concurrently reduce the anaesthetic risk. VNs can lead regular weight clinics for these patients. High body condition score can slow the elimination of drugs, leading to a delayed postoperative recovery, and contributes to the narrowing of the airways [ 4 ].
Fasting period
The client should be made aware that the fasting period should be shorter than usual, due to the risks of hiatal hernia in dogs with BOAS [ 5 ]. A small amount of wet food can be given 4 – 6 hours before anaesthesia to lower the risk of regurgitation [ 6 ]. delivered by mask is more effective in oxygenating the patient and less wasteful, the tight application of the mask that is required can stress the patient further. Flow-by O 2 is less stressful and better tolerated, but does not improve oxygenation as effectively.
Once sedation has been achieved, the VN should ensure all intubation equipment is immediately available in anticipation of rapid patient decompensation( Table 2) [ 2, 9 ].
Table 2. Intubation equipment [ 2, 9 ].
Equipment Reason
Stress reduction
Stress can increase the risk of respiratory distress, where the patient may begin to pant, increasing their O 2 requirement. This greater respiratory effort can cause the airway to narrow further and in, extreme cases, lead to airway collapse [ 6 ].
To manage stress, anxiolytic medication, such as trazodone 4 mg / kg( Pharma) and / or gabapentin 10 – 20 mg / kg( Pfizer), should be considered by the VS before the patient ' s admission [ 7 ]. Handling the patient for examination and premedication should be kept to a minimum to avoid restricting their ability to breathe, and to reduce stress.
Pre-anaesthetic examination
A selection of endotracheal tubes
A laryngoscope A stylet
A dog urinary catheter
Include sizes smaller than expected for the size of the patient, as their airway may be narrower than that of a similarsized mesocephalic patient
To visualise the airway To aid visualisation of the larynx
May be used to intubate the patient if the airway is so narrowed that a normal endotracheal tube will not pass. This will allow temporary delivery of O 2 and can be attached to an O 2 circuit via the barrel of a 2.5 ml syringe and a 7 mm endotracheal tube connector
The heart and lungs should be auscultated as these patients are at risk of congenital heart defects, such as murmurs, and aspiration pneumonia [ 1 ]. The American Society of Anesthesiologists( ASA) grade for these patients is at least ASA II and, if their anatomy impacts on their normal function, they would be considered ASA III and at risk of death while under anaesthesia [ 8 ].
Preoperative nursing
Ideally, an intravenous( IV) catheter should be placed as soon as the patient is admitted, to ensure there is IV access in case of an emergency. However, if the patient becomes stressed during IV catheter placement, premedication should be given intramuscularly( IM) and the catheter placed once the patient is sedated and calm [ 9 ].
The patient should be monitored constantly once premedicated in case of respiratory distress, and preoxygenation with 100 % O 2 should be given as standard for at least 5 min before intubation [ 10 ]. Mask or flow-by O 2 delivery are both acceptable as long as the method chosen is well tolerated [ 11 ]. Although O 2
Although it is the VS ' s task to prescribe the premedication, it is important for the nursing team to be aware of the impact of these drugs on the patient and their anaesthetic.
Opioids such as methadone( Comfortan, Dechra, 10 mg / ml, 0.2 mg / kg IV or IM) are often used in low doses as they provide good pain relief, are reversible and may reduce the need for higher doses of other drugs [ 9 ]. Consideration should be given to the fact that opioids may cause nausea [ 2 ] and respiratory depression, but this is not a reason to avoid using them completely [ 11 ]. Opioids also have an antitussive effect, which will allow the patient to tolerate the ET tube for longer postoperatively [ 2 ].
An alpha-2 agonist such as medetomidine hydrochloride( Sedator, Dechra, 20 µ g / kg IV or IM) will cause bradycardia and profound sedation but, as it is reversible, it is still often used in premedicating these patients. Acepromazine( ACP 2 mg / ml, Elanco, 0.03 – 0.125 mg / kg IM or slow IV) can also be used; however, as these patients, especially boxers, often have a higher vagal tone leading to syncopal episodes, care should be taken in its use [ 2 ].
46 Veterinary Nursing Journal