Aug/Sept 2015 NAVTA JOURNAL · July 10-14 in Boston. NAVTA had a strong presence at the conference. Be sure to read the recap that is included in this edi-tion of The NAVTA Journal

NAVTAJOURNALTHE

A Publication of the National Association of Veterinary Technicians in America

Aug/Sept 2015

in this edition…Celebrate National Veterinary Technician Week in Style!

Dexmedetomidine: Your New Favorite Analgesic

Local Blocks and Epidurals

Banfield

QUALITY CAREat Ban� eld Pet Hospital

ERSStep into a Ban� eld hospital and feel the

energy and compassion we bring to pet care.We are looking for Licensed Veterinary

Technicians who have a real passion for what they do and thrive in a team-oriented

environment of a full-service hospital. Partner with us to grow your career

while making life better for pets.

Learn more atBan� eld.com/Careers

I am a certi� ed veterinary technician and credentialed project manager at Ban� eld’s Central Team Support. I joined the practice in 2001, and have spent � ve years working in di� erent hospital roles. I now lead a team of project managers and veterinary professionals and work on a variety of exciting projects.

Rachel Beck, CVT, PMPManager, Medical Programs Ban� eld has been very

supportive of my development. They have helped pay for my CVT

education through a partnership with Penn Foster and they encourage my

training while on the job. I use my skills and expand my knowledge daily, while

doing a job that I love!

Katie HogueShi� Lead, Portland, OR

Penn Foster Student

“

You are navta!

President’s Message ...................................4Member Updates ...........................................6PHP Workbook Release .......................13Continuing Education: Dexmedetomidine: Your New Favorite Analgesic Adjunct ..............15

Continuing Education: Blocking It All Out; Utilizing Local Blocks and Epidurals ...........................................23

Continuing Education: They Can’t Cry if They Can’t Breathe: Recognizing and Alleviating Dyspnea ....................35

Case Study: True Friend ................................................44

WVC/NAVTA Scholarship ....................46

NVTW ................................................................47

AVMA Update ..............................................48

Advertiser Index .........................................50

in this edition…

NAVTAJOURNALTHE


Aug/Sept 2015

in this edition…Celebrate National Veterinary

Technician Week in Style!

Dexmedetomidine:

Your New Favorite Analgesic

Local Blocks and Epidurals

Publication of the National Association of Veterinary Technicians in America 3

Who are NAVTA members?The National Association of Veterinary Technicians in America (NAVTA) is made up of people just like you… people who want to make a difference in the lives of animals.

NAVTA is a growing global network of:

§ Credentialed Technicians § Veterinary Technician Specialists § Assistants § Veterinarians § Practice Managers § Educators § Researchers § Industry Sales § Allied Industry § Students

NAVTA empowers you to succeed in your career. Together, we strengthen the veterinary technician profession.

Why NAVTA?NAVTA is a membership-based non-profit association that acts as the national voice of the veterinary technician profession. In addi-tion to serving its members, NAVTA educates the allied industry and the general public about the veterinary healthcare team. NAVTA initiatives include:

§ Monitoring legislation that affects the veterinary technician profession on a national level

§ Continuing education and networking through state and local networks and student chapters

§ Celebrating National Veterinary Technician Week

§ Strengthening relationships with allied associations and NAVTA sponsors

§ Distributing technician demographic and salary surveys

§ Creating ongoing public relations campaign about the importance of credentialed technicians

NAVTA!You Are

Now is the best time to renew your membership — so tell your colleagues about all

the benefits of NAVTA membership, and join today!

To learn more about what NAVTA can do for you, visit www.navta.net.

National Veterinary Technician Week is dedicated to every Veterinary Technician that lives and breathes patient care day in and day out. Thank you, from the bottom of our hearts for your passion and dedication.

On the Cover

QUALITY CAREat Ban� eld Pet Hospital

ERSStep into a Ban� eld hospital and feel the

energy and compassion we bring to pet care.We are looking for Licensed Veterinary

Technicians who have a real passion for what they do and thrive in a team-oriented

environment of a full-service hospital. Partner with us to grow your career

while making life better for pets.

Learn more atBan� eld.com/Careers

I am a certi� ed veterinary technician and credentialed project manager at Ban� eld’s Central Team Support. I joined the practice in 2001, and have spent � ve years working in di� erent hospital roles. I now lead a team of project managers and veterinary professionals and work on a variety of exciting projects.

Rachel Beck, CVT, PMPManager, Medical Programs Ban� eld has been very

supportive of my development. They have helped pay for my CVT

education through a partnership with Penn Foster and they encourage my

training while on the job. I use my skills and expand my knowledge daily, while

doing a job that I love!

Katie HogueShi� Lead, Portland, OR

Penn Foster Student

“

The NAVTA Journal | Aug/Sept 20154

4

Letter from the president

The annual AVMA (American Veterinary Medical Association) convention was held July 10-14 in Boston. NAVTA had a strong presence at the conference. Be sure to read the recap that is included in this edi-tion of The NAVTA Journal.

This issue is dedicated to Pain Manage-ment in the veterinary practice. You are the advocate for your patients, and often, you are the first one to recognize pain. Beef up your knowledge and understanding about the physiology of pain, and the multi-mo-dalities that are available to help prevent or decrease pain in patients with a variety of conditions. Be sure to visit the Anesthesia Nerds Corner as well!

As we begin to roll into fall, don’t forget how important preventive healthcare is for your patients. If you haven’t already, visit the NAVTA webpage and order your Preventive Healthcare workbook – and get a consis-tent program started in your hospital. This 80-page workbook is free for NAVTA mem-bers, and lays out a detailed plan for you, the patient champion, to get the ball rolling!

Dan Swenson NAVTA President, 2015

Summer is upon us once again. Many areas of the country are experiencing record breaking weather conditions. For those that have had the unfortunate experience of flooding or tornados, our thoughts and prayers are extended to you. Our veterinary profession is amazing, and when members need help, a shout out is sent, and dedi-cated professionals such as you, respond. NAVTA thanks all of you for your dedication and helping fellow Technicians in distress.

Speaking of recognizing amazing Veterinary Technicians, National Veterinary Technician Week will be the third week of October. This year’s poster was created with you, and by you, the members of NAVTA. We asked you to submit pictures, and you did! Look carefully for you and your fellow colleagues! Be sure to visit our website to download the press release to help you promote this very special week within each of your communities.

President's MessageNAVTAJOURNALTHE

NAVTAExecutive Director: Julie Legred, CVTCommunications Director: Kara Burns, MS, M.Ed., LVT, VTS (Nutrition)P.O. Box 1227Albert Lea, MN 56007Phone: 888-99-NAVTA | Fax: [email protected] | www.navta.net

2015 NAVTA EXECUTIVE BOARDPresident: Dan Swenson, CVTPresident Elect: Rebecca Rose, CVTSecretary: Elizabeth Reed, BS, LVT, CCRATreasurer: Beckie Mossor, RVTMember at Large: Mary Berg, BS, RLATG, RVT, VTS (Dentistry)Member at Large: Ed Carslon, CVT, VTS (Nutrition)Past President: Vicky Ograin, MBA, RVT, VTS (Nutrition)

COmmITEE ChAIRsNAVTA SCNAVTA Chairperson & Board Advisor: Lori Renda-Francis, PhD, LVTNAVTA CVTS Chairperson: Margi Sirois, EdD, MS, RVT, LATNAVTA State Representative Chairperson: Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM)NAVTA AVA Chairperson: Dennis Lopez, M.Ed., LVTNAVTA Exhibiting Representative :Virginia Rud, CVT, RVT

ThE NAVTA JOURNALEditor in Chief & Website CoordinatorHeather Prendergast, RVT, CVPMAssociate Editor in Chief Kara Burns, MS, M.Ed., LVT, VTS (Nutrition)

Editorial BoardJosh Clark, MS, RVTKatie Larsen, DVMEllen I Lowery, DVM, PhD, MBAOreta M Samples, RVT, MPH, DHScJennifer Schori, MS, VMDPat Telschow, BS, LVT

DesignKalico Design | www.kalicodesign.com

Printing and FulfillmentBoelte-Hall, LLC | www.boelte.com

The NAVTA Journal Editorial Deadlines

• Oct/Nov ‘15 edition: Aug 1(CE articles and case studies) and Aug 15 (all other content)

• Dec/Jan ‘16 edition: Oct 1(CE articles and case studies) and Oct 15 (all other content)

• Feb/Mar ‘16 edition: Dec 1(CE articles and case studies) and Dec 15 (all other content)

• Apr/May ‘16 edition: Feb 1(CE articles and case studies) and Feb 15 (all other content)

Opinions and statements in The NAVTA Journal are those of the authors and not those of NAVTA, unless so stated. NAVTA assumes no responsibility for, and does not warrant the accuracy or appropriateness of, recommendations or opinions of the authors or of any product, service, or technique referred to in The NAVTA Journal.

Published advertisements in The NAVTA Journal are not an endorsement of any product or service.

Protection against six parasites instead of only three.

smart is…BROAD COVERAGE

IN A SOFT CHEWABLE

© 2015 Virbac Corporation. All Rights Reserved. SENTINEL and SPECTRUM are registered trademarks of Virbac Corporation. Heartgard and the Dog & Hand logo are registered trademarks of Merial. 2/15 15336

* A. caninum. * * Prevents flea eggs from hatching; is not an adulticide.

TO ORDER, CALL YOUR DISTRIBUTOR REPRESENTATIVE OR CALL YOUR VIRBAC REPRESENTATIVE AT 1-844-4-VIRBAC (1-844-484-7222).

Dogs should be tested for heartworm prior to use. Mild hypersensitivity reactions have been noted in some dogs carrying a high number of circulating microfilariae. Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm protection. Please see full product label for more information or visit www.virbacvet.com.

Over the past several months, the NAVTA SRC has been in touch with representa-tives of various state veterinary technician associations, discussing both national and local scale goals and challenges associa-tions face on a day to day basis. Through these discussions, the SRC has set our near future goals to improve communication between NAVTA and the state associations, aid in developing leadership and associa-tion management skills among leaders, and provide opportunities and resources for state associations to serve their member-ship. Collaboration through the national network comprised of state level veterinary technician advocacy groups is imperative in achieving large national scale goals.

The SRC members have held meetings with state representatives at conferences and state meetings to gain perspectives on each state. The 2nd annual NAVTA Veterinary Leadership Development Workshop was held at the AVMA Convention in Boston, with 29

CACVT is busy planning for upcoming CACVT CE events, gearing up for public and industry outreach events, and is excited for its annual Board Orientation, to be held in August. Here is just some of what CACVT has coming up!

CACVT Upcoming CE Events:

OCTOBER: Western Slope Chapter CE, featuring Megan Brashear, CVT, VTS (ECC)

veterinary technician leaders from 16 state veterinary technician associations and 6 VTS academies participating in learning about leadership and networking for a stronger collective voice. On a separate occasion, many state associations were offered an opportunity to work with Merial to bring CE focused on the veterinary technician’s role in client education about heartworm prevention to their states.

Future plans include continuing to foster regular avenues of communication through meetings and bulletins, working with the AVMA to incorporate technicians into the AVMA Veterinary Leadership Conference program, and seeking more opportunities to provide resources that state associations can use to support their membership.

The State Representative Committee is continually seeking your input on how we can serve state associations better. For those of you involved in state association

JANUARy: Focus Conference, featuring Kurt A. Grimm, DVM, MS, PhD, Anesthesia

ApRIL: Spring Conference 2016, featuring various speakers and topics, labs, exhibits and a luncheon

To learn more about CACVT events, please visit CACVT.org/events

CACVT OUT AND ABOUT IN JULy:

NAVTA Leadership Workshop, Boston, MA CACVT Executive Director, Juliebeth, was glad to see all the participants at the event.

Denver Dumb Friends League CatFest CACVT will had a booth at DDFL CatFest, where we engaged pet owners in discussions about veterinary technician certification and the importance of choosing veterinarians who hire and utilize CVTs.

– Juliebeth Pelletier, CVT Executive Director


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Member UpdatesNAVTA State Representative Committee (SRC)

Colorado Association of Certified Veterinary Technicians (CACVT)

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and VTS academy leadership, please ac-cept our invitation to join the “NAVTA State Association and VTS Academy Leadership” Facebook group (www.facebook.com/groups/318542778312547/) which serves as an information exchange and communica-tion forum. Please email us at [email protected] with any suggestions, or if you are interested in becoming a part of the com-mittee! We welcome any passionate and dedicated individuals to help us in our effort.

We are honored to be able to publicize the incredible activity occurring in each of the states, all with the common goal of progress-ing the veterinary technician profession to new levels. Thank you all, for everything that you do, to make this field amazing as it is!

– Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM) NAVTA State Representative Committee Chairperson

6


The 2nd Annual NHVTA Spring Symposium held on Sunday May 17th was a huge suc-cess with 93 technicians in attendance! Our featured speaker for the day was Brandy Sprunger-Helewa, CVT, RVT, AAS, VTS (ECC) who did a wonderful job!

The comments on the symposium evaluation were very complimentary.

“Excellent speaker, very informative, high education level.”

“Awesome, Awesome topics!”

“Very informative and interesting topics pre-sented today. Brandy spoke well and was fun to listen to.”

“Venue was pleasant and clean. Presen-tations were very well planned out and informative.”

“All presentations were well presented & very informative.”

“Great Speaker. Great Topics. Enjoyed a Sunday inside even though it was a beauti-ful day outside! :) “

And that is just a small sampling of the comments!

As busy as they were organizing and plan-ning the Symposium, the CE Committee still found time to plan other continuing educa-tion events!

On Sunday June 28th, Leah Limone, DVM from Northeast Equine Veterinary Dental Services, presented a 2 hour lecture on Equine Dentistry at the University of New Hampshire Thompson School in Durham, NH. Dr. Limone gave an overview of equine dental care and its importance in the well-ness program. Equine oral anatomy was covered along with dental preventative medicine (who, what, where, when and how), and methods of focal odontoplasty (floating). Pathology and updates in diag-nostic methods and a review of common dental problems was also be included.

The CE committee is also currently finalizing details for a Sunday brunch CE on Septem-ber 13th Ed Carlson, CVT, VTS (Nutrition) will present a 2 hour lecture on raw and alternative diets. Watch our website and Facebook page for more details.

National Veterinary Technician Week will be here before we know it. Have you started planning for it yet? The NHVTA Executive Board is and it’s going to be awesome!

– Ed Carlson, CVT, VTS (Nutrition) NHVTA State Representative to NAVTA

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Caution Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.

Indications SENTINEL® SPECTRUM® (milbemycin oxime/lufenuron/praziquantel) is indicated for the prevention of heartworm disease caused by Dirofilaria immitis; for the prevention and control of flea populations (Ctenocephalides felis); and for the treatment and control of adult roundworm (Toxocara canis, Toxascaris leonina), adult hookworm (Ancylostoma caninum), adult whipworm (Trichuris vulpis), and adult tapeworm (Taenia pisiformis, Echinococcus multilocularis and Echinococcus granulosus) infections in dogs and puppies two pounds of body weight or greater and six weeks of age and older.

Dosage and Administration SENTINEL SPECTRUM should be administered orally, once every month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, 4.55 mg/lb (10 mg/kg) lufenuron, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least 6 months after exposure to mosquitoes.

Dosage Schedule

Body Weight

Milbemycin Oxime per chewable

Lufenuron per

chewable

Praziquantel per

chewableNumber of chewables

2 to 8 lbs. 2.3 mg 46 mg 22.8 mg One

8.1 to 25 lbs. 5.75 mg 115 mg 57 mg One

25.1 to 50 lbs. 11.5 mg 230 mg 114 mg One

50.1 to 100 lbs. 23.0 mg 460 mg 228 mg One

Over 100 lbs. Administer the appropriate combination of chewables

To ensure adequate absorption, always administer SENTINEL SPECTRUM to dogs immediately after or in conjunction with a normal meal.

