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Unfortunately, recovery from surgery and the anesthetic episode does not ensure a successful or rapid recovery. There are multiple sequelae to which intestinal volvulus patients may succumb during the immediate postoperative period. Aggressive supportive care and vigilant monitoring are vital, owing to the dynamic and rapid progression of shock. Table 9.1 includes recommendations by the authors for postoperative stabilization in dogs following exploratory surgery for an intestinal volvulus. Fluid loss, shock, and reperfusion injury must be addressed. Isotonic crystalloid therapy (PlasmaLyte and Normosol‐R) provides the mainstay treatment for hypovolemic shock, and is administered to effect for stabilization of hemodynamic parameters. Capillary refill time, heart rate, blood pressure, and lactate concentrations can be used to guide the volume and rate necessary. Intensive monitoring whenever available, including central venous pressures and colloid osmotic pressures, is recommended. For patients struggling to maintain normotension, colloids (hetastarch or plasma) or hypertonic saline can be administered along with adjusted rates of crystalloids, again with a goal‐directed plan dictating volume and rate. Positive inotropes (dopamine or dobutamine) or vasopressors (epinephrine or norepinephrine) may become necessary in patients refractory to fluid resuscitation [34–36]. Because patients are considered to be at risk for, or in, septic shock, antimicrobial therapy with broad‐spectrum bactericidal coverage (enrofloxacin and ampicillin) should be administered [34]. Therapy with free radical scavengers may be warranted. Even though antioxidants are difficult to come by in veterinary medicine, possible benefits may be obtained with lidocaine, however optimal dosages have not been established [37–39]. Some patients may benefit from antiemetic therapy (prokinetics, neurokinin‐1 receptor antagonists and centrally acting antiemetics, such as metoclopramide, dolasetron, and maropitant) and may require therapy for peritonitis (fluid replacement and analgesics) [40–42]. Analgesics are an important component of perioperative care (see Chapter 1). Enteral or parenteral nutrition should be considered.

Table 9.1 Emergency therapies.

Therapy	Dosage
Fluids
Crystalloids (Normosol‐R, Plasma‐Lyte)	Shock dosage: up to 90 mL/kg to effect, maintenance: 40–60 mL/kg/day
Hypertonic saline	4–7 mg/kg to effect
Colloids
Hetastarch	Shock dosage: 5–20 mL/kg to effect, maintenance: 10–20 mL/kg/day
Plasma	10–15 mL/kg
Vasoactive agents
Positive inotropes
Dopamine	3–10 mcg/kg/min CRI
Dobutamine	2–15 mcg/kg/min CRI
Vasopressors
Epinephrine	0.1–1 mcg/kg/min CRI
Norepinephrine	0.5–2 mcg/kg/min CRI
Antibiotics
Enrofloxacin	10 mg/kg/day IV q24 h
Ampicillin	22 mg/kg q8 h
Antiemetics
Metoclopramide	1–2 mg/kg/day CRI
Dolasetron	0.6 mg/kg IV q24 h
Maropitant	1 mg/kg SQ q24 h

CRI, constant rate infusion; IV, intravenous; SQ, subcutaneous.