I had my yellow lab with ME neutered in the summer and I printed out the guidelines from this group which the hospital followed. He did fine. But I got the vets to agree to these guidelines beforehand since they were unfamiliar with ME. I have pasted Dr. Kathy Morris’ guidelines below: Oh and the tube goes down the trachia, not the esophagus. And have the vet give an injection of Reglan not a pill since he will be fasting for the surgery:
Anesthesia and surgery in megaesophagus patients:
When a patient with megaesophagus requires anethesia there are some precautions which are suggested to minimize reflux of stomach contents into the esophagus, therefore minimizing aspiration pneumonia. Pretreating one half hour before anesthesia induction with metoclopromide in those dogs who can tolerate it, will encourage the stomach to empty. Elevating the head end of the surgical table, or placing the patient on a slant, so that the head is above the rear end, minimizes reflux of stomach contents into the esophagus. Leaving the endotracheal tube in until the dog is very actively swallowing, to minimize aspiration, is important. Maintaining elevation of the front end of the pet, preferably in a vertical position (body perpendicular to the floor), while recovering from anesthesia allows any fluid that accumulates in the esophagus to “drain” into the stomach. Any fluid build-up in the esophagus can be easily refluxed and precipitate aspiration pneumonia in dogs with megaesophagus. Some hospitals assign an assistant or technician to keep the pet elevated, others allow the owner to hold the pet as soon as it is extubated. Prevention of regurgitation, at all costs is paramount in these pets. Submitted by Dr. Kathy, November 29, 2007
Weigh what surgery(ies) you really do NEED performed:
Since we all worry about surgery for our ME dogs, weigh the risk from anesthesia with their need prior to getting something done. Surgeries like, neutering/spaying, teeth cleaning, repairing an injury, PRAA or LES, etc may be necessary but need to be done following the guidelines above. The biggest risk is your dog aspirating, so make sure you are clear about how versed your veterinarian is in working on an ME dog BUT ALSO make sure either you or vet techs who are monitored well attend to your dog afterwards in recovery.
CRITICAL: The last sentence above is of such importance that I am placing this piece of any surgery here in bold red to reiterate MAKE SURE YOUR DOG IS MANAGED PROPEERLY AFTER ANY SURGERY.
My surgical stories with ME GSD Gretyl: I am blessed to have veterinarians here who allow me to be there when our ME Gretyl is “coming around” after surgeries (could be there while they are performing them, but have opted to be recovery person to free up staff from watching her). I stand and make sure any discharge from her mouth and nose is wiped away and that she is elevated with her head and shoulders. The only time we had to place her with head down was immediately following teeth cleaning. She is very sensitive to any anesthesia or sedative, but what Dr Huddleston did was great. He and his assistant were on a ready, set go with the cleaning instruments while Gretyl received the sedative. I held her and they took no more than 1 minute to clean the back molars that were the ones we needed the most. They brought her around but she was starting to vomit, so we got head down ONLY to expel what was brought up then she was held up and monitored closely. Her 2 major surgeries of having the Persistent Right Aortic Arch (PRAA) heart surgery then a few months later spaying were significant. But doc took great pains to make sure she was cared for before, during and after each surgery. I was there as he was closing on each surgery and was able to stand and hold her for about 1 1/2 hrs after the PRAA surgery, then close to same after spaying. He made sure she was ready to go home, but also sent his cell number in event of emergency. We did need to call him when she got home from spaying as she went through a bout of vomiting and regurging the meds. Doc got us through that short period by phone and she recovered beautifully. I should also say after the major PRAA surgery she had to stay with doc for about 2 weeks ONLY due to complications from prior situation. We adopted her as owner surrender and her first 6 months were rather horrific which took extra time for full healing and recovery.
Short list prior to surgeries:
Inform the DVM, AND the techs who will be assisting that day that extra care is required.
Make sure post anesthesia cage is within easy earshot and preferably eyesight of someone who can watch and listen for regurg or vomiting.
The head may need to be lowered or elevated, during the procedure.
It would appear that all forms of gas anesthesia should be avoided! Isoflurane is apparently commonly used (at least in South Africa) and is on top of the avoid list!