Incidence of post-anaesthetic arrhythmias in dogs

Development of perioperative premature ventricular contractions as an indicator of splenic hemangiosarcoma and median survival times

OBJECTIVE

The objectives of this study are (1) to determine whether there is an association between dogs with splenic hemangiosarcoma (HSA) and the development of premature ventricular contractions (VPCs), (2) to determine if there is a higher likelihood for dogs with ruptured splenic masses to be diagnosed with HSA and to develop VPCs, (3) to determine if the development of VPCs affects median survival times compared to dogs with benign or non-HSA malignant splenic masses.

STUDY DESIGN

Retrospective case series.

ANIMALS

Forty-five dogs.

METHODS

Medical records of dogs undergoing splenectomy were reviewed for signalment, perioperative electrocardiogram (ECG), hematological values, histologic diagnosis, metastasis, and survival times. ECGs were performed preoperatively, intraoperatively, and continuously postoperatively. The presence of VPCs was recorded. The data were evaluated for an association between the development of VPCs and the histologic diagnosis of HSA.

RESULTS

Eighteen out of 45 (40%) dogs were diagnosed with HSA with 13/18 (72%) dogs having VPCs postoperatively (P = .02). Ruptured splenic HSA and VPCs were noted in 13 dogs (P = .73). An association between dogs with and without VPCs diagnosed with HSA and median survival times could not be established.

CONCLUSION

Postoperative VPCs were more likely with splenic HSA. Splenic masses were more likely to be HSA if ruptured but less likely to develop VPCs. Development of VPCs does not affect median survival times.

CLINICAL SIGNIFICANCE

Development of postoperative VPCs may be a potential indicator of HSA, however, this warrants further investigations. Development of VPCs does not have a deleterious effect on survival.

Anesthetic risk during subsequent anesthetic events in brachycephalic dogs that have undergone corrective airway surgery: 45 cases (2007-2019)

OBJECTIVE

To determine whether previous corrective upper airway surgery in brachycephalic dogs would decrease perianesthetic complications in subsequent anesthetic events.

ANIMALS

45 client-owned dogs.

PROCEDURES

Brachycephalic dogs undergoing any combination of staphylectomy, nasal alaplasty, or laryngeal sacculectomy that were anesthetized at a later date for additional surgical procedures or imaging from August 2, 2007, to February 8, 2019, had their medical records reviewed during both anesthetic events for signalment, American Society of Anesthesiologists status, perianesthetic drug administration, anesthetic duration, presence and total time of positive-pressure ventilation, procedure invasiveness, and perianesthetic complications such as bradycardia, hypothermia, hypotension, cardiac arrhythmias, hypertension, vomiting or regurgitation, dysphoria, respiratory distress, hypoxemia, reintubation, and prolonged periods of recovery.

RESULTS

The odds of having complications during the postanesthetic period following subsequent anesthetic events were decreased by 79% in dogs having previous surgical intervention to correct clinical signs of brachycephalic airway syndrome. Intra-anesthetic bradycardia increased the odds of developing a postanesthetic complication by 4.56 times. Every 15-minute increase in anesthetic duration increased the odds of having a postanesthetic complication by 12% and having an intra-anesthetic complication by 11%.

CONCLUSIONS AND CLINICAL RELEVANCE

Previous corrective upper airway surgery decreased odds of postanesthetic complications in brachycephalic dogs that underwent subsequent anesthetic events. Findings in this study indicated that corrective upper airway surgery for brachycephalic dogs may reduce postanesthetic complications following subsequent anesthetic events, which may reduce perianesthetic morbidity in patients undergoing multiple surgical or diagnostic imaging procedures.

The prevalence and nature of cardiac arrhythmias in horses following general anaesthesia and surgery

Background

The prevalence and nature of arrhythmias in horses following general anaesthesia and surgery is poorly documented. It has been proposed that horses undergoing emergency surgery for gastrointestinal disorders may be at particular risk of developing arrhythmias. Our primary objective was to determine the prevalence and nature of arrhythmias in horses following anaesthesia in a clinical setting and to establish if there was a difference in the prevalence of arrhythmias between horses with and without gastrointestinal disease undergoing surgery. Our secondary objective was to assess selected available risk factors for association with the development of arrhythmias following anaesthesia and surgery.

Methods

Horses with evidence of gastrointestinal disease undergoing an exploratory laparotomy and horses with no evidence of gastrointestinal disease undergoing orthopaedic surgery between September 2009 and January 2011 were recruited prospectively. A telemetric electrocardiogram (ECG) was fitted to each horse following recovery from anaesthesia and left in place for 24 hours. Selected electrolytes were measured before, during and after surgery and data was extracted from clinical records for analysis. Recorded ECGs were analysed and the arrhythmias characterised. Multivariable logistic regression was used to identify risk factors associated with the development of arrhythmias.

Results

Sixty-seven horses with gastrointestinal disease and 37 without gastrointestinal disease were recruited. Arrhythmias were very common during the post-operative period in both groups of horses. Supra-ventricular and bradyarrhythmias predominated in both groups. There were no significant differences in prevalence of any type of arrhythmias between the horses with or without gastrointestinal disease. Post-operative tachycardia and sodium derangements were associated with the development of any type of arrhythmia.

Conclusions

This is the first study to report the prevalence of arrhythmias in horses during the post-operative period in a clinical setting. This study shows that arrhythmias are very common in horses following surgery. It showed no differences between those horses with or without gastrointestinal disease. Arrhythmias occurring in horses during the post-anaesthetic period require further investigation.

Clinical evaluation of a new formulation of propofol in a medium-chain and long-chain triglycerides emulsion in dogs

Propofol formulated in a mixed medium-chain and long-chain triglycerides emulsion has been recently introduced for clinical use as an alternative to the conventional long-chain triglycerides formulation. This prospective multicentric study evaluated the clinical effectiveness and the complications associated with the use of this new formulation of propofol in dogs. Forty-six Spanish veterinary clinics participated in this study. A total of 541 anaesthesias (118 ASA I, 290 ASA II, 101 ASA III and 32 ASA IV) performed for various diagnostic and therapeutic purposes were evaluated. The anaesthetic protocol was not controlled, with the exception that propofol had to be used at least for induction of anaesthesia. The induction dose of propofol and the incidence of anaesthetic complications throughout the procedure were recorded. A chi-square test compared the incidence of complications according to the maintenance agent used (propofol vs. inhalatory anaesthesia), anaesthetic risk (ASA classification) and the reason for the anaesthesia. The patients premedicated with alpha2 agonists needed lower doses (mean +/- SD, 2.9 +/- 1.3 mg/kg i.v.) than the animals premedicated with phenothiazines (3.9 +/- 1.4 mg/kg i.v.) or benzodiazepines (4.0 +/- 1.4 mg/kg i.v.). The most frequent complications were difficult endotracheal intubation (1.3%), postinduction apnoea (11.3%), cyanosis (0.6%), bradypnoea (2.6%), tachypnoea (2.8%), bradycardia (2%), tachycardia (2.6%), hypotension (0.2%), shock (0.2%), vomiting (4.6%), epileptiform seizures (2.8%), premature awakening (7.4%) and delayed recovery (0.9%). There were no cases of pain on injection or aspiration pneumonia. Three dogs died (0.55%), one during induction and two during recovery from anaesthesia. This study demonstrates that the new formulation of propofol is an useful and effective drug to induce general anaesthesia in dogs.