March 2026
Veterinary Controversies and Ethical Dilemmas - Provocative Reflections on Clinical Practice. Edited By Tanya Stephens, R. Eddie Clutton, Polly Taylor, Kathy Murphy (2026)
Recommended by: Joanna Potter
Joei graduated from Murdoch University in 2005 and worked in both large and small animal practice in rural and metropolitan Australia before moving to England to pursue specialist training at the University of Bristol. Joei became a Diplomate of the ECVAA in 2016 and moved to Ireland in 2018, where she worked at University College Dublin until December, 2025. From 2026 Joei will be taking a career break to (hopefully) complete a PhD that will include topics on large animal welfare in research environments. Other research interests include optimising the transition from an online learning platform to the development of a practical skillset and determining whether or not CBD could have a more evidence-based role in veterinary medicine. In her free time, Joei is a taxi driver for three wonderful children and is the Chief Operations Officer of the Walsh Family facilitating her much loved husband’s work and tennis addiction. Joei also enjoys occasional singing gigs in Dublin and recently joined the Dublin Consort of Voices performing beautiful choral music.
Commentary
This is no ordinary book. It has stimulated thought and challenged beliefs and as such perhaps what follows is more a response than a review. This book has been a much-anticipated occupant of my work-related book collection. However, it was surprising just how much of the writing spoke to me with a reach far beyond that of my occupation. I knew that it was likely to challenge my thoughts and even morals surrounding my chosen work in ways that would be both uncomfortable and enlightening. I was extremely flattered to be asked to review anything, never mind this, written and edited by people whom I have held in such esteem throughout my career. I hope I do it some modicum of justice, without caving to the feeling that the authors penning these chapters should not be questioned. However, is that not the point of this book? To raise questions, have arguments and engage in meaningful conversation about what it is to be a veterinarian today, with the technology we have at our fingertips, with the weight of that responsibility to our patients on our shoulders but also with the expectations of owners and indeed society binding our hands?
After noting the editors of this book, I recalled the memorable occasion of the Vienna AVA congress, where Polly Taylor and I enthusiastically bonded over the shared impact of Eddie Clutton crowd surfing as his legs collided with our outstretched hands. Eddie, to my eternal amusement, smiled happily and said, “Try anything once!” We, along with many other revellers that evening, enjoyed sharing the weight of our colleagues on our linked arms. And this metaphor is not lost on me as I read this book. Eddie and Polly, along with Kathy Murphy and Tanya Stephens, arranging the thoughts and questions which many of us have had, sharing the burden of what it means to be veterinarian. Death and suffering are universal for humans. But we, in the veterinary profession are privileged to be able to relieve some of that suffering for our patients. Indeed, we are bound by duty and oath to do just that. Is it true that we have lost sight of this goal? Perhaps.
The book is divided into three sections – an introduction, a section on the ethical challenges we face, and a section on the veterinary-client-patient relationship. One of the overarching themes of the book appears to be “when is a good time to die” and “by what means,” along with “who chooses this moment?” Surely, the most any of us can hope for, to coin Peter Singer’s terminology, is a good life and a humane and swift death, something which veterinarians, unlike any other profession, have the power and the honour to administer. Other discussions in the book which are of equal importance are the consideration of the laws within which vets must work, both for companion animals and for laboratory animals, and the argument that laboratory animals are considerably better protected. Readers are forced to consider when innovation and experimentation are appropriate and when they aren’t. Just because technology and cutting-edge therapies may be at our fingertips, does not yet mean that there is evidence to support their use, and using them definitely should be considered ‘experimental’ until such a time as we have the research to confirm their validity. One then must consider whether experimentation on a client-owned animal is acceptable – given that a pet does not benefit from the protections afforded to animals destined for use in research. The authors of the book suggest including ethics committees for the oversight of such issues in veterinary hospitals, not only academic institutions. The chapter by Ngaire Dennison is exemplary in demonstrating the potential use of laboratory animal welfare for veterinary practice, and calling for a system that offers protections for companion animals should be lauded. Importantly, in my opinion, this section includes great detail about ethical review, why it should be utilised, when, where, by whom, and how.
A chapter on ‘post truth’ in the veterinary world discusses the emergence of ‘alternative facts,’ and the widespread availability of evidence-based veterinary medicine on social media. Unfortunately, the two are not good bedfellows, and, to coin Eddie’s term, the “emotionally incontinent” are certainly not well placed to separate science and evidence from anecdote and desperation. Thus, there has been an erosion of the public’s trust in the veterinary profession. In some ways perhaps this is enabled by a push from institutions/journals for quantity over quality, and the marked increase in predatory journals with incomplete, poorly designed and non-peer-reviewed works, or reviewed papers that are, at best, substandard.
