A 4-year old male miniature schnauzer with severe pulmonic stenosis was presented for percutaneous balloon valvuloplasty. The dog had been managed medically with atenolol for a month prior to the procedure. Clinical examination was unremarkable except for auscultation of a grade V/VI left-sided systolic murmur. The dog was premedicated with pethidine. Anaesthesia was induced using diazepam and etomidate and maintained using sevoflurane in oxygen. Angiography was uneventful, but when the guidewire was threaded through the right side of the heart to allow insertion of the balloon catheter, marked desaturation with visible cyanosis developed. This resolved on withdrawal of the guidewire and catheter but recurred each time the guidewire and catheter were repositioned. Balloon valvuloplasty was eventually successful in reducing the pressure gradient across the stenotic valve from 102 to 52 mmHg. Hypoxaemia did not recur during recovery and the dog was discharged the following day.

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Background: Fluid therapy is a life-saving measure, which is fundamental in managing horses with colic. It is essential for the clinician to be familiar with the available options when devising a fluid plan, so that it is both beneficial to the patient and financially viable for the owner. Underpinning this is an understanding of basic physiology associated with body fluid compartments and an awareness of the potential adverse effects of fluid therapy.Aim of the article: This article, the first in a two-part series, discusses basic physiological concepts of body fluids, available fluid types and the practicalities of administration in the adult horse. The second part, covering clinical aspects of fluid therapy in adult horses with colic and some of the controversies surrounding fluid rates, fluid types and the management of metabolic acidosis, will be published in a subsequent issue of In Practice

Background: Fluid therapy is a controversial topic in both human and veterinary medicine. While it is appreciated that fluid therapy can be immediately life-saving, particularly in animals suffering from hypovolaemic shock, it is increasingly recognised that inappropriate fluid therapy can lead to significant morbidity.Aim of the article: This article, the second in a two-part series, considers some clinical aspects of fluid therapy in adult horses with colic and some of the controversies surrounding fluid rates, fluid types and the management of metabolic acidosis. The first part, published in last month’s issue of In Practice, discussed basic physiological concepts of body fluids, available fluid types and the practicalities of administration in the adult horse.

BackgroundMeasurement of invasive blood pressure as reflection of blood flow and tissue perfusion is often carried out in animals during general anesthesia. Intravascular cannulation offers the potential for gas to directly enter the circulation and lead to arterial gas embolism. Cerebral arterial gas embolism may cause a spectrum of adverse effects ranging from very mild symptoms to severe neurological injury and death. Although several experimental models of arterial gas embolism have been published, there are no known published reports of accidental iatrogenic cerebral arterial gas embolism from flushing of an arterial line in animals.Case presentationA 7-day-old Red Holstein–Friesian calf (No. 1) and a 28-day-old Holstein–Friesian calf (No. 2) underwent hot iron disbudding and sham disbudding, respectively, under sedation and cornual nerve anesthesia. Invasive arterial blood pressure was measured throughout the procedure and at regular intervals during the day. Before disbudding, a sudden and severe increase of blood pressure was observed following flushing of the arterial line. Excitation, hyperextension of the limbs and rapid severe horizontal nystagmus appeared shortly thereafter. Over the following minutes, symptoms ameliorated and blood pressure normalized in both cases. Prompt diagnosis was missed in calf 1; supportive fluid therapy was provided. Severe deterioration of neurologic status occurred in the following 24 h and culminated with stupor. The calf was euthanized for ethical reasons and the histological examination revealed extensive cerebral injury. Treatment of calf 2 consisted of supportive fluid and oxygen therapy; furosemide (1 mg/kg IV) was injected twice. Calf 2 appeared clinically normal after 2 h and showed no neurologic sequelae on a 3-month-follow up period.ConclusionsThere are no known reports of cerebral arterial gas embolism following flushing of the auricular arterial line in calves. The injection of a small amount of air at high pressure in a peripheral artery may lead to a significant cerebral insult. The clinical presentation is non-specific and can favour misdiagnosis and delay of therapy.