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In our new feature ‘Ask VETbytes’, our team of vets will be answering your questions. This week we were asked “What are the options for post-operative pain relief in dogs and cats undergoing caesarean section?”

This is an area where veterinary evidence is lacking and where our patients don’t always receive adequate analgesia, so we have drawn on both human studies and specialist veterinary consensus to create a practical guide for you and your patients:

• Despite the paucity of published evidence regarding the safety of analgesic drugs in the pregnant or lactating dog and cat it is important to recognise our responsibility to the welfare of our patients regarding the provision of adequate analgesia¹⁰
• It is estimated that the neonate receives approximately 1–2% of the maternal dose of a drug¹⁴
• A longer acting opioid injection may be administered after all the foetuses have been removed e.g. methadone 0.1–0.2 mg/kg^10,41
• In women, NSAIDs are considered safe and effective analgesia after caesarean section because of their low excretion in breast milk^38,40
  The same is considered likely to apply to dogs and cats due to the known physiochemical properties of the drugs^13,14
  A single dose administered in the immediate postoperative period is generally advocated^10,14
  Consider ongoing administration, as required, for 1-2 days after discharge¹³
• Paracetamol is generally considered safe in dogs¹⁴ 
• NSAIDs should only be administered if the bitch/queen is normovolaemic and normotensive¹³
• Paracetamol should NOT be used in cats¹⁴
• None of these drugs are licensed for lactating bitches or queens, ensure that prior owner consent is obtained for their use

Sign up for a free trial of the VETbytes emergency and critical care module to receive full clinical guides or subscribe for an annual licence for only £99/year!

References:

10. Self, I. (2019)
Anaesthesia for canine caesarean section
Companion Animal; 24 (2) 84-90
Abstract

13. Robertson, S. (2016)
Anaesthetic management for caesarean sections in dogs and cats
In Practice;38(7) 327-339
Abstract

14. Mathews, K., Kronen, P.W., Lascelles,D., et al. (2014)
WSAVA Guidelines for Recognition, Assessment and Treatment of Pain
Journal of Small Animal Practice; 55 (6) E10-68
Full text available

38. Bloor, M. and Paech, M. (2013)
Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation
Anesthesia and Analgesia;116 (5) 1063-1075
Abstract

40. Spigset, O., Hägg, S. (2000)
Analgesics and Breast-Feeding: Safety considerations
Paediatric Drugs 2(3), 223–238
Abstract

41. Romagnoli, N., Barbarossa, A., Cunto, M., et al (2019)
Evaluation of methadone concentrations in bitches and in umbilical cords after epidural or systemic administration for caesarean section: A randomized trial
Veterinary Anaesthesia and Analgesia 46(3), 375-383
Abstract

Emergency and critical care work can be stressful and demanding, and rising caseloads are contributing to more cases of burnout in the veterinary profession. With the application of evidence-based veterinary medicine, VETbytes offers a stress-relief manifesto.

A new survey conducted by the British Veterinary Association has found that three-quarters of vets are concerned about stress and burnout, with the small animal vet category ‘most concerned’ – a situation compounded by the coronavirus pandemic.

Emergency medicine has the added stress of long work hours, an intense work environment with pressure to efficiently identify clinical needs and manage client expectations. Being able to access the best clinical guidance in emergency situations can be a key factor in managing stress levels and improving patient outcomes.

The emergency and critical care app from VETbytes was created as a clinical support tool for veterinary teams, providing evidence-based veterinary information in concise clinical guides. Vets can now also access the ‘latest updates’ feature to seamlessly stay up to date with the latest findings in ECC.

“VETbytes exists to bring evidence-based medicine to the fore of veterinary general practice,” said Zoë Coker and Bronwen Eastwood, co-founders of VETbytes. “Now is a crucial moment for vets to take action to help reduce stress levels, VETbytes offers a cost-effective and simple way to do this.”

VETbytes provides clear benefits to clinicians such as more efficient case management and reduction of errors and stress, which are especially important during the pandemic.

VETbytes is accessible on mobile, iPad and desktop. The latest evidence added to the ECC app is available to view here.

The point-of-care clinical support tool, VETbytes, has added to the veterinary resource by introducing a ‘latest updates’ feed to its first app for emergency and critical care (ECC).

Launched in July in partnership with the BSAVA, VETbytes has enhanced its ability to make relevant research accessible to the end user by implementing a ‘latest updates’ evidence feed to its emergency and critical care (ECC) app.

