A couple of days ago I had a full surgery schedule. My first
case of the day was a routine spay on a 5-month-old small breed puppy.
Pre-operative bloodwork and physical examination were unremarkable.
The surgery went well, although the skin and fat just below
the skin were bleeding a fair amount and continued to ooze after I closed. I
figured it would stop in a few minutes.
I didn’t count on the puppy becoming dysphoric from her
post-op pain medication (buprenorphine). I’d only seen patients trip out before
on morphine, hydro, and the like; buprenorphine uniformly made patients calm
and happy in my experience. While the patient was freaking out her incision
continued to ooze at a pretty good rate.
At that point I was
starting to freak out too. What if one of my ligatures slipped and that was why
she was bleeding? Well, her color was good, pulses were strong, temperature was
normal and she was alert so she likely wasn’t in hypovolemic shock …
Thank goodness one
of the experienced RVTs mentioned she had seen oozing like that before and
suggested a pressure bandage (although I’ve probably done 50-100 spays so far I’ve
NEVER seen that before). We applied the bandage. Then I mentioned that I
thought the puppy was dysphoric from her meds, and she (the RVT) mentioned that
we had naloxone on hand and could partially reverse the drug. So we did that
too. Puppy stopped freaking out, and when we removed the bandage an hour later
the bleeding had stopped.
What I learned:
- Buprenorphine can cause dysphoria (I also think that this patient’s dysphoria may have caused higher blood pressure and made it harder to stop the subcutaneous bleeding)
- Most of the time your closure will stop subcutaneous bleeding, but occasionally you will need a pressure wrap
- A good tech can save your butt
I suspect (fear) that this will not be the last I-want-to-crap-my-pants-from-fear
experience in my career. There are only so many things you can see and
experience in your senior year of veterinary school. I can only hope that I
have enough basic knowledge to reason my way through things and solve problems
as they come up – and that I have a great tech nearby too.
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