SENTINEL SPECTRUM may be offered to the dog by hand or added to a small amount of dog food. The chewables should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed a few minutes after administration to ensure that no part of the dose is lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended.

Contraindications There are no known contraindications to the use of SENTINEL SPECTRUM.

Warnings Not for use in humans. Keep this and all drugs out of the reach of children.

Precautions Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of SENTINEL SPECTRUM, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. SENTINEL SPECTRUM is not effective against adult D. immitis.

Mild, transient hypersensitivity reactions, such as labored breathing, vomiting, hypersalivation, and lethargy, have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating microfilariae. These reactions are presumably caused by release of protein from dead or dying microfilariae.

Do not use in puppies less than six weeks of age.

Do not use in dogs or puppies less than two pounds of body weight.

The safety of SENTINEL SPECTRUM has not been evaluated in dogs used for breeding or in lactating females. Studies have been performed with milbemycin oxime and lufenuron alone.

Adverse Reactions The following adverse reactions have been reported in dogs after administration of milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, salivation, and weakness.

To report suspected adverse drug events, contact Novartis Animal Health at 800-637-0281 or the FDA at 1-888-FDA-VETS.

Manufactured for: Novartis Animal Health US, Inc. Greensboro, NC 27408, USA

NADA #141-333, Approved by FDA © 2013 Novartis Animal Health US, Inc NAH/SSC/BS/1 1/14

New Hampshire Veterinary Technician Association (NHVTA)

Photo credit - Janine Graham, CVT

On Tuesday June 2nd, the Joint Committee on Consumer Protection and Professional Licensure held a hearing to hear testimony on several bills before this term’s legisla-ture, including HB 224-an act to establish a subsidiary board for veterinary technology. This bill is commonly known as the Veterinary Technician Licensure Bill. MVTA Vice-Presi-dent, Erin Spencer, was present at the hear-ing to testify in favor of the bill and the MVMA submitted a written statement to the Com-mittee as well. This hearing is the first step in the long process of getting a bill passed and we have been through this hearing before. One interesting difference this time was that there were several questions from some of the new members of the Committee. It was encouraging to see this interest, as there have not been many questions in the past. One representative did have some hesitation about the bill so we hope to set up a time to meet with him and discuss his concerns in the future. The lobbyists who are helping us navigate the legislative process are also planning to set up meetings with other Com-mittee members and key legislators in the coming weeks and months.

Registration for our 5th annual Veterinary Technician Conference in Marlborough MA has opened. This year’s conference date

Vermont is buzzing! We had an awesome dentistry weekend with a full-to-capacity and wetlab. Midmark and Henry Schein helped us support super VTS dentistry technicians Benita Altier and Pat March. We are look-ing forward to hosting Harold Davis, BA, RVT, VTS (ECC)(Anesthesia) in October.

We are working hard to keep exceptional CE coming to our state. We enjoy offering it to our members along with rabies titers and vaccinations to keep our techs safe. We have

CaRVTA holds strategic planning meeting

The California RVT Association will have a strategic planning meeting in July to talk about the future of the association, new benefit offerings, our legislative agenda, budgeting, and more. We are currently in the process of polling our membership to find out how we can better serve techni-cians and assistants in the state. We look forward to sharing our results with you in future issues of the NAVTA Journal.

CaRVTA Co-sponsors UC Davis Back To school Veterinary Technician & Assistant seminar

We are thrilled to co-sponsor the 8th Annual BTS Seminar at UC Davis July 25 and 26. Esteemed instructors from the UC Davis Veterinary Medical Teach-ing Hospital will lead more than 3 tracks including presentations on emergency and critical care, feline medicine, practice management, and anesthesia, just to name a few. This conference is always a hit with technicians and assistants and we look forward to sharing photos from the event in the next issue.

In addition to great CE, CaRVTA will hold its annual Membership Meeting on July 25th where we will announce the Califor-nia RVT of the Year recipient! We can’t wait to surprise this year’s winner!

– Liz Hughston, MEd., RVT, VTS (SAIM, ECC) CaRVTA NAVTA Representative

is Sunday, November 1st. An exotic small animal track, nutrition track, client interaction track and an interactive, hands on lab for central and peripheral lines are just some of the offerings at our all day conference.

In addition to our annual conference, we are continuing to reach out to our members and non-members by holding CE lectures and dinners. These lectures are being held at dif-ferent locations throughout Massachusetts. In June our dinner CE was held at Wignall Animal Hospital in Dracut MA. Our guest speaker Melissa McCue-McGrath, CPDT-KA presented her lecture Coming To The Table: Putting Certified Trainers and Veterinary Professionals Together to Better Under-stand Where our Dogs are Coming From - and How Best to Help Them. Our next CE dinner lecture will be held on July 16th. The speaker, Amy Breton CVT, VTS (ECC) will present CPR: Basic Life Support. This lecture, being held at Blue Pearl in Waltham MA, will include the current recommenda-tions for veterinary specific CPR. Additional information can be obtained through our website, www.massvta.org.

– Robyn Townsend, CVT NAVTA State Representative

decades of experience at the helm, and love taking care of our members.

We are looking to strengthen our association with lots of new blood. Look at our website classified sections. If you want an exceptional quality of life, a great state association and plenty of maple syrup, come see us!

– Deborah Glottmann, CVT VVTA President

Member UpdatesMassachusetts Veterinary Technician Association (MVTA)

Vermont Veterinary Technician Association (VVTA)


California Registered Veterinary Technician Association (CaRVTA)

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Our newly elected executive board of the NJVTA had their first in-person meeting on June 17th. Despite the evening hour, the meeting was very energizing and there were great ideas flowing to bring the NJVTA to the next level!

Newly elected president Erika Ervin pre-sided over the meeting and all new board members were present, including some committee members as well. Topics ad-dressed at the meeting included:

• Transfer of responsibilities from previous board members to new members.

• Brainstorming new ways to get our mem-bership recognized, active, and involved.

• Revamping our website to include new exciting additions for communicating to the membership.

• Re-establishing some committee job de-scriptions and combining others before recruiting volunteers.

• Membership and credentialing forms were updated; proposal for change of membership terms to get all members on the same time frame was discussed.

• Upcoming exhibiting events, including the Hambletonian Equine Conference in August and Atlantic Coast Veterinary Conference in October.

Planning for a late fall CE event that will include the Merial Tech Champion Presenta-tion, “Let’s Talk Heartworm: Strengthening the Tech to Pet Owner Conversation”. This is a unique RACE approved talk that focuses on developing the teaching skills for techni-cians and assistants when educating clients about their pet’s health. The presentation will show how to strengthen heartworm conversations by grabbing and holding pet owners’ attention with proven techniques that help effectively deliver heartworm disease knowledge at the pet owner level, and mo-tivate clients to use what they have learned after they leave the clinic. It’s all about how we deliver the message, with the end goal of helping more pets get the protection they need against heartworm disease. Date and location of event will be posted on the NJVTA website, www.njvta.com

The 9th Semester of the Brookdale NAVTA Approved Veterinary Assistant Program in collaboration with Red Bank Veterinary Hospital graduated on June 2nd. Twelve stu-dents successfully completed the program; 11 passed the AVA exam at first attempt! We congratulate these new AVA’s and wel-come them to the profession.

The AVMA Accredited Veterinary Technician Program at Bergen Community College held their graduation ceremony on August 5th, 2015. 21 very excited new veterinary techni-cians joined the profession. We congratulate them on their accomplishment!

The Education Committee is in the process of assisting Camden County College in pre-paring to submit their VA program to NAVTA for approval. We are excited about a third AVA program in NJ!

– Janet McConnell, CVT, NAVTA State Representative

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New Jersey Veterinary Technician Association (NJVTA)

The Ohio Association of Veterinary Tech-nicians has been hard at work planning our yearly technician symposium, Discov-ery 2015. It will take place on October 10-11, 2015 in Columbus. We polled our attendees from last year and have been diligently trying to put together the topics and speakers that appeals most to them. All information and registration information is available on our website, www.ohiorvt.org. Along with planning our CE weekend, we have been work-ing on updating all our social media outlets to be better able to reach out to our entire association. Members of the board have been visiting the technician schools in the state in an effort to spread the word on the importance of a strong association as well as to reach out a helping hand to introduce new grads to this amazing and diverse field. Lastly, we have put together a survey that will be going out to all association members to gather some helpful data on the techni-cian work force in Ohio in order to better educate and represent current and future technician generations.

CURRENT BOARD mEmBERs:president: Earl Harrison RVT Vice president: Cindy Curto RVT Treasurer: Peggy Dahlhausen RVT secretary: Sandy Matthews, RVT Interim Executive secretary: Janet Buck RVT

DIsTRICT COmmITTEE ChAIRs: Janet Lazarus RVT, Kim Myers RVT, and Vicki Riley RVT

We welcomed three new Representatives to the Board: Christie Myers RVT, Kristina Burd RVT, and Alisa Martinez RVT.

– Christie Myers, RVT

Local vet tech students engaged in con-versations about possible career paths for RVTs in New Mexico at the Third Annual Ca-reer Exploration Night. Hosted by the New Mexico RVT Association and Hills, thirty-five attendees were treated to dinner and pre-sentations by local RVTs on their personal careers. Speakers included newly minted RVT, Tracy Tobyas who spoke on the physi-cality of the equine practice while show-ing the students several typical and large pieces of equipment used. (Just how heavy is a horse’s head?) Association President Marissa Luke, RVT, explained the need for detail (and personal protective equipment) when working in the State Veterinary Diag-nostics Laboratory. Craig Fischbach spoke of his transition from emergency medicine to his current career working for Hills.

Mary Meyers, RVT, shared her twenty-year-plus journey among several positions within veterinary medicine – emergency medicine, equine, day practice, mixed practice, teach-ing, neurology, and now, physical therapy. Her advice - give 150% at all times; when

you cannot, find a position that fits your needs and lifestyle that will give you fulfill-ment and balance. She continued, ‘there are many options available, make a list of pros and cons. Avoid burnout!’

Our evening concluded with NAVTA Veteri-nary Technician of the Year and New Mexico resident, Heather Prendergast, RVT. Ms. Prendergast spoke of overcoming personal challenges (for example, not getting into vet school) to achieving her dream of owning her own business. ‘Keep learning,’ she ad-vised. ‘Set both personal and practice goals.’

Ms. Prendergast spoke of a number of initiatives taking place both within NAVTA (e.g. VTS in Education) and in partnership with NAVC (e.g. the Fear Free Initiative). Her presentation concluded with heartfelt advice – ‘Challenge yourself. You never know what you too can achieve.’

– Janine Fales, RVT State Representative for New Mexico

Ohio Association of Veterinary Technicians (OAVT)

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Member Updates


New Mexico Registered Veterinary Technician Association (NMRVTA)

Pictured left to right: Tracy Tobyas, RVT with her bucket of equine tools; Heather Prendergast, RVT, shares her passion for her career

Elections Officer elections were held in June and the OVTAA would like to announce that Andrea Thompson, CVT has been selected to fill our Member at Large position. Welcome Andrea!

Community Outreach The Umpqua Valley Veterinary Technician and Assistant Association invited members of the OVTAA to travel to Sutherlin, OR to participate in an event called Woofstock. Woofstock is an annual festival to celebrate

The ACVS Surgical Summit is fast approach-ing and the Academy of Veterinary Surgical Technician’s can’t wait to see you there! The Summit is being held from October 22- 24th at the Gaylord Opryland Resort & Convention Center in Nashville, Tennessee. We will be holding our annual credentialing exam at the meeting and will have a booth in the exhibit hall. For those interested in becoming a VTS in surgery, there will be a session dedi-cated to “How to become a VTS (Surgery)” presented by Heidi Reuss-Lamky, LVT, VTS

dogs and promote the human animal bond. The goal is to provide positive and educa-tional activities for pet owners, while raising funds to support rescue groups and shelters. The OVTAA staffed an information booth at the event and Becky Smith gave a talk on Pet CPR and First Aid.

– Tiah M. Schwartz, BS, CVT, SRT, RLATG NAVTA State Representative

Specialty Updates

We Want to Hear Your News!In each edition of The NAVTA Journal we share state association, specialty academy, and SCNAVTA updates. Share news and photos about your group by emailing updates to [email protected]. (Photos must be supplied as jpg files at 300dpi)

The deadline for the Dec/Jan ‘16 edition is: Oct 15, 2015.

Member UpdatesOregon Veterinary Technician and Assistant Association (OVTAA)

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11Publication of the National Association of Veterinary Technicians in America

Academy of Veterinary Surgical Technicians (AVST)(Anesthesia, Surgery). We will also hold our pinning ceremony for those that earned their credentials by passing the 2014 exam, and meeting at 6:30pm on Thursday evening. All those interested in more AVST information or to support our new inductees are welcome to attend and join us for refreshments.

We would like to congratulate our very own Teri Raffel, CVT, VTS (Surgery) on the release of the new book “Surgical Patient Care for Veterinary Technicians and Nurses”! This book

is available through Wiley.com or other book sellers and is sure to be a hit for Veterinary Surgical Technicians!

Hope to see you at the Summit!

– Karen Ellis, LVT, VTS (Surgery) AVST President


Workbooks are free to NAVTA members. Log into the NAVTA website to place your order (offer limited to the first 1000 requests!) Non-members are welcome to purchase the workbook through the NAVTA online store.

industrY neWs

Preventive healthcare is an important part of your commitment to quality care for your patients. But, at any busy practice, preven-tive pet healthcare can get lost during the non-stop action of a regular day. Sometimes it takes a talented, passionate someone to remind the practice team to keep preventive healthcare a priority in your clinic. That some-one can be you!

Preventive Pet Healthcare: Your Guide to Becoming a Practice Champion is a work-book developed by your peers, designed for you. It’s your guide to lead a step-by-step process to increase the emphasis on preven-tive healthcare in your practice. It includes tips from getting support from your practice leadership to developing effective ways to roll out plans to the entire staff. You can use this workbook to help your team become aligned

on your practice’s philosophy and speak with one voice. Let this workbook be your roadmap to making a difference with your patients, clients, practice, team and you.

Learn new leadership skills to earn new leadership responsibilities at your practice by becoming a Champion of preventive pet healthcare today. Whether you’re an old pro at leading initiatives or an enthusiastic first-timer, this workbook has everything you need. You can do this!

Want more support? Check out the 45-min-ute webinar, “Preventive Pet Healthcare: Your Guide to Becoming a Practice Cham-pion-A User’s Guide” developed by your colleagues for a page-by-page walkthrough of the workbook.

Become the Practice Champion or Preventive Health!

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Many clinics throughout the world use dexmedetomidine for sedation. However, did you know that dexmedetomidine is also labeled as an analgesic? This is a fact that often gets overlooked in practice. Dexme-detomidine is the active S-enantiomer of the α-2 agonist, medetomidine. Removal of the inactive molecule, levomedetomide results in dexmedetomidine being a “puri-fied” product with increased potency

Dexmedetomidine:Your neW favoriteAnalgesic A junct

Tasha McNerney BS, CVT Objective: After reading this article, participants will have an increased understanding of dexmedetomidine, both as an anesthetic and analgesic. In addition, readers will be able to identify several efficient and effective routes of administration.

This program was reviewed and approved by the AAVSB RACE program for 1 hour of continuing education in jurisdictions which rec-ognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.

Continuing eduCation

and decreased stress on the liver. Many practices are familiar with dexmedetomi-dine as an α-2 agonist sedative that is reliable, fast-acting, and reversible with atipamezole. But now, more practices are beginning to expand their use of dexme-detomidine to take advantage of its anal-gesic effects as well. Dexmedetomidine is non-narcotic and can be very useful when combined with opioids for a multimodal analgesic protocol. Dexmedetomidine also comes with the benefit of being a time saver. It’s an unscheduled sedative/analge-sic so the clinician does not have to worry about time spent in drug logs.

