Plus-Hex CLINICAL
This extended patient care report focuses on the following three nursing considerations:
• ET intubation
• Maintenance of anaesthesia with total intravenous anaesthesia( TIVA)
• Airway management after anaesthesia.
ET intubation
Preoxygenation prior to induction of anaesthesia is strongly recommended in brachycephalic patients, particularly when airway examination is anticipated, as the use of anaesthetic agents can induce apnoea, and any delay in establishing pulmonary ventilation may increase the risk of hypoxaemia [ 3 ]. Brachycephalic breeds also have significantly lower arterial blood oxygenation levels compared with non-brachycephalic animals, which may decrease the desaturation time during periods of apnoea [ 2 ].
McNally et al. [ 4 ] reported that preoxygenation in dogs via a face mask for 3 minutes prolonged the desaturation time by 1 – 4 minutes. Ambros et al. [ 5 ] found evidence of an increase in the inspiratory fraction of oxygen when a face mask was used( 89.7 % ± 5.5 %) compared with the use of flow-by oxygen( 30 % ± 5.4 %). Although this patient could have benefited from preoxygenation via a face mask, the patient did not tolerate the mask and so oxygen was administered via flow-by to avoid stress and further respiratory compromise. In brachycephalic animals, a face mask can also cause corneal trauma if it is not well tolerated [ 6 ]( Figures 1 and 2). Cyanosis can be detected by the human eye only when SpO 2 is lower than 85 %; therefore, a pulse oximeter can be helpful to monitor for oxygen desaturation between the induction of anaesthesia and ET intubation [ 7 ].
Figure 2. Silicone face masks can be an alternative way to provide oxygen supplementation in brachycephalic patients. They are better tolerated and present less risk of corneal damage. Although they are not tight-fitting, they can provide higher concentrations of oxygen compared with the flow-by technique.
When planning an airway examination, emergency intubation equipment( Figure 3) and oxygen supplementation should be readily available.
Figure 1. A French bulldog receiving preoxygenation with a polycarbonate face mask without the silicone strap, prior to induction of anaesthesia. Ideally, the mask should be tight-fitting, but the technique must be adapted to the conformation of the patient ' s head.
Figure 3. Equipment prepared in expectation of a difficult endotracheal( ET) intubation: a rigid urinary catheter, a 2.5 ml syringe connected to a 7.0 mm ET tube female adaptor, a bougie, a wide range of ET tubes, a stylet, an inflator syringe, anaesthesia induction agent, a tie, a laryngoscope and lidocaine spray.
Volume 40( 3) • June 2025
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