the most common cause of hypotension is excessive anaesthetic depth.  Many anaesthetic drugs, particularly the inhaled anaesthetics isoflurane, and sevoflurane, tend to reduce arterial blood pressure as a result of decreased cardiac contractility and vasodilation (Mutoh, 1997). Other causes include hypovolaemia due to intra-operative bleeding or pre-operative dehydration, hypothermia, hypoxia or decreased surgical stimulation.

Drugs such as acepromazine which is a long acting tranquiliser commonly used in small animal practice, may contribute to hypotension as it causes a vasodilation which can result in a reduction in systemic vascular resistance and for this reason is best avoided in critical and hypovolaemic patients.

What’s wrong with a low blood pressure?

If blood pressure is too low, certain vital organs (brain, kidney, heart) may not receive sufficient blood to meet their metabolic needs, and organ damage may occur, or, in rare cases, death may result.  Vital organs such as the brain and kidneys have the ability to adjust blood supply for their metabolic needs through autoregulation of their vascular beds. This autoregulation is effective only if the mean arterial blood pressure is between 60 and 160 mm Hg (Wagner2006). 

A mean arterial blood pressure (MAP) below 60mmHg (Systolic <90mmg) for over 30mins can lead to:

  • Renal failure
  • Delayed recovery
  • Neuromuscular complications
  • Decreased hepatic metabolism of drugs
  • CNS abnormalities such as blindness 

Dr Grauer, an expert on renal disease in animals, suggests that measuring arterial blood pressure during anaesthesia would help reduce the likelihood of renal ischemia (Grauer, 1996).

A study of anaesthetic management of people in the United States concluded that intraoperative hypotension was a significant predictor of increased mortality during the year after an anaesthetic episode, suggesting that "intraoperative anaesthetic management may affect outcomes over longer time periods than previously appreciated." (Monk, 2005).

How can we measure blood pressure?

Whilst we can make a crude assessment of blood pressure status by monitoring perfusion status through clinical hands on examinations, hypotension cannot be reliably detected without measuring blood pressure.  Simply feeling an animal’s pulse is not enough.  A strong, palpable pulse indicates only that difference between systolic and diastolic blood pressures, not necessarily that mean blood pressure, or blood flow to vital organs, is optimal, therefore during anaesthesia patients may have “normal pulses” whilst actually having a low blood pressure.

We have two methods of measuring blood pressure in our patients:

  • Direct (invasive) monitoring
  • Indirect (non – invasive) monitoring
    • Oscillometric
    • Doppler
    • High Definition Oscillometry (HDO)

While direct arterial blood pressure (DABP) measurement is considered the gold standard, it is technically demanding, as it requires placement of an arterial catheter and the use of a transducer and monitor.  The dorsal pedal artery is commonly used for catheter placement. DABP is recommended for critically ill patients or those that are at risk of developing major blood losses during surgery.

The Oscillometric method, involves placing a cuff around a limb or the tail and activating a machine that automatically inflates and deflates the cuff at programmed intervals. By sensing changes in oscillations of the arterial wall as the cuff is inflated and deflated, the monitor can determine blood pressure.  Oscillometric devices that were developed for humans may not work as efficiently as veterinary specific machines.

The Doppler ultrasonic flow detector and sphygmomanometer has a cuff and a Doppler ultrasonic crystal which must be placed over an artery to create an audible signal.  The reading is obtained when you manually inflate and then deflate the cuff, and watch the sphygmomanometer needle drop while listening for the return of pulse sounds, as pulse sounds return this is your systolic BP.

In one clinical study in dogs, sensitivity of Doppler BP for hypotension was around 67% and specificity was 87%, which gives us confidence in knowing that when the doppler is reading low the patient’s blood pressure is actually low and we should be doing something about it. It does however indicate that a normotensive reading especially if a borderline reading, may actually mean the patient is hypotensive (Bourazak & Hofmeister, 2018), which highlights the importance of being proactive to prevent hypotension.

