Postoperative Hemostasis Monitoring and Management

Right atrial thrombus formation in a dog after successful electrical cardioversion for atrial fibrillation

Right atrial masses in dogs are commonly diagnosed as malignant tumors. This report describes a dog with a right atrial mass that appeared after successful electrical cardioversion of atrial fibrillation and resolved with antithrombotic treatment. A 9-year-old mastiff was presented for acute vomiting, and occasional cough of several weeks' duration. Ultrasonographic and radiographic examinations of the abdomen and chest identified mechanical ileus, as well as pleural effusion and pulmonary edema, respectively. Echocardiography indicated a dilated cardiomyopathy phenotype. During anesthetic induction for laparotomy, atrial fibrillation developed. Electrical cardioversion successfully restored sinus rhythm. An echocardiogram performed 2 weeks later disclosed a right atrial mass, which had not been apparent before cardioversion. Repeat echocardiography after 2 months of clopidogrel and enoxaparin treatment failed to detect the mass. Intra-atrial thrombus formation is possible after successful cardioversion of atrial fibrillation and should be considered as a differential diagnosis for echocardiographically detected atrial masses.

Influence of use of a bipolar vessel sealing device on short-term postoperative mortality after splenectomy: 203 dogs (2005-2018)

OBJECTIVE

To compare short-term postoperative mortality in dogs after splenectomy performed with or without a bipolar vessel sealing device (BVSD) and to identify variables associated with mortality.

STUDY DESIGN

Retrospective study.

SAMPLE POPULATION

Client-owned dogs (n = 203).

METHODS

Medical records of dogs that underwent splenectomy from 2005-2018 were reviewed. Mortality rates were compared between dogs that underwent splenectomy with or without BVSD. Causes of death and variables associated with short-term mortality were assessed.

RESULTS

Fifteen of 203 (7.4%) dogs died prior to discharge, and seven (3.4%) dogs died prior to suture removal for a total short-term mortality rate of 22 of 203 (10.8%). The estimated difference in proportion of deaths prior to discharge between the BVSD and non-BVSD groups was -0.01 (95% confidence interval = -0.08 to 0.06). Duration of anesthesia was longer when splenectomy was performed without BVSD (median 168 vs 152 minutes; P = .03). Multivariate analysis identified intraoperative (odds ratio [OR] 5.7) or postoperative (OR 13.6) administration of blood products, increasing duration of anesthesia (OR 1.15 per additional 16 minutes), and intraoperative ventricular arrhythmias (OR 6.8) as significantly associated with death prior to discharge. Intraoperative (OR 3.2) or postoperative (OR 7.7) administration of blood products was associated with death prior to suture removal.

CONCLUSION

Use of a BVSD did not appear to increase short-term mortality after splenectomy.

CLINICAL SIGNIFICANCE

Dogs undergoing splenectomy that require intraoperative or postoperative transfusions, experience intraoperative ventricular arrhythmias, or have prolonged anesthesia may be at risk for death in the short-term postoperative period.