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Frontiers in veterinary science2018; 5; 96; doi: 10.3389/fvets.2018.00096

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.
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Publication Date: 2018-06-08 PubMed ID: 29951488PubMed Central: PMC6008567DOI: 10.3389/fvets.2018.00096Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

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

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 5
Pages: 96
PII: 96

Researcher Affiliations

Marolf, Vincent
  • Department of Clinical Veterinary Science, Division of Anaesthesiology and Pain Treatment, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
Mirra, Alessandro
  • Department of Clinical Veterinary Science, Division of Anaesthesiology and Pain Treatment, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
Fouché, Nathalie
  • Swiss Institute of Equine Medicine (ISME), Vetsuisse-Faculty, University of Bern and Agroscope, Bern, Switzerland.
Navas de Solis, Cristobal
  • Swiss Institute of Equine Medicine (ISME), Vetsuisse-Faculty, University of Bern and Agroscope, Bern, Switzerland.

References

This article includes 25 references
  1. Pariaut R, Reynolds C, Bednarski RM, Muir WW, Pariaut R, Reynolds C. Bradyarrhytmias and conduction disturbances. Small Animal Critical Care 2nd ed St. Louis: Saunders Elsevier; (2014). p. 246–9.
  2. Marr CM, Reef VB, Marr CM, Bowen M. Dysrhythmias: assessment and medical management. Cardiology of the Horse 2nd ed ‎Philadelphia: Saunders Elsevier; (2010). p. 159–78.
  3. Bednarski RM, Muir WW. Arrhythmogenicity of dopamine, dobutamine, and epinephrine in thiamylal-halothane anesthetized dogs.. Am J Vet Res 1983 Dec;44(12):2341-3.
    pubmed: 6660624
  4. Whitton DL, Trim CM. Use of dopamine hydrochloride during general anesthesia in the treatment of advanced atrioventricular heart block in four foals.. J Am Vet Med Assoc 1985 Dec 15;187(12):1357-61.
    pubmed: 4086353
  5. Trim C, Shepard M K. Horses with colics. Veterinary Anesthesia and Analgesia 5th ed New Jersey, United States: Wiley Blackwell; (2015). p. 867–85.
  6. Murrell JC. Adrenergic Agents. Veterinary Anesthesia and Analgesia 5th ed New Jersey, United States: Wiley Blackwell; (2015). p. 183–95.
  7. Haga HA, Risberg Å, Strand E. Resuscitation of an anaesthetised foal with uroperitoneum and ventricular asystole. Equine Vet Educ 2011 23(10):502–7.
    doi: 10.1111/j.2042-3292.2011.00233.xgoogle scholar: lookup
  8. Mion G, Rousseau JM, Selcer D, Samama CM. Cardiac arrest: should we consider norepinephrine instead of epinephrine?. Am J Emerg Med 2014 Dec;32(12):1560.e1-2.
    doi: 10.1016/j.ajem.2014.05.046pubmed: 24997106google scholar: lookup
  9. Lindner KH, Ahnefeld FW, Schuermann W, Bowdler IM. Epinephrine and norepinephrine in cardiopulmonary resuscitation. Effects on myocardial oxygen delivery and consumption.. Chest 1990 Jun;97(6):1458-62.
    pubmed: 2347230doi: 10.1378/chest.97.6.1458google scholar: lookup
  10. Richardson DW, Kohn CW. Uroperitoneum in the foal.. J Am Vet Med Assoc 1983 Feb 1;182(3):267-71.
    pubmed: 6681809
  11. Love EJ. Anaesthesia in foals with uroperitoneum. Equine Vet Educ 2011 23(10):508–11.
    doi: 10.1111/j.2042-3292.2011.00258.xgoogle scholar: lookup
  12. Wilkins P, Dunkel B. Rupture of the urinary bladder. Equine neonatal medicine Philadelphia: Elsevier Saunders; (2006). p. 237–45.