There is extensive discussion on what could be termed ‘over diagnosis’ or ‘over-treatment’ and too much veterinary care, with a focus on oncology and intensive care medicine and palliation. There are some suggestions about what could be driving this, but the reader is left with quite a few quandaries, not least, how to identify suffering in this patient population and who decides whether the chance of return to a ‘good life’ is worth the side effects of the treatment being undertaken. The idea of ‘gold-standard’ care versus ‘affordable care’ is also discussed, with the suggestion of aiming for something called ‘contextualised care’. What is not questioned in this book, is what, exactly, is considered ‘too much’? Where does one draw the line? If guidelines were to be created, who would provide them? Who would enforce them? Is cardiac bypass going too far for our patients? What about several days of ventilation and intensive care after snake envenomation? It is hard to state that X% of patients will return to full function after such treatments when that data is not readily available and the data that there is does not necessarily reflect the whole population due to limited data collection in our profession. For example, I have treated many animals for snake envenomation and have never had to report the success or not of those cases, but for what it’s worth, many make a complete recovery after days of intensive care, including mechanical ventilation. Another problem is that the numbers of animals that have undergone procedures such as cardiac bypass are currently so small that extrapolation to another individual and another institution is tenuous. Therefore, while attempting to support every recommendation with evidence-based veterinary medicine is heralded as the way forward, in reality this can be difficult to achieve.
The chapter on evidence-free veterinary medicine is both challenging and interesting to read. There are many vets offering complementary veterinary treatments and there is precious little to support these treatments in the scientific lexicon. The author of the chapter asks why complementary medicine is not held to the same scientific rigour as conventional therapies – and as a reader, I too am forced to question this. More specifically, the author asks whether supplying or administering these unproven treatments be considered malpractice. The alternative medicines (and, for that matter, supplements) are poorly regulated, if at all, and there are significant challenges to implementing regulation. In particular, if these alternative therapies were to be considered worthy of regulation as an ‘act of veterinary medicine’, does this legitimise their use when there is poor evidence of their success and validity? Perhaps in line with the ‘post truth era’ there appears to be great appetite from the public to pursue these alternative therapies, again despite the absence of evidence, and those who purport to utilise these therapies seem to be ardent believers in their efficacy, again despite the absence of evidence. The worry is that the client’s funds are spent on care with little proof of successful outcome and not on therapies for which there may be an abundance of evidence in the conventional medicine archives. Two important questions raised in this chapter are whether the veterinarian is duty bound to protect both animals and the public from therapies for which there is no scientific support, and whether removing access to alternative therapies reduces a client’s autonomy over their animal.
The reader, on reaching the chapter on the changing profession, would be justified in thinking both the younger generation of vets and in fact, young female vets, are being unfairly maligned. An example of a wound in a dog where a ‘young lady’ vet prescribes cleaning, debridement and suturing, after first doing a blood test to make sure the older patient can be safely sedated given the dog’s mildly antisocial behaviour comes to nearly £500. The owner elects to try a different vet down the road, who is older, male, and suggests not to do anything except a course of antibiotics (note that in some countries giving antibiotics without a culture and sensitivity test first is no longer legal – this older male vet could be breaking the law). The author questions the different strategies of the two vets, suggesting a decline in clinical judgement and over-reliance on laboratory investigations. Perhaps this is the protocol of the corporate practice in which the ‘young lady’ worked and she’s simply doing what she has been told by her employer. Is this ‘too much’? Maybe. One potential sequelae for the older, male vet, is that the infection is not responsive to the course of antibiotics, festers, the owner doesn’t realise, the leg starts to smell, the infection reaches bone, finally there is a re-visit to the vet and repeated sedations over several weeks for open wound management, there is a multi-resistant bacteria present and eventual amputation of the limb is required. The costs here would be far in excess of the £500 originally estimated by the young lady, and yet she would be accused of ‘money-making’ in today’s world.
Some of the chapters in the book require a response, rather than a review. There is considered discussion about whether the content of our university courses is adequate to cover the ethical challenges we face (in my opinion it is not), and whether our student selection processes are at fault and we are not recruiting individuals with enough resilience. There are many topics that I wish had been covered when I was a student – rather than learning them on the job. Some things only come with experience, interpreting a facial expression that indicates the costs involved will be challenging to an owner, or body language that indicates dissatisfaction, what to do when an owner is verbally abusive, or threatening, or just downright rude. I have regularly been forced to question my career choices, for example, the night when told that a large and angry man was going to wait for me in the car park and ‘do me in’ because I euthanised a wild bird rather than fix its broken wing. Or the owner that told me he would relieve his cat’s urethral obstruction using a biro rather than pay our fees. Or the owner that says, look if you don’t euthanise this (perfectly healthy) cat, then they will put it in a bag with a load of bricks and throw it in the river. Who is to say the owner is lying? No one discussed how to manage the multitude of feelings that encompass these sorts of events when I was at university. Colleagues within my own discipline have offered the thought that people who are resilient don’t need that sort of instruction, but this is a shallow claim in front of a body of professionals who clearly do need better support through these sorts of situations. Their own ethics and morals may not align with those of the owners, or their employer, or the general public – and naturally this leads one to question who is right? The anxiety is borne from not knowing if your ethical choices, that you wholeheartedly believe in, are, in fact, correct. Certainly, there are many things that need to be added to vet school curricula, and the most important one highlighted in this book is welfare based clinical decision making. This should encompass both the one-welfare outlook for non-companion animals, as well as the ability of vets to provide options to an owner that consider the animal’s needs, the condition and likelihood for recovery balanced with the owner’s wants and circumstances. We need to recognise that “gold-standard” is not necessarily the same as using the best evidence when it comes to treating the individual and the needs of the owner – and this could certainly be better addressed at university level.
