Species: dog
Breed: Crossbreed
Sex: m, neutered
Weight: 13 kg
Birth date: 2021-04-08 00:00:00
Primary diagnosis: Private vet: Intestinal foreign body surgery 14.11, drainage placement 28.11, perineal urethrostomy with urinary catheter placemens 29.11. Suspicion of dysuria because of urolithiasis. 02.12: cystotomy tube and surgical urinary catheter placement.
Situation: Pre-surgery
Medical history: The dog was presented to our clinic on 02.12.2024. Loki was operated two weeks ago (on 14.11.24) because of a foreign body (coin of 2.-). He recovered well, but after 10 days he developed fever, he started holding his tail between the legs, being very tired, apathetic, being anorexic (progressive since 5d post OP). Thursday of last week (28.11) they return to the private vet. The dog went into surgery again, drains were palced and the dog remained hospitalized. The day after the drains were removed, but he was not urinating well. The urine problem already sterted after the first surgery, the urine was a little bloody. After the second operation the dog could not urinate anymore --> on friday a perineal urinary catheter was put in and on saturday it was removed. The day of presentation according to the owner the dog urinated through the penis but with difficulty. The morning of presentation the dog got Clavaseptin and Meloxicam, according to the owner the dog felt a bit better afterwards. The dog has no known problems and takes no medication. At our clinic a caudal midline parapreputial laparotomy with placing of a cystotomy tube and surgical urinary catheter was performed.
Medication: Before presentation: Clavaseptin, Meloxicam. 02.12 before observation 1: no medication. 02.12 after observation 1: Ampicillin 30 mg/kg IV 2x during surgery then 1x at 24 and them stopped, Methadone 0.2 mg/kg IV q4h then stopped at 03, Fentanyl CRI 5 µg/kg/h IV started during surgery then continued from 02, Ondansetron 0.3 mg/kg IV TID. 03.12: Fentanyl CRI & Ondansetron same as 02.12, Ampicillin 30 mg/kg IV at 09 and 17, Metamizol 30 mg/kg IV TID & Gabapentin 10 mg/kg PO TID started at 13. 04.12 (only Ondansetron (& Fentanyl CRI) given before observattion 3): Ondansetron 0.3 mg/kg IV TID, Fentanyl CRI 5 µg/kg/h IV stopped at 10 then switch to Methadon 0.2 mg/kg IV q4h, Metamizol 30 mg/kg IV TID, Gabapentin 10 mg/kg PO TID. 05.12 (nothing given before observation 4): Ondansetron & Metamizl & Gabapentin same as 04.12, Methadon 0.2 mg/kg IV / Buprenorphin 0.02 mg/kg IV.
Anesthesia: Intervention on 02.12.2024: Exploration, cystostomy tube, surgical urinary catheter placement. Premedication at 21:35: Dexmedetomidin 0.005 mg/kg IV (already got Methadon 0.2 mg/kg IV in the ICU). Induction: Midazolam 0.2 mg/kg IV, Ketamin 1 mg/kg IV, Propofol 1 mg/kg IV. Maintenence: FiO2, Isofluran. Analgesia: 2x Bolus Fentanyl 0.003 mg/kg IV, IV Infusion Fentanyl 0.005 mg/kg/h, IV Infusion (Dex)medetomidin 0.001 mg/kg/h, IV Infusion Lidocain 1.8 mg/kg/h, Local anaesthesia Epidural Rpivacain 1 mg/kg. Antibiotics: Ampicillin/Sulbactam 30 mg/kg IV. Wake up phase: postoperative sedation Dexmedetomidin 0.001 mg/kg IV, Bolus Methadon 0.2 mg/kg IV. Intervention duration: 155 min. Anaesthesia duration: 220 min.
Pain type: acute, inflammatory, visceral, somatic
Pain origin: Perineal region
Estimated pain severity: 48