General anaesthesia
Consent was obtained from the owner for general anaesthesia( GA) and surgery, if required.
A pre-induction check was carried out according to the veterinary hospital ' s standard operating procedure:
1. Check patient identification( ID). All patients are given an ID tag with their name, ID number and weight on admission.
2. Check consent form. This details the reason for admission, risks, estimate of costs, owner signature and date.
3. Form completed by the clinician. This includes the date, procedures in confirmed order( in this case, abdominal ultrasonography, GA and exploratory laparotomy), patient history, differential diagnoses, blood analyses required, and the surgical procedure, to include clip and preparation information, positioning, surgical equipment, antibiotic requirements, diathermy type and requirement for scrub assistance.
4. Anaesthetic station and airway equipment checked. Safety checks are carried out on the anaesthetic machine, including checking for correct circuits and inhalational agents, and confirming no leaks or errors. Endotracheal tubes are checked to ensure they are clean and leak-free.
5. Meeting with the anaesthetist. This discussion covers the expected risks and emergency anaesthetic dose prescribed by the anaesthetist.
6. Check the bladder before surgery. This is to prevent patient discomfort and the contamination of the surgical site / sterile site. In this case, the bladder was small, which was not unusual considering the patient ' s hydration status.
The veterinary surgeon( VS) prescribed the medications listed in Table 3.
During the planning stage, to reduce the duration of GA, the patient was clipped from the sternum to the scrotum, to include the lateral edges and medial aspects of the hindlimbs proximal to the stifles. Once anaesthetised, he was positioned in dorsal recumbency. The skin was prepared using a solution of 50:50 Hibiscrub and water. During the preparation stage, an arterial catheter and a new intravenous( IV) catheter were placed to maintain patent vascular access.
A presurgical checklist was completed once the patient had been transferred to the theatre:
1. All surgery sites and sides confirmed? An exploratory laparotomy to identify and remove a suspected foreign body.
2. Antibiotic type and frequency confirmed? Cefuroxime( 22 mg / kg IV) administered at 3:55 pm, to be administered every 90 minutes.
3. Purse string / throat pack needed? Not applicable.
4. ChloraPrep applied? Yes, theatre technician applied, using sterile gloves.
5. Staff introductions? VS, anaesthetist, scrub assistant, theatre runner and veterinary nurse( VN) monitoring the GA.
6. Anticipated problems? Bleeding.
7. Diathermy type confirmed? Monopolar, mat applied.
8. Instrument sterility confirmed? Yes.
9. Swabs and sharps confirmed? Yes.
10. Required imaging displayed? Not applicable.
11. Appropriate depth of anaesthesia? Yes.
Table 3. Medicines prescribed to the patient. |
Anaesthetic phase |
Drug |
Dose |
Route of administration |
Premedication |
Methadone |
0.2 mg / kg |
IV |
Induction |
Alfaxalone |
1.3 mg / kg |
IV |
|
Midazolam |
0.3 mg / kg |
IV |
Maintenance |
Isoflurane |
1.2 % |
Inhalation |
|
Lidocaine |
20 – 30 µ g / kg / min |
IV via CRI |
|
Fentanyl |
5 – 10 µ g / kg / hour |
IV via CRI |
CRI, constant-rate infusion; IV, intravenous |
38 Veterinary Nursing Journal