Part III of the text includes a chapter on the ethics surrounding veterinary corporatisation. This is one of the most heated discussions in our field currently. How can the ethics of the veterinarian (animal first) align with corporate culture (shareholder first)? Having vets who must aim to meet certain targets doesn’t sound ethical – upselling food or health and wellness checks, or a multitude of other things smacks of money-making for the shareholder under the guise of providing ‘gold standard’ care. How is it that conferences purely for certain corporate groups have been allowed to go ahead to the detriment and decimation of other congresses, for example, the BSAVA yearly congress? Even if this is not ‘illegal’, it seems morally contemptible to exclude your colleagues from CPD, or to only allow your staff to attend specific congresses based on your own corporate group’s interests. The purchasing power of the corporates to have their own drug production lines, own food labels and so on, means that it becomes very difficult to maintain your own clinical judgement. For example, when I worked for a corporate practice, they developed their own line and labelling of propofol. I noticed one day that some of the rubber from the seal of the bottle was fracturing off into the liquid that was aspirated into the syringe prior to injecting it into a patient. Of course, I didn’t use this solution, but found another bottle and tried again, only for the same thing to happen. Injecting a small plug of rubber into an animal’s vein prior to anaesthesia could be highly detrimental for the patient. I raised this immediately, suspecting there was a batch of bottles of poor quality. A new batch was obtained, but the same thing continued happening. I encouraged everyone at the practice to use only alfaxalone or ketamine as alternatives until the issue was resolved. I was told this was not allowed, because the corporate wanted propofol to be their standard protocolised induction agent because they could obtain it more cheaply and make better margins. I argued against the safety of this. I was told I must ‘ignore’ the pieces of rubber that were being aspirated and simply ‘do my job.’ I resigned. This experience has undoubtedly clouded my appreciation for corporate enterprises in the veterinary world. Yet, my experience is not unusual. There are many colleagues who have experienced similar issues at the hands of corporates, or stories of people who have spoken out and then have been backed into a corner resulting in termination of their job. It is difficult to believe in the corporate veterinary world’s ideals that are penned in this book, because it seems not to be the experience of a great many veterinary professionals. New graduate programmes in corporate practices are implemented where the young vets receive dedicated support. Yet everyone knows a new graduate who has been placed sole charge in a branch practice and has been left unsupported for months at a time. Clearly, we haven’t been able to implement corporatisation with quite all the bells and whistles that were promised by consolidation. Establishing moral and ethical boundaries for the vets, that the staff can believe and feel supported in, and placing the shareholder pockets firmly into the lower tier of priorities in these clinics/hospitals will be the ongoing aim of corporate vets in practice.
Speaking up for animal welfare is a welcome beacon of hope at the end of the book. It is reassuring to see that there are people who are making the advancement of ethics for animals their aim and to see the possibilities for implementation into the wider profession. It would be even better if these strategies could be targeted toward farming and animal welfare outside of the pet and laboratory animal population. It is true that many veterinary regulatory bodies seem to be complicit in horrific practices, for example sow stalls. An additional question that should be asked when considering medical ethics is ‘What is the best societal outcome?’ Are we aiming for cheap meat or higher welfare meat? Perhaps this is a topic for a different book.
Finally, I want to address the idea of ‘having a go’ and resilience. Is it ok to ‘try anything once’ as Eddie put it for his moment of crowd surfing? Eddie was supported by his colleagues on that evening, so as not to injure himself. But who supports the animals when the vet is asked to just ‘have a go’? The book does not adequately answer this question. The author of the chapter “the art of veterinary science” uses the word ‘experiment’ when discussing their ability to turn their learned theory into practice on a client-owned animal, despite the earlier chapters clearly advocating for rigorous control on experimentation in pets. Clearly, there are situations where there is precious little choice. Remote rural communities where the nearest other vet is some 600 km away spring to mind. The owner who says, “I don’t want to refer the dog, I’d rather you did your best”. These situations have left me operating on a gastric dilation volvulus in the middle of the night having called my mum to assist with the anaesthetic and read aloud from the surgical textbook to allow me to operate. Is that ethical? Was it even legal? The dog ultimately died, three days later, potentially because of my poor surgical ability, maybe because both my mum and I understood precious little about anaesthesia of the highly unstable patient. We had no monitoring. Only an apnoea alert and a finger on the pulse. My boss was not answering his phone that evening and had stated many times that calling a nurse in out of hours was not acceptable. We also weren’t supposed to ‘waste’ bags of IV fluids. Was it ethical to even attempt the surgery given the lack of equipment and skill available? Many readers will look back on equivalent situations in their own lives and be forced to question whether what they did really placed the welfare of the animal above all else. One could argue that if we hadn’t proceeded the way we did, then there would have been no learning, no improvement in my surgical abilities, no chance at all of the animal surviving – it would have died anyway. But I reflect and consider that the animal would have done better under someone else’s knife or suffered less had I euthanised it.
