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64 Anesthetic-Related Complications

(M/E) ratio, completeness and orderliness ○ Prednisolone 2-4 mg/kg PO q 24h (large- PROGNOSIS & OUTCOME
2
of maturation, presence of abnormal cells breed dogs, 40 mg/m /day). After the Depends on primary disorder
VetBooks.ir required to make a diagnosis. The aspirate • If inadequate response with prednisolone PEARLS & CONSIDERATIONS
○ PRCA: a bone marrow aspirate/biopsy is
PCV stabilizes, taper the medication by
15%-25% every 2-4 weeks.
reveals no or very few precursor cells, with
a M/E ratio > 75 : 1 (normal: 1 : 1 to 2 : 1).
medications (p. 60):
Lymphocytosis is common in cats and alone, consider other immunosuppressive Comments
occasionally seen in dogs. ○ Azathioprine 2 mg/kg PO q 24h, tapering • With acute anemia of any cause, 3-5 days
○ Special tests on marrow may be indicated to 0.5-1 mg/kg PO q 48h (dogs only) are required to detect reticulocytosis.
(e.g., immunofluorescent antibody test ○ Cyclosporine microemulsion (Atopica, • Anemia of inflammatory disease is usually
for FeLV) Neoral) 5 mg/kg PO q 12h; pharmaco- mild (PCV > 25%).
• Coombs’ test (p. 1328) dynamic monitoring recommended • Chronic nonregenerative anemias often result
○ PRCA: Dogs are usually negative, and ○ Mycophenolate mofetil 5-10 mg/kg PO in a gradual onset of clinical signs due to
approximately 50% of cats are positive. q 12h compensation, even if the anemia itself is
• PRCA may require long-term (months) of quite severe.
TREATMENT immunosuppressive therapy before response • Bone marrow evaluation is needed to dis-
to therapy is noticed. tinguish PRCA from other nonregenerative
Treatment Overview • Repeat transfusions may be necessary; cross anemias.
Therapy for nonregenerative anemias consists of match first. • Over half of cats with primary IMHA anemia
supportive care (improve oxygen-carrying capac- present with nonregenerative anemia.
ity, transfusion) and treatment of the primary Possible Complications
or underlying cause. It is essential to determine • Secondary infections due to immunosup- Technician Tips
the primary cause of the anemia to initiate pressive therapy • Inspect blood units before infusion; discol-
effective, appropriate therapy. The cornerstone • Adverse drug effects ored, hemolyzed, or expired units should be
of therapy for PRCA is immunosuppressive ○ Prednisolone: polyuria/polydipsia, poly- discarded.
therapy, particularly corticosteroids. phagia, GI ulceration, weakness • Monitor patients closely during the trans-
○ Azathioprine: myelosuppression, hepa- fusion and use a checklist to ensure careful
Acute General Treatment topathy patient monitoring and early recognition of
Transfusion is typically indicated if HCT is ≤ ○ Cyclosporine: vomiting, diarrhea, potential reactions.
15% and/or the patient has developed clinical decreased appetite
signs due to the severity of anemia. Packed red ○ Mycophenolate: diarrhea SUGGESTED READINGS
blood cells (pRBCs) from a universal donor is • Transfusion reactions (p. 989) Abrams-Ogg A: Non-regenerative anemia. In Ettinger
the blood product of choice. SJ, et al, editors: Textbook of veterinary internal
Recommended Monitoring medicine, ed 7, St. Louis, 2010, Saunders Elsevier,
Chronic Treatment Repeat PCV every 1-2 weeks until it increases pp 788-797.
• Treat underlying disorders. or the patient develops clinical signs of anemia. AUTHOR: John M. Thomason, DVM, MS, DACVIM
• Anemia of chronic inflammatory disease After the PCV begins to increase, monitor every EDITOR: Jonathan E. Fogle, DVM, PhD, DACVIM
resolves with treatment of the underlying 2-4 weeks until normal and stable. The PCV
cause. should be re-evaluated before any dose reduc-
• Immune-mediated nonregenerative anemia tion and 1-2 weeks after a reduction to detect
and PRCA require immunosuppressive therapy. relapse.

Anesthetic-Related Complications Client Education
Sheet

BASIC INFORMATION • Brachycephalic breeds may be difficult Clinical Presentation
to intubate and have difficulty breathing
Definition after extubation due to airway swelling or DISEASE FORMS/SUBTYPES
Complications occurring in the peri-anesthetic edema. • Respiratory complications
period attributed to an anesthetic cause • Cardiovascular complications
RISK FACTORS • Equipment failure
Epidemiology Increased risk: • Anesthetic overdose
SPECIES, AGE, SEX • Extremes of age (neonates, geriatrics) • Anaphylaxis
Any species/age/sex • Coexisting disease (ASA status ≥ 3), • Hyperthermia, hypothermia
especially cardiovascular and pulmonary • Prolonged anesthetic recovery
GENETICS, BREED PREDISPOSITION disease
• Sighthounds may have delayed recovery from • Emergency anesthesia HISTORY, CHIEF COMPLAINT
barbiturates, propofol, or alfaxalone. • Prolonged anesthetic duration • Pre-anesthetic/anesthetic
• Herding breeds may have exaggerated effects • Small size (cats < 2 kg; dogs < 5 kg) ○ Apnea/hypoventilation/dyspnea
of drugs, including acepromazine and • Anesthetic monitoring not used ○ Pallor/cyanosis
torphanol. ○ Bradycardia/tachycardia/arrhythmias
• Boxers of European descent may have an ASSOCIATED DISORDERS ○ Hypotension/hypertension
adverse reaction to acepromazine, character- Respiratory arrest, cardiac arrest, hypotension ○ Hypothermia/hyperthermia
ized by bradycardia and collapse.

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