Dexmedetomidine’s main effect is to pro-duce sedation and both somatic and visceral analgesia. Analgesic effects of dexmedeto-midine are principally due to spinal anti-no-ciception via binding to non-noradrenergic receptors (heteroreceptors) located on the dorsal horn neurons of the spinal cord. This

mechanism of action inhibits the release of norepinephrine (a catecholamine

released by the adrenal gland and part of the fight-or-flight response), and therefore prevents transmission of further nerve impulses. This provides both sedation and analgesia.

Dexmedetomidine was approved for human use in 1999 as a continuous rate

infusion to provide sedation in the inten-sive care settings.1 In human medicine there has also been the recent anecdotal report of dexmedetomidine use in obstetric analgesia. The report asserts that, because of its high lipophilicity, dexmedetomidine is retained in placental tissue and passes less readily into the fetal circulation and is less susceptible to cause harmful fetal brady-cardia when compared to other sedatives.2

Dexmedetomidine has also been studied more recently for the management of pain and sedation in pre-mature neonates. This study demonstrated the achievement of adequate sedation when neonates were given a continuous infusion of dexmedeto-

Dexmedetomidine, continued



16


midine as compared to another group that were given infusions of fentanyl. Patients in the dexmedetomidine group required less adjunctive analgesic and sedation medi-cations compared to the fentanyl group, suggesting that dexmedetomidine effec-tively provides both anti-nociception and hypnosis in premature infants.3

Although dexmedetomidine can be used alone, it produces an increased level of analgesia when combine with opioids. Opi-oids and α-2 agonists such as dexmedeto-midine work synergistically with opioids increasing both the intensity and duration of analgesia. When dexmedetomidine is used as part of the pre-operative combina-tion, lower levels of inhalant anesthetics are required. When dexmedetomidine is used as part of the post-operative analge-sic protocol, rescue doses of opioids are used less frequently.

Dexmedetomidine is also being used fre-quently as an in hospital constant rate infu-sion for rough recoveries and breakthrough analgesia. Constant rate infusion of low dose dexmedetomidine (1 to 2 mcg/kg/hr); can be used in severely painful or anxious patients to provide sedation and analgesia.

The International Veterinary Acad-emy of Pain Management has many resources available for practitioners who want to increase their knowledge of various analgesics drugs and pro-tocols. The IVAPM website is also a valuable resource for finding certified veterinary pain practitioners (CVPP) in your area. For more information on dexmedetomidine and how you can incorporate this sedative/analgesic in your practice visit www.IVAPM.org or, join the Facebook group Veterinary Anesthesia Nerds to discuss this and other anesthesia and pain manage-ment topics.

Dexmedetomidine can also be added to a preexisting opioid infusion for increased sedation and analgesia. Because dexmedetomidine has the potential to cause severe bradycardia and hypoten-sion, these patients should be monitored very closely by a dedicated recovery technician. A loading dose of at least 0.5 µg/kg (0.0005 mg/kg) dexmedetomidine IV should precede the initiation of the dexme-detomidine CRI.4

Epidural use of dexmedetomidine can en-hance the analgesic effects of other agents given epidurally. Besides the previously mentioned action at heterotropic spinal receptors, dexmedetomidine also produces analgesia by stimulation of cholinergic interneurons when given epidurally.1 It acts synergistically with epidural opioids, im-proving the quality and duration of analge-sia, and recent human studies have shown that the addition of 2 µg/kg dexmedeto-midine epidurally to 2.5 ml of intrathecal bupivacaine prolongs the duration of an-algesia, and decreases the requirement of rescue analgesics in patients undergoing lower-limb orthopedic surgery.5 It should be noted that dexmedetomidine is highly lipophilic, and is rapidly absorbed from the

N

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CH3 CH3

CH3

Dexmedetomidine



Continuing EduCation

epidural space, which can lead to systemic levels of the drug.

Dexmedetomidine is gaining some ground recently as more practices are experiment-ing with using it transmucosally in felines, in addition to the intra-muscular and intra-venous routes. Transmucosal dosing allows even fractious cats to receive sedation and analgesia. Often, cats given transmucosal dexmedetomidine are not at a surgical plane of anesthesia but are sedate enough to allow physical exams, blood draws, and IV catheter placement. Dexmedetomidine can also be combined with buprenorphine and given via the oral-transmucosal route.6 Oral dosing can range from 20-40mcg/kg.

It should be noted that dexmedetomidine has serious cardiac side effects and seri-ously affects cardiac output. Dexmedeto-midine should be reserved for patients that are heart healthy and have no exercise intolerance. α-2 agonists are not intended for animals with respiratory or cardiovascu-lar compromise.

About the Author:

Tasha mcNerney Bs, CVTTasha has worked at Rau Animal Hospital in Glenside, PA for ten years as an O.R. / Anesthesia technician. Her areas of interest include sighthound and brachycephalic anesthesia as well as pain management. Tasha has been a featured speaker on various anesthesia and pain management topics at conferences such as Atlantic Coast Veterinary Conference, AVMA conference and the Wild West Veterinary Confer-ence. In July of 2012 Tasha authored an article for the NAVTA journal entitled “Anesthesia in the Sighthound Patient”, and several articles for “Fetch” a blog dedicated to pet parents. Tasha is also the author of the Surgical Pain Management chapter for the textbook “Pain Manage-ment for Veterinary Technicians” (Shaffran and Goldberg, eds.). Tasha is also currently working on obtaining her CVPP.

In 2013 Tasha created the Facebook group Veterinary Anesthesia Nerds, which has almost 6000 members participating in education and exchange of ideas in all aspects of veterinary anesthesia and pain management.

Tasha recently partnered with Firstline magazine to produce a video blog series for technicians entitled “Coffee on the Couch” which show-cases various technician job avenues and encourages technician growth and career development.

References

1. Gaynor J.S. & W.W. Muir (eds), Hand-book of Veterinary Pain Management, 2nd Edition, Elselveir, St.Louis, MO

2. Grosu, I. & Lavand, P. (2010) The Use of Dexmedetomdine for Pain Control. F1000 Medical Reports v.2 2010 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3026617/

3. O’Mara, Kelian, et. Al. (2012) Dexmedeto-midine vs Standard Therapy with Fentanyl for Sedation in Mechanically Ventilated Pre-mature Neonates. J Pediatric Pharmacology & Therapy Jul-Sep; 17(3): 252-262

4. Zeltman, Phil. (2013) CRI’s: Base Drug Choice on Patient Need, Health. Veterinary Practice News, June 2013. Pg 35

5. D Jain, RM Khan, D Kumar, N Kumar (2012) Perioperative effect of epidural dex-medetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia. Southern African Journal of Anaesthesia and Analgesia Vol. 18 (2)

6. Santos, L.C. Et Al. (2010) Sedative and cardiorespiratory effects of dexmedeto-midine and buprenorphine administered to cats via oral transmucosal or intramus-cular routes. Vet Anaesth Analg. 2010 Sep;37(5):417-24.

Dexmedetomidine, continued



1. What inactive molecule was removed from medetomidine to create the “purified” product? a. Dexmedetomidine b. Levomedetomidine c. Carbon d. Xylazine

2. Dexmedetomidine has which of the following properties? a. Sedation b. Analgesia c. Both A and B d. None of the above

3. Which type of analgesia is dexmedetomidine responsible for producing? a. Somatic analgesia b. Visceral analgesia c. Both A and B d. None of the above 4. Norepinephrine is a catecholamine released by what organ? a. Pituitary gland b. Adrenal gland c. Liver d. Lymph nodes

5. Which of the following is NOT a common side effect of dexmedetomidine administration? a. Bradycardia b. Hypotension c. Sedation d. Excitability

6. Dexmedetomidine can be used as an epidural injection combined with opioids. a. True b. False

7. Which of the following is NOT considered an appropriate route of administration of dexmedetomidine? a. Intra-muscular injection b. Intravenous constant rate infusion c. Tramsmucosal administration d. Per os, mixed with food

8. prior to starting a continuous infusion of dexmedetomidine, what loading dose of dexmedetomidine should be given intravenously? a. 1 mg/kg IV b. 10 mg/kg IV c. 5 mcg/kg IV d. 0.5mcg/kg IV

Dexmedetomidine Quiz

9. Which of the following drug classes can be used in combination with dexmedetomdine? a. Opioids b. Inhalant Anesthetics c. Both A and B d. None of the Above

10. When dexmedetomidine is used as part of the pre-operative combination, what happens to the required levels of inhalant anesthetics? a. Increased requirements of inhalant anesthetics b. Decreased requirements of inhalant anesthetics c. No change in requirements of inhalant anesthetics

This article is worth one continuing education credit and will be accepted for grading until Sept 1, 2017. To receive credit, please complete the quiz online

at www.VetMedTeam.com. There will be a $5 fee for each quiz.

*Due to updates and changes authorized by NAVTA, the online quiz may not be the same as the printed exam within The NAVTA Journal. Read each question thoroughly and answer it as it appears in the online exam. Please do not simply copy your answers from the printed version.

®

Knowledge you can put into practice™

IDEXX Learning Center

© 2010 IDEXX Laboratories, Inc. All rights reserved. • 9683-00 • All ®/TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries. The IDEXX Privacy Policy is available at idexx.com.

When you can’t make time for education, education should make time for you{ }

Chaos Theory

CE isn’t useful if you can’t find time to take it. So the IDEXX Learning Center offers a comprehensive curriculum. And learning options that fit the style and schedule of everyone in your practice: from the veterinarian who wants to learn from experts face-to-face, and techs who love the convenience of online courses, to the practice manager who needs to create customized learning tracks to keep your entire team on the same page. To turn theory into reality, visit idexxlearningcenter.com.

NAVTA NomiNATioNs 2016 call for

The NAVTA Executive Board adopts these guidelines to assist the Nominating/Election Task Force appointed by the President in identifying candidates who are well qualified for the NAVTA offices for which they have been nominated. This task force will secure the written acceptance of all nominees before preparing the nomination slate or ballot. All active members will be sent a ballot or link to an on -line ballot to be returned or completed by the appointed date.

Potential Board members should understand the commitments and duties required of the NAVTA Executive Board and their position. These commitments and duties need highly motivated team players who are self-starting individuals and have a passion for propelling the veterinary technician profession forward. There will be travel and time requirements of each Board member for conferences and monthly telephone Board meetings. Candidates also acknowledge that this is a volunteer position and is not a paid position on the Board.

As a member of the Executive Board, officers have the opportunity to:

Executive Board Positions Available For 2016president-Elect (three-year term) member at Large (two-year term)

Responsibilities connected to each elected position must be performed weekly. Each position has its own unique duties; some requiring a great time commitment.

position descriptions and duties can be found at navta.net?

Duties listed for each of the positions above are enumerated in the NAVTA by- laws. Candidates should review the Association by-laws for further information

Potential candidates are required to submit their resume or CV and an essay stating his or her qualifications, accomplishments and reasons they are interested in their nominated position. They must be postmarked or emailed to [email protected] no later than October 1, 2014 on the election year.

• Be involved in the growth and development of the veterinary technology profession on a national level.

• Serve as a source of information and resource for not only the Association members but also the general public.

• Gain knowledge, personal career growth, recognition and advancement.

• Network at local, national and international levels.

www.NAVTA.net


Knowledge you can put into practice™

IDEXX Learning Center

© 2010 IDEXX Laboratories, Inc. All rights reserved. • 9683-00 • All ®/TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries. The IDEXX Privacy Policy is available at idexx.com.

When you can’t make time for education, education should make time for you{ }

Chaos Theory

CE isn’t useful if you can’t find time to take it. So the IDEXX Learning Center offers a comprehensive curriculum. And learning options that fit the style and schedule of everyone in your practice: from the veterinarian who wants to learn from experts face-to-face, and techs who love the convenience of online courses, to the practice manager who needs to create customized learning tracks to keep your entire team on the same page. To turn theory into reality, visit idexxlearningcenter.com.

The NAVTA Journal | June/July 201522

2016ORLANDO, FL

JANUARY 16-20 EXHIBITS 17-20

HEALING.Being a veterinary professional is about more than just loving animals. It’s about the never-ending drive to ensure all animals lead long, happy and healthy lives. As Chestnut begins to heal, Dr. Tiffany Hall knows her passion and commitment make all the difference between her young patient just getting by and thriving.

What moves Dr. Hall is seeing Chestnut gallop in the fields again, pain-free and carefree.

Share what moves you and read other stories like Dr. Hall’s.

NAVC.com/Move



Objective: After reading this article, participants will be able to describe the advantages of local blocks and identify procedures in which patients will benefit from injections with local anaesthetics. In addition, readers will become familiar with techniques used to administer local blocks.

placement of Local Anesthetic Blocks The use of local anesthetic blocks as part of a multi modal approach to analgesia, is po-tentially the most effective form of analgesia for many small animal surgeries, but also, for the majority of veterinary clinics, the most under used. For the majority of the blocks that will be discussed all that is needed is a syringe, a needle, local anesthetic and a knowledge of the relevant anatomy. Techni-cally these blocks do not require any spe-cialist equipment, but nerve location equip-ment is recommended to guide perineural injections of local anesthetic.


utilizing Local Blocks and epidurals

Blocking it All out;

Louise O’Dwyer MBA BSc(Hons) VTS(Anaesthesia & ECC)

DipAVN(Medical & Surgical) RVN

Christine M. Crick, CVT RVT VTS (Anesthesia)(ECC)

Figure 1: Location of the intraorbital canal on a canine skull.



Local anesthetic blocks can be used to enhance analgesia while the animal is under general anesthesia; this means that less volatile agent will be required to maintain an-esthesia, and is likely to result in a ‘smoother’ anesthetic event. Local anesthesia can also be used in sedated or occasionally conscious patients in order to allow minor surgical pro-cedures or manipulations to be performed.

Local anesthetics are the only class of analgesics that are true analgesics, in that they completely block pain sensations; all the other drugs that are considered to be ‘analgesics’, e.g. opioids and non-steroidal anti-inflammatory drugs, are technically ‘hypoalgesics’ as they only decrease pain sensations to a tolerable level. Local anes-thetic drugs block pain because the stop

the nerves conducting the pain signals and therefore work on the transmission part of the pain pathway. Local anaesthetics, when used in combination with other analgesic drug groups, e.g. opioids, NSAIDs, ketamine and alpha 2-adrenergic agonists, play a major role in multi-modal analgesia. This concept uses drugs that work at different parts of the pain pathway to provide more effective analgesia, while utilizing smaller doses of drugs and therefore limiting their side effects. Local anesthetics prevent the transmission of the electrical impulses along nerves, by blocking the sodium channels in the nerve fibers. Both sensory and motor nerves may be affected, so areas of the body can be desensitized but the animal may temporarily lose function and movement of that part of the body if the mo-tor nerves are affected.

Local Anesthetic DrugsLocal anesthetic are subdivided into two groups depending on their chemical struc-tures; lidocaine, bupivacaine, mepivacaine and ropivacaine all belong to the amide-linked group, which undergo hepatic metabolism. Procaine belongs to the ester-linked group; these drugs are broken down in the blood by enzymes. The most commonly used in small animal practice are lidocaine and bupivacaine. Lidocaine has a short onset of action (5–10 minutes) but also lasts a short time (up to 1 hour), while bupivacaine has a longer onset (30 minutes) and duration (6–8 hours) of action. Combining lidocaine and bupivacaine together, produces a fast onset block which has a relatively long duration, but there are some schools of thought that combining the two drugs can actually lessen their effect.

Local Blocks, continued

Figure 2: Care should be taken in cats to ensure the needle is not placed into the infraorbital canal beyond the medial canthus, and to ensure the needle is aimed in a dorsoventral direction, to prevent injury to the globe.

