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Incorrect anaesthetic breathing system setup and suspected vagal response with subsequent cardiac arrest in a dog undergoing thyroidectomy

Published:November 22, 2021DOI:https://doi.org/10.1016/j.vaa.2021.11.002
      An 11 year-old neutered female crossbreed dog weighing 7.8 kg presented to the Small Animal Teaching Hospital of the University of Liverpool for thyroid carcinoma excision. Physical examination was unremarkable. Total thyroxine measured within normal limits. Premedication consisted of methadone (Synthadon; Animalcare, Netherlands) 0.2 mg kg–1 and medetomidine (Sedator; Dechra, UK) 0.01 mg kg–1 administered intramuscularly. A 22 gauge intravenous (IV) cannula (Zoetis, Jiangsu, China) was placed in the right cephalic vein. Following preoxygenation, anaesthesia was induced with propofol (PropoFlo; Zoetis, UK) 1 mg kg–1 and ketamine (Ketamidor; Chanelle, UK) 1 mg kg–1 IV. Orotracheal intubation was performed with a 7.5 mm internal diameter cuffed endotracheal tube (ETT) (VentiSeal HVLP Cuffed; Flexicare, UK). The cuff was inflated until no leak was detected following delivery of a manual breath and the ETT was connected to a Mapleson D nonrebreathing system (Intersurgical Ltd, UK) delivering isoflurane (IsoFlo; Zoetis, UK) in oxygen. Anaesthetic monitoring in the preoperative room and in theatre consisted of electrocardiography (ECG), pulse oximetry, side-stream capnography with volatile agent analyser and oesophageal temperature using a thermistor probe (Datex AS/3 Compact multiparameter monitor; GE Healthcare, OR, USA). The left dorsal pedal artery was cannulated for invasive blood pressure (IBP) measurement. IV fluid therapy was administered at 4 mL kg–1 hour–1 using Hartmann’s solution (Aqupharm-11; Animalcare, UK) and ketamine was administered as an infusion at 0.01 mg kg–1 minute–1. Once in theatre the dog was positioned in dorsal recumbency and connected to a different Mapleson D system at a flow of 2 L minute–1.
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