This is the issue – what are the ethical guidelines for these situations? It is disappointing to see the author of the chapter suggesting that we should be third world vetting and not hiding behind evidence-based medicine. Third-world vetting taught me a lot – but in honesty it mainly taught me the type of vet I didn’t want to be, how I would prefer to be able to provide quality anaesthesia care, to have methadone at my disposal, not just butorphanol, how I wanted to be able to properly investigate a patient, rather than send them all away with the boss’s preferred cocktail of antibiotics and cortisone. Lessons that I would rather have learned under someone’s tutelage in preference to making a mistake on someone’s beloved best friend and, yes, increasing its suffering unnecessarily. If the animal’s care requires a skill I don’t have, and the owner can’t pay for referral level care, euthanasia is a viable option – otherwise, am I not just experimenting, toying with the life of another being for some amorphous hope of a good outcome? Or, is this just putting into practice the theory that I was taught at vet school, and therefore, it’s ok to try? These sorts of questions still plague me, even after reading the book. But isn’t that the point of this text? To bring these questions into the open, to encourage the implementation of recognised ethical standards into the university curricula, to introduce ethical governance to practices? Isn’t the point now to do as Eddie said and ‘try this thing once’ – try and bring this ethical debate into the limelight, during this time of huge technological advancement and changing veterinary professional landscape? With huge thanks to the editors for their enthusiasm for addressing these issues, let’s have a go at supporting the veterinary profession to make ethically sound decisions for themselves, their patients, their practices, their communities. Start by reading the book.
Past Reviews
December 2025
Anaesthesia and sedation guidelines with Dr Lydia Love from VetLit – A free resource keeping us all up to date with veterinary literature. It is continuously updating with recent publications from every field
Recommended by: Briony Alderson
Briony became a European Specialist in Veterinary Anaesthesia and Analgesia in 2007 and is currently Professor of Veterinary Anaesthesia, Analgesia and Education at the University of Liverpool and Head of the Small Animal Teaching Hospital. She graduated from Liverpool in 2000 and after 20 months in mixed practice in Manchester returned to the University of Liverpool to complete her residency. After 3 years in UK private referral practice she returned to Liverpool. Briony particularly enjoys undergraduate teaching in anaesthesia. In her free time she enjoys watching cricket, rugby and American football and scuba diving.
Commentary
The VetLit minis podcast feed, although only started in January 2025 has been a great and easy to access resource for me this year. This month’s is anaesthesia-related and really worth a listen (and its only 42 minutes). The podcast starts with a very brief overview of the recently published anaesthesia and sedation guidelines in small animals. I particularly like that they pick out some of the article’s themes and expand on these, especially sedation. With Dr. Cook (a UK criticalist who started VetLit) questioning the conversation flows very well. Dr Love is pragmatic, sensible and is engaging so is very easy to listen to. There is a useful link to the articles referred to on the podcast’s section on the VetLit website. I have also listened to the other relevant podcasts from VetLit, although I’m not sure anything will help me understand the complexities of coagulation!
The whole website is a useful resource for those of us that are busy (so all of us!) and need some help to filter through the masses of literature coming out every month. There are newsletters for some disciplines (you can sign up for free), but not yet anaesthesia (maybe someone reading this will be keen enough take on that role?). There is a section with resources, including a useful article for residents on how to interpret a journal article and some recommendations. Personally, I have found the ECC section most useful to help guide me to want I want to learn this area.
June/July 2025
Campoy L. Development of Enhanced Recovery After Surgery (ERAS) protocols in veterinary medicine through a one-health approach: the role of anesthesia and locoregional techniques. Journal of the American Veterinary Medical Association. 2022 Sep 15;260(14):1751–9
Recommended by: Elisa Bortolami
Elisa became a European Specialist in Veterinary Anesthesia and Analgesia in 2013 and is currently the coordinator of the Anaesthesia and Analgesia Department at San Marco Veterinary Clinic in Italy.
She graduated from the University of Padua and then moved to the UK, where she completed a rotating internship, followed by a residency at the University of Bristol. She went on to pursue further education, earning both a PhD and a MSc. Elisa enjoys all aspects of veterinary anaesthesia, with a particular interest in pain management. In her free time, she enjoys spending time with her family—especially outdoors.