There are a number of studies in anaesthetised cats that suggests that there is a large variability in doppler measurement accuracy (Cunha et al, 2014). Whilst not 100% accurate it should be used to monitor trends and proactively treat.

Whether using the oscillometric or Doppler method of blood pressure monitoring, cuff size selection is important. The length of the cuff doesn’t matter, but the width of the cuff should be 40% the circumference of the leg/tail.  

The cuff should be positioned level with the heart as arterial pressures will be grossly high if below the heart and low if above the heart. This can be particularly challenging in the anaesthetised patient who is positioned in dorsal recumbency so this is when monitoring trends becomes very important alongside your hands on observations.

High definition oscillometry (HDO) is a non- invasive blood pressure device which measures systolic, mean, diastolic pressures and heart rate. The data can be transferred straight to a computer and displays a real-time pulse wave.

Prevention and treatment of hypotension

In a patient experiencing hypotension during anaesthesia we should ask ourselves a series of questions so that we can initiate the correct treatment.

  • Are we using the correct size cuff and is it positioned correctly?
  • Is the depth of anaesthesia appropriate?
  • Is circulating blood volume adequate?
  • Is the patient normothermic?
  • Is the patient’s heart rate appropriate?
  • Is the patient excessively vasodilated?
  • Is there compromised myocardial contractility?

Please click here to download your useful Quick Reference Guide for the treatment of hypotension.

Summary

Blood pressure monitoring is a vital part of patient care, unfortunately, many veterinary practices still don’t routinely monitor blood pressure and if they do they don’t have an in-house protocol to treat their findings. It is the veterinary nurse who needs to drive its routine use forwards to improve patient care and outcomes.

Article by
Claire Roberts
Dip AVN(Surg) PGCertVetAA CertVNECC RVN

Claire has been veterinary nursing for over 24 years her main interests include anaesthesia, ECC, patient care and infection control. In 2006 she gained the Diploma in Advanced Veterinary Nursing (Surgical) and in 2013 she gained the VN certificate in Emergency and Critical care. Claire went on to successfully pass the post graduate certificate in veterinary anaesthesia and analgesia in 2018.

In February 2020 Claire joined Linnaeus as Professional Development Manager alongside running her own CPD company called SynergyCPD which consists of a team of specialist nurses who provide bespoke in house CPD for the whole veterinary team. 

Originally published: Tuesday, 11th February 2020

References

Bourazak & Hofmeister (2018). Bias, sensitivity, and specificity of Doppler ultrasonic flow detector measurement of blood pressure for detecting and monitoring hypotension in anesthetized dogs. JAVMA. 253(11): 1433-1438.

Da Cunha AF, Saile K; Beaufrere H; Wolfson W; Seaton D; Acierno MJ (2014) Measuring level of agreement between values obtained by directly measured blood pressure and ultrasonic Doppler flow detector in cats. J Vet Emerg Crit Care. 24(3): 272-8. doi: 10.1111/vec.12161. Epub 2014 Apr 3.

Ettinger, S. J., & Feldman, E. C. (2005). Textbook of veterinary internal medicine (6th ed.). St. Louis, MO: Elsevier Saunders.

Grauer, G. F. (1996). Prevention of acute renal failure. Veterinary Clinics of North America: Small Animal Practice, 26: 1447–1459

Monk,T. G., Saini,V.,Weldon, B. C., & Sigl, J. L. (2005). Anesthetic management and one-year mortality after noncardiac surgery. Anesthesia and Analgesia, 100: 4–10.

Ramsay I (ed). (2014). BSAVA Small Animal Formulary 8th Edition. BSAVA, Gloucester, UK.

Wagner AE (2006). Anesthesia-related hypotension in small animal practice. Journal of Veterinary Medicine Series A. 01(1): 22-26  

Keep reading... More news items that may interest you.

Reducing anaesthetic risk in the perioperative period – a team approach

Sadly, complications can occur during the peri-anaesthetic period with potentially detrimental effects on the patient. In this article Lou Northway, VNCertECC NCert(Anaesth) RVN, examines the most common causes of adverse peri-anaesthetic events and the steps that can be taken to reduce their incidence.

