Minimum Pre-anaesthetic Profile

Re: Minimum Pre-anaesthetic Profile

Michael Woodhouse — Wed, 11 Sep 2013 09:27:23 GMT

[quote user="Mark Holmes"]Michael I will look up those strips for you.[/quote]

Found them on Henry Schein under BUN. I rang them a couple of months ago for some Azo-sticks and they told me unavailable and no alternative!

Thanks

Re: Minimum Pre-anaesthetic Profile

Glenn Hodgson — Wed, 11 Sep 2013 07:34:05 GMT

that is the ketone thingy we have also.

we get cartriges from qcr, quality clinical reagents.. lots of options

Re: Minimum Pre-anaesthetic Profile

Mark Holmes — Wed, 11 Sep 2013 06:59:22 GMT

Michael I will look up those strips for you. Provided you know what to expect from them they're fine. They are reliable at demonstrating BUN is normal. It's a bit patronising to point out there are many forms of azotaemia but external bloods are available to give further clarity. The quantity of blood they require us tiny which is useful. If you want to use them for monitoring NSAID use they are handy. Some tests are "good enough" to be excellent in the right circumstances - providing you accept the limitations and are prepared to test further when necessary. Yes urine SG will tell you almost as much, but is often less convenient.

Re: Minimum Pre-anaesthetic Profile

David Mills — Tue, 10 Sep 2013 23:47:52 GMT

[quote user="Michael Woodhouse"]Mark - what are the BUN strips? [/quote]

They are strips, look a bit like STT strips but yellow, and change colour in response to BUN which you then read off a scale (remembering to translate first), beloved of the PDSA and VetsNow amongst others. Whilst they appear cheap and cheerful they are next to useless for when BUN is raised, which is, afterall, when you want to document it as they lack significant accuracy above around 10. Further, BUN is non specific for kidney issues. Far more information from a cysto regarding kidney function I would say.

I-stats are great. VetTests are good if you do a lot of in-house bloods and hardly send any away (as we do), but if its used seldomly there are some quite severe quality control issues.

Re minimum database, the question is what are you going to change on the basis of the bloods? As others have said, it is sage to stick everything over 10 (cats) or over 7 (dogs) - or whatever cut off you want (maybe best practice to drip everything?) - on a drip, but in the vast majority of cases changes in the bloods aren't going to change your GA decision once you've decided that, clinically, it needs one, surely?Interestingly, there is no evidence to support pre-dripping geriatric patients for a few hours pre-GA in terms of GA complications or deaths, unless they are in shock or acutely dehydrated (in chronic dehydration, such as CKD cats, there is no effect to reducing azotaemia pre-op unless its acute on chronic) but strong basis for ivft in all geriatric patients. Also, the evidence currently is that pre-GA bloods have no effects on outcome....

Re: Minimum Pre-anaesthetic Profile

Michael Woodhouse — Tue, 10 Sep 2013 23:23:33 GMT

We use these for ketones

http://www.ebay.co.uk/itm/FreeStyle-Optium-ketone-Blood-Glucose-Monitor-Meter-BRAND-NEW-AND-SEALED-UK-/121156267812?pt=UK_Health_Beauty_Mobility_Disability_Medical_ET&hash=item1c3579ef24

Cheap and great for cattle work.

Where do you get the cartridges? Woodley?

Re: Minimum Pre-anaesthetic Profile

Rob Loxley — Tue, 10 Sep 2013 23:22:35 GMT

[quote user="Michael Woodhouse"]what would be your minimum pre-anaesthetic database in an animal where you believed it was clinically indicated?[/quote]

Run it up and down the car park a couple of times and check it doesn't keel over?

Re: Minimum Pre-anaesthetic Profile

Glenn Hodgson — Tue, 10 Sep 2013 22:58:39 GMT

we have i-stat and a same day courier for external lab. delighted with i-stat. easy to use and quick. also got a second hand blood ketone meter, occ usefull.

Re: Minimum Pre-anaesthetic Profile

Michael Woodhouse — Tue, 10 Sep 2013 22:32:44 GMT

Thanks guys. You have pretty much confirmed what I was thinking.

Mark - what are the BUN strips? I looked very hard for Azo-strips but was told they were unavailable and no-one offered me an alternative.

I *may* have just taken a gamble and bought a 2nd hand I-Stat. Think I will have enough use for it to justify the cost. There was no way I could make it pay spending £1000's on one. Think it will be useful for sick cows checking calcium and acid/base status.

Re: Minimum Pre-anaesthetic Profile

Martin Atkinson — Tue, 10 Sep 2013 11:14:26 GMT

[quote user="Laurence Webb"]

We have a VetTest and do run their pre-anaesthetic panels on it.

Last week I ran one on a elderly cat that was in for an elective procedure - all was well on the bloods but 2 days later it presented in renal failure. I don't doubt the results I got (well, as much as one trusts a VetTest anyway) but it has made me question whether a urine SG would be a more sensitive and cheaper test in those animals that look as though they would benefit. Along with a PVC and TP via a refractometer I think that would cover most areas. For animals that look ill then more extensive testing can be done with an external lab.

[/quote] We have a VetScan and would do their prep profile on a older cat with no clinical indications of disease this is: TP, BUN, Crea, ALP. ALT, & Glu plus a PCV, anything that was geriatric and/or showing relevant clinical symptoms would get their comprehensive profile: the above plus Alb, Glob, Amyl, Tbil, Ca, Phos, Na & K. plus a CBC and urine dipstick & SG.

Re; that cat that got renal failure I'd also give a frail elderly cat fluids regardless of renal function on test even if it was only 60ml saline subcut., wrap them up and keep them warm and reverse their pre-anaesthetic sedation if they weren't up and about 5 mins after coming off GA.

Re: Minimum Pre-anaesthetic Profile

Laurence Webb — Tue, 10 Sep 2013 09:03:11 GMT

We have a VetTest and do run their pre-anaesthetic panels on it.

Re: Minimum Pre-anaesthetic Profile

Mark Holmes — Tue, 10 Sep 2013 06:41:51 GMT

I work for charity and we have no access to routine pre ga bloods. To be honest I haven't really missed them. We have BUN strips which are amazing. PCV and Tp can be done with refractometer and centrifuge. Urine Sg similarly. We have a glucometer. In 12 months I cannot think of an animal which would have had a better outcome had things been different. Electrolytes would be handy occasionally, but so occasionally that for those animals who really NEEDED it to support all the costs it would be pretty costly.