Anesthetic management of a dog with severe subaortic stenosis and mitral valve disease complicated with atrial fibrillation undergoing ovariohysterectomy

Abstract

The anesthetic management in patients with subaortic stenosis and mitral valve disease should involve intensive monitoring and the anesthesiologist’s main concern is to ensure oxygen delivery and tissue perfusion. Since anesthetic procedures in such patients are rare, there is no previous report about the anesthetic management. A 5.5-year old, 32-kg Boxer, suffering a severe heart disease due to a final stage subaortic stenosis and mitral insufficiency, was anesthetized for an ovariohysterectomy to remove an ovarian tumor that was producing high-volume ascites. Methadone (0.3 mg kg −1 ) was administered intramuscularly (IM) for pre-anesthetic medication, etomidate (1.3 mg kg −1 ) and midazolam (0.2 mg kg −1 ) were used for the induction of anesthesia and after endotracheal intubation, anesthesia was maintained with sevoflurane vaporized in oxygen and air. Fentanyl (5–10 μg kg −1 h −1 ) and paracetamol (15 mg kg −1 ) were administered to improve analgesia. Previous persistent atrial fibrillation was refractory to medication (digoxin, diltiazem, and pimobendan) and continued during the anesthetic procedure. Dobutamine (1.5–5 μg kg −1 minute −1 ) helped to maintain mean arterial blood pressure above 60 mmHg. Epidural morphine (0.1 mg kg −1 ) and incisional bupivacaine (2 mg kg −1 ) were administered at the end of surgery to provide postoperative analgesia. Anesthesia was otherwise uneventful, and recovery was considered excellent.

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

“…The main haemodynamic goals in the anaesthetic management of this patient included preservation of preload due to increased intrapericardial and intracardiac pressure and compromised cardiac chamber filling, and control of HR to maintain atrial contribution to ventricular filling and avoid decreased CO. 3 Another important goal was to maintain or improve contractility, important in patients with increased ventricular and atrial dimensions and associated decreased myocardial contractility. 42,28 Moreover, the presence of AF is another anaesthetic concern, as the characteristic uncoordinated atrial activity interferes with atrial contraction and leads to a reduced CO. 10 Methadone administered IV was expected to provide adequate perioperative sedation and analgesia with minimal effect on cardiovascular function. 43,44 Methadone may also decrease HR, which is desirable as tachycardia and AF increase myocardial oxygen demand and reduce CO. 45 For induction of general anaesthesia, midazolam was chosen to enhance the quality of sedation and muscle relaxation with no clinically detectable cardiovascular changes.…”

“…The main haemodynamic goals in the anaesthetic management of this patient included preservation of preload due to increased intrapericardial and intracardiac pressure and compromised cardiac chamber filling, and control of HR to maintain atrial contribution to ventricular filling and avoid decreased CO 3 . Another important goal was to maintain or improve contractility, important in patients with increased ventricular and atrial dimensions and associated decreased myocardial contractility 42,28 . Moreover, the presence of AF is another anaesthetic concern, as the characteristic uncoordinated atrial activity interferes with atrial contraction and leads to a reduced CO 10 …”

Multimodal anesthesia associated with regional block in a dog who underwent corrective surgery for persistent right aortic arch: case report

“…Therefore, inadequate or negligent management of pain control can lead to severe postoperative complications for the patient. Such complications include hypertension that can increase bleeding risks, tachycardia, and arrhythmias, which can compromise cardiac output (ARENILLAS; CARO-VADILLO;DE SEGURA, 2019), in addition to the development of chronic pain (SILVA et al, 2008).…”

Anaesthetic management of a dog with severe pulmonary stenosis and R2A right coronary artery anomaly undergoing placement of a hybrid transventricular pulmonary stent

“…30 Inhalants would have played a role producing dose-dependent decrease in cardiac output, myocardial contractility and systemic vascular resistance, leading to decreased arterial blood pressure. 59,60 Dobutamine between 1 and 7 μg/kg/min was used to increase blood pressure. Dobutamine is an agonist of β 1 adrenergic receptors, which has dose-dependent positive inotropic effects.…”

“…In severe PS, the right ventricle stroke volume is reduced, which in turn will impair the left ventricle output, resulting in low systemic arterial blood pressure 30 . Inhalants would have played a role producing dose‐dependent decrease in cardiac output, myocardial contractility and systemic vascular resistance, leading to decreased arterial blood pressure 59,60 …”