Read On...

Paper summary: Effects of hypothermia on recovery from general anaesthesia in the dog.

This paper by Pottie et al (2007) examines the effects of hypothermia on recovery from general anaesthesia in the dog.

Read On...

How can we calm and sedate the uncooperative kitty?

Uncooperative, aggressive or stressed cats are commonly encountered in the veterinary clinic. This article examines the aims for calming these patients, the importance of planning and considers selected sedative protocols.

Read On...

Paper summary: Intramuscular butorphanol/alfaxalone combination for sedation of cats prior to echocardiography

The sedation of cats prior to cardiac examination requires a drug protocol that has minimal effects on the cardiovascular system. This study examined a combination of butorphanol and alfaxalone administered intramuscularly on echocardiographic assessment and on cardiovascular function.

Read On...

Anaesthesia: where can we maximise efficiency and save time?

Improving efficiency and “saving time” are key to increasing throughput in busy clinical practice, especially when the normal working environment has been disrupted, where there is an increased demand for services, or when surgical lists become overloaded. This article provides potential solutions for some common bottlenecks and inefficiencies during the anaesthetic process.

Read On...

Paper summary: The effect of propofol or alfaxalone on post-induction heart rate in healthy dogs

The maintenance of heart rate and cardiac output are essential to ensure adequate organ perfusion. This study by Okushima et al examined the effects of alfaxalone versus propofol on heart rate at the time of induction of anaesthesia.

Read On...

Paper summary: Effect of intravenous dose escalation with alfaxalone and propofol on the occurrence of apnoea in dogs.

Apnoea following induction of anaesthesia can result in both morbidity and mortality if not identified early and managed successfully. In this 2012 article by Keates and Whittem alfaxalone and propofol were administered to dogs at 1x, 2x, 5x, 10x and 20x multiples of the labelled dose to determine the incidence of apnoea and the respiratory safety profile of each drug.

Read On...

Intravenous induction of anaesthesia in dogs, cats and pet rabbits.

In this article Karen Heskin, Veterinary Technical Manager for Jurox UK, and Carl Bradbrook, RCVS & European Veterinary Anaesthesia and Analgesia Specialist and President of the Association of Veterinary Anaesthetists, discuss the three most commonly used intravenous induction agents for cats, dogs and pet rabbits in the UK. To complement this discussion we have created three useful summaries to download as quick reference guides for your clinical personnel.

Read On...

ASA Classification and Patient Safety Checklists

As clinics and hospitals reduce routine treatments and move towards critical and emergency care during the COVID-19 crisis, to complement our previously published articles on ASA classification and the use of checklists in anaesthesia, we have created this short slide presentation to act as a useful summary.

Read On...

Paper summary: Proportion of litters of purebred dogs born by Caesarean section.

It is recognised that brachycephalic dog breeds are more likely to experience dystocia and require Caesarean section. This study examined the influence of breed on the incidence of interventional surgery.

Read On...

Caesarean section. Part 1: Physiology relevant to anaesthesia.

In this first of four parts discussing anaesthesia for the Caesarean section we examine the anaesthesia-relevant physiological changes that occur during pregnancy.

Read On...

Cardiovascular stability with Alfaxan Multidose

Cardiovascular stability is a major feature of Alfaxan Multidose. In this article we examine the benefits for your patients and the supporting evidence.

Read On...

Paper summary: Effect of lingual swab placement on pulse oximetery readings

This study by Mair et al (2016) examined what effect the placement of swabs of different thicknesses and colour would have on pulse oximetry readings.

Read On...

Practical pulse oximetry for the Veterinary Nurse

Pulse oximetry is one of the most commonly performed monitoring procedures in veterinary anaesthesia. In this article Courtney Scales, RVN and owner of Anursethesia discusses the why and how we use pulse oximeters, the advantages and pitfalls, and how to manage abnormal readings.

