Advanced Atrio-Ventricular Blocks in a Foal Undergoing Surgical Bladder Repair: First Step to Cardiac Arrest?
Authors: Marolf Vincent, Mirra Alessandro, Fouché Nathalie, Navas de Solis Cristobal
Journal: Frontiers in veterinary science
Summary
# Editorial Summary A three-day-old foal presenting with uroabdomen secondary to bladder rupture developed severe hyperkalaemia, hyponatraemia and hypochloraemia—electrolyte derangements that proved difficult to fully correct before emergency surgical repair due to technical drainage challenges and progressive abdominal distension. Intraoperatively, the foal experienced advanced atrioventricular (AV) blocks that were refractory to anticholinergic medication, necessitating epinephrine administration and cardiac massage to restore sinus rhythm; mechanical ventilation with positive end-expiratory pressure was also required to manage concurrent hypoxaemia. Though the foal ultimately recovered successfully and was discharged three days post-operatively, this case highlights how severe electrolyte abnormalities—particularly hyperkalaemia—can precipitate life-threatening dysrhythmias during anaesthesia and surgery in critically ill neonates. The authors emphasise that advanced AV blocks represent a cardiovascular emergency requiring immediate recognition and advanced life support protocols, and that early identification of this complication is crucial for improving perioperative survival rates in foals with uroabdomen. Equine clinicians managing neonatal abdominal emergencies should therefore prioritise aggressive pre-operative electrolyte correction where feasible, maintain heightened vigilance for dysrhythmias during induction and surgery, and be prepared to initiate resuscitation protocols promptly if advanced AV blocks develop.
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Practical Takeaways
- •Foals presenting with uroabdomen require aggressive pre-operative electrolyte correction, particularly hyperkalemia management, as severe imbalances increase perioperative cardiac dysrhythmia risk during anaesthesia
- •Advanced AV blocks during surgery should be treated immediately as a cardiovascular emergency with epinephrine and cardiac massage rather than waiting for antimuscarinic response, as these drugs alone may be ineffective
- •Continuous cardiac monitoring is essential in foals undergoing surgery for uroabdomen, even when anaesthesia appears stable, to enable rapid detection and intervention for life-threatening dysrhythmias
Key Findings
- •A 3-day-old foal with uroabdomen secondary to bladder rupture developed advanced atrio-ventricular blocks during anaesthesia induction, unresponsive to antimuscarinic drugs
- •Advanced AV blocks were successfully treated with epinephrine and cardiac massage, restoring sinus rhythm and allowing surgical completion
- •Severe electrolyte abnormalities (hyperkalemia, hyponatremia, hypochloremia) were present on presentation but only partially corrected pre-operatively due to abdominal drainage obstruction
- •Early recognition of advanced AV blocks as a cardiovascular emergency enabled timely intervention and prevention of cardiac arrest in this foal