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Other treatments
Once the patient was intubated and anaesthesia was being maintained, intravenous fluid therapy( IVFT) was started. The anaesthetist prescribed a constant fluid rate of 4 ml / kg / hour using a compound sodium lactate( Hartmann ' s) solution, and this was maintained throughout the general anaesthetic. IVFT is used to support patients in many ways, including to correct dehydration and to support the intravascular volume. It can be easily provided using an adjustable-rate giving set and pump. The continuous flow of fluids through the intravenous catheter will maintain catheter patency by preventing the formation of clots, which is important as it ensures vascular access throughout the period of fluid administration [ 45 ]. A problem with the flow of fluids will alert the VN to a potential problem with the intravenous catheter.
While the patient was being clipped and prepared for surgery, 22 mg / kg of cefuroxime was administered intravenously. Cefuroxime is a broad-spectrum antibiotic that is commonly used in veterinary medicine. It is useful in treating and preventing soft tissue infections and is used during TPLO surgeries to reduce the risk of infection-related complications after the procedure [ 46 ]. This dose of cefuroxime was repeated every 90 minutes throughout the general anaesthetic until the surgery was finished; the patient received a total of three doses.
Postoperative treatment
After the surgery was completed and postoperative radiographs had been taken( Figure 4), a recovery checklist was performed. This included swab and sharp counts, recording the details of the surgical procedure and ensuring any important information was shared with the team before the patient was woken up [ 13 – 15 ].
Figure 4a. Postoperative radiograph of the patient ' s right stifle.
Figure 4b. Postoperative radiograph of the patient ' s right stifle.
Once the checklist was complete and all team members were happy, the isoflurane was turned off and the patient received only O 2 and medical air through the
ETT. The patient ' s vital signs were closely monitored using the multiparameter monitor. The ETT was removed carefully, once the patient ' s palpebral reflex had returned and he began to try to swallow. Waiting until these signs are present ensures that the laryngeal reflex has returned and therefore reduces the risk of reflux and regurgitation or aspiration occurring. After extubation, the patient was monitored until he was conscious and able to hold up his head. Owing to the long surgical time, the patient was mildly hypothermic on recovery, so an electrical heat mat was placed in his kennel and blankets were used to help warm him. The patient ' s temperature was monitored regularly and once normothermia was reached the heat mat and extra blankets were removed.
The patient was prescribed methadone at a dose range of 0.1 – 0.3 mg / kg, to be administered intravenously every 4 – 6 hours depending on the patient ' s pain score. The Glasgow Composite Measure Pain Scale( CMPS) for dogs( Appendix 3, see link on page 56) was used to ascertain the level of pain the patient was experiencing; this scale comprises a range of questions used to assess and score different signs of pain, with a maximum total score of 24 [ 47 ]. Pain must be controlled following surgery as it can have a negative impact on the patient ' s recovery and lead to delayed healing, increased morbidity and the risk of developing chronic persistent pain [ 47 ]. Pain scoring should be completed a minimum of every 4 hours and the score recorded appropriately.
Following surgery, the VS will create a postoperative plan for the patient, in line with the hospital ' s protocol. This will provide a dose range for the medications that can be administered – for example, a dose range of 0.1 – 0.3 mg / kg of methadone that can be administered in accordance with a pain score. The VN will use the total pain score to ascertain whether the patient requires more analgesia; if, in their opinion, the patient is still in pain after the maximum dose has been given, they must inform the VS so the analgesia plan can be altered. The patient in this case mostly scored very low on the CMPS and therefore received only two doses of methadone during his hospitalisation.
The patient was also prescribed oral medications that were to be started once he was awake and eating. These included: meloxicam, which is an NSAID used to treat pain and inflammation [ 48 ]; Pardale-V, which is an analgesic medication containing paracetamol and codeine, which is used to treat acute pain of traumatic origin [ 49 ]; and Rilexine( cefalexin), an antibiotic used to treat bacterial infections [ 50 ].
Dispensing antibiotics after a routine and clean orthopaedic surgery requires careful consideration by the VS; they must consider the risk of bone infection against the cost and possible side effects of antibiotics and the risk of antibiotic resistance. It is recommended that antibiotics are not prescribed after clean surgeries that last less than 60 minutes [ 51, 52 ]. Surgeries with a
Volume 40( 3) • June 2025
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