Read On...

Paper summary: Comparison of direct and oscillometric blood pressure assessment using a veterinary specific device

Blood pressure management requires accurate monitoring. In this summary of an article by Acierna et al (2013) we compare a veterinary specific oscillometric device to direct blood pressure measurement.

Read On...

Having their best interests at HEART: Coronary collateral circulation in the rabbit, stress & the effects of alpha-2 agonists, phenothiazines and volatiles.

How extensive is the coronary collateral circulation in the rabbit and what are the effects of stress and drugs on the heart of this species?

Read On...

Co-induction of anaesthesia. Is there a clear advantage?

In this article Matt Gurney, RCVS/ECVS specialist in Veterinary Anaesthesia and Analgesia, examines whether co-induction techniques are advantageous.

Read On...

What are the benefits of slow administration of alfaxalone and does co-induction with alfaxalone/midazolam have any benefits in healthy dogs?

In this summary of a study by Miller et al (2019) we examine if there are any benefits to an alfaxalone/midazolam induction over alfaxalone alone in the healthy dog.

Read On...

Peri-anaesthetic management of the gastric dilation and volvulus (GDV) patient

In this article Carl Bradbrook discusses the peri-ananesthetic management of the canine gastric dilatation and volvulus (GDV) patient.

Read On...

Paper summary: Clinical efficacy and cardiorespiratory effects of alfaxalone, or diazepam/fentanyl for induction of anaesthesia in dogs that are a poor anaesthetic risk.

In this summary of a paper by Psatha et al (2011) we examine the clinical benefits of alfaxalone in high-risk patients when compared to the induction protocol of diazepam + fentanyl.

Read On...

Getting to the HEART of the matter - considerations for anaesthetising the cardiac patient.

In this article Miranda discusses the challenges of anaesthetising patients with cardiac disease and how protocols can be modified to accommodate these patients.

Read On...

Paper summary: How does buprenorphine compare to butorphanol for postoperative analgesia in cats?

A prospective multi-centre clinical trial comparing buprenorphine vs butorphanol for postoperative analgesia in cats.

Read On...

Paper summary: Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions.

With dental surgery one of the most commonly performed procedures in small animal practice, what benefits do dental nerve blocks provide in cats?

Read On...

What should we consider when anaesthetising patients, including geriatrics, for dental procedures?

What should we consider when anaesthetising both adult and senior patients admitted for dental treatment?

Read On...

Checklist for geriatric dental anaesthesia

This article summarises and combines "Anaesthesia for the geriatric patient" and "What should we consider when anaesthetising patients, including geriatrics, for dental procedures?" into a single checklist for anaesthesia for the geriatric dental patient. A downloadable summary is also available by following the link.

Read On...

How do we recognise, assess and treat chronic pain in companion animals?

In this article Ian Self, Associate Professor in Veterinary Anaesthesia and Analgesia, School of Veterinary Medicine and Science, Nottingham, reflects on the recognition, assessment and management options for chronic pain in companion animals

Read On...

The physiology of acute and chronic pain.

In this article, which accompanies " How do we recognise, assess and treat chronic pain in companion animals?", Ian Self describes the physiology of acute and chronic pain

Read On...

What should we consider when anaesthetising the geriatric patient?

With an increasing number of anaesthetics being performed in older pets is there anything we should be aware of or do differently? In this article Carl Bradbrook examines the management of anaesthesia in geriatrics..

Read On...

Paper summary: What effect does does rapid, high volume fluid therapy have on cardiovascular function?

In this summary of a paper by Valverde (2012) we examine the effects of high-volume, rapid fluid therapy on cardiovascular function and hematological values during isoflurane-induced hypotension in healthy dogs.

Read On...

Paper summary: Pre-anaesthetic screening of geriatric dogs

In this summary of a paper by Joubert (2007) we examine the value of pre-anaesthetic screening in geriatric dogs and how the results influence the anaesthetic process.

Read On...

Anaesthesia for Canine Cushing's disease: What should we assess and what should we monitor?

