2. The Case of the Missing Hedgehog Gastric Foreign Body in a Dog VETE: 4325 Anesthesia and Surgical Nursing Sarra Borne, LVT

3. Gustav 2 years old Intact male Airedale terrier mix 2 day history of vomiting and lack of appetite Lethargic Other dog is unaffected Missing squeaky toy?

4. Vital Signs: Quiet, alert and responsive Weight: 53 lbs (24 kg) Rectal Temperature: 102.4 F Thoracic Auscultation: 140 beats per minute, no murmur or arrhythmia detected Respiratory Rate: 36 breaths per minute Mucous membranes: pink, slightly tacky Capillary Refill Time: <2 seconds Abdominal Palpation: Tense, painful in the cranial abdomen. Firm structure palpable in the stomach region.

5. Veterinary Detective Work Blood work (CBC, Chem 27) Abdominal X-Ray +/- Abdominal Ultrasound

6. Laboratory Database  CBC  WBC – 19 x 10 3 /ul  Neutrophils – 12000/ul  Band Neutrophils – 450/ul  RBC – 7 x 10 6  PCV – 65% Consistent with dehydration, and a mild left shift.  Serum Chemistry  BUN – 20 g/dL  Creatinine – 0.7 g/dL  Albumin – 4.5 g/L  Total Protein – 5.8 g/dL  ALT ( Alanine Aminotransferase ) - 18 u/L  ALP (Alkaline Phosphatase) – 72 u/L  Total Bilirubin - 0.1 mg/dL Serum chemistry is normal.

7. The Inside Picture (ACVS: American College of Veterinary Surgeons, 2014) Right, lateral survey radiograph There’s the firm structure palpated in the stomach. Could it be the missing toy? Choices: Endoscopy or surgery?

8. Pre-Anesthetic Drugs and Setup  IV catheter  Fluid therapy for the dehydration  Plasmalyte at Body weight (kg) x % dehydration = volume (L) / 24 hours plus his maintenance requirements at 132 x body weight (kg) 0.75 / 24 hours (Davis et al., 2013)  24 x 0.05 = 1.2 L or 1200 mL plus 132 x 24 = 2376 ml /24 hours = 149 ml/hr  Premedications  Gustav is painful so a combination including opioids is a good choice.  Midazolam (5 mg/mL) 0.2 mg/kg IV = 0.96 mL IV  Hydromorphone (2 mg/mL) 0.1 mg/kg IV = 1.2 mL

9. Induction and Intubation Gustav will be induced with Propofol (10 mg/kg) IV at 4-6 mg/kg 96 – 144 mg IV given to effect. He will be intubated and maintained on Isoflurane in a semi-closed system. Oxygen will be provided at 0.5-1 L/ 10 kg bodyweight per minute

10. Endoscopic Foreign Body Videos Basket Snare (Theodore Veterinary Hospital, 2013) Net (AB Vet veterinarni klinika, 2012)

11. Success!  The toy was extracted endoscopically.  Gustav would not have to undergo surgery.  Healing time will be shorter and less painful.  His owners are very pleased.

12. Aftercare in the hospital 24 hour hospital stay  Additional doses of hydromorphone for pain  Sucralfate 1g every 6 hours for the irritated esophagus and stomach  Kept off food for an additional 12 hours  Feed a bland diet once food is allowed

13. Aftercare at home Back to his old self.  Tramadol 50 – 100 mg orally every 8 hours as needed for pain or discomfort for 3 days  Sucralfate 1 gm tablet as a slurry orally every 6 hours for 7 days  Recheck in 1 week  No toys that are small enough to ingest.

14. References AB Vet veterinarni klinika. (2012, November 29). Gastroscopy dog - Endoscopic removal of foreign body [Video file]. Retrieved from https://www.youtube.com/watch?v=qSs7mMVEd7k ACVS: American College of Veterinary Surgeons. (2014). Gastrointestinal Foreign Body X-Ray [image]. Retrieved from https://www.acvs.org/sites/default/files/images/Figure%202%20Gastric%20foreign%20body%20latera l%20radiograph.jpg Davis, H., Jensen, T., Johnson, A., Knowles, P., Meyer, R., Rucinksy, R., & Shafford, H. (2013). 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats. Journal of the American Animal Hospital Association, 49(3), 149-159. Retrieved from DOI 10.5326/JAAHA-MS-5868 Theodore Veterinary Hospital. (2013, February 5). Canine Minimally Invasive Foreign Body Removal - Bouncy Balls [Video file]. Retrieved from https://www.youtube.com/watch?v=IlH_qUHstU8 Thomas, J., Kerche, P., & McKelvey, D. (2011). Anesthesia and analgesia for veterinary technicians. St. Louis, MO: Mosby/Elsiver.