GDV

Question 1

Main cardiovascular, respiratory and GI system dysfunctions in a GDV patients are?

Answer 1

• Decreased cardiac output due to lowered intravascular volume creating diminished venous return and leading to shock
• Decreased coronary blood flow, myocardial ischemia and catecholamine release = ventricular arrhythmias
• Respiratory dysfunction from dilatation impending caudal movement of the diaphragm results in hypoventilation
• Gastric necrosis and hemorrhaging due to hypoperfusion and physical damage due to stretching

Question 2

What is the primary goal of treatment for GDV?

Answer 2

Correct and eliminate the cause of shock

-aggressive fluid therapy to provide better intravascular volume

Question 3

How is sedation for gastric decompression usually achieved?

Answer 3

A combination of a pure-mu agonist opioid and a benzodiazepine

• opioids have very little cardiovascular consequences with minimal effect on blood pressure
• benzodiazepines have very minimal effects to cardiovascular and respiratory system, wide margin of safety and provide sedation and muscle relaxation

Question 4

What drugs should you avoid using in a GDV patient?

Answer 4

Morphine and meperidine as they can cause histamine release and contribute to hypotension

Phenothiazines (Acepromazine) -avoid as can cause peripheral vasodilation and contribute to hypotension, no reversal agent

Alpha-2 agonist: cause bradyarrhythmias and reduce cardiac output

Induction with barbiturates (thiopental): can cause peripheral vasodilation

Question 5

Ketamine + opioid and benzodiazepine for GDV

Answer 5

• Good as it increases cardiac output and blood pressure

* Not good when already tachycardic

Question 6

Etomidate used in GDV

Answer 6

• Pros: rapid induction, minimal changes in cardiovascular status
• Cons: if adrenocortical suppression is detrimental (sepsis, SIRS)

Question 7

Propofol as induction agent in GDV

Answer 7

Pros: rapid induction
Cons: apnea and hypotension due to respiratory depression and vasodilation

Question 8

What drug would you use to pretreat for vagal stimulation in a GDV patient?

Answer 8

A anticholinergic

Question 9

What is lidocaine routinely used for GDV?

Answer 9

Not only for it’s antiarrhythmic and analgesic effect

• Also a free radical scavenger
• Reduces ischemic damage and reperfusion injury

Question 10

What kind of anesthetic would you consider for a hemodynamically unstable or those showing negative signs towards inhalants?

Answer 10

TIVA (Total intravenous anesthesia)

Question 11

What drugs would you consider if hypotension persist in a GDV patient despite IVF and minimal anesthetic agents?

Answer 11

Positive inotropes and vasopressors (dopamine, Dobutamine, norepinephrine, and vasopressin)

Question 12

What kind of arrhythmias are common in GDV patients and what are the causes?

Answer 12

Ventricular arrhythmias. Myocardial ischemia, lactic acidosis, electrolyte imbalances, reperfusion injury