Cushing's disease (hyperadrenocorticism) is relatively common in the dog and this article discusses the appropriate pre-anaesthetic assessment we should perform and why careful monitoring is essential.

Read On...

Paper summary: How frequently are intravenous catheters removed as a result of complications due to bacterial contamination?

In this summary of a paper by Ramos (2018) we examine the incidence of bacterial colonisation of intravenous catheters removed as a result of cannula complication

Read On...

What's the Point? Peripheral Intravenous Cannulation.

Peripheral venous cannulation is a common invasive procedure in small animals, but what are the best-practice insertion techniques and what can we do to avoid complications?

Read On...

Rabbit Anaesthesia – Understanding Your Patient.

How does the anatomy, physiology, behaviour and response to drugs affect your decision making when anaesthetising the rabbit patient?

Read On...

Paper summary: Heated intravenous fluids alone fail to prevent hypothermia in cats under general anaesthesia.

In this summary of a paper by Jourdan et al (2017) we examine the common practice of warming intravenous fluids and the effect on patient temperature.

Read On...

​Considerations for anaesthesia of the brachycephalic dog.

In this article Matt Gurney discusses the induction of anaesthesia and intubation of the brachycephalic patient.

Read On...

Watch the induction and intubation of a brachycephalic.

Induction of anaesthesia and intubation of a brachycephalic dog with Matt Gurney.

Read On...

Paper summary: The effect of omeprazole on oesophageal pH in dogs during anaesthesia

This summary of a publication by Panti et al., examines the effect of orally administered omeprazole on gastro-oesophageal reflux in the anaesthetised dog.

Read On...

How does a syringe driver benefit your patients?

Syringe drivers are becoming increasingly commonplace in modern veterinary practice and are a useful tool for multiple applications. This article looks at the science behind constant rate infusions and the basics of syringe driver use.

Read On...

Paper summary: Pet owner opinions about anaesthesia, pain and surgery in small animals

In this paper we explore perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals.

Read On...

Achieving Safer Anaesthesia with ASA and Joanne Michou MA VetMB DipECVAA MRCVS

How can a Veterinary version of the ASA Physical Status Classification help you achieve safer anaesthesia? To find out how watch our webinar.

Read On...

Paper summary: ASA classification and risk of anaesthetic related death in dogs and cats.

This scientific paper assessed whether the American Society of Anesthesiologists (ASA) Physical Status Classification correlated with the risk of anaesthetic death in dogs and cats.

Read On...

New! Methadyne, Our New Methadone Now Available

This is our third product launch this year, and the latest addition to our anaesthesia and analgesia portfolio, Methadyne, contains 10mg/ml methadone as its active ingredient. It can be administered for analgesia of moderate to severe pain in dogs and cats, to provide neuroleptanalgesia, and as part of a patient’s premedication protocol prior to general anaesthesia.

Read On...

A retrospective comparison of two analgesic strategies after uncomplicated tibial plateau levelling osteotomy in dogs.

In this review we summarise a publication by Bini (2018) examining two protocols for the administration of methadone following TPLO surgery in dogs.

Read On...

Practical Acute Pain Assessment

In this summary of acute pain assessment, Carl Bradbrook examines why we should be monitoring patients for pain and looks at the commonly used scoring systems.

Read On...

Alfaxan for the maintenance of anaesthesia: Peer reviewed clinical papers.

In this article we have identified the key clinical peer reviewed papers to support the use of Alfaxan for maintenance of Anaesthesia in Cats and Dogs.

Read On...

TIVA or not? (Total intravenous anaesthesia).

In this article the Jurox UK Technical Team discuss the use of intravenous agents to maintain anaesthesia in the dog and cat.

Read On...

Benzodiazepines - can they help reduce anaesthesia related side effects?

In part 4 of this series on premedicant agents we examine the pros and cons of benzodiazepines.

Read On...

