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that confirmed a small intestinal foreign body; Acierno, M.J., Brown, S., Coleman, A.E., Jepson, R.E.,
intestinal perforation secondary to the foreign Papich, M., et al. (2018) ACVIM consensus statement:
VetBooks.ir body was highly suspected at that time and emer- ment of systemic hypertension in dogs and cats. Journal
guidelines for the identification evaluation, and manage-
gency surgery was indicated for the patient.
of Veterinary Internal Medicine 32, 1803–1822.
Regardless of the dog’s response to the intravenous
fluids administered after presentation, she is at a high Berger, A. (2001) Oscillatory blood pressure monitoring
devices. British Medical Journal 323, 919.
risk of further hypotension once under anesthesia Bodey, A.R., Michell, A.R. (1996) Epidemiological study
(many commonly used inhalant drugs have vasodila- of blood pressure in domestic dogs. Journal of Small
tory effects) and her cardiovascular status is likely to Animal Practice 37, 116–125.
be further compromised. In order to provide the Crowe, D.T., Spreng, D.E. (1995) Doppler assessment of
greatest chance of a successful anesthetic experience blood flow and pressure in surgical and critical care
and diminish secondary organ damage, it is essential patients. In: Bonagura, J.D. (ed.) Kirk’s Current
that efforts are directed toward maintaining appro- Veterinary Therapy XII. W.B. Saunders, Philadelphia,
priate blood pressure both throughout anesthesia Pennsylvania, USA, pp. 113–119.
and in the hours following surgery. Important con- Duke-Novakovski, T. (2017) Basics of monitoring equip-
siderations prior to anesthesia include ensuring the ment. The Canadian Veterinary Journal 58, 1200–1208.
patient is volume replete and placement of an arterial Duke-Novakovski, T., Carr, A. (2015) Perioperative
blood pressure control and management. Veterinary
catheter for direct blood pressure monitoring. Clinics of North America: Small Animal Practice 45,
Continuous rate infusion (CRI) of multiple phar- 965–981.
macologic agents may be necessary and potential Jepson, R. (2011) Feline systemic hypertension: classifi-
drugs can be prepared prior to surgery to improve cation and pathogenesis. Journal of Feline Medicine
response time under anesthesia. Consideration is and Surgery 13, 25–34.
given to sympathomimetics for their vasopressor Joles, J.A. (1998) Obesity in dogs: effects on renal func-
effects; these drugs have short half-lives (only 2–3 tion, blood pressure, and renal disease. Veterinary
minutes) and need to be administered as a CRI. In Quarterly 20, 117–120.
this case, norepinephrine was infused at 0.1 μg/kg/ Klabunde, R.E. (2016) Cardiovascular physiology con-
min (epinephrine infused at 0.01–0.03 μg/kg/min is cepts. Available at: www.cvphysiology.com (accessed
21 July 2019).
another consideration). Additional vasopressor sup- Mazzaferro, E.M. (2009) Arterial catheterization. In:
port was necessary and was provided by the use of Silverstein, D.C., Hopper, K. (eds) Small Animal
vasopressin at a rate of 0.002 IU/kg/min. A concern Critical Care Medicine. Saunders, St. Louis, Missouri,
with vasopressors is that the vasoconstriction (and USA, pp. 206–208.
increase in SVR) may increase blood pressure read- Remillard, R.L., Ross, J.N., Eddy, J.B. (1991) Variance of
ings, but this change may not be associated with an indirect blood pressure measurements and prevalence
increase in cardiac output and perfusion. Therefore, of hypertension in clinically normal dogs. American
these drugs should be used for as short a period as Journal of Veterinary Research 52, 561–565.
possible. Positive inotropic therapy may be com- Rondeau, D.A., Mackalonis, M.E., Hess, R.S. (2013) Effect
bined with the aforementioned vasopressor therapy; of body position on indirect measurement of systolic
arterial blood pressure in dogs. Journal of the American
dobutamine improves cardiac output through β-1 Veterinary Medical Association 242, 1523–1527.
receptor stimulation. In this case, dobutamine was Simmons, J.P., Wohl, J.S. (2009) Hypotension. In:
infused at a rate of 3 μg/kg/min. Sympathomimetic Silverstein, D.C., Hopper, K. (eds) Small Animal Critical
drugs have the potential to cause cardiac arrhyth- Care Medicine. Saunders, St. Louis, Missouri, USA,
mias and electrocardiographic monitoring should pp. 27–30.
be available during such infusions. Following anes- Stepien, R.L. (2011) Feline systemic hypertension: diag-
thesia, continued care must be directed at blood nosis and management. Journal of Feline Medicine
pressure monitoring, maintenance of appropriate and Surgery 13, 35–43.
fluid balance, and pharmacologic intervention. Vincent, J. (2008) Understanding cardiac output. Critical
Care 12, 174–176.
Whittemore, J.C., Nystrom, M.R., Mawby, D.I. (2017)
Further Reading Effects of various factors on Doppler ultrasonographic
measurements of radial and coccygeal arterial blood
Acierno, M.J., Labato, M.A. (2005) Hypertension in renal pressure in privately owned, conscious cats. Journal
disease: diagnosis and treatment. Clinical Techniques of the American Veterinary Medical Association 250,
in Small Animal Practice 20, 23–30. 763–769.

44 D.S. Foy