  13. Dunkel B, Palmer JE, Olson KN, Boston RC, Wilkins PA. Uroperitoneum in 32 foals: influence of intravenous fluid therapy, infection, and sepsis.. J Vet Intern Med 2005 Nov-Dec;19(6):889-93.
    doi: 10.1111/j.1939-1676.2005.tb02783.xpubmed: 16355686google scholar: lookup
  14. Muir WW. Cardiovascular physiology. Veterinary Anesthesia and Analgesia 5th ed New Jersey, United States: Wiley Blackwell; (2015). p. 417–72.
  15. Kim NH, Oh SK, Jeong JW. Hyperkalaemia induced complete atrioventricular block with a narrow QRS complex.. Heart 2005 Jan;91(1):e5.
    doi: 10.1136/hrt.2004.046524pmc: PMC1768656pubmed: 15604312google scholar: lookup
  16. Riordan LL, Schaer M. Potassium disorders. Small Animal Critical Care 2nd ed St. Louis: Saunders Elsevier; (2014). p. 269–73.
  17. Jesty SA. Cardiovascular System. Equine emergencies, treatment and procedures 4th ed St. Louis: Saunders Elsevier; (2014). p. 124–56.
  18. Mahoney BA, Smith WA, Lo DS, Tsoi K, Tonelli M, Clase CM. Emergency interventions for hyperkalaemia.. Cochrane Database Syst Rev 2005 Apr 18;2005(2):CD003235.
    doi: 10.1002/14651858.CD003235.pub2pmc: PMC6457842pubmed: 15846652google scholar: lookup
  19. Langdon Fielding C, Gary Magdesian K. Potassium homeostasis and derangements. Equine Fluid Therapy New Jersey, United States: Wiley Blackwell; (2015). p. 27–44.
  20. Nannarone S, Vuerich M, Moriconi F, Moens Y. Hot peritoneal lavage fluid as a possible cause of vasovagal reflex during two different surgeries for bladder repair in a foal. J Equine Vet 2016 36:5–9.
    doi: 10.1016/j.jevs.2015.10.006google scholar: lookup
  21. Lerche P. Anticholinergics. Veterinary Anesthesia and Analgesia 5th ed New Jersey, United States: Wiley Blackwell; (2015). p. 178–82.
  22. Berne RM, Belardinelli L. Effects of hypoxia and ischaemia on coronary vascular resistance, A-V node conduction and S-A node excitation.. Acta Med Scand Suppl 1985;694:9-19.
    doi: 10.1111/j.0954-6820.1985.tb08795.xpubmed: 2988289google scholar: lookup
  23. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).. Circulation 2004 Nov 23;110(21):3385-97.
    doi: 10.1161/01.CIR.0000147236.85306.15pubmed: 15557386google scholar: lookup
  24. Jokisalo JM, Corley KT. CPR in the neonatal foal: has RECOVER changed our approach?. Vet Clin North Am Equine Pract 2014 Aug;30(2):301-16, vii.
    doi: 10.1016/j.cveq.2014.04.010pubmed: 25016493google scholar: lookup
  25. Ehrlich A, Schroeder CL. Chapter 5: The cardiovascular System. Medical Terminology for Health Profession 7th ed USA: Delmar, Cengage learning; (2013). p. 146.

Citations

This article has been cited 2 times.
  1. Avison A, Gelzer AR, Reef VB, Wulster Bills KB, de Solis CN, Kraus MS, Slack J, Stefanovski D, Deacon LJ, Underwood C. Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses. J Vet Intern Med 2024 May-Jun;38(3):1751-1764.
    doi: 10.1111/jvim.17027pubmed: 38514200google scholar: lookup
  2. Gómez-Torres F, Ballesteros-Acuña L, Ruíz-Sauri A. Histopathological changes in the electrical conduction of cardiac nodes after acute myocardial infarction in dogs and horses, compared with findings in humans: A histological, morphometrical, and immunohistochemical study. Vet World 2023 Oct;16(10):2173-2185.
    doi: 10.14202/vetworld.2023.2173-2185pubmed: 38023272google scholar: lookup
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