Paper summary: Effect of benzodiazepines on the dose of alfaxalone needed for endotracheal intubation in healthy dogs

This paper examined whether a benzodiazepine, administered as a co-induction agent with alfaxalone, improved endotracheal intubation, and reduced the dose of alfaxalone, in the dog

Read On...

Putting methadone in its place in your pain management.

In this article we examine why methadone could be considered the analgesic of choice for many of our patients and understand its importance in modern veterinary medicine. The article includes a link to a downloadable summary sheet.

Read On...

Food for Thought: Pre-anaesthetic Fasting

In this article Karen examines why we fast our canine and feline patients prior to anaesthesia and what the current recommendations are. Karen also investigates why rabbits are different and should not be starved before anaesthesia.

Read On...

​Purr-fecting Pain Management

In this article summary we examine which of the two opioids, buprenorphine or butorphanol, provides the most appropriate analgesia following ovariohysterectomy in the cat.

Read On...

Perspectives on Premeds - Phenothiazines: from Mental Health to Premedication

In this article from the Perspectives on Premeds series, Karen takes us through the properties and uses of phenothiazines in modern veterinary practice.

Read On...

Methadone with Acepromazine - when is enough, enough?

This study looks at the effects of three methadone doses combined with acepromazine on sedation and some cardiopulmonary variables in dogs.

Read On...

AceSedate®, Our New Acepromazine, Available Now.

We have extended our anaesthesia and analgesia portfolio with the launch of AceSedate®. Containing the tried and trusted, long-acting sedative agent acepromazine as its active ingredient, AceSedate can be used for the premedication, sedation and tranquilisation of cats and dogs.

Read On...

Time: is 30 minutes long enough?

This recent study examined whether the application of EMLA cream, for 30 or 60 minutes, would be a useful tool to improve patient compliance prior to intravenous cannula placement in the veterinary clinical practice setting.

Read On...

Caesarean Section Survival Guide. Part 2: Anaesthetic Protocol Selection & Peri-operative Considerations.

In this second instalment of the 2-part article, we explore premedication, induction, maintenance & monitoring, recovery and analgesia for the Caesarean section patient.

Read On...

Buprenorphine: it’s not all static in rabbits

Opioids are well known for causing gastrointestinal stasis in mammalian species. This recent paper examined the effects of a single high dose of buprenorphine on the rabbit gastrointestinal tract using non-invasive imaging techniques.

Read On...

Caesarean Section Survival Guide. Part 1: Physiology & Pre-anaesthetic Considerations.

In the first instalment of this 2-part review Karen examines the physiological changes that occur during pregnancy and how those adjustments can affect the selection of anaesthetic protocols for the increasingly common Caesarean section.

Read On...

No leeway for the spay: A comparison between methadone and buprenorphine for perioperative analgesia in dogs undergoing ovariohysterectomy.

This recent paper compares post-operative pain scores and requirement for rescue analgesia following premedication with methadone or buprenorphine, in combination with acepromazine or medetomidine, in 80 bitches undergoing ovariohysterectomy.

Read On...

Cardiac arrest - the human factor

Cardiac arrest in dogs and cats is, thankfully, relatively rare. However, when it does happen it can have devastating consequences for the animal, owner and the veterinary team. This study examined the common causalities leading up to a cardiac arrest with the aim of changing protocols to improve outcomes.

Read On...

Are you Using Safety Checklists in your Practice?

In this article, Carl focuses on the benefits of introducing a safety checklist in practice to reduce patient morbidity, mortality and to improve communication between members of the veterinary team. The article contains links to the AVA safety checklist as well as a link to a customisable list that you can adapt to your practice needs. 

Read On...

The Big Chill - Temperature Management in Sedated and Anaesthetised Patients

The effects of hypothermia are very far reaching throughout the peri-anaesthetic process. In this article, James takes us through the interesting mechanisms of body cooling and warming, the clinical relevance of hypothermia and what we can do to prevent it.

Read On...

