Hello, and welcome to Chattering With iCatCare.
I'm Yaiza Gomez Mejias, iCatCare Veterinary Community Coordinator
and host of this month's podcast.
Our clinical spotlight today is focused on physical rehabilitation in cats.
Dr Kelly St. Denis will be interviewing Mary Ellen Goldberg
on therapies and exercise.
The interview on the first part of this article series was released in
July as part of another episode where Mary Ellen discussed common conditions
benefiting from physiotherapy.
Remember, if you want to read it, that all articles in the Journal of Feline
Medicine and Surgery are open access and can be found on the journal website.
Before completing this comprehensive overview on rehabilitation though, I
will be interviewing Morgan Debuigne first author of a JFMS article on
supraglottic airway devices, which won the resident best paper award in 2024.
The full title of this article is "Placement of the feline V-gel-Advanced
supraglottic airway device and tracheal selectivity during controlled
mechanical ventilation: a clinical and tomodensitometric evaluation".
So thank you very much for your time, congratulations
for your award.
Thank you very much for having me and thank you for this amazing prize,
that was really a very nice surprise.
So what were the primary objectives of this study?
What exactly were you trying to find out?
So the primary aims of the study were to see if using the manufacturer's
recommendations, can we be sure that the device is correctly placed?
The second aim was to see if after controlled mechanical ventilation, if
we could have aerophagia or let's say gas trapping in the digestive tracts,
because it had been shown that we could ventilate cats and rabbits with the
V-gel with quite high pressures, but we wanted to see if we were sure that it was
going only in the respiratory tract and not in as well in the digestive tract.
So how did you assess whether the tubes were positioned in the right way?
So to assess if the V-gels were correctly placed, we performed
a CT scan of the cats actually.
So what we did is that we performed four CT scan of each cat.
One CT scan without anything.
So the cat was just heavily sedated and the CT scans were going from the
nose to the stomach to see as well the digestive tracts and to evaluate
the gas in the digestive tracts.
One just after the placement of the V-gel.
One after a five minute period of controlled mechanical ventilation,
and one after intubation with an endotracheal tube.
And so to evaluate that the V-gel was correctly placed we looked on the CT scan.
We looked at five criteria.
We looked at the epiglottis lying freely in the larynx.
So it included the fact that the V-gel was not occluding the larynx.
We looked if the tip of the device was in the oesophagus because
this is how it's supposed to be.
The tip of the device should be occluding the oesophagus.
So the third criterion was to see if the tip of the device was occluding
the oesophagus so that we had no leaks around the tip of the device.
in the oesophagus.
We looked if the device was rotated or not regarding with the axis of the
larynx and we looked as well at the laryngeal symmetry just to see if we were
inducing or not a rotation of the larynx.
This enabled us to create a specific score from zero to five.
So one point for each criterion, that we were having and then a score of
five was a device perfectly placed and a score of zero was a device
perfectly misplaced, let's say.
Very thorough indeed.
And what were the key findings in this study?
So the key findings were that globally the devices were correctly placed.
We were a little bit surprised in the good way regarding the results.
We never found a laryngeal compression or a device that was very misplaced.
There was just only one cat that had a score over five, which
is a device perfectly placed.
The majority of cats had a score of three over five or four over five.
The decreased score was due to an incomplete occlusion of the oesophagus,
or a mild rotation of the device that didn't induce rotation of the larynx.
So it was minor abnormalities of placements that were observed.
The only thing is that this complete inclusion of the oesophagus could
be quite a problem because what we found as well was that we could have a
lack of complete tracheal selectivity because we found that we had some gas
trapping in the digestive tract after the placement of the device and after
the period of mechanical ventilation.
So we know that maybe we can induce a kind of small gas trapping in the
digestive tracts after placement of the device and after the ventilation period.
And maybe this could be due to the incomplete seeding around the oesophagus
during the placement and the ventilation.
Which was not really a problem during our study because it was
only five minutes of ventilation.