Vets treating small animals can now access condensed summaries of the most recently published papers relevant to ECC, enabling them to keep up to date with the evidence without having to spend hours reading.

“This new feature will allow users to access real-time updates to the app so they can be assured they are following the most up-to-date clinical guidance,” said Zoë Coker and Bronwen Eastwood, co-founders of VETbytes.

The British Small Animal Veterinary Association (BSAVA), the founding partner of VETbytes, welcomes the development to the ECC app for its members: “The latest addition to the app advances our joint goal with VETbytes, to provide the latest practical, accessible, evidence-based resources for the small animal veterinary community.” said BSAVA President Professor Ian Ramsey.

The VETbytes app is available to BSAVA members with discounted subscription fees and free access is offered to veterinary students.

To view the ‘latest updates’ feed, click here.

The ECC app, available from VETbytes, currently covers more than 100 topics and includes other features such as drug (and CRI) calculators, a quick reference section and links to hundreds of source abstracts, as well as CPD accreditation for reflective learning through usage of the app.

VETbytes is available at the point of care on mobile, iPad or desktop. To start a free trial or subscribe to the VETbytes app, visit vetbytes.co.uk.

We’ve noticed an increase in parvovirus cases recently so we thought we’d share a few snippets from the treatment section of our parvovirus page. To see the full condition, subscribe or sign up for a free trial today.

Did you know?

• In a recent study, parvovirus-infected puppies that received faecal microbiota transplantation (FMT) in addition to standard therapy showed a faster resolution of diarrhoea compared to dogs that only received standard therapy
• 61% of cases receiving FMT showed resolution of diarrhoea within 48 hours compared to only 5% without

Method

• 10 g of healthy donor faeces diluted in 10 ml 0.9% NaCl and introduced anally to the proximal rectum via a urinary catheter
• Maintain in lateral recumbency for 2 minutes with pelvis raised 45% from the surface
• Perform within 6–12 hrs of admission and repeat q48h until resolution of diarrhoea, or up to five doses

Perira, G.Q., Gomes, L.A., Santos, I.S. et al. (2018)
Fecal microbiota transplantation in puppies with canine parvovirus infection
Journal of Veterinary Internal Medicine; 32 (2) 707-711. Full text available

Don’t forget environmental control

• Parvovirus can survive in the environment for up to 1 year and is very difficult to kill
• Clean the area thoroughly first as the presence of organic matter, e.g. faeces or blood, can greatly impact the efficacy of disinfectants
• Disinfect the environment with sodium hypochlorite (bleach)
  0.75% solution for 1 minute contact time or
  0.37% solution with 15 minute contact time
• Steam cleaning for surfaces that do not tolerate bleach
• Careful disposal of faeces

Cavalli, A., Marinaro, M., Desario, C., Corrente, M., Camero, M. and Buonavoglia, C. (2018)
In vitro virucidal activity of sodium hypochlorite against canine parvovirus type 2
Epidemiology and Infection; 146 (15) 2010–2013. Full text available

VETbytes provides the latest evidence-based treatment with its Keep It Simple Summaries (KISS). Quickly access a general overview of how to handle a case, later access the detailed section when you have more time and can reflect upon your learning with our CPD links.

Try VETbytes for 30 days for free, or subscribe for only £9.99/month or £99.00/year (BSAVA members get 33% off). Sign up today.

Would you know how to handle a case of xylitol toxicity? Get straight to the point of care with VETbytes’ treatment action plan. Read the ‘Key Points’ checklist in under a minute before the client arrives and know that you are up-to-date and ready for action!

• Ingestion can cause hypoglycaemia, hepatic failure or both
• Dogs that ingest > 0.05–0.1 g/kg are at risk for developing hypoglycaemia
  This usually occurs 30–60 minutes after ingestion
• Dogs that ingest > 0.5 g/kg are at risk for developing hepatotoxicosis and acute hepatic failure. This usually occurs 1–3 days after ingestion
• Can estimate that 1 cup of xylitol contains 190g and 1 piece of gum contains 0.3-1g of xylitol
• Emesis is indicated unless the animal is showing signs of hypoglycaemia or has ingested 100% xylitol products more than 30 minutes prior to presentation as clinical signs may develop during decontamination, risking aspiration
• Charcoal is NOT recommended as xylitol is readily absorbed from the gastrointestinal tract and binds poorly to charcoal
• Administer dextrose to hypoglycaemic patients at a dose of 0.25–0.5 g/kg 50% dextrose i/v over 10 minutes (0.5–1 ml/kg 50% dextrose)
• Hepatoprotectants are indicated in patients that have ingested hepatotoxic doses, e.g. SAMe, Silybin or N-acetylcysteine. There is however no strong clinical evidence to prove their efficacy
• Additional treatments may include management of coagulation defects and gastroprotectants although evidence is scarce that hepatic disease is a direct cause of gastroduodenal ulceration and erosion

Don’t be caught out!

