Acute noncardiogenic pulmonary edema in an anesthetized Nubian goat kid.
METHODS
A 1-month-old Nubian goat presented for sialocyst resection. Physical examination and bloodwork were unremarkable. While pre-oxygenating, the goat was sedated with midazolam and morphine (0.1 mg kg(-1) each) intravenously (IV). General anesthesia was induced 5 minutes later with 1.7 mg kg(-1) propofol. Sevoflurane was administered in oxygen without assisted ventilation via a cuffed orotracheal tube. Throughout the first 85 minutes of anesthesia, the goat was well-oxygenated (SpO(2), > or =97%), ventilating adequately (Pe'CO(2), 36-48 mmHg), and had normal mean arterial blood pressure (MAP, 60-85 mmHg). Blood-gas values at 45 minutes were consistent with adequate ventilation on oxygen. At 75 minutes, the goat moved in response to surgical stimulation, requiring additional propofol (0.4 mg kg(-1)). After 10 minutes, MAP dropped precipitously to 40 mmHg and frequent multiform premature ventricular contractions (PVCs) were observed. Crystalloids, hetastarch, and dopamine (5 mug kg(-1) minute(-1)) were administered to correct the hypotension. Arterial blood-gas analysis revealed that the goat had become hypoxemic (PaO(2), 50 mmHg). Intermittent positive pressure ventilation (IPPV) was initiated. Subsequent blood-gas analysis did not show significant improvement in PaO(2) (53 and 56 mmHg, respectively). Occasional PVCs were observed thereafter. Surgery ended, and sevoflurane and IPPV were discontinued. The goat was extubated within 7 minutes and received 100% oxygen by mask. Diffuse crackles were ausculted over both hemithoraces. Suspecting pulmonary edema, furosemide (1 mg kg(-1)) was administered IV. Radiographs taken immediately post-operatively revealed a severe, caudodorsal airspace (alveolar) pattern, confirming the diagnosis. Respiration improved considerably within an hour with nasal oxygen and two additional doses of furosemide.


CONCLUSIONS
The goat developed acute, drug-induced, noncardiogenic pulmonary edema in response to the second dose of propofol.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA. jmb264@cornell.edu
Jordyn M
JM
Boesch
Robin D
RD
Gleed
Jason W
JW
Gagne
Kyla
K
Ortved
Nathan L
NL
Dykes
William A
WA
Horne
D000768:Anesthesia, General / Q000009:adverse effects / Q000662:veterinary; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D000818:Animals; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D015511:Goat Diseases / Q000139:chemically induced*; D006041:Goats; D010100:Oxygen / Q000627:therapeutic use; D015742:Propofol / Q000009:adverse effects*; D011654:Pulmonary Edema / Q000139:chemically induced / Q000188:drug therapy / Q000662:veterinary*
D018686:Anesthetics, Intravenous; D004232:Diuretics; D005665:Furosemide; D010100:Oxygen; D015742:Propofol