Meet Fern – Laryngeal paralysis
Fern is a 13y9m Labrador who presented to Samantha Lane in the surgical referral team for investigation of her gradually increasing respiratory noise and decreased exercise tolerance. She had markedly deteriorated in the 24 hours before presentation.
On clinical examination Fern had inspiratory stridor with increased inspiratory effort, she was slightly underweight and had muscle wastage of her hind limbs. Heart auscultation was normal but auscultation of Fern’s lungs was difficult due to referred upper airway stridor. During the consultation Fern productively retched several times.
As Fern was admitted into the hospital her respiratory noise and effort began increasing. Butorphanol was administered and oxygen was supplemented. There was a continued deterioration in her respiration with worsening inspiratory and expiratory effort so a decision was made to induce anaesthesia urgently.
On induction her larynx was examined and laryngeal paralysis was confirmed. Three view chest radiographs showed a large, dilated oesophagus. Haematology and biochemistry were largely unremarkable (including T4/TSH). Arterial blood gas analysis was consistent with respiratory acidosis.
Due to Fern’s recent deterioration a decision was made to perform a CT scan. The presence of Fern’s megaoesophagus could have been pathological, due to aerophagia or because she was under general anaesthetic and we were concerned that Fern may have aspirated and this had caused her recent deterioration.
On CT there were no signs of aspiration pneumonia or other changes which would contraindicate surgery. Radiographic changes due to aspiration pneumonia can lag behind clinical signs so intravenous broad-spectrum antibiotics were started.
Sam proceeded to perform a left sided arytenoid lateralisation under the same anaesthetic and Fern was recovered quietly under close supervision in case respiratory compromise or desaturation occurred. Fern recovered well from her anaesthetic and was able to go home the next day. It was recommended that she was positionally fed.
At her final post-operative check up a conscious lateral radiograph confirmed no megaoesophagus was present so postural feeding was no longer required.
This case highlights the importance of rapid action in deteriorating respiratory cases to ensure that the patient does not deteriorate to respiratory arrest or death. Having an experienced team who are closely supervising these patients and can rapidly intervene if respiratory compromise occurs is paramount. Bath Veterinary Referrals have Veterinary Surgeons and Veterinary Nurses on site 24 hours which enables rapid intervention if patients deteriorate.
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