Anaesthetic management of a dog with severe pulmonary stenosis and R2A right coronary artery anomaly undergoing placement of a hybrid transventricular pulmonary stent

Abstract

A 7-month-old, 12.2 kg, male, neutered, English bulldog with severe pulmonary stenosis and R2A right coronary artery anomaly was anaesthetised for placement of hybrid right ventricle to pulmonary artery stent. An alfentanil bolus (10 μg/kg intravenously) was used as premedication. Anaesthesia was induced with midazolam (0.2 mg/kg) and etomidate (1 mg/kg) intravenously, and maintained with sevoflurane in 100% oxygen. Perioperative analgesia was achieved combining locoregional techniques with intravenous analgesics. The main intraoperative complications were hypotension, bradycardia, ventricular premature complexes, ST-segment depression and transient hypoxaemia. Lidocaine constant-rate infusion (50 μg/kg/min) and magnesium sulphate constant-rate infusion (5 mg/kg/h) were used to prevent arrhythmias during the cardiac manipulations and stent placement. Hypotension was treated with dobutamine and noradrenaline constant-rate infusion. The use of different drugs and anaesthetic techniques (balanced anaesthesia) provided antinociception, muscle relaxation and appeared to be effective in preventing major cardiovascular complications.