Page 399 - WSAVA2018
P. 399

or there is clinical regression, however, the benefit of prolonged CRIs is unknown. In hospitals that regularly use regional anaesthesia (especially bupivacaine) then IVLE should be added to the arsenal of emergency drugs available, in case of overdose or adverse reaction.
B. Niemiec1
1Veterinary Dental Specialties and Oral Surgery, Dentistry, San Diego, USA
San Diego, CA USA
The history will generally include anorexia, drooling, gagging, and pain during mastication. Physical exam will typically include a thin pet with unkempt fur. The oral exam will reveal severe stomatitis usually over all teeth. The inflammation will most commonly be worse on cheek teeth than canines and incisors. However, faucitis is the key clinical finding. Severe hyperplastic inflammation to the gingiva can result from periodontal disease, however faucitis will not be present.
A pre-operative blood panel will generally show a marked elevation in globulins (Polyclonal gammopathy) and total protein.
Medical Therapy: Most medical therapies will work for a while, however in general resistance will start within a year or less. In addition, most therapies have side effects worse than the disease process in and of itself. In general, medical therapy is very frustrating to the practitioner and client.
Corticosteroids are the mainstay of most medical therapy today. It is generally very effective at first and is relatively inexpensive for the client. In my experience, injectable (depomedrol 10 mg IM) is much more effective than
oral preparations in my experience. However, they will typically loose effectiveness after a year or so requiring higher and higher doses at shorter increments. This generally results in significant deleterious effects. About 10% of stomatitis cases we treat are already diabetic!!!
Antibiotics are safer than steroids but much less effective, especially in long term therapy. They are generally disappointing in their success. Metronidazole and clindamycin are the mainstays of therapy; however Clavamox and amoxicillin can be used as well. Metronidazole may be the antibiotic of choice due to its anti-inflammatory effect.
Other immune suppressive such as Imuran, Cytoxan, Gold Salts, Cyclosporine have been used. However, they are all very expensive with numerous adverse side effects (mylosuppression). Cyclosporine is currently the most commonly prescribed immune modulatory drug (other than steroids) for this disease process. However, its chronic use is somewhat expensive and has been implicated in severe fungal and protozoal infections.
Your Singapore, the Tropical Garden City
  1. Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia- Amaro MF, Cwik MJ. Pretreatment or resuscitation with
a lipid infusion shifts the dose-response to bupivacaine- induced asystole in rats. Anesthesiology 1998;88(4):1071- 5.
2. Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine- induced cardiac toxicity. Regional Anesthesia and Pain Medicine 2003;28(3):198-202.
3. Rothschild L, Bern S, Oswald S, Weinberg G. Intravenous lipid emulsion in clinical toxicology. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010;18:51.
4. French D, Smollin C, Ruan W, Wong A, Drasner K, Wu AH. Partition constant and volume of distribution as predictors of clinical efficacy of lipid rescue for toxicological emergencies. Clinical Toxicology 2011;49(9):801-9.
5. Peacock RE, Hosgood G, Swindells KL, Smart L. A randomized, controlled clinical trial of intravenous lipid emulsion as an adjunctive treatment for permethrin toxicosis in cats. Journal of Veterinary Emergency and Critical Care 2015;25(5):597-605.
6. Robben JH, Dijkman MA. Lipid therapy for intoxications. The Veterinary Clinics of North America Small Animal Practice 2017;47(2):435-50.
7. Yuh EL, Keir I. Hypertriglyceridemia and transient corneal lipidosis in a cat following intravenous lipid therapy for permethrin toxicosis. The Canadian Veterinary Journal 2018;59(2):155-8.
8. Seitz MA, Burkitt-Creedon JM. Persistent gross lipemia and suspected corneal lipidosis following intravenous lipid therapy in a cat with permethrin toxicosis. Journal of Veterinary Emergency and Critical Care 2016;26(6):804- 8.
9. Hayes BD, Gosselin S, Calello DP, Nacca N, Rollins CJ, Abourbih D, Morris M, Nesbitt-Miller A, Morais JA, Lavergne V. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clinical Toxicology 2016;54(5):365-404.

   397   398   399   400   401