Abstract
Observations
A 9 year-old, 40 kg, female spayed Bouvier des Flandres was anesthetized for surgical
removal of an intra-cardiac mass. Pre-anesthetic work-up included thoracic radiographs,
which revealed moderate pleural effusion, and cardiac ultrasound, which identified
a mass attached to the wall of the right ventricular outflow tract (RVOT). The mass
caused dynamic obstruction of the RVOT during systole. The dog was pre-medicated with
intravenous (IV) hydromorphone (0.05 mg kg−1). Following pre-oxygenation, anesthesia was induced with ketamine (3.75 mg kg−1, IV) and diazepam (0.18 mg kg−1, IV). Anesthesia was maintained with isoflurane in oxygen, an intravenous constant
rate infusion (CRI) of fentanyl (10–30 μg kg−1 hour−1) and a CRI of lidocaine (50–200 μg kg−1 minute−1). A right lateral thoracotomy was performed. The heart was stopped transiently with
a cold cardioplegic solution for 7.83 minutes to allow the removal of the mass through
an open-heart procedure. No cardiopulmonary bypass was used. The heart was successfully
restarted after cardiopulmonary resuscitation with internal cardiac massage and internal
defibrillation. The dog recovered uneventfully from anesthesia without any apparent
neurological sequelae. Post-operative analgesia consisted of intercostal nerve blocks
with bupivacaine, CRIs of fentanyl (2–5 μg kg−1 hour−1) and lidocaine (40 μg kg−1 minute−1) and with oral meloxicam (0.1 mg kg−1). Five days following surgery, the dog was discharged from the hospital. Histopathology
and immunohistochemistry of the mass identified an ectopic thyroid carcinoma.
Conclusions
This case showed the feasibility of whole body hypothermia and using a cold cardioplegic
solution to induce cardiac arrest for a short open-heart procedure.
Keywords
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Article info
Publication history
Accepted:
May 16,
2008
Received:
March 27,
2008
Identification
Copyright
© 2009 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Inc. All rights reserved.