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Nathalie Dowgray: Hello welcome
to the September 2023 episode of

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Chattering With ISFM. I'm
Nathalie Dowgray head of ISFM

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and host of this month's
podcast. First up this month Dr.

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Yaiza Gomez-Mejias is speaking
with Dr. Jenny Brown on her ISFM

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2023 Delegates Choice
Award-winning abstract,

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perioperative anaesthetic
complications and healthy cats

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undergoing anaesthesia for
neutering in first opinion

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practice. We're also featuring
our monthly JFMS clinical

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spotlight interview. This month
Dr. Kelly St Denis discusses

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inhalational therapy for feline
inflammatory airway disease with

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Dr. Michael Barchilon. We hope
you enjoy this episode.

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Yaiza Gomez-Mejias: And at the
ISFM Congress in Dublin, Jenny

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presented the results of her
study on perioperative

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anesthetic complications in
healthy cats undergoing

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anesthesia for nurturing. We
neuter cats on a daily basis.

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Would you mind summarising the
main results of your study for

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the vets who are listening to
this podcast?

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Jenny Brown: Yeah, sure. So we
looked at, it was a

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retrospective chart analysis.
So we looked at anesthetic

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charts from, just over a
thousand cats and looked at a

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few different things. So the
first thing looked at obviously,

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was that was the mortality rate.
And sadly, we did have one cat

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in the study who did die. It
wasn't really a big enough

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numbers in the study to really
come to conclusions about that,

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but it was consistent with
previous studies in similar

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populations.  Next sort of
thing, we looked at the most

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common complications that have
been identified in these cats,

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and our top three were
hypotension, so low blood

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pressure, bradycardia, so low
heart rate, and hypothermia, so

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cold temperature. And we made
the definitions by doing like a

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literature review first, so we
knew what we were looking for.

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And then our final bit was
looking at any factors that were

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associated with an increased
instance of these complications.

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And so really the most stunning
one was that a longer anesthetic

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duration was associated with
increased likelihood of all

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three of our top complications.
And we had a few other things.

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So the drugs the animals
received, because it was a

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retrospective study, they'd just
received whatever the vets and

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nurse had had chosen to give
them. So hypotension was

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associated with an acepromazine
pre-med, whereas bradycardia was

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associated with medetomidine,
which is probably unsurprising

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for people who know how the
drugs work.  So there were some

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interesting sort of drug effects
as well.

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Yaiza Gomez-Mejias: As an
advanced practitioner in

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anesthesia, would you like to
share any recommendations or

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tips regarding the use of
isoflurane and medetomidine?

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Jenny Brown: So think in terms
of isoflurane, that definitely

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was potentially linked with an
increased risk of hypothermia if

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they had a higher maximum
percent of isoflurane. So across

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quite a lot of complications, we
were seeing that the higher

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isoflurane, the more likely we
were to see these complications.

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So I think it is important to
think about how we can minimise

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the isofluorine dose. So using
multimodal analgesia, making

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sure that when we do see these
things like low blood pressures,

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we're turning the vaporizer down
and looking at other  ways to

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provide analgesia for them.
Medetomidine, other than being

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associated with bradycardia,
didn't seem to be a risk factor

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for any of the complications.
And I think when we look at

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bradycardia, we looked at the
literature definition. It

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probably wasn't in a population
of cats who were receiving Alpha

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Twos because quite a lot of
literature is when we were back,

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when we were using acepromazine.
So I would say don't be worried

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about using it

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Yaiza Gomez-Mejias: Thank you. I
think that's going to be very

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helpful for many people. Thank
you so much.

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Jenny Brown: Oh, thank you very
much.

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Nathalie Dowgray: And now over
to Dr. Kelly St Denis. She's

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speaking with Dr. Michael
Berchilon about his JFMS

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clinical spotlight article.
Breathe Easy. A review of

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inhalational medications for
feline inflammatory airway

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disease. Don't forget JFMS is an
open access journal now and the

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link to read the full article is
in the show notes.

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Kelly St Denis: What's the
difference between asthma and

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chronic bronchitis and what's so
important about knowing why it's

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different?

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Michael Barchilon: I think
there's a couple reasons. I

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think practically probably the
most important thing is that

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they don't tend to have airway
collapse, which is one of the

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hallmarks of cats with asthma.
So they should be treated

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differently, because they don't
have airway collapse.  I think

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that's probably the most
practical difference. The other

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thing I think, that's a little
bit tangential, but I think is

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important is that if we diagnose
a patient with asthma, one of

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the hallmarks of asthma is that
they have eosinophilic airway

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disease. And if we can prove
that, then we know that there

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are other things that cause
eosinophilia, like heartworms,

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lung worms, even just knowing
that it's eosinophilic versus

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neutrophilic, which is typical
of bronchitis patients, then we

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still can further pursue
additional diagnostics to make

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sure the patient truly has
asthma, and not heartworm

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disease, for example.

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Kelly St Denis: Yep. Thinking
about steroids, probably a lot

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of cats we were talking about
earlier end up on oral steroids.

