Suspected lidocaine toxicity and the use of metoclopramide and neostigmine to treat post‐operative small intestinal ileus in a donkey

Abstract

A 17‐year‐old donkey underwent exploratory laparotomy to correct a caecal impaction via typhlotomy in combination with pelvic flexure enterotomy. Intravenous lidocaine (3 mg/kg/h; lidocaine 2% solution, BOVA Specials, London, UK) was administered throughout general anaesthesia following a loading dose (1.3 mg/kg, intravenously [IV]). The donkey recovered uneventfully. One hour after recovery, shortly after returning to the stable and commencement of lidocaine, the donkey showed ataxia, muscle fasciculations and tachycardia with progression to recumbency. Lidocaine toxicity was presumed, so the infusion was stopped and the donkey returned to standing. On Day 2 after surgery, post‐operative reflux was voluminous, so a metoclopramide infusion (0.04 mg/kg/h IV; metoclopramide 5 mg/ml injection, Siegfried Hameln, Hameln, Germany) was commenced. On Day 3, post‐operative reflux persisted, so a neostigmine infusion (0.008 mg/kg/h IV; neostigmine methylsulfate injection 2.5 mg/ml, Siegfried Hameln, Hameln, Germany) was also administered. Small intestinal motility improved by Day 5 and post‐operative reflux resolved by Day 6. Both infusions were stopped and food was re‐introduced. There was no further indication of gastrointestinal hypomotility and the donkey was discharged 11 days later.