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Running head: CANINE INTESTINAL SURGERY

Case Study:
Intestinal Resection and Anastomosis in a Dog
Rebecca M. England
4325 Companion Animal Anesthesia and Surgical Nursing
Tarleton State University

CANINE INTESTINAL SURGERY

Elf is a one-year-old spayed female Beagle cross that presented with acute vomiting for
less than 24 hours (Rockett & Christensen, 2010). The owner was concerned that it may be due
to the ingestion of part of a pillow that she had recently torn apart. When the owner returned
home two days ago, she was unable to find locate most of the stuffing. Elf started vomiting about
24 hours later (Rockett & Christensen, 2010).
Her physical exam findings:
BCS: 3/5 at 44 lbs.
Temperature: 102.1 F
HR 120 bpm
RR panting
Mucous membranes: pale pink and dry
Respiratory: no abnormalities heard
Gastrointestinal: Resistance during abdominal palpation, discomfort seen, no F.B. detected
Dehydration assessment: 6% deficit
Due to the clinical history and presentation of Elf at this examination, the veterinarian
recommended abdominal radiographs be performed to assist in ruling out the possibility of a
foreign body obstruction. The owner consented. Survey radiographs, in addition to contrast
radiographs, were taken. In looking at the study, delayed gastric emptying was noted (Rockett &
Christensen, 2010). The veterinarian diagnosed vomiting secondary to foreign body ingestion, so
an abdominal exploratory was scheduled (Rockett & Christensen, 2010).
The veterinarian requested an ECG prior to induction of anesthesia (Rockett &
Christensen, 2010). A technician started the procedure, and it was quickly noted that it was being
performed incorrectly. The pictures in this text show two techniques, and Figure 5-9a is
obviously correct, shown on the next page (Rockett & Christensen, 2010). This placement is
correct in that the dog is placed in right lateral recumbency (not left) and the leads are placed
appropriately, slightly proximal to the elbows and stifles and on the correct limbs (Thomas &
Lerche, 2011). A fifth lead may sometimes be used at the apex of the heart on the left side of the

CANINE INTESTINAL SURGERY

thorax to obtain additional information. It appears to be appropriately placed in this picture. The
lead placement is often remembered by a common rhyme used among technicians, white on the
right (or snow over grass), and smoke over fire. This allows quick placement of the leads using
the colors of the leads. There is also a color photograph for comparison, but without the chest
and green leads, as it is difficult to determine if the leads are placed on the proper limbs due to
the black and white nature of the photograph.

Figure 5-9a: Obtaining an ECG on a dog. Correct positioning shown.


From Rockett & Christensen, 2010

Standard 3-lead ECG commonly used in veterinary patients, retrieved from personal photography library.

CANINE INTESTINAL SURGERY


In Figure 5-9b below, positioning of the patient and application of the leads is incorrect.
The patient is in left lateral recumbency and the leads have been placed distal to the elbows and
stifles. Again, there is also a color photograph for comparison, but without the chest and green
leads, as it is difficult to determine if the leads are placed on the proper limbs due to the black
and white nature of the photograph.

Figure 5-9b: Obtaining an ECG on a dog. Incorrect positioning shown.


From Rockett & Christensen, 2010

Standard 3-lead ECG commonly used in veterinary patients, retrieved from personal photography library.

CANINE INTESTINAL SURGERY

After the ECG is performed, the technician starts to gather equipment and supplies
needed for the induction and monitoring of anesthesia (Rockett & Christensen, 2010). The
technician gets out an esophageal stethoscope, shown below. An esophageal stethoscope is used
to manually auscultate and monitor heart rate and rhythm (Tear, 2012). If the end of the tubing is
adjacent to the lung fields, breath sounds may also be auscultated (Tear, 2012).

Esophageal stethoscope. From Tear, 2012

The veterinarian also wants Elfs percent oxygen saturation (Rockett & Christensen,
2010). The monitoring equipment needed to obtain this data is called a pulse oximeter (Tear,
2012), as seen below.

CANINE INTESTINAL SURGERY

The assistant prepared to use a non-rebreathing anesthetic set-up for this patient, seen
below. This tubing, however, is not appropriate for a patient of Elfs size, being that she is 44
pounds. Non-rebreathing circuits are for use in patients weighing less than 15 pounds.

A rebreathing circuit such as a universal F rebreathing circuit is appropriate for Elf, seen below.
It is ideal for patients larger in size weighing more than 15 pounds.

The size of rebreathing reservoir bag to be used must be calculated based on the patients weight
and tidal volume of the lungs. See the formula and calculation below:

CANINE INTESTINAL SURGERY


Tidal volume = body weight in pounds x 30 = bag size in milliliters (mL)
44 pounds x 30 = 1,320 mL
Tidal volume > 1,000 mL but < 2,000 mL = 2-liter bag
A 2-liter rebreathing reservoir bag is appropriate for Elf. A picture is shown below:

The veterinarian wants to use Olsen-Hegar needle drivers for the surgical procedure
(Rockett & Christensen, 2010). In the text (Rockett & Christensen, 2010), this instrument is
labeled A, seen below. This instrument in particular has scissor blades set behind the jaws,
whereas the Mayo-Hegar needle drivers have no scissor blades.

