The dog had a retained testicle which was larger than the normal testicle which was suspected to be cancerous.   However, the doctor soon discovered that the dog’s tongue was turning white and his heart had stopped beating. Immediately, CPR was done to resuscitate the dog. It was not very long before the dog started breathing again but that period felt like a thousand years had gone pass.  It was probably due to the age of the dog that his heart was not able to take the dosage of the anaesthetic. Luckily, the doctor was able to revive the dog and quickly got his teeth scaled before he woke up again. After that, I bathed and groomed the dog.

My report on the case

"Listen to the breathing sounds," I asked Mr Saw to put his ear close to the opening of the endotracheal tube which had been disconnected from the anaesthetic machine. Mr Saw shook his head. He cupped his fingers on the chest. "No heart beat," he shook his head again. So, was there any hope?  The dog did not respond for the first minute of resuscitation. No breathing chest movements seen.  So this one minute "really felt like a thousand years". 

I stopped neutering. My right hand gripped the chest to stimulate heart beating while my assistant Mr Saw blew into the endotracheal tube to inflate the lungs and expel the anaesthetic gas. He blew once while I massaged the heart with my right hand firmly 3X and this was repeated several times over a minute. There seemed to be no hope as this dog had heart disease and had died since resuscitation took over 1 minute and no breathing had returned. 

The 8-year-old Shih Tzu took >2 minutes to start breathing. Chest movements started, indicating breathing had commenced. The tongue was still pale. No more anaesthesia was given and the neuter surgery was completed without the need for more anaesthesia. There was no time to waste.

Emergency oxygen could be supplied by pressing the red valve. However my experience is that blowing via the endotracheal tube into the lungs and strong cardiac massage are preferred to revive the dog.

The veterinarian must know what to do in the event of heart failure during general anaesthesia. In human medicine, the surgeon just focus on his surgery and another doctor specialises in anaesthesia. But this is not the case in veterinary medicine. A good veterinary assistant with experience in emergencies would be great but they needed the hands-on experience. Since such cases are relatively rare in practice as most dogs are fit for anaesthesia, it is important that new assistants be given hands-on experience and mentorship to learn what to do as they become "paralysed", don't know what to do, when an emergency heart failure during surgery occurs.  

The isoflurane gas was given by mask for a short while to enable me to do the dental scaling. The dog woke up soon and had no further problem. 

Post-operation self-inflicted traumatic injury to the surgical site happens in some male adult dogs after neuter despite pain-killers like tolfedine and rimadryl injections being given after surgery. The lady owner had said that there was "pus" in the surgical site and so I had the dog checked at the 6th day. There was no pus. Some blood stains on the hind paw. The dog was bathed and sent home. By 6th day after neuter, the redness in the skin had disappeared 60% due to anti-inflammatory drugs being given. The dog was normal and active.

Note: The undescended (retained) testicle had tripled in size, indicating a cancerous growth. Always get your dog's undescended testicles removed at a young age.

Toa Payoh Vets Clinical Research
Be Kind To Pets