Keeping the Finger on the Pulse -  Nuances in CV Monitoring

All patients are exposed to the risks associated with general anaesthesia. Continuously monitoring anaesthetised patients maximises patients safety and wellbeing. In this article, Dan takes us through the common monitoring techniques that provide information about the cardiovascular status of your patient. 

Read On...

Effect of Maropitant on Isoflurane Requirements & Postoperative Nausea & Vomiting

Despite being widely recognized in humans, postoperative nausea and vomiting (PONV), and the role of maropitant in reducing inhalational anaesthetic requirements have been poorly documented in dogs. This recent study evaluates PONV and isoflurane requirements after maropitant administration during routine ovariectomy in bitches.

Read On...

New! Alfaxan® Multidose Now Available

We are happy to announce we have enhanced our anaesthesia and analgesia portfolio with the introduction of Alfaxan®Multidose for dogs, cats and pet rabbits.

Read On...

Sevoflurane requirement in dogs premedicated with medetomidine and butorphanol

Little information is available about the effect that different doses of medetomidine and butorphanol may have when using sevoflurane for maintenance of anaesthesia in dogs. This recent study evaluates heart rate and median sevoflurane concentration required at different dose rates.

Read On...

Capnography II - What happened to the elephants? A summary of abnormal traces

In this second article of the capnography series, James provides a guide to a few of the most common traces that you will encounter during surgery. Scroll to the end of the article to download a printable capnography cheatsheet. 

Read On...

Pain, what a Pain! (Part 2) – Practical Tips On How To Perform Dental Nerve Blocks In Companion Animal Practice

In this second article of the Pain, what a Pain! series, Dan takes us through the LRA techniques associated with dental and oral surgery. In this article, you will find practical tips and pictures on common dental nerve blocks as well as safety concerns to consider.

Read On...

​Peri-anaesthetic mortality and nonfatal gastrointestinal complications in pet rabbits

This recent retrospective study looks at the cases of 185 pet rabbits admitted for sedation or general anaesthetic and evaluates the incidence and risk factors contributing to peri-anaesthetic mortality and gastrointestinal complications.

Read On...

Pain, what a Pain! How Locoregional Anaesthesia can Improve the Outcome and Welfare of Veterinary Patients (Part 1)

In this first article out of a series of two, Dan takes us through an introduction and practical tips for appropriate local anaesthesia delivery. Find out why these anaesthesia techniques, that are well recognised in human medicine, have seen an increase in popularity in veterinary medicine over the recent years

Read On...

Perspectives on Premeds – Opioids

Perspectives on Premeds is a series of articles touching on different pharmacological, physiological and clinical aspects of pre-anaesthetic medication. This second article aims to provide a refresher on opioids.

Read On...

Effects of Dexmedetomidine with Different Opioid Combinations in Dogs

Read the highlights of a recently published research paper that evaluates cardiorespiratory, sedative and antinociceptive effects of dexmedetomidine alone and in combination with morphine, methadone, meperidine, butorphanol, nalbuphine and tramadol. 

Read On...

Preoxygenation Study Highlights

This study evaluates the effectiveness of two methods of preoxygenation in healthy yet sedated dogs and the impact of these methods on time taken to reach a predetermined haemoglobin desaturation point (haemoglobin saturation (SpO2) of 90%) during an experimentally induced period of apnoea.

Read On...

Capnography – Not Just a Load of Hot Air

Capnography is the measurement of inhaled and exhaled carbon dioxide (CO2) concentration. The graphical illustration of CO2 within respired gases versus times is known as the capnogram.

Read On...

Perspectives on Premeds – Alpha-2 Agonists

Perspectives on Premeds is a series of articles touching on different pharmacological, physiological and clinical aspects of pre-anaesthetic medication. This first article aims to provide a refresher on α2 agonists.

Read On...

Alfaxan - now licensed for use in pet rabbits

Jurox Animal Health is delighted to announce that Alfaxan is now licensed for cats, dogs and pet rabbits. This is an exciting advance and could change the way rabbits are anaesthetised in the U.K.

Read On...
Repeatable. Reliable. Relax.