Post sedation multi-organ failure... :(

Re: Post sedation multi-organ failure... :(

Bibs — Wed, 30 Apr 2014 16:52:16 GMT

I would have thought that if a dog suffered multiple organ failure due to poor perfusion / low blood pressure it wouldn't take 2 days to start to show any symptoms. I would have thought it would be hours. Strange.

Re: Post sedation multi-organ failure... :(

Miriam Lodewyks — Thu, 24 Apr 2014 19:41:11 GMT

Thank you all so much for the support. Lepto did cross my mind too, but the dog was recently vaccinated with Lepto4 and so the referral centre dismissed it straight off. I still think it has to be a possibility though? Unfortunately no PM done, so I guess we'll never know.

Re: Post sedation multi-organ failure... :(

Emily Nightingale — Wed, 23 Apr 2014 22:03:09 GMT

Dear GrooveJet..

So sorry to hear about this. It's up there with all the nightmare scenarios we can be confronted with and I can well understand how this will have left you feeling winded and knocked off your perch.

My first thoughts, like others, are Lepto.. so potentially subclinical infection at the time you saw him, developing to fulminant disease at the referral centre. Poor dog, poor owners.. POOR YOU!!!

Deep breath, you know you have done everything you could and I find it hard to see how you could have changed what you did to avoid the outcome if it was hypotension that caused the issue.

You're a great vet- because you care. Hope you feel better about it all soon, tragic as it is.

/ Emily

Re: Post sedation multi-organ failure... :(

emma_j — Wed, 23 Apr 2014 12:11:45 GMT

Reading through I was wondering lepto too, what other possible causes were ruled out?

My sympathies, I can't see anything wrong with the protocol and would have done/do similar routinely myself.

Re: Post sedation multi-organ failure... :(

Andrew Kent — Tue, 22 Apr 2014 10:11:58 GMT

[quote user="Kirsten Simpson"]

Saw something similar OOH. Given synulox + metacam for a UTI at own vets as had bit of a temp. Became jaundiced, kidney/liver failing, referred to specialists, thought Metacam tox. Dog died + had post mortem - turned out hadn't been vaccinated for a couple of years and had Lepto! O's still trying to blame their vets for killing it with Metacam but told countless times, no , was the fact you didn't vaccinate that killed it.

[/quote]

Lepto was one of my first thoughts as well so be interesting to know what kind of investigations the dog had at the referral centre.

Otherwise I would agree that metacam is a much more likely candidate than the sedation for this kind of complication.

Andy

Re: Post sedation multi-organ failure... :(

Kirsten Simpson — Tue, 22 Apr 2014 10:09:33 GMT

Re: Post sedation multi-organ failure... :(

Martin Atkinson — Tue, 22 Apr 2014 09:26:43 GMT

I can't see what you did wrong. However, I don't generally give any NSAIDs pre or peri-operatively just as a precaution in case something goes wrong with the anaesthetic as the referral vet intimated but as you don't mention a difficult anaesthetic and your pre-op bloods were normal I find this difficult as the explanation. Did you send the dog home with post op NSAIDs and if you did, is there a chance they over-dosed? I would also emphasise to the owners that they must not give any post-op NSAIDs for a further 24 hrs and that they must only give them with food and must not give them if diarrhoea or vomiting occurs.

I had one owner, a GP incidentally, who persisted in giving NSAIDs post op even though the dog wasn't eating and had D&V and it died although it was pretty old and knackered to start with. This was the same GP who phoned me up to ask how she could tell if the dog was dead or not!

Re: Post sedation multi-organ failure... :(

Hannah Wynne Richards — Mon, 21 Apr 2014 19:34:05 GMT

It seems such a standard procedure, I'd be wondering if something else caused the haemorrhagic diarrhoea? Parvo?Clostridial disease ? Acute staph enteritis? I don't know if a PM was done,and if so,how far they looked. My sympathy

Wynne

Re: Post sedation multi-organ failure... :(

Michael Woodhouse — Mon, 21 Apr 2014 18:51:13 GMT

"all anaesthetics, sedations and surgical procedures come with an inherent degree of risk" or similar working is on our consent forms.

This might have nothing to do with your sedation.

It does laugh in the face of pre-operative bloods if they were normal and this still happened. At least you can show 'normal' before surgery.

What did you find on the biopsy? Some crazy autoimmune conditions might be related.

It would be madness to suggest giving IV fluids to every quick sedative.

Re: Post sedation multi-organ failure... :(

jamie winstone — Mon, 21 Apr 2014 18:48:19 GMT

I have never seen the multi-organ failure that you have described and it must be incredibly rare. I would be much more worried about the meloxicam injection being the cause than the sedation. Perhaps either one on their own would have been fine but the combination of low blood pressure and the NSAID was the problem.

On the human side non-steroidals are blamed for thousands of deaths annually.

Jamie