Postanaesthetic pulmonary oedema in a dog following intravenous naloxone administration after upper airway surgery

Abstract

A cavalier King Charles spaniel was anaesthetised for upper airway surgery. A constant rate infusion of fentanyl at 6 μg/kg/hour and top-up boluses (5 μg/kg in total) were used for intraoperative analgesia. Intermittent positive pressure ventilation (IPPV) was instituted due to tachypnoea and inability to maintain normocapnia. Apnoea and severe hypercapnia developed after cessation of IPPV. IPPV was recommenced for 10 min to reduce hypercapnia, after which spontaneous ventilation returned. The patient had not awakened 45 minutes after isoflurane was turned off and 0.01 mg/kg naloxone was administered intravenously due to suspected fentanyl-induced narcosis. Following immediate arousal, the patient vomited and suddenly developed symptoms and radiographic changes consistent with pulmonary oedema. General anaesthesia was reinduced and 1 mg/kg furosemide was administered intravenously. IPPV was started with application of positive end expiratory pressure in an air/oxygen mixture for 60 minutes. Recovery was uneventful. This is the first report of a dog developing pulmonary oedema following intravenous naloxone.

Anaesthetic and perioperative management of a dog with biventricular congestive heart failure and advanced second‐degree atrioventricular block

“…This is highlighted further by Bruniges and Rigotti, who successfully managed a case of pulmonary oedema as an adverse reaction to naloxone administration, using pressure controlled MV. 38 In this patient, MV was ceased 12 hours after the end of surgery, despite a significantly elevated RR. At this time the dog was breathing with minimal effort, achieving a tidal volume of 9 ml/kg and maintaining a normal ETCO 2 .…”

“…While a specific ventilation strategy cannot be recommended, the benefit of simple pressure‐controlled ventilation is likely to be adequate for management of cases of pulmonary oedema in dogs. This is highlighted further by Bruniges and Rigotti, who successfully managed a case of pulmonary oedema as an adverse reaction to naloxone administration, using pressure controlled MV 38 …”

Postobstructive negative pressure pulmonary oedema in a dog

“…IPPV with PEEP has been used in veterinary medicine for treatment of non‐cardiogenic pulmonary oedema 46. The application of PEEP counterbalances the hydrostatic forces leading to pulmonary oedema, redistributing the extravascular fluid from the alveoli into perivascular interstitium and maintaining airway patency 47.…”