Commentary
This article discusses the development of Enhanced Recovery After Surgery (ERAS) protocols in veterinary medicine, reflecting similar advancements in human healthcare. ERAS aims to improve patient outcomes by re-evaluating preoperative, intraoperative, and postoperative care. Locoregional anesthetic techniques play a key role, offering effective pain management while potentially reducing the need for systemic analgesics, shortening hospital stays, and lowering costs. The article emphasizes the importance of careful patient selection, clear client communication, and the use of short-acting anesthetic drugs to optimize care. It explores various locoregional techniques for specific surgeries, such as pelvic limb and abdominal procedures, highlighting the advantages of ultrasound guidance and newer fascial plane blocks. The author concludes by advocating for increased training in locoregional anesthesia to support the broader adoption of ERAS protocols in veterinary practice.
As a veterinary anesthesiologist working in a busy clinical setting, I chose this article because it directly addresses a growing need in our field: optimizing patient outcomes through ERAS protocols. I am constantly seeking ways to improve pain management, enhance patient welfare during hospitalization, and shorten recovery times. This article offers a valuable overview of how locoregional techniques can be strategically integrated into surgical plans, with concrete examples for common procedures. In conclusion, I believe that the ERAS approach aligns closely with my commitment to providing the best possible care for veterinary patients.
May 2025
Langer, T., Brusatori, S. & Gattinoni, L. Understanding base excess (BE): merits and pitfalls. Intensive Care Med 48, 1080–1083 (2022). https://doi.org/10.1007/s00134-022-06748-4
Recommended by: Gerardo Citarella
Gerardo Citarella earned his Master's degree in Veterinary Medicine from Aldo Moro University in Bari, Italy, in 2018. He then completed a rotating internship in Naples before undertaking his residency in Zurich. He became a diplomate in 2024 and is now working as the head of the anaesthesia service at the Ennetseeklinik, Evidensia, in Zug, Switzerland.
When not working, he enjoys spending his free time with his family and pursuing his passions for guitar, running, boxing, cooking, traveling, hiking, skiing, humanitarian missions, and simply living life to the fullest.
Commentary
I chose this article because I believe it is an important vehicle for understanding the concept of base excess (BE). Acid-base equilibrium has always aroused spicy curiosity in me and every time I sit down to reflect on the caridian concepts of understanding acid base equilibrium, I always come to reshape my view of the same topic. In my little experience, I have several times noticed how the concept of BE can cause doubts and difficulties in understanding. This article clarifies, but does not simplify the theories on BE from Professor Siggaard-Andersen (inventor of the BE concept), re-proposing them from a critical and analytical perspective. Above all, the article makes it possible to understand what lies behind the BE concept without having to resort and read Prof. Andersen's nomograms. The last author of this article, Professor Luciano Gattinoni, who deceased three months ago, represents a giant of our profession. Known to many for his revolutionary discoveries in the field of ventilation, he was also a profound expert of acid base equilibrium as well as a refined physiologist. The title of this article I believe best exemplifies his way of seeing the profession of anaesthetist and that is with the word "Understanding" at the base of everything. Happy reading!!
April 2025
Loomes K, Louro LF. Recovery of horses from general anaesthesia: A systematic review (2000-2020) of risk factors and influence of interventions during the recovery period. Equine Vet J. 2022; 54: 201–218. https://doi.org/10.1111/evj.13517
Recommended by: Stephan Neudeck
Stephan Neudeck has been a Diplomate of the ECVAA since December 2022 and has worked at the Small Animal Clinic of the University of Veterinary Medicine Hannover since April 2021. Prior to this, he worked at the Equine Clinic of the same university from 2016 onward. His scientific focus areas include general anaesthesia, macro- and microperfusion alterations in various diseases, glycocalyx shedding, as well as endotoxemia and sepsis. He has gained extensive experience in his primary fields of work, the anaesthesia and critical care departments. In his free time, Stephan enjoys spending time with his wife and two children. Their family life is well-balanced by the presence of their two dogs and horse.
Commentary
I came across this systematic review during my study period for the exams. I particularly like this review because it provides us with basic information and answers to various questions on how to improve the recovery phase. Additionally, this review serves as good literature for the training of residents and specialist veterinarians.
It provides a comprehensive overview of the current evidence on risk factors and interventions influencing the quality of recovery in horses after general anesthesia. The authors have conducted an extensive literature search and critically evaluated 39 studies to identify factors that impact recovery quality, including anesthesia duration, American Society of Anesthesiologists (ASA) physical status, and surgical procedure. The review also highlights the importance of pharmacological interventions, such as the administration of alpha-2 adrenoceptor agonists, in improving recovery quality. The findings of this review will be valuable for equine anesthesiologists and veterinarians seeking to optimize recovery outcomes in horses undergoing general anesthesia.
