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Dr. Bruce, I have had a similar experience as the people

Dr. Bruce, I have had...
Dr. Bruce,

I have had a similar experience as the people who lost their pug after a dental cleaning, and who wrote to you.

I have a 12 yr old doxie - healthy, happy - like a puppy. He went in for a dental. Bloodwork normal. Heartworm/Lyme negative. I went to pick him up and he was having trouble coming out of anesthesia, breathing rapidly. The vet wanted me to leave him. I asked who would be there overnight. No one. So against their advice, I took him home.

Went straight to the ER. Came very close to losing him, not out of the woods yet. X-rays cloudy - both lungs. No blood pressure. High red cell count. Unresponsive other than occasionally opening his eyes. Threw up blood. Didn't seem to recognize me. Could not reach the vet to find out type of anesthesia, drugs used. Fluids helped blood pressure. Lots of blankets, heating pad. Team of vets worked on him for almost 6 hours.

He survived the night. On fluids and oxygen. Antibiotics, antinausea meds. He is improving - alert, sitting and standing. Eating. No improvement in x-rays - lungs still cloudy. ER docs say it is now a matter of time, weeks for his lungs to improve.

My assumption is aspiration pneumonia due to some kind of malfunction or poor handling of the intubation. I would appreciate your take on this. Thank you.
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Answered in 54 minutes by:
8/11/2013
Dr. Bruce
Dr. Bruce, Veterinarian
Category: Veterinary
Satisfied Customers: 19,793
Experience: 15 years of small animal veterinary medicine
Verified
Hi,

Welcome. I'm Dr. Bruce and I've been a small animal veterinarian for over 12 years. I'm very sorry to hear about this situation with Zoom. Anesthetic complications / procedure complications are things no owner wants to hear about and no veterinarian wants to have happen. Unfortunately, even the best laid out surgical / anesthetic approach can have complications to it. Could the endotracheal tube cuff had a leak in it? Could he have had some stomach regurgitation after being extubated (the tube pulled out and the trachea no longer protected) because he was awake enough to have it pulled? Could he have had a reaction to something while anesthetized? I've seen a few cases where vaccines were given under anesthesia and very severe reactions happened (pretty rare). At this time, I'm very glad you took him to the ER clinic for them to do their treatments through the night and are continuing with them. Lung lesions are ones that require time. Currently at my ER, I have a young puppy with bad pnuemonia that is in the oxygen cage and on antibiotics. This one is a time situation now like Zoom. I hope he responds here quickly to the therapy and makes a full recovery. I'll be on and off line all day long so please let me know what questions I can further address.
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Customer reply replied 4 years ago
I should add that my dog's heart is NOT enlarged and there is no murmur.

I understand that there is always a risk with anesthesia, but I think this is more than that. It was also inexcusable that I could not reach the vet for info.

No disrespect but your answer is basically that there are risks to anesthesia. I do know that. If you have nothing to add, I understand. But your answer is rather vague.
Customer reply replied 4 years ago
Answer was generic. Did not tell me anything I didn't already know. No disrespect intended. It just didn't provide me with new information or insight.
I want to help as much as I can in this situation Beth. But do realize, that to be more specific, I would have to evaluate him and in all reality be there during the procedure itself. I have to be vague as I can't be exact. But in saying that, the initial vet should be available to give as much information / history and testing as they can. Honestly, the best decision you made was to not leave him there overnight unobserved. This would have been a mistake in my eyes as he would have been there receiving no observation / care during the hours no one was there. He obviously needed to be treated more aggressively and has received that from the ER clinic. In this situation, my top rule outs are failure of the endotracheal tube or it being pulled to soon and him regurgitating and aspirating that. PLease let me know what questions this brings up. This is meant to be a back and forth conversation and I want to further continue to help.
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Hi Beth,

How is Zoom doing today? I'm very curious to hear about his progress. I'm hoping that the time that has passed since your last communication have shown some big improvements with him.
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Customer reply replied 4 years ago

Zoom had a very difficult week. The evening I brought him to the ER, a team of 3 people worked on him for 7 hours to get a blood pressure and pulse. We were not able to get any information from the vet who did the dental so had to work blind. We did eventually get information as to what type of anesthesia, but nothing more than that. Initial bloodwork had been done and it was normal.


 


No vaccines were given. Only anesthesia They insist that Zoom was fine, came out of anesthesia, and only began having difficulty the moment I walked in to pick him up. This just isn't possible. As fluid-filled as his lungs were, they couldn't have been observing him closely without realizing he was in distress. There is no excuse.


 


Basically Zoom has aspiration pneumonia and/or pulmonary edema (it seems these two can be inter-related).


 


I could have done more diagnostics, but it would put Zoom at risk and I'm not willing to do that.


 


I appreciate your input, but basically your information informed me that anesthesia has risks and I knew that. I was looking for what kind of events could cause this. To my way of thinking there was either a failure in the equipment or in the technique of intubation/adminstering anesthesia. I have no hard proof however. I do feel the vet should take responsibility, but I cannot make them do the right thing.


