Species: dog
Breed: Rottweiler
Sex: f, neutered
Weight: 39 kg
Birth date: 2019-07-27 00:00:00
Primary diagnosis: Complete cruciate ligament rupture right
Situation: pre surgery
Medical history: The dog started going lame on the right hindlimb around 2.5 months ago (beginning of april). They gave Meloxicam for a week but the lameness didn't improve. The private vet took radiographs of the stifle and had a positive drawer test. Two weeks ago radiographs were taken at our clinic and now the dog is here for surgery. In january 2023 the dog already got operated because of cruciate ligament rupture of the left. On the 23.05 surgery was started, they completed arthroscopy but then the dog developped a spontaneaus hyperkalemia so the surgery was interrupted. The reason for it is unclear, it might have been the combination of stress and a high dose of dexmedotmidin. On the 25.06 he dog came back to perform the TPLO the day after. A chill protocoll with Gabapentin and Trazodone was started as soon as the dog arrived in the afternoon.
Medication: Before surgery 23.05: Carprofen 2.7 mg/kg PO SID. During/after surgery: Bricanyl 0.01 mg/kg SC, Novorapid 0.1 mg/kg IV, Glucose 25% 500 mg/kg IV, Ca-Gluconate 6 ml. Before obervation 3 (25.06, at 14:30): Gabapentin 24.2 mg/kg (900 mg) PO, Trazodone 6.7 mg/kg (250 mg) PO. At 17:00 the dog got Gabapentin 5.4 mg/kg (200 mg) PO and Trazodone 2.7 mg/kg (100 mg) PO, then at 24:00 she got Gabapentin 29.6 mg/kg (1100 mg) PO and Trazodone 9.4 mg/kg (350 mg) PO, and at 07:00 she got again Gabapentin 29.6 mg/kg (1100 mg) PO and Trazodone 9.4 mg/kg (350 mg) PO. 26.06: Ampicillin 30 mg/kg IV TID, Methadon 0.1 mg/kg IV q4h (given before obervation 5), Meloxicam 0.2 mg/kg IV SID (given before obervation 4), Tranexamic acid 20 mg/kg IV TID (given before obervation 5), Trazodone 10 mg/kg PO TID (given before obervation 4, then only if needed), Gabapentin 30 mg/kg PO TID if needed. 27.06: before obervation 6 Ampicillin 30 mg/kg IV & Gabapentin 19 mg/kg PO.
Anesthesia: Intervention on 23.05.2024: arthroscopy right stifle. Premedication at 09:00: Acepromazine 0.03 mg/kg IM, methadon 0.3 mg/kg IM, Dexmedetomidin 0.03 mg/kg IM. Induction: Ketamin 1 mg/kg IV, Propofol IV (dosage? quantity?). Maintenance: FiO2, Isofluran. Analgesia: Bolus Methadon 0.2 mg/kg, Bolus (S-)Ketamin 1 mg/kg, Local anaesthesia femoralis/ischiadicus Ropivacain 8 ml. Antibiotics: Ampicillin/Sulbactam 30 mg/kg IV. Complications: hypotension, bradycardia -> Glykopyrrolat, Atropin, Ephedrin. (during the first hour of anaesthesia the dag was fine. she was a bit bradycardic, but with high pressure, she was also breathing well spontaneusly. she reacted to the skin incision and a bolus of Keta and Methadon were given. afetr one hour of anaesthesia and 30 min (more or less) of surgery she became apneic, I switch to VCV, and the breathing got better. few min after she also beacame suddently bradycardic (20-30 HR) and hypotense, with first sings of AV blocks which canged to bradycardia without P waves. they gave twice Glyco bolus + twice atropine bolus and nothing changed, HR was still around 35 and the mean pressure around 50. then they tried ephedrin bolus and got a little better. they took blood to analyse the electrolites and the resolt was that she was strongly Hyperkalemik (8. ..). they gave insuline, glucose, and calcium pyrolate, and stopped the surgery before the TPLO was made). Wake up phase: postoperative antagonization: Atipamezol 0.8 ml. Intervention duration: 90 min. Anaesthesia duration: 240 min. Intervention on 26.06.2024: TPLO right stifle. Premedication at 09:05: Acepromazine 0.01 mg/kg IV, Methadon 0.3 mg/kg IV. Induction: Alfaxolon 0.25 mg/kg IV, Ketamin 2 mg/kg IV. Analgesia: local anaesthesia Femoralis / Ischiadicus block 0.54 mg/kg & 0.8 mg/kg (4 & 6 ml). Antibiotics: Ampicillin / Sulbactam 30 mg/kg IV. Wake up phase: Trazodone 10 mg/kg rectally. Intervention duration: 140 min. Anaesthesia duration: 310 min.
Orthopedic exam: Gait: severe lameness of right hindlimb. Orientating palpation: muscular atrophy of right hindlimb. Specific palpation under anaesthesia: drawer test of right hindlimb positive, tibial compression test positive with significant internal rotation right hindlimb.
Pain type: chronic, orthopedic, somatic
Pain origin: hind legs
Pain duration: more than 7 days
Estimated pain severity: 25