CANINE INTESTINAL SURGERY

The veterinary assistant heats up 0.9% sodium chloride in the incubator. Is this type of
fluid appropriate for flushing the abdomen? Yes, it is. 0.9% sodium chloride is an isotonic fluid,
which closely matches the bodys fluids. It is primarily used in the event that intestinal contents
leaked into the abdominal cavity (Tear, 2012). Flushing the abdomen will decrease the chance of
peritonitis from occurring.

The veterinarian needs a specific type of towel clamp that would be appropriate for holding the
suction tubing in place. The other clamp choices are not appropriate as they are sharp and could
potentially puncture the drape material or the suction tubing. This clamp is identified as C in the text
(Rockett & Christensen, 2010), and shown below. It is blunt and will not penetrate materials.

CANINE INTESTINAL SURGERY

Prior to anesthetizing Elf for her surgical procedure, an IV catheter is placed so that she
can receive fluids to replace her dehydration deficit. She is considered to be 6% dehydrated. The
volume of fluid she will need to replace the deficit is calculated below:
Dehydration deficit calculation:
Dehydration % x BWlb x 500
6% x 44 lbs. x 500 = 1,320 ml to replace the deficit.
After receiving fluids, Elf was induced using propofol at a dose of 2 mg/lb. She received
8.8 ml of propofol IV for induction. See the calculation below:
Propofol is 10 mg/ml (Plumb, 2011)
44 lbs. * 2 mg/lb. = 88 mg
88 mg divided by 10 mg/ml = 8.8 ml propofol

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A large amount of pillow batting was removed from the proximal portion of the jejunum
(Rockett & Christensen, 2010). The assistant asks about the location of the jejunum in
relationship to the stomach. Here is a drawing below, depicting the gastrointestinal system of a
dog:

Once the surgery is complete, Elf is monitored in the recovery room. Extubation should
be performed until the patients primary reflexes return. These include a palpebral reflex
response and the ability to swallow. The ability to swallow is most crucial for the patient. If the
patient is unable to swallow, and then subsequently extubated too early, the patient will not be
able to protect the airway. This could lead to aspiration, an inability to breath, and even death.
Therefore, a patient should not be extubated until swallowing well. Five minutes after
extubation, Elf starts to vomit. It is important in a situation like this that the patient be propped
up in a sternal position to minimize the chances of aspirating fluid or other contents from the

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gastrointestinal tract. If severe or the patient has complications breathing, reintubation may be
necessary. Otherwise, monitor and keep the patient sternal until the vomiting has subsided. It
may be necessary to administer antinausea medication per the veterinarians orders if it persists.
Now that the surgery room is no longer being used, it must be prepared for the next
patient. There are several things that should be done to clean and maintain the room properly
(Tear, 2012):
1. The O.R. should be cleaned daily, even if it is not used
2. Equipment used to clean the O.R. should only be used in the O.R to prevent crosscontamination
3. All surfaces of the room should be damp-dusted and wiped down before and after
each patient
4. Any equipment and furniture that is visibly soiled needs to be cleaned at the end of
each procedure
5. All instruments should be removed from the O.R. and washed/cleaned/repackaged in
a designated area
6. Surfaces should be cleaned with an appropriate disinfectant (this will vary depending
on the hospitals need and exposure to diseases)
7. When cleaning surfaces, a scrubbing motion should be used
8. Examples of surfaces to clean include:
a. Surgical lights
b. Tables
c. Glass sliding cabinets
d. Wheels, step stools, foot pedals, wall telephones, light switches
e. All handles (doors, drawers, and cabinets)
f. Anesthesia machine
g. Ventilation faceplates and doorway ledges
9. The floor should be swept and mopped with a fresh bucket of appropriate disinfectant
and a clean mop head
10. The surgery door should be kept closed at all times to reduce the chances of
contamination
Based on hospitals standards, there may be additional things to perform. Overall, however, the
concept is the same.
This case study reveals the wide variety of knowledge that is necessary to carry out a
surgical procedure such as this one. A variety of equipment is needed, and one must be familiar
with its function and how to apply it to patient use. Several calculations are also necessary, from

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induction to the post-operative period. Patient anatomy is especially important to understand, not
only from a procedural standpoint, but also in order to educate owners. Maintaining the O.R. is
also an vital daily task.

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References

Colville, T. and Bassert, J. (2007). Clinical Anatomy and Physiology for Veterinary Technicians, 2nd ed.
St. Louis, MO: Mosby.
Plumb, D. C. (2011). Plumbs Veterinary Drug Handbook, 7th ed. PharmVet Inc.
Rockett and Christensen (2010). Case Studies in Veterinary Technology: A Scenario-Based Critical
Thinking Approach. Heyburn, ID: Rockett House Publishing LLC.
Sonsthagen, T. (2005). Veterinary Instruments and Equipment: A Pocket Guide. St. Louis, MO: Mosby.
Tear, M. (2012). Small Animal Surgical Nursing: Skills and Concepts, 2nd ed. St. Louis, MO: Mosby
Elsevier.
Thomas, J. A. and Lerche, P. (2011). Anesthesia and Analgesia for Veterinary Technicians, 4th ed. St.
Louis, MO: Elsevier.