TECHNICIAN UPDATE
Unresponsive Tachycardia in an Equine Patient During Surgical Correction of a Small Intestinal Volvulus By Lori Dressel CVT, BSP, VTS (AVTAA) Lg Animal, and Jane Quandt DVM, MS, DACVAA, DACVECC 24-year-old, 340-kg gelding pony was admitted to the University of Georgia Veterinary Teaching Hospital for evaluation of small intestinal colic. According to the owner, the patient became lethargic and depressed for 12 hours before the referring veterinarian was called. The patient was referred because the pony was nonresponsive to treatment and had previous colic surgery, an exploratory celiotomy 3 years prior for a strangulating lipoma. At that time 8 feet of necrotic bowel were removed, and a jejunocecostomy was performed.
Clinical Examination
Clinical Findings
Over the next few days the patient seemed to gradually improve until the evening of the 5th night. The patient required several doses of IV xylazine and butorphanol due to uncontrollable pain with violent rolling. The patient underwent an exploratory celiotomy that evening. The surgical diagnosis was a distended small intestine and colon displacement. Biopsies were taken of the intestine and histopathologically diagnosed as lymphocytic plasmacytic enteritis with eosinophils. Following surgery, the patient was maintained on IV fluids, IV lidocaine CRI, IV anti-inflammatories such as flunixin meglumine, oral gastrointestinal protectant omeprazole and sucralfate, IV dimethyl sulfoxide (DMSO), and IV antibiotics gentamicin sulfate and penicillin G potassium. There were intermittent bouts of tachycardia, fever, and tachypnea. The patient was passing feces, and food was slowly being rein-
A 24-year-old gelding was lethargic and depressed for 12 hours before the referring veterinarian was called.
Images courtesy of Lori Dressel
Upon arrival at the teaching hospital, the patient was dull, lethargic and depressed. He had a body condition score of 5/9, heart rate of 40 bpm, respiration rate of 20 bpm, and a rectal temperature of 99.3° F. The mucus membranes were hyperemic and moist with a prolonged capillary refill time of 3 seconds. No abnormalities were heard on auscultation of the heart and lungs. Borborygmi were auscultated in all abdominal quadrants. The blood work showed a PCV of 22% and TS of 6.0 g/dL (range PCV 26–45%, TS 4.6-6.9 g/dL). Abnormal CBC findings
were a fibrinogen of 500 mg/dL (range 100-400), and lymphopenia of 1.118x10 ^3/µL (range 5.7-11.7x10 ^3/µL). There was no net reflux; the rectal exam was normal, and the abdominal ultrasonography results showed a thickened small intestine. The patient was placed on IV fluids and taken to a stall for observation.
The horse is sedated and awaiting transfer to the induction stall. While the sedation takes effect, the patient is cleaned and clipped, and his mouth is rinsed.
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The patient is in right lateral with his head extended. A bite block was placed in between the front teeth and a 26mm endotracheal tube was placed before the patient is hoisted and placed in the OR in dorsal recumbency.
