Boesch Jordyn M, Gleed Robin D, Gagne Jason W, Ortved Kyla, Dykes Nathan L, Horne William A
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
Vet Anaesth Analg. 2009 Nov;36(6):567-73. doi: 10.1111/j.1467-2995.2009.00488.x.
A 1-month-old Nubian goat presented for sialocyst resection. Physical examination and bloodwork were unremarkable. While pre-oxygenating, the goat was sedated with midazolam and morphine (0.1 mg kg(-1) each) intravenously (IV). General anesthesia was induced 5 minutes later with 1.7 mg kg(-1) propofol. Sevoflurane was administered in oxygen without assisted ventilation via a cuffed orotracheal tube. Throughout the first 85 minutes of anesthesia, the goat was well-oxygenated (SpO(2), > or =97%), ventilating adequately (Pe'CO(2), 36-48 mmHg), and had normal mean arterial blood pressure (MAP, 60-85 mmHg). Blood-gas values at 45 minutes were consistent with adequate ventilation on oxygen. At 75 minutes, the goat moved in response to surgical stimulation, requiring additional propofol (0.4 mg kg(-1)). After 10 minutes, MAP dropped precipitously to 40 mmHg and frequent multiform premature ventricular contractions (PVCs) were observed. Crystalloids, hetastarch, and dopamine (5 mug kg(-1) minute(-1)) were administered to correct the hypotension. Arterial blood-gas analysis revealed that the goat had become hypoxemic (PaO(2), 50 mmHg). Intermittent positive pressure ventilation (IPPV) was initiated. Subsequent blood-gas analysis did not show significant improvement in PaO(2) (53 and 56 mmHg, respectively). Occasional PVCs were observed thereafter. Surgery ended, and sevoflurane and IPPV were discontinued. The goat was extubated within 7 minutes and received 100% oxygen by mask. Diffuse crackles were ausculted over both hemithoraces. Suspecting pulmonary edema, furosemide (1 mg kg(-1)) was administered IV. Radiographs taken immediately post-operatively revealed a severe, caudodorsal airspace (alveolar) pattern, confirming the diagnosis. Respiration improved considerably within an hour with nasal oxygen and two additional doses of furosemide.
The goat developed acute, drug-induced, noncardiogenic pulmonary edema in response to the second dose of propofol.
一只1月龄的努比亚山羊因涎囊肿切除术前来就诊。体格检查和血液检查未见异常。在预充氧时，山羊通过静脉注射咪达唑仑和吗啡（各0.1mg/kg）进行镇静。5分钟后，用1.7mg/kg丙泊酚诱导全身麻醉。通过带套囊的口气管导管在氧气中给予七氟醚，无需辅助通气。在麻醉的前85分钟内，山羊氧合良好（脉搏血氧饱和度，≥97%），通气充分（呼气末二氧化碳分压，36 - 48mmHg），平均动脉血压正常（60 - 85mmHg）。45分钟时的血气值表明在吸氧情况下通气充分。75分钟时，山羊对手术刺激有反应而移动，需要追加丙泊酚（0.4mg/kg）。10分钟后，平均动脉血压急剧降至40mmHg，并观察到频繁的多形性室性早搏（PVCs）。给予晶体液、羟乙基淀粉和多巴胺（5μg/kg·分钟⁻¹）以纠正低血压。动脉血气分析显示山羊出现低氧血症（动脉血氧分压，50mmHg）。开始进行间歇正压通气（IPPV）。随后的血气分析显示动脉血氧分压没有显著改善（分别为53mmHg和56mmHg）。此后偶尔观察到室性早搏。手术结束，停止使用七氟醚和IPPV。山羊在7分钟内拔管，并通过面罩给予100%氧气。双肺听诊可闻及弥漫性湿啰音。怀疑有肺水肿，静脉注射呋塞米（1mg/kg）。术后立即拍摄的X线片显示严重的尾背侧气腔（肺泡）影像，证实了诊断。通过鼻导管吸氧和额外两次使用呋塞米，呼吸在1小时内有明显改善。
山羊在第二次使用丙泊酚后发生了急性药物性非心源性肺水肿。
