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Questions and Answers
What are the proposed cut-off values for detecting nerve block failure in dogs undergoing arthrotomy?
What are the proposed cut-off values for detecting nerve block failure in dogs undergoing arthrotomy?
The proposed cut-off values are b p values of 6 mmHg, DSAP greater than 10 mmHg, and DDAP greater than 8 mmHg.
Explain the range of agreement levels used for assessing nerve block outcomes.
Explain the range of agreement levels used for assessing nerve block outcomes.
The agreement levels are categorized as: no (0), slight (0.01e0.20), fair (0.21e0.40), moderate (0.41e0.60), substantial (0.61e0.80), and perfect (0.81e1.00).
What is the minimum alveolar concentration (MAC) of isoflurane in dogs according to the study?
What is the minimum alveolar concentration (MAC) of isoflurane in dogs according to the study?
1.28%
What physiological variables did nurse anaesthetists speculate have overlapping effects on intraoperative assessment?
What physiological variables did nurse anaesthetists speculate have overlapping effects on intraoperative assessment?
What MAC multiple was observed to inhibit movement in 95% of anesthetized humans?
What MAC multiple was observed to inhibit movement in 95% of anesthetized humans?
How did cardiovascular and ventilatory variables relate to surgical stimulation responses, according to the study?
How did cardiovascular and ventilatory variables relate to surgical stimulation responses, according to the study?
Which cardiovascular variable had the best discriminating ability in the ROC analysis?
Which cardiovascular variable had the best discriminating ability in the ROC analysis?
What was the average anaesthetic time for premedication before the arthrotomy?
What was the average anaesthetic time for premedication before the arthrotomy?
What challenges does an inadequate plane of anaesthesia pose according to the study?
What challenges does an inadequate plane of anaesthesia pose according to the study?
What was the clinically relevant fraction of expired isoflurane (FE0 Iso) used in the study?
What was the clinically relevant fraction of expired isoflurane (FE0 Iso) used in the study?
What is the significance of the 50% and 80% ranges proposed by the ACVIM for oscillometric measurements?
What is the significance of the 50% and 80% ranges proposed by the ACVIM for oscillometric measurements?
Did the study find that 1.5 times MAC of isoflurane was sufficient to prevent a hemodynamic response in humans?
Did the study find that 1.5 times MAC of isoflurane was sufficient to prevent a hemodynamic response in humans?
Why did none of the dogs require rescue analgesic intervention during the study?
Why did none of the dogs require rescue analgesic intervention during the study?
What two types of blocks were analyzed in the study for their effectiveness in detecting responses to surgical stimulus?
What two types of blocks were analyzed in the study for their effectiveness in detecting responses to surgical stimulus?
What were the premedications used in this study for dogs undergoing anesthesia?
What were the premedications used in this study for dogs undergoing anesthesia?
What conclusion can be made about the respiratory variables in comparison to cardiovascular variables in the study's ROC analysis?
What conclusion can be made about the respiratory variables in comparison to cardiovascular variables in the study's ROC analysis?
What was the age and body weight range of male dogs included in the study?
What was the age and body weight range of male dogs included in the study?
What role do isoflurane and medetomidine play in the cardiovascular effects observed in dogs under anesthesia?
What role do isoflurane and medetomidine play in the cardiovascular effects observed in dogs under anesthesia?
What were the anticipated outcomes regarding block failure in the BBB group compared to the GBB group?
What were the anticipated outcomes regarding block failure in the BBB group compared to the GBB group?
Why should the absolute values of cardiovascular variables be approached with caution in surgical patients?
Why should the absolute values of cardiovascular variables be approached with caution in surgical patients?
What criteria were used for the objective assessment of nerve block outcomes in the study?
What criteria were used for the objective assessment of nerve block outcomes in the study?
What concern is raised regarding the use of oscillometric devices in detecting surgical stimulus responses?
What concern is raised regarding the use of oscillometric devices in detecting surgical stimulus responses?
What effect can different anesthetic drug combinations have on the cardiovascular system of a dog?
What effect can different anesthetic drug combinations have on the cardiovascular system of a dog?
How might the antinociceptive effects of medetomidine and morphine interfere with monitoring during anesthesia?
How might the antinociceptive effects of medetomidine and morphine interfere with monitoring during anesthesia?
What are the prevalence rates of nerve injury and systemic toxicity as reported by Barrington et al. (2009)?
What are the prevalence rates of nerve injury and systemic toxicity as reported by Barrington et al. (2009)?
What does the SHAM score proposed by McGuirk et al. (2011) signify in the study context?
What does the SHAM score proposed by McGuirk et al. (2011) signify in the study context?
How did the BBB group compare to other groups regarding the risk of nerve injury?
How did the BBB group compare to other groups regarding the risk of nerve injury?
What role do placebo groups play in peripheral nerve block studies according to Papadopoulos et al. (2022)?
What role do placebo groups play in peripheral nerve block studies according to Papadopoulos et al. (2022)?
What practice was maintained across all three groups to reduce serious complications?
What practice was maintained across all three groups to reduce serious complications?
What precautions were taken regarding needle positioning in the study?