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And of course, that delivers
steroids to the entire system,

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whereas we have the option to
deliver steroids directly to the

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lungs, which is probably more
ideal. But there is a lot of

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pushback, it can be really
difficult to get caregivers

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interested in this. I think it
can be quite extensive in time,

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but certainly worth the while.
And as you say, if people are

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clicker training or working with
their cats at home, that's just

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something you could start
working towards should they ever

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need it. What's your sense of
how long it would take to train

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a cat if you were just cold
turkey, starting to train them?

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Michael Barchilon: Yeah, so my
conversations with owner is

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typically about a month. My
conversations with caregivers

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tends to be somewhere in the
range of, it's gonna take time.

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Let's try Prednisolone for a
month, and then slowly

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transition over to that 'cause I
think the worst thing to do is

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to accelerate or try to
accelerate it and force a cat to

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to do inhalation when it doesn't
want it. And then you've totally

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broken the trust. I typically
give them a couple weeks to a

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month, for that slow
progression.

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Kelly St Denis: Yeah, and it
seems like it's, it just takes

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patience. In the article it says
inhaled glucocorticoids are not

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immediate acting, so it's
recommended to overlap treatment

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with oral glucocorticoids
anyway, so as you say, that kind

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of gives them time. We're
talking about inhalational

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therapy and one thing that I'm
not very familiar with is

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nebulizers. so they, I don't
know if it's because they're not

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readily accessible or well
promoted or just that we get

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what we need for asthma out of
the inhalational therapy through

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the inhalers and masks. Did you
wanna tell us a little bit about

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nebulizers and what kinds are
available and what role they

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would have for us in practice?

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Michael Barchilon: Yeah, so
there are, a couple different

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kinds of nebulizers and they all
have, just like everything, I

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guess, pros and cons.  Probably
the most common one that would

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be used for vet med would be the
jet nebulizers. They tend to be

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the cheapest nebulizers. But
what nebulizers do is they

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basically aerosolize whatever
medication you, you're doing,

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versus something like a puffer
like you, you described, it's

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already aerosolized and you're
just delivering it. So a

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nebulizer changes the
composition of whatever you're

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giving. So jet nebulizers, can
be used, they tend to be a

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little bit loud, which obviously
has its downsides but they tend

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to be relatively cheap and so
contrast that with, something

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like mesh nebulizers, which,
aerosolize things through a

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mesh. And those tend to be more
expensive. But are much more

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quieter. And there are studies
looking at different types of

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nebulizers, and there's also
like piezoelectric, Which is in,

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in the middle, if you will.
There are no studies really

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comparing the efficacy of these
things in cats and there's a

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surprisingly little amount of
information comparing the

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efficacy of them in humans.
Different nebulizers can or

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can't be used with certain
medications just because of the

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way they nebulize things. So if
you do decide to get a

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nebulizer, you have to make sure
that whatever drug you're

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nebulizing can be used with that
type of nebulizer. I think that

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nebulizers could represent a
really good way to, to

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aerosolize medications. and one
of the things that I think,

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potentially could be, in the
future is trying to nebulize

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molecules that are even smaller
to try and get down to the lower

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airways 'cause if you think
about a cat, their airways are

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already so small. Most of what
is available, there, there are

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obviously some veterinary
products, but not uncommonly

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people will buy human nebulizers
which will aerosolize the

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medications for human airways. I
think that there are going to be

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some smaller molecules that,
that will be available.  But as

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far as I'm aware, they're not
currently available for Vet Med.

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And the other big problem here
is price and so nebulizers, you

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have to buy the machine. It's,
it can be loud. It can be

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expensive, but I think
nebulizers potentially can offer

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a very good way for us to get
medications to our patients, but

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I think we're really just in the
infancy of inhalational medicine

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to begin with. But I think that
they're promising. I think that

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they're promising.

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Kelly St Denis: Yeah, I hadn't
really given it any thought

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before. I was reading the
article. I'm like, wait a

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second. I haven't really thought
about nebulizers before, because

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we do focus so much with asthma
and inhalational therapy with

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the chambers.

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Michael Barchilon: I think the
chambers are, are relatively

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easy, and they're relatively
cheap compared to the

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nebulizers. Whether they're
better or worse than nebulizers.

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I still think I think we need to
figure that out.

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Kelly St Denis: Yeah. And it may
be just like you said, what

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applications each has that may
be different. So at least for

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now, we're, we're doing well
with what we have.

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Nathalie Dowgray: If you are an
ISFM member, don't forget, you

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00:10:02,980 --> 00:10:05,590
can listen to the full version
of this podcast and all the

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00:10:05,590 --> 00:10:09,310
other ISFM member benefits,
including congress recordings,

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00:10:09,430 --> 00:10:13,120
monthly webinars, the clinical
club, the discussion forum, and

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00:10:13,120 --> 00:10:16,720
much much more at
portal.icatcare.org. If you're

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looking for more free CPD, we do
have two open access webinars in

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00:10:19,990 --> 00:10:23,410
October from IDEXX and Purina we
have diagnosing and managing

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feline multiple morbidities,
simple answers for complex

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cases. And that's with Rebekah
Mack-Gertig and Marge Chandler

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on the third of October. From
Dechra, on the 10th of October,

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we have uraemic toxins, why we
should be concerned? And that's

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with Dr. Jessica Quimby. We'll
be back again next month. If you

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don't want to miss out, do make
sure you're signed up to

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