March 2025
Mealey, K. L., Owens, J. G., & Freeman, E. (2023). Canine and feline P-glycoprotein deficiency: What we know and where we need to go. Journal of Veterinary Pharmacology and Therapeutics, 46, 1–16.
Recommended by: Ivana Calice
Ivana became a diplomate in 2022 and is currently working at the Anaesthesia Unit of Vetmeduni Vienna. Originally from Serbia, shebegan her veterinary studies in Belgrade and completed them in Vienna, where she also finished her residency after working in industry and private practice for some time.
She enjoys anaesthesia involving airway management, particularly in head, neck, and thoracic surgeries, as well as all forms of regional anesthesia. Her current research focuses on interventional pain medicine in dogs. Outside of work, she does her best to juggle life as a mum of two teenagers and enjoys listening to podcasts, when she finds a moment to do so.
Commentary
I came across this review while preparing for a resident round, and I found it really interesting. The topic itself isn’t new, but it makes it clear that we can no longer think about it simply in terms of whether an animal has a gene mutation or not. Even though the review doesn’t focus specifically on anesthetic drugs, I think it’s still very relevant to our work since we often deal with animals that have P-glycoprotein (P-gp) deficiency or dysfunction.
What I really liked about this review is that it highlights species differences and knowledge gaps in dogs, cats, and humans when it comes to P-gp. Understanding these differences is important, especially when considering different drugs and safety.
Additionally, I appreciate the review’s use of clear terminology, referring to "P-glycoprotein deficiency and dysfunction" rather than solely discussing the presence of the MDR1 (ABCB1) gene mutation. This distinction is clinically relevant, as it shifts the focus from genetic status to the functional consequences of P-gp impairment. This approach may also facilitate better communication with clients. It’s not uncommon for owners to say their dog is “MDR1-positive”, but that can be confusing—even for us. Does it mean the dog has the mutation and is P-gp deficient? Or does it mean the dog is unaffected? Using terms like "having" or "not having P-glycoprotein deficiency" could make things a lot clearer when taking a history and, in turn, help us provide safer anesthesia.
February 2025
Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis Wang, Kun et al. British Journal of Anaesthesia, Volume 123, Issue 6, 777 - 794
Recommended by: Malina Filipas
Originally from Romania, Malina worked in both first opinion and referral practice in the UK before undertaking a residency at the University of Cambridge and passing the exam last year. She particularly enjoys farm animal anaesthesia, mechanical ventilation and critical care. When not in work, you'll find her either tending to her indoor plants, in the garden, or out and about with my lovely Wirehaired Vizsla Maisie who seems to enjoy camping more than she does.
Commentary
I came across this review during my revision time when instead of focusing on the curriculum, I entered the rabbit hole that is dexmedetomidine and its effects. We obviously do not know everything there is to know about this interesting molecule and we are constantly learning new ways in which to use it. This review not only highlights a potential anti-inflammatory and attenuating effect on perioperative stress when given as a constant rate infusion (which maybe isn't as surprising knowing its sympatholytic effects) but seems to enhance the immune function. These benefits may contribute to a reduction in postoperative complications for surgical patients. I would be excited to see if these effects actually translate in better clinical outcomes, but until such evidence emerges, I shall continue adding it to my protocols for all its other benefits.
January 2025
Mosing, M. and Senior, J.M. (2018), Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation. Equine Vet J, 50: 282-291. https://doi.org/10.1111/evj.12793
Recommended by: Abdur Kadwa
Abdur became a diplomate of the ECVAA at the end of 2022 and is currently working at the Onderstepoort Veterinary Academic Hospital at the University of Pretoria Faculty of Veterinary Science. He completed his undergrad, internship and residency at the same facility (peril of being the only vet school in the country!). He particularly enjoys cardiothoracic anaesthesia and acid-base physiology. During his time off, he tries his best to keep up with his 2 sons and his daughter, travelling with his wife and fishing.
Commentary
I came across this review ' Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation' during my residency, whilst preparing for one of our bi-weekly discussions, this time concerning equine ventilation. In this review, Profs Mosing and Senior (both well known names in the fields of equine anaesthesia and mechanical ventilation) succinctly discuss the history of inhalational anaesthesia in horses as it is relevant to modern equine anaesthesia. The relevant pharmacokinetics and -dynamics of modern inhalational anaesthetic drugs are briefly compared after which the review segues into mechanical ventilation of the horse. The relevant anatomy and physiology relevant to mechanical ventilation is described, including the physiological effects of ventilation, followed by various ventilation techniques and modes. The review concludes by suggesting what the next 50 years of equine anaesthesia might bring forth.
The authors have gathered information regarding equine anaesthesia, spanning the last half century and have presented the relevant 'highlights', so to speak. I suggest this review to anyone involved in equine anaesthesia, from a new resident to the time-pressed exam candidate. Personally, I find the review framework useful for discussing mechanical ventilation in horses with residents, both at the patient side or during formal discussion sessions.
