Plus-Hex CLINICAL which would enable any VN or VS present at the time of the seizure to easily identify the plan and administer the correct medication swiftly before contacting the VS in charge of the case for guidance on the next steps .
In line with the hospital ' s protocol , veterinary staff often use a modified version of the Glasgow Coma Scale to monitor the progression of neurological deficits and the effects of therapeutic measures , and to assess the overall prognosis of patients with suspected or known intracranial disease . However , in this case , the scale was not used , as opioids affect a patient ' s mentation , making it difficult to accurately score the patient .
Misty recovered well and was discharged within a week following her surgery .
Conclusions
Nursing patients with increased ICP can be challenging . This can be further exacerbated when the patient is under general anaesthesia . VNs play a vital role in monitoring these patients and providing high-quality care and interventions to manage ICP in response to clinical signs .
As highlighted by this case report , suitable interventions were implemented by the veterinary personnel involved in the care of the patient , as directed by the anaesthetist and operating VS , in response to readings from the multiparameter monitoring . This meant the patient had a stable general anaesthetic and uneventful recovery .
On reflection , the author feels that the successful placement of an arterial line would have meant that invasive blood pressure monitoring could have been implemented . Placement was attempted by a trained and experienced member of staff but was unsuccessful . Placement of an arterial line would have allowed more accurate blood pressure readings and enabled changes to be detected as they occurred . Furthermore , placement would have facilitated arterial blood sampling , enabling blood gas measurements to be easily obtained . This would have been beneficial in monitoring the patient ' s metabolic status following surgery . However , it is important to be aware that once placed , arterial lines come with potential complications , such as infection , haemorrhage ( due to dislodgement or patient interference ), thromboembolism , ischaemia or accidental drug administration , and placement requires trained and experienced personnel .
Additionally , the author feels that it would have been more beneficial to intubate the patient with a plain PVC endotracheal tube rather than an armoured PVC tube . The patient was positioned adequately , with the head elevated using aids placed in a way that did not cause jugular compression . The use of a plain PVC endotracheal tube would have prevented the need to reintubate the patient before CT ; reintubation increases the risk of increased ICP due to the cough reflex . Other risks associated with reintubation include tracheal trauma , laryngeal spasm and potential aspiration .
This case analysis demonstrates the importance of VNs having a good understanding of the pathophysiology and pharmacokinetics involved when anaesthetising patients with suspected increased ICP . Alongside this knowledge , it is important that suitable anaesthetic plans are designed , discussed and implemented , with clear intervention points , to prevent the occurrence of raised ICP and to allow swift action to be taken , if necessary , to ensure the best possible outcome for the patient .
Acknowledgements
Thanks to Misty ' s owner for consenting to the patient ' s participation in this study .
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