Advanced Atrio-Ventricular Blocks in a Foal Undergoing Surgical Bladder Repair: First Step to Cardiac Arrest?
Abstract: A 3-day-old Swiss Warmblood colt was diagnosed with uroabdomen after urinary bladder rupture. The foal had classical electrolyte abnormalities (hyponatremia, hypochloremia and hyperkalemia) on presentation. The foal was supported prior to surgery with intravenous fluids and the electrolyte abnormalities were treated with physiologic saline, glucose and insulin. Urine could not be drained from the abdomen prior to surgery because the omentum was continuously occluding the drainage cannula and due to progressive abdominal distension, it was decided to pursue surgery without further correction of electrolyte abnormalities. After induction of anaesthesia, signs of hypoxemia were present. Controlled mandatory ventilation using a pressure-controlled ventilation mode with positive end-expiratory pressure was initiated. Urine was drained from the abdomen by free flow. Atrio-ventricular (AV) blocks unresponsive to intravenous antimuscarinic drugs developed. After low dose of epinephrine and cardiac massage, sinus rhythm was restored. Surgery was completed successfully and the foal recovered from anaesthesia. The postoperative period was uneventful and the foal was discharged from the hospital three days later. Based on a clinical case, the purpose of the manuscript is to provide the clinician with potential causes, prevention and treatment of this already known but rarely observed dysrhythmia which could lead to fatal consequences. Definitions of cardiac arrest and asystole are reappraised. We discuss the fact that advanced AV-blocks should be treated as a cardiovascular emergency with advanced life support. The early recognition of advanced AV blocks is the first step to reduce perioperative mortality and morbidity of foal suffering from uroabdomen.
Publication Date: 2018-06-08 PubMed ID: 29951488PubMed Central: PMC6008567DOI: 10.3389/fvets.2018.00096Google Scholar: Lookup
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Summary
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This research article tells the story of a 3-day-old foal who survived a surgical operation for a ruptured urinary bladder, despite suffering advanced atrio-ventricular (AV) blocks, a life-threatening heart condition. The authors discuss the importance of early detection and treatment of advanced AV-blocks in reducing perioperative mortality and morbidity in foals with uroabdomen.
Clinical Case
- The colt was diagnosed with uroabdomen, a condition resulting from urinary bladder rupture. It presented with several electrolyte abnormalities such as hyponatremia (low sodium), hypochloremia (low chloride), and hyperkalemia (high potassium).
- Pre-surgical interventions involved intravenous fluid therapy using physiologic saline, glucose, and insulin. However, the continuous obstruction of the drainage cannula by the omentum made preoperative correction of the electrolyte abnormalities and urine drainage from the abdomen impossible.
- Hypoxemia was observed after surgery was initiated, prompting the anesthetist to apply pressure-controlled ventilation with positive end-expiratory pressure.
- The appearance of AV blocks in the foal during surgery, unresponsive to the administered intravenous antimuscarinic drugs, escalated the peril. Sinus rhythm was restored through a low dose of epinephrine and cardiac massage.
- Despite the setbacks, the surgery was successfully completed and the foal comfortably transitioned from anesthesia. The foal was fit enough to be discharged from the hospital three days later.
Purpose of the Manuscript
- Through this case, the researchers aim to contemplate and establish the potential causes, preventive measures, and courses of treatment for the relatively uncommon dysrhythmia that was observed in the foal. This dysrhythmia has potentially lethal implications.
- The authors also aim to shed light on how definitions of cardiac arrest and asystole are applicable in the context of this study.
- The report underscores the criticality of advanced AV-blocks, suggesting that such instances should be treated as cardiovascular emergencies that necessitate advanced life support.
- There is demand for the reinforcement of the idea that to reduce the risks of death and disease around surgical procedures, again using the case of the foal with uroabdomen as an example, the early recognition and active management of advanced AV-blocks are fundamental.
Cite This Article
APA
Marolf V, Mirra A, Fouché N, Navas de Solis C.
(2018).
Advanced Atrio-Ventricular Blocks in a Foal Undergoing Surgical Bladder Repair: First Step to Cardiac Arrest?
Front Vet Sci, 5, 96.
https://doi.org/10.3389/fvets.2018.00096 Publication
Researcher Affiliations
- Department of Clinical Veterinary Science, Division of Anaesthesiology and Pain Treatment, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
- Department of Clinical Veterinary Science, Division of Anaesthesiology and Pain Treatment, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
- Swiss Institute of Equine Medicine (ISME), Vetsuisse-Faculty, University of Bern and Agroscope, Bern, Switzerland.
- Swiss Institute of Equine Medicine (ISME), Vetsuisse-Faculty, University of Bern and Agroscope, Bern, Switzerland.
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