Transcript Gastric Dilation Volvulus (GDV) Surgery

Pharmacology and Pharmacy
VETE 4305
02/22/2015
Jennifer Hohle, LVT
Ashley Lawley, LVT
Michelle Hervey, LVT
A three-year-old intact male Great Dane was presented with a history
of abdominal distention and retching. The owner had noticed the
retching several hours earlier, but thought the dog had eaten
something it found in the yard. Upon recognizing the abdominal
distention, the owner immediately brought the dog to your clinic.
Radiographs revealed a gas distended stomach with classic “doublebubble” sign. The veterinarian suspected gastric dilation volvulus and
the dog was brought immediately into surgery.
http://www.tiararadoanimalhospital.com/wpcontent/uploads/dane-home2.png
http://arlingtonvet.com/files/gdvedited.jpg
In this particular case there are a few things to watch for
• First – Great Danes run the risk of cardiac arrythmias.
• Second – If the patient becomes bradicardic during
anesthesia a drug like glycopyrrolate should be
administered.
http://adventistheart.org/userfiles/im
ages/newsiteimages/Arrh1.jpg
http://www.acesurgical.com/media/cata
log/product/cache/1/image/800x800/9df
78eab33525d08d6e5fb8d27136e95/9/5/95
01681_01_15.jpg
Volvulus
Hypovolemic Shock
 Means twisting
 Is caused by rapid or severe fluid
 In this case twisting of the
loss.
 Corrected by bolus of
intravenous fluids
stomach.
http://www.weimaraner-puppies.com/wpcontent/uploads/2014/02/dog-bloat.jpg
http://o.quizlet.com/qx5V.stoVEiGE88oO7CSQ.png
What is an ASA?
Explain the clinical significance
of a Class IV assignment.
 ASA stands for American Society
 It ranges from ASA I (normal,
of Anesthesiologists
 ASA is a classification for
patients going under anesthesia
to determine their anesthetic
risk.
healthy patient) to ASA VI (no
brain activity).
 This particular patient was given
a grade of ASA IV, meaning that
this is a patient with severe
systemic disease that is life
threatening (Thomas, 25).
Please describe the actions you will take to determine why
the animal is responding to stimuli/rapidly lightening up.
First - Check Equipment
1.
2.
3.
4.
5.
Vaporizer – sufficient anesthetic gas (Isoflurane).
Endotracial tube – patient is not breathing around the tube.
Rebreathing tube – hooked up properly to the machine. Inspiration and
expiration is hooked up correctly.
CO2 Canister – soda lime is not exhausted and is tightly sealed.
Bag – no new leaks in the bag, and the correct size bag is being used for
this patient.
Second – Check Patient
1.
Patient’s anesthetic plane was not compromised by shallow respiration
(Bauer, 2010, pp. 8-16).
Please describe the clinical signs associated with
excessive anesthetic depth.
• Decreased Respiratory Rate (< 12 RPM)
• Bradycardia (<60 BPM)
• Decreased SPO2 (<95 SPO2)
• Pale Mucus Membranes
http://www.paragonmed.com/sm_mo
nitor_pic/9500_small.jpg
• Dilated Pupils
http://www.animaleyeassociatesstl.com/
wpimages/wp02d553e8_05.jpg
http://image.slidesharecdn.com/anesthesia
monitoringbulger-130213075850phpapp01/95/anesthesia-monitoringbulger-79-638.jpg?cb=1360764197
 First – decrease or turn off vaporizer.
 Second – bag patient with pure oxygen every 5 seconds
until normal vitals return, and can safely get the
patient back to stage 3, plane 1 or 2 anesthetic depth
(Bauer, 2010, pp. 8-16).
 Third – increase IV fluids to help increase patient’s
blood pressure.
The animal’s depth of anesthesia is determined by evaluating reflexes without
using any equipment, and response of vital signs to surgical stimulation using
equipment such as heart rate and respiratory rate monitors.
1.
Swallowing – monitored by observing movement in the ventral neck. This
shows that the animal is too light under anesthesia. If not shown, animal is
in a moderate plane.
2.
Pedal – Notice by pinching a digit and observing whether the animal flexes
the leg or withdraws the paw. Due to this being lost during inductions, if
the animal shows this reflex, it is too light under anesthesia.
3.
Palpeberal – Tested by lightly tapping the medial cantus of the eye and
observing whether the animal blinks in response.
4. Corneal – Obtained by gentle palpation of the lateral aspect of the cornea
which causes reflex closure of the eyelids. Not always reliable in a dog.
5.
Lacrimation - Tear formation
6.
Laryngeal – Stimulated by attempting to pass an endotracheal tube.
Disappears in light anesthesia.
7.
Pupillary Responses – Heavily influenced by pre-medication. In an unpremedicated patient, the pupil is dilated in the early excitement phase and
then becomes progressively constricted as surgical anesthesia occurs. With
very deep surgical anesthesia the pupil begins to dilate again and with entry
into phase 4, with respiratory and cardiac arrest, the pupil is maximally
dialated.
8.
Muscle Relaxation
http://www.nhvetspecialists.com/wp-content/uploads/2013/07/surgical-suitesurgery-in-progress-300x217.jpg
Five Stages of Anesthesia
1.
lost Not anesthetized
2.
Excitatory phase, loss of consciousness
3.
Surgical Anesthesia
Plane 1 – Light anesthesia. Palpebral reflex is present.
Plane 2 – Moderate anesthesia. Adequate for all procedures.
Laryngeal reflexes are lost.
Plane 3 – Deep Anesthesia. No lacrimation, cornea is dry. Animal
is receiving too much anesthesia and should be lightened.
4.
Overdose
5.
Death
The swallowing reflex is usually last under a medium plane of anesthesia.
The pedal reflex is usually lost during induction.
The palpebral reflex is during a light plane of anesthesia.
 White – Right Forelimb proximal to elbow
 Black – Left hind limb proximal to elbow
 Red – Left hind limb proximal to stifle
 Green – Right hind limb proximal to stifle
 Brown – Ventral chest above the heart
http://vetgirlontherun.com/wp-content/uploads/2014/04/OptECG2300x225.jpg
Please state where you will apply each of the following colors:
White, Black, Red, Green, and Brown.
 White-Proximal to the elbow on the
right forelimb.
 Black-Proximal to the elbow on the
left forelimb.
 Green-Proximal to the stifle right
hind limb.
http://www.sz-wholesaler.com/p/670/676-1/onepiece-5-lead-cable-bd-mc05-268332.html
 Red-Proximal to the stifle left hind
limb
 Brown-Ventral chest above the
heart.
http://www.datasci.com/images/cardiovascularecg/jet-electrode-placement.png?sfvrsn=0
What is a PVC? What are
common causes of PVC?
“Classic Looking” PVC
 A PVC is a beat originating from
 PVC is something that would be
ventricles instead of the SA node,
causing the ventricles to contract
before the atria, and resulting in a
decrease in the amount of blood
pumped to the body (Romich
2010).
 PVCs can be caused by heart
disease, drugs, hypoxia, acid-base
or electrolyte disorders (Thomas
2011).
 PVCs can also be caused by
restrain of a fearful animal. This
can cause epinephrine release and
cause a PVC (Thomas 2011).
seen in this case due to the acidbase imbalance, and once the
stomach is untwisted could
cause epinephrine release in the
patient.
http://www.favoriteplus.com/blog/wpcontent/uploads/2013/05/trigeminy.jpg
What is the medical term for
this phenomenon?
What drug is most commonly
used to treat this condition?
 Premature Ventricular
 Lidocaine 1% 0r 2% most commonly
Contractions is the medical term
for PVC.