 


Thank you.

Hi Beth,

Have you been going to this veterinarian that did the dental procedure for quite some time? What type of relationship do you feel that you have with them / the practice?

I can say that at my ER clinic I have similar situations happen where cases come in that have been at a day practice earlier in the day or week and they come in critical with a huge void of information about what happened at the other practice. One thing that I tell every client that I deal with is to in the future ask for copies of all records, blood work, etc... on discharge so they can have this just in case some thing happens after hours when that clinic can't be reached. It isn't a perfect system, but it is at least something.

I would ask to talk to the veterinarian / hospital director / or medical review board for that hospital. At this time, you have questions and concerns about what has happened to Zoom and you deserve some response / answers. I can't vouch for what happened at that clinic as only they know what happened. You can ask the veterinarians at the ER clinic to put together a case report to take to the original clinic to let them see what all happened. You're correct in that something happened under their watch. Did they ignore it or just plainly not see it. Unfortunately I have seen cases come into my clinic where plain ignorance / lack of monitoring has happened and this caused bad situations.

I'm sorry that I was general before with my answer as I usually start this way and then get more specific as the situation drives it. I will say that this could have been a failure of the endotracheal tube cuff of inflating, it being pulled too soon, or Zoom vomiting / regurgitating after the anesthetic procedure itself and the tube being pulled at a time that seemed safe.

As far as your concern about them doing the right thing, you can always present this case (and let the clinic know that) to the veterinary state board in your state of residence. This is something that can start to get some answers.

Please do let me know how I can further help out. I want to help as much as I can. When you rate my service as poor, it actually reflects bad on my ratings for the site and I try my absolute best to always help.

I'm hoping that Zoom continues to fight and pulls through all this. It sounds like there is an awesome team of vets at the ER clinic helping him out!
Dr. Bruce
Dr. Bruce, Veterinarian
Category: Veterinary
Satisfied Customers: 19,793
Experience: 15 years of small animal veterinary medicine
Verified
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Customer reply replied 4 years ago

Thank you. This gives me a little more to go on.


 


I have several vets (one for my exotic pets; one for dogs/cats). My exotic vet does give me copies of everything -- bloodwork, etc. And I will, from now on, ask for copies of exactly what was done with every visit to the vet.


 


Frankly, it is going to be difficult to EVER have another animal go under anesthesia again.


 


Zoom did not eat for the 12 hours prior to his procedure, so he should not have vomited. My guess is the endotracheal tube was removed too soon and he inhaled some of the water from the dental procedure. I did ask about culturing from a swab from his nasal-oxygen tube, but it was explained to me that this would be contaminated and wouldn't tell us much.


 


I did talk to the practice owner who insists everything was normal until I walked in to retrieve Zoom. I do plan on following up with review boards. If the result is that it makes the vet more careful, then that is something. Unfortunately, I cannot take back what Zoom had to suffer through.


 


The ER clinic was phenomenal. Clearly they played a huge part in Zoom's survival and recovery. A very dedicated and knowledgeable staff. Zoom also worked hard, and I spent hours with him each day, feeding him and talking to him. Keeping him warm. Talking to him.

I've had some owners come into my ER clinic that literally have 3 ring binders with a chronological sequence of all exams / records / blood work. It is so nice on those cases to sit down for a couple minutes to be able to read a history and what is going on rather than trying to pull the information needed from an owner. Every owner tries their best to relay a good history, but as you can guess, it is altered in some areas and splotchy in others - and in no way their fault!

I truly understand your concern for future anesthetic events. I can attest that when an owner has a bad experience it makes them extremely cautious. I wish I could say I've never had an anesthetic complication, but I can't. As a veterinarian, if you practice long enough and work on enough cases, despite all your skills, experience, precautions, monitoring and best intentions - one will creep out of no where. Mine was an extremely bad reaction to an induction agent being given in the exact manner and dose that it was supposed to and the patient had an extremely rare reaction to it going into cardiac arrest.

But, in saying all this, anesthesia is a very valuable tool in being able to prepare a patient for a procedure that is needed to help them maintain a good health status. The risk of the procedure has to be weighed against the reward each and every time.

The not eating for 12 hours prior to the procedure means that there is no food in the stomach. They can still have saliva and stomach secretions that can be brought up and go down the wrong way. The culture from the nasal - oxygen tube wouldn't have been that informative too as I agree on the contamination from the nostrils.

If everything was normal until you walked in to retrieve Zoom, that is their story and it is hard to disprove. But, I will say that it was on the verge of a horrible decision to just keep him there with no one there to monitor him. That was going down a bad path and I'm glad you absolutely didn't go down that one!

I'm glad you're having a good experience with the ER clinic. No one wants to see us at the ER clinic as we see owners and their pets on their worst days. But, we do our best to help them through these tough times.
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Dr. Bruce
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