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ABSTRACT OF THE WEEK

Journal of the American Veterinary Medical Association
Volume 251 | Issue 2 (July 2017)

Anesthesia Case of the Month.

J Am Vet Med Assoc. July 2017;251(2):159-162.
Chi Won Shin, Sujin Gang, Won Gyun Son, Jong-Pil Seo, Wan-Hee Kim, Inhyung Lee

Companion Notes

Case report of anesthesia mumps (acute transient sialadenopathy) in a dog

- not previously reported in veterinary patients

    

Overview on anesthesia mumps

- in human medicine:

- rare prevalence in patients undergoing general anesthesia: 0.2%

- in 1 report of incidence with retrosigmoid and far-lateral craniotomy: 0.84%

- cause is unclear

- in 1 report, dehydration is a common cause in children

- usually resolves spontaneously

- supportive therapy may be helpful

- warm compresses

- adequate hydration

- antimicrobials may be indicated when crepitus is evident

- severe swelling occurs rarely that may require reintubation or tracheostomy

    

Case report of a 7-month-old, 1.3 kg (2.87 lb), intact, sex:M dog

- at referral for microhepatica

- historical signs, physical examination and testing from referring clinician (rDVM)

- presentation for anorexia, weakness and growth retardation

- physical examination: signs of hypoglycemic shock and blindness

- presumptive diagnosis: portosystemic shunt

- at referral for CT to confirm diagnosis of portosystemic shunt

- preanesthetic medication not administered due to pup’s condition

- propofol induction with isoflurane maintenance in oxygen

- rebreathing circle system

- temporary apnea induced to facilitate detailed CT images

- induced with manual hyperventilation

- end-tidal carbon dioxide at 25-30 mmHg for 1 minute

- bradycardia developed after first manual breath

- corrected with glycopyrrolate

- diagnosis: extrahepatic portoazygos shunt

- re-presentation 1.5 months later for surgical therapy (ameroid ring constrictor)

- CBC and biochemistry: leukocytosis and thrombocytosis

- increased aspartate transaminase

- increased alkaline phosphatase

- hyperphosphatemia

- elevated ammonia

- low creatinine

- hypoproteinemia

- premedication

- tramadol, 1 mg/kg IV

- ranitidine, 2 mg/kg IV

- cefazolin, 44 mg/kg IV

- preanesthetic blood glucose relatively low

- saline solution with 2.5% glucose given during surgery

- propofol induction with isoflurane maintenance in oxygen

- bradycardia developed immediately after anesthetic induction

- glycopyrrolate, 10 µg/kg sc

- dorsal recumbency with head and neck positioned naturally to the side

- atracurium, 0.2 mg/kg IV to ease surgical access

- total duration of anesthesia: 2 hours 12 minutes

- total volume of IV fluids during anesthesia: 28.1 mL

- after extubation with dog in sternal

- swelling of submandibular region, bilateral, noticed immediately

- not present before anesthesia

- resolved in 3 days with supportive treatment

- differential diagnosis for the submandibular swelling

- anaphylactic reaction

- no other clinical signs consistent with this present

- hemorrhage and hematoma

- cytology of fluid specimens revealed saliva

- air from an iatrogenic tracheal tear

- no dyspnea or subcutaneous emphysema

- mandibular sialocele (preoperative serum amylase normal)

- acute transient sialadenopathy diagnosed by exclusion

(anesthesia mumps)

- treatment of anesthesia mumps

- manual massage, 15 minutes

- neck bandage to apply gentle compression

- swelling smaller the next day and no additional treatment done

- spontaneously resolved over 3 days

- outcome 12 days postop: no evidence of recurrence

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