title: Two cases of bradyarrhythmia and hypotension after extradural injections in dogs.
abstract: METHODS
  Two healthy obese, seven-year-old, female Rottweilers weighing 40 and 57 kg were submitted for cranial cruciate repair. They were premedicated with intravenous methadone (0.1 mg kg(-1)) and acepromazine (0.01 and 0.02 mg kg(-1)). Anesthesia was induced with propofol (3.6 and 2.5 mg kg(-1)) and maintained with isoflurane in oxygen using a circle breathing system. The dogs were placed in sternal recumbency and epidural injection of lidocaine/bupivacaine or lidocaine/bupivacaine/morphine (0.2 mL/kg, 8 and 11 mL) was carried out over 1.5 and 4 minutes. Epidural pressures were 79 and 72 mmHg at the end of the injections. The first dog's heart rate decreased from 80 to 65 beats minute(-1) with a second degree atrioventricular (AV) block. The arterial pressure decreased from 100 to 50 mmHg. These responded to atropine (0.01 mg kg(-1) IV). The second dog's heart rate decreased from 120 to 60 beats minute(-1) while arterial pressure decreased from 72 to 38 mmHg. No treatment was given and heart rate and arterial blood pressure returned to acceptable ranges.
  
  
  CONCLUSIONS
  These cases suggest that large increases in epidural pressure may cause significant cardiovascular effects. This may be avoided by using lower volumes and discontinuing injection if significant back pressure is detected.
authors.affiliation: Clinic of Anaesthesiology and Perioperative Intensive Care, Clinical Department of Small Animals and Horses, Veterinary University, Vienna, Austria. i.iff@liv.ac.uk
authors.forename: Isabelle
authors.initials: I
authors.lastname: Iff
authors.forename: Yves
authors.initials: Y
authors.lastname: Moens
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D000818:Animals; D001919:Bradycardia / Q000139:chemically induced*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D004283:Dog Diseases / Q000139:chemically induced*; D004285:Dogs; D005260:Female; D007022:Hypotension / Q000139:chemically induced; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000700:Analgesics; D009020:Morphine; D008012:Lidocaine; D002045:Bupivacaine