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Date:   10 June, 2011  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Unstable isoflurane anaesthesia in a poodle with cryptorchidism
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   10 June, 2011 
Be Kind To Pets
Veterinary Education
Project 2010-0129
"Anaesthesia for a young dog is very safe," I told the mother and young adult daughter as the mum spoke about the dog dying on the operating table. "No young normal dogs should die on the operating table unless they have some heart defects or allergies or the vet has some mistakes in his procedures. A complete blood test ought to be done but this is optional as I give the owners a choice since there will be a charge of $150 payable. Young normal dogs usually are OK without the need of a blood test."

The mother said: "My dog's blood test could not be taken by another vet. I would like to get a blood test done."

This poodle had cryptorchidism. It is a rare condition in which the testicles do not descend into the scrotum. They were present as two large lumps of 1.5 x 1.0 cm below the skin, some distance from the scrotum and to the side of the penis. These undescended testicles have a high likelihood to become cancerous and so it was wise of the owner to get them removed since the male poodle would not be used for breeding.

On May 30, 2011, the dog came in for surgery. The mum was waiting in the reception room till the dog got operated. "Please go home," I said. "I prefer to have peace of mind, without the owner sitting outside waiting for the surgery to be completed." The maid of another owner whose cat came in for removal of claws (scratched her expensive furniture and her boy's face for the last 2 years) was also sitting on the chair, waiting.

I find that it is best that owners go home first as surgeries and anaesthesia need full attention, without the owners being around to enquire the status. Distracting staff and the vet.

The poodle was sedated with xylazine 0.2 ml IM. My assistant Mr Min who replaced the experienced Mr Saw (who had worked for 3 years with me) needed much coaching as regards monitoring of anaesthesia.

This poodle seemed to have difficulty in being fully anaesthesized. At one time, his tongue was bright red and dry. I stopped the gas and let the dog stabilise to a normal pink tongue colour.

"The dog stops breathing," he commented as I was about to operate. "I get the respiratory stimulant injection."

"By the time the injection is drawn out from the bottle and given, it will be too late," I said to Mr Min. He had never encountered respiratory emergencies before in his past years of work with vets in Malaysia and Myanmar.

I just disconnected the tube, cardiac massage 3 times, blew in air into the lungs. Repeated another 5 times. The dog started to breathe. This dog had difficulty in being anaesthesized by isoflurane. The vet must know what to do.

1. Re-stabilise by giving isoflurane by mask if coughing reflexes occur and the dog is getting up. Pull out the tube and use mask to knock down the dog, at 5% isoflurane dose for around 2 minutes, to effect. Monitor eyelids, eyeball rotation and observe the breathing rate and tongue colour.
2. Intubate
3. Isoflurane at 3%.
4. Be patient. Give the gas for > 60seconds till the dog achieves surgical anaesthesia. There is a temptation to use 5% to quickly knock down the dog. However, the dog has unstable anaesthesia occurrence, so it is not wise to give high dose.  

In this case, the dog was back to normal anaesthesia and did not feel any pain. He was neutered. Dental scaling done after that. I syringe the wax off the ear canal esp. the left ear. Went home to a happy mother and child without problems. No post-op complications except for Day 2 when the owner phoned me regarding some bruising of the right surgical area. The tolfedine oral tablets worked effectively as there are no complaints for the past 14 days. Stitches will dissolve and I don't get to see the dog to remove the stitches in most cases.

P.S Around 1% of dogs will have this anaesthetic instability problem As to the cause, it is hard to say.


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