VNJ Volume 41 (4) August 2026 | Page 37

Plus-Hex CLINICAL and 10 mg / kg paracetamol( Paracetamol, 10 mg / ml, B Braun). The antibiotic cefuroxime sodium( Flynn Pharma Ltd), prescribed by the referring veterinary surgeon( VS), was continued IV at 20 mg / kg.

Pain scoring using the( modified) short form of the Glasgow Composite Pain Scale was performed every 4 hours before methadone was given, to assess the appropriate dose. The patient ' s resting energy requirement( RER) was calculated( using the formula RER = bodyweight( kg) 0. 75 × 70) and the patient was offered a soft wet food every 4 hours until midnight; after this time, she was starved in preparation for a second anaesthetic. A second IV catheter was placed in the left saphenous vein to maximise venous access for surgery the following day.

For the second procedure, the patient was anaesthetised with an IV premedication of 0.005 mg / kg medetomidine and 0.2 mg / kg methadone, and induced with 1 mg / kg IV propofol, and a transmylohyoid orotracheal intubation was performed. This method of intubation involves the proximal end of the endotracheal tube being passed through a small incision in the mylohyoideus muscle in the base of the mouth, to avoid passing the tube through the oral cavity and blocking effective observation of the dentition and bones of the mouth. This technique is often used in human patients with extensive maxillofacial or nasal injuries requiring surgery. The patient was maintained on inhalational isoflurane and oxygen throughout surgery. Monitoring of the patient ' s vital parameters was carried out as for the first surgery.

During the surgery, the patient received IV lactated Ringer ' s solution at a rate of 5 ml / kg / hour and a constant-rate infusion( CRI) of ketamine at a rate of 10 µ g / kg / min. Further analgesia was provided by a single dose of 1 µ g / kg fentanyl( Fentadon, 50 µ g / ml, Dechra). Perioperative antibiotics( 20 mg / kg IV cefuroxime sodium) were administered at 90 min intervals throughout the surgery.

The right caudal mandibular fracture was reduced and a plate was placed. Enucleation of the left globe was performed. Due to the age of the injury and the formation of fibrous tissue, repositioning the left maxillary fracture was not possible without re-fracturing it to place a splint or fix it internally. Instead, an intraoral splint was placed on the maxillary incisors and wire was passed between the maxillary canine teeth, across the incisors.

A CT scan was performed after the surgery, confirming good placement of the splint and appropriate reduction of the right mandibular fracture. The malocclusion was still present due to maxillary torsion. An elastic training device was placed from the lingual aspect of 404( the lower right canine tooth) to the buccal aspect of 108( the upper right fourth premolar). In the immediate postoperative period, analgesia was administered( Table 1) dependent on the patient ' s pain score, assessed using the( modified) short form of the Glasgow Composite Pain Scale.

Side effects of opioid analgesia can include a reduction in the patient ' s tear production [ 1 ], so regular eye lubrication was also provided throughout the period when opioid analgesia was given. Antibiotics continued to be administered every 12 hours.

The patient was hospitalised for a further 3 days to manage her pain and monitor the efficacy of her mastication and deglutition after surgery. A strict soft-food diet was continued throughout the hospitalisation, and the RER was recalculated based on a new bodyweight measurement every morning to ensure the patient was provided with adequate nutrition.

This nutrition was provided via oral consumption of a soft, wet and nutritionally complete diet, Royal Canin Gastrointestinal and Recovery wet diets. IV fluid therapy was continued at a rate of 2 ml / kg / hour for the first 24 hours after surgery. The ketamine CRI was reduced to 1 µ g / kg / min after 12 hours and then stopped after 20 hours.

The patient was discharged in the evening of day 5 of hospitalisation with oral cefalexin( 300 mg at 20 mg / kg q12h)( Rilexine, Virbac) and multimodal pain relief consisting of meloxicam( 1.5 mg / ml oral suspension at 0.1 mg / kg 24h)( Metacam, Boehringer Ingelheim) and paracetamol / codeine phosphate( 400 mg paracetamol and 9mg codeine phosphate at 10 mg / kg q8h)( Pardale-V, Dechra).

Evaluation of nursing interventions

When evaluating the nursing considerations and interventions for this patient, it would be valuable to look first at the demeanour of the patient, alongside the management of the patient ' s airway, temperature,

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