But what is unknown if we go for a longer period of ventilation, we don't
know what could be the consequences.
So it could be a problem actually, but for a short period of ventilation
as we did, it was not, the gas scores that we had after the
ventilation were quite acceptable.
And on a CT scan, the amount of gas that we found was not something that appeared
completely abnormal to our radiologists.
And the other results that we found is that we didn't find that we needed
more time or more attempt to place an endotracheal tube which contrasts
with the results of previous studies where the time required to place
an endotracheal tubes was increased.
And when you said that it's appropriate for short procedures because you
were talking about the potential complications associated with gas, with
the distension of the gastrointestinal tract due to gas accumulation and
you referred to short procedures.
What's the short procedure in this context?
Yes.
Actually, it's a good question because I think the indications for
using V-gel are not super clear.
If you read the manufacturer's recommendations, you almost could
use it in every case or procedure.
What we concluded with in our study is that endotracheal intubation remains
the gold standard and the V-gel doesn't replace an endotracheal tube.
So yes, when I said short procedures, the question of when should we use a V-gel?
And actually the indications are not so wide.
I think it's very in interesting in those procedures that are quite minor and quite
short, such as castrations for cats, a small wound, radiotherapy, especially when
you have to anaesthetise the cats several times in the same week, for example.
Or abscesses procedures, maybe for abdominal ultrasounds as well.
When you have a critical patient that you have to induce and to maintain with
volatile anaesthesia it could be more interesting to have the V-gel rather
than to intubate the cats and finally I think it can be very interesting
in respiratory endoscopies for bronchoscopies in cats, tube or almost.
You can't have an intubated cat and the bronchoscope is going in the endotracheal
tube, so often what we do is that we have cats that are not intubated, and
it can be a little bit problematic when you have to ventilate the patient.
So, with the V-gel, it can be an alternative where you can pass
your bronchoscope into the V-gel.
And then you have this control of the upper airways and this ability
to ventilate with the V-gel during your bronchoscopic examination.
Again, I'm not saying that you can ventilate a patient for half an hour
with a V-gel because we don't know what could be the consequences, but
for several rescue ventilations let's say, it can be very interesting.
I've used it once in a patient that was very, very critical.
It was diaphragmatic hernia that we had to ventilate for a little
bit longer than the surgery.
And the cat was too awake to tolerate the endotracheal tube, but we could actually
place the V-gel and then we could have the complete control of the upper airway.
We could ventilate a little bit when it was necessary in a semi comatose
cat so it can be interesting on those cats that, let's say for example, a
status epilepticus or something like this where the cat is really too awake
to tolerate an endotracheal tube, but to anaesthetise or to be happy with the
cat, having nothing to protect the, or to trying to protect the upper airways.
Thank you so much for discussing all this 'cause those are things that you
didn't talk about in the article and I think it will be a great addendum.
Now,
Dr. Kelly St Denis will continue her conversation with Mary Ellen
Goldberg on physical rehabilitation in cats therapies and exercises.
Welcome Mary Ellen.
It's so exciting to talk to you again.
Thank you so much Dr. Kelly.
I appreciate y'all having me tremendously.
So when we're talking about physical rehabilitation in our cats, I
wondered is this something that any veterinary team member can do?
Yes, there are things that are definitely set aside for people that
are certified or have specialties in physical rehabilitation.
They can teach others in the practice how to do this, whether
it's other technicians or assistants.
So what type of things are we talking about?
Manual therapies such as massage or things like therapeutic laser or things like
PEMF and passive range of motion, you can do things like a big one that helps
with pain, cryotherapy, cold therapies.
That can help.
And the rule of thumb is the first 72 hours postoperative,
they like to use something cold.
After the 72 hours they like to switch it to heat.
Cats aren't always overjoyed with cold now when the, it may feel good when
they're waking up from surgery and that kind of thing, but don't get hysterical
if they're not gonna lay there and let you put ice packs on a specific
limb or something if they're mobile.