December 2024
Savvas et al. (2021) Evaluation of the effect of the inspired oxygen fraction on blood oxygenation during inhalant anaesthesia in horses: A systematic review with meta-analysis. Animals, 11(8), 2245.
Recommended by: Klaus Hopster
Klaus became an ECVCAA diplomate in 2012. Upon finishing his training, he worked as a Lecturer in Anesthesia and Pain Management at the Hannover School of Veterinary Medicine's Equine Hospital until his departure to the University of Pennsylvania in 2016. His main research focus is on intraoperative lung function and tissue oxygenation under general anesthesia. In his free time he enjoys spending time with his dogs and horses on his little farm in rural Chester County Pennsylvania.
Commentary
I read this review article at least once every year. Authors evaluate the effects of different inspired oxygen fractions (FIO2) on blood oxygenation in horses during inhalant anesthesia. The study aims to determine whether lower FIO2 levels (<0.6) improve oxygenation indices compared to higher levels (>0.8). Five studies, including four experimental and one clinical, were reviewed, with a meta-analysis performed on the experimental studies. The findings revealed that lower FIO2 levels significantly reduced arterial oxygen partial pressure (PaO2) but also decreased the alveolar-to-arterial oxygen tension difference (P(A-a)O2), indicating improved gas exchange. In contrast, high FIO2 increased PaO2 but compromised pulmonary function by worsening P(A-a)O2. Data limitations prevented meta-analysis for some indices, such as the PaO2/FIO2 ratio. The review concluded that while high FIO2 raises PaO2, it can impair pulmonary function, whereas lower FIO2 improves gas exchange but reduces overall oxygenation.
It reminds me of the dire need for further research to refine oxygenation strategies in clinical practice.
November 2024
Opioids Regulate the Immune System: Focusing on Macrophages and Their Organelles
Recommended by: Manuela Pascal
Manuela is originally from Romania where she has worked for a good part of her career and spent time in the University in Bucharest. She became a Diplomate in June 2021 when the world started to recover from the pandemic after finishing her residency at the Animal Health Trust, UK. She has been working since in several referral practices in UK and enjoys delivering CPD and anaesthesia training to interns, residents, and nurses.
She enjoys all aspects of anaesthesia, but she has a particular interest in cardio-pulmonary by-pass, critically ill patients, sepsis, and opioid-free anaesthesia.
Outside work she enjoys spending time in her garden and reading anything that comes across. I am now following my second dream of being a maths scientist and trying to understand why 2+2 might not always be equal to 4.
Commentary
I chose this review as it has always fascinated (and scared) me how science evolves, especially related to drug interactions with our body system. Opioids remain one of the most frequent drugs in anaesthesia and have been studied extensively. However, their effect on the immune system and role in cancer biology are not the first ones to come to mind in the daily practice. This review summarized the latest evidence regarding effects of opioids on macrophage function in the last 20 years. It is well written and an easy read, while providing a base for further research. Its findings might contribute to the big debate around opioid free anaesthesia.
October 2024
Obstructive Lung Disease - Anesthesia and Critical Care Reviews and Commentary (ACCRAC)
Recommended by: Jodie Hughes
I became a Diplomate in 2019 after completing a residency at the University of Liverpool and am now working in a private referral hospital in the south of England. Outside of work I love travelling, scuba diving and knitting. I am trying to enjoy renovating my house.
Commentary
I came across this podcast when studying for my ECVAA exams. It is a fantastic resource for revision and I still enjoy listening to it now. The podcast is created by Jed Wolpaw, an associate professor in anesthesia and critical care medicine at Johns Hopkins University School of Medicine. His aim is to provide accessible reviews of anaesthesia and critical care topics, he most definitely achieves this. Jed is incredibly engaging and gives great tips for understanding and remembering the topics covered. I’ve selected an older episode here which really cemented for me an understanding of spirometry loops. The podcast is free to listen to, I hope you enjoy.
September 2024
Neuromuscular block management: evidence-based principles and practice. Rodney, G. et al. BJA Education (2024),24(1),13-22
Recommended by: Alexandru Tutunaru
Alex became a diplomate in 2022 and is currently working as a senior anaesthetist at the small animal hospital of the University of Liège. He is heavily involved in the teaching of interns and residents and provides CPD (Continuing Professional Development) in anaesthesia and intensive care in his home country, Romania. His main interests in anaesthesia include the use of neuromuscular blocking agents and anaesthesia for oncology patients. In his free time, Alex enjoys taking care of his two children and loves hiking in the mountains.
Commentary
Neuromuscular blocking agents (NMBAs) were first used and documented in anaesthesia in 1942 by R. Griffit, more than 400 years after the Europeans discovered them being used by the indigenous in South America, and 100 years after they were tested on animals and their properties described. However, even though “the start was missed”, nowadays NMBAs are routinely used in human anaesthesia to ease intubation. However, In veterinary medicine their use is still limited to intraocular, intrathoracic and specific orthopaedic procedures. This review article provides you with an up-to-date definition of neuromuscular block depth, pharmacological variability of NMBAs and reversal therapies, the consequences of residual block and its prevention, and the differences between acceleromyography and electromyography. I hope this might spark your curiosity to read it.
