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

Recovery

Before ending the anaesthetic you should:
• Ensure the pharynx and mouth are clear of stomach contents

• Check if the patient can maintain a normal saturation on room air.

• Check the patient’s temperature

• Repeat blood work - lactate, PCV/TP, glucose, BUN/crea.

In the recovery area they should have oxygen available, nasal oxygen prongs or nasal catheters are a good way of providing oxygen. These patients are at risk of hypoventilation and so hypoxaemia, due to their generally large size, they will have been in dorsal recumbency for a long time, and they may be on respiratory depressant drugs.

Active warming should be used to increase and maintain the patients’ core temperature.

Closely monitoring the patient post surgery is crucial in the first few hours. Monitoring heart rate, rhythm, pulse rate and quality will indicate if there is an arrhythmia.

Ideally the patient should be connected to an ECG machine in recovery and have blood pressure monitored regularly. If this equipment isn’t available then cardiac auscultation and monitoring heart rate, pulse rate, rhythm will still indicate abnormalities.

If the patient is poorly perfused or has suffered periods of hypoxia sinus tachycardia or Ventricular premature complexes can be present in recovery. These should subside when the patient is more stable in recovery.

Aggressive fluid therapy may be necessary in these cases. As GDVs are common in large breed dogs large amounts of crystalloids may be required to improve perfusion.

Monitoring the patient’s hydration status is very important. Are the mucous membranes tachy (dry) dehydrated? Are they moist? Is the patient feeling nauseous post surgery? Are they pink, pale, grey and in need of oxygen supplementation, blood transfusion? Is the CRT prolonged or normal? (1-2 seconds)

Analgesia must continue in recovery, adding anti emetics may be of advantage to the patient. If the patient is tachycardic in recovery assess pain first of all to rule out the cause of the tachycardia.

If the patient is tachycardic and having VPCs then therapy for this may be indicated. If you do not have an ECG machine to confirm this but you have weak pulses or deficits then VPCs are very likely. Giving low doses of lidocaine (1mg/kg slow iv) and auscultating the heart and checking pulse quality to see if this make the heart and pulse rhythm regular can confirm if the lidocaine is helping the arrhythmia. Maximum dose is 8mg/kg total. Setting up a CRI maybe indicated (see above)

High lactate levels can indicate poor tissue perfusion and hypoxia.

The surgeon may place a gastrotomy tube at the time of surgery, not only can the tube be used to feed the patient, but can also relieve bloating post surgery which is a possible post operative complication.