Lecture Link: Patients with GDV—Challenging and rewarding cases
In her session "Pre- and Post-op Care of the GDV Patient" at the Western Veterinary Conference in Las Vegas, Elisa Mazzaferro, MS, DVM, PhD, DACVECC, said not to dread seeing these patients because you can make a difference. Here are some highlights from her presentation.
Stabilize cardiac output
Dr. Mazzaferro emphasizes that the most important intervention in patients with suspected gastric dilatation-volvulus is to stabilize their cardiovascular status first, before obtaining abdominal radiographs. To optimize intravenous fluid flow, she suggests placing the largest bore catheter possible into the cephalic vein initially. And when abdominal radiographs are obtained, a right lateral view is best.
Because anesthetic management of patients with GDV can be challenging, Dr. Mazzaferro recommends administering premedications such as buprenorphine, hydromorphone, or fentanyl, which have minimal adverse cardiovascular effects. She stresses that premedication relieves a dog's anxiety and helps decrease the total dose of anesthetic induction agents and inhalant anesthetics required to maintain general anesthesia—without compromising cardiac output and arterial blood pressure. She also cautions against morphine administration in these patients.
Anticipate postoperative problems
Dr. Mazzaferro always discusses potential postoperative complications with her clients so they may better anticipate them. Ventricular dysrhythmias, gastrointestinal hypomotility, electrolyte imbalances, systemic inflammatory response syndrome, and disseminated intravascular coagulation are all potential problems to make owners aware of. And let owners know you'll monitor for these problems in their pets postoperatively and treat as necessary.
Provide timely nutrients
Dr. Mazzaferro says that because enterocytes atrophy within 24 to 48 hours without luminal nutritional support, feeding should begin as soon as possible after surgery. Most patients with uncomplicated GDV (no evidence of gastric necrosis) can be fed the next morning or within 12 to 24 hours of anesthetic recovery. However, if gastric resection is required or if a patient has severe gastric atony at the time of surgery, place a feeding tube to provide adequate nutrients during the postoperative recovery period.