August 2024
The failed peripheral nerve block by Bottomley, Gadsden and West. BJA Education, 23(3): 92e100 (2023)
Recommended by: Ian Self, Vice President ECVAA
Ian Self has been a practising Diplomate for several years having worked in private practice and academic institutions. He is continually fascinated by his patients and the ways they never quite do what you think they should do- he guesses they haven't read the textbooks! Increasingly, he is interested in how students, under- or post-graduates learn, so much so that he is carrying out a PhD study examining attitudes to lifelong learning in the veterinary profession which leaves little time for his twin hobbies of boating and tai chi.
Commentary
Just last week, I performed two peripheral nerve blocks whilst on clinics. One, a subscalenic block in a dog presented for forelimb surgery, worked beautifully, with the patient virtually awake throughout surgery. But on recovery I noticed an ipsilateral Horner's Syndrome - difficult to explain that one to the owner but luckily signs resolved as soon as the bupivicaine wore off. The next block, a couple of days later, was a fairly straightforward femoral/sciatic for TPLO surgery. I had great ultrasound visualisation and saw the local anaesthetic spread around the nerves. But of course, the dog required lots and lots of rescue analgesia despite my confidence that the block was placed correctly. This got me thinking about how we measure block success (reaction to surgery?) and how we approach the failed block situation.
The human review I have highlighted, although basic, I found to be very useful in asking the right questions about blocks and how to approach the 'what now' following block failure. I hope you find it an interesting read.
June/July 2024
End Tidal CO2; Roadside to Resus Podcast
Recommended by: Matt Gurney, Past President ECVAA
Outside of work, I love travelling and in particular visiting the wine regions of the world. In this photo I am braving the rain showers on a trip to one of our excellent English vineyards in Hampshire.
Commentary
The podcast that I have chosen to highlight to our ECVAA community is called The Resus Room.This podcast is hosted by three emergency doctors and each month they cover papers of the month and a Roadside to Resus topic. The hosts have a chatty, yet scientific style and convey information in a clear way. One of the recent topics covers end tidal CO2 in resuscitation and is an easy to listen update for those of use working with emergency cases. The papers of the month feature is a great way for us as veterinary anaesthetists to scan the horizon for topics that may have relevance to us and also to hear from emergency doctors on the ground what their thoughts are.
May 2024
Women in anaesthesia: a scoping review. Laura Bosco, Gianni R. Lorello, Alana M. Flexman, Maya J. Hastie. BJA 124 (3): 134-147 (2020). DOI:https://doi.org/10.1016/j.bja.2019.12.021
Recommended by: Thaleia Stathopoulou
Thaleia became a diplomate in 2021 after completing her residency at the Royal Veterinary College. She had previously worked at a first opinion small animal practice in London, followed by an anaesthesia internship at the University College Dublin. She is currently co-head of the Anaesthesia service at the Royal Veterinary College, London, and she is enrolled in a part-time PhD program. Her research focuses on mitophagy in Duchenne Muscular Dystrophy and metabolic imaging for skeletal and cardiac muscle.
Commentary
I chose for this month a slightly different article that is a scoping review on the gender biases that women face in anaesthesiology. Even though the data originate from the human field, I believe that is an interesting read and possibly highly relevant to us. Women constitute approximately 80% of the veterinary college student population in several countries (United Kingdom, United States, Canada). However, talking with colleagues we are still under the impression that women are facing gender disparity in leadership and faculty positions. It would be very interesting to conduct a similar study in our field.
The paper is open access, and is a part of the ‘Women in Anaesthesia Special Issue’ and you can access it through the link above.
April 2024
Basic pharmacology of local anaesthetics. A. Taylor and G. McLeod. BJA Education, 20(2): 34-41 (2020)
Recommended by: Charlotte Sandersen
Charlotte became a diplomate of our college in 2013 after having worked half of her career as a specialist in equine internal medicine before deciding to focus on anaesthesiology. She is now the head of the veterinary anaesthesiology section at the University of Liege. Her research focuses on inflammation and mitochondrial function and how anaesthetics interact with them. When not busy with doing anesthesia, Charlotte rides her horse or alternatively her motorbike or refurbishes antique furniture.
Commentary
I decided to suggest this article because it is a very easy and enjoyable read, refreshing our knowledge on local anaesthetics. It reminds us of the nerve physiology, the mechanism of action of local anaesthetics, and their pharmacology. This article offers a brief and easy read, and I can tolerate the omission of procaine in this paper, as it is written by human anaesthetists. 🙂
If you do not have access to the article, please contact me and I will send it to you by email: Charlotte.Sandersen@uliege.be