Monday, August 27, 2012

1062. Antisedan is the antidote to be given routinely

"No point giving Antisedan," Dr Daniel was behind me and saw the deep purplish blue tongue tip of the 8-year-old Jack Russell as I was making a post-op check on this beloved dog of a lady in her 30s. "The dog has died."

"Get the dog out of the cage," I said but did not waste time informing him that I could see the dog's eye flickering, meaning he is still alive. "I am getting the Antisedan injection." 30 minutes ago, the dog had 75% of my Dom+Ketamine IV formula and had dental scaling and ear irrigation. I did the ear irrigation personally as that was what the owner wanted me to handle her dog's ear itchiness problem which had persisted for the last 2 months after Vet 1 had been consulted and given her ear drops. The 8-year-old female Jack Russell was still scratching her ears and dark black pigment and rough skin developed near the ear canal opening.
Many of my old clients had disappeared as proximity is important for them since around 50 vet clinics have been opened in recent years. I checked my case records.

In Oct 30, 2005, this dog had vaccination and false pregnancy. No more visit till Mar 5, 2008 when I diagnosed false pregnancy as there was milk. "My dog had ear infection and you had treated her successfully," the lady said. Dog owners always remembered their pet's medical history and the vet who can deliver results and those who failed them. It is a tough competitive world in Singapore vet medicine and all over the world in 2012!

I reviewed my case sheets. Sure enough. In August 17, 2009, I did an ear irrigation of the left ear otitis externa and teeth scaling as well as vaccination and deworming. "Left ear drawing - I wrote "red+, pus, 1 week".

In Dec 13, 2009, I treated the dog for inflamed D3/D4 interdigital right hind lameness. That meant the ears were no problem anymore.

So, that was why she came to consult me after 2 months of ear drops cleaning from Vet 1.

Back to the present situation, I injected Antisedan 0. 4 ml IM. The dog was walking and OK. I went out to buy surgical equipment and the surgical gloves at Jalan Besar. Later, the lady came and was most happy to see her dog. The dog's tongue was pink. As to why the tongue tip which protruding out and in between the teeth turned cyanotic, I don't know. The dog was resting on her chest and the head was on her paws. The teeth clamped on the protruding tongue tip. Cyanotic tongue colour meant no oxygen flow and in that stage, it would lead to death.

From now, I would insist on Antisedan to be given routinely. As the associate vets have their own judgment, they don't usually given Antisedan. I had advised but each vet has his or her own ideas as do all doctors. This case showed the importance of Antisedan as there would be no such drama if the associate vet under my mentorship had given Antisedan routinely as instructed by me.

It is not necessary to give Antisedan reversal in all cases, but in old dogs, this should be done. But my associate vets sometimes do it and sometimes don't and this case clearly illustrated the importance of getting the antidote and letting the dog recover faster from sedation.  

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