Now, the, you also have to be very concerned if they're on things
like opioids, postoperatively, they're not gonna be feeling
things the way they would.
And so you, as the person doing this, have to make sure that the time for cold
is limited, 10 to 15 minutes and no more because you don't want them to have
any problems that occur because of this, like frostbite or something like that.
Same rules would apply is that, when we're trying to keep patients
warm, is that we have to be very careful not to burn them, but.
Yes.
But what i'm saying is if you have an area where animals are recovering from
surgery anybody can do this with some coaching, training, that kind of thing.
And they'd probably be using those kind of in conjunction
with things like pain scales.
So acute pain scales like feline grimace scale.
One of the things I've taught my students to do is have the cage card on the cage
and it lets you know what time the next evaluation for pain is supposed to be.
So let's say they come out 30 minutes later, here's a cage card.
They can fill it out from the Glasgow pain scales.
And then if an animal needs intervention someone is contacted and says, will you
come look at this animal and tell me?
And the assistants can do that easily.
I love the feline grimace scale love, love it, and all the
work that has gone into it.
And that just really helps too, probably with applying these techniques
postoperatively 'cause I know in the article you do talk about the things
that you can do in that immediate postoperative period, and there's probably
a list of things that you shouldn't be doing in a postoperative period
in those kinds of situations as well.
So I know you covered that in the article, but that helps probably with
the pain management scales there to know if you're doing things, if it's
making a benefit for that patient, or if we should adjust what you're doing.
Absolutely.
And when you think about, so for instance, with passive range of motion exercises.
An animal that comes out of orthopaedic surgery, why do you want them to be able
to move the limb immediately or whatever?
You don't want adhesions or things to build up in that particular limb to
cause pain because if adhesions build up, to break them up so that the limb
can move normally is gonna hurt worse, is more painful.For our animal patients,
if they do a hip replacement or if they're doing femoral head osteotomy
or whatever, they get the patient up.
They don't want them just laying in the cape.
They may help them to stand and just hold them.
They even have these things, they're called physio balls that are used in
physiotherapy, whether the cat or a dog has neurological problems or orthopaedic
problems, you can help them stand over this so it supports their weight and they
can just touch their feet on the ground to get sensation back into their pads.
And all of this is very important, especially with neurological patients,
of stimulation and getting those nerve connections back and working normally.
You can take something like a brush or a toothbrush and rub it on the
foot, and those are the kinds of things that owners can be taught.
Owners can be taught how to do passive range of motion.
If people do their homework with their pet, it can help them save money and
that may be a big consideration for some.
Thank you so much for listening.
If you want more CPD from iCatCare and you're a iCatCare Veterinary
Society Member, on the 1st day of October you can start with our Monthly
Member Webinar where Dr Katie Tolbert will discuss gastroprotectants.
As always, a week later we will have an opportunity to join the speaker
live at our Monthly Clinical Club, as well as the other panelists, so you
can ask all your questions about the topic discussed and share any related
clinical cases you may be dealing with.
Don't forget that as an iCatCare Veterinary Society Member, you can
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including recordings of the webinars, clinical clubs and congress lectures,
the discussion forum and the resources library at portal.icatcare.org.
If your interested in our open access content, we have several
free access webinars coming.
On the 30th of September, Dr Becky Mullis will discuss Caring For The
Aging Cat - Managing Common Conditions and Maintaining Their Weight.
On the 16th of October, Dr Bill Saxon, a renowned specialist in internal medicine
and critical care, will discuss diagnosis and management of early feline cardiac
diseases if you want an update on this.
And a few days later on the 21st of October, Laura Watson, iCatCares Welfare
Coordinator, will explain everything about cat friendly kitten clinics.
So join us, spread the word and again thank you so much for joining us.
We will be back again next month with more from the world of Feline Medicine and the
Journal of Feline Medicine and Surgery.