Anaesthetic management in a dog with constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation undergoing subtotal pericardiectomy

Abstract

A 2‐year 8‐month‐old female dobermann presented for a recheck after previous crown reduction and vital pulp therapy. On cardiac auscultation, rapid and irregularly irregular heart rhythm and irregular and asynchronous pulses were detected. On electrocardiogram and transthoracic echocardiogram, findings were suggestive of constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation. Subtotal pericardiectomy was performed. The patient was premedicated with methadone (0.2 mg/kg intravenously), and anaesthesia was induced with midazolam (0.2 mg/kg intravenously) and propofol (60 mg), and maintained with isoflurane in oxygen. Constant‐rate infusions of fentanyl (0.1–0.2 µg/kg/min) and lidocaine (50 µg/kg/min) were administered. Dobutamine (1–5 µg/kg/min) helped to maintain mean arterial blood pressure above 65 mmHg. Fluid resuscitation and noradrenaline infusion (0.1 µg/kg/min) started after constriction was released to optimise preload. Haemodynamic support and ventricular rate control continued during the immediate postoperative period. Recovery from general anaesthesia was uneventful.

Successful medical management of septic pericardial effusion in a dog

“…17 An optimal consensus treatment protocol for dogs with pericardial effusion is lacking 6 ; however, pericardiectomy is often recommended to permanently avoid further abnormal fluid accumulation (regardless of the aetiology) and reduce risk of constrictive pericarditis development. 18,19 Constrictive pericarditis is characterised by loss of elasticity, fibrosis and increased thickness of the pericardium, usually secondary to chronic inflammation. 19,20 A poorly compliant pericardium will limit cardiac filling, consequently reducing diastolic function and stroke volume.…”

“…18,19 Constrictive pericarditis is characterised by loss of elasticity, fibrosis and increased thickness of the pericardium, usually secondary to chronic inflammation. 19,20 A poorly compliant pericardium will limit cardiac filling, consequently reducing diastolic function and stroke volume. 20 Clinically, this will manifest with signs of right-sided heart failure, such as ascites, exercise intolerance, collapse, weakness and lethargy.…”

“…An optimal consensus treatment protocol for dogs with pericardial effusion is lacking 6 ; however, pericardiectomy is often recommended to permanently avoid further abnormal fluid accumulation (regardless of the aetiology) and reduce risk of constrictive pericarditis development 18,19 …”

“…Constrictive pericarditis is characterised by loss of elasticity, fibrosis and increased thickness of the pericardium, usually secondary to chronic inflammation 19,20 . A poorly compliant pericardium will limit cardiac filling, consequently reducing diastolic function and stroke volume 20 .…”