Monday, April 5, 2010

9. Enucleation of the eye in a high anaesthetic risk Chihuahua

The mother and teenaged daughter adopted the abandoned Chihuahua. For the past 2 weeks, the dog was rubbing her eyes. Dirt and bacteria got trapped inside the eyes, irritating the dog. So, she rubbed more. When I was consulted, the eye cornea was deeply ulcerated. A 3rd eyelid flap would be the recommended surgery.



But the dog had a serious heart disease and was panting a lot. Therefore, I did not proceed with the surgery as she would likely just die on the operating table. A 90% chance of dying. The dog went home with heart disease medication, antibiotics, eye ointment and an e-collar. It was better to have a live pet than to attempt general anaesthesia leading to a dead dog on the operating table. The teenaged daughter was attached to her. No vet wants a dead dog as a result of anaesthesia. No owner wants that too. So, I decided not to take the risk.

One week later, the eye ulcer had perforated. A gelatinous plug protruded out from the eye. What to do now? Bacteria would get inside the eye causing enopthalmitis. Uveitis was controlled by antibiotics eye drops. There was one solution. Surgery to remove the whole eyeball (enucleation). The dog was not panting now as the heart drugs had helped considerably.

Performance counts. In this case, a good surgical outcome is a live dog at the end of the surgery. The following is my management of this case:

1. The dog was already on Fortekor and frusemide tablets and was no longer panting.
2. Pre-anaesthetic dextrose saline 20 ml SC and antibiotics were given.
3. The dog was thin, weighing was 2.5 kg.
4. Pre-anaesthetic dose of Zoletil 100 @ 0.1 ml IM.
Atropine 0.65mg/ml @ 0.2 ml IM. Isoflurane gas mask and then intubate.
5. The dog's eyelids were shaved fast. The eyeball was taken out in <10 minutes.
6. The teeth were scaled. 4 loose ones extracted.
7. The dog was on <1% isoflurane gas and was anaesthesized without problems.
8. Post-op 5% dextrose saline 20 ml SC and tolfedine painkillers were given.
9. The Chihuahua went home on Day 2. No problems. Everybody is happy when a dog is alive at the end of surgery and anaesthesia.

Conclusion:
Never anaesthesize a dog with severe panting as this is extremely risky. You will get a dead dog and a very unhappy owner. Stablise the heart condition with medication for 2 weeks. Unfortunately, the deep ulcer perforated and surgery to remove the infected eyeball was necessary. A short surgery would lead to a higher chance of survival. Know what to do pre and during surgery. In this case, a live dog was what the owner wanted. In any industry, results count. You may be the best veterinary surgeon in the country, but if you produce a dead dog on the operating table, you are the worst doctor as far as the affected family is concerned. Just don't take unnecessary risks in anaesthesia.

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