Claire Roberts rvn dipavn(Surg) vncertecc aetiology and Patient Presentation of the gdv patient

Hypoventilation

Hypoventilation is a reduced tidal volume, this is likely to be a complication of GDV’s due to the enlarged stomach restricting the diaphragm and the pain involved in this disease.

A reduced tidal volume prevents the excretion of carbon dioxide, this builds up in the body resulting in respiratory acidosis. This can be corrected by providing ventilatory support. This can be either manual IPPV or mechanical ventilation if available. This should aim to provide a normal tidal volume which will normalise carbon dioxide levels and correct respiratory acidosis.

Pain

Gastric torsion is a very painful experience! Opioid CRI provides the best means for managing that pain.

Fentanyl CRI provides excellent analgesia with minimal effects on the cardiovascular system, it is short acting and so is rapidly removed from the system within 30 minutes after it is stopped. The dose can be quickly titrated to effect. It can cause some respiratory depression so be prepared to provide ventilatory support.

Morphine CRI can be used during anaesthesia, it will provide very good analgesia with minimal cardiovascular effects although some respiratory depression may be seen.

Ketamine CRI could be considered if opioid and lidocaine CRI does not provide enough analgesia. Sub-anaesthetic doses are used for analgesia purposes so the sympathetic stimulation see at induction doses may not be a problem.

Epidural morphine can provide up to 24hours analgesia, and would be a good choice for a GDV patient assuming their coagulation factors are normal. It may be best to provide an epidural post surgery before recovery due to the need to get these patients into surgery quickly.