This week the Cornell University Feline Health Center posted a report on their Facebook page about the negative consequences of using spring-loaded mouth gags in cats. The story soon went viral, popping up in the newsfeeds of hundreds of veterinary professionals around the world.
The story that went viral is indeed deserved of such noteworthy attention. It involves the use of common spring-loaded mouth gags which are utilised to keep an animal's mouth open during general anaesthetics. Ordinarily these are used during dental procedures or oral surgery in small animals but sometimes they are used to prevent an animal from biting down on the endotracheal tube and thus theoretically helping to maintain a clear airway.
This story immediately caught my attention as I have always been very reluctant to use these gags in cats. Not only does the continual force of the spring cause the cat's fragile jaw to be extended to an abnormal angle, but the metal framework of the gags often are traumatic to the delicate gingivae and tiny teeth. It turns out that my concerns were valid. The excessive opposition of the mandible as the mouth is forced open by the gag appears to result in a blockage of blood flow through the maxillary artery which could have serious consequences.
The significance of this relates to an interesting finding by the aforementioned Feline Health Center which reported that some cats experience post-anaesthetic blindness and while this is usually temporary, it is alarming to consider that it is likely iatrogenic in origin. A new study funded by the Feline Health Center sheds light on this finding with CAT scan images demonstrating how hyper-extension of the mouth cuts off blood flow to the brain and eye of cats.
This story is an important revelation for many reasons. First, the impact of social media to rapidly distribute this information could very well save the eyesight of a cat tomorrow when a spring-loaded gag is put aside instead of automatically being used during a feline anaesthetic. It is great to see stories like this reach people who may not have otherwise taken time to read journals this month, or kept abreast of the latest industry news. For that reason alone, social media is an important part of staying current in a rapidly evolving profession.
Second, the revelation of this phenomena in cats points to the importance of clinical research and the many ways that we can learn so much more about the patients that we work with every day by supporting rigorous and scientific process. Supporting research is important for our future and the development of our profession and as VNs we have an excellent insight about some key issues within the clinical setting which could do with further research.
Third, this story emphasises how easy it is to put our patients at risk with the simplest of actions, even when we think we are using the utmost of care. It's a good reminder to reconsider our actions every day, to evaluate the reasons why we are doing things a certain way, and to challenge old traditions. How many of us can say that we noticed that a cat's mouth was significantly distorted when the gag forced it open too far? If we did notice it, did we do something about it by mentioning it to others and changing the procedure?
Even the most basic of actions deserve to be critically evaluated and improved on. If we save just one life in our career because of it, it will be worth it.
We hope you enjoy this issue of The Veterinary Nurse.