• Dogs may present with acute hepatic failure without having shown initial signs of hypoglycaemia
• Asymptomatic dogs with known ingestion of xylitol should be hospitalised for at least 72 hours in case of delayed-onset hypoglycaemia which may be seen when gum is ingested, or in case of development of hepatic failure without hypoglycaemia

Try VETbytes for 30 days for free, or subscribe for only £9.99/month or £99.00/year (BSAVA members get 33% off). Sign up today.

Summer is the time of year when we are most likely to be presented with a case of heatstroke. Are you up to date with the do’s and don’ts of active cooling? Use VETbytes to quickly access the information you need to make the right clinical decisions.

Cooling before presentation to the vet is associated with improved survival

• Advise the owner to begin cooling immediately using either wet towels to wipe/wet the patient or a hose with cool water
• Recommend that the owners keep the windows open in the car on the way to the surgery

Recommended methods for cooling:

• Running water – hose, shower
• Fan (care not to apply near the head and apply lubricant to the eyes to protect the corneas)
• Place on a cool surface
• Spray alcohol onto the extremities
• Cold packs on large vessels (e.g. axilla, groin, jugular)
• Massaging while active cooling
• Flow by oxygen
• Room temperature enema (severe hyperthermia)

Do not:

• Immerse in water or ice bath
• Leave wet towels over the patient
• Use ice-cold water (will result in vasocontriction and discomfort)
• Place in a small cage
• Use antipyretics, e.g. NSAIDs as may have multi-organ dysfunction

Monitoring:

• Monitor the temperature every 10 minutes
• Avoid hypothermia, stop cooling when temperature 39.5°C

Don’t forget that early therapeutic renal support is crucial in heatstroke treatment as AKI is often only observed hours after thermal injury

Subscribe for a free trial to see the complete clinical guide to heatstroke management.

Special offers for BSAVA members. BSAVA members receive exclusive discounts and access to VETbytes. To find out more, click here.

Treating feline urethral obstruction can challenge the most experienced vet. You have an unstable patient who will die if left untreated. You need to make critical decisions about investigation and treatment for a successful outcome. Your clients and patients are depending on it.

VETbytes is your new clinical companion. On desktop, tablet or phone, its evidence-based concise clinical summaries will support you every step of the way. Available at the point-of-care, when and where you need it, VETbytes has the answers to help you treat these cases with confidence.

• Step 1 – I/V fluids to manage cardiovascular compromise
• Step 2 – Manage hyperkalaemia if still present
• Step 3 – GA or sedate to relieve obstruction +/- place indwelling catheter
• Step 4 – Analgesia, muscle relaxants, supportive care
• Step 5 – Manage any post-obstruction diuresis
• Step 6 – Address the underlying cause

Find urgent answers to critical-care questions with VETbytes:

What about cystocentesis?

• Controversial, however recent evidence concluded that it is a low-risk procedure in this population of patients
• May aid catheterisation, reduce discomfort and improve GFR
• Potential risk of bladder tear/rupture
• Indicated for those cases in which urethral catheterisation cannot be performed or that are very unstable and need sedation/GA
• To reduce risk, use a flexible collection system and enter the ventral aspect of the bladder wall and angle caudally 45 degrees
• Repeated cystocentesis is discouraged

What about I/V fluids? Will I rupture the bladder?

• It is vital to achieve cardiovascular stability before general anaesthesia or sedation
• Due to reduced renal blood flow and decreased GFR, urine production will be minimal so concerns about bladder rupture at this stage are misguided
• However, relief of the obstruction should follow immediately after cardiovascular stability has been achieved

Which catheter do I choose?

