After venting to my roommate about the complicated anesthesia case that kept me late –a Pekingese with heart disease, lung disease, and urinary stones obstructing his bladder and urethra— I reheated a frozen meal and checked my email before heading to bed. I awoke to the buzz of my phone at 1:30 am, my sheets twisted in knots and my nightshirt sticky with sweat in the humid air. The hospital was calling me in for an elderly Sheltie with an esophageal foreign body.
I pulled on some scrubs, filled my pockets with gear, and buzzed off to the hospital, trusting my adrenaline to wake me up. I arrived before the anesthesia tech, so I read the Sheltie’s medical record, recording pertinent facts about his blood work and previous health history on my anesthesia workup sheet. It turned out that the Sheltie swallowed a beef bone he was given as a treat, and began retching when it lodged far down in his esophagus. Luckily his owner sought help immediately at her primary veterinarian, who referred him for endoscopic removal of the bone when attempts to push it into the stomach failed. Quick action to remove esophageal foreign bodies is important, because the longer the object distends and irritates the esophagus, the greater the risk that the esophagus will tear, allowing bacteria to enter the chest and cause a life-threatening infection that is very difficult to treat.
Before designing his individualized drug plan, I went to find him in ER. He was quiet, a little depressed, and drooling a little. When the anesthesia tech arrived, we decided that we wanted to avoid opioids like morphine because they constrict esophageal sphincters, which would impede removal of the bone. We gave reversible and short-acting drugs (because of his depressed mental status and old age) and started him on a higher IV fluid rate than usual (because of his drooling and dehydration).
The Sheltie did great under anesthesia, and it was fascinating to watch the screen as the doctors manipulated the endoscope to grasp the bone and slowly-but-surely tug it out. The four of us—student, technician, resident, and clinician—gave an audible cheer when the bone was finally extracted from the pharynx using a pair of long tweezers. We watched the Sheltie wake up and gave him some pain meds before breaking down our equipment and double-checking our paperwork. I walked to my car in the dark, but by the time I flopped into bed beside my snoozing cat, the sky was brightening and the first birds were beginning their cheerful songs.