Unilateral diaphragmatic paralysis associated with surgical mitral valve repair in dogs.

OBJECTIVES: Unilateral diaphragmatic paralysis (UDP) due to phrenic nerve injury is a potential complication of thoracic surgery. This study evaluated the prevalence of UDP associated with surgical mitral valve repair (MVR) and its effect on surgical outcomes in dogs. ANIMALS, MATERIALS AND METHODS: Two hundred ninety-four dogs that underwent MVR were included in the study. A retrospective review of medical records was performed for dogs surviving surgery. Diagnosis of UDP was based on preoperative and postoperative thoracic dorsoventral radiographs. RESULTS: A total of 284 dogs survived until the day after surgery. The prevalence of UDP on the day after surgery, on the day of discharge, and after the first postoperative month was 30%, 24%, and 9%, respectively. One case of UDP was observed at 3 months after surgery. Unilateral diaphragmatic paralysis was exhibited by nine of the 21 patients that died in the hospital. The proportion of patients with UDP was higher in dogs that died of respiratory failure than in dogs that died of other causes (p = 0.002). Most dogs whose deaths were suspected to have been related to respiratory failure also had pre-existing respiratory diseases. The occurrence of UDP did not relate to the lengths of stay in the intensive care unit or the hospital. CONCLUSIONS: Our findings suggest that UDP is a common complication in dogs after MVR and that the prevalence of UDP decreases with time after surgery. Unilateral diaphragmatic paralysis is a risk factor for postoperative death, especially in patients with pre-existing respiratory disease.

Suspected bilateral phrenic nerve damage following a mediastinal mass removal in a 17-week-old pug.

The anesthetic management of a pediatric pug for removal of a mediastinal mass is described. During recovery from anesthesia, the dog's respiratory pattern was compatible with bilateral diaphragmatic paralysis. Incidence, complications, possible treatments of phrenic nerve injury, problems of long-term mechanical ventilation, and alternative case management are discussed.

Lésion bilatérale suspectée du nerf phrénique après l'ablation d'une masse médiastinale chez un Pug âgé de 17 semaines. Nous décrivons la gestion anesthésique d'un Pug pédiatrique présenté pour l'ablation d'une masse médiastinale. Durant le réveil après l'anesthésie, le profil respiratoire du chien était compatible avec la paralysie diaphragmatique bilatérale. L'incidence, les complications et les traitements possibles d'une blessure du nerf phrénique, les problèmes de la ventilation mécanique à long terme et les solutions pour la gestion du cas sont discutés.(Traduit par Isabelle Vallières).

Evaluation of diaphragmatic motion in normal and diaphragmatic paralyzed dogs using M-mode ultrasonography.

Diagnosis of unilateral diaphragmatic paralysis in dogs is currently based on fluoroscopic detection of unequal movement between the crura. Bilateral paralysis may be more difficult to confirm with fluoroscopy because diaphragmatic movement is sometimes produced by compensatory abdominal muscle contractions. The purpose of this study was to develop a new method to evaluate diaphragmatic movement using M-mode ultrasonography and to describe findings for normal and diaphragmatic paralyzed dogs. Fifty-five clinically normal dogs and two dogs with diaphragmatic paralysis were recruited. Thoracic radiographs were acquired for all dogs and fluoroscopy studies were also acquired for clinically affected dogs. Two observers independently measured diaphragmatic direction of motion and amplitude of excursion using M-mode ultrasonography for dogs meeting study inclusion criteria. Eight of the clinically normal dogs were excluded due to abnormal thoracic radiographic findings. For the remaining normal dogs, the lower limit values of diaphragmatic excursion were 2.85-2.98 mm during normal breathing. One dog with bilateral diaphragmatic paralysis showed paradoxical movement of both crura at the end of inspiration. One dog with unilateral diaphragmatic paralysis had diaphragmatic excursion values of 2.00 ± 0.42 mm on the left side and 4.05 ± 1.48 mm on the right side. The difference between left and right diaphragmatic excursion values was 55%. Findings indicated that M-mode ultrasonography is a relatively simple and objective method for measuring diaphragmatic movement in dogs. Future studies are needed in a larger number of dogs with diaphragmatic paralysis to determine the diagnostic sensitivity of this promising new technique.

Acute respiratory distress in an alpaca.

An alpaca was presented with a history of respiratory difficulty and death. Histology of the phrenic nerves and diaphragm revealed degenerative changes consistent with denervation atrophy, and a diagnosis of diaphragmatic paralysis was established. No gross or histological abnormalities were observed in the spinal cord or other organs. The etiology of the phrenic nerve neuropathy could not be determined. The need to examine phrenic nerves and diaphragm in camelids with respiratory distress is emphasized, as failure to examine these samples will preclude a diagnosis of diaphragmatic paralysis.

Neurological causes of diaphragmatic paralysis in 11 alpacas (Vicugna pacos).

BACKGROUND: Diaphragmatic paralysis is a relatively uncommon medical condition in animals not reported in alpacas. OBJECTIVES: Describe the signalment, physical examination, diagnostic testing, clinical, and histopathologic findings related to diaphragmatic paralysis in alpacas. ANIMALS: Eleven alpacas with spontaneous diaphragmatic paralysis. METHODS: A retrospective study examined medical records from a 10-year period and identified 11 alpacas with confirmed diaphragmatic paralysis admitted to Washington State University and Colorado State University Veterinary Teaching Hospitals between September 2003 and October 2009. RESULTS: The 11 alpacas ranged in age from 2 to 12 months. Fluoroscopic imaging confirmed the presence of bilateral diaphragmatic paralysis in the 7 alpacas that were imaged. Arterial blood gas analyses showed hypercapnea, hypoxemia, and low oxygen saturation. Seven alpacas died or were euthanized between 2 and 60 days after onset of respiratory signs. Histopathologic examination of tissues found phrenic nerve degeneration in the 6 alpacas that were necropsied and additional long nerves examined demonstrated degeneration in 2 of these animals. Two animals had spinal cord lesions and 2 had diaphragm muscle abnormalities. No etiologic agent was identified in the alpacas. CONCLUSIONS AND CLINICAL IMPORTANCE: The etiology for diaphragmatic paralysis in these alpacas is unknown. A variety of medical treatments did not appear to alter the outcome.