What precautions were taken regarding needle positioning in the study?
Who provided financial support for the study mentioned in the acknowledgements?
Who provided financial support for the study mentioned in the acknowledgements?
Which organizations were acknowledged for supplying equipment for the study?
Which organizations were acknowledged for supplying equipment for the study?
What is the purpose of the surgical Pleth Index in assessing anaesthesia?
What is the purpose of the surgical Pleth Index in assessing anaesthesia?
How does remifentanil administration affect propofol consumption and recovery times in outpatient anaesthesia?
How does remifentanil administration affect propofol consumption and recovery times in outpatient anaesthesia?
What was one of the outcomes measured in the comparison of femoral and sciatic nerve blockade for surgeries in dogs?
What was one of the outcomes measured in the comparison of femoral and sciatic nerve blockade for surgeries in dogs?
Why is heart rate variability significant in monitoring anaesthesia depth in dogs?
Why is heart rate variability significant in monitoring anaesthesia depth in dogs?
What are the challenges associated with identifying nerve block failure during procedures?
What are the challenges associated with identifying nerve block failure during procedures?
What was the focus of the evaluation conducted by Bergfeld et al. regarding local anaesthetic interventions?
What was the focus of the evaluation conducted by Bergfeld et al. regarding local anaesthetic interventions?
How does pupillometry serve in veterinary anaesthesia monitoring according to Mills et al.?
How does pupillometry serve in veterinary anaesthesia monitoring according to Mills et al.?
What role does K€ astner SB's research play in the context of veterinary anaesthesia?
What role does K€ astner SB's research play in the context of veterinary anaesthesia?
Flashcards
Blood Pressure (BP) Variables
Blood Pressure (BP) Variables
Measurements used to evaluate nerve block effectiveness in dogs during surgery.
Nerve Block Failure
Nerve Block Failure
Situation where the surgical nerve block does not provide adequate pain relief.
Arthrotomy
Arthrotomy
Surgical procedure involving joint opening.
Prospective Study
Prospective Study
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Guided Saline Block (GSB)
Guided Saline Block (GSB)
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Guided Bupivacaine Block (GBB)
Guided Bupivacaine Block (GBB)
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Premedication
Premedication
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Propofol
Propofol
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Isoflurane
Isoflurane
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Subjective Assessment
Subjective Assessment
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Objective Assessment
Objective Assessment
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Heart Rate (HR)
Heart Rate (HR)
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Changes in HR
Changes in HR
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Cardiovascular Variables
Cardiovascular Variables
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Respiratory Variables
Respiratory Variables
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ROC Analysis
ROC Analysis
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Discriminative Ability
Discriminative Ability
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Mean Arterial Pressure (MAP)
Mean Arterial Pressure (MAP)
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Diastolic Arterial Pressure (DAP)
Diastolic Arterial Pressure (DAP)
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DBP Variables
DBP Variables
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Enhanced Recovery After Surgery (ERAS)
Enhanced Recovery After Surgery (ERAS)
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Study Notes
Introduction
- Authors investigated the use of blood pressure (BP) variables to detect nerve block failure in dogs undergoing arthrotomy.
- This was a prospective study involving 30 dogs.
- They evaluated the association between nerve block confidence scores & subjective and objective scores for the outcome of the block.
- A comparison was made between guided saline block (GSB) and guided bupivacaine block (GBB).
Methods
- Dogs were premedicated with medetomidine & morphine before induction with propofol.
- Anesthesia was maintained with isoflurane.
- Nerve block outcome was evaluated subjectively and objectively.
- Objective assessment of nerve block failure was based on changes in HR, DHR, fR, DfR, SAP, DSAP, MAP, DMAP, DAP, and DDAP.
Results
- There was a poor association between nerve block confidence scoring and the outcome of the block based on subjective and objective scores .
- ROC analysis revealed that cardiovascular variables had good discriminative ability in distinguishing a response to surgical stimulus while respiratory variables showed poor discriminating ability.
- HR, DHR, fR, and DfR did not meet the criteria for diagnostic purposes.
- MAP and DAP were the most effective variables for detecting a response to surgical stimulus.
Discussion
- The results suggest that DBP variables can be considered as an objective score to detect a response to surgical stimulation and nerve block failure.
- The authors warn against direct translation of these findings to all dogs due to factors like anaesthetic drug combinations and individual cardiovascular system function.
- They emphasize the importance of considering the effects of different anaesthesia drug combinations and individual cardiovascular system function in determining criterion values.
- The use of invasive arterial BP and veterinary-specific oscillometric devices is discussed, with emphasis on the limitations of oscillometric devices in detecting a response to surgical stimulus.
- Although the study acknowledges the risk associated with blind bupivacaine block, it highlights the importance of placebo groups in nerve block studies.
- The need for good standard of practice in all groups to reduce the incidence of serious complications is stressed.
Conclusion
- Use of DBP variables can potentially be a valuable tool for objectively detecting a response to surgical stimulation and identifying nerve block failure.
- Determination of these criterion values for different canine populations can enhance evaluation of nerve block techniques and improve ERAS (Enhanced Recovery After Surgery).
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