Soft Tissue Surgery
Anaesthesia and analgesia
Before Visiting the Specialist
Biggles was out walking with his owners when he ran away to chase something exciting. When he returned, he couldn’t breathe properly, so his owners took him to their vet. The vet took an x-ray of Biggles’ chest which showed that there was lots of trapped air in the gap between the lungs and the ribcage (also known as a pneumothorax) this air was not supposed to be there, and was stopping Biggles’ lungs being able to expand properly. The vet realised Biggles needed specialist veterinary care, and quickly, so he gave Biggles some pain relief before swiftly referring him to Anderson Moores Veterinary Specialists.
When Biggles arrived at the referral hospital, he was able to walk but he was breathing very heavily. Biggles had most likely run into something on his walk, as he was very painful on the left hand side of his chest despite being given more pain relief. This meant he would need to have an anaesthetic to be treated- the intention being to drain the air from the space between his lungs and ribs.
Biggles deteriorated rapidly under anaesthesia, and was unable to breathe properly- this meant the oxygen level in his blood was dangerously low, and the air between his lungs and ribs needed to be removed immediately. It was ‘all hands on deck’ at the hospital, with a team of 5 specialist vets (anaesthetists, surgeons and internal medicine specialists) and 5 veterinary nurses all working together to try to save Biggles. Two chest drains were quickly placed but it was not possible to remove all of the air, even when using a special continuous suction device- this meant Biggles’ chest need to be opened up, as it was likely there was a hole in the lung that air was leaking from.
When Biggles’ chest was opened, the trapped air was released and his lungs were able to inflate properly (with the help of a mechanical ventilator)- this meant the oxygen levels in his blood improved. There was a hole on the inside of his chest wall, and a hole in part of his lung, where the air was leaking from. The hole in his lung went all the way through and was not able to be repaired. The surgeons performed a lung lobectomy – a special surgical stapling device was used to seal the airway and blood supply to the affected lung lobe allowing it to be removed. This meant that there would no longer be any air leaking into the chest cavity once the chest was closed. The chest was filled with warmed fluid to ensure no bubbles were seen coming from any other injuries to Biggles’ lungs and luckily there were no other leaks seen. The hole in the chest wall was sutured closed (and luckily was not all the way through the skin). The chest was closed and then drained of any air or fluid. The mechanical ventilator was turned off and Biggles was able to breathe more normally immediately after surgery.
Biggles recovered very well from his surgery- he was up, eating and wanting to go outside very quickly. He spent 5 days in the referral hospital so that he could be closely monitored by the specialist vets and ICU nurses, and was given lots of pain relief and TLC. Biggles went home to his owners, who were delighted with the quick action of both their first opinion vet and the specialist referral centre- together, they managed to save Biggles. Hopefully, Biggles has learnt his lesson and will be more careful when he runs away next time!
Case provided by Aoife Ryan and Matt Eayrs