http://s1.hubimg.com/u/6020172_f248.jpg

used.
Used because it depresses
myocardial excitability.
Used IV to control or treat PVCs and
ventricular tachycardia.
Side effects are rare (Romich 2010).
Procainamide, tocainide, and
mexiletine can be used but can
cause ataxia, unsteadyness,
vomiting, diarrhea, hypotension
and weakness.
In this case the other medications
would not be recommended
because of side effects.
How many mL of fluid will the dog receive during the
first hour of anesthesia?
Conversion Formula:
 Wt(lb) x 1kg/2.2lb x mL/kg/hr =
Answer in mL/hr
Conversion with animals
weight in pounds:
 150 lb x 1kg/2.2 lb = 68.2 kg
 68.2 kg x 1mL/1kg/1hr=682 mL/1 hr
http://www.countryviewvets.com/photos/s
lideshows/data/images1/iv_fluids.jpg
Conversion Formula:
•
mL/hr x 1hr/60 min. x gtt/mL =
Answer in gtt/min.
•
gtt/min. x 1 min./60 sec. = Answer in
gtt/sec.
Conversion with patients
calculated amount of
fluids.
•
682 mL/hr x 1 hr/60 min. x 10 gtt/mL =
114 gtt/min.
•
114 gtt/min. x 1 min./60 sec. = 2 gtt/sec.
http://www.peteducation.com/i
mages/articles/8744fluids.jpg
http://www.drsfostersmith.com/
product/prod_display.cfm?pcatid
=1452
The patient recovered from surgery very well and will remain in the
clinic for the next 3-7 days for observation. GDV surgery is an extremely
severe condition and the patient is lucky the client brought him to the
clinic in time. When the patient is stable enough to go home the client
can take him home.
http://www.birchhaven.org/wpcontent/uploads/2009/04/img_9043-medium.JPG
Anesthesia Monitoring.(2015, January 1). Retrieved February 23,
2015, from http://www.ruralaeavet.org/PDF/AnesthesiaPatient_Monitoring.pdf
Bauer, M., (2010). Anesthesia. In The Veterinary Technician’s Pocket
Partner. (pp. 8-16.Clifton Park, NY, Delmar Cengage Learning.
Print
Ettinger, S.J., Feldma, E.C..Textbook of Veterinary Internal
Medicine.W.B. Saunders, Philadelphia. Print
Romich, Janet, A.(2010).Fundamentals of Pharmacology for
Veterinary Technicians Second Edition.Delmar, Cengage
Learning. Print
Thomas, J., A., Lerche, P.,(2011).Anesthesia and Analgesia for
Veterinary Technicians Fourth Edition. St. Louis, MO, Mosby
Elsevier. Print