Haemoabdomen cbd

ANAESTHETIC CASE BASED DISCUSSION

Haemoabdomen

Hal Drummond, Pako Tlhalerwa, Katie Jamieson, Tom Sparks

Case

A 10 year old German Shepherd dog weighing 40kg requires anaesthesia for exploratory laparotomy and possible splenectomy. The dog is in a collapsed state. Heart rate is 180 beats/min and femoral pulses are weak. Mucous membranes are pale but PCV is within the normal range (33%). Abdominal ultrasonography reveals the presence of free abdominal fluid and a splenic mass.

A 10 year old German Shepherd dog weighing 40kg requires anaesthesia for exploratory laparotomy and possible splenectomy. The dog is in a collapsed state. Heart rate is 180 beats/min and femoral pulses are weak. Mucous membranes are pale but PCV is within the normal range (33%). Abdominal ultrasonography reveals the presence of free abdominal fluid and a splenic mass.

Key Anaesthetic Considerations

Age- geriatric will lower metabolism there for altering effecting drug metabolism

German Shepherd-potential for cardiac disease(DCM) Splenectomy – likely to lose a significant amount of

blood Collapsed state Tachycardic (HR 180bpm) and weak femoral pulses –

hypovolaemia MM pale but PCV normal

Normal PCV indicates this is an acute bleed Fluids anaemic

Presence of free abdominal fluid and splenic mass – likely diagnosis ruptured haemangiosarcoma

Pain

Pre-op management

Check biochemistry/haematology prior to fluid administration to gauge organ function

Hypovolaemic – Fluids are vital. Must replace fluid deficit prior to surgrey. Shock rates at 90ml/kg of crystalloids for 15mins and then reassess vital parameters. These fluids should be continued well into the post operative period. Colloids should be considered but very expensive! Double IV access should be obtained to speed flid

delivery.

Which pre-medication?

Alpha 2? ACP? Benzodiazapine? Opioid?

Which pre-medication?

Alpha 2 ACP

Benzodiazapine Midazolam – 0.2mg/kg IV

Opioid Methadone – 0.2mg/kg IV

Induction

The animal should be induced with propofol (160mg/16ml) Alfaxalon is a suitable alternative if it

available but is more expensive Both induction agents should be titrated to

affect when used Assess eye position, reflex and jaw tone

Maintanence

Following induction the dog should be intubated (size 12 ET tube approx) and maintained on isoflurane

As this is a large breed dog, a circle or coaxial bain should be used to deliver the anaesthetic gas to the patient Want a circuit that is suitable for sustained IPPV if

the animal becomes apnoeic intra-operatively Setting up a ventilator would also be advised

Augmentin IV every 90 minutes during sx Avoid using NSAIDS in this case as potential

for renal failure.

Perioperative Management

Careful monitoring of HR, BP and RR is essential

Intravenous boluses of fentanyl would be appropriate in this case to deal with noxious stimulus Dose – 40 - 200μg q20 mins as necessary

Augmentin IV should be continued every 90 minutes throughout the procedure

Post-op treatment

ICU Fluids should be continued and

reassessed every half hour Pain should be assessed every hour

according to Glasgow Pain score and further analgesia should be administered if required

Monitor HR, RR, MM and pulse quality

Questions?