Ventilatory failure and successful management for a dog with severe cervical meningioma.

A 12-year-old intact male mongrel dog with a weight of 22 kg was referred with a complaint of progressive tetraparesis. Cervical myelography revealed an intradural-extramedullary mass at the second cervical vertebra. After computed tomography (CT) under general anesthesia, the patient showed dyspnea and cyanosis caused by insufficient movement of the chest wall. Positive pressure ventilation was therefore initiated. Hemilaminectomy and partial mass removal were performed 12 hr after the CT. The mass was histopathologically diagnosed as meningioma. Gradual weaning from the mechanical ventilation lasted for 80 hr after the operation. The patient eventually recovered from the ventilatory failure and the tetraparesis at approximately 6 and 14 days after the operation, respectively.

A fuzzy-classifier system to distinguish respiratory patterns evolving after diaphragm paralysis in the cat.

We applied the fuzzy "k-nearest neighbor" (k-NN) classifier of the pattern recognition theory to fathom the abnormal way of breathing resulting from diaphragm paralysis and to distinguish the dominant component, tidal or frequency, of the breathing pattern on which ventilatory compensation relies in such a pathological state. We addressed this issue in the experimental model of diaphragm paralysis as a result of bilateral phrenicotomy in anesthetized, spontaneously breathing cats. Of several variables recorded, we selected two features, minute ventilation and arterial CO(2) tension, that were used for the k-NN analysis. The results demonstrate that the ability to maintain ventilation critically depended on the increase in frequency of breathing. Other breathing pattern strategies were ineffective. The k-NN evaluation with the two selected features discerned the prevailing pattern of breathing with sufficient probability. Such an evaluation may be a useful tool in predicting the development of compensatory strategies in disordered patterns of breathing.

Transient post-traumatic hemidiaphragmatic paralysis in two cats.

A diagnosis of post-traumatic hemidiaphragmatic paralysis was made in two cats. Both cats had a history of trauma and paradoxical inward movement of the abdominal wall at inspiration. Thoracic radiographs were taken at inspiration and expiration. Although the images were suggestive of hemidiaphragmatic paralysis, definitive diagnosis was reached by fluoroscopy in one cat and by ultrasonography in the second. Both cases resolved spontaneously and diaphragmatic function was normal at follow-up.

Bilateral diaphragmatic paralysis in a pony.

An adult pony had a 1-month history of severe respiratory distress that was resistant to treatment and environmental changes. Results of blood gas analysis were indicative of alveolar hypoventilation. Simultaneous recordings of thoracic and abdominal wall motion by inductance plethysmography, together with complete pulmonary mechanics evaluation that included transdiaphragmatic pressure monitoring, revealed complete passive behavior of the diaphragm during breathing. Because radiography, necropsy, and histologic examination did not reveal any major lesion to explain the clinical and functional observations, bilateral diaphragmatic paralysis was diagnosed.

Surgical management of bilateral diaphragmatic paralysis in a dog.

Bilateral diaphragmatic paralysis of uncertain cause developed in a 3-month-old Golden Retriever. A surgical procedure for tightening the diaphragmatic muscle was used to help alleviate the dog's respiratory distress. During thoracotomy, the central tendon of the diaphragm was plicated, using an interlocking suture pattern. The dog improved after surgery, and although complete recovery from paralysis was achieved only on one side, the dog has remained clinically normal 1 year after surgery.

Respiratory paralysis secondary to epidural anesthesia in a dog.

Transient respiratory paralysis developed in a 12-year-old spayed female Cocker Spaniel that received an anesthetic epidurally for excisional biopsy of perianal masses. Paralysis developed almost immediately after injection of 2.5 ml of 2% lidocaine (1 ml/4.9 kg), and was managed by mechanical ventilation and appropriate fluid therapy IV until spontaneous respiration returned. The respiratory paralysis was attributed to the excessive cranial extent of the anesthetic block.

Toxicity of aminoglycoside antibiotics.

In cats, aminoclycosides cause vestibular damage followed in a few days by renal damage. The reverse is true in the dog, except that streptomycin causes vestibular damage prior to renal damage. To avoid toxicities, therapeutic doses of aminoglycosides should not be given longer than a week and they should be given cautiously in animals with renal impairment. Failure of the kidneys to eliminate aminoglycosides will result in very high blood levels, even with therapeutic doses, that can cause further renal and vestibular damage. The oral administration of aminoglycosides is seldom dangerous when normal therapeutic doses are employed. Although it is remote, the possibility exists that animals with renal impairment and intestinal obstruction may become intoxicated. Kanamycin is less nephrotoxic to dogs than neomycin and it is less destructive to the auditory nerve than vestibular damage than streptomycin. Gentamicin in cats is twice as toxic to the vestibular apparatus as streptomycin and more toxic to the cochlea than streptomycin or dihydrostreptomycin. Neomycin is more toxic than kanamycin, gentamicin, and streptomycin to both cats and dogs. Amikacin causes renal damage in dogs similar to other aminoglycosides. It also causes vestibular damage.