Is there a specific fluid rate for intra-operative fluids in dogs with CHF?

RE: Use of intra-operative fluids in dogs with CHF

Sarah Keir — Tue, 19 Nov 2024 18:19:29 GMT

[quote userid="11308" url="~/f/clinical-questions/31079/use-of-intra-operative-fluids-in-dogs-with-chf/246043#246043"]Stage B1-C CHF due to MMVD - so wide catchment.[/quote]

It is therefore meaningless. This is one time that treatment MUST be tailored to the individual.

RE: Use of intra-operative fluids in dogs with CHF

Anthony Dennison — Mon, 18 Nov 2024 13:18:02 GMT

[quote userid="9515" url="~/f/clinical-questions/31079/use-of-intra-operative-fluids-in-dogs-with-chf/245984#245984"]And are we talking about MMVD dogs that are currently in congestive heart failure or ones that have an episode but are now controlled by diuretics? And what is their systolic function like? And do they have atrial fibrillation? Are they predominately left sides failure or right sided or biventricular? So many questions, a blanket advice could potentially be detrimental...[/quote]

It is for Stage B1-C CHF due to MMVD - so wide catchment.

Interesting responses. We are developing a 'cheat sheet' type thing for vets to access, giving ideas on diagnostics, treatment (acute and chronic) and links to advice for owners. During one of our meetings it was mentioned about if there is any publicised data for anything more specific, which there isn't.

Also, these are not designed as a strict protocol that everyone has to follow, more of an easy access, easy to follow flow chart to help those vets less confident in diagnosis and management of certain conditions.

RE: Use of intra-operative fluids in dogs with CHF

Sarah Keir — Sun, 10 Nov 2024 18:33:33 GMT

I think you should discuss this with a cardiologist, but to me blanket putting all dogs in congestive heart failure on intravenous fluids of any rate will be detrimental rather than helpful. Much more appropriate to have advice over the drugs to use and not use and have IVFT available as blood pressure support. And are we talking about MMVD dogs that are currently in congestive heart failure or ones that have an episode but are now controlled by diuretics? And what is their systolic function like? And do they have atrial fibrillation? Are they predominately left sides failure or right sided or biventricular? So many questions, a blanket advice could potentially be detrimental...

RE: Use of intra-operative fluids in dogs with CHF

Michael Woodhouse — Sat, 09 Nov 2024 22:18:28 GMT

I find some of these things quite concerning, there is almost the assumption that IVFT makes an anaesthetic better/safer and yet the biggest piece of research we have on this (that I am aware of) showed increased chance of death when IVFT used in (if I remember correctly) sick dogs and even healthy cats. Personally, my view is to correct problems before anaesthesia wherever possible (a GDV or ruptured spleen is going to be on fluids) and the majority of anaesthetised animals shouldn't be on IVFT. In a cat I'd rather give fluid sub cut where I can.

I've never seen a consent form suggesting that fluids associated with increased mortality, although I have seen many that try and upsell them to make things 'safer'.

[quote userid="5012" url="~/f/clinical-questions/31079/use-of-intra-operative-fluids-in-dogs-with-chf/245968#245968"]If I felt IVFT was needed, just give at maintainence rates.[/quote]

I get cross when I see young vets using such low rates. If it needs fluids then I'd say it needs more than maintenance (unless you are correcting your figures for a higher maintenance under anaesthetic with abdomen open, then I apologise).

If you want to be honest and practice EBVM then I guess you say to the heart patient "your anaesthetic is already higher risk and if we give fluids we increase the chance of your pet dying".......

https://www.rvc.ac.uk/Media/Default/staff/files/dbrodbelt-thesis.pdf

RE: Use of intra-operative fluids in dogs with CHF

Rob Loxley — Sat, 09 Nov 2024 09:34:34 GMT

[quote userid="11308" url="~/f/clinical-questions/31079/use-of-intra-operative-fluids-in-dogs-with-chf"]Does anyone have any information about specific fluid rates for this at all? Otherwise we will just stick with 'care must be taken'[/quote]

I'm not sure of a generic fluid rate to suggest, but I'd want such guidelines/frameworks to maybe expand on 'care must be taken' ie what should we (and our nurses etc) be monitoring if using IVFT to know if there is an issue

RE: Use of intra-operative fluids in dogs with CHF

Clive Ansell — Fri, 08 Nov 2024 18:04:45 GMT

[quote userid="11308" url="~/f/clinical-questions/31079/use-of-intra-operative-fluids-in-dogs-with-chf"]all I have found is 'care should be taken'.[/quote]

But, care should taken with ALL of our patients, so should we really be saying take more or better care?

If there was no initial dehydration or fluid deficit, I wouldn't give IVFT for a short procedure anyway, but would monitor CV and respiratory parameters closely and have an i/v cannula in place in case its needed. Circulatory overload and pulmonary oedema would be a concern with IVFT, so ideally capnography, and the ability to measure bood gases in an ideal world. Would prefer a full GA, intubation and oxygenation, over sedation with minimal or no monitoring.

If there were a fluid deficit, dehydration etc, I would address and stabilise prior to surgery.

If I felt IVFT was needed, just give at maintainence rates. Monitor closely.