• A rigid catheter, e.g. Standard (Jackson-type) tomcat catheter (polypropylene) can be used to relieve the obstruction if unsuccessful with softer catheters, but these are not suitable to be left in situ
• A polytetrafluoroethylene open-ended catheter or a 20–22 G over-the-needle catheter (with stylet removed) may be more useful for distal obstructions
• Larger catheters may cause more irritation or trauma, smaller catheters may get luminal obstruction and the patient may be able to urinate around the catheter
• Use 3.5 Fr or 5 Fr

Should I leave an indwelling catheter?

• Indicated if severe azotaemia, severe bladder distension, cystic calculi or grossly abnormal urine
• Indwelling catheters need to be soft (e.g. polyurathane), atraumatic and long enough to reach the bladder in large cats and should be attached to a sterile collection system
• Optimal duration not determined so suggestion is to remove when urine looks clear, metabolic derangement and POD have resolved

Additional features:

• Coccygeal blocks – a step by step guide (easy when you know how!)
• Quick reference data section e.g. retrograde positive contrast urethrogram
• Drug calculators for speed of dose calculation for every drug on the site

Special offers for BSAVA members. BSAVA members receive exclusive discounts and access to VETbytes. To find out more, click here.

Revolutionary Point-of-Care App Launches, Giving Veterinary Professionals Rapid Evidence-Based Clinical Support

In partnership with the British Small Animal Veterinary Association (BSAVA), Vet2Vet has launched VETbytes, a mobile point-of-care clinical support tool that gives small animal veterinary professionals critical access to the latest evidence-based information

22 July, London – A new mobile app called VETbytes goes live today, providing veterinary surgeons, nurses and animal healthcare teams with an extensive library of concise medical summaries drawn from global guidelines and peer-reviewed journals. The web-based App has been launched in collaboration with the BSAVA, with discounted subscription fees for members and free access to veterinary students.

Founded by veterinary surgeons’ Dr Zoe Coker and Dr Bronwen Eastwood, VETbytes addresses the need for a mobile-friendly centralised resource of practical and evidence-based clinical guides that vets can access quickly and easily.

The Emergency Medicine app is the first part of a substantially developing resource for vets, nurses and practice teams. Created in association with first opinion vets, nurses and specialists, VETbytes provides the perfect balance of expertise and practicality.

“There is rarely time during the working day to read all the necessary journals, articles and up-to-date texts”, said Coker. “VETbytes collates all the evidence on a specific medical condition and consolidates it into a short synopsis called a Keep it Simple Summary (KISS).”

The goal of VETbytes is summarised by Eastwood: “The intention is to reduce stress in the workplace while improving clinical outcomes,” she said.

VETbytes was launched in collaboration with the BSAVA, whose guiding principle is to promote clinical excellence and evidence-based education to the veterinary community.

“BSAVA is excited and proud to be involved in the VETbytes project, which should provide significant benefits and support for our members,” said BSAVA President Professor Ian Ramsey. “Every busy small animal clinician should try out VETbytes as it is a real paradigm shift in mobile resources for vets.”

The summaries are readable in a few minutes and will guide veterinary professionals through the whole patient journey, enabling them to integrate the latest evidence-based guidance into their clinical workflow.

The VETbytes Emergency Medicine app currently covers more than 100 topics developed in consultation with more than 25 veterinary experts. Further benefits include drug (and CRI) calculators, a quick reference section and links to hundreds of source abstracts. The content encourages reflective learning and can be used towards CPD hours.

Available at the point of care on mobile, iPad or desktop, veterinary professionals can access the answers to their clinical questions, when and where they need them.

To start a free trial or subscribe to the VETbytes app, visit vetbytes.co.uk.

Key features of VETbytes

About Vet2Vet 

Vet2Vet was founded by veterinary surgeons’ Dr Zoe Coker and Dr Bronwen Eastwood, who launched VETbytes as a simple, accessible resource helping vets to practise evidence-based medicine and surgery. For more information, visit vetbytes.co.uk.

About BSAVA

The British Small Animal Veterinary Association (BSAVA) exists to promote excellence in small animal practice through education and science. BSAVA is a not-for-profit professional body, founded in 1957 to serve veterinary surgeons treating companion animals, and now includes veterinary nurses. BSAVA has over 10,000 members, the majority work in practice as veterinary surgeons or veterinary nurses. www.bsava.com

Contact information:

For media and marketing enquiries, email Alex Beveridge, alex@vetbytes.co.uk.

Contact BSAVA: PR & Communications Office, press@bsava.com or call 01452 726729.