01/14/2023
Gastric dilation and volvulus (GDV) is a relatively common surgical emergency seen in dogs. The anesthetic management of these dogs can be challenging due to the emergent need for surgical intervention, but also because of the wide range of complex changes that can occur in dogs as a result of this pathology. Bonnie Gatson successfully managed not one, but TWO GDV cases this past week! Here are a small handful of tips and tricks on successful anesthetic management of these cases:
~Measure lactate values throughout the resuscitation period prior to anesthesia - if they begin to decline as the animal receives appropriate fluid therapy, then the chance of successful anesthetic management increases significantly! However, it is possible that lactate values may increase in the immediate post-operative period after stomach rotation and decompression, as less oxygenated tissues begin to receive adequate circulation.
~ Place two intravenous catheters and an arterial line (if possible) to measure direct blood pressure, as these animals can undergo sudden changes in their peripheral circulation throughout the surgical procedure.
~ Mechanical ventilation is preferred, as a large distended stomach can compromise appropriate ventilation. However, remember that mechanical ventilation can decrease preload, negatively effecting cardiac circulation. I tend to start patients on mechanical ventilation, but will switch to spontaneous ventilation if cardiac depression is significant following initiation of mechanical ventilation.
~ Any induction protocol will suffice, as long as it allows rapid intubation and inflation of the endotracheal tube to secure the airway!
~ Place ECG leads on the patient prior to anesthetic induction. I find that you are very unlikely to completely eliminate all cardiac arrhythmias prior to general anesthesia and this should not be a reason to delay cases. However, treatment of life-threatening arrhythmias, such as sustained high-rate ventricular tachycardia shown below, should be prioritized.
~Lidocaine constant-rate infusions during surgery and in the 24 hours following anesthetic recovery have been shown to decrease the rate of life-threatening cardiac arrhythmias and acute kidney injury in the post-operative period, allowing patients to be discharged from the hospital more quickly. (https://pubmed.ncbi.nlm.nih.gov/22805421/) The dose is a 2 mg/kg IV bolus followed by a constant rate infusion of 30 mcg/kg/min.
For more tips like these, remember that Safe Harbor Anesthesia provides training and CE for veterinarians and staff members. Contact us today if you need any refresher training on the anesthetic management of GDVs, or other common emergency patients.
Availability of the anesthesiologist may change on a week-by-week basis. Please contact us to check for availability and scheduling.
