Page 126 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Thoracic pain

VetBooks.ir illson 1 horacic surgery; important considerations ildgaard , Petersen R , ansen et al. 1 ultimodal
analgesic treatment in video-assisted thoracic surgery
and practical steps. Veterinary Clinics of North America: Small
lobectomy using an intraoperative intercostal catheter.
Animal Practice 45, 489 6
European Journal of Cardio-Thoracic Surgery 41, 1 7 1 77
alsh P , Remedios A , erguson et al. 1999
Thoracoscopic versus open partial pericardectomy in dogs: oolf C and Chong S 199 Preemptive analgesia treating
comparison of postoperative pain and morbidity. Veterinary postoperative pain by preventing the establishment of central
Surgery 28, 47 479 sensitization. Anesthesia and Analgesia 77, 6 79
e ex p e Pneumothorax

pneumothorax and pneumomediastinum
HISTORY AND PRESENTATION
secondary to rupture of pulmonary bullae.
An 8 year old male neutered Labrador The animal was anaesthetized and prepared
Retriever presented with a 9 day history of for surgery.
increased respiratory e ort, tachypnoea and
lethargy. The owner reported no history of 1
trauma and that the dog had been quieter ■ aceproma ine . 1
than normal for the last couple of months. mg kg i.v. methadone . mg kg i.v.
■ propofol 1 ml i.v.
CLINICAL SIGNS ■ 9. mm
■ circle ventilator
Clinical signs included pink and moist ■ ml kg h
mucous membranes, a capillary re ll time of
less than seconds, a heart rate of 9 bpm, A median sternotomy was performed.
palpable and synchronous femoral pulses, Bullae were identi ed on the right middle,
panting, increased expiratory e ort, and a right cranial and left caudal lung lobes. No
o
temperature of 7 C. Thoracic auscultation obvious leaks were identi ed at surgery but
showed loud inspiratory and expiratory noises two of the bullae (right middle and left
but no crackles or whee es. Peripheral lymph caudal appeared to have healing scars in
nodes and abdominal palpation were their central portions. Stapled partial
unremarkable. No signs of pain were present. lobectomy of the left caudal lung lobe and
hilar lobectomy of the right middle lung lobe
INVESTIGATIONS AND TREATMENT were performed and a thoracic drain placed.
he thoracic cavity was ooded and no
Thoracic radiographs revealed a further leaks were identi ed. Routine closure
pneumothorax. Thoracentesis retrieved and placement of a wound soaker catheter
ml of air. Routine haematology and was achieved with appropriate intra -
biochemistry were unremarkable. Computed thoracic pressure being reached.
tomography C showed a bilateral
pneumothorax and pneumomediastinum. At PERIOPERATIVE MANAGEMENT
the periphery of the mid ventral portions of
the right middle and right cranial lung lobes A bolus of fentanyl 1 g kg i.v. was given
there were multiple thin walled, gas lled at the beginning of surgery followed by a
structures, the largest of which was at least continuous rate infusion CRI of fentanyl
.6 cm long, which also contained a ne . g kg h throughout the procedure.
network of thin soft tissue dense stranding. The fentanyl CRI was stopped at end of
he C ndings were consistent with a the procedure and a bolus of morphine

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