Species: dog
Breed: Boxer
Sex: m, not neutered
Weight: 39 kg
Birth date: 2017-01-16 00:00:00
Primary diagnosis: Tartar, severe gingivitis/periodontitis, severe gingival growth. Mast cell tumor ear margin on the right
Situation: Post-surgery
Time since surgery: < 2 hrs
Recovered from anesthesia: Mild sedation (1)
Medical history: The dog was presented to the clinic on 26.11.2024 for an ispection of the mouth and bit. The dog then came on 03.12 for dental restoration. As the dog also had a mast cell tumor on the right ear margin, it was decided to perform a CT of thorax and abdomen wiht an abdominal ultrasound with FNA of the liver and spleen the day after to check for metastasis. CT report (04.12): Soft tissue mass, lateral pinna of the right ear; Bilateral chronic ear canal mineralizations; Ventricular asymmetry (L>R); Crown fracture 304,404 with open pulpa; Tooth root remodelling 101-103 and 201. Tooth loss with remaining root remnants 407; Minimal enlargement of the right prescapular lymph node and right mandibular lymph node; Diffuse pulmonary heterotropic bone; Mild multifocal peripheral interstitial lung pattern; Small focal soft tissue mass cranioventral abdomen; Beninge prostatic hyperplasia; Mulitfocal spondylosis deformans; Degenerative lumbosacral stenosis with bilateral moderate foraminal stenosis --> The soft tissue nodule of the right ear is compatible with the knwon mast cell tumor. Lymph node mapping did not reveal a clear sentinal lymph node to the timepoint until 16 min after peritumoral infiltration. The mild right prescapular lymphadenomegaly is either incidental (DDx: positional) or represents true enlargement (DDx: reactive vs. neoplastic infiltration); The focal soft tissue mass of the cranioventral abdomen represents most likely atopic splenic tissue (DDx: primary splenic neoplasia) or an unrelated abdominal nodule (eg. granuloma, chronic haematoma, benign ometal nodule). Ultrasound report (04.12): FNA of the liver, spleen, suspected acessory spleen, bilateral mandibular and retropharyneal lymph nodes -> cytology: No evidence of metastatic disease was found in any of the smears. After performing the CT and US the dog went home. On 18.12 the dog came back to perform the excision of the mass and the day after he was released again. November 2023: Rostral mandibulectomy because of fibroma/epulides. June 2024: suspicion of idiopathic Horner syndrome.
Medication: No medication before presentation on 03.12. After surgery before observation 2 (as written in anaesthesia report of 03.12): Methadon 0.1 mg/kg IV, Carprofen 4 mg/kg IV. No medication before presentation on 18.12. Before observation 4: Meloxicam 0.2 mg/kg IV (+ medication for premedication and induction). 18.12 after observation 6: Buprenorphin 0.001 mg/kg IV at 20, Omeprazol 1 mg/kg IV at 20. 19.12 (nothing given before observation 7): Meloxicam 0.1 mg/kg IV SID, Buprenorphin 0.01 mg/kg IV TID, Omeprazol 1 mg/kg IV SID.
Anesthesia: Intervention on 03.12.2024: gingivectomy, tooth extraction, tartar removal. Premedication at 10:20: Methadon 0.2 mg/kg IM, Dexmedetomidin 0.005 mg/kg IM. Induction: Ketamin 1 mg/kg IV, Propofol 0.3 mg/kg IV. Maintenance: FiO2, TIVA with Propofol (0.05 - 0.1 mg/kg/min) and Remifentanyl (0.03 - 0.2 mcg/kg/min) CRIs. Antibiotics: Cefazolin 22 mg/kg IV. Complications: bradycardia (but with good BP). Wake up phase: Methadon 0.1 mg/kg IV, Carprofen 4 mg/kg IV. Intervention duration: 155 min. Anaesthesia duration: 215 min. Intervention on 18.12.2024: Excision of mast cell tumor on right ear pinna. Premedication at 09:30: Dexmedetomidin 0.005 mg/kg IM, Methadon 0.2 mg/kg IM. Induction: Ketamin 1 mg/kg IV, Propofol 0.8 mg/kg IV. Maintentance: FiO2, Isofluran, Dexmedetomidin CRI 1 µg/kg/h. Analgesia: 1x Bolus Fentanyl 0.005 mg/kg IV, IV Infusion (Dex)medetomidin 0.001 mg/kg/h (as already mentioned) for 65 min, IV Ifusion Fentanyl 0.05 mg/kg/h for 10 min, local anaesthesia auriculotemporal block 1 ml Bupivacain & great auricular nerve block 2 ml Bupivacain. Antibiotics: Ampicillin / Sulbactam 30 mg/kg IV. Complications: bradycardia. Wake up phase: postoperative antagonisation Atipamezol 0.09 ml, Bolus Buprenorphin 0.01 mg/kg IV, Bolus Meloxicam 0.2 mg/kg IV. Intervention duration: 20 min. Intervention duration: 105 min.
Pain type: acute, inflammatory, somatic
Pain origin: ears
Pain duration: Less than 24 hours
Estimated pain severity: 28