Figure 3: Intraoral approach to the infraorbital canal.



When using local anaesthetics, the maximum doses of the drugs should be calculated and adhered to, but it should be remembered that many local blocks will also have a maximum volume of injectate. The volumes suggested in the following text are appropriate for an aver-age sized doliocephalic dogs, and should be reduced appropriately according to the size of the dog or cat.

When performing any of these blocks, aspira-tion to check for blood, following needle insertion, but prior to local anesthetic injec-tion, should always be performed, as local anesthetics (with the exception of lidocaine in certain circumstances) should never be given intravascularly. Intravenous administration or overdose of local anesthetics can cause cardiotoxic (peripheral vasodilation, hypoten-

sion, decreased myocardial contractility and arrhythmias) or neurotoxic (sedation, disorien-tation, ataxia, convulsions) side effects.

head/Dental BlocksMany of these blocks can be used for dental procedures, mandibular and maxillary surgery. If masses are being removed from the skin on the head or gums, this type of block will provide excellent analgesia, but instead of in-jecting around the mass, which may dissemi-nate tumor cells, the injection site is remote from the surgery site. When deciding which block is appropriate in a given case, it should be remembered that only structures rostral to the injection site will be desensitized. The infraorbital and the mental nerve blocks may not desensitize teeth, unless the needles are inserted into the canals. However, the teeth

will be blocked if the more caudal blocks (maxillary and mandibular) are performed.

Infraorbital nerve block

•Theinfraorbitalforamenislocatedapproximatelymidwaybetweentherostrodorsalborderofthezygomaticarchandcanineroottip(Fig1,2&3)

•Localanestheticinjectedherewillblockallteethandassociatedboneandsofttissuesrostraltothefourthpremolar

•Maxvolume3ml.

Maxillary nerve block

• Localanestheticinjectedintothepterygopalantinefossa,betweentherostralalarforamenandthemaxillaryfora-men(entrancetotheinfraorbitalcanal).

Figure 4: Placement of the needle for the maxillary nerve block should be where the ventral portion of the zygomatic arch joins with the maxilla, placing the tip of the needle at the caudal entrance of the infraorbital foramen.

Figure 5: Placement of maxillary nerve block.



•Thenerveisblockedbyinsertinganeedleundertherostralportionofthezygomaticarchdirectingittothemaxil-laryforamen(Figure4&5).

•Thisblockdesensitizesallofthemaxil-larybone;softandhardpalate;noseandupperlip;dentitionrostraltothesecondmaxillarymolar

•Maxvolume3ml.

Mental nerve block

•Thementalforamenisventraltotherostral(mesial)rootofthesecondpremolar.Themiddlementalforamenisbiggestindogs,andcarriesthelargestofthementalnerves(Figure6,7&8).

•Blocksallteethandassociatedboneandsofttissuesrostraltothesecondmandibularpremolar

•Maxvolume2ml.

Mandibular (inferior alveolar) nerve block

•LocatedwheretheinferiorbranchofthemandibularnerveentersthemandibularcanalatthemandibularforamenCanbeperformedeitherintraorallyorpercutaneously(Figure9&10).

• Toblockthisnerve,palpatethelipofthemandibularforamen.Inserttheneedlepercutaneouslyatthelowerangleofthejaw,andadvanceitagainstthemedialsideofthemandibleanddirectittowardstheforamen.Oftentheneedlecanbeguidedasyoucanfeeltheforamenandnervefrominsidethemouthonthemedialsurfaceofthemandible.

•Localanestheticsdepositedherewillblocklowerteeth,mandible,skinandmucosaoflowerlip.

•Maxvolume2ml.

Retrobulbar or parabulbar BlockThe retrobulbar block is very useful for ocular surgery. The retrobulbar block involves inject-ing local anesthetics behind the globe and will block cranial nerves II, III, IV, V (ophthalmic and maxillary branches) and VI. So as well as desensitizing the globe, lids, conjunctiva, and much of the upper face, it will block the extra-ocular muscles and therefore produce a central eye. Some eyelid tone may remain from palpebral (cranial nerve VII) innerva-tion. There is a chance that the globe can be punctured when executing this block so it is best to reserve its use for surgeries when enculeation is planned. Retrobulbar injec-tions may produce traction on the optic nerve and therefore the technique is often avoided in shallow orbited cats, whose optic nerves (both in the injected eye and the contralateral one) may be compromised by this tension.

•Theneedleisinsertedat10o’clockand5o’clocksites(Figure11).Aslightlycurved21–23gneedleisusedandthetipoftheneedleshouldbe‘bouncedoff’theorbituntilthetipsitsbehindtheglobe.


Figure 6: Location of mental foramen in a canine skull.

Figure 7: Note the small mental foramen in cats.



An alternative is to perform a parabulbar block, where by local anesthetics is injected around the eye. Using this method the needle is not bent, therefore the operator has more idea of where the needle tip is located. Injec-tions are made dorsal and ventral to the eye using this technique, and will result in local anesthetics diffusing around the orbit.

•Maxvolume5ml.

•Aspiratenotjusttocheckforbloodbutalsoforcerebrospinalfluid.

Auriculotemporal and Great Auricular Nerve BlockBlocking the auriculotemporal and great auricular nerve desensitizes the inner surface of the auricular cartilage and the external ear canal. This block can be utilized in ear surger-ies such as total ear canal ablation.

•Theauriculotemporalnerve(whichinnervatesthecranialportionoftheverticalcanal)isblockedbyinsertinganeedlerostraltotheverticalearcanalanddirectingittowardsthebaseofthe‘V’formedbythecaudalaspectofthezygomaticarchandtheverticalcanal.

•Thegreatauricularnerve(caudolateralinnervation)isblockedbyinsertinganeedleventraltothewingoftheatlasandcaudatotheverticalearcanal,anddirectingitparalleltotheverticalcanal.

•Analternativetothisblockisa‘splash’blockwherelocalanaestheticissquirteddowntheearcanalduringsurgeryorinjectedaroundthesurgicalsitepriortoclosureorawoundsoakercathetermaybeplacedpriortofinalwoundclosure.

Intratesticular BlocksIntratesticular blocks are obviously a useful block to perform on castrations. Some firm back pressure may be expected during injection.

•Thetesticleissecuredinthescrotumwithonehand,andtheneedlead-vanced,usingtheoppositehand,fromthecaudalpoletothecranialpoleofthetesticle.Applyaspiration,withthe

negativepressureheldforseveralsecondstoensurenoflashback(thistissueismoredensethanmostothers).

• Injectthelocalanestheticwhilewithdrawingtheneedlecaudallyuntilthetesticleisfelttobeturgid;thiswilltakeaboutone-thirdofthevolume.Thenrepeatintheothertesticle.Theremaininglocalanestheticcanbeusedtoperformalineblockattheincisionsite.

•Despitetheexpectedrapidonsetoflidocaine,ittakesuptotenminutesfortheblocktomoveupthecordandachievethemaximumeffect.Iftheblockissuccessful,theabsenceoftheexpectedcremastermuscletwitchwhentheclampisappliedwillbenotable.

Figure 8: Placement of mental nerve block.

Figure 9: Location of mandibular foramen for mandibular (inferior alveolar) nerve block.


Limb BlocksAs orthopedic surgery becomes more and more commonplace in general practice, most aspects of limbs can be desensitized using a number of different regional blocks.

Intra-articular AnalgesiaThis is a simple local anesthetic block which can be done pre or post any surgery involving a joint, including arthroscopy. As with all local anesthetic blocks, it must be done in a strictly aseptic manner to avoid introducing infection into the joint. This technique should be carried out as a ‘one-off’ rather than as a continuous infusion. As with all analgesia, pre-emptive administration is best, and so ideally the drug should be injected before surgery (often this can be performed once a joint tap has been performed, using the same needle left in place). Alternatively it can be injected at the end of surgery just before the joint is closed. Bupivacaine is used as the local anesthetic of choice, but in animals with chronic joint disease morphine can also be added to the local anesthetic. In such cases of chronic joint inflammation, synovial opioid receptors are upregulated, and morphine should improve the quality and the duration of the analgesia.

Ring Block Local anesthetic agents can be injected to encircle the area of interest, e.g. a distal limb. It is vital that local anaesthetic without adrenaline is used, otherwise the blood sup-ply to the distal area could be compromised. The solution of local anesthetic may be diluted to provide a more convenient volume to inject, and reduce the risk of causing toxicity. It is important not to inject through inflamed or infected tissue as this may disseminate infection and will be less effective due to the altered pH of the tissue.

IVRAIntravenous regional analgesia (IVRA) is a technique which can be used to desensitize distal limbs. When using this method only lidocaine (without adrenaline) should be used, as it is the least cardiotoxic of the local anes-thetic. Lidocaine is injected distal to a tourni-

quet which is in place to keep the drug in a discrete area (including the surgical site). The local block works for as long as the tourniquet is in place, as the drug doesn’t return to the liver to be metabolized. The tourniquet, how-ever, should not be left in place for more than 60–90 minutes. This technique also results in exsanguination of the limb, and therefore a bloodless field for surgery.

1. Clip and prepare the area of interest and place an IV catheter (facing away from the heart).

2. Exsanguinate the limb from the toe upwards by wrapping some cohesive bandage starting at the toe, tying a tour-niquet at the top, and then unwinding the bandage from the toe upwards.

3. Inject lidocaine into the catheter (up to 4 mg/kg and flush), then the catheter can be removed (Figure 12).

4. Wait 5 minutes before you start surgery.

5. The tourniquet should not be removed until at least 15 minutes after the local anesthetic is injected. If the tourniquet should require removal earlier than this, then ECG monitoring should be performed for PR & QRS prolongation and resulting arrhythmias.

Digital Nerve BlockThis block is useful for any pad or digital surgery, including digit amputation. It is par-ticularly useful with sedation to suture pads, and without sedation to pull torn nails. Insert a short needle in the gap between the digits. This will need to be done in the interdigital space either side of the affected digit. After aspiration to check for blood, a maximum volume of 0.5 ml can be injected either side.

Radial, Ulnar, median and muscucutaneous Nerve BlocksBlocking these nerves will desensitize the dis-tal forelimb, for procedures of the elbow and antebrachium. In the cat, blocking the medial,



Figure 10: Placement of mandibular nerve block, the tip of the needle is being palpated intra-aurally to ensure accuracy.

Figure 11: Retrobulbar block being performed.

Figure 12: IVRA being placed.

29


ulnar and radial nerves will desensitize the forepaw. These nerves can often be palpated, making this technique relatively straightfor-ward to perform.

•Theradialnervecanbeblockedbyin-jectinglocalanestheticsubcutaneouslydorsomedialtothecarpus,proximaltothejoint.

•Themedialandulnarnervesareblockedbyinjectingmediallyandlater-allytotheaccessorycarpalpadonthepalmarsurfaceofthepaw.Blockingtheradial,ulnar,medianandmusculocuta-neousnervesinthedogwilldesensitizetheforelimbdistaltotheelbow.

•Theradialnerveisblockedbyinject-ingproximaltothelateralepicondyleofthehumerusanddirectingbetweenthebrachialisandlateralheadofthetriceps.

•Theulnar,medialandmusculocutane-ousnervesareblockedbyinjectingproximaltothemedialepicondyleofthehumerusanddirectingbetweenbicepsbrachiiandthemedialheadofthetriceps.

•Aswithanyblock,aspiratethesyringebeforedepositinglocalanestheticandadjunctdrugsnearthesenerves,avoidingintra-arterial,intravenous,andintraneuralinjection.

Brachial plexus BlockBlocking the nerves of the brachial plexus will provide excellent analgesia for procedures be-low the elbow The traditional brachial plexus (axillary) block, injecting approximately 10–15 ml of local anaesthetic (for a 25 kg dog) into the axillary space at the level of the point of the shoulder blocks the lower forelimb, but not the shoulder or the proximal humerus.

1. The patient should be positioned in lateral recumbency with the leg to be blocked placed uppermost, being held in a natural position (perpendicular to the longitudinal axis of the body)

2. The proposed puncture site should be clipped and aseptically prepped

3. lnsert a spinal needle into the axillary region, medial to and at the level of the shoulder joint, directed toward the costochondral junction and parallel to the vertebral column.

4. The needle’s distal end should lie just caudal to the spine of the scapula (Figure 13).

5. As with any local block, aspirate the syringe to avoid intravascular adminis-tration, and then inject two-thirds of the dose. Inject the remaining one-third as you slowly withdraw the needle.

6. Increasing the volume of local anesthet-ic used by diluting it with sterile saline solution up to 50% can improve the degree of blockade by increasing the volume injected.

Pneumothorax is a potential complication of both of these brachial plexus blocks and as-piration to check for air should be performed before each injection. Bilateral blocks should be avoided due to potential blockade of the phrenic nerve.

pelvic Limb BlocksThe sciatic nerve block may be combined with either a femoral nerve or lumbar plexus block to provide analgesia for pelvic limb surgery. Electro neurolocation is recommended for these techniques to improve accuracy, ensure safety and reduce the dose of local anaes-thetic required. It is also unlikely satisfactory local anaesthesia will be gained without electro-neurolocation.

The sciatic nerve is blocked at its proximal location caudal to the greater trochanter of the femur. The puncture site is located at the junction of the cranial and middle thirds between a line drawn between the greater trochanter of the femur and the ischial tuber-osity (Figure 14). The depth of needle inser-tion varies depending on the size of patient and may be up to 6cm to 8cm. The femoral nerve is blocked at its location on the medial

Publication of the National Association of Veterinary Technicians in America

Figure 13: Premeasuring the needle prior to placement of a brachial plexus block.

Figure 14: Needle placement for sciatic nerve block, using a nerve locator.

Figure 15: Lumbar plexus block being performed.



aspect of the pelvic limb in the femoral triangle. The femoral artery is palpated within the femoral triangle, held in place with light digital pressure and the femoral nerve is located and blocked cranial to the artery, usually in a superficial location.

An alternative to the femoral nerve block is the lumbar plexus block, which allows for the femoral nerve to be blocked more proximally and avoids the risk of missing the saphenous nerve high within the inguinal region. The saphenous nerve supplies the cutaneous innervation to the stifle and therefore if missed a patient may respond to skin incision. The lumbar plexus block is performed with the patient positioned in lateral recumbency with the side to be blocked uppermost (Figure 12). The dorsal process of L7 is palpated and from this the dorsal process of L5 identified. The needle is inserted lateral to L5 (approximately 2cm to 3cm) until the transverse process is contacted. The needle is then walked off bone caudally and a loss of resistance may be felt as it passes through the intervertebral ligament. Local anesthetic is then injected after aspiration.

Epidural AnalgesiaEpidural Administration Epidural analgesia is a technique which has regained popularity in both dogs and cats. No special equipment is needed to perform this technique except a filter needle for drawing your agents and a spinal needle. It has practi-cal application in many cases with a relatively high success rate and relatively low com-plication rates with selection of appropriate patients and technical affinity.

In the stable patient, epidurals are useful in the operative management of reducing anesthetic MAC, increased opportunity for synergistic analgesia with systemic agents, and few deleterious cardiovascular effects.

Epidurals can be used in critical anesthesia candidates to enhance analgesia and reduce the dependency on halogenated agents however it should be avoided in patients with hypovolemia, sepsis or sever hypotention.

Multiple agents have been used in the epidural space with varying efficacy. Opioids, local anesthetics, dissociatives and even non steroidal anti-inflammatories can be adminis-tered. Further reading is available on these combinations however a standard protocol is morphine 0.1mg/kg +/- bupivacaine 1 mg/kg.

Morphine without preservative is desirable however conventional morphine with pre-servative can be used if only performed as a single injection. Morphine with preservative should never be used with epidural catheters and epidural CRIs.

In dogs, the volumentric dose of epidural drugs typically is 0.1 – 0.22ml/kg and a stan-dard to not exceed 6ml in total volume.

Palpation of anatomical landmarks may be per-formed in either the sternal or lateral position.

sternal Approach:

1. The patient is placed in sternal recum-bency with either a) the rear limbs pulled cranially, knees bent and symmetric to one another or b) legs may be splayed in a ‘frog’ appearance if the patient has limited flexibility or trauma where forward traction is considered questionable.

2. Begin at the cranial border of the ilial wings. Palpation with the non-dominant hand with the thumb and middle finger on the wings helps the anesthetist to use the index finger draw invisible line across where the prominence of the L6 dorsal spinous

Local Anaesthetic Dose Onset Duration Signs of Toxicity

Lidocaine 2mg – 4mg/kg 5 – 10 mins 1 – 2 hours >8mg/kg

Bupivacaine 1.0mg – 1.5mg/kg 15 – 20 mins 6 – 8 hours > 2mg/kg

Levobupivacaine 1.0 – 1.5mg/kg 15 – 20 mins 6 – 8 hours > 2mg/kg

Ropivacaine 1.5mg/kg 15 – 20 mins 6 – 8 hours > 2mg/kg


Doses of local anesthetic used in small animal anaesthesia.



process lies. L6 is the last of the taller processes, while L7 is approxi-mately 1/3 of the height and some-times more difficult to palpate. Walk-ing the index finger caudally off the L7 dorsal spinous process allows for the discovery of a larger ‘divot’ or area of depression. This is most appreciable in thinner, well-muscled animals. This is the location of the lumbosacral junction (L7 – S1), the preferred entry to the epidural canal.

3. Once landmarks are found, the patient is to surgically prepped and draping is recommended. Sterile gloves are stan-dard when performing the procedure.

4. Introduce the spinal needle in a 45 degree angle, with the bevel pointing cranially. Pass through the skin, the epidural fat and then the interarcuate ligament (ligamentum flavum). In some animals there may be a distinctive resis-tance, referred to as a ‘pop’ when this ligament is transected. This is normal and advancement may continue. The needle can be slowly advanced into the epidural space.

If the needle encounters obstruction or bot-toms out into bone, back the needle out a small distance.

There are methods in which to verify place-ment of the needle into the epidural space however each has limitations and varying efficiencies. The author believes that proper anatomical understanding and practice will help build the confidence that other methods may give false negative feedback.

(i.e.… ‘hanging drop technique’ or the ‘air-whoosh’ method)

Remove the stylet from the spinal needle, using the non-dominant hand to stabilize the needle lumen. Attach the test syringe which contains a small amount of sterile, non-bacte-riostatic 0.9% NaCl. Injection should be smooth with no crepitation.

Test injections are recommended to be from a sterile glass syringe. Many epidurals are successfully performed with low resistance plastic or even conventional sterile syringes.

Once the test injection is successful, detach the test syringe while stabilizing the spinal needle hub and affix syringe with analgesic agent. Complete the epidural by injecting the full amount.

Lateral Approach:

The lateral approach is considered more advanced however, has advantages when performing co-administration of a local anesthetic.

If a local anesthetic is not to be instilled, there would be no benefit to administration from this position other than anesthetist’s prefer-ence or patient comfort.

The affected side where impulse blockade is desired (such as a pelvic limb amputa-tion) should be placed recumbent. When the needle is properly placed and slow ad-ministration of agents is infused, the nerve roots on the affected side are ‘bathed’ in the local anesthetic. Motor blockade can complicate situations and bladder expres-sion may need to be performed during the active time of blockade.

Thoracic BlocksIntercostal nerve block Intercostal nerve blocks are a useful analgesic adjunct for lateral thoracotomy surgeries, but also can be used to good effect to provide pain relief for rib fractures and for the place-ment of chest drains.

•Theintercostalnervesdescendintheintercostalspacealongthecaudalborderofeachrib,associatedwiththeventralbranchesoftheintercostalarteryandvein.

•Thereismuchoverlapofinnervationofthechestwall,sothatatleast2‘segments’cranialandcaudaltotheintercostalssite/swhereanalgesiaisneeded,shouldbeblocked.

•Usea23–25g,5/8–1”needle.

1. Aiming perpendicular to the body wall, slide the needle through the skin, off the caudal border of the rib, and proximal to the ‘wound’.

2. Aim as near to the intervertebral fora-men as possible (i.e. as high up the intercostal nerve as possible, so as to block most of its branches).

3. Aspirate, to check that the needle tip isn’t in a vascular part the of the neuro-vascular bundle.

4. Use ~1 ml per site, depending upon the animal’s size

Interpleural AnalgesiaLocal anesthetic can also be infused into the pleural cavity (between the visceral and parietal pleura). Interpleural analgesia is also useful after thoracotomy, or for lateral thora-cotomy or sternotomy. Local anesthetics is in-

*Of note: The spinal cord usually ends at L6 in the canine while in the cat it ends at S1. There is a lesser opportunity for spinal puncture in dogs however cerebrospinal fluid may be encountered in either species. If this happens, it is important to reduce the quantity of injectable by 50% or when crepitation is encountered upon injection. If blood is encountered, the needle is to be removed and repositioned a single time. If blood is encountered a second time, it is recommended to not continue attempts.



stilled down the chest drain whilst the animal is still under anesthesia, and then the animal is rolled so that the drug bathes the affected area (as long as the animal’s ventilation is not compromised by that position). Interpleural anesthesia can also provide pain relief for animals with indwelling chest drains. Analge-sia of cranial abdominal organs and cranial mammary glands is also produced when local anesthetics are injected inter-pleurally, due to the stellate ganglion in the thorax providing innervation to these organs.

•Canbeeffectedbyinstillinglocalanaes-theticdownanindwellingchestdrain.

• Otherwise,acathetermaybeplacedintothepleuralspaceeitherpercutaneously,orunderdirectview,forexamplebeforeclosureofathoracotomyincision.

The mechanism of analgesia has been sug-gested to be due to diffusion of local anes-thetic through the parietal pleura, causing in-tercostal nerve block, blockade of the thoracic sympathetic chain and splanchnic nerves, and diffusion of the anesthetic into the ipsilateral brachial plexus, resulting in blockade of the parietal peritoneum. Because cranial abdomi-nal nerves enter the spinal cord at the level of the thorax, intrapleural administration of a local anesthetic blocks the cranial abdominal nerves, and this technique may be useful for acute pancreatitis or cranial abdominal surgi-cal procedures.

Wound soaker CathetersThese are useful following large surgeries such as mammary strips and forequarter amputa-tions, but the catheters can be implanted in any closed incision to provide excellent postopera-tive local analgesia. They are loosely tacked into place in the subcutis before skin closure, and then secured to the skin using a roman sandal suture. They can be removed easily by pulling once the roman sandal suture is cut. Local anaesthetic is diffused through the catheter after injecting it through a bacterial filter system (which is included in the catheter set), and can be injected in bolus doses or as a continuous rate infusion by attaching the catheter, via an extension set, to a syringe driver.

ConclusionLocal anesthetic techniques are easily em-ployed in practice as part of a balanced, mul-timodal approach to anesthesia and analgesia and should be considered where appropriate. With a good knowledge of anatomy and care-ful dose calculation, the various blocks can be carried out with excellent success. For the majority of the discussed techniques, no spe-cialist equipment is necessary, requiring only items commonly utilized in practice. The use of local anaesthetic techniques can greatly im-prove patient analgesia both during anaesthe-sia and into the recovery period and beyond. There can also be a noticeable improvement

About the Author:

Christine m. Crick, CVT RVT VTs (Anesthesia)(ECC)Chris has worked in surgical and critical care medicine more than 15 years, with a strong interest in high level, emergent anesthesia & enjoys the most complicated cases available. Currently employed with VCA, she works as the Regional Technical Devel-opment Coordinator for primarily the Sacramento region. Chris began her technician career in 2001 with taking the VTNE, proceeding to work toward her board specializa-tion in 2003 with the Academy of Veterinary Technician Anesthetists, followed by the Academy of Veterinary Emergency and Critical Care Technicians in 2007. Currently she is a candidate of the Certified Veterinary Pain Practitioner credential with the IVAPM, after successfully completing the examination process.

Professional activities have included authoring book chapters and articles, lectur-ing, being a member of the AAVSB Exam Committee for the Veterinary Technician National Examination, the Examination Committee for AVECCT, the Board of Direc-tors for the International Veterinary Academy of Pain Management, a member of the Credentialing Committee and a Member-at-Large term on the Board of Regents for the AVTA and most recently on the Membership Committee for the Society of Criti-cal Care Medicine.

About the Author:

Louise O’Dwyer mBA Bsc(hons) VTs(Anaesthesia & ECC) DipAVN(medical & surgical) RVN Louise holds both the Diploma in Advanced Veterinary Nursing (Surgical) and (Medi-cal). She also gained her VTS (ECC) in 2011 and VTS(Anaesthesia) in 2014. She has contributed to over 35 journal articles and book chapters, and lectures regularly on all aspects of anaesthesia, emergency and critical care, surgery and infection control. She is currently Clinical Director of PetMedics in Manchester the largest emergency clinic in the UK. Louise is the co-author of ‘Practical Emergency and Critical Care Veterinary Nurs-ing’ as well as ‘Wound Management in Small Animals: A Practical Guide for Veterinary Nurses and Technicians’, and the BSAVA ‘Pocketbook for Nurses’ and the forthcoming ‘A Veterinary Nurse’s Guide to Infection Prevention and Control’ due 2015.


in post-operative pain scores and subsequent reduction in analgesic requirements during the recovery period.

References:

1. Campoy L. and Read M. (eds.) (2013) Small Animal Regional Anesthesia and Anal-gesia. Wiley- Blackwell, Ames IA.

2. Ko J. (ed) (2013) Small Animal Anesthesia and Pain Management. Mason Publishing, London UK, pp. 249-273

3. Grimm K., Lamont L., Tranquilli W. et al. (2015) Veterinary Anesthesia and Analgesia 5th edition. Wiley-Blackwell, Ames IA.



1. What is the recommended dose of bupivacaine?a. 0.5-0.75 mg/kgb. 1.0-1.5 mg/kgc. 2.0-2.5 mg/kgd. 2.0-4.0 mg/kg

2. At what dose do we start to see signs of toxicity with lidocaine use?a. >2mg/kgb. >4mg/kgc. >6mg/kgd. >8mg/kg

3. Which of the following local anesthetics does NOT undergo hepatic metabolism?a. Lidocaineb. Bupivacainec. Procained. Mepivacaine

4. Which block will desensitize all of the maxillary bone, including soft and hard palate; nose and upper lip; dentition rostral to the second maxillary molar?a. Brachial plexusb.Maxillaryc. Infraorbitald. Mental

5. When performing an IVRA block, what is the maximum length of time the tourniquet should remain in place?a. 30-45 minutesb. 60–90 minutesc. 120-180 minutesd. 240-360 minutes

6. Which of the cranial nerves does the retrobular block affect?a. II, III, IV, V and VIb. III, IV,, V, VI and VIIc. IV, V, VI, VII and VIIId. V, VI, VIII, and IX

7. Epidural administration is useful in all of the following except for:a. Increased opportunity for synergistic

analgesia with systems agentsb. Reducing anesthetic MACc. Increasing the dependency on

halogenated anestheticsd. Help in having many agents able to

be chosen from, most appropriate per individual patient

8. morphine in the epidural space:a. Must always be preservative freeb. Never has to be preservative freec. Must always be preservative free

when used as an epidural CRId. Should never be administered into

the epidural space

9. The total volumetric dose of epidural drug amount in the dog:a. Should not exceed 6ml in total

volumeb. Should not exceed 6ml/kg c. Should not exceed 0.6ml/kgd. Should not be less than 6ml in total volume

10. When palpating the anatomical landmark of the dorsal spinous processes, immediately parallel to the cranial border of the ilial wings is vertebral body:a. L6b. L7c. S1d. wL5




®

Local Blocks Quiz

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Objective: After reading this article, the participant will be able to define dyspnea, describe clinical symptoms associated with the condition, and discuss techniques used to alleviate dyspnea.

AbstractDyspnea is a common problem in humans with cardiopulmonary disease, and is suspect in veterinary patients as well. Dys-pnea is defined as a variable sensation of uncomfortable breathing, and by definition can only be recognized by the subject ex-periencing it.1 Human patients can verbalize this feeling, informing their provider when they are experiencing dyspnea. Dyspnea


Noah Jones, RVT, RCP, RRT


tHEY cAn’t cRY

Can’t Breathe:recognizing and alleviating dyspnea

if they



has been shown to occur in up to 50% of patients in acute care hospitals, and the presence of dyspnea is associated with in-creased intensive care unit (ICU) length of stay.1,2 Dyspnea is also a sensitive predictor of mortality in humans, and is more sensi-tive than chest pain in predicting death of human cardiac patients.1 Veterinary pa-tients however are unable to verbalize this feeling, and thus this symptom likely goes unrecognized in many patients, just as the sensation of pain does. Recent advances in veterinary pain recognition have improved pain management in our patients, however similar advances in dyspnea recognition and management have not been realized. Given that the sensation of dyspnea can be quite uncomfortable and interfere with ac-tivities of daily living, it is extremely impor-tant for the veterinary medical provider to understand how to recognize patients that may be suffering from dyspnea, the causes of dyspnea, as well as the tools available for alleviating this debilitating symptom and improve outcomes in these patients.

physiology of DyspneaDyspnea is a subjective unpleasant sen-sation felt by the subject experiencing it, therefore it is difficult to study in veterinary patients. Despite this, there is sufficient evidence that some veterinary patients experience unpleasant sensations related to breathing, though the exact sensations being felt by these patients are largely un-known.3 The sensations of dyspnea are cre-ated by the complex interplay of the sensory cortex, central chemoreceptors, peripheral chemoreceptors, lung receptors, and chest wall receptors. Dyspnea is generally classi-fied into three qualitative groups: air hunger, increased work of breathing, and chest tightness.1,3 While these three classifications exist, it is likely that no one classifications accounts for all of a patient’s dyspnea, and instead the sensations experienced are due to multiple factors.1,3

Normal respiratory drive is mainly influenced by central chemoreceptors (located in the

brainstem) sensitive to cerebral spinal fluid pH, and peripheral chemoreceptors (located in the carotid sinuses and aortic arch) sensi-tive to blood carbon dioxide and oxygen levels, however chemical and mechanical receptors in the lungs and chest wall also influence breathing.4,5 These receptors provide abundant afferent information to the respiratory centers in the pons and medulla. The pontine respiratory centers, specifically the pontine respiratory group (PRG) and the apneustic center, receive information from chemical and mechanical receptors in the lungs and chest wall and maintain a smooth respiratory pattern by providing this informa-tion to the medullary respiratory centers, including the dorsal respiratory groups (DRG) and the ventral respiratory groups (VRG).4,5 The DRG collect and assimilate various afferent ventilatory information and then provide this information to the VRG, which in turn use this information in conjunc-tion with direct stimulation from the central chemoreceptors to determine precise firing of inspiratory neurons that trigger phrenic nerve impulses leading to respiratory muscle stimulation.4,5 All the while, corollary afferent signals are sent to the cerebral cortex that allow for conscious perception of breath-ing, and conscious control of breathing via conscious efferent signals to the respiratory muscles.1,3,4,5

Similar to the sensation of pain, dyspnea is thought to be mainly influenced by increased or abnormal activity of chemical and mechanical receptors in the airways and chest wall, although activation of peripheral chemoreceptors enhances the sensation of dyspnea.1,3 Air hunger exists when there is a mismatching of ventilation demand (what the patient needs) and ventilation achieved (what they actually perform), causing the patient to feel they are not getting enough air.1,3 Normally the subconscious respira-tory drive meets the patient’s metabolic and ventilatory demands. If however the effective ventilation is insufficient to meet the needs of the patient, the patient’s afferent signals increase, and the patient becomes aware of

the need to increase ventilatory drive.1,3 This can become very uncomfortable and cause aversive behavior associated with seeking more air, as experienced during prolonged underwater breath holding.1,3 Air hunger is mostly triggered by insufficient pulmonary stretch, as signaled by decreased slowly adapting receptor (SAR) activity from the lungs, and is exacerbated by peripheral che-moreceptor stimulation, such as hypoxemia or hypercarbia.1,3 Excessive rapidly adapt-ing receptor (RAR) activity due to chemical irritation of the airways and changes in lung fluid volume also contribute to sensations of air hunger.1,3

This increased need for air causes an increase in the patient’s efferent ventilatory output, meaning the VRG sends out signals to increase minute ventilation.1,3 While air hunger occurs due to mismatching of chemi-cal and mechanical afferent inputs (input mismatch), the sensation of increased work of breathing occurs due to mismatching of mechanical afferent and efferent signals (input/output mismatch). The increased efferent output in conjunction with changes in mechanical receptor activity in the re-spiratory muscles results in a mismatch of efferent and afferent signals, resulting in the patient feeling like they are working harder to breath. This sensation can take place whether the muscles are actually performing the work or not.1,3 This is of particular impor-tance in patients with muscle weakness or impending ventilatory failure, where muscle efforts may or may not be exaggerated, but efferent output is maximal. Mechanorecep-tors in the chest wall that send signals to the brain on muscle position, stretch, and tension provide most of the information on work of breathing.1,3 In addition to mechano-receptor stimulation, airway C fiber receptor stimulation also causes work of breathing dyspnea, likely due to increased airway resistance.1,3

Another form of dyspnea is chest tightness, typically described in human patients as a “tight” or “heavy” feeling on their chest.1

Recognizing and Alleviating Dyspnea, continued



the level of the pulmonary capillaries.1,3 As is the case with other forms of dyspnea, it is unknown whether veterinary patients experi-ence tightness dyspnea.

Recognizing Dyspnea and CausesJust like pain, dyspnea is a symptom. It cannot be quantified or measured. Although dyspnea, under its current definition, can

Tightness dyspnea is typically caused by bronchospasm that occurs during an asthma attack.1 Receptors in the airways are thought to mediate tightness dyspnea, though the exact mechanisms at play are still unclear.1,3 The tightness felt due to pul-monary congestion or pulmonary hyperten-sion may be due to stimulation of pulmonary C fiber receptors in the terminal airways at

be positively documented in humans but not animals, animals will display dyspneic behaviors. Rats will avoid chambers with in-creased carbon dioxide levels or decreased oxygen levels, even when tempted with food, suggesting they may experience dyspneic sensations while breathing under these conditions.3 Perhaps a veterinary specific definition would allow for better recognition

Dyspnea score Respiratory signs Behavioral Changes Recommendations

0Comfortable, no respiratory distress, some panting during exercise.

None Normal patient. Consider other cause for signs.

1May be tachypneic, or have increased respiratory effort, no hypoxemia.

Mild exercise intolerance Search for underlying cause and treat.

2

Tachypneic with increased effort, orthopneic, mild or non-existent intercostal retractions and accessory muscle use, mild hypoxemia.

QAR/BAR, reluctant to walk, but will when encouraged, inappetant but drinking water, inter-ested in surroundings.

Provide oxygen therapy, search for underlying cause. Consider adjunct therapies for dyspnea.

3

Tachypneic with increased effort, orthopneic or platyp-neic, moderate intercostal retractions and accessory muscle use, moderate hypoxemia.

QAR/dull, reluctant to walk, not interested in food/water, not interested in surroundings, only fo-cused on breathing, may be incontinent.

Provide oxygen therapy, search for underlying cause. Consider adjunct therapies for dyspnea. Consider mechanical ven-tilation if no improvement.

4

Tachypnea or bradypnea with increased effort, may have decreased effort due to fatigue, platypneic or laterally recumbent, marked intercostal retrac-tions and accessory mus-cle use, marked hypoxemia and/or hypercapnia.

Obtunded/stuporous, non-ambulatory, not interested in surroundings or not responsive, only focused on breathing, incontinent.

Provide oxygen therapy and search for underlying cause. Provide adjunctive therapies for dyspnea. Mechanical ventilation necessary if no immediate improvement.

TAble 1



and management of dyspnea. Rather than a definition focused on patient symptoms, as is the case in human medicine, a definition focused on animal behaviors and patient signs may allow for more clinical utility. Therefore in veterinary medicine, dyspnea can be simplistically defined as “abnormal or aversive behaviors due to altered cardiopul-monary status”.

The best way for us to recognize the behav-iors and signs is by performing a thorough respiratory assessment. The assessment of the patient in respiratory failure is similar

to any other patient assessment. The first thing the clinician should assess is menta-tion, which can be accomplished upon presentation. If the patient is unresponsive or otherwise unconscious, immediate steps should be taken to confirm the presence or absence of cardiopulmonary arrest (CPA), and cardiopulmonary resuscitation (CPR) should be initiated without delay if indi-cated. In addition to assessing mentation, a patient’s posture should be assessed. Patients will assume positions that minimize work of breathing, and patients using this positioning can be assumed to be experi-

encing dyspnea.6 Typically these patients will have difficulty breathing while lying down (orthopnea), will abduct the elbows (to maximize chest wall excursions), and extend the neck into the “sniffing position” (which maximizes laminar airflow in the conducting airways).6 The absence of these behaviors does not indicate the absence of dyspnea, however their presence is a good indicator that the patient is having to alter their normal behavior due to discomfort, just as animals with injured limbs will refuse to walk due to pain.6


Airway Obstruction

pulmonary parenchyma

pleural space Thoracic-wall

mentation Dull, frantic, pawing at face/neck

Dull, anxious, glazed-look

Dull, anxious, glazed-look Dull, weak

posture Orthopnea, recumbent

Orthopnea, recumbent



Breathing patternExaggerated, prolonged inspiration or expiration

Open-mouth, cough, paradoxical, nasal flaring

Open-mouth, rapid-shallow, tachypnea, paradoxical

Paradoxical, tachy-pnea, rapid-shallow

Chest palpation Decreased movement, asymmetrical

Fremitus, crepitus, decreased movement

Decreased movement, asymmetrical

Decreased movement, no diaphragm use

percussion Normal to hyperresonant Normal to dull Dull to hyperresonant Normal to dull

AuscultationStridor, bronchial, wheezing, crackles, diminished

Crackles, increased bronchovesicular, diminished

Diminished, pleural friction rub, GI sounds, fluid-line

Diminished, crackles

historyCough, vocal changes, noisy breathing, acute/chronic

Cough, dysphagia, PU/PD, trauma, rodenticide, exercise intolerance

Trauma, exercise intolerance, neoplasia, thoracic surgery

Trauma, progressive, chronic, electrolyte loss

TAble 2



Immediate assessment of the airway via an oropharyngeal exam accomplishes two things: visual assessment of the patient’s upper airway, and assessment of patient responsiveness. If the patient is conscious and/or responsive, caution should be ob-served during the oral exam to avoid being bitten; even normally gentle patients can be defensive in an emergency or when suffering from dyspnea. When assessing the airway, the clinician should be looking for any evi-dence of trauma to the airway such as blood in the oropharynx, swelling, redness, or obvi-ous deformity, as well as mucous membrane color to assess for cyanosis, which is a late indicator of hypoxemia at which at least 5 g/dL of the patient’s hemoglobin is deoxygen-ated.7 Assessing upper-airway sounds can also provide vital information to the clini-cian. Stertor (originating from the nasal or pharyngeal structures) and stridor (originat-ing from the laryngeal structures or trachea) are usually readily apparent on presentation and indicate airflow obstruction.8 When airflow limitation is severe, a slow, deep, breathing pattern with excessive abdominal effort indicates the patient is attempting to optimize work of breathing and minimize air-flow resistance, and may indicate a patient is experiencing dyspnea.8,9 This breathing pattern may also be exhibited by patients with lower airway obstructive disease such as asthma or bronchitis.9 Clinicians should be prepared to immediately secure a patent airway should a patient present with severe airflow limitation or airway trauma.

After assessing the patency of the airway, a patient’s respiratory rate and character should be recorded. Other finer details such as tachypnea, presence of nasal flaring, intercostal/substernal/suprasternal retrac-tions, abdominal paradox, and chest wall motion should also be documented, and can indicate significant respiratory distress.6,7,9 Palpation of the thorax should be performed to assess for obvious musculoskeletal deformities as well as palpate for tactile fremitus which can indicate secretions in the airways. Percussion can be performed by

the experienced clinician and aid in local-izing a patient’s problem: normal percussion is resonant, hyperresonant percussion indi-cates air-trapping or pneumothorax, and dull percussion indicates consolidation or pleural effusion.9 Finally auscultation should be performed. Any adventitious breath sounds or heart sounds should be recorded in the medical record.

Assessing oxygenation and ventilation is an obvious and necessary step when as-sessing the patient in respiratory distress. Pulse oximetry is a useful screening tool, but only provides a portion of the patient’s clinical picture. Pulse oximetry is unable to assess the position of the oxyhemoglobin dissociation curve in a given patient, and therefore can provide misleading results as to a patient’s oxygenation status.10,11 Furthermore, pulse oximetry is less accurate in patients with low perfusion, patients with motion (such as those that are dyspneic and unable to be restrained), and in patients with readings lower than 90%.10,11 If hypoxemia is suspected, an arterial blood gas (ABG) should be performed to fully evaluate a pa-tient’s oxygenation and ventilation status.10,11 The ABG provides valuable prognostic data for providers and may alter the course of therapy in a given patient, especially when data is trended.10 For example, increasing blood carbon dioxide levels may indicate ventilatory fatigue long before clinical signs of fatigue are observed, and improving oxygenation indices may indicate patient im-provement even without significant change in chest radiography or clinical signs.

Dyspnea scales exist in human medicine and are used for grading the severity of dyspnea and its effects on activities of daily living, but these scales are not easily applied to veterinary patients.1,3 By modifying a popular veterinary pain assessment scale12, a veterinary-specific dyspnea scale can be used when assessing patients for dyspnea. Higher levels of dyspnea may indicate the need for patient reevaluation and change in therapy. (Table 1)

Alleviating DyspneaAfter performing each step of the chest assessment, the clinician should assess the need for immediate intervention. Many emer-gent patients will benefit from oxygen thera-py during the initial stages of resuscitation; some will require intubation and mechanical ventilation. Oxygen therapy should be based on clinical signs and assessment of oxygen-ation via pulse oximetry and/or arterial blood gas analysis. Respiratory distress (not to be confused with anxiety or pain) and shock (as determined by perfusion parameters) are indications for oxygen therapy, and the amount of oxygen should be titrated to keep SpO2 >92% and PaO2 >60 mmHg, which usually corresponds with some relief of dyspnea.13,14 When compared to standard nasal cannula or non-rebreathing mask oxygen therapy, high-flow nasal cannula oxygen therapy was shown to be superior in relieving dyspnea in human patients likely due to meeting inspiratory demands and re-ducing anatomic dead space, and therefore high-flow oxygen therapy may be considered in veterinary patients.15 This is typically ac-complished by using a commercial heated and humidified oxygen system that provides variable oxygen flow and concentration, though these devices are not widely used in veterinary medicine. Heliox, a mixture of oxygen and helium, has a much lower density than that of oxygen and nitrogen, and therefore can be beneficial in patients with increased airway resistance. If oxygen therapy does not increase arterial oxygen content above critical levels or improve work of breathing, mechanical ventilation may be necessary. Additionally, if oxygen therapy im-proves oxygenation, but the patient develops significant hypercapnia (PaCO2 >60 mmHg with pH <7.3) then mechanical ventilation will be necessary.10

Perhaps the best method of alleviating dyspnea is to address the underlying cause. Thorough physical examination can aid the veterinary clinician in narrowing a patient’s differential diagnosis list significantly, al-lowing us to better anticipate the patient’s



needs. Patients with pleural space disease often require emergent therapy such as tho-racentesis or thoracostomy tube placement, however these therapies will be ineffective in treating a patient with diaphragmatic hernia, which requires surgical correction. Patients with obstructive disease may require intuba-tion if obstruction is severe, but mild-to-mod-erate obstruction can be successfully treat-ed with pharmacologic therapy. Parenchymal disease will frequently require treatment, but most therapies will require time to exert their effects and resolve the underlying problem. Chest wall disease frequently requires im-mediate intervention by securing any airway and initiating mechanical ventilation, though mild trauma or neuromuscular disease can be treated successfully with pharmacologic therapy. Regardless of the underlying cause, it should be determined and addressed as soon as feasible. (Table 2)

Another tool available for alleviating dyspnea is through systemic analgesia, sedation, or anxiolysis. Patients suffering from dyspnea are frequently anxious and difficult to handle or restrain. Common medications given to relieve dyspnea in these patients include morphine, butorphanol, acepromazine, and midazolam.16 Given in smaller doses, these drugs do not significantly affect ventilation, however in patients with respiratory compro-mise, a small change in ventilation may mean the difference between life and death, so caution should be observed. Opioid recep-tor agonists do not cause the significant re-spiratory depression that can be observed in human patients, however opioids do cause dose-dependent desensitization of cen-tral chemoreceptors.16 Acepromazine and midazolam do not typically affect ventilation, however higher doses of acepromazine can alter pulmonary vasomotor tone, and higher doses of midazolam can decrease respira-tory rate.16 Systemic opioid use has been shown to relieve dyspnea in human patients, though the exact mechanism of action is unknown.17,18 It is possible that since opioids reduce respiratory drive, they reduce corol-lary signals sent to the cerebral cortex, thus

reducing dyspnea, but this has not been proven.1,17 It is possible that since opioids at lower doses do not significantly reduce respiratory drive in veterinary patients that they do not have as significant of an effect on relieving dyspnea.1,17 Giving sedative medications will also decrease peak inspira-tory flow, which can be desirable in patients with upper-airway obstruction to reduce the negative upper-airway pressure generated during increased inspiratory effort, however the therapeutic margin is narrow due to the potential for relaxation of upper airway struc-tures causing worsening obstruction.8,16

Medicated aerosol delivery to the airways may also be of benefit in alleviating a patient’s dyspnea. An obvious example of this is aerosolized beta agonists, such as albuterol, which elicit bronchodilation via stimulation of beta 2 receptors.18 These medications relieve bronchospasm, and can aid in relieving dyspnea in patients suf-fering from this condition. Methylxanthine derivatives, such as aminophylline and theophylline, also relieve bronchospasm, but are not as effective and cause more side effects when compared to aerosolized beta agonists.18 A multi-dose inhaler (MDI) or a nebulizer can be used to generate the aerosol and administer the medication. If an MDI is to be used, it should always be used with a valved-holding chamber to maximize lower airway deposition of the aerosol. Anticholinergics also elicit bronchodilation via blocking acetylcholine and appear to act synergistically with beta agonists.18 Atro-pine is effective but also associated with systemic side effects.18 A better choice is ipratropium bromide which appears to be twice as effective in causing bronchodilation in dogs, with minimal side effects.18 Ipat-ropium bromide is available as both a MDI and solution for nebulization. Aerosolized opioids appear to be as effective in treating dyspnea in terminally-ill human patients with fewer side effects, though data is mixed, and veterinary data is virtually non-existent.1,3,17,19 While staff exposure during opioid nebuliza-tion is a concern, this has not been borne

out in human data, and therefore concerns over staff exposure should not preclude the careful use of aerosolized opioids in patients with dyspnea that doesn’t respond to conventional treatment.19 Aerosolized fu-rosemide has been shown to be an effective therapy in treating human patients suffering from dyspnea and reduce the cough reflex, likely via modulation of several receptors including SARs, RARs, and airway C fiber receptors, which are not stimulated by systemic use of furosemide.1,3,19,20 Nebulized furosemide has also been shown to blunt response to experimentally induced airway occlusion in cats.3 Bland aerosol therapy involves the nebulization of patients with normal saline. This therapy can be useful in treating patients with thick secretions, especially when used in conjunction with chest physiotherapy (postural drainage and coupage).14 Cool bland aerosol delivery can also help decrease swelling in patients with upper-airway edema.14

In addition to pharmacologic therapy, environmental therapy may be effective as well. Distraction has been shown to be an effective modulator of dyspnea in humans.1

Human COPD subjects reported lower levels of dyspnea during exercise when listening to music, and therefore veterinary patients may benefit from distractive auditory stimuli, though further research could help identify what this stimuli should be.21 Some studies have shown dyspnea relief in human patients subjected to acupressure and acu-puncture, but the data is limited.1 Trigeminal nerve stimulation has been shown to relieve dyspnea, and human patients reported lower levels of dyspnea when cold air was blown in their face.1 Thus use of a fan directed at dyspneic patients may serve a physiologic benefit in modulating dyspnea.

ConclusionThorough understanding of pulmonary anatomy and physiology is required when caring for critically ill patients that are suf-fering from dyspnea. By recognizing the pathophysiology occurring in these patients




we can better direct our care and improve patient outcomes. Thorough physical exami-nation is paramount, and it is important to accurately document this information in the medical record to ensure continuity of care. Various therapies are available in the treat-ment of dyspnea, however the best method of treatment is to address the underlying cause. Dyspnea research is difficult to perform in veterinary patients, however suf-ficient evidence exists to support the conclu-sion that veterinary patients suffer from a form of dyspnea, and use of a standardized dyspnea scale may aid in research of poten-tial therapies.

References

1. Parshall MB, Schwartstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calver-ley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE, et al. An official American Thoracic Society statement: Update on the mechanisms, assessment, and manage-ment of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-452.

2. Branson RD, Blakeman TC, Robinson BRH. Asynchrony and dyspnea. Respir Care. 2013;58(6):973-989.

3. Mellema MS. The neurophysiology of dyspnea. Journal of Veterinary Emergency and Critical Care. 2008;18(6):561-571.

4. Campbell VL, Perkowski SZ. (2004). Hypoventilation. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 53-60). St. Louis, MO:Saunders.

5. Des Jardins T. (2013). Cardiopulmonary Anatomy and Physiology: Essentials of Respira-tory Care. Clifton Park, NY:Delmar.

6. Hendricks JC. (2004) Respiratory muscle fatigue and failure. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 61-65). St. Louis, MO:Saunders.

7. Lee JA, Drobatz KJ. (2004). Respiratory distress and cyanosis in dogs. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 1-12). St. Louis, MO:Saunders.

8. Holt DE. (2004). Upper airway obstruction, stertor, and stridor. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 35-42). St. Louis, MO:Saunders.

9. Harpster NK. (2004). Physical examination of the respiratory tract. In King LG (ed.), Text-book of Respiratory Disease in Dogs and Cats (pp. 67-72). St. Louis, MO:Saunders.

10. Haskins SC. (2004). Interpretation of blood gas measurements. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 181-193). St. Louis, MO:Saunders.

11. Hendricks JC. (2004). Pulse oximetry. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats. St. Louis, MO:Saunders.

12. Epstein M, Rodan I, Griffenhagen G, Kadrlik J, Petty M, Robertson S, Simpson W. 2015 AAHA/AAFP pain management guide-lines for dogs and cats. Journal of the American Animal Hospital Association. 2015;51(2):67-84.

13. Boyle J. (2012). Oxygen therapy. In Burkitt 14. Creedon J and Davis H (Eds.), Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care (pp. 263-73). West Sussex, UK: Wiley-Blackwell.

15. Tseng LW, Drobatz KJ. (2004). Oxygen supplementation and humidification. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 205-213). St. Louis, MO:Saunders.

16. Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of high-flow nasal can-nula for acute dyspnea and hypoxemia in the emergency department. Respir Care. 2015.

Accessed July 1 2015: http://rc.rcjournal.com/content/early/2015/06/09/respcare.03837.full.pdf+html

17. Perkowski SZ. (2004). Anesthesia of the patient with respiratory disease. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 253-261). St. Louis, MO:Saunders.

18. Ekstrom M, Nilsson F, Abernethy AA, Currow DC. Effects of opioids on breathless-ness and exercise capacity in chronic obstruc-tive pulmonary disease: A systematic review. AnnalsATS. 2015. Accessed July 1 2015: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201501-034OC#.VZXPpflVhBc

19. Boothe DM. (2004). Drugs affecting the respiratory system. In King LG (ed.), Textbook of Respiratory Disease in Dogs and Cats (pp. 229-252). St. Louis, MO:Saunders.

20. Kallet RH. The role of inhaled opioids and furosemide for the treatment of dyspnea. Respir Care. 2007;52(7):900-910.

21.Nishino T, Ide T, Sudo T, Sato J. Inhaled furosemide greatly alleviates the sensation of experimentally induced dyspnea. Am J Respir Crit Care Med. 2000;161:1963-1967.

22. Shingai K, Kanezaki M, Senjyu H. Distrac-tive auditory stimuli alleviate the perception of dyspnea induced by low-intensity exercise in elderly subjects with COPD. Respir Care. 2015;60(5):689-694.

About the Author:

Noah Jones, RVT, RCp, RRT Mr. Jones studied biology at Humboldt State University and became a California Registered Veterinary Technician via the alternate route. Before moving to North Carolina and joining the Regional Emergency Animal Care Hospital of Asheville, he worked at a number of specialty referral hospitals in Northern and Central California. He is a member of numerous professional organizations including the Veterinary Emergency and Critical Care Society, the American Association of Criti-cal Care Nurses, the American Thoracic Society, and the American Association of Respiratory Care. Noah is also a Board Moderator for the Veterinary Support Personnel Network, a Continuing Education Instructor for the Veterinary Informa-tion Network, and an international lecturer. After obtaining his degree in Respiratory Therapy from Southwestern Community College, becoming a Registered Respirato-ry Therapist, and obtaining his license to practice as a Respiratory Care Practitioner in May 2015, Noah is pursuing a baccalaureate degree in Respiratory Therapy from University of North Carolina, Charlotte. Noah is also pursuing a Veterinary Techni-cian Specialty (VTS) certification in Emergency and Critical Care. His veterinary interests include ventilator patient management, critical patient anesthesia, and advanced cardiac life support. When Noah can find time away from his work, he enjoys spending time with his family in the outdoors.



1. Dyspnea isa. Another term for respiratory effort.b. The sensation of uncomfortable breathing.c. Easily recognized in veterinary patients.d. Associated with good outcomes in humans.

2. Normal respiratory drive is mainly influenced by:a. Central and peripheral chemoreceptors.b. Conscious control of breathing.c. Airway receptors.d. SpO2.

3. Air hunger causes a sensation of:a. Wanting to eat more food due

to hypoxemia.b. Dietary indiscretion associated

with hypoxia.c. Not getting enough air due to

decreased pulmonary stretch.d. Chest tightness due to decreased

pulmonary stretch.

4. Dyspnea is thought to occur in animals based on:a. Presence of hypoxemia.b. Presence of increased respiratory effort.c. Presence of hyperglycemia.d. Presence of aversive behaviors.

5. Cyanosis is:a. An early indicator of hypoxia.b. Present if the SpO2 really is 90%.c. Required if the patient is truly hypoxemic.d. Only present if deoxyhemoglobin is at

least 5 g/dL.

6. pulse oximetry is a reliable indicator of oxygenation status:a. In all patients.b. In normal, well perfused patients,

without motion artifact.c. If you have an expensive model.d. If you put the sensor on the tongue.

7. Arterial blood gas should be performed:a. If hypoxemia or hypercapnia is suspected.b. Only during CPR.c. Only if the patient is on a mechanical

ventilator.d. Only in the academic setting.

8 Dyspnea scales can:a. Increase awareness about dyspnea.b. Assist providers in caring for dyspneic

patients.c. Potentially improve patient outcomes.d. All of the above.

9. Oxygen administration should:a. Only be supplied after confirming

hypoxemia with arterial blood gas.b. Be supplied to a patient with dyspnea.c. Be tailored based on individual response

to therapy.d. Both B and C.

10. Adjunct therapies for dyspnea relief include:a. Opioid administration.b. Aerosolized furosemide.c. Using a fan to blow cool air on the face.d. All of the above.




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ST NAVTA Journal Ad 2015 07 13.indd 1 7/13/15 1:57 PM

NAVTA Nominations 2015 Call For

•Vet Tech of the Year

•SCNAVTA Chapter of the Year

•SCNAVTA Advisor of the Year

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Make Your Voice Heard! Nominations Due October 1, 2015 Download a nomination form at www.navta.net and let us know who you think should be recognized!


Case studY

signalment/history Georgia is a 9 ½ year old, spayed golden retriever that presented for weight loss, lack of appetite, and halitosis on March 16, 2015. Georgia is updated on her rabies vaccine. Both the bordetella and 5-1 vaccines are overdue by eight months. Over the past two weeks the owner noticed a decrease in ap-petite and activity. Georgia seemed to sleep more often and panted frequently. In addition, the owner mentioned Georgia was drinking and urinating more frequently. Georgia was also eating grass.

Initial physical Exam March 16, 2015 Georgia presented as quiet and responsive. Her temperature was 101.6. She weighed in at 30 kg, with a body condi-tion score of 2/5 (underweight). Her heart rate was 124 beats per minute with strong pulses

and she was panting. No murmurs were detected and her lungs auscultated clear. She had pink mucous membranes and her capillary refill time was less than 2 seconds. She exhibited discomfort on abdominal palpa-tion. Her sclera in both eyes was red and a two small meibomian cysts were on the upper right lateral eyelid. She had heavy dental calculus on her teeth. Hydration was normal with no delayed elasticity. Atrophy in hind limbs was evident. Prescapular, popliteal, and mandibular lymph nodes were palpable and enlarged. A large 1.5cm mass was palpated on her right lateral chest.

Diagnostics And Results Recommendations included a wellness blood profile, ova parasite/Giardia fecal test, and urinalysis. In addition, thoracic and abdominal radiographs were ordered.

A fasted blood profile revealed a normal complete blood count. Blood chemistries revealed an alk phosphatase of 197 IU/L (normal ranging 5-131). Hemolysis of 2+ was noted, but had no significance to results. Urine was collected via cystocentesis using a 22G needle. Appearance was cloudy, trace protein, 1+ bilirubin, 0-1 red blood cells/high power field, 2-3 amorphous crystals/high power field, and 4-10 fat droplets/high power field. Ova parasite and Giardia fecal tests were negative.

Right lateral and ventrodorsal radiographs of Georgia’s abdomen were performed, which revealed an enlarged liver and spleen, spondylosis in the sacral vertebra, and empty stomach. No bowel in the intestines. There was a small bladder with no evidence of stones. Kidneys appeared normal size.

Case Study: True Friend By Patricia Hilliard, BS, RVTg


Case studY

dose of Elspar. Georgia had a slight decrease in appetite and activity for three days and slowly returned by the fifth day. She was started on oral Cyclophosphamide 53mg at a dose of 1 capsule every other day beginning May 6, 2015.

The owner’s main goal was to ensure Georgia quality of life. The prednisone dose was increased to 20mg once a day and she was allowed to eat “people” food and sleep on their bed. It was a special day with the family, playing with the children, and many hugs and kisses. The next morning she appeared very depressed and was breathing loudly. Upon presentation her submandibular nodes were extremely enlarged and palpated 3.5 inches. The owner’s were thankful for the time they were able to spend with her and decided it was time to let her be at peace.

blood. Hepatocytes display mild to moderate frothy cytoplasmic vacuolization.

Pathologist’s interpretation is lymphoma, high grade (both organs); mild to moderate vacu-olar hepatopathy.

Diagnosis Diagnosis is high grade lymphoma.

Conservative Treatment The owner started high dose oral prednisone 20mg at a tapering dose of 1 tablet twice a day for 7 days, 1 tablet once a day for 7 days, and then 1 tablet every other day. Immediately the owner noticed an improvement. Pant-ing decreased, appetite increased, activity increased, and redness in the eyes resolved. Although prognosis was poor, Georgia’s no-ticeable response to the oral prednisone gave the owner hope to pursue chemotherapy with Elspar (Asparaginase). The possibility of al-lergic reaction with symptoms including hives, difficulty breathing, and swelling of the face, lips, tongue, or throat were discussed.

March 30, 2015 Georgia was premedicated with 50mg oral Diphenhydramine (Benadryl). An entire vial of Elspar (asparaginase) con-taining 5000 international units (IU)/ml was administered intramuscularly (IM). For the next two days, Georgia was more active.

April 6, 2015 Georgia was receiving oral Prednisone 20mg 1 tablet once a day. She is responding well according to the owner. Activity is up, eating 6 cups of dry food and 6oz of canned food once a day divided.

April 13, 2015 Georgia’s was weighed at home by the owner with a gain of three pounds. She is now 34kg. She also received her second treatment of Elspar (Asparagi-nase) 5000 international units (IU)/ml post administration of 50mg Diphenhydramine (Benadryl) orally. Prednisone 20mg is now administered 1 tablet every other day. Hepato support one capsule twice a day with food was added to support liver function. A phone update from the owner was similar to the first

Right lateral and ventrodorsal radiographs of Georgia’s thorax were performed, which re-vealed possible pleural effusion in the caudal chest cavity. No abnormalities present in the lungs.

As a result of the radiographs and Georgia’s physical exam an ultrasound was scheduled for cardiac and abdominal scans. March 23, 2015 the cardiac ultrasound performed by the veterinarian resulted in no detections of mass-es or effusion, with good contractility. Marked changes in the liver and severe changes were detected in the spleen. Adrenal glands were normal size and shape. The iliac node was moderately large (slightly hyperechoic) and many small lymph nodes are visible. Findings from the ultrasound led to the recommenda-tion of a fine needle biopsy of both the liver and spleen. Georgia was pre-medicated with 50mg of Diphenhydramine intramuscular (IM) prior to the procedure. No sedation was indi-cated. Four unstained slides of the spleen and five unstained slides of the liver were obtained and sent for evaluation. A post procedural scan of the abdomen was negative for the presence of blood. Georgia had an uneventful recovery from the procedure.

microscopic Description/ Cytological Results March 27, 2015, the pathologist’s review of spleen slide samples revealed very many large to very large lymphocytes, characterized by round nuclei, fine granular or lacy chromatin, multiple distinct nuclei, and small amount of fluid stained cytoplasm. There are numerous mitotic figures and frequent apoptotic cells. There are also few macrophages and neutro-phils, few small lymphocytes, and abundant globular cytoplasmic debris. Macrophages contain variable amounts of apoptotic nuclear debris.

Liver slide samples contain many large to very large lymphocytes similar to those de-tected in the spleen samples. There are also many small to large fragments of hepatic tis-sue, few to moderate numbers of neutrophils, few macrophages, and abundant peripheral


WVC/NAVTA ScholarshipThe Western Veterinary Conference and the National Association of Veterinary Techni-cians in America are pleased to announce a scholarship opportunity for veterinary technician students. This scholarship will be awarded to two individuals who have demonstrated leadership skills within their SCNAVTAs (Student Chapter of the National Association of Veterinary Technicians of America), as well as a high academic level throughout enrollment of their current veteri-nary technology program.

The Western Veterinary Conference is a very well attended conference with many tracks of continuing education for the entire veterinary team. The conference runs march 6th – 10th, 2016 at the mandalay Bay Resort & Casino in Las Vegas, Nevada.

The scholarships will consist of:

• $1000 Scholarship

• Registration for the Western Veterinary Conference

• Airfare

• Hotel for 3-4 nights

• $25 per diem for 4-5 days

It will also be required that the recipient of the scholarship arrive in time to attend a Sunday evening reception and attend two breakfast meetings on Monday and Tuesday morning. The recipient will be able to depart on either Wednesday or Thursday of that week.

Eligibility Requirements:

• Candidates must be a full-time student of an American Veterinary Medical As-sociation (AVMA) accredited Veterinary Technology Program and be a student member of NAVTA.

Candidates must submit the following:

• Application signed and dated

• Typed essay about their academic level and leadership skills and accomplishments

• Current school transcript

All completed applications and

Western Veterinary Conference/ National Association of Veterinary Technicians in America scholarship Application Please print or type

1. Name: __________________________________________________________________ (Last, First, Middle)

2. Current Address: _________________________________________________________

3. Telephone: _______________________ E-mail: ________________________________

4. Permanent Address: _______________________________________________________

5. Social Security Number: ___________________________________________________

6. Date of Birth: _____________________________________________________________

7. Veterinary Technology Program Currently Attending: ____________________________

8. Dates of Attendance: ______________________________________________________

9. Anticipated Graduation Date: _______________________________________________

11. Cumulative GPA: ________________________________________________________ *Please enclose current transcript*

12. Verification (To be signed by faculty advisor to student) In signing this form, I verify that the above applicant is a full-time student in good academic standing at this institution.

Signature: ________________________________ Phone# _________________________

13. List specific academic achievements: _______________________________________

___________________________________________________________________________

14. On a separate sheet, write at least a one page essay to include your experiences/interests in Veterinary Technology.

I certify that I have truthfully and accurately answered the above questions to the best of my knowledge and belief, and that I understand any false or concealed information will be grounds for rejection of my application or subsequent termination of my scholarship.

Furthermore, I hereby authorize the scholarship committee of NAVTA and WVC to commu-nicate with the financial aid officer at the program as necessary in regard to my application. If additional information or documentation is required of me, I shall be pleased to furnish it. If selected as a scholarship recipient, I grant the NAVTA and WVC permission to use my name and /or photograph in press releases and/or other publicity.

Signature __________________________________________ Date ________________

submissions must be received at the NAVTA office no later than October 2nd, 2015

P.O. Box 1227 | Albert Lea, MN 56007

WvCa/navta sChoLarships

46


nationaL vet teCh WeeK

Calling all veterinary technicians! This is your week! This is a week to celebrate you, your career, your passion! You give 150% everyday, and we know it! NAVTA wants to help you celebrate, and bring recognition of the hard work you do to your employer, your clients, and your community!

This year, the National Veterinary Technician Week poster was created with you, our members. We asked you to submit pictures of Veterinary Technicians in action. Look carefully! If you submitted a picture, you could be on the poster! In ad-dition, NAVTA thanks Hills for their contin-ued support of this special poster.

22 years ago, the United States Con-gress voted to declare the third week of October as National Veterinary Technician Week. With this act, Veterinary Technicians are celebrated for the tireless work they perform as advocates and caretakers for animals. We perform many duties through-out the hospital – nursing, patient assess-ment, surgical assisting, radiology, dentals, client communication, education, laboratory analysis, just to name a few.

How can you make this week your week? Visit our webpage, www.NAVTA.net to

download your National Veterinary Techni-cian Kit, which includes a printable poster and press release. Place the printable poster in your break room for all employees (including your leadership) to see at the end of September. Lead a team discussion about National Veterinary Technician Week, and what it means to you to be a Veterinary Technician. Ask other technicians what it means to them. What is your purpose behind this discussion? To inform non-technician staff members why you love this job and give your sole to your patients, day in and day out.

Place the poster included with your NAVTA Journal in the lobby for all of your clients to see. Along side of this poster, place pictures of your entire Veterinary Technician team. Your clients will notice and ask staff member’s questions. Your prior discussion with fellow team members will give anyone the ability to answer these questions with pride!

Customize the press release for your hospital and submit to local media outlets: news stations, newspapers, and community newsletters. Inform the community about this awesome event!

Consider hosting an open house at the practice during the week. Invite clients and patients to come and enjoy some appetiz-ers (both human and pet) with the Techni-cian team. Be sure to include this invitation in the press release above. In addition, invite your clients through Facebook, Twit-ter, and other social media platforms. Send an e-blast to all of your clients, and place invitations at the receptionist desk two weeks prior to the event.

If you have a local farmers market or other community events that are occurring within your community that week, have a booth and invite veterinary technicians from all area practices to come and represent. Teach the community what this wonderful profession is all about!

Be sure to take pictures of your events and submit to the NAVTA Journal! you may see it in print!

Have a wonderful week! Thank you for all you do, and all you give, EVERYDAY.

–The NAVTA Team

National Veterinary Technician WeekOctober 11-17, 2015


avma Convention

The annual AVMA (American Veterinary Medical Association) convention was held July 10-14 in Boston. NAVTA had a strong presence at the conference, and represented in a variety of ways!

The conference started out on Friday with the State Representative and VTS Leadership Workshop. NAVTA had 30 people in atten-dance with 16 states and 5 veterinary techni-cian specialties represented. With our partner-ship with NAVC, we were able to include four of NAVC’s leaders to help facilitate this event. Those that attended walked away with goals set for the individuals of state associations and veterinary technician specialties.

Virginia Rudd, CVT, represented the NAVTA booth in the exhibit hall and spoke with many Veterinary Technicians, Assistants and students. Thanks to all of those who stopped by! Virginia answered many questions, and handed out books and journals.

Julie Legred, CVT, NAVTAs executive director, attended many meetings on behalf of NAVTA with industry leaders, allied associations, and continued partners. She also had a chance to meet many of you and answer your questions.

AVMA Recap

She listened to your ideas for NAVTA and your profession.

Julie had an opportunity to create more videos about the veterinary technician profes-sion with Steve Dale, radio personality and avid veterinary technician advocate. In addi-tion, she participated in the State Represen-tative and VTS Leadership Workshop. Let’s just say, we kept her busy in meetings with not much time to eat too much lobster!

NAVTA, in conjunction with Partners for Healthy Pets released a new workbook, titled Preventive Pet Healthcare: Your Guide To Becoming a Practice Champion Advocat-ing for Pets. All attendees to the session received their own copy of the workbook. Heather Prendergast, RVT, CVPM, NAVTA Journal editor, presented the workbook to attendees and walked them through the process of starting their own preventive healthcare program in their hospitals. The workbook was well received, and very appre-ciated not only by veterinary technicians, but veterinarians and industry partners as well! Julie Legred presented the workbook to the Directors of Partners for Healthy Pets.

Many of NAVTAs Executive Team were also in attendance, and spoke to attendees on a variety of topics.

mary Berg- Dentistry and Personal/Profes-sional Development

Kara Burns- Nutrition and Heartworm Prevention

Vicky Ograin- Nutrition

heather prendergast – Practice Management, Partners for Healthy Pets, and Nutrition

Rebecca Rose- Personal/Professional Development and Practice Management

margi sirois- Technician Boot Camp

Ken yagi- Open Hospital Policy

President Elect Rebecca Rose hosted a career panel that consisted of numerous Vet-erinary Technicians with impressive careers. Mary Berg, RVT, VTS (Dentistry); Megan Brashear, CVT; Michelle Krasicki-Aune, CVT; Aggie Kieffer, LVT; David Liss, RVT, VTS (ECC, SAIM), CVPM; and Heather Prend-ergast, RVT, CVPM participated in the panel that allowed attendees to ask questions about career paths.

The Purina ProPlan Performance Dogs provided 3 entertaining shows for attendees.

Veterinary Technician Students from Globe University (Woodbury Campus, Minnesota) visit the NAVTA booth.

49

CASE REPORT SuBMiSSiONS ARE NOW BEiNg ACCEPTED. please email your submission to: [email protected], include your name, address, phone number and email address.

spAce is limiTed submiT your cAse TodAy!

At the 2016 NAVC ConferenceTechnician case report presentations

Submit Your Case

Report Today!

Had an interesting case recently that you’d like to share? Wondering if you would enjoy public speaking? Or want to begin lecturing? Submit a case report for consideration using the guidelines listed below. If your case is selected you will present your case to an audience of your fellow techni-cians and a panel of judges. The judges will offer invaluable oral critiques of all presentations!

There’s no better way to improve your lecturing skills! Technicians selected to present case reports will receive a complementary conference registration.

Case Report Presentations guidelines• Credentialed veterinary technicians,

with limited lecturing experience, are eligible.

• Cases from any veterinary discipline may be submitted for consideration.

• Authors of all case report must have had a significant role in the case.

• All cases must first be assessed by a licensed DVM or VTS to determine the initial quality of the case report being submitted.

Case report submissions should be 1 to 2 pages in length and be constructed as follows:

1. Title2. Introduction 3. Signalment4. Presenting complaint5. Initial assessment6. Physical findings7. Treatment plan including your

role in patient care8. Key nursing care points9. Final Outcome10. Conclusion

Authors of selected cases will present their case report at the January 2016 NAVC Conference.

Presentations should follow a format similar to the written case report submitted.

15 minutes will be allowed for each presen-tation with an additional 5 minutes allotted for questions from the audience and judges. followed by a constructive oral critique from each of the judges. What an awesome learn-ing opportunity!

An award will be given for the overall best presentation.

Criteria for evaluation of the case reports presented will include:

• Presentation quality• Case quality• Ability to present the case within the

allowed timeframe• Ability to answer questions

submissioN deAdliNe OCTOBER 1, 2015

Publication of the National Association of Veterinary Technicians in America


Banfield ..............................................................2

Blue Pearl .....................................................43

Boehringer Ingelheim ...........................14

IDEXX..............................................................20

Merial ................................Back Cover

NAVC ...............................................................22

NAVTA Call Nominations .........21, 43

NAVTA Membership ...............................51

Vet Folio .........................................................34

Virbac .................................................................5

Zoetis .............................................................12

Advertising SalesIf you are interested in advertising in The NAVTA Journal or would like to request an Advertising Sales Kit, please contact:

Julie Legred, CVTExecutive Director

[email protected]

Mailing AddressP.O. Box 1227

Albert Lea, MN 56007

phone: 888.99.NAVTA

fax: 507.489.4518

50

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2015 Calendar of Events

See Your Article in Print!Do you have experience in a particular disease or procedure? Have you participated in an interesting

case that could be a learning experience for others? Do you have special expertise that you’d like to

share with your fellow NAVTA members? No matter the subject, we would love to include your articles

and photos in The NAVTA Journal. Each bimonthly journal contains general editorial articles and three

Continuing Education articles that can be used to earn CE credits.

Visit: www.navta.net for full editorial guidelines.

General Editorial Deadlines

ISSUE DATE DEADLINE

Oct./Nov. 2015 Aug. 15, 2015

Dec./Jan. 2016 Oct. 15, 2015

Feb./March 2016 Dec. 15, 2015

Apr./May 2016 Feb. 15, 2016

Continuing Education articles are due 6-8 weeks in advance.

NAVTAJOURNALTHE


Apr/May 2015

in this edition…The Assistants’ Role

in Transfusion Medicine

Improving Adoption

Rates of Shelter Cats

Toxic Pesticides and Plants

Fluid Therapy

NAVTAJOURNAL

THE


June/July 2015

in this edition…Oral HealthcareSnakes & Spiders &ToadsCanine Glaucoma

Color Coding 0n Dog Chewables Ivermectin Pyrantel Foil Backing Weight Per Month Content Content and Carton

Up to 25 lb 1 68 mcg 57 mg Blue 26 to 50 lb 1 136 mcg 114 mg Green 51 to 100 lb 1 272 mcg 227 mg Brown

chewables

®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. ©2015 Merial, Inc., Duluth, GA. All rights reserved. HGD14TR2015TRADEAD-5 (01/15).

CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian.

INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense).

DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows:

HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables.

ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food.The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole.

Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended.

HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last exposure to mosquitoes.

When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication.

If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms.

Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites.

EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense).

ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs.

PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus.

While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae.

Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans.

Store between 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light.

ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation.

SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended.

HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program.

In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time.

HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables.

For customer service, please contact Merial at 1-888-637-4251.

Have you renewed your

NAVTA membership?

No? Here’s what you’ll miss:

• Annual CE credits —NAVTA publishes seven issues per year with a total of 19 RACE approved CE credits.

• Member updates from the state, SCNAVTA and specialty organizations across the country. Don’t miss out on what your colleagues are doing.

• Monthly newsletters — NAVTA sends an e-newsletter every month with the latest and greatest information for you.

NAVTAJOURNALTHE

A Publication of theNational Association of Veterinary Technicians in America

Apr/May 2014

American heartworm

society guidelines

news from the trenches –

sea turtles

cranial cruciate Ligament rupture

canine sports medicine and

injuries – part two

in this edition…

APRIL IS HEARTWORM AWARENESS MONTH

NAVTAJOURNALTHE


June/July 2014

Become more effi cient in Your practice!

implement and Utilize Veterinary Assistants!

providing Comfort to recumbent

and neurological patients with rehabilitation

nasoesophageal and nasogastric intubation

Understanding the septic patient

in this edition…

NAVTAJOURNAL

THE


Aug/Sept 2014

NEW! Veterinary Assistant CE: Hamster Educationpain management in physical rehabilitationpulmonary Atelectasisibuprofen toxicosis in ferrets

in this edition…

for supporting your NAVTA!

www.navta.netapply online now!

If you have renewed your membership, thank you! It’s members such as yourself that make NAVTA possible.

THANk you

IMPORTANT RISK INFORMATION: HEARTGARD® Plus (ivermectin/pyrantel) is well tolerated. All dogs should be tested for heartworm infection before starting a preventive program. Following the use of HEARTGARD Plus, digestive and neurological side effects have rarely been reported. For more information, please visit www.HEARTGARD.com.

No to Heartworms.

No to rouNdworms.

No to Hookworms.

saY

Say yES to Only HEARTGARD® Plus (ivermectin/pyrantel) prevents

heartworm disease and treats and controls pre-existing

hookworms and roundworms with a Real-Beef Chewable

dogs love to take.1-5

Heartworms Hookworms/rouNdworms

PuPPIes@ 6 weeks

PreFerred1-6 satIsFaCtIoNGuaraNteed7

®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. All other marks are the property of their respective owners. ©2015 Merial, Inc. Duluth, GA. All rights reserved. HGD14TR2015TRADEAD-5 (01/15).

1 Of dogs showing a preference in two studies, all dogs preferred HEARTGARD Plus Chewables to TRIFEXIS® (spinosad + milbemycin oxime) beef-flavored chewable tablets; Executive Summary VS-USA-37807 and VS-USA-37808.2 Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to SENTINEL® (milbemycin oxime-lufenuron) chewable tablets; Executive Summary VS-USA-37809 and VS-USA-37810.3 Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to IVERHART PLUS® (ivermectin/pyrantel) beef-flavored tablets; Executive Summary VS-USA-37811 and VS-USA-37812.4 Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to IVERHART MAX® (ivermectin/pyrantel/praziquantel) beef-flavored tablets; Executive Summary VS-USA-37813 and VS-USA-37814.5 Of dogs showing a preference in one study conducted, all dogs preferred HEARTGARD Plus Chewables to SENTINEL® SPECTRUM (milbemycin oxime/ praziquantel/lufenuron) beef-flavored tablet; Executive Summary VS-USA-37801.6 Opinion Research Corporation, Heartworm Prevention Medication Study, 2012. Data on file at Merial.7 Data on file at Merial.

xhg237479_NAVTA-8.5x11_rsg.indd 1 2/10/15 2:30 PM

Documents

Aug/Sept 2015 NAVTA JOURNAL · July 10-14 in Boston. NAVTA had a strong presence at the conference. Be sure to read the recap that is included in this edi-tion of The NAVTA Journal