duration of action of 6 – 8 hours and so this block also provided analgesia postoperatively.
A ketamine CRI was also administered by the IV route at a dose of 10 μg / kg / min. This was an additional method of adjunctive analgesia to prevent nociception during surgery. Paracetamol was also administered IV as another analgesic agent. Multimodal analgesia protocols, such as that described in this case, can reduce the amount of inhalant agent required to maintain a suitable depth of anaesthesia and ultimately maximise patient comfort both peri- and postoperatively.
Normothermia was maintained with the use of a Bair Hugger( 3M, UK) warm air blanket, and the patient ' s temperature was monitored using an oesophageal temperature probe. Patients that undergo an MRI scan and are then transferred straight to surgery often have a relatively long anaesthetic, meaning that active warming is required to ensure normothermia.
As the patient was brachycephalic, additional anaesthetic considerations included the use of maropitant and omeprazole. These were administered IV to reduce the risk of regurgitation, which is a common complication of anaesthesia in brachycephalic breeds [ 17 ].
Recovery from anaesthesia
On completion of surgery, an anaesthetic recovery plan was established( Table 1).
Table 1. Anaesthetic recovery plan.
Initial recovery
Airway management
Preparation for dysphoric / aggressive recovery
Postoperative analgesia
Analgesia and sedation
PPS, peri pain score.
Planned interventions Apply Otrivine to the nares
Nebulise( 1:5 adrenaline: saline)
3 μg / kg medetomidine diluted in 3 ml saline readily available to administer in 1 μg / kg increments if required
Continue ketamine CRI, reduced to 5 μg / kg / min
Administer 0.1 – 0.3 mg / kg methadone, q4 – 6h PPS, with a minimum of 0.1 mg / kg administered q6h
Administer medetomidine CRI( 0.5 – 1 μg / kg / hour) throughout the hospitalisation period, to provide analgesia and light sedation to minimise patient stress
Patient recovery was relatively uneventful, with no upper airway obstruction or regurgitation noted. A dose of 1 μg / kg medetomidine was required as the patient became slightly aggressive in the immediate recovery period.
The postoperative analgesia plan involved a multimodal approach, with the Glasgow Composite Pain Scale scoring system being used to ensure appropriate analgesia was provided throughout the patient ' s hospitalisation period [ 18 ]. The use of a relatively low dose of medetomidine as a CRI also optimised patient amenability and reduced patient stress.
Conclusions
The patient assessment, investigation and treatment of IVDD are demonstrated in this case of an aggressive brachycephalic French bulldog with L2 – L3 disc disease graded 2 on the modified Frankel scale. The patient and client pathway demonstrates the implementation of an effective anaesthesia and analgesia plan.
In conclusion, implementing a multimodal analgesic protocol effectively reduces nociceptive input during invasive surgical procedures. For this hemilaminectomy case, the integration of locoregional anaesthesia with appropriate premedication and a ketamine CRI maintained a stable anaesthetic plane and